Just did this assessment yesterday in class, and somehow totally forgot that occlusive dressings existed... When I exposed the patient's chest, my instructor didn't inform me it was a sucking chest wound. Totally spaced, but this video is extremely helpful for review, thank you! Fingers crossed I get it tomorrow during review.
The only thing I would have done differently is every time he assessed lung sounds and was told they were diminished or absent, I'd have burped that chest seal/occulsive dressing. And as an EMT, requested ALS, if available. Otherwise, this is a great demonstration for EMT classes.
This is really well done. Thank you. One thing - I failed my initial Systematic Exam because I palpated both sides of the hip at one time. They said critical fail on that. Just a thought so just in case anyone else has that issue.
Always show respect to these guys for what they do, I'm such a weiny I cringed just at the scenario - doesn't help that its one of my fears. Thanks for sharing
Surely BP warranted an early check and treatment plan given the traumatic injury. BP of 70/40 and heart rate of 118 needs immediate support and indicates internal bleeding.
I've seen so many videos and this is by far the best one. Sure you missed a few things but for testing purposes, would you failed for not getting consent? No you would not. This is a passing assessment, great job.
Really good assessment with high level of theoretical skills, but not for a critical patient. In Sweden we use PHTLS, (X-ABCDE). A few questions: We are presented with a critical patient in chock after penetrating trauma (Both a B and C problem), where is the need for a distal status on the lower extremities (no found injury)? Why on scene and not during transport? If there is a gun wound, why is log roll first on E and not X or C? (To look for exit hole/wounds). This patient would've a detailed and thorough report but could have died on the way to the hospital because we took time on the scene to do non life saving assessment... If there was no B or C problem and no chock present, THEN this is very good! I know this is a examination and once again it was impressive on many levels. Just get us going after first assessment is done if we think this is critical. A gunshot patient with chock: X- ABCDE: Would dressing or tournique, look for exit holes posterior as well. Chest seal and high O2 on mask. Check for other bleedings. Minimal immobilisation if needed. Minimal time on scene. Reassess and IV during transport keeping BP on max 90mmhg. Be ready for ARS and/or "barping" the chest seal. Be safe! //Paramedic from Sweden.
Medic from Germany and USA here: same thoughts here. This is an inefficient method. No one uses that except these guys, obviously. It's way too slow and ineffective. Don't do that. Outdated stuff...
Shouldn't we control bleeding first and then do everything else, especially if we know that shots fired. It feels that AnO can wait, especially year question
Great video but I have a question. Patient informed that she was shot in the chest and we were informed she had dimished lung sounds on the right side. She also had a life threatening bleed on her right upper extremity. During the log roll would it be advisable to roll the patient on the right side instead of the left to preserve the function of the good lung?
Hello, yes you bring up a fair point, good question. In an ideal situation this patient would be taken off scene after a quick primary assessment. We would have the patient semi fowlers on a gurney and simply move the patient's torso forward to have access to the posterior for assessment.
I noticed at the end he said he would lift the seal on exhalation and place it back down on exhalation. So you would keep it lifted for a full breath? Exhale to exhale?
Im a little late to this video but should the candidate have "burped" or lifted the seal upon the first time that he was told that there were absent lung sounds on the right?
Lifting the seal wouldn't necessarily fix that issue, because the absent lung sounds are due to the pneumothorax itself. It would only be necessary to lift it if the patient started having trouble breathing.
With blood pressure being so low, and penetrating trauma to the torso, what about the thoughts of a fluid challenge and or also 1 g TXA? great video though
Hello, yes for an ALS provider those would be appropriate treatments. However, this is a BLS level simulation for an EMT-B skills test. Great thinking for the next level!
Great video, thank you. However noticed three things that I don’t think were asked. Are you on any medications, are you allergic to anything and most importantly as you’re treating a female, are you or do you think you’re pregnant. Other than that, so well done.
Absolutely, you are correct. Those would all be part of a comprehensive history taking. In the video the SAMPLE history is delegated to another provider but in reality a quick history before starting the assessment would be appropriate.
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in? 8:098:14
I mean, where was the exit wound? It took awhile to roll her. No exit wound to back? Shouldn’t he have rolled her after noticing gsw to chest so she wasn’t bleeding out of back?
