Paramedic National Registry Trauma Assessment

[Albertopuentes1]

second set of vitals is normal on a patient going into hypovolemic shock? o.O

[lixian25]

anyone use the mosby's second edition ?



[rmd2387]

Someone forgot to reassess PMS after immobilization...

[UMGMentor]

@rmd2387 I noticed that... PMS before and after FSI. Good catch.

[brownshood]

i was sweating bullets when i had to do this shit!!!

[213Gremlin]

hmm this tells you how acquainted with medical professionals...i was able to successfully follow all that my first watch through and understand all that...which is good because im going to become a paramedic hopefully...can anyone tell me if its an interesting job? im the type of person who likes a different day every day and like to move around alot. also is it super hard to get thru school for paramedic? srry if i sound like an idiot

[mmillner81]

@213Gremlin You first need to complete your EMT Basic course, which is around 6 months. When you are done with that, you take a state or national exam. You then can start to apply for paramedic school. The paramedic course runs almost 1 year. In addition to class room, you spend clinical hours in the Intensive care unit, ER, pediatric, operating room and some other floors. You also do a field internship on a paramedic unit. It's not super hard to pass the paramedic course and exam.

[mmillner81]

@213Gremlin

My best advice is to call some fire departments and ems departments you live near. Do a few ride alongs with them, if they allow it. See what it is like before making a commitment to school. Some towns and cities require medics to be firefighters. The majority of places don't. Be aware that not every EMS agency does 911 transport. They do nursing home to radiation treatment centers and so forth. Good luck with your search

[memphisboy29]

Did he ever put him on oxygen? Cause I didn't hear it if he did.

[lindsayhopejoyner]

@memphisboy29 Yes he applied a BVM with 100% oxygen.

[fakereality]

Wait, how many partners does he have? He had 1st partner holding c-spine, then said he would have his partner insert an OPA. Typically only 1 partner, right?

[o0rxkxrox0o]

@fakereality In the beginning of the video when she's saying his requirements, she says he can assume he has 2 partners.

[charmedchchi]

@fakereality typically you have have 1 partner in the field. but since this is an auto v ped its assumed that youll have additional units. he requested additional units aswell, but on scene youll have pd and fire. pd are usually trained at the 1st responder level and fire are usually trained emts and medics

[pujimeng]

Always been taught to roll towards the injury.

[halosfan02]

@mike9077 - ventilate @ 16-20 breaths/minute. It wasnt a volume of O2 measurement. 15 lpm is standard for nrb and bvm. Patient gets nearly 100% O2 with a BVM and up to 90% with non rebreather.

[mike9077]

16 to 20 lpm? thats a bit excessive I was always taught to never go above 15 lpm.

[racestarter88]

@mike9077 you dont go above 15 lpm for non-rebreather. for BVM, you want to use as much high flow O2 as possible.

[ejdonaghy]

That wasn't terrible, I definatly would have did it a little differant. But for registry you gotta do stuff kinda differant. A great video to check out is the guy running a megacode, I think from ohio. He did a great job...

[ejdonaghy]

@AustinTE03 I didn't say he didn't do good, just that I would have done it different. This is not an english class, but thanks for the corrections chief. If your so good at all this, shouldn't you be out evaluating paramedic registry exams and not watching youtube videos???

[ejdonaghy]

@AustinTE03 different does not mean wrong. Being a paramedic is not a black and white job. Your never going to do things "verbatim" on a scene. (cheers if you do, but it's rare) I wasn't ragging on him, just stating I would have done it different. Im a little confused why that offends you so much. If your a paramedic student you should probably spend more time studying then correcting youtube spelling. When you have an EMT-P patch on your arm then feel free to comment on how good/bad students do

[KuistiTV]

He did a great job... don't get me wrong. But my instructor would have failed me for not immediately placing BVM and C-collar directly following the impression. Or at the very least direct a partner to hold c-spine.

