What are the 6 R's 3 C's and an E
6 R's
Right patient
Right Medication
Right time
Right dose
Right route at the right site
Right Documentation
3 C's and an E
Colour
Clarity
Concentration
Expiry date
Clearing the Airway
Adult 15 secs at a time
Child 10 seconds at a time
Infant 5 seconds at a time
Normal Breathing Rates
Adult 10 to 20 (puberty and up)
Child 15 to 30 (1 to the onset of puberty)
Infant 25 to 50 (0-1)
Neonate 30-60 (24 hours old)
NOTE: if not taking an accurate count the breathing rate can be described as
Regular
Irregular
Rapid (Tachypnea)
Slow (Bradypnea)
Inadequate Breathing Rates
Adult under 8 b/min, over 28 b/min (important for ACP)
Child under 10 b/min
Infant under 20 b/min
neonate under 30 b/min
ATTEMPT TO VENTILATE!
Artificial Ventilation
Adult 1 every 5 seconds (24 for 2 min cycle)
Child 1 every 3 seconds (40 for 2 min cycle)
Infant 1 every 3 seconds (40 for 2 min cycle)
Neonate 1 every 1-1.5 seconds
ACP: if doing CPR while patient is intubated ventilation rate become 1 breath every 6-8 s
Oxygen Mask (Concentration & LPM)
Supplemental Masks (Demand Masks):
Nasal Cannula (low flow): Concentration of 24-44% = 2-6 LPM
Simple Face Mask (post seizure or after faint): Concentration of 35-50% = 6-10 LPM
Non Rebreather (high flow): Concentration of 60-90% = 10-15 LPM
Ventilation D
Pulse Rates
Adults 60-100 (av. 72) can be lower in athletes and older persons
Children 80-120
Infants 100-160
NOTE: if an accurate count is not taken, the pulse can be described as
Regular: a normal pulse occurring at regular intervals
Irregular: Intervals between be
Critical Blood Loss
Adult = 1 litre
Child = 500 mls
Infant = 100 mls
CPR Compression depth
Infant = 1/3 -1/2 depth of chest
Child = 1/3 - 1/2 depth of chest
Adult = 1 1/2 -2 inches
CPR Compression: Ventilation Rates
One rescuer
Adult 30:2
Child 30:2
Infant 30:2
Two Rescuer
Adult 30:2
Child 15:2
Infant 15:2
if doing CPR while patient is intubated ventilation rate become 1 breath every 6-8 seconds (all age groups).
Signs and Symptoms of Shock
restlessness and anxiety
Pallor or blue-grey colour to the skin
Cold, clammy skin
Weak, rapid pulse
shallow rapid respiration
Thirst
Nausea and vomiting
Changes in the LOC
Cyanosis
Blood pressure drops gradually (late sign) [in shock BP will stay in range
Vital/Diagnostic Signs
LOC - GCS
Skin
Pupils
Airway
Breathing
Pulse
BP
SPO2
BGL
Normal Blood Pressure
Adult Male = Age + 100 to a max of 150
Adult Female = Age + 90 to a max of 140
Child = 2x age + 80 up to age 12
Diastolic Normal: from 60 to 96 for everyone
Point spread should be between 20 to 40 points.
Palpated = Done without a stethoscope and recorded
SpO2 Levels
An adequate reading would be 96-100%
93-95% Mild Hypoxia
90-92% Moderate Hypoxia
under 90% Severe Hypoxia
EMR Roles
Promote safety
Protect Your safety and the safety of your crew, bystanders, and patients
Gain access to the patient
Assess the patient to identify life threatening problems
Alert additional EMR resources- provide care based on assessment findings
Assist o
Responsibilities of an EMR
Guard your personal health and safety
Maintain a caring attitude
Maintain your own composure
Keep a neat, clean, professional appearance
Maintain up to date knowledge and skills
Maintain current knowledge of local, provincial and national issues affecting
Stress
Any change in the body's internal balance when outside demands are greater than the body's resources
Techniques to help rescuers with high stress situations
Remember the patient needs your skills
Gain control of your emotions
Focus on necessary skills
Maintain a proper diet
Emotional aspects of emergency care
Maintain patient's dignity
Respect the patient
Communicate with the patient
Deal with the family in a tolerant manner
Listen with empathy
No false assurances, allow for hope
Gentle tone of voice
Reassurance
Comfort of family
Critical incident
An event that causes unusually strong feelings that interfere with your ability to function either during the incident or later
Critical incident stress debriefing
a system that has been developed to help rescuers cope with stress
Defusing
a shorter and more informal technique than debriefing, usually within a few hours of the event. It is attended only by those directly involved and lasts about 30-45 minutes. Defusing allows rescuers to vent their feelings and get any info they need for a
Debriefing
Ideally, it is held within 24-72 hours of the critical incident. It is not an investigation of interrogation. Allows rescuer to explore any physical, emotional, or mental symptoms they may be experiencing. All info is confidential. CISD counsellors and me
