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When taking the station, two people go in at a time and switch off between being the victim and the one doing the station. The station involves two skills: trauma and a treatment. There are multiple scenarios for the trauma, including motor vehicle accidents, falls, and assaults. Treatments include occlusive dressings, stopping bleeding, suctioning, and using a ventilator. It's important to pass both skills and not just provide oxygen. The examiner will provide dispatch information and you have a time limit to complete the station. You can ask questions to the examiner to get more information. It's important to make a good impression and be confident. The station involves assessing the patient's general impression, airway, and breathing. Oxygen therapy is initiated using a rescue device. Life-threatening injuries are addressed during the assessment. So when you go to take the station, you'll go in two at a time. One will do the station, one will be the victim, and you'll switch off. You have to do both skills. It is a two-skill, one-station station. So 3A and 3B is Station 3. You can fail 1, you can fail 3B, you can fail 3A, or you can fail 3A and 3B, and it's only one station. But you must pass them both, okay? So first thing we're going to do is go over trauma. So look at 3A. Now as you're looking at 3A, you see how it says Scenarios and it says A, B, and C? There's actually multiple scenarios, which I'm going to give you now. The first scenario you might see is motor vehicle rollover with ejection. Motor vehicle rollover with ejection, patient's lying like 30 feet away from the vehicle. You could get construction worker falls 20 feet off a roof and lands on rebar impaling his leg with a rebar. So of course you have to stabilize, stop any bleeding, that kind of stuff. Little old lady fall down, go boom. Old lady falls down the stairs, have to assess her. Yeah? How much of it, how far? 20 feet, 20 feet. You could get the ATV rollover with ejection, because ATV, all motorcycles, you get ejected. Or you could get the assault at the bar and it turns out that the patient gets shot in the axillary region, but you don't notice it until you do the assessment. Okay? Got those? Now there could be other scenarios that I don't know. Those are the ones that I hear about that I know that they use. What was the fourth scenario? After the lady falls? ATV rollover. ATV rollover. With ejection. With ejection. Yeah, it's like a four-wheel, like a quad. Number three was the old lady falls and hits her elbow. Falls down the stairs. Little old lady falls down, go boom. What is that? Little elbow, elbow, L-O-L-F-D, L-O-L-F-D-G-B. L-O-L-F-D-G-B. People put that years ago, people put that on their GCRs. Everybody knew what it meant. Little old lady falls down, go boom. Little old lady falls. Don't do that. Out. Anyway, so with that said, the wounds that you're going to see or the treatments you're going to have to do are for the trauma. The sucking chest wound, the penetrated chest wound, how do we treat that? The occlusive dressing. You're going to have a patient with an arterial bleed, how do we fix it? Burn again. You have a patient that has one in the airway, how do we fix it? Suctioning. And you're going to have a patient with a flail segment, two or more ribs broken in two or more places causing paradoxical motion. How do we fix it? BBM. Ventilator. Those are the four injuries you're going to have. So if you go to the trauma station and you go all the way through the station and the only thing you did was put them on oxygen, you're going to fail. You missed something. You must do a treatment. Okay? Oxygen and color is not a treatment. So first things first. The examiner is going to say, you know, tell me when you're ready. Yeah, I'm ready. And he's going to give you dispatch information. You're being dispatched with a 68-year-old female. Status post call down the stairs. Police and fire on the scene. You have an imaginary partner, sister, whatever you need. You must perform all functions yourself. You have 10 minutes to make a transport decision. You have 15 minutes with which to complete the station. If you go beyond that, you'll be stopped and graded to that point. Do you have any questions? No. Okay. All treatments and vital signs are verbalized. You may begin. So you're going to say, scene safety BSI for myself and my partner. Before I make contact, see where it says number one? Scene safety BSI? That's your time starts. Well, somewhere in that area, I want you to write 1A. And you're going to write general impression. You can write GI if you want. General impression. When you do this station, you're going to go in that room, or you're going to be in some kind of a room. There's going to be a victim, you, and the examiner. You have no point of reference other than what the examiner told you. So you may want to ask some questions. The general impression. Mr. Examiner, how many students do I have? I mean, how many patients do I have? One. Is the patient looking at me? Are they following with their eyes? Do I see any life-threatening injuries as I approach? What is the environment