Great moulage - Well done. I am unhappy with "springing the pelvis", any clot may be popped and the pt may empty their whole blood volume (plus it would probabily be repeated in the ER?!?) With a systolic of 70, would have expected a weak / absent radial. Weak pulse + mechanism = pelvis without examining any further? In the primary survey, why not apply a pelvic binder during the "C" phase of evaluation - to reduce any further bleeding from a probable "open-book" - then reassess intervention
I assume you are a physician. You are absolutely correct about rocking the pelvis on a patient that complains of pelvic pain or tenderness after a significant MOI. Students are warned not to do that if the patient is alert and complains pelvic pain. You are also correct about the peripheral pulses. There are many issues that I have with this scenario and demo. This candidate would have failed. Unfortunately, this is the standard to which army medics are trained. Lastly, MARCH is not taught here.
Very thorough examination, well done. Not too sure about springing the pelvis... surely this could "pop" any forming clot and provoke a catastrophic bleed...(plus it would have to be repeated at the ER) With the systolic at 70, one would expect the radial pulse to be weak or absent - combine this with the mechanism and I'd be thinking about the pelvis during my primary survey. Using MARCH method, application of a sam splint early would be advisable. Any consideration for pain relief?
The army used to have a competency examination called the Skills Qualification Test (SQT) before adopting the NREMT-B certification program. Problem was that the SQT was frequently compromised through cheating and pencil-whipping test results. It seems the only way the medical department leadership could come up with to prevent the cheating and standardize the test was to adopt the NREMT-B since it is prepared by civilians and is nationally recognized. Not to mention the recruiting value...
...one problem is that the standard of care for civilian vs. combat medicine are entirely different. So the only real usefulness of the EMT-B curriculum is for skill development standardization. Only problem there is that the skills are tested by the people that teach them (they may not be the primary instructors, but all their instructors work for the same boss and you can guess where his/her priorities lay). So here we are back to the original problem/dilemma.
when u put the patient on the back board u need to tilt the hole back board a bit because he have pelvis fracture u cant just pull his legs unless u have no other choice.
On my test we had to check for lung sounds after rate and quality of respirations. Make sure they are equal and bilateral. Just a heads up for other people who see this. You might get tested on that too.
If you did that during the initial assessment, you would be wrong (critical fail). Auscultation with a steth woud be considered "performing other detailed exam". The soonest you should use it woud be during the rapid trauma assessment.
For some reason I can't see what I said, BUT I go to Inver Hills and they teach to listen to lung sounds during the Detailed Assessment. I did so and passed with 100%
Unless you did that during the Detailed exam, you would be wrong. Auscultation of breath sounds during the Initial Assessment is inappropriate and checking respiratory rate during the Rapid Assessment is not required before auscultation.
Such as? Bear in mind that the patient was alert and responsive and not complaining of dyspnea. Immediate conditions are assessed/managed during the Initial Assessment.
I am an EMT-B student studying for my upcoming final exam and NREMT. Since this patient is in obvious shock but has a possible spinal and/or pelvic injury wouldn't the treatment for shock only be administering appropriate O2, treat bleeding then covering (ie: no trendelenburg position due to injury)? Is this correct? Suggestions welcome. Thanks.
A true Trendelenburg position would require you to put the patient on a LSB and elevate the foot of the board. You should not just elevate the legs if you cannot tilt the entire body. Hope this helps/clarifies.
Sorry for the late reply. That would be incorrect. Once the patient is properly positioned on the PSG/MAST trousers covering the long board using a scoop litter he/she should also be placed in the Trendelenburg position as part of shock management/prevention.
This is very helpful as I am an EMT student having trouble with all the different assessments and the order I am to take in doing each one. Thank you.
I think first and foremost the caregiver never gains consent. The man is responsive and in sound mind, he should ask before he starts helping. Battery!
Good observation. One should always obtain consent from an alert adult. Fortunately, most patients are not aware of the legal requirement but don't be fooled...that ambulance chaser is!
haha.o wow i remember watching this video when i was in advanced indiv. training. brought back some memories and its good to hear this for helping me remeber these skills. thanks for putting this up.
This video is amazing. I have my hands-on assessment final for my EMT-B class. This video has helped me study and has settled me. I'm sure I will have no issues. Thanks for posting!
excellent observation! You are correct. Only a proficient evaluator would catch and document the failure. You must be a perfectionist that will not lose salvagable casualties. keep up the good work!
Nice Video, does anyone of the readers know a homepage where i can find an overview about the told abbreviations? I just know the German way of TLS and i'm very interested in the American way.
