Overall gets most of it right, but a few comments: 1) We were taught to assess immediate life threats as part of the Chief Complaint right after checking responsiveness. That is where you would look and deal with catastrophic hemorrhage before moving to the ABCs as mentioned in some of the other comments in here. 2) Log roll of the patient should always be done on the count of the person holding c-spine. That only happened on the roll back to the board. Also, the board should be higher than the patient, not lower, so the head is not hanging off. 3) Since this is a high priority patient, secondary injuries and reassessments should be done during transport. Treating the femur was correct since it is life threatening, but the rest should have waited.
Great tips! We should mention that while we agree with your advice, none of them are critical failure points per the NREMT skill sheets. Thanks for your input!
Whether or not they are "critical failure points per the NREMT skill sheets", is irrelevant. Ask yourself this, are you training students to save lives or pass a test? All the points mentioned above should be taught to student regardless if they are on a test or not.
@ eddie almasi they are LITERALLY just doing this to help you pass the test. Your instructors in class should be teaching you to save lives. Also not one of those "misses" would have cost that patient their life so your comment is "irrelevant. #youreanewEMT #calmdownsparky
Yah boy, I’m a 3rd year med student. Did my ACLS/BLS stuff. I guess that’s why this in my recommendation. Big ups for the emt and paramedics. Enjoy watching how you guys work.
I have my big test day tomorrow for a higher license and these have helped me so much considering I have developed some bad habits in the field. Thank you for these!
@@iris201000 I can't speak for him personally but most of the time we don't run the full sheet like this during an assessment. Like let's use the medical one as an example. If you have a person whose suffering from chest pain, has a history of angina, and was prescribed Nitro for it, are you really going to ask him what his "last oral intake" was? Probably not. So a lot of times we'll skip over some questions on the sheet.
Remember that you NEVER move a patient until the person in control of the head has checked that everybody is ready and then counts the roll in (i.e. ready, steady, roll). THE HEAD IS ALWAYS IN CONTROL.
Good thought Martin, you'll need to verbalize treatment that would be expected at the advanced level, but other than that, there isn't much of a difference
I know I’m like 2 years late on this but there definitely were things that were missed on this. The only real difference with this station is being able to perform advanced treatments. I’m going for my A and just finished class waiting to test. For this, as soon as you noticed that the skin was pale and cool, you should suspect shock. Immediately keep the patient warm and start an IV and give fluids. Also check for any gross bleeds either during your general impression or during circulation, as it’s a life threat you want to get that out of the way ASAP and treat appropriately
Same lol best thing I learned first day of medic school was BLS comes before ALS dnt start worrying about placing IV’s & pushing meds if you dnt evn have an airway 😂
I love how everyone’s a perfect medic in the comment section. You can judge and criticize all day long, but i guarantee you every person that takes the nremt tests are shitting bricks the whole time. I know I was lol
I'm thankful for these videos, but here are some things to note: His partner let go of manual stabilization for a moment there. Lead EMT took his left hand off the shoulder when log rolling/back assessment. He didn't slant the long board for a smooth log roll. I learned that in order to properly center the patient when they're on the board that you must slide down first, then up, in order to prevent further spinal injury.
Hey CentralEMS, some of that is implied. It's hard to verbalize everything you're doing AND also do each step correctly. Stick to the sheets and you'll do great. Thanks for commenting!
This seems more like a basic level assessment than an advanced/paramedic level. The biggest bell in my mind here, among others, is what are my lung sounds? And more importantly, are they clear and equal? The guy did them but got no feedback from it. With shallow breathing at any rate, the BVM would be the first O2 device I’d reach for. Pupil response is also important on the ALS side, and nobody mentioned starting an IV to treat for decompensated shock. I’d also address venous bleeding quickly if it were on the face. Venous bleeds still have a steady flow to them, and on the face it can quickly become an airway issue.
Kayla M also a super simple thing and as soon as you noticed cool and pale skin, put a blanket on the patient. If there are signs of shock, KEEP THEM WARM. Shivering just makes things worse
A few people seem to mentioning the application of a C collar. A quick reminder that a c collar is only a reminder, MILS is a far more efficient and affective method of maintaining the patients head position given her Aloc when ( if ) she becomes more responsive she will move and thrash around increasing the possibility of further injury etc. I’m Australian we only have advanced care paramedics as your entry level paramedic but I’m taking it this crew would be a BLS crew so therefor their use of a person on MILS was the correct choice as they don’t need to gain IV access and administer drugs ( I’m guessing I’m not familiar with the scope of practice of BLS crews ) and if they did they can always utilise police or fire to maintain mils. Obviously once they have loaded the patient and they don’t have extra resources then collar while you then administer pain relief etc so it depends on the situation. Identify if your patient is a “ stay and play “ or time critical and you need to “ load and go “ Good video for those just starting off in the Industry :)
everyones a perfect medic period until its 3 am your by yourself in the back of the medic unit and they are beginning to crump and your driver is a first responder firefighter and your an hour from the hospital
When doing primary assessment, can you do CAB instead of ABC? Doesn't mention under critical criteria, and our department's proctors said real-world (I know, I know... NREMT skills "teach to the test") that is how it would be done.
