Chapter 7-12
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73 terms
Terms | Definitions |
|---|---|
 Scene size up | 1. Determine scene safety 2. Nature of the call (Criminal vs medical) 3. Determine mechanism of injury OR Nature of patients illness 4. Determine the # of patients 5. Request additional help such as Police, fire, and ALS if needed. |
| Danger Zones Limitations | No apparent hazards- 50 feet When fuel has been spilled or leaking- 100 feet Collision MV on fire- 100 feet ALWAYS park uphill and upwind! |
| Nature of the call | Mechanism of injury or nature of the patients illness |
| Mechanism of injury | A force or forces that may have caused injury |
| Blunt Trama | Injury caused by a blow that does not penetrate the skin or other body tissues |
| Nature of illness | What is wrong with the patient or what MAY be wrong according to the patients chief medical complainant 1. The patient is #1 source of INFO. 2. Family members of bystanders are #2 source 3. The scene- Dangerous or unsafe living conditions. |
| General Impression | This helps you determine how serious the patients condition is and to setup priorities for care/ transport 1. patients environment 2. chief complaintant 3. Appearance (skin showing signs of shock?) |
| Interventions | Actions taken to correct a patients problems |
| Chief complaint | The reason EMS was contacted in the patients own words! |
| Mental Status | Level of responsiveness AVPU |
| Airway STEPS | 1. Insert an Oral or nasal airway 2. Check respiration a. If Respiratory arrest than rescue breath b. If slower than 8 bpm and UNCONSCIOUS than ADMIN High Concentration H2O at 100% (BVM W/ bag attached) c. If patient is alert and conscious, but respiration faster than 24 bpm ADMIN High-Concentration. H20 via Non-Rebreather d. If breathing is inadequate and faster than 24bpm ventilate BVM 100% H20 |
| Circulation | Poor- Pale and Clammy Good- warm and pink Lips and nail beds should be pink! |
| High-Priority Conditions | a. Poor general impression b. Unresponsive c. Responsive, but not following commands d. Difficulty breathing e. Shock! f. Complicated child birth g. Chest pain + systolic BP >100 h. Uncontrolled bleeding i. Severe pain ANYWHERE |
| Circulation infants and children | Capillary refill under 6 YOA |
| Mental status in infants | Shout as a verbal stimulus Flick feet as a pain stimulus |
| Initial assessment 6 STEPS in order | 1. Form a general impression 2. Asses mental status 3. Assess airway 4. assess breathing 5. Assess circulation 6. Determine the priority of the patient for treatment and transport |
| Vital signs | Outward signs of whats going on outside the body |
| Pulse rate | # of beats per min. Is it: Normal, rapid, or slow?.... |
| Rate and Quality | When taking pulse you are concerned with these 2 factors |
| Pulse Quality | The rhythm (regular or irregular) and force (strong or weak) of the pulse. Regular- When intervals btwn. beats are constant. |
| Pulse force | Pressure of the pulse wave as it expands the artery. Pulse should be "strong or full" |
| Tready Pulse | When the pulse feels weak and thin |
| Respiratory Quality | Quality of a patients breathing: Normal or abnormal 1. Normal 2. Shallow 3. Labored 4. Noisy |
| Breath rates at REST per min | Adult- 12-20 Child- 11-14 YOA 12-20 6-10 YOA 15-30 6 months- 6 YOA 20-30 Newborn- 6 months 25-50 |
| Snoring | Airway is blocked= Open patients airway and transport |
| Wheezing | Medical problem such as asthma: Help patient take MEDS/ Prompt transport |
| Gurgling | Fluids in airway: Suction airway/ prompt transport |
| Crowing | Sounds like harsh sound when inhaling Cant be treated on scene so transport ASAP! |
| Yellow tint on skin | Jaundiced skin- Caused from liver abnormalities |
| Pale skin | Poor circulation of blood through the bloodstream. EX. Major blood loss |
| Cyanotic Skin | Usually blue or gray- Not enough oxygen being delivered to red blood cells |
| Cold, moist skin | Body is losing heat |
| Cool, clammy skin color | Sign of shock or anxiety |
| Dilated, constricted, or pinpoint eyes | Drug influence head injury eye injury |
| Unequal eyes | head injury eye injury Stroke Fake eye like Fuchy |
| Blood Pressure | Force of blood against the blood vessels |
| High blood pressure causes | Medical condition Exertion Fright Emotional distress Excitement |
| Low blood pressure causes | Athlete Blood loss Late sign of shock |
| Oxygen Saturation | Ratio of the amount of oxygen present in the blood to the amount that could be carried, expressed as a % EX. SpO2 |
| Oxygen Saturation readings | Hypoxia: 91-95% Significant Hypoxia: 86-90% Severe Hypoxia: 85% or less |
| Objective | Something you can see, hear, feel. Tangible EX. Signs |
| Subjective | An indication you cant observe but the patient feels and tells you about. EX. Symptoms |
| Tachycardia | Rapid pulse= any pulse above 100 beats per min. |
| DCAP-BTLS | D- Deformities (part of body W/ out normal shape) C- Contusions (Bruises) A- Abrasions (Scrapes of the skin) P- Punctures/ Penetrations (Gunshot, screwdriver, knife) B- Burns Reddened, blistered, or charred looking areas) T- Tenderness (Area hurts when pressure applied to it) L- Lacerations (OPEN wounds that MAY cause Sign blood loss) S- Swelling (Injured capillaries bleeding under the skin) |
