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Debate with PHTLS (NAEMT) Instructor

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I understand the frustration with the instructor's answer regarding the question; however, the scenario seems very straight foreword to me unless I am missing something. Obvious gunshot wound to the head, no pulse and no respirations paints a clear picture in my mind.

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I think part of the confusion may arise from the way these questions are formulated. They are written with all the information needed to arrive at the correct answer. If you needed more information it would have been provided. If additional info is not included it is not necessary therefore left out. In other words, don't read into it.

In this case, it is an obvious GSW to the head with a dead victim. You don't need any additional info to arrive at the correct answer. It's an obvious GSW. Pulseless & apneic. Dead.

Many of these type tests have questions that are structured this way. It is part of the test taking skills needed for this type class/exam.

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I agree with chbare and Mike. It's a pretty straight forward question that is being looked to far into. By saying it's an obvious GSW they are telling you that you can clearly see it is a GSW, not something to be confused with a lac or an abrasion. There is no hidden trick to the question like the guy is a dialysis pt who missed his dialysis yesterday and went into cardiac arrest while cleaning his gun. GSW to the head with no pulse and no breathing is dead (according to PHTLS). I would assume that the questions that show up on the test have been tested to make sure that they are fair questions or this may have been a question that was being tested.

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:shifty: Gee, wish I had said that...

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During my clinical rotation in the E/R on Friday night, a patient was brought in by EMS. The patient had an OBNIOUS GSW to the left temple. In this cse, it was a small caliber round and it never penetrated the cranial vault. This patient had been tubed and was being 'bagged' as they rolled through the doors.

Had this patient suffered a cardiac event that left him pulseless, would it have been a different story; or should the responding crew just chosen to withhold recuscitation based on the fact that there was that damn "OBVIOUS GSW"?

As far as 'corroborating signs', how about some of the ones we use in other cases:

DeapitationDismemberment

Decomposition

Gross lividity

Rigor/liver mortise

Significant loss of blood volume, as to be incompatible with life functions

Exposed brain matter?

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Totally different story bro. You are doing the worst possible thing. You are injecting information into a scenario to make it fit what you personally think is right. Take questions at face value and do not add additional information. Consistently going against this rule of thumb will make your future testing experiences rather painful.

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Why are you arguing this?

This is how the questions are written. They tell you all the info you need to answer them. If additional info that is not included then it is irrelevant to the question at hand. Most of these little alphabet courses test this way. National Registry tests this way. It is a test taking skill that you need to learn now or, as CHBARE has astutely noted, your future testing experiences will be rather painful.

Stop reading into it. Stop overthinking it. Stop going out of your way to make it harder than it needs to be. Answer they question they ask you. Not the question you think they should have asked you.

edit: spelling error

Edited by paramedicmike

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tcripp, I don't think it is an issue of the instructor not giving an adequate answer since that is the only answer. I think what he was trying to say is that when you take a specific test, you have to play by their rules. When you take ACLS, ATLS, PHTLS, etc, you have to answer the question based on what the specific course teaches, even if it is what is different from what you protocols say. Even though LS's protocols say you need certain criteria, PHTLS teaches that GSW to the head with no pulse or resp effort is dead.

LS, I agree that this shows why we need a national standard.

Lord, isn't that the truth. You have to play to the test. It sucks, but you have to do it if you want what's offered to you from completing the test.... licensure, certification... you think that's a bad question, try some of my NCLEX style stuff!

Wendy

CO EMT-B

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During my clinical rotation in the E/R on Friday night, a patient was brought in by EMS. The patient had an OBNIOUS GSW to the left temple. In this cse, it was a small caliber round and it never penetrated the cranial vault. This patient had been tubed and was being 'bagged' as they rolled through the doors.

Not to get too far of the original topic but I have to ask. If the bullet did not enter the skull why was this guy tubed and bagged?

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