What type of assessment does the SAMPLE History fall under?
Secondary Assessment
What does the Acronym SAMPLE stand for?
1. S = signs and symptoms
2. A = Allergies
3. M = Medications
4. P = Pertinent past history
5. L = Last oral intake
6. E = Events leading to illness or injury.
Which part of the acronym SAMPLE during the history does the OPQRST fall?
Under signs and symptoms
What does OPQRST stand for?
1. O = onset
2. P = provocation
3. Q = quality
4. R = radiation
5. S = severity
6. T = time
What section of the SAMPLE does medications, foods, and environment fall under?
Allergies
What section of the SAMPLE does Prescriptions, OTCs, Vitamins, and Herbs fall under?
Medications
What type of pulse would you expect to observe with individuals that have Internal bleeding (early stages), fear, heat emergency, overexertion, high blood pressure, or fever?
Rapid, Strong Pulse
What type of pulse would you expect to observe with individuals that undergoing shock, blood loss, heat emergency, or diabetic emergency?
Rapid, Weak Pulse
What type of pulse would you expect to observe with individuals that have a stroke, skull fracture, or brain injury?
Slow, strong pulse
What is the term for circulation of oxygenated blood to tissues and organs?
Perfusion
What is the term for inadequate circulation of oxygenated blood to tissues and organs and removal of waste materials?
Hypoperfusion
What is the leading cause of death for persons aged 1 to 44?
Trauma
What are the three types of bleeding?
1. Arterial Bleed
2. Venous Bleed
3. Capillary Bleed
What type of bleed is dark red (oxygen poor), usually has a steady flow (low pressure), debris and air can be sucked into the wound, clotting rate is dependent on the size of the area or vessels involved, and the bleeding is easier to control?
Venous Bleed
What type of Bleed is a slow, oozing bleed that is dark red, has a good chance of infection, and clots easily?
Capillary bleed
What type of Bleed is bright red (oxygen rich), spurting, rapid, profuse, clot formation is difficult, and is the most difficult to control?
As blood pressure drops, spurting also drops.
Arterial bleed
Severe or uncontrolled blood loss will lead to what?
Shock, (Hypoperfusion), and possibly death
Most Bleeding will stop by itself within how long?
6-10 minutes
What is the average blood volume for an adult?
5-6 liters
What is the serious volume loss amount for an adult?
1 liter
What is the average blood volume for an adolescent?
2-3.5 liters
What is the serious blood volume loss amount for an adolescent?
3/4 liter
What is the average blood volume for a child?
1.5 to 2 liters
What is the serious blood volume loss amount for a child?
0.5 liters
What is the average blood volume for an infant?
500-600 mL
What is the serious blood volume loss amount for an infant?
100-200 mL
How would you care for an external bleed?
1. Wear proper Body Substance Isolation.
2. Maintain airway
3. Cover wound with a clean dressing to reduce risk of infection.
4. Follow basic steps for controlling bleeding.
What are the basic steps for controlling bleeding?
1. Direct Pressure
2. Elevation (if no assoc. fract.)
3. Put pressure on arterial pressure points.
4. Tourniquet (last resort)
What is the arterial pressure point for an upper extremity bleed?
Brachial Artery
What is the arterial pressure point for a lower extremity bleed?
Femoral Artery
What is good for venous and capillary bleeding?
Air splints
Once bleeding is controlled, what do you apply?
pressure bandage
What should be sterile, placed directly on the wound, and aids in controlling bleeding and reduces risk of further contamination?
Dressings
What holds the dressings in place, aids in controlling bleeding, provides support to injury, and reduces risk of further contamination
Bandages
True or False:
Internal Bleeding may not be obvious and may take time for signs and symptoms to appear.
True
For signs and symptoms of an internal bleed, what is significant?
1. Significant MOI
2. Bruising
3. Painful, swollen, or deformed extremities
4. Anxiety & Restlessness
5. Bleeding from mouth, ears, nose, rectum, or vagina
Contusions over the abdomen or chest the size of your fist is equivalent to how much blood loss?
10% blood volume loss
What is the term for the optimum time limit between the time of trauma and care (or surgery) at the hospital?
Golden Hour
What is the term for the optimum time limit (excluding extrication time) at scene for trauma patient to have best chance of survival using "golden hour" concept?
Platinum Ten Minutes
What are some types of closed wounds?
1. Contusions
2. Hematomas
3. Crush Injuries
What are some examples of crush injuries?
1. Internal Lacerations
2. Internal punctures
3. Rupture of Internal Organs
What is the term for an injury in which the skin is interrupted, broken, exposing underlying tissue?
open wound
What are some types of open wounds?
1. Abrasions (road rash or rug burns).
2. Lacerations
3. Avulsions
4. Punctures
5. Amputations
These bullet points describe what type of open wound?
� Shearing forces
� Ooze blood
� Painful
� Risk of infection due to debris in wound
Abrasions
These bullet points describe what type of open wound?
