# NREMT Practical Trauma help



## RetroRocket (Aug 1, 2012)

I'm retaking my practical on Friday since the last one i took & passed expired. Had noooo idea they expired within a year but anyway. I noticed that the skill sheets are a bit new/updated.

I think i'm freaking out because I know the material but i get so nervous having to show my knowledge of the skills. 

for trauma: I start off with bsi, scene safety, number of patients, moi, additional resources, general impression, avpu, c spine stabilization, airway(jaw thrust&oropharyngeal airway), breathing(check for equal chest rise/fall) and put patient on 12 lpm via bvm, circulation(check carotid pulse), assess for any bleeding, 
then:
If the patient is unresponsive: Determine that the patient is high priority and load and go, in the ambulance i will begin the rapid assessment where i check the head(eyes, ears, nose, mouth, scalp), neck(trachea, jvd, cervical spine), chest(inspect and palpate, auscultate), abdomen(inspect/palpate all four quadrants), pelvis(inspect/palpate), verbalize genitalia, and check all extremities for pulse,motor, sensory, log roll the patient towards me and check the posterior for DCAP-BTLS. Vital signs, manage any secondary injuries such as fractures then reassess my patient every 5 mins. The end.

Now: If my patient is responsive
I would do the bsi, scene size up, a(jaw thrust)b(12lpm via nonrebreather)c(carotid pulse), obtain Sample, and determine the patient needs to be transported immediately but isn't a high priority patient
then i'll start a focused assessment based off of the patients chief complaint, will check vitals, and transport patient reassessing every 5 mins.

Am I missing anything when it comes to the Trauma assessment?


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## Doczilla (Aug 1, 2012)

How current is your EMT book? If its not that old, try looking in the back. Mine (2003, mind you) had NREMT checklists for all that stuff.


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## RetroRocket (Aug 1, 2012)

*NREMT Practical Medical help*

The medical assessment I feel I need to freestyle on a little bit. Only because I believe it is virtually impossible to remember each and every different OPQRST approach for each illness. It ultimately confuses the hell out of me. 

So, I keep praying I get a respiratory emergency scenario again.

I start off with BSI, scene safety, how many patients, NOI, additional resources, general impression, avpu( patient is alert and responsive if they are able to communicate with me), then my abc's Airway-the patient has an open airway if they are speaking with me, breathing- patient may not be breathing adequately so i result to putting them on 12 lpm via nonrebreather, circulation- i check my patients pulse and assess for any bleeding, decide that the patient should be transported immediately, then start OPQRST- Onset, Provokes, Quality, Radiates, Severity, Time, then Sample history, Assessment of affected body system??, Vital signs, my field impression of the patient, then treatment chosen(albuterol, nitro, epi pen, aspirin, activated charcoal) & the six rights- right patient, right med, right route, right dose, right date, right time then Ask how the patient feels afterwards, transport and reassess every 15 mins.

Am i missing anything?
Can anyone help me with the break down of adverse side effects for medicine that EMT B's use?


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## RetroRocket (Aug 1, 2012)

Mine is from 2010, the "EMT Prehospital care", At the end of each chapter it has pictures of people conducting the skills that relate to each chapter. Hmmm, thank you..maybe I can study up on these too. I suppose that will definitely help with long bone, or joint immobilization techniques(praying i don't get those for my random skill portion) ^_^


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## DesertMedic66 (Aug 1, 2012)

Here are the answers to the trauma assessment and what needs to be done:

https://www.nremt.org/nremt/downloads/EMT Patient Assessment Management - Trauma.pdf


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## Tigger (Aug 1, 2012)

I hope you are not using a BVM on every patient just because they are unresponsive, right?


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## PVC (Aug 1, 2012)

Find a volunteer to practice the skill sheet on. Visualization of the process was always helpful to me. Get someone to watch so you can teach the as you go. Watch videos of someone else during the practical execution of the skill sheet. When you involve all areas of your brain in learning it is more lasting. See it, do it, teach it and your confidence will grow.

I practiced on my dog. It learned to roll over so I could check its airway. It is still a hoot to watch.


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## RetroRocket (Aug 1, 2012)

Tigger said:


> I hope you are not using a BVM on every patient just because they are unresponsive, right?



No not always but, for this I think it was the proper device to use. What would you suggest?


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## RetroRocket (Aug 1, 2012)

firefite said:


> Here are the answers to the trauma assessment and what needs to be done:
> 
> https://www.nremt.org/nremt/downloads/EMT Patient Assessment Management - Trauma.pdf



Lol, I'm already using this. Thanks though.