[silveradorunner]

to anybody that know or that can help, i start school this january. everything this guy is saying is confusing as hell an i know nothing,,,,obviously, but after school (3 months) for emt-b, will i completely understand all of this or is this a little bit more advanced, thank you :)

[egomike88]

@silveradorunner I'm a paramedic instructor if you need any help or questions with school just message me. You should understand a large amount of what hes doing after basic school.

[sarahmedic311]

@silveradorunner You will understand the basic trauma assessment, this one is supposed to be for the NREMT-P, but it doesnt really differ from the one you'll use for your state EMT exam.

[silveradorunner]

@sarahmedic311 Thanks alot, appreciate it, cant wait to start the 26th :) :) :), sure hope the economy isnt so crappy i cant get on with a company out here :(

[sarahmedic311]

@silveradorunner Good Luck with everything! Trust me you will have no problem finding a job, especially if you intend to go for your Paramedic, people are desperate for Paramedics right now!

[Sorinphyre]

BSI, is my scene safe? My MOI is? My number of patients is 1. I have additional help on standby. I will have my partner take and maintain C-Spine stabilization throughout the entire call. My general impression of the patient is poor. "Sir/Ma'am, my name is Airman (available on DVD), Sheppard EMS, I'm an EMT-B, can I help you?"

Passed Skills outright. HUA!!!

[knpdyeballarice]

One of the things that my instructor is really stressing on the class is to never say "good" or "okay good" when you doing something like this. With a situation like this in real life, why would you ever so "okay good" when you find something critical on a patient?

[hilda03]

how can he have a partner hold manuel inline stabilization another apply the bulky dressing for the flail segment n another control bleeding on the leg when he only has 1 parthner he also didnt check for pulse motor sensation after backboarding

[abervintageman42]

@hilda03 i think they said 2 partners? but even still that wouldnt make sense, apply pressure with a gloved hand, dress and splint and then continue your assessment

[sta1ndsoul]

is this guy a doctor? or paramedic? i dont get it.

[kstone157]

The only thing i noticed is he said he would have a partner do close to 4 or 5 different things, if he only had 2 partners, who were ventilating and stabilizing c-spine, there would be no one else available. Other than that, GREAT job! :)

[racestarter88]

@kstone157 if that was the case, no one would have to stabilize the Cervical spine, because they would have placeda c-collar on right away. so therefor, the second EMS worker would be Ventilating the patient.

[kthanid83]

c-collar does not stabilise spine, it still needs to be manually stabilisied. Only C-collar plus backboarding stabilises spine by itself.

Anyway the purpose of the exercise is to test ability for them to assess and direct treatment, not worrying about imaginary logistics. They have unlimited assistants for the purpose of the test accoridng to the NREMT.

[racestarter88]

@kthanid83 ohhh thank you. i made a mistake at what i said. i went back and looked it up and i was wrong, but now i know whats right. you didnt have to write me a book telling me whats right when i got the book right next to me. i made that comment when i was halfway through my emt class. i am through and passed my class. i know what im doing.

[kstone157]

@racestarter88 Even after a c-collar is placed, the head still has to be stabilized until it is strapped onto the board.

[nanocr]

nice vid

[423Cree]

umm you didnt mention but when you were"putting" him on the spine board was the other member at the head easing his head down or just letting it fall because if it was just being dropped then there could be more damage done if he had injury to head or neck!

[opethdtr]

Testing is only a few days away :-(

[mrskillz8910]

did very well... 4 most part, seemed similiar to ski patrol treatment (oec)

[LASportsFan4Life]

Put the patient on EKG also.

[wetnoodle666]

yea blood sugar and a sample.. and id put the c-collar on right after u check the neck so u dont forget

[haxlord]

If i was this guy i would just treat the kill zones and pick up and haul ass...forget the extremities.