Just want to ask, does saying: “we’ll take standard precautions” include the application of PPE. In my class we’ve been told that it is a critical fail if you don’t verbalize ppe application.
i would hesitate to just say "standard precautions". Seems a bit vague, but that's just me. I would verbalize "I"m going to maintain BSI and PPE precautions throughout".
@gabemedina2275 thats awesome, congrats! I'm about to head out in a few minutes to do some practice stations at the testing site. My test is tomorrow morning. I can only hope for a 6/6!
Further...This is an EMT-B skill but may fall outside of the scope in some Counties. Some Counties prohibit it and consequently do not teach or allow this. These guys are in Miramar in San Diego County CA and this is clearly within their scope there.
Don't forget in certain situations we are allowed to assume. For example if a person cannot consent to CPR due to unresponsiveness we can assume they want it unless a DNR form is presented to you. Or implied consent where, for extending they are extending their arm to the EMT.
Its all fun and games until your instructor gives you a multi-system trauma involving blunt force trauma, low and high/mid velocity penetrating trauma, and sexual assault with an unconscious Pt with no bystanders to get sample history from other than "he stumbled out of the rest room, collapsed and we have no idea who he his". 😅 These videos look like sesame street after my professor gave me the aforementioned scenario. Great job on your assessment brother. And thank you guys for the content
I wouldnt recommend this assessment at all. Its too hollywod. This is taking unimaginably long. This is not a real concept for an actual gun shot victim.
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in? 8:098:14
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in? 8:098:14
why is this better than anything my professors have taught me. kudos to this program for saving my ass
This is probably the best trauma assessment video I've seen. Detailed and to the point.
Thank you!
r9😮
r95😊4😢0🎉😢🎉😊😊hp5😊😅
Agreed. I always come back to it for review.
she was desaturisig!!
wow this was by far the best trauma assessment ive seen. getting ready for mine here from san fransisco, thanks!!
Thanks! Good luck!
a tip : watch movies on flixzone. Been using them for watching a lot of movies these days.
@Jamari Bishop definitely, have been watching on flixzone for months myself :)
@Jamari Bishop yea, I have been using flixzone for months myself :)
Awesome work
This is very good but I love how calmly she says I got shot in the chest
I actually don’t because it doesn’t add to the realness of the situation and ruins the whole scenario
Just did this assessment yesterday in class, and somehow totally forgot that occlusive dressings existed... When I exposed the patient's chest, my instructor didn't inform me it was a sucking chest wound. Totally spaced, but this video is extremely helpful for review, thank you! Fingers crossed I get it tomorrow during review.
Outstanding. This is a very solid trauma assessment. Textbook, right from the NREMT Standard. Good job all.
tu.hd😢e g
That very last part was great because i was wondering the whole time what to do if breathing worsened. Great job
Best trauma assessment on UA-cam!
Thank you!
The only thing I would have done differently is every time he assessed lung sounds and was told they were diminished or absent, I'd have burped that chest seal/occulsive dressing. And as an EMT, requested ALS, if available. Otherwise, this is a great demonstration for EMT classes.
Good stuffs. I love the demonstrations.
This is really well done. Thank you. One thing - I failed my initial Systematic Exam because I palpated both sides of the hip at one time. They said critical fail on that. Just a thought so just in case anyone else has that issue.
I find talking through it makes things so much easier. Its difficult when you aren't talking as the pacing is difficult.
Always show respect to these guys for what they do, I'm such a weiny I cringed just at the scenario - doesn't help that its one of my fears. Thanks for sharing
very informative, many thanks UK
This is great and a great example for students
Surely BP warranted an early check and treatment plan given the traumatic injury. BP of 70/40 and heart rate of 118 needs immediate support and indicates internal bleeding.
Very informative, thanks!
You're welcome!
There is no way this is just a student.
This is a medic or an EMT instructor that’s been on the field for a while.
This was a staff member yes
Currently in emt-b training and have state skills in just a few weeks. This will help for my trauma assessment
Amazing assessment, definitely going to use this for study for my tsop exams
Great Video I didn't hear if there was an exit wound as well did I miss it or none found when he checked her back?
