# trouble with trauma assessment



## rubyfruit17 (Dec 6, 2009)

I am having a problem getting past my trauma assessment.
I attempted it, didn't miss anything but went over time limit..I think I took too long with the rapid assessment.  I checked for blood under the body, dcap-blts everything...checked pms(also did these with detailed)  I was 2 minutes over, any suggestions on how to speed me up?
I want to succeed and get certified soooo bad>:sad:


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## JPINFV (Dec 6, 2009)

Just practice practice practice. If you can practice on a person, than good, but you can also just run through the list from memory.


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## MMiz (Dec 6, 2009)

Go over the NREMT assessment protocol (PDF) many times.  Do it so many times that you could do it in your sleep.


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## scottyb (Dec 7, 2009)

I went through it so many times that I was just sick and tired of looking at the sheet.  I practiced until I had a good pace and then practiced some more.  After a while it will be second nature and you wont have to focus on what the next step is, it will just come to you and you will just know what to do.  

It takes practice.  Some people pick it up quick, I was not one of them.  I used to bug my wife to play patient all the time for hours at a time.  Just practice, practice, practice.  Before you know it the time limit will seem like an eternity and you will be finishing well ahead of it.


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## Lifeguards For Life (Dec 7, 2009)

scottyb said:


> \.  I used to bug my wife to play patient all the time for hours at a time.  Just practice, practice, practice.  Before you know it the time limit will seem like an eternity and you will be finishing well ahead of it.



The assessment follows a predictable pattern. consider why you are doing what you are doing, and why in that order.  with a little bit of understanding, the need to memorize decreases. Like when you were a small child and had to learn to count to 100. memorizing all those numbers was dang near impossible. though as soon as you recognized that there was a logical pattern, you could count to any number with ease. Once you see the logical patttern it will just "click".

-hope that made sense and hope it helps you


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## scottyb (Dec 7, 2009)

Lifeguards For Life said:


> The assessment follows a predictable pattern. consider why you are doing what you are doing, and why in that order.  with a little bit of understanding, the need to memorize decreases. Like when you were a small child and had to learn to count to 100. memorizing all those numbers was dang near impossible. though as soon as you recognized that there was a logical pattern, you could count to any number with ease. Once you see the logical patttern it will just "click".
> 
> -hope that made sense and hope it helps you



That is a much better way of saying what I was trying to say.


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## firetender (Dec 7, 2009)

Go to your closest college. You didn't specify if you're male or female, so if female, go to the male dorm. If male, go to the female dorm. Place a notice "Will tuck you in in return for you helping me in my trauma assesment!"

Then, show Up around midnight and work your way down the dorm. Guaranteed, in two nights you'll either be proficient or arrested!


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## medichopeful (Dec 8, 2009)

firetender said:


> Go to your closest college. You didn't specify if you're male or female, so if female, go to the male dorm. If male, go to the female dorm. Place a notice "Will tuck you in in return for you helping me in my trauma assesment!"
> 
> Then, show Up around midnight and work your way down the dorm. Guaranteed, in two nights you'll either be proficient or arrested!


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## Akulahawk (Dec 9, 2009)

Practice, practice, practice. When you think you've practiced enough, do it some more. Incorporate the NREMT stuff as you want to maximize the points and not get any critical fail points. As you do things, you'll see that you're going to be looking for the same things over and over and over.... just in different areas of the body.

Practice verbalizing. The proctor will not know what you're looking for if you don't say it.

Eventually, you'll get to the point where you can run through a hand-on trauma exam very, very quickly. Later, you'll find that this really _does _become second-nature to you. Practice is what it takes to get there.


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## rhan101277 (Dec 9, 2009)

Lifeguards For Life said:


> The assessment follows a predictable pattern. consider why you are doing what you are doing, and why in that order.  with a little bit of understanding, the need to memorize decreases. Like when you were a small child and had to learn to count to 100. memorizing all those numbers was dang near impossible. though as soon as you recognized that there was a logical pattern, you could count to any number with ease. Once you see the logical patttern it will just "click".
> 
> -hope that made sense and hope it helps you



I've noticed this to with going through paramedic school and having experience as a basic.  You just know what to do and why and no reason to think about it.  I will still be practicing though, we have checks offs at the end of every semester and it goes towards lab grade.