[wnaburgencesante]

@haxlord That makes perfect sense in the real World like if NR actually understood that, but after I took it once I realized that NR should be banned. It is NOT a field relevant exam process . I would expect most of thecritical patients you'd treat using the NR process would die on you with their methods of testing if they were applied to field use !

[10ring]

@wnaburgencesante This is exactly the conclusion I came to after going through it. Doing well on the National Registry tests, both practical and written, does NOT mean you'll make a good paramedic in the field. National Registry is a bureaucratic joke on the national EMS community.

[mckenna2211]

@wnaburgencesante I agree 100%, they need to judge you on weather they would want you working on their family. because you dont even need to know anything about paramedicine and can pass NR skills, you just need to memorize the sheets. im taking registry next week and ive just been memorizing the sheets, granted when we go to take the written thats where knowledge comes into play. stoked for the internship tho

[ActontheActor]

@mckenna2211 sounds pretty subjective ... examiner can just decide "hey, I don't want you working on my mother ... you fail ."

[alalaheyoo]

According to the "check off" sheet for "testing purposes" this guy did just fine. Too bad things dont go like this.

[Donutsalad99]

BSI....for my battle and I

[norcalyota]

and check blood sugar

[norcalyota]

I would not intubate if the OPA is doing its job and remember it is a load and go. It takes a sec to intubate. I thought was okay, didn't check pms after strapping to the backboard and didn't verbalize removing shoes. Def keep checking that right side decreased lung sound for a developing tension pneumo. Start two large bore IV's and shock position verbalized earlier.

[2100km]

@norcalyota I agree with what you say about the OPA. Load and go.

[lvowens11]

I kinda agree with the OPA thing, and i do think if it is working then dont screw up a good thing!.. but if you have to use a OPA then they are not doing a good job of protecting their airway! which seems like an indication for intubation!!.. but this is one of those debates for the ages! so i agree with load and go OPA, but would caution saying if they cannot protect their airway, and you can intubate it would definatly be worth it!!

[rwrw21]

@norcalyota Load and go for sure, however, that OPA is gonna cause gastric distension and the fact that he has a flail segment is more than enough indication for an ETT. if the pt. does develop a tension pneumo it would be nice to already have a tube in place before doing a chest decompression. OPA's dont do such a greatr job when the pt. is collared because you can't properly align the airway with a head tilt.

[medicbr549]

a warm blanket and trendelenberg position for shock, will do as much as a liter of (usually cold fluid in most ambulances) fluid in the field.

Nothing pisses me off more than to get a trauma Pt. in with a blanket and a cold IV!!!

WHAT IS THE TEMP OF YOUR IV FLUIDS???

[medicbr549]

If you don't treat whats killing or trying to kill your pt. , you are doing your Pt. no good.

Very poor assesment!!!!

if this pt. really had these injuries, he would have mostlikley died from his early rights to a GOLDEN HOUR.

Time is tissue, especially in SHOCK!!!!

[medicbr549]

bottom line folks...

When you find a altered Pt., its a load and go situation and you can do the secondary in route!

Intubate ASAP.... if you don't do it early, you may not get the chance do to head injuries clenching the jaw.

Warming the trauma Pt. is one of the best things you can do for shock.

warming a pt. is more important that starting an IV!!! yup, you heard it here first folks!!!

[harteverette]

this guy was all ate up, jumping around and forgetting stuff, his assessment was too chaotic. look at the dcmt trauma assessment, they are about as close to perfect as i seen, not much to improve on there. if you follow this video you will FAIL PARAMEDIC

[meedow99]

I don't recall hearing him say it, but don't forget your head blocks after collaring and backboarding.

[KRAZYHAZEL]

didn't take lung sounds on the back before you backboard. That's supposed to be done right?

[moelink]

@KRAZYHAZEL You can get L/S from the chest and sides, also his resp's were 8, skin cool and moist. Most importantly this PT was unconcious if I'm not wrong, forget L/S, start the intubation asap.

