NREMT Medical Assessment Chest Pain

[@herbiesnerd]

My son is in EMT school right now so I was curious to watch this. Well done drill. I’m a retired firefighter paramedic of 36 years. A couple points of constructive criticism: 1) Blood pressure was missed initially. With a real patient presenting this severely, sudden onset-crushing chest pain-pale cool clammy, instant alarm bells of probable acute MI are going off in your head immediately. If you don’t grab a BP immediately, you may never get a chance to obtain one. This patient is at severe risk of sudden cardiac arrest. 2) For an EMT, if there is an AED available, hook it up. AEDs are capable of recording EKG data although it may not have a monitor screen. In the event of any dysthymia or shock given, it will record all of it. The flash card can be removed and the data retrieved. 2) Lung sounds- always expose the skin. With experience this practice is only reinforced. Taking lung sounds over clothing or fabric is only out of laziness. It’s not a short cut. I learned this in paramedic school in 1982 from a highly respected ER doctor in Los Angeles. He had a list of different fabrics and the sounds they can mimic. Unfortunately the only one I remember is silk pajamas will mimic Rales. I always applied the stethoscope directly to the skin. 3) This patient needs rapid transport so direction needs to be given to your partner or crew about preparing to package up the patient. Gurney in the room, etc. Also, have your resuscitation equipment near the patient and be ready to use it. 4) Obviously follow your local protocols/standing orders for drug therapy but nitro is crucial to get onboard rapidly. NTG is instant acting, while Aspirin is not. 5) Heart sounds? I’m open for someone to educate me here, but out of my 20,000+ patient contacts in my career, I never listened to Heart sounds. EMS does not listen to Heart sounds, except on a newborn infant possibly for an audible pulse. There is no information in the prehospital setting that heart sounds will give you that you can identify or treat. Leave heart sounds to the Cardiologist. That being said, I encourage anyone to practice listening for heart sounds for personal knowledge, but there is no EMS use for it. Pulse and BP (and EKG when you become a medic) are all you need for cardiac info. I’ll send your channel link to my kid so he can see you guys practicing. Good stuff. Also, ALWAYS be open and accepting of constructive criticism and learning moments. The learning never ends. It’s a career endeavor. Experience teaches you recognition of what you were taught, until one day…….you’re the teacher.

[@nataleedenlinger635]

i get what you’re saying and agree except that although in real life the bp may be true, on the nremt you have to do vitals almost last

[@Requis70]

@@nataleedenlinger635 This. Doing things by the book for testing is how its preferred but the way things are done in the field are completely different.

[@toniencheff4046]

I love your valuable information

[@herbiesnerd]

@@Requis70 One thing I agree with you is this: You have to pass the test. So if this is what is taught to become an EMT, then do it. If you don’t pass the test, you can’t become an EMT. Being an EMT is the beginning of an EMS career. It’s step 1 of the stepping stones towards advancement. All that being said, whoever designed the curriculum to delay vital signs have their heads so far up their keesters it’s not funny. It’s medically incompetent to delay vital signs.

[@schmay3312]

The quote at the end was chilling but very true. Thanks for the video and good luck to all the future EMT's out there.

[@johnnysins9044]

Unfortunately they got rid of the skills portion of testing

[@littlefeet2]

@@johnnysins9044 not yet.

[@justinbartolini6039]

I hope I too have a big white board behind the patient with all the steps and reminders when i take my test!

[@Shawbaz]

lol

[@jbarkley4198]

Lol right?! They add a rule to the test: “You may bring any one item into the room during your station.” (Every candidate wheels in a huge whiteboard with all the steps written down.) 😂

[@JoshDeutschOfficial]

Sorry but you can not bring anything with you other than a blank sheet of paper and pen/pencil

[@lorilam4191]

Thank you so much for your videos! I start EMT school in September with my 26 year old son and my husband. I have been sending these videos their way, and taking notes!

[@OriginalCyndi]

Are you now an emt?

[@skaterz49]

In the EMT class I took, I was told that nitro has to be prescribed to the patient in order to assist with it.

[@skaterz49]

in CT

[@RallypointEMSNREMTDemos]

That is correct, we are only allowed to “assist” with a patient’s prescribed Nitroglycerin, Epi-pen (epinephrine), and albuterol M.D.I.’s. Thanks for picking up on this. When I created the scenario the patient was instructed to report that he was prescribed Nitro but, he did not. I’m going to keep this video up despite the minor oversight because it’s still a good demonstration. When you test, in the scenario provided to you, it should be reported the patient is prescribed Nitroglycerin and you should carry out administration as depicted in this video. Thank you Rallypoint EMS/Jeremiah

[@ak12d]

although the protocols vary state to state on meds its still a great video

[@krysistheabyss]

5 rights

[@Hedgeflexlfz]

Jacob, it depends on your jurisdiction/county/state. In my county I can administer it because I work out of a more rural county. Most county protocols don't allow for this though.

