National Registry EMT Medical Patient Assessment/Management
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- Опубліковано 27 кві 2019
- National Registry EMT Medical Patient Assessment/Management
This is a fifteen(15) minute station where you will conduct the assessment of a medical patient and "voice" treat all conditions discovered
I’m in my second week of EMT school and this is quite intimidating I won’t lie 😂
Keep up with it and ask for help if you need it!!!
I agree. I’m in week 3 and there’s so much to take in especially with zero knowledge of healthcare
Hell yea
Same, I’m a couple months in and overwhelmed but powering forward. It’s mostly hard because every person we talk to has a different opinion. Ie. Idk if they have to verbalize when they get in the ambo, but we would’ve done in it scenario pretty much after hearing the patients having chest pain and taking basic vital signs. Everything else can be done in the truck en route because she’s a med red. But this is a helpful assessment to watch. I like the flow of the convo verses the broken down sample opqrst. I do better thinking of it as a narrative vs thinking about it step by step. And the clinical I just had was pretty awful XD didn’t meld with the preceptor at all.
@@robertpalofox7446 I’m in week 5 (though we missed a week because of weather) and it’s soooo much info..
I love this series - I just wish you had a diabetic, overdose, and allergic reaction scenario. Way better than the rest on youtube. Thank you!
Im back and my practical Is in an hour I'll come back to tell if i passed
Edit: I'm back and i passed!!!
Yay!! I'm taking my skills test tomorrow and I'm getting a last minute cram in before
Congratulations!!
Proud of u!! Mine is in 2.5 hours lol wish me luck
My testing with state is this Saturday in 2 days and I’m terrified
@amniewilliams1241 i was too. I just calmed myself down and remembered what I had learned and it wasn't too bad. I'm sure you'll do fine
Week 10 in EMT class and we went from 25 students now down to 9
They’re always mowing the damn lawn haha
@@HellenKellerDenier That's why I use a riding lawn mower :)
Or shoveling snow.
🤣🤣🤣
Bruh, right?! I was thinking the same! Like, imma let my grass grooooow, baby. I like my heart! 😂
Wow that was very smooth. I just did my first practice scenario in class the other day and I was all over the place
Keep up the practice! It takes hard work but eventually it will become second nature!
Just remember your SAMPLE and OPQRST and you'll be good buddy.
@@rhoonah5849 I memorized those..but when I ran through a scenario I completely blanked...soo embarrassing.🤦♂️
@@paintballfanatic7231 it happens. Just practice, practice, practice. I used to run through scenario after scenario with my classmates. We watch each other then critique. It really helped. Then I'd cube home and run through trauma assessments in my wife and stuff. There were a few things i kept forgetting so I'd leave notes all over the house... bathroom mirror, computer monitor, steering wheel of my car. Whatever it took. You'll get it!
@@rhoonah5849 great ideas! Thanks. I'll be trying to practice on my family members and friends. I have I hard time feeling comfortable touching people, any advice for that?
I’m on my second week of EMT school and the amount of knowledge you have to know is freaking me out🥵
I’m on the same boat.
I just found out I passed my NREMT two days ago, good job past me for not quitting
You'll be alright bro
Im about to test..what helped me is i just took the med sheet and copied it into my notes over and over then eventually could do it without looking and remember the first couple parts if trauma and medical are almost the same
@@scherff1399 I already passed it, the comment above was me replying to my past self
Great video. Only three things I am not wild about are going straight to nrb O2 with no SPO2 check, asking a female about ED drugs and taking so long to admin ASA and Nitro. His assessment was very good covered everything. Some may say he over assessed but we have to remember that in these NREMT evals they are looking for reasons to fail you.
Thank you for your response. As to the items you addressed
1. The NREMT requires that each patient receive high flow O2.
2. Female patients can be on forms of ED medication to treat Pulmonary Hypertension hence why it must be asked prior to administering nitro.
3. A full proper assessment must be preformed prior to administering any medications as all medications have side effects which can be found during the detailed exam.
@@yalenewhavenhealthcenterfo8754 Thank you for the information. A lot has changed over the years. I am currently starting my recert and then NREMT exam for instructor purposes. This has been very helpful.