[CurtisSalopek]

So..Damn..Nervous

[3bood2009]

we did that all the times, but the most important thing after assessing general impression and LOC is to control any major bleeding , PMS, and that we do all times

[joshchurch123]

Where's the radio call report?

[i5adam8]

If you find a tension pneumo,are you supposed to decompress as soon as found,or wait until finished with the head to toe assessment?

[RCRhythm]

Yeah, I'd like to know that, too. Anybody on here know the answer to that? My guess is that, since his respirations were adequate, and the breath sounds on the side with the flail were only "slightly" diminished, he was still compensating, and therefore not in immediate need of decompression.

But what if he wasn't? My understanding is that you "treat as you go." So, would you stop the assessment and decompress if the guy was tidal volume, rate, rhythm and quality were inadequate?

[chereka1979]

we were taught to never remove your hand from the patient's shoulder when rolling hin/her or it is an automatic fail.i noticed he removed his hand from the pt's shoulder.

[TuathDedanaan]

he stabilizes the flail segment with a bulky dressing...according to the most recent PHTLS text management is oriented toward ventilatory support instead of largely ineffective exterior splinting

[aliciaaw28]

I would have checked lung sounds posterior of the patient---that would have been a critical faliure

[Rreynaertt]

That is alot of stuff to memorize.

[espman666]

The thing I really wonder about is, he doesn't check the patient's breath at all...

[steveonrock]

He assessed breath sounds, so I'm not sure where you're getting that from.

[espman666]

Trust me, in real life scenarios you can't HEAR the breath way too often. ==>IMHO a detailed check with FEELING, HEARING the breath and SEEING the belly go up and down would be a better check.

[steveonrock]

Trust you? I don't care about all that, I'm sure you'll say you do this everyday, which will make two of us, mate.

You said he didn't do it at all, well he did. It's a proctored skill assessment, not real life. It is what it is man...

[sessa34607]

Im about start emt and medic, this stuff looks like so much you have to remember at once all in an emergency. Does it just become routine and easy after learning it?

[Eleazarsc]

It looks overwhelming but after a while it becomes second nature. I was also a bit nerves watching a few of these before i started emt-b training, but now it just flows naturally.

This assessment was a bit disappointing because everything he did (minus the IV) is in the emt-b scope of practice. Would have been nice to see some medic stuff.

[sessa34607]

thanks man I appreciate it.

[psychocloud]

He did an IV.

[psychocloud]

And a c-collar isn't required until AFTER the initial assesment and RTA of the head and neck. Just as long as someone manually stabilizes c-spine.

[psychocloud]

His RTA is atrocious. He didn't voice dcap-btls for any body part, especially when palpating and inspecting the head and neck before c-collar immobilization.

[JoeSmith03301]

Take a listen at 3:27, he did indeed voice it for the chest at least. However, it is important to realize that a practical station is not designed to "voice" your way through it. (in fact if you "voice and do not do" you will fail) The registry rules state that injuries must be present and moulaged. It cannot be a "guess what is there" thing, they must be obvious. Therefore asking is redundant. All in all not a bad demonstration, maybe a few things could be smoother, but not bad.

[psychocloud]

My EMT State Registry had quite possibly the worst moulage ever. My team almost failed because the evaluator wanted us to splint the injuries. The c-collar looked pretty bad too. We ended up passing though and I have my cert now but I made sure to voice AND DO everything. They just told me to voice everything as well because evaluators often miss certain things that you did and didn't voice. Many EMTs told me they failed because they did not voice something and the evaluator missed it.

[vickiormindyb]

Is it true they don't use indirect pressure anymore?

Someone told me the Nat'l Registry changed their rules to include not using indirect pressure.

I was in a car accident where I cut my arm so bad that direct pressure didn't work, but eventually indirect pressure stopped the bleeding.

If they do it the new way, won't people lose their limbs when they don't really have to?

I kind of like the idea of having my lower arm attached to my body, and it wouldn't be so if they used the new rules.

