Flashcards in Exam 3: 11-14 Deck (98):
What is scene size-up?
steps taken when approaching the scene of an emergency call: checking scene safety, taking Standard Precautions, noting the mechanism of injury or nature to the patient’s illness, determining the number of patients, and deciding what, if any, addditional resources to call for. one ambulance per patient. ex, look for dark areas, smoke, traffic, wires
What are body substances?
include blood, saliva, and any other body fluids or contents can be infected via bleeding, coughing or sneezing, body substance can enter through cuts or openings like eyes, nose and mouth. ex. when have tuberculosis or something spread through air wear N-95 or high efficiency particulate (HEPA) respirator to filter out airborne particles patient exhales or expels
What is danger zone?
the area around the wreckage of a vehicle collision or other incident within which special safety precautions should be taken. ex. never parjk ambulance within or fifty feet in all directions from wreckage if fuel spilled (dont use flares use reflective) 100 feet upwind, if hazardous material park 2000 feet. ex. crime scene or vioelnce see or hear fighitng, threateneing words or actions, weapons visible, signs of alcohol or other stuff, silence, prior violences
What are the three kinds of collision?
first- vehicle with object, second- patient’s body strikes interior of vehicle 3- organs of patient strike within body
What happens in a head on collision?
potential for great injury for everyone with two types of injuries present, up-and-over (up and over steering wheel striking head on widnshield head, neck and chest injuries and breathing problems esp. not wearing seat belt) and down and under (striking knees on dash, cuasing knee, leg, and hip injuries).
What are different kinds of injuries?
injuries to bones and joints- usually associated with falls and vehicle collisions
burns- common to fire and explosions
penetrating soft-tissue injuries- gunshot wounds
collapsed steering wall suggests driver has suffered chest-wall injury with possible rib, lung or heart damage
blood-spattered windshielf- forehead or scalp laceration and a severe blow to head causing head or spinal injury,
What is a side-impact collision?
injuries to neck with head, chest, abdomen, pelvis, and thighs can be struck directly.
shearing inuries (aorta off tendon) to the elderly
What is a rollover collision?
multiple impacts can be most serious injury. flying objects and body if not belted, rotational forces with multiple impacts
What is a rotational collision?
involve cars struck then spin causing subseqnet impacts with multiple injury patterns
What is a rear-end collision?
common causes of neck and head injuries
What happens in falls?
height from which patient fell, surface the patient fell onto, part of patient that hit surface and anything interrupts fall. adult- falling 20 feet, child under 15 10 feet, or three times childs heat is a severe fall and should be transproterd to trauma center
height from which patient fell
surface patient fell onto
part of patient that hit surface
anything that interrupted fall
What is penetrating trauma?
injury caused by an object that passes through the skin or other body tissues ex. low velocity usually limited to area that was penetrated, medium velocity- handguns and shotguns arrow, high velocity- high-powered assalt rifle cause damage almost anywhere in body causing damage in path depending on bullet size, path and cavity formed, and fragments.
what organs under there and it is classified by the velocity of the item that caused the injury and is it still in there only one or two wounds? high velocity stuff will go through not leaving a lot of cavitation but shotgun doe sa lot of damage around it. never cut through bullet or knife hole go around it.
What is blunt-force trauma?
injury caused by a blow that does not penetrate the skin or other body tissues ex. blow will cause travel through body causing serious injury to and even rupture internal organs and vessels with hemmorrhage or spilling oforgan may cause ore problems than pentrative may appear reddened so look for mechanism of injury. signs are often subtle and easily missed, index of suspicion is based on MOI.
