Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
223 Cards in this Set
- Front
- Back
Scene Size up: Steps
|
1. Person (EMT)
2. “What happened to you?” 3. “Nothing on Me (glove up) 4. Are there more (patients) 5. Dead or Alive 6. Am I in a fix (Urban) |
|
After Scene Size Up?
|
Gain Consent and Control
|
|
Life Threats: ABCDEF
|
1. Airway
2. Breathing 3. Circulation/Bleeding 4. Disability/Decision (MOI = Mechanism of Injury) 5. Environment 6. Fast or Slow (load n go, stay n play) |
|
Vital Signs
|
LOR = Level of Responsiveness
• A+O x (1-4) Person→Place→Time→Event o Verbally o Pain o Unresponsive HR = Heart Rate • BPM (Beats per minute) 15 sec x 4 • Quality – Strong/Weak, Bounding/Thready • Rhythm – Regular/Irregular RR= Respiratory Rate • Deep/Easy • Labored/Unlabored • Wheeze • Prod. Cough SCTM =Skin • Color/Pink/Pale • Temp/Warm/Cold • Moisture/Dry/Clammy 02 = Oxygen • Pulse-oximotor, O2 reading <80 = Bad! • Carbon monoxide poisoning Temperature • Core temp = rectal thermometer Pupils • PERRL • Pupil, Equal, Round, Reactive to Light • Unresponsive pupil dilation to neurological trauma, drug use, blindness etc BP = Blood Pressure • Diastolic Pressure = Consistent • Systolic Pressure = Spike • 120/80 = SP/DP mmHg • Auscultation= Listen o Listen with stethoscope o Listen for Beat (Systolic) o Listen for silence (Diastolic) • Palpation = Feel o Use BP cuff o 110/P • Estimation = Guess o 1. Pedal Pulse o 2. Radial o 3. Brachial (Arm pit area) o 4. Femoral (Groin) o 5 . Carotid |
|
Head to Toe Examination
|
Palpate and examine from Head, Shoulders, Chest, Abdominal, Genittal
|
|
SAMPLE Patient History:
|
S=Symptoms
A= Allergies • Any? Have you been exposed? What happens when you’re exposed? M= Medications • Prescriptions, vitamins, supplements, drugs/alc P= Past medical history L= Last ins/outs, Drinks, Eats, urination/defecation E= Events leading up to incident |
|
SOAP Note Format:
|
STORY:
1. “I have a 25 year old MALE whose C.C is PAIN IN RIGHT ELBOW 2. Pt. states, “sledding, fast, tumbled at speed” (MOI) OBSERVATION: • H TO T i. Pt. was found LYING ON BACK IN SNOW ii. Head to Toe Reveals 2” Bruise Right ELBOW, Right KNEE TENDERNESS iii. No Other Injuries • VITALS i. LOR: A+O X 4 ii. HR 68/ST/REG iii. RR 16/UNLAB/REG iv. SCTM: P/W/D v. Pupil: PERRL vi. T: None • SAMPLE i. S:No other symptoms ii. A: allergic to Ibuproffen/No exp./ Sev. iii. M: “G” drug for Diabetes iv. P: Diabetic v. L: Good/normal vi. E: Good/normal ASSESSMENT • +MOI • INJ (R) Elbow • INJ (R) Knee PLAN • B. Board • Splint Elbow • Support Knee |
|
Negligence
|
• Duty to act
• Breech of Duty • Physical or Psychological Injury • Cause: Omission/Commission ETOH = Alcohol Slander/Libel |
|
Types of Bleeds
|
• Capillary: Oozing, not concerned B.L
• Venous: Veins return blood except for Pulmonary o Dark colored, not a lot of O2 o Slow bleeding, not under pressure, mild concern • Arterial: carry o2 blood to heart o Bright, spurting, great concern o Stabbing, vehicular accident |
|
How to treat bleed?
|
• APPLY PRESSURE- From Patient
• Elevate area • Still bleeding – Apply more pressure, pressure bandage Tourniquet • Wide bandage • Tie proximal to wound • Use stick/pen, fold over • BP cuff = good tourniquet |
|
MAST?
|
Military Anti Shock Trousers
• Used for peeps who need BP elevated • Used for bleeding control • Pregnant women, head injuries, people in shock, lower extremity bleeding • Until Systolic P >= 100, or Velcro cracks |
|
Shock? Types?
