Technical question on trauma and med assessments (skills testing today, help!)

Deganveran

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I've been studying for a week for my EMR class and I thought I had everything down but now I am confused by some of the youtube vids I have been seeing and I want to be sure I am doing things right.

For Trauma: Do you still do SAMPLE and OPQRST?

For Medical: Do you still do DCAP-BTLS?

Thanks for the help.
 

CountryEMT-bGurl

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I've been studying for a week for my EMR class and I thought I had everything down but now I am confused by some of the youtube vids I have been seeing and I want to be sure I am doing things right.

For Trauma: Do you still do SAMPLE and OPQRST?

For Medical: Do you still do DCAP-BTLS?

Thanks for the help.

I think you have those mixed up!
You always want to try and do a sample on both Medical & Trauma.
If you can not on Tramua;

TRAUMA-DCAP-BTLS

MEDICAL-OPQRST!

Hope this helps. If anyone wants to add to that, or correct me please do!


Also for Medical I learned to do your OPQRST inside of your sample instead of after.
Example:S (opqrst) AMPLE!
 
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kai.kasin

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prob. stupid question but DCAP-BTLS is a shortcut for?
 
OP
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Deganveran

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Deformiies/Drainage
Contusions
Abrasions
Punctures/Penetrations
Burns
Tenderness
Lacerations
Swelling
Instability
Crepitus

Thanks a lot countryemt-bgurl, that was what I was thinking till some misinformation made me doubt myself.
 
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kai.kasin

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Great, tnx :) something i can take with me :) dosnt have those "letters" here :) AMLS is probably the same as yours, with SAMPLE and OPQRS ,but for trauma its just ABCDE
 

JPINFV

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You should do OPQRST for every chief complaint to the amount that it is applicable. This is a large part of your "history of present illiness." Similarly, SAMPLE should be taken on every patient. I'm actually tempted to look through Bates tongiht when I get home and see if SAMPLE is even mentioned.

DCAPBTLS is useless.
 

Shishkabob

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You can do OPQRST for trauma AND medical, as to give yourself a better picture of what's going on.

SAMPLE should be used on everyone, always.


DCAP-BTLS isn't really done in the real world, as it's more to help basic students know what they're looking for, but in reality you'll notice if someone seems wrong.






Don't get trapped in to thinking OPQRST is only medical. It's not. If someone complains of calf pain (Medical and traumatic in nature) you can go through the whole OPQRST to help get to a differential.
 
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Deganveran

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You should do OPQRST for every chief complaint to the amount that it is applicable. This is a large part of your "history of present illiness." Similarly, SAMPLE should be taken on every patient. I'm actually tempted to look through Bates tongiht when I get home and see if SAMPLE is even mentioned.

DCAPBTLS is useless.

For Los Angeles EMR cirriculum DCAP-BTLS is a mandatory skill. What do you mean I should do OPQRST for every chief complaint? What if its insignificant trauma (low grade abrasions, sprained ankle, etc)?
 

EMSLaw

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For Los Angeles EMR cirriculum DCAP-BTLS is a mandatory skill. What do you mean I should do OPQRST for every chief complaint? What if its insignificant trauma (low grade abrasions, sprained ankle, etc)?

If the patient is complaining of pain, then you're going to go through OPQRST to "unpack" the blanket statement "my X hurts". That could be trauma or medical, depending on MOI/NOI.

And remember, sometimes medical problems mask trauma and vice versa. If the patient is in a car accident, and complaining of chest pain, you probably want to ask when the pain started (and then follow up with PQRST) - did he hurt his chest in the accident, or did he have the accident because of an AMI?
 

JPINFV

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Why not do OPQRST on a sprained ankle? What caused it (O)? What makes it worse? What makes it better? (P) Sharp pain? Dull pain? Ache? (Q) Region (ok.. given). How bad is it? Scale of 0-10? (S) When did it happen? (T) These all should be components of your history of present illness.

As far as DCAPBTLS, first off it's not a skill. It's a memory aid. Ok... arguable all mnemonics are. However the information contained in DCAPBTLS isn't really hard to remember provided that you (generic "you") aren't trying to overcomplicate things. DCAP-BTLS can essentially be distilled down to "If it's not normal, document it." You shouldn't need a prompt to know that you need to look for bleeding or deformaties.
 

EMSLaw

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You shouldn't need a prompt to know that you need to look for bleeding or deformaties.

I have to agree. You don't need EMT training to realize that you should "Put the white stuff on the red stuff." and "Wow, he's not supposed to have an extra elbow there."
 

CountryEMT-bGurl

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For Los Angeles EMR cirriculum DCAP-BTLS is a mandatory skill. What do you mean I should do OPQRST for every chief complaint? What if its insignificant trauma (low grade abrasions, sprained ankle, etc)?

Ya for TESTING purposes,
They want to see you do SAMPLE on both Medical and Trauma. And Of coarse if you can do a SAMPLE on a Trauma pt. then add your S (opqrst) AMPLE, then your DCAP-BTLS. Trauma/Medical you want to treat ALL life threats 1ST!!! Then if you have time in Route you can do your OPQRST for trauma.
So you would just say (when testing on Trauma if your pt. isnt alert and oriented) is there any family members or close friends who can give me a SAMPLE on my pt. If they say NO, then move on.



