Conflicting test question...

MERRYWIDOW46 · Feb 17, 2010

ABCs is why it is AIRWAY,

1. Airway open

2. Breathing

3. Circulation

No matter what, ALWAYS do basics first then secondary assessment.

Can NEVER go wrong assessing anyone in that manner.

Good Luck.

DirtyBlackSocks · Feb 17, 2010

I understand the concept behind it, and I'm well past receiving my EMT-B from that course.

I just recall it caused a lot of controversy among everyone, including some of the other instructors who did not agree with it being airway.

Essentially if a patient is shooting blood from an artery, he could be unconscious from blood loss by the time you perform airway.

In my actual practice as a medic in the army, critical thinking like this came into play a lot more. If I'm treating some one with profuse bleeding and they're conscious and screaming I most certainly consider the bleeding my primary focus.

llg, PhD, RN · Feb 17, 2010

A screaming patient is breathing. I'd be stopping the bleeding -- and that is what I would answer.

I wonder though ... the fact that we noted the screams and concluded that the patient was breathing as we approached might actually be considered "assessing the patient" -- done before we actually laid our hands on him. So we actually would assess airway before stopping the bleeding.

Music in My Heart · Feb 17, 2010

Obviously if the pt is screaming their airway is fine

See, you DID the first step first... you just didn't realize it.

DirtyBlackSocks · Feb 17, 2010

Conversely, even if the patient isn't breathing - arterial bleeding would still likely be my primary concern knowing what I do now.

Performing CPR on a patient who has a ruptured artery is counter productive to keeping them alive, isn't it? Especially from the femoral artery?

animal1993 · Feb 17, 2010

Conversely, even if the patient isn't breathing - arterial bleeding would still likely be my primary concern knowing what I do now.
Performing CPR on a patient who has a ruptured artery is counter productive to keeping them alive, isn't it? Especially from the femoral artery?

I have had that exact question on a few of my tests, and our class has always argued the same points. The way my instructors have always explained it (and I tend to agree) is that if your patient is not breathing, it does not matter how much or how little blood they have left in their body--they won't be around much longer to need it if you can't get them breathing again.

Da_Milk_of_Amnesia, MSN · Feb 17, 2010

I used to work with patients s/p caths and i used to take out femoral sheaths and a-line and cordis' etc etc. If I saw that I'm gonna put my fist in his groin and call for some help. The guy is screaming so you know he has an airway, now if he was not breathing and pulseless well thats a different story. But my first job would be to control the bleeding and get fluids widddde open, and find a fem-stop somewhere.

GilaRRT · Feb 17, 2010

This is a ridiculous and inane question IMHO, the type of question disconnected nursing instructors who lack real world experience dream up. Unfortunately, it is most likely a question that is often encountered.

The ABC dogma is being replaced by more practical approaches. It is well known that uncontrolled hemorrhage is a leading cause of death, and extremity hemorrhage is potentially controllable unlike many other traumatic problems. A newer CAB approach is sometimes advocated when control of life threatening hemorrhage takes priority. It is clearly evident that a screaming patient has an airway and is breathing and the life threat is in fact the arterial hemorrhage. Teaching students otherwise is almost criminal IMHO.

Look at it by the numbers:

The content of arterial oxygen formula is utilised to tell us how much oxygen is present per 100 ml of blood. CaO2 = (1.39 * Hemoglobin * SaO2) + (PaO2 * 0.003)

It should be clearly evident that adequate amounts of well saturated hemoglobin plays the most critical role in the CaO2 concept. Having an open airway and good gas exchange is worthless if you do not have the means of transporting that oxygen, because it exanguinated out of the patients femoral artery.

So, a practical approach should be taught. A primary survey to rapidly detect and treat the immediate life threats is the critical factor. Immediate life threats are not always airway related.

CuriousMe · Feb 17, 2010

You arrive on the scene with a patient screaming and squirting bright red blood from the femoral artery, what is your first step?
Answers were along the lines of check airway, control bleeding, take pulse and something silly.
Just about everyone missed it, according to the instructor it's check airway - I chose control bleeding. Obviously if the pt is screaming their airway is fine, and if they've got arterial bleeding that seems like a bigger issue.
Thoughts on this one? Bumped my test score from an A to a B.
Note that this is an older question from an EMT course I took in the military, I don't know why I thought of it now.

In a sense, you disagreed with yourself. You stated that, "if the pt is screaming their airway is fine." Well, that kind of is an airway assessment.

I run into the same problem, in my mind checking the airway means doing something...but really...it means ensuring that they have a functional airway....recognizing that a screaming PT has a functional airway does that.

Valerie Salva, BSN, RN · Feb 17, 2010

A screaming patient is breathing. I'd be stopping the bleeding -- and that is what I would answer.
I wonder though ... the fact that we noted the screams and concluded that the patient was breathing as we approached might actually be considered "assessing the patient" -- done before we actually laid our hands on him.So we actually would assess airway before stopping the bleeding.

:up: :up: :up: :up: :yeah: :yeah: :yeah: :yeah: :nurse: :nurse: :nurse: :nurse:

ohgoodnessgracious · Feb 17, 2010

I *hate* questions like these - absolutely not practical at all. Like you said, if he's screaming - air's moving in and out of that face. If he's blue, then that's a different story!