Infectious disease
A contagious disease that can be transmitted from one person to the other
Infectious agent
The cause of a communicable disease, such as a virus, bacterium or parasite
Contamination
The presence of an infectious agent on body surfaces, water, food or non-sterile wound dressings
Body substance isolation
a strict form of self protection with all patients
Personal protective equipment
items that keep you from coming into contact with patient's blood or fluids
Disinfecting
is cleaning, plus using a chemical like alcohol or bleach to kill the micro-organisms
Sterilizing
a process in which a chemical or other substance kills all micro-organisms
Routes of Transmission
Direct
Blood borne contact
Indirect
Vehicle
Airborne
Vector - animal bite or sting
BSI - PPE List
Gloves
Masks
Gowns
Eye protection
Hand washing
Cleaning equipment
Immunizations
(should able to repeat this when saying 'donning BSI' during practical exam)
Competent
an adult who is lucid and able to make an informed decision
Incompetent
a person who is:
Under the influence of drugs or alcohol
Has AMS
Has injury or illness that can affect judgement
Is mentally ill
Expressed Consent
could be verbal, a nod, or gesture
Implied Consent
Could be when:
Patient is unresponsive or deteriorating
Patient refuses help, then becomes unresponsive
Patient is not competent
Guardian is not available for child patient
Informed Consent
because we have a duty to respond this means we have the duty to offer our help and the duty to make someone understand the pros and cons of receiving that help; what it is we want to do, why, and what the outcome will be.
Living Will
is a written document that must be signed by the patient and the doctor (DNR = do not resuscitate)
Patient Refusal
Try to persuade the patient to accept treatment or transport
Be sure patient can make an informed decision
Consult medical direction as required
Have patient sign a refusal or release form
Encourage patient to seek help
Alert patient to EMS in case of cha
Assault and battery
if you touch a person's clothes or body without permission
Abandonment
stopping provision of care for a patient without making sure that the same or better care would be provided
Negligence
carelessness, inattention, disregard or oversight that was accidental but preventable
Confidentiality
patient's history, condition, personal info, etc, is private. Also, the protection of any personal property taken from casualty or handed over by bystander
Steps to Avoid Litigation
Perform emergency care to a reasonable standard of care
Use skills to level of training
Keep good records
Use common sense
Respect the legal rights of the patient
Be polite and professional
Document, document, document
(ACP exam - if there is a question t
Evidence Preservation
- DO NOT cut through holes in clothing
- DO NOT cut through knots in rope ties
- DO NOT wash evidence or allow patient to wash
Legal Duties
Follow provincial protocol regarding scope of care
Ethical Responsibilities
Make patient's physical and emotional needs a priority
Practice your skills to the point of mastery
Update skills on a regular basis
Review performance
Document honestly
Work in harmony with other responders, health care professionals, and workers at the
Anatomical Position
Patient is standing erect, facing forwards with arms down at sides and palms forward (always default to anatomical position when asked Q's in exams)
Patient Positions
Supine: patient is lying face up on back
Prone: patient is lying on their stomach
Lateral Recumbent: patient lying on their left or right side
Trendelenberg position - feet elevated (used to be shock position) about 12 inches
Semi-seated or Fowler's posit
Perfusion
the delivery of oxygen and other nutrients to the cells of all organ systems, which results from the constant adequate circulation of blood through the capillaries
Not adequate perfusion = hypoperfusion (Shock = a lack of this delivery) Insufficient suppl
Enteral Administration
Drugs enter the body via the GI tract
Oral (PO)
Sublingual (SL)
Buccal
Rectal
Parenteral Administration
Drugs enter other than the GI tract
Intravenous
Endotracheal (ET)
Intramuscular (IM)*
SubcutaneousTransdermal
Inhalation (MDI, neb)*
Buccal
not within our scope of practice
Pharmokinetic Phase
the study of how the body handles a drug over a period of time, including
Absorption = involves the movement of drug molecules from the site of entry to the general circulation.
