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231 Cards in this Set
- Front
- Back
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BLS Skills (5)
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- Basic assessment
- Artificial Respiration (infant, child, adult) - Cardiopulmonary resuscitation (infant, child, adult) - mild airway obstruction ( infant, child, adult) - severe airway obstruction (infant, child, adult) |
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Time is critical Chart (5)
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0 - 1 minutes - cardiac irritability
0 - 4 minutes - brain damage unlikely 4 - 6 minutes - brain damage possible 6 - 10 minutes - brain damage likely over 10 minutes - irreversible brain damage |
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When should BLS Not be started? (5)
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- Rigor mortis or stiffening of the body
- dependent lividity - putréfaction or décomposition of the body - Evidence of a non survivable injury - existing DNR or no- CPR order |
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Discontinuing CPR scenarios (3)
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- patient is revived
- it is dangerous to continue - medical direction indicates |
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Three C's
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Check - check scene and for responsiveness
Call - call EMS/ 9-1-1 Care - Treat for any life threats / ABC's |
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Hazards and Dangers song
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No Fire, wire, water, gas, glass
Look up, look down, look all around *No needles or knives and no ex wives* funny version |
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Assessing a patients response by.. (2)
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- yelling "Are you okay"
- gently tapping shoulders |
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Activate EMS for any patient…
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that is not alert and oriented
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A "Patent" airway is…
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an open airway
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Open the airway: (2)
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- Head-tilt / chin lift
- modified jaw thrust / manual jaw thrust |
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A patient who is suspect to have a spinal injury, what method do you use to open their airway and why?
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jaw thrust, does not move the head (head tilt) possibly causing further damage
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ABC's
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Assessment
Breathing Circulation |
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Describe A process in ABC's
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look, listen, and feel for signs and symptoms of normal breathing and circulation for no more than 10 seconds
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Describe B process in ABC's
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initiate 2 slow ventilations (1 second each) if the patient is not breathing
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Describe C process in ABC's
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assess for signs and symptoms of circulation :
- feeling for carotid pulse - looking at skin colour and condition - looking for movement, breathing, coughing * usually done at the same time as A |
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Apneic
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not breathing
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If there are no signs of circulation…
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initiate CPR and request AED backup
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Deadly bleeding assessment
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perform rapid check of entire body looking for any bleeding
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Treat any deadly bleeding found immediately: (3)
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Rest
Elevate Direct Pressure |
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Why must you treat deadly bleeding before CPR?
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performing CPR will increase the bleed out time by getting the heart pumping more blood
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Artificial Respiration Age Diagram: ratio, quantity per minute, length
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Adult - 1:5 12/min 1 sec
Child - 1:3 20/min 1 sec Infant - 1:3 20/min 1 sec |
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Ventilation procedure (3)
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- open the airway
- apply the pocket mask - give slow rescue breaths ( 12breaths/min - adult , 20 breaths/min - child & infant) |
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Gastric Distention
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bloating of the stomach when air is being pushed into it
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Gastric distention is most likely to occur if: (4)
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- ventilations are provided too powerfully
- ventilations are provided too rapidly - patient's airway is obstructed - patient's airway is improperly opened |
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Pediatric needs for respiration (4)
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- if child is breathing, let child maintain their position
- ventilate infants using mouth to nose&mouth - ventilate every 3 seconds or 20 times per minute - if air does not enter freely check the airway and re initiate opening the airway |
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How do you ventilate a stoma?
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- plug mouth and nose
- ventilate the hole |
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Cardiopulmonary Resuscitation diagram: ratio, Qty / min, Depth
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Adult 30:2 5x / 2mins 4-5cm
Child 30:2 5x / 2mins 1/3 - 1/2 chest Infant 30:2 5x / 2mins 1/3 - 1/2 chest |
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Chest Compressions
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Artificial circulation by applying rhythmic pressure and relaxation to the lower half or third of the sternum
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External chest compressions provide approximately…. % of the blood normally pumped
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25% - 33%
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Chest compressions must be accompanied by...
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artificial ventilations
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Adult CPR process (6)
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- perform initial assessment
- activate EMS - determine whether the patient is breathing - determine whether the patient has a pulse - place your hands on the chest - give 30 compressions, followed by 2 (1 second) ventilations |
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When there are two rescuers performing CPR (on one patient), where do they position themselves around the patient?
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one is positioned at the head, the other at the patients side
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When there are two rescuers performing CPR (on one patient), how long do they wait before switching positions?
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2 minutes or an entire cycle ( 5 sets of 30 compresses and 2 breaths)
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What is the recovery position?
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Patient is lying on his side, floor arm raised so that head may rest on it while other out in front stabilizing upper body, floor leg straight while top leg is bent at the knee in front of him also stabilizing the patient.
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What is the top priority when dealing with a pediatric patient?
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opening the airway
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How can you access the circulation in a child's body?
