# EMT class scenario ideas!



## pullnshoot25 (Mar 22, 2011)

OK, so I have to act out a scenario with a class partner for tomorrow for my EMT course. My current scenario is a cook getting an oil burn and falling on a knife but I figured I would ask what scenario you guys have in mind. 

Yes, it is a bit last minute but I have time!


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## abckidsmom (Mar 22, 2011)

Does it have to be trauma?


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## pullnshoot25 (Mar 22, 2011)

Trauma preferred, I think. Here is a sample of what we did today.

-Joe Dirt cutting off his hand with a crosscut sawblade
-Skater chick falling off skateboard and breaking her arm
-Construction worker falling 3 stories onto rebar with a pneumothorax, broken femur, etc. (yeah, I don't know about survival on that one)
-Childbirth with meconium staining (that was a funny one) (sp?)
-Bar fight ending up with a stabbing
-Unrestrained car collision from playing chicken with a stop sign.


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## Handsome Robb (Mar 22, 2011)

If you really wanna be mean make it trauma caused by an underlying issue, but make the trauma real nasty and distracting.


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## pullnshoot25 (Mar 22, 2011)

Got any suggestions or good ones from personal experience?


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## Handsome Robb (Mar 22, 2011)

I had a guy smack a tree the other day. Turned out he hit the tree because he passed out because his BGL was LO thats all the glucometer would read so on ours <20.

Another one thats pretty standard is the MI that causes someone to crash a car, fall off a roof, something of those sorts.


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## samiam (Mar 22, 2011)

tonic clonic off of the roof and foot first into a stump grinder...ouch

:sad:


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## ffemt8978 (Mar 22, 2011)

http://www.emtlife.com/showthread.php?t=22480


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## bigbaldguy (Mar 23, 2011)

I like the one where the guy comes in from jogging and collapses just inside the front door. Presents initially as a possible cardiac event. When a complete assessment is done the students (if they do it right) find a small wound in the axillary area that turns out to be a GSW.


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## pullnshoot25 (Mar 23, 2011)

bigbaldguy said:


> I like the one where the guy comes in from jogging and collapses just inside the front door. Presents initially as a possible cardiac event. When a complete assessment is done the students (if they do it right) find a small wound in the axillary area that turns out to be a GSW.



I love it. Sneaky and it weaves in my.love for high-speed projectiles. That's what I will do!


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## Handsome Robb (Mar 23, 2011)

Tonic clonic off the roof wouldn't be a fun call to run then into a stump grinder is just adding insult to injury.


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## bigbaldguy (Mar 23, 2011)

pullnshoot25 said:


> I love it. Sneaky and it weaves in my.love for high-speed projectiles. That's what I will do!



Put a little red sticker or piece of tape under their arm with gunshot wound written on it


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## Amycus (Mar 23, 2011)

I used to love throwing "trick" scenarios at my study group when I used to drill them- i.e. scenarios that unless they ask the right questions, they'll take the wrong course...

i.e. the respiratory distress patient who has some obscure allergy to a food. If you forget to ask about last oral intake, you'd miss that he ate something triggering an allergic reaction

The cardiac patient who casually forgets to tell you he uses viagra, unless you asked specifically, etc. etc.

Sometimes keeping it simple can catch people off guard.


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## ffemt8978 (Mar 23, 2011)

But if every one else is throwing out zebra scenarios, sometimes it is better to go with a simple, obvious one to see if they overthink it.

Another one I used was a MVA, pt was CAOx4 with neck pain.  Pt has head leaning toward shoulder, and when they try to place in nuetral position for C-collar, pain becomes stabbing and pt develops tingling and numbness in extremities.  Then you get to watch how they maintain cspine without a c-collar.


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## JPINFV (Mar 23, 2011)

Amycus said:


> The cardiac patient who casually forgets to tell you he uses viagra, unless you asked specifically, etc. etc.
> 
> Sometimes keeping it simple can catch people off guard.



Want to catch people? What about the cardiac patient on revatio? Of course this is where getting use to using the generic name is important instead of the brand name. For example, use naloxone instead of narcan. Hint: Revatio is not prescribed for impotence.


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## BLS4LYFE (Mar 23, 2011)

My suggestion - pick another career.


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## Handsome Robb (Mar 23, 2011)

FF I like your style!

blanket roll and lots and lots of tape to secure it in the position you have it in.


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## Rubles (Mar 23, 2011)

NVRob said:


> FF I like your style!
> 
> blanket roll and lots and lots of tape to secure it in the position you have it in.



By "blanket roll" do u mean folding up a long piece of cloth and winding it around the patient's neck?


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## samiam (Mar 23, 2011)

NVRob said:


> Tonic clonic off the roof wouldn't be a fun call to run then into a stump grinder is just adding insult to injury.



a person on the ground could turn it off fairly quickly and then they could call him stumpy h34r:


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## Veneficus (Mar 23, 2011)

I have seen this only twice in my career:

http://en.wikipedia.org/wiki/Mitoch...hy,_lactic_acidosis,_and_stroke-like_episodes


or if you like I saw this once the other day.

http://en.wikipedia.org/wiki/Atrial_myxoma


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## samiam (Mar 23, 2011)

I saw a interesting case of botulism.... lots of posturing and weird nuero like symptoms.... canned fruit


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## Handsome Robb (Mar 23, 2011)

Rubles said:


> By "blanket roll" do u mean folding up a long piece of cloth and winding it around the patient's neck?



