PA HELP

[amartin]

ok so patient assesment is about to be the death of me considering that my practicals are on thursday...

i somehow get mixed up in the scene size up and the inital assesment down to the ABCs...

any advice on making this click in my lil head?

[PRPGfirerescuetech]

be more specific on what your difficulty is.

[Callthemedic]

Treat it like a story board and construct the "movie" Patient Assessment skills from the "script", the skill sheet itself.

You and your partner are driving up on the scene.

What do you see yourself doing?

You are putting on gloves

What is happening outside the windows?

MVA? You would look at the scene and size it up, Right? the first thing you think of is safety of course. Gas on the road,oncoming traffic, power lines

Just "see" yourself there and take steps, not leaps

Your grader will give you the characters, just follow the formula in blocks of "scenes".

Scene #1

BSI Scene Safety

What are you doing?

Scene #2

Initial impression

What does the patient look like?

And so on

[Ridryder 911]

Go to WWW.NREMT.org obtain the patient assessment check list, maybe this will clarify each step.

Scene size up is before even touching the patient. What are the dangers, to me, partner, patient. How many, what is the mechanism of injury, am I going to need back-up, Is there something wrong with this picture type feeling ?....

BSI

ABC..of course is after you made contact with the patient: C-spine immobilization, Airway, Breathing, Circulation, check and treatment of shock

Good luck,

R/r 911

[amartin]

Go to WWW.NREMT.org obtain the patient assessment check list, maybe this will clarify each step.

Scene size up is before even touching the patient. What are the dangers, to me, partner, patient. How many, what is the mechanism of injury, am I going to need back-up, Is there something wrong with this picture type feeling ?....

BSI

ABC..of course is after you made contact with the patient: C-spine immobilization, Airway, Breathing, Circulation, check and treatment of shock

Good luck,

R/r 911

I've got the PA checklist...but somewhere between the mech of injury and apparent life threats i get really confused on what i'm missing or forget to say...

[Callthemedic]

After scene size-up ask the grader "where is my patient?"

What do you do when you are walking up to the patient?

[emskp1]

Mechanism of Injury, on the accident scene what do you see that can cause injury, ie cracked windshield, front end damage, air bag deployment.

Life threatening-what injuries do you find on the patient. Bleeding from head, neck, ears, nose. Broken legs, unconscious. Head Trauma.

Don't explain what you see (evaluator is telling you what you see)...It's one step after the other... MOI you see it ok (or evaluator states it)...say duly noted...Life threatening injuries....you're doing your assessment abc to toe. ABC's first as you assess and evaluator tells you about injury, state how you would treat and move onto the next. Just one step right after the other.

Move on down the line, and don't look back.

[rocket]

Lots of students get tripped up on assessment practicals. I think part of the problem is because half of the exercise is "imagined" (a healthy 20-something sits in the chair and plays the part of the 65 year-old CP patient....hard for some folks to look at one person and describe another) and the other half is "scripted" (there is a definite sequence to follow and questions/tasks to perform).

The bottom line is that the exercise is not going to change between now and when you take your practical exam. As PRPG suggests, your best plan is to determine exactly where/how you are having problems and focus on addressing them.

If you are unsure where the problem is then may I suggest video/audiotaping yourself? Pick a scenario and either alone or with a friend go through the assessment. When done review the tape with your checklist in hand...perhaps this will highlight the place or way you are going wrong.

Beyond that I can only give general advice based on what I have observed. The students I've worked with (assuming they're putting in an effort to study and understand the material) seem to fall into two categories when it comes to problems with patient assessment:

(1) Conversant interviewers

(2) Literal Learners

(1) A conversant interviewer is generally the type with lots of ride-along experience. They tend to want to replicate what they see on real calls; they ask a lot of questions of the patient....and thus run into trouble verbalizing something they would normally do inside their mind. These students usually have more of a problem with the unconscious trauma victim scenario.

(2) Literal learners need to recite back the "script" exactly and can lose their stride if they believe they "missed a point". For these folks it seems imperative that they follow the sequence in the checksheet. If the checksheet does not agree with what feels comfortable for their scenario (e.g., some folks might have trouble indicating that they would take and hold C-spine prior o introducing themselves to the patient) then they can get into trouble quickly.

For both types of students I recommend a "be the teacher" approach. Although the elements of assessment as evaluated in your practical exam are in fact the ones you will be using in real life I about guarantee you that the practical exam itself is in fact a unique experience that you will not be in again until recert time. Better then to treat the practical as its own event; this will help to create a new "logic" to follow that might help you to keep your place and perform well.

