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BLS PCS Standards + General > Medical Standards > Flashcards

Medical Standards Flashcards

1
Q

Abdominal Pain (non-Traumatic) Standard

What LIFE/LIMB/FUNCTION threats are you going to consider?

What do you do if you discover a pulsatile mass?

What do assess the abdomen for?

A

leaking or ruptured abdominal aortic aneurysm

ectopic pregnancy

other non-abdominal disorders that may present with abdominal pain including:
- diabetic ketoacidosis
- pulmonary embolism perforated or obstructed hollow organs with or without peritonitis

acute pancreatitis,

testicular torsion

pelvic infection

AND

strangulated hernia

Do not continue with further abdominal palpation

Pulsations
scars
discoloration
distention
massess
guarding
rigidity
tenderness

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2
Q

Abdominal Pain (non-Traumatic) Standard

What should you do if you suspect an AAA?

What else should you be observing when using this standard?

A

Palpate the femoral pulses for weakness/absence

Melena
Hematemesis
Frank rectal bleeding

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3
Q

Airway Obstruction Standard

Perform assessments and obstructed airway clearence maneuvers as pe ?

Consider airway obstruction for what kind of pts?

Attemp to ?

A

Current Heart and Stroke Foundation of Canada Guidelines

Smoke inhalation
Anaphylaxsis
Epiglottitis
Orophryngeal malignancy

Clear the airway using oropharyngeal/nasopharyngeal suction

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4
Q

Allergic Reaction (Known or Suspected) Standard

What potential LIFE/LIMB/FUNCTION threats are you considering?

What are common allergens?

A

Anaphylaxsis

Penicillin and other antibiotics in the penicillin family

Latex

Venom of bees, wasps, hornets

Seafood - shrimp, crab, lobster, other shellfish

Nuts, strawberries, melons, eggs, bananas

Sulphites (food and wine preservatives)

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5
Q

Allergic Reaction (Known or Suspected) Standard

What and where do you assess at a minimum as a secondary survey?

A

The site of allergic reaction - if applicable

The lungs - for adventitious sounds through auscultation

AND

The skin - for erythema, urticaria, and edema

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6
Q

Allergic Reaction (Known or Suspected) Standard

What are the 2 or more body manifestations you’re going to be looking for?

What are the historical findings you should use, in conjuction with the body systems mentioned above, as evidence towards anaphylaxis?

A

Respiratory - Dyspnea, wheezing, stridor or hoarse voice

Cardiovascular - Tachycardia or hypotension/shock

Neurological - Dizziness, confusion, or loss of consciousness

Gastrointestinal - Nausea, vomiting, abdominal cramps, or diarrhea

Dermatological/mucosal - Facial, orolingual, or generalized swelling/flushing/urticaria

Difficulty swallowing/tightness in the throat

Difficulty breathing/feeling of suffocation

Fearfulness, anxiety, agitation, confusion, or feeling of doom

Generalized itching

History of any of the body system involvement listed above/before

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7
Q

Allergic Reaction (Known or Suspected) Standard

What potential problems are you preparing for?

A

Cardiac arrest

Airway obstruction

Anaphylaxis

Bronchospasm

Hypotension

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8
Q

Altered Level of Consciousness Standard

What should you attempt to determine?

What should you do if the pt has an unproteced airway or is apneic?

What should you perform?

A

If there’s a specific cause (AEIOUTIPS)

Use an OPA/NPA
AND
Vetilate the pt as per ‘Respiratory Failure Standard’

A secondary survey to assess the pt from head-to-toe
AND
Trauma assessments if trauma is obvious/suspected/can’t be ruled out

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9
Q

Back Pain (Non-Traumatic) Standard

What potential LIFE/LIMB/FUNCTION threats are you considering?

Guideline - what if TAA (thoracic aneurysm) is suspected?

What do you assess in the secondary survey?

