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224 Cards in this Set

  • Front
  • Back
Scene Size up: Steps
1. Person (EMT)
2. “What happened to you?”
3. “Nothing on Me (glove up)
4. Are there more (patients)
5. Dead or Alive
6. Am I in a fix (Urban)
After Scene Size Up?
Gain Consent and Control
Life Threats: ABCDEF
1. Airway
2. Breathing
3. Circulation/Bleeding
4. Disability/Decision (MOI = Mechanism of Injury)
5. Environment
6. Fast or Slow (load n go, stay n play)
Vital Signs
LOR = Level of Responsiveness
• A+O x (1-4)
Person→Place→Time→Event
o Verbally
o Pain
o Unresponsive
HR = Heart Rate
• BPM (Beats per minute) 15 sec x 4
• Quality – Strong/Weak, Bounding/Thready
• Rhythm – Regular/Irregular
RR= Respiratory Rate
• Deep/Easy
• Labored/Unlabored
• Wheeze
• Prod. Cough
SCTM =Skin
• Color/Pink/Pale
• Temp/Warm/Cold
• Moisture/Dry/Clammy
02 = Oxygen
• Pulse-oximotor, O2 reading <80 = Bad!
• Carbon monoxide poisoning
Temperature
• Core temp = rectal thermometer
Pupils
• PERRL
• Pupil, Equal, Round, Reactive to Light
• Unresponsive pupil dilation to neurological trauma, drug use, blindness etc
BP = Blood Pressure
• Diastolic Pressure = Consistent
• Systolic Pressure = Spike
• 120/80 = SP/DP mmHg
• Auscultation= Listen
o Listen with stethoscope
o Listen for Beat (Systolic)
o Listen for silence (Diastolic)
• Palpation = Feel
o Use BP cuff
o 110/P
• Estimation = Guess
o 1. Pedal Pulse
o 2. Radial
o 3. Brachial (Arm pit area)
o 4. Femoral (Groin)
o 5 . Carotid
Head to Toe Examination
Palpate and examine from Head, Shoulders, Chest, Abdominal, Genittal
SAMPLE Patient History:
S=Symptoms
A= Allergies
• Any? Have you been exposed? What happens when you’re exposed?
M= Medications
• Prescriptions, vitamins, supplements, drugs/alc
P= Past medical history
L= Last ins/outs, Drinks, Eats, urination/defecation
E= Events leading up to incident
SOAP Note Format:
STORY:
1. “I have a 25 year old MALE whose C.C is PAIN IN RIGHT ELBOW
2. Pt. states, “sledding, fast, tumbled at speed” (MOI)

OBSERVATION:
• H TO T
i. Pt. was found LYING ON BACK IN SNOW
ii. Head to Toe Reveals 2” Bruise Right ELBOW, Right KNEE TENDERNESS
iii. No Other Injuries

• VITALS
i. LOR: A+O X 4
ii. HR 68/ST/REG
iii. RR 16/UNLAB/REG
iv. SCTM: P/W/D
v. Pupil: PERRL
vi. T: None

• SAMPLE
i. S:No other symptoms
ii. A: allergic to Ibuproffen/No exp./ Sev.
iii. M: “G” drug for Diabetes
iv. P: Diabetic
v. L: Good/normal
vi. E: Good/normal

ASSESSMENT
• +MOI
• INJ (R) Elbow
• INJ (R) Knee

PLAN
• B. Board
• Splint Elbow
• Support Knee
Negligence
• Duty to act
• Breech of Duty
• Physical or Psychological Injury
• Cause: Omission/Commission

ETOH = Alcohol
Slander/Libel
Types of Bleeds
• Capillary: Oozing, not concerned B.L
• Venous: Veins return blood except for Pulmonary
o Dark colored, not a lot of O2
o Slow bleeding, not under pressure, mild concern
• Arterial: carry o2 blood to heart
o Bright, spurting, great concern
o Stabbing, vehicular accident
How to treat bleed?
• APPLY PRESSURE- From Patient
• Elevate area
• Still bleeding – Apply more pressure, pressure bandage
Tourniquet
• Wide bandage
• Tie proximal to wound
• Use stick/pen, fold over
• BP cuff = good tourniquet
MAST?
Military Anti Shock Trousers
• Used for peeps who need BP elevated
• Used for bleeding control
• Pregnant women, head injuries, people in shock, lower extremity bleeding
• Until Systolic P >= 100, or Velcro cracks
Shock? Types?
Results from inadequate perfusion
Perfusion is soaking organs/systems w/ o2
• Hypovolemia = low volume of fluids
• Cardiogenic = Heart attack
• Vasogenic = vasodilation of veins/arteries, BP drops, severe allergic reaction
o Anaphylaxis
o Spine Injury
o Infection (Systemic, Sepsis)
o Pyschogenic (mind, not REAL shock)
Mild Compensatory
• Signs/Symptoms
o Nausea
o ^HR, ^ RR
o Pale, Clammy, Cool
o BP no change
o Pupils N.C
o Temp N.C
o Syncope = fainting
• Treatment
o Elevate feet
o Wilderness = Water
o Tx (treat) cause
o Warm, provide 02
o Lay on Ground, HR = X
o Stand him up, 2 min, HR = X + 30 (Orphostatic, Mild)
Decompensatory
• S/S
o HR ^, weak, thready
o RR, ^, fast shallow
o BP drop
o T, P = same
• Treatment = Same as M.C, EVAC from wilderness
Eventually, irreversible, “circling the drain” = Dead
• Slow P
• HR ^
• Erratic RR
• BP v
CPR

