@@HellenKellerDenier That's why I use a riding lawn mower :)

Or shoveling snow.

🤣🤣🤣

Bruh, right?! I was thinking the same! Like, imma let my grass grooooow, baby. I like my heart! 😂

Keep up with it and ask for help if you need it!!!

I agree. I’m in week 3 and there’s so much to take in especially with zero knowledge of healthcare

Hell yea

Same, I’m a couple months in and overwhelmed but powering forward. It’s mostly hard because every person we talk to has a different opinion. Ie. Idk if they have to verbalize when they get in the ambo, but we would’ve done in it scenario pretty much after hearing the patients having chest pain and taking basic vital signs. Everything else can be done in the truck en route because she’s a med red. But this is a helpful assessment to watch. I like the flow of the convo verses the broken down sample opqrst. I do better thinking of it as a narrative vs thinking about it step by step. And the clinical I just had was pretty awful XD didn’t meld with the preceptor at all.

@@robertpalofox7446 I’m in week 5 (though we missed a week because of weather) and it’s soooo much info..

Yay!! I'm taking my skills test tomorrow and I'm getting a last minute cram in before

Congratulations!!

Proud of u!! Mine is in 2.5 hours lol wish me luck

My testing with state is this Saturday in 2 days and I’m terrified

@amniewilliams1241 i was too. I just calmed myself down and remembered what I had learned and it wasn't too bad. I'm sure you'll do fine

Keep up the practice! It takes hard work but eventually it will become second nature!

Just remember your SAMPLE and OPQRST and you'll be good buddy.

@@rhoonah5849 I memorized those..but when I ran through a scenario I completely blanked...soo embarrassing.🤦‍♂️

@@paintballfanatic7231 it happens. Just practice, practice, practice. I used to run through scenario after scenario with my classmates. We watch each other then critique. It really helped. Then I'd cube home and run through trauma assessments in my wife and stuff. There were a few things i kept forgetting so I'd leave notes all over the house... bathroom mirror, computer monitor, steering wheel of my car. Whatever it took. You'll get it!

@@rhoonah5849 great ideas! Thanks. I'll be trying to practice on my family members and friends. I have I hard time feeling comfortable touching people, any advice for that?

Thank you!!! We are working on creating more scenarios!

Totally agree!

@@yalenewhavenhealthcenterfo8754 Yes please.

@@yalenewhavenhealthcenterfo8754 Did we get more videos?! : )

I’m on the same boat.

I just found out I passed my NREMT two days ago, good job past me for not quitting

You'll be alright bro

Im about to test..what helped me is i just took the med sheet and copied it into my notes over and over then eventually could do it without looking and remember the first couple parts if trauma and medical are almost the same

@@scherff1399 I already passed it, the comment above was me replying to my past self

Thank you for your response. As to the items you addressed 1. The NREMT requires that each patient receive high flow O2. 2. Female patients can be on forms of ED medication to treat Pulmonary Hypertension hence why it must be asked prior to administering nitro. 3. A full proper assessment must be preformed prior to administering any medications as all medications have side effects which can be found during the detailed exam.

@@yalenewhavenhealthcenterfo8754 Thank you for the information. A lot has changed over the years. I am currently starting my recert and then NREMT exam for instructor purposes. This has been very helpful.

It's a good thing he asked about recreational drug use because if she has a history of cocaine use/amphetamines, it could lead to dilated cardiomyopathy and present with chest pain. So very important to ask and rule out.

@@michaelreyes2301big facts

Paul we believe in you buddy! Let us know how it went :)

Best of luck!!!

Results??

Did you pass????

@@miserylovescompany9042 sorry for the late reply, been busy but I passed both my skills test! Thanks for the encouraging words!

I take my med assessment in 3 days, I keep watching these videos and following along with the NREMT sheet and its helping me alot! good Luck!

@@WoWzErZ2003_ yes I did. Work in Florida for a few months but now I'm joining the military.. EMT did I live up to the hype

@@whymemanwhyl0lp751did you pass?

@@ZacharyLookas hello i did pass. Became an emt for almost 7 months. Decided it was not for me and now im in the military.

