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59 Cards in this Set
- Front
- Back
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First thing you do on scene |
Put on BSI |
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Scene survey |
S: scene. Is the scene safe for myself, partner, bystanders and the patient? P: patients. Is there one patient or others E: environment. Is there anything happening around that could impede my approach or affect safety R: resources. Based on what i know; i will need 4 EMR, 4 ff, police, utilities, poision control M: mechanism of injury. What is the mechanism of injury
Interview bystanders General impression |
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Primary survey |
Introduction Decision of c-spine stabilization Assess LOC using AVPU Asses airway: is the airway open and clear Assess breathing: what is the rate, rhythm, depth, effort and quality Administer oxygen based on findings Assess circulation: what is the rate, rhythm and quality of the pulse Assess shock: what is the patients skin cool and temperature Assess deadly bleeds: are there any deadly or life-threatening bleeds? |
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Decision to load and go |
Yes because.. Based on findings in LOC and ABCs |
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Primary head to toe. Check for |
deformities Contusions Abrasions Punctures/penetrations Burns Lacerations Sweeling. |
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Head |
Look for dcap-bls Look for racoon eyes and battle signs, drainage from the ears, eyes, mouth and noss. Are there any lost teeth Color of the mucosa Ask: are there any deviations from normal? |
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Neck |
Look for dcap-bls and tic Look for JVD and tracheal deviation. Determine if any medical alerts Ask: are there any deviations from normal Delegate color application if trauma |
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Chest |
Look for dcap-bls and tic Watch for symmetrical rise and fall Ask: is there sucking chest wound or flail chest Determine stability of the chest wall by placing the side of your hand on the sternum while pressung into the chest wall on one side and then the other Asctate the apices and bases |
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Abdomen |
Look for dcap-drt Eviseration and a pulsating mass - do not palpate if any Ask: does the patient guard? And did i palpate a pulsating mass |
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Pelvis |
Look for dcap-bls and tic Determine stability of the pelvis by pressing in and then down Each movement ask; is the pelvis stable Ask: is there any incontinence, bleeding or priapism? |
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Lower extremities (compare bilaterally) |
look for dcap-bls and tic
assess circulation by the pedal pulses assess motor function by having the patient push up and down into your hands assess sensation by squeezing a common toe and having the patient identify it. ask: are the findings normal |
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Upper extremities (compare bilaterally) |
look for dcap-bls and tic assess circulation with the radial pulses assess motor function by having the patient squeeze your hands assess sensation by squeezing a common finger and having the patient identify it ask: are the findings normal |
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back |
look for dcap-bls and tic |
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before secondary survey you must |
declare you want to be off scene |
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secondary survey |
whenever a patient is moved, or there is a status change of any type, reassess LOC, ABCs and intervention |
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vital signs |
while i obtain the patients history, my partner will assess the vital signs. blood pressure body temperature blood glucose pupils pulse pulse oximetry loc using the glascow coma scale breathing skin color and condition - shock |
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history |
S: sample - signs and symptoms A: allergies M: medications P: past medical history - has the happened before L: last oral input and output E: events |
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understanding the complaint assessment |
O: onset - sudden or gradual P: provoke - what makes it better or worse Q: quality - allow the patient to describe their pain R: region/radiate t: time - when did this start |
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After history is completed |
request vital signs from partner administer medications |
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secondary head to toe |
same as primary |
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vital signs |
ask for another set of vitals from partner |
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ongoing survey |
reassess LOC, ABCs, vital signs and symptoms every 5 minutes along with interventions. |
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PATCH |
P: patient C: chief complaint A: assessment T: treatment |
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vitals |
ask for another set of vitals ask if you can be at the hospital |
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components of the scene survey |
scene, patients, environment, resources, mechanism of injury, interview bystanders and general impression |
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main components of primary survey |
LOC, ABCS |
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assessments performed in secondary survey |
history - sample vital signs understanding the complaint assessment - OPQRST secondary head to toe ongoing survey PATCH another vitals |
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why is SAMPLE and OPQRST obtained |
understanding patients complaint |
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what does AVPU mean |
alert
responsive to verbal responsive to pain unresponsive |
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if the person is alert what else do you assess
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orientation |
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4 areas of orientation to assess |
person time place event |
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glascow coma scale - eye opening |
spontaneous - 4 to voice - 3 to pain - 2 no response - 1 |
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glascow coma scale - best verbal response |
oriented and converses - 5
disoriented and converses - 4 inappropriate words - 3 incomprehensible words - 2 no response - 1 |
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glascow coma scale - best motor response |
obeys command - 6 localizes pain - 5 withdrawal - 4 abnormal flexion - 3 abnormal extension - 2 no response - 1 |
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reasons the LOC may be altered |
alcohol consumption epilepsy insulin requirements overdose of drugs uremia kidney failure trauma infection psychiatric/poison stroke |
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what question do you ask when assessing breathing in primary |
what is the rate, rhythm, depth, effort and quality of breathing |
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what question do you ask when assessing breathing by ausculation in primary/secondary |
is air way entry present, adequate and clear |
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treatment for sucking chest wound |
occlusive dressing
applied tapped on 3 sides |
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treatment for flail chest |
bulky dressing tapped over flail segement |
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treatment if an unconscious, head injured patient does not open airway |
jaw thrust head/tilt, chin/lift |
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when would you give a OPA |
when the patient is unconscious |
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patients always receive what medication after assessing breathing |
oxygen |
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if breathing is between 10 and 30 breaths per minute, what mask do you use |
non-rebreather mask |
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if breathing is less than 10 and greater than 30 what mask do you use |
bvm |
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an adult patient is not breathing, what is your ventilation using a bvm
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1 ventilation every 5-6 seconds up to 10-12 beats per minute |
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a pediatric patient is not breathing, what rate of ventilations in a minute |
1 ventilation every 3-5 seconds. |
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normal respiratory rates |
adult: 12-20 child: 16-24 infant: 30-60 |
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bvm |
team is required deliver breaths until you see chest rise, but no more than one second. |
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normal pulse rates |
adult: 60-100 child: 80-120 infant: 100-160 |
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pulse rate assessed on a conscious patient |
radial |
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pulse rate assessed on a unconscious patient |
carotid |
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pulse rate assessed on an infant |
brachial |
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rate of CPR |
adult: 30:2 child: 30:2 - team: 15:2 newborn: 3:1 |
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systolic pressure
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the pressure reflects maximal pressure against the arterial walls when the left ventricle contracts |
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diastolic pressure |
this pressure reflects pressure against the arterial walls when the left ventricle is filing. thus the heart is relaxed. high blood pressure occurs becuase of atheroscleosis and is a risk factor for heart disease and stroke. it is called the silent killer.
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pupils |
are they equal and reactive to light |
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body temperature |
a normal body temperature is between 36.5 and 37.5 |
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skin color and condition |
warm and dry is normal. pale, cool, clammy or diaphoretic indicates shock hot, red and dry indicates heat stroke |
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blood glucose level |
measures the level of sugar in the blood. normal value is between 4 and 6 mmol/L |