What is the index of suspicion?
awareness that there may be injuries
What is the nature of illness?
what is medically wrong with the patientreason patient called EMS
information may be obtained from many sources
family membrs or bystanders
What is primary assessment?
focus exclusively on life threats like those interfering with airway, breathing and circulation. the first element in a patient assessment; steps taken for the purpose of discovering and ealing with any life-threateneing problem. 1) forming a general impression 2) assessing mental status 3) assessing airway 4) assessing breathing 5) assessing circulation 6) determining the priority of the patient for treatment and transport ot the hospital
What happens if the patient is lifeless and has no pulse?
if lifeless and has no pulse do not use ABC, instead use CAB (circulation [compressions], airway, breathing) based on who needs it most
steps on things to do: vomit in airway enters lungs can be serious and fatal should do first
exsanguinating (very severe, life threateneing) bleeding must be stopped immediately) with damage to major vessels, especially arteris possibly causing death extremely rapidly from bleeding and the bleeding must be controlled
breathing and circulation- vital especially breathing adequately
then shift to oxygen
What are interventions?
actions taken to correct or manage a patient’s problems
What are general impressions?
impression of a the patien’s condiiton that is formed on first approaching the patient based on the patient’s environment chief complaint and appearance
What do you do to patients who appear lifeless?
patients who appear lifeless, or have altered mental status, or who are pale and swetay (shock), bvious trauma to the head chest abdomen or pelvis (head bleeds a lot, airway problems, pelvis fatal bleeding), tripod (breathing) or levine (chest pain or discomfort)
What is a chief complaint?
in emergency medicine, the reason EMS was called, usually in the patient’s own words
What is a clinical judgement?
judgement based on experience in observing and treating patients
What is a mental status?
level of responsiveness if lower than alert provide high concentration oxygen by nonrebreather mask
What is AVPU?
a memory aid for calssifying a patient’s level of presponsiveness or mental status. the letters stand for alert, verbal response, painful response, unresponsiveness
What are ABCs?
airway, breathing, and circulation
When do you assist with breathing?
if patient is in respriatory arrest with pulse perform rescue breathing
patient not alert and breathing inadequate (insufficient minute volume from decrease rate depth or both) provide pressure ventilaitons with 100% oxygen
patient alert but breathing inadequate- assist with 100% oxygen based on own respirations
patients breathing is adequate but signs or symptoms suggesting respriatory distress or hypoxia
What is circulation?
once breathing problems corrected, assess patient’s circulation by taking pulse if lifeless on approach so assess pulse, skn and bleeding if skin at wrist warm pink and dry good circulation if pale and clammy- shock. look at pulse for normal limits or if unusually slow or fast.
What is priority?
the decision regarding the need for immediate transport of the patient versus further assessment and care at the scene
What are the different kinds of stability?
stable, potentially unstable or unstable, unstable- high priority
When is a patient stable?
patient needs to have vital signs in normal range or only slightly abnormal, small deviations,
What is potentially unstable or stable?
threat to airway, breathing or circulation, actual or imminent rules out stable with depressed level of responsiveness has an immediate priority for transport to hopsital with assessment and care contnuing en route.
What is a high priority?
priority: poor general impresssion, unresponsiveness, responsive but not following, difficult breathing, shcok, complicated childrbirth, chest pain consistent with cardiac problems, uncontrolled bleeding, severe pain
What are the vital signs?
outward signs of what is going inside the body, including respiration; pulse, skin color, temperature, and condition (plus capillary refill in infants and children); pupils; and blood pressure and oxygen saturatioin
What is pulse?
the rhythmic beats felt as the heart pumps blood through the arteriolespulse rate- the number of pulse beats per minute wantingto see rate and quality
What is pulse rate?
number of pulse beats per minute is normal, rapid or slow with age, physical condition, degree of excercise, medications, blood loss, stress, and temperature influence with 60-100 beats per minute if fluctuating normal if syaying high or low bad. if have ventricular assist device wont feel pulse at all
What is tachycardia?
a rapid pulse; any pulse rate above 100 beats per minute
What is bradycardia?
a slow pulse; any pulse rate below 60 beats per minute
What is pulse quality?
the rhythm (regular or irregular) and force (strong or weak) of the pulse
What is radial?
the pulse felt at the wrist taken in people one year or older
What is brachial pulse?
the pulse felt in the upper arm in infants
What is carotid pulse?
the pulse felt along the large carotid artery on either side of the neck
What is the respiratory rate?
