trauma assessment question

[huey28]

Then you are wrong. If you don't control pneumo/tension pneumo, you fail. In the classroom, and at life.

ding ding ding

 

[Ridryder911]

It has nothing to do with laziness, it has to do with what's correct and what's incorrect.

Feel free to back up your theories with actual references...

Until then, Paramedic Care: Principles & Practice Vol II > BLSBoy.

Be careful quoting textbooks, as they are always making modifications. As well, they are out of date by the time they hit publishing. It takes about three years to be published.

Now, if you really want proof consider looking up literature such as Journal of Trauma, Chest and Lung, prehospital care, etc...


R/r 911

 

[TomB]

According to the PHTLS texbook (Sixth Edition):

"In the patient with abnormal ventilation, the prehospital care provider exposes, observes, and palpates the chest rapidly. The provider auscultates the lungs to identify abnormal, diminished, or absent breath sounds. Injuries that may impede ventilation include tension pneumothorax, spinal cord injuries, and traumatic brain injuries. These injuries should be identified during the primary survey and require that ventilatory support be initiated at once." - p.96

So auscultation of the chest is encouraged during the primary survey when you have identified an abnormality in the patients ventilatory status.

 

[MSDeltaFlt]

http://www.nremt.org/EMTServices/exam_coord_man.asp?secID=1#ASkillSheets

The above link will offer practical check sheets on NR. Do what they say do.

Alaska, what your book may or may not say is mute when referenced against what the testing agency (National Registry) is wanting. I posted the above link for a reason. It says to assess breathing. It does not say "auscultate". It does not say "don't auscultate". The below is a copy/paste from the above link.

Breathing
-Assess breathing (1 point)
-Assures adequate ventilation (1 point) 4
-Initiates appropriate oxygen therapy (1 point)
-Manages any injury which may compromise breathing/ventilation (1 point)

How can you adequately manage any injury which may compromise breathing/ventilation (i.e. tension pneumo) without listening to the lungs in the first place?

Saying a blanket statement of what you will or what you will not do in a given situation where the rules give you options might not be the wisest thing to say. Loosely translated, never say never. Never say always. What that means is, if your trauma pt on the NR check off has a pneumo and you don't assess breathing and manage properly during your primary survey, then you will have to retest that station. That is a critical criteria.

Since we are all nationally registered emergency medical technicians, I'm less worried about what the books say and more worried about what the NR says.

 

[MOflightmedic]

When it comes to testing, you need to make sure you jump through the hoops they are setting out for you. If they say no breath sounds in the primary, then that's what I'd give them--or vise versa.

Real world; I ALWAYS listen to breath sounds on every patient--even a sprained ankle. Listening to breath sounds on every patient is a good practice to establish. Make it routine and it will become a habit. It will also help your lung sound assessment skills. You have to frequently listen to lung sounds to get good at distinguishing between them.

Personally, I REALLY like to assess anything that can "kill ya" and I like to do it early in my assessment. As we know, a tension pneumo can be fatal and it's also a condition that we can treat.

Absent or diminished breath sounds, in my opinion, is the most important clinical finding when suspecting a pneumothorax. Granted, It's only one piece of the "puzzle" in a differential diagnosis but I would argue it's the biggest piece. Naturally, other signs, symptoms, and factors would be taken into consideration, but lung sounds don't lie.

Every ALS clinician should make it a priority to develope strong lung sound assessment skills.

Good luck with your test!

 

[AlaskaEMT]

According to the PHTLS texbook (Sixth Edition):

"In the patient with abnormal ventilation, the prehospital care provider exposes, observes, and palpates the chest rapidly. The provider auscultates the lungs to identify abnormal, diminished, or absent breath sounds. Injuries that may impede ventilation include tension pneumothorax, spinal cord injuries, and traumatic brain injuries. These injuries should be identified during the primary survey and require that ventilatory support be initiated at once." - p.96

So auscultation of the chest is encouraged during the primary survey when you have identified an abnormality in the patients ventilatory status.

Ding ding ding.

Rid: Agreed. I've heard as much as 5 years old by publication. Either way, I was sourcing what I had.

Thanks Delta. There is definitely room to interpret "Assess breathing".

 

[akflightmedic]

It is MOOT not MUTE....

It is REGARDLESS, not IRREGARDLESS...

Sigh, pet peeves, my bad