NREMT - Trauma Assessment Test

[@kennethmcconnell3699]

I would think that putting the C- collar on in the beginning would make it difficult to assess tracheal deviation, jvd, and clavicles during the rapid assessment.

[@BestPracticeMedicine]

Absolutely Stu! In the process of sizing and placing a C-collar you should take a moment to asses for those clinical findings. There are typically holes in the collar for continues assessment, but it is best to get the baseline during application.

[@kareenakumar2402]

@@BestPracticeMedicine You would probably want to verbalize that you've determined clavicular stability

[@McCarthy1776]

Yeah our instructors told us to wait until the DCAP-BTLS in the secondary assessment right after we assess the C-spine, neck and throat.

[@kareenakumar2402]

Overall good, but 1) you shouldn't put a C-collar on ever before you determine clavicular stability. You can direct one of your partners to hold manual C-spine, go through your primary, assess airway breathing and circulation, determine the need for O2, then priority and transport considerations. Have one of your partners get SAMPLE from bystanders/family, good, and then when you do your rapid trauma be feeling everywhere. There's a lot more you should be looking for as you palpate and go through your rapid trauma. I didn't hear DCAP-BTLS or crepitus or looking in the eyes at the pupils.

[@MarkTozer]

Can you expand on this notion of ‘clavicular stability’? What are the inherent issues if a clavicle is unstable?

[@McCarthy1776]

Interesting, that makes sense logically. All our instructors drilled it into us to always put it on after assessing the the cervical spine and neck during the secondary assessment. But I think they are just trying to make it as simple stupid as possible for the exam, as they've already told us real world will be different and that we just need to check a box for the exam and then our engine companies will teach us how we do things in real life. Lol nobody in the class has even verbalized checking the clavicles during the secondary assessment, and the instructors have said nothing, but they will if we piss practically anything else on the body. Lol it seems so common sense now that I think about it but for some reason the clavicales are completely overlooked in my class.

[@McCarthy1776]

​@MarkTozer ikr, that's like the one thing on the body that we haven't even touched on in my class. It's weird now that I think about it.

[@NoelleEtheridge]

lol idk why it's so cute how she tilts her head out of place and he whispers "hey u gotta keep ur head in a neutral position" and moves it back

[@MattFarrisMUSIC]

Does it make you wet

[@ceciliawallis3239]

Can anyone clarify when you would make the decision to apply oxygen via nonrebreather vs. BVM? To me, the buzzword for BVM is "shallow" and if the respiratory rate is low. But in this scenario the instructor says 22 and weak. If I was testing in the scenario, I would almost feel inclined to bag them. So why does he just do nonrebreather?

[@BestPracticeMedicine]

Hey Cecilia, thats an awesome question! The real key to BVM use is shallow AND inadequate respirations. This is a subtle bu t important distinction. A patient can have "shallow" respirations (a somewhat subjective finding) but still be perfusing adequately. Signs like cyanosis or full apnea would indicate this inadequate respirations. As out Pt in the video has respirations at 22/min - even though they are shallow - a NRB is the preferred intervention. It's also important to note that across EMS new studies are showing the detrimental effects of hyperventilation not just in rate but also volume. Switching to positive pressure ventilation with a BVM is also a pretty extreme procedure for BLS scope providers. Particularly with head injury and risk of intracranial pressure, you really want to utilize a BVM as a last resort when there are signs of brain stem herniation.

[@ceciliawallis3239]

@@BestPracticeMedicine thank you so much for the thorough and fast response! This makes a lot more sense to me now. I passed the nremt, but i have the state test next week. The video was very helpful :)

[@RandomPerson-vs2yh]

@@BestPracticeMedicine I think cyanosis and full on apnea are late signs of inadequate respirations. You don't have to wait until it gets that bad to decide that the shallowness of breathing is inadequate. You can just rule that out because it's shallow. And in the video calling breaths weak is a weird way to word it. Either way, it sounds inadequate. Also, I'd instruct a partner during ABC at B to put on the pulse ox to rule out whether its adequate or inadequate. In the video, the BP appears normal range, just that the pulse is high. A sign of brain herniation would be the opposite: high systolic BP and decreased heart rate. I'd still go back and look at the pulse ox.

[@Official_lil_shroom]

One of the best videos I've seen so far,thanks for the knowledge

[@McCarthy1776]

This helps a lot. I know the sheet and the order of things but sometimes its hard to really know how to verbilize certain things and all our instructors keep telling us different things. I like the way he does it all in the video. Its been awkward for me having the MOI, general impression and chief complaint almost back to back it feels like you're just repeating yourself, but this guy did it in a less awkward way

[@Joseph-wh5of]

A couple of things I noticed that were not right. Shouldn't you have checked for any spine issues prior to putting on the cervical collar. Also, shouldn't an npa have been administered to help with oxygenation and ventilation?

[@douglascollyer3042]

would you not assess pupils with a patient w/ bruising around the eyes?

[@Deepside00]

I thought the sternum rub isn’t supposed to be used anymore

[@RyanSmith40905]

This video is 4 years old bro

[@melongstrike]

How do you assess for painful stimuli?

[@McCarthy1776]

​@RyanSmith40905 Lol we were taught to do it in my recruit class in summer of 2024. But idk what the official NREMT standard is on that.

