skills testing -- feedback

B

Bubbles

Forum Probie
Messages
11
Reaction score
0
Points
1
I failed skills -- medical --

Appreciate any feedback.

Below is what I did as best as I can remember.

Scenario: 67 y/o male with chest pain, may have had pain in arm, but I can't remember

BSI
scene safety
NOI
# pts
ALS
c-spine not needed
-------------
hello my name is ...
AVPU
pt A/O x3

"why did you call"
pt answers
"pts cc is chest pain. Airway is open bc pt is talking"
apply NRB @ 15LPM
check skin, color, temp, condition (given by examiner)
scan body for bleeding
cover pt to treat for shock & dignity purposes
high transport decision

OPQRST
walking in park, can't remember if there was pain anywhere else, pain was a 6, happend 10 mins ago, took 1 nitro
SAMPLE
pt does takes nitro, but hasn't taken any today, or maybe he took one

listen to lungs -- mid clav x2, mid ax x2
DID NOT PALPATE CHEST FOR DCAP-BTLS OR CHECK JVD OR ANKLE EDEMA

vitals - Used live pt -- BP, skin, respiration, I DID NOT STATE O2 SATURATION

will contact med control for permission to intervene & transport immediately.
permission granted

systolic above 100, told pt how to take nitro, 5 right plus expiration, administered nitro

DID NOT STATE CONTRAINDICATIONS OR ASK PT IF HE WAS TAKING ED MEDS

DID NOT STATE SIDE EFFECTS

stated reassessment: 2 mins after intervention and every 5 minute. Repeat all vitals, repeat primary & secondary assessment
I DID NOT STATE THAT I WOULD REASSESS PRIMARY COMPLAINT

Did my PCR

Now that I'm writing this all out. I did repeat the vitals that I actually took as well as the vitals the examiner gave me.
 
Well I only saw a few things wrong with it. First off I didn't see where he said he had trouble breathing and AHA has been making a big deal lately about giving O2 to CP pt's that don't complain of trouble breathing. You never said if this was Basic or Advanced EMT testing, if it is advanced they would want an IV if its basic then you can't do that. You didn't ask if he took anything like Viagra before you gave the Nitro and they will want you to do that. Everything else seems right.

The only fail criteria that I see would be if you didn't give a full report to ALS when they arrived I had a few class mates fail because of that.

Hope this helps a little, and good luck next time.
 
Where you certainly failed was in not asking about any current meds or state any specific contraindications to YOU giving the nitro. You also didn't note any JVD or pedal edema. That's an assessment thing you should do on every patient anyway. If you're going to do a full head to toe, you look for that stuff too. If you're getting vitals and you can do SpO2, you take that reading. Try to get a baseline/room-air reading first. It's possible that if it's >94% you don't give any supplemental O2. You didn't appear to have asked for difficulty/trouble breathing, nor which came first. That may be important down the road.

I also don't see any response to allergies, last oral intake, and any current meds.

While in real life you'd reassess the chief complaint, you have to verbalize that for testing purposes so the examiner knows/follows your train of thought.

There's a few things I'd do differently than you did, but I'm not exactly sure of the sequence you did them and I don't have a skill sheet in front of me to compare that to, so I'll have to get back to that later.

Probably the biggest thing that led to failing is failure to verbalize everything. It's not a natural thing to do and I sure as heck don't do it... unless I'm in a testing environment. Find yourself a test sheet and go back over it and verbalize going through the entire station again and do it over and over again. Your next "medical" won't likely be a chest pain... so don't focus on just doing that type of scenario.
 
I am testing for EMT-B

I have been practicing different scenarios with classmates and I can see where I went wrong. I was a bundle of nerves when I did it, but I'm becoming more confident now.

I did do a complete SAMPLE, but I didn't write it all out here.

Realized in our school that we don't do SpO2

GAstudent: the PCR is when I handoff to ALS.

Thanks for your input. Gonna nail it next time.
 
Practice.
Practice.
practicepracticepracticepracticepracticepractice
 
I had a cardiac for my skills too :)
What I said differently from you was I never applied o2. I said I considered o2 therapy. Even though we didn't have a pulse ox during testing , I asked level and evaluator just gave a number. , I believe she said 95. I explained I wouldn't apply o2 on that patient unless the o2 SATs were lower or patient felt severe distress.

Dcap-btls
Never use It myself. However it is more for trauma related calls.
Did you give aspirin? Is that allowed there?
Once you went high priority, they like to see you get a bp, ask about Viagra, tell them you will assist in nitro up to three total checking bp each time.
Load, it was high priority, and get rest of history and vitals. Tell them you will intercept als enroute .
I like to ask how far out from hospital

Just remember, they are looking down at the sheet and don't always see it. Verbalize everything!
 
You must log in or register to reply here.
Back
Top