-
What does the scene size up consist of in medical and trauma patients?
- scene safety
- BSI
- MOI/NOI
- number of pts
- additional resources needed?
- spinal immobilization needed?
-
What does the primary assessment in medical and trauma patients consist of?
- general impression (sick or not sick/chief complaint)
- treat life threats
- assess LOC (AVPU)
- spinal immobilization
- ABCs
- prioritize pt's needs
- identify priority pts
- transportation decision
-
What is the secondary assessment on a responsive medical patient?
- OPQRST
- SAMPLE
- Differential diagnosis
- baseline vitals
- treatment as needed
-
What is in the secondary assessment in an unresponsive medical patient?
- rapid assessment (differential diagnosis)
- baseline vitals
- SAMPLE
- treatment as needed
-
What is in a detailed physical exam in a medical patient?
- complete head to toe
- assess posterior of body
- reassess vitals
-
What is in the ongoing assessment of a medical patient?
- reassess mental status
- maintain airway
- monitor breathing
- reassess pulse
- monitor skin color and temperature
- reassess vitals signs
- repeat focused exam
- check interventions
-
What are the 5 steps for patient evaluation?
- determine chief complaint
- determine the organ system likely involved (consider cardio and respiratory one system)
- generate differential diagnosis
- perform physical assessment of that organ system
- revise differential diagnosis as needed
-
What are the three ways to judge an area of complaint?
visualize palpate, and ausculate
-
What does AEIOUTIPPS respresent for a patient with an altered LOC?
- A=alcohol/acidosis
- E=epilepsy/electrolytes/endocrine
- I=insilin
- O=overdose
- U=under dose/uremia
- T=trauma
- I=infection
- P=phycosis
- P=pump/poison
- S=stroke/shock
-
What are the clues in a patient exam that lead you believe the injury is in the cardio/respiratory system?
- LOC
- skin
- JVD
- chest/lungs
- pedal edema
- compare BP of each arm
- vitals
-
What are the clues in a patient exam that lead you to believe that the injury is in the neurological system?
- LOC (*don't forget to consider AEIOUTIPPS*)
- skin
- eyes
- facial droop
- distal pulses
- hand grips
- vitals
-
What are the clues in a patient exam that lead you to believe that the injury is in the genitourinary system?
- skin
- abdomen
- femoral pulses
- distal pulses
- vitals
-
What are the clues that lead you to believe that the injury is in the gastrointestinal tract?
-
When lung sounds in the setting of SOB in a medical or trauma pt that are different from side to side - list the findings vs rule outs.
- decreased on one side = pneumothorax, hemothorax
- coarse crackles on one side = pneumonia (with fever), other infections
- wheezing = respiratory infection
-
When lung sounds in the setting of SOB in a medical or trauma pt that
are different from top to bottom - list the finding vs rule out.
fine crackles in bases = CHF
-
When lung sounds in the setting of SOB in a medical or trauma pt that
are the same throughout - list the findings vs rule outs.
- clear = pulmonary embolism, ACS
- wheezing = asthma, COPD, anaphylaxis
-
What does the secondary assessment in a trauma patient with significant MOI or altered LOC consist of?
- continue in line stabilization
- reconsider transport decision
- reassess mental status
- rapid secondary assessment (60sec head-to-toe, anterior and posterior)
- baseline vitals
- SAMPLE
- treatment as needed
-
What does the secondary assessment in a trauma patient with a non-significant MOI/patient is alert and oriented?
- assess the injury site (modified secondary assessment)
- baseline vitals
- SAMPLE
- treatment as needed
- transportation decision
-
What does the reassessment of a trauma patient consist of?
- reassess all of the following:
- general impression
- mental status
- airway
- breathing (quality/rate)
- pulse (quality/rate)
- skin color, temp, condition, bleeding
- pt priority
- vitals
- emergency care
continue to monitor the pr
-
If there is a change in a trauma patient, you should...
