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197 Cards in this Set
- Front
- Back
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Hypothermia / Systemic Cold Injury
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systemic cooling of the body's core temperature to less than 35 degrees celcius
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Localized Cold Injury
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a cold related injury that is isolated to one body part or body parts
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Systemic Heat Injury / Hyperthermia
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systemic warming of the body's core temperatures to more than 38 degrees celcius
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What are 14 environmental Conditions? (9)
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- hypothermia (mild, moderate, severe)
- Frostbite (superficial, deep) - cold water submersions - heat cramps - heat exhaustion - heat stroke - drowning & near drowning - spinal injury with submersion incidents - scuba diving problems (air embolism, decompression sickness) |
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What are the 5 methods of heat less? (5)
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- Conduction (transfer of heat from body to colder objects)
- radiation (loss of body heat directly into a colder environment) - convection (transfer of heat through circulating air) - evaporation (cooling of body through sweating) - respirations (loss of body heat during breathing) |
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Mild Hypothermia: pathophysiology (2)
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- core body temperature is less than 35 degrees C
- body compensated by peripheral vasoconstriction |
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Mild Hypothermia: signs / symptoms (7)
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- shivering
- tachycardia - tachypnea - red to pale to cyanotic skin - peripheral and circumoral cyanosis - loss of fine motor function - anxious / withdrawn |
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Mild Hypothermia: treatment (8)
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- remove wet & restrictive clothing
- gently handle patient - high O2 - AMPLE - OPQRSTA - vital signs - transport - initiate passive rewarming |
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Moderate Hypothermia: pathophysiology (1)
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- core body temperature is between 32 and 35 degrees C
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Moderate Hypothermia: signs / symptoms (5)
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- absence of shivering (body is no longer compensating)
- confused, sleepy - loss of all motor coordination - Bradypnea - Bradycardia |
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Moderate Hypothermia: treatment (9)
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- remove wet & restrictive clothing
- handle patient gently - high O2 - AMPLE - OPQRSTA - vital signs - transport - defibrillate a maximum of 1 times if required - initiate passive rewarming |
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Who are more susceptible to cold emergencies? (3)
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- patients on vasodilators
- infants - geriatrics |
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The weather has to be below freezing for patients to be hypothermic. T/F
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False
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Severe Hypothermia: pathophysiology (2)
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- core body temperature is less than 32 degrees C
- body will temporarily maintain itself in a "metabolic ice box" * think cryogenics |
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Severe Hypothermia: signs / symptoms (3)
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- cardiac arrhythmias
- unresponsive - respiratory depression / arrest |
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Severe Hypothermia: treatment (9)
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- remove wet & restrictive clothing
- gently handle patient - high flow O2 - AMPLE - OPQRSTA - vital signs - transport - defibrillate a maximum of 1 times if required - initiate passive rewarming |
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Cold Water Submersion / Mammalian Driving Reflex: pathophysiology (2)
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- a patient is completely submerged in cold water causing the body to take significant defensive mechanism to protect itself
- this causes a decrease in metabolic oxygen demand, therefore the 4 to 6 minutes guideline does NOT apply in theses circumstances |
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Cold Water Submersion / Mammalian Driving Reflex: signs / symptoms (3)
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- rapid decrease in heart rate
- rapid decrease in respiratory rate - systemic vasoconstriction (shunts blood to the core) |
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Cold Water Submersion / Mammalian Driving Reflex: treatment (8)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport - pulse check of at least 60 secs - handle patient gently - initiate passive rewarming |
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The …… the water, the …… the submersion and the ….. the patient the greater the chance of successful resuscitation without deficits
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colder
faster younger |
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Systemic Cold Injury Assessment & Treatment (9)
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- remove the patient from cold environment
- do not allow patient to walk - remove any wet clothing and cover with blankets - handle the patient gently - do not massage extremities or allow patient to eat or to use any stimulants - give warm, humidified oxygen if available - begin passive rewarming only (no external heat source applied to patient, cover with blankets, increase patient compartment temperature prn) - consult medical control - note the lack of giving the patient any stimulants (caffeine) |
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Systemic Cold Injury Assessment & treatment: AED Considerations (1)
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- if no carotid pulse found after a minimum 60 second check
initiate CPR initiate AED protocols (maximum one shock) |
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Superficial Frostbite: pathophysiology (1)
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the skin has frozen due to exposure to cold, while the deeper tissues are unaffected
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Superficial Frostbite: signs / symptoms (4)
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- pale, cold skin
- little or no pain - lack of sensation in the area - swelling of affected are |
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Superficial Frostbite: treatment (4)
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- remove wet & restrictive clothing
- gently handle the patient - actively rewarm the affected part - protect from further cold exposure |
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Frost bite is also known as …
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frostnip
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Where does frost bite usually affect? (3)
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ears
nose fingers |
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Deep Frostbite: pathophysiology (3)
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tissues affected are frozen causing permanent tissue damage by
- the formation of ice crystals in the tissues - a change in electrolyte balance int the tissues |