he number of breaths taken in one minute adults usually 12-20 if over 24 a problem and below 8 a problem (must give high concentration oxygen)
What is respiratory quality?
the normal or abnormal (shallow, labored, or noisy) character of breathing look for pronounced movement of shoulder, neck or abdominal muscles and nasal flaring, retractions (above collarbones or between ribs) stridor (high pitched sound on inspiration), grunting on expiration (infants), and gasping. crowing (harsh sound- need immediate transport)
What is respiratory rhythm?
regular or irregular spacing of breaths not important in conscious paients
What do you look at in changes of the skin?
look at nail beds, inside of cheek, and inside of lower eyelids. infants and children palms of hands and feet
What is a pupil?
the black center of the eye looking for size equality and recatvity (to light)
What does pale skin mean?
pale skin- poor circulation of bloo with loss of blood
What does cyanotic skin mean?
cyanotic skin (blue-gray)- not enough oxygen getting to red blood cells inadequate breathing
flushed- exsposure to heat or emotional
What does flush skin mean?
flushed- exsposure to heat or emotional
What is jaundice?
jaundice- yellow from liver
What is mottling?
mottling- blotchy appearance especially children and elderly in shock
What does cool, clammy skin mean?
cool, clammy- sign of shock anxeity
What does cold, moist skin mean?
cold, moist- body losing heat
What does cold, dry skin mean?
cold,dry- exposure to cold
What does hot, dry and/or moist mean?
hot,dry- high fever, heat exposrue
hot,moist- high fever, heat exposrue
What do goose pimples mean?
goose pimples with shivering chattering teeth blue lips and pail skin- chiills communicable disease exposure to cold pain or fear
What does dilated pupils mean?
get larger- fright, blood loss, drugs, eye drops
What does constricted pupils mean?
get smalle, drugs, eye drops
What does unequal pupils mean?
stroke, head injury, artificial eye, eye drops
What does reactivity in the pupils suggest?
in the pupils of the eyes, reacting to light by changing sizewith a lack thereof due to drugs or lack of oxygen to brain
What is blood pressure?
the force of blood agaisnt hte walls of the blood vessels changes based on situation really low blood pressure diastolic below 80 means possibility of shock. find blood pressure on every patient more than 3 years old. stable patients get signs every 15, unstable gets them every 5 minutes and after each medical intervention
What is systolic blood pressure?
pressure created when the heart contracts and forces blood out into the arteries
What is diastolic blood pressure?
he preessure remaining in the arteris when the left ventricle of the heart is relaxed and refilling
What is a sphygmomanometer?
the cuff and gauge used to measure blood pressure hold arm at level of heart cant determine diastolic by palpation just wait till you feel again.
What is a brachial artery?
major artery of arm
What is auscultation?
listening. a stethoscope is used to auscultate for characteristic sounds
What is palpation?
touching or feeling. a pulse or blood pressure may be palpated with the fingertips
What is a blood pressure monitor?
blood pressure monitor- a mchine that automatically inflates a blood pressure cuff and measures blood pressure.
What is temperature?
use to test for influenza temperature normal if more than 96 and less than 100 with older peope having lower temperatures
What is a pulse oximeter?
an electronic device for determining the amount of oxygen carried in the blood, oxygen staturation SpO2. inaccurate in patients with carbon monoxide and other uncommon types of poisoning (anemia, hypovolemia) be falsely high in carbon moxxide and other poisonings with cigarettes. use on dorsal foot in infants.
What is oxygen saturation?
(SpO2)- the ratio of the amount of oxygen present in the blood to the amount that could be carried, expressed as a percentage normal between 96-100. 91-95 is mild hypoxia, and 86-90 moderate hypoxia, 85 is severe.
When do you use the nonrebreather mask?
(bag-valve if patient's respiratory rate and depth are inadequate) when exposed to carbon monoxide, moderate to severe hypoxia (saturation less than 90), severe respiratory distress (regardless), peripheral perfusion poor can't get oximeter reading. check to make sure still needs
What oxygen percentage would you use a cannula?