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check brachial artery for circulation assessment
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Infant CPR procedure (6)
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- place infant on firm surface and maintain airway
- place two fingers, one finger below nipple line - use two fingers to compress the chest about 1/3 - 1/2 at a rate of 100+ / min - allow sternum to return briefly to it's normal position between compresses - coordinate rapid compressions and ventilations in a 30 :2 ration - reassess the infant for return of breathing and pulse, every 2 mins (5 cycles) |
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Child CPR Procedure (6)
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- place child on firm surface and maintain airway with one hand
- place heel of other hand over lower half of the sternum (avoid Xiphoid) - Compress chest about 1/3 - 1/2 at a rate of 100/min - Coordinate compressions with ventilations in 30 - 2 ratio, pausing for ventilations - If the child resumes effective breathing, place child in recovery position |
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CPR provides ………….. and buys patient time until ………. can be provided.
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cerebral oxygenation, ALS
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Mild obstruction qualifications (4)
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- some air exchange
- able to speak - breathing is noisy - patient may be coughing |
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Sever obstruction qualifications (2)
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- inadequate air exchange
- some high-pitched wheezing may be noted |
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Removing a foreign body in conscious patient sitting down or standing (7)
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- stand behind patient
- make a fist with one hand - press your fist into the patient's abdomen, thumb side toward patient - do not place your thumb inside your fist - other hand encloses your fist - perform "J thrusts" ( in and up) - repeat thrusts in sets of five ensuring proper land marking |
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Removing a foreign body in a conscious patient crumpled or lying flat (7)
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- place the patient in a supine position
- kneel beside the patient's torso - perform chest compressions as you would CPR - after appropriate number chest compressions inspect airway, remove any foreign matter - NO blind finger sweeps - attempt ventilation - repeat chest compressions as needed (prn) |
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Supine position
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lying down with the face up, sometimes with the hands behind the head or neck
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Prone position
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lying down with the face down, sometimes with the hands behind the head or neck
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Chest Thrusts procedure (4)
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- Stand behind the patient
- wrap your arms around the patient's chest - make a fist with one hand; grasp the fist with the other hand - press your fist into the patient's chest with backward thrusts until the object is expelled or patient becomes unconscious |
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What are the two types of manual foreign object removal techniques? (2)
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- cross finger technique
- finger sweep |
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Mild airway obstruction procedure (4)
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- encourage the patient to cough
- give 100% oxygen using a none rebreathing mask - provide prompt transport - request ALS backup |
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Is the process to removing foreign bodies in children the same as adults?
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yes
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In an unconscious child, what is the process to removing a foreign body? (10)
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- place the child on a firm, flat surface
- inspect the upper airway and remove any visible objects - attempt rescue breath - if ventilation is unsuccessful, position hands on the chest (CPR placement) - give 30 chest compressions - open airway again to try and see object - only try to remove object if you see it - attempt a rescue breath - if unsuccessful, reposition head and try again - repeat chest compressions if obstruction persists |
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In a conscious child, what it the process to removing a foreign body? and when he falls unconscious?(6)
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- kneel behind the child
- give the child five abdominal thrusts - repeat the technique until the object comes out - if the child becomes unconscious, call EMS if not done already, inspect airway - attempt a rescue breath - if airway remains obstructed, start 30 chest compressions |
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In a conscious infant, what is the process to removing a foreign body? (5)
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- hold the infant face down
- deliver 5 back blows - turn infant over face up on your thigh - give 5 quick chest thrusts - repeat cycle until the patient can breathe |
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Scope of Practice (4)
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- outlines the care you can provide
- is defined by provincial law (AOCPs) & medical control - further defined in protocols and standing orders - authorized through online and offline medical direction |
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Standard of Care (3)
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- standards imposed by local custom
- standard imposed by the law - professional or institutional standards |
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Duty to Act (3)
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- individual has a responsibility to provide patient care
- responsibility to provide care comes from either statute or function - legal duty to act begins once an ambulance responds to a call or treatment is initiated |
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Negligence
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the act of deviating from the accepted standard of care through carelessness, inattention, disregard, inadvertence or oversight that was accidental but avoidable
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What are the 4 determinants for negligence? (4)
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- duty to act (while on duty must provide care to patients who need it and consent to it)
- breech of duty (failure to act within expected and reasonable standard of care) - damages (physical of psychological harm) - cause (the emr caused the injury) |
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Abandonment (3)
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- termination of care without patient's consent
- termination of care without provisions for continued care - care is stopped without someone of equal or higher training taking over |
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Expressed consent
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when a patient gives permission for care
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Implied consent
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assuming permission of an unresponsive patient requiring care
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Forcible restraint (2)
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- require law enforcement / check local protocols
- requires at least 4 rescuers to properly and safely restrain ( 1 per limb as a minimum) |
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Assault and Battery
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Touching or treating a person without their consent
- assault "perception of threat/harm" - battery "act of contracting " |
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Avoid assault and battery charges by?
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obtain consent from a patient or their guardian
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Refusal of Treatment (4)
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- mentally competent adults have the right to refuse care
- patients must be informed of risks, benefits, treatments and alternatives - EMR should obtain a signature on their Patient Care Report (PCR) - always inform the patient that they may change their mind and call back for help |
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Emergency Medical Aid Act (3)
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- when a person voluntarily offers medical aid without expectation of compensation somewhere without adequate medical facilities and equipment
- the person is not liable for damages for injuries to or the death of that person - also known as the good samaritan law |
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What is a DNR?
