abc's or cpine

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indyingdays07

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I know this may sound like an uneducated questions but I'm a student who has been out of class for a while and preparing for my nremt. Relating to taking a test Everyone keeps saying always go with ABC's if it has to do with opening airway pick it... if it has to do with providing oxygen pick it.... well i keep arguing with my self on this because wouldn't you take c-spine precautions in a trauma patient before you open airway.. or wouldn't gushing blood be an apparent life threat what you would address before airway... should you always stick to the ABC rule FIRST ofter scene safe bsi when taking a test... for example if I get a quetion that says unresponsive trauma patient involved in a mva breathing 12 times per minute what do you do first.. 1. take cspine 2.open airway using jaw thrust 3.provide oxygen non rebreather 15lpm or 4.transport well I would say grap cspine is this correct or should it be insure open airway does abc's ALWAYS come first.. when would it not..

thanks
 
Look at your sheets, I believe c-spine is indicated in those first 6 or so steps above the abc's.
 
If you're asking for the test, follow the sheets. If you're asking for the field, multitask. In the field if you cannot get an adequate airway while holding C-spine your priority is the airway.
 
I believe the sheets say consider the need for C-spine. The scenarios assume you have 2 other EMT-B's with you. You should be able for the practicals portion of your exam to vocalize considering c-spine and having your partner take care of it.

on a written exam, follow what your books and sheets say.
 
Whats "cpine"?
 
indyingdays07 said:
I know this may sound like an uneducated questions but I'm a student who has been out of class for a while and preparing for my nremt. Relating to taking a test Everyone keeps saying always go with ABC's if it has to do with opening airway pick it... if it has to do with providing oxygen pick it.... well i keep arguing with my self on this because wouldn't you take c-spine precautions in a trauma patient before you open airway.. or wouldn't gushing blood be an apparent life threat what you would address before airway... should you always stick to the ABC rule FIRST ofter scene safe bsi when taking a test... for example if I get a quetion that says unresponsive trauma patient involved in a mva breathing 12 times per minute what do you do first.. 1. take cspine 2.open airway using jaw thrust 3.provide oxygen non rebreather 15lpm or 4.transport well I would say grap cspine is this correct or should it be insure open airway does abc's ALWAYS come first.. when would it not..

thanks
Click to expand...

ABC's -- Airway, Breathing, Circulation: So if they're gushing blood, it is an immediate concern, but not until AFTER airway and breathing have been addressed, because it won't matter that they're bleeding out, if they're not even breathing in the first place (in that the C is circulation, so it comes after A and B.)

Always address C-spine before ABC's when you suspect possible trauma or a fall. It doesn't take that much more time to hold C-spine. If there's no way to hold C-spine safely or easily and the patient isn't breathing, then you're first priority is back to ABC's.

It's tricky with the NREMT questions, because they're kind-of ambiguous. In the real world, you will probably be multi-tasking and doing several things at once. Just pick what would seem to be the BEST answer, if it seems that several answers are correct.

If you get a question where you find a patient in bed, not breathing, the wife says that he wasn't feeling well and went to lie down... Then you can rule out c-spine and the answer would be to open airway.

NREMT wasn't as hard as people made it sound. You have 3 tries, so don't stress out too much about it.
 
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If it's JUST YOU, ABCs before c-spine. Who cares if they're paralysed if they're dead?

Of it's you and other people there is no reason why one person can't hold c-spine while the other does initial assesment.


Bits it's ABCs before anything, at all times. Takes no time at all to assess.
 
re

simple series to remember

ABCBSS

Airway
Breathing
Circulation
Bleeding
Spine
Shock


In order of importance. If your with others then you can multi task it. Otherwise these are you priorities in order of importance. The shock seems out of place here but this is an old one and that refers to shock position and warming
 
A.B.C.C...... Airway, Breathing, Circulation, C-Spine. In that order.
Deal with life threats as you find them.
If you are given a partner you direct your partner to maintain manual
C-spine while you continue to check ABC's and deal with life threats as you find them.
Remember to use jaw thrust to open an airway if trauma is suspected.

If you get a question like: trauma pt in MVA RR-12/shallow, skin pale, cool, clamy and pulse 120 and weak.
What to do first?
A) Manual C-spine
b) Head-tilt chin lift and BVM with 100% O2
C) Check for bleeding
D) High flow O2 with NBM at 15L/min
 
re

Also along those lines, once you get your cert and are working as a provider never EVER EVER merry the head. Leave that to the fire/rescue on scene as you will want to remain available to perform other patient care tasks and assist your ALS partner as needed
 
The thing that is annoying is there isn't just one of you, your partner, a bystander, a firefighter, a cop etc, can all be instructed on how to old c-spine.
 
medic3416 said:
A.B.C.C...... Airway, Breathing, Circulation, C-Spine. In that order.
Deal with life threats as you find them.
If you are given a partner you direct your partner to maintain manual
C-spine while you continue to check ABC's and deal with life threats as you find them.
Remember to use jaw thrust to open an airway if trauma is suspected.