+Jeff Ogiba Hey Jeff, not a critical fail for NOT doing that, but it's a great idea to show your proctor how well you know your treatment plans. Great question!
I was hung up on the fact that he deemed her a critical patient, as a load and go but took the time to put her on a traction splint before backboarding her. If she truly is a load and go, why wouldn't you manage that on the way to the hospital?
+babygirl39942 great question!! Long bone fractures can be life threatening injuries and extremely painful at the very least. Stabilizing before moving the patient is critical.
I agree - the video demonstration is very good but unfortunately the music was a little too loud for the volume of your demonstrator's voice and I had a hard time catching everything because of it.
In the UK, we would control catastrophic hemorrhage before anything else, but not 'check circulation' before airway, only stem major bleeding before ABC
If there is an obvious bleed that is an obvious life threat, you address that first in the order CAB. If there is no sign of obvious trauma, or bleeding, ABC is to be followed as normally.
El Chapo, Not certain about the points made but ,if anyone else wants to discover emt paramedic training online try Elumpa Paramedic Expert Alchemist (do a google search ) ? Ive heard some great things about it and my co-worker got amazing results with it.
@@ryanemond675 true! but I was trying to tell him when you use a opa. I haven’t watched the vid in a while so I might watch it again and comment on that
Could you take off one or both of the scary beginning and ending music? I really have needed these but that sound has reached annoyance with my anxiety about the exam.
Ya, I don't see c-collar anywhere in the critical failure list. The assistant maintained manual stabilization through till the end so the spine was sufficiently immobilized for testing purposes.
Just my .02 24 and inadequate tidal volume/low sats would be opa with ventilations Blood sweep in abcs After assessing abcs and identifying rapid/immediate transport I quickly asses neck then apply c collar, asses pelvis then log roll, assess posterior then onto backboard, and then rapid/immediate transport with the rest of rapid assessment in the box. Ivs in case they deteriorate and maintains radial pulse/90 systolic Feedback is appreciated
No you don’t need to ventilate with a BVM or use a OPA high flow o2 with a non rebreather should be applied and monitored to see if breathing improved. LEAST INVASIVE TO MOST INVASIVE
Also you do your rapid before u get in the box to treat major bleeding and ABCS then quickly move to ambulance and then a detailed exam is appropriate while keeping patient stable to hospital
Question: Lets say the patient is in "decompensated shock", would you apply the traction split before the LSB or after once in the ambulance? Considering it is time consuming. (For testing purposes)
Yes, go for it. The worst thing that happens is the proctor says "the patient does not accept" but you've then covered all of your bases. If the pt does accept, you've secured the airway.
For the situation in this video, no. The airway is patent...nasal cannula at best.... please dont ever shove an OPA in someone who is breathing 24 times a minute with an SpO2 of 92%. jesus christ.
Gotta disagree with you there, while the airway is patent, the patient is unconscious, and its best to go ahead and secure the airway somewhat, whether with a OPA or NPA, and the initial assessment said that his breathing was shallow, always use shallow as a key indicator to assist ventilation with a BVM, it means that they are not getting the air down into their lungs and provide proper oxygenation, however with the SpO2 being 92 percent, i can see why he put him on a non re-breather, but I would still have assisted ventilation.
You insert the opa and if they have a gag reflex take it out and insert the nasalpharengeal airway unless they have head trauma then you would just have to do your best, as with any scenario you decide whats best on training
Im getting ready to take my Trauma practical for Paramedic this weekend. At what point would I verbalize obtaining 2 large bore IVs with a fluid bolus? after the secondary or after the history taking? When would I also let them know if I were in need of a pressor if the bolus wasn't effective?
It's situationally dependent but you could verbalize that when you discuss how you would transport the patient, letting the proctor know what you would do en route to the hospital.
In the NREMT-P trauma assessment, is there only one head to toe assessment that goes on? I notice on the skills sheet it only lists it once, but in ITLS we were taught to do a rapid and a focused trauma assessment.