I've seen so many videos and this is by far the best one. Sure you missed a few things but for testing purposes, would you failed for not getting consent? No you would not. This is a passing assessment, great job.
Consent is implied
@@oscarr9128she’s A&O X4. Correct me if I’m wrong but I think you still need to somehow get consent. Definitely could be wrong though
Excellent
Really good assessment with high level of theoretical skills, but not for a critical patient.
In Sweden we use PHTLS, (X-ABCDE).
A few questions: We are presented with a critical patient in chock after penetrating trauma (Both a B and C problem), where is the need for a distal status on the lower extremities (no found injury)? Why on scene and not during transport? If there is a gun wound, why is log roll first on E and not X or C? (To look for exit hole/wounds).
This patient would've a detailed and thorough report but could have died on the way to the hospital because we took time on the scene to do non life saving assessment...
If there was no B or C problem and no chock present, THEN this is very good! I know this is a examination and once again it was impressive on many levels. Just get us going after first assessment is done if we think this is critical.
A gunshot patient with chock: X- ABCDE: Would dressing or tournique, look for exit holes posterior as well. Chest seal and high O2 on mask. Check for other bleedings. Minimal immobilisation if needed. Minimal time on scene. Reassess and IV during transport keeping BP on max 90mmhg. Be ready for ARS and/or "barping" the chest seal.
Be safe!
//Paramedic from Sweden.
Medic from Germany and USA here: same thoughts here. This is an inefficient method. No one uses that except these guys, obviously. It's way too slow and ineffective. Don't do that. Outdated stuff...
This was good
Shouldn't we control bleeding first and then do everything else, especially if we know that shots fired. It feels that AnO can wait, especially year question
Great video but I have a question. Patient informed that she was shot in the chest and we were informed she had dimished lung sounds on the right side. She also had a life threatening bleed on her right upper extremity. During the log roll would it be advisable to roll the patient on the right side instead of the left to preserve the function of the good lung?
Hello, yes you bring up a fair point, good question. In an ideal situation this patient would be taken off scene after a quick primary assessment. We would have the patient semi fowlers on a gurney and simply move the patient's torso forward to have access to the posterior for assessment.
Why did you decide to not burp the chest seal after noticing diminished LS?
I noticed at the end he said he would lift the seal on exhalation and place it back down on exhalation. So you would keep it lifted for a full breath? Exhale to exhale?
No. The chest seal would be lifted as exhalation starts and replaced prior to the next inhalation. So a very brief adjustment.
Would we have put the patient in the trendelemburg position once in route due to the low bp if bleeding was controlled?
Trendelemburg position is not very widely used in our county (San Diego). Placing the patient supine is typically the recommended practice here.
Im a little late to this video but should the candidate have "burped" or lifted the seal upon the first time that he was told that there were absent lung sounds on the right?
Lifting the seal wouldn't necessarily fix that issue, because the absent lung sounds are due to the pneumothorax itself. It would only be necessary to lift it if the patient started having trouble breathing.
With blood pressure being so low, and penetrating trauma to the torso, what about the thoughts of a fluid challenge and or also 1 g TXA? great video though
Hello, yes for an ALS provider those would be appropriate treatments. However, this is a BLS level simulation for an EMT-B skills test. Great thinking for the next level!
Greetings from the Dominican Republic, Prehospital or Paramedic professional, greetings, hug
Great video, thank you. However noticed three things that I don’t think were asked. Are you on any medications, are you allergic to anything and most importantly as you’re treating a female, are you or do you think you’re pregnant. Other than that, so well done.
Absolutely, you are correct. Those would all be part of a comprehensive history taking. In the video the SAMPLE history is delegated to another provider but in reality a quick history before starting the assessment would be appropriate.
Well done,i absolutely like it at most points..,..at least i won't struggle with trauma assessment
Wondering if we know MOI/Location of shot, is it necessary to go over ALL the steps or this is for demonstrative purpose?
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
8:09 8:14
its good po..thank you
Sincde the bp was low once transporting would it be appropriate to verbalize starting an iv and giving fluid?
