Taking practical tomorrow!

[DJRedNight]

I'm taking the practical tomorrow for my EMT. One of my WORST stations was trauma in the review... i wrote this ALL down by memory. did i miss something?

Trauma Scenario: BSI, Scene Safe?, MOI/NOI, # of pt., ALS on Standyby, Consider C-Spine. Now moving on to the patient. Form a general impression. Poor or Stable. Patient is poor. Now assess AVPU. patient is COAx0. Now do a gross blood sweep. Nothing found. Check Airway by opening mouth, nothing found. Apply 15L/min NRB. Check Breathing, nothing found. Check circulation in carotid, and radial pulses, nothing found. Now a rapid trauma assessment. You will cut off all your patients clothing and cover and un cover them as needed. Check the head for DCAPP-BTLS (Deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations, and swelling). Nothing noted. Check the neck for DCAPP-BTLS as well as step offs in C1 through c7. Also noting any JVD or TD. Next apply a C-Collar. Move down to the chest and palpate using the y formation midclavicular forming the intersection right in between the 3rd and 4th intercostal space and going down to the xiphoid process. After that place both hands on sides of patients rib cage and press inwards. Nothing noted. Move down to the abdomen. Palpate using both hands overlapping each other and in a wave motion once in all four regions. Note for any distension, rigidity, or masses. Also note if patient is responsive to this. Nothing noted, moving onward. If patient is CAO > 1 then ask if the pelvic region hurts. if yes dont touch it. If not palpate by applying firm pressure on both sides of the pelvic bone and pressing inwards and upwards at the same time. Nothing noted. Check genitalia if needed. (Please note during all phases of your rapid trauma assessment we are looking for DCAPP-BTLS as well if i forgot to mention if before moving on to a different area of the body). Next we go to the legs. Doesn't matter which one is first. Check for DCAPP-BTLS, Pedial Edema, PMS, and foot skin color in both legs. Ask patient if CAO > 0 if they can feel you touching them, and if they can wiggle their toes. Nothing noted. Next is the arms. DCAPP-BTLS on the arms, then check PMS in both arms. Nothing noted. If there WAS anything noted it would have been taken care of if the injury was either life threatening or was obstructing the airway. Now board em and go. Make sure that you are maintaining C-Spine precautions at all times INCLUDING WHILE putting the CID's on the head. Now in the ambulance try and get a focused physical exam which includes everything from the rapid trauma exam but in more detail. Check ears for spinal fluid, check eyes for PERRL, check nose for obstructions. Check chest, and abdomen and further. etc etc. Obtain a SAMPLE history, OPQRST, and see if anyone in the general area is family first. then bystanders.

Do this all in 10 minutes. kgo.

Anything? Sorry for all the sloppiness... Anybody able to get back to me tonight? I'm about to go to bed. I've been awake for over 36 hours... i'll be up for about another half hour.

 

[nwhitney]

Ignore this post. I can't figure out how to delete it.

 

[nwhitney]

"Apply 15L/min NRB. Check Breathing"

Swap that. No good putting a NRB on if your pt. isn't breathing.

Once you finish your Circulation then treat for shock. This can be as easy as saying "I would now treat for shock by keeping the pt. warm/covered, O2 therapy whatever that may be and would normally elevate the legs but will not due to a possible spinal injury.

Before you board your pt. and while they are log rolled (assuming a stable pelvic) do a detailed of the back (lumbar/thoracic) DCAP-BTLS/step offs. If an unstable pelvic using a scoop to transfer the pt. to board while on scoop detail of the back and then when on board pelvic wrap.

Also when doing your detailed in the ambulance check raccoon eyes and check for battle signs and treat secondary injuries.

Don't forget your vitals every 5min for an unstable pt and every 15 if stable.

I'm sure someone will chime in if I missed something. Good luck.

 

[firemedic0227]

Go straight off the sheet line for line.
BSI
Scene Safety
MOI/NOI
# of Patients
Additional Help
C-Spine Considerations
General Impression of the Pt.
AVPU
Chief Compliant
Airway/Breathing
-Patent/Open/Clear
-Respiration's and Quality
-Suction If needed
Circulation
-Major Bleeding
-Skin Color Temp and Condition
-Shock Treatment (if Needed and always Voice it)
Apply C-Colar and Backboard (checking back for DCAP-BTLS)
Transport Decision
History (OPQRST and SAMPLE)
Vital Signs
Chose Correct Physical Exam (Quick or Detailed)
Head Checking for DCAP-BTLS (Entire Head and Face)
-Looking for Fluids in ears mouth and Nose
-Open Airway (Still Patent)
-Checking Eyes (PEARRL)
JVD/Trachial Deviation
Chest looking for Crepitation
Abdoment (Palpate all 4 regions)
Pelvis
Genitals
Legs
-DCAP-BTLS
-Checking Pedal Pulses
-CSM
Arm
-DCAP-BTLS
-Radial Pulses
-CSM
Initial Assessment again
Ongoing Assessment

 

[phideux]

If you checked both the breathing and the pulses with "nothing found", you should have stopped your assessments right there and started CPR.

 

[medichopeful]

Once you finish your Circulation then treat for shock. This can be as easy as saying "I would now treat for shock by keeping the pt. warm/covered, O2 therapy whatever that may be and would normally elevate the legs but will not due to a possible spinal injury.

In the class I help teach, they're not treating for shock with Trendelenburg anymore. Not sure how the OP learned it, but something to keep in mind!

 

[DJRedNight]

Yes we did not learn to treat for shock and use the shock position. However....

I PASSED MY PRACTICAL!!!!

I'm happy. enuf said. lol

 

[nwhitney]

Yes we did not learn to treat for shock and use the shock position. However....

I PASSED MY PRACTICAL!!!!

I'm happy. enuf said. lol

Congrats!!

 

[DesertMedic66]

If you checked both the breathing and the pulses with "nothing found", you should have stopped your assessments right there and started CPR.

Glad I wasn't the only one who saw that lol.

 

[DJRedNight]

lawl my bad... yea... nothing found as in nothing MAJOR found as in NO pulses... idk.. my mind was shot... i'm still shot from that... :/ the written is tomorrow... I'm even more nervous. i hate written tests.