It's a good thing he asked about recreational drug use because if she has a history of cocaine use/amphetamines, it could lead to dilated cardiomyopathy and present with chest pain. So very important to ask and rule out.
@@michaelreyes2301big facts
Really good video. I was following along on my checklist and memorizing the steps. I also took notes on my checklist and have been rehearsing it, this video covers everything!
You all did a great job on this video. I wish you had more scenarios.
Thank you!!! We are working on creating more scenarios!
Totally agree!
@@yalenewhavenhealthcenterfo8754 Yes please.
@@yalenewhavenhealthcenterfo8754 Did we get more videos?! : )
I got skills testing this week and I pray that I'll come back to this comment in the future knowing I passed
Paul we believe in you buddy! Let us know how it went :)
Best of luck!!!
Results??
Did you pass????
@@miserylovescompany9042 sorry for the late reply, been busy but I passed both my skills test! Thanks for the encouraging words!
OPQRST and SAMPLE questions were textbook, good job.
This is rad, uploaded on my birthday 4 years ago, and I have my medical assessment test tomorrow.
Second week of emt school and this is alot easier then it sounds in the book
I'm a new EMT student, and we are just now dabbing our toes in patient assessment. I'm going to bookmark this video because right now this seems so overwhelming and like I'll never get it. Hopefully in 3 months when I come back, this type of scenario is second nature.
I take my med assessment in 3 days, I keep watching these videos and following along with the NREMT sheet and its helping me alot! good Luck!
As a student, I find going from SAMPLE into OPQRST flows easier from events to onset and that will knockout 2 letters in one motion 😉
I am about 10 weeks in and I forgot to call for ALS backup 🤦🏾♀️ won't do that again. I'm glad we were practicing
Great vid . If you guys want feedback, I’d say the only problem is the background echo noise . Other than that , solid video
*My nremt is legit in 12 hours.... its 2am and im doing last min study sheeesh*
@@WoWzErZ2003_ yes I did. Work in Florida for a few months but now I'm joining the military.. EMT did I live up to the hype
@@whymemanwhyl0lp751did you pass?
@@ZacharyLookas hello i did pass. Became an emt for almost 7 months. Decided it was not for me and now im in the military.
I hope I can get as good as this guy.... and quickly!!
I'm coming up to practicals in a few weeks and this is still intimidating
Best of luck!
I’m reviewing patient assessment and it made 0 sense to me as I was unable to comprehend it after reading the textbook many times. Watching this allowed me to connect the dots!
Did you pass the nremt
@@spilledsoju03 I did the state test a tiny bit over a year ago. Been doing volly and paid for almost a year now!
Perfectly done bravo 👏
Practicals in 2 days!! Wish me luck, super nervous !!
This is fairly simple, are there more uncommon assessments?
U should make scenario of how to assist a patient with their EpiPen
Every Chest pain doesn’t need ALS intercept especially if the pt is stable because you can get them to the hospital usually faster than waiting on the intercept especially if you have an AEMT
about to start the EMT program this fall and this looks intimidating as hell
How is your schooling going so far?
@@bossnone739 I'm currently on my 3rd about to be 4th week into the program and I like it!. It's A LOT of information to take in in such short period of time but i think it'll all be worth it at the end
@@jesuslezama8800 how is it going, did you pass?
I’m doing a 2 week NRemt class start to finish with both medical & trauma assessment. I’m literally stressing big time learning this
@@farisqader7919 yes I did! . I’m now an intermediate getting ready for paramedic class next semester
If this scenario was an allergic reaction and the patient had her prescribed Epi-Pen would I still need to contact med control before administration?
Jacob Johnson yes because then they’re gonna assume you know standing orders and question you on those
Per NREMT Guidelines the ONLY medication an EMT can give without contacting MEDCONTROL is Oxygen. So to answer your question yes you would still need to contact MEDCONTROL
Follow local protocols. In MA Epi's are SO but MA is switching to check and inject.
Here in Texas, as EMT's there are 8 medications in our standing orders that we can give WITHOUT contacting medical direction. I believe every state's laws differ. We give epinephrine, activated charcoal, O2, Nitro, Narcan, aspirin, albuterol and oral glucose. OF course if there's a question of # of doses or any situation outside of the 5 rights we would contact MD.
