So I notice a few folks are commenting what they would do rather than CPAP and stuff. These videos are NOT meant to be a reflection of working in the field. These are designed to help pass the NREMT skills test and for NREMT we are taught in class to always use CPAP for all respiratory distress and intubations. He chose the proper intervention for the NREMT test however it may be different in the field due to local and state protocols.
OPQRST O: Onset- what were you doing when this started P: Provocation/Palliation- what makes it better and what makes it worse Q: Quality- describe the pain (sharp, dull, throbbing, etc.) R: Region/Radiation- where is the pain and does it radiate anywhere S: Severity- on a scale of 1-10 how would you rate your pain 10 being the worst T: Time- at what time did all of this start
She said that she had an inhaler but she said she didn't had any past medical history. You should have asked her if she has any asthma history or something like that cuz some patients do not consider that as relevant. I would have asked her again for ashtma, asked her if she had used her MDI for today, consider if the MDI is for albuterol sulfate, and depending on her answers, basically administer it, and stay with the nonrebreather or simply place the CPAP with the nebulizer or a simple mask with the albuterol sulfate on it. And his OPQRST were sloopy.
Well, good approach but don't ask specifically, "do you have asthma?" because sometimes patients really don't know or remember the name(s) of their medical conditions and will sometimes just say yes in order to answer the question. Instead, ask them, "what is the reason you were given an inhaler and by whom?" This will help to prevent leading the patient to an answer and also let you know if a provider gave it to them or if they were given an inhaler by someone they know (you know, since people actually share medications without being trained in medicine).
why would you use CPAP here? the lung sounds were diminished and he didn't say there was fluid sounds in the lungs. Why wouldn't you go with a duoneb treatment, especially because she has a hx of using an inhaler?
4 hours in to asthma (lacking a copd history to go on) you're in stage 2 and the bronchioles are too full of mucous for the beta-2 agonist to contact receptors. CPAP is acceptable in progressive systems at this stage. The best bet is to go for CPAP with the reported diminished breath sounds, then if your mask allows add a neb circuit to it to try and CPAP in the medication as things hopefully open up. Some protocols also allow a dose of 1:1000 epi similar to anaphylaxis, and you definitely want 2g of mag sulfate and either solumedrol or decadron at the Paramedic level. But for I99 the CPAP and epi are easily in scope.
NREMT says don't administer to symptomatic tachycardia, I would imagine as in a form of SVT >150 or it was drug induced tachycardia. Let me know what you think.
Definitely something to consider Andrea. Treatment of illnesses depends on a lot of factors. For the test, whatever treatment you choose should be backed up with rationale for why you're intervening.
T can represent whether their situation is constant or comes and goes. Example if chest pain is subsiding and comes back or if it is constant and does not go away
So I notice a few folks are commenting what they would do rather than CPAP and stuff. These videos are NOT meant to be a reflection of working in the field. These are designed to help pass the NREMT skills test and for NREMT we are taught in class to always use CPAP for all respiratory distress and intubations. He chose the proper intervention for the NREMT test however it may be different in the field due to local and state protocols.
OPQRST
O: Onset- what were you doing when this started
P: Provocation/Palliation- what makes it better and what makes it worse
Q: Quality- describe the pain (sharp, dull, throbbing, etc.)
R: Region/Radiation- where is the pain and does it radiate anywhere
S: Severity- on a scale of 1-10 how would you rate your pain 10 being the worst
T: Time- at what time did all of this start
I would have gone a nebulizer with attrovent and salbutamol instead of a cpap.
She said that she had an inhaler but she said she didn't had any past medical history. You should have asked her if she has any asthma history or something like that cuz some patients do not consider that as relevant. I would have asked her again for ashtma, asked her if she had used her MDI for today, consider if the MDI is for albuterol sulfate, and depending on her answers, basically administer it, and stay with the nonrebreather or simply place the CPAP with the nebulizer or a simple mask with the albuterol sulfate on it. And his OPQRST were sloopy.
Can you write steps for respiratory assessment in this video?
Well, good approach but don't ask specifically, "do you have asthma?" because sometimes patients really don't know or remember the name(s) of their medical conditions and will sometimes just say yes in order to answer the question. Instead, ask them, "what is the reason you were given an inhaler and by whom?" This will help to prevent leading the patient to an answer and also let you know if a provider gave it to them or if they were given an inhaler by someone they know (you know, since people actually share medications without being trained in medicine).
Great video !
Would you do sample 1st to know what to treat if patient had asthma copd or anything
A great educational video.
0:32 Why didn't he do that?
why would you use CPAP here? the lung sounds were diminished and he didn't say there was fluid sounds in the lungs. Why wouldn't you go with a duoneb treatment, especially because she has a hx of using an inhaler?
4 hours in to asthma (lacking a copd history to go on) you're in stage 2 and the bronchioles are too full of mucous for the beta-2 agonist to contact receptors. CPAP is acceptable in progressive systems at this stage. The best bet is to go for CPAP with the reported diminished breath sounds, then if your mask allows add a neb circuit to it to try and CPAP in the medication as things hopefully open up.
Some protocols also allow a dose of 1:1000 epi similar to anaphylaxis, and you definitely want 2g of mag sulfate and either solumedrol or decadron at the Paramedic level. But for I99 the CPAP and epi are easily in scope.
Why wouldn't he [help her] administer a dose from her inhaler? I am going for EMSB, is that the difference?
Good question Anne, we went off the national registry skill sheets.
EMTprep in what country?
merica
Could albuterol or atrovent still be given for this patient since her heart rate was above 100 bpm?
NREMT says don't administer to symptomatic tachycardia, I would imagine as in a form of SVT >150 or it was drug induced tachycardia. Let me know what you think.
Past medical history?
+EdDerp101 Great idea Ed!
Wouldnt you give albuterol?
Definitely something to consider Andrea. Treatment of illnesses depends on a lot of factors. For the test, whatever treatment you choose should be backed up with rationale for why you're intervening.
It's a good thing it's not for the EMT basic level then
@@Emtprep the Albuterol might of been contraindicated due to her heart rate
I believe O of the OPQRST mnemonic is "What were you doing when this started?" T is "How long".
really o and p are lol you are correct
o*
O represents onset
not correct. O is onset. Was it immediate onset? Gradual onset? T is when did it start. P is what makes it worst or better.
T can represent whether their situation is constant or comes and goes. Example if chest pain is subsiding and comes back or if it is constant and does not go away
Inhaler...5 rights.
6 rights
6, definitely 6
@@bajamedic 10 actually: patient(and allergies), drug, dose, route, time, documentation, right to refuse, education, assessment, evaluation
@@thespaceelefant2441 that's not a thing
@@bajamedic oh yes it is. just look it up