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Do not resuscitate orders
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DNR orders (5)
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- only valid if the patient does not have a pulse and is not breathing
- you have to see the order for it to be valid - patients have to right to refuse resuscitation efforts - require a written order from one or more physicians - when in doubt, begin resuscitation and transfer care to a hospital where decision will be rendered |
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Ethical Responsibilities (6)
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- make the physical/ emotional needs of the patient a priority
- practice/maintain skills to the point of mastery - critically review performances - attend continuing education / refresher programs - be honest in reporting - model appropriate behaviour on and off duty |
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Confidentiality guidelines (3)
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- medical information received from or about a patient is considered confidential
- disclosing information without permission is considered a breach of confidentiality - information can only be disclosed if the patient signs a written release |
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What is subpoena
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a written release of confidential patient information
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Who gets confidential information? (2)
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-law enforcement
- any other medical profession who will be in direct contact with the patient for continuity of care (triage nurse) |
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Records and Reports (4)
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- complete documentation is a safeguard against legal complications
- if an action or procedure is not recorded, courts assume it was not performed - an incomplete or untidy report is considered evidence of incomplete or inexpert care - anything written down is admissible in a court of law (personal notes, subjective opinions…) |
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What are the 5 types of Law ?
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- legislative law
- administrative law - common law - criminal law - civil law |
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Legislative law (1)
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made by legislative branches in the government
- statutes, constitutions (city councils, district boards, U.S. congress) |
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Administrative Law (2)
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- regulations developed by a governmental agency to provide details about the function and precess of the law
- regulatory agencies may revoke or suspend license |
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Common Law (4)
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- case or judge made law
- derived from customs or norms over time - based on decisions of state/federal judicial systems - court decisions may define (acceptable conduct, negligence, interpretation of EMS statutes and regulations) |
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Criminal Law (3)
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- government prosecutes person for violating laws designed to protect society
- public complaint - punishment by fine, imprisonment, or both |
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Civil (tort) Law (2)
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- private complaints brought agains a defendant for illegal act/wrong doing
- plaintiff requests court to award damages |
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What are the 16 regulations relevant to EMS (16)
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- Health discipline Act
- Ambulance Services Act - Health Professions Act - Highway Traffic Act - Child Welfare Act - Persons in Care Act - Fatality Inquiries Act - Transportation of Dangerous Goods Act - Health Information Act - Freedom of Information & Privacy Act - Controlled Drugs & Substances Act - Emergency Medical Aid Act - Limitations Act - Mental Health Act - Personal Directives Act - Occupational Health & Safety Act |
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Health Disciplines Act (
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- regulates scope of practice, registered requirements, use of professional title, and required duties for all prehospital care staff in the province
- Scope of Practice section 9: EMR scope of practice section 10: EMT -A scope of practice section 11: EMT- P scope of practice section 12 (1): EMT-A skills section 12 (2): EMT-P skills - required duties goal is to ensure the highest quality of patient care and highest ethical standards of any profession |
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Under Health Disciplines Act, Section 9: EMR scope of practice, what may an EMR provide/do? (9)
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- conduct primary and secondary surveys, including scene assessments
- use basic methods of managing medical, traumatic and obstetrical emergencies - use airway management techniques, including oropharyngeal airways, oral suction devices and oxygen supplemented mask devices to assist ventilation - administer oxygen using basic delivery devices including masks and nasal canula - basic bandaging - cardiopulmonary resuscitation - patient extrication - use basic splinting techniques, including spinal immobilization with long spine boards and cervical collars - automated and semi-automated defibrillation |
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Ambulance Services Act (4)
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- to ensure public safety and ambulance service reliability by providing the regulation of ...
- confidentiality (treat information respecting a patient private, use information collected only for the purpose that it was collected for… ) - licensing and ambulance maintenance (adequate insurance… ) - Staff, vehicle and equipment (ambulance must be stocked and staffed appropriately, PCR's are completed, patient is transported in patient compartment securely…. ) |
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Health Professions Act (5)
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* will be replacing Health Disciplines Act
- deal with processes such as registration, continuing competency, professional conduct, restricted activities, and investigation & discipline - restricted activities ( only authorized persons may perform them, ….) - mandatory registration (must be registered with ACP…) - continued competency (continuing education, keeping up to date with current practices….) |
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Traffic Safety Act (6)
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* this act replaces "HighWay Traffic Act" & "Motor vehicles Administration Act"
- to license drivers, ensure the safe operation of vehicles on highways, to explain steps to take in the event of a collision, and to provide clear regulations when operating motor vehicles - if involved in an accident (remain at scene, provide care) - speed limit in school playground zones (this includes emergency vehicles, even when responding to a call) - right of way is a privilege not a guarantee (a collision involving an emergency vehicle is usually the emergency vehicles fault) - Cannot go any faster than 10% of the speed limit |
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When an emergency vehicle is involved in a collision, it is usually the other persons fault. T/F
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False, it is usually the emergency vehicles fault.
