National Registry EMT Trauma Patient Assessment/Management

National Registry EMT Trauma Patient Assessment/Management
This is a ten(10) minute station where you will conduct the assessment of a trauma patient and "voice" treat all conditions discovered

[@cshony]

Professional, thorough and I was able to hear everything said! This video totally helped me pass my NREMT Practical. Thank you so much. All of your NREMT videos are excellent.

[@castroeric]

Thank you for the thorough video documenting a trauma assessment conducted rapidly as it happened in real time. I appreciate how the candidate verbalized his actions in full and then repeated the acronym each time to help remind himself, and other students watching this video, what he was doing during his secondary assessment.

[@rosaleacodywilliams1570]

This assessment was amazing, hands down

[@juanvelasquez7067]

olice Sat, Nov 20, 8:45 AM (10 days ago) Thank you for emailing the Minneapolis Police Department. If your situation requires a Police, Fire, or Emergency Medical response, please call 911 immediately.

[@firestorm521]

That is hella impressive how fast and thorough he is! Nice job!

[@Dylan-gs9sm]

Better trauma assessment than most videos thanks!

[@sadiyodirie7324]

I have exam this Friday, this is powering and making me confident.

[@meghanhill7152]

Y’all. This is perfect and what I need for my NR & upcoming State Practical! Thank you for these videos!

[@yalenewhavenhealthcenterfo8754]

You're welcome!

[@theprez5242]

This is awesome! I am currently taking a paramedic course and this helps me out tremendously. Thank you fellas👍!!

[@Name-dw7ix]

for a EMT this is pretty good. in Germany we use xABC(Quick Trauma Assessment Thorax Abdomen Pelvis Legs)DE. if uncsonsious then there will be no SAMPLER OPQRST. If its a tactical situation we will use either Tactical Field Care or Tactical Evac Care. this was a mix of two and i think it is Outdated allready.

[@rhey7783]

OPQRST sample is used mostly on medical patient sir, while trauma we used DCAPBTLS because most of time your patient will be unresponsive...

[@joshuamcleod3442]

My instructor taught us to assess smc's on both feets/hands at the same time. He stressed the importance of testing if they felt the same. I understand that the patient was unresponsive and that this wouldn't change anything in his case.

[@yalenewhavenhealthcenterfo8754]

It is personal preference on how you assess, as long as all extremities are assessed

[@koby685]

Hard to assess csm’s if there unconscious

[@katieblevins7705]

Best trauma assessment video I have seen yet!

[@jacobpacheco5955]

Forgot to check gag reflex before inserting OPA. Transport should have been way sooner BEFORE the secondary assessment. C collar could have also been put on a lot sooner there’s no need to hold c spine for the long if you have the airway under control. Head to Toe assessment was beautiful though! I’m glad you checked as you were rolling for backboard. (Most don’t) Could have gotten another full set of vitals once in transport But overall good job

[@GLaurence1997]

Attempting the OPA will tell you if he has a gag reflex or not, that and the fact he's not even responding to painful stimuli. As for the c collar, it probably just comes down to his care maps, personally my province would of had the pt have a rapid lower body survey to look for life threats then secure cspine and transport before the rest. Who knows what his system calls for though.

[@brayden4940]

Wouldn’t you have wanted to check for an exit wound? Or is that what you did when you asked if there was blood underneath him?

[@TwoGendersOnly]

As someone who is considering the emt class in a month, this was very informative but also intimidating. Im looking for a career change and have been debating emergency medical. 😊

[@asianchopsticks5048]

Why did he roll the patient on to the injured side with the sucking chest wound? No secondary injuries is kinda crazy

[@makesense4once]

I will never do that! Always taught not to cause pain or harm, so roll onto the uninjured side. Other than that, an excellent video!

[@makesense4once]

Excellent demonstration!

[@BakedHadoken]

If it's high priority, wouldn't you want to put him on a backboard first and do the secondary on the rig? Or is it already assumed that you are on the rig?