Negative. No collar, put him on the board, roll a blanket up and go from the shoulder up and over the head and back to the other shoulder like a 'U'.


Depending on the pt though a blanket roll around the neck might be a option


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## Rubles (Mar 24, 2011)

NVRob said:


> Negative. No collar, put him on the board, roll a blanket up and go from the shoulder up and over the head and back to the other shoulder like a 'U'.
> 
> 
> Depending on the pt though a blanket roll around the neck might be a option



lol.. I was talking abt an improvised cervical collar. like the one made by folding a towel or jacket. Isnt that a suitable way to immobilise the neck in such a situation?

Also, could you please elaborate on the blanket roll method..what I understood was that we wrap one end of the blanket around the patient's upper arm, take the blanket over the patient's head and then wrap the other end around the other arm??


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## Smoke14 (Mar 25, 2011)

My favorite: dispatched to a nursing home on seizures. On arrival you find an elderly male patient on the floor next to his bed laying in his own urine. He is no longer seizing but is slow to respond and is not well oriented. Spinal precautions are initiated and a head to toe exam reveals no injuries. He has a pulse of 106 and regular but weak, a blood pressure of 108/66 with respirations at 12 a minute.

????????


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## Veneficus (Mar 25, 2011)

Smoke14 said:


> My favorite: dispatched to a nursing home on seizures. On arrival you find an elderly male patient on the floor next to his bed laying in his own urine. He is no longer seizing but is slow to respond and is not well oriented. Spinal precautions are initiated and a head to toe exam reveals no injuries. He has a pulse of 106 and regular but weak, a blood pressure of 108/66 with respirations at 12 a minute.
> 
> ????????



That sounds like most nursing home patients.


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## Rubles (Mar 25, 2011)

Somebody please tell me how to immobilise a bent neck. I didnt get the technique described by NVRob.


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## Veneficus (Mar 25, 2011)

Rubles said:


> Somebody please tell me how to immobilise a bent neck. I didnt get the technique described by NVRob.



use something to pad it just as it is and tape it together.


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## Rubles (Mar 25, 2011)

ok. "Pad" as in place appropriately-sized pads (pillows etc.) around the neck and tape them?


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## Rubles (Mar 25, 2011)

I was going through an article on the internet and I think I've understood wat NVRob was referring to:
http://health.howstuffworks.com/medicine/first-aid/first-aid5.htm

but what if you have to place the victim in recovery position..shouldnt the neck be stabilised in such a way that the head does not move back (apart from side to side) while moving?


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## Melclin (Mar 25, 2011)

The following were good when I was at uni and I use some of these same ideas with my first aiders. 

-Scenarios targeted at common conflicts are good. Eg in my first aid classes, people often get a patient who is unconscious with a high likelihood of a spinal injury, the conflict being that spinal pts are managed on their back, while an unconscious person must be managed on their side..get people thinking and not just following the cook book.  

-Scenarios that shock people in unexpected ways or force people to ask difficult questions. Attempted suicide, vaginal bleeding, pregnancy issues, intoxicated & lecherous male patients.

-Scenarios where the student has no idea whats going on, but they have to manage anyway. I've used the MELAS pt before, not expecting people to know what it is, in fact hoping that they wouldn't, but just forcing people to deal with the complex symptoms, hx and getting people to communicate with carers. 

-Scenarios with dispatch information that leads them down the wrong path unless they specifically clarify it once they're with the pt, to remind people that dispatch information is wrong 117% of the time. 

-Scenarios where a bit of information/tool that you are used to relying on is no longer available. This can force the student to return to their pathophys or problem solving. Eg The BSL meter is broken, based on hx and physical, is your pt having a hypo or a hyper; communication with and assessment of deaf/blind/locked-in syndrome/intellectually disabled/mentally ill pts; your walk lift belt is soiled, what other lifting aid is appropriate for situation X.


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## Handsome Robb (Mar 25, 2011)

Rubles said:


> lol.. I was talking abt an improvised cervical collar. like the one made by folding a towel or jacket. Isnt that a suitable way to immobilise the neck in such a situation?
> 
> Also, could you please elaborate on the blanket roll method..what I understood was that we wrap one end of the blanket around the patient's upper arm, take the blanket over the patient's head and then wrap the other end around the other arm??



What you just described is a snake. Usually used in conjunction with a collar.

Manual c-spine to get him on the board, then once he is all strapped up the rolled up blanket goes over the top of the head from shoulder to shoulder, then is securely taped. Used it the other day when someone didnt put headblocks back in the equipment bag 

The towel/blanket roll replaces the blocks.


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## pullnshoot25 (Mar 26, 2011)

Well, I did the gunshot wound to the right chest and tried to fake it as a heart attack but I was a nerd and put the GSW entry on the anterior instead of the posterior so the scenario got solved pretty quickly.  Teacher loved the scenario idea though so that's cool. 

Thanks guys!


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## bigbaldguy (Mar 26, 2011)

pullnshoot25 said:


> Teacher loved the scenario idea though so that's cool.
> 
> Thanks guys!



Your welcome.

Ps you were supposed to put the GSW sticker right up under the armpit to make it really tricky


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