If you get a question like: trauma pt in MVA RR-12/shallow, skin pale, cool, clammy and pulse 120 and weak.
What to do first?
A) Manual C-spine
b) Head-tilt chin lift and BVM with 100% O2
C) Check for bleeding
D) High flow O2 with NBM at 15L/min
Click to expand...

Well this is a good example of exactly what I am trying to figure out.. I would say D) High flow O2 with NBM at 15L/min but I keep arguing with my self that cervical spinal stabilization comes before ABC's please let me know If I am correct in my answer.. if the patient had adequate breathing without signs and symptoms of shock like the question shows then wouldn't you take c-spine first ?
 
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However, in the field, I would hope that if you noticed a gushing bleed literally pouring out, your first action would be to tell someone to apply direct pressure while you assess the other ABCs. It is also no use to have a n open airway if the oxygen going in has no hemoglobin to attach to...
 
indyingdays07 said:
if the patient is showing signs and symptoms of shock wouldnt it be more inportant to provide oxygen in this situation.. if im wrong im looking for explainations here
Click to expand...

Lets keep it simple, for the sake of taking the exam. I agree that someone would put pressure on the wound, but for the sake of the exam, that comes at 'C.'

--And this is my disclaimer. I'm a *new* EMT, my first day on the job's Wednesday. However, I did just take the NREMT recently, so I remember how the questions were pretty well. People, feel free to correct me if I'm wrong! :)

First of all, I've never seen the term NBM. I'm assuming this stands for "nasal/ bag mask"?? But I would think it's supposed to be NPA -- "naso-pharyngeal airway", used in conjunction with a BVM -- "bag valve mask." Maybe I'm not familiar with other terminology. (?)

But, it only takes a minute to hold c-spine, and presumably you have a partner. In this case, if the patient has a potential spinal injury and you insert an NPA and start using a BVM, presumably you would have performed a jaw-thrust to open the airway first, which essentially happens at the same time as you hold c-spine.

SO:

(BSI/ is the scene safe? How many patients do I have? What is my general impression?...)

C-spine/ jawthrust -- done at same time (NOT head-tilt/ chin-lift, because there's trauma) -- That's A -- Airway (also, I guess includes the NPA)

BVM -- B --Breathing. DON'T ever forget to insert an NPA or OPA first -- try OPA first if the pt is unconscious. If the pt is gagging or conscious, use NPA.

Circulation/ Shock -- C -- apply pressure to a wound. For the sake of the exam, this is 3rd.

and so on, from there.


Also, although the respirations were 12, which is within normal range, they are shallow, so breathing is inadequate (also, pulse is thready, so pt is going into shock. Pale/ cool/ diaphoretic) -- that 's why you use NPA/ BVM instead of rebreather (was that even an option, I don't remember!)

One more thing -- read the questions CAREFULLY! If you miss one word, it could throw you off. For example, if it were a specified age -- child/infant -- you would have a different range for RR/HR/BP. They give you a board to write on. Work the problems out on the board if you have to. You can't go back and change your answers.

Don't sweat it, you're gonna do fine! You're on here, that shows initiative. If your asking questions, that tells me that you're an inquisitive learner, so don't stress yourself out too much about it. You get 3 tries, and it's not as bad as you might think.
 
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Waaait a minute. Okay I got it. NBM stands for non-rebreather mask. For some reason, I haven't seen the acronym for it (right? but, wouldn't that be NRM. Someone help, now I'm confused!). So there you go. I would still go for the NPA/ BVM.
 
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Ok, first of all it should read NRM my typo, sorry… I’m sorry if this confused an already confusing question. Minus the typo, this is a very registry type question.

The correct answer in this case is A) C-Spine.

The biggest thing to remember about registry is you have to pick the best and most appropriate answer; there may not even be a right answer or there may be two “right” answers to choose from, and you have to find the best answer.

In the scenario I posted, the pt has shallow respirations so if BVM was an option that would be the best and most appropriate answer because airway is always first and BVM is needed for any patient with shallow breathing, however since NRM is an option C-Spine is the best answer because it is an appropriate action for a trauma patient rather than putting a NRM on someone with shallow breathing.

I know this may be confusing but it’s really not; just break it down and find the BEST and most appropriate answer.
 
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c-spine priority

My understanding is that if you find an "immediate life threat" aka a major bleed, that is the very first thing you address. BEFORE ABC/c-spine.
Scenario: MVA, pt. has laceration on neck w/ profuse bleeding, resp's/vitals insufficient. The correct order of Tx, I believe, is;
1) occlusive dressing (i.e. someone's hand) on wound to deal w/ life threat;
2) c-spine/airway (use jaw thrust- this accomplishes both) and insert an OPA/NPA;
3) BVM w/ O2. ;
4) rapid assessment strip & flip;
5) load & go.
Note that the C-collar doesn't have to be applied immediately, as long as someone's holding c-spine this could be done anytime before strapping them to the board. You could use the collar to hold the dressing in place.
At least that's what I've been taught ;)
 
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