# Technical question on trauma and med assessments (skills testing today, help!)



## Deganveran (Dec 2, 2009)

I've been studying for a week for my EMR class and I thought I had everything down but now I am confused by some of the youtube vids I have been seeing and I want to be sure I am doing things right.

For Trauma: Do you still do SAMPLE and OPQRST?

For Medical: Do you still do DCAP-BTLS?

Thanks for the help.


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## CountryEMT-bGurl (Dec 2, 2009)

Deganveran said:


> I've been studying for a week for my EMR class and I thought I had everything down but now I am confused by some of the youtube vids I have been seeing and I want to be sure I am doing things right.
> 
> For Trauma: Do you still do SAMPLE and OPQRST?
> 
> ...



I think you have those mixed up!
You always want to try and do a sample on both Medical & Trauma.
If you can not on Tramua;

TRAUMA-DCAP-BTLS

MEDICAL-OPQRST!

Hope this helps. If anyone wants to add to that, or correct me please do!


Also for Medical I learned to do your OPQRST inside of your sample instead of after. 
Example:S (opqrst) AMPLE!


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## kai.kasin (Dec 2, 2009)

prob. stupid question but DCAP-BTLS is a shortcut for?


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## Deganveran (Dec 2, 2009)

Deformiies/Drainage
Contusions
Abrasions
Punctures/Penetrations
Burns
Tenderness
Lacerations
Swelling
Instability 
Crepitus

Thanks a lot countryemt-bgurl, that was what I was thinking till some misinformation made me doubt myself.


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## kai.kasin (Dec 2, 2009)

Great, tnx   something i can take with me  dosnt have those "letters" here  AMLS is probably the same as yours, with SAMPLE and OPQRS ,but for trauma its just ABCDE


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## JPINFV (Dec 2, 2009)

You should do OPQRST for every chief complaint to the amount that it is applicable. This is a large part of your "history of present illiness." Similarly, SAMPLE should be taken on every patient. I'm actually tempted to look through Bates tongiht when I get home and see if SAMPLE is even mentioned. 

DCAPBTLS is useless.


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## Shishkabob (Dec 2, 2009)

You can do OPQRST for trauma AND medical, as to give yourself a better picture of what's going on.

SAMPLE should be used on everyone, always.


DCAP-BTLS isn't really done in the real world, as it's more to help basic students know what they're looking for, but in reality you'll notice if someone seems wrong.






Don't get trapped in to thinking OPQRST is only medical.  It's not.  If someone complains of calf pain (Medical and traumatic in nature) you can go through the whole OPQRST to help get to a differential.


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## Deganveran (Dec 2, 2009)

JPINFV said:


> You should do OPQRST for every chief complaint to the amount that it is applicable. This is a large part of your "history of present illiness." Similarly, SAMPLE should be taken on every patient. I'm actually tempted to look through Bates tongiht when I get home and see if SAMPLE is even mentioned.
> 
> DCAPBTLS is useless.



For Los Angeles EMR cirriculum DCAP-BTLS is a mandatory skill. What do you mean I should do OPQRST for every chief complaint? What if its insignificant trauma (low grade abrasions, sprained ankle, etc)?


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## EMSLaw (Dec 2, 2009)

Deganveran said:


> For Los Angeles EMR cirriculum DCAP-BTLS is a mandatory skill. What do you mean I should do OPQRST for every chief complaint? What if its insignificant trauma (low grade abrasions, sprained ankle, etc)?



If the patient is complaining of pain, then you're going to go through OPQRST to "unpack" the blanket statement "my X hurts".  That could be trauma or medical, depending on MOI/NOI.  

And remember, sometimes medical problems mask trauma and vice versa.  If the patient is in a car accident, and complaining of chest pain, you probably want to ask when the pain started (and then follow up with PQRST) - did he hurt his chest in the accident, or did he have the accident because of an AMI?