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Child, Youth and Family Enhancement Act (2)
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- to ensure the safety, security and development of children, many of whom are unable to seek help themselves for abusive behaviour
- any person who has reasonable and probable grounds to believe that a child is in need of intervention shall forthwith report the matter |
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A child is in need of intervention if there are reasonable and probable grounds to believe that the survival, security or development of the child is endangered because of any of the following… (8)
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- the child has been abandoned or lost
- the guarding of the child is dead and has no other guarding - the child is neglected by the guarding - the child is in danger of being physically or sexually abused by the guarding - the guardian of the child is unwilling or unable to protect the child from physical injury or sexual abuse - the child has been emotionally injured by the guardian - the guardian is unwilling or unable to protect child from emotional injury - the guardian has subjected the child to or is unable /unwilling to protect the child from cruel and unusual treatment or punishment |
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Persons in Care Act (2)
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- to report suspected elder/person in care abuse to law enforcement and to protect the employment of the person reporting
- every agency has a duty to protect the patients it serves from abuse and maintain a reasonable level of safety |
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Fatality Inquiries Act (1)
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- specifies which deaths must be investigated, which deaths must be reported and who is able to investigate them
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Death that require reporting are… (10)
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- deaths that occurred mysteriously
- deaths that occurred unexpectedly when deceased was in apparent good health - deaths that occur as the result of violence, accident or suicide - maternal deaths that occur during or following pregnancy - deaths that are the result of poisoning - deaths that may have occurred as the result of or improper or negligent treatment by any person - death that occurs during, within 10 days, of a surgery or while under anesthesia - death that occurs under the care of a physician - death occurs while deceased is under custody of a peace officer - deaths related to diseases, illnesses, toxic substances |
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Transportation of Dangerous Goods Act (
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- to ensure the safe handling, transport and receiving of dangerous goods through Canada via a training and certification program
- everything is labeled properly - packaged properly - anyone shipping, receiving or transporting have completed requires courses/training - have an emergency responder plan |
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Oxygen in a cylinder is considered… (1)
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dangerous goods
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Health Information Act (6)
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- to establish strong and effective mechanism to protect the privacy of individuals with respect to their health information
- to enable health information to be shared and accessed to provide health service and to manage the health system - to provide access to information for the patient about their own records - individual right to access - right to refuse access - confidentiality of information |
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FOIP
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Freedom of Information & Privacy Act
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Freedom of Information & Privacy Act (5)
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- to allow any person a right to access to the records under certain circumstances
- to control the manner in which information is collected about an individual - to control how personal information is used - to allow individuals, subject to limited and specific exceptions as set out in this Act, a right of access to personal information about themselves that is held ….. * this means EMR's must safeguard the location of their PCR's and watch what they say about any call they discuss with individuals not related to that patient's care |
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Controlled Drugs and Substances Act (3)
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- defines which drugs are considered illegal, the rights individuals and law enforcement as it relates to the creation, possession, selling, transport and administration of controlled drugs
- for EMS we are concerned with the medications commonly given at the paramedic level regulated in this act * unless you are a registered paramedic with ACP, do NOT touch, carry, deliver, transport, administer, or look at many of the paramedic level medications (especially opioids) |
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Emergency Medical Aid Act (3)
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- to protect trained and untrained individuals from rendering emergency medical first aid to someone who is hurt when they do not have a duty to care
- provides protection from legal repercussions * unless it is established that the injuries or death were caused by gross negligence on his or her part |
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Limitations Act (2)
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- to provide a reasonable period of time for individuals who were injured due to a breach of duty or negligent conduct to initiate law suit proceedings
- to provide a reasonable period of time after which an individual has immunity from the above lawsuits ….. |
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Mental Health Act (3)
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- to ensure the safety of the public and the patient in circumstances where a patient is deemed dangerous to themselves or the public
- must be reasonable ground to believe (patient is suffering from mental disorder, is in a condition presenting danger to others, should be examined in persons own safety) …. * occasionally EMS may request assistance from law enforcement to utilize this act in order to treat an uncooperative patient |
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Personal Directives Act (6)
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- to provide the ability to Albertans to provide advance personal instructions regarding their own personal matters
- AKA DNR - person over the age of 18 can make a personal directive ….. * Relevance to EMS - you must see the personal directive for it to be valid - if you are unsure if the order is valid, initiate resuscitation protocols - check the local protocols of your service, they vary slightly from service to service |
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Occupational Health and Safety Act (
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- to provide a safe and healthy working environment for all Albertans by defining:
Obligations of employers, workers etc. Regulations of a safe working environment What protection is required for a worker What safety procedures are required for varying worksites - no worker shall…. (unreasonable, unsafe, existing of imminent danger - work) - if an accident does occur at a work site, an officer may attend at the scene of the accident and may make inquiries, this will include the findings EMS personnel make on their PCR |
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Pertinent Positive
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- a finding (sign or symptom) that you would expect to find in a patient with this condition
ex: substernal crushing chest pain in a patient suspected of having a heart attack |
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Pertinent Negative
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- a finding (sign or symptom) that you would expect to find in a patient with a condition that is not present
* no half- paralysis of a patient suspect of having a stroke |
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Patient Assessment Process (12)
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- assess dispatch information
- scene assessment - patient overview - provide spinal motion restriction - primary survey - apply O2 - transport decision - vital signs and history - special assessments and treatments - secondary survey - reassess vital signs - ongoing assessment and care |
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Assessing dispatch information (6)
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- potential hazards and safety notes
- mechanism of injury - number of patients - chief complaint - other emergency vehicles responding/ already on scene - address and/or location |
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LLD
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legal land description
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What protective equipment is available for when dealing with BSI? (4)
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- latex or nitrile gloves ( should ALWAYS be worn)
- eye protection (should ALWAYS be worn) - mask - Gown |
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Scene Assessment
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- gloves, goggles and note the time
- check for hazards (fire, wire, water, gas, glass) - Mechanism of Injury (MOI) and bystander info -how many patients are there - need for backup and/or specialized equipment or personnel |
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When assessing a scene for hazards, always ensure your safety by considering … (9)
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- power lines or boxes
- fire or threat of fire - HazMat (fluids, liquids, spills) - explosion or threat of explosion - posible estructure collapse - presence of other emergency vehicles - violence or crime (animals, patients, bystanders…) - environment (heat, cold, low oxygen, wind, rain, snow) - traffic |
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What are the 5 components to a patient overview/ general impression? (5)
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- assess if eyes are open and tracking
- assess their skin colour and condition - assess respiratory distress / work of breathing - assess for deadly bleeding - assess for obvious deformities / fractures |
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The 5 components to a patient overview/ general impression should be assessed when? (1)
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when approaching the patient - before contact
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The initial 5 patient overview components will allow you to ……. and to …….
