Tuesday, January 30, 2018

Case Study: Days 1 through Day 5

I greeted students at the door and invited them to grab a seat wherever they felt comfortable in the classroom (#flexible seating, arranged in a circle around the room).

#flexibleseating - why not be comfortable when learning?

While they were filling out #IWishMyTeacherKnew slips, I took attendance and asked students their preferred name/nickname/pronunciation. I then pointed up to this banner and read it out loud to set the tone for the semester:

Student-made banner (from @medicalaxioms on Twitter)

I requested a volunteer and walked them out into the hallway. I asked the student to "play unconscious" and lay on a blanket I set out in the middle of the classroom (see classroom picture above). When we returned to the classroom, I gave the class this task:

Brainstorm, to the best of your abilities, causes for concern and/or questions surrounding this scenario. Here is what they came-up with in their stated order, in their exact words:

Next, I asked them as a group to determine 1) what they thought their highest priority concerns were and/or 2) which of these concerns could be accomplished or determined without delay. The seven circled concerns reflect that (above).

Next, I asked them to prioritize these seven concerns in a logical order.

Once this was done (with some guidance and input from me) we started diving into each of the seven concerns, in order. Each of these is accompanied by hands-on demonstrations by students:
Scene safety: awareness of dangers in the form of weapons, assailants, traffic (if on the highway), used hypodermic needles, etc. We all need to go home in one piece at the end of our shift.

Scene survey: looking for clues such as flipped-over rug (suggesting a trip & fall), a ladder (suggesting a fall), overturned or smashed furniture (suggesting an assault), pills or bottles on the floor (suggesting overdose or intoxication).

Skin color:
  • Pale —> shunting blood from the skin to the core
  • Flushed —> distributing blood to the skin
  • Cyanotic —> profoundly hypoxic, only have minutes to act
  • Jaundiced (yellow) —> dysfunction
  • "Normal"

Level of Consciousness (AVPU):
  • Alert: eyes open & tracking
  • Verbal: eyes open & patient responds to verbal stimulus
  • Pain: only responds to verbal stimulus
  • U: unresponsive/unconscious

  • pulse (carotid):
    • yes —> fine
    • no —> initiate AED and immediate chest compressions
  • control massive external bleeding:
    • direct pressure
    • elevation
    • pressure points (brainstorm common pulse locations prior)
    • tourniquet

Airway: patient MUST have a patent airway

  • yes & adequate —> fine
  • no and/or inadequate --> airway adjunct:
    • oropharyngeal airway (OPA) for no gag reflex
    • nasopharyngeal airway (NPA) for gag reflex

The end result of this portion of the case study is that students are able to assess life-threatening conditions within 30 seconds of patient contact.

Next up: History & Physicals (H&Ps)!

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