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Deep Frostbite: signs / symptoms (5)
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- hard, frozen body part with no motor/sensory
- white, waxy appearance - blisters - swelling - red, purple, mottled, cyanotic or waxy appearance |
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Deep Frostbite: treatment (5)
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- handle the injured part gently
- remove wet and restrictive clothing - high flow O2 - AMPLE - OPQRSTA - vital signs - transport - *** do not rewarm the affected body part *** - cover with dry, sterile, bulky dressing |
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Localized Cold Injury Assessment & Treatment info (2)
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- never attempt rewarming if there is any chance the frostbitten part may freeze again before the patient reaches the hospital
- a warm water bath may be indicate if (protocols allow, time to hospital is lengthy - 2 + hours, the body part has no chance of refreezing) |
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Why should you never attempt to reward a frostbitten part if there is any chance if could refreeze before arriving to the hospital? (2)
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- could cause necrosis
- a lot of pain |
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Warm Water Baths: process (6)
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- water temperature should be 38 - 42 degrees C
- recheck water temperature constantly - circulate water to keep temperature distribution even - keep body part in water until warm and sensation returns - dress with dry, sterile dressings - * Don't let the affected part touch the sides of the container, it will stick like a tongue to cold steel |
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Factors Affecting Heat Loss (3)
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- body attempts to maintain normal temperature, 37.0 degrees C (+ / - 1 degree) despite ambient temperature
- body cools itself down (sweating, dilation of blood vessels) - high temperature and/or humidity decrease effectiveness of the body's cooling mechanism |
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Which to ways does a body cool itself by? (2)
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- sweating (evaporation)
- dilation of blood vessels |
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Heat Cramps: pathophysiology (1)
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- an electrolyte imbalance / dehydration causes painful muscle cramping (usually in lower extremities)
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Heat Cramps: signs / symptoms (3)
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- cramping, painful muscle
- inadequate hydration - increase in exertion or activity |
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Heat Cramps: treatment (2)
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- replace fluids by mouth (water or diluted sports drink 50/50)
- transport to hospital if cramping does not stop |
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Heat Exhaustion: pathophysiology (4)
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the body's ability to maintain normal temperature is impaired by:
- working in a warm or hot environment for extended periods - exercising without sufficient rest - dehydration |
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Heat Exhaustion: signs / symptoms (7)
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- pale, cold, clammy skin
- dry tongue and thirst - dizziness, weakness, or fainting - usually have normal vital signs - pulse may increase - blood pressure may decrease - normal or slightly elevated body temperature |
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Heat Exhaustion: treatment (9)
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- remove extra clothing and remove from hot environment
- initiate cooling measures - high flow O2 - AMPLE - OPQRSTA - vital signs - transport - if patient is alert, give water or diluted sports drink 50/50 - be prepared to transport |
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How can hospitals or higher levels of care replenish fluids/ electrolytes? (1)
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via IV
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Heat Stroke: pathophysiology (1)
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- the body's cooling mechanisms have been overwhelmed to a point where they are no longer functional
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Heat Stroke: signs / symptoms (6)
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- no sweating (no longer compensating)
- hot, red / flushed, dry skin - changes in behaviour - decreased or absent LOC - pulse rate is rapid, then slows, then stops - blood pressure drops |
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Heat Stroke: treatment (9)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport - move patient out of the hot environment - provide air conditioning at a high setting - remove the patient's clothing - initiate cooling measures ASAP (covering with wet sheet & fan, apply cold packs to the patient's neck, armpits, and groin) |
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Drowning (1)
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death as a result of suffocation after submersion in water
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Near drowning (1)
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survival, at least temporarily, after suffocation in water
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Drowning and Near drowning: emergency care (4)
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- begin airway management and ventilations as soon as possible
- maintain cervical spine stabilization - check pulse and start CPR if needed - keep patient warm and transport |
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You should suspect a spinal injury, regarding submersion incidents if….. (3)
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- submersion has resulted from a diving mishap or long fall
- patient is unconscious - patient complains of weakness, paralysis, or numbness |
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Scuba Diving Problems (3)
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- descent problems (sudden increase in pressure)
- bottom problems (not commonly seen) - ascent problems (air embolism and decompression sickness) |
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Decompression Sickness (5)
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- occurs when bubbles of gas obstruct blood vessels
- can result from rapid ascent - most common symptom is abdominal and/or joint pain and/or tooth pain - symptoms may develop after hours - can also develop if air-travel comes after scuba diving within too short a time interval |
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Decompression Sickness: signs / symptoms (9)
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- blotching
- froth at the mouth and nose - severe pain in muscles, joints, or abdomen - dyspnea and/or chest pain - dizziness, nausea, and vomiting - dysphasia (difficulty speaking) - difficulty with vision - paralysis and/or coma - irregular pulse or cardiac arrest |
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Decompression Sickness: emergency care (5)
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- remove the patient from the water
- keep patient calm - high flow O2 - AMPLE - OPQRSTA - vital signs - transport - place pt in left lateral recumbent position with their head down (traps air bubbles in right atrium - provide prompt transport to hyperbaric chamber (per protocols) |
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Temperatures that threaten ……. patients may not seem uncomfortable to responders.
