EMT-B Trauma Assessment Demo (no longer the DCMT performance standard)

[BinaryMasta]

I'm taking the class myself, just a question. Shouldn't an OPA have been used if it was a guy who fell off his motorcycle due to the possibility of head trama? Using an NPA Can sometimes be dangerous with head trama, Correct?

[vision57]

why is he holding c-spine like that? or is he jaw thursting also? i cant tell..if that is just c-spine i think hes choking the guy

[go4broek]

Would "just c-spine" be appropriate?

[funkymonk104]

He never checked posterior lung sounds...

[go4broek]

not required for NREMT certification.

[FirebirdBuco]

damn good job!

[marius357]

Very good, would have like to see more of a abdomen check on this male patient since males are typically belly breathers, This is more personal preference though, makes it a little easier to feel. Also when assessing PMS in extremities why were they not assessed at the same time to compare for weaknesses to one another. This is usually done to determine deficits between the two. But again very good job you can work on me anytime or would be glad to have you as a partner.

[brickielay]

An OPA is just to maintain a clear airway (hold tounge) the best airway is a LMA intubation woulda been the best way to keep good airway BUT they Failed!! lol Where was checking for Danger, Response then Airway? lol and if he was tubed y would u ask him if u can push?

[go4broek]

LMA is not part of the NREMT-B standard of care. Advanced airways are taught by exception only in certain states.

[kaitlynpreston]

why did u use a nasal airway and not a oropharyngeal airway?

[go4broek]

Please read my previous posts. Thanks!

[xgotarox]

why did he insert an NPA before bagging?

would you wait until the detailed physical exam before checking for an airway obstruction?

[go4broek]

Manual stabilization of the airway is not enough on patients with compromised airways. One should use an airway adjunct to prevent the tongue from obstructing the airway. The NPA is really the better adjunct vs. an OPA especially if you are not able to secure the head right away. No, do not wait until the deatailed exam. Part of securing/establishing an airway is assuring it is patent. If altered mentation, you should use an adjunt and check patency before inserting.

[xgotarox]

so the student in the video was late to check for an airway obstruction? on an unconscious patient, i'm being taught to use an OPA first, then an NPA only if the patient starts gagging or becomes conscious.

[go4broek]

No he was not. Remember, the interventions are voiced. If he had been required to perform it (a separate skill test) he would have checked. He assessed respirations. If there had been a FBAO he would have caught it. As for your teaching, that may work fine on a local quiz or exam, but it will result in a missed answer at the registry exam or a dead patient. NPAs should also be used in cases of maxillofacial trauma where an OPA would be improper/ineffective.

[xgotarox]

right.. he didn't voice any check before placing an NPA and bagging, but he did during the detailed assessment.

also, may i ask what your credentials are?  i'd like to know a little more information before i present what you've said to my teacher.

and an OPA should be used with any head trauma, where an NPA could cause more damage, right?

[marius357]

Why would you use an OPA first and cause the patient to gag. If they have a head injury gagging will cause an increase in ICP and be detrimental to your patient, also you run a risk of aspiration if your patient vomits after that gag.

[go4broek]

SAY IT AGAIN, MARIUS357!! I'm horrified by the number of posters who say they were taught to "always" use an OPA and who cannot properly determine LOC. I know that is the case at DCMT. I hope that is not the case everywhere else! You should be using the AVPU scale. "P" is their LOC if they require painful stimulation in order to get a response. If they respond to pain, they are NOT unresponsive! Head injury is NOT a contraindication for NPA. Worry less about what MAY BE and more about what IS.

[oladeinde]

Very nice, when i did my EMT-B practical it ran just as smooth. Nice Job

[psychocloud]

I wish I could have said that! I passed everything but the trauma station went a little bumpy.

[davidbathke]

were did you do your testing at? i got mine on the 26th this month...kinda nervous

[waytohell2]

he didnt listen to lung sounds

but AWsome job :D

[go4broek]

Actually, he did. Thx for your comment.