A

abdominal/thoracic aortic aneurysm

acute spinal nerve root(s) compression

intra-abdominal disease (e.g. pancreatitis; peptic ulcer)

AND

possible occult injury (e.g. pathologic fracture)

Perform a bilateral blood pressure

back - for abnormal appearance/findings

chest - as per Chest Pain (Non-Traumatic) Standard

abdomen - as per Abdominal Pain (Non-Traumatic) Standard

distal pulses

AND

extremities - for circulation, sensation, and movement.

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10
Q

Cardiac Arrest Standard

What are the 6 steps to follow in the standard?

What should you do if you have to plan to interupt CPR?

How do you perform CPR on a pt who is approx GREATER then 20 weeks gestation?

A

1 - Position the pt on a firm, flat surface

2 - initiate CPR inncluding the defib

3 - establish an airway

4 - consider reversible causes initiating further assessment/management

5 - minimize CPR disruptions

6 - Continue all meaures of cardiac resus until TOR granted

Perform CPR and have a partner perform left uterine dislacement

reinitiate CPR as quickly as possible at a predetermined point

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11
Q

Cardiac Arrest Standard

CPR - chest compressionists should

What intervention application should you have ready to use?

what device should be in use aswell?
What about mechanical CPR devices?

A

Switch every 2min if available

Suction in case of emesis

End-tidal carbon dioxide (ETCO2) monitoring should be considered.

You can use mechanical CPR devices IF there are limited rescuers available and the CPR monitoring is prolonnged in ambulance

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12
Q

Cardiac Arrest Standard

What O2 should the pt receive if they have a ROSC? What if they’re apneic?

Always remember to keep

What should you do in conjunction with the ‘Patient Assessment Standard’?

A

Maintain O2 sat at 94-98% BUT if they’re apneic then continue to ventilate

Cardiac monitoring

Obtain vital signs at least every 15min after the 1st hour
AND
Every 30min after the 1st hour OR if there’s a change in pt status

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13
Q

Cardiac Arrest Standard

What do you do if en-route the pt re-arrests?

A

Resume CPR

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14
Q

Cerebrovascular Accident (CVA, ‘Stroke’) Standard

What potentially serious conditions can mimic a stroke?

What do you assess on the head/neck for?

What do you assess the cenral nervous system for? Is there anything else you want to assess for?

A

drug ingestion (e.g. cocaine)

hypoglycemia

severe hypertension
hypertensive emergency

OR

central nervous system (CNS) infection (e.g. meningitis)

Speech abnormalities
Stiff neck
Pupils size, ERLA

Facial Symmetry
Pupillary size, ERLA
Speech abnormalities
Stiff neck?

Abnormal motor function, eg. hang grip strength, arm/leg movement or drift
AND
Sensory loss

Also assess for incontinence of urine/stool

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15
Q

Cerebrovascular Accident (CVA, ‘Stroke’) Standard

What should you ensure during movement and/or transport?

What potential problems should you prepare for?

A

That there is adequate support for the pt’s body/limbs AND that there is extra padding beneath the affected limbs for support

possible airway obstruction (if loss of tongue control, gag reflex)

decreasing LOC

seizures
AND
agitation, confusion, or combativeness

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16
Q

Cerebrovascular Accident (CVA, ‘Stroke’) Standard

What are the signs of cerebral herniation?

What should you attempt to maintain ETCO2 values at?

What should you do if signs of cerebral herniation are present?

A

Deteriorating GCS <9 with

dilated and unreactive pupils
OR
asymmetric pupillary response
OR
a motor response that shows either unilateral or bilateral
decorticate/decerebrate posturing

35-45mmHg

Attempt to hyperventilate the pt with ETCO2 values of 30-35mmHg

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17
Q

Cerebrovascular Accident (CVA, ‘Stroke’) Standard

If you don’t have ETCO2 monitoring then how do you hyperventilate an Adult pt?

Child pt?

Infant that is LESS then 1y old pt?

A

approx 20 breaths/min

approx 25 breaths/min

approx 30 breaths/min

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18
Q

Cerebrovascular Accident (CVA, ‘Stroke’) Standard

What if the LAMS score is GREATER/EQUAL to 4?

What else do you do for a secondary screen of LVO using LAMS?

