Our college is giving us some practice exams to prepare for our practical final exams and then upcoming psychomotor NREMT later this summer. we as a class have found that some outside non -college examiners 'prefer' a certain method, and 'critically fail' folks who don't do 'their ' method. Example: we are taught our maximum BVM o 2 flow is 15 lpm EMT-basic, an outside proctor failed several of us stating BVM is to be 25 LPM not 15. (25 is ALS LPM ; state, 15 max is BLS.) Examiner fails another for inserting O/P airway with tongue depressor and 180 rotation, which is the precise method in our textbook. (he wanted no tongue depressor , marked its use a critical fail.) Examiner fails another for asking secondary medical - history and OPQRST questions 'out of order' about cardiac pain during 'circulation' part of A B C (while giving hi flo O2 to remedy circulation/breathing increased RR and HRs.) (followed by ordering ALS/'possible MI ' and checking whole SAMPLE/OPQRST list.) since we get immeidate feedback on our skill stations, we hear what the criteria were. some of us are feeling that we should politely ' discuss' --as we get our critical - fail grades --why our intervention was different from the proctor's, and give him /her evidence of why we are in compliance with our training and textbook. others say NO, that we need to deal with this through having our our own instructors at the college who should discuss these issues. Any and all advice is most appreciated; we are sick at heart to think we are doing things the way our book says only to have ' critical fails' in practice. this does not bode well for us taking NREMT psychomotor this summer.. . and in fact is discouraging some of us from even trying to finish the college course.. Please can some of you with a lot more experience tell us how we should handle these issues? :sad:
advice ?psychomotor/instructor conflicts
- Thread starter kaisardog
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Depressors should be used only for little peds, because you do zero rotation for an infant.. You don't use depressors on adults, what book is your class using?
There's a reason why there is a specific order. Do it that way.
If your O2 regulator has a dial that goes up to 25, ad a tank that supports that flow rate, you have the wrong kind of regulator and tank for a BLS class.
Yes, you should. That's how you learn.. You don't have to argue, but you need to be on the same page..
more info
our book is Limmer, AAOS 11th edition "emergency care" 11th Ed. p. 159: Ch. 6 Airway Adjuncts..
".. position the airway so that the tip is pointing toward the roof of the patient's mouth..insert and slide it along the roof of the mouth.. any airway insertion is made easier by use of a tongue blade.. gently rotate the airway 180 degrees.."
BVM we were taught cannot go to 25 LPM in our state unless we are A-EMTs (paramedics) though the regulators all go to 25. in our skills drills cranking regulator to 25 was a "Fail" then on the outside examiner's score sheet it was a fail for not cranking to 25..
We as a group are very reluctant to question the examiners about these issues as they are giving us our practice exams , since we know our college has a v ery hard time getting practitioners who are EMT s to serve as proctors. but this divide between what we are being taught and what the real world practitioners want us to do to pass practice skills causes us to think we are doomed.
thanks for your time in replying.
our book is Limmer, AAOS 11th edition "emergency care" 11th Ed. p. 159: Ch. 6 Airway Adjuncts..
".. position the airway so that the tip is pointing toward the roof of the patient's mouth..insert and slide it along the roof of the mouth.. any airway insertion is made easier by use of a tongue blade.. gently rotate the airway 180 degrees.."
BVM we were taught cannot go to 25 LPM in our state unless we are A-EMTs (paramedics) though the regulators all go to 25. in our skills drills cranking regulator to 25 was a "Fail" then on the outside examiner's score sheet it was a fail for not cranking to 25..
We as a group are very reluctant to question the examiners about these issues as they are giving us our practice exams , since we know our college has a v ery hard time getting practitioners who are EMT s to serve as proctors. but this divide between what we are being taught and what the real world practitioners want us to do to pass practice skills causes us to think we are doomed.
thanks for your time in replying.
ThadeusJ
Forum Lieutenant
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When using a BVM, the reservoir collects the oxygen that is used on subsequent breaths. The ability to deliver 100% oxygen is based on respiratory rate, tidal volume and peak inspiratory flow. Any combination of those will affect gas delivery. Therefore, when presented with a situation where those there parameters are not given, unless you are giving flows over and above what is necessary, one cannot give a simple LPM answer. The classic answer for proper input flow to deliver 100% is "the flow that does not allow the reservoir to collapse in inhalation".
Considering that this is basic resuscitation technique, to state one LPM for one provider and another LPM for others doesn't make a whole lotta sense.
Considering that this is basic resuscitation technique, to state one LPM for one provider and another LPM for others doesn't make a whole lotta sense.
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What's the reason for the specific order? Am I not allowed to ask about quality before I ask about provocation? Can I not then probe more in depth about family and social history after that?
I don't think he's talking about asking OPQRST in order; he's talking about asking OPQRST during the initial assessment when assessing circulation in ABC.
NomadicMedic
I know a guy who knows a guy.
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When you make patient contact, you need to ask "what's wrong". When the guy says "my chest hurts", say okay, I'll get back to that in a moment. Then finish your initial assessment, correct any immediate life threats (put on that EMT oxygen) and THEN start a focused exam with SAMPLE and OPQRST.
Make sense?
Make sense?
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That was how I understood it..
Well, just for the sake of discussion.. I'm not an instructor, but in a classroom scenario, *I* don't think they should be done out of OPQRST order.. I think that would be a bad habit for me to begin, and maybe it's just me, but I want to prevent every bad habit I can. Especially if I'm still in the classroom.
Train as you fight. That's what I say.
OP, there is a 12th edition of that Limmer book out. Maybe you guys aren't "on the same page"? <---see what I did there?
PaddyWagon
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Bingo. This.
Bring it up with your program director or teacher. Had the same problem and when I told him about what happened, we were pulling traction for an open femur fracture, and while checking pedal pulses, I only stated pulses present, not pedal pulses present...so yea...needless to say my director didn't like proctor and definitely didn't like how he failed me. That's my advice, good luck, do your best to hear their reasoning and I guess just learn as many ways as possible so you're prepared for any proctor.