The only thing I would have done differently is every time he assessed lung sounds and was told they were diminished or absent, I'd have burped that chest seal/occulsive dressing. And as an EMT, requested ALS, if available. Otherwise, this is a great demonstration for EMT classes.
Just did this assessment yesterday in class, and somehow totally forgot that occlusive dressings existed... When I exposed the patient's chest, my instructor didn't inform me it was a sucking chest wound. Totally spaced, but this video is extremely helpful for review, thank you! Fingers crossed I get it tomorrow during review.
Always show respect to these guys for what they do, I'm such a weiny I cringed just at the scenario - doesn't help that its one of my fears. Thanks for sharing
This is really well done. Thank you. One thing - I failed my initial Systematic Exam because I palpated both sides of the hip at one time. They said critical fail on that. Just a thought so just in case anyone else has that issue.
Really good assessment with high level of theoretical skills, but not for a critical patient. In Sweden we use PHTLS, (X-ABCDE). A few questions: We are presented with a critical patient in chock after penetrating trauma (Both a B and C problem), where is the need for a distal status on the lower extremities (no found injury)? Why on scene and not during transport? If there is a gun wound, why is log roll first on E and not X or C? (To look for exit hole/wounds). This patient would've a detailed and thorough report but could have died on the way to the hospital because we took time on the scene to do non life saving assessment... If there was no B or C problem and no chock present, THEN this is very good! I know this is a examination and once again it was impressive on many levels. Just get us going after first assessment is done if we think this is critical. A gunshot patient with chock: X- ABCDE: Would dressing or tournique, look for exit holes posterior as well. Chest seal and high O2 on mask. Check for other bleedings. Minimal immobilisation if needed. Minimal time on scene. Reassess and IV during transport keeping BP on max 90mmhg. Be ready for ARS and/or "barping" the chest seal. Be safe! //Paramedic from Sweden.
Medic from Germany and USA here: same thoughts here. This is an inefficient method. No one uses that except these guys, obviously. It's way too slow and ineffective. Don't do that. Outdated stuff...
I've seen so many videos and this is by far the best one. Sure you missed a few things but for testing purposes, would you failed for not getting consent? No you would not. This is a passing assessment, great job.
Shouldn't we control bleeding first and then do everything else, especially if we know that shots fired. It feels that AnO can wait, especially year question
Great video but I have a question. Patient informed that she was shot in the chest and we were informed she had dimished lung sounds on the right side. She also had a life threatening bleed on her right upper extremity. During the log roll would it be advisable to roll the patient on the right side instead of the left to preserve the function of the good lung?
Hello, yes you bring up a fair point, good question. In an ideal situation this patient would be taken off scene after a quick primary assessment. We would have the patient semi fowlers on a gurney and simply move the patient's torso forward to have access to the posterior for assessment.
I noticed at the end he said he would lift the seal on exhalation and place it back down on exhalation. So you would keep it lifted for a full breath? Exhale to exhale?
With blood pressure being so low, and penetrating trauma to the torso, what about the thoughts of a fluid challenge and or also 1 g TXA? great video though
Hello, yes for an ALS provider those would be appropriate treatments. However, this is a BLS level simulation for an EMT-B skills test. Great thinking for the next level!
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in? 8:09 8:14
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
Im a little late to this video but should the candidate have "burped" or lifted the seal upon the first time that he was told that there were absent lung sounds on the right?
Lifting the seal wouldn't necessarily fix that issue, because the absent lung sounds are due to the pneumothorax itself. It would only be necessary to lift it if the patient started having trouble breathing.
Great video, thank you. However noticed three things that I don’t think were asked. Are you on any medications, are you allergic to anything and most importantly as you’re treating a female, are you or do you think you’re pregnant. Other than that, so well done.
Absolutely, you are correct. Those would all be part of a comprehensive history taking. In the video the SAMPLE history is delegated to another provider but in reality a quick history before starting the assessment would be appropriate.
Just want to ask, does saying: “we’ll take standard precautions” include the application of PPE. In my class we’ve been told that it is a critical fail if you don’t verbalize ppe application.
i would hesitate to just say "standard precautions". Seems a bit vague, but that's just me. I would verbalize "I"m going to maintain BSI and PPE precautions throughout".
@gabemedina2275 thats awesome, congrats! I'm about to head out in a few minutes to do some practice stations at the testing site. My test is tomorrow morning. I can only hope for a 6/6!
Further...This is an EMT-B skill but may fall outside of the scope in some Counties. Some Counties prohibit it and consequently do not teach or allow this. These guys are in Miramar in San Diego County CA and this is clearly within their scope there.
I mean, where was the exit wound? It took awhile to roll her. No exit wound to back? Shouldn’t he have rolled her after noticing gsw to chest so she wasn’t bleeding out of back?
Its all fun and games until your instructor gives you a multi-system trauma involving blunt force trauma, low and high/mid velocity penetrating trauma, and sexual assault with an unconscious Pt with no bystanders to get sample history from other than "he stumbled out of the rest room, collapsed and we have no idea who he his". 😅 These videos look like sesame street after my professor gave me the aforementioned scenario. Great job on your assessment brother. And thank you guys for the content
Don't forget in certain situations we are allowed to assume. For example if a person cannot consent to CPR due to unresponsiveness we can assume they want it unless a DNR form is presented to you. Or implied consent where, for extending they are extending their arm to the EMT.
I wouldnt recommend this assessment at all. Its too hollywod. This is taking unimaginably long. This is not a real concept for an actual gun shot victim.
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in? 8:09 8:14
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in?
"Yes I agree." Question here ..Should you guys go when it's ongoing shootout and you have to rescue a guys on the ground bleeding out and it's common sense but when if so what gives you a grant or to support your action by going in? 8:09 8:14