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## JPINFV (Dec 2, 2009)

Why not do OPQRST on a sprained ankle? What caused it (O)? What makes it worse? What makes it better? (P) Sharp pain? Dull pain? Ache? (Q) Region (ok.. given). How bad is it? Scale of 0-10? (S) When did it happen? (T) These all should be components of your history of present illness. 

As far as DCAPBTLS, first off it's not a skill. It's a memory aid. Ok... arguable all mnemonics are. However the information contained in DCAPBTLS isn't really hard to remember provided that you (generic "you") aren't trying to overcomplicate things. DCAP-BTLS can essentially be distilled down to "If it's not normal, document it." You shouldn't need a prompt to know that you need to look for bleeding or deformaties.


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## EMSLaw (Dec 2, 2009)

JPINFV said:


> You shouldn't need a prompt to know that you need to look for bleeding or deformaties.



I have to agree.  You don't need EMT training to realize that you should "Put the white stuff on the red stuff." and "Wow, he's not supposed to have an extra elbow there."


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## CountryEMT-bGurl (Dec 2, 2009)

Deganveran said:


> For Los Angeles EMR cirriculum DCAP-BTLS is a mandatory skill. What do you mean I should do OPQRST for every chief complaint? What if its insignificant trauma (low grade abrasions, sprained ankle, etc)?



Ya for TESTING purposes, 
They want to see you do SAMPLE on both Medical and Trauma. And Of coarse if you can do a SAMPLE on a Trauma pt. then add your S (opqrst) AMPLE, then your DCAP-BTLS. Trauma/Medical you want to treat ALL life threats 1ST!!! Then if you have time in Route you can do your OPQRST for trauma.
So you would just say (when testing on Trauma if your pt. isnt alert and oriented) is there any family members or close friends who can give me a SAMPLE on my pt. If they say NO, then move on.



From NREMT skills sheet.

FOCUSED HISTORY AND PHYSICAL EXAMINATION/RAPID ASSESSMENT
Selects appropriate assessment (focused or rapid assessment) 
Obtains, or directs assistance to obtain, baseline vital signs 
Obtains S.A.M.P.L.E. history
If Rapid, you are going to another quick head to toe running your hands down each exterminty checking for DCAP-BTLS and Blood then load an go. Do your focused in Route)

DETAILED PHYSICAL EXAMINATION
Inspects and palpates the scalp and ears 
Assesses the head Assesses the eyes 
Assesses the facial areas including oral and nasal areas 
Inspects and palpates the neck 
Assesses the neck Assesses for JVD 
Assesses for tracheal deviation 
Inspects 
Assesses the chest Palpates 
Auscultates 
Assesses the abdomen 
Assesses the abdomen/pelvis Assesses the pelvis 
Verbalizes assessment of genitalia/perineum as needed 
1 point for each extremity 
Assesses the extremities includes inspection, palpation, assessment of motor,
sensory and circulatory function
Assesses the posterior Assesses thorax 
Assesses lumbar 
Manages secondary injuries and wounds appropriately 
1 point for appropriate management of the secondary injury/wound
Verbalizes re-assessment of the vital signs


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## medichopeful (Dec 3, 2009)

Do a SAMPLE history and OPQRST on both trauma patients AND medical patients, if possible.

Look for DCAP-BTLS on any patient, if indicated.  It doesn't matter if they're a trauma patient or a medical patient.


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## CountryEMT-bGurl (Dec 3, 2009)

Did u take your skills test yet??? How did it go?


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## medic93 (Dec 18, 2009)

*Trauma Assesment VS Medical Assessment*

Basically the main difference between trauma assessment and medical assessment is a lot more simple than you think. Take your practical skills sheets and set them next to each other.
Notice that your scene size up and initial assessment are exactly the same on both sheets at least till you get to the line where you make your transport decision. That is where the differences begin. Trauma assessment focuses more on the head to toe examination and less on the SAMPLE history. Whereas Medical assessment focuses less on the head to toe exam and more on the sample history. OPQRST are the question you ask to obtain the signs and symptoms which is the first step in your sample history.

