Remediation

In this video we are going to show you now some remediation stuff to take place where you are doing a skill evaluation or a classroom type of training. I want to help you help the student so that the student can learn best without putting the student down. So that's what we are going to cover today so first of all Roy, Roy and I are both doing this as instructors that are certified in doing this and have been doing this for many years and we are going to try to bring out some of the common mistakes that people do on a regular basis. So first of all I'll be a skill evaluator and Roy will be a student who's come in and I'm the skill evaluator who's not prepared. That's what we are going to play out in this situation or I'm in a hurry or in a rush so let's see how this goes. Okay Roy I see that you are here for the skill evaluation hey look I've got some other people coming here in ten minutes so we've got to get this done now so go ahead and show what you've got. Speaker 2: Okay well I haven't done this in a long time so I'm a little bit rusty so Speaker 1: Just go ahead and do CPR for me a minute okay? Go ahead Speaker 2: Just regular CPR? Speaker 1: Yeah go ahead. Speaker 2: Okay. Speaker 1: Hurry up. Speaker 2: Just get right into the compressions? Speaker 1: Yes yeah just well no we've got to start with the beginning but let's get this done because man I'm telling you I've got to hurry. Speaker 2: Okay so the scene is safe Speaker 1: Yes the scene is the safe. Speaker 2: So the gloves are on Speaker 1: Yeah Speaker 2: My shield is available Speaker 1: Got it. Speaker 2: Okay, I think I tap and shout first Speaker 1: Yeah go ahead just do Speaker 2: Are you alright? Are you alright? Speaker 1: That's fine. That's fine he's not good okay come on Speaker 2: Does he respond? Speaker 1: I no. There's no response at all. Speaker 2: He didn't respond. Speaker 1: Nope. Speaker 2: And Speaker 1: Next thing come on we've got to move right along here cause Speaker 2: I think don't I start with two breaths? Speaker 1: No no no no no. Speaker 2: That's right cause now I remember Speaker 1: That was way old. Speaker 2: So it goes right into compressions Speaker 1: No no listen you're a healthcare provider you need to know this stuff come on Speaker 2: I mean it's been a long time I thought you were suppose to help me practice first Speaker 1: Listen well okay let's just move on. Let's just keep moving okay so you're going to call your code 911 whatever check your pulse check your pulse. Speaker 2: Is the code called then? Speaker 1: Yeah check your pulse. Speaker 2: You're making me kind of nervous in being such a hurry. Speaker 1: This is okay let's just move come on. Check your pulse. Speaker 2: Okay. Speaker 1: Okay. Speaker 2: There's no pulse? Speaker 1: There's no pulse. Speaker 2: There's no pulse so you're just making me nervous speaking me up like this is just really frustrating Speaker 1: Well let's just do some compressions at least. Just get going come on I've got to hurry up. Got to make you know what you're doing here. Speaker 2: How many do I've gotta do? Speaker 1: Okay that's enough. That's good. Okay and now the breaths. Hurry up. Okay you're not giving the breaths in come on. You're suppose to have done this stuff. What is wrong with you? Speaker 2: You know what this obviously is not working so why don't we just quit okay? Speaker 1: Alright we're outta here. Now obviously this was overreacted but you will see that the skill evaluator was not prepared. I wasn't ready in this situation and you see how that made you feel. Speaker 2: Yeah I was frustrated. Speaker 1: Extremely frustrated. I wasn't helping the student at all and that's not what we want see in a skill evaluator instructor. What we want to make sure is you help the student through this and you see the student came in and the student was ready and willing to learn I just wasn't ready to help teach that student and that's a major problem. As a skill evaluator instructor you need to be prepared to help the student practice the skills first that's part of the skill evaluation- practice and evaluation. What are some of the things to add to that to be prepared a skills evaluator? Speaker 2: Well you know my experience as well it doesn't matter what the tenure of the professional if you haven't done it two years even if you aced the test when it comes to the practical they could have a lot of nervousness you know especially if they are old school and they've gone through other instructors like this who put a lot of pressure on them this testing anxiety could sometimes make them make mistakes that they ordinarily wouldn't if they felt relaxed and felt confident with their instructor. Speaker 1: Exactly exactly. Well let's go on now to move on to the the idea of some of the skills and how to actually help that student so you notice doing certain things these these