abc's or cpine

[Shishkabob]

You started off good, ROP, then it went downhill. For the most part, paralysis is not an immediate life threat. Having no oxygen in your system is. Hypoxemia and hypoxia are not good things.


"Air goes in and out, blood goes round and round, any deviation is not good"--- cliche but true. First you secure the airway. At a basic level that could just be a jaw-thrust, or it could be an OPA / NPA / King-LT.

Next, you provide oxygen. Totally dependent on the pt. Could be 2lpm NC or 15lpm NRB or BVM.


Third, you correct any circulation problems. This could be providing compressions to a weak/absent pulse, or bandaging wounds.


Only after those 3 things (ABC) are done, should you, as a lone provider, even think about C-spine.




But that's for a lone provider. If there are 2 or more people there, there is absolutly no reason why all 4 things can't be done at the same time. Heck, A and B can be done in one quick swoop.

 

[R.O.P.]

Yes- I was assuming more than one rescuer.
Re: immediate life threats: this is what Brady's 2008 book reads (p246)-
"If you identify an obvious life threatening condition during the general impression phase as you begin to assess the patient, you must immediately treat it."
It goes on to list the various threats, ie open chest wounds, major bleeding, etc.
My understanding on the NREMT-B is that if you do not immediately address a life threat, when first encountered, you fail.

 

[Maya]

Oh man.. we're really gonna confuse this guy. For the sake of NREMT, assume that you're running a normal call. So, you have a partner. You're partner would hold c-spine. If you were on your own, they would tell you that.

If there were a huge arterial bleed, you would see it and that would be part of the question, but since it doesn't say that in the question, and instead offers " search for bleeding wounds," I would say definitely stick with c-spine.

That's the problem with NREMT, sometimes the questions are ambiguous. But part of choosing the *best* possible answer is assuming a *typical* situation unless other information is provided. If you start saying, "... well.. what if...," you're gonna screw yourself up." NREMT is not that hard, it's this ambiguity that's the hardest part. Now, you know what to expect. I hope we haven't confused you too much!

 

[mycrofft]

The gist of the question is about passing the test.

Memorize their answers and regurgitate.

Now, where did I put that article about airway restorations being delayed or hampered by C spine stabilizations?

OK, your patient is gushing blood, not breathing and his neck is at a funny angle after falling off a roof onto a, er , trashcan. You are alone. Keep it simple and remember what gets you first (anoxia), what you need first (which is help; start screaming "FIRE" and someone will look out their window), and what happened first (this pt sustained multiple fatal insults and is bloody well probably going to be dead in a couple minutes no matter what).

Learn the material and pass the test, and hope you don't run into one of those medical Alamo scenes for a while.

(PS: head tilt, two rapid rescue breaths, kneel on the bleed or rapidly tourniquet or compress dress it, go back to breathing and airway, all the while sceaming for help. Yelling "FIRE" will often get responses while "HELP THIS GUY HAS A CUT LEG, APNEA, AND I THINK HE BROKE HIS NECK" is less likely to. But don't quote me).

 

[Shishkabob]

When it comes to the NREMT skill, you have "2 partners equal to your certification" meaning 2 other EMT-Bs.

That is the time that you say "I would have one of my partners maintain C-spine precautions"


But it's still ABC in the assessment.

 

[indyingdays07]

When it comes to the NREMT skill, you have "2 partners equal to your certification" meaning 2 other EMT-Bs.

That is the time that you say "I would have one of my partners maintain C-spine precautions"


But it's still ABC in the assessment.

so c spine counts for A in the abc'c ? if you choose to hold c spine your automatically going to perform a jaw thrust ? there for moving on to breathing and circulation.. which with circulation if you see blood steadly flowing from a open laceration in the leg and the patient is breathing inadequatley then whats more important in that situation applying direct preassure to the bleeding because its an appairent life threat or bagging them because of their breathing

 

[Shishkabob]

No. The way the NREMT does it, you have to specify that you or someone will hold c-spine. Just because you do a jaw thrust does not mean you're holding c-spine.