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anticipate the nature of the illness/injury
prioritize treatment accordingly |
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C-Spine control
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means that the patient will be unable to move their head / aggravate a potential injury
*task should be delegated (partner, firefighter, other trained person at scene) |
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Primary Survey begins when? (1)
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once you introduce yourself to the patient
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LOC
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level of consciousness
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Primary Survey (6)
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- LOC
- Airway - Breathing - Circulation - Head to toe primary survey - transport decision |
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AVPU
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Alert
Verbal stimulus (responsive to ...?) Pain (responsive to ...?) Unresponsive |
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AVPU scale assigns a patient to one of four letters according to their… ?
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response to stimulus
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When assessing mental status what abbreviation do you use?
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AVPU
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When assessing mental status of a patient, what else should you use besides AVPU? (1)
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check for orientation
- patients memory (Person, Place, Time, Event) |
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If a person is fully alert and oriented remembering (person, place, time and event) how would you write this out? (1)
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A + O x 4
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When assessing a patients airway, what signs could you look for to determine if an airway is compromised? (4)
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- two to three word sentences
- use of accessory muscles / retractions / in drawing - nasal flaring and use of accessory muscles in children - laboured breathing / noisy breathing |
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If a patient is talking, is their airway patent? (1)
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Yes, it is open
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Signs of Airway obstruction in an unconscious patient (3)
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- obvious trauma, blood, or other obstruction
- noisy breathing such as gurgling, wheezing, stridor, snoring or other abnormal sounds - extremely shallow or absent breathing |
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Stridor
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a harsh or grating sounds
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When assessing breathing what three things should you monitor? (3)
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- rate (number of breaths in 1 minute)
- rhythm ( is it regular or irregular in pattern) - Depth ( shallow or deep or regular) |
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If a patient is cyanotic, what colour do they appear?
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blue
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For patients respirating faster than 30 breaths per minute or lower than 10 per minute, what would you ventilation equipment would you consider using? (1)
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Bag- Valve- Mask
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BVM
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Bag- Valve- Mask
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Breathing over 30 breaths/min where a BVM is not tolerated, needs to be…. (1)
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coached down with a NRB being used
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NRB
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non-rebreather- mask
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When dealing with an unresponsive patient, how would you proceed? (4)
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- consider spinal cord injury (MOI)
- look, listen and feel technique - provide high flow oxygen (after assessing rate, rhythm, depth) - assist ventilations if needed |
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When assessing circulation, where would you assess the pulse? (2)
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- carotid
- radial locations |
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What three things do you assess for circulation? (3)
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- rate (number of beats per minute)
- rhythm (is it regular or irregular in pattern) - quality (what does it feel like - strong weak) |
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When assessing circulation are are the steps you must follow? (5)
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- assess rate
- assess rhythm - assess quality - perform rapid wet check - evaluate skin colour, condition and temperature |
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When evaluating skin colour, condition and temperature what are you looking for?