� Various depths
� Blunt force trauma
� Difficult to determine degree of underlying injury
� Profuse bleeding possible
Lacerations
What are the two types of lacerations?
Linear (incision like, regular edges)
Stellate (jagged, irregular edges).
These bullet points describe what type of open wound?
� Flaps of skin &/or tissue torn loose or off
- degloving (ring avulsion)
- extruded avulsion (avulsed eye)
� May bleed profusely
� Can have extensive tissue damage
� Can result from blunt force trauma
Avulsions
These bullet points describe what type of open wound?
� Typically caused by sharp objects (nails, knives,etc.)
� Often no serious external bleeding but internal may be profuse
� Contamination can be a serious problem
Punctures
What are the two types of puncture wounds?
1. Penetrating (entrance wound only)
2. Perforating (both entrance & exit wound present)
These bullet points describe what type of open wound?
� Feet, toes, hands, fingers or entire limbs
� Bleeding - minimal to profuse
� Tissue damage may be extensive
� Includes:
- Crush injuries
Amputation
What can result from an avulsing injury and bleeding may or may not be severe?
Degloving amputations
What is the treatment for minor open wounds that are superficial, and minimal bleeding?
- Wash area thoroughly with soap & water
- Cover with sterile dressing & apply direct pressure to control bleeding
- Once bleeding controlled, dress and bandage
What is the treatment for major open wounds?
- Activate EMS
- BSI protection
- Exposure wound
- Apply dry, sterile dressing
- Control bleeding
- Assess pulse or capillary refill, motor function, sensation distal to injury
- Bandage
- Treat for hypoperfusion as appropriate
For puncture wounds you should always check for what?
entrance and exit wounds
Do not remove impaled objects unless when?
it is a perforating wound to the cheek and is causing airway obstruction.
True or false:
For avulsion injuries you should fold the flap back into place.
True
What are the proper steps in handling an amputated body part?
- Wrap amputated part in sterile dressing - Wrap or bag in plastic
- Keep cool without freezing
- Do Not complete partial amputations
- Immobilize
Open neck wounds may cause what?
An embolism (Air or dirt pulled into the wound site and into
circulation)
What type of dressing do you use for an open sucking chest wound?
An occlusive dressing
For a person with an open abdominal injury you should lay the victim on their back with their knees flexed. Do not touch any exposed internal organs, and do not push the organs back in. You should cover the wound with what type of dressing?
Occlusive dressing with a towel
What type of burn is from a flame, excessive heat from fire, steam, hot liquids, or hot objects?
Thermal Burn
What type of burn occurs from an acid or alkaline substance?
Chemical
What type of burn occurs from an AC/DC circuit or lightning?
Electrical
What type of burn occurs from the sun (UV) or nuclear substance?
Radiation
What type of burn occurs from an intense light source?
Light
A superficial burn is considered what severity?
1st degree burn
What are the signs and symptoms of a superficial 1st degree burn?
1. Redness
2. Pain
3. Moist appearance to skin
What layer of skin does a superficial, 1st degree burn involve?
epidermis
A partial thickness burn is considered what type of severity?
2nd degree burn
What are the signs and symptoms of a partial thickness, 2nd degree burn?
1. Severe Pain
2. Swelling
3. Blistering
4. Redness (may appear mottled)
Which layer of skin does a partial thickness, 2nd degree burn involve?
Epidermis and dermis
A full thickness burn is considered what type of severity?
3rd degree burn
A full thickness burn is hard to distinguish from a partial thickness burn, but what are some characteristic appearances of a 3rd degree, full thickness burn?
� white, maroon, charred
� Usually dry or leathery in appearance
� Loss of sensation (except at periphery)
- May require skin grafting
- Dense scarring
- Infection of major concern
A full thickness, 3rd degree burn involves what layer of skin?
Involves the epidermis, dermis and subcutaneous layers, muscle, bone or organs
In an adult the head is considered how much BSA (Body Surface Area)?
9%
In an adult the anterior trunk is considered how much BSA?
18%
(9% chest + 9%Abdomen)
In an adult the posterior trunk is considered how much BSA?
18%
(9% upper back + 9% lower back and buttocks)
In an adult each upper extremity is considered how much BSA?
9%
In an adult each lower extremity is considered how much BSA?
18%
In an adult the groin is considered how much BSA?
1 %
In a child/infant the head is considered how much BSA?
18%
In a child/infant the anterior trunk is considered how much BSA?
18%
(9% chest + 9%Abdomen)
In a child/infant the posterior trunk is considered how much BSA?
18%
(9% upper back + 9% lower back and buttocks)
In a child/infant each upper extremity is considered how much BSA?
9%
In a child/infant each lower extremity is considered how much BSA?
14%
In a child/infant the groin is considered how much BSA?
1%
These bullet points describe the care for which type of burn?
- Stop Burning Process, Cool Burn
- Activate EMS as appropriate
- BSI precautions
- Ensure Airway, Complete Primary Assessment
- Treat for Shock, Do Not Clear Debris
- Remove smoldering clothin
Thermal Burn
These bullet points describe the care for which type of burn?