As for the bleeding vs breathing-- what comes first. B or C? You secure the airway, you make sure they have adequate breathing THEN you worry about blood.

 

[Ridryder911]

Don't see the confusion. One can establish LOC with hand on head (holding the head for C-spine), Open the airway using MJT and ventilate if necessary. Quickly apply immobilization or have anyone hold the head and do a rapid trauma assessment. No where does it imply one would hemmorage control before assessing and tx the airway.

R/r 911

 

[exodus]

A.B.C.C...... Airway, Breathing, Circulation, C-Spine. In that order.
Deal with life threats as you find them.
If you are given a partner you direct your partner to maintain manual
C-spine while you continue to check ABC's and deal with life threats as you find them.
Remember to use jaw thrust to open an airway if trauma is suspected.

If you get a question like: trauma pt in MVA RR-12/shallow, skin pale, cool, clamy and pulse 120 and weak.
What to do first?
A) Manual C-spine
b) Head-tilt chin lift and BVM with 100% O2
C) Check for bleeding
D) High flow O2 with NBM at 15L/min

C! I choose C!

 

[trevor1189]

Lets keep it simple, for the sake of taking the exam. I agree that someone would put pressure on the wound, but for the sake of the exam, that comes at 'C.'

--And this is my disclaimer. I'm a *new* EMT, my first day on the job's Wednesday. However, I did just take the NREMT recently, so I remember how the questions were pretty well. People, feel free to correct me if I'm wrong!

First of all, I've never seen the term NBM. I'm assuming this stands for "nasal/ bag mask"?? But I would think it's supposed to be NPA -- "naso-pharyngeal airway", used in conjunction with a BVM -- "bag valve mask." Maybe I'm not familiar with other terminology. (?)

But, it only takes a minute to hold c-spine, and presumably you have a partner. In this case, if the patient has a potential spinal injury and you insert an NPA and start using a BVM, presumably you would have performed a jaw-thrust to open the airway first, which essentially happens at the same time as you hold c-spine.

SO:

(BSI/ is the scene safe? How many patients do I have? What is my general impression?...)

C-spine/ jawthrust -- done at same time (NOT head-tilt/ chin-lift, because there's trauma) -- That's A -- Airway (also, I guess includes the NPA)

BVM -- B --Breathing. DON'T ever forget to insert an NPA or OPA first -- try OPA first if the pt is unconscious. If the pt is gagging or conscious, use NPA.

Circulation/ Shock -- C -- apply pressure to a wound. For the sake of the exam, this is 3rd.

and so on, from there.


Also, although the respirations were 12, which is within normal range, they are shallow, so breathing is inadequate (also, pulse is thready, so pt is going into shock. Pale/ cool/ diaphoretic) -- that 's why you use NPA/ BVM instead of rebreather (was that even an option, I don't remember!)

One more thing -- read the questions CAREFULLY! If you miss one word, it could throw you off. For example, if it were a specified age -- child/infant -- you would have a different range for RR/HR/BP. They give you a board to write on. Work the problems out on the board if you have to. You can't go back and change your answers.

Don't sweat it, you're gonna do fine! You're on here, that shows initiative. If your asking questions, that tells me that you're an inquisitive learner, so don't stress yourself out too much about it. You get 3 tries, and it's not as bad as you might think.

Not saying this is a head trauma pt in the hypothetical scenario, but aren't NPAs contraindicated in head trauma? Just for clarification...

 

[DrankTheKoolaid]

re

Yes, NPA are contraindicated with a suspected head injury...

There is a reason the term ( distraction injury ) is taught in school. Anything that distracts you from first assessing and then maintaining the airway, breathing and circulation in any patient is simply a distraction that you just need to make a mental note on and address it after you have addressed ABC first.

 

[trevor1189]

Ok thanks. I thought so.

 

[MrBrown]

ABCs come before C spine, always, always, always. We complete our primary survey and don't consider spinal imobilization until the beginning of the secondary survey.

That said obviously it depends how you are paired; if you're working solo you would indeed have to do it after, but if you are fully crewed you can have your partner do ABCs while you do C spine.