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- colour (cyanotic, flushed, pale, jaundiced, mottled, ashen, dusky)
- condition (dry or clammy or diaphoretic) - warm, cold, hot or cool |
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Restoring circulation steps (3)
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- control bleeding and improve oxygen delivery
- if unresponsive and pulseless begin CPR - apply and operate AED as quickly as possible |
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What patients should you not use an AED on? (2)
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- patient who does not need it
- patient with a catastrophic traumatic injury |
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Identifying Priority Patients (9)
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- poor general impression
- unresponsive with no gag or cough reflexes - difficulty breathing - sign of poor perfusion - childbirth - uncontrolled bleeding - severe pain - severe chest pain - problems with motor or sensation |
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Significant Mechanism of Injury (12)
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- ejection from vehicle
- death in passenger compartment - fall greater than 15'-20' - vehicle rollover - high speed collision - vehicle pedestrian collision - motorcycle crash - unresponsiveness or altered mental status -penetrating trauma to head, chest, or abdomen (assume spinal injury) - fall greater than 2 to 3 times their height - bicycle crash - significant burns |
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Hidden injuries include (2)
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- seat belts (may cause injuries if worn improperly)
- airbags (look beneath airbag for bent steering wheel, powder burns to face and eyes) |
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Palpate
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to feel
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Trauma Assessment, look for… (9)
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- deformities
- contusions - abrasions - punctures - penetrations - burns - tenderness - lacerations - swelling |
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Trauma Assessment, palpate for… (6)
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- tenderness
- instability - crepitus - distention - rigidity |
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contusion
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a bruise often cause by blunt force trauma; typically seen as a discoloured and swollen area of soft tissue
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abrasion
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a rubbing or scraping force that penetrates and destroys the outermost layers of skin
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punctures
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a penetration of the skin that damages the soft tissue in the path of the penetrating object
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laceration
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a cut to the skin and/ or to the layers of soft tissue beneath the skin caused by a sharp object
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crepitus
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the grating sound when broken bone ends rub together
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distention
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state of being stretched out, enlarged or distended
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What is the purpose of the primary survey? (1)
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to find and treat any immediate threats to the patient's life.
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What does DCAPP stand for?
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Deformities
Contusions Abrasions Punctures Penetrations |
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What does BTLS stand for?
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Burns
Tenderness Lacerations Swelling |
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What does TIC stand for?
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Tenderness
Instability Crepitus |
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What does DRT stand for?
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Distention
Rigidity Tenderness |
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Assessing the Head (3)
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- look for DCAPP - BTLS
- look to see if pupils are PEARRL - Palpate for TIC |
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PEARRL stands for?
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Pupils Equal, and Round, Reactive to Light
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Assessing Neck (4)
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- look for DCAPP - BTLS
- look for medical tags - look for flat dissented neck veins, midline trachea - palpate for TIC |
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JVD
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Jugular venous distention
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Assessing Chest (8)
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look for DCAPP - BTLS (expose and examine)
- retractions or in drawing of the intercostal muscles or any increased breathing - paradoxical motion - barrel chestedness Auscultate for any adventitious breath sounds - assess at the apices of the lungs bilaterally - middle of the clavicle one inch below - assess at the bases of the lungs bilaterally - straight down from the xiphoid process to the mid auxiliary line palpate for TIC |
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barrel chestedness
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chest shaped like a barrel
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Assessing Abdomen (2)
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- look for DCAPP - BTLS (expose and examine)
- palpate for DRT * palpate ALL four quadrants individually |
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Assessing Pelvis (3)
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- Look for DCAPP - BTLS (expose and examine)
- gently compress both sides of the iliac crest - do NOT push down on the Iliac crests, press inward not down - Also assess for (incontinence of urine or feces, priapism/ vaginal bleeding) - Palpate for TIC |
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Assessing Upper and Lower Extremities (4)
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- look for DCAPP-BTLS (expose and examine)
- check for medical -alert tags - Palpate for TIC - Assess CMS (circulation - radial, posterior tibialis, dorlias pedis) (motor function - push down with feet, squeeze fingers with hands) (sensory function) |
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Assessing Posterior (back) (2)
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- look for DCAPP- BTLS & palpate for TIC
- may require moving the patient, if so, assess the posterior as you move the patient - if your initial assessment (ABC) requires moving, this may be done at that time |
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Transport Decision - what must you complete before determining the need to transport? (4)
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- scene assessment
- patient overview - LOC and ABC's + critical intervention check - primary survey |
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What are your two options once you've finished your initial 4 assessments (scene, patient overview, LOC ABC, primary survey) ? (2)
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- Load and go
- stay and stabilize (with transport later) |
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What are the 9 load and go criteria? (9)
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- an altered LOC or memory loss (including any history of an alteration in mentation prior to EMS arrival)
- complications with airway -complications with breathing - complications with circulation - bilateral femur fracture - unstable pelvis - abdominal problems (medical) - thoracic trauma |
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What is a serious in nature injury that is NOT a load and go situation? (1)
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isolated spinal cord injury
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When leaving a scene with a patient, be sure to bring… (3)
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- pertinant bystanders / family members
- patients medications - other personal belongings |
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Once having decided to load and go, what must you think through? (4)
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- how you are getting the patient on the stretcher
- what position are they going to be on the stretcher - remember to switch O2 from portable tank to the main tank in the unit - who will be driving, and are you on route to the hospital |
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Once on route to the hospital, you must… (5)
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- assess vitals signs (every 5 minutes in a critical patient, delegated)
- Assess history (AMPLE & OPQRSTA) - perform any specialized assessments required - perform a detailed physical exam if time allows - perform a radio patch to the hospital / intercept |
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Vitals signs must be done every… in a normal patient and ….. in a critical patient. (2)
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15 mins, 5 mins
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AMPLE
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A - allergies (food, medications, environment?)
M - medications (OTC, prescription, herbal, recreational, supplemental) P - past medical history L - last ( oral intake, menstrual cycle, bowel movement) E - events leading to episode |
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OPQRSTA
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O - onset: did it start suddenly or gradually?