Variables that effect drug absorption
blood flow to the site
pH
Solubility
co
Half Life
time required by the body to metabolize or inactivate half the substance taken in
This Must be Done Every Time You Administer a Drug
Ensure indications/contraindications for use of this drug and the route of administration are evaluated
take universal precautions
determine the patient is not allergic to the medication (SAMPLE)
explain the procedure to the patient (must be informed cons
Drug Names
Chemical Name: never have to commit to memory; a precise chemical description
Generic Name: (non-proprietary name) - an abbreviated for of the chemical name of the drug
Trade name: (brand or proprietary name)
Official Name: followed by the initials USP or
KED order for clipping straps
My Baby Looks Hot Tonight: Middle, Bottom, Legs, Head, Top
Long Board strapping order
Chest, Abdomen, Mid-thigh, Mid-calf, (blanket between legs), Shoulder straps, Head
Emergency Moves made when
only when there is immediate danger or threat of danger to the patient, such as:
fire or threat of fire
explosion or threat of explosion
inability to protect the patient from other hazards
inability to gain access to the patient who requires life-saving c
Signs of Inadequate Breathing
Abnormal rates
Irregular breathing problems
Diminished or absent breath sounds
Unequal or inadequate chest expansion
Inadequate depth
Pale skin or cyanosis
Accessory muscle use
Nasal flaring
Seesaw breathing in infants
Abnormal Breathing Sounds
Snoring: tongue relaxes and rests on back of throat
Crowing: foreign body airway obstruction (strider)
Gurgling: some sort of fluid; needs to be suctioned
Coughing: FBO, anaphylactic, allergies
Gasping: FBO, anaphylactic, allergies
General Principles For Suctioning
BSI Precautions
Correct type of catheter
Tonsil tip or Yankaur for mouth and throat
Flexible or French for Nose
Insert to base of tongue (without suction)
Apply suction moving catheter from side to side
Types of Airway Obstruction
Tongue
Foreign Object - Food
Foreign object - non-food
Liquid - blood, vomit, water
Medical - allergies
Strangulation
Smothering
Signs of Airway Obstruction
Partial
choking
poor air exchange
wheezing
high pitched noises
Complete
Choking
clutching the throat
gasping for air
unable to cough or speak
cyanosis
Differences Between Adults and Children or Infants
mouth and nose smaller
bigger tongue can block airway easier
narrower trachea easily obstructed
hyperextension can easily close the trachea
breathing depends more on diaphragm as chest wall is softer
Anoxia
a total lack of oxygen
Hypoxia
lack of oxygen in the tissues
Causes of Hypoxia
Depletion or deletion of O2 supply
Blockage of the airway
Inadequate breathing
Inadequate pumping
CO2 in the blood is the major stimulus for breathing. In most cases of COPD the body adapts to the high levels of CO2 and the stimulus becomes low levels of
Signs of Hypoxia
decreased heart rate in children
shortness of breath
increased heart rate in adults
irritable and excitable (combative)
vomiting
Cyanosis
Dilated pupils
Convulsions
Unconsciousness
Decreased heart rate in adults
Large or wide pupils
some signs the same as
Oxygen Toxicity
progressive failure of ventilation of the lungs when pure O2 is breathed over long periods of time. O2 at >40% over 24 hrs.
Safe Residual Pressure
No cylinder should be used at less than 200 PSI (pin index safety system). Below this number inadequate O2 is delivered to the patient.
Cylinder Factors
M 1.56 (quite large, mounted in an ambulance or in a room)
E 0.28 (taller and skinnier)
D 0.16 (portable tank)
Formula for Calculating Amount of Oxygen
(GP-SR) x CF
-------------------
FR
= time in min
GP = Gauge pressure (variable)
SR = Safe Residual (constant:has to be 200 always)
CF = Cylinder Factor (depending on what tank I'm using)
FR = Flow Rate (variable, EMR chooses)
Flow Rate = 2 to 15 liters p
Cylinder Operation Safety Procedures
Keep clear of oil, grease or similar substance
Keep clear of flames
No electrical devices (AED)
Etc...
Contraindication to using NPA
suspected head and spinal injury: particularly dangerous, could be pushing bone fragments or equipment into brain. Using an NPA on someone suspected head and spinal would be a critical fail on test.
Indication for Using OPA
Only used on unconscious patients that do not have a gag reflex (exam: will ask about semi-conscious person getting OPA, correct answer: no)
Chain of Survival
Healthy life style choices
Early recognition
Early access
Early CPR
Early Defibrillation
Early advanced care
Early rehabilitation
Signs of Successful CPR
Pulse felt in carotid artery during compressions
Chest should rise and fall with ventilation
Pupils may react or appear normal
Skin colour may improve
Spontaneous breathing may return
Heart rate may return
When to Do CPR
Should be breathless and pulseless for CPR, unless your patient is a child or infant and they are not breathing, has a pulse but pulse is less than 60 bpm, and your patient shows poor signs of circulation DO CPR.
What is sudden Cardiac Arrest (SCA)?
The heart's electrical systems malfunction
The heart unexpectedly and abruptly stops beating
Generally caused by an abnormal heart rhythm called "ventricular fibrillation
The AED can be used if the casualty is...
Not responsive, with no breathing and no pulse
Ventricular fibrillation (V-Fib)
Pulseless Ventricular Tachycardia (V-Tach)
The AED will not shock
Asystole
Pulseless electrical activity
Normal Sinus Rythym (NSR)
ECG of a healthy heart shows an organized, uniform rhythm called normal sinus rhythm (NSR)
Ventricular Fibrillation (VF)
VF is the most common abnormal rhythm associated with SCA-Unorganized rhythm of chaotic electrical activity
Pulseless Ventricular Tachycardia
V-Tach often precedes VF. When the ventricular muscle fires rapidly and takes over as the dominant pacemaker. If untreated a pulseless VT will result in death.