Best of luck!

Did you pass the nremt

@@spilledsoju03 I did the state test a tiny bit over a year ago. Been doing volly and paid for almost a year now!

How is your schooling going so far?

@@bossnone739 I'm currently on my 3rd about to be 4th week into the program and I like it!. It's A LOT of information to take in in such short period of time but i think it'll all be worth it at the end

@@jesuslezama8800 how is it going, did you pass?

I’m doing a 2 week NRemt class start to finish with both medical & trauma assessment. I’m literally stressing big time learning this

@@farisqader7919 yes I did! . I’m now an intermediate getting ready for paramedic class next semester

NREMT standards only accept 100% of O2. Again this is a testing scenario not real life

Jacob Johnson yes because then they’re gonna assume you know standing orders and question you on those

Per NREMT Guidelines the ONLY medication an EMT can give without contacting MEDCONTROL is Oxygen. So to answer your question yes you would still need to contact MEDCONTROL

Follow local protocols. In MA Epi's are SO but MA is switching to check and inject.

Here in Texas, as EMT's there are 8 medications in our standing orders that we can give WITHOUT contacting medical direction. I believe every state's laws differ. We give epinephrine, activated charcoal, O2, Nitro, Narcan, aspirin, albuterol and oral glucose. OF course if there's a question of # of doses or any situation outside of the 5 rights we would contact MD.

Depends on your state. In my state, standing orders allow us to give two doses unless patient is over 65 or under 6 months then we contact medical control. Remember this though, when it doubt, call med control. You're NEVER wrong to call and confirm.

Why is BP unsafe for nitro? In my course we learned that bp

@@matthewthompson6455 everyones is different cause for us we learned its 90 and above is safe

best one I've seen since it's made as realistic as possible

THIS CANDIDATE HAS A NATURALLY GROWN BULLET PROOF VEST OMG

How's it going 👀

Great question Isidro! It is a NREMT requirement that the EMT provide high flow O2 to the patient even if the respiratory status is within the "normal range"

@@yalenewhavenhealthcenterfo8754 that's interesting, why is that?

Try to tell it like you're telling a story. What you found, what you did, and where you are now. Keep it simple!!!!

@@yalenewhavenhealthcenterfo8754 thanks that helps a lot!

Did u pass?

If you believe the patient is suffering for a Cardiovascular Emergency, the patient meets no contraindications for ASA or Nitro administration, and MEDCONTROL has has approved the administration you can give the patient both ASA and Nitro. It is recommended that you give the patient ASA fist due to it being administered PO, and Nitro second due to it being a SL administration

@@yalenewhavenhealthcenterfo8754 Would it bet jumping the gun, if after getting the first set of vitals, asking of contraindications, give the ASA and Nitro earlier since we already suspect and MI and have asked for ALS? That is if we live in a state were ASA and Nitro are already pre approved with standing orders.

That would still be appropriate

The candidate made a transport decision by stating "the patient is a high priority" thus initating transport

Thank you for your response as to your questions. 1. EMT's must call a MD for all interventions other than Oxygen per the NREMT. 2. The candidate is given two(2) partners for the scenario, but the candidate must be the one who actually obtains all information. 3. This is a testing scenario not a field scenario. 4. EMT-B's cannot obtain a 12 lead ECG, Morphine is not given by EMT-B's. 5. The NREMT does not accept "International Standards"

@@yalenewhavenhealthcenterfo8754 Many thanks for taking the time to reply and clarification. I find it fascinating seeing how other agencies train. How are EMT-B level staff used? Do they crew ambulances as a pair, or with a paramedic?

@@coover65 You're very welcome!! EMT-B's can be staffed with another EMT-B or a Paramedic

@@yalenewhavenhealthcenterfo8754 Many thanks for the clarification. Here by law registered advanced care paramedics is the minimum standard allowed but in some cases we have volunteer first responders and also "technicians". FRs are in remote areas, cannot transport and provide basic care until the paramedics arrive. The "technicians" are a controversial recent addition. Only indigenous people can enter the "technician" program, and must live in an Aboriginal or islander community. Such communities are generally in remote areas away from white settlements. We don't have "technicians" in the cities, only paramedics with a university degree.

yes

Women too can be on forms of E.D Medications designed to treat Pulmonary Hypertension hence why the question sill needs to be asked for females

Before as it is done during your ABCs!

