# Bleeding control/Shock management



## res47cue (May 20, 2011)

My paramedic practical exam is in 2 weeks, and I'm just trying to clarify minor details about some of the skill stations so there are no surprises.  The current skill sheet for the bleeding control station jumps right from applying direct pressure to applying a tourniquet.  Obviously, this is the new trend in training and education, but for those of you who have taken the practical test recently - did you not even mention elevation and pressure points?  And what kind of tourniquet equipment did the testing center provide for you to use?

All the older practical skill videos on YouTube show the bleeding being controlled with pressure point techniques.


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## usafmedic45 (May 20, 2011)

> Obviously, this is the new trend in training and education, but for those of you who have taken the practical test recently - did you not even mention elevation and pressure points?



If it's not on the skills sheet, don't bring it up.  A practical skills examination is not the time nor the place to try to do anything but jump through the hoops placed in front of you (sadly). 



> And what kind of tourniquet equipment did the testing center provide for you to use?



Why not call your test center and ask them which one they use?  That would be much more beneficial for you to know than what a testing center in California utilizes.


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## res47cue (May 20, 2011)

I could call and ask, and probably will before test day.  Just looking to hear from anyone who tested recently about their experience.


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## ClaymoreCharlie (May 20, 2011)

Bleeding control and shock management should NOT be the random basic skill.  Presently, there is no universally accepted method of applying a tourniquet.  Also, there is no way to test this skill on a human subject (like we do for spinal immobilization seated/supine) because you would be applying and removing tourniquets so many times, it would not be a fun experience for the guy playing patient.

After speaking to our sim lab manager, who is also a registry rep/question writer, he basically said that, for the above reasons listed, bleeding control/shock management has basically been thrown out of skills testing for the time being.


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## EMT-IT753 (May 20, 2011)

1. Apply direct pressure
2. Apply tourniquet
3. Elevate feet
4. Keep patient warm

Those are the 4 steps required to pass this basic random station. That is ALL you need to know so do not overcomplicate this simple station if you happen to get this.

We were instructed to know this station as it was going to possibly be one of the stations. We will be using the blood pressure cuff as the tourniquet, which is an approved method.


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## LucidResq (May 20, 2011)

You forgot high flow O2 (most proctors will consider that necessary as part of "treating for shock"). 

For testing, when I apply pressure to an upper extremity I elevate by holding their arm in their air at the same time. Why not? 

They used the same tourniquets the military issues in my refresher.


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## usafmedic45 (May 20, 2011)

> Presently, there is no universally accepted method of applying a tourniquet.



How so?



> Also, there is no way to test this skill on a human subject (like we do for spinal immobilization seated/supine) because you would be applying and removing tourniquets so many times, it would not be a fun experience for the guy playing patient.



Three words:  IV practice arm.


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## JPINFV (May 21, 2011)

ClaymoreCharlie said:


> Also, there is no way to test this skill on a human subject (like we do for spinal immobilization seated/supine) because you would be applying and removing tourniquets so many times, it would not be a fun experience for the guy playing patient.


If there are people willing to let medical students use them to learn pelvic (including paps, minus the scraping), breast, and rectal exams, I'm sure that there are people who are willing to let students practice putting a tourniquet on them for the right amount of money.


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## usafmedic45 (May 21, 2011)

JPINFV said:


> If there are people willing to let medical students use them to learn pelvic (including paps, minus the scraping), breast, and rectal exams, I'm sure that there are people who are willing to let students practice putting a tourniquet on them for the right amount of money.


That was my thought as well.


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## HotelCo (May 21, 2011)

It'll more than likely be KED or backboarding. Practice those.


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## mycrofft (May 21, 2011)

*Claymore went to a tough school!*

I think he or she meant that civilians are trying to make up thier minds about WHEN to use a TK, not how to apply it.

OP, listen to Uncle USAF, find out what they want and then do it.


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## usafmedic45 (May 21, 2011)

> I think he or she meant that civilians are trying to make up thier minds about WHEN to use a TK, not how to apply it.



Ah...that's what I figured but wanted to demand clarification in order to be certain.


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## ClaymoreCharlie (May 21, 2011)

Hey guys, maybe you are correct?  I'm saying what was told to me at my school.  Those were the reasons provided to us, and we were pretty much told to not expect bleeding control and shock management.

I too, thought about using an IV arm for this, I suppose there isn't really a way to evaluate this?  Again, just saying what we were told.

As far as the tough school comment, don't really appreciate that.  My school was very rough, and we have an attrition rate of roughly 50-60%.


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## mycrofft (May 21, 2011)

*TK practice*

Two words: Auto Appliction


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