# Practical exam tomorrow - any advice?



## IcantThinkofAname (Dec 22, 2008)

I've passed my EMT-B class with flying colors, so I'm confident that I know the material...academically anyway.  My practical exam is tomorrow and I know I'll have 5 or 6 stations.  I feel good about airway, long board and KED, and bleeding control.  I even feel pretty good about medical and trauma assessment although I've been given pretty easy practice cases in class it seems (abdominal pain that clearly led to a suspicion of appendicitis, car vs. unconscious pedestrian, etc.).  So far I haven't had to evaluate a cardiac or respiratory emergency, with self-prescribed meds or anything.  But I still feel like I know how to run it pretty well.

Strangely, I don't feel all that confident about splinting and I don't know why.  I know how the traction splint works pretty well, but there are so many darn ways to splint joints and long bone injuries that I guess I'm a little afraid that I'm going to mess that one up.

CPR/AED is kind of weird because you don't actually have to show CPR, just direct it and make sure it's adequate while you run the AED.  The only problem is that the AED has its own schedule and it doesn't coincide with the skill sheet.  

Anyway, any advice?  I think at this point I just want to do it and get it over with and I'm just freaked about the unknown.


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## rhan101277 (Dec 22, 2008)

Well you are going to have the unknown on every call.  Just be confident when you go in there and you should be allright.  I had to to medical, trauma, bleeding control, oral and nasal airways, oxygen admin, AED w/ CPR in progress.  Just be confident in your skills, remember you ABC's and do forget to do the sample history.

My medical was a shortness of breath, I got thrown a curve about how she had a inhaler and it didn't help.  I had to verbalize calling med control and I assisted her with it and it didn't help <_<.  So I have her on high flow oxygen with BVM at 12-20 verbalized.  I get sample history and find out she is a smoker and so on and such.

But I tried to zone everything out and act like I was really there.  At this point you either know what you need do to or you don't.  Seems like you do, so you should be good.


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## WuLabsWuTecH (Dec 22, 2008)

Tips for everything:  Before you even look at the situation, verbalize BSI/Scene Safety.

Tips for immobilization: Make sure whatever you are immobilizing doesn't move!  For C-spine, never release manual unless you verbalize that your partner is taking over.  Secure body before head.

tips for Assessment:  Remember the 5 things that come before everything else on the NREMT sheet (right after BSI).  I think they are scene safety, MOI/NOI, number of patients, considers calling for backup, c-spine considerations.

^^^ those were the stumbling blocks for my class, especially with the immobilization and the KED board.

When doing assessment for trauma with unresponsive patient, be sure to expose everthing.  One of our maniquins had a "wound" under he clothes on her back so we had to control the bleeding there.  Remember, A before B, B before C.  If you can't get A yet, don't even start thinking about B or C.


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## IcantThinkofAname (Dec 22, 2008)

Thanks for the advice.  BSI/Scene Safety has been drilled into our heads from day 1, so we just automatically say it whenever we approach anything.  

Ah, exposing...I don't think anyone in our class remembers to do that.  I'm the only one who remembered to put a c-collar on after doing DCAP-BTLS on the head and neck for a rapid trauma exam.

Question - if they have meds like an inhaler or nitro, when in the assessment do you call medical control?  I mean, with nitro, I have to make sure their BP is over 100 mmHg systolic, so would you stop in the middle of the SAMPLE history to call medical control, or would you continue SAMPLE and OPQRST and then do baseline vitals and then call medical control?  That's what throws me off.  Interventions are at the bottom of the list, after SAMPLE but it just seems odd to wait to give them medicine they might need until after the focused history and exam.  Same thing with oral glucose and Epi-pen.  

Also, when would you do a finger stick for glucose check?  I know you do them for anyone with altered mental status, but when specifically would you do it?  Again, after the physical exam or after SAMPLE?

Thanks again!


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## Shishkabob (Dec 24, 2008)

When doing CPR, don't open the airway THEN check for a pulse :glare:

As for calling medical control, it really depends on your state.  In my state, Texas, I'm allowed to give Nitro, Glucose, Charcoal, Oxygen, Epi, ASA without having to contact medical control... yours might be different so make sure you find out.



EDIT-- darn 2 days too late.  Hope ya passed!


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## IcantThinkofAname (Dec 24, 2008)

I PASSED!!  YAHOO!  

Thanks everyone!  On to the NREMT computer test...


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