ALS Indicators

Question 1

Abdominal Pain

Answer 1

Discomfort or pain or unusual sensations between the navel and the jaw if the patient is over 40 yo and/or has cardiac hx
Severe, unremitting abdominal px

Question 2

Breathing

Answer 2

Resp over 30/min
Failure to respond to repeated inhalers
Asthma attack with hx of previous intubation
Audible wheezing not improved with inhaler
Abnormal respiratory patterns
Resp distress with patient in tripod position

Question 3

Burns

Answer 3

Possible airway involvement
Burns with associated injuries: electrical shock, fracture, major trauma
Deep partial thickness or full thickness burns to the face/head, genitals, or >20% TBSA
Full thickness circumferential burn to extremity
Hazman burn

Question 4

Cardiac

Answer 4

Suspected ACS.
ACS: acute coronary syndrome.
1. Any of the following:
-uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back.
-Pain that spreads to the shoulders, neck, or arms
-Chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath

OR

2. Any two s/s:
   -Atypical chest pain, stomach, or abdominal px. This may include discomfort that can be localized to a point, that is “sharp” in nature, that is reproducable by pamp, or that is in the “wrong” location.
   -Unexplained nausea or lightheadedness w/o chest px
   -SOB & difficulty breathing
   -Unexplained anxiety, sensation of impending doom, weakness or fatigue
   -Palpations, cold sweat, or paleness.

Question 5

CVA

Answer 5

LAMS 4 or greater
Other ALS indicators (vitals, LOC)

Question 6

Diabetic

Answer 6

Unable to swallow
Fails to respond to oral glucose
Suspected ketoacidosis
Hypoglycemia w/ decreased LOC

Question 7

Hypothermia

Answer 7

Temp <95 degrees oral or tympanic
Decreased LOC
Hypothermia w/ significant comorbidity (elderly, illness, circumstances, trauma, drugs, alcohol)

Question 8

LOC/Neuro

Answer 8

GCS < or = 12
Abnormal behavior associated with possible drug/alcohol overdose or trauma

Question 9

Vitals

Answer 9

Hypotension: <90 in appropriate clinical setting
Sustained tachycardia: >120 bpm in appropriate clinical setting (ie signs of shock)
Positive posturals (decrease in systolic bp >20 or increase in pulse >20)
Systolic >200 or diastolic >110 with symptom
Pregnancy with systolic <90 or >140
Severe bradycardia: HR<40 in appropriate clinical setting
RR >30, <8

Question 10

OBGYN

Answer 10

Severe unremitting pelvic pain
Excessive vaginal bleeding
Possible ectopic pregnancy
Dispatched to birthing center or midwife situation
Pregnancy complications: placenta previa, abruptio placenta, diabetes, multiple births, breech or limb presentation, prolapsed cord, shoulder dystocia, postpartum hemmorrhage
Imminent birth or birth has just occurred
Pregnancy 3rd trimester with abdominal trauma
Pregnancy with significant trauma MOI

Question 11

Placenta previa

Answer 11

Placenta is attached too low in the uterus, covering the cervix. When the cervix starts to open during labor, the placenta can tear, causing severe bleeding

Question 12

Abruptio placenta

Answer 12

Placenta separates from the uterine wall before the baby is born, the premature separation can lead to reduced oxygen and nutrient supply to the baby and can cause severe bleeding in the mother

Question 13

Sepsis

Answer 13

Decreased LOC
Respiratory distress or RR >30/min
S/S of shock

Question 14

Seizure

Answer 14

Multiple seizures
Seizure still ongoing upon EMS arrival
Postictal state with unstable airway
Pregnant female
Severe headache
Seizures associated with concurrent trauma, drugs/ alcohol, or hypoglycemia

Question 15

Shock

Answer 15

Hypotension: systolic bp >90
Tachycardia: sustained >120 bpm
HR > systolic bp in appropriate clinical setting
Unexplained ams
Poor skin signs: cool, clammy, pale, delayed cap refill

Question 16

Trauma

Answer 16

Mechanism:
-Falls >2x height of patient
-Struck and thrown >10 ft
-Any underwater rescue
-Significant intrusion, ejection, death in same vehicle

Injury pattern:
-Penetrating injury to head, neck, eyes, chest or abdomen
-Skull deformity, suspected skull fracture
-Chest wall instability, deformity, or suspected flail chest
-Eviscerated abdominal contents
-Pelvic fracture, bilateral femur fracture
-Femur fracture with excessive swelling
-Open fracture except hands and feet
-Severe pain with significant MOI
-Suspected spinal cord injury with new motor or sensory deficit
-Crushed, degloved, mangled, or pulseless extremity
-Amputation (excluding fingers and toes)
-Active bleeding requiring a tourniquet