Conflicting info, please help

[BlackOut]

So I was reading through an EMT-B study guide and one of the questions was:

"You arrive on scene to discover a 65-yo female lying on the floor of her living room. Your first step in the care of this patient is to

a) begin chest compressions
b) apply AED
c) maintain an open airway
d) assess level of consciousness

book says the correct answer is D, assess level of consciousness

However...

When I was learning primary assesment, we were first told to take care of c-spine, then go through and verbalize ABC findings, THEN work on LOC after ABC is clear. Shouldn't maintaining an open airway be first before assessing LOC?....I don't understand why the book says differently. Thanks for any input!

 

[enjoynz]

I can see where you are coming from,
but you need the check if the patient is responsive by speaking to them first.
If she starts talking to you, you know she has an open airway.
If she's not, then you check the airway.


Cheers Enjoynz

 

[stonez]

we were taught HHHABC
H - Hazards,safety
H- Hello- see if patient is concious
H- Help - call for help if needed
then
your ABC.

Of course the HHH are done quickly so if needed the ABCs are not delayed.

 

[seanm028]

I agree with Enjoynz. If the patient looks at you and says "Hi", then there's no need to assess airway. So really, the first thing you're doing is a basic LOC assessment. When the book says "assess consciousness" after ABCs, it's probably referring to AVPU or GCS, and getting a more definitive measurement.

 

[BlackOut]

I agree with Enjoynz. If the patient looks at you and says "Hi", then there's no need to assess airway. So really, the first thing you're doing is a basic LOC assessment. When the book says "assess consciousness" after ABCs, it's probably referring to AVPU or GCS, and getting a more definitive measurement.

Yeah thats what I thought too, I donno what I was thinking before, I think I just overanalyzed the situation. Training says to talk to patient first, if they respond then airway is open and they are conscious (so I guess when the book says "assess level of consciousness", they mean a really BASIC assessment, as in conscious or not) , so both are done at the same time.

 

[seanm028]

I've overanalyzed my fair share of study guide questions, too. Especially when you're on the eightieth one of the hour...

 

[skyemt]

keep it systematic...

while you are correct about C-spine precautions, which is technically part of the scene size up, the INITIAL assessment is comprised of your general impressions, AVPU, and chief complaint BEFORE the ABC's...

it is this way in every text i have ever seen.

 

[firecoins]

So I was reading through an EMT-B study guide and one of the questions was:

"You arrive on scene to discover a 65-yo female lying on the floor of her living room. Your first step in the care of this patient is to

a) begin chest compressions
b) apply AED
c) maintain an open airway
d) assess level of consciousness

book says the correct answer is D, assess level of consciousness

However...

When I was learning primary assesment, we were first told to take care of c-spine, then go through and verbalize ABC findings, THEN work on LOC after ABC is clear. Shouldn't maintaining an open airway be first before assessing LOC?....I don't understand why the book says differently. Thanks for any input!

Scene saftey is obviously first because it involves you not getting hut. C-spine is only if you suspect trauma, loc. You check LOC first because if she alert enough to be making any sort of noice, she has an airway and is breathing. Of course, you have to judge the quality.

 

[skyemt]

also, don't lose focus on the big picture...

who is the best source of information for your assessment?
the patient! what if you get there, don't talk to the patient...
first, when you do your ABC's you wont' even know what had happened...

secondly, what if the patient goes unconscious after as you're doing your ABC's... now you haven't gotten any information from her, and you won't be able to...

you get to the patient, and it's AVPU and CHIEF COMPLAINT..... then ABC's...

every time...

if this doesn't make sense to you, i advise you to get some extra help from your instructors, because you are not getting the idea here...

 

[BossyCow]

I think I see where your confusion arose. The first step in a primary assessment occurs after your initial size up. The level of consciousness is part of the initial scene size up, not the primary assessment.

 

[skyemt]

actually,

technically, the AVPU is part of the primary assessment, not the scene size-up... don't get that wrong on your exam...

however, i have seen where some will teach it right after the ABC's, but I and many learned to ask it before the ABC's...

in reality, things happen at once, where determining the ABC's and AVPU really happen simultaneously...

but for your purposes, they happen step by step... check with your instructor, and follow the sequence you are taught.

 

[firetender]

It's all about running through a process of elimination as quickly as you possibly can. Speaking to the patient and having them respond takes you into another level of the "decision tree" immediately.

 

[MikeRi24]

NY State Protocal for pt assessment (medical OR trauma) is this:
1) BSI/Scene Safety
2) LOC
3) C-spine
4) ABCs

do LOC first because if they are alert and concious, you can talk to them and find the answers to your next 3 questions: "Sir, can you hear me? Do you know what day it is?" if they answer you "did you fall?" if they say yes "ok, my partner is going to come up behind you and hold your head. I need to to remain as still as possible" so right there you know thier LOC, and the fact that they are talking to you means that they have an airway. just walking up to someone and grabbing thier neck to do c-spine will probably scare them and they will be more likely to jerk around. and if you ask them if they fell as part of you LOC assessment, and they say no, then you don't even need to really worry about c-spine.

