AEMT I99 Paramedic - Advanced Skills: Trauma Assessment - EMTprep.com 

Great tips! We should mention that while we agree with your advice, none of them are critical failure points per the NREMT skill sheets. Thanks for your input!

EMTprep thanks again for the videos. Nice work

Whether or not they are "critical failure points per the NREMT skill sheets", is irrelevant. Ask yourself this, are you training students to save lives or pass a test? All the points mentioned above should be taught to student regardless if they are on a test or not.

@ eddie almasi they are LITERALLY just doing this to help you pass the test. Your instructors in class should be teaching you to save lives. Also not one of those "misses" would have cost that patient their life so your comment is "irrelevant. #youreanewEMT #calmdownsparky

Jordan Parton he is doing an exam you clown shut up please

True! We definitely want people to hold us to a high standard, but at the same time we must remember to not "eat our own." One team.

Hey Olliez, do you mind if I borrow "armchair medics" from you? lol

@@Emtprep very well put. One team indeed.

Thanks Mickey! Congrats on med school. Keep up the strong work.

Few comments ring truer Patrick!

I noticed a few things missing but I shat bricks all day long, long after the test was done

Cause I was when I did my emt trauma assessment. And now I'm preparing to take my advanced emt trauma assessment.

Just did that today💩💩💩 I got so nervous I whent blank. I did manage to pass. But wow! I was not expecting myself to get so nervous.

I wanna know what the bad habits were... lol

@@iris201000 I can't speak for him personally but most of the time we don't run the full sheet like this during an assessment. Like let's use the medical one as an example. If you have a person whose suffering from chest pain, has a history of angina, and was prescribed Nitro for it, are you really going to ask him what his "last oral intake" was? Probably not. So a lot of times we'll skip over some questions on the sheet.

Good thought Martin, you'll need to verbalize treatment that would be expected at the advanced level, but other than that, there isn't much of a difference

I know I’m like 2 years late on this but there definitely were things that were missed on this. The only real difference with this station is being able to perform advanced treatments. I’m going for my A and just finished class waiting to test. For this, as soon as you noticed that the skin was pale and cool, you should suspect shock. Immediately keep the patient warm and start an IV and give fluids. Also check for any gross bleeds either during your general impression or during circulation, as it’s a life threat you want to get that out of the way ASAP and treat appropriately

Same lol best thing I learned first day of medic school was BLS comes before ALS dnt start worrying about placing IV’s & pushing meds if you dnt evn have an airway 😂

Hey CentralEMS, some of that is implied. It's hard to verbalize everything you're doing AND also do each step correctly. Stick to the sheets and you'll do great. Thanks for commenting!

Kayla M also a super simple thing and as soon as you noticed cool and pale skin, put a blanket on the patient. If there are signs of shock, KEEP THEM WARM. Shivering just makes things worse

+Jeff Ogiba Hey Jeff, not a critical fail for NOT doing that, but it's a great idea to show your proctor how well you know your treatment plans. Great question!

Thanks for the feedback Frank. We will take it into consideration during our next round of videos.

I agree - the video demonstration is very good but unfortunately the music was a little too loud for the volume of your demonstrator's voice and I had a hard time catching everything because of it.

It would also be nice if the captions were in a color I could actually read.

No you don’t need to ventilate with a BVM or use a OPA high flow o2 with a non rebreather should be applied and monitored to see if breathing improved. LEAST INVASIVE TO MOST INVASIVE

Also you do your rapid before u get in the box to treat major bleeding and ABCS then quickly move to ambulance and then a detailed exam is appropriate while keeping patient stable to hospital

It's situationally dependent but you could verbalize that when you discuss how you would transport the patient, letting the proctor know what you would do en route to the hospital.

Me too on Monday

Hopefully you give me an update when you finish and get a license,i will too

Follow what the sheet says for sure, but verbalizing what you would do in the exam is always a good idea.

+Tanner Hyatt Hey Tanner, as long as you hit everything on the skill sheets in order, verbalizing your treatment choice either way should be fine.

