Sunday, May 15

Practical Skills Exam Done!

Marched in graduation today and went with the family to a graduation party at the ambulance station. I'm tired and going to bed, but wanted write an update on the state practical skills exam I took Saturday.

For my state practical skills exam we had to do 18 “skill stations”, not finding out which they would be until the morning of the test (there are over 30 to know). Each station has some maximum number of points and “critical fail” criteria. To pass the station, you need some number of points out of the total possible (it varies from station to station) AND you need to have no critical failures (doing something you shouldn’t or not doing something you should). The stations I was tested on were:

1. Patient Assessment – Medical (Difficulty Breathing with a history of emphysema). In this station we need to go over an entire medical call, from scene size-up to handing the patient over to the hospital. Each assessment or treatment is “voiced” and information is given to you as you discover it.

2. Nebulized Medicine Administration (albuterol 2.5 mg in 3ml NS via small volume nebulizer). Hardest part to this is verbalizing that you would dispose of the equipment in a “red bag” container. Forget to say this and you fail the station (there isn’t a red bag there, which makes it hard for me).

3. Patient Assessment - Trauma (ejected from car – flail chest, deformed shoulder and broken femur). Same idea as medical but with a trauma victum.

4. Immobilization of a joint injury – Sling and swath for a shoulder.

5. ET Tube – Adult + secondary verification and suctioning – lots of chances to mess this up. Open the patient's airway manually, insert an adjunct, bag the patient, bag the patient with 02, tube them, make sure the tube is in the right place, suction the tube. Lots of fun.

6. ET Tube – Child. Similar to above but an added issue was that child mannequin had three holes – esophagus, trachea, and a torn hole near the velecula. Time for a new mannequin!

7. ET Tube Medication Administration (Epi 1:10,000).

8. Intravenous Line – appropriate gauge needle for the scenario and the right fluid, start the line, etc.

9. IV Bolus Admin (1 mg/kg Lidocaine – my patient weighed 100KG – convenient, eh?)

10. IV Drip (Lidocane at 2mg/min)

11. Sub-Q Drug Administration (0.3 mg of Epi 1:1000)

12. Static Cardiology where you look at four strips, one at a time. For each strip, you voice treatment per protocol (mine were 2nd degree type II heart block – Bradycardic; underlying sinus rhythm with malignant multi-focal PVCs; asystole; course v-fib).

13. Dynamic Cardiology – similar to static, but as you are treating your patient the rhythm changes and you need to change your treatment accordingly (my patient: sinus brady; v-fib; asystole; sinus)

14. Cardiac“Pacing”- Give some electricity to your favorite bradycardic patient.

15. Imobilizing an infant in a car seat. Lots of towels and lots of tape.

16. Imobilizing an adult from a sitting position (using a “KED”)

17. Simple airway adjuncts and suctioning - same BLS station from our EMT-Basic test. Easy as pie.

18. Bleeding and Shock Management

This whole process is made more difficult, in my mind, by their not telling you how you've done until you finish all 18 stations. Fail 5 or fewer and you can re-test them. Fail 6 or more and you have to re-take the whole class!

Thankfully, I passed them all first time through. In fact, I only missed one point on the whole exam. I am very pleased and am left just needing to get ready for the state written on Thursday. Unless something strange happens, I’ll be a medic on Friday of this week.