A

Then classify the pt as a CTAS 2

Inform the receiving hospital whether the LAMS screen was +or-

AND

Document the LAMS screen for pts presenting with CVA/Stroke symptoms 0-24h from symptom onset

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19
Q

Chest Pain (Non-Traumatic) Standard

What potential LIFE/LIMB/FUNCTION threats rae you considering?

ALWAYS?

A

acute coronary syndrome/acute myocardial infarction (e.g. ST-segment elevation myocardial infarction [STEMI])

dissecting thoracic aorta

pneumothorax, tension pneumothorax/other respiratory disorders (e.g. pneumonia)

pulmonary embolism

AND

pericarditis

aquire a 12-lead electrocardiogram

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19
Q

Excited Delirium Standard

Give particular attention to ?

Wha if the the pt is or is suspected to be violent/agressive?

Recoginize the need for ? (2) ?

A

personal safety as per the general measures standard

Refer to the Violent/Aggressivve Patient Standard

Police in conjunctino with the ‘Police Notification Standard’

AND

The potential need for advanced patient care as per the ALS PCS

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19
Q

Chest Pain (Non-Traumatic) Standard

Perform a secondary suvery to assess at a minimum:

A

Chest - TIASSSU
- subcutaneous emphysema
- accessory muscle use
- urticaria
- indrawing
- shape
- symmetry
- tenderness

Lungs - for decreased air entry and adventitious sounds (e.g. wheezes, crackles), through auscultation

abdomen, as per the Abdominal Pain (Non-traumatic) Standard

neck - for tracheal position and JVD

AND

extremities - for leg/ankle edema

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19
Q

Dysphagia Standard

What potential LIFE/LIMB/FUNCTION threats are you going to consider?

What if the pt does have epiglottitis?

What should your secondary survey be assessing?

A

anaphylaxis

AND

upper airway infections (e.g. epiglottitis)

Do NOT open the mouth to inpect the airway!

head/neck, for
- drooling
- hoarse voice or cough
- nasal flaring
- swelling or masses
- tracheal deviation

AND
lungs - for adventitious sounds through auscultation

19
Q

Dysphagia Standard

What if oxygen administration is indicated?

How should you position the pt?

What potential problem should you prepare for?

A

You should attempt to minimize agitation.

Position the pt in a sitting or semit-sitting position

Complete airway obstruction

19
Q

Excited Delirium Standard

Provide pt care based on ?

What potential problem are you preparing for?

A

presenting signs and symptoms as per the standards

Rapid deterioration

20
Q

Epixtaxis (Non-Traumatic) Standard

What potential LIFE/LIMB/FUNCTION threats are you going to consider?

What potential problems are you going to prepare for?

What does your secondar survey assess? - attmept to??

A

Upper airway obstruction

airway compromise
Hypotension

for estimated blood loss (e.g. hemorrhage duration, rate of flow, presence of clots, quantity of blood-soaked materials at scene, quantity of blood vomited)

AND

head/neck - for foreign bodies in nares, and headache

attempt to control the bleeding

20
Q

Excited Delirium Standard

What potential LIFE/LIMB/FUCNTION threats are you considering?

What are the symptoms of excited delirium?

A

Asphyxia
Cariopulmonary arrest
AND
Dysrhythmias

Impaired thought processes, e.g. disorientation, acute paranoia, panic, or
hallucinations

Unexpected physical strength

Significantly decreased sensitivity to pain

Sweating, fever, heat intolerance, or, dry/hot skin with no sweating despite
extreme agitation

Sudden tranquility after frenzied activity

21
Q

Extremity Pain (Non-Traumatic) Standard

What potential LIFE/LIMB/FUNCTION threats are you considering?

What should attempt to be doing?

What should your secondary survey be assessing with respect to the affected extremity compared to the unaffected extremity?

A

acute spinal nerve root(s) compression

possible occult fracture

soft tissue and joint infections

AND

vascular occlusion (e.g. peripheral vessel, intra-abdominal vessel, intrathoracic vessel)

keep movement to a minimum AND protect from further injury

distal pulses

circulation, sensation, and movement

skin colour, temperature, and condition

AND

swelling, deformity, and tenderness

22
Q

Fever Standard

What are the potential LIFE/LIMB/Function threats you’re considering?