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older
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Fetus (1)
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the developing, unborn child in the uterus
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Uterus (2)
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- the muscular organ where the fetus grows, commonly called the womb
- this is the organ that is responsible for contractions during labor |
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Birth Canal (1)
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the vagina and cervix
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Cervix (1)
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the lower not third, or neck of the uterus
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Bloody Show (1)
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a messy plug of pink tinged mucous that is discharged when the cervix begins to dilate
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Vagina (2)
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- the outermost cavity of a woman's reproductive system
- the lower part of the birth canal |
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Perineum (1)
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area of skin between the vagina and anus
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Placenta (1)
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the tissue attached to the uterine wall that nourishes the fetus through the umbilical cord
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Umbilical cord (1)
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the conduit between mother and infant, attaches to the infant and placenta
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Amniotic Sac (1)
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the fluid filled bag like membrane in which the fetus develops, also offers protection to the fetus
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Para (1)
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the number of live births the woman has had or the number of times the woman has been a parent
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Gravida (1)
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the number of pregnancies the woman has had
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Multipara (1)
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a woman who has had more than one live birth
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Primapara (1)
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a woman who has had one live birth
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Multigravida (1)
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a woman who has experienced multiple pregnancies
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Primagravida (1)
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a woman who is experiencing her first pregnancy
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Contractions (2)
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- strong, wave like muscle movements from the uterus
- occurs when the body is preparing for and actually delivering the child |
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Contraction Duration (2)
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- the time of the contraction
- measured from the beginning to the end of one contraction |
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Contraction Interval (2)
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- the amount of time between contractions
- measured from the end of one contraction to the beginning of the next |
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Anatomical changes during pregnancy (5)
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- blood volume increases by approx. 45%
- heart rate increases by 10-15 beats per minute - blood pressure decreases by approx. 10-15 mmHg - cardiac output increases - a blood loss of 30-35% can occur in pregnant woman before changes in BP or heart rate are detected |
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Conception time frame (1)
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1 to 4 weeks
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1st trimester time frame (1)
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0 to 12 weeks
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2nd trimester time frame (1)
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12 to 28 weeks
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3rd trimester time frame (1)
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28 to 40 weeks
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Recommended prenatal care schedule (4)
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- week 0 to 12 (initial visit)
- week 14 to 32 (once every month) - week 32 to 36 (once every 2 weeks) - week 36 to 40 (once every week) |
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Over ….. % of deliveries are "textbook" deliveries, requiring no intervention
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95
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Obstetrical Conditions: 1st & 2nd trimester (2)
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- ectopic pregnancy
- spontaneous abortion |
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Ectopic Pregnancy: pathophysiology (2)
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- a fertilized egg comes to lie in an are outside of the uterus, usually a fallopian tube
- at 6 to 8 weeks of development, the tube is too small to hold the fetus, the tube ruptures producing massive internal hemorrhaging and pain |
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Ectopic Pregnancy: signs / symptoms (5)
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- unilateral RLQ or LLQ pain
- possibility of being pregnant - hypovolemia - N/V - possible vaginal bleeding |
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Ectopic Pregnancy: treatment (2)
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- high O2
- transport |
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Miscarriage / Spontaneous Abortion: pathophysiology (2)
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- the body has terminated the pregnancy for any number of reasons
- delivery of the fetus or placenta before the 20th week |
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Miscarriage / Spontaneous Abortion: signs / symptoms (3)
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- unusually heavy menstrual flow
- pt may know she was pregnant - passing of tissues, usually into a pad or the toilet |
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Obstetrical Conditions: 3rd Trimester (4)
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- abruptio placenta
- placenta previa - hypertensive emergencies (preeclampsia, eclampsia) - supine hypotensive syndrome |
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Abruptio Placenta: pathophysiology (1)
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premature separation of the placenta from the uterine wall
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Abruptio Placenta: signs / symptoms (4)
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- bright red bleeding with a lot of pain
- anxiety - tachycardia - hypotension |
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Abruptio Placenta: treatment (2)
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- high O2
- transport |
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Abruptio Placenta can occur due to …. (2)
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- trauma
- spontaneous (no reason) |
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Placental separation can be …. or …… (2)
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partial or complete
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Placenta Previa: pathophysiology (1)
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- when the placenta has partially or completely covered the cervix
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Placenta Previa: signs / symptoms (4)
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- bright red bleeding with no pain
- anxiety - tachycardia - hypotension |
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Placenta Previa: treatment (2)
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- high O2
