Practical Exam on Saturday

I made it to the EMR (emergency medical responder) level last April. Now, I will have the hands-on practical exam for EMT level this Saturday. I’m trying not to freak out, and its not really working. The same old routine, but always so intense. I keep picturing myself holding a splint and there’s just a gap on how to tie it.

The rest of it, I have have committed to memory. There’s an order…even to emergencies…and I’m glad I learned it. 1) BSI/scene safe 2) Number of patients 3) Assess need for additional resources 4) Assess the mechanism of injury or nature of illness 5) Consider c-spine (hold someone’s head/jaw in order to prevent spinal damage).

After you do the first 5 things above: It’s your A, B, C, D’s. A: Airway: is the airway open? B: Breathing: is the person breathing? C: Circulation: Does the person have a pulse? D: Transport Decision: Is this rapid/high priority transport or not?

If someone does not have a pulse, CPR is your next move. CPR is 30 and 2. 30 head compressions and two breaths with pocket mask or bag-valve-mask. AED will also be applied and shocks likely adminstered.

This is where it divides. Trauma Assessment or Medical Assessment. If it is a trauma, and the person is unconscious, you will start at the head and feel for broken bones and look for bleeding and hard abdomen/internal bleeding. You will look for pulses in ankles. Press on visible skill and notice if the capillary refill time is under 2 seconds (healthy) or takes longer than that (not good). With a Trauma Assessment, you will look for family members or bystanders to give you more information. When did this start? Does this person have any allergies? Is this person taking any medications? What is this person’s medical history: any history of asthma or heart issues?

Medical Assessment: AVPU: Alert (Can the person say their name, where they are, know what time of year it is?), Verbal (Can the person make sounds and some verbalizations, but doesn’t exactly know what is happening?), Pain (If you rub hard above their eye brows, will the person show some response?), Unresponsive (None of the above). OPQRST: Onset: What were you doing when this started? When was that? Provocation: Does anything make it better or worse? If you take a deep breath is that worse (lung issue, rather than heart)? Quality: Is this a dull pain? Sharp? Radiate: Does the pain radiate/spread to anywhere else? Your side? Your shoulder? Severity: Where 0 is no pain and 10 is the worst pain you’ve felt in your life, where are you now? SAMPLE: Signs and Symptoms: Observing shortness of breath or the person verbalizes they can’t breathe or they’ve been feeling progressively worse all day. Allergies: Do you have any allergies? Medications: Can you show me the medications you take? Pertinent medical history: Have anything like this ever happened before? Do you have a history of heart or breathing issues? Last oral intake: When is the last time you had anything to eat or drink? Events leading up to: Can you tell me again what was happening prior to this?

Meanwhile/during these questions: The second EMT or EMR is getting vitals. Pulse, Blood Pressure, counting Respirations, Blood sugar, shining a light in their eyes to check dilation, asking: Can you feel my hands? Can you squeeze my hands? And listening to lung sounds.

Oxygen is often given via nasal cannula at a rate of 4 to 15 ml.

A person in shock needs to be kept warm. A pregnant person shouldn’t be transported flat on their back (compresses an artery).

When you are headed to the hospital, you should give a radio report/let them know what to prepare for: “This is ——-, transporting a ——year old male with shortness of breath and blood sugar was low. Administered glucose. Blood pressure is——–. Pulse is————. Reports a history of ———–. Pulse ox showed 95%, so we are administering oxygen via nasal cannula at a rate o 4ml. Do you have any questions for us?”

That’s all I can think of for now.

Happy Tuesday!

Terra Rose