# Need help with a question.



## ethomas9449 (Dec 11, 2009)

I payed money for a EMT-B Prep test to check my knowledge, I just had a question that I thought was very poorly worded and want to see if i was correct. 

A construction worker has fallen from a height of 10 feet. When you arrive, he is conscious, but confused about how the fall occurred. He tells you that he is having difficulty breathing and cannot feel his legs. What is the first priority in the initial assessment of this patient?

You chose: Open the airway.
The correct answer for this question is: Take spinal precautions.

I assumed that since C-spine precautions would be considered in the Scene-size up portion, and you would than work with the initial assessment of the ABC's. Maybe i'm wrong I just wanted to get some other opinions.


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## JPINFV (Dec 11, 2009)

What were all of the options?


However, I would definately choose spinal precautions over "open airway." For starters, if he's talking his airway is open.


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## Lifeguards For Life (Dec 11, 2009)

ethomas9449 said:


> I payed money for a EMT-B Prep test to check my knowledge, I just had a question that I thought was very poorly worded and want to see if i was correct.
> 
> A construction worker has fallen from a height of 10 feet. When you arrive, he is conscious, but confused about how the fall occurred. He tells you that he is having difficulty breathing and cannot feel his legs. What is the first priority in the initial assessment of this patient?
> 
> ...



why would you open the airway if he is talking to you?


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## Lifeguards For Life (Dec 11, 2009)

here is a copy of the exam coordinator documents from the NRMET website.

http://www.nremt.org/nremt/downloads/patientassessmentmanagementtrauma.pdf

as far as NREMT testing goes, do what the sheets say, in the order they tell you too do them


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## JPINFV (Dec 11, 2009)

That exam document isn't going to help for a written exam.


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## ethomas9449 (Dec 11, 2009)

A. Open the airway.
 B. Take spinal precautions.
 C. Obtain a blood presssure.
 D. Check for distal pulses, motor function, and sensation.

Where all of the options, I was just thinking that a fall of 15' is considered traumatic, I thought of it as a scenario that you would initially take c-spine due it being a consideration of the scene size-up, So I basically over looked it. Well thanks for the help!


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## Lifeguards For Life (Dec 11, 2009)

JPINFV said:


> That exam document isn't going to help for a written exam.



the exam document still shows the same order of steps they expect in a written evaluation


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## JPINFV (Dec 11, 2009)

A- Talking=grossly intact. 

C-not that far yet.

D- Not even close to being that far in an assessment yet.


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## ethomas9449 (Dec 11, 2009)

Yeah I feel like an idiot. ><


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## JPINFV (Dec 11, 2009)

Lifeguards For Life said:


> the exam document still shows the same order of steps they expect in a written evaluation



Taking that route, then it is a bad question since it specifically mentions "initial assessment." The bigger issue is that checklists like that are in no way applicable in real life. No one walks onto an emergency scene and says "BSI, scene safety..." In fact, most of the assessment and decision making is done subconsciously. In most cases, determining mechanism, ABC, LOC, c-spine, general impression, and initial transport decision (may change as more information comes in) is all going to occur in the span of less than 30 seconds. In fact, out of that list the only thing that can't be done as you approach the patient is c-spine. Sure, you might not have A/Ox4, but you can generally see if the patient is alert, combative, confused, talking, etc before you even introduce yourself.


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## ethomas9449 (Dec 11, 2009)

While I'm here this is the other one I missed 
Question #2 : After responding to a call for a respiratory arrest, you find the patient lying on the floor between her bed and the wall. You and your partner move her out into the middle of the room where there is space to work. This move is considered:

You chose: inappropriate without the use of a cervical collar and backboard.
The correct answer for this question is: an urgent move.

A. an urgent move.
B. a nonurgent move.
C. inappropriate without the use of a cervical collar and backboard.
D. foolish because of the potential for a back injury to the EMT-Bs.

I don't know if these are even close to what the NREMT offers, but if it is I need to stop over analyzing.