Can’t start a iv at bls level
I got shot in that exact spot and most of these procedures were used. I dont remember them using chest seal though
Did they put anything on the wound?
@@jamesc2793 not to my recollection no
I mean, where was the exit wound? It took awhile to roll her. No exit wound to back? Shouldn’t he have rolled her after noticing gsw to chest so she wasn’t bleeding out of back?
Just want to ask, does saying: “we’ll take standard precautions” include the application of PPE. In my class we’ve been told that it is a critical fail if you don’t verbalize ppe application.
i would hesitate to just say "standard precautions". Seems a bit vague, but that's just me. I would verbalize "I"m going to maintain BSI and PPE precautions throughout".
@@putnam2800 haha thanks for the response man. I actually took my test last week and passed 6/6 stations first tey
@gabemedina2275 thats awesome, congrats! I'm about to head out in a few minutes to do some practice stations at the testing site. My test is tomorrow morning. I can only hope for a 6/6!
@@putnam2800 hope you crush it dude. Just seeing this now so lmk how it went!
@gabemedina2275 appreciate it! For sure, I'll let ya know 💪just finished bubbling in the form. 😣😣😖😖😖
Is this something that a basic emt would be doing? Or advanced emt or paramedic?
This is a civilian EMT-B, or 68W (Medic) or Corpsman skill. The scope for 68W and Corpsman is broader but this is still a basic skill.
Further...This is an EMT-B skill but may fall outside of the scope in some Counties. Some Counties prohibit it and consequently do not teach or allow this. These guys are in Miramar in San Diego County CA and this is clearly within their scope there.
Best Trama video
Thanks!
He says you have blood on the left glove he says I have bleeding on my right side, and he grabs her arm to apply pressure.?
Oh correction had to recheck my rt and left 😂
He shouldav checked and palpated nose for stability and any nose bleeding, also upper and lower jaw and dont forget to feel the forehead.
best
Thank you!
Good job but where is the I.v line and fluid and are you sure about the mode of trauma 🤔 shot or accident with multiple trauma 😅
No IV at the BLS level
Blood pressure cuff on arms
some one mentioned in one of the other videos ben affleck and Matt Damon became emt's lol
they guttin
SAMPLE and OPQRST
Hot shot 😂
great video, Did he forget to ask for consent?
For demonstration purposes it was not included, however EMS providers should always obtain consent before assessing and treating.
Don't forget in certain situations we are allowed to assume. For example if a person cannot consent to CPR due to unresponsiveness we can assume they want it unless a DNR form is presented to you. Or implied consent where, for extending they are extending their arm to the EMT.
@@martialartsnerd7673 Yes, but in this situation, the patient was conscious and responsive.
@@CloroxBleach-rm5nj but shot in the chest with a sucking wound lmao
@@CloroxBleach-rm5nj yeah he didn’t get consent. I don’t care if it’s for training purposes. He should’ve asked for consent.
0:52
The one thing I will point out is your not supposed to reach over the patient
THIS GUY IS DIALED
Its all fun and games until your instructor gives you a multi-system trauma involving blunt force trauma, low and high/mid velocity penetrating trauma, and sexual assault with an unconscious Pt with no bystanders to get sample history from other than "he stumbled out of the rest room, collapsed and we have no idea who he his". 😅 These videos look like sesame street after my professor gave me the aforementioned scenario. Great job on your assessment brother. And thank you guys for the content
Damn….that’s “cold-blooded”😂
@@ajvoiceovers3349 Made me more than ready for my skills testing tho Ill tell ya that much xD
That is one GORGEOUS EMT on the floor
Critical fail only said Scene Safety nothing about BSI OR PPE NREMT critical fail
lmao SD, tell me that’s not PB
This is actually to detailed lol my class teaches it a bit simpler and less words to remember 😭
Forgot to request ALS as soon as you noted pneumothorax.
ALS was called in primary survey.
@@snot4389 he “considered additional resources” that isn’t the same as requesting.
Vitals way too late
I wouldnt recommend this assessment at all. Its too hollywod. This is taking unimaginably long. This is not a real concept for an actual gun shot victim.
Very true
She can be my partner any day
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
8:09 8:14
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
8:09 8:14