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Trauma Standards Flashcards

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1
Q

Genral Trauma Standard

What should you advise the pt to do 1st?

What Standard should always consider before extricating?

A

Remain as still as possible

The SMR Standard

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2
Q

General Trauma Standard

When do you perform extrication (if it’s safe to do so)?

What do you do immediately following the primary survey unless otherwise indicated in the standards?

A

When the scene survey identifies conditions which may immediately endanger the patient
OR
The primary survey identifies conditions requiring immediate interventions which can’t happen at the patient’s locations

A rapid trauma survey

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3
Q

General Trauma Standard

In what ways can you attempt to estimate blood loss?

5 things

When do you perform a complete secondary survey of all body systems (including auscultation)?

A

Hemorrhage duration
Rate of flow
Presence of clots
Quantity of blood-soaked materials
AND
Quantity of blood vomited

For obvious OR suspected major/multiple trauma

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4
Q

General Trauma Standard

A
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5
Q

General Trauma Standard

You’ve come across a patient with an impailed object….what should you be doing?

What do you do if the object doesn’t fit in the ambulance?

Are there situations in which you WOULD make an attempt to remove?

A

Make no attempt to remove
Stabilize the object as found (using bulky dressing/bandages)

Attempt to shorten the object or rquest assistance from alied resources

Unless otherwise stated by the standards
Compromising the airway
Interfering with CPR during cardiac arrest (after already trying to change hand placement)

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6
Q

General Trauma Standard

What do you ASSESS an injury site for?

What do you PALPATE a patient for?

A

Contusion/colour/cyanosis/contamination
Laceration
Abrasions/asymmetrical motion/abdominal breathing (diaphragmetic)
Penetrations/punctures/protruding objects or organs
Swelling/sucking wounds/subcutaneous emphysema
Distension/deformity/dried blood/diaphoresis

Tenderness
Instibility
Crepitus
Swelling/subcutaneous emphysema
Deformity

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7
Q

General Trauma Standard

What do you assess at a minimum if a patient has an isolated injury?

What’s something that could compromise the injury site?

A

You assess the injury site/body system
AND
Other body parts/systems likely to be injured by considering potentially assoiciated life/limb/function threats

Clothing or jewelry - remove it

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8
Q

General Trauma Standard

What do you do if, upon arrival, the patient’s injury site is already dressed/splinted?

What are the splinting priorities?

A

Use judgement - if the site is correctly managed as per the standards then leave it

Spine (neck thoraco-lumbar, head)
Pelvis
Femurs
Lower legs
Upper limbs

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9
Q

General Trauma Standard - Truama and the PREGNANT patient

What’s it most often associated with?

What’s not obvious until well advanced?

A

Domestic violence

Signs of shock

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10
Q

General Trauma Standard - Truama and the PREGNANT patient

What are the major causes of death in maternal and fetal death respectively?

What’s more susceptible to injury and hemmorrhage?

What could blunt truama result in?

A

Hemmorrhage shock AND fetal hypoxemia

An enlarged uterus

Premature labour, spontaneous abortion, placental abruption, ruptured diaphragm, liver, spleen, or uterine rupture

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11
Q

General Trauma Standard - Truama and the PREGNANT patient

For WHAT do you maintain a high index of suspicion for and WHY?

What should you observe for in terms of blunt trauma to the abdomin?

A

For internal injury after MINOR blunt acceleration/deceleration force traumas as a stillbirth or placental abruption could occur within hours.

Abdominal/uterine enlargement

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12
Q

Aputation/Avulsion Standard

A
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13
Q

Aputation/Avulsion Standard

A
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14
Q

Aputation/Avulsion Standard

A
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15
Q

Aputation/Avulsion Standard

What potential LIFE/LIMB/FUNCTION threats SHALL you consider?

What do you assess if the pt has a partial amputation or avulsion?