like? Is it raining out? Is it cloudy out? Do I have bystanders around? Paint yourself a picture so you can get an idea. The examiner has to answer any questions you ask. The only one he won't answer is, how do I do this? I know. But every other answer he asks, any other question you ask, he has to answer. And he has to answer honestly. They're not there to trick you. They're there to see if you know the station. If you know the station and you're banging through this, you're going to have no problem. And it only comes with practice. And that's part of that, is you want to sell yourself. So you go in, Mr. Examiner, Scene Safety BSI is myself and my partner. As I approach the patient before I make contact, I like to ask a couple of questions. How many patients do I have? What's the environment like? Is the patient following with their eyes? Do I see any life-threatening injuries that I observe when I walk up? And you know what the examiner is going to say? Get sharp. On the ball. You're less likely to be picky-oom when you get to make a mistake further on down. You're selling yourself in these exams. Go in confident. And the only way to go in confident is to practice the shit out of these so you do them in your sleep. So you make your general impression. You don't have to do that. You don't have to answer, ask any questions. That's for you. Use that if you'd like to paint a picture. So then, Mr. Examiner, I'm going to make contact with the patient. Of course, scene safety BSI. I'm going to have my partner take manual in-line neutral stabilization of the head. Again, I'm not going to say C-spine. Anybody can say C-spine. You're going to say, I'm going to have my partner take manual in-line neutral stabilization of the head. Keep your arm. Get sharp. Right? You're selling yourself. If you said C-collar, you wouldn't be wrong. I'm going to have my partner take C-spine. You wouldn't be wrong for that. But you want to say the right thing. Say, make it look good. Then you're going to determine level of consciousness. You do not do this until after you've taken minutes. Sir, sir, can you hear me? Unresponsive. Do an ear pinch, a sternal rub, however you want to do it. Unresponsive. Maybe moaning. You're going to open the airway and assess the breathing. Or open and assess the airway. So what you're going to do is the patient, you might find the patient has snoring respirations. How do you fix that? Open the airway. That fixes it. If the patient has bubbling, gurgling in their airway, what do you do? Stop shin. See, it all comes together now. Everything comes together in this. CPR, back boarding, squinting, it all comes together in this. So you're going to assess the airway. You're going to assess and open the airway. And then you're going to assess breathing. So you're going to assess the airway and then breathing. Mr. Examiner, how many times is it, what is the patient's respiratory rate? Is it, you know, and you might say six and shallow. Or eight and shallow. If he doesn't, it's six. Okay, is it shallow or normal breathing? You want to get an idea. Paint the picture. That's what breathing's about. Then number six, Mr. Examiner, measure and insert an OPA. Does the patient accept it? You can do an NPA. Don't do an NPA with head trauma, though. That's why we know an OPA. The examiner will say the patient will take it because they want you to do that. That's why it says inserts or simulates insertion of the OPA. You're not going to have to insert one. I don't think, I don't know of any schools that have mannequins you insert one in because you have to have them at the station and they don't normally do that. So you just verbalize. Measure from the corner of the mouth to the corner of the ear. Scissor finger technique. Open the airway. Drop it in. Does the patient accept it? Yes. Initiate oxygen therapy. Mr. Examiner, I'm going to put my patient on high flow 15 liters by ventilations, by VVM, delivering 12 to 20 breaths per minute, ensuring chest rise. So I'm not just bagging them. I'm going to explain everything. Ten to 15 liters high flow O2 via VVM, ensuring adequate chest rise, delivering 12 to 20 breaths per minute. You have to put the patient on oxygen and it has to be a rescue device. For trauma, it's going to end up being a ventilation because patients who take an OPA will not have an adequate respiratory rate. When in doubt, bag them. If you're not sure, just bag them. Because let's say you have a patient that has a decent respiratory rate and they just need oxygen and you're not sure and you say, I'm going to ventilate the patient. The examiner might say, are you sure you want to do that? Yeah, I want to do that. Alright, that's delivering high flow O2. Get back in the patient. That's not wrong. Maybe they don't need it, but it's not going to hurt them so you've done the task. So when in doubt, bag them. Breathing injury management, right there I want you to write IPA. And no, I don't mean the delicious beer. IPA. Respect, palpate, and auscultate. You're going to fillet the clothes. Not the chest. Fillet the clothes. Expose the chest. You're going to look for any life-threatening injuries. Mr. Examiner, do I see