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NREMT Psychomotor Exam With complete

solutions 2024/

TRAUMA - ANSWER- 1. SCENE SIZE-UP

BSI/PPE

Scene safe MOI/NOI

of patients

ALS backup Consider c-spine

2. PRIMARY SURVEY/RESUSC. General impression AVPU/LOC Chief complaint/apparent life threats Airway: open & assess, insert adjunct Breathing: assess, assure adequate ventilation, O₂ therapy if necessary, manage any injury compromising breathing Circulation: check pulse, assess skin, assess and control major bleeding, initiate shock management if indicated Identify patient priority level/make transport decision
3. HISTORY TAKING Obtain baseline vitals (BP, P, & RR) Obtain SAMPLE history
4. SECONDARY ASSESSMENT/DCAP-BTLS Head: Inspect/palpate scalp & ears, eyes, mouth, nose, and facial area Neck: Check tracheal position, jugular veins, palpate c-spine Chest: Inspect, palpate, and auscultate chest Abdomen/Pelvis: Inspect & palpate abdomen + pelvis, verbalize assessment of genitalia if needed Lower extremities: Inspect, palpate, and check PMS Upper extremities: Inspect, palpate, and check PMS

Posterior thorax/lumbar/buttocks: Inspect and palpate Manage secondary injuries and wounds appropriately

5. REASSESSMENT Indicate how and when to reassess patient MEDICAL - ANSWER- 1. SCENE SIZE-UP BSI/PPE Scene safe MOI/NOI

of patients

ALS backup Consider c-spine

2. PRIMARY SURVEY/RESUSC. General impression AVPU/LOC Chief complaint/apparent life threats Airway: open & assess, insert adjunct Breathing: assess, assure adequate ventilation, O₂ therapy if necessary, manage any injury compromising breathing Circulation: check pulse, assess skin, assess and control major bleeding, initiate shock management if indicated Identify patient priority level/make transport decision
3. HISTORY TAKING OPQRST & any clarifying questions SAMPLE
4. SECONDARY ASSESSMENT Assess affected body part/system Cardiovascular, pulmonary, neurological, musculoskeletal, integumentary, GI/GU, reproductive, psychological/social
5. VITAL SIGNS BP, pulse, respiration rate and quality State field impression (armchair diagnosis/ddx) Verbalize interventions/treatment
6. REASSESSMENT State how and when to reassess to determine changes in condition Provide accurate verbal report to arriving EMS unit BVM VENTILATION OF AN APNEIC ADULT - ANSWER- PPE Check responsiveness ALS backup

Check breathing and pulse (carotid) simultaneously (NO MORE THAN 10 SECONDS) Open airway properly (head tilt-chin lift, if c-spine then jaw thrust) (Examiner says "mouth is full of secretions and vomitus") Prepares rigid suction catheter Turn on power to suction or retrieve manual suction device Insert rigid suction catheter without applying suction Suction the mouth and oropharynx (Examiner says "mouth and oropharynx are clear") Open airway manually (head tilt-chin lift, if c-spine then jaw thrust) Insert oropharyngeal airway (Examiner says "no gag reflex present & patient accepts airway adjunct") Ventilate the patient immediately using a BVM unattached to oxygen OR with O₂ within 30 seconds (Examiner states ventilation is being properly performed without difficulty) Re-check pulse (carotid) for no more than 10 seconds Attach the BVM assembly to oxygen (15L/min) Ventilate the patient adequately (proper volume to cause visible chest rise AND proper rate [1 ventilation every 5-6 seconds]) (Examiner asks "How would you know if you are delivering appropriate volumes with each ventilation?" answer: see chest rise and fall/enough for chest rise) OXYGEN ADMIN. VIA NON-REBREATHER - ANSWER- PPE Gather appropriate equipment Crack valve on O₂ Assemble regulator to O₂ tank Open O₂ tank valve Check O₂ tank pressure Check for leaks Attach non-rebreather mask to correct port of regulator Turn on O₂ flow to prefill reservoir bag Adjust regulator to assure O₂ flow rate of at least 10L/min Attach mask to patient's face and adjust to fit snugly SPINAL IMMOBILIZATION (Seated patient) - ANSWER- PPE Direct assistant to place/maintain head in neutral, in-line position Direct assistant to maintain manual stabilization of the head Reassess PMS in each extremity Apply appropriately sized extrication collar Position the immobilization device behind the patient Secure the device to the patient's torso

Evaluate torso fixation and adjust as necessary Evaluate and pad behind the patient's head as necessary Secure patient's head to device Verbalize moving the patient to a long backboard Reassess PMS in each extremity SPINAL IMMOBILIZATION (Supine patient) - ANSWER- PPE Direct assistant to place/maintain head in neutral, in-line position Direct assistant to maintain manual stabilization of the head Reassess PMS in each extremity Apply appropriately sized extrication collar Position the immobilization device behind the patient Direct movement of the patient onto the device without compromising integrity of the spine Apply padding to void between the torso and the device as necessary Immobilize patient's torso to device Immobilize patient's head to device Secure patient's legs to device Secure patient's arms to device Reassess PMS in each extremity BLEEDING CONTROL/SHOCK MANAGEMENT - ANSWER- PPE Apply direct pressure to wound (Examiner will state the wound is still bleeding) Apply tourniquet (Examiner will state patient is showing signs/symptoms of hypoperfusion/shock) Properly position the patient (supine with legs elevated) Administer high-flow O₂ Initiate steps to prevent heat loss (blankets under and on top) Indicate the need for immediate transport CARDIAC ARREST MANAGEMENT/AED - ANSWER- PPE Scene safe? Attempt to question bystanders about arrest events Check patient responsiveness ALS backup Check breathing and pulse simultaneously (NO MORE THAN 10 SECONDS) (Examiner will state "patient is unresponsive, apneic, and pulseless") Immediately begin chest compressions (adequate depth and rate; allow chest to recoil completely) Perform high-quality, 1-rescuer CPR for 2 minutes:

Adequate depth and rate Correct compression-to-ventilation ratio Allows chest to recoil completely Adequate volumes for each breath Minimal interruptions of no more than 10 seconds throughout (After 2 minutes/5 cycles, reassess and second rescuer resumes compressions while you operate AED) Turn on AED Follow prompts and correctly attaches pads/AED to patient Stop CPR to ensure all individuals are clear of patient during rhythm analysis Ensure all individuals are clear of patient and deliver shock from AED Immediately direct rescuer to resume chest compressions JOINT IMMOBILIZATION - ANSWER- PPE Direct application of manual stabilization of the injury Assess PMS in injured extremity (Examiner states "PMS functions are present and normal") Select proper splinting material Immobilize site of injury Immobilize the bone above and then the bone below the injury Secure entire injured extremity Reassess PMS in injured extremity (Examiner states "PMS are present and normal") LONG BONE IMMOBILIZATION - ANSWER- PPE Direct application of manual stabilization of injury Assess PMS in injured extremity (Examiner states "PMS functions are present and normal") Measure the splint Apply the splint Immobilize the joint above and then the joint below the injury Secure entire injured extremity Immobilize the hand/foot in position of function Reassess PMS in injured extremity (Examiner states "PMS are present and normal")