-
Focused History: OPQRST
- O: Onset - when did the problem start?
- P: Provoking factors - does this make it better/worse?
- Q: Quality of pain - sharp, dull, deep, surface, throbbing, etc.
- R: Radiation - is the pain spreading
- S: Severity - pain on a scale of 1-10
- T: Time - how long have you had this problem?
-
SAMPLE History
- S: Signs and Symptoms
- A: Allergies
- M: Medications
- P: Pertinent Past Medical History
- L: Last oral intake
- E: Events leading to injury or illness
-
Chief Complaint
The major sign and/or symptom the patient reports
-
Symptoms vs Signs
- Symptoms: problems or feelings reported by patient
- Signs: conditions that can be seen, heard, felt, smelled, or measured
-
Vital Signs
- BP
- Pulse
- Respirations
- Pupils
- Skin
-
Blood Pressure
- Systolic/Diastolic
- "normal" = 120/80
- Systolic: estimate 100 + age for male, 90 + age (until age 40)
- too high: hypertension
- too low: hypotension
-
Respirations
- Look for:
- Rate: normal rate 12-20 breaths per minute for adult, 15-30 children, 25-50 infants
- Quality: normal, labored, noisy
- Rhythm: regular, irregular
- Strength: shallow or deep
-
Pulse
- Look for:
- Rate: 60-100 bpm
- Strength: strong, weak
- Rhythm: regular or irregular
- too fast = tachycardia
- too slow = bradycardia
- Radial: wrist, bp > 80
- Carotid: neck, bp > 60
- Brachial: inner arm
- Femoral: inner thigh, bp > 70
- Dorsalis pedis: top of foot
-
Pupils
- PERRL
- Pupils Equal Round, Reactive to Light
-
Skin
- Check CTC
- Color: pale, blue, red, normal
- Temperature: hot, cold, normal
- Condition: dry, sweaty/clammy, normal
-
AVPU alertness scale
- A: Alert, responsive
- V: Response to verbal stimulus
- P: Response to painful stimulus
- U: Unconscious, unresponsive
-
Patient Assessment
- 1. BSI
- 2. Scene Safe
- Approach patient
- 1. Medical vs Trauma
- 2. LOC
- 3. ABC
- 4. D - decision: go or stay
-
BSI
Body Substance Isolation - gloves, goggles, gown
-
ABC's
- 1. Airway
- - open, clear, maintain
- - if responsive, ask 'open your mouth, stick out your tongue'
- - normal respirations: 12-20 breaths per minute (15-30 children, 25-50 infants)
- - less than 10 per minute ==> BVM
- - more than 29 per minute + 2 signs of hypoxia (blue, tachycardia, sweat, etc.) ==> BVM
- - ventilate once per 5 seconds
- 2. Breathing
- - IPASS GAS: Inspect, Palpating, Auscultate, Seal, Stabilize, O2
- - Inspect: look
- - Palpating: feel, 5 points
- - Auscultate: listen - stethoscope, both sides, front back
-
-
-
C
- Circulation
- - check pulse
- - check CTC
- - check bleeding
-
RMA
Refusal of Medical Assistance
-
PCR
Pre-hospital or Patient Care Report
-
AMS
Altered Mental Status
-
LOC
- Level of Consciousness
- AVPU, A+O x4
-
Expressed Consent vs Implied Consent
- Must get consent to treat
- Implied if:
- unconscious
- minor w/o parents
- AMS
- mentally incompetent
-
Assault vs Battery
- Assault - includes verbal
- Battery - physical harm
-
DNR
- Do Not Resuscitate
- Document applicable for patients no breathing and have no pulse
- Requires name of patient, signature, doctor's signature within 90 days (3 months)
- Must have on person at site
- If not, then Duty to Act
-
MOLST
- Medical Orders for Life Sustaining Treatment
- document applicable for patients on life support
-
A + O x 4
- Alert and Oriented x4
- 1. Who - what is your name?
- 2. Where - do you know where you are?
- 3. Day - what day of the week / today's date? year?
- 4. Recall - what happened?
- exceptions:
- 1. vacation - lost sense of time
- 2. children - don't know date or address, etc.
- 3. elderly - ask things like SSN, DOB, who is the president of the USA
-
Special Reporting Requirements
- Child abuse
- Child birth
- Exposure to infectious disease
- Crime scene
- Death
-
-
Signs of Death
- Dependent lividity: blood pooling, gravity dependent, < 1 hr death
- Rigor mortis: jaw locked
- Putrefaction - body decomposition
-
Shock Position
Feet raised 6-12 inches
-
-
Cardiac electrical firing rate
- SA node: 60-100 bpm
- AV node: 40-60 bpm
- Purkinje fibers: 20-40 bpm
-
Peripheral Nervous System
- Check PMS
- Pulse, Motor, Sensory
-
Stop CPR if:
- S: starts breathing/pulse
- T: transferred care to equal or higher
- O: out of strength (bad)
- P: physician tells you to stop
-
-
MCI
Multiple Casualty Incident
-
COPD
Chronic Obstructive Pulmonary Disease
-
Scene Size-up
- 1. BSI
- 2. Scene Safety
- 3. # of Patients
- 4. Additional Resources?
- 5. MOI/NOI
-
DCAP-BTLS
- Deformity
- Contusion
- Abrasion
- Perforation/Puncture
- Burns
- Tenderness
- Laceration
- Swelling
|
|