[@RallypointEMSNREMTDemos]

Thanks for commenting. I’m so glad this video was helpful! Good luck in your endeavors! Please tell others about this page!!!! RallypointEMS/Jeremiah

[@terrysmith9729]

the videos that you do for the practical assessments are great , I just wish I could remember them like that.

[@alexthomas5535]

Good job on the video would love to see more medical assessments! Also while it’s not NREMT required I notice a lot of people overlook it, I think a video on proper radio and bedside reports would be a benefit to a lot of people watching.

[@angele5811]

You have to ask specific questions. Instead of saying “do you know where you are” say “where are you”. Or else they can just say “yeah” 😉

[@commiekiller]

i made that mistake lol

[@rdahlinger4509]

😉👌👌👌

[@gregorybrown9101]

So what? Then you just follow up with "Okay, where are you?" People like you are desperate for a "gotcha!", this video is excellent, you're just looking for any holes or mistakes you can point out. Lol.

[@ddahstan6876]

Just an immense appreciation for all these helpful resources. So thorough and detailed!!

[@besmirzhaku222]

Jeremiah is an awesome paramedic. I had the opportunity to be his in his class recently, and let me say he's very easy to understand, I'm getting ready to take my practicals soon, and this video definitely helps a lot.

[@HaloAubreeMariee]

Great video! I'm taking a fast paced EMT course (8weeks), and KZbin videos are really helpful! Thank you!

[@kirsten7883]

Katelyn hey! How did your course go?

[@andrewelam1612]

Are you still in EMS you should be on your second cert

[@fatimatomax5353]

You can’t forget the 15L on non rebreather when treating for shock

[@jackieeguiditv]

He did at 2:51

[@alexatriolo5685]

Remember to verbalize the 5 rights when administering medications

[@Lt_SGR]

This is a great video for a Patient Assesment. Good Job

[@curlyfriezz2173]

Wow best video I have found, helped me on my assessment. Thanks!

[@porkyman]

Excellent demonstration. The details that you add in all your videos are incredibly helpful.

[@PRINCEBONAVENTURE-wh7et]

Thanks a lot for this video I was so confused with the steps, but am now okay... Would like to watch more videos, this man is a professor like for real.

[@veronicavera1198]

Thank you so much for this video . It describes everything with detail, very helpful. As an EMT student l really appreciate it, l cant wait to see more .God bless you all.

[@masonwall4864]

Maybe the protocols where you're at have changed since the creation of this video but in San Diego, CA we are not allowed to administer high flow O2 via a NRB because when the patient is taken to the hospital and is recieving definitive care there is a possibility that free radicals can get released in the body and harm the patient due to an oversaturation of O2. Per San Diego Protocol S-126 we can titrate O2 at 2lpm via a NC.

[@andrewelam1612]

What! For real you can't put a patient on 15lpm non-rebreather for shortness of breath also?

[@masonwall4864]

@@andrewelam1612 For SOB yes but for just chest pain no. We are only supposed to maintain O2 saturation. NRB or BVM is only to be used as needed.

[@andrewelam1612]

@@masonwall4864 yeah chest pain really would only need a NC unless it leads up to sob because the pain could be getting worse

[@emtpreston1]

I personally would use caution giving nitro without a 12 lead EKG prior. In the event that the patient is having an inferior MI giving nitro can tank their blood pressure pretty quick.

[@doncoleman4938]

We were taught to rate pain on a scale of 0 to 10 (zero being no pain). You'll always get patients who just don't understand a quantative pain scale question. "On a zero to ten, I'd say pretty bad"...…..

[@dylanfitch2997]

The whole Wang Baker thing is subjective but does paint a good vague picture

[@SarafinaSummers]

For me 1 meaning nothing makes zip sense. I tell the medics/doctors "0/10, Please! I don't give a flip if you have to write it differently. Verbally ask me 0/10. It takes you five seconds and helps me. Thank you so much for y'all's consideration!" I should have it as a little medallion for my necklace. /hj

[@MrRocknken]

i just realized they live town over from this place at least i think its the same place im thinking of, great video very informative

[@trishia3938]

Thanks for the video’s. My tsops are coming up fast and these videos are helping me prepare!!!! Thank u

[@markour-parkour1918]

For cardiovascular you want to feel for the pulse and check the blood pressure. If you listen to the heart and figure out what’s going on your going into cardiology or your a cardiologist. I would never do that.

[@phxrsx]

Guys gonna stroke out by the time you finish your assessment.

