We Never Looked at the Son of a Bitch

Josh Kennedy Photography

“Oh Happy! How could you use such foul language on your blog?”

How could you use such foul language in your run report?

Two of the most misunderstood yet widely used abbreviations in EMS today are WNL and SOB.

They drove me nuts as a basic, troubled me as an intermediate, frustrated me as a medic and now that I’m in charge of reading all these charts, I’m simply disappointed.  And it’s not just my guys and gals either.

How many of you out there are noting ‘WNL” for a vital sign or in a narrative describing a patient’s range of motion, bruising, etc?  Yes you have, don’t deny it.

WNL – What does it mean?  It has multiple entries in the medical lexicon, including We Need Lawyer, We Never Looked and, down at the bottom, Within Normal Limits.  But even then WNL needs a qualifier to be accepted.  For example “WNL 79″ for a blood glucose level.  WNLX is an accepted medical abbreviation but only when the value (X) being measured is mentioned.  Simply writing WNL in the abdominal section does not count.

What gives me the most frustration, however, is that many folks apply THEIR OWN normal limits in this assessment, not those of the patient.  If the blood pressure is 210/100 and they state that is their normal, can we mention “WNL 210/100 per patient”?  Absolutely!  Please do, because that will guide me as to why you didn’t treat for acute hypertension.  A simple WNL for BP is shoddy documentation and makes me wonder if you even assessed the value and applied it to the entire patient presentation.

So, WNL can be used, but only if qualified.  Got it?  Good.

SOB- Commonly referred to in EMS circles as Shortness of Breath, but that’s about it.  outside of EMS, most notably in legal circles, it can mean something else entirely.  Officially SOB refers to See Order Blank unless, wait for it, it is given a qualifier.  For example, SOBOE is official for Shortness of Breath on Exertion, but a simple SOB is not enough to describe the patient’s condition.  When looking at the Chief Complaint drop down you may find a fancy word dyspnea.  Dyspnea is defined as the perception of respiratory discomfort, so someone can’t technically be complaining of a perception of difficulty breathing, can they?  Sure we could apply this term to a number of our asthma related complaints that have no idea what true breathing difficulty looks like and seem to have no trouble lighting up a cigarette during our assessment, but does it apply to our large population of unknown respiratory difficulty patients?

How do we describe shortness of breath without using SOB? Describe the signs and symptoms of course.

“Pt c/c SOB” tells me nothing. “Pt c/c difficulty breathing on inspiration” now there we go, and it didn’t take all that much longer to type.

It is also a good idea every now and again to define your abbreviations long hand in the chart. “Patient presents SOBOE (Short of Breath on Exertion)…” to allow for review and as a defense in case your abbreviations are ever called into question.  Your QI or a lawyer will pull your charts and see you are consistent in your use of the terms and abbreviations.

Now I hope your O2 sat reading doesn’t say WNL…

 

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2 thoughts on “We Never Looked at the Son of a Bitch”

  1. I would argue that applying WNLs to a BP of 210/100 is never correct. 210/100 might be “normal” (“normal” doesn’t denote health though) for a patient, but it is not within the normal limits of a blood pressure. The important thing is that “normal limits” for things like lab values is based off of epidemiological data, in general being what is normal for 95% of the general population (mean value +/- 2 standard deviations).  As such, a diabetic might normally have a BGL of 200 mg/dL, but a BGL of 200 mg/dL is never within normal limits.

    Additionally, just because a lab value is within normal limits doesn’t necessarily mean that a lab value is appropriate. If a hormone (this concept is normally applied to endocrine disorders) is failing to compensate because of a lack of downstream response, then it can be “inappropriately normal,” which is an indicator of where the disorder is at.

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