The students breathing assessment was minimal and incomplete. How can you treat injuries to the chest if you don't assess for it? When a patient is breathing rapid/shallow the correct adjunct to use is a BVM if it's tolerated, later in the assessment the patient was breathng 28/min, he needs assistance with his tidal volume. Doing a rapid trauma assessment/SAMPLE/Vitals while on scene is a fail point with a critical patient. Didn't ask about loss of consciousness. Do over!!
Using positive pressure ventilation (PPV) on an alert patient will result in resistance. Alert patients should be coached to breathe slower/deeper. If that fails, PPV would be indicated. Completing the RTA on scene is not a failure. Staying beyond the Platinum 10 is. If you listen, you will hear him assess the patient's chest. He verbalized the exam, but did a poor demonstration of technique. Unfortunately, some testing sites are less interested in proper technique than in memorization of steps.
The BP is for demonstration purposes. The contralateral pulse checks is to rule out other medical conditions such as dissecting aorta or equal strength.
Great moulage - Well done. I am unhappy with "springing the pelvis", any clot may be popped and the pt may empty their whole blood volume (plus it would probabily be repeated in the ER?!?) With a systolic of 70, would have expected a weak / absent radial. Weak pulse + mechanism = pelvis without examining any further? In the primary survey, why not apply a pelvic binder during the "C" phase of evaluation - to reduce any further bleeding from a probable "open-book" - then reassess intervention
drpaulsmith 2 years ago
I assume you are a physician. You are absolutely correct about rocking the pelvis on a patient that complains of pelvic pain or tenderness after a significant MOI. Students are warned not to do that if the patient is alert and complains pelvic pain. You are also correct about the peripheral pulses. There are many issues that I have with this scenario and demo. This candidate would have failed. Unfortunately, this is the standard to which army medics are trained. Lastly, MARCH is not taught here.
go4broek 2 years ago
Very thorough examination, well done. Not too sure about springing the pelvis... surely this could "pop" any forming clot and provoke a catastrophic bleed...(plus it would have to be repeated at the ER) With the systolic at 70, one would expect the radial pulse to be weak or absent - combine this with the mechanism and I'd be thinking about the pelvis during my primary survey. Using MARCH method, application of a sam splint early would be advisable. Any consideration for pain relief?
drpaulsmith 2 years ago
How did DCMT become part of the civilian sector.
Doesn't it stand for Department of Combat Medic Training?
My brother's in the military. He told me about it.
vickiormindyb 2 years ago
The army used to have a competency examination called the Skills Qualification Test (SQT) before adopting the NREMT-B certification program. Problem was that the SQT was frequently compromised through cheating and pencil-whipping test results. It seems the only way the medical department leadership could come up with to prevent the cheating and standardize the test was to adopt the NREMT-B since it is prepared by civilians and is nationally recognized. Not to mention the recruiting value...
go4broek 2 years ago
...one problem is that the standard of care for civilian vs. combat medicine are entirely different. So the only real usefulness of the EMT-B curriculum is for skill development standardization. Only problem there is that the skills are tested by the people that teach them (they may not be the primary instructors, but all their instructors work for the same boss and you can guess where his/her priorities lay). So here we are back to the original problem/dilemma.
go4broek 2 years ago
when u put the patient on the back board u need to tilt the hole back board a bit because he have pelvis fracture u cant just pull his legs unless u have no other choice.
waytohell2 2 years ago
Actually, if you suspect a pelvic fracture, you should not be log rolling at all. use the scoop litter.
go4broek 2 years ago
On my test we had to check for lung sounds after rate and quality of respirations. Make sure they are equal and bilateral. Just a heads up for other people who see this. You might get tested on that too.
rocker5k 2 years ago
If you did that during the initial assessment, you would be wrong (critical fail). Auscultation with a steth woud be considered "performing other detailed exam". The soonest you should use it woud be during the rapid trauma assessment.
go4broek 2 years ago
For some reason I can't see what I said, BUT I go to Inver Hills and they teach to listen to lung sounds during the Detailed Assessment. I did so and passed with 100%
rocker5k 2 years ago
Unless you did that during the Detailed exam, you would be wrong. Auscultation of breath sounds during the Initial Assessment is inappropriate and checking respiratory rate during the Rapid Assessment is not required before auscultation.
go4broek 2 years ago
He forgot to assess for any additional airway injuries that need to be immediately addressed
tlkennedy5 2 years ago
Such as? Bear in mind that the patient was alert and responsive and not complaining of dyspnea. Immediate conditions are assessed/managed during the Initial Assessment.
go4broek 2 years ago
BRAVO! WELL EXICUTED!
woosmoney 2 years ago
I am an EMT-B student studying for my upcoming final exam and NREMT. Since this patient is in obvious shock but has a possible spinal and/or pelvic injury wouldn't the treatment for shock only be administering appropriate O2, treat bleeding then covering (ie: no trendelenburg position due to injury)? Is this correct? Suggestions welcome. Thanks.