- transport |
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Placenta Previa may progress to ….. (1)
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Eclampsia
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Eclampsia: pathophysiology (2)
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- a condition that develops after the 20th week of pregnancy, usually in primagravidas
- pregnancy induced hypertension, full cause unknown |
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Eclampsia: signs / symptoms (6)
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- seeing spots
- swelling of the hands and feet - headache - anxiety - hypertension - N/V |
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Eclampsia: treatment (2)
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- high O2
- transport |
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What is the only way to end a eclampsia convulsion? (1)
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to deliver the infant, usually by C-section
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Supine Hypotensive Syndrome: pathophysiology (1)
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low blood pressure from lying supine due to compression of the inferior vena cava resulting in inadequate return of blood to the heart
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Supine Hypotensive Syndrome: signs / symptoms (5)
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- dizziness / light headedness while lying flat
- hypotension - tachycardia - tachypnea - anxiety |
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Supine Hypotensive Syndrome: treatment (3)
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- position pt in the left lateral recumbent position
- high O2 - consider transport |
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Normal Childbirth - Stage 1 (3)
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- dilation of the cervix, mom's body is preparing for delivery)
- requires 1 to 32 hrs - average is 10 hrs |
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Normal Childbirth - stage 2 (3)
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- delivery of the infant, child is in the birth canal
- requires 0 - 6 hrs - average is 2 hrs |
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Normal Childbirth - stage 3 (2)
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- delivery of the placenta
- usually occurs within 30 mins if infant delivery |
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When would you consider a field birth? (4)
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- delivery can be expected within a few minutes
- a natural disaster or other catastrophe makes i impossible to reach a hospital - no transportation is available - baby is presenting / crowning |
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Normal Childbirth: preparation for childbirth (6)
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- childbirth is a messy process (use proper BSI, with goggles)
- be calm and reassuring while protecting the mother's modesty - contact medical control for a decision to deliver on scene or transport if unsure - prepare OB kit - position mom (semi-sitting position) - position blankets (over both legs, under mom) |
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Normal Childbirth: delivery (11)
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- support the head as it emerges, apply gently back pressure to reduce tearing
*Once the head emerges, (the shoulders may be visible) - suction the mouth, then nose as soon as possible - support the head and upper body as the shoulders are delivered - handle the infant firmly but gently as the body is delivered * Once the body emerges - clamp the cord twice, 6cm away from the infant and another 4 cm further away - cut the cord with the sterile scalpel supplied between the clamps - expect some minor oozing - quickly and vigorously dry and clean the infant, discard towel after use - wrap the infant in a fresh, warm towel and core in baby bunting (silver "space blanket") to keep baby warm, avoiding hypothermia - the drying and rewarming process stimulates the infant to breathe - baby's only shiver for a few seconds before energy reserves are depleted |
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Normal Childbirth: after delivery (3)
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- obtain an APGAR score at the 1 and 5 minute mark after delivery
- present infant to mom - encourage breast feeding (provides nutrition, heat source for the child and stimulates uterine contraction decreasing post partum haemorrhage) |
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APGAR
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A - appearance
P - pulse G - grimace A - activity R - respiration |
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APGAR scale/chart (5)
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A (skin colour)
0 - blue over all 1 - blue extremities body pink 2 - normal P (heart rate) 0 - absent 1 - <100 2 - > 100 G (reflex / irritability) 0 - no response to stimulation 1 - grimace / feeble cry when stimulated 2 - sneeze, cough/ pulls away when stimulated A (muscle tone) 0 - none 1 - some flexion 2 - active movement R (respirations) 0 - absent 1 - weak or irregular 2 - strong |
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Normal Childbirth: care for mum (6)
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- continue providing high flow oxygen
- expect placental delivery 20 - 30 mins after infant(s) delivery - DO NOT tug on the umbilical cord - transport should commence as soon as delivery is completed (do not delay transport for placental delivery) - post-partum hemorrhage, up to 500mL is normal, may be controlled by (external uterine massage, bulky sterile dressings applied externally to control hemmorrhage) - place placenta in supplied bad, transport to hospital with mum and infant, hospital personnel will want to inspect the placenta |
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Complications with a normal childbirth (4)
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- unruptured amniotic sac
- umbilical cord around the neck - meconium aspiration - multiple gestation |
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Unruptured Amniotic Sac (1)
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puncture the sac and push it away from the baby, expect a gush of fluid
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Umbilical cord around the neck (1)
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gently slip the cord over the infants head if possible, it may have to be cut (clamp before cutting)
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Meconium Aspiration (7)
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- serious complications may develop due to meconium present in the amniotic fluid
- meconium is the infants first bowel movement, resulting from hypoxia to the infant - as the baby becomes hypoxic due to lox oxygenation, the anal sphincters relax and allow fecal matter to escape into the amnion - if this material makes its way into the airway, meconium aspiration occurs - detection of meconium staining the amnion is a serious matter - prompt suctioning of the oropharynx then nasopharynx is required - ensure that receiving facility is aware of the meconium situation, as deep tracheal suctioning may be required by ALS providers |
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Multiple Gestation (3)
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- twins are usually smaller than single infants
- delivery procedures are the same as that for single infants - there may be one or two placentas to deliver |
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Delivery Complications: Breech delivery (4)
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- presenting part is the buttocks or legs
- breech delivery is usually slow, giving you time to get to the hospital - support the infant as it comes out - make a "V" with your gloved fingers then place them inside the vagina to prevent it from compressing infants airway |
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Delivery Complications: Limb Presentation (4)
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- when an arm of a leg presents first