[@yalenewhavenhealthcenterfo8754]

Great question! In this form of an assessment by stating "the patient is a high priority" it is a verbal indication that the candidate is aware that the patient needs to be transported quickly but must first assess for other injuries prior to transport.

[@migueld4084]

I thought we were suppose to do the secondary assessment en route or so I’ve been told

[@migueld4084]

Quantum Karma holy fuck man I wish the best no pressure just breath and ignore the person judging

[@migueld4084]

Quantum Karma well don’t ignore him just have a small convo. so you’ll feel a bit comfortable being around them

[@yalenewhavenhealthcenterfo8754]

@@janeeyre1511 When the candidate states "This is a High Priority Patient" they are stating they understand they must transport quickly however they must complete a secondary assessment prior to physically transporting

[@gracemcpadden3708]

@@janeeyre1511 good luck! I have mine tomorrow!

[@jacobgonzales4979]

I know this comment is old, but I was taught the same thing, primary assessment (determine LOC, treat any life threats), then transport decision (in this case, I would say load and go since they’re showing signs of shock), then en route perform your secondary assessment

[@nedlarn7223]

Holy cow! This is stellar!

[@cisco5204]

2:51 wouldn’t you use a BVM instead of a non rebreather ,The patient is unconscious

[@PGEGCC]

depends on how many hands you have eh?

[@jsanderson-xd4hi]

No. BVM would be forcing more pressure into a compromised lung via positive pressure. It's a contraindication to use one in this situation.

[@jamesbaumblatt4689]

How does rolling patient on their bad side compromise there good lung, makes absolutely no sense, could be compromising other injuries

[@Logan-cb5em]

weren't you supposed to use a BVM because he was unresponsive (also because you didn't check O2 saturation before applying the NRM or state how many L/M) and you ran through each part of the head without asking if there was any DCAP-BTLS or soft tissue damage, instead you just stated that you were checking instead of asking... or is that just me

[@BrandonA]

The proctor stated the R/R before the EMT applied the NRB, and the EMT did state that he was applying "15L/m of 100% O2 via NRB w/OPA" during the assessment. Moreover, he asked if his therapy "is adequate," and the proctor stated that it was. Personally, I would've tossed on a pulse-ox to verify. Given the scenario, I'm surprised that respiratory failure or arrest wasn't present; 24 breaths/min or "a little fast" is a bit odd for an unresponsive situation. It would have made more sense if he had an altered mental status. If the proctor stated that the pt's breathing was severely labored, shallow, tachy'd, brady'd, apneic or inadequate, O2 delivery would have went in BVM's favor. Also the EMT stated DCAP-BTLS was being observed on the cranial aspect, implying most of the head. He also stated previously that he will be checking for DCAP-BTLS throughout his secondary assessment.

[@sneakydevilx]

wouldn’t it be necessary if the patient was unresponsive to verbal and painful stimuli that you would immediately check his pulse and breathing? i know the gunshot wound requires immediate attention as well, but varying on whether he is pulseless or not will indicate the need for CPR or continuity of patient assessment, which isn’t established here

[@AnIronicSobriquet]

As this is a gunshot wound, are we supposed to state that we are checking for an exit wound during our DCAPBTLS sweeps? Or is this assumed, and the proctor would state "You have found an exit wound" during exam?

[@yalenewhavenhealthcenterfo8754]

Excellent question! Yes there can be an exit wound. During the life threat assessment if the candidate found a pool of blood coming from under the patient it would be necessary for the candidate to roll the patient and access for an exit wound. In this scenario there was no pooling of blood coming from behind the patient which would not result in an extra roll.

[@Logan-cb5em]

you should never assume which is an entrance and an exit wound. and he said there was no blood on the ground under him which means there is no exit wound.