In all these videos, the EMT just takes a glance at the neck and ascertains "No JVD". I have been googling and looking over several videos that addresses this topic. I haven't yet found a video that teaches a quick visual inspection to ascertain this. Do you have any tips? I do not have a medical background, but I have the role of first responder at a facility with some thousand employees.
Should've included treatments he would've done during transport. Large bore IV's etc. at least could've had his other parter hold pressure on venous bleed while continuing his assessment. Should've had a c-collar placed prior to log roll to keep the neck more stabilized during the log roll. No crit fails but this is stuff that makes the difference between good and poor Emt's/medics
Question: How come he didn't try to call her name or get her attention verbally before checking for pain? If she was aware enough to respond to verbal or her LOC was good enough, wouldn't you skip the oro airway and put a naso in?
To my understanding the traction splint is for closed midshaft femur fractures. The only splint for tib/find is a regular old splint with some ice and bandaging. If you're advanced levels maybe consider some pain control
Wouldn't starting two large bore IVs and giving fluids tko be indicated for this patient? Also initiating standard care of shock such as keeping the patient warm and possibly even elevating the legs should at least be considered. The blood pressure of 92/64, pulse of 112, respirations of 22, O2 sat of 94% on 15L O2 and the fact that the patient is only responsive to pain and has a femur fracture all points towards hypovolemic shock due to a femur fracture. I don't think I heard them once mention that they suspected shock. What are your thoughts?
Proctor said her breathing volume is shallow so BVM ventilation should've been started. But yes the hypovolemic shock from femur fracture sounds about right
I have a test soon in this, I am a highschool student. My biggest problem is trying to do this under 10min. Do you have any tips on getting under 10min
Hey Ally! Absolutely, try to converge the steps into an acronym or memory aid that you can remember. Sometimes people group the steps into 4 or 5 different acronyms that they repeat over and over during the test. This helps them ensure they're within the time limits. Great question!
Just a question, I'm a starting out student so my knowledge is pretty basic so excuse me. But would an IV drip of sodium chloride solution (saline) help increase the blood pressure of the patient?
AVPU assessment was kind of strange, seemed to have skipped verbal stimulus and went straight to sternum rub ?? For the RTS for chest- missed sternum stability check and pelvis- didn't check for incontinence. And c-collar not placed before log roll
It’s hilarious to read these “supermedics” in the comments, you’ll be humbled real quick once you get out into the field. Assuming you know everything is a good way to get someone hurt
LOC Responsive to pain -> NPA U don’t need an airway adjunct to use a NR also her resp were shallow (BAG!) c/c / Appearent life treats C//C “possible mutisystem trauma, so I will go ahead & expose my PT to identify any major life treats or check & quick check for bleeding” Life treats ??🙃🙃
Sure no worries: D - danger so like your scene assessment (Safety, Cause/mechanism, Environment including access/egress issues, Number of patients, Extra resources required) With global overview of patient ie appearance (pale, sweaty, facial droop, alert, cyanosis, oedema of face) work of breathing (accessory muscle use, cyanosis again, any audible stridor or wheeze or obvious dib, rate etc) and circulation to skin (malar flush, pallor) Response - AVPU, gain consent Catastrophic haemorrhage - any massive bleeding externally/ potential internal? Correct this (external normally) before moving on. Including blood sweep. So Tourniquets, blast dressings etc, consideration to splinting limbs if you think it's main problem I guess, ie bleeding into thigh from fractured femur, that's caused hypovolaemia and reduction in consciousness (or something ha) Airway with c spine consideration - blockage from fluids or objects or odeama - jaw thrust /head tilt / suction /postural drainage Breathing - red flaps twelve... Rate effort depth feel look auscultation percussion sides and back tracheal deviation wounds bruising surgical emphysema laryngeal crepitus absent venous distension I forget last e haha Circulation - address bleeding / minor bleeding, bilateral pulses, BP, capillary refill time, consider splintage/ traction/ Iv access etc Ecg Disability - fast test (face arms speech test) gcs blood glucose level, sensation changes etc. Neurological status etc. Expose and evaluate - any other secondary survey stuff to do? / Chop clothes of if not done already ready for head to toe assessment etc.