In my opinion you would want to do it before moving them to a backboard to avoid movement at the site of the fracture when rolling onto a back board.

Bleeding. Airway. Breathing. Circulation.

Only if gag reflex, broken teeth or any obstructions to oral airway, and a+o x 4

@@doma7389 she was breathing at 24 b/m regular but shallow I would start the NRB without an adjunct and see if her sp02 improved

@@ryanemond675 true! but I was trying to tell him when you use a opa. I haven’t watched the vid in a while so I might watch it again and comment on that

@@ryanemond675 yeah after review he should have just gave her high flow o2 via NRB at 15lt/min and monitored for trends

Agree

Thanks for the feedback James, we will take it into consideration as we prepare our next set.

+El Chapo Hey El Chapo, what do the NREMT skill sheets say?

Not if you're a professional.

In the UK, we would control catastrophic hemorrhage before anything else, but not 'check circulation' before airway, only stem major bleeding before ABC

If there is an obvious bleed that is an obvious life threat, you address that first in the order CAB. If there is no sign of obvious trauma, or bleeding, ABC is to be followed as normally.

El Chapo, Not certain about the points made but ,if anyone else wants to discover emt paramedic training online try Elumpa Paramedic Expert Alchemist (do a google search ) ? Ive heard some great things about it and my co-worker got amazing results with it.

Great idea for a new video, thanks!

+babygirl39942 great question!! Long bone fractures can be life threatening injuries and extremely painful at the very least. Stabilizing before moving the patient is critical.

Femur fractures are a life threat, thats a big jagged bone floating dangerously close to the largest artery in the body

KENNEDY CINEMA third to the aorta and pulmonary but yeah.

Hey Chance, it really depends on patient presentation, hard to say for certain either way.

Yes, go for it. The worst thing that happens is the proctor says "the patient does not accept" but you've then covered all of your bases. If the pt does accept, you've secured the airway.

For the situation in this video, no. The airway is patent...nasal cannula at best.... please dont ever shove an OPA in someone who is breathing 24 times a minute with an SpO2 of 92%. jesus christ.

Gotta disagree with you there, while the airway is patent, the patient is unconscious, and its best to go ahead and secure the airway somewhat, whether with a OPA or NPA, and the initial assessment said that his breathing was shallow, always use shallow as a key indicator to assist ventilation with a BVM, it means that they are not getting the air down into their lungs and provide proper oxygenation, however with the SpO2 being 92 percent, i can see why he put him on a non re-breather, but I would still have assisted ventilation.

You insert the opa and if they have a gag reflex take it out and insert the nasalpharengeal airway unless they have head trauma then you would just have to do your best, as with any scenario you decide whats best on training

Thanks Ezequiel, we will look into why that may be occurring.

check your headphones lol

Thank you! I was about to give up on watching because I only had the right headphone in lol

Mines was the same way and nothings wrong with my headphones

Lol I had only my right ear in wondering what happened. I’m glad I was reading the comments while watching.

How’d it go?!

@@Emtprep I passed

Hey Jason, thanks for your input. The ability to verbalize what your plan is to the test proctor is critical. Great catch there.

Hey Heather, that is definitely something he could have checked. That is a great tip!

Great question! The Sager Splint is used for femur fractures.

To my understanding the traction splint is for closed midshaft femur fractures. The only splint for tib/find is a regular old splint with some ice and bandaging. If you're advanced levels maybe consider some pain control

Implied when he stated taking full C spine precautions. just the way testing is man its not real life

Ya, I don't see c-collar anywhere in the critical failure list. The assistant maintained manual stabilization through till the end so the spine was sufficiently immobilized for testing purposes.

Manual stabilization takes place of that

Some day!