DO not start when...

STOP when
• Life
• Unsafe
• Lethal Inj.
• Dep. Lividity
• Rigor Mortis
• DNR

Stop:
• Life
• Safe
• Exhausted
• Pronounced Dead
• Wilderness = 30 minutes
Hypothermia
• Withhold compressions in severe case
o Resc. “B”
• Avalanche
o “A” step concern
• Lightning
o “B” Step
RIB fx: S/S? Tx?
• Pain/pain on breathing
• Bruising/ S.O.B
• Croupades, rattle/crackle
Rib Tx (treatment)
• Semi-cirm. Tape
• Ace/02
• Sling/Swattle
• Breath
Flail Chest? TX?
Flail Chest =Multiple breaks in multiple places
• Pain/D.O.B, S.O.B (dyspnea)
• Soft section
• Paradoxical movement/breathing = late onset/sign
F.C Tx
• Roll onto padding/Bulky Dressing
• Lie on affected side
• Non Steriodal Anti Inflamatory Drug (Ibuprofen)
• Evac!
Sucking Chest wound/Open Chest? S/S? TX?
• S/S
o Notice hole, large knife, gunshot, entrance/exit
o Some blood, not a lot of arteries/veins
o Sound of air, DOB, SOB
• TX
o Gloved hand
o Occlusive dressing (plastic bag) to stop air passage, tape down over wound, 4 sided
o 02/monitor
o rapid EVAC!
Closed Chest Wound?
Pneumothorax?
Hemothorax?
• Trauma creates opening on inside, tear in visceral plura space, air/blood come in
o Pneumothorax = air seep
o Hemothorax = blood seep, internal bleeding
o Spontaneous pneumothorax
• S/S
o DOB, SOB
o Shallow resp.
o Diminished Lung sounds, lung wont fully inflate -> absent
o Collapsed Lung =tension pneumothorax
• Cyanatic = blueish tinge
• Distension jugular vein = JVD
• Deviated trachea
• Tx
o Position of comfort
Lung Sounds: Vitals
• Listen ½ down clavicle
• Right below armpit
• Below scapula
• Normal = equal, bilateral
HIPAA
Health Insurance Portability and Accountability Act