I'm not saying I don't like the tattoos, they are really cool. All I'm saying is that I get distracted easily and any movement I see takes my attention away from the video. Also your videos are really cool. I want to be a paramedic when I grow up. :)
theres gonna be alot of distractions in the field more prominent than tatoos and what if your partner of assisting personnel have tattoos? Is that going to distract you from performing a thorough and complete assessment in real time????
sorry for asking this question so late in the game, but based on this patient's GCS and the fact that she accepted an OPA and had shallow respirations, shouldn't intubation be considered to protect the airway from aspiration? Genuinely asking for my own benefit and not trying to be too critical here. Eyes - didn't open so she gets a 1, Verbal - incomprehensible moaning which is a 2, and the she localized to pain stimuli which is a 5 totaling 8. Maybe I'm looking too much into this scenario. Thanks!
Intubation is always in the back of a Paramedic's mind for someone who is not breathing adequately on their own. However, one difficult thing to remember is the right indications. If an OPA is sufficient then there is no reason to drop a tube. If uncontrollable bleeding into the airway, risk of vomiting and aspiration, or airway swelling such as in burns was a concern then intubating would be more at the forefront. However if the problem is simply a decreased level of consciousness leading to an inability to protect the airway, then it is appropriate to use only the interventions necessary (ie: OPA)
@@joshrau7549 i know its years later, but im a emt student taking my trauma test today and my question is why would he use on a OPA if she wasn't fully unconscious?
Overall gets most of it right, but a few comments:
1) We were taught to assess immediate life threats as part of the Chief Complaint right after checking responsiveness. That is where you would look and deal with catastrophic hemorrhage before moving to the ABCs as mentioned in some of the other comments in here.
2) Log roll of the patient should always be done on the count of the person holding c-spine. That only happened on the roll back to the board. Also, the board should be higher than the patient, not lower, so the head is not hanging off.
3) Since this is a high priority patient, secondary injuries and reassessments should be done during transport. Treating the femur was correct since it is life threatening, but the rest should have waited.
Great tips! We should mention that while we agree with your advice, none of them are critical failure points per the NREMT skill sheets. Thanks for your input!
EMTprep thanks again for the videos. Nice work
Whether or not they are "critical failure points per the NREMT skill sheets", is irrelevant. Ask yourself this, are you training students to save lives or pass a test? All the points mentioned above should be taught to student regardless if they are on a test or not.
@ eddie almasi
they are LITERALLY just doing this to help you pass the test. Your instructors in class should be teaching you to save lives. Also not one of those "misses" would have cost that patient their life so your comment is "irrelevant. #youreanewEMT #calmdownsparky
Jordan Parton he is doing an exam you clown shut up please
Yah boy, I’m a 3rd year med student. Did my ACLS/BLS stuff. I guess that’s why this in my recommendation. Big ups for the emt and paramedics. Enjoy watching how you guys work.
Thanks Mickey! Congrats on med school. Keep up the strong work.
Residency over yet doc?
I have my big test day tomorrow for a higher license and these have helped me so much considering I have developed some bad habits in the field. Thank you for these!
I wanna know what the bad habits were... lol
@@iris201000 I can't speak for him personally but most of the time we don't run the full sheet like this during an assessment. Like let's use the medical one as an example. If you have a person whose suffering from chest pain, has a history of angina, and was prescribed Nitro for it, are you really going to ask him what his "last oral intake" was? Probably not. So a lot of times we'll skip over some questions on the sheet.
Everyone's so damn critical, armchair medics, he did a good job under stress.
True! We definitely want people to hold us to a high standard, but at the same time we must remember to not "eat our own." One team.
Hey Olliez, do you mind if I borrow "armchair medics" from you? lol
@@Emtprep very well put. One team indeed.
Remember that you NEVER move a patient until the person in control of the head has checked that everybody is ready and then counts the roll in (i.e. ready, steady, roll). THE HEAD IS ALWAYS IN CONTROL.
I was taught this exactly when learning to be a basic. I thought it would be a little different when done on the ALS level.
Good thought Martin, you'll need to verbalize treatment that would be expected at the advanced level, but other than that, there isn't much of a difference
I know I’m like 2 years late on this but there definitely were things that were missed on this. The only real difference with this station is being able to perform advanced treatments. I’m going for my A and just finished class waiting to test. For this, as soon as you noticed that the skin was pale and cool, you should suspect shock. Immediately keep the patient warm and start an IV and give fluids. Also check for any gross bleeds either during your general impression or during circulation, as it’s a life threat you want to get that out of the way ASAP and treat appropriately
Same lol best thing I learned first day of medic school was BLS comes before ALS dnt start worrying about placing IV’s & pushing meds if you dnt evn have an airway 😂
I love how everyone’s a perfect medic in the comment section. You can judge and criticize all day long, but i guarantee you every person that takes the nremt tests are shitting bricks the whole time. I know I was lol
Few comments ring truer Patrick!