- repeat primary/secondary assessment
- provide appropriate emergency care
- reassess vitals
- continue to monitor pt
-
When performing the rapid secondary assessment on a trauma patient, you should expose, inspect, palpate, and auscultate the following portions of the head
- scalp and skull
- face
- ears
- eyes/pupils
- mouth
- nose
maintain in-line stabilization
-
When performing the rapid secondary assessment on a trauma patient, you
should expose, inspect, palpate, and auscultate the following portions
of the neck
- anterior and posterior
- apply c-collar
-
When performing the rapid secondary assessment on a trauma patient, you
should expose, inspect, palpate, and auscultate the following portions
of the chest
- clavicles
- anterior/ausculate
- assess breathing
-
When performing the rapid secondary assessment on a trauma patient, you
should expose, inspect, palpate, and auscultate the following portions
of the abdomen
-
When performing the rapid secondary assessment on a trauma patient, you
should expose, inspect, palpate, and auscultate the following portions
of the pelvis
- anterior - press gently upward and downward
- assess femoral pulses as needed
-
When performing the rapid secondary assessment on a trauma patient, you
should expose, inspect, palpate, and auscultate the following portions
of the extremities
lower and upper extremity - PMS
-
When performing the rapid secondary assessment on a trauma patient, you
should expose, inspect, palpate, and auscultate the following portions
of the posterior side of the body
- maintain in-line stabilization
- assess posterior thorax, lumbar, buttocks, and back of legs
-
At the end of your rapid assessment of a trauma patient, you should
backboard by rolling after assessing posterior
or use scoop
-
What are the 5 rights?
- right patient
- right medication
- right dose
- right route
- right time
-
What are the adequate breathing rates for adult, child, and infant?
- adult: 12-20
- child: 15-30
- infant: 25-50
-
What are the different kinds of noisy breathing?
- crowing (whooping)
- audible wheezing (could be on inspiration, expiration or both)
- gurgling
- snoring/sonorous
- stridor (whistling)
-
Define respiratory distress.
a condition where breathing is difficult or not effective
-
What is COPD?
Chronic Obstructive Pulmonary Disease
could be emphysema, chronic bronchitis, but not asthma since that is episodic
-
Define emphysema
destruction of the alveolar walls causing a decrease in surface area on the alveoli, which in turn causes a retention in CO2 because capillaries cannot function properly
-
What would you find on the assessment of a patient with emphysema?
- pursed lip breathing
- difficulty breathing
- pink complexion ("pink puffers") - b/c of CO2 retention
- tachypnea
- tachycardia
- diaphoresis
- tripod position
- may be on home O2
-
Define chronic bronchitis
- persistent productive cough for 3 consecutive months, 2 years in a row
- inflammation, swelling, and thickening of the bronchi and bronchioles with excessive mucous production
-
What would you find in the assessment of a patient with chronic bronchitis?
- typically overweight
- chronic cyanotic complexion ("blue bloaters")
- difficulty in breathing
- productive chronic cough
- coarse lung sounds (crackling)
- wheezing
-
Define Asthma
an episodic inflammatory disease that causes air to get trapped in the alveoli from narrowing and mucous obstruction of the bronchi and bronchiole
-
Define pneumonia
common disease in the elderly and those with suppressed immune systems, it is an acute infectious disease affecting the alveoli that is caused by bacteria or a virus
-
Define Acute Pulmonary Edema
sudden onset of fluid in the lungs caused by swelling and leaking of capillaries into lungs causing the alveoli to drown
-
Define Pulmonary Embolism
blockage in lungs (fat, blood, or air bubble) obstructing blood flow.
pts with high suspicion of index: recent surgery, long international flights, sedentary lifestyle, family history of blood clots, divers
-
Define a spontaneous pneumothorax
a sudden rupture of visceral lining that changes the pressure in the lungs causing one to collapse
-
Define hyperventilation syndrome
a respiratory disorder involving breathing too deeply or too rapidly causing the pt to blow off too much CO2
-
Define Epiglottitis
inflammation of the upper airway
-
Define pertussis
- "whooping cough"
- a highly contagious bacterial disease that starts similar to a cold, leads to complications especially in young children because of a lack of O2/CO2 gas exchange
-
Define cystic fibrosis
hereditary disease diagnosed earlier in life characterized by abnormal transport of chloride and sodium across an epithelium, leading to thick, viscous secretions causing pulmonary failure
-
What are the three things that you can use through an MDI spacer?