A

Hemorrhagic shock
Loss of limb
Loss of function

The injury site for circulation, sensation, and movement
AND
The distal pulses, circulation, sensation, and movement with respect to the injury site

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16
Q

Aputation/Avulsion Standard

With respect to the injury site you SHALL?

6 things

What if the amputation is proximal to the wrist or ankle?

A

Control hemorrhage as per the ‘Soft Tissue Standard’
Cleanse wound of gross surface contamination
Immoblize affected extremity
Elevate
If PARTIAL amputation/avulsion - place everything in near-normal anatomial position as possible
If COMPLETE amputation - cover the stump with moist sterile pressure dressing followed by a dry dressing whist NOT twisting or constricing any remaining tissue

Evalute the patient under the FTT Standard

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17
Q

Aputation/Avulsion Standard

What do you do with respect to the amputated avulsed part?

Prior to ambulance transport (4 things)?

When you unable to locate the part prior to transport? (2 things)

A

Preserve all amputated tissue
Gently rinse with saline IF grossly contaminated
Wrap/cover the end with moist sterile dressing
AND
Place the part in a suitable container to then immerse in cold water (if possible)

Attempt to have others at the scene look for the amputated/avulsed part - tell them to bring it to the recieving facility
DO NOT delay transport

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18
Q

Blunt/Penetrating Injury Standard - Abdominal/Pelvic Injury

What potential LIFE/LIMB/FUNCTION threats should you consider?

What do you do if the pt has evisceration of intestines?

A

Spinal Cord Injury
Rupture, perforation, laceration, or hemorrhage of organes and/or vessels in the abdomen AND potential in the thorax or pelvis

Make no attempt to replace intestines back into the abdomen
AND
Cover eviscerated intestines using moist, sterile, large and bulky dressings

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19
Q

Blunt/Penetrating Injury Standard - Abdominal/Pelvic Injury

What do you do if the pt has a pelvic fracture?

A

1- attempt to stabilize the clinically unstable pelvis (circumferential sheet wrap/commercial device)
2- Secure the pt to a spinal board or adjustable break-away stretcher
3- Avoid placing anything over the pelvic area (including stretcher straps)
4- Secure and immobilize lower limbs to prevent additional pelvic injury

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20
Q

Blunt/Penetrating Injury Standard - Bite Injury

What LIFE/LIMB/FUNCTION threats are you considering?

What do you attempt to determine?

What should you always be wary of?

A

Injuries to underlying organs, vessels, or bones
AND - specific to snake bites
- Anaphylaxis
- Shock
- Central nervous system toxicity
- Local Tissue Necrosis

The source of bite + owner
Immunization + communicable disease status

The potential for bacterial contaminations or disease transmission (eg. rabies, Hep B, HIV) through bites

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21
Q

Blunt/Penetrating Injury Standard - Bite Injury

What SHALL you do if there is known or suspected envenomation?

How long SHALL you irrigate bites for IF the pt is stable?

A

1- Position the pt supine
2- Immobilize the bite area at or slightly below heart level
3- DO NOT apply cold packs

5min

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22
Q

Blunt/Penetrating Injury Standard - Chest Injury

What LIFE/LIMB/FUNCTION threats should you consider?

7 things - what’s the 1st thing you should do after creating a DDX?

What do you assess for if the pt has a PENETRATING chest wound?

A

Tension Pneumothorax
Hemothorax
Cardiac Tamponade
Myocardial Contusion
Pulmonary Contusion
Spinal cord injury
Flail chest

Auscultate the pt’s lungs for air enry and adventitious sounds

Entry and exit wounds
Tracheal Deviation
Jugular vein distension
AND
Airway and/or vascular penetrating (foamy hemoptysis, sucking wounds)

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23
Q

Blunt/Penetrating Injury Standard - Chest Injury

What do you do if the pt has a SUCKING chest wound?

Should you place the pt sitting /semi-sitting?

What should you do for suspected pnemothorax pt requiring ventilations?