Asystole
There is no electrical activity in the heart. Often referred to as "flat line" on an ECG.
An AED will "NOT SHOCK" this rhythm
Pulseless Electrical Activity (PEA)
Appears as a normal heart rhythm - not enough blood
AED cannot be used with...
Trauma patient: AEDs are not designed to fix trauma patient but medical conditions.
Asystole
Pulseless electrical activity
The AED will...
Analyze heart rhythm
Recognize a shockable rhythm
Advise whether to shock or check for a pulse
Defibrillation Electrode Pad Placement
1. right upper anterior chest wall
2. left lower anterior chest wall
Special Circumstances for AED
Patient is on wet or metal surface: not ideal but yes
Patient is wearing a pacemaker: yes but can't put pad directly over pacemaker. Make sure pad is at least one inch away from pace maker scar
Patient is wearing a patch medication: Yes, just take patch o
How to Use the AED
1. Press the POWER ON button
2. bare the chest
3. shave/dry chest
4. connect cable to AED attach cables to electrode
If casualty regains pulse, or turning casualty over to other resources, leave pads in place.
3 R's of Reacting
Retreat
Flee from danger
Take cover
Discard your equipment
Radio
Call police for assistance and to warn others
Speak slowly and clearly, describe the exact nature of the problem
Re-Evaluate
Ensure scene has been secured by police
Pulse Points
Temporal
Maxillary
Carotid: Used on unconscious patients
Brachial: Primary pulse point in an infant because of underdeveloped neck area
Radial
Ulnar
Femoral
Popliteal: posterior to patella
Posterior Tibial
Dorsalis Pedis
Low BP
(Hypovolemia; early stage of hemmoraghic shock) Indicates there is not enough pressure in the arteries to keep the organs supplied with blood, may be due to blood loss, heart attack, drugs or shock. Indicative of internal bleeding.
High BP
an be from damaged arteries including those in the brain, may be due to medical conditions, head injuries, and certain drugs. Indicative of intracranial pressure.
LOC
Normal state of consciousness: a person is alert, oriented in time and space and speaks coherently
LEVELS REFER TO AVPU
A = Alert
V = Responds to voice
P = Responds to painful stimuli
U - Unconscious
NOTE: Assessment of consciousness is done by using the
Situations that will affect an SpO2 reading
High ambient light
Nail polish or fake nails (fix: clamp on side and have light run through side of finger)
Excessive movement
Dyes in the blood
Hypovolemia
Hypothermia
Carbon Monoxide poisoning (will have a high reading - 100%)
External Bleeding (3 Kinds)
Arterial: blood spurts and bright red
Venous: blood flows steadily and is dark red
Capillary: blood oozes slowly and is dark red
Methods to control bleeding
direct pressure to the wound
Elevate bleeding extremity
pressure to pulse points
cold compress near the wound, e.g. nosebleed
tourniquets (as a last resort)
HAS TO GO IN THIS ORDER EVERY SINGLE TIME!!!
Signs and Symptoms of Internal bleeding
Increased respiratory and pulse rates
Pale, cool, clammy skin
Changes in mental status
Weakness, faintness, dizziness
Hematemesis
vomiting of bright red blood (Pharyngeal), dark coffee grounds
Melena
dark tarry stools
Hematochezia
stools with bright red blood
Hematuria
blood in the urine
Hemoptysis
coughing up blood
Emergency Care for Bleeding
ABC's
Treat for shock
Transport
Natural Body Mechanisms to Control Bleeding
Constriction of blood vessels
Retraction of blood vessels
Blood pressure drops
Blood clotting mechanism
Shock
Inadequate perfusion of the body tissues
3 major organs affected by shock
brain, heart, and lungs
3 major cause of shock
Blood volume loss
failure of the heart
vasodilation
Hemorragic/Hypovolemic Shock
decreased volume of blood available for perfusion of the body's organs (just blood is hemorragic, a type of hypovolemia which is low fluids)
Vasogenic/Neurogenic Shock
Usually the result of a spinal or head injury which causes the nervous system to loss of control over the vascular system
Septic Shock
a result of toxins produced by a severe infection
Psychogenic Shock
the common faint, a sudden reaction of the nervous system resulting in vascular dilation
Anaphylactic Shock
a result of the body's abnormal reaction to a foreign protein from a source such as a bee sting or foods
Cardiogenic Shock
a result of inadequate pumping of the heart. Conditions that cause this are coronary artery disease, etc.
