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Colt45

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So I have a question that kind of threw me off during an exam. And I haven't been able to find the information in my book as to what order to do certain steps in.

Basically a patient is unresponsive and breathing. Scene safety and BSI have been established and you and your partner enter the scene. You check your patient doesn't respond to verbal commands and You feel a strong bilateral pulse around 74 beats per minute. What is your next action?

My question basically is when do you take C-spine? is it before Airway and Breathing? I can't find it anywhere and I got tripped up on a question like this. I have another one as well that's regarding regaining circulation after CPR. It sounded something like this.

After delivering a third shock to your Cardiac Arrest patient you get return of circulation. which would be your next step in managing your patient?
 
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redundantbassist

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For the first question, it indicates that your patient is breathing, assuming that the task of checking breathing was already completed. If the patient is uninjured, maintaining spinal precautions is unnecessary and you will maintain an airway. However, if the patient shows signs of injury managing the airway and maintaining c spine stabilization should occur simultaneously.

As for the second one, you have already checked for a pulse, as you have confirmed ROSC. There is no need for CPR. Ensuring a patent airway holds the highest priority.
 

Aprz

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@Colt45 Instead of asking us what is the answer or what we would do, tell us what you think should be done and why.

Redudantbassist might be right, but he also might be wrong. I can't say...
 
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Colt45

Colt45

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Honestly my first thought for the second question was to check the pulse. It didnt state where CPR was being done so my first instinct was to manually check for a Carotid pulse and go from there to airway. The tests i used are the type who dont tell you if you were right or wrong, they just give you a score at the end. For the first question I thought that sincr he is not responsive we dont know if there was any injury so i think C-spine comes first because you change how you open the airway in regards to spinal precautions. I asked because i want a definitive answer of start to finish. What steps to take.
 

Aprz

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Unfortunately, it is unlikely you will get a definitive answer from us because the tests that instructors provide are not standardized. Also you are relaying only your interpretation of the question and answers; You may have missed a key word in the question or answer, or you could've misunderstood them. We can give you a very educated guess at best.

Here are the skill sheets for NREMT that relate to your test questions.

Cardiac Arrest

Medical Assessment

Trauma Assessment

Usually the answer is the first thing that comes up as you go down the list.

I'll tell you my experience in real life. I rarely work traumatic cardiac arrest; They are usually determined to be dead on scene. If I did work them and got ROSC (return of spontaneous circulation ie they got a pulse back), I would fully immobilize them. I have not fully immobilized any cardiac arrests that I have worked. I don't know how others feels about it, but I personally don't think about c-spine when working a cardiac arrest. Unfortuantely, most of the time, they are determined to be dead after working them for about 20 minutes in my county. If we do get ROSC, we usually use a scoop and transport them immediately.

Like I said earlier, ROSC means return of spontaneous circulation or it is fancy for they got a pulse back. ROSC doesn't guaranty that they are breathing too.
 
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