91-95 use cannula.
In order to test a patients glucose what do you have to do?
must have permission from medical direction to test glucose clean patient's finger, wipe away first drop to get second and lower than heart. normal glucose level at least 60-80 mg/dL no more than 120 or 140
What is MOI?
mechanism of injury
What is NOI?
nature of injury
What do you look for scene safety as you near collision scene?
MVC_ look and listen for other emergency units approaching
look for signs of a collision-related power outage
observe traffic flow
look for smoke in direction of collision scene
What do you look for scene safety when within sight of scene?
look for clues indicating hazardous materials
look for collision victims on or near road
look for smoke not seen at a distance
look for broken utility poles and downed wires
look for people walking on road to see what’s happening
watch for police and follow directions
What do you look for scene safety when on scene?
wear protective and reflective gear
be aware of surroundings
follow direction of those in charge
follow ICs and local protocols
park your vehicle for easy egress
What do you do in a crime scene?
single thing way in and out and tell police what you've moved and touch, don't use phone or bathroom
evaluate for threat of violence
fighting or loud voices
weapons visible or in use
signs of alcohol or other drug use
knowledge of prior violence
be careful of low diabetic blood sugar
What is mechanism of injury?
mechanism of injury
forces that caused injury
understanding forces can predict injury patterns
twisting- body moves one direction when rest is in motion
forced flexion or extension- whiplash
indirect- knee injury indirect from force of ankle breaking
can be very useful in preducting injuries associated with certain types of motor vehicle crashes
What is the order for scene size up?
MOi or NOI- general impression scolor, injuries, age, male or female, position they are in location, voice, coughing signs of illness,
number of patients- one person killed in situation rest are high priority
What is the goal of primary assessment?
deal with potentially life threatening. half a minute having other people around to help bad if on scene more than 15 minutes for anybody. patient has golden hour from time of injury to surgery. platinum ten- time on scene
What is CCABCD?
C(C-spine injuries) C(level of consciousness AVPU-PPTE)A(airway- LLF) B(breating- LLF)C(circulation- if aware and speaking if no response check carotid then perfusion distal pulse CTC- if bleeding pressure, if extremity tourniquet) D (Decision- load and go)- if anything in this assesment they are priority patients move quickly and do secondary assessments in ambualnce.
What is AVPU?
four levels of assessment Alert (altered mental status- AMSeyes open, responsive to external) verbally responsive (how do they respond to stimuli, sternal rub) painful (sternal rub) Unconscious
What is derived by AO times 4?
alert oriented x4: PPTE- (long-term) person, place, time, event (short-term)- say alert and oriented to which
What is LLF?
look (things in way, puncturing of lung) listen (sounds-snoring- fix tongue, gurgling- suctioning, wheezing) feel
What do you do if punctured lung?
IV tecchoderm semi-occlusive dressing of airway leave corner or side open for air to come down
What do you do if flail chest?
paradoxical motion- PPV positive pressure ventilation internally spling him from the inside.
What is CTC?
color temperature condition especially for shock visual sticky test. trauma looking for bleeding physical sticky test check everywhere for blood checking core first come back and see if its bleeding
What is CRT?
capillary refill time
What is the general impression?
obvious signs of illness, bleeding, surrounding enviornment
What do you do if you think there is shock?
anything under airway, breathing or circulation is unstable and can be shock.if think shock give oxygen, stop bleeding, supine, blankets until proven not necessary wiht spO2 of 95 or above
What is so bad about testing the distal neural response?
doesn't test the central nervous system
What is HPI?
: history of present illness what they tell you the major problem.
What is OPQRST?
O(onset-when did it start)P (palative/provocative have u done anything or does anything make it better or worse) Q (quality- tell me about it document what they say condition itself or pain) R (radiation or region pain in other areas secondary problems), Severity (rate level of pain kid sad- 5, crying-10) T (change/time how it progressed)
What is pleural effusion?
lean back hurts, sit up is better