- this is a very rare occurrence - this is a true emergency that requires immediate transport and cannot be successfully delivered pre-hospitally - position mum in the "knee - chest" position during transport to the hospital |
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Delivery Complications: Prolapsed Cord (4)
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- when the cord is presenting first
- transport Immediately - complications include (kinking of cord cutting off circulation) - insert fingers into the vagina, push the vaginal wall off the cord, reducing kinkage - this position must be maintained all the way to the hospital |
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Delivery Complications: Fetal Demise (5)
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- an infant that has died in the uterus before labor
- this is a very emotional situation for family and providers - the infant may be born with blisters, skin sloughing, and dark discolouration - do not attempt to resuscitate an obviously dead infant - provide emotional support for the family, it's okay for the family to hold the infant (after it's been wrapped appropriately) |
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Sexual Assault
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- do not examine genitalia unless there is obvious bleeding
- the patient should not wash the area, defecate, eat, or drink until examined by hospital staff (crime scene is patients body) - hospital will contact local rape crisis centre as per protocols - document carefully and preserve evidence |
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Generalized Obstetrical Assessment & Treatment (5)
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- conduct an OB/GYN exam
- always maintain professionalism - remember childbirth is a messy process, ensure PPE - provide a lot of reassurance for mum and those at scene - you have at least two patients (mum & baby) |
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OB / GYN Special Survey (7)
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- Gravida: how many times have you been pregnant
- Para: how many live deliveries - Abortion history: any spontaneous abortions, due to trauma or medical - Any Complications expected: i.e. low birth weight, baby with large head - how much prenatal care (if any) - expected date of confinement (due date) - single or multiple gestation |
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Kinematics (1)
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introduces the basic physical concepts that dictate how injuries occur and affect the human body
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Work (1)
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force acting over distance (movement)
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Kinetic Energy (1)
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energy of moving object (velocity)
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Potential Energy (1)
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product of weight, gravity, and height
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What are three vehicular collisions? (3)
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- car vs. object
- patient vs car - organs/structure vs patient |
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Significant Mechanism of Injury - involving a vehicle (
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- severe deformities to the frontal part of the vehicle (>20 cm intrusion)
- moderate intrusion from a T-bone accident - severe damage from the rear - collisions in which rotation is involved - death of an occupant - no seatbelt or airbag deployment |
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Types of Motor Vehicle Collisions (5)
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- frontal
- lateral - rear end - spins - rollovers |
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Frontal Collisions (5)
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- evaluate seat belts and airbags, steering wheel and windshield
- remember that supplemental restraint systems cannot prevent all injuries (suspect the worst, hope for the best) - check of contact points - steering wheels can also cause chest injuries, especially if no airbag is present - windshields and visors may be deformed |
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Rear - Ended Collisions (4)
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- commonly causes whiplash type injuries
- assess head rest height relative to patient height - unrestrained passengers will be thrusted forward into the dashboard - back seat passengers wearing only lap belts might have a higher incidence of lumbar and thoracic spine injury |
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Lateral Collisions (3)
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- responsible for the highest incidence of deaths and spinal cord injury
- there may be intrusions into the passenger compartment - C Spine injuries are more common with this type of collision |
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Spins (3)
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- vehicle is put into rotational motion
- vehicle often strikes a fixed object, combining forces of rotation with lateral impact - centrifugal force may cause unexpected injuries |
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Rollover Crashes (4)
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- injury patterns differ if patients are unrestrained
- the most unpredictable injuries are to unrestrained passengers - ejection if the most common life threatening injury - centrifugal force may cause unexpected injuries |
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Falls (3)
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- injury potential is related to the height of the fall and objects stuck in the way down
- a fall either 15 feet or three times the person's height is considered significant - suspected internal injuries from a significant fall |
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Considerations for Falls (4)
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- the height of the fall
- the surface struck or struck during the fall - the part of the body that hit first, follow by the path of energy displacement - a fall from 3 - 5 feet can cause significant injury |
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Penetrating Trauma (3)
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- penetration can be low energy, or medium or high velocity
- greater the speed of penetration, the greater the injuries |
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Low Energy Penetrating Trauma (2)
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- cause accidentally by and object or intentionally with a weapon
- injury caused by the sharp edges of the object moving through the body |
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Medium Velocity and High Velocity Penetrating Trauma (4)
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- usually caused by bullets
- bullets can change shape and ricochet within the body - pressure waves cause cavitation - if possible, identify weapon caliber and shooting distance |
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Medium to High Velocity Lead Poisoning
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- the amount of injury caused is related to its speed and size
- speed is most critical element doubling speed quadruples damage doubling size doubles damage Ek = 1/2 mv2 |
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Newton's First Law (1)
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- objects at rest tend to stay at rest, and objects in motion tend to stay in motion, unless they are acted upon by some force
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Newton's Second Law (2)
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Force (F) is Mass (M) times Acceleration (A)
F = MxA - it is not speed that kills, but the sudden stop at the end |
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Newton's Third Law (2)
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- for every action, there is an equal and opposite reaction
- vehicle parts or components that have been moved will pass their force on to the other end i.e. stack of hanging metal balls with the end one swinging back and forth |
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Understanding and applying kinematics knowledge will result in ……….
