therring Posted September 25, 2006 Posted September 25, 2006 Can someone tell me if this sounds correct. I will be following Louisiana Practical Skill sheets. Body Substance Isolation/Scene Safety Question First Responder: How long have you been performing CPR? Do you know what happened to this patient? Direct FR to stop CPR while I check for a pulse. Examiner will state, “no pulse.” Direct FR to resume CPR while I get the AED ready and attach to patient. (right pec. and left ribs) Direct everyone to stand clear of patient. (at this time the machine will give directions……..) After 3 shocks check pulse. Examiner will state, “no pulse.” Direct FR to resume chest compressions I will check for effectiveness of CPR Direct my professional partner to measure for appropriate size airway adjunct and insert at this time. Direct partner to begin ventilations via BVM at 15 lpm. Ventilations will continue without unnecessary/prolonged interruptions. Questions any bystanders that may have shown up. AED will begin analyzing patient, direct everyone to stand clear of patient. Deliver 3 shocks Check for pulse (examiner will state one of 3 things) No pulse and No respirations (load patient continue cpr while in route) Pulse and no Respirations (continue to ventilate via BVM while in route) Pulse and Respirations (ventilate via non-rebreather) Consider this station complete
Timmy Posted September 25, 2006 Posted September 25, 2006 Sounds ok to me. Our training is different in Australia but the basic idea is there.
akflightmedic Posted September 25, 2006 Posted September 25, 2006 You stated you will be following the LA skill sheets. I will assume that since you are a new graduate and will be testing soon, the skill sheets are right there in front of you. If they are not, then you need to get them and put them in front of you. Again assuming you now have the skill sheets in front of you. look at them. See if they state what you just printed. If they do match up, then I would say yes..what you just wrote is correct. Great job!
vs-eh? Posted September 25, 2006 Posted September 25, 2006 As AK said, if these are the skill sheets you are following then (for testing purposes) they are correct. If you are looking if it "sounds correct" basing it on some sort of "newer" BCLS/ACLS standard then no, it is different now... Can someone tell me if this sounds correct. I will be following Louisiana Practical Skill sheets. Body Substance Isolation/Scene Safety Question First Responder: How long have you been performing CPR? Do you know what happened to this patient? Standard questions asked are usually "Witnessed or Unowitnessed?", "How long has CPR been going on for?", "Last seen/heard from? if unwitnessed", "Complaints prior? If possible" Direct FR to stop CPR while I check for a pulse. Examiner will state, “no pulse.” Direct FR to resume CPR while I get the AED ready and attach to patient. (right pec. and left ribs) Direct everyone to stand clear of patient. (at this time the machine will give directions……..) After 3 shocks check pulse. Examiner will state, “no pulse.” New ACLS is one shock only 360J Mono, or 120>150>200J Biphasic. There are no stacked shocks anymore. Direct FR to resume chest compressions I will check for effectiveness of CPR Direct my professional partner to measure for appropriate size airway adjunct and insert at this time. Direct partner to begin ventilations via BVM at 15 lpm. Ventilations will continue without unnecessary/prolonged interruptions. I don't like the above sentence as effective (faster, harder, deeper) CPR is your main concern now, ventilations are secondary and should only be 6-8 per minute. Questions any bystanders that may have shown up. AED will begin analyzing patient, direct everyone to stand clear of patient. Deliver 3 shocks Check for pulse (examiner will state one of 3 things) No pulse and No respirations (load patient continue cpr while in route) Pulse and no Respirations (continue to ventilate via BVM while in route) Pulse and Respirations (ventilate via non-rebreather) I also don't like the "ventilate via NRB", because well, you can't. It should read assist ventilations if patient begins breathing on their own. No patient is instantly going to be breathing effectively immediately post-arrest. Assist with any inadequate spontaneous breathing. Consider this station complete That being said I have never used an AED.
Michael Posted September 25, 2006 Posted September 25, 2006 An Excellent Description. Verbalizing that you would first move pt. out of standing (or, hey, running) water, blot off any excess moisture from torso, avoid pads' touching metal jewelry, piercings, or implants will help too.
AnatomyChick Posted September 25, 2006 Posted September 25, 2006 Clarify with your Lead Instructor / Coordinator to verify which of the Guidelines you will be using for your test.... The NREMT went to the 2005 Guidelines in July... so, I'm guessing that your state will follow suit... if so, then vs-eh has given you the new info. Always ask your instructor... we can help, and are more than willing to do so, however as an instructor I will tell you that I may have different rules for my class than some of the information that you will receive here. Just my 2 cents, Jo
therring Posted September 25, 2006 Author Posted September 25, 2006 Yes, that was a question in class about the guidelines. They have changed since I finished class, and my instructor told us that they would test us on what was current while in the class. For example, we trained on 2 sets of stacked shocks. The machine we tested on just has an on and off, analyze and shock button. I finished my course in June and took the NREMT Exam August 5. I have to retake some practicals, in case any of you are not aware how Louisiana system works, well it works slow. They only test once a month usually the first Saturday of the month, occasionally twice a month. They have to receive your testing application before the 5th of every month to test for the next month. Now I am stuck waiting until November to take my test. At least that gives me more time to study. Sometimes what I struggle is when I get nervous I get tongue-tied. For example when I was doing a rapid trauma assessment of the head, I said I am check for CFS, instead of CSF. I guess the examiner felt I had the right idea. I am having a little trouble with Apneic Patient, getting my timing down. I also had trouble ventilating the patient because the head was hard to tilt back. I am squeezing with right hand and trying to hold the head back with left, I feel uncoordinated, but because I did not tilt, the head back far enough the chest would not rise and fall. Then when I got to the point of when your partner assists you, I was able to hold the head back with both hands and it was then I saw the chest rise and fall. Any advice concerning this matter?
AnatomyChick Posted September 25, 2006 Posted September 25, 2006 It's going to sound mean.. but.. Practice.. Practice using different manikins, practice using different face masks, practice using different BVM's.... Each has it's own unique difficulties, so my final word is .... Practice.
MedicNorth Posted September 25, 2006 Posted September 25, 2006 Lots of good advice up here. Make sure which protocol you will be tested on, and then practice until you can do a scenario in your sleep, then practice some more. Write it out, say it, make up a song about it - whatever it takes to make it so automatic that tongue-tied is not an issue. The things that may be thrown at you - liquid on or under patient, metal jewelry, excess body hair, etc. need to be thrown in at random, so that you can practice making the adjustments. Write out your script, and at the times when these may become an issue, ask someone you may be practicing with to change these variables. Lots of time to get it under control if you are tested in November - Good luck!
therring Posted September 27, 2006 Author Posted September 27, 2006 No, anatomychic you do not sound mean. It is like I have enough confidence to work as an EMT it is just getting through the practical exams. The good about taking the exam over is now I know what to look forward to and that helps alot. My instructor told me that nearly every test she took rather it was EMT exams or anything, she had to go through retakes. I guess she was trying to be encouraging, but she told that she has noticed that people that to work a little to pass the exams usually end up being the best EMT. I will just be so glad when I can test and get this done. I am really eager to get out into the field. What bothers me sometimes is that I am 33 years old and I have wanted to be an EMT since high school, I have know idea why I did not do this sooner. Oneday I met a man that was 65 years old and he told me he did not become a paramedic until he was 60. Better late than never.
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