National Registry EMT Medical Patient Assessment/Management This is a fifteen(15) minute station where you will conduct the assessment of a medical patient and "voice" treat all conditions discovered
Same, I’m a couple months in and overwhelmed but powering forward. It’s mostly hard because every person we talk to has a different opinion. Ie. Idk if they have to verbalize when they get in the ambo, but we would’ve done in it scenario pretty much after hearing the patients having chest pain and taking basic vital signs. Everything else can be done in the truck en route because she’s a med red. But this is a helpful assessment to watch. I like the flow of the convo verses the broken down sample opqrst. I do better thinking of it as a narrative vs thinking about it step by step. And the clinical I just had was pretty awful XD didn’t meld with the preceptor at all.
@@paintballfanatic7231 it happens. Just practice, practice, practice. I used to run through scenario after scenario with my classmates. We watch each other then critique. It really helped. Then I'd cube home and run through trauma assessments in my wife and stuff. There were a few things i kept forgetting so I'd leave notes all over the house... bathroom mirror, computer monitor, steering wheel of my car. Whatever it took. You'll get it!
@@rhoonah5849 great ideas! Thanks. I'll be trying to practice on my family members and friends. I have I hard time feeling comfortable touching people, any advice for that?
Im about to test..what helped me is i just took the med sheet and copied it into my notes over and over then eventually could do it without looking and remember the first couple parts if trauma and medical are almost the same
Really good video. I was following along on my checklist and memorizing the steps. I also took notes on my checklist and have been rehearsing it, this video covers everything!
I'm a new EMT student, and we are just now dabbing our toes in patient assessment. I'm going to bookmark this video because right now this seems so overwhelming and like I'll never get it. Hopefully in 3 months when I come back, this type of scenario is second nature.
Great video. Only three things I am not wild about are going straight to nrb O2 with no SPO2 check, asking a female about ED drugs and taking so long to admin ASA and Nitro. His assessment was very good covered everything. Some may say he over assessed but we have to remember that in these NREMT evals they are looking for reasons to fail you.
Thank you for your response. As to the items you addressed 1. The NREMT requires that each patient receive high flow O2. 2. Female patients can be on forms of ED medication to treat Pulmonary Hypertension hence why it must be asked prior to administering nitro. 3. A full proper assessment must be preformed prior to administering any medications as all medications have side effects which can be found during the detailed exam.
@@yalenewhavenhealthcenterfo8754 Thank you for the information. A lot has changed over the years. I am currently starting my recert and then NREMT exam for instructor purposes. This has been very helpful.
It's a good thing he asked about recreational drug use because if she has a history of cocaine use/amphetamines, it could lead to dilated cardiomyopathy and present with chest pain. So very important to ask and rule out.
I’m reviewing patient assessment and it made 0 sense to me as I was unable to comprehend it after reading the textbook many times. Watching this allowed me to connect the dots!
Every Chest pain doesn’t need ALS intercept especially if the pt is stable because you can get them to the hospital usually faster than waiting on the intercept especially if you have an AEMT
Airway is patent, breathing is 22 and normal... why do you need to administer oxygen, especially at 15L? She is fine. To address the chest pain maybe give 6L nasal canula if you want to administer oxygen. Am I missing something here?
@@bossnone739 I'm currently on my 3rd about to be 4th week into the program and I like it!. It's A LOT of information to take in in such short period of time but i think it'll all be worth it at the end
Per NREMT Guidelines the ONLY medication an EMT can give without contacting MEDCONTROL is Oxygen. So to answer your question yes you would still need to contact MEDCONTROL
Here in Texas, as EMT's there are 8 medications in our standing orders that we can give WITHOUT contacting medical direction. I believe every state's laws differ. We give epinephrine, activated charcoal, O2, Nitro, Narcan, aspirin, albuterol and oral glucose. OF course if there's a question of # of doses or any situation outside of the 5 rights we would contact MD.
Depends on your state. In my state, standing orders allow us to give two doses unless patient is over 65 or under 6 months then we contact medical control. Remember this though, when it doubt, call med control. You're NEVER wrong to call and confirm.