- Albuterol
- Proventil
- Ventolin
-
What is albuterol?
a bronchodilator
-
How much additional O2 can you give with a small volume nebulizer?
6 lpm
-
What are the components of blood and what do they do?
- RBCs = carry O2, hemoglobin, glucose
- WBCs = soldiers of the immune system
- Plasma = carry everything else
- Platelets = responsible for clotting
-
Define CHF
congestive heart failure: the inability of the heart to pump all of the blood that is presented to ut bu the venous system; may be L or R sided (L sided = pulmonary edema = more serious)
-
Define aortic aneurism
a weakening or ballooning of the artery wall that could rupture causing severe pain, massive internal hemorrhage, and potentially death
-
Define aortic dissection
occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta, forcing the layers apart
-
Define arteriosclerosis
thickening, hardening, and loss of elasticity of arterial walls resulting in impaired blood circulation
-
Define Atherosclerosis
a condition in which an artery wall thickens as a result of the accumulation of fatty materials
-
Define Ischemia
a restriction in blood supply to tissues, causing a shortage of oxygen (caused from vasoconstriction, thrombosis, or embolism)
-
Define Acute Coronary Syndrome
a term for the signs and symptoms that result from cardiac ischemia
-
Define Angina Pectoris
chest pain due to ischemia of the heart muscle, caused from a mismatch in the O2 required and the O2 available
-
Define myocardial infarction
death of cardiac tissue from O2 deprivation (ischemia)
-
Signs and Symptoms of a Myocardial Infarction
- chest discomfort - squeezing, dull, tightness, heaviness
- discomfort may radiate
- dysrhythmias, pulmonary edema
- tachycardia or bradycardia
- sudden death from VF
-
Define Lumen
hole inside artery wall that blood flows through
-
What is a thrombus and how does it form?
- a blood clot inside a blood vessel that obstructs blood flow
- fat pushes so much on lumen that platelets form to prevent rupture and cause ischemia
-
Treatment for ACS
- the same treatment as for an MI
- ABC's
- O2 as indicated
- OPQRST
- aspirin per protocol
- nitro per protocol
- defib as necessary
-
Treatment for an MI
- the same treatment as for ACS
- ABC's
- O2 as indicated
- OPQRST
- aspirin per protocol
- nitro per protocol
- defib as necessary
-
What are the possible causes of Angina
- physical excercise
- strong emotion
- extremes of temperature
- (all these things increase cardiac workload)
-
What is the classic presentation of ACS?
- AHA classic warning signs of cardiac ischemia:
- pressure, fullness, squeezing, or pain in the center of the chest that lasts more than a few minutes
- discomfort that spreads to the shoulders, neck or arms
- chest discomfort with lightheadedness, fainting, sweating, nausea, or SOB
-
What is an atypical presentation of ACS?
- AHA less common warning signs of cardiac ischemia:atypical chest, stomach, or abdominal pain - well-localized, described as sharp in nature, wrong location such as upper abdomen
- unexplained nausea without vomiting or chest pain
- lightheadedness (not vertigo) without chest pain
- unexplained anxiety, weakness or fatigue
- palpitations, cold sweat, or pallor
All these symptoms may be more common in women, diabetic and elderly
-
Treatment for Cardiac Ischemia
- O2
- position of comfort (semi-reclining)
- loosen tight clothing
- restrict pt's movement and exertion (lift pt to stretcher)
- administer aspirin and assist with nitro per protocol
- ALS eval required
- transport immediately (if no ALS/ALS is too far)
-
What are the pertinent negatives in a patient with cardiac ischemia?
- previous episodes (does this feel the same as is did last time?)
- associated symptoms - cough recently, productive cough, fever, chills
- effects of treatment - use of nitro - any effect, was it "fresh"
- risk factors - BP? smoker? cholesterol?
- family history - any family members with cardiac history
-
What are the indications for the use of aspirin?
s/s of ACS
-
What are the contraindications for the use of aspirin?
- allergic to aspirin
- pt took aspirin just prior to EMS arrival
-
What is the suggested dosage of aspirin?
- 325 mg PO chewed (4 81mg children's chewable tablets)
- not indicated for pediatric pts
-
What class of drug is aspirin?
- anti-platelet
- non-narcotic analgesic
- NSAID
- antipyretic (fever reducer)
-
Precautions or adverse reactions to aspirin?