any? And then you're going to palpate with your hand and I'm going to show you how to do that. One side and then the other. And then you're going to listen with the stethoscope called auscultate. When you expose the chest, if you see any life-threatening injuries, you fix it at that moment. Now if the patient had a flail segment and you're bagging the patient, you're fixing it. But the examiner is going to want to see that you recognize it. So he's going to say to you, the patient has a flail segment. How do you fix that? Well, Mr. Examiner, I'm ventilating the patient. That is fixing the problem. Bam! You got it. If you see a sucky chest wound, bam, you fix it. Arterial bleed, you should test that right when you walk up to the patient. That's why I always say, Mr. Examiner, I'm going to just ask a couple questions. Do I see any life-threatening injuries? And if he says you see an arterial bleed, the moment you touch that patient, men's have a firefighter put a glove hand on that and we're going to apply a tourniquet. Does that stop the bleeding? Boom! That does it. Remember, XABCs. Then you're going to assess for a pulse and major bleed. So you're going to check a radial and carotid pulse with the trauma. Unresponsive, you get both the radial and carotid. And then very quickly, you're going to run your hands down behind the patient and you're going to look for any life-threatening bleeding, any bleeding that might be occult or hidden. Because if what happens if I put my hands underneath the patient and I come out and I see blood on my glove, what do I have to do? I have to long roll them, which means I've got to apply a collar, measure and apply a collar. So keep that in mind. Then I'm going to assess the skin. When you go to palpate the radial and carotid pulse, you're assessing the skin. So Mr. Examiner, I'm going to check for a pulse. What am I getting? Great rhythm quality. While I'm here, I'm checking the skin. What am I getting for skin color, temperature, condition? See what I'm asking? And then he's going to give me that information and I'm going to make my transport priority. Unlike in real life, all of these stations are high-priority transports. You're going to say, Mr. Examiner, we're going to call, we're going to transport this patient high-priority, call ALS for an intercept. You're going to say that on every single patient. It may not be like that in real life, but for the national exam, every patient is a high-priority transport, call ALS for intercept. So you can write that down if you want. At that point, he's going to mark down a time. As long as you're within 10 minutes from your start time to that time, you're good. Now I've been standing here gabbing and I think that was less than 10 minutes. I did all of that. You literally should be able to do this in two minutes. It's basically, scene safety BSI, quick general impression, MIMS, open the airway, assess breathing, IPA the chest, check the circulation, make your transport decision. Literally two minutes. This whole station should take you about less than 10 minutes to do. So once you make a high-priority patient, I want you to think of this as two separate stations. It's 1 through 12, and then 13 through 25. Separate them. So 13 through 20 is literally check the body. You're going to inspect, palpate the whole body. Start at the head, work to the feet, then you're going to apply a collar, log roll and check the back, and log roll them onto a backboard. That's literally what you're doing at 13 through 20. That's it. As long as you touch your body part and say what it is, you're going to get the point. 21, obtain baseline vital signs. Now there's a funny thing to this, because what are your vital signs? Level of consciousness. Didn't you get that at the beginning? Excuse me, Mr. Examiner, my level of consciousness at the beginning was, I'd like to get a set of baseline vital signs. First of all, my patient was unresponsive. Has it changed? No. Heart rate. You gave me a heart rate of 120 and 30. Has it changed? No. You gave me a respiratory rate of 6. We're bagging 12 to 20. Has anything changed? No. Do I still have good compliance with the bag? Yes. Blood pressure. That's the only one you haven't gotten yet. Mr. Examiner, what's the blood pressure? 6 dollars over 9 is solid. He'll give it to you. What is the skin? I got cool tail clammy. Has it changed? No. Pupils. He didn't do pupils yet. Mr. Examiner, what do I get for pupillary response? I'm looking for Pearl. He'll tell you. Midpoint reactive. Sluggish. Left pupil dilated. Non-reactive. Whatever he tells you. Can we write it down, everything you said? Yeah. You can bring a notepad and a pen with you. You can wear gloves. A lot of people wear gloves and they write the vitals on the glove. You can do that too. But the thing is, is people bring in pads of paper and they start writing down like history, methodologies and they eat up their time. So just be careful of that. If he tells you the vitals and you forget, ask him again. Mr. Examiner, what was the pulse you gave me? Because on the field, you can just take it again. So he'll give them to you. Mr. Examiner, I'd like to know the vital signs. I'd