[@Operation_Pew_Pew]

I would think not sense dcapbtls covers a bullet hole, that’s like saying it twice

[@gaildotson8080]

Yes I passed

[@msks723]

No, EMT will expose me like that. And we addressed this is living will.

[@chocolatetobi]

The Outro is starting to get stuck in my head, I'm finding myself humming it randomly throughout the day now.

[@mahimohsin731]

How is it possible your second partner take history he was on manual stablization of c spine otherwise excellent video

[@brinak888]

If the pt is unresponsive shouldn't we check check circulation (CAB) to make sure they have a pulse 1st?

[@bachtv6247]

I think it’s bc if its a gunshot wound there could be uncontrolled hemorrhage which is treated before airway/breathing

[@lordandriolf]

Rock solid video, thanks a bunch!

[@kevinpanek-e1n]

great job knows his stuff.

[@KerbyUlysse-s7i]

That was amazing

[@bobbylight8833]

Correct me if I'm wrong, but would you also have to decompress the pt's chest on the right side? Or is the occlusive dressing the only thing required? Just curious cause even after he applied the occlusive dressing chest rise was diminished.

[@yalenewhavenhealthcenterfo8754]

Needle decompression is an ALS level skill. This is a BLS assessment only

[@KBMassingill]

Excellent video.

[@jalensailin]

Is there a reason that he skipped the 'sticky test' where you assess for arterial bleeding underneath the patient during the Circulation (C) assessment? Is that a new requirement or something that's only local to where I am (MA)?

[@yalenewhavenhealthcenterfo8754]

First I'm hearing of the "sticky test" can you elaborate?

[@jalensailin]

@@yalenewhavenhealthcenterfo8754 it is where you gently stick your gloved hands underneath the patient from head to toe, to assess for major/arterial bleeds that cannot be seen from the front. It is done very quickly during the circulation portion of the ABCs, at least in the class I am in now

[@yalenewhavenhealthcenterfo8754]

@@jalensailin Thank you for the information! That is a good trick for field work, however it is not directly on the NREMT sheet, but you would not be marked wrong for completing that step!!! Keep up the great work in class!

[@mariahpeck8153]

Would it be necessary to place on a cervical collar prior to rolling the patient, I don't think I heard that being mentioned.

[@yalenewhavenhealthcenterfo8754]

Yes it would be necessary. If you look around 6:20 the candidate states they would secure the patient's cervical CSPINE with a C-Collar

[@martykerker9464]

candidate stated that one of his partners was manually stabilizing C spine.

[@michele0324]

It seems odd the Pt has a history of MI, an Rx for nitroglycerin + aspirin, is experiencing chest pain but she isn't taking her Rx. And, it seems odd the EMT didn't ask her why because asking her may have revealed an altered mental status. No doubt the EMT took the correct course of action based on the Pt's chief complaint, history, slightly elevated RR, slightly elevated HR, elevated blood sugar, appearance of her skin, nausea and protocol.

[@rhey7783]

he said the patient is unresponsive, shouldn't you check 1st the pulse and and if the patient is breathing?? this can turn into CPR sometimes, but meh it all went well.... just my 2cents...

[@yalenewhavenhealthcenterfo8754]

This assessment follows the NREMT Trauma Assessment Station and is for learning purposes

[@tyleradams3877]

I thought positive pressure ventilation was indicated for any unequal movement of chest rise and fall? Been a while so I could be wrong.

[@katieblevins7705]

Currently in EMT training and taking the NREMT soon. We have not been taught that. Depending on rate, rhythm, and quality as well as SpO2.

[@dutyboy100]

I also thought the same thing because of the breathing/being unresponsive and to help inflate the lung we should use the BVM.

[@coffeehouse9019]

You can place the patient on a nrb with an opa?

[@yalenewhavenhealthcenterfo8754]

Yes if the patients respiratory rate is within normal rage and the quality is good

[@meghanhill7152]

My instructor says it’s also OK to place OPA (in real life scenario), because the gag reflex is a form of response, when they’re unconscious. Gagging is a good sign of life.

