# advice ?psychomotor/instructor conflicts



## kaisardog (Apr 24, 2013)

Our college  is  giving  us  some  practice  exams to  prepare  for our  practical  final  exams  and  then    upcoming  psychomotor NREMT later  this  summer. we  as  a  class  have  found  that  some  outside non -college examiners 'prefer' a  certain  method,  and 'critically  fail'  folks  who  don't  do 'their ' method. Example: we  are  taught    our  maximum  BVM  o 2 flow  is  15  lpm  EMT-basic, an outside  proctor  failed several  of  us stating  BVM  is  to  be  25 LPM  not   15. (25  is  ALS  LPM  ; state, 15  max is  BLS.) Examiner   fails  another  for  inserting  O/P  airway  with    tongue  depressor  and  180  rotation,  which  is the  precise  method  in  our textbook. (he  wanted  no  tongue  depressor , marked  its use   a  critical  fail.) Examiner  fails  another  for asking  secondary medical - history  and  OPQRST questions 'out of  order'  about  cardiac  pain during 'circulation'  part  of  A B C (while  giving hi  flo O2  to  remedy circulation/breathing increased  RR  and  HRs.)   (followed  by ordering  ALS/'possible  MI '  and   checking  whole SAMPLE/OPQRST list.)     since  we  get  immeidate feedback  on our  skill  stations,  we  hear  what  the  criteria  were.     some  of  us  are  feeling that  we  should  politely ' discuss'   --as  we  get  our  critical - fail  grades --why  our  intervention  was  different  from  the  proctor's,  and give  him /her evidence  of  why  we  are  in  compliance  with  our  training and textbook.  others  say  NO,   that  we  need  to deal  with  this  through having  our  our  own  instructors  at  the  college who  should  discuss  these issues.  Any  and  all  advice  is  most  appreciated;  we are  sick  at  heart  to  think  we  are  doing  things  the  way  our  book  says  only  to  have ' critical  fails' in  practice.  this  does  not  bode  well  for us  taking  NREMT psychomotor this  summer.. .  and  in fact  is  discouraging  some  of  us  from  even  trying  to  finish  the  college   course..  Please  can  some  of  you  with a  lot  more  experience  tell  us how  we  should  handle  these  issues?  :sad:


----------



## Household6 (Apr 24, 2013)

> Examiner fails another for inserting O/P airway with tongue depressor and 180 rotation, which is the precise method in our textbook.


Depressors should be used only for little peds, because you do zero rotation for an infant.. You don't use depressors on adults, what book is your class using?



> Examiner fails another for asking secondary medical - history and OPQRST questions 'out of order' about cardiac pain during 'circulation' part of A B C


There's a reason why there is a specific order. Do it that way.



> BVM is to be 25 LPM not 15


If your O2 regulator has a dial that goes up to 25, ad a tank that supports that flow rate, you have the wrong kind of regulator and tank for a BLS class.



> some of us are feeling that we should politely ' discuss' --as we get our critical - fail grades


Yes, you should. That's how you learn.. You don't have to argue, but you need to be on the same page..


----------



## kaisardog (Apr 24, 2013)

*more  info*

our  book  is Limmer, AAOS  11th  edition "emergency care" 11th  Ed.  p. 159: Ch. 6  Airway  Adjuncts..

".. position  the  airway  so  that  the tip is  pointing  toward the  roof  of  the  patient's  mouth..insert  and  slide  it  along  the  roof  of  the  mouth..  any  airway  insertion  is  made  easier  by  use  of a tongue  blade..  gently  rotate  the  airway  180  degrees.."

BVM we  were  taught  cannot  go  to  25  LPM  in our  state unless  we  are  A-EMTs (paramedics)  though  the  regulators  all  go to  25. in  our  skills  drills  cranking  regulator  to  25  was  a "Fail"  then  on  the  outside  examiner's  score  sheet  it  was  a  fail  for  not  cranking  to  25..

We  as  a  group  are  very  reluctant  to  question the  examiners  about  these  issues as  they  are  giving  us  our  practice  exams ,  since  we  know  our  college  has  a v ery  hard  time  getting  practitioners  who  are  EMT s  to serve  as  proctors. but  this  divide  between  what  we  are  being  taught  and  what  the  real  world  practitioners  want  us  to  do  to  pass  practice  skills   causes us  to  think  we are  doomed.

thanks  for  your  time  in  replying.


----------



## ThadeusJ (Apr 24, 2013)

When using a BVM, the reservoir collects the oxygen that is used on subsequent breaths.   The ability to deliver 100% oxygen is based on respiratory rate, tidal volume and peak inspiratory flow.  Any combination of those will affect gas delivery.  Therefore, when presented with a situation where those there parameters are not given, unless you are giving flows over and above what is necessary, one cannot give a simple LPM answer.  The classic answer for proper input flow to deliver 100% is "the flow that does not allow the reservoir to collapse in inhalation".  

Considering that this is basic resuscitation technique, to state one LPM for one provider and another LPM for others doesn't make a whole lotta sense.


----------



## STXmedic (Apr 24, 2013)

Household6 said:


> There's a reason why there is a specific order. Do it that way.


What's the reason for the specific order? Am I not allowed to ask about quality before I ask about provocation? Can I not then probe more in depth about family and social history after that?


----------



## Aprz (Apr 24, 2013)

PoeticInjustice said:


> What's the reason for the specific order? Am I not allowed to ask about quality before I ask about provocation? Can I not then probe more in depth about family and social history after that?


I don't think he's talking about asking OPQRST in order; he's talking about asking OPQRST during the initial assessment when assessing circulation in ABC.


----------



## NomadicMedic (Apr 24, 2013)

When you make patient contact, you need to ask "what's wrong". When the guy says "my chest hurts", say okay, I'll get back to that in a moment. Then finish your initial assessment, correct any immediate life threats (put on that EMT oxygen) and THEN start a focused exam with SAMPLE and OPQRST. 

Make sense?


----------



## Household6 (Apr 24, 2013)

Aprz said:


> I don't think he's talking about asking OPQRST in order; he's talking about asking OPQRST during the initial assessment when assessing circulation in ABC.



That was how I understood it..




PoeticInjustice said:


> What's the reason for the specific order? Am I not allowed to ask about quality before I ask about provocation? Can I not then probe more in depth about family and social history after that?



Well, just for the sake of discussion.. I'm not an instructor, but in a classroom scenario, *I* don't think they should be done out of OPQRST order.. I think that would be a bad habit for me to begin, and maybe it's just me, but I want to prevent every bad habit I can. Especially if I'm still in the classroom.  

Train as you fight. That's what I say.

OP, there is a 12th edition of that Limmer book out. Maybe you guys aren't "on the same page"? <---see what I did there?


----------



## PaddyWagon (Apr 24, 2013)

Aprz said:


> I don't think he's talking about asking OPQRST in order; he's talking about asking OPQRST during the initial assessment when assessing circulation in ABC.



Bingo.  This.


----------



## dlodest (May 12, 2013)

Bring it up with your program director or teacher. Had the same problem and when I told him about what happened, we were pulling traction for an open femur fracture, and while checking pedal pulses, I only stated pulses present, not pedal pulses present...so yea...needless to say my director didn't like proctor and definitely didn't like how he failed me. That's my advice, good luck, do your best to hear their reasoning and I guess just learn as many ways as possible so you're prepared for any proctor.


----------