Limits availability of patient Info/privacy
CQI
Continuous Quality Improvement:
System of Internal/External reviews
Abduction
Motion away from midline
Adduction
Motion toward midline
Alveoli
Air sacs in lungs ex. o2, co2
Anterior
Front surface
Posterior
Back Surface
Aorta
Principal artery leaving left side of body, carrying 02 blood through body
Lateral
Outside of body
Medial
Inside of Body
Proximal
Close to trunk
Superior
Close to head
Inferior
Near feet
Ventral
Belly side of patient
Dorsal
Spinal Side
Medial
Inner structures
Prone position
lying face down
Fowlers Position
Knees Bent, sitting slightly
Supine Position
Lying face up
Shock Position
Face up, Legs up
Recovery Position
Lying on side
Flexion/Extension
Bending/Straightening of joint
Abdominal is divided into Quadrants
RUQ = Gallbladder, Liver
LUQ = Spleen/Stomach
RLQ = Illiac Crest/Appendix
LLQ = Colon/small intestine
Trendelenburg Pos.
Body on backboard/Shock
Temporal Region
Side of skull
Radius
Anterior bone of arm
Ulna
Posterior bone of arm
Thyroid Cartilege
Adam's apple
Cricothyroid cartilege/ membrane
Below A.A / Thin tissue joins Thy. Cart and Cri. Cart
Sternonucleidomastoid Muscle
Side of neck muscle
Trachea
Below Thy Cart, windpipe, upper part of esophogaus
Spinal Column:Hight to Low
Cervical (C1-7)
Thoracic (7-12)
Lumbar (12-17)
Sacrum(17-22)
Coccyx(22-24)
Thorax
Chest cavity that contains heart
Xiphoid Process
End edge of sternum
Diaphragm
Muscular dome that forms inferior boundary of thorax
Angle of Louis
2nd Rib
Costal Arch
Arch of Ribs
Femor
Thigh Bone
Illium/Iliac Crest
Inner/Outer Hipbone
Humerus
Upper arm bone
Exhaled air
Inhaled air
16% o2, 79% nitrogen
21% o2, 78% nitrogen
Brachial Artery
Major vessel in upper extremity, blood to arm
Autonomic nervous system
regulates functions, digestion, sweating
Carotid Artery
supplies blood to head and brain
Central Nervous System
Brain and Spinal chord
Diastole
Relaxed heart pulse, ventricles
Femoral Artery
Artery of thigh, supplies blood to lower abdominal, lower leg
Epiglottis
thin valve that allows area, not food
Foramen Magnum
Large opening base of skull, connects brain to spinal chord
Inferior Vena Cava
one of two largest veins, carries blood from lower extremities
Pleura
Serous membrane covering lungs, lining thoracic activty
Perfusion
Circulation of oxygenated blood
Auscultation
Method listening to sounds with stethoscope
A+O
V
P
U
Scale
assesses level of responsiveness
Bradycardia
slow heart rate < 60
C.C?
Cheif Complaint
Cyanosis
Blueish/Gray tinge from lack of o2 in blood
Diaphoretic
Profuse sweating
Labored Breathing
breathing takes greater effort, grunting, stridor
OPQRST
Onset
Provocation
Quality
Region
Severity
Timing of pain
Hyper/Hypo-tension
Higher/Lower BP
Stridor
harsh sound of obstructed airway
Systolic Pressure
Increased pressure along arteries with each contraction (systole) of ventricles
Adequate RR for adults
12-20 breath/min
Hypoxia
Body tissues/cells not enough o2
Oropharyngeal adjunct
Oral Airway passage, prevents tongue from blocking airway in unconscious patient

Measured from mouth to ear
Nasopharyngeal adjunct
Used if gag reflex intact, through nose
Suctioning
Used to clean vomit/liquid secretions to clear passage
O2 tank procedure?

set at __ psi
Make sure pressure regulator intact, pin index safety pin match up

between 40-70 psi
Nasal Cannulas/nonrebreathing masks are used to deliver O2 in field...
What o2 level?
15 L/min, 90% o2
CSM for fingers and toes
Circulatory, Sensory, Motion
BVM
Bag valve Mask
Nosebleeds
Pinch cartilege
place gauze, push up
Causes= digital trauma
altitude
Lean forward
Mouth to Mouth delivers _ % o2
BVM with o2 resovoir delivers _
55%
100%
Agonal respirations
gasping breaths, heart stopped
Apnea
period of not breathing
Aspiration
introduction of vomitus / foreign material into lungs
Ataxic respirations
Ineffective/irrelgular respirations
Bilateral
Bodypart/condition on both sides of body
Dyspnea
Difficulty breathing
Gastric Distention
Air fills stomach, result from high vol and pressure during artificial ventilation
Perfusion
Circulation of oxygenated blood
Stridor
harsh sound of obstructed airway
Systolic Pressure
Increased pressure along arteries with each contraction (systole) of ventricles
Auscultation
Method listening to sounds with stethoscope
A+O
V
P
U
Scale
assesses level of responsiveness
Adequate RR for adults
12-20 breath/min
Bradycardia
slow heart rate < 60
C.C?
Cheif Complaint
Hypoxia
Body tissues/cells not enough o2
Cyanosis
Blueish/Gray tinge from lack of o2 in blood
Oropharyngeal adjunct
Oral Airway passage, prevents tongue from blocking airway in unconscious patient

Measured from mouth to ear
Diaphoretic
Profuse sweating
Nasopharyngeal adjunct
Used if gag reflex intact, through nose
Suctioning
Used to clean vomit/liquid secretions to clear passage
Labored Breathing
breathing takes greater effort, grunting, stridor
OPQRST
Onset
Provocation
Quality
Region
Severity
Timing of pain
O2 tank procedure?