If you believe the patient is suffering for a Cardiovascular Emergency, the patient meets no contraindications for ASA or Nitro administration, and MEDCONTROL has has approved the administration you can give the patient both ASA and Nitro. It is recommended that you give the patient ASA fist due to it being administered PO, and Nitro second due to it being a SL administration
@@yalenewhavenhealthcenterfo8754 Would it bet jumping the gun, if after getting the first set of vitals, asking of contraindications, give the ASA and Nitro earlier since we already suspect and MI and have asked for ALS? That is if we live in a state were ASA and Nitro are already pre approved with standing orders.
how do you remember everything at the end to tell the doctor? im taking biology this year and then hopefully getting into the EMT course, im already scared lol
Hello On the primary assessment he assesed for breathing , the proctor said 22 and normal why did he give her oxygen 15L/ per minute via non rebreather mask when she was breathing normal
Great question Isidro! It is a NREMT requirement that the EMT provide high flow O2 to the patient even if the respiratory status is within the "normal range"
Chest pain is a life threat. If room air sats are >94 O2 is contraindicated due to free radicals and tissue damage. Excessive oxygen causes a larger infarct - contraindicated for stroke and MI. ASA needs to be administered ASAP with a chest pain pt per ACLS guidelines. BP is not safe for NTG. Strong risk for cardio genie shock and loss of preload that will lead to death. Place pt supine as long as lung sounds are clear and BP may increase due to reduction of gravity on the heart to be able to give NTG. No idea how far out ALS is why not just load, do assessment en-route, and give the hospital a STEMI alert to activate the cath lab. If interception with ALS happens that’s great. Every minute a pt has chest pain on average 500 myocytes die the pt will never have again which can lead to LVH, RVH, PEF, etc.Just my thoughts.
Because it's a female and because females can also be prescribed ED meds for other health conditions, I can understand why the question was asked, but would it be appropriate to instead ask "are you taking any vasodilators?" Or is it specified as ED medication on the exam?
Wow, this SO different to what I'm accustomed to. Thanks for the upload. Questions from an Australian paramedic; Why do you need to call a doctor via radio and give a sitrep? Seems like an unnecessary waste of time. GTN contraindicated in a patient with a BP
Thank you for your response as to your questions. 1. EMT's must call a MD for all interventions other than Oxygen per the NREMT. 2. The candidate is given two(2) partners for the scenario, but the candidate must be the one who actually obtains all information. 3. This is a testing scenario not a field scenario. 4. EMT-B's cannot obtain a 12 lead ECG, Morphine is not given by EMT-B's. 5. The NREMT does not accept "International Standards"
@@yalenewhavenhealthcenterfo8754 Many thanks for taking the time to reply and clarification. I find it fascinating seeing how other agencies train. How are EMT-B level staff used? Do they crew ambulances as a pair, or with a paramedic?
@@yalenewhavenhealthcenterfo8754 Many thanks for the clarification. Here by law registered advanced care paramedics is the minimum standard allowed but in some cases we have volunteer first responders and also "technicians". FRs are in remote areas, cannot transport and provide basic care until the paramedics arrive. The "technicians" are a controversial recent addition. Only indigenous people can enter the "technician" program, and must live in an Aboriginal or islander community. Such communities are generally in remote areas away from white settlements. We don't have "technicians" in the cities, only paramedics with a university degree.
So I was thinking this patient would be suffering from CHF. What makes this another heart attack vs. CHF? Was it the clear lung sounds that made a difference?
Low BP is a contraindication for the Nitro that needs to be checked first and there are steps to get to that point before vitals i.e ABOCs Sample history ect.
You want to assess life-threats first and foremost which means your ABCs and primary assessment. Airway, Breathing, Circulation. Need breathing, quality of breaths, patent airway, pulse strength, rate, rhythm. You need to assess mental status, is it altered or is the patient unconscious? This can affect the patient's ability to maintain patent airway and makes them a higher priority for emergency care and possible need for ALS assistance. If they are stable, ABCs all look good, and they are conscious, alert, and aware, you still want to be cognizant that they could deteriorate. Because there's a chance they could become unstable and lose consciousness, or their mental status could deteriorate, you want to complete your history taking right away for your secondary. This is because your best opportunity to get accurate history info is directly from the patient, and if they lose consciousness or become confused you can no longer get a good history. That information is vital to offering them appropriate care, and when they get to the hospital they will also need that information from you. Information from your history and physical are also necessary prior to administering or assisting with any kind of medications (save for oxygen, although you do assess for signs of shock, poor perfusion, etc. during your primary that indicates oxygen therapy or ventilations). You need to know allergies, medical history, pertinent vitals and prescriptions, also need to know what meds they are taking to give accurate doses (what if patient had already taken 3 tabs of ASA then you can only give 1) and whether contraindications are there (what if they were on Levitra for example, that would contraindicate the nitro). TL;DR while you would like to treat a patient as quickly as you can, in order to provide appropriate and high quality care that will not harm the patient you have to make sure you go through your checklist. You don't want to accidentally give a patient any medications that could make them worse because once you've given them a drug you cannot "undo" it so to speak.