[JoeSmith03301]

@ vicki, not sure what you mean by indirect pressure, but think of it this way, if the bleeding is unable to be controlled death will follow. The goal is to stop the bleeding. In the past direct pressure was followed by elevation and pressure points. The whole time the patient is bleeding. Recent studies have shown that these steps are not effective. Therefore if direct pressure does not work a tourniquet is indicated. Contrary to old teaching the limb can survive for hours with a tourniquet on.

[sbcemt]

I'm doing my first assessment skills stations tomorrow so I am by no means criticizing this assessment.. just asking for some input..

My initial reaction would be to do a rapid trauma assessment and load and go, getting some fluids on board and continuing my detailed physical and managing secondary injuries en route considering theres a positive ALOC and multiple signs of shock. Is that wrong? I work in the field so its difficult to differentiate between what NR wants and what actually happens

[canadianboy40]

I hate national Registry.

[racestarter88]

@canadianboy40 i do too, but think about it this way. it filters out all of the dumb asses from the smart people.

[medic70648]

...not sure if it's a pass / fail as to whether or not you do the detailed exam enroute or on scene, but I'm pretty sure my old instructor would make -me- the trauma victim if I did it on scene, with the patient being "load-n-go"... :)

[canadianboy40]

Transport decision is in the first part of your assesment after initial assesment.

[incognitii]

Be sure to assess distal PMS AFTER backboarding... they skipped this part, and it will cost you points if you don't. Not a critical failure BUT... .:)

[lrmis11111]

I wish I had been as smooth as he was when I did my trauma assessment test out. I felt a bit like Barney Fife doing mine.

[mitch8569]

The guy followed the NREMT sheet to the "T"! There was no profound hypoventilation, JVD, etc.. (Mosby's) I would have collared him a little sooner but that's not a fail. Cardiac monitor? WTF!? NOT ON SCENE GUYS! (Oh, NYC 5min txpt.) Try feeling for arrhythmia in the pulses. Platinum 10 is part of the golden hour! Golden hour is insult to surgery! This is National Registry World! I'm ACLS, PALS, and Neonate Resuscitation certified and registry passed. Some of these comments are downright stupid!

[UFB85]

I agree with mitch8569. He did fine! What is it with all these people wanting to criticize everything he did?

[mitch8569]

You know what they say, "Let the haters hate."

Mitch W. NREMT-I

[gelineau1]

he bagvalved with out an Oropharyngeal airway?

[canadianboy40]

its not necessary, just and adjunct

[freak4jesus33]

O2, IV, EKG, PULSE OX!!!!

[david13640]

He did did give 100% O2 with bagvalve mask.  He also did IV in the rig. pulse ox may have been done by his partner in the vitals? However the patient should have been hooked up to a cardiac monitor for transport.

[eaglescoutjoe11]

He did not control the airway with an advanced device, ie ET tube. The patient took an oral airway without reflex, should have intubated.

[canadianboy40]

The skill isnt ET intubation, its Trauma Assesment

[hayloe916]

Would have liked to see cardiac monitor after the IV and in california there's not enough info to jump to needle decompression. Medical direction would probably deny you. Diminished lung sounds could have been caused by the flail segment interfering with proper expansion of the chest cavity. And hukaba i agree with not finding flail in the initial.

[rwrw21]

how about hookin up a cardiac monitor after that IV set up. hard to believe this is a pass

[rwrw21]

somebody should hit him at 15 mph what a tool!!!!

[polosport69]

hes not a tool hes very thorough

[mrod91030]

He also didn't mention treatment for decreased lung sounds on right side. "I'd like to consider needle decompression for possible pneumothorax". In this skill you need to identify and manage wounds or injuries appropriately as you go. He managed the incidence of flail chest and open tib fib but disregarded lung sounds.

-LA MEDIC

[erasetheend000]

My understanding is that for registry the only time a tension pneumothorax is possible is when there is a deviated trachea, which was not present in this scenario.