From NREMT skills sheet.

FOCUSED HISTORY AND PHYSICAL EXAMINATION/RAPID ASSESSMENT
Selects appropriate assessment (focused or rapid assessment)
Obtains, or directs assistance to obtain, baseline vital signs
Obtains S.A.M.P.L.E. history
If Rapid, you are going to another quick head to toe running your hands down each exterminty checking for DCAP-BTLS and Blood then load an go. Do your focused in Route)

DETAILED PHYSICAL EXAMINATION
Inspects and palpates the scalp and ears
Assesses the head Assesses the eyes
Assesses the facial areas including oral and nasal areas
Inspects and palpates the neck
Assesses the neck Assesses for JVD
Assesses for tracheal deviation
Inspects
Assesses the chest Palpates
Auscultates
Assesses the abdomen
Assesses the abdomen/pelvis Assesses the pelvis
Verbalizes assessment of genitalia/perineum as needed
1 point for each extremity
Assesses the extremities includes inspection, palpation, assessment of motor,
sensory and circulatory function
Assesses the posterior Assesses thorax
Assesses lumbar
Manages secondary injuries and wounds appropriately
1 point for appropriate management of the secondary injury/wound
Verbalizes re-assessment of the vital signs
 
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medichopeful

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Do a SAMPLE history and OPQRST on both trauma patients AND medical patients, if possible.

Look for DCAP-BTLS on any patient, if indicated. It doesn't matter if they're a trauma patient or a medical patient.
 

medic93

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Trauma Assesment VS Medical Assessment

Basically the main difference between trauma assessment and medical assessment is a lot more simple than you think. Take your practical skills sheets and set them next to each other.
Notice that your scene size up and initial assessment are exactly the same on both sheets at least till you get to the line where you make your transport decision. That is where the differences begin. Trauma assessment focuses more on the head to toe examination and less on the SAMPLE history. Whereas Medical assessment focuses less on the head to toe exam and more on the sample history. OPQRST are the question you ask to obtain the signs and symptoms which is the first step in your sample history.

The Skills sheets i am referring to are the sheets from the NREMT curriculim.
 

JPINFV

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OPQRST are the question you ask to obtain the signs and symptoms which is the first step in your sample history.

OPQRST are the points needed to investigate the various complaints, not elicit signs and symptoms.
 

zmedic

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EMSLaw; said:
I have to agree. You don't need EMT training to realize that you should "Put the white stuff on the red stuff." and "Wow, he's not supposed to have an extra elbow there."

The reason we have training is so that we can do these pretty simple things in crazy situations where everyone else is freaking out. Yes, most people should be able to figure out that a broken arm should be stabilized some way, if they had the time to think. But it's amazing how the simple stuff can fly out the window on the side of the highway, at night, in the rain, with freaking out family members standing by. That's why we have the class and do the training.

We used to rely on common sense and whoever had a car get the patient to the hospital, and there were a lot of uneeded deaths.
 

JPINFV

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I spend more time thinking about what the definition of DCABTLS is than looking for the signs that make up DCAPBTLS.
 

Trauma's Mistress

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SAMPLE OPQRST should be done on both Medical and Trauma assessments if possible.

The trick to trauma is i like to call. See Treat ask and Go.
See something - fix it !
Ask sample and opqrst while you are loading and going.

Medical is all about Sample and opqrst questions. the worst thing to do is assume anything. ask ask ask. Thats my trick for medicals.

I help teach and my instructor did this to a group of "know it all" group
She did the scenaro and she told them " you are called to a scene where the daughter (me) thinks that Mom (teacher) had a stroke.

They all focused on stroke and didnt ask any pertinent sample opqrst to me, the teacher was pretending to have a severe stroke , lethargic ,non verbal etc. Which if you take out that you being the emt being told " thinks she had a stroke" You would also think about a diabetic emergency. Because me being the family member - what do I know. i thought it was a stroke.

well, she got them all and it was a fun thing, to really knock them down a peg and really understand how crucial getting any and all information is HUGE in this stuff. The line i had was " I dont know what happened, I just came home and I found her like this, I think she had a stroke" and no one asked if she ate anything recently, they wree all like -- load and go load and go. Which if they asked the proper questions it could also have led to -did she eat anything today at all? does she take any medications ? ( the answer would have been, yes takes insulin.) Does she have any past medical history thats pertinent , ( why yes, emt, she does - shes diabetic ! lol ) does she by chance have diabetes? They were all like OHH Diabetic shock !

The lesson, ask anything you think might help, because some times a stroke isnt a stroke. just a weak diabetic patient. :)
 

juxtin1987

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Another hint for testing purposes is you cannot ask a wrong question the only mistake you can make is failing to ask an important question.

OPQRST, DODAEISF, HDIII, SWHOIE, HWHEPI etc.

That's hallarious about the diabetic shock scenario, i would've laughed my *** off at someone failing that. We did a scenario for extrication where we staged a 2 car collision in a parking lot with multiple victims, one of which was a bystander pinned between the two vehicles, which of course our fake IC removed first, but the funny (or not so funny depending on interpretation) part was that there was an empty carseat under the front end of one vehicle which remained untouched throughout the entire scenario.
 
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