Stages of Shock
Compensatory
Body compensates trying to maintain normal function
Heart rate increases slightly
Skin is pale
BP is still in normal range
Restlessness or anxiety
Delayed capillary refill in infants (don't really use for overall circulation test--just for fo
Crush Syndrome
Prolonged state of shock resulting from a collection of tissue fluid and blood and the release of toxins
Acute renal failure as a result of a crush injury of a large tissue mass
Cells become impaired and begin to leak fluid into surrounding tissues
Contin
Soft Tissue Injuries
Injury to the skin, muscles, nerves and blood vessels
Often referred to as a wound
Can be open or closed
Closed Soft Tissue Injuries
soft tissues beneath the skin are damaged but the skin remains intact
Contusion
Clamping injury
Crushing injury
Open Soft Tissue Injuries
soft tissues beneath the skin are damaged and the skin is broken
Abrasion
Laceration
Penetration/puncture
Amputation
Avulsion
Crush injury
Dressing
a protective covering applied to a wound
Function and Characteristics of Dressings
Function:
Control bleeding
Absorb discharge from wound
protects from further damage
prevents contamination and infection
Characteristics
sterile or as clean as possible
highly absorbent and porous
Thick, soft, and compressible
non-adherent and lint free
l
Types of Dressings
Universal
Gauze
adhesive
roller
burn
pressure
field
occlusive
Improvised
Plastic
foil
towel
sheet
sanitary napkin
disposable diaper
clothes
Bandages
any prepared or improvised material which is used to:
hold a dressing in place
apply and maintain pressure
secure a splint
support and immobilize
apply and maintain traction
Characteristics and Types of bandages
Characteristics
as clean as possible
large and strong enough
wide enough
non-allergic material
Types
crepe or tensor elastic bandage
self adhering, form fitting
elastic adhesive backed
roller gauze
tube gauze
triangular bandage (broad, narrow, ring pad, t
Contamination
soiling of a wound with foreign matter, bacterial or other infectious agents. All wounds are contaminated to some degree
Infection
the presence and growth of harmful bacteria in a wound
Signs and Symptoms of Infection
S - swelling of the infected part and or lymph nodes in the affected area
H - heat around the wound
A - ache and local tenderness around the wound
R - redness around the wound (fever may also develop)
P - pus beneath the skin or draining from the wound
Tetanus (lockjaw)
Infectious disease of the CNS caused by the tetanus bacillus
Signs and Symptoms
stiffness in the jaw
difficulty swallowing
stiffness in the neck
irritability
headache
fever
Prevention
keeping immunization up to date
clean all wounds thoroughly
Very dirty
Gas Gangrene
an infection caused by an organism resembling the tetanus bacillus
occurs primarily in deep wounds with considerable muscle damage, poor drainage and contamination from soil
Signs and Symptoms
low grade fever
swelling and tenderness
sudden, severe pain
*o
Complications of Open Chest Wounds
Pneumothorax = air in the pleural space
Hemothorax = blood in the pleural space
Tension Pneumothorax = air in the pleural space cannot escape and causes the lung to collapse putting pressure on the good lung and heart
Spontaneous Pneumothorax = air leaks
Pulmonary Contusion
bruising of the lung
Signs and Symptoms
severe shortness of breath
Rapid pulse
extensive bruising of the chest wall
Myocardial Contusion
Signs and Symptoms
Generalized chest pain
obvious bruising to the chest wall
Rapid, sometimes irregular pulse
Traumatic Asphyxia
Chest compression puts pressure on the heart forcing blood back into the veins
Signs and Symptoms
shock
JVD
Bloodshot protruding eyes
Cyanotic tongue, lips, head, and neck
Coughing up or vomiting blood
Swollen appearance of head, neck, and shoulders
Open Abdominal Injury
opening of the peritoneum to the outside caused by a penetrating injury
Closed Abdominal Injury
blunt injury in which the skin remains intact
Acute Abdomen
injuries to the hollow organs can cause Peritonitis which is the inflammation of the peritoneum
Emergency Management for Abdominal Injury
BTLS
high flow oxygen
control obvious bleeding
protect protruding organs and keep moist
cover open wound with sterile dressing
place patient in position of comfort
stabilize and protect foreign objects
treat for shock
Hernia
a protrusion of a portion of the abdominal content through the wall of the abdomen
Signs and Symptoms
sharp pain
swelling
feeling of "something giving way"
Emergency Management
place patient supine with knees flexed
treat for shock transport
Treatment for Sexual Assault and Rape
Do not examine genitalia unless there are injuries to treat
apply dressings as required
do not allow dressings to be discarded
give appropriate first aid for other injuries
avoid having patient wash, urinate, or defecate before medical examination
obtain
Burn Classifications
Superficial - 1st degree: involves epidermis
Partial thickness - 2nd degree: involves epidermis and dermis
Full thickness burn - 3rd degree: involves all layers of the skin and the subcutaneous fatty tissues, and likely into the muscle beneath
Rule of Nines
Adults
Head and Neck = 9%
Anterior Trunk = 18%
Posterior Trunk = 18%
Upper extremity = 9%
External Genitalia = 1%
Lower extremity = 18% each
Children
Head = 18%
Upper extremity = 9%
Chest and abdomen = 18%
Back = 18%
Lower Extremity = 14% each
Palmar method
palm equals 1% of body surface area
Complications of Burns
shock
infection
breathing difficulties
swelling
Types and Treatments of Burns
Inhalation = humidified O2, continue to monitor vitals
Thermal = cool, remove clothing, treat for shock, transport
Chemical = remove chemical, remove clothing, flush with tepid water, cover with sterile dressings, treat for shock, transport
Electrical = A
When treating burns do not
apply lotions
break blisters
touch the burn
breathe or cough on the burn
remove clothing that is stuck to the burn
give anything by mouth
leave the patient unattended
delay transport
Direct force
high energy, e.g., gunshot wounds, blows
Indirect force
Mechanical (repetitive overuse), Violent muscular contraction, poor body mechanics, e.g. lifting
Twisting force
sports injuries, osteoporosis
Pathological fracture
bone disease
Types of Musculoskeletal Injuries
Strain = muscle
Sprain = ligament
For both:
1st degree over-stretching
2nd degree partial tear
3rd degree full tear
Types of Fractures
Back of coil booklet p. 77
R.I.C.E.