[@HyenaBellaDanceNSing]

That’s what I was thinking, if he’s having a heart attack treat what you can on scene and haul ass. Unless als is closer why call them? You can do secondary assessment and sample and stuff in the ambo. I’m in EMT school currently and we aren’t even allowed 15 min in any scenario. I feel like we would fail if we did it this way. I do like how he explains the nmeonics though because I’ve heard them said differently and I think these are the correct ones,

[@Eirik36]

@@HyenaBellaDanceNSing nremt is a fucking joke, as you probably know by now, an assessment in the field goes by a lot quicker and in a different way

[@CloroxBleach-rm5nj]

@@Eirik36 In the field, you learn what short cuts you can take. For the Nat'l Reg. you have to be thorough like this for your exam even if it is unrealistic, so you prove you know all the steps.

[@kevindellea2939]

Every video I watch they always treat Onset as the time it started, which is incorrect. Time is when did it start. Onset is did it happen gradually or all of a sudden.

[@HyenaBellaDanceNSing]

See I’ve heard it different ways. We were told inset is when it started and acute or gradual and time is does it come and go. I feel like if you ask all the right questions it shouldn’t really matter what order you go in, as long as you ask the important things first. Like wouldn’t you ask when, first? So how can time be when , when t is at the end

[@joe8246]

I have some constructive criticism. 1. You should not check lung sounds over clothing as it may cause artifact in what you are hearing, lung sounds should always be assessed directly on the skin. 2. The blood pressure cuff should not be placed over any clothing even if it is light clothing. 3. Do not use your thumb to hold the bell of the stethoscope while checking your blood pressure. 4. This part you did not do wrong but you should also note that if the aspirin has a vinegary smell it should not be used as the chemical composition has been broken down, although these type of things you would note while checking your ambulance prior to any calls.

[@RallypointEMSNREMTDemos]

Jose, These are all great points and I agree with you With experience, you may find there are times where you may be able to adequately assess lung sounds or a B/P over clothing. This has been addressed in the classroom, but it wasn’t in the video. You absolutely should not use your thumb on the back of a stethoscope that has a diaphragm on the other end. Depending on the model or type though you may be able to. The question is, does your stethoscope have a pediatric diaphragm or is it a bell? One example is the Littman Master Classic II, model 2147, which is what I normally use and carry. This has a single-sided chest piece with a tunable diaphragm. With this model you can use your thumb when auscultating without any interference. Like you said, if you have done a rig check you shouldn’t have to worry about bad or expired Aspirin. Thank you for your input and thank you for watching! I appreciate your feedback too, I hope this information clarifies questions other may have had while watching! Rallypoint EMS/Jeremiah

[@joe8246]

Rallypoint EMS NREMT Demos Yes, I understand. Especially with emergency situations that are more of a load and go where you will be rushing to get everything done and have the patient transported as soon as possible. I'm actually an EMT already I did my NREMT in 50 questions which took about 15-20 minutes lol so much time learning and preparing for a 20 minute test. I enjoy seeing such detailed example videos, you seem like a great instructor I would love to see how well your students pick stuff up from you. Unfortunately for other places there are less reliable teachers. For myself I had to pretty much learn on my own because the instructors were not as thorough as you!

[@RallypointEMSNREMTDemos]

Congratulation's on obtaining your EMT! What an awesome accomplishment. It sounds like you were well prepared for your examination. EMT school wasn't easy for me when I took it. When I began teaching I saw many students struggling and I would tutor them as much as I could. The problem was I just didn't have enough time to provide tutoring as much as every student needed it. It would upset me because I felt like I was letting them down, so my solution was to make videos to supplement my teachings. The videos were private for awhile and I never thought this channel would do much or go anywhere. It wasn't until a few months ago I saw the channel had over 125,000 views. I really enjoy teaching and I try to make sure that everything I teach is accurate and up-to-date. I still work on the ambulance and I just finished paramedic school. I've seen a LOT of crappy videos out there, I wanted these to be better. At times I'm awkward on video, but i'm sure I'll get better with practice. Good luck with your endeavors. Like I tell everyone, this job is a front row seat to the best show on earth! Be safe. Rallypoint EMS/Jeremiah

[@roggad]

Jose Ruiz he verbalized that he exposed the skin during the primary.

[@renatamoffitt6672]

Rallypoint EMS NREMT Demos I take my skills exam Tuesday for EMT b. I'm nervous about medical skills. it's very detailed.

[@dylanfitch2997]

Since when was steve carrel a paramedic

[@coryhankerson2165]

I literally laughed out loud.

[@aggee10]

The guy in the video is not a paramedic, he's an emt.

