Soooo you THINK you know your steps to control bleeding !!!!!

[MrBrown]

We no longer teach pressure points however, like the Heimlich, will be used in common practice for some time yet.

Recently the CAT tourniquet was introduced here at our Technician (BLS) level and has been very effective so far.

 

[lightsandsirens5]

Both elevation and pressure points were found not to be very effective which is why they were deemphasized. Direct pressure and tourniquet use are the primary methods for bleeding control. Of course you can use elevation... nothing say's that you can't.

The tourniquet is effectively your pressure point.

Yea. In fact in my county, if direct pressure is not appreciatively effective, you go strait to a tourniquet.

 

[dannios3]

mhmmmm well i will keep all this in mind like i said i just wanted to make sure bc i dont want to make a mistake on the NREMT-B exam

 

[Sandog]

All the NREMT skill sheets can be found here.
https://www.nremt.org/nremt/about/exam_coord_man.asp

 

[usafmedic45]

Honestly, if you have more pressing concerns (airway?) and not enough help, skipping the direct pressure and going straight to a tourniquet for significant hemorrhage from an extremity would be a good idea.

 

[Veneficus]

What does that involve exactly?

it is a 120 hour course, some have upped it to 150.

It could take 120 hours to explain the physiology of shock. Then there would be no time for learning how to use a spineboard.

 

[Shishkabob]

Honestly, if you have more pressing concerns (airway?) and not enough help, skipping the direct pressure and going straight to a tourniquet for significant hemorrhage from an extremity would be a good idea.

That's what we have. If we think the bleeding is severe enough, they get a CAT right off the bat. After we establish stability in other stuff, we can go back and remove the tq.

 

[Sam Adams]

If you're testing for NR, it's direct pressure followed by TQ. No in between... if pressure can't stop it you don't fool around with anything else but TQs.

NR? I'm not familiar with that abbreviation.

 

[jjesusfreak01]

Treat for shock if necessary

What does that involve exactly?

Massive fluid boluses with at least 3 IVs, vasoconstrictors, all holes plugged up, and MAST trousers. If their BP isn't at least 200 systolic, then you aren't treating the shock correctly.

 

[lightsandsirens5]

Massive fluid boluses with at least 3 IVs, vasoconstrictors, all holes plugged up, and MAST trousers. If their BP isn't at least 200 systolic, then you aren't treating the shock correctly.

Please, please tell me you are being sarcastic.

Cause in my county we are supposed to maintain them at 75-90 systolic.

 

[lightsandsirens5]

NR? I'm not familiar with that abbreviation.

National Registry

 

[Sam Adams]

National Registry

Righto. A little more obvious than I was thinking...

 

[Tanker299]

Types of shock were not only mentioned during my recently finished EMT-B class but subsequently, and quite stringently, tested upon as part of the module testing.
The question was raised (to my dismay) during class why we needed to know the different types of shock if we couldn't do anything about them other than simply "treat for shock".

The instructor answered in the most polite fashion he could muster "It provides a solid foundation when you know these differences and will help you and your patient should you want to make a living at this."

 

[dannios3]

in my bls class we learned the diffrent types of shock and how to notice wich ones they are so even tho we may not be able to treat with drugs or what not at least we know what to expect and of course how to treat with bls care

 

[18G]

In the context of the discussion I thought it was assumed we were all talking about hypovolemic/hemorrhagic shock.

 

[NomadicMedic]

Massive fluid boluses with at least 3 IVs, vasoconstrictors, all holes plugged up, and MAST trousers. If their BP isn't at least 200 systolic, then you aren't treating the shock correctly.

I thought the new standard was 260 systolic.

Hmm. I better get my protocol book out.

Permissive Hypertension = "Sir, I'm gonna make your blood peressure really high. Is that okay? I need your permission. Sir? ... Sir?"

 

[Akulahawk]

Where does ice fit into the equation?

It normally doesn't. There are times that it does, but in EMS, the times you'd see that ice makes a difference would be pretty rare. Seriously, it'd take a while to explain when it's going to make a difference and when it won't.

 

[akrall83]

Where does ice fit into the equation?

You throw the amputated limb in it

 

[hocomedic]

my teacher said:

apply pressure with your hand(yes gloved) and a bandage under your hand

if bleeding continues elevate and apply more bandages

if it still continues, apply tourniquet and treat for shock.

 

[juxtin1987]

I feel bad for the OP on this thread, he was aiming for a simple Q&A about NREMT Standards and started a discussion of the common "You took a 100 hour course and couldn't POSSIBLY know anything" debate. Some of us "100 Hour Coursers" Have spent upwards of 2000 hours doing our own research and education as to have the foundation that all medical professionals should build upon. Not to mention if you take the proper approach to a 100 hour course as i feel i did you can take away from it more than enough to be considered a qualified EMT-B level care provider. What do i mean by this you may ask... well, my class met for 3 hour sessions 2x per week, my study group met for 5+ hour sessions 1-2x per week, i personally spent 4-5 hours every evening researching the Physiology associated with what was being taught to me at the Basic Level, and volunteered in the local ED every saturday and sunday for 12 hour shifts each day because a textbook doesn't explain to you the smell of death and the nature of the beast that is emergency medicine. I agree that it is rather unfortunate that the only thing offered for EMT-B students is a 100 hour course (At least in my area), but until the system changes, the new-hires will always be green unless they're actually driven to be a healthcare provider.

P.S. To reply to this post, and many future/past posts concerning NREMT standards, the best option in regards to what protocols/proceedures are for testing standards is to check with the NREMT direct protocols prior to taking your exam. My class was outdated with not only Bleeding Control, but aslo outdated in AED use so make sure you check the NREMT Registry before testing.