are just some common things we see quite frequently. Let's start with some compressions so alright why don't you start going ahead and show me some compressions here a little bit and maybe not exactly crack there. Speaker 2: Okay so some of the more common wrongful compression I'm gonna kind of model that a little bit maybe too low. Speaker 1: Okay so as we see compressing here he's on his stomach actually and we are going to see that so I would say, Roy you know what there's a better place to put your hands. What we want to try to do is be directly in the center of the chest above the area where the ribs come together that would be considered the lower third of the sternum. Let's put your hands right there in the center of the chest let's try that. That that's perfect. That that's the correct location. Now let's try those compressions. Excellent. Great job. So you see how that was done? That was the idea of encouraging that student showing that student what to do not to say just put it there just get it there. That didn't help the student to bark commands at him you want to actually show the student and that's going to be the most helpful thing to have that student actually remember this. Let's try a couple of other compressions. Speaker 2: Yeah technique issue. Speaker 1: So you see what's happening here obviously he's over exaggerating the arms are are all over the place. What we want to do is Roy what we want to do is lock those elbows nice and straight. Good and let your body weight do the work of the compression so you're pivoting the hips to let the body weight go down deep into the chest. We are going to 2.4 inches deep. Excellent job. And again the arms are a big problem. Other people want to jab or they want to jerk and that doesn't produce a very effective compression. We want to make sure we get smooth deep compression down into the chest. Let's try another problem. Speaker 2: That might be the hopping all the way off the chest. Speaker 1: As we see here again this is not effective. It's not producing a heart to squish to produce that blood flow that we want accomplish so the way to crack that is we say oh look take your hands on the chest when you push down push all the way down. When you come up let the chest fully recoil but don't pull your hands out of contact with the chest. That's the idea. Excellent. Great. So we're definitely pushing down on the way coming up all the way but not coming off the chest and that's another thing to crack there's a well good. Now that we've covered the common issues with chest compressions let's move on to breathing. Okay Roy go ahead let's try a couple of breaths but let's try with some of the common mistakes people do right here. You see what's happening. The airway is not open the chest is not going to rise and fall the lungs are not going to get air into them. The simple fix to this is remind the student to open the airway to chin lift just like that. You will see this clearly it open ups the airway it allows the air to go into the lungs and the chest rise and fall it's one of the biggest problems. Another thing is that the person doesn't pinch the nose and the real person and the manniquin the manniqun's nose is obviously sealed but in a real person if you don't pinch the nose the air will come up and the other thing is too forceful of the breath. Do you want to try that? Oh boy as you see if you this on a real person that would be real problem. The air has to go somewhere and if it is going to the stomach and if it goes into the stomach it will probably vomit at that point and we don't want that it causes more complications so we don't want to see forceful breaths or too much of a breath or too long the other problem is not enough breath. So we go down just like that well they're not making the chest rise at all and again that's not gonna help the person either. We need to actually get the air into the lungs and make that chest rise and fall. Any things you want to add to that Roy? Speaker 2: Yeah I think that's really all these mannequins depending on the type of mannequin you are using it is common for the lungs to sometimes to have a twist in them or in the airway there's something binding it so it can be very common when you are under pressure or maybe the student is putting pressure on you as a skill evaluator to hurry this thing up and they go to do a rescue breath that they can see that you are doing the technique correctly but the chest is not rising or falling. Make sure that your equipment is operating correctly. I guess in a worst case scenario you have complete mannequin failure you could explain to them manually you should see chest rise and fall with each successful breath but in most cases just troubleshoot your mannequin. I bet it's something simple that you can fix and then you will be able to see that chest rise and fall and create that confidence level in your student.