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## RetroRocket (Aug 1, 2012)

PVC said:


> Find a volunteer to practice the skill sheet on. Visualization of the process was always helpful to me. Get someone to watch so you can teach the as you go. Watch videos of someone else during the practical execution of the skill sheet. When you involve all areas of your brain in learning it is more lasting. See it, do it, teach it and your confidence will grow.
> 
> I practiced on my dog. It learned to roll over so I could check its airway. It is still a hoot to watch.




Ooh thank you soo much, lol. I plan on practicing on my dog when I get home.


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## PVC (Aug 1, 2012)

RetroRocket said:


> Ooh thank you soo much, lol. I plan on practicing on my dog when I get home.



Have fun! Little brothers are good little dummies as well. Get it? Little dummies? Oh,never mind! 

I do hope it is helpful to you.


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## Nathan (Aug 1, 2012)

You do realize to pass the practicals all you have to do is hit everything on the sheet, right? I mean on mine I never touched the dummy. I just verbalized everything and asked questions. Spend an hour studying the sheet and memorize the critical fails, because as long as you don't hit them you will pass. Oh. Don't forget oxygen, got half way through the medical and then smiled when I realized I dun goofed.


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## PVC (Aug 1, 2012)

Touch the dummy, chuckle, chuckle.


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## Handsome Robb (Aug 1, 2012)

It's really frustrating from a proctoring standpoint when students don't touch the mannequin. 

We were required to take our own first bp and pulse manually during my intermediate and medic along with having to expose the patient to find moulaged injuries. 

It doesn't show you know how to do a rapid head to toe if you just talk your way through it. I'm not saying it's wrong, it's a common problem that people being tested don't get "hands on". 

We use volunteers for our testing so it's a real human. This is a touchy feely job, you have to get used to it. 

Study your NREMT sheet and you'll be fine. If you understand why you are doing what you are doing rather than just memorizing the sheet it makes it a whole lot easier.


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## bigbaldguy (Aug 1, 2012)

Remember to go slow. You have lots of time and most mistakes come from rushing. At the end reassess everything.

Good luck you'll do fine.


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## Tigger (Aug 2, 2012)

RetroRocket said:


> No not always but, for this I think it was the proper device to use. What would you suggest?



Without assessing the patient's respiratory status I would have no idea. When is it appropriate to use a non-rebreather and when would a BVM be a better choice?


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## Nathan (Aug 2, 2012)

Slow is smooth, smooth is fast, unless you're over the ten minute time limit, then you're screwed.


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## nwhitney (Aug 7, 2012)

RetroRocket said:


> The medical assessment I feel I need to freestyle on a little bit. Only because I believe it is virtually impossible to remember each and every different OPQRST approach for each illness. It ultimately confuses the hell out of me.
> 
> So, I keep praying I get a respiratory emergency scenario again.
> 
> ...



You forgot to consider c-spine, field impression and report.  You may not be reassessing every 15.  If your PT is unstable then it's every 5.  

I don't approach OPQRST differently for each illness.  I'm using OPQRST to help narrow things down a bit more for me so I can get to the cause.  I may not be able to treat the cause and only treat the symptoms and that's OK but the more information I can pass along to the medics, nurses and doctors the better.


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## nwhitney (Aug 7, 2012)

NVRob said:


> It's really frustrating from a proctoring standpoint when students don't touch the mannequin.
> 
> We were required to take our own first bp and pulse manually during my intermediate and medic along with having to expose the patient to find moulaged injuries.
> 
> ...



We also use volunteers as PT's for both medical and trauma.  I would have a hard time not marking the "Competent EMT" critical criteria if the candidate didn't touch the PT.


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## nwhitney (Aug 7, 2012)

RetroRocket said:


> I'm retaking my practical on Friday since the last one i took & passed expired. Had noooo idea they expired within a year but anyway. I noticed that the skill sheets are a bit new/updated.
> 
> I think i'm freaking out because I know the material but i get so nervous having to show my knowledge of the skills.
> 
> ...



Treat for shock!!!!!!  Just realized you already retook your test.  Hope you passed.


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## RetroRocket (Aug 7, 2012)

Heyy! Yeah I have to retake my trauma assessment because my partner who was team leader forgot to assess the front of the skull & I didn't tell him. :glare:


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## RetroRocket (Aug 7, 2012)

Lol I passed the medical assessment!


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## MMiz (Aug 7, 2012)

Merged threads.


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