Depends on your state. In my state, standing orders allow us to give two doses unless patient is over 65 or under 6 months then we contact medical control.
Remember this though, when it doubt, call med control. You're NEVER wrong to call and confirm.
Two weeks left of my EMT basic lol I test out of medical and trauma and splinting tomorrow!
NY state protocol for nitro BP has to be over 120 systolic
what blood pressure cuff is he using?
Airway is patent, breathing is 22 and normal... why do you need to administer oxygen, especially at 15L? She is fine. To address the chest pain maybe give 6L nasal canula if you want to administer oxygen. Am I missing something here?
NREMT standards only accept 100% of O2. Again this is a testing scenario not real life
how do you remember everything at the end to tell the doctor? im taking biology this year and then hopefully getting into the EMT course, im already scared lol
Try to tell it like you're telling a story. What you found, what you did, and where you are now. Keep it simple!!!!
@@yalenewhavenhealthcenterfo8754 thanks that helps a lot!
I start emt on monday. I want this so bad but im getting anxious to do this.
How's it going 👀
Can I give the patient ASA and Nitro at the same time or it has to be one or another?
If you believe the patient is suffering for a Cardiovascular Emergency, the patient meets no contraindications for ASA or Nitro administration, and MEDCONTROL has has approved the administration you can give the patient both ASA and Nitro. It is recommended that you give the patient ASA fist due to it being administered PO, and Nitro second due to it being a SL administration
@@yalenewhavenhealthcenterfo8754 Would it bet jumping the gun, if after getting the first set of vitals, asking of contraindications, give the ASA and Nitro earlier since we already suspect and MI and have asked for ALS? That is if we live in a state were ASA and Nitro are already pre approved with standing orders.
Hello
On the primary assessment he assesed for breathing , the proctor said 22 and normal why did he give her oxygen 15L/ per minute via non rebreather mask when she was breathing normal
Great question Isidro! It is a NREMT requirement that the EMT provide high flow O2 to the patient even if the respiratory status is within the "normal range"
@@yalenewhavenhealthcenterfo8754 that's interesting, why is that?
Just want to ask, what are types of exams in NREMT? Written and practical?
Greetings 🙏
After completing Diploma in emergency health care how many years you have to do in the university for Bachelor emergency health care?
Nice
I’m in my 4th week. Good luck guys 😅
Did u pass?
awesome
Because it's a female and because females can also be prescribed ED meds for other health conditions, I can understand why the question was asked, but would it be appropriate to instead ask "are you taking any vasodilators?" Or is it specified as ED medication on the exam?
That would still be appropriate
this looks fun
best one I've seen since it's made as realistic as possible
THIS CANDIDATE HAS A NATURALLY GROWN BULLET PROOF VEST OMG
do you give oxygen after u obtain medical history and sample or before?
Before as it is done during your ABCs!
Chest pain is a life threat. If room air sats are >94 O2 is contraindicated due to free radicals and tissue damage. Excessive oxygen causes a larger infarct - contraindicated for stroke and MI. ASA needs to be administered ASAP with a chest pain pt per ACLS guidelines. BP is not safe for NTG. Strong risk for cardio genie shock and loss of preload that will lead to death. Place pt supine as long as lung sounds are clear and BP may increase due to reduction of gravity on the heart to be able to give NTG. No idea how far out ALS is why not just load, do assessment en-route, and give the hospital a STEMI alert to activate the cath lab. If interception with ALS happens that’s great. Every minute a pt has chest pain on average 500 myocytes die the pt will never have again which can lead to LVH, RVH, PEF, etc.Just my thoughts.
Why is BP unsafe for nitro? In my course we learned that bp
@@matthewthompson6455 everyones is different cause for us we learned its 90 and above is safe
i have my testing this week. i thought it was six rights of medication admin. does it vary based on your service's protocols?
As long as you check the necessary rights you should be covering them all. Best of luck in your testing!
Wow, this SO different to what I'm accustomed to. Thanks for the upload. Questions from an Australian paramedic; Why do you need to call a doctor via radio and give a sitrep? Seems like an unnecessary waste of time. GTN contraindicated in a patient with a BP
Thank you for your response as to your questions.