P - provoke: what makes it worse? Q - quality: how does it feel? (do not lead) R - radiate: does it travel or move anywhere else? S - severity: scale of 1 - 10 (10 is worst) T - time: how long have you had the discomfort, and is it constant or intermittent? A - alleviate: is there anything that makes it better? |
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What are the basic minimum questions you must ask a patient? (2)
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- AMPLE
- OPQRSTA |
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What are 5 specialized assessments that may be warranted for additional information from a patient? (5)
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- medication assessment
- neurologic assessment - GI / GU assessment - poisoning / OD assessment - OB / GYN assessment |
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What is a secondary survey, when should it be performed and where? (3)
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- a more in depth exam based on a focused physical exam
- should only be performed it time and the patient's condition allows it - usually performed in the ambulance en route to the hospital |
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Performing the detailed physical exam - Head (10)
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- look DCAPP - BTLS
- eyes: is the sclera white and conjunctiva pink? - bruising around the eyes or behind the ears? - fluids: coming from ears, eyes, mouth or nose? - trauma to the mouth or nose? - unusual breath odours? - pupils PEARRL? - skin colour / condition / temperature - palpate for TIC |
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Performing the detailed physical exam - Neck (6)
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- look DCAPP - BTLS
- subcutaneous emphysema - flat of distended neck veins? (JVD) - tracheal deviation - medical alert tags - palpate for TIC * if they have c-collar on, check best you can |
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Performing the detailed physical exam - Chest (9)
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- look DCAPP - BTLS
- retractions / accessory muscle use - barrel chestedness - paradoxical motion - surgical scars - medication patches - subcutaneous emphysema - auscultate for any adventitious breath sounds ( assess at the apices of the lungs bilaterally, assess at the base f the lungs bilaterally) - palpate for TIC |
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Performing the detailed physical exam - Abdomen (6)
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- look DCAPP - BTLS
- pulsating massess - surgical scars - needle marks - eviscerated organs - palpate for DRT (all 4 quadrants if possible) |
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Performing the detailed physical exam - Pelvis (4)
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- look DCAPP - BTLS
- incontinence - vaginal bleeding or priapism (prolonged erection of the penis) - palpate for TIC |
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CMS
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circulation
motor function sensory function |
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Performing the detailed physical exam - lower & upper extremities (5)
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- look DCAPP - BTLS
- look for medical alert tags - look for pitting endema - palpate for TIC - assess for CMS |
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Edema
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an abnormal accumulation of fluid in intercellular spaces of the body
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Pitting edema
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A swelling in the tissue under the skin, resulting from fluid accumulation, that is measured by the depth of indentation made by finger pressure over a boney prominence.
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Performing the detailed physical exam - posterior (3)
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- look DCAPP - BTLS
- feel for TIC *if the patient is strapped to a spine board, verbalize an attempt at reassessing |
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Ongoing assessments include… (4)
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- reassess vital signs
- repeat any specialized assessments - intervention check (see if it's had an affect; oxygen flowing, occlusive dressings occluding, bandages bandaging, splints splinting, immobilizations immobilizing… ) - hospital patch ( age, gender, MOI, C/C, Tx, vitals and ETA) * repeat ongoing assessments continuously |
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List of obvious critical life threats (4)
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- major multi system trauma
- devastating single system trauma - end-stage disease presentations - acute presentations of chronic conditions |
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List of potential life threats (2)
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- serious multi system trauma
- multiple disease etiologies |
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List of non - life threatening presentations (2)
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- minor illness or injury
- EMS system misuse (EMS systems are for emergencies) |
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When it comes to fundamental thinking, EMR's must have the ability to … (4)
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- differentiate relevant and irrelevant data
- analyze and compare similar situations - recall situations where diagnosis was incorrect - explain decision - making reasoning and construct arguments |
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Mental Checklist (5)
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- stop and think
- scan the situation - decide to act - maintain clear and concise control - regularly and continually reevaluate patient |
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The 6 R's of patient care (6)
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- read the patient
- read the scene - react -re-evaluate - revise management plan - review performance |
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Reading a patient (6)
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- Observe (level of resp., skin colour, position & location)
- Talk (find C/C, new problem or worsening pre-existing condition) - Touch (skin temp & moisture, pulse rate, strength, regularity) - Auscultate (lung sounds) - Identify life threats - Vital signs (triage tool to estimate severity, assists in identifying life threats, influenced by age, physical & medical conditions, current medications) |
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Reading a scene (3)
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- environmental conditions
- evaluate immediate surroundings - mechanism of injury |
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Reacting (4)
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- address life threats in the order found
- determine most common and probable cause that fit's patients presentation - consider most serious condition that fits patient's initial presentation - if clear, medical problem is elusive, presenting signs and symptoms |
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Reevaluate (3)
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- focused and detailed assessment
- response to initial management / interventions - discovery of less obvious problems |
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Revise management plan (1)
|