A

Seal wound with commercial occlusive dressing with 1-way-valve OR 3-sided dressing
Apply a dressing that will cover several cm beyond the edges of the wound
Monitor for tension pneumothorax (rapid deterioration in cariorespiratory status)
If tension pnemo occurs then remove/replace the occlusive dressing

ONLY if the pt is concious AND doesn’t meet the SMR standard

Ventilate at a lower tidal volume and rate of delivery to prevntent exacerbation of increaing intrathoracic pressure

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24
Q

Blunt/Penetrating Injury Standard - Chest Injury

What potential problems would you prepare for in a chest wounded pt situation?

A

Tension pnemothorax
Cardiac Tamponade
Cardiac Dysrhythmias
Hemoptysis

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25
# Blunt/Penetrating Injury Standard - Eye Injury What should you assume and what should you do if there's active bleeding? | What do you do if the eyes are swollen shut? ## Footnote What other standards should you follow to asses the pt and eye respectively?
Assume threats to vision Control the bleeding with the minimal amount of required pressure | leave eyelids as is ## Footnote Blunt/Penetrating Injury Standard - Head Injury AND Visual Disturbance Standard
26
# Blunt/Penetrating Injury Standard - Eye Injury What if the eye is EXTRUDED/AVULSED? | What should you do if there's a suspected rupture or puncture of the glo ## Footnote What other interventions should you perform for eye injuries? (4)
Do NOT attempt to replace it Cover with a moist sterile dressing + stabilize as an impailed object | NO manipulation, palpation, irrigation, direct pressure NO cold packs ## Footnote Cover the eye with dressing Cover both eyes IF injury is severe/there's pain in the affected eye Advise the pt to keep eye movement at a minimum Transport the pt supine with head elevated 30 degrees
27
# Blunt/Penetrating Injury Standard - Face/Nose Injury What should you consider and what standard should use use to assess the pt? | If nose injury is obvious or suspected assess the pt as per the?
Potential concurrent head, c-spine injuries AND the 'Blunt/Penetrating Injury Standard - Head Injury' | The Epistaxis (non-traumaic) Standard
28
# Blunt/Penetrating Injury Standard - Face/Nose Injury What's the guideline for teeth? ## Footnote What potential problems would you prepare for?
You can replace a completely intact, avlused tooth in the socket and have the pt bite down to stabilize AS LONG AS the pt is alert and stable Place the tooth in saline or milk if it can't be replaced ## Footnote Epistaxis Airway obstruction if sever injury and/or massive uncontrolled oral hemorrhage
29
# Blunt/Penetrating Injury Standard - Face/Nose Injury What can you do (or not do) with the pt if they're conscious, don't meet SMR, AND you want to transport them on a spinal board/break-away stretcher?
Do NOT apply cold packs Position the pt to be semi-sitting and leaning forward to assist draining/expectoration of blood (spitting) Elevate the head 30 degrees
30
# Blunt/Penetrating Injury Standard - Head Injury What potential LIFE/LIMB/FUNCTION threats are you considering? | Pts with suspected concussions require? ## Footnote What 7 things are you observing for?
Intracranial and/or intracerebral hemorrhage Neck/spine injuries Facial/skull fractures Concussion | transport for further assessment ## Footnote Fluid from the ears/nose eg.CSF Mastoid Bruising Abnormal Posturing Periorbital Ecchymosis Agitation or fluctuating bahviour Urinary/fecal incontinence AND Emesis
31
# Blunt/Penetrating Injury Standard - Head Injury What are signs of cerebral herniation?
Dilated and unreactive pupils Asymmetric pupillary response Motor response that shows either unilateral or bilateral decorticate/decerebrate posturing
32
# Blunt/Penetrating Injury Standard - Head Injury When vetilating the pt due to apneia or inadequate respirations AND ETCO2 monitoring is available, you SHALL?
Attempt to maintain ETCO2 values of 35-45mmHg If you notice signs of cerebral herniation after adressing hypoxemia and hypotension THEN hyperventilate the patient attempting to maintain ETCO2 of 30-40mmHg
