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EMT Practicals Preparation: The Medical Patient


The Medical Patient

As you read this preparatory guide to help you to pass your advanced EMT practicals, please keep in mind that the author is an AEMT who practices in the state of Iowa, and that the information is current as of the year 2012.

Following are the steps necessary to take to pass the exam. Make sure to VERBALIZE to the examiner all of the steps.

1. Always start by verbalizing to the examiner that you have taken body substance isolation (BSI) precautions. This simply involves putting on gloves, and showing the examiner that your hands are gloved.

2. Ask if your scene or situation is safe. This is ensuring scene safety.

3. If you're not told, ask for the nature of illness (NOI).

4. Confirm the number of patients you have. (You can say out loud, "I see that I have one patient.")

5. Verbalize whether you will need to call for additional help. That additional help could be the fire department, the electrical power company, or paramedic back-up.

6. Verbalize whether you will or will not take/hold C-spine (cervical spine).

7. State your general impression of your patient. For example, you can say, "My general impression is of a female in her late 60s with difficulty breathing.

8. Using AVPU or the Glascow coma scale, determine your patient's level of consciousness/responsiveness.

9. Determine your patient's chief complaint while looking for any apparent life threats. You can ask the patient, "So, what's going on today, Mr. Smith?"

10. Assess breathing. If your patient is unresponsive, open the airway to assess. Determine if your patient is breathing at the proper rate for his age, and if there's proper tidal volume. Have your real or imaginary assistant record this vital sign. It's okay to ask the examiner what your patient's breathing rate is. If your patient is apneic, you should immediately intervene by inserting an airway adjunct and proceeding with ventilations with room air and then attaching high flow oxygen at 12 -15 lpm. If there are no threats to the airway and if breathing is adequate, you should initiate oxygen therapy (12-15 lpm of oxygen by non-rebreather or 2-4lpm by nasal cannula if the patient won't tolerate a mask). During EMT practicals, assume the use of the non-rebreather mask.

11. Assess the circulation. What is the color, temperature, and condition of the patient's skin? What is the pulse? How is the pulse (weak, thready, etc.)? State that your assistant is recording this vital sign. Look for any hemorrhage that needs to be controlled and initiate shock management if early signs of shock are found.

12. You should now have enough information to make a transport decision. Is your patient a high priority? Remember to VERBALIZE everything to the examiner so that he/she knows what you are doing and thinking. This is the very purpose of your advanced EMT practicals.

13. At this point, it would be a good idea to verbalize that your assistant is getting a blood pressure and an oxygen saturation reading, as well as a SAMPLE history. You should be very familiar with what SAMPLE is. Remember to use the EMS mnemonic OPQRST to gather information needed about the signs and symptoms part of SAMPLE (S).

14. Be sure to ask questions that are appropriate for the chief complaint. For example, if the complaint is chest pain, you don't need to ask how long the person was exposed to the cold--a question that would be appropriate when assessing a local cold injury.

15. Perform your physical examination such as noting not only the rate of the pulse, but also the "quality" of it if the patient reports chest pain. You can even listen for irregular heart beats. You might want to verbalize an application of an EKG monitor in cases of dyspnea and/or chest pain, if local protocols call for it.

16. State your field impression of the patient, the plan of treatment, that you're going to evaluate the patient's response to the treatment, and that you're going to repeat your assessment and the taking of vitals en route to the emergency department (ED).

Memorization and lots of practice with these steps will help to ensure that you have the best chance at passing your advanced EMT practicals.

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How an EMT Uses OPQRST for Medical Patient Assessment

Christian Paramedics and Emergency Medical Technicians: The Challenges Faced

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