[@oneness1_]

@Aggee...You are fucking kidding right! He said at beginning of the skill he was an EMT but you didn't catch that because you seem like you're jealous or some shit...focussing on his credentials instead of his performance which was really good. I'm assuming you are a high and mighty superior paramedic but sad that your attitude is condescending!!!

[@aggee10]

@@oneness1_ i know he said he's an emt in the video. I was correcting dylan fitch. Me correcting someone doesn't make me a paragod. So stfu. BTW I'm so jealous of a emt lmao

[@dylanfitch2997]

@agee, you should be, we get to know all the dialysis techs, at the clinic on a first name basis, and get payed fast food wages on rescue shifts. It's only the life one could dream of lol.

[@graysonclark7453]

Did you ask about ED Meds?

[@alexatriolo5685]

this one will get you !! can't forget!

[@Disregarding]

Why is his thumb in the stethoscope?

[@theonedude129]

Morgan Dean so he can hear his own heart rate better

[@carlostorres4538]

Do you guys give nitro before a 12 lead? , would if he had an inferior MI

[@CloroxBleach-rm5nj]

After SAMPLE, since your patient has CP, I would check his Exercise Tolerance. Ask him to count to 10 to check for # of words he can get out.

[@devriessigns9149]

How does the patient answer your OPQRST questions with his non rebreather mask on? 🤔

[@crystald360]

Maybe I heard wrong but if he said 50 lpm on a non rebreather that is wrong and respotory is took in vitals but this is a good video over all

[@dadhatter]

7:44 made me laugh so hard. They both look so awkward😂

[@jorgeramirez6527]

Hi im new to an emt class. When do we ask for consent? I seen a few videos, but have not seen anyone ask for consent. Sorry i know it must be a silly question or im over looking at something. Thanks.

[@gemmacarrillo3653]

“Technically” you’re given consent by being called there but, before you touch the patient ask for consent. Always try to keep the patient as calm and comfortable as possible. And don’t feel you’re questions are stupid! Always ask questions! Hope this helped :)

[@benyeargin1005]

the fact that the patient is answering questions satisfies expressed consent, to the best of my knowledge as I am only a student at this point --

[@benyeargin1005]

@@gemmacarrillo3653 Be careful--I don't think your statement is correct--The person who called for the ambulance may have been calling for someone else who they think needs treatment but does not want it

[@mollerbt]

Why would you give a nonrebreather mask at 15lpm? No signs of respiratory distress or hypoxia right? Why would you oxygenate a patient who doesn't need oxygen? This goes opposite what my emt course is teaching us.

[@VBM1]

Alright, let me explain exactly what causes chest pain. Ischemia is a condition in which lack of oxygen is getting to the tissue and cells, in the case of a Myocardial Infarction, a coronary artery is blocked which is causing ischemia. Oxygen can be as powerful (if not more powerful) of a pain reliever than nitroglycerin and aspirin. Which actually do the same thing, aspirin is a platelet inhibitor which stops embolisms and prevents them from occurring allowing blood to take oxygen to where it needs to go more efficiently. Nitroglycerin is a vasodilator, which dilates the blood vessels and arteries to allow blood to flow more efficiently, this is why it lowers blood pressure. So, the reason why chest pain exists (when it's of cardiac origin) is because of lack of oxygen. This is why you give ALL patients with cardiac chest pain, 100% oxygen via a nonrebreather. Not only that, but generally cardiac issues pair with dyspnea (shortness of breath). Also, Cool, pale and clammy skin is symptoms of shock. Basically, this patient had a heart attack, and is in cardiogenic shock. For patient in shock, you ALWAYS give oxygen.

[@VBM1]

Also, if your class isn't teaching you this, then you're gonna have a HUGE problem with the NREMT written exam. Best of luck friend, I have no clue how you've been passing your FISDAP exams.

[@HyenaBellaDanceNSing]

@@VBM1 I had this question as well, but what you say also makes sense. We have adjuncts in class as well as our instructor and it gets confusing because different people say different things. So would you say, for cardiac symptoms, use the nrb mask at 15, however for other issues where breathing seems pretty adequate and only slightly over or maybe under the norm, you could use a nasal cannula at 2-6? We did a scenario in class the other day where for one patient I chose a nasal and a different person chose a nrb for a different patient and the instructor was angry at us for the nrb usage. If I remember correctly, both patients were only slightly over the normal range of breathing. None of which were cardiac patients. If I remember correctly as this was last week, we had stings, hypoglycemia, and I can’t remember what else. I appreciate your feedback.

