# Logic of BVM skill station sequence?



## intelli78 (Dec 9, 2012)

Hey everybody,

My practicals are coming up on Monday - I feel well prepared, but there is something on the BVM skill sheet that's been bothering me because it doesn't seem to fit with the usual treatment sequence.

The question is, why don't they ask you to open the pt's airway before the breathing check? 

It's my understanding that when approaching an unconscious patient, you always want to open the airway _before_ assessing breathing as per the A-B-C order (the biggest exception being when cardiac arrest is suspected, the order changes to C-A-B, and thus the airway isn't opened until after the first sequence of compressions is done). 

Can anyone explain? See attachment for a visual. Thanks much.


----------



## DesertMedic66 (Dec 9, 2012)

Because national registry hasn't caught up to the new AHA guidelines. 

Also CAB is used for any unconscious patient (you won't know they are in a full arrest until you check for a pulse.)


----------



## intelli78 (Dec 9, 2012)

firefite said:


> Because national registry hasn't caught up to the new AHA guidelines.
> 
> Also CAB is used for any unconscious patient (you won't know they are in a full arrest until you check for a pulse.)



By "new AHA guidelines," are you referring to AB-CABS? I hadn't even heard of this until I just Googled for new guidelines. AB-CABS makes WAY more sense to me than the 2010 plain CAB guidelines.


----------



## DesertMedic66 (Dec 9, 2012)

I was referring to the ABC vs CAB. I have not heard anything about this AB-CABS


----------



## leoemt (Dec 9, 2012)

For the most part the skills sheets don't have to be done in exact order. I would be very shocked if you failed your skills station because you opened the airway sooner than it said on the sheet. 

That said, lets keep in mind what the skill sheets are intended for. Their sole intent is to evaluate you on a particular skill set. In this case they are evaluating you on your BVM usage and appropriateness. 

Here is our skill sheet for passing (its like 3 or 4th page down): http://www.doh.wa.gov/Portals/1/Documents/Pubs/530093.pdf

Much better than the NREMT ones IMHO.


----------



## intelli78 (Dec 9, 2012)

leoemt said:


> For the most part the skills sheets don't have to be done in exact order. I would be very shocked if you failed your skills station because you opened the airway sooner than it said on the sheet.



I totally agree & think you're right - but I still feel there has to be SOME reason the NREMT made the sheets the way they did. Even if it's purely academic, I am just trying to understand. 

I do appreciate the responses so far, but I am still not satisfied.

Let me put my question a different way. 

1. According to the NHTSA curriculum, the FIRST STEP to treating an unconscious/unresponsive patient is to ASSESS the airway and make it PATENT. In my text book, AAOS 10th ed, this is plainly stated on p.265-266, as well as on the medical/trauma skill sheets that use the A-B-C sequence.

2. However, directly contradicting that, the _BVM_ skill sheet (as well as the CPR/AED skill sheet, in fact), DOES NOT have the candidate assess and open the airway before checking breathing. The order is not ABC, and it is not even CAB. It is, in fact, *BCA* - right on the BVM sheet I posted, the order is 

check responsiveness
check *b*reathing
call for backup
check *c*irculation (pulse)
open *a*irway.

That is *BCA*.

I cannot understand this. I am trying to either 1) understand the underlying logic, or 2) get confirmation that the order of those skill sheets are actually contradictory to the rest of the curriculum.


----------



## leoemt (Dec 9, 2012)

I don't understand it either. However realistically you can do alot of those steps simultaneously. 

Realistically speaking, I am calling for ALS as soon as I know my patient is unresponsive and I am calling a Medic 7 Rule as soon as I know patient is pulseless. 

Personally, I think your putting too much thought into understanding these skill sheets. I don't do anything the NREMT way in the field.


----------



## Medic Tim (Dec 9, 2012)

I was told the nr tests to the latest aha guidelines when I was helping out with a class a few weeks ago.


----------