[mrod91030]

My comment was for treatment of a "pnuemothorax". Any decrease in lung sounds post traumatic (blunt chest event) will warrant needle thoracostomy. Tracheal deviation is a very, very late sign of a tension pneumo hemo. There is more you can do for your patient b4 this symptom presents.

[laurenfanson]

a deviated trachea and jvd are signs of tension pneumothorax and u wouls have to place an occlusive dressing over the puncture wound EMT-B massachusetts

[alexwoot5106]

The reason for not putting the c-collar on sooner was the fact that he hadnt checked for JVD or a deviated trach yet during is trauma assessment...had he put the collar on earlier finding that would have been almost impossible

[huckaba2]

He would have failed in New York EMS FDNY Academy. , he didnt find flail segment in his initial assesment..FAIL !!!

[adios29121998]

was that a pass or fail?

[TheTerrorSerra]

pass

[alinsocal21]

The video is probably out of date

[Twyrchtwych]

yeah. C-spine should have been done earlier.

[mountshasta2002]

not really

bsi, scenes safety

# of patients

MOI

additional resources?

C-Spine

etc...

[rwrw21]

hey if your gonna wear those kick ass goggles you might as well put on a mask too! in order to hit the eyes wouldnt it have to go passed the mouth and nose first?

[badgerboyUK]

he never listened to the chest as part of his brething assessment....but mabey thats not what they do in the US

[thegathering18]

He should have checked the patients Pulse Motor and Sensation after he placed him on the backboard, to make sure he didn't have the patient strapped on too tight. Just noticed.

[hmelmore]

he should have verbalized his c-spine consideration in the scene size up tho he did do it, he should have considered it early on

[thegathering18]

Who cares he did it.

[hmelmore]

eh..

[propagandapandas]

furthermore when you arrive at the hospital with a dead patient and they ask why you were delayed on scene and your answer is i was auscletating for muffled heart sounds youl get a slap in the face and told that you are not a physician. sure we can do it on occasion but its not practical in these scenarios plus beck's triad is JVD,Hypotension,muffled heart sounds... the patient had no JVD.

[propagandapandas]

all these comments about s3 and s4s are rediculous medics become old fashioned ambulance drivers in trauma scenarios. im not funna foock around on scene BESIDE A FKIN STREET no less listening for s3 and s4 sounds.

[MooCowMooo]

Should he have done a rapid -> put on log board and *then* do detailed en route?

[emtsell]

Oh one question.....Where the heck is the C-spine stablization?? Why so late? This guy was hit by a car!!! MOI= C-SPINE!!

[bottomfeeder89]

it was verbalized before the initial assessment

[emtsell]

This would be a rapid trauma assessment. Heart tones are more of a focused exam. Monitor. BLS before ALS. Emts do this all the time. Treat your patient not your monitors.

[roadjournal]

I thought that was a dummy he blinked his

[ffdisch]

ok first pt had a flaied chest on his Right side w/ diminished lung sounds......needle decompress. trach devation is a late sign so do it. Remember ABC's guys. Also the pt is responseive to painful stimuli. His GCS was a 6. SO AS YOU KNOW.....less than 8....intubate. Also the sad thing is that pt was never hooked up to the monitor and a spo2 was never done to see how well ventalations were doing. Read your books and just use this as a guide line. God Bless and everyone stay safe!

[bfromeyer]

I would Intubate as soon as possible. That would help stabilize that flail chest. Then you may be given more info as to wether or not they do have a tension pneumo. (BVM Compliance is a major major indicator of a TP, also she said his neck veins were flat, I know he may be hypovolemic and you may not see JVD but I would get some more info before i decompressed this particular pt. You have to be careful not to Decompress a Simple Pneumothorax. I agree otherwise as with the trach deviation.

[eepta]

It's so essential to measure the Cervical Collar before to apply it directly.Check detail about DCAPBTLS on the cervical area, is there any Tracheal Deviation, JVD, Battle Sign, Fracture clavicle and Fracture Mandible. All this checking should be in order, then apply C-Collar.