1. EMT's must call a MD for all interventions other than Oxygen per the NREMT.
2. The candidate is given two(2) partners for the scenario, but the candidate must be the one who actually obtains all information.
3. This is a testing scenario not a field scenario.
4. EMT-B's cannot obtain a 12 lead ECG, Morphine is not given by EMT-B's.
5. The NREMT does not accept "International Standards"
@@yalenewhavenhealthcenterfo8754 Many thanks for taking the time to reply and clarification. I find it fascinating seeing how other agencies train. How are EMT-B level staff used? Do they crew ambulances as a pair, or with a paramedic?
@@coover65 You're very welcome!! EMT-B's can be staffed with another EMT-B or a Paramedic
@@yalenewhavenhealthcenterfo8754 Many thanks for the clarification. Here by law registered advanced care paramedics is the minimum standard allowed but in some cases we have volunteer first responders and also "technicians". FRs are in remote areas, cannot transport and provide basic care until the paramedics arrive. The "technicians" are a controversial recent addition. Only indigenous people can enter the "technician" program, and must live in an Aboriginal or islander community. Such communities are generally in remote areas away from white settlements. We don't have "technicians" in the cities, only paramedics with a university degree.
So I was thinking this patient would be suffering from CHF. What makes this another heart attack vs. CHF? Was it the clear lung sounds that made a difference?
yes
Why didn’t he give the aspirin and nitro quicker?
Low BP is a contraindication for the Nitro that needs to be checked first and there are steps to get to that point before vitals i.e ABOCs Sample history ect.
You want to assess life-threats first and foremost which means your ABCs and primary assessment. Airway, Breathing, Circulation. Need breathing, quality of breaths, patent airway, pulse strength, rate, rhythm. You need to assess mental status, is it altered or is the patient unconscious? This can affect the patient's ability to maintain patent airway and makes them a higher priority for emergency care and possible need for ALS assistance. If they are stable, ABCs all look good, and they are conscious, alert, and aware, you still want to be cognizant that they could deteriorate.
Because there's a chance they could become unstable and lose consciousness, or their mental status could deteriorate, you want to complete your history taking right away for your secondary. This is because your best opportunity to get accurate history info is directly from the patient, and if they lose consciousness or become confused you can no longer get a good history. That information is vital to offering them appropriate care, and when they get to the hospital they will also need that information from you. Information from your history and physical are also necessary prior to administering or assisting with any kind of medications (save for oxygen, although you do assess for signs of shock, poor perfusion, etc. during your primary that indicates oxygen therapy or ventilations). You need to know allergies, medical history, pertinent vitals and prescriptions, also need to know what meds they are taking to give accurate doses (what if patient had already taken 3 tabs of ASA then you can only give 1) and whether contraindications are there (what if they were on Levitra for example, that would contraindicate the nitro).
TL;DR while you would like to treat a patient as quickly as you can, in order to provide appropriate and high quality care that will not harm the patient you have to make sure you go through your checklist. You don't want to accidentally give a patient any medications that could make them worse because once you've given them a drug you cannot "undo" it so to speak.
@@LilJbm1 I'm still a bit confused as to why he did a whole reassessment with seemingly full vitals before intervention after he had history/examination/contraindications and a previous set of vitals etc
@@danieljaywoods9950 because this is how the exam works. Baseline vitals come before Interventions. In real life, this would probably go a bit more quickly but this is a demonstration for the NREMT exam
Good video but I'm pretty sure he didn't begin transporting this patient after the primary assessment, If you suspect heart attack always transport asap
The candidate made a transport decision by stating "the patient is a high priority" thus initating transport
Was there a reason to ask about Ed meds for a female? Is this in case the female could be trans, they go by she pronouns but still have male plumbing? Or is this because woman may take Ed meds recreational? I read about a new cream using generic viagra but wasn’t sure how it effects vasodilation. Thanks, I just started Emt class 8/16 and have medical patient assessment test tomorrow.
Recently finished my emt course. I believe Sildenafil can also used for pulmonary hypertension in both males and females. And I’m sure there are other reasons for use too. A lot of meds also have approved “off label” usage for conditions that aren’t consistent with the original med indication but that react therapeutically. My chest pain “patients” were always male and idk that asking a female is a requirement or for good measure. A good question for your instructor tho.