We're taught to do the vitals before secondary assessment because when we update EMS it gives them a "bigger picture" as to what they're walking into

Hannah Sheehan same for me

Intubation is always in the back of a Paramedic's mind for someone who is not breathing adequately on their own. However, one difficult thing to remember is the right indications. If an OPA is sufficient then there is no reason to drop a tube. If uncontrollable bleeding into the airway, risk of vomiting and aspiration, or airway swelling such as in burns was a concern then intubating would be more at the forefront. However if the problem is simply a decreased level of consciousness leading to an inability to protect the airway, then it is appropriate to use only the interventions necessary (ie: OPA)

@@joshrau7549 i know its years later, but im a emt student taking my trauma test today and my question is why would he use on a OPA if she wasn't fully unconscious?

Hey Jordan, typically speaking giving IV solution administration will increase the BP, great thinking!

If someone has a systolic BP above 90 (which she does), you would likely not do fluid therapy, onky TKO. Too much saline will affect clotting.

The pt wasn't FULLY unresponsive, she responded to painful stimuli

If it’s trauma it’s cabc the c is c spine a air way then b ,c if no trauma it’s abc a always before b and c

Hey Ally! Absolutely, try to converge the steps into an acronym or memory aid that you can remember. Sometimes people group the steps into 4 or 5 different acronyms that they repeat over and over during the test. This helps them ensure they're within the time limits. Great question!

EMTprep This Video and advice helped me! I need up passing he exam. Thank you so much for being available!

+Tormod Steinsholt Hey Tormod, Body Substance Isolation Precautions

+EMTprep that literally means the same as BSI

Proctor said her breathing volume is shallow so BVM ventilation should've been started. But yes the hypovolemic shock from femur fracture sounds about right

most cases fluids don't hurt but good lord please PLEASE make sure that honey doesn't have CHF

Yeah except you can push drugs 🤣

Nessa Roy I came here specifically to leave that comment but saw you had already hit the nail on the head a year ago

Hey Billy, I am not sure what you mean here.

EMTprep I'm not sure if I missed it or not, but would you be following a DR CAcBCDE approach? with the first C being catastrophic haemorrhage?

Hey Billy, to be honest, we've never heard of that. Can you explain the acronym?

Sure no worries: D - danger so like your scene assessment (Safety, Cause/mechanism, Environment including access/egress issues, Number of patients, Extra resources required) With global overview of patient ie appearance (pale, sweaty, facial droop, alert, cyanosis, oedema of face) work of breathing (accessory muscle use, cyanosis again, any audible stridor or wheeze or obvious dib, rate etc) and circulation to skin (malar flush, pallor) Response - AVPU, gain consent Catastrophic haemorrhage - any massive bleeding externally/ potential internal? Correct this (external normally) before moving on. Including blood sweep. So Tourniquets, blast dressings etc, consideration to splinting limbs if you think it's main problem I guess, ie bleeding into thigh from fractured femur, that's caused hypovolaemia and reduction in consciousness (or something ha) Airway with c spine consideration - blockage from fluids or objects or odeama - jaw thrust /head tilt / suction /postural drainage Breathing - red flaps twelve... Rate effort depth feel look auscultation percussion sides and back tracheal deviation wounds bruising surgical emphysema laryngeal crepitus absent venous distension I forget last e haha Circulation - address bleeding / minor bleeding, bilateral pulses, BP, capillary refill time, consider splintage/ traction/ Iv access etc Ecg Disability - fast test (face arms speech test) gcs blood glucose level, sensation changes etc. Neurological status etc. Expose and evaluate - any other secondary survey stuff to do? / Chop clothes of if not done already ready for head to toe assessment etc.

That is a great way of learning the content!! Do you feel learning it this way has helped you solidify the information in your brain?

She was unconscious in this video, she was only alert to painful stimuli.

+Julia Lewis Hi Julia, we like his tattoos!

I'm not saying I don't like the tattoos, they are really cool. All I'm saying is that I get distracted easily and any movement I see takes my attention away from the video. Also your videos are really cool. I want to be a paramedic when I grow up. :)

+Julia Lewis Gotcha! Thanks for the feedback!

Thanks for the great videos. :)

theres gonna be alot of distractions in the field more prominent than tatoos and what if your partner of assisting personnel have tattoos? Is that going to distract you from performing a thorough and complete assessment in real time????