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Transcript

Preparation Task (10 minutes)

Research Task (20 minutes)

Analysis Task (20 minutes)

Create Task (30 minutes)

Hear from a professional in this role to see how they might approach this task.The following pages are a detailed model answer for the work simulation on the Healyh Care Industry, geared towards a student interested in becoming a Paramedic.

Document and Present (15 minutes)

Reflection Task (15 minutes)

Expected Outcome

Model Answer

Simulation

PREPaRAtion task

Understanding the Key Components of a Nursing Assessment:

In an emergency care setting, a structured nursing assessment is crucial for determining a patient's immediate health needs and planning interventions. The primary focus in emergency assessments is on the ABCs (Airway, Breathing, Circulation), as any compromise in these areas poses a life-threatening risk. History-taking also plays a vital role in understanding pre-existing conditions, while a head-to-toe assessment provides a systematic approach to identifying injuries or abnormalities. For paramedics, quick and accurate nursing assessments can mean the difference between life and death, making these skills critical in the pre-hospital environment.

Simulation

research task

Collect data:

45-year-old male involved in a car accident

Scenario

The patient is semi-conscious and unresponsive to verbal commands, but has a weak pulse. Bystanders mention that the accident occurred roughly 10 minutes ago, and the patient has no visible medical tags or identification. The patient appears to have been wearing a seatbelt and there are no signs of ejection from the vehicle.

Patient History Collection

  • Head trauma (e.g., concussion, skull fractures)
  • Spinal injuries (e.g., cervical spine fracture)
  • Internal bleeding (e.g., abdominal trauma)
  • Pneumothorax (collapsed lung due to chest injury)
  • Bone fractures (e.g., ribs, legs)
  • Hypovolemic shock (due to significant blood loss)

Common Injuries to Consider

Simulation

Analysis Task

Analysis Task:

Prioritised Plan for the Physical Examination:Based on the patient’s involvement in a car accident, the most likely injuries include head trauma, chest injuries, fractures, and internal bleeding.

Using a differential diagnosis approach, I would prioritise the assessment as follows:

  1. Airway: Check if the airway is clear, and if necessary, perform airway manoeuvres or insert an airway device.
  2. Breathing: Assess for any breathing difficulties or abnormal lung sounds, considering potential pneumothorax or rib fractures.
  3. Circulation: Monitor heart rate, pulse, and signs of shock or internal bleeding.
  4. Head-to-toe: Focus on identifying visible injuries such as fractures, deformities, and bruising, as well as hidden injuries like abdominal bleeding.

Simulation

Create Task

A. What is a DORA?

A DORA (Dynamic On-scene Risk Assessment) is a systematic evaluation process used in emergency situations to ensure both patient and paramedic safety. In the case of an accident, this involves assessing environmental risks such as vehicle hazards, fire, or unstable debris. By identifying these risks early, paramedics can make informed decisions about how to approach and treat the patient safely. It is crucial for maintaining safety while delivering effective care.

  • Airway: I would first check if the patient has a clear airway by looking, listening, and feeling for any obstructions. If the patient cannot maintain their airway, I would use the jaw-thrust manoeuvre or insert an airway device such as an oropharyngeal airway.
  • Breathing: I would inspect the patient’s chest for any deformities or wounds that might indicate rib fractures or pneumothorax, listen for breath sounds, and assess the rate and depth of breathing. Any respiratory distress would be managed by providing supplemental oxygen or, if necessary, performing a needle decompression.
  • Circulation: I would assess the patient’s pulse, blood pressure, and skin signs to evaluate circulation. In the case of suspected shock, I would initiate fluid resuscitation and continue monitoring for internal bleeding or cardiac arrest.

B. ABC Assessment:

Simulation

Create Task

C. Head-to-Toe Physical Assessment:

Starting with the head, I would palpate the skull for any signs of fractures or hematomas and check the pupils for responsiveness.Moving to the neck, I would stabilise the cervical spine and palpate for any misalignment, swelling, or tenderness.I would then assess the chest for symmetry, breath sounds, and possible rib fractures. The abdomen would be palpated for tenderness, rigidity, or swelling that could indicate internal bleeding.Finally, I would assess the extremities for deformities, tenderness, and range of motion, and immobilise any fractures.

  • After completing the initial assessment, I would reassess the ABCs, monitor vital signs regularly, and document all findings. This includes any changes in the patient's condition, interventions performed, and responses to those interventions. Documentation should be detailed and include vital signs like heart rate, blood pressure, oxygen saturation, and mental status.

D. Reassess and Record:

Simulation

Document and Present

Patient Report Form:PC: Semi-conscious 45-year-old male involved in a car accident, weak pulse, no visible bleeding.HPC: Car accident occurred 10 minutes ago; patient was wearing a seatbelt.OA: Patient found semi-conscious with weak pulse, bystanders state no immediate loss of consciousness; no external bleeding visible.OE:

  • A: Airway partially obstructed, cleared with jaw-thrust manoeuvre.
  • B: Shallow breaths, decreased breath sounds on the left side; chest trauma suspected.
  • C: Weak radial pulse, signs of hypovolemic shock.
  • D: Glasgow Coma Scale: 10/15 (E3, V2, M5).
  • E: No external bleeding, but abdominal tenderness and deformity in the left leg.
  • PMH: Unknown.
  • MEDS: Unknown.
  • ALLERGIES: None identified on-scene.

Simulation

Reflection Task

Application

Reflect on the Process:

This simulation highlighted the importance of staying calm and methodical during high-pressure situations. One of the most challenging aspects was prioritising the patient’s needs while considering the potential for unseen injuries like internal bleeding. The ABCs proved essential in ensuring immediate threats were managed first, particularly securing the airway and stabilising circulation. Communication with bystanders provided valuable context, but a more structured way of gathering information from non-verbal patients needs improvement. This exercise reinforced the necessity of thoroughness in documentation and patient reassessment to ensure no critical details are missed.

Simulation

Expected outcome

Through this simulation, I have successfully conducted a comprehensive nursing assessment, prioritised patient care, and documented all relevant findings. This experience improved my ability to perform under pressure, handle critical decision-making, and communicate findings efficiently, which will greatly benefit future paramedic roles.

Expected Outcome