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## apumic (Dec 9, 2009)

Practice, practice, practice.

The trauma assessment really is quite simple -- 4 easy steps:
1. Walk in and say the 6 things before the initial quickly (use your hands and count 'em if needed -- scene safe, BSI, # pts, MOI, ALS, c-spine) -- maybe 15 sec at most
2. ABCs (B--give O2, C--check major/life-threatening bleeding) & general impression (w/ xport decision) -- maybe 1 minute at most
3. Assessment: rapid trauma or focused assessment (will most likely be a rapid trauma so the proctor can see you examine the whole body; just DCAP-BTLS everything starting from the head, straight through the trunk and legs, verbalizing _everything_ you check for and making sure to mention any special things you check for -- crepitation of the head, JVD of the neck, flailing chest, etc.; do the arms after both legs have been done; verbalize checking posterior as pt is placed on spine board); have your partner take vitals & Hx while you do the trauma assessment (say "[partner], check vitals and get SAMPLE Hx" and have "him" handle any traumatic injuries throughout the trauma assessment) -- longest part, probably 3-6 min
4. Tell the proctor you will tansport the pt high priority (unless it is not indicated, which seems unlikely for the trauma practical) and that you will perform a detailed assessment (demonstrate if required), and reassess vitals, interventions, and physical condition (detailed assessment) every X min (depending upon condition) -- 30-60 sec. at most (maybe 3-5 min if you demonstrate the whole detailed assessment -- if your instructor asks for the detailed, do it extremely fast and mostly just show that you know to check the face and what you're checking for)

Pretty basic if you just break it down. You must be getting stuck on something or spending unnecessary time somewhere (perhaps being too detailed or giving a "dissertation" about the pt's condition or treatment) if it's taking you 12 min.

Edit: I should note I don't have the critical criteria in front of me, so it is possible that in my simplification of it I may have missed something, so please check the criticals. I tried to hit on everything I recall being a part of the practical but I may have made a mistake or two so don't trust me w/o checking your sheet first.


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## 8jimi8 (Dec 9, 2009)

think of it this way.

In the skill check off they want to know that you know what a proper head to to assessment is.

You can run your hands over the mannequin in 20 seconds to "show them how you check," as well as listing the details that you would check.  Don't do a "real assessment" on a mannequin.  Do it fast, say what you are looking for and get on with the algorithm.  You can do a detailed assessment in the back of the ambulance...

Remember in real life you are going to look for life threats and then assess and treat as you go.

Your motions don't have to be slow and methodical for the check off.


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## JCampbell (Dec 10, 2009)

I just failed my trauma assessment twice. I have to go and try for the third (and last) time next week. Talk about nervous?  I do NOT want to take a refresher course because of a stupid mistake. I'll tell you why I failed the second time so you can laugh...I did not remove the patients clothing! I checked for DCAP-BTLS and everything else during rapid and detailed assessment but never removed the clothing, just ran my hands down the body and palpated over the clothes. Why?  Because thats how I had been practicing, so it never even dawned on me that THIS patient was wearing break away clothing for a reason!


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## MissMedicCMO (Dec 27, 2009)

You don't know it well enough then.  I was able to go in there and just spit it off...from top to bottom without even thinking about it...Its all about memorization...over and over again..then just go in there and repeat it just like you would on your paper when you are practicing.  It doesn't matter what the scenario is..your always going to go through those same steps!


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## Trauma's Mistress (Dec 27, 2009)

yea I have to agree ... 

  The best  way to get thru  those practicals  is  talk,   talk   talk 
 Verbalize  everything that you do. and yes,  talk out loud. go in order  top to bottom and you wont miss anything.  Alot of  times  students  tend to  skip around and  then they forget something and  bam, they fail..   Also  it doesnt mater the situation  . its all the saame  stuff no matter what  .     my    teacher used to say to those who didnt know it ..  you need to know this stuff like  you know your name


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## Freddy_NYC (Dec 28, 2009)

Get a legal pad and write it out, over and over. You'll find you after a while you wont have to flip the pages cause you would have memorized it already. 