like to know the heart rate. Well, I gave you that already. Yeah, but I forgot. Can you tell me again? Sure, 93. Let me get it. That would not be a problem. No, it wouldn't be a problem. They're not there to trick you. You don't recommend bringing a notebook to write down. No, you can if you'd like. I just don't want you to bring it in and start writing a whole frickin' story because it's going to eat up your time. If you want to use it for vitals and injuries, that's fine. Real quick. Yeah. Obtains a sample history. Now, your patient is unconscious. Do you think you're going to be able to get a sample history? No. There might be bystanders around, but I guarantee you they don't know much about the patient. And the reason why is you're going to be doing a sample in OPQRST and the medical. So, why am I going to have you do one in the trauma? I'm going to see you do it. Right? I've got 50 students I have to examine today. I'm not going to spend time giving them all a secondary sample. So, you'll just say, Mr. Examiner, I'd like to get a sample history. My patient is unresponsive. Can I get a sample history from anybody? No, there's nobody around. They don't know. They don't know. Okay, done. But you said it. You said it. If the patient's conscious, for whatever reason, ask him the question. Manages secondary injuries or wounds appropriately. These are injuries that you did not fix in the primary assessment. If he's got a scalp laceration that's just oozing or an open tib-fib fracture that's oozing, something like that, he's got a road rash, scrapes, that's where you treat that then. If you wanted to splint an upper extremity, you treat that then. Those are things that we skip and move on because they're not life-threatening. Then you're going to verbalize a detailed physical exam. Basically, you're going to say, Mr. Exam, I will perform the detailed physical exam en route if time allows. You're not going to do one because a detailed physical exam is a secondary survey. It's a little more detailed. It takes a little more time. I'm not going to bother doing it because I'm not going to make you do it again. You're just going to say, we're going to do a detailed exam if time allows. Then the next one is verbalizing ongoing assessment. Mr. Examiner, we're going to do vitals every five minutes, constantly reassessing our patient, hopefully linking up with ALS during transport. He's going to say, are you done? You're going to say, yes, and you're done. That's it. Now, a couple of caveats to this. First things first. The examiner may ask you in a couple of different ways. He might say, are you done? I'm done. Good. Or he might go, are you done yet? If he asks you like that, think about it. If the examiner is running through your thing and he says, hold on a minute. Is there something else you want to do first? Sometimes they prod you. Sometimes they know you're nervous and they'll give you a little prod. Listen to your examiner. Listen closely to what they say. If you don't understand something or you missed something, go back and ask. Sometimes they'll give you a little hint. Maybe you forgot to put the collar on. They'll be like, are you sure there's something you want to do first? Just like Will does. He gives you little prompts when you take it. Then he'll write your end time, and it has to be within 15 minutes. If not, he'll be stopping right there. If you go 15 minutes and two or three seconds, he's going to let you go. But if you start getting into 30 seconds, he's going to stop you. So let's look at the critical criteria down at the bottom. 15 minutes for the whole thing, 10 minutes for a transport decision. So you should be able to make a transport decision within four, and you should be able to do the station within eight, literally. You should be able to do the station completely twice in the 15 minutes. So critical criteria. Did not assess cervical spine or provide the spinal protection when indicated. You didn't measure and apply a collar. You didn't hold men's. And if I find that out, I'm going to shoot you in the head with a tack hammer because we've already covered this once when we did back boarding. Remember, trauma, collar, back boarding. Did not assess or manage conditions of airway, breathing, circulation. That's a pretty ambiguous statement. If the examiner doesn't like the way you're doing the station, he can find a way to fail you under that critical criteria. Did not provide high concentrations of oxygen. If you don't put them on oxygen, you deserve to fail. Everybody gets oxygen, right? Did other physical exam before assessing airway, breathing, or circulation. I've seen this where patients start doing the assessment, they start IPA-ing the chest, they inspect that osculate, then they inspect the abdomen, and then the pelvis. In other words, they go right from their primary assessment at the top to their secondary survey at the bottom. If you do that, you're going to fail. Remember where you are. Did not make correct transport decision within the 10 minute time limit. And did not achieve 17 of 25 points, which is basically a seven. Any questions on that? Okay. Go to the back one. Medical assessment.