[@rdahlinger4509]

Your patient looks thrilled lol

[@jonathansalazar5100]

ABC before a head to toe... aspirin should have been given a long time ago, and vitals should have been done before getting a sample and opqrstu. He is smart and we all make mistakes especially under pressure, so easier said than done. Asprirn and nitro could have been given quicker after assessing SAMPLE and OPQRSTUI finding out that there is crushing chest pain, no allergies, lung sounds checked, vitals checked. Head to toe should have been done in the secondary assessment. Checking for pedal edema is a good one to check right away but a full body should be done sooner.ECG for even basic and I.V access for intermediates and above. Could have given morphine as well (MONA) Good job though all together good video.

[@RallypointEMSNREMTDemos]

Hi, thank you for your feedback. You bring up some great points. I will look to add the above in our updated video. Thanks again!!!

[@brutus6328]

jonathan Salazar......Protocol in Texas is if it's a conscious medical patient (as in this case).....history comes BEFORE physical then vitals when doing the secondary assessment. You get a history from the patient anytime you can to take advantage of the info because IF they go unconscious, you can't get that info and it could be critical if no one else is around to help (ie a family member) . Physical comes first for ALL trauma and only unresponsive medical. (again, responsive medical patient is history first, physical then vitals ). In Texas we would do a quick 30 second "rapid head to toe" and then a detailed exam upon reassessment but while on the way during transport.

[@VBM1]

Here's a question... what if the patient has a medical condition that contraindicates aspirin? Or what if he has an allergy to it? Why would you not get a history before giving a patient medications?

[@ryanlabrecque2910]

@@RallypointEMSNREMTDemos did you ever post the updated video? I looked through your page and didnt find the video

[@louisianastrong7698]

In the book it says not to ask WHY questions

[@RallypointEMSNREMTDemos]

Hi! What book are you using?

[@louisianastrong7698]

Emergency care and transportation of the sick and injured 11th edition

[@RallypointEMSNREMTDemos]

Okay. We use the same book. What part of the assessment video are you referring to regarding the why questions?

[@brutus6328]

GramGirl…..You never heard of the 5 why's? Yes, you shouldn't interrogate a patient and ask "why" in that sense.. just google Six Sigma DMAIC. The "5 why's" is very popular and a great way to a root cause of a problem.

[@JesuSaleme]

hi everyone ,if anyone else wants to discover emt testemt test prep try Nadazma Paramedic Helper (Have a quick look on google cant remember the place now ) ? Ive heard some unbelievable things about it and my cousin got amazing success with it.

[@anthonyrodrigues5032]

Do you know aren't good questions to ask because some patients will tell you yes I do. Just ask where we are and etc

[@Daniel-nz7pd]

We do not study to pass a test, we study to prepare for the day when we are the only thing between a human & the grave..

[@keyviswright]

This looks way easier than when I took my medical exams we had nothing on our boards no hints no nothing and only had ten minutes

[@Michael-gs8og]

Duhh. You are supposed to memorize it... There is a reason as to why it is called BOARDS exam...

[@ricardoortiz6287]

This dude looks like a future Walmart security guard.

[@coover65]

Forgive me for asking (my speakers aren't working); why isn't a 12 lead part of the assessment? Also, at 11:50 you mention about "requesting permission from Medical Control". What is that all about? I'm an Australian paramedic (so not totally familiar with how you guys in the US operate). Here, we work on guidelines, not protocols. We are authorized to administer about 50 drugs (and we're expected to know all the does (repeat does included), indications, precautions, contras, side effects etc. without consulting a DTP book (although we are allowed to use them). The idea of having to consult for a drug administration is a rare event (administering IVI Midazolam after Droperidol for acute behavioural disturbances is one). I should add too (probably what makes our patient management different) is 1. A prerequisite to being a paramedic is having a Bachelor of Paramedical Science (we don't have EMT level, only Advanced Care and Critical Care), and 2. Our ambulance services are run by each state government (8 states/territories=8 services). All pretty much similar (you could transfer from one state to another with minimal training in local guidelines), and our EMS is not attached in any way to any FD (totally separate services). If you're wondering why have DTPs if we're expected to know our drugs verbatim, it's a back up. There was a time when during a training session, we were expected to verbalise the calculation for say, midazolam doses for a 6 year old, when and how much the repeat doses are and so on. Nowadays we just say "X mg of X drug X route, with a further X mg after X minutes if X is still happening" (something like that). If an assessor asks side effects or precautions or whatever you're expected just to blurt out all those mentioned in the DTP. This is a very good video. Well put together.

[@CristiansProduction]

In America 12 leads are not part of an EMT's scope of practice.