|
Results from inadequate perfusion
Perfusion is soaking organs/systems w/ o2 • Hypovolemia = low volume of fluids • Cardiogenic = Heart attack • Vasogenic = vasodilation of veins/arteries, BP drops, severe allergic reaction o Anaphylaxis o Spine Injury o Infection (Systemic, Sepsis) o Pyschogenic (mind, not REAL shock) Mild Compensatory • Signs/Symptoms o Nausea o ^HR, ^ RR o Pale, Clammy, Cool o BP no change o Pupils N.C o Temp N.C o Syncope = fainting • Treatment o Elevate feet o Wilderness = Water o Tx (treat) cause o Warm, provide 02 o Lay on Ground, HR = X o Stand him up, 2 min, HR = X + 30 (Orphostatic, Mild) Decompensatory • S/S o HR ^, weak, thready o RR, ^, fast shallow o BP drop o T, P = same • Treatment = Same as M.C, EVAC from wilderness Eventually, irreversible, “circling the drain” = Dead • Slow P • HR ^ • Erratic RR • BP v |
|
CPR
DO not start when... STOP when |
• Life
• Unsafe • Lethal Inj. • Dep. Lividity • Rigor Mortis • DNR Stop: • Life • Safe • Exhausted • Pronounced Dead • Wilderness = 30 minutes |
|
Hypothermia
|
• Withhold compressions in severe case
o Resc. “B” • Avalanche o “A” step concern • Lightning o “B” Step |
|
RIB fx: S/S? Tx?
|
• Pain/pain on breathing
• Bruising/ S.O.B • Croupades, rattle/crackle Rib Tx (treatment) • Semi-cirm. Tape • Ace/02 • Sling/Swattle • Breath |
|
Flail Chest? TX?
|
Flail Chest =Multiple breaks in multiple places
• Pain/D.O.B, S.O.B (dyspnea) • Soft section • Paradoxical movement/breathing = late onset/sign F.C Tx • Roll onto padding/Bulky Dressing • Lie on affected side • Non Steriodal Anti Inflamatory Drug (Ibuprofen) • Evac! |
|
Sucking Chest wound/Open Chest? S/S? TX?
|
• S/S
o Notice hole, large knife, gunshot, entrance/exit o Some blood, not a lot of arteries/veins o Sound of air, DOB, SOB • TX o Gloved hand o Occlusive dressing (plastic bag) to stop air passage, tape down over wound, 4 sided o 02/monitor o rapid EVAC! |
|
Closed Chest Wound?
Pneumothorax? Hemothorax? |
• Trauma creates opening on inside, tear in visceral plura space, air/blood come in
o Pneumothorax = air seep o Hemothorax = blood seep, internal bleeding o Spontaneous pneumothorax • S/S o DOB, SOB o Shallow resp. o Diminished Lung sounds, lung wont fully inflate -> absent o Collapsed Lung =tension pneumothorax • Cyanatic = blueish tinge • Distension jugular vein = JVD • Deviated trachea • Tx o Position of comfort |
|
Lung Sounds: Vitals
|
• Listen ½ down clavicle
• Right below armpit • Below scapula • Normal = equal, bilateral |
|
HIPAA
|
Health Insurance Portability and Accountability Act
Limits availability of patient Info/privacy |
|
CQI
|
Continuous Quality Improvement:
System of Internal/External reviews |
|
Abduction
|
Motion away from midline
|
|
Adduction
|
Motion toward midline
|
|
Alveoli
|
Air sacs in lungs ex. o2, co2
|
|
Anterior
|
Front surface
|
|
Posterior
|
Back Surface
|
|
Aorta
|
Principal artery leaving left side of body, carrying 02 blood through body
|
|
Lateral
|
Outside of body
|
|
Medial
|
Inside of Body
|
|
Proximal
|
Close to trunk
|
|
Superior
|
Close to head
|
|
Inferior
|
Near feet
|
|
Ventral
|
Belly side of patient
|
|
Dorsal
|
Spinal Side
|
|
Medial
|
Inner structures
|
|
Prone position
|
lying face down
|
|
Fowlers Position
|
Knees Bent, sitting slightly
|
|
Supine Position
|
Lying face up
|
|
Shock Position
|
Face up, Legs up
|
|
Recovery Position
|
Lying on side
|
|
Flexion/Extension
|
Bending/Straightening of joint
|
|
Abdominal is divided into Quadrants
|
RUQ = Gallbladder, Liver
LUQ = Spleen/Stomach RLQ = Illiac Crest/Appendix LLQ = Colon/small intestine |
|
Trendelenburg Pos.