Breathing rate rhythm?? And quality? Or rate depth and quality????
Rate/Rhythm/Quality
I thought those two in the back were real people the whole time lmao
ED question for a female? Mine as well! You never know.
Women too can be on forms of E.D Medications designed to treat Pulmonary Hypertension hence why the question sill needs to be asked for females
I have a question please: does the NREMT require we take two sets of vitals? I don't see it in the script but I notice the EMT takes it twice. Is this to cover primary and secondary? Thank you in advance!
A full set of vital signs is completed once. However there are aspects of the vital sign check that is completed in other portions of the assessment.
@@yalenewhavenhealthcenterfo8754 thank you!
I passed my NREMT skills and get to keep my cert because of your videos!!!! Thank you so so so much!
@@vanessamarietorres7245 Congratulations!!! You did all of the hard work!!!
Can anyone tell me why he called for ALS before he knew if there was anything serious going on?
Chest pain is always an ALS call
i thought one of the contraindications of nitroglycerin was having a heart rate above 100
Having a heart rate below and taking ed medication are the contraindications since nitro is a vasodilator
What is the hardest part of being a paremdic /EMT?
Besides stress, hours, etc....
What is the hardest part in becoming an EMT?
SlayinSaiyan 94 knowing whether or not that you are giving the right interventions I would say. I’m a hs emt student and I will say that being an emt is a very strenuous job considering all the assessments that you have to know for skills day. It’s more so remembering all the nitty gritty details that make you want to explode!!
I'm an EMT in Texas......hardest part is SCHOOL!!! LMAO.....no joke, the program comes at you EXTREMELY fast with tons of info and not much time between exams. They have a pretty good weeding out process (and rightly so) as our school only has a pass rate of approx. 25%!!! Then again, those who fail out, I wouldn't want them touching me anyway. Many do not take it as serious as they should considering the responsibility you have as a first responder.
FYI, I currently work for a private ambulance company and I'm getting ready to start paramedic school.
Definitely school! You have to focused and serious about it
@Ryan Summers.....I agree 100%. I too work for a private ambulance company in Austin Tx and as an EMT I was fortunate enough to be placed on an ALS truck so I get to see and learn lots as I assist the medics I work with. I also agree regarding O2. The only time we disregard the Spo2 # is for a pregnant woman (baby needs O2) and inhaled respiratory issues such as poisons. Those are the only two times we give oxygen regardless of Spo2 reading. And we certainly wouldn't have someone on a non rebreather at 15lpm!!! A nasal cannula ta 2 lpm.....if I HAD to…...but not a nonrebreather.
Ryan Summers i agree that the SpO2 was high enough that O2 admin wasn’t necessary, but personally i would give the O2 because of the pale, cool ,clammy skin as it indicates that the patient may be hypoxia/perfusing poorly, plus oxygen is a standard intervention for chest pain. Don’t treat the monitor, treat the patient as they present, especially since pulse ox isn’t the most accurate device to begin with.
I finished the course and my exam is on February 27 am I need to study more tbh haha
He gets a BP over her long sleeve?
As long as the shirt is thin enough it is possible if you know how to do a bp
Cool. I was taught to always go bare skin
The reply made by Nissim is correct
BP's are done out in the field OVER clothing all the time. Of course in school we are taught to be on bare skin...….same with listening to lung sounds but you can't just rip someone's shirt off them out in public. LMAO
My question is why he didnt make her uncross her legs... when I worked as a med aid for a nursing home we had to make them...
Did my first scenario last week and totally messed it up
Keep working at it !!! You'll get it!
Good evening everyone
4 more weeks and we'll be through.
Microphone is a tad too bad so it's slightly difficult to make out whats being said unfortunately.
Examiner blousing his boots is a critical fail.
I am studying 2nd year bsc.emt
What does he say is "times 4 over 4? before the GCS of 15? He rattles this stuff off so fast it's hard to understand what he is saying.
he says A&O x 4 its alert and oriented to person, place, time and event.
@@joshhayes2196 Thanks for clarifying. Trying to soak up as much info before classes start in September and a lot of this is the first time I've heard it before.