[@coover65]

EggyPlanet thanks for your reply. from what I've read, it seems that EMT scope of practice is similar to our non-emergency Patient Transport staff. At no fault of EMS frontline staff, it seems the US is falling behind many other countries (Australia, NZ, Canada, Ireland) in providing a higher level of pre-hospital emergency medical care. It would seem that the almighty dollar inhibits professional development. Feel free to correct me if I'm wrong-I'm basing my observations on research done as a member of Paramedics Australasia, and from speaking first hand to American EMS staff during visits to the US. 12 Lead ECGs (EKGs are Americans call them) has been standard in Australia for a decade. It was part of the pre requisite for implementing the treatment of STEMIs by all frontline staff. I guess we're lucky in that ambulance services are free for all Queensland residents, and no matter whether you're in a city of 200-500k residents or a small outback town you're guaranteed to get a paramedic with the same skill set.

[@7soulcraft7]

EMT basic - monitoring is not in the protocol ( ALS territory).

[@coover65]

Ed M That explains it, many thanks. Do US ambulances run with just EMT crews, or must one crew member per ambulance be at least ALS/paramedic?

[@SuperSnallygaster]

12 leads are in our EMT protocol. It probably varies based on locality.

[@samzinman8639]

this is so good thanks

[@coetzeenandie7438]

Non rebreather for what sir? Simple face mask will do aswel patient is just suspected of having a MI

[@ahmad-gk3bv]

10/10 he would never have that face with the scale on 10. Had many patience that says 10 but are watching tv like no pain

[@drummaboy303]

Hi is this exactly how you proceed and do the psychomotor for the nremt paramedic?

[@vinny57ish]

Yikes... this guy playing the patient sounds a bit like me. I have low level or boarder line hypertension low stage 1 and take medicine to help control it or manage it and i also am allergic to penicillin but im a tad older im 62 but so far ? No angina but i use to be a EMT B back 39 - 36 year's back. I enjoy the video's it's brought back memories. Before i go ? Could i get one of those asprins ?? Lol... just kidding on the aspirin things.

[@allen480]

One would think that the 911 call taker/dispatcher would have also tapped out ALS the same time as EMS.

[@cmrtscherer]

So I'm currently enrolled in a AEMT class and National Registry is required. I hope for the practical exam they're not expecting a assessment like this ! Lol. C'mon what pt. Is gonna tolerate this kinda questioning !? I'm surprised he didn't check the pts. Stool sample ! Lol. Seriously though from working big city fire department als unit with a medic. Pts wouldn't tolerate all these questions but you can kinda ask questions too while taking vitals. That's if the pt. allows it but most times that's not the case or we gotta do a more rapid assessment and go. Which in mostly all the cases are so in one way or another. I would of thought it was reproducible chest pain considering what the pt. Was doing at time of incident also pain seems to more higher if I recall with movement. Being that the pt claims heart problems in his history and his symptoms relate. Then we would treat with nitro,aspirin,ekg etc. I know it's not about what we know or think it's about covering your ads and knowing and going over opqrst and sample but c'mon lol like knowing pts temp and last oral intake etc. Oh and giving a blanket for shock, um is this a trauma assessment or medical... Seems a little waste of time considering the nature of illness. Not looking forward to the end practical and test. Especially from what I hear how the NR test is....

[@juwaldtsieberhagen1120]

Is this a patient assessment or a vinette ?

[@shirleymiller5056]

ty 4 great info please do more scenarios

[@mikeharding8209]

Standing over the patient

[@cooperholland3976]

Wait what I thought you cant give more than 40 L/m with a non rebreather??

[@zacharymorrow6186]

15-20l

[@brutus6328]

In Texas , we never do more than 15l/m......at least not for EMT.

[@debcunningham3983]

for a NRM, 15 is the key number. I think thatts what he said, not 50

[@Sarahhuff0704]

I thought he said 50 too. But I think he said 15

[@Tyrogrs1994]

IF the spo2 is above 95% in a cardiac patient, do you still give o2?

[@carlosbaca3734]

tyler rogers you treat the patient not the numbers

[@westkelser3804]

You use a nasal cannula if it's over 94, and a NRB if it's under that.

[@fireemscraftsman2016]

No O2 >94%

[@krysistheabyss]

Depends on protocols, my county has us have the 02 sat between 94-98. I'll keep them on 2 if there around there.

[@arturo707]

No you dont, i just learned that today. Giving o2 can cause more harm then good.

[@louisianastrong7698]

Does it easier once you master patient and trauma assessment down?