|
Body on backboard/Shock
|
|
Temporal Region
|
Side of skull
|
|
Radius
|
Anterior bone of arm
|
|
Ulna
|
Posterior bone of arm
|
|
Thyroid Cartilege
|
Adam's apple
|
|
Cricothyroid cartilege/ membrane
|
Below A.A / Thin tissue joins Thy. Cart and Cri. Cart
|
|
Sternonucleidomastoid Muscle
|
Side of neck muscle
|
|
Trachea
|
Below Thy Cart, windpipe, upper part of esophogaus
|
|
Spinal Column:Hight to Low
|
Cervical (C1-7)
Thoracic (7-12) Lumbar (12-17) Sacrum(17-22) Coccyx(22-24) |
|
Thorax
|
Chest cavity that contains heart
|
|
Xiphoid Process
|
End edge of sternum
|
|
Diaphragm
|
Muscular dome that forms inferior boundary of thorax
|
|
Angle of Louis
|
2nd Rib
|
|
Costal Arch
|
Arch of Ribs
|
|
Femor
|
Thigh Bone
|
|
Illium/Iliac Crest
|
Inner/Outer Hipbone
|
|
Humerus
|
Upper arm bone
|
|
Exhaled air
Inhaled air |
16% o2, 79% nitrogen
21% o2, 78% nitrogen |
|
Brachial Artery
|
Major vessel in upper extremity, blood to arm
|
|
Autonomic nervous system
|
regulates functions, digestion, sweating
|
|
Carotid Artery
|
supplies blood to head and brain
|
|
Central Nervous System
|
Brain and Spinal chord
|
|
Diastole
|
Relaxed heart pulse, ventricles
|
|
Femoral Artery
|
Artery of thigh, supplies blood to lower abdominal, lower leg
|
|
Epiglottis
|
thin valve that allows area, not food
|
|
Foramen Magnum
|
Large opening base of skull, connects brain to spinal chord
|
|
Inferior Vena Cava
|
one of two largest veins, carries blood from lower extremities
|
|
Pleura
|
Serous membrane covering lungs, lining thoracic activty
|
|
Perfusion
|
Circulation of oxygenated blood
|
|
Auscultation
|
Method listening to sounds with stethoscope
|
|
A+O
V P U Scale |
assesses level of responsiveness
|
|
Bradycardia
|
slow heart rate < 60
|
|
C.C?
|
Cheif Complaint
|
|
Cyanosis
|
Blueish/Gray tinge from lack of o2 in blood
|
|
Diaphoretic
|
Profuse sweating
|
|
Labored Breathing
|
breathing takes greater effort, grunting, stridor
|
|
OPQRST
|
Onset
Provocation Quality Region Severity Timing of pain |
|
Hyper/Hypo-tension
|
Higher/Lower BP
|
|
Stridor
|
harsh sound of obstructed airway
|
|
Systolic Pressure
|
Increased pressure along arteries with each contraction (systole) of ventricles
|
|
Adequate RR for adults
|
12-20 breath/min
|
|
Hypoxia
|
Body tissues/cells not enough o2
|
|
Oropharyngeal adjunct
|
Oral Airway passage, prevents tongue from blocking airway in unconscious patient
Measured from mouth to ear |
|
Nasopharyngeal adjunct
|
Used if gag reflex intact, through nose
|
|
Suctioning
|
Used to clean vomit/liquid secretions to clear passage
|
|
O2 tank procedure?
set at __ psi |
Make sure pressure regulator intact, pin index safety pin match up
between 40-70 psi |
|
Nasal Cannulas/nonrebreathing masks are used to deliver O2 in field...
What o2 level? |
15 L/min, 90% o2
|
|
CSM for fingers and toes
|
Circulatory, Sensory, Motion
|
|
BVM
|
Bag valve Mask
|
|
Nosebleeds
|
Pinch cartilege
place gauze, push up Causes= digital trauma altitude Lean forward |
|
Mouth to Mouth delivers _ % o2
BVM with o2 resovoir delivers _ |
55%
100% |
|
Agonal respirations
|
gasping breaths, heart stopped
|
|
Apnea
|
period of not breathing
|
|
Aspiration
|
introduction of vomitus / foreign material into lungs
|
|
Ataxic respirations
|
Ineffective/irrelgular respirations
|
|
Bilateral
|
Bodypart/condition on both sides of body
|
|
Dyspnea
|
Difficulty breathing
|
|
Gastric Distention
|
Air fills stomach, result from high vol and pressure during artificial ventilation
|
|
Perfusion
|
Circulation of oxygenated blood
|
|
Stridor
|
harsh sound of obstructed airway
|
|
Systolic Pressure
|
Increased pressure along arteries with each contraction (systole) of ventricles
|
|
Auscultation
|
Method listening to sounds with stethoscope
|
|
A+O
V P U Scale |
assesses level of responsiveness
|
|
Adequate RR for adults
|
12-20 breath/min
|
|
Bradycardia
|
slow heart rate < 60
|
|
C.C?