[sunsetat6]

I watch this every day to get ready for assessments.

[bestevez25]

I am in the process of studying for my EMT-B and this video has been a BIG help. Thank you for posting it and all others like it.

[koroxia]

I live in Canada, and have only taken a 2 week course, called Occupational First Aid Class 3. I knew everything up to about 6 minutes in (once patient was in the spine board). How long is the EMT-B course, just as a point of reference?

[CaribaBeba]

It depends big time on what class you take. It will vary by state (mine is 148 hours) and how much you squeeze in to each week. I'm finishing up a class that took about 2 1/2 months doing 4 hours a day, 3 days week and some weekends. I've heard of EMT classes last several months though that fit less into each week. I've also heard of EMT classes (like in fire academies) that do 6-8 hours a day for only a few weeks.

[stnewton09]

It varies depending on your class schedule. I go once a week and it's from May to October. Most classes though are about 2 months, 3 days a week. Overall legal requirement is 154 hours I believe. The guys in this video are probably at Fort Sam Houston for 68W Health Care Specialist AIT (Army medic). It's like 8 weeks there, with another 7 of TC3 (Tactical Combat Casualty Care). But I'm an Infantryman so I ended up taking the civilian class instead.

[noctumflame87]

it depends on if you go throught an college or an EMT training facillity

[go4broek]

The Department of Transportation's EMT-B curriculum requires a minimum of 110 hrs for the course.

[koroxia]

Yeah, mine was a total of 80 required hours. I put in at least another 30, came in on days off, stayed late every day, etc. I know I'm just starting :)

[go4broek]

did your course get you certified as an NREMT or just state?

[wakeoforion99]

my ghost medic? why wouldnt you insert the npa??

[go4broek]

If you listen to the evaluator's instructions, the candidate will work as if he/she has two additional EMTs there. It is up to the training site on whether there are any actually there. I believe he DID select the NPA. Some have posters questioned the wisdom. With what is known about the patient's condition, that would be the best adjunct. Concerns about CSF and brain matter are valid, however, the medic would have seen those if he was minimally competent.

[sunsetat6]

Can I hire you to help me study for my EMT-b???

PLLLLEEEEEAAAAAASSSEEEE???

[Erkbitch]

Now mostly everything seemed spot on. But I have a question Im taking my EMT B exam this monday and a guy at my fire station used to be an evaluator. He said if the patient is not conscious its load and go no matter what. You DCAP collar board o2 check airway JVD and go nothing else just state vitals are taken on the way to the hospital. Is this maybe a state to state or something

[CaribaBeba]

That might be what he would do in the real world, but not what you want to do on your exam. Do everything exactly the way you were taught in your emt class.

[go4broek]

Your instructor illustrated the "you call, we haul" tradition of EMS. It would work in many situations, but is not absolutely correct for NREMT exam purposes. Remember your "Platinum 10". If you are minimally competent, you should be able to complete a RTA/RA on scene and transport within that time.

[jaybirdy15]

Good job, however when checking ABC's when you are on breathing you shouldnt just get rapid and shallow resp and go straight into BVM, you should check for JVD, nasal flaring, paradoxical movement, deviated trachea, accessory muscle use or flail chest, also hes unresponsive so check for gag reflex and use an orophranygeal airway. Furthermore you skipped the BC's and transport decision in the initial assesment and when into the rapid exam... your skipping back and forth.

[go4broek]

If you listen, you will hear/see that he checks all those things at the appropriate times. You will also hear him note that the patient responds to pain. Therefor he is NOT unresponsive. Gag reflex should be assumed to be intact unless UNRESPONSIVE (and even then it is not guaranteed). NPA is the best choice.

[jjimenez1980]

@ 1:44 with a significant MOI being a motorcycle accident I don't think I would use a nasal airway. You always would have to suspect a head injury. If there is a head injury you cannot use a nasal airway. Since he is unresponsive to any stimuli I would use an oral airway, since he wouldn't have no gag reflex? Also did you do 2 rapids?