The Skills sheets i am referring to are the sheets from the NREMT curriculim.


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## JPINFV (Dec 18, 2009)

medic93 said:


> OPQRST are the question you ask to obtain the signs and symptoms which is the first step in your sample history.



OPQRST are the points needed to investigate the various complaints, not elicit signs and symptoms.


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## zmedic (Dec 18, 2009)

EMSLaw; said:
			
		

> I have to agree.  You don't need EMT training to realize that you should "Put the white stuff on the red stuff." and "Wow, he's not supposed to have an extra elbow there."



  The reason we have training is so that we can do these pretty simple things in crazy situations where everyone else is freaking out. Yes, most people should be able to figure out that a broken arm should be stabilized some way, if they had the time to think. But it's amazing how the simple stuff can fly out the window on the side of the highway, at night, in the rain, with freaking out family members standing by. That's why we have the class and do the training. 

We used to rely on common sense and whoever had a car get the patient to the hospital, and there were a lot of uneeded deaths.


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## JPINFV (Dec 18, 2009)

I spend more time thinking about what the definition of DCABTLS is than looking for the signs that make up DCAPBTLS.


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## Trauma's Mistress (Dec 28, 2009)

SAMPLE  OPQRST     should be done on both  Medical and Trauma  assessments if  possible.  

  The  trick to trauma is   i like to call.   See Treat  ask and Go.
  See something -  fix it !
Ask  sample and opqrst   while you are loading and going.  

 Medical  is all about Sample and opqrst questions.  the worst thing to do is assume anything.    ask ask ask. Thats my  trick for medicals. 

   I help teach and  my  instructor  did this to  a group of "know it all" group 
 She did  the  scenaro  and she told them   "  you are called to a scene where the daughter (me) thinks that   Mom (teacher)  had a stroke.   

 They all focused on  stroke and  didnt ask  any pertinent  sample  opqrst  to me,  the  teacher  was  pretending to have a severe stroke , lethargic ,non verbal etc.   Which  if you take out that you being the emt  being told " thinks she had a stroke"   You would  also    think  about a diabetic emergency.  Because me being the  family member  - what do I know. i thought it was a stroke.   

  well, she  got them all and  it was a fun thing, to really knock them down a peg and  really understand  how  crucial  getting   any and all information is    HUGE  in this stuff.     The  line i had was  "  I dont know what happened,  I just came home and  I found her like this, I think she had a stroke"  and no one asked  if she  ate anything recently, they wree all like -- load and  go  load and  go.     Which  if they asked the proper questions it could also have led to  -did she  eat anything today at all?  does she take any medications ? ( the answer would have been, yes takes insulin.)   Does  she  have any past medical history thats pertinent ,   ( why yes, emt,  she does -  shes  diabetic !   lol )    does she by chance have diabetes?       They were all like  OHH  Diabetic  shock ! 

  The lesson,   ask  anything you  think might help, because  some times a stroke isnt a stroke.   just a weak  diabetic patient.


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## juxtin1987 (Dec 28, 2009)

Another hint for testing purposes is you cannot ask a wrong question the only mistake you can make is failing to ask an important question.

OPQRST, DODAEISF, HDIII, SWHOIE, HWHEPI etc. 

That's hallarious about the diabetic shock scenario, i would've laughed my *** off at someone failing that. We did a scenario for extrication where we staged a 2 car collision in a parking lot with multiple victims, one of which was a bystander pinned between the two vehicles, which of course our fake IC removed first, but the funny (or not so funny depending on interpretation) part was that there was an empty carseat under the front end of one vehicle which remained untouched throughout the entire scenario.


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## Trauma's Mistress (Dec 28, 2009)

WOW , JUST WOW  lol


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## Trauma's Mistress (Dec 28, 2009)

i am pretty sure  that comes along with  .. ohh  gosh .. i dont know  ...  the  very  first thing -- scene size up! lol  

  And  the  diabetic shock,  oh it was   great !    Me and my  teacher always  take  the  most  cocky ( who have absolutely no room to be)  most immature  group  and   use this  scenario  to  "wake them up"  because  people think, they  dont have to pay attention in class?   Crazyness !