What’s a known fever temp?

What do you do for the pt after asessing them?

A

Overdose

Sepsis

Meningitis

Heat-related illness

>38.5°C

remove excess layers of clothing to promote passive cooling

AND

do NOT actively cool the pt

23
Q

Fever Standard

What are you assessing in your secondary survey?

What potential problems are you preparing for?

A

lungs - for adventitious sounds through auscultation

skin - for jaundice, rash, and signs of dehydration

head/neck - for photophobia, scleral jaundice, stiff neck, and headache

AND

abdomen - as per the Abdominal Pain (Non-Traumatic) Standard

AND

Temperature

Febrile children

Suspected serious disorders-meningitis adult

Seizures

24
Q

Headache (Non-Traumatic) Standard

What potential LIFE/LIMB/FUNCTION threats are you considering?

What potential problems are you preparing for?

What S+S indicate underlying disorder or cause?

A

intracranial/intracerebral events (e.g. hemorrhage, thrombosis, tumour)

central nervous system or other systemic infection

severe hypertension

AND

toxic event/exposure (e.g. carbon monoxide poisoning)

Seizures

Sudden onset of severe headache with no previous medical hx of headache

Recent onset headache (days, weeks) with sudden worsening

Change in pattern of usual headaches

Any of the above accompanied by one or more of the following:
- Altered mental status
- Decrease in LOC
- Neurologic deficits
- Obvious nuchal rigidity and fever or other symptoms of infection
- Pupillary abnormalities (inequality, sluggish/absent light reactivity)
- Visual disturbances

25
Q

Headache (Non-Traumatic) Standard

What are you assessing for in your secondary survey?

A

head/neck - for pupillary size, equality, and reactivity

CNS for
- abnormal motor function (e.g. hand grip strength, arm/leg
movement/drift)
- sensory loss

26
Q

Heat-Related Illness Standard

What potential LIFE/LIMB/FUCNTION threats are you going to consider?

What should you do for the patient?

What are you assessing in the secondary survey?

A

Heat stroke
Hypovolemic shock

remove heavy/excess layers of clothing

move the pt to a cooler area
AND
remove heavy/excess layers of clothing

central nervous system

mouth, for state of hydration

skin, for temperature, colour, condition, state of hydration

extremities, for circulation, sensation, and movement

temperature

27
Q

Heat-Related Illness Standard

If the pt is conscious, cooperative, able to understand directions and is not nauseated or vomiting AND there is some available at the scene, what should you give the pt?

Guideline - what are the signs that you should discontinue cooling procedures?

A

Provide water or electrolyte containing fluids in SMALL quantities

Skin temp feels nomal to touch
Generalized shivering develops
The pt’s LOC normalizes

28
Q

Heat-Related Illness Standard

What are the next steps if working assessment indicates heat exhaustion?

Heat stroke?

A

move the patient to the ambulance

AND

remove as much clothing as possible

move the patient to the ambulance

remove as much clothing as possible

withhold oral fluids

cover the patient with wet sheets

AND

apply cold packs to the axillae, groin, neck and head.

29
Q

Heat-Related Illness Standard

What are the chief complaints/presenting problems of heat-related illnesses?

Overdose of tricyclic anti-depressants, antihistamines and β-blockers, as well as cocaine, Ecstasy or amphetamine abuse may also lead to heat stroke

A

Heat syncope

Heat cramps: severe cramping of large muscle groups

Heat exhaustion: mild alterations in mental status, and non-specific complaints (headache, giddiness, nausea, vomiting, malaise), with excessive sweating in healthy adults; or hot, dry skin in the elderly

Heat stroke: severely altered mental status, coma, seizures, hyperthermia
≥40°C

30
Q

Hematemesis/Hematochezia Standard

What potential LIFE/LIMB/FUNCTION threats are you condsidering?

What is hematochezia?

What is you suspect hemoptysis?