[@TroyDeanMusic]

I never know the true answer to this. My instructor says never use opa w nrb. Only bvm? I hear different things all the time. 😥

[@christopherm.nuccio5917]

@@meghanhill7152 Unfortunately, gagging is also a warning sign that the patient may vomit. Constant stimulus of that reflex (as in keeping an OPA in a patient who has the reflex) increases the risk of vomiting and, consequently, aspiration. (Yes. I'm aware that this reply is over one year after the post. :) )

[@christopherm.nuccio5917]

@@TroyDeanMusic Loss of the gag reflex indicates damage to the vagus nerve. If the vagus is affected, then ventilation is adversely affected. The need for an OPA (and fact that the patient accepts it!) indicate ventilatory insufficiency. Placing an NRB on a patient that has such brain disfunction that they lose their gag is improper, in my opinion. Besides, let me put a big piece of plastic in your airway and let's see how well you breathe, without anything wrong with you in the first place!

[@Tacoyaki99]

Great work

[@racel99]

when he was unresponsive to pain. how come he didn.t check pulse ?

[@yalenewhavenhealthcenterfo8754]

That comes following the check for responsiveness

[@marcelleousbyoune4459]

Perfect PCA

[@chrisschwarz4652]

Wouldn’t you want to roll the patient on his good side to reduce further injury?

[@kenh5211]

Rolling them on their good side can possibly damage their good side. Making it so that you have both sides injured. Its better to protect that good side even if it means worsening the injured side.

[@yalenewhavenhealthcenterfo8754]

Chris Ken is correct. This patient is showing signs of a collapsed lung on the affected side. When this occurs the good lung is compensating for the affected lung. If you were to roll the patient onto the good side you would put more pressure on the good lung causing it to work 4X as hard.

[@aymarsandoval786]

Beautiful

[@benbowen2262]

There was an exit wound on the back patient bled out and is now dead

[@tylerhalley6927]

Very helpful!

[@carolineshishem1693]

Very good

[@alexdavidson1709]

Assessment was great but a detailed exam of the patient should be done after ABCs are taken care of and patient is loaded in the back of the medic. You shouldn’t stay on the scene while the patient is slowly dying.

[@brinak888]

I didn't know we give and opa with a non rebreather...

[@babyelephants135]

i was wondering this too. Wouldnt it be a BVM?

[@xmagnaxtank1179]

@@babyelephants135 yes it would be a bvm, I've never heard of an opa and nrb.

[@GLaurence1997]

I know this is a year late but an OPA just secured the Airway, keeping the tongue off the back of the throat his resps were adequate enough to support just the NRB, the way it was taught to me was BVM when resps are under 8 or over 30.

[@wrathgoodwin4896]

Guys how much do you get pay as an emt?

[@yalenewhavenhealthcenterfo8754]

It depends on location. Average is around $ 18/hr

[@wrathgoodwin4896]

@@yalenewhavenhealthcenterfo8754 thank you

[@honeybadger4198]

@@yalenewhavenhealthcenterfo8754 starting paramedic pay where im at is lower then $18/hr :(

[@seanparker892]

i wish someone would make in the field assessments not nremt

[@yalenewhavenhealthcenterfo8754]

Good suggestion. However we must be sure that our students are successful in obtaining their NREMT certification so that they can become certified and practice field assessments.

[@vincentdolente7053]

So in otherwords. Everyone else: quick, call someone who knows what they are doing!

[@CherylBeatrice-j4x]

Frecherylb 24❤❤❤❤❤❤happy

[@lizc7417]

Ok but we are all assuming he needed his airway opened what if it was just fine 🤬🤬🤬🤬

[@jenniferminopoli2062]

lol you're joking, right?

[@0jessicarabbit279]

🥰

[@annamarieuren8523]

crazy

[@gabrielleracine4439]

cab