[go4broek]

see previous post. Secondly, he performed a RTA and a Detailed Physical Exam as required by the NREMT.

[Dream7656]

amazing assessment! good luck man! i just graduated EMT and i will deff use this for future reference!!

[mtsacemt2008]

Seemed a little nervous when checking bilateral breath sounds but he very well on this assessment.

[GQube3]

This helped a lot, my final is this Saturday, haha.

[theduffstick]

he is unresponsive to pain..use an OPA. other then that good job!

[go4broek]

watch again...he determines that the patient flinches when stimulated with pain. Ergo, the patient is responsive to pain, not unresponsive.

[organicangie]

Awesome job! Excellent assessment and extremely thourough. I was taught to check for priapism and the pubic symphisis.

[lrmis11111]

Good stuff. Made this a favorite so I can go through it on occasion for a review.

[landgrader6]

Now thats impressive man. I am about to finish my first responder class, and I am taking a EMT class at Camp Pendleton this summer. This is a great video to study, thanks man!

[simusid]

My EMT-B class is testing in a week. I passed this out to everyone! Fantastic job!

[dudeitsivan]

spot on, man. I can only hope I do it this well at lifeguard academy

[killtankbts]

You really shouldnt use a Npa on a trauma patient that may have internal head injury. I would of went with the Opa. Other that that great job! good luck with the NREMT !!

[mchamberlain]

one thing, u cant BVM at 15 lpm. thats for a nonrebreather

[ryanblaze13]

i got the test today...thanks for the review

[wrathofthemath]

not sure if you'd ask him to push or pull with his feet being that it's spinal...asking him to wiggle his toes should be sufficient when determining cms, yes?

[scottso241]

good job i have been a emt for many years and you did a very very good job .WELL DONE!!!!!!!!!!!!!

[Ziebice]

Holy crap! 6:20 You can hear "We set the Standard!" Gotta love foxtrot.

[go4broek]

"6:20"? I assume Foxtrot is stopping their timers after the RTA again?? If so, they are wrong and making up their own standards. The clock does not stop until you complete everything on the skill sheet or 10 minutes. Whichever comes first. They have been corrected about that before by the NREMT.

[ipjunky]

Dude you rocked that out. Nice Job. I have my exam coming up and am nervous! This really hepled! THX

[ElTuch20]

Does the army do a full body physical assessment in the field or on route? Reason im asking is because that was a trauma assessment.

[go4broek]

Actually, that was a rapid assssment and detailed exam. The NREMT standards are the same regardless of which testing site does the certification.

[cubanthugs]

DUDE u aced that shit....smoked it.......i know how to do half of it but sometimes i get disorganised and i get nervous in front of everybody in da class

[ManFred07]

very thorough! A+

[tylerchristifulli]

Yah a cervical collar should of been applied way before he did

[go4broek]

the collar must be applied before the patient is moved excessively (usually log-roll time). Other than that, there is no "too late".

[tgudda08]

@go4broek false...The patient can be log rolled with manual stabilization of the spine in the neutral position. What book are you reading?

[go4broek]

The question was about whether the C-collar should be applied before it was on the video. Perhaps in your state an EMT can wait until it is time to secure the patient to the spine board, but in most other places you could be found liable for possible injury to the patient for waiting that long. Do it this way and no one can question it because you applied it as soon as practicable. Do it your way and there is room for doubt. Some medics take unnecessary risks and do fine. For a while.

[mountshasta2002]

100/100 Good job. This makes me think my class is a little behind...

[hwdstrn]

Good stuff! A textbook demonstration.

[aproctor88]

Ugh...DCAP-BTLS is like permanently burned into my mind..

Deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations, swelling...I hear it in my nightmares and I've only been in my training class for 1 month!