A

Esophageal varices
AND
Gastrointestinal Disease

Frank rectal bleeding

Attempt to ascertain the origin:
- lung tumours or other lung disease

31
Q

Hematemesis/Hematochezia Standard

What are you assessing for in the secondary survey?

What other information are you looking for regarding hemorrhage?

How do you estimate blood loss?

A

chest, if hemorrhage is oral, as per the Chest Pain (Non-Traumatic) Standard

AND

abdomen, as per the Abdominal Pain (Non-Traumatic) Standard

The type - coffee-grounds emesis, melena, of hematochezia

Duration of hemorrhage

Rate of blood flow

Presence of clots

Quantity of blood-soaked/filled materials

32
Q

Nausea/Vomiting Standard

What are the potential LIFE/LIMB/FUCNTION threats you’re considering? 10

What potential problem are you preparing for?

What is your secondary survey assessing?

A

acute coronary syndrome/acute myocardial infarction (e.g. STEMI)

anaphylaxis

increased intracranial pressure

toxicological emergencies

bowel obstructions

infection

acute pancreatitis

intra-abdominal emergencies

AND

uremia

airway compromise

the abdomen as per the ‘Abdominal Pain (Non-Traumatic) Stanard

33
Q

Respiratory Failure Standard

Ventilate the pt as par the ?

Guideline - maintain ETCO2 to ?
Maintain ETCO2 for COPD pts GREATER 50?

What SHALL you do for the pt?

A

current ‘Heart and Stroke Foundation of Canada Guidelines’

35-45mmHg
COPD pts that had an initial ETCO2 of 50 should be 50-60mmHg

Observe chest rise and fall + auscultate lung fields to assess vetilation adequacy

Minimize the interruptions to ventilations

Continue assisted vetilations until pt’s spontaneous respirations are adequate

34
Q

Seizure Standard

What potential LIFE/LIMB/FUNCTION threats are you considering in general?

In neonates? In pts GREATER/EQUAL to 50y old?

In pregnant pts? In young children?

A

Intracranial event
Hypoglycemia
Infection (e.g. CNS, meningitis)
Alcohol withdrawal including delirium tremens)
Drug ingestion/withdrawal
Known seizure disorder

Seizures

Trauma-delivery
Congenital disorders
Prematurity
Hypoglycemia

Brain tumour or orther intracranial event (e.g. hemorrhage, thrombosis)
Cardiac dysrhythmias
Cardiovascular disease
Cerebrovascular disease
Severe hypertension

Febrile convulsions realated to infection

35
Q

Seizure Standard

What are YOU doing if the pt in in active seizure?

What potential problems are you preparing for?

A

Attempt to position the pt in recovery position

Attempt to protect the pt from injury

Observe for
- eye deviation
- incontinence
- parts of the body affected
- the type of seizure (full body, focal, etc.)

airway compromise

Recurrent seizures

post-ictal combativeness or agitation

36
Q

Seizure Standard

What are you assessing in your secondary survey?

seizure related occurrences

A

Bleeding from the mouth

Incontinence

Secondary injuries resulting from the seizure

tongue injury

37
Q

Shortness of Breath Standard

What Acute Respiratory Disorders are you considering? 7

What Other Causes are you considering? 3

What Acute Cardiovascular Disorders are you considering? 4

A

Partial airway obstruction

asthma

anaphylaxis

aspiration

inhalation of toxic gases or smoke

COPD

AND

respiratory infections

Cerebrovascular accident
Toxicological effects
Metabolic acidosis

acute coronary syndrome/acute myocardial infarction (e.g. STEMI)

Congestive heart failure

Pulmonary edema

AND

Pulmonary embolism

38
Q

Shortness of Breath Standard

Assume ? about hyperventilation

What if the pf is on home O2?

What if the pt is apneic or respirations are inadequate?

A

That all hyperventilation is due to an underlying disorder

elicit hx regarding changes in use

then ventilate as per the ‘Respiratory Failure Standard’

39
Q

Shortness of Breath Standard

What are you assessing during your secondary survey?

How should you position the pt?

A

The chest as per the ‘Chest Pain (Non-Traumatic) Standard’

Head/neck for
- cyanosis
- nasal flaring
- excessive drooling
- tracheal deviation
- JVD

The extremities for
- cyanosis
- edema

In a sitting or semi-sitting position

40
Q

Syncope/Dizziness/Vertigo Standard

What potential LIFE/LIMB/FUNCTION threats are you considering? (9)

How should you position the pt?

What are the potential porblems you’re preparing for?

A

Hypoglycemia

Cardiac dysrhythmias

CVS/Transient Ischemic Attack

Hypovolemia

Toxicological effects

Heat-related illness

Anemia

Renal failure

Sepsis

Supine or in recovery position

Cardiac dysrhythmias

Hypotension

Seizures

Decreased LOC

41
Q

Toxicological Emergency Standard

Attempt to determine ?

In cases which the agent is the prescription medication you should ?

What if the pt’s LOC is decreased or they’re unconcious?

A

Agent(s)
Quantity
Time
Route - absorption, inhalation, ingestion, or injection

identify the date of prescription and remainder of prescription amount

Refer to the ‘Altered Level of Consciouness Standard’

42
Q

Toxicological Emergency Standard

What potential problems are you preparing for?

Always attemp to refer to (2) ?

Assume carbon monoxide poisoning where the pt, or multiple pts, exhibit what S+S?

A

Cardiac arrest

Airway obstruction

Respiratory arrest

Respiratory distress

Altered/changing LOC

Sudden violent behaviour

Hyperthermia

Seizures

Emesis

Poison control resources - don’y delay

A Material Safety Data Sheet

Altered mental status

Cardiac Dysrhythmias

Emesis

Headache

Light-headedness

Nausea

Seizures

Syncope

Weakness

VSA

43
Q

Vaginal Bleeding Standard

A
44
Q

Vaginal Bleeding Standard

What potential LIFE/LIMB/FUNCTION threats are you considering in post-menopausal women and 1st trimester complications?

2nd and 3rd trimester complications?

A

Tumours

AND

Spontaneous abortion

Ectopic pregnancy

Gestational trophoblastic disease

Spontaneous abortion

Placental abruption

Placena Previa

Ruptured Uterus

45
Q

Vaginal Bleeding Standard

What are you assessing at a minimum during your secondary survey?

What if you suspect assult?

What should you attempt to determine if the pt it pregnant?

A

The abdomen as per the ‘Abdominal Pain (Non-Traumatic) Standard’

if the pt is pregnant Note uterine height and palpate for contractions
AND
note fetal movements

Refer to the ‘Sexual Assault (Reported) Standard’

If bleeding is painless or associated with abdominal pain/cramping

the number of prior episodes and cause (if known)

46
Q

Vaginal Bleeding Standard

When you’re assessing bleeding characteristics, what should you attempt to determine?

How much can a normal sized pad or tampon hold? menstrational bloodlos?

What do you do if bleeding is profuse (what problems are you preparing for)?

A

Blood loss

Fetal parts

Other tissues

AND

Presence of clots

10-35mL

5mL

Shock

Place an abdominal pad under the perineum and replace pads as required

Document # of pads used on the Ambulance Call Report

47
Q

Visual Disturbance Standard

What potential LIFE/LIMB/FUNCTION threats are you considering?

What are you assessing in your secondary survey?

A

Intracranial, intracerebral or retinal hemorrhage/thrombosis

Acute glaucoma

The eyes for
- Pupillary size, ERLA
- Abnormal movements
- Positioning
- Redness
- Swelling
- Tearing
AND
- Presence of contact lenses

The eye-lids for ptosis (upper eyelid droops over the eye)

AND

Vision for
- distortion/diplopia (double vision)
- loss
- visual acuity

48
Q

Visual Disturbance Standard

How do you minimize movement and assist with pt comfort?

What potential problems are you preparing for? 3

A

Considering patching the eyes

Alterations in LOC

Neurological Deficits

Emesis

BLS PCS Standards + General (12 decks)

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