MEDICAL Patient Assessment/Management Medical Essay to Skill Examiners Objectively observing and recording each candidate s performance for feedback. Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid any perceived harassment of any candidate. Recording, totaling, and documenting all performances as required on all skill evaluation forms Thoroughly reading the specific essay for the assigned skill before actual evaluation begins Checking all equipment, props prior to and during the examination Briefing Simulated Patient for the assigned skill Assuring professional conduct of all personnel involved with the particular skill throughout the examination Information pertaining to vital signs should not be provided until the candidate actually takes the vital signs of the Simulated Patient (BP, P and R) using a stethoscope and a blood pressure cuff. Each candidate must actually obtain vital signs on the patient, including blood pressure, pulse rate and respiratory rate. Be sure to record the measured and reported vital signs on the appropriate spaces of the skill evaluation form. Acceptable ranges for scoring purposes are based upon the vital signs that you measure and record on the Simulated Patient: Blood pressure: ± 10 mmhg Pulse: ± 10 beats per minute Respiratory rate: ± 5 breaths per minute After the candidate measures the actual vital signs of the Simulated Patient, you may need to inform the candidate of adjusted vital signs based upon the approved testing scenario for the examination as compared to the actual vital signs just obtained by the candidate. INSTRUCTIONS TO THE PSYCHOMOTOR SKILLS CANDIDATE FOR PATIENT ASSESSMENT/MANAGEMENT MEDICAL This is the Patient Assessment/Management - Medical skill. In this skill, you will have fifteen (15) minutes to perform your assessment, patient interview, and "voice" treat all conditions discovered. You should conduct your assessment as you would in the field, including communicating with your Simulated Patient. Using the term simulated removal xxx clothing is acceptable. As you progress through this skill, you should state everything you are assessing. Specific clinical information not obtainable by visual or physical inspection, for example blood pressure, should be obtained from the Simulated Patient just as you would in the out-of-hospital setting. You and your team will be working with you. They can only perform the interventions you indicate necessary and I will acknowledge all interventions you order. I may also supply additional information and ask questions for clarification purposes. Do you have any questions?
Nature of the call: Chief complaint: Breathing: Circulation: Onset: Provokes: Quality: Radiate: Severity: Time: Interventions: Allergies: Medications: Past medical history: Last meal: Vital signs: Mentation You arrive at a residence and find a 61 year old male on home oxygen. He appears overweight and is sitting in a tripod position in the chair. He is breathing rapidly and you observe cyanosis around his lips, fingers and capillary beds. I can t breathe. (coughing) I need to go to the hospital. (more coughing) 28 and labored; pursed lips Pulse 120 and strong Breathing has gotten worse over the past 2 days. Gets really bad when I use the stairs. Can t seem to catch my breath. No pain anywhere else. I think I m dying. I can t stop coughing. Woke me up 3 hours ago. Still can t catch my breath. I turned up the oxygen to 3 L/minute about 1 hour ago. Penicillin, bee stings Oxygen, hand-held inhaler (bronchodilator) 10 year history of emphysema I ate breakfast this morning. BP 140/88, P 120, R 28 and SpO2 is 87% on 3 L/minute nasal canula Alert and appropriately oriented to person, place, and time Patient Assessment/Management Medical Examination gloves O2 Kit Pulse Oz Glucometer, Lancets Band aides and Alcohol wipes Pen Paper Watch with second hand Penlight Blood pressure cuff Stethoscope Thermometer Blanket Simulated Patient