I noticed a few things missing but I shat bricks all day long, long after the test was done
Cause I was when I did my emt trauma assessment. And now I'm preparing to take my advanced emt trauma assessment.
Just did that today💩💩💩 I got so nervous I whent blank. I did manage to pass. But wow! I was not expecting myself to get so nervous.
I'm thankful for these videos, but here are some things to note:
His partner let go of manual stabilization for a moment there.
Lead EMT took his left hand off the shoulder when log rolling/back assessment.
He didn't slant the long board for a smooth log roll.
I learned that in order to properly center the patient when they're on the board that you must slide down first, then up, in order to prevent further spinal injury.
maybe i missed it but i saw he did manual cspine but i never heard him say he was putting a c-collar on pt.
Hey CentralEMS, some of that is implied. It's hard to verbalize everything you're doing AND also do each step correctly. Stick to the sheets and you'll do great. Thanks for commenting!
This seems more like a basic level assessment than an advanced/paramedic level. The biggest bell in my mind here, among others, is what are my lung sounds? And more importantly, are they clear and equal? The guy did them but got no feedback from it. With shallow breathing at any rate, the BVM would be the first O2 device I’d reach for. Pupil response is also important on the ALS side, and nobody mentioned starting an IV to treat for decompensated shock. I’d also address venous bleeding quickly if it were on the face. Venous bleeds still have a steady flow to them, and on the face it can quickly become an airway issue.
Kayla M also a super simple thing and as soon as you noticed cool and pale skin, put a blanket on the patient. If there are signs of shock, KEEP THEM WARM. Shivering just makes things worse
A few people seem to mentioning the application of a C collar.
A quick reminder that a c collar is only a reminder, MILS is a far more efficient and affective method of maintaining the patients head position given her Aloc when ( if ) she becomes more responsive she will move and thrash around increasing the possibility of further injury etc.
I’m Australian we only have advanced care paramedics as your entry level paramedic but I’m taking it this crew would be a BLS crew so therefor their use of a person on MILS was the correct choice as they don’t need to gain IV access and administer drugs ( I’m guessing I’m not familiar with the scope of practice of BLS crews ) and if they did they can always utilise police or fire to maintain mils. Obviously once they have loaded the patient and they don’t have extra resources then collar while you then administer pain relief etc so it depends on the situation.
Identify if your patient is a “ stay and play “ or time critical and you need to “ load and go “
Good video for those just starting off in the Industry :)
everyones a perfect medic period until its 3 am your by yourself in the back of the medic unit and they are beginning to crump and your driver is a first responder firefighter and your an hour from the hospital
Watching these to help with my nationals
I approbly watching over 30 tme I hve exam on Monday...really appreciate hve got a clue
Me too on Monday
Hopefully you give me an update when you finish and get a license,i will too
When doing primary assessment, can you do CAB instead of ABC? Doesn't mention under critical criteria, and our department's proctors said real-world (I know, I know... NREMT skills "teach to the test") that is how it would be done.
In class after we labeled the patient as immediate transport, we verbalized adding 2 14 gauge IV's; is that a necessity or just a good add on?
+Jeff Ogiba Hey Jeff, not a critical fail for NOT doing that, but it's a great idea to show your proctor how well you know your treatment plans. Great question!
I was hung up on the fact that he deemed her a critical patient, as a load and go but took the time to put her on a traction splint before backboarding her. If she truly is a load and go, why wouldn't you manage that on the way to the hospital?
+babygirl39942 great question!! Long bone fractures can be life threatening injuries and extremely painful at the very least. Stabilizing before moving the patient is critical.
Femur fractures are a life threat, thats a big jagged bone floating dangerously close to the largest artery in the body
KENNEDY CINEMA third to the aorta and pulmonary but yeah.
Does UA-cam require the background music? It's NOT needed
Thanks for the feedback Frank. We will take it into consideration during our next round of videos.
I agree - the video demonstration is very good but unfortunately the music was a little too loud for the volume of your demonstrator's voice and I had a hard time catching everything because of it.
It would also be nice if the captions were in a color I could actually read.
Arent you supposed to check for circulation and bleeding first and control that before airway?
+El Chapo Hey El Chapo, what do the NREMT skill sheets say?
Not if you're a professional.
In the UK, we would control catastrophic hemorrhage before anything else, but not 'check circulation' before airway, only stem major bleeding before ABC
If there is an obvious bleed that is an obvious life threat, you address that first in the order CAB. If there is no sign of obvious trauma, or bleeding, ABC is to be followed as normally.