[GM911]

Also, taking vital signs on a load and go is ill advised. do it in the ambulance instead, and only if there is time.

[ffdisch]

its not ill advised to do a basic set of vitals. Get a baseline so you know if the dude is crashing. Also if bagging.....noticing an increase in heart rate is a good sign of poor ventalations! Plus its good practice to do

[mfmedic32]

how come when he came across the leg he did not cover the open wound with a starile dressing or at least attempt to stop the bleeding?

[go4broek]

because all treatments are "voice" treatments. He directed an assistant to bandage and splint the wound.

[canephin30]

the other thing is she specifically said there are no major bleeds so there was no reason to make that a priority at the time. THe main thing was to treat the shock with IV therapy and monitor his respiratory rate since he had what looked like flail chest to me and since he is unconscious. Get him to a hospital as quickly as possible.

[verukaemt]

In a severe trauma you wouldn't want to worry about the tibia and fibula. Trauma assesment really is just the proximal extremities. He won't bleed out from open fractures to the lower leg, his breathing quality and rate are much more important to keep an eye on.

[bubblegum74]

Make sure when you check the lung sounds you also listen to the patient's heart tones..I noticed he missed that. And when you strap the patient, make sure you strap them chest first, pelvis, above the knee/below the knee, and then the head last.

[canephin30]

in my paramedic class i have yet to hear of anyone listening to a pt. heart. I have seen it on other videos but i have yet to hear of a reason for it if you are checking for distal perfusion what would be the point of checking the heart? Other than for disrythmia which you will find out in an EKG anyway? Just wondering.

[bfromeyer]

Refer to the S&S's of a Cardiac Tamponade. Muffled Heart tones are one of those as is clear breath sounds, JVD, and a narrowing pulse pressure. As well as signs of poor perfusion. Heart sounds will also key you in on CHF pts(S3 commonly heard in CHF) and patients with Heart Valve Disorders.

[canephin30]

S3 and S4 are almost completely not heard especially in the field. Doctors often need a completely quiet room in order to assess S3. I understand that S3 complications are completely associated with CHF. But IMO checking of heart sounds is completely rediculous in the field. Ill check my lung sounds and get an EKG going for chest pain calls to see whats going on. To think you are going to get a clear S3 is just not going to happen in the truck. Not knocking you i just wouldnt do it personally.

[bfromeyer]

I understand its not practical but you should know what it means if you do come across it. I think if I had someone who was showing S&S's of Cardiac Tamponade I would try my damndest to listen to Heart tones

[canephin30]

look, again in this situation you will not hear it. I am telling you. Look it up. You would actually be waisting time that you could be spending on evaluting you patient or treating other serious trauma to that tamponade because most likely they got the tamponade from something traumatic like a car accident. In my personal opinion which is based off of care that i have learned in south florida i would not waste time evaluating for a S3. Its already nearly impossible to hear.

[bfromeyer]

I understand that its nearly impossible to hear heart tones in an ambulance however IF you COULD HEAR THEM, AND YOU HEARD S3...YOU WOULD KNOW THE PATHOPHYSIOLOGY BEHIND IT! You need to think of injuries that would kill your pt fastest. If you had someone with a low BP, Cool clammy skin, and a narrow Pulse pressure, the ER doc & trauma surgeon would want to know about heart tones. You could save alot of that patients time just by listening to their heart and calling ahead. Just TRY, Thats all

[canephin30]

actually no they won't. I am not trying to upset you. But they are not going to care what your assesment of that heart tone is. Cuase they are going to do it again themselves. Giving them those indications will help them to know to possibly check for S3 but your assesment of S3 means nothing to them. Don't believe me? Check what the nurses write down at the desk from what you told them in your run report. Gaurantee its most likely only the vitals and MOI or CC. Trust me.