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## medichopeful (Dec 28, 2009)

Trauma's Mistress said:


> i am pretty sure  that comes along with  .. ohh  gosh .. i dont know  ...  the  very  first thing -- scene size up! lol
> 
> And  the  diabetic shock,  oh it was   great !    Me and my  teacher always  take  the  most  cocky ( who have absolutely no room to be)  most immature  group  and   use this  scenario  to  "wake them up"  because  people think, they  dont have to pay attention in class?   Crazyness !



I sort of wish you had done that to some of the groups in my class...


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## Trauma's Mistress (Dec 28, 2009)

pass  along  the idea   to  your  teacher, Im sure it  will work.  

 The one thing that bothers me most is not the lack of respect to me or the others, its the   thought that , they just dont get it. They will be  in charge of someones life, and  as my teacher said. you do it in practice, you do it in the feild.


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## fma08 (Dec 28, 2009)

Only thing I'm going to add for now is OPQRST*I*

I- Interventions

Very important to ask your patients if they have taken anything for their condition and of course assessing whether or not it has hurt or helped them.

Great example being chest pain. Pt. stating they took a full adult aspirin at the onset, then that's one thing you can knock off your list of things to do. (Make sure you see the bottle, old people don't always know that IBU and APAP are not the same as ASA  )


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## Lifeguards For Life (Dec 28, 2009)

fma08 said:


> Only thing I'm going to add for now is OPQRST*I*
> 
> I- Interventions
> 
> ...



Interventions is covered under "P". The"P" stands for provocation and palliation.


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## fma08 (Dec 28, 2009)

Lifeguards For Life said:


> Interventions is covered under "P". The"P" stands for provocation and palliation.



My understanding had been that P referred to physical means like position, pressure, etc. And that I referred more to pharmacological interventions, at least that was how I learned it. If it was taught different where you went, feel free to ignore my post ^_^ Just trying to help out.


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## redcrossemt (Jan 4, 2010)

fma08 said:


> My understanding had been that P referred to physical means like position, pressure, etc. And that I referred more to pharmacological interventions, at least that was how I learned it. If it was taught different where you went, feel free to ignore my post ^_^ Just trying to help out.



Never heard that before... Always was told it referred to "provocation" as in "what makes it worse?"

Also, was taught that interventions were covered under T for "treatment". Have also heard T used for "time", but I thought it was easier to group "time" and "cause" under Onset.


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## Trauma's Mistress (Jan 4, 2010)

P  is  for  Provocation/palliation.  Provocation.


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## fma08 (Jan 4, 2010)

redcrossemt said:


> Never heard that before... Always was told it referred to "provocation" as in "what makes it worse?"
> 
> Also, was taught that interventions were covered under T for "treatment". Have also heard T used for "time", but I thought it was easier to group "time" and "cause" under Onset.



I'll clarify what I was trying to say. Yes, P stands for provocation/palliation (worse or better respectively). When I was in school it had seemed to refer to more physical means of making it better like position, pressure, etc. I- Interventions, was added to emphasize the importance for asking about pharmacological interventions that the patient may have done. 

This was the way I had learned. I'm just trying to give a different perspective. If it's confusing please feel free to ignore


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## Jeffrey_169 (Jan 5, 2010)

I agree with countryemt-bgurl. Just remember to perform the scence size up and PPE frst, and then the ABC's. After those steps, assess based on MOI. DCAP-BTLS is used for trauma pts, and OPQRST is used for medical pts; on the med pt perform OPQRST while within SAMPLE, and on the trauma still do a SAMPLE if you can. 

Whatever you do just remember to take a deep breath and try to relax. Don't let the proctor make you too nervous and you will do fine. 

Good luck.


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