ensure your treatment is appropriate for how the patient is presenting now (as opposed to how they were earlier)
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Review performance (1)
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identify areas that can be improved on similar calls in the future
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Baseline Vital Signs (3)
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- key signs used to evaluate patients condition
- first set of vitals is known as baseline vitals - repeated vital signs are compared to the baseline vitals |
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What are the 9 vital signs that are required for each set of vitals taken? (9)
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- skin
- LOC - eyes - respirations - pulse - temperature - blood pressure - blood glucose - pulse oximetry |
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BGL
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blood glucose
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SPO2
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pulse oximetry
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Assessing vital signs - skin (4)
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- colour (red, flushed, pink, cyanotic, pale, ashen)
- condition (diaphoretic, clammy, dry) - temperature (hot, warm, cool, cold) - use back of ungloved hand on the patients forehead (or abdomen if child) |
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Diaphoretic
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inducing perspiration
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Assessing vital signs - LOC (2)
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- mentation (AVPU)
- orientation (person, place, time, event) |
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Assessing vital signs - eyes (2)
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- assess for PEARRL (pupils equal and round reactive to light) shining a pen-light into one eye and then the other, observing their reactivity (pupils normally constrict)
- assess size of pupil (mm) size of the pupil is measured without shining the light into the eye |
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What are two abnormal pupil reactions? (2)
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- fixed with no reaction to light
- unequal in size |
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Assessing vital signs - respiration (4)
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- rate (number of breaths in 1 min) count for 15 secs x 4
- rhythm (regular or irregular) - depth (shallow, normal, deep) - be aware of laboured or unlabored breathing |
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Assessing vital signs - pulse (3)
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- rate (number of beats in 1 minute)
- rhythm (regular or irregular in pattern) - quality (bounding, strong, normal, weak, thready) |
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What are possible assessment locations for a pulse? (9)
|
- carotid
- brachial - apical - radial - femoral - popliteal - ulnar - dorsalis pedis - posterior tibialis |
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Assessing vital signs - temperature (2)
|
- thermometer to measure via tympanic membrane (ear drum) very accurate, non invasive, quick to use
- normal range ( 37 degrees celcius + or - 1 degree) |
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Where are other temperature measuring locations? (3)
|
- oral
- rectal - axilla |
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What are 3 abnormal temperature ranges and what do they indicate (3)
|
- less than 35 degrees celcius (hypothermia)
- over 38 degrees celcius (low grade fever) - over 39.5 degrees celcius (high grade fever) |
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Assessing vital signs - blood pressure assessment through auscultation (6)
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- place cuff on patient's arm
- palpate brachial artery and place stethoscope - inflate cuff until you no longer hear pulse sounds or no longer feel a radial pulse - continue pumping to increase pressure by an additional 20 mm Hg - note the systolic and diastolic pressure as you slowly let air escape (NOT as you inflate the cuff) - as soon as pulse sounds stop, open the valve and release the air quickly (patient will appreciate this) |
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What is a sphygmomanometer? (1)
|
BP cuff
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|
Systolic BP
|
measures the maximum force exerted against the arteries as the left ventricle contracts, which occurs near the end of the cardiac cycle
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Diastolic BP
|
minimum pressure in the arteries, which occurs near the beginning of the cardiac cycle when the ventricles are filled with blood
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Assessing vital signs - blood pressure assessment by palpation (
|
- secure cuff
- locate radial pulse - inflate until the radial pulse is no longer palpable + 20 mm/Hg - slowly release air until pulse is felt * method only obtains systolic pressure (i.e. 122/p) |
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Blood glucometry
|
measures the amount of sugar in capillary blood in millimoles per liter (mmil/L)
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|
|
What is the normal range for blood glucometry? (1)
|
3.8 - 7.0 mmol/L
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|
Assessing vital signs - blood glucometry (5)
|
- sterilizing sample site with alcohol (let it dry)
- obtain a sample of capillary blood (use lancet provided) - draw up the drop of blood into test-strip - wait to obtain reading - cover sample site with gauze or s Band-Aid |
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Pulse Oximetry
|
measures the saturation of hemoglobin with oxygen ( how "red" the blood is)
normal vitals are 95% and up |
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How does a pulse oximetry work? (1)
|
it uses a device with two LED's and a pair of receiving sensors, light is passed through the finger/toe/ear lobe and the machine calculates the percentage
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What factors limit a pulse oximetry? (4)
|
- environmental (large amounts of ambient light)
- equipment failure (improper size sensor for pt, improper positioning of sensor, pt movement) - others (dysfunctional hemoglobin - carbon dioxide / anemia , dark nail polish, medications) - patient influences (cold extremities…. ) |
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What are patient influences limiting a pulse oximetry? (8)
|
- cold extremities
- peripheral vasoconstriction - impeded venous return - blood pressure cuff / tourniquet - hemodynamic compromise - poor peripheral perfusion - edema - clenched fists / hypertonicity |
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Assessing vital signs - time (3)
|
- it is critical to always document time with the vital signs
- time is always measure using the 24hr clock EMS - vitals should be measure every 5 minutes for critical patients & 15 minutes in a stable patient |
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Normal Vital Signs
|
Skin - P / W / D
LOC - A + Ox4 Eyes - PEARRL @ 4mm Resps - 12 - 20 N/R unlabored (for adults) Pulse - 60 - 100 S/R (for adults) Temp - 37.0 degress celcius (+ or - 1 degree) BP - 120/80 ( + or - 20 pts) BGL - 3.8 to 7.0 mmol/L Pulse OX - 95% and up |
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Reassessment of Vital signs, stable & unstable patients (2)
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- stable every 15 mins
- unstable every 5 mins |