[TheBox67]

how long into the class did you go into until you were this confidant in your assessment, im taking a class noww and were up to intial assessment but not trama yet but i am slightly intimidated by this video i know ill be this fast and efficient but im just curois on how long until you were

[ABQEMS]

As a Basic, why would'nt you request ALS? Not sure how it is in the military or any other state, but here in New Mexico when we take our state, if we dont call for ALS, the proctor will make sure the pt goes into ALC condition and then we fail! Even if ALS is not needed, at least you dont have to worry about failing for something that small.

[rudaxter]

I agree, at least in a non military situation you would definitely want ALS in route

[JEDEYEnite27]

good job man,i get nervous when administering trauma assessment. my test is coming up,and your footage was very helpful

[jaycloomis]

why npa? unresponsive to painful stimulis, probably would have no gag reflex, shoulda done opa.

[downhillracer69]

it really doesnt matter...does the same thing...since he is unconcious he might have a gag reflex..thats what i would think at least

[breakonthrough27]

I agree w/ downhillracer69. It really doesn't matter. But if you use a opa and the patient vomits, then you have to suction. Its a huge hassle. Why not err on the safe side and npa. Unresponsive patients can still have a gag.

[hilaryellis]

I'm a current EMT-B student and I'm very impressed with this. Now I just need to remember everything. Great video!

[farmonthefreeway]

agreed. i would have used an opa vs. and npa due to the fact he could have a skull fracture and i wouldnt want the npa to go into the brain.

[hmelmore]

fantastic job! i have my practical exam tomorrow and i am using this to polish up my skills

[iceisit]

Good but one problem. Patient fell off of a motorbike which suggest head trama. This is a contraindicator for use of an NPA.

[go4broek]

head trauma by itself is not a contraindication. the presence of brain matter/CSF in the oro-naso pharynx is the contraindication. Good luck to you and thanks for your comment.

[clayson187]

Actually, as a basic suspected head trauma IS a contradiction for use of a NPA. My only critiques of his performance were not having ALS in route, ESPECIALLY after seeing his patient had an altered mental status, And also using an OPA with suspected head trauma.

[go4broek]

their is no distinction for basic and advanced providers when using the NPA. The contraindication is against using it in patients with SEVERE head trauma IF bleeding/CSF is noted from the nose/ears. Head trauma alone is not the contraindication. Please refer to your books if you are confused or were told otherwise. Ultimately, follow your local protocol/medical direction.

[munky875821417]

Not bad. Rapid and Shallow? Where is the rate for airway? And what about the pulse rapid and weak with no rate? I didn't like where the instructor went with that. Cool clammy skin which is a sign of shock and patient should have been transported rapidly with ongoing assessment or rapid assessment. He should have at least tried the OPA.

[go4broek]

Ever consider how long you would spend getting precise rates? Now consider how long you should take to complete an Initial Assessment. Do the math. A ballpark estimate is all you need to determine stable vs. unstable and that is all you need to know during the Initial. You would probably be ok with an OPA on a responsive unstable patient, but then again, maybe not. Your call in the field. Good luck.

[naybay123]

ahh I hate trauma assessments but you're all calm and collected. HOW?

[go4broek]

Quality instruction and quality practice. The old "perfect practice makes perfect...or nearly so!". LOL. Good luck!

[Somethinzfishy]

I wanted to ask a question in reference to this trama assessment. If there is a significant difference between initial trama assessment regimen training with Military EMT-B's verses civilian EMT-B's. I understand the need for thoroughness but this military version seems really really really involved as compared to what I thought EMT-B requirements were but then again..I'm not an EMT so like I'd really know anyway !

[go4broek]

Excellent question! The standard is the same. The NREMT is the same across the US. States have variations, but then they are not held to a national standard. Sadly, some training sites focus more on written exams than skills (DCMT not excepted!). Good luck to you!

[cess186]

This trauma assessment covered all the same expectation my civilian EMT-B class covered. For the National Registry Practical Examination we are expected to actually expose the patient while examining and to cover them with a blanket immediately after examination to conserve warmth. I personally would have requested ALS backup considering the MOI suggests a multi-trauma patient, not to mention the altered LOC.