33
# Blunt/Penetrating Injury Standard - Head Injury When vetilating the pt due to apneia or inadequate respirations AND ETCO2 monitoring isn't available, you SHALL? | 3 categories (adult, child, infant) ## Footnote You have already adressed hypoxemia and hypotension but signs of cerebral herniation persist, what do you do?
Adult - approx. 20 breaths/min Child - approx 25 breaths/min Infant LESS than 1 year old approx 30 breaths/min
34
# Blunt/Penetrating Injury Standard - Head Injury What do you do if protruding brain tissue is present? | What do you do if cerebrospinal fluid leak is suspected? ## Footnote What can you do if they're conscious, don't meet SMR, AND you want to transport them on a spinal board/break-away stretcher?
Cover with non-adherant material (moist sterile dressing) | Apply a loose sterile dressing over the source opening ## Footnote Position them in a sitting or semi-sitting position
35
# Blunt/Penetrating Injury Standard - Head Injury What are the POTENTIAL PROBLEMS to prepare for? | 4
Respiratory Distress/arrest Seizures Decreasing level of consciousness Agitation or Combativeness
36
# Blunt/Penetrating Injury Standard - Neck/Back Injury What should you assume if it's a penetrating neck injury? | What should you do 1st? ## Footnote What do you do if the pt has a penetrating wound?
Vascular and ariway lacerations or tears | Auscultate the lungs for decreased air entry and adventitious sounds ## Footnote Assess for entry and exit wounds Apply pressue lateral to the airway NOT directly over Apply occlusive dressings to wounds
37
# Blunt/Penetrating Injury Standard - Neck/Back Injury What do you observe for? | What should you always keep in consideration? ## Footnote What does the secondary survey assess?
Diaphragmetic breathing Neurologic Deficits Priapism Uriniary/fecal incontinence/retention | That you should sit within the pts view to avoid head/neck turns ## Footnote For airway/vascular penetration The ausculation of the lungs, whether there's decreased air entry or adventitious sounds The head and neck for JVD and tracheal deviation The chest for subcutaneous emphysema
38
# Burns (Thermal) Standard What's the 1st thing you should do if your patient is in a smoke/fume filled environment?
Request assistance from fire personnel and ensure the pt is moved to a fresh air zone as quickly as possible
39
# Burns (Thermal) Standard What SHALL you consider? ## Footnote What do you attempt to determine?
Airway burns Asphyxia Carbon monoxide/cyanide poisoning Shock ## Footnote The source of burn Whether the burn pt (if caused by fire) was unconcious or lost consciousness during their exposure If burn was due to fire whether it happened in an enclosed space
40
# Burns (Thermal) Standard What do you do if the pt is burning?
Stop the burning process Remove any clothing from the injury site excluding anything adhered to the skin
41
# Burns (Thermal) Standard How do you estimate severity? ## Footnote What else do you perform during a secondary survey?
Area burned (location, circumferencial -all around) Burn depth (degree) AND Percentage of body surface area burned ## Footnote Asess distal neurovascular status in burned extremities Assess for signs of smoke inhilation and upper airway injury If burns involve the eye (follow the visual disturbance standard) AND If burns involve the eye and it's swollen shut THEN leave them shut
42
# Burns (Thermal) Standard Utilize the Rule of Nines to?
Estimate % of BSA burned
43
# Burns (Thermal) Standard Utilize the Parkland Burn Formula
44
Fracture Identification
45
Wound + Injury Identification
46
Wound + Injury Identification 2
47
# Suctioning - Treatment Age Dose Max Dose Dosing Interval Max # of doses
48
# Burns (Thermal) Standard If administering oxygen what should you do in case of facial burns?
You can apply gause underneath the edges of the O2 mask to help with pain + irritation
49