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better suspicion of potentially occult injuries and improved patient care
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Body Mechanics (4)
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- shoulder girdle should be aligned over the pelvis
- lifting should be done with legs - weight should be kept close to the body - grasp should be made with palms up |
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Performing the Power Lift (11)
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- tighten your back in its normal upright position
- spread your legs apart about 15" - grasp with arms extended downy the side of the body - adjust your orientation and position - reposition feet - lift by straightening legs - keep your shoulders back (No hunching) - a power grip gets the maximum force from your hands - arms and hands face palm up - hands should be at least 10" apart - curl fingers and thumb tightly over the top of the handle |
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Weight and Distribution (2)
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- patient will be heavier on head end
- patients on a backboard or stretcher should be diamond carried |
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Diamond Carry (3)
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- one rescuer at head end
- one rescuer at foot end - one rescuer on each side of the patients torso |
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One- Handed Carrying (3)
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- face each other and use both hands
- lift the backboard to carrying height - turn in the direction you will walk and switch to using one hand |
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Carrying Backboard or Cot on Stairs (3)
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- strap patient securely to the backboard (4 straps at least)
- carry patient down stairs foot end first, head end elevated - carry patient up stairs head end first |
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Additional Guidelines: carrying patients (5)
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- find out how much the patient weighs (estimate)
- know how much you can safely lift - communicate with your partners - do not attempt to lift a patient who weighs over 250lbs with only two EMS practitioners - avoid unnecessary lifting or carrying (get firemen o do it) |
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Principles of Safe Reaching and Pulling (11)
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- back should always be locked and straight
- avoid any twisting of the back - avoid hyperextending the back - when pulling a patient on the ground, kneel to minimize the distance - most injuries occur when reaching or stretching too far - use a sheet or blanket if you must drag a patient across a bed - unless on a backboard, transfer patient from the cot to a bed with a body drag - kneel as close as possible to patient when performing a log roll - elevate wheeled ambulance cot or stretcher before moving - never push an object with your elbows locked - Do not push or pull from an overhead position |
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what are 9 different emergency moves/ drags (9)
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- clothes drag
- blanket drag - arm to arm drag - arm drag - front cradle - firefighters drag - one person walking assist - pack strap carry - firefighters carry |
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What are 2 non urgent moves/drags (2)
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- direct ground lift (requires 3 people)
- extremity lift (requires 2 people) |
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Scoop Stretcher (5)
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- adjust stretcher length while the two halves are still connected, ensure pins are in indexing holes, listen for "click"
- disconnect the two halves, NEVER pass the scoop over the patient for fear of dropping - adjust patient slightly and slide stretcher into place, one side at a time - lock stretcher ends together, top end first - secure patient and transfer: torso, legs, head last |
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What are scoop stretchers used for? (4)
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- bilateral femur fractures
- unstable pelvis - bilateral thoracic trauma - any major trauma involving multiple fractures where log rolling would aggravate injuries |
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Loading the Wheeled Ambulance Cot (4)
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- tilt the head of the cot upward if that is the "Load position" for that stretcher model
- release the undercarriage lock and lift - roll the cot into ambulance - secure the cot to ambulance clamps to prevent any rolling |
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Moving and Positioning the Patient (3)
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- take care to avoid injury to the patient and rescuers whenever a patients is moved
- practice using equipment - know that certain patient conditions call for special techniques and equipment |
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Situations that require spinal motion restrictions (9)
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- motor vehicle crashes
- pedestrian motor vehicle collisions - falls - blunt or penetrating trauma to hear, neck, chest or abdomen - motocycle crashes - hangings - driving accidents - recreational vehicle accidents - unwitnessed unknowns |
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Signs & Symptoms of a Spinal Injury (7)
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- MOI to support it
- pain or tenderness of spine - deformity of spine - tingling in the extremities - loss of sensation or paralysis - incontinence - priapism |
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Questions to ask in your assessment of spinal injury (6)
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- what happened?