[@McCarthy1776]

​@@melongstrikejust kick em

[@BryanCruz-km2ex]

@@melongstriketrap squeeze

[@DanJanucik]

No assessment of PERRL, no management of secondary injury to the lower left leg. How are you going to check for neck crepitus/inline spine in neck with a c-collar placed?

[@avery8677]

Why would you assume pulse is normal in rate instead of asking for it? Let the proctor do his job lol. You also completely skipped over whether you were using or withholding oral adjuncts even though pt is unresponsive and not able to protect their own airway….Nor did you verbalize how you’d open the airway

[@wilh923]

Was she responsive to pain?

[@danie1pere2]

Thank you for this super informative video

[@McCarthy1776]

You didnt verbilize chief complaint and that there was no apparent life threats though. Or maybe that wasnt one of the points at the beginning when this was made idk

[@MrMGutierrez84]

No vitals collected?

[@DanJanucik]

In my state, Connecticut, obtaining vitals only has to be verbalized for trauma assessment. portal.ct.gov/-/media/Departments-and-Agencies/DPH/dph/ems/pdf/Training/EMS-Training/2020-EMR-and-EMT-Psychomotor-Skill-Sheets.pdf

[@deltonwestberry9219]

Y’all murdered her!!!!!!!

[@lubomir8747]

-+:j+j been been🌚💗👥🌾🌻🌸🌷🌺🌼😌😌😴🥰

[@OnlyoneBai]

General impression? Chief complaint? Treat for shock? Immediate transport? I didn’t hear those I may be wrong though

[@BestPracticeMedicine]

Hey Bai! These are some great clarifying questions. Miles does note a General Impression at 2:22, including a brief description of the patient sex, age, and positioning. At 2:30 he states that he does not see any apparent life threats, which is a part of the Chief Complaint on the current NREMT psychomotor exam sheet. With an unresponsive patient the only chief complaint we can really obtain is "unconscious". As far as immediate transport Miles does call for "high priority transport" at 3:23 indicating a rapid trauma assessment followed by effective and efficient transport. Treatment for shock in the scope of an EMT includes 1. High Flow O2 2. Supine positioning 3. Keeping the Patient warm and 4. Rapid Transport. All of these steps were accomplished throughout the assessment, minus the specific warming of the patient. Thank you for the insightful questions and for keeping us sharp. Please let us know if there is any other material you'd like us to cover!

[@OnlyoneBai]

Best Practice Medicine well thank you for clarifying! I am actually in the process of trying to pass trauma assessment, minor things get me caught up every time just wanted to make sure!

[@tmbnjmm]

I know this is 2 years old but skin was pink and warm, to me that would not indicate shock so I would not treat for shock.

[@troyevans9722]

He has a nice radio voice! Lol

[@RoidRager]

And a made for radio face! (I AM KIDDING the young man is very handsome I just wanted to make this joke lol)

[@roland.j.ruttledge]

many thanks UK

[@McCarthy1776]

And how do you know there were battle signs and racoon eyes? Without the proctor telling you what you see?

[@toniraburn2572]

Even though the pt is unconscious but alert to painful stimuli why would"t you use a BVM?

[@SporkPlays212]

You can still be unconscious but breathing adequately.

[@shirleymiller5056]

Unconscious pt opa/trauma jaw thrust/verilize expose chest

[@ZachyD7]

Didnt need an OPA as she was breathing. Now, yes it was 22/min but she was still breathing on her own. Also no need for a jaw thrust, again, since she is breathing on her own and he inspected the mouth, informed there were no fluids/debris. As far as the exposing chest, I dont know 100% if he verbalized that or not.

[@avery8677]

@@ZachyD7 Yes she’s breathing but she’s unconscious and therefore unable to protect her own airway. “no need for a jaw thrust, again, she is breathing on her own”, what? If she’s in full spinal precautions after suffering a 15ft fall then it only makes sense to use the jaw thrust maneuver as it is indicated for pts with suspected spinal injuries. I hope that you’re IFT and not 911 with this reasoning 😂

[@ZachyD7]

@@avery8677 It hurts that you cant tell im joking. You new to EMS?

[@avery8677]

@@ZachyD7 lol if you say so 😂😂 and nope, been at it since 2019

[@ZachyD7]

@@avery8677 Still new lmao

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[@richardmarkram8444]

She has nice eyes. Oh wait, he never checked them. With a suspected base of skull fracture, have your advanced airway kit on standby.

[@jamesross4350]

I see multiple points missed but I'm willing to bet he would have passed regardless, it's what we all hope for.

[@AmaliePreecha]

personally i find the make belive tests very hard to do, to get into the situation, im not sure if this was his actual test or them just showing how the test would be. if this was his actual test i felt he did great informational on camera and practice wise, but yes he did skip some steps i would have tried too good find

[@illya0000]

when he said his partner took vital signs i would assume his partner looked at her pupils too

[@JaredFan666]

He said some thing about raccoon eyes and battle signs. Which means he looked at the eyes?

[@ZachyD7]

@@JaredFan666 TECHNICALLY he didn't look at the eyes, he inspected around the eyes. Raccon eyes/battle signs can be a good indicator to a hematoma or skull fracture if you look at the pupils and they are constricted, uneven, and non-reactive to light

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