[@RallypointEMSNREMTDemos]

It's hard to say. Everyone is different and everyone struggles with various skills. I'm going to make a video on how to master the first part of the Medical and Trauma Sheet. It's a mnemonic I created and works really well. Either way, ask your instructor for scenarios and then go home and practice. With medical i recommend the following: 1: Create a scenario for yourself or ask your instructor to give you a Chest Pain Scenario. For example: 55y/o male A&Ox4 with a GCS of 15, at home reporting 9/10 substernal chest pain that radiates to his left arm and jaw for the last 30 minutes. Onset - 30 mins ago Provocation - none Quality - Crushing Radiation - left arm/jaw Severity - 9/10 Time - constant (7/10 when it began, this tells you it's getting worse) Interventions - hasn't done anything to help himself Signs and symptoms - pain and patient looks ill Allergies - none Medications - nitroglycerin, metoporolol, Lisinopril Pertinent Hx - Heart attack 2 years ago, Hypertension, High Cholesterol) Last Oral Intake - Breakfast 1-hour ago Events - No physical Exertion, just watching TV Vitals: 158/72, RR: 24 Equal & Bilateral, HR 120 Strong: Pupils: PEARRL, Skin: Pale, cool, clammy, SPO2 94% 1: Memorize the sheet and keep it simple. On each line of the sheet you should write what question you would ask when you get there. For example on the line that reads: assesses responsiveness you would write " My patient is alert because they are speaking to me" "Sir can you tell me your name, Do you know where you are, Do you know what year it is? Do you remember the events leading up to your calling us?" 2: Rehearse the sheet and verbalize the questions you would ask, plug in the information from the scenario and the OPQRST/SAMPLE stuff above 3: Do a thorough secondary assessment. I do that in this video and I have another video on secondary assessment questions 4: Treatment - Remember, because you are being tested they are going to want to see that you know the sheet so you will have to do a treatment. Ask yourself, what the treatment is for Chest Pain? Besides treating for shock with a blanket, high flow oxygen you would give 324 mg of chewable Aspirin and 0.4 mg of nitroglycerin under the tongue. Make sure the patient hasn't taken ED medications in the last 24 - 48 hours and make sure the systolic BP is over 100 mmHg. Don't forget the 5 (6) rights of drug administration Keep practicing, it will get easier! Hope this helps! RallypointEMS/Jeremiah

[@teixeirao]

great video. but patient is alert and rescuer did not ask for patient's consent.

[@RallypointEMSNREMTDemos]

This is a demonstration of a national registry style practical examination. In our program we teach the skill stations in two ways. The first style is directed towards performing the skills as required per national registry. The second style is "real world". As this is a timed station there is not a lot of wiggle room to add or ask additional information outside of the templated format to which we teach the medical assessment. Remember the scenario given to the students will be fairly straightforward and the students are being tested on their ability to competently complete the skill. At no point is a patient going to refuse treatment because the station would then be over and we wouldn't be able to assess one's knowledge of the skill sheet form top to bottom. If you notice, there were many things I didn't do throughout the skill that I normally do on a day-to-day basis. For instance, I didn't actually expose the patient, instead I verbalized it. If you chose to, you can strip your patient down to their undergarments. When you go for your examination the proctor will advise you " you may remove the simulated patient's clothing down to his/her shorts or swimsuit if you feel it is necessary." In 7 years I have never seen a student actually do this. In addition, I didn't place the stethoscope directly on the patient's skin. We didn't actually cover the patient with a blanket when we determined he was in shock. We didn't ask who was in the room, their relationship to the patient and if it was okay for them to be present during the assessment. We didn't verbalize that we would extricate the patient from his home in a stair chair, to the stretcher awaiting outside and then load them into the stretcher for transport on a priority 1. All of what has been mentioned here is pertinent and necessary but if you were to say everything to the letter, you would be well over the 15 minute time limit. I do agree it is very important you receive consent from every conscious patient however; not asking for consent during your practical exam is not a critical failure. Thanks for watching and for the feedback. If I do another Medical Assessment I will add an informed consent question. Rallypoint EMS/Jeremiah

[@coover65]

There's verbal consent, then there's implied consent.

[@vinny57ish]

Yep... another good point. And in the video here? Even though the Tech is telling the instructor what he is doing he should of at least in my view also talked to the other instructor playing the patient to show a better real field on scene procedure. I did it and it worked great for me ... but that was my way back 36 - 40 years ago. Ancient times. Lol. If your in the biz? Good luck and i hope you enjoy the EMS industry. Be safe out there too.

[@dutch1187]

When you go on calls usually primary assment and OPQRST is written on a giant board behind you at all times and the patient is very cooperative?

[@RallypointEMSNREMTDemos]

No Brad, it is not....but it sure would make our job easier if it was!!! Thanks for watching!

[@dutch1187]

Rallypoint EMS NREMT Demos lol currently an EMT student in nj.

[@RallypointEMSNREMTDemos]

Good luck my friend. Let me know if you’ve got questions or I can do anything to help!!!

[@austinrn4218]

Any numbness, tingling ?? And always always always do an EKG before giving nitro!!

