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Thread: How not to RYFW with real life examples

  1. #1
    practical experience, FTW MaeZe's Avatar
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    Jun 2016
    Ralph's side of the island.

    How not to RYFW with real life examples

    Why don't you Google 'emergency first aid for tension pneumothorax'?

    I have a better idea for you though, get a book on wilderness medicine or emergency first aid and pick out an injury that meets your story needs.

  2. #2
    practical experience, FTW MaeZe's Avatar
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    Ralph's side of the island.
    Quote Originally Posted by P.K. Torrens View Post
    A tension pneumothorax is not easy to diagnose... at all.

    I am wondering how a nurse (who typically aren't train to make diagnoses) would diagnose that. This is really far-fetched. Go for a stab wound or something simple.
    What country are you in?

    Technically neither a nurse nor a doctor could make that diagnosis without an X-ray or tapping the pleural space to see if blood or air were there. Both professions are capable of suspecting a deflated lung on one side.

    In the US nurses diagnose a lot of things. In this case we look at a different aspect but one doesn't just say, "Gee, the guy is having trouble breathing". You would note air was only going in one lung. Once that is determined there are only a couple things that would cause it.

    Nanda Nursing Diagnosis List
    - Disruption of gas exchange:
    Decreased exchange of oxygen and / or carbon dioxide between the alveoli and vasculature.
    This reaction can occur only following a medical problem but may also result from an ineffective airway clearance and / or ineffective breathing pattern.
    – Ineffective airway clearance:
    Inability to clear the airways obstructions that impede the free passage of air.
    – Mode of breathing ineffective:
    Way to inspire and / or expire does not allow fill or empty the lungs properly.
    – Inability to sustain spontaneous breathing:
    Depletion of energy reserves making the person unable to maintain respiration sufficient to ensure their basic needs.
    – Intolerance cessation of assisted ventilation:
    Inability to adapt to a decrease in mechanical ventilation and which interrupts extends the withdrawal process.
    Sorry, I get my hackles up when people have old fashioned ideas about nursing.
    Last edited by MaeZe; 06-23-2018 at 08:49 PM.

  3. #3
    practical experience, FTW MaeZe's Avatar
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    Ralph's side of the island.
    Quote Originally Posted by P.K. Torrens View Post
    I certainly didn't mean to imply that a nurse's response would be:
    "Gee, the guy is having trouble breathing".

    I've worked in NZ, Aus and UK, and in those countries only nurse practitioners are trained to make complex diagnoses.
    "Complex" diagnoses? You're not helping yourself.

    I'm pretty sure this nurse and this nurse are capable of making complex nursing diagnoses.

    Quote Originally Posted by P.K. Torrens View Post
    Nurse practitioners make up a very small portion of registered nurses, and I think it's important to make this distinction so that the OP can make the scenario more realistic (as I think that's the goal the OP has in mind). I still think it would be fair to say that a nurse without advanced training (i.e. without a nurse practitioner qualification with a focus on emergency medicine) would have difficulty making that diagnosis. As would a primary care/family doctor, paediatrician etc. as they simply don't have the training.
    No offense but that's silly. Do you imagine a nurse with years of experience would be unable to cross an invisible line because it's not their place? Think they don't know what it is they are listening to when they assess the patients' lungs.

    "Gee, I don't hear any breath sounds on the right but I'm just a nurse, I don't know what that means."

    Quote Originally Posted by P.K. Torrens View Post
    Excluding nurse practitioners, one of the defining differences between a nurse and a doctor is the formulation of a diagnosis, no?
    No, that is not the difference. Nursing is a profession in its own right. You can even get a doctorate in nursing.

    Quote Originally Posted by P.K. Torrens View Post
    There are certain differences between the two professions that are complimentary. For example, doctors have no idea how to draw up and administer medicines because it's not part of their training. I don't think that's an old-fashioned idea - it's the reason we have the two professions. I would love to know if you think I'm wrong about this though!
    Bingo, see you do know the difference. You just have a misperception about what nurses actually do. The reason the nursing diagnoses categories seem 'vague' to you is probably because you are unfamiliar with them. They are not vague.

    But rather than get off track here, think of it as overlapping knowledge. If a nurse is providing nursing care to a patient with a pneumothorax, they have a clear idea what is medically wrong with the patient. How would a nurse manage a patient on a ventilator if they couldn't assess a hemo or pneumothorax?

    What would you say to the doctor when you called them? "Come quick, something's wrong but I don't know what it is"

    No. You would say, "The patient's O2 sats are crashing and there are no breath sounds on the right." But you would know why those two things were happening and why those were the things you needed to tell the doctor.

    Quote Originally Posted by P.K. Torrens View Post
    That aside, the question here was regarding a tension pneumothorax, specifically, which can be a difficult diagnosis to make even in a well-equipped emergency department setting. So, I think making it on a sidewalk would be hard.
    I don't think it's that difficult of a diagnosis.

    As a writer, you want the reader to get it. I doubt a reader is going to say, "A nurse wouldn't know that," or, "How would they know that in the field."

    I agree with you partially, there would need to be an exterior wound to make the scene realistic. How else would you be able to jam the top of a pen into the chest if not through an existing hole?

    But more importantly, it would take a lot of certainty to act on the suspicion of a pneumothorax. I doubt most doctors would act on that diagnosis in the field unless there was an exterior wound.
    Last edited by MaeZe; 06-24-2018 at 10:11 PM.

  4. #4
    Saving up for a typewriter P.K. Torrens's Avatar
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    I'm gonna stop engaging now as I don't think this is constructive for the OP.

    For the OP: IMO, I still think that a tension pneumothorax is a complex diagnosis to make streetside and differentiating it from a haemothorax and pneumothorax streetside wouldn't be easy. And, ideally, you wouldn't put a pen through the same wound, but in a separate incision high on the chest (2nd intercostal space, mid-clavicle) - the risk being you ping a large vessel/heart.
    Last edited by P.K. Torrens; 06-25-2018 at 02:39 AM.
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  5. #5
    Herder of Hamsters AW Admin's Avatar
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    You know this is so entirely inappropriate I'm at a bit of a loss.

    I'm locking this until the mod can take a look.

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