@@adams7597 that’s great! Good luck you will enjoy it I’m sure.
Where's the ECG taking?
This is a BLS Station
soliddddddddd
isn't a contraindication of Nitro a heart beat of over 100?
Systolic BP over 100 is the contraindication
BP less than 90 systolic, and HR less than 50 or greater than 100
whoever did the captions is hilarious
Here I come, NREMT!!
Did u pass?
@@flores222 oh my gosh yes I did! Coming back as a paramedic student.
good job im proud of you
@@janellemoreno3547
Why isn't he giving the patient aspirin or nitroglycerin after the first set of vitals? It took quite a long time before he even attempted to give nitro or aspirin.. He did a great job! i couldn't of done all that fantasy stuff! But still..
he didnt ask about ed drugs or hypertension drugs
He did. I forget the timestamp but did ask if she was taking any kind of erectile dysfunction meds before giving any nitro.
Go to 9:14 the candidate does ask about ED medications or any further contraindications
Why did he stay and complete the secondary assessment when it seemed to be a heart attack from the start? Wouldn’t it be safe to say transport then complete the secondary assessment
He did not stay. After he completed the circulatory assessment he made a transport decision to transport on a high priority
@@yalenewhavenhealthcenterfo8754 ohh ok awesome I missed that part!
🤔 I'm confused... Around the 6:20-6:40 mark on the timer... Why did he ask of she is taking some erectile dysfunction medication?
It's because ED meds are contraindicated for nitro if used in the last 24 hrs
@@nathanaelswanda2031 aw ok thanks. 👍 Just through me off they asked a woman that.
Julio Morales some women use Ed medication to lower their blood pressure
@@Chris-qe6qr aw ok. Thanks.
Slebhy Crook Simmons
I don't know why he checked her vital signs twice in a row lol
Review the NREMT Medical Patient Assessment Form and you will understand why. The Primary Assessment includes vital sign checks to get a baseline of the patient. The second vital sign check is to be sure the patient is stable enough for any interventions
My exam is today and I’m nervous ASF
How'd you do?
Why did she need oxygen at the being I don’t understand cause her breathing was normal 🥺 so confused
The patient could be possibly suffering from a cardiovascular event which requires additional subliminal oxygen treatments.
Everyone gets oxygen in your medical assessment scenario 😁
@@yalenewhavenhealthcenterfo8754 couldn't you give a nasal cannula??
Should’ve got sp02 before giving oxygen. Too much oxygen is bad
The hard on for highflow oxygen administration that the nremt has is ridiculous lol
I get this is NREMT but I just want to point out that giving high flow O2 to someone that is having chest pain is a terrible idea cuz it will causing coronary vasoconstriction and farther harm her if she is having STEMI using O2 as needed for people with chest pain is the best route for sure
Why people still saying I’m ganna❌ in best of I’m going✅
Might be a regional thing. Either way, he makes his point clear, and his vernacular isn't in anyway indicating that he is ignorant. I'm GONNA give him an A+. This assessment was flawless.
When you ask a woman if she has taken any erectile dysfunction drugs
Female patient's can be prescribed erectile dysfunction medications due to pulmonary hypertension. That is why you must ask for both male and females.
This guy doin too much 😂 some of the things he did were great, but not necessary
why the cop coming over for sex ?
shook oh realy ? fools
I’m not sure why we would ask a female if she’s taken erectile disfunction medication 😭
Some females are on forms of ED medications to treat pulmonary hypertension
There are several reasons; the most important is the contraindication. Both drugs cause vasodilation and when combined it can lead to a sharp and prolonged drop in systemic blood pressure and decreased blood flow in compromised coronary vessels. This by itself can result in a cardiac event.
AND
Pt has a history of MI which means the heart has been compromised and reducing blood flow can be fatal.
AND
In the US both females and males are prescribed Viagra for increased blood flow to the genitalia.
AND
Viagra isn't limited to The treatment of ED. It's prescribed for COPD, hypertension and other medical conditions.
What is the point of ALWAYS calling for ALS. So stupid.
In this case being chest pain ALS will be able to do a 12 lead and other medications that the BLS can not.