- If dry substance (brush away 1st then flush)
- Flush area with copious amounts of water � At least 20 minutes
- Do Not allow victim to stand in water - Apply sterile dressing or burn sheet
-
Chemical Burn
These signs and symptoms describe which type of burn?
- Respiratory Difficulty
- Coughing
- Smokey Smell or Odor of Chemicals on Breath
- Black Carbon Residue
- Singed Nasal or Facial Hair
Smoke &/or Inhalation Burns
True or False:
You should remove a patient immediately from an electrical source?
False:
Do Not attempt to remove patient from electrical source
If a patient is still in contact with an electrical source or you are not sure, you should not do what?
touch the patient
For electrical burns, the entrance wound is usually what?
small
For electrical burns, the exit wound may be what?
extensive and deep
Electrical burns may be accompanied by what?
Cardiac arrest
These bullet points describe the care for which type of burn?
- Ensure your own safety
� Safety Zones
� Turn power off prior to contacting victim
- Activate EMS
- Complete initial assessment
� Care for ABC's
� Monitor closely for respiratory and cardiac a
electrical burns
A break in the continuity of bone is called what?
A Fracture
A fracture where the ends are widely separated from each other is called what?
Complete fracture
A hairline crack in a bone is called what?
incomplete fracture
Injuries to ligaments usually from a stretching force is called what?
Sprains
Injuries to muscles or tendons usually from over stretching or violent contractions is called what?
Strains
Displacement of bones in a joint from their normal anatomical positions is called what?
Dislocations
A painful, swollen, deformed extremity is treated how?
As if a significant bony or soft tissue injury has occurred
These bullet points describe what type of injury?
� No break in the continuity of the skin
� Displaced (angulated) or non-displaced
Closed, simple fracture
These bullet points describe what type of injury?
� A break exists in the continuity of the skin
� Can be displaced or non-displaced
� Can result from
� penetrating wounds
� lacerations from crush injuries
� sharp bone fragments tearing through the soft t
Open or compound fractures
The signs and symptoms of bone and joint injuries include what?
1. Pain and Tenderness
2. Point tenderness or guarding
3. Pain may be referred distal or proximal to the injury site.
4. Deformity or Angulation.
5. Swelling and Bruising (Discoloration)
6. Loss of Motion
7. Grating or Crepitus
8. Exposed Bone
9. Loss of
Signs and symptoms of complete or partial dislocations include all of the previous ones listed plus what?
1. Loss of motion
2. Deformity at joint
3. Joint locked into position
In caring for musculo-skeletal injuries, you should use what two methods?
1. DOTS
2. DCAP/BTLS
What does DOTS stand for?
deformity, open injuries, tenderness, swelling
What does DCAP/BTLS stand for?
deformities,contusions,abrasions, punctures/burns, tenderness, lacerations, and swelling
The purposes of splinting are to do what?
1. Prevent motion of bone fragments, bone ends, and joints.
2. Minimize complications
What is the process of splinting musculoskeletal wounds?
� Assess distal pulse, motor function and sensation before and after splinting
� Immobilize joints above & below injury
� Remove or cut away clothing
� Cover open wounds with a sterile dressing
� Do not replace protruding bone ends
� Pad Splints
� Splint
What are the general rules if the patient either has a sever deformity, cyanotic distal extremity, or pulseless distal extremity?
1. Align with gentle traction
2. Only one attempt
3. Only Attempt this if EMS is greatly delayed.
What are the different types of splints?
1. Rigid (Board, SAM, Vacuum, and Back Board)
2. Soft Splints (Sling and Swathe, Air splints)
3. Traction Splints
Indications for use of what type of splint are a painful, swollen, deformed mid-thigh with no joint
or lower leg injury?
Traction Splinting
These bullet point describe the signs and symptoms of which type injury?
� Paralysis of arms &/or legs
�Numbness,tingling,weakness
� Loss of sensation below suspected area of injury
� Point tenderness
� Pain & tenderness (pain with movement - Do Not have
Spinal Injuries
If mechanism of injury exerts great force to the upper body or if there is soft tissue damage to the head, face or neck due to trauma, assume what?
there is a possible cervical spinal injury.
Any unconscious patient who is the victim of an accident must be cared for as a what?
spinal injury patient
Injuries to the scalp are very what?
vascular, and may bleed more than expected
Injury of brain tissue or bleeding into the skull will cause what?
an increase of pressure in the skull
Non-traumatic injuries to the brain may occur due to what?
clots or hemorrhaging
The signs and symptoms of non-traumatic injuries are what?
� Non-traumatic brain injuries can be a cause of altered mental status.
� S & S similar to traumatic injury without the trauma
The signs and symptoms of brain and skull injuries are what?
�Contusions, lacerations, hematomas to the scalp
� Deformity to the skull
� Blood or fluid (cerebrospinal fluid) leakage from the ears or nose
�Bruising (discoloration) around the eyes
�Bruising (discoloration) behind the ears (mastoid process)