# Burns (Thermal) Standard Guideline - what should you do if you suspect carbon monoxide/cyanide poisoning? ## Footnote What do you do for burns covering LESS than 15% of the BSA?
Administer High concentration of O2 ## Footnote cool burns but limit it to LESS than 30min to prevent hypothermia!
50
# Burns (Thermal) Standard Cover all 1st degress burns with? | Cover all 2nd degree burns estimated to involve LESS than 15% of BSA% ## Footnote Cover all 2nd degree burns estimated to involves GREATER or EQUAL to 15% of BSA?
With MOIST sterile dressing and a dry sheet or blanket | With MOIST sterile dressing and a dry sheet or blanket ## Footnote With DRY sterile dressing or sheet
51
# Cold Injury Standard
52
# Burns (Thermal) Standard How do you re-moisten the dressing if required to cool the burn? | What do you do if the pt begins to shiver or hypotension develops? ## Footnote Cover all 3rd degree burns with?
Take the dry sheet/blanket off and re-apply saline to the previously applied dressing | Discontinue cooling efforts ## Footnote A DRY sterile dressing or sheet
53
# Burns (Thermal) Standard How do you dress the digits? | What do you do with blisters?
Individually | Leave them intact
54
# Burns (Thermal) Standard What problems should you prepare for? | What else should you do for the pt?
Airway obstruction Respiratory distress/arrest Agitation or combativeness Bronchospasm - if airway burns Orolingual/laryngeal edema - if airway burns | Keep them warm
55
# Cold Injury Standard What's the 1st thing you should do if the patient is in the cold? | When do you do this?
Remove them from it - after primary - AND if the patient is trapped then use blankets to prevent heat loss
56
# Cold Injury Standard What LIFE/LIMB/FUNCTION threats are you considering? ## Footnote What shall you attempt to DETERMINE?
Severe hypothermia Severe frostbite Underlying disorder/precipitating factors like DDX list Alcohol, BGL, Truama, etc. ## Footnote Duration of exposure AND Type of exposure
57
# Cold Injury Standard Guideline - for a pt with known or suspected hypothermia you SHALL ## Footnote Guideline- What core temp do you assume a pt is at if they are not really shivering and begining to deteriorate?
Check pulse and respirations every 10 SECONDS! ## Footnote 32 degrees celcius
58
# Cold Injury Standard What shall you do with respect to the SECONDARY survey? ## Footnote What are the severities of frost bite/how do they differ?
Epose ONLY areas being examined then cover asap Attempt to determine hypothermia if it's known/suspected Attempt to determine the severity of frostbite ## Footnote Frostnip - mild blanching of skin Superficial frostbite - Skin waxy/white and supple Deep frostbite - Skin cold, hard and wooden
59
# Cold Injury Standard What do you do with frozen clothing? | What are the identifiers for severe hypothermia? ## Footnote For Mild-Moderate Hypothermia (shivering present), you shall?
You leave until thawing occurs AND remove any wet or constrictive clothing or jewelry | no shivering present, unconcious pt with cold stiff limbs, slow/no HR+RR ## Footnote Wrap the pts body/affected parts in a blanket or foil rescue blanket AND Provide external warming to axillae, groin, neck, and head - using hot pack/hot water bottles
60
# Cold Injury Standard What shall you do for a pt with severe hypothermia? | What do you NOT do to prevent a cetain heart rythym?
Wrap the pts body/affected parts in a blanket or foil rescue blanket AND | Vigorously suction - prevents ventricular fibrillation
61
# Cold Injury Standard Guideline - does any equipment NOT work on a pt due to the cold?
The SPO2 would only pick up poor/reduced peripheral circulation due to the pt's cold extremities.
62
# Cold Injury Standard If the pt has frostbite what do you do to the affected parts? | What do you NOT do? ## Footnote What do you do blisters and digits?
Wrap the pts body/affected parts in a blanket or foil rescue blanket making sure to cover and protect the part | Do NOT rub or massage the skin ## Footnote Leave the blisters intact AND wrap the digits seperately
63