Rest, Immobilize, Cold, Elevate (This is the new RICE, old RICE will be on ACP as well, choose this one, only cold on closed fractures)
Tips for Splinting
do not release manual stabilization until the injured limb is totally immobilized
If a long bone is fractured immobilize the joint above and below
if a joint is injured immobilize the bone above and below
splint in position found
do not cover wounds with
Pull traction on one injury
unilateral or one-sided mid shaft closed femur fractures with impaired distal circulation.
To pull traction you can use
Sager splint
Hare splint
Speed splint
Despite what splint you're using, pull traction until
Until the two feet meet
until pain is relieved
until distal pulse returns
Extra rule for Sager splint
allowed to pull 1 pound of pressure per every 10 pounds of body weight up to a maximum of 15 pounds of pressure
General Signs and Symptoms of Cardiac Emergencies
Chest pain (described as heavy or squeezing, may radiate)
Difficulty breathing (shortness of breath)
unusual pulse (rapid, weak, slow, or irregular)
indigestion (nausea, vomiting)
Profuse sweating
skin colour changes (may be pale, grey, or cyanotic)
feeli
Atherosclerosis
is a build up of fatty deposits in the arteries
Arterioscerosis
is a hardening of the arteries caused by calcium deposits within the artery walls resulting in a loss of elasticity.
Angina
is a pain in the chest characterized by a sensation or pressure on the anterior chest. Caused by insufficient O2 supply to the heart muscle and aggravated by exercise or tension. Relieved by rest or medication.
Myocardial Infarct
the damaging of heart muscle caused when O2 supply to the heart muscle is cut off to a blockage and the heart muscle dies.
Congestive Heart Failure
results when the heart no longer pumps blood effectively through the body. Caused by damage from a heart attack, long term high blood pressure, coronary heart disease or damage to the heart valves
Cardiac Dysrythmias
Abnormal heart rhythms that follow a heart attack generally caused by damage to the heart's electrical system
Emergency Management of Cardiac Diseases
Administer aspirin; one adult tablet or two child (look in pharmacology section of coil booklet)
position for absolute rest and ease of breathing
administer high flow oxygen
transport to medical aid
Brain cells may be damaged permanently if deprived of O2 for more than?
4 minutes
How much O2 in normal air? Exhaled air?
21% Oxygen in normal air, 16% in exhaled air
Respiratory Distress
when a person has shortness of breath, has air hunger and has laboured breathing
Signs and Symptoms of Respiratory Distress
Inability to speak in full sentences without pausing for a breath
noisy breathing
use of accessory muscles in neck, intercostals and abdomen
Increased pulse rate
Altered mental status
Emphysema
the alveoli lose their elasticity and the air becomes trapped and the alveoli cannot work. Barrel shaped chest (usually specific to emphysema)
Chronic bronchitis
Characterized by inflammation, edema and excessive mucous. To be considered chronic one must have a productive cough (produce something when they cough) for at least three months over two consecutive years
Asthma
characterized by laboured breathing and wheezing due to an acute spasm of the bronchi or swelling of the mucous membrane in the bronchial walls
Pneumonia
is a group of illnesses characterized by lung infection and fluid or pus filled alveoli. may be caused by bacteria, virus, or inhaled irritants.