[serth16]

DCAP-BTLS. He keeps saying it over and over. Anyone can say a acronym but what do they mean and how do they affect the MOI and the PT's condition.(Deformities Contusions, Abrasions, Punctures /Penetrations, Burns, Tenderness, Laceration & Swelling.) He does not ask the examiner to explain what his palpitations feel on the Patient. Overall, Great Job.

Seth, Current EMT-B Student.

[go4broek]

Thanks for The practical exam is not to be used to assess cognitive knowledge which was tested elsewehere. Students should not be made to use up their time regurgitating/explaining what the acronyms mean. Examiners are forbidden from this common practice by the NREMT. Good luck.

[serth16]

Thanks I get it now. By the way I passed my NR. I am an EMT-Basic :-)

[roadjournal]

Nice Job!

[flashpo1nt]

outstanding job

[GemInEyeMatt]

Nothing says you can't check if the patient will take the oro...a good way to check if the patient has a gag reflex is by flicking the patient's eyelash. If the eyelash doesn't twitch then there's probably no gag. Always check carotid and radial in an unresponsive patient. I wish you could've heard patient's vitals and so on, would've made a little more sense maybe.

[go4broek]

Thanks for the comment. All the things you listed ARE good to look for, but none of them are things which the EMT-B can fix during a RTA and are unlikely causes of the present emergency. Good to look for but the NREMT does not require them. Thanks again.

[Godzilla1985]

THANK YOU! This is a very helpful for my EMT-B course, final on Tuesday!

[KFCisallisee]

-Why did he go the the nasophangeal instead of the oro? Sometimes in trauma patients you should not use naso if they might have a skull fracture.

-He should also be checking the carotid pulse at the same time as the radial.

-What about indicating need for shock management?

There a few other minor details he left out, otherwise great job. No point in writing out what I think he missed because my program might be different then his.

[go4broek]

He selected naso because the patient responded to pain. Oro is for unresponsive patients with no gag reflex. The carotid check is only indicated if assessing presence of a pulse. Unless cardiac arrest is suspected, one should begin with a radial pulse in an adult. You are right about the shock mgt tho. Thanks for the comment and the catch.

[go4broek]

Jamie, it's not true that you never put an NPA in just cuz there is trauma. The NPA is contraindicated in the presence of CSF from the nose or ears. Thanks for your comment.

[go4broek]

You MUST attempt to get consent from an adult patient before attempting to treat. Go back to your medical/legal chapter for further reference.

[foofightbd]

1. B.S.I./P.P.E. (P.E.N.M.A.N.) scene safety.

2. Initial Assessment/General Impression.

3. Spinal Immobilization/Assesses Mental Status (A.V.P.U.)L.O.C.

4. Airway - Determine patient has a clear and patent airway, no need for suction or airway adjunct.

5. Breathing - Rate Effort & Quality? Apply Oxygen.

6. Circulation - Asses (radial & carotid) pulse for presence rate & quality of perfusion. Asses skin color/temp/moisture, and capillary refill. Cut & expose, asses for major bleeding.

[go4broek]

Thanks for taking to write out these steps, but I am not trying to re-write the skill evaluation tool. Besides...you left out some of the steps.

[policescanner1]

When noting patient is Unconscious the consent is "implied". Only if the patient is conscious or a minor( under 18 ) without a parent or any guardian then you need a verbal consent.

[go4broek]

You are correct...so far. Minors WITH parents also require consent (from the parent). Thanks for your comment.

[fastroadkill]

air way should have been assesed right after c spine stabalization

Always ABCs first

airway

brething

cirrcullation

[go4broek]

he assessed mental state then ABCs. You must determine LOC before grabbing the patient and assessing ABCs otherwise it is assault/battery. Once he determined an altered LOC, he could treat under implied consent, but he still needed to determine the AVPU level. Thanks for your comment.