| Inadequate breathing | 1. Skin- Pale or cynatolic 2. Cool/ clammy skin] 3. Nasal flaring 4. Restlessness 5. Anxiety 6. Dizziness |
| Suction how? | 15 secs MAX Always insert than suction on the way out. |
| Mouth-Mask ventilation | Easiest way to feel for compliance and good chest rise on unresponsive patients |
| Frothy spectrum | Blood is leaking into the lungs |
| Full tank | 2000 PSI Never use a tank less than 200 PSI M tanks 3000 PSI/ Fixed tanks in ambulances/ fire trucks H tanks- 6900 liters/ Largest tank on the market |
| Airway Delivery Devices | Nasal canual/ re-breathers 45-50% Non-Rebreathers 95-100% |
| 3 signs Inadequate breathing | 1. Chest not rising/ falling 2. Airway not open/ toung blocking airway 3. bad connection W/ airway EX. Stoma/ leaking mask w/ bad seal |
| Who needs supplemental H20? | 1. Shock patients 2. Trauma patients 3. cardiac arrest patients 4. Blood loss 5. Head injuries Always set to 15 Liters HIGH Flow!= 95% or < H20 Saturation level |
| Gastric Distention | More common in kids. Stomach feels up W/ H2O |
| Ventilation rates BVM | Adult- 5 secs Child/ infant- 3 secs |
| SMI Sign. Mechanism of Injury (Adult) | Ejection from MV Death in a passenger compartment Falls 15 feet > or 3X patient height Rollover of Mv High-speed MV collision vehicle pedestrian collision MV crash Unresponsive or altered mental status Penetrations of head, chest, or abdomen EX. stabbing or gunshot wounds |
| SMI Sign. Mechanism of Injury (Adult) | Adult MOIs + 1. Falls more than 10 feet 2. bicycle collision 3. MV medium speed collision |
| SMI means? | A way of getting hurt that carries a high risk of serious injury If patient has a SMI: Perform a rapid assessment |
| Rapid Assessment Top-Bottom | Head- Check for Crepitation (broken bones rubbing against each other) If blood on gloves from back of head than apply a sterile dressing ASAP. Neck- Assess for crepitation and jugular vein distention. (neck veins bulging) Neck veins that are flat when supine= shock/ blood loss Chest- check for paradoxical motion (Movement of part of the chest in the opposite direction of the other side of chest) EX. Prob Flail chest. Segment of ribs broken at 2 ends Abdomen- Check for firmness, softness, and distention (abdomen appears larger than normal= Internal Bleeding! Pelvis- Crepitation or other pain Extremities- Assess for pulse and sensation. Check capillary refill and sensation. Posterior body- Check spine, butt, and back of head for injuries/ bleeding. Next step Long Board! |
| Tracheostomy | Surgical incision held by a medical or plastic tube in the neck |
| Colostomy | Surgical opening in the stomach for patient to crap into. |
| Priapism | A LARGE erection of the penis due to spinal cord injuries. 40 year old virgin on Viagra |
| Detailed Physical Exam | Purpose is to gather INFO. about the patients injuries and conditions. Mostly performed on Trama patients en route to hospital |
| Detailed Physical Exam STEPS | 1. Reassess general impression of patient 2. Check mental status 3. ABC's 4. Ears- Fluid drainage/ bleeding Eyes- Discoloration, unequal pupils, blood in anterior chamber Nose- Fluid Drainage/ bleeding Mouth- Discoloration, foreign objects, broken teeth, swelling or lacerations of tongue Look for bruises behind the ear: Battle sign= Skull injury 5. Repeat Rapid Assessment 6. Reassess vital signs |
| Responsive Medical Patient | Treat patient as a medical patient: 1. History of present illness 2. SAMPLE History 3. Focused physical exam- Concrete on area of injury. 4. Check baseline vitals |
| OPQRST | O- Onset (what were you doing when it started? P- Provokes (Can you think of anything that may have triggered this pain?) Q- Quality (Can you describe your pain for me?) R- Radiation (Where exactly is the pain? Is it spreading anywhere else?) S- Severity (How bad is your pain 1-10.) T- Time (When did the pain start? Has it changed since it started?) |
| Unresponsive Medical Patient | 1. Conduct rapid physical exam (Head-Toe) 2. Obtain baseline vitals: Respiration, pulse, skin color, Temp., condition, pupils, and blood pressure 3. Gather history present illness- OPQRST 4. SAMPLE Hist. from family or bystanders 5. Continue interventions and transport |
| Ongoing assessment | A procedure for detecting changes in a patients condition: 1. Repeat the initial assessment 2. Repeat and record vitals signs 3. Repeat the focused assessment 4. Check interventions Always treat life-threatening conditions first: ABC's |
| Trending | Changes over time in the patients condition |
| Check Interventions 3 Prong | 1. Ensure adequacy of H2O delivery and artificial ventilation 2. Ensure management of bleeding 3. Ensure adequacy of other interventions |
| Ongoing assessment TIMES | Stable adults: 15 mins Unstable Adults: 5 mins Altered mental status, ABCs, blood loss, Significant MOI |
| NORMAL pulse rates by Age | Adult 15+ (60-100) Adolescent 11-14 (60-105) School Age 6-10 YOA (70-110) Preschool 3-5 YOA (80-120) Toddler 1-3 YOA (80-130) Infant Birth-3 YOA (80-140) |
| Bachycardia | Low pulse rate usually below 60 beats per min. |
| Hyperfusion | This means patient is showing signs of shock: 1. Anxiety and restlessness 2. Cool and clammy skin 3. 4. 5. 6. |
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