Recently finished my emt course. I believe Sildenafil can also used for pulmonary hypertension in both males and females. And I’m sure there are other reasons for use too. A lot of meds also have approved “off label” usage for conditions that aren’t consistent with the original med indication but that react therapeutically. My chest pain “patients” were always male and idk that asking a female is a requirement or for good measure. A good question for your instructor tho.

Keep working at it !!! You'll get it!

Low BP is a contraindication for the Nitro that needs to be checked first and there are steps to get to that point before vitals i.e ABOCs Sample history ect.

You want to assess life-threats first and foremost which means your ABCs and primary assessment. Airway, Breathing, Circulation. Need breathing, quality of breaths, patent airway, pulse strength, rate, rhythm. You need to assess mental status, is it altered or is the patient unconscious? This can affect the patient's ability to maintain patent airway and makes them a higher priority for emergency care and possible need for ALS assistance. If they are stable, ABCs all look good, and they are conscious, alert, and aware, you still want to be cognizant that they could deteriorate. Because there's a chance they could become unstable and lose consciousness, or their mental status could deteriorate, you want to complete your history taking right away for your secondary. This is because your best opportunity to get accurate history info is directly from the patient, and if they lose consciousness or become confused you can no longer get a good history. That information is vital to offering them appropriate care, and when they get to the hospital they will also need that information from you. Information from your history and physical are also necessary prior to administering or assisting with any kind of medications (save for oxygen, although you do assess for signs of shock, poor perfusion, etc. during your primary that indicates oxygen therapy or ventilations). You need to know allergies, medical history, pertinent vitals and prescriptions, also need to know what meds they are taking to give accurate doses (what if patient had already taken 3 tabs of ASA then you can only give 1) and whether contraindications are there (what if they were on Levitra for example, that would contraindicate the nitro). TL;DR while you would like to treat a patient as quickly as you can, in order to provide appropriate and high quality care that will not harm the patient you have to make sure you go through your checklist. You don't want to accidentally give a patient any medications that could make them worse because once you've given them a drug you cannot "undo" it so to speak.

@@LilJbm1 I'm still a bit confused as to why he did a whole reassessment with seemingly full vitals before intervention after he had history/examination/contraindications and a previous set of vitals etc

@@danieljaywoods9950 because this is how the exam works. Baseline vitals come before Interventions. In real life, this would probably go a bit more quickly but this is a demonstration for the NREMT exam

Having a heart rate below and taking ed medication are the contraindications since nitro is a vasodilator

As long as you check the necessary rights you should be covering them all. Best of luck in your testing!

Chest pain is always an ALS call

SlayinSaiyan 94 knowing whether or not that you are giving the right interventions I would say. I’m a hs emt student and I will say that being an emt is a very strenuous job considering all the assessments that you have to know for skills day. It’s more so remembering all the nitty gritty details that make you want to explode!!

I'm an EMT in Texas......hardest part is SCHOOL!!! LMAO.....no joke, the program comes at you EXTREMELY fast with tons of info and not much time between exams. They have a pretty good weeding out process (and rightly so) as our school only has a pass rate of approx. 25%!!! Then again, those who fail out, I wouldn't want them touching me anyway. Many do not take it as serious as they should considering the responsibility you have as a first responder. FYI, I currently work for a private ambulance company and I'm getting ready to start paramedic school.

Definitely school! You have to focused and serious about it

@Ryan Summers.....I agree 100%. I too work for a private ambulance company in Austin Tx and as an EMT I was fortunate enough to be placed on an ALS truck so I get to see and learn lots as I assist the medics I work with. I also agree regarding O2. The only time we disregard the Spo2 # is for a pregnant woman (baby needs O2) and inhaled respiratory issues such as poisons. Those are the only two times we give oxygen regardless of Spo2 reading. And we certainly wouldn't have someone on a non rebreather at 15lpm!!! A nasal cannula ta 2 lpm.....if I HAD to…...but not a nonrebreather.