El Chapo, Not certain about the points made but ,if anyone else wants to discover emt paramedic training online try Elumpa Paramedic Expert Alchemist (do a google search ) ? Ive heard some great things about it and my co-worker got amazing results with it.
With that strong a response to painful stimuli I'm not sure I would go with an OPA . I'm pretty new at this so maybe someone can clarify for me?
Only if gag reflex, broken teeth or any obstructions to oral airway, and a+o x 4
@@doma7389 she was breathing at 24 b/m regular but shallow I would start the NRB without an adjunct and see if her sp02 improved
@@ryanemond675 true! but I was trying to tell him when you use a opa. I haven’t watched the vid in a while so I might watch it again and comment on that
@@ryanemond675 yeah after review he should have just gave her high flow o2 via NRB at 15lt/min and monitored for trends
Agree
Shouldn't the roll to spine board be on the count of the person controlling the head, on his count?
Could you take off one or both of the scary beginning and ending music? I really have needed these but that sound has reached annoyance with my anxiety about the exam.
Need distal pulses on the affected leg. Great job!
Font used is a little hard to read, news bulletin style would be better. Great video!
Thanks for the feedback James, we will take it into consideration as we prepare our next set.
the only critical fail of note is that I don't see him ever mention a c-collar.
Implied when he stated taking full C spine precautions. just the way testing is man its not real life
Ya, I don't see c-collar anywhere in the critical failure list. The assistant maintained manual stabilization through till the end so the spine was sufficiently immobilized for testing purposes.
Manual stabilization takes place of that
Where is the happy music when I take the NREMT? I want a refund.
Some day!
Just my .02
24 and inadequate tidal volume/low sats would be opa with ventilations
Blood sweep in abcs
After assessing abcs and identifying rapid/immediate transport I quickly asses neck then apply c collar, asses pelvis then log roll, assess posterior then onto backboard, and then rapid/immediate transport with the rest of rapid assessment in the box.
Ivs in case they deteriorate and maintains radial pulse/90 systolic
Feedback is appreciated
No you don’t need to ventilate with a BVM or use a OPA high flow o2 with a non rebreather should be applied and monitored to see if breathing improved. LEAST INVASIVE TO MOST INVASIVE
Also you do your rapid before u get in the box to treat major bleeding and ABCS then quickly move to ambulance and then a detailed exam is appropriate while keeping patient stable to hospital
Question: Lets say the patient is in "decompensated shock", would you apply the traction split before the LSB or after once in the ambulance? Considering it is time consuming. (For testing purposes)
+Tanner Hyatt Hey Tanner, as long as you hit everything on the skill sheets in order, verbalizing your treatment choice either way should be fine.
In my opinion you would want to do it before moving them to a backboard to avoid movement at the site of the fracture when rolling onto a back board.
would you still put a opa in if the patient alerted to painful stimuli?
Hey Chance, it really depends on patient presentation, hard to say for certain either way.
Yes, go for it. The worst thing that happens is the proctor says "the patient does not accept" but you've then covered all of your bases. If the pt does accept, you've secured the airway.
For the situation in this video, no. The airway is patent...nasal cannula at best.... please dont ever shove an OPA in someone who is breathing 24 times a minute with an SpO2 of 92%. jesus christ.
Gotta disagree with you there, while the airway is patent, the patient is unconscious, and its best to go ahead and secure the airway somewhat, whether with a OPA or NPA, and the initial assessment said that his breathing was shallow, always use shallow as a key indicator to assist ventilation with a BVM, it means that they are not getting the air down into their lungs and provide proper oxygenation, however with the SpO2 being 92 percent, i can see why he put him on a non re-breather, but I would still have assisted ventilation.
You insert the opa and if they have a gag reflex take it out and insert the nasalpharengeal airway unless they have head trauma then you would just have to do your best, as with any scenario you decide whats best on training
Didn’t check for major bleeding or did I miss something
Im getting ready to take my Trauma practical for Paramedic this weekend. At what point would I verbalize obtaining 2 large bore IVs with a fluid bolus? after the secondary or after the history taking? When would I also let them know if I were in need of a pressor if the bolus wasn't effective?
It's situationally dependent but you could verbalize that when you discuss how you would transport the patient, letting the proctor know what you would do en route to the hospital.
In the NREMT-P trauma assessment, is there only one head to toe assessment that goes on? I notice on the skills sheet it only lists it once, but in ITLS we were taught to do a rapid and a focused trauma assessment.
