# Some Questions about trauma and KED: EMT B



## JohnH (Jun 13, 2011)

Hello

I am retaking trauma and KED on Wednesday. Since I was not allowed to take the practical again at the place where I took my classes, I registered at another location not to far away. Today they hosted a practice session which I attended. My first question is about the KED station. My last EMS educator always told us to pad the void in the back of the head. Today the new EMS instructor at the practice session told us that we could instruct the assistant EMT to lean against the back of the KED were it wraps around the head while we bring the patient back down after the KED is positioned behind. He said that it is totally acceptable and eliminates the need to pad behind the head because by doing this the back of the KED is right up against the head. What do you all think? If I did that on the exam would that be acceptable? My last emt instructor always said to pad and pad and pad and was very strict on that. Would this fly in the practical? 

Now for trauma: Is it needed to voice an insertion of an OPA? no one ever said anything about this is my previous class and this came to my mind right now. How would one treat a flailed chest segment with paradoxical breathing if the patient is unconscious? There is no way to treat a distended abdomen, you just note that correct? If a patient had an opened femur fracture with capillary bleeding, I would just cover that with a sterile dressing and apply NO pressure? no splint is needed since he is immobilized to a backboard?

Thanks for any help.


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## medicdan (Jun 13, 2011)

What state are you from? Are you taking a state exam or NREMT stations? That will help us answer your questions.


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## JohnH (Jun 13, 2011)

Yes, I should have mentioned that. I am taking the exam in Connecticut and it is the state NREMT-B Practical exam. I will only be taking trauma and KED since on my first attempt I failed those two stations but passed the other four.


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## Chief Complaint (Jun 14, 2011)

JohnH said:


> Hello
> 
> My last EMS educator always told us to pad the void in the back of the head. Today the new EMS instructor at the practice session told us that we could instruct the assistant EMT to lean against the back of the KED were it wraps around the head while we bring the patient back down after the KED is positioned behind. He said that it is totally acceptable and eliminates the need to pad behind the head because by doing this the back of the KED is right up against the head. What do you all think? If I did that on the exam would that be acceptable? My last emt instructor always said to pad and pad and pad and was very strict on that. Would this fly in the practical?
> 
> ...



For the KED station, only pad the void if its necessary.  Your "patient" on exam day may or may not need to padded, ive never heard of it being acceptable for your partner to lean against the KED in order to achieve immoblization.  When your partner stops leaning, the patient's head may not be in line anymore.  The pad is in the kit for a reason, pad if they require it.

As for the trauma station, verbalize the insertion of an OPA if its needed (snoring respirations, a non patent airway, etc.)  If they are breathing adequately there isnt a need for a basic airway.  Most trauma station scenarios will require an airway adjunct in my experience though.  

Treatment for a flail chest consists of a bulky dressing over the segment, taped on both sides.  For a distended abdomen, just note it, there isnt much you can do in terms of treatment.

For an open femur fracture you are correct.  Cover the wound with a sterile dressing and use the spider straps to immoblize the leg.  If you apply a traction splint or use manual traction, you will increase the risk of infection by placing the exposed bone back into place.  Once the femur has been exposed its not a good idea to "pull" it back into the leg, infection is a very dangerous thing.


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## cwmedic (Jun 14, 2011)

As for the question regarding testing, there is no reason you shouldn't have seen the NR testing sheets by now. Do what those say. The end.


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## JohnH (Jun 16, 2011)

Ok so I took the state practical. I beat up tramua, I feel I did well on it. On KED I felt very confident that I passed but on the way home I started  thinking about it and I cant remember if I locked the c collar into place ( its an adjustable one). Im pretty sure I did but if I didnt is that a critical failure? If I fail just one station I can go to my ems imstructor and reveiw it and it would count as a pass?


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## Chief Complaint (Jun 16, 2011)

JohnH said:


> Ok so I took the state practical. I beat up tramua, I feel I did well on it. On KED I felt very confident that I passed but on the way home I started  thinking about it and I cant remember if I locked the c collar into place *( its an adjustable one)*. Im pretty sure I did but if I didnt is that a critical failure? If I fail just one station I can go to my ems imstructor and reveiw it and it would count as a pass?



Ive never seen one that isnt adjustable, can you post a pic of the one you are talking about?

That _could_ be seen as a fail criteria, although it may have been tough for your tester to see.  Its hard to say though since i have no clue what kind of collar you are talking about.


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## JohnH (Jun 22, 2011)

Just to update this, I got my practical results back and I passed. I have another question though, in order to pass the NREMT CBT, the candidate has to get an 80% or higher on the test?


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## bajamedic (Jul 7, 2011)

*Never seen  KED used in 22 years on the JOB*

Not here in So-Cal anyway.


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## TransportJockey (Jul 7, 2011)

Used one twice in the last month... Never used one in a car though.


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