TRAUMA Patient Assessment/Management Trauma Essay to Skill Examiners Objectively observing and recording each candidate s performance for feedback. Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid any perceived harassment of any candidate. Recording, totaling, and documenting all performances as required on all skill evaluation forms Thoroughly reading the specific essay for the assigned skill before actual evaluation begins Checking all equipment, props prior to and during the examination Briefing Simulated Patient for the assigned skill Assuring professional conduct of all personnel involved with the particular skill throughout the examination Information pertaining to vital signs should not be provided until the candidate actually takes the vital signs of the Simulated Patient (BP, P and R) using a stethoscope and a blood pressure cuff. Each candidate must actually obtain vital signs on the patient, including blood pressure, pulse rate and respiratory rate. Be sure to record the measured and reported vital signs on the appropriate spaces of the skill evaluation form. Acceptable ranges for scoring purposes are based upon the vital signs that you measure and record on the Simulated Patient: Blood pressure: ± 10 mmhg Pulse: ± 10 beats per minute Respiratory rate: ± 5 breaths per minute After the candidate measures the actual vital signs of the Simulated Patient, you may need to inform the candidate of adjusted vital signs based upon the approved testing scenario for the examination as compared to the actual vital signs just obtained by the candidate. INSTRUCTIONS TO THE PSYCHOMOTOR SKILLS CANDIDATE FOR PATIENT ASSESSMENT/MANAGEMENT TRAUMA This is the Patient Assessment/Management - Medical skill. In this skill, you will have fifteen (15) minutes to perform your assessment, patient interview, and "voice" treat all conditions discovered. You should conduct your assessment as you would in the field, including communicating with your Simulated Patient. Using the term simulated removal xxx clothing is acceptable. As you progress through this skill, you should state everything you are assessing. Specific clinical information not obtainable by visual or physical inspection, for example blood pressure, should be obtained from the Simulated Patient just as you would in the out-of-hospital setting. You and your team will be working with you. They can only perform the interventions you indicate necessary and I will acknowledge all interventions you order. I may also supply additional information and ask questions for clarification purposes. Do you have any questions?
Nature of the call: Mechanism of injury: You respond to a car crash and find an ejected victim. He is laying 60 feet from the overturned car. A mid 30 s male, semiconscious. Injuries: To be reported as the Team identifies or examines the patient in specific areas during either the Rapid or Primary examination o Moans to pain o Right side flail chest o Decreased breath sounds on the right o Pale, cool, moist skin o Weak, rapid carotid pulse palpable o Pupils equal and sluggish o Pelvis stable o Closed, angulated deformity to the right lower leg Vital signs Initial: BP 72/60, P 138, R 28 and SpO2 no reading displayed Recheck with appropriate treatment: BP 92/74, P 118, R 22 and SpO2 is 93% Recheck with inappropriate treatment: BP 68/48, P 142, R 38 and SpO2 no reading displayed Patient Assessment/Management Trauma Examination gloves Penlight Pulse Oz O2 Kit Blood pressure cuff Stethoscope Blanket Rigid splint materials (various sizes) Roller gauze Tape Head immobilizer (commercial or improvised) Cervical collar (appropriate size) Patient securing straps (spider) Long spine immobilization device (long board) A live Simulated Patient
PIT Crew CPR. Scenario 1 Time Action Mark 1200 1st Due Brush on scene. Names Command Full arrest confirmed, Family history obtained, Airway maybe started.( BVM OPA, or King) 1203 2nd Due Brush on scene. Crews move into proper positions per SOG ( may have to reset AED trainer) 1204 Analyze and shock delivered, continue compressions. King should be completed now by Driver of 2nd Brush Driver. Proper Vent and Compressions rate. (not to fast) 1206 Medic Arrives. Monitor switch from AED. V-fib, shock delivered. End tidal CO2 20, continue compression 1207 1st IV attempt. 1mg Epi 1208 Reassess rhythm V-fib, shock delivered, End tidal CO2 22 continue compressions 1209 Amiodarone 300 mg Ambulance crew arrives. DP162 1210 Reassess rhythm V-fib, shock delivered, End tidal CO2 20 continue compressions 1211 Medic ask when last epi, when answered, then delivers another 1mg 1212 Reassess rhythm V-fib, shock delivered, End tidal CO2 24 continue compressions 420 Arrives 1213 Amiodarone 150 mg 1214 Reassess rhythm V-fib, shock delivered, End tidal CO2 22 continue compressions 1215 1mg Epi 1216 Reassess rhythm Sinus, check pulse, 122 end tidal CO2 51 1217 Vitals, end of scenario Discuss items done good, and where improvements can be made. PIT Crew CPR Examination gloves AED Trainer Airway Manikin CPR Manikin 2 Airway Kits Stethoscope Clipboard with CPR Tracking sheet Suction (from a Apparatus) Cervical collar