Follow what the sheet says for sure, but verbalizing what you would do in the exam is always a good idea.
Does shallow breathing mean assist with BVM and not a non-rebreather??
when listening on headphones the voices are only in the left speaker.
Thanks Ezequiel, we will look into why that may be occurring.
check your headphones lol
Thank you! I was about to give up on watching because I only had the right headphone in lol
Mines was the same way and nothings wrong with my headphones
Lol I had only my right ear in wondering what happened. I’m glad I was reading the comments while watching.
In all these videos, the EMT just takes a glance at the neck and ascertains "No JVD". I have been googling and looking over several videos that addresses this topic. I haven't yet found a video that teaches a quick visual inspection to ascertain this. Do you have any tips? I do not have a medical background, but I have the role of first responder at a facility with some thousand employees.
Great idea for a new video, thanks!
This guy put an oral adjunct in a Pt with a pain reflex (meaning they probably have a gag reflex too and will likely reject the airway)
Should've included treatments he would've done during transport. Large bore IV's etc. at least could've had his other parter hold pressure on venous bleed while continuing his assessment. Should've had a c-collar placed prior to log roll to keep the neck more stabilized during the log roll. No crit fails but this is stuff that makes the difference between good and poor Emt's/medics
Hey Jason, thanks for your input. The ability to verbalize what your plan is to the test proctor is critical. Great catch there.
Question: How come he didn't try to call her name or get her attention verbally before checking for pain? If she was aware enough to respond to verbal or her LOC was good enough, wouldn't you skip the oro airway and put a naso in?
Hey Heather, that is definitely something he could have checked. That is a great tip!
Why did the lead provider skip the Secondary and go to Baseline Vitals?
We're taught to do the vitals before secondary assessment because when we update EMS it gives them a "bigger picture" as to what they're walking into
Hannah Sheehan same for me
place an oral adjunt with a NRB?
Learning to be EMT
Don't you go CAB if the patient is unresponsive? That's what I was taught.
The pt wasn't FULLY unresponsive, she responded to painful stimuli
If it’s trauma it’s cabc the c is c spine a air way then b ,c if no trauma it’s abc a always before b and c
Didn’t open the airway
Going in for my test now
How’d it go?!
@@Emtprep I passed
Why would you use a traction splint on a femur? I thought it was for tib/fib fractures injuries
Great question! The Sager Splint is used for femur fractures.
To my understanding the traction splint is for closed midshaft femur fractures. The only splint for tib/find is a regular old splint with some ice and bandaging. If you're advanced levels maybe consider some pain control
this is very similar to EMT b assessment
Yeah except you can push drugs 🤣
Wouldn't starting two large bore IVs and giving fluids tko be indicated for this patient? Also initiating standard care of shock such as keeping the patient warm and possibly even elevating the legs should at least be considered. The blood pressure of 92/64, pulse of 112, respirations of 22, O2 sat of 94% on 15L O2 and the fact that the patient is only responsive to pain and has a femur fracture all points towards hypovolemic shock due to a femur fracture. I don't think I heard them once mention that they suspected shock. What are your thoughts?
Proctor said her breathing volume is shallow so BVM ventilation should've been started. But yes the hypovolemic shock from femur fracture sounds about right
most cases fluids don't hurt but good lord please PLEASE make sure that honey doesn't have CHF
im worried about backboards, i prefer vacuum mat for trauma patients
I have a test soon in this, I am a highschool student. My biggest problem is trying to do this under 10min. Do you have any tips on getting under 10min
Hey Ally! Absolutely, try to converge the steps into an acronym or memory aid that you can remember. Sometimes people group the steps into 4 or 5 different acronyms that they repeat over and over during the test. This helps them ensure they're within the time limits. Great question!
EMTprep This Video and advice helped me! I need up passing he exam. Thank you so much for being available!
Just a question, I'm a starting out student so my knowledge is pretty basic so excuse me.
But would an IV drip of sodium chloride solution (saline) help increase the blood pressure of the patient?
Hey Jordan, typically speaking giving IV solution administration will increase the BP, great thinking!
If someone has a systolic BP above 90 (which she does), you would likely not do fluid therapy, onky TKO. Too much saline will affect clotting.
AVPU assessment was kind of strange, seemed to have skipped verbal stimulus and went straight to sternum rub ?? For the RTS for chest- missed sternum stability check and pelvis- didn't check for incontinence. And c-collar not placed before log roll
Nessa Roy I came here specifically to leave that comment but saw you had already hit the nail on the head a year ago
What is the "P" in BSIP?
