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50 Cards in this Set

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A-V-P-U
A:Alert V:Reponds to Verbal Stimuli P:Responds to Painful Stimuli U:Unresponsive
2 Actions that should be taken when a priority patient is identified
1. Expidite transport

2. ALS Support, if it does not delay transport, try for ALS intercept otherwise
9 Categories of Priority patients
1. Unresponsive
2. Responsive by cannot follow commands
3. Difficulty breathing
4. Shock
5. Uncontrolled breathing
6. Severe pain
7. Chest pain w/ BP < 100mmHG
8. Complicated childbirth
9. Poor general impression
Adult indicators of inadequate breathing
< 8 respirations /min

or

> 24 respirations /min
Quality of breath can be placed in 4 categories
1. Normal
2. Shallow
3. Labored
4. Noisy
2 factors which should be observed when assessing breathing
1. Rate
2. Quality
4 abnormal skin colors
1. Pale (pallor) - Poor pefusion/impaired bloodflow
2. Cyanotic (blue/gray) - Inadequate oxygenation or poor perfusion
3. Flushed (red) - Late sign of carbon monoxide exposure
4. Jaundice (yellow) - Liver abnormalilties
Methods to obtain SAMPLE history for an unresponsive patient
1. Information from Family, friends, or bystanders

2. Medical ID
S-A-M-P-L-E
S - Signs and sympotms
A - Allergies
M - Medications taken
P - Patient past history
L - Last oral intake or menstral period
E - Events leading to illness or injury
O-P-Q-R-S-T
O - Onset
P - Provacations
Q - Quality
R - Radiation
S - Severity
T - Time
General situation that would not require a detailed physical exam
1. Patient with isolated trauma injury

2. Alert medical patient with specific complaint
The intervals for performing an on-going assessment
1. Every 15 minutes for stable patient

2. Every 5 minutes for unstable patient
5 components of baseline vitals
1. Respiration - Rate & quality
2. Pulse - Rate & quality
3. Skin - Color, temperature, condition
4. Pupils - Size, reactivity
5. Blood Pressure - Ausculation, palpation
Differentiate between signs and symptoms
1. Sign - Something the rescuer seer, feels, or hears

2. Symptom - Something the patient tells about his condition
D-C-A-P B-T-L-S
D - Deformities
C - Contusions
A - Abrasions
P - Puncture, penetrations, paradoxical movement
B - Burns
T - Tenderness
L - Lacerations
S - Swelling
O2 Tank capacity
Portable:
D - 350 L,
E - 625 L---

Onboard:
M - 3000 L,
H - 6900 L
Acute Abdomen - Signs & Symtoms
Abdominal Pain,
Guarding,
Tachypnea,
Referred Pain,
Anorexia,
N/V,
Abdominal Distension,
Bloody diarrhea,
Tachycardia,
Hypotension,
Fever,
Rebound tenderness
Acute Abdomen - Exam
1. Place patient in supine position

2. Gently palpate
Acute Abdomen - Etiology
GI disturbances
Female reporductive - Ovaries, ectopic pregnancy
Anneurysm
Acute Abdomen - Care
ABC
O2
No P.O
No Pain meds
Aniticpate shock
Monitor vitals
Transport
Normal flow rates for :

Nonrebreather mask
Nasal cannula
Pocket mask
BVM
Nonrebreather mask - 15 lpm

Nasal cannula - 1 - 6 lpm

Pocket mask - 15 lpm

BVM - 15 lpm
Normal CO2 levels in body
35 - 45
Types of shock
Compensated:
Tachycardia - Maintain cardiac output
Tachypnea - Increase oxygenation
Cool pale skin - Shunting of blood to core away from skin
Nausea - Shunting of blood to crore away from G/I
Thirst - Body recognition for more fluids
Confusion,agitation - Poor perfusion of the brain

Decompensated:
S/S of compensated
Drop of B/P < 90 mmHg
Must be aggresively treated
Can lead to organ failure

Irreversable
S/S of decompensated
Fatal
Oxygen delivery devices
Nonrebreather mask

12 - 15 lpm 80 - 90%

Nasal Cannula

1 - 6 lpm 24 - 44%
Types of flowmeters
Bourdon Gauge
PSI and Flow gauges
Inaccurate at low flow rates
Rugged
Can't compensate for backpressure

Pressure Compensated Flowmeter
Must be upright
Not practical for protable O2

Constant Flow w/ Selector Valve
Stepped increments for flow adjustment
Rugged
O2 Cylinder Duration of Flow
Cylinder Constants
D = 0.16 E = 0.28 M = 1.56 G = 2.41
H = 3.14 K = 3.14

(Gauge Presssure - 200) * Cyl Constant/Flow Rate
Normal Rates of Rspiration
Adult
12 - 20

Child
15 - 30

Infant
25 - 50
Hypothermia - Mild
Cold
Shivering
Pale
Lethargic
Reduced LOC
Frostbite - Signs & Symptoms
Occurs in extremities

Cold
Pain
Numbness
Initial Redness, changing to whtie or gray

Treatment:

Remove form hostile environment
Blanket
Transport
Barbituates - Signs & Symptoms
Contricted pupils
Diaphoretic
Coma
Bardaycardia
Bradypnea
Hypotension
Amphetamines - Signs & Symptoms
Dialated pupils
Diaphoretic
Seizures/Tremors/Anxiety
Tachypnea
Tacycardia
Hypertension
Narcotics - Signs & Symptoms
Constricted pupils
Pulmonary edema
Decreased LOC
Coma
Depressed Respirations (Slow and shallow)
Bardycardia
Hypotension
Flail Segment
3 or more ribs broken in 2 or more places