 

[skyemt]

NY State Protocal for pt assessment (medical OR trauma) is this:
1) BSI/Scene Safety
2) LOC
3) C-spine
4) ABCs

do LOC first because if they are alert and concious, you can talk to them and find the answers to your next 3 questions: "Sir, can you hear me? Do you know what day it is?" if they answer you "did you fall?" if they say yes "ok, my partner is going to come up behind you and hold your head. I need to to remain as still as possible" so right there you know thier LOC, and the fact that they are talking to you means that they have an airway. just walking up to someone and grabbing thier neck to do c-spine will probably scare them and they will be more likely to jerk around. and if you ask them if they fell as part of you LOC assessment, and they say no, then you don't even need to really worry about c-spine.

okay... i'm an emt in ny state, and i have never seen that. please post where you are quoting that from. C-spine considerations not only are part of the scene size up done PRIOR to AVPU, but if you didn't do it that way on the practical you would have failed. so i'd really like to know where you got that from.

the c-spine consideration is due to mechanism, which is determined PRIOR to reaching the patient. if you talk to him, it is possible to rule out c-spine, but it is applied FIRST before talking and ruling it out.

what if he hit is head and doesn't remember? what if the pt is unconscious??

i don't know of any NYS document that says what you said.

 

[AZFF/EMT]

I learned
BSI/SS
LOC-C-Spine
A,B,C's

 

[firecoins]

NY State Protocal for pt assessment (medical OR trauma) is this:
1) BSI/Scene Safety
2) LOC
3) C-spine
4) ABCs

do LOC first because if they are alert and concious, you can talk to them and find the answers to your next 3 questions: "Sir, can you hear me? Do you know what day it is?" if they answer you "did you fall?" if they say yes "ok, my partner is going to come up behind you and hold your head. I need to to remain as still as possible" so right there you know thier LOC, and the fact that they are talking to you means that they have an airway. just walking up to someone and grabbing thier neck to do c-spine will probably scare them and they will be more likely to jerk around. and if you ask them if they fell as part of you LOC assessment, and they say no, then you don't even need to really worry about c-spine.

okay... i'm an emt in ny state, and i have never seen that. please post where you are quoting that from. C-spine considerations not only are part of the scene size up done PRIOR to AVPU, but if you didn't do it that way on the practical you would have failed. so i'd really like to know where you got that from.

the c-spine consideration is due to mechanism, which is determined PRIOR to reaching the patient. if you talk to him, it is possible to rule out c-spine, but it is applied FIRST before talking and ruling it out.

what if he hit is head and doesn't remember? what if the pt is unconscious??

i don't know of any NYS document that says what you said.

1 BSI
2. Scene Safety
3. MOI/NOI - consider C-Spine
4. AVPU
5. ABC

In realty though most of this is done at the same time but this is how I remeber this being on the NYS sheets.

 

[BlackOut]

In my class we have learned it this way....

1. PPE (personal protective equipment)
2. Scene size up
3. Patient contact/C-spine
4. ABCs
- Patient's airway is open and unobstructed because pt is talking to me
- Pt's breathing is quiet and regular
- Circulation radial pulse is strong and regular
- Skin signs are pink, warm, and dry
- LOC- Pt is alert and oriented to person, place, time, and event with no signs of fall or loss of consciousness.

Release c-spine

SECONDARY ASSESMENT

Anyone learn it this way?

 

[skyemt]

1 BSI
2. Scene Safety
3. MOI/NOI - consider C-Spine
4. AVPU
5. ABC

In realty though most of this is done at the same time but this is how I remeber this being on the NYS sheets.

Firecoins,

that is exactly how it is in New York State... C-Spine considerations before AVPU...

i'm sure the other guy just made a mistake... wouldn't pass the NYS exam any other way.

 

[firecoins]

Firecoins,

that is exactly how it is in New York State... C-Spine considerations before AVPU...

i'm sure the other guy just made a mistake... wouldn't pass the NYS exam any other way.

actually most testers wouldn't care if you swithed as long as you did it at the beginning.

 

[JPINFV]

Ok, first off, everyone put away your cookboo.... err protocols. Sitting here posting links and quoting protocols over which is first, ABC or LOC is about as stupid as having DCAPBTLS as an acronym. As have been mentioned earlier, if you greet a patient and s/he greets you back than the patient's ABC are grossly intact [i.e. the patient has an airway, is breathing, and has a pulse. Mileage in those three categories will vary from patient to patient though.] Real life doesn't have purdy little check boxes and just because you verbalize scene safety and BSI doesn't mean a damn, nor that things will stay the same.

In reality, ABC can be assessed long before LOC [oh, our patient is walking around, therefore he probably has an airway [exception: choking, since I know someone is going to call me out on that one B)], the patient is breathing, and the patient has a pulse [if your patient is walking and doesn't have a pulse, then you need a priest, not a medic].

Ok, now let's look at the question itself.

"You arrive on scene to discover a 65-yo female lying on the floor of her living room. Your first step in the care of this patient is to

a) begin chest compressions
b) apply AED
c) maintain an open airway
d) assess level of consciousness

Ok, A and B requires you to check a pulse before they happen. C requires you to check the patient's airway prior to taking that step. D is the only actual assessment up there. "Lying on the floor" is not "unconscious" and we don't maintain airways in patient's who can maintain their own [Law 13*], especially as basics [show me a system that allows basics to RSI and I'll show you a lawsuit waiting to happen].

To expand further, especially if you want to bring "protocols" into this, thing back to good old CPR. What's the first thing you do? Shake and shout. We just call it checking a patient's LOC instead.

Edit: taking C-spine precautions on all patients is stupid, but that's for a different thread.



*Law 13 of the House of God: The delivery of good medical care is to do as much nothing as possible.