Ryan Summers i agree that the SpO2 was high enough that O2 admin wasn’t necessary, but personally i would give the O2 because of the pale, cool ,clammy skin as it indicates that the patient may be hypoxia/perfusing poorly, plus oxygen is a standard intervention for chest pain. Don’t treat the monitor, treat the patient as they present, especially since pulse ox isn’t the most accurate device to begin with.

As long as the shirt is thin enough it is possible if you know how to do a bp

Cool. I was taught to always go bare skin

The reply made by Nissim is correct

BP's are done out in the field OVER clothing all the time. Of course in school we are taught to be on bare skin...….same with listening to lung sounds but you can't just rip someone's shirt off them out in public. LMAO

My question is why he didnt make her uncross her legs... when I worked as a med aid for a nursing home we had to make them...

Did u pass?

@@flores222 oh my gosh yes I did! Coming back as a paramedic student.

good job im proud of you @@janellemoreno3547

Systolic BP over 100 is the contraindication

BP less than 90 systolic, and HR less than 50 or greater than 100

he says A&O x 4 its alert and oriented to person, place, time and event.

@@joshhayes2196 Thanks for clarifying. Trying to soak up as much info before classes start in September and a lot of this is the first time I've heard it before.

@@adams7597 that’s great! Good luck you will enjoy it I’m sure.

A full set of vital signs is completed once. However there are aspects of the vital sign check that is completed in other portions of the assessment.

@@yalenewhavenhealthcenterfo8754 thank you!

I passed my NREMT skills and get to keep my cert because of your videos!!!! Thank you so so so much!

@@vanessamarietorres7245 Congratulations!!! You did all of the hard work!!!

This is a BLS Station

Rate/Rhythm/Quality

He did. I forget the timestamp but did ask if she was taking any kind of erectile dysfunction meds before giving any nitro.

Go to 9:14 the candidate does ask about ED medications or any further contraindications

The patient could be possibly suffering from a cardiovascular event which requires additional subliminal oxygen treatments.

Everyone gets oxygen in your medical assessment scenario 😁

@@yalenewhavenhealthcenterfo8754 couldn't you give a nasal cannula??

Should’ve got sp02 before giving oxygen. Too much oxygen is bad

Review the NREMT Medical Patient Assessment Form and you will understand why. The Primary Assessment includes vital sign checks to get a baseline of the patient. The second vital sign check is to be sure the patient is stable enough for any interventions

He did not stay. After he completed the circulatory assessment he made a transport decision to transport on a high priority

@@yalenewhavenhealthcenterfo8754 ohh ok awesome I missed that part!

How'd you do?

It's because ED meds are contraindicated for nitro if used in the last 24 hrs

@@nathanaelswanda2031 aw ok thanks. 👍 Just through me off they asked a woman that.

Julio Morales some women use Ed medication to lower their blood pressure

@@Chris-qe6qr aw ok. Thanks.

Might be a regional thing. Either way, he makes his point clear, and his vernacular isn't in anyway indicating that he is ignorant. I'm GONNA give him an A+. This assessment was flawless.

Female patient's can be prescribed erectile dysfunction medications due to pulmonary hypertension. That is why you must ask for both male and females.

Some females are on forms of ED medications to treat pulmonary hypertension

There are several reasons; the most important is the contraindication. Both drugs cause vasodilation and when combined it can lead to a sharp and prolonged drop in systemic blood pressure and decreased blood flow in compromised coronary vessels. This by itself can result in a cardiac event. AND Pt has a history of MI which means the heart has been compromised and reducing blood flow can be fatal. AND In the US both females and males are prescribed Viagra for increased blood flow to the genitalia. AND Viagra isn't limited to The treatment of ED. It's prescribed for COPD, hypertension and other medical conditions.

In this case being chest pain ALS will be able to do a 12 lead and other medications that the BLS can not.