- where does it hurt? - can you move your hands and feet? - can you feel me touching your fingers? Your toes? - do you have any numbness or tingling? - does your neck or back hurt? |
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If unsure if a patient has spinal injury….. (1)
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always treat for the worst and hope for the best
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Generalized Spinal Injury Assessment & Treatment (3)
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- manually stabilize the cervical spine after your scene survey and patient overview (delegate this task - BEFORE talking to or Touching the patient)
- DO NOT roll a patient without a C-Collar (exception is if they are prone on arrival) - Full Spinal motion restriction does not happen until the Full Rapid Body Survey |
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Cervical Collars (3)
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- fit 90% of the population
- many different types - occasionally they will not fit ( in this case continually stabilize the head manually) |
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Applying a Cervical Collar (7)
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- performed at the earliest after a full assessment of the neck in the primary survey
- measure the patient from the angle of the chin, straight back on the neck, then measure the number of fingers it takes to get to the trapezes muscle - apply this measurement to stoker side of the collar and make sure the red indicator dot is adjusted to the location covered by your finger - line up the collar on the patient's chest and slide it up slowly under their chin - place the chin support snugly under the chin, wrap the collar around the neck - pull the collar snugly and secure with Velcro - ensure that the collar fits properly (pt must be able to open their mouth and swallow the saliva in their mouth) |
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Stabilization of the Cervical Spine (
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- delegate before the LOC and ABC checks and after the patient overview
- hold head firmly with both hands - support the lower jaw - move to eye-forward position - maintain the position until patient is fully secured to a backboard with a blanket roll or head blocks and tape - Do not force head back into a neutral position if spinal injury is obvious |
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Do not force a patient's head into a neutral, in line position if … (4)
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- muscles spasm
- pain increases - numbness, tingling, or weakness develop - detect crepitus or encounter resistance * if a paten airway is not obtainable with modified jaw thrusts, the neck must be moved (head tilt chin lift) |
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What four positions will patients generally present in? (4)
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- supine
- prone - sitting - standing |
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Preparation for Transport: Supine patients (5)
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- maintain in line stabilization
- have the other team members position the immobilization device - log roll patient (recommended 4 rescuers) after application of a C Collar - secure patient to backboard - reassess ABC's and circulation, motor and sensory function after each move of the patient |
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Preparation for Transport: Prone patients (8)
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- obtain manual C spine immobilization
- assess ABC's - have the other team members positions the immobilization device - log roll patient straight onto the board (recommended 4 rescuers) and check the posterior prior to rolling - maintain in line stabilization - perform ABC re-check perform the primary survey - secure patient to backboard - reassess ABC's and pulse, motor and sensory function after each move of the patient |
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Preparation for Transport: Sitting patients (9)
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- maintain manual in line stabilization
- apply a cervical collar - place a short board / KED / XP1 behind patient - position device around patient - turn patient and lower to long backboard - secure short and long backboards together - reassess the pulse, motor function, and sensation - Note: only use KED if patient is stable * for unstable patients, utilize rapid extrication techniques to immobilize the patient |
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Preparation for Transport: Standing patients (4)
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- stabilize the head and neck and apply a cervical collar
- position board behind patient - carefully lower the patient to the ground (requires 2 or 3 rescuers) - secure patient to the board after they are horizontal, including re-sizing the collar (necks shrink a collar size moved from standing to horizontal) |
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Helmet removal must be accomplished if…. (3)
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- there is an ABC problem
- if you are unable to properly assess LOC - the helmet does not fit properly or is damaged |
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A patient wearing a helmet is usually in a …… position while lying supine.