Acute Pulmonary Edema
Accumulation of fluid in the pulmonary tissues and air spaces
Pulmonary Embolism
A sudden blocking of a pulmonary artery or one of its branches by a blood clot or other particle carried in the blood
Hyperventilation
Rapid breathing to the extent that the arterial carbon dioxide level is abnormally low
Diabetes Mellitus (Type I and II)
Glucose is the main source of energy used by the body cells, and some organs (such as the brain) require a constant supply in order to function appropriately
Glucose is brought to the body via food and is moved into the body cells with the help of a hormo
Hypoglycemia (insulin shock)
Abnormally low levels of blood sugar
at extremely low levels symptoms may include sweating, tremors, palpitations, bizarre behaviour, and coma
may be caused by too much insulin or not enough food intake, or too much activity
Hyperglycemia (Diabetic Coma)
Abnormally high levels of blood sugar
takes longer than hypoglycemia to develop signs and symptoms
Severe form can produce diabetic coma/ketoacidosis (fruity or acetone breath) - low levels of insulin cause blood sugar levels to rise because glucose is no
Why do you never give glucose to a hyperglycemic?
make sure to check BGL levels before administering glucose (never give glucose to a hyperglycemic as an EMR: their blood sugar is already too high!)
Normal BGL
Normal BGL (3.8 -8 mmol/L)
below 3.8 - hypoglycemia
above 8 - hyperglycemia
Any patient with an AMS, should have a BGL done to determine if the cause is Glucose related
Sometimes referred to as 4 to 9 feeling fine
Cerebrovascular Accident
An interruption of arterial blood flow lasting long enough to damage the brain. This causes a sudden altered LOC of loss of consciousness, sensation, and voluntary movement.
Thrombus
a clot that forms in the cerebral artery [at the site]
Embolus
a clot, air bubble, or foreign material that forms elsewhere and travels to the brain [travels from elsewhere in the body to cause block at site]
Aneurysm
a weak spot in the arterial wall that ruptures [aneurysm is a weakened spot; a ruptured vessel is called a ruptured aneurysm: we live with aneurysms we die from ruptured aneurysms]
Compression
can be caused by a tumour or by displaced cerebral tissue following hemorrhage putting pressure on a cerebral artery
FAST
Facial droop, Arm drift, Slurred speech, Time
Transient Ischemic Attack (TIA)
is a stroke of short duration where blood flow to the brain is temporarily interrupted
produces sudden effect on the brain
the person may experience some of the symptoms of a stroke but will recover without any effect
Signs and symptoms: the same as for s
Seizure
any involuntary sudden change in sensation behaviour, muscle activity, or LOC. Results from overactive brain cells
Epilepsy
Epilepsy is not a disease. It is a symptom of a structural or chemical disorder affecting the brain, which causes erratic, uncontrolled electrical discharges. These discharges result in seizures
Absence
brief, lasting seconds can be staring or daydreaming
Myclonic Seizure
jerking of extremities usually occurs when falling asleep
Tonic Clonic
Convulsions which cause unconsciousness as a result of uncontrolled electrical activity in the brain
Phases of a Tonic Clonic Seizure
Aura Phase
part of a seizure
AMS
patient is aware that it is coming
characterized by unusual smells, feeling of pins and needles, or a flash of light
Tonic Phase
lasts 15-20 seconds
consciousness lost
eyes roll upwards
patient may stop breathing
increased
Status Epiepticus
single seizure lasting 5-10 mins or two or more seizures without a return to consciousness
prolonged periods of Apnea can result in brain damage
Complications include: Cardiac arrhythmias, hyperthermia, Pneumonia, respiratory arrest, extreme hypertension
Peritonitis
an inflammation or irritation of the peritoneum
Referred Pain
pain felt on a distant body part associated with the same area of the spinal column as the organ causing the pain
Colic Pain
a painful intestinal cramp caused by strong or interrupted peristaltic waves
Causes of Acute Abdomen
Appendicitis
ulcer
pancreatitis
kidney stones
ectopic pregnancy
pelvic inflammatory disease
Poison enters the body in 4 ways (3 I's and an A)
Ingestion
Inhalation
Injection
Absorption
Normal Human Body Temp
37c
Body Core
refers to heart, brain, lungs and abdominal organs
Body Shell
refers to skin muscles and extremities
Body can lose heat by
Conduction = transfer by contact
Convection = transfer through air
Evaporation = loss of heat by vaporization
Respiration = exhalation
Radiation = from body to cooler environment
Stages of Hypothermia
shivering
Apathy and decreased muscular function
decreased level of responsiveness
decreased vital signs
death
Mild Hypothermia
increased respiration
increased pulse
slow, thick speech
staggering walk
sluggish pupils
apathy, drowsiness
uncontrolled shivering
Severe Hypothermia
extremely slow
slow respiration
extremely slow pulse
unresponsiveness
fixed dilated pupils
absence of shivering
Stages of Frostbite
Superficial (frost nip)
exposed skin is more often affected
affects the epidermis
skin goes white
painless
usual sites - ears, nose, chin, fingers, toes
Skin becomes firm, underlying tissues remain soft - when skin is being warmed it can turn black (necro
Immersion Foot
Caused by wet cooling of the feet over a long period
initially feet may be cold swollen, waxy, and numb