@@LilJbm1 I'm still a bit confused as to why he did a whole reassessment with seemingly full vitals before intervention after he had history/examination/contraindications and a previous set of vitals etc
@@danieljaywoods9950 because this is how the exam works. Baseline vitals come before Interventions. In real life, this would probably go a bit more quickly but this is a demonstration for the NREMT exam
I have a question please: does the NREMT require we take two sets of vitals? I don't see it in the script but I notice the EMT takes it twice. Is this to cover primary and secondary? Thank you in advance!
Good video but I'm pretty sure he didn't begin transporting this patient after the primary assessment, If you suspect heart attack always transport asap
Was there a reason to ask about Ed meds for a female? Is this in case the female could be trans, they go by she pronouns but still have male plumbing? Or is this because woman may take Ed meds recreational? I read about a new cream using generic viagra but wasn’t sure how it effects vasodilation. Thanks, I just started Emt class 8/16 and have medical patient assessment test tomorrow.
Recently finished my emt course. I believe Sildenafil can also used for pulmonary hypertension in both males and females. And I’m sure there are other reasons for use too. A lot of meds also have approved “off label” usage for conditions that aren’t consistent with the original med indication but that react therapeutically. My chest pain “patients” were always male and idk that asking a female is a requirement or for good measure. A good question for your instructor tho.
SlayinSaiyan 94 knowing whether or not that you are giving the right interventions I would say. I’m a hs emt student and I will say that being an emt is a very strenuous job considering all the assessments that you have to know for skills day. It’s more so remembering all the nitty gritty details that make you want to explode!!
I'm an EMT in Texas......hardest part is SCHOOL!!! LMAO.....no joke, the program comes at you EXTREMELY fast with tons of info and not much time between exams. They have a pretty good weeding out process (and rightly so) as our school only has a pass rate of approx. 25%!!! Then again, those who fail out, I wouldn't want them touching me anyway. Many do not take it as serious as they should considering the responsibility you have as a first responder. FYI, I currently work for a private ambulance company and I'm getting ready to start paramedic school.
@Ryan Summers.....I agree 100%. I too work for a private ambulance company in Austin Tx and as an EMT I was fortunate enough to be placed on an ALS truck so I get to see and learn lots as I assist the medics I work with. I also agree regarding O2. The only time we disregard the Spo2 # is for a pregnant woman (baby needs O2) and inhaled respiratory issues such as poisons. Those are the only two times we give oxygen regardless of Spo2 reading. And we certainly wouldn't have someone on a non rebreather at 15lpm!!! A nasal cannula ta 2 lpm.....if I HAD to…...but not a nonrebreather.
Ryan Summers i agree that the SpO2 was high enough that O2 admin wasn’t necessary, but personally i would give the O2 because of the pale, cool ,clammy skin as it indicates that the patient may be hypoxia/perfusing poorly, plus oxygen is a standard intervention for chest pain. Don’t treat the monitor, treat the patient as they present, especially since pulse ox isn’t the most accurate device to begin with.
BP's are done out in the field OVER clothing all the time. Of course in school we are taught to be on bare skin...….same with listening to lung sounds but you can't just rip someone's shirt off them out in public. LMAO
@@joshhayes2196 Thanks for clarifying. Trying to soak up as much info before classes start in September and a lot of this is the first time I've heard it before.
Why did he stay and complete the secondary assessment when it seemed to be a heart attack from the start? Wouldn’t it be safe to say transport then complete the secondary assessment
Review the NREMT Medical Patient Assessment Form and you will understand why. The Primary Assessment includes vital sign checks to get a baseline of the patient. The second vital sign check is to be sure the patient is stable enough for any interventions
I get this is NREMT but I just want to point out that giving high flow O2 to someone that is having chest pain is a terrible idea cuz it will causing coronary vasoconstriction and farther harm her if she is having STEMI using O2 as needed for people with chest pain is the best route for sure
Might be a regional thing. Either way, he makes his point clear, and his vernacular isn't in anyway indicating that he is ignorant. I'm GONNA give him an A+. This assessment was flawless.
There are several reasons; the most important is the contraindication. Both drugs cause vasodilation and when combined it can lead to a sharp and prolonged drop in systemic blood pressure and decreased blood flow in compromised coronary vessels. This by itself can result in a cardiac event. AND Pt has a history of MI which means the heart has been compromised and reducing blood flow can be fatal. AND In the US both females and males are prescribed Viagra for increased blood flow to the genitalia. AND Viagra isn't limited to The treatment of ED. It's prescribed for COPD, hypertension and other medical conditions.