Paradoxical movement of chest wall
Dyspnea
Pain on respiration
Myocardial Contusion - Signs & Symptoms
Only early S/S will be irregular pulse
Cardiac dyssrhythmias
Cardiogenic shock
Pulmonary Contusion - Signs & Symptoms
Results from rapid deceleration forces and develops over several hours

Cyanosis
Hemptysis
Pulmonary edema
Dyspnea
Tachypnea
Tachycardia
Traumatic Asphyxia - Signs & Symptoms
Bulgins, bloodshot eyes
JVD
Bulging tongue
Rapid cyanosis
Hemothorax - Signs & Symptoms
Blood in thorax

Dyspnea
Decreased or absent breath sound on affected side
Hemoptysis
Tachypnea
Tachycardia
Hypotension
Spontaneous Pneumothorax - Signs & Symptoms
Occurs in young, thin, athletic males or patients with long standing COPD

Dyspnea
Sudden onset of pain
Decreased or absent breath sounds on affected side
Will progress to Tension Pneumothorax if untreated
Simple Pneumothorax - Signs & Symptoms
Usuall results form blunt injury to chest

Dyspnea
Chest pain
Decreased or absent breath sounds on affected side
Will progress to Tension Pneumothorax if untreated
Oxygen (O2) Pharmacology
Indications: All hypoxia or ischemia, known or suspected

Physiological Actions: Increases O2 tension in blood

Theraputic Effects: Reduces/reverses hypoxia/ischemia

Contraindications: none

Precautions: possible respiratory depression with COPD

Side Effects: Drying of mucous membranes if not humidified

Dosage/Route: NC 2-6 lpm, NRB 10-15 lpm, BVM 10-15 lpm
Activated Charcoal (Actidose)Pharmacology
Indications: Poisoning or overdose by mouth

Physiological Actions: Gastrointestinal absorbent

Theraputic Effects: Absorbs & prevents physiological uptake of oral poisons or chemicals

Contraindications: Ipecac adminstration within 1 hour, unconciousness

Precautions: Very distasteful, may need to be mixed (soda, pudding)

Side Effects: N/V, Black stools

Dosage/Route: 0.5 - 1G/kg PO/NG
Albuterol (Proventil, Ventolin) Pharmacology
Indications: Dyspnea w/ bronchospasm (indicated by wheezes/silence) due to asthma or exacerbation of COPD

Physiological Actions: Smooth muscle relaxant

Theraputic Effects: Broncodilation (lasts 2-3 hrs.)

Contraindications: Poor tidal volume, tacydysrhythmias, ventricula entropy, CHF/pulmonary edema, severely obtunded/unconcious patient

Precautions: DX if heart rate ^ by >= 20 bpm or dysrhythmias appear

Side Effects: Tachydysrhytmias, vetricular ectopy, N/V, anxiety, palpatations

Dosage/Route: 2.5 mg in 3 ml of NS by nebulized inhalation @ 6 lpm. May be repeated once in 10 minutes PRN

or


90 mcg per spray with Handheld Meter Dose Inhaler
Epinephrine (Adrenaline)
1:1,000 EPI-PEN Pharmacology
Indications: Allergic reactions, anaphylaxis

Physiological Actions: Mimics sympathetic nervous system

Theraputic Effects: Bronchodilation, ^ systemic vascular resistence, ^ heart rate

Contraindications: Myocardial Ischemia, hypertension, tachydysrhythmias, pulomonay edema

Precuations: Causes ^ myocardial O2 demand & ^ heart rate

Side Effects: Ventricular ectopy, tachydysrythmias, angina, hypertension, palpatations

Dosage/Route: adult: 0.3 mg IM
Oral Glucose (Gutose, Insta-glucose) Pharmacology
Indications: Hypoglycemia, established/suspected

Physiological Actions: Carbohydrate glucose source

Theraputic Effects: Raises blood glucose level

Contraindications: Decreased mental status (NPO)

Precautions: Distateful; "smear" on oral mucosa in patients w/ altered LOC

Side Effects: None

Dosage/Route: 25-80G PO
Nitroglycerin (NTG, Nitrostat) Pharmacology
Indications: Chest pain secondary to angina/MI

Physilogical Actions: Smooth muscle relaxant, dilates arterial and venous vessels, decreases cardiac work, vasodilation of coronary arteries, increases perfusion of ischemic mycardium

Theraputic Effects: vasodilation, BP reduction, coronary artery dilation, pain relief within 2 minutes, therputic effects within 30 minutes

Contraindications: ^ ICP, hypotension, hypovolemia, Viagra, Cealis, Levitra usage

Precuations: Recheck BP before each dose, prepare to support hypotension with positioning & fluids, patients may develop tolerance, drug deteriorates rapidly once opened, light sensitive

Side Effects: Hypotension, headache, syncope, dizziness, flushing, tachycardia

Dosage/Route: 0.4 mg SL (tablet or spray); repeat very 5 minutes x 2
Albuterol Dosage
2.5 mg in 3 ml NS Nebulized

90 mcg per spray with Handheld Meter Dose Inhaler
Activated Charcoal Dosage
.5 - 1G/kg PO

25 - 50G
Epipen Dosage
0.3 mg IM
Oral Glucose Dosage
25 - 80G PO
Nitro Dosage
0.4 mg SL