Here is what I suggest in that context:

Pretend that your evaluator knows nothing about patient assessment. This evaluator needs to have everything spelled out for him or her; including the little things that we normally take for granted. Be the "teacher" for this evaluator; show them how to perform a patient assessment, rather than how you perform an assessment.

Take an "outline" approach, spelling out what each section of the assessment is and what needs to be done. For example:

"The first thing I will do is make sure that I am protected. I will take BSI precautions in the form of donning exam gloves at this time".

"Now that I have met the minimum BSI requirements, I'll size-up the scene to find more about my situation. First and foremost I need to determine if the scene is safe. Is the scene safe for me to enter?.

Next I will determine what the mechanism of injury or nature of illness is. This call came in as chest pain. Do I see any obvious evidence of trauma at the scene? (no) Since I see no evidence of trauma at the moment so I will presume the nature of illness to be chest pain for the time being.

Next I will determine the number of patients. I see one patient. Are there any other patients at the scene in this scenario? (no). OK. My EMT assistant and I are equipped to handle one patient so I will not call for additional manpower at this time.

Next I will consider the use of C-Spine stabilization. C-spine stabilization should be considered in the event any significant mechanism of injury or in the case of a patient with altered level of loss of consciousness. As a precaution, I will instruct my EMT assistant to take and hold C-spine stabilization at this time.

Now that I have the scene sized up and under control I will move on to assessing my patient. I begin by making a note of what I see...in other words my general impression. I see a 65 year-old male sitting upright in the tripod position in a chair. This patient appears to be conscious, and I do not see any obvious bleeds, deformities, accessory muscle use of breathing.

I will now determine this patient's level of consciousness. This first bit of interaction will help me to solidify my general impression and give me clues as to how helpful this patient will be in determining his history and chief complaint. If the patient is alert and responsive I will make an attempt to determine his orientation in terms of person, place, and time. I will also ask for his permission of treatment.

Hello sir, I am Trevor from F&B Ambulance. Do I have your permission to treat you?

(yes)

My his response I presume this patient's level of mentation to be alert. I will ask further questions to determine his orientation.

What is your name sir?

(Bob)

Bob, can you tell me where you are right now?

(I'm at the rescue station).

And can you tell me what day this is?

(It's Monday).

This patient appears to be alert and oriented to person, place, and time. This tells me that he will likely be a good historian and help me to determine why he called EMS today. I will now ask him to tell me that information in the form of is Chief Complaint:

Bob, can you tell me why you called EMS today?

(I am having chest pains).

OK. Now that Bob has informed me of his chief complaint I want to perform the rest of my initial assessment on him. The purpose of the Initial assessment is to identify and treat per protocol any apparent life threats. The physical part of this assessment deals with the "ABC's"...that is, Airway, Breathing, and Circulation. I will begin by assessing Bob's airway by ......

~~~~~~~

..and on and on. This same outline methods can be used all the way through the exam and helps to spell out the OPQRSTI SAMPLE questions, etc.

If you like the feel of this "be the teacher" method, give it a try. It might help you to stay focused and relaxed during the practical exam. Definitely figure out exactly where you are going wrong and work on it whether or not you choose to use the "be the teacher" method.

Good luck!

-Trevor

[Dustdevil]

Lots of students get tripped up on assessment practicals. I think part of the problem is because half of the exercise is "imagined" (a healthy 20-something sits in the chair and plays the part of the 65 year-old CP patient....hard for some folks to look at one person and describe another) and the other half is "scripted" (there is a definite sequence to follow and questions/tasks to perform).

Excellent point!

I blew a trauma scenario once because during the reading of the script, it was mentioned that there was a staircase near where I found my shooting patient. I forgot that part. There was no staircase in the room this scenario was given in. Had there been, then I obviously would have taken into consideration that the patient may have fallen down them and done a full immobilisation.

The advice from this point is that you have to keep your ears as open as your eyes and listen VERY CAREFULLY to what the evaluator is telling you. You can't get tunnel visioned on the chief complaint and ignore all the little details that sound like irrelevant distracters. Attention to detail. It's what being a good medic is all about.

[amartin]

thanks all you guys for the help...last night/morning when i finally got in bed all i could do is say the entire PA sheet in my head :? things are becoming clearer now i just gotta work on my 150 ? take home final