NOOOOPE, there are none
-
What are the indications for the use of nitroglycerin?
- chest discomfort from ACS
- symptoms similar to previous cardiac event
-
What are the contraindications to the use of nitroglycerin?
- pts taking viagra, cialis, levitra in past 48 hrs
- severe bradycardia (HR <50/mins)
- tachycardia (HR>100/min)
- BP less than 100 mmHg systolic)
-
What are the precautions/adverse reactions to the use of nitroglycerin?
hypotension, headache
-
What is the suggested dosage for nitroglycerin?
- adult: 0.4 q 3 mins until pain relief
- pediatric: not indicated for pediatric patients
-
Assist with nitroglycerin dose every ___ minutes until ____ symptoms have subsided or BP falls below ____ mmHg systolic
-
Do not give pt a dose of nitroglycerin if pt has already taken dose within the last _______
3 minutes
-
How do you administer nitroglycerin?
sublingual
-
What class of drug is epinephrine?
adrenergic
-
What are the indications for the administration of Epinephrine?
- pt is displaying s/s of anaphylaxis: respiratory distress or shock or difficulty swallowing (throat edema) and consents to treatment
- Epi-Pen Jr. is indicated in pts less than 30 kg (66 pounds)
-
What are the precautions/adverse reactions to epinephrine?
- increased BP
- tachycardia
- may cause cardiac ischemia in the elderly or in pts with know coronary artery disease
-
What is the suggested dosage for epinephrine?
- adult: 0.3 epi-pen
- pediatric: 0.15 epi-pen jr
-
What are the other names for albuterol?
-
What are the indications for the use of albuterol?
- treatment of moderate to severe bronchospasm
- repeat treatments as needed for symptoms of respiratory distress
- s/s of hyperkalemia
-
What are the contraindications for the use of albuterol?
none
-
What are the precautions/adverse reactions of albuterol?
arrhythmias, tachycardia, severe chest discomfort
-
What are the suggested dosages for albuterol?
- Adult: nebulized initial dose - 5 mg; repeat as needed; MDI via BiPAP - 0.5 puffs, repeat as necessary up to 20 puffs; Nebulized - 10 mg added to 1 ml of sterile saline (hyperkalemia dose)
- Pediatric: nebulized - 2.5 mg in 2.5 ml of saline if less than 2 y/o; otherwise use adult dose
-
If pt has home nebulizer machine and albuterol, the EMT may assist the pt with the use of the machine in place of an MDI with an additional ___lpm of O2
6
-
What class of drug is O2?
oxidizer
-
What are the indications for the use of O2?
pts with s/s of shock, respiratory distress, respiratory arrest
-
What are the indications to begin ACS management?
- any of the following s/s:
- uncomfortable "pressure", "fullness", or "squeezing" or discomfort in the chest or neck that lasts more than a few minutes, or that goes away and comes back
discomfort that radiates to shoulders, neck, or arms
chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath
symptoms similar to previous cardiac event
-
What are the contraindications for the use of an AED?
meets the criteria for DIF
-
What are the indications for the use of AED?
pts 1 yr or older who have confirmed circulatory arrest
-
If it is an unwitnessed cardiac arrest, what are your next two steps?
- perfrom CPR for 2 minutes
- then initiate defib protocol
-
What are the ALS upgrades for chest pain/discomfort/heart problems?
- pt presenting with typical or atypical symptoms of ACS
- chest discomfort associated with use of street drugs
- upper abdominal pain, age greater than 35
-
What are the indications for an MDI assist?
- patient has a prescribed MDI of albuterol, proventil, or ventalin and
- SOB unrelieved by epinephrine for anaphylaxis or
- pt exhibiting s/s of breathing difficulty presumed secondary to asthma or COPD
-
What are the contraindications for an MDI assist?
pt is in respiratory arrest
-
What is the first step in the MDI assist procedure?
ALS upgrade
-
Who is at risk for an atypical MI?
-
What are the two rhythms does an AED shock?
-
Explain the 60 cycle interference.
electrical devices that interfere with what the AED is analyzing. ex: fish tank, reclining bed, etc (if it is within spitting distance, unplug it
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