set at __ psi
Make sure pressure regulator intact, pin index safety pin match up

between 40-70 psi
Nasal Cannulas/nonrebreathing masks are used to deliver O2 in field...
What o2 level?
15 L/min, 90% o2
Hyper/Hypo-tension
Higher/Lower BP
CSM for fingers and toes
Circulatory, Sensory, Motion
Backboard
device used to provide support to patient suspected of having hip, pelvic, spinal, lower extremity injury
Apnea
Not breathing
Bilateral
Injury on both sides
agonal respirations
occasional gasping breaths
Exhalation
diaphragm, intercostal muscles relax, air escapes
Gastric Distention
Air fills stomach, results from high vol and press. during artificial ventilation
Hypoxia, Hypoxic drive
Body tissues not enough o2

chronic low levels stimulate respitory drive
Dyspnea
Difficulty breathing
Ischemia
Lack of o2 that deprives tissues, possible stroke
Nasal Cannula
oxygen delivered through nose, 24-44% supplemental o2
Sellick maneuver
prevents gastric distention, pressure applied to cricoid cartilege
Nonbreathing mask
Mask + Reservoir bag = 90% o2
Crepitus
Grinding of bone
coagulate
clot forming to plug opening in blood vessells
DCAP
BTLS
Deformities, Contusions, Abrasions, Punctures
Burns, Tenderness, Lacerations, Swelling
BSI
Body Substance Isolation: Infection control safety precaution; gloves, etc
CSM
Circulation, Sensation, Motion
OPQRST
Onset, Provoking fac.s, quality, radiation, severity, time
Paradoxical Motion
Opposite motion of chest (flail)
Index of Suspicion
concern for potentially serious underlying and unseen injuries
Kinetic Energy
1/2mv^2
Newton's laws
1=rest stays rest
2= F equals M x A
3= Every action, equal opposite reaction
coup-countrecoup brain injury
force to head, injury on opposite side
Movement of bloodflow in heart...
Oxygen poor blood travels down Superor Vena, up from Inferior Vena
Into Right Atrium
Into Right Ventricle, out Left pulmonary Artery

Blood flows in Left pulmonary vein
into left atrium
into left ventricle
out of aorta
Five types of blood vessels
Arteries
Capillaries
Arterioles
Venules
Veins
Body will not tolerate ___% acute loss of blood
20 % volume
Bleeding is serious when:
Significant MOI
Poor appearence
symptoms of shock (hypoperfusion)
Significant blood loss
Uncontrolled bleeding
6 Methods to control bleeding
Pressure
Elevation
Dressing
Points
Splinting
PASG
Bleeding head/nose? Worst case?
WC = Skull Fracture
Signs of Internal bleeding
Vomiting Blood
Black Tarry Stool
Coughing up Blood
Distended abdomen
Broken Ribs
Aorta
Main artery, recieves blood, delivers from left ventricle to all other arteries
Arterioles
Smallest branches of arteries leading to the vast network of capillaries
Hematoma
Mass of blood in the soft tissue
Hypovolemic Shock
low blood volume, due to massive internal or external bleeding results in inadequate perfusion
PASG
Pneu. Anti Shoc Garm
Anaphylactic Shock

Signs
violent reaction to substance to which has been sensitized

Flushed, itched, burn
hives
edema
pallor
Dilation
drop BP
Dizziness
Sneezing
Tightness

Caused by
Injections
Stings
Ingestion
Inhalation
Sensitization
becoming sensistive to substance that wasnt before
Septic Shock
insufficient vol of fluid, complication of surgery
Cardiogenic Shock
Inadequate heart function
Hypovolemic Shock
Loss of Fluid
Neurogenic Shock
Damaged spine
Psychogenic Shock
Fainting, Anxiety, Not real
How to treat flail chest?
large bulky dressing 2' tape
Spontaneous pneumothorax
rupture of weak spot on lung, air enters plural space, maybe become tension pneumothorax
Hemopneumothorax
Accumulation of blood in lungs
Hemoptysis
Spitting up blood
Pericardium
Fibruous sac surrounding heart
Myocardial contusion
heart bruise
CNS tissues
Somatic NS
Peripheral NS
Brain and Spinal Chord