CAgirlinOz 2 years ago
A true Trendelenburg position would require you to put the patient on a LSB and elevate the foot of the board. You should not just elevate the legs if you cannot tilt the entire body. Hope this helps/clarifies.
go4broek 2 years ago
Sorry for the late reply. That would be incorrect. Once the patient is properly positioned on the PSG/MAST trousers covering the long board using a scoop litter he/she should also be placed in the Trendelenburg position as part of shock management/prevention.
go4broek 2 years ago
dude that was awesome, i hoped you passed, looked like u did. WELL DONE!!!!!
stenu 2 years ago
This is very helpful as I am an EMT student having trouble with all the different assessments and the order I am to take in doing each one. Thank you.
CAgirlinOz 2 years ago
I think you did a great job on your assessment, I would be happy for you to treat me if I were the one who fell. I hope I can do as well on my NREMTs
maxlombardy 3 years ago
I think first and foremost the caregiver never gains consent. The man is responsive and in sound mind, he should ask before he starts helping. Battery!
RoughCut1 3 years ago
Good observation. One should always obtain consent from an alert adult. Fortunately, most patients are not aware of the legal requirement but don't be fooled...that ambulance chaser is!
go4broek 2 years ago
Thank YOU!!!!
tourniquet84 3 years ago
Thank you for this video. It has helped me very much. Time to hit the books again lol
SpeedyThaSnail 3 years ago
yes!! thank you soo helpful!!
:D
07chillwill07 3 years ago
haha.o wow i remember watching this video when i was in advanced indiv. training. brought back some memories and its good to hear this for helping me remeber these skills. thanks for putting this up.
aleciadauchenbaugh 3 years ago
This video is amazing. I have my hands-on assessment final for my EMT-B class. This video has helped me study and has settled me. I'm sure I will have no issues. Thanks for posting!
fireshallfear 3 years ago 3
With the pt's bp he is unstable and is in shock. Is it not a failing criteria to treat for shock?
rdcarter 3 years ago
excellent observation! You are correct. Only a proficient evaluator would catch and document the failure. You must be a perfectionist that will not lose salvagable casualties. keep up the good work!
go4broek 3 years ago
lol military boy, 5:54 he calls hooah lol thats whats up,
817wjfd 3 years ago
Just what I was looking for; so helpful!
nerfherd3r 3 years ago
Nice Video, does anyone of the readers know a homepage where i can find an overview about the told abbreviations? I just know the German way of TLS and i'm very interested in the American way.
BTW: Nice demonstration.
Sanitoeter911 3 years ago
this whole series is fantastic - thanks so much - states tomorrow and your help is much appreciated
ablebabel 3 years ago
The students breathing assessment was minimal and incomplete. How can you treat injuries to the chest if you don't assess for it? When a patient is breathing rapid/shallow the correct adjunct to use is a BVM if it's tolerated, later in the assessment the patient was breathng 28/min, he needs assistance with his tidal volume. Doing a rapid trauma assessment/SAMPLE/Vitals while on scene is a fail point with a critical patient. Didn't ask about loss of consciousness. Do over!!
Xpinhead1 3 years ago
Using positive pressure ventilation (PPV) on an alert patient will result in resistance. Alert patients should be coached to breathe slower/deeper. If that fails, PPV would be indicated. Completing the RTA on scene is not a failure. Staying beyond the Platinum 10 is. If you listen, you will hear him assess the patient's chest. He verbalized the exam, but did a poor demonstration of technique. Unfortunately, some testing sites are less interested in proper technique than in memorization of steps.
go4broek 3 years ago
You are correct. There will be local preferences, but the result should be to adhere to the NREMT guidelines. Thanks for your comment.
go4broek 4 years ago
thanks this helps
good job
roadjournal 4 years ago 2
hey, thanks for posting!
I have to recert and this is good to view.
Cmdr213 4 years ago
i dont understand why in both videos (trauma and medical) they lean across the patient to check the pulse and bp.
CooooookieMonsta 4 years ago
The BP is for demonstration purposes. The contralateral pulse checks is to rule out other medical conditions such as dissecting aorta or equal strength.
go4broek 4 years ago
No i think what the guy meant was why not take the bp on the close arm instead of leaning over.
ruinedwithregret 3 years ago