I PASSED MY NAT'L NREMT PRACTICAL EXAM-just one more final to go...(read this at your own risk-lots of technical crap in here)

BACKGROUND:

I have been SWEATING BULLETS for the practical final exam. It's different from the written exam for class and the NREMT written exam, and the reason why is because the North Orange County Regional Occupational Program EMT-B program is sanctioned by the National Registry of Emergency Medical Technicians to administer the practical exam, so it's a practical for my CLASS AND for the NREMT organization. Here's a pic of two of my study group guys after we found out WE HAD PASSED!!!!! (I looked like shit, but I decided that since it was raining, I wasn't there to win any beauty contests so I slicked my hair back, didn't put on any makeup, my hair is out of my eyes and out of the way. Not even any eye cream. I wanted to look professionally dull. I guess I succeeded, but TOTALLY forgot about photo ops! Oh well, at grad on Thursday the 29th I'll look better!!! I hope, anyway-I washed my shirt and the damn thing shrunk, but then again, I'd gained about 10# since my ridealongs in early December because of the holidays, so it MIGHT'VE been a combination of the two.)

For the last few weeks we've been going over practical applications of

Oxygen Administration (operating an oxygen tank; opening it, checking for leaks, making sure that it's at the correct PSI of 2000, attaching a non-rebreather mask, making sure the O2 bag is filled before applying the mask, taking that off and inserting a nasal cannula at 4-6 l/m)

Oralpharangeal and Nasopharangeal Airway Adjunct Administration (selecting/measuring and inserting an OPA down the mouth of a patient, then being instructed that the patient is gagging and vomiting so taking out the OPA, starting suction by turning on the unit, checking the tip for suction, kinking the hose to stop suction, putting the tip into the mouth as far as I can SEE vs. farther in, unkinking the hose and suctioning upward for no more than 15 seconds, {if a child, no more than 5 seconds} shutting off the unit and selecting/measuring then inserting an NPA up the nose of the patient after first lubricating it)

Apneic Patient, breathing or not:
Create a proper seal using a mask and using the "C" hold on the mask, then using a Bag-Valve-Mask to 'bag' the patient 1x every 5 seconds, attaching the O2 line to the BVM with 15 l/m high flow O2:

COPD & Patient Assessment (that's the one I got-I could've gotten Myocardial Infarction/Angina or Diabetes, but Chronic Obstructive Pulmonary Disease was my 2nd choice anyway) Even though this one LOOKS like the longest station, it actually took less time than the others because it was all verbal.
Describing what COPD is which is a progressive chronic disease affecting the lungs and how oxygen ISN'T getting into the body and perfusing adequately, describing the two types of COPD (actually there's KINDA three but Asthma isn't considered a TRUE COPD since it's not progressive, isn't constantly bugging, it's acute attacks triggered by an allergen), Emphysema description is the alveoli (where the exchange of the oxygen and CO2 gasses takes place), in the lungs being coated with mucus and material so that enough oxygen isn't being taken into the body thereby allowing 'hypercapnia' which is too much CO2 in the system. When the CO2 gasses in the bloodstream go down, that's a sign or signal to the body for respiration aka BREATHE!, BUT when there's TOO MUCH CO2, then the body goes into a "hypoxic drive" (hypo meaning not enough and oxic meaning with oxygen) and the body doesn't get the signal to breathe. Most people with emphysema have to be on 1-3 l/m low-flow O2 thru a nasal cannula to get adequate O2. These folks, due to the excessive CO2, are called 'pink puffers' because they 'puff' exhale, are barrel chested since they spend all their time trying to breathe because of the trapped air in the lungs, and and are pink flushed. (People who try or succeed at suicide by car exhaust in a garage from CO are extremely red-faced) The other disease of COPD is Chronic Bronchitis, which is an inflammation of the bronchi (think broccoli and you'll get a picture of the bronchial tubes going into the lungs connecting at the alveoli), and with an inflammation, you get SWELLING. So if the bronc tubes are swollen, not as much O2 is getting in. These folks are called 'blue bloaters' and are cyanotic (cyan meaning 'blue', you can check your ink color on your printer and it'll say 'cyan') and they're always trying to get air into their lungs.
I also gave him the EMT treatment options for COPD and actually went into MI/Angina a bit to tell him the analogies I came up with, like with Angina you can liken it to a skimmer in a pool-when the skimmer gets quasi-logged with leaves, water doesn't flow thru as well so the pump has to work harder. Pump works harder, it'll give out quicker. With an MI, the leaves TOTALLY clog the skimmer (in this case, the coronary artery) and no water gets to the pump. The pump tries to keep going, sounding weird and 'quivering', then it'll eventually burn itself out. Same way with the heart. He said it was really good and he would use that analogy in his class. He's the one who gave me a 'Good Job!!' on my paper, which was pretty doggone good since the secretary who took our completed skills sheets said she had never seen him write that. He's a hard-ass and part of the executive staff at the facility where we had the skills final, so I felt pretty good about that.
Our instructor Janell told us that if we remember the 5 scenes or bricks of a pt assessment, we couldn't go wrong, so during this pt assessment I went thru the 5 bricks:
Brick One: PENMAN (PPE/BSI; Ensure scene safety; Number of patients; MOI VS NOI; Advanced Life Support vs. Basic Life Support (EMT-B's give BLS); and Need for additionaL resources, i.e an extrication or swift-water team, C-sping/Spinal immobilization expecially with a trauma patient.
Brick Two: GI General Impression; R/ALOC-AVPU (Responsiveness/Altered Level of Consciousness-Alert, Verbal, Pain and Unresponsive); CC Chief Complaint: ABCT (Airway, AIRWAY, AIRWAY! Breathing, Circulation and decision to transport or not.
Brick Three, if Trauma Pt., or Brick Four if Medical Patient: SAMPLE (Signs and Symptoms, then if medical patient, (Brick Three)OPQRST Onset/Provocation-Palliation, i.e. what makes it worse-better/Quality of Pain or discomfort i.e. stabbing, shooting, Radiation or radiating pain or discomfort, Severity on a scale of 1=10, and Time of incident/how long it's been going on; then back to SAMPLE with if the pt. has any Allergies; is on any Medications; Last Oral Intake; and Events leading up to the problem.
Brick Four, if Trauma Patient is DCAP-BTLS; doing a rapid physical assessment, palmating the body and checking for Deformities, Contusions, Abrasions/Avulsions, Punctures/Penetrations, Burns, Tenderness, Lacerations, and Swelling:
Vital Signs depending on medical or trauma patient:
Brick Five, REASSESS, REASSESS, REASSESS, because the pt. can 'tank' on you when you least expect it.
Whew....continuing on...(and those last paragraphs were 5 stations out of 7)

I then did the CPR station, which was a witnessed arrest. The scenario was the pt. 'told' me he had chest pains, so I verbalized BSI, the pt. 'tanked' on me & went into cardiac arrest, so I told my partner to get the O2 and call for ALS, then I got out the AED (since it was a witnessed arrest), shocked him, did a look-listen-feel and checked pulse, then did two breaths and did 30 compressions, imaginary partner came back with O2 so I verbalized doing a BVM with PPV. (I will admit that the examiner helped me a tad, but I don't remember much of it. I do know that I didn't fail any of the critical criteria on my own-he didn't have to tell me any of that stuff to do or not to do)

My last station was Traction Splinting or Spinal Immobilization. I have a serious hunch that a lot of people were getting traction because it was the faster of the two to demonstrate.
I messed up a little on it in that I didn't verbalize cutting off the pt. jeans, but I did ok. I did make sure that the examiner (who was also my regular instructor) knew I extended the traction mechanism at least 6-12" down from the heel of the injured leg, and then he quizzed me on the arteries, which I WAS NOT prepared for, namely the posterial tibial artery and the dorsal arteria. Oh, well. At least that wasn't a critical pass/fail criteria.

My front skills sheet was all checked off, all good, turned it in to the division secretary, jumped out of the facility, then waited for Mike and Pat to come out and got a picture or two. The reason the pics are actually that 'orange-y' is because that's the actually color of the inside of the patio/overhang and so it reflected off of us as well.

I now have only two more tests-the final written 150 question multiple choice test on Tuesday the 27th on which I have to get 80%-no problemo, I'm carrying a 90.37% in my class right now.

I hate the picture below even more.