after warming becomes hot, swollen, red, and may blister
in advanced stages gangrene may develop
Chillblain
results from repeated slight exposure to cold
recognized by localized swelling, itching
Snow blindness
ultraviolet rays reflecting off the snow injure the retina
treatment is to cover the eyes and transport to medical aid
heat cramps
dehydration
heat exhaustion
get so warm that it starts to cause a circulation problem
heat stroke
break in temperature control mechanism
if signs of allergic reaction develop
keep injury lower than the heart
monitor airway and breathing
transport immediately to medical aid
Toxemia
poisoning of the blood
usually in the last trimester
usually affects women in their 20's and first pregnancy
Stages of Labour
Stage One - dilation
contractions
appearance of bloody show
rupture of the amniotic sac
Stage Two - fetal birth
crowning
baby passes through the birth canal
Stage Three - placenta birth
placenta separates from the uterine wall and is expelled
Ectopic Pregnancy
egg implants itself outside of the uterus
Spontaneous Abortion
naturally occurring loss of pregnancy before the 20th week of gestation (anything after 20 weeks is still birth)
Eclampsia
a condition whereby a woman experiences seizures in addition to Preeclampsia; usually occurs 3rd trimester
Preeclampsia
hypertension and excess fluid retention occurring during pregnancy
Placenta Previa
abnormally low positioning of the Placenta in the Uterus
Abruptio Placenta
a premature separation of the Placenta from the uterine wall
Prolapsed Umbilical Cord
cord comes out of vagina before the baby (common in breech births)
Limb Presentation
legs or arms come out of canal first
Gravida/Para
Gravida (gravidity): # of Pregnancies
Para (parady): # of live births
WOMAN HAS TWO KIDS, ONE ABORTION, AND IS CURRENTLY PREGNANT: Gravida = 4; Para = 2
Leading cause of death in infants and children
Trauma
When approaching intersection ambulance must
STOP and then proceed
Phases of Response
P-DEAT-P
Preparation
Dispatch
En-Route to the Scene
Arrival on Scene
Transfer of Care
Post-Run Activities
Responding to a HazMat Incident
identify the hazmat incident
identify the hazardous material
establishing command
Creating central zones
Hot zone = most dangerous
warm zone = outside the hot zone
cold zone = all contaminated clothes and equipment must be removed before entering it
Estab
MCI
Multiple casualty incident any incident where there are more than three people involved
Disaster
any event natural or man made resulting in multiple casualties and tasking the medical resources of an area
Triage
sorting or selection of patients to determine priority of care rendered
Priorities of Triage
HIGH PRIORITY (RED)
Airway and breathing problems
Uncontrolled or severe bleeding
Decreased Mental state
SECOND PRIORITY (YELLOW)
burns without airway problems
major or multiple painful, swollen, deformed extremities
back injuries
LOW PRIORITY (GREEN)
min
S.T.A.R.T
Simple Triage And Rapid Transport
Triage Initial assessment
All casualties will get an initial assessment. The interventions performed during this phase, will be positioning of an Airway, or repositioning of a casualty to maintain Airway, and control of severe bleed
Fresh Water Drowning
Water passes through the lungs and into the bloodstream causing hemodilution (simple asphyxia is the cause of death)
Salt Water Drowning
aspirated water is saltier the body fluids, so water leaves the bloodstream and enters the lungs to help dilute the salt. Frothy foam forms and acts as a barrier to oxygen exchange
Wet Drowning
When fluid is aspirated into the lungs
Dry Drowning
occurs when severe spasm of the larynx cuts off the airway preventing aspiration of fluid (approx 10 - 40% of all drownings are dry)
Before Attempting a Water Rescue Must Meet Four Criteria
1. you are a good swimmer
2. you are wearing a PFD
3. you are trained in water rescue
4. you are accompanied by other rescuers
If You Meet Four Criteria For Water Rescue
Reach: hold any object for patient to grab
Throw: throw an object that floats
Row: use a boat to get closer
Go: if the above three are not possible, then swim to the patient and tow them back
Air Embolism
alveoli rupture which allows air bubble to enter the bloodstream. Embolism moves through system until it becomes lodged in a vessel somewhere in the body
Decompression Sickness (Bends)
Occurs when gases (usually Nitrogen) breathed by the diver are absorbed into the bloodstream.
Squeeze
divers are at increased risk when they have an upper respiratory tract infection
Rescue
to free a Pt from danger by prompt vigorous action
Extrication
part of the rescue, the removal of a patient
Extrication of Pt and Gaining Access
Simple Access = no tools required
Complex Access = tools required and specialized equipment
If trench is more than waist deep
special rescue is needed
4 Phases of Rescue Operation: easiest to hardest
1. removal of lightly pinned patients
2. removal of patients who are trapped but can be rescued with equipment on hand and minimal time
3. removal of patients whose extrications are difficult
4. removal of dead persons
When to call for A Medivac
normal ground travel is more than 30 min
extrication will be prolonged
remote site
patient needs paramedic level care
Pt has life or limb threatening injury
Pt condition is unstable
Serious mechanism of injury
Loading Zone Tips: read book