Patient Assessment - Trauma

Someone once told me that the most failed station by ALS test takers was the Trauma Patient Assessment (PA).

Then again, I have also heard the same about the Oral Station, KED, Dynamic, Static, IV, and Airway Management.

The trick to surviving the trauma PA station is this....

"BSI, Is the scene safe? What is my mechanism of injury? How many patients to I have? Do I foresee needing addition resources? My general impression is that this is a critical patient that will need rapid transport. I will have my partner maintain C-spine immobilization while I assess the patient's responsiveness and ABCs. Do I see any major bleeding as a approach the patient?"

If you don't know what any of that means, please go back and learn. Saying all of this stuff sets you up as a test-taker who knows what they are doing so the examiner is probably less apt to pay attention at this point.

Whenever I have an unresponsive trauma patient scenario (they ALWAYS seem to be unresponsive, or painfully responsive) I place an appropriately sized OPA and ventilate the patient on high flow oxygen with a BVM at a rate of 10-12 per minute, to chest rise.

I'm not sure how many folks fail this station on critical criteria or just fail because points. I'm guessing it has more to do with points than anything.

Lastly, make sure you know what you are going to do when you walk into the station and the patient is lying prone.

Please leave comments saying I'm full of bologna or whatever.

Oral Station NR practical Exam

Part of the National Registry Practical exam is two Oral Stations, I have discussed it previously here.

 I'm not sure but I have heard that the addition of these Oral Stations is a relatively new addition to the test.

Obviously checklist station scenarios do a poor job of assessing higher brain function in the paramedic student.

You can teach a monkey to pass Dynamic. What really separates a Paramedic from other level providers is their critical thinking skills and ability to control a scene.

The Oral station is suppose to test that.

I don't think I am suppose to discuss the specifics of my scenarios that were presented but I can say that they weren't that difficult to deal with.

 And that is what really screwed folks up.

 I am guessing that the reason so many folks failed the station was that they didn't ask all the SAMPLE questions and take a complete set of vitals.

Honestly, I only did it because during practice one of my instructors told me I should (when testing the Oral Stations).

Also, when I say a "complete set of vitals" I am talking HR, RR, BP, SP02, pupils, lung sounds, temperature, FSBG, skin color, temperature, and moisture.

I can tell you that one of the patients I flat out would not have taken FSBG or temperature if faced with that exact situation in the field, because I honestly don't think there would be enough time(it was an 8 minute transport time to trauma center)

I may very well may have not asked about allergies either, because in this case the patient really didn't "need" any medications.

But I did ask, and I passed. Folks I know didn't ask, and didn't pass.

This whole situation kind of goes against what Paramedic instruction presses.

Paramedics are taught to form a differential diagnosis, and ask pertinent questions regarding patient presentation and that underlying differential.

If it doesn't matter what the patient's temperature is, I really don't think that someone should be penalized for not asking about it.


 So future paramedic student test-takers keep that in mind....

 

Practicals

So I am done testing....I passed my practical.

I had to retest KED.

I just wanted to carry on the proud tradition of ALS test-takers failing the BLS station.


Parts of it were easier than I thought they would be...other parts were harder.

Now I'm just waiting for my cards to show up.

National Registry CBT

All I can say is that the most important thing to remember is to be the BEST answer...as the instructions at the beginning on the computer based test state. I have found that if this statement is phrased another way, it makes taking the test a whole lot easier....

Always pick the least wrong answer

Often, I found myself reading a question, and finding that the answer that I had formulated in my mind was not listed, not even a little bit, so I was forced to pick things like "don an air-purifying mask" before started triage at an hazardous chemical spill MCI, where the appropriate answer was "GET THE HELL OUT OF THERE!!"

But anyway, I passed. The test cut me off after 80 questions, so I guess I did pretty good.

There was a ton of scenario based questions for sure, so I would suggest getting very comfortable with those.

Only a few times (probably about 4) did I have to straight up just guess an answer.

Now, on to the Practical!!!