Protected by
Dura Mater
Arachnoid
Pia Mater

Somatic= voluntary activity
PNS = 31 pairs of spinal nerves, 12 pairs of cranial
ANS
sympathetic (fight or flight) system
parasympathetic (rest and recovery)
Anterograde
cant remember events after injury
Cerebellum
Cerebral edema
Meninges
Movement
Swelling of brain
Three protective layers surrounding brain
Ways to administer drugs
Intravenous
Intramuscle
Subcutaneous (beneath skin)
orally
sublinguaklly
intraosseously (bone)
transcutaneously
inhalation
rectum
Charcoal
Helps bind to toxins for overdoses
6 steps before administering medication
order from. med control
verify dose, route
check exp. date
reasses vitals
document
Nitroglycerin
Treats angina
increase blood flow
Dont administer is systolic is less than 100 mm Hg
Hypoglycemia
Low blood sugar, leads to Altered Mental Status
Dyspnea can be caused by
Infection
Acute Pulmonary Edema
Chronic Obstructive pulmonary disease
spontaneous pneumothorax
Pleural effusion
Pulmonary Embolism
Carbon dioxide retention
condition of chronic high blood level of co2
COPD
Chronic obstructive pulmonary disease
slow process if dilation and disruption of airway and alveoli, ala Emphysema
pleural effusion
collection of fluid between lung and chest that compresses lung
Pulmonary Edema
buildup of fluid in lung, result of congestive heart failure
Gas exchange in lungs takes place in...
alveoli, thin walled air sacs next to capilaries
Brain stem senses level of ___ in arterial blood
Co2, stimulates breathing, if CO2 is high, breathing is more rapid and deep
Pulmonary Arteriole
Pulmonary Duct
carries deoxygenated blood to heart
carries oxygenated blood to body
In disorders of lung, one of these situations exists:
Pulmonary veins, arteries are obstructed from absorption, releasing from fluid, infection, collapsed air space
Alveoli are damaged and cannot transport
Air passages are blocked by muscle spasm, clot
Pleural space is filled with fluid, air
Chronic lung disease, lungs have too much ___ IN BLOOD
Co2
Pneumothorax
accumulation of air in pleural space
OPQRST:
Onset
Provocation
Quality
Radiation
Severity
TIme
Hypoxic drive
Used to low amount of o2 to breathe
too much o2- no breathe-death
Acids are eliminated when
Co2 is eliminated-> anxiety>hyperventiliation
Peritonitis
Pain, tenderness, distention, caused by pus, blood, feces, urine, gastric juices, in the peritoneum
Cholecystitis
inflammation of the gallbladder, storage of digestive juices
Cystitis
inflammation of the bladder, common in women
Colic
acute, intermittent cramping of abdominal pain
Peritoneum
membrane lining the abdominal cavity and covering the organs
Renal Colic
Passing of kidney stone
PID
Pelvic inflamatory disease in women
Aneurysm
Swelling in the arterial wall
Hernia
Portrusion of an organ through a hole
Without Insulin...
glucose from food remains in blood and rises to high levels (hyperglycemia)
Insulin
hormone that is produced by endocrine glands on pancreas enabling glucose to enter cells
Type 1 Diabetes
Insulin dependent, usually from birth, more likely extended problems
Type 2 diabetes
appears later in life, non insulin dependent, but need assistance
Hyperglycemic when...
>200mg/dL, lots of water loss
Hyperglycemic symptoms:
Polyuria: frequent urination
Polydipsia: freq. drinking
Polyphagia: freq. eating

Diabetic Coma
When burning fats, ketones and fatty acids effect...DKA s/s?
blood tissue, lead to acidosis, lot os acidosis = DKA

S/S
Kussmaul respirations (rapid), vomit, abdominal pain, fruity breath
Hypoglycemia S/S
Pale, clammy, rapid RR, dizzy, headache, low BP
Insulin Shock
Significant Hypoglycemia:

Mistaken for drunkeness, cool, rapid RR, clammy
emesis
vomitting
diverticulitis
inflamation of small pockets in the colon
retroperitoneal space contains
pancreas, kidneys, ovaries
Acute Abdomen Symptoms
Local/diffuse pain
Silence, shock
rapid, shallow breathing
referred, distant pain
Fever
Hypotension
ileus
paralysis of muscular contractions
Ectopic pregnancy
emergency situation, egg implanted in f tubes, when large enough ruptures tube, causing hypovolemic shock
Local cold injuries
frostbite = tissues freeze
frostnip
immersion foot
T/X for hypothermic patient?
stablize vitals, rewarm, prevent further heat loss
Heat Illness: Cramp, exhaustion, stroke?
Heat Cramp: painful muscle spasms that occur with excerise
Heat Stroke: life threatening, dry, high temp
Heat Exhaustion: Hypovolemic shock via dehydration, cold clammy
Air embolism
air bubbles (scuba)
Breathholding syncope
loss of conscioussness caused by decreased breathing
Embolism S/S
Blotching
Pink froth
severe pain
dyspnea
dizziness
Cannot lose more than ___ % of total blood
20
Bleeding is serious if:
serious MOI
bad look
shock
rapid blood loss