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flexed
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Helmet Removal Steps (5)
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- prevent head movement
- one EMR secures the head and the other removes the helmet - extend the base of the helmet laterally to allow for ease of removal (some helmets do not bend) - slide helmet off while partner supports head - second EMR removes the helmet by pulling out and then up on the sides of the helmet (slight rocking motion of the helmet may be necessary) |
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Pediatric Needs when dealing with a suspected spinal injury (5)
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- immobolize a child in the car seat , if possible
- children may need extra padding to maintain immobilization - car seats need to be strapped to the stretcher, jump seat or bench - consider a KED if length is appropriate - generously pad both lateral sides of the paediatric patient on an adult spine board to minimize patient movement |
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Shock
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- stat of collapse and failure of the cardiovascular system
- leads to inadequate circulation and blood flow prioritization (keeping the vital organs perfused) - without adequate blood flow, cells cannot get rid of metabolic wastes - often called hypo perfusion |
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What are the different types of Shock that will lead to inadequate tissue perfusion, eventually resulting in systemic shut down (death) ? (8)
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Cardiovascular
- cardiogenic - neurogenic - hypovolemic - septic Non- cardiovascular - respiratory - anaphylactic - psychogenic - metabolic |
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Cardiogenic Shock (5)
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- pump failure
- when the heart can not meet the metabolic demands of the body = can not effectively circulate blood - causes a backup of blood into the lungs (pulmonary edema or JVD) - pulmonary edema leads to decreased O2 in the blood - potential causes - MI, electrocution…. |
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Neurogenic Shock (5)
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- spinal shock
- damage to the cervical spine may affect control of the size and muscular tone of blood vessels - the vascular system increases in diameter (blood in the body cannot fill the enlarged system resulting in a lower BP = hypo perfusion) - also called container failure - other possible causes (anaphylaxis, sepsis…) |
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Hypovolemic Shock (7)
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- volume failure
- results from fluid or blood loss - no blood = no hemoglobin = O2 being transported through the body - no fluid, no BP = hypoperfusion - blood is lost through external and internal bleeding - severe thermal burns cause plasma loss - dehydration may lead to this type of shock |
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Septick Shock (4)
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- combined vessel and content failure
- some patients with severe bacterial infections, toxins, or infected tissues contract septic shock - toxins damage vessel walls, causing leaking and impairing ability to contract = lowered BP - leads to dilation of vessels and loss of plasma, causing shock |
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Respiratory Insufficiency (4)
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- respiratory shock
- patient with a severe chest injury or airway obstruction may be unable to breathe adequate amounts of oxygen - insufficient oxygen in the blood (hypoxemia) will produce shock - potential causes (asthma, COPD, sucking chest wound, flail, etc.) |
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Anaphylactic Shock (4)
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- occurs when a persons body over reacts to a substance
- histamines being released into the blood stream lead to "leaky" vessels with the inability to constrict, thus leading to a dropping BP - Five categories of common causes: (injection/stings, absorption, ingestion, inhalant, chemical) - while this affects the circulatory system, this also affects the respiratory system ( bronchoconstriction, swelling of the tongue and lips… ) |
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Psychogenic Shock (3)
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- caused by sudden reaction of the nervous system that produces a temporary, generalized vascular dilation resulting in a disruption of blood flow to the brain
- common referred to as fainting (syncope) - can be brought on by causes ranging from fear or bad news to unpleasant sights |
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Metabolic Shock (
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- electrolyte imbalance
- patients with excessive fluid loss through diarrhea, vomiting, diaphoresis not only lose wage, but the delicate balance of salts and other electrolytes - this can lead to arrhythmias and neurological dysfunction |
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Progression of Shock (3)
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compensated shock
decompensated shock irreversible shock |
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Compensated Shock (6)
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- the body is unable to adjust any or all of the following in order to maintain full systemic perfusion
respiration rate / depth / regularity pulse rate / regularity / strength vasodilation / vasoconstriction - the body is using more energy then usual to maintain a normal environment within the body - the body can only compensate for so long till the energy runs out |
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Compensated Shock: signs / symptoms (13)
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- agitation
- anxiety - restlessness - feeling of impending doom - altered mental status - weak, rapid pulse - clammy skin - pallor - shallow, rapid breathing - shortness of breath - nausea or vomiting - delayed capillary refill - marked thirst, dry mouth |
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Decompensated Shock (4)
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- the body is no longer able to supply systemic perfusion and will begin prioritizing blood flow away from the following
GI / GU tract, skin and the extremities BP begins falling (late finding) - the body no longer has the energy reserves to continue to maintain a normal environment within the whole body, so it starts conserving energy and focusing in on the vital organs only - attempting to keep the vital organs perfused |
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Decompensated Shock: signs / symptoms (6)
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- falling blood pressure
- laboured, irregular breathing - ashen, mottled, cyanotic skin - thready or absent pulse - dilated pupils - depressed LOC (late signs) |
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Irreversible Shock (3)
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- this is the terminal stage of shock
- the body has tried to compensate, failed, tried to prioritize blood flow to keep only vital organs perfused and now can not do that either - a transfusion of any type will not be enough to save the patient's life |
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When to expect Shock (7)
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- multiple severe fractures
- abdominal or chest injuries - spinal injuries - severe infection - heart attack / respiratory compromise - anaphylaxis - …. whenever you have a patient you should be looking for shock |
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Generalized Shock Assessment & Treatment Notes (3)
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- consider trendelenburg position if your patient is hypovolemic
- strongly consider load and go criteria - cover patient with a blanket |