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## JPINFV (Dec 11, 2009)

ethomas9449 said:


> Yeah I feel like an idiot. ><



Trust me... I know that feeling. The "Dee dee dee" answers always costs me a few points on exams.


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## JPINFV (Dec 11, 2009)

Will a patient in respiratory arrest die without immediate intervention?


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## Lifeguards For Life (Dec 11, 2009)

ethomas9449 said:


> While I'm here this is the other one I missed
> Question #2 : After responding to a call for a respiratory arrest, you find the patient lying on the floor between her bed and the wall. You and your partner move her out into the middle of the room where there is space to work. This move is considered:
> 
> You chose: inappropriate without the use of a cervical collar and backboard.
> ...



if there is no space to ventilate this patient, then an urgent move is appropriate to get her into an area where you can properly work


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## ethomas9449 (Dec 11, 2009)

Yeah that makes sense now, better paralyzed then dead. Well thanks for the tips and help, gonna go over just CPR and take my NREMT tomorrow morning. I appreciate all the help guys!


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## Lifeguards For Life (Dec 11, 2009)

ethomas9449 said:


> Yeah that makes sense now, better paralyzed then dead.



"Life over limb"


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## medichopeful (Dec 12, 2009)

ethomas9449 said:


> A. Open the airway.
> B. Take spinal precautions.
> C. Obtain a blood presssure.
> D. Check for distal pulses, motor function, and sensation.
> ...



FYI, ANY fall is considered traumatic.  A fall of 15' may be considered a severe MOI.  If I remember correctly, I've heard that and 3x the patients height.  Either way, C-Spine comes first.


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## firetender (Dec 12, 2009)

ethomas9449 said:


> Yeah I feel like an idiot. ><



Sometimes you will. If the thread were "Who doesn't feel like an idiot sometimes?" it'd be blank.

The reality of the profession is in the real world, sometimes you do miss the obvious and sometimes the consequences are great. 

Make all the mistakes you can on paper, like you're doing. Then learn from them.


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## JPINFV (Dec 12, 2009)

firetender said:


> Sometimes you will. If the thread were "Who doesn't feel like an idiot sometimes?" it'd be blank.



See, I have the opposite problem. If the question was "Who doesn't not feel like an idiot sometimes?" My hand would be up.


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## Angel (Dec 12, 2009)

rationale is really important...what book are you using?
goodluck


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## EMTecBOB (Dec 13, 2009)

JPINFV said:


> Will a patient in respiratory arrest die without immediate intervention?




IMHO, you are responding to respiratory arrest. You do not know how long this person has been down. She is not breathing...no airway, no patient. A urgent move would be in order.


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## Lifeguards For Life (Dec 13, 2009)

medichopeful said:


> FYI, ANY fall is considered traumatic.  A fall of 15' may be considered a severe MOI.  If I remember correctly, I've heard that and 3x the patients height.  Either way, C-Spine comes first.



If they are not breathing, and you do not have room to ventilate them, move them with an urgent move


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## ethomas9449 (Dec 24, 2009)

Well guys I past the NREMT-B. I am very grateful for the help you provided and evaluated with me. Just wanted you guys to know you provided me with knowledge I did not understand and made me "not over look" the obvious with what I do from time to time. EMt-I here I come. But once again a very gratcious thanks and stay safe guys. I hope to meet you in the field and shake your hand. (with proper BSI). God speed ladys and gents.


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## tactics (Dec 24, 2009)

*ABCs*

Taking c-spine control can help you check the airway and you would knock out two birds with one stone.  However I do agree with other post that the subject is talking to you and that can determine the condition of the airway.  Also I agree that you should follow your NR competency sheets.  Taking c-spine will put you right at the airway so you could check it very easily.


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## tactics (Dec 24, 2009)

*Sorry*

I didn't continue with reading the thread and I posted a reply.  I apologize for the late information, but congradulations on passing.


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