Station 2: Patient Assessment Trauma

This is the Irvington VAC EMS Training Center UA-cam channel. We are a New York State, Department of Health, EMS Training Center dedicated to excellence in EMS Education. In addition to training countless NYS Emergency Medical Technicians over the last 25 years, we also enjoy filming EMS training videos to help the EMS public. In charge of the training center is NYS Paramedic Benjamin Fontanilles. Please check out our website at www.irvingtonems.com.

[@tomport1259]

The patient looks like Sal from impractical jokers, very informative video and I love the background music lol

[@anthonyalecca3414]

I’m an EMT in NYS and I’m scared of recertification because I have not practiced since 2021. Any advice recertification is tomorrow

[@cleverpython1546]

This makes me so much more confident

[@roygumpel8415]

did you guys make this teaching video and put this synthesizer sound over it while you're speaking ...on purpose?

[@lizc7417]

😂

[@EmpathicVibez]

Thanks so much for these videos, they helped with my exam here in NYS

[@jamesringler987]

Please lose the back ground noise trying to hear your instructions

[@geesview9491]

You didn’t apply the neck brace or directed a Emt to do so

[@encryptionxyz4278]

no he did, he said c-spine in the beginning

[@lindacarter4543]

I thought elevating the feet to manage shock, was a treatment no longer used now days??? Due... to, secondary adverse contradictions for the patient, based on research.

[@jbuccilli1]

what published authority of research (*other than cardiogenic shock), states adverse effects of elevating feet 8-12" with low BP due to trauma? Im open minded and would like to read but at least in NYS, consideration of elevating legs to pool bloodflow to vital organs during low perfusion states resulting from trauma, has always been in play (*see 2015 NYS DOH prehospital provider protocols sc-2 / sub: IV )

[@lindacarter4543]

@@jbuccilli1I am aware that the modified Trendelenburg position or the passive leg raise (PLR) is still being used as a pervasive treatment for "shock" despite the numerous studies failing to show it's effectiveness? More studies showing negative contradictions exasperating current underlying medical issues of the patient during their status of shock, it's an ongoing debate but, studies HAVE showed, this position to be much more appropriate for "fluid responsiveness", in patients undergoing shock... Read more: [JAMA.2016 Sep 27; 316 (12): 1298-309 Hemodynamically unstable patients responded better to a bolus of intravenous fluids, during the (PLR) assessments, showed vast improvement, and performed better in the "pooled analyses". There is very little evidence to support the benefits of (PLR) standard shock protocol that is of any real benefit. But I do know it is a MUST for National Registry won't argue on that one but, from a personal analytical perspective is it really beneficial for the patient undergoing shock out here in a real life scenario? or does it just look good and helpful? If you think about it? You know there is no available blood to the lower extremities because the casualty is cold and pale - lower extremities are already shunting ANY available blood to the core by vasoconstriction.

[@jbuccilli1]

@@lindacarter4543 I agree to a point re blood being shunted from lower extremities and agree that fluid bolus's to maintain systolic of 90 is goal but as EMT's with no IV capabilities, at least in NYS, its O2, keep warm and elevating feet. You'd have to ask the medical advisory board for NYSDOH why they feel its still in play to elevate feet when treating for shock. I will look into JAMA article and thank you for providing info

[@lemonlime7998]

@@jbuccilli1 I'm getting licensed here in a week in the state of florida, NREMT of course, and they no longer use the Trendelenburg position d/t 'applying pressure to the diaphram with little aid to actual shunting'. In essence, you're body is already shunting the blood, and to raise the feet only puts pressure on an already over-worked diaphram. It appears this is just how medicine is, it changes every year, and it's on each medical providers judgement on to and not to use techniques. Not saying Trendelenburg/PLR posture is incorrect, but it is no longer being taught to new EMTS,

[@101Ari101]

Great video!

[@TroyDeanMusic]

Just curious why you didnt check the bp pulse or resperation before 2nd assesment? Im in training now just making sure im doing this right. Thanks for the video!

[@alexneumeister6729]

For the NYS practical exams BP, Pulse, and respiration rate and quality are taken in the secondary assessment. The primary assessment are your ABCs. All you are doing is making sure that they are breathing, will continue breathing, and has a pulse. At that point all you are doing is making sure he is alive. Either before or after doing your head-to-toe exam you will actually take the vital signs.