|
Cheif Complaint
|
|
Hypoxia
|
Body tissues/cells not enough o2
|
|
Cyanosis
|
Blueish/Gray tinge from lack of o2 in blood
|
|
Oropharyngeal adjunct
|
Oral Airway passage, prevents tongue from blocking airway in unconscious patient
Measured from mouth to ear |
|
Diaphoretic
|
Profuse sweating
|
|
Nasopharyngeal adjunct
|
Used if gag reflex intact, through nose
|
|
Suctioning
|
Used to clean vomit/liquid secretions to clear passage
|
|
Labored Breathing
|
breathing takes greater effort, grunting, stridor
|
|
OPQRST
|
Onset
Provocation Quality Region Severity Timing of pain |
|
O2 tank procedure?
set at __ psi |
Make sure pressure regulator intact, pin index safety pin match up
between 40-70 psi |
|
Nasal Cannulas/nonrebreathing masks are used to deliver O2 in field...
What o2 level? |
15 L/min, 90% o2
|
|
Hyper/Hypo-tension
|
Higher/Lower BP
|
|
CSM for fingers and toes
|
Circulatory, Sensory, Motion
|
|
Backboard
|
device used to provide support to patient suspected of having hip, pelvic, spinal, lower extremity injury
|
|
Apnea
|
Not breathing
|
|
Bilateral
|
Injury on both sides
|
|
agonal respirations
|
occasional gasping breaths
|
|
Exhalation
|
diaphragm, intercostal muscles relax, air escapes
|
|
Gastric Distention
|
Air fills stomach, results from high vol and press. during artificial ventilation
|
|
Hypoxia, Hypoxic drive
|
Body tissues not enough o2
chronic low levels stimulate respitory drive |
|
Dyspnea
|
Difficulty breathing
|
|
Ischemia
|
Lack of o2 that deprives tissues, possible stroke
|
|
Nasal Cannula
|
oxygen delivered through nose, 24-44% supplemental o2
|
|
Sellick maneuver
|
prevents gastric distention, pressure applied to cricoid cartilege
|
|
Nonbreathing mask
|
Mask + Reservoir bag = 90% o2
|
|
Crepitus
|
Grinding of bone
|
|
coagulate
|
clot forming to plug opening in blood vessells
|
|
DCAP
BTLS |
Deformities, Contusions, Abrasions, Punctures
Burns, Tenderness, Lacerations, Swelling |
|
BSI
|
Body Substance Isolation: Infection control safety precaution; gloves, etc
|
|
CSM
|
Circulation, Sensation, Motion
|
|
OPQRST
|
Onset, Provoking fac.s, quality, radiation, severity, time
|
|
Paradoxical Motion
|
Opposite motion of chest (flail)
|
|
Index of Suspicion
|
concern for potentially serious underlying and unseen injuries
|
|
Kinetic Energy
|
1/2mv^2
|
|
Newton's laws
|
1=rest stays rest
2= F equals M x A 3= Every action, equal opposite reaction |
|
coup-countrecoup brain injury
|
force to head, injury on opposite side
|
|
Movement of bloodflow in heart...
|
Oxygen poor blood travels down Superor Vena, up from Inferior Vena
Into Right Atrium Into Right Ventricle, out Left pulmonary Artery Blood flows in Left pulmonary vein into left atrium into left ventricle out of aorta |
|
Five types of blood vessels
|
Arteries
Capillaries Arterioles Venules Veins |
|
Body will not tolerate ___% acute loss of blood
|
20 % volume
|
|
Bleeding is serious when:
|
Significant MOI
Poor appearence symptoms of shock (hypoperfusion) Significant blood loss Uncontrolled bleeding |
|
6 Methods to control bleeding
|
Pressure
Elevation Dressing Points Splinting PASG |
|
Bleeding head/nose? Worst case?
