putting it all together

Question 1

key points

Answer 1

• Safety of providers and patients- Number one priority
• Prearrival preparedness and scene assessment- Assessment begins before arriving at the scene
• Sufficient resources?
• How many patients are involved?
• Are there special scene needs?
• Access to patient
• General impression- History and mechanism of injury (kinematics)
• Identify immediate life threats and manage them- Primary assessment
• Transport and destination decision
• Physically immobilize the patient as needed- Manually (hand), then mechanically (device)
• Patient extrication
• Assess and treat identified injuries and resulting conditions- Principles versus preferences
• Transportation and destination
• Communication and documentation

Question 2

principle

Answer 2

what needs to be done for a patient based upon the assessment

Question 3

preference

Answer 3

-how the principle is accomplished
-This will change depending on the:
• Situation at the scene
• Severity of the patient
• Knowledge and skills of the prehospital care provider
• Resources available

Question 4

airway and breathing

Answer 4

• Manually stabilize cervical spine as indicated
• Suction as needed
• Provide supplemental oxygen early
• Support ventilations as necessary
• Use simple interventions before complex
• Example: Bag-mask device before intubation
• Ventilate before and between intubation attempts
• Maintain a proper rate of ventilation

Question 5

circulation

Answer 5

• Control obvious bleeding
• Conserve red blood cells
• Immobilize major fractures
• Maintain body temperature
• IVs can be started while en route- be careful how much
• Provide no more fluid than necessary
• Avoid over-resuscitation that can lead to increased blood loss

Question 6

disability

Answer 6

• Maintain manual cervical stabilization until immobilization is complete
• Calculate GCS score
• reassess for changes in the patient’s condition over time

Question 7

patient handling

Answer 7

• Identify patients requiring rapid extrication
• Maintain manual stabilization while performing extrication
• Recognize the limitations of immobilization devices
• Maintain a team approach

Question 8

transportation

Answer 8

• Transport to appropriate destination without delay

- Utilize appropriate transport method and mode

Question 9

communication

Answer 9

-Provide clear, concise, accurate, timely, and complete communication with the receiving facility

Question 10

documentation

Answer 10

-Complete documentation is important for continued care, research, and accountability

Question 11

potential pitfalls

Answer 11

• ignoring or failing to recognize scene hazards
• Focusing on distracting, non-life-threatening injuries
• Performing secondary assessment before life-threatening conditions have been assessed and managed
• Not performing a secondary assessment when indicated
• Missing life-threatening conditions by not exposing and assessing the patient
• Not maintaining body temperature
• Prolonged scene times
• Inappropriate selection of destination

Question 12

golden principles

Answer 12

• Ensure the safety of the prehospital care providers and the patient
• Assess the scene situation to determine the need for additional resources
• Recognize the kinematics that produced the injuries
• Use the primary assessment to identify lifethreatening conditions
• Provide appropriate airway management while maintaining cervical spine stabilization as indicated
• Support ventilation and deliver oxygen to maintain an SpO2 greater than 95%
• Control any significant external hemorrhage
• Provide basic shock therapy, including appropriately splinting musculoskeletal injuries and restoring and maintaining normal body temperature
• Maintain manual spinal stabilization until the patient is immobilized
• For critically injured trauma patients, initiate transport to the closest appropriate facility as soon as possible after EMS arrival on scene
• Initiate warmed intravenous fluid replacement en route to the receiving facility
• Ascertain the patient’s medical history and perform a secondary assessment when life-threatening problems have been satisfactorily managed or have been ruled out
• Provide adequate pain relief
• Provide thorough and accurate communication regarding the patient and the circumstances of the injury to the receiving facility
• Above all, do no further harm

Question 13

our patients did not choose us we chose them

Answer 13

true