GENERAL STANDARDS Flashcards
(23 cards)
1
Q
patient refusal- capacity
A
-make a reasonable effort to inform pt or SDM that treatment and transport are recommended and explain the possible concequences.
- confirm the pt or SDM has aid to capacity
- advise the pt or SDM to call 911 if any further concerns arise.
- obtain a signature and completed addition documentation required.
2
Q
patient refusal incapable pt- medic shall carry out emergency tx and transport if:
A
- pt does not have capacity
- pt is apparently experiencing severe suffering or is at risk if the tx is not administered promptly
- the delay required to obtain a consent or refusal on pt behalf with prolonged suffering that the pt is apparently experiencing or will put the pt at a risk of suffering
3
Q
patient refusal capable pt- medic shall carry out emergency tx and transport if:
A
- pt is apparently suffering or is at risk if tx is not administered promptly.
- the communication required in order for the pt to give or refuse consent cannot take place bc of a language barrier, or disability
- steps that are reasonable in the circumstances have been taken to find a practical means of enabling the communication to take place but no such means has been found
- delay required to find a practical means of enabling the communication to take place will prolong the suffering that the pt is is experiencing or will put them at risk
-there is no reason to believe pt does not want the treatment.
4
Q
oxygen therapy standard
A
maintain spo2 stats between 92-96%
5
Q
oxygen therapy standard- continuously administer oxygen to pt who have:
A
- CO or cyanide/ noxious gas exposure
- upper airway burns
- scuba diving related disorders
- CPR
- complete airway obstruction
- sickle cell anemia with suspected vaso-occlusive crisis
6
Q
oxygen therapy standard- if pulse ox is not functioning or not providing an interpretable waveform for those above and:
A
- age specific hypotension
- respiratory distress
- cyanosis, ashen colour or pallor
- altered LOC
- abnormal pregnancy or labour
7
Q
oxygen therapy and COPD
A
- keep o2 stat between 88-92 by nasal cannula at 2lpm above pt home o2
- reassess the vitals every 10 mins
- maintain oxygen flow rate at that level if the pt improves
- increase oxygen by 2l[m above starting level approx every 2-3 mins if pt is deteriorating or feels worse
- be prepared to ventilate
8
Q
field trauma triage physiological criteria
A
- pt does not follow commands
- SBP <90 mmhg
- RR <10 or >30 breaths per min
- <20 in infant- 1 year
9
Q
field trauma triage anatomical criteria
A
- penetrating to the head, neck or torso and extremities proximal to elbow or knee
- chest wall instability or deformity
- 2 or more proximal long bone fractures
- crushed, devolved , mangled or pulseless extremities
- amputation proximal to wrist or ankle
- pelvic fracture
- open or depressed skull fracture
- paralysis
10
Q
field trauma triage mechanism of injury
A
- adult fall >6m
- children <15 fall >3m or 2-3 times the hight of child
- high risk auto crash
- intrusion >0.3 on occupant side
- intrusion >0.5 on any site incl. roof
- ejection
- death in the same passenger compartment
- vehicle telemetry data consistent with high risk injury
- pedestrian or bicyclist thrown, run over or struck with significant impact >30 kms/hr
- motorcycle crash >30km/hr
11
Q
field trauma triage special criteria
A
- age: risk of injury/ death after age 55
- SBP <110 may represent shock after age 65
- anticoagulation and bleeding disorders
- burns with trauma mechanism
- pregnancy 20 weeks
12
Q
SMR mechanism of injury
A
- any trauma with complaints of neck or back pain
- sports accidents
- diving accidents and submersion injuries
- explosions or other forceful injuries
- falls
- pedestrian struck
- electrocution
- lightning strikes
- penetrating trauma to the head neck or torso
13
Q
SMR risk criteria
A
- neck or back pain
- spine tenderness
- neurological signs or symptoms
- altered LOC
- suspected drug or alcohol intoxication
- distracting painful injury
- anatomical deformity of spine
- high moi: fall, axial loading, MVC >100km/hr, hit by bus, ATV accident, bicyclist struck or collision
- age >64 fall from standing
14
Q
if pt has penetrating trauma to head neck or torso, determine if they exhibit :
A
- no spine tenderness
- no neurological signs or symptoms
- no altered LOC
- no suspected drug or alcohol intoxication
- no distracting painful injury
- no anatomical deformity of spine
15
Q
DNR life saving interventions that cannot be done
A
- CPR
- defibrillation
- ventilation
- OPA, NPA, SGA
- endotracheal intubation
- transcutaneous pacing
- advanced resuscitation medication
16
Q
DNR to be valid must include
A
- name of pt
- check box that indicates either pts expressed wishes when capable, or SDM consent, OR physicians current opinion that CPR will not benefit the pt
-check box to identify the professional designation of who has signed (MD,RN, RPN) - printed name of the Health care professional
- signature of health care professional
- date the form was signed, which must precede the date ambulance was requested
- DNR can be original or a copy of original
17
Q
deceased pt standard means
A
- obviously dead
- medical certificate of death
- VSA with DNR
- VSA with TOR
- VSA with a withhold resuscitation order
18
Q
obviously dead as per the standard
A
- decapitation, transection or visible decomposition
- VSA
- grossly charred body
- open head or torso wound with gross outpouring of cranial or visceral contents
- gross rigor mortis
- dependent lividity
19
Q
in all cases of death, the paramedic shall
A
- confirm the death
- ensure deceased is treated with respect and dignity
- consider the needs of family
- in suspected cases of foul play, follow police notification standard
- if applicable follow directions issued by coroner
- if TOR occurs in ambulance enroute to hospital, contact CACC/ACS and continue to hospital unless otherwise directed by CACC
- in cases of obvious death, note and document time which the medic confirms pt was deceased.
20
Q
in cases of an unexpected death, the paramedic shall:
A
- advise CACC of the death
- if the coroner indicates they will attend the scenes the paramedic will remain until they arrive
- if police are present and have secure the scene the paramedic may depart after documentation completion
- where at any time the paramedic hasn’t received any further direction from CACC, the paramedic shall request the CACC seek direction from the coroner concerning when they may leave the scene.
21
Q
in cases of expected death. the paramedic shall
A
- advise CACC of death
- make a request for responsible person if present to notify primary care giver
- if unable to, the paramedic shall advise CACC and they will attempt to notify, to gain their presence on scene.
- if responsible person present will remain then paramedic shall depart scene
- if primary care practitioner cannot be contacted and there is no responsible person, crew shall notify CACC in which case they will notify police or coroner and stay on scene.
- if requested by coroner, paramedic will provide circumstances of death and the medic will be released or instructed to remain.
22
Q
pediatric standard: consider assessment for
A
- change in apetite
- change in behaviour or personality
- excessive drooling
- decreased number of wet diapers
-lethargy - positioning (tripod)
- work of breathing
23
Q
in peds assess for
A
- respiratory arrest: primary cause of ped cardiac arrest
- abnormal vitals
- toe- head assessment
- have caregiver present unless interfering with care
- assess fontanelles in infants.