[@Chris-fv3qi]

You don't need to do one, nor are you expected too, for the NRE. It is a beyond the EMT scope of practice.

[@austinrn4218]

Ohh this is the EMT- B assessment, no wonder

[@rodriguezhectorricardo8445]

lastima la traduccion no funciona

[@crystald360]

You did ask it though interventions

[@grill.daddy_3433]

Why would you consider c-spine on a chest pain patient? It doesn't make any sense to me.

[@jonathansalazar5100]

For the NREMT skills sheet, it says to consider C spine on every PT, if there is no reason for it, as he stated with no falls or head trauma, than say there is no need to take C spine.

[@RallypointEMSNREMTDemos]

Under the scene size-up section of the skill sheet you may be awarded up to one point for 'considering stabilization of the spine'. I agree with you that for a chest pain patient, C-spine is probably not needed however, for the practical examination if you want the point (at least out here in Connecticut), it is highly encouraged you verbalize that you would "consider c-spine'. You can add that you would consider it, but it is not needed at this time. Some how or some way, I would mention it though. It is not a critical fail if you do not check C-spine during the medical assessment, but it's an easy point if you do consider it. In the real world, I ask all my patients if they have had any recent trauma or falls during my assessment regardless of the complaint. It is especially important of our elderly patients who may be on blood thinners. None of this applies to the above video, but its how I do my assessments on a day-to-day basis. I hope this helps! Stay safe.

[@vinny57ish]

@Black Sarah Yes great point. I use to be 35-39 years ago? Be an EMT and that was the way i was taught and practiced in the field . We were never taught to assume much in the field. As an old rule of thought for me back then ? Was what i didn't see ? I basically didn't know. Thats why there are several questions to be asked if the scene calls for it directed at the patient or maybe a relative that was in the home that can also give information to you on scene if possible in giving added witnessing help to better assess the patient and scene . In close no two calls will be the same. Great catch.

[@JennferRash]

Chest pain Cardiograph ems hospital June with go to the sleep and all fall bedroom ER ?

[@BJ-pu6tp]

God bless the nremt... My patient is a 55 year old male with angina??? Chances are the boxes you see he is moving are from a strangers home. I should assess the obvious paint huff marks that are shown on this man's face, and question why the fuck im even here responding to this problem

[@BJ-pu6tp]

And so... 2:24 in

[@samuelf8879]

pale, cool and clammy load and go don't stay and play

[@jeremiaht7063]

The badge lol 😂

[@paulinemcleggan7585]

Why did this take so long.. Patient obviously has a heart problem. I would have transported to hospital long ago. I know this is a training video and your going through the whole scenario but its still to long

[@TroyDeanMusic]

Usually this would be going on in the back of the ambulance en route to the ED

[@VBM1]

Its an NREMT skill assessment. A test to see if you can take a full medical assessment, what happens in the field is completely different.

[@danielc9774]

I hate that checksheet so much. Angina/possible MI + shock (likely cardiogenic) and you're going to sit there and do OPQRST/SAMPLE/PASTE ? I Know you called for ALS but this is a trauma patient now. He should have already been in a moving box with a medic, halfway to ALS intercept, or closer to a hospital if intercept is too far out. Load and go. The Golden Hour should never be mentioned or taught in medical academia. This medic failed a basic emt checkoff.

[@sineadduffy8253]

i think he has a fever

[@crystald360]

As well I’m history there is now I it’s opqrsti

[@jonathanjacobo612]

LMFAO at least talk to your patient at eye level when doing this 😂😂😂

[@sandiago7564]

The movie Onward.

[@Kewl_Kev]

A NRB can't be 100% o2

[@VBM1]

at 12-15 lpm, NRB is 100% oxygen.

[@louisianastrong7698]

Why did you call us today

[@RallypointEMSNREMTDemos]

Gotcha. There are ways to maybe word this question better. I didn't even realize I had worded it in such a way. It's not a critical fail and I don't think most instructors would even give you a hard time. Thank you for the comment though. I try to make sure all the videos match what is written in the book! Good luck with your class and thank you for watching!

[@Ryan78336]

ECG and Sats!!!!!!!!!!! Cyanosed?

[@leaguemastergg3647]

Do you watch Doctor Who?

[@moawiaalzahra3095]

if has a MI .then you are losing a valuable time

[@hearthrob5682]

This guy's kind of a dork

[@RallypointEMSNREMTDemos]

You spelled “intellectual badass” wrong

[@livingsoulandspirit]

@@RallypointEMSNREMTDemos are you going to put out any new 2021-22 videos for NREMT examinations?would love to see a playlist with all skill sheets tested and verified.Thank you for all the videos already out!

[@nathankline127]

nathankkline278