# Electrocution/Electrical Injury Standard How many min apart do you continue to asses the distal neurovascular status in the affected extremity? ## Footnote What POTENTIAL PROBLEMS shall you prepare for?
Every 10min ## Footnote Dysrhythmias Extremity neurovascular compromise
64
# Electrocution/Electrical Injury Standard What do you do if the pt is touching a potential energized souce? | If there's a lightning strike ## Footnote What do you attempt to DETERMINE?
Make no attempt to touch the source or the pt | focus efforts on those who are VSA - high potential for resuscitation ## Footnote The type of current. AND The voltage
65
# Electrocution/Electrical Injury Standard What LIFE/LIMB/FUNCTION threats are you considering? ## Footnote What do you asses for in signs of significant electrical injury?
Cardiopulmonary arrest Dysrhythmias Extremity neurovascular compromise Multiple and/or Severe truama Seizures Significant internal tissue damage ## Footnote 1- Burns 2- Cold/mottled/pulseless extremities 3- Dysrhymias 4- Entry/Exit wounds 5-Muscle spasms 6-Neurological impairment 7-Shallow/irregular respirations
66
# Extremity Injury Standard What are you assessing before and after splinting? | What do you do with joint injuries? ## Footnote What do you do if there's no pulse or the extremity is severely angulated?
Assess distal CSM (circulation, sensation, movement) | Splint as found ## Footnote Apply gentle traction - if there's any resistance or severe pain then splint as found
67
# Extremity Injury Standard What do you do for open or closed femur fractures? | What do you do if the injury affects a joint? ## Footnote What shall you do in cases with open fractures?
Splint with traction splint UNLESS the limb is partially amputated | Immoblize above and below the injury ## Footnote If there's gross contamination then irrigate with saline or sterile water AND Cover end with moist sterile dressings and/or padding
68
# Extremity Injury Standard After splinting the pt, what can you do for the extremity? | If adequate circulation/sensation is absent after splinting then? ## Footnote When do you re-assess distal neurovascular status if the status was compromised on initial assessment.
Elevate if practical AND Consider application of a cold pack | Re-manipulate the extremity if possible to restore neurovascular status
69
# Extremity Injury Standard Guideline - How should you splint children if splints don't fit? ## Footnote Guideline- what do you do with respect to fractured femurs or tibias?
Splint body part to body part with pads in between (eg. arm-trunk or leg-leg) ## Footnote Stablize to the uninjured leg prior to tranfer to a spinal board/break-away stretcher Log roll onto the uninjured side
70
# Foreign Bodies (Eye/Ear/Nose) Standard What do you adivse the pt? | What do you inspect the affected area for? ## Footnote What shall you do if the foreign body is in the eye
NOT to attempt to remove/STOP attempting Injury Bleeding AND Discharge | Foreign body ## Footnote Follow the 'Blunt/Penetrating Injury Standard - Eye Injury' AND flush the affected eye IF penetration of the globe is NOT suspected AND Use a wet cotton-tip swab or gause to attempt manual removal if the object is not on the cornea AND is visible
71
# Foreign Bodies (Eye/Ear/Nose) Standard If the foreign body is in the ear? | You should consider the potential of ## Footnote What do you do?
a perforated ear drum if a blunt/penetrating object was inserted ## Footnote Leave the object in place and support/cover
72
# Foreign Bodies (Eye/Ear/Nose) Standard If the foreign body is in the nose?
Leave the object in place
73
# Hazardous Materials Injury Standard What LIFE/LIMB/FUNCTION threats do you consider?
If there's chemical in the eye - vision loss Burns Systemic toxicity secondary to chemical absorption through the skin
74
# Hazardous Materials Injury Standard Who should you consult for potential exposure of hazardous materials?
CANUTEC
75
# Hazardous Materials Injury Standard What should you attempt to determine ## Footnote Guideline - when attempting to determine the type and concentration of the hazardous material use what resources?
The type and concentration of the hazardous material and duration of exposure ## Footnote Allied emergency services Bystanders CANUTEC Resources - CANUTEC Emergency Line - Transport Canada Emergency Response Guidbook Dangerous goods placard or product code number Material Safety Data Sheet Poison Control Centre