+Tormod Steinsholt Hey Tormod, Body Substance Isolation Precautions
+EMTprep that literally means the same as BSI
It’s hilarious to read these “supermedics” in the comments, you’ll be humbled real quick once you get out into the field. Assuming you know everything is a good way to get someone hurt
LOC
Responsive to pain -> NPA
U don’t need an airway adjunct to use a NR also her resp were shallow (BAG!)
c/c / Appearent life treats
C//C
“possible mutisystem trauma, so I will go ahead & expose my PT to identify any major life treats or check & quick check for bleeding”
Life treats ??🙃🙃
catastrophic haemorrhage check?
Hey Billy, I am not sure what you mean here.
EMTprep I'm not sure if I missed it or not, but would you be following a DR CAcBCDE approach? with the first C being catastrophic haemorrhage?
Hey Billy, to be honest, we've never heard of that. Can you explain the acronym?
Sure no worries:
D - danger so like your scene assessment (Safety, Cause/mechanism, Environment including access/egress issues, Number of patients, Extra resources required)
With global overview of patient ie appearance (pale, sweaty, facial droop, alert, cyanosis, oedema of face) work of breathing (accessory muscle use, cyanosis again, any audible stridor or wheeze or obvious dib, rate etc) and circulation to skin (malar flush, pallor)
Response - AVPU, gain consent
Catastrophic haemorrhage - any massive bleeding externally/ potential internal? Correct this (external normally) before moving on. Including blood sweep. So Tourniquets, blast dressings etc, consideration to splinting limbs if you think it's main problem I guess, ie bleeding into thigh from fractured femur, that's caused hypovolaemia and reduction in consciousness (or something ha)
Airway with c spine consideration - blockage from fluids or objects or odeama - jaw thrust /head tilt / suction /postural drainage
Breathing - red flaps twelve... Rate effort depth feel look auscultation percussion sides and back tracheal deviation wounds bruising surgical emphysema laryngeal crepitus absent venous distension I forget last e haha
Circulation - address bleeding / minor bleeding, bilateral pulses, BP, capillary refill time, consider splintage/ traction/ Iv access etc
Ecg
Disability - fast test (face arms speech test) gcs blood glucose level, sensation changes etc. Neurological status etc.
Expose and evaluate - any other secondary survey stuff to do? / Chop clothes of if not done already ready for head to toe assessment etc.
That is a great way of learning the content!! Do you feel learning it this way has helped you solidify the information in your brain?
BSI ABC-D
she is unresponsive so he should have checked her jugular for pulse instead of radial
Correct me if I'm wrong but if pt. Is conscious shouldn't we introduce ourself and let pt. Know what we are doing and ask for consent to help her.
She was unconscious in this video, she was only alert to painful stimuli.
Shit this is like an emt scenario
If the airway isn't patent...your patient will expire. Bottom line.
His tattoos are distracting for me.
+Julia Lewis Hi Julia, we like his tattoos!
I'm not saying I don't like the tattoos, they are really cool. All I'm saying is that I get distracted easily and any movement I see takes my attention away from the video. Also your videos are really cool. I want to be a paramedic when I grow up. :)
+Julia Lewis Gotcha! Thanks for the feedback!
Thanks for the great videos. :)
theres gonna be alot of distractions in the field more prominent than tatoos and what if your partner of assisting personnel have tattoos? Is that going to distract you from performing a thorough and complete assessment in real time????
sorry for asking this question so late in the game, but based on this patient's GCS and the fact that she accepted an OPA and had shallow respirations, shouldn't intubation be considered to protect the airway from aspiration? Genuinely asking for my own benefit and not trying to be too critical here. Eyes - didn't open so she gets a 1, Verbal - incomprehensible moaning which is a 2, and the she localized to pain stimuli which is a 5 totaling 8. Maybe I'm looking too much into this scenario. Thanks!
Intubation is always in the back of a Paramedic's mind for someone who is not breathing adequately on their own. However, one difficult thing to remember is the right indications. If an OPA is sufficient then there is no reason to drop a tube. If uncontrollable bleeding into the airway, risk of vomiting and aspiration, or airway swelling such as in burns was a concern then intubating would be more at the forefront. However if the problem is simply a decreased level of consciousness leading to an inability to protect the airway, then it is appropriate to use only the interventions necessary (ie: OPA)
@@joshrau7549 i know its years later, but im a emt student taking my trauma test today and my question is why would he use on a OPA if she wasn't fully unconscious?