If writing is not your thing then get a pocket voice recorder and verbalize it to yourself. you can play it back and stop it when ever you want to test yourself. 

If you get nervous during your test then you probably need to practice on real people. Practice on a friend, work partner, or spouse. The more you do it the better you get. You will find that the Trauma Assessment is very progressive. one thing leads into the other  

Go to your state's Dept of health website, print out the trauma assessment testing pages for your Test figure out what are the critical failures. Just make sure you perform or verbalize those things.

Don't worry, everyone gets performance anxiety but the more you perform the better you get. 

Good luck


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

Yea  i hear  writing is  good for  some people
    also one of the best ways  to memorize something is do it right before your going to bed.  be awake  just enough to  read the material    soak it  in.  and  do this  till you  can say it  to yourself without looking at the  paper.
 then  stop  and go to bed  ( trust me)  

  Your brain is like a filing cabinet. it wants to file things away.  you going to bed. your brain is  like.. hey hey hey .. whats going on here !  i still have  thoughts !!!  I need file them away - guess where they go??  your memory bank !   You  will be saying trauma assessment in your sleep -- literally!     when you  wake up the next day   done be  discouraged  that  you cant remember all of it. let your brain  just  wake up a little.     refresh over the materials  just  lightly -- because if  you make one mistake in your  refreshing - you will remember the mistake  and not the  correct info. 

 Then  go  take your   practical. you will  amaze yourself   to how much your brain actually remembers.


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

also 

 my late mother used to have a saying
  Math is done the same way  each and every time. 

   The same  goes with the steps. same order  each and every time.    the scenario  might  change  their  might  be a ton of people  screaming at you,  blood everywhere,   guts   hanging out.  the  steps are done the same way  each and every time


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## writchey (Jan 7, 2010)

*Failed 3x..HOW I PASSED*

The key to this is that it is a* TRAUMA ASSEMENT NOT A MEDICAL ASSESSMENT.*  If you take to long and start doing a medical you will run out of time.  I had to redo all 12 so I feel for you..

I passed by keeping that fact in mind, load and go, and removing my patients clothing and verbalizer high flow O2 via NRB.  

Go into this station as if you really where on scene and the person in front of you is dying and you need to get going and remember THIS A TRAUMA NOT A MEDICAL ASSEMENT TO MANY DETAILS AND YOU RUN OUT OF TIME!!!


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## EMTinNEPA (Jan 8, 2010)

Disclaimer:  Here's how it's done in my area.  Check with your instructor.

Scene Safety, BSI, tell your pt not to move, c-spine, consent, evaluate ABCs, place the pt on supplemental oxygen at 15lpm via NRB.

Check the head for DCAP-BTLS.  Also check for cerebrospinal fluid coming fro the ears or bleeding from the ears, nose, or mouth.

Check the neck for DCAP-BTLS.  Also check for JVD and tracheal deviation.  Once the neck is clear, apply a c-collar.

Check the chest for DCAP-BTLS.  Also check for equal and symmetrical expansion, flail segments, and paradoxical movement.  Check lung sounds (doesn't matter if you hear rales, etc., just make sure they're present).

Check the abdomen for DCAP-BTLS.  Palpate for masses, distension, and rigidity.

Check the pelvis for DCAP-BTLS.

Check the lower extremities for DCAP-BTLS.  Assess PMS.

Check the upper extremities for DCAP-BTLS.  Assess PMS.  If you really want to impress your proctor, check for a positive Babinski sign.

When your roll the patient to place them on a backboard, quickly check the back of the head, the back, and the buttocks for DCAP-BTLS.  Also check lung sounds on the back.

If you have the luxury of a bystander, clear one of the patient's arms early so that your partner can pass c-spine off to said bystander and obtain vital signs while you complete your assessment.

Like writchey said, this is a _TRAUMA_ assessment, not a _MEDICAL_ assessment.  Don't get caught up in things like percussing the abdomen, you'll just waste your time.  It's called a RAPID trauma assessment.  Minute details are what you have a detailed physical exam and ongoing assessment for.

Best of luck.


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