Practical Exam

Question 1

BVM Ventilation of an Apneic Adult Patient

Answer 1

1. Takes or verbalizes appropriate BSI precautions
2. Checks Responsiveness (Unresponsive)
3. Checks Breathing (Apneic)
4. Request additional EMS assistance
5. Check pulse for at least 5 but no more than 10 seconds (Weak carotid of 60)
6. Opens Airway properly (Mouth full of secretions)
7. Prepares rigid suction catheter
8. Turns on power to suction device or retrieves manual suction device
9. Suctions the mouth and oropharynx
10. Inserts oropharyngeal airway (Patient accepts adjunct)
11. Ventilates patient immediately using a BVM device unattached to oxygen (No difficulty ventilating)
12. Rechecks pulse for at least five secs (no more than 10 secs)
13. Attaches BVM assembly to oxygen (15 L/min)
14. Ventilates patient adequately
    - Proper volume to make chest rise
    - Proper rate (10-12 per minute)
    (How would you know if you are delivering appropriate volumes with each ventilation?)

Question 2

Patient Assessment-Medical

Answer 2

1. Takes or verbalizes BSI precautions
2. Determines scene/situation is safe
3. Determines nature of illlness
4. Determines number of patients
5. Requests additional help if necessary
6. Considers stabilization of spine
7. Verbalizes general impression of the patient
8. Determines responsiveness/level of consciousness (AVPU)
9. Determines chief complaint/life threats
10. Assess airway & breathing
    - Assessment
    - Assures adequate ventilation
    - Initiates appropriate oxygen therapy
11. Assesses circulation
    - Assesses/controls major bleeding
    - Checks pulse
    - Assesses skin (color, temp, condition)
12. Identifies patient priority & makes treatment/transport decision
13. Takes history of present illness (OPQRST)
14. Takes past medical history (SAMPLE)
15. Assesses affected part/body system (Cardiovascular, pulmonary, neurological, musculoskeletal, integumentary, GI/GU, reproductive, psychological/social)
16. Vital signs (BP, Pulse, RR)
17. States field impression of patient
18. Verbalizes Interventions/Treatment
19. Determines how and when to reassess patients and determine change in condition
20. Provides accurate verbal report to arriving EMS unit

Question 3

Spinal immobilization (Seated patients)

Answer 3

1. Takes or verbalizes standard precautions
2. Directs partner to take/maintain head in neutral position
3. Directs partner to maintain manual, in-line stabilization
4. Reassess CSMs in each extremity
5. Apply appropriately-sized extrication collar
6. Positions immobilization device behind patient
7. Secures device to patient’s torso
8. Evaluates torso fixation and adjusts as necessary
9. Evaluates and PADS behind head as necessary
10. Secures patient’s head to device
11. Verbalizes moving patient to long backboard
12. Reassesses CSMs in each extremity

Question 4

Patient assessment- Trauma

Answer 4

1. Takes or verbalizes BSI precautions
2. Determines scene/situation is safe
3. Determines MOI
4. Determines number of patients
5. Requests additional help if necessary
6. Considers stabilization of spine
7. Verbalizes general impression of the patient
8. Determines responsiveness/level of consciousness (AVPU)
9. Determines chief complaint/life threats
10. Assess airway
    - Opens & assesses
    - Inserts adjuct as indicated
11. Assesses breathing
    - Assures adequate ventilation
    - Initiates appropriate oxygen therapy
    - Manages injury that may compromise breathing
12. Assesses circulation
    - Assesses/controls major bleeding
    - Checks pulse
    - Assesses skin (color, temp, condition)
    - Initiates shock management (positioning, conserving body heat
13. Identifies patient priority & makes treatment/transport decision (GCS)
14. Attempts/Obtains SAMPLE history
15. Detailed full body exam
    Head
    - Inspects mouth, nose, assesses facial area
    - Inspects and palpates scalp and ears
    - Assesses eyes
    Neck
    - Checks position of trachea
    - Checks JVD
    - Palpates C-spine
    Abdomen/pelvis
    - Inspects and palpates abdomen
    - Assesses pelvis
    - Verbalizes assessment of genitalia/perineum as needed
    Lower extremities
    - Inspects, palpates and assesses CSMs
    Upper extremities
    - Inspects, palpates, & assesses CSMs
    Posterior back & buttocks
    - Inspects thorax, lumbar, buttocks & palpates areas
16. Vital signs
    - Baseline vitals (Pulse, RR, BP)
    - Manages secondary injuries and wounds appropriately
17. Reassesssment
    - Demonstrates how and when to reassess patient

(NOTE: in unstable patients, do rapid full body exam before vitals, then do vitals, patient history, detailed exam)

Question 5

Spinal immobilization (Supine patient)

Answer 5

1. Takes or verbalizes body, substance, isolation precautions
2. Directs assistant to place/maintain head in the neutral in-line position
3. Directs assistant to maintain manual stabilization of the head
4. Reassesses CSMs in each extremity
5. Applies and positions appropriately sized extrication collar
6. Positions immobilization device appropriately
7. Directs movement of patient onto device without compromising the integrity of the spine
8. Applies PADDING to voids between torso and the device as necessary
9. Immobilizes patients torso to device
10. Evaluates and PADS behind patient’s head as necessary
11. Immobilizes the patient’s head to device
12. Secures patient’s legs to device
13. Secures patient’s arms to device
14. Reassesses CSMs in each extremity