|
WC = Skull Fracture
|
|
Signs of Internal bleeding
|
Vomiting Blood
Black Tarry Stool Coughing up Blood Distended abdomen Broken Ribs |
|
Aorta
|
Main artery, recieves blood, delivers from left ventricle to all other arteries
|
|
Arterioles
|
Smallest branches of arteries leading to the vast network of capillaries
|
|
Hematoma
|
Mass of blood in the soft tissue
|
|
Hypovolemic Shock
|
low blood volume, due to massive internal or external bleeding results in inadequate perfusion
|
|
PASG
|
Pneu. Anti Shoc Garm
|
|
Anaphylactic Shock
Signs |
violent reaction to substance to which has been sensitized
Flushed, itched, burn hives edema pallor Dilation drop BP Dizziness Sneezing Tightness Caused by Injections Stings Ingestion Inhalation |
|
Sensitization
|
becoming sensistive to substance that wasnt before
|
|
Septic Shock
|
insufficient vol of fluid, complication of surgery
|
|
Cardiogenic Shock
|
Inadequate heart function
|
|
Hypovolemic Shock
|
Loss of Fluid
|
|
Neurogenic Shock
|
Damaged spine
|
|
Psychogenic Shock
|
Fainting, Anxiety, Not real
|
|
How to treat flail chest?
|
large bulky dressing 2' tape
|
|
Spontaneous pneumothorax
|
rupture of weak spot on lung, air enters plural space, maybe become tension pneumothorax
|
|
Hemopneumothorax
|
Accumulation of blood in lungs
|
|
Hemoptysis
|
Spitting up blood
|
|
Pericardium
|
Fibruous sac surrounding heart
|
|
Myocardial contusion
|
heart bruise
|
|
CNS tissues
Somatic NS Peripheral NS |
Brain and Spinal Chord
Protected by Dura Mater Arachnoid Pia Mater Somatic= voluntary activity PNS = 31 pairs of spinal nerves, 12 pairs of cranial |
|
ANS
|
sympathetic (fight or flight) system
parasympathetic (rest and recovery) |
|
Anterograde
|
cant remember events after injury
|
|
Cerebellum
Cerebral edema Meninges |
Movement
Swelling of brain Three protective layers surrounding brain |
|
Ways to administer drugs
|
Intravenous
Intramuscle Subcutaneous (beneath skin) orally sublinguaklly intraosseously (bone) transcutaneously inhalation rectum |
|
Charcoal
|
Helps bind to toxins for overdoses
|
|
6 steps before administering medication
|
order from. med control
verify dose, route check exp. date reasses vitals document |
|
Nitroglycerin
|
Treats angina
increase blood flow Dont administer is systolic is less than 100 mm Hg |
|
Hypoglycemia
|
Low blood sugar, leads to Altered Mental Status
|
|
Dyspnea can be caused by
|
Infection
Acute Pulmonary Edema Chronic Obstructive pulmonary disease spontaneous pneumothorax Pleural effusion Pulmonary Embolism |
|
Carbon dioxide retention
|
condition of chronic high blood level of co2
|
|
COPD
|
Chronic obstructive pulmonary disease
slow process if dilation and disruption of airway and alveoli, ala Emphysema |
|
pleural effusion
|
collection of fluid between lung and chest that compresses lung
|
|
Pulmonary Edema
|
buildup of fluid in lung, result of congestive heart failure
|
|
Gas exchange in lungs takes place in...
|
alveoli, thin walled air sacs next to capilaries
|
|
Brain stem senses level of ___ in arterial blood
|
Co2, stimulates breathing, if CO2 is high, breathing is more rapid and deep
|
|
Pulmonary Arteriole
Pulmonary Duct |
carries deoxygenated blood to heart
carries oxygenated blood to body |
|
In disorders of lung, one of these situations exists:
|
Pulmonary veins, arteries are obstructed from absorption, releasing from fluid, infection, collapsed air space
Alveoli are damaged and cannot transport Air passages are blocked by muscle spasm, clot Pleural space is filled with fluid, air |
|
Chronic lung disease, lungs have too much ___ IN BLOOD
|
Co2
|
|
Pneumothorax
|
accumulation of air in pleural space
|
|
OPQRST:
|
Onset
Provocation Quality Radiation Severity TIme |
|
Hypoxic drive
|
Used to low amount of o2 to breathe
too much o2- no breathe-death |
|
Acids are eliminated when
|
Co2 is eliminated-> anxiety>hyperventiliation
|
|
Peritonitis
|
Pain, tenderness, distention, caused by pus, blood, feces, urine, gastric juices, in the peritoneum
|
|
Cholecystitis
|
inflammation of the gallbladder, storage of digestive juices
|
|
Cystitis
|
inflammation of the bladder, common in women
|
|
Colic
|
acute, intermittent cramping of abdominal pain