The DCMT Trauma Assessment Standard

Filmed by the administration to standardize how the skill should be performed and tested.

Category:

Howto & Style

Tags:

• trauma
• assessment
• and
• management
• NREMT-B
• EMT-B
• skill

[drpaulsmith]

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

[go4broek]

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.

[rocker5k]

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.

[go4broek]

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.

[tlkennedy5]

He forgot to assess for any additional airway injuries that need to be immediately addressed

[go4broek]

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.

[fireshallfear]

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!

[roadjournal]

thanks this helps

good job

[drpaulsmith]

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?

[rocker5k]

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%

[go4broek]

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]

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]

...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]

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.