76
# Hazardous Materials Injury Standard What do you do with contaminated clothing or jewlery? | What do you do before leaving the scene? ## Footnote What do you do if there's chemical injury to the eye?
Attempt to remove | Attempt decontamination ## Footnote Assess as per the 'Visial Disturbance Standard' AND Advise the pt to remove contact any contact lens if lens is readily removable
77
# Hazardous Materials Injury Standard If there's a chemical injury to the extremity? | Solid, powdered hazardous materials get ? if on the pt ## Footnote Attempt to follow whose procedures?
Assess distal neurovascular status in affected extremity | Brushed off or manually removed ## Footnote first aid and decontamination procedures outlined in the Transport Canada Emergency Response Guidebook
78
# Hazardous Materials Injury Standard What do you do with with the exposed site? | 3 ## Footnote How much time do you irrigate the burn it's is known to be alkali?
Irrigate the site using large volumes of cool NOT cold water AND DON'T do that If the chemical is water-reactive AND Have the irrigation solution contain rinse water if possible ## Footnote 20min AND only if patient is stable, try to irrigate en route too
79
# Hazardous Materials Injury Standard If the pt is stable AND the burn is known to be acid in nature, you irrigate for how long? | If the chemical is unknown how do you proceed? ## Footnote What do you do if there are still particles stuck to the skin after irrigation?
10min at scene | Irrigate for a minimum of 20min at scene ## Footnote You attempt manual removal then cover affected areas with wet dressing and/or towels
80
# Hazardous Materials Injury Standard What are the 4 things to remember with respect to eye irrigation? | What position should the pt be in if 1 eye is affected vs when 2 eyes r? ## Footnote What other STANDARD care should be provided?
Attempt to utilize eye wash station/equipment if available at scene Advise the pt NOT to rub their eye Manually open eye lids if required Attempt to irrigate AWAY from tear duct(s) | 1 eye - with the affected side down 2 eyes - supine ## Footnote Birn care as per the 'Burns (Thermal) Standard
81
# Hazardous Materials Injury Standard Who should you notify and what should you be doing after the call?
Notify the receiving facility of the hazardous material exposure and associated decontamination effrots via the 'Reporting of Patient Care to Receiving Facility Standard' AND Decontaminate immediately after if there's gross contamination of ambulance or self
82
# Soft Tissue Injuries Standard Consider what kind of injuries? ## Footnote Guideline-How to apply proper well-aimed direct pressure?
Underlying injuries to depp structure like nerves, vessels, or bones ## Footnote expose the wound cavity Attempt to visualize the source of bleeding inside the wound cavity Clear away blood/debris to better visualize Be firm and aggressive in applying pressure knowing that could cause local tissue damage Apply pressure with accuracy to directly and firmly cover a SMALL surface area
83
# Soft Tissue Injuries Standard What are the 3 steps for wound hemorrhage control if the wound is located on an extremity? | If the wound is located in a junctional location? ## Footnote (head, shoulders, armpit, neck, pelvis, groin)
1 - apply well aimed direct digital pressure at the site of bleeding 2 - Apply a tourniquet, apply a 2nd if the 1st fails or cannot be used 3 - pack the wound with hemostatic dressing (or standard gauze - if hemostatic was unavailable or contraindicate) AND maintian pressure while securing a pressure dressing ## Footnote 1 - Apply well aimed direct digital pressure at the site of bleeding AND 3 - Pack the wound with hemostatic dressing (or standard gauze - if hemostatic was unavailable or contraindicated) AND maintian pressure while securing a pressure dressing
84
# Soft Tissue Injuries Standard What are the 3 steps for wound hemorrhage control if the wound is in the hollow spaces of the skull, chest, or abdomen?
1- Apply manual pressure with a flat palm and a hemostatic dressing where available/appropriate or standard gauze 2- Do NOT pack dressings of any kind into the hollow spaces 3- Do NOT insert fingers into the hollow spaces
85
# Soft Tissue Injuries Standard - Use of a Tourniquet Where do you place/not place them? | Can it be removed? ## Footnote What and where do you document?
Place - over large muscle mass Not place - joints or twinned long bones | NO, it shouldn't be removed in the pre-hospital setting ## Footnote The time it was placed and on the ACR AND to the receiving facility at transfer of care
86
# Soft Tissue Injuries Standard - Use of a Tourniquet Can you cover it? | What do you remember to do if there's an MCI? ## Footnote What happens if the 2nd tourniquet fails?
NO, do not cover it once in place | Document the time it was placed BOTH on the tourniquet AND and patient ## Footnote Move immediately to use of pressure and hemostatic dressings
87
# Soft Tissue Injuries Standard - Use of Hemostatic Dressings What do you do when packing junctional OR extremity wounds?
1- maintain pressure continuously 2- ensure wound cavity is completely filled with densely packed dressing material 3- Do NOT remove the packed dressings AND do NOT apply subsequent dressing on top
88
# Soft Tissue Injuries Standard What do you do about contaminants and embedded objects? | What do you do in a stable pt? ## Footnote If there are impailed objects, you should do what during injury care?
Attempt removal of large surface contaminants AND Leave embedded objects in place | Cleanse injury surfaces using saline or sterile water ## Footnote Stabilize
89
# Soft Tissue Injuries Standard What do you do with protruding tissue/organs? | What do you do with open wounds? ## Footnote What do you do with the digits?
Cover with non-adherant materials (moist sterile dressings or plastic wrap) | Dress and bandage prior to splin application ## Footnote Wrap/dress them individually leaving space for the fingertips to observe for nerovascular status - - loosen bandages to restore status/activity
90
# Submersion Injury Standard
91
# Submersion Injury Standard Guideline - The lef-sided positioning with regards to atrial gas embolisms is | What's the 1st thing you do coming to scene with submersion situations? ## Footnote Should you participate in the rescue?
Recommended for other reasons like the reduction of aspiration risk (it hasn't been shown to offer advantages to impede movement of embolism to the head) | Rquest appropriate personnel to carry out rescue operations ## Footnote NO, make no attempt
92
# Submersion Injury Standard What are the LIFE/LIMB/FUNCTION threats you're considering? ## Footnote What are you considering Specific to Scuba-diving?
Asphyxia Aspiration Hypothermia Pulmonary Edema Underlying disorders that could have precipitated events DDX (drug/alcohol consumption, hypoglycemia, cardiac, truama) ## Footnote Barotruama - (ears, sinuses, pneumothorax) Decompression sickness Aterial ger embolism
93
# Submersion Injury Standard Attempt to determine?
Duration of submersion Water temperature What the water contains (pollutants, debris, chemicals)
94
# Submersion Injury Standard - Scuba-diving Attempt to determine? | Indication of possible gas embolus? ## Footnote Indication of possible decompression sickness?
Number, depth, and duration of dives Rate of ascent When the symptoms occured | If symptoms arose underwater, upon surfacing, or within minutes ## Footnote If symptoms occur more than 10min after surfacing
95
# Submersion Injury Standard - Scuba-diving How do you position the pt if an air embolism is suspected AND they're on a spinal board or break-away stretcher? | And their LOC is declining ## Footnote Prepare for...?
Do NOT elevate the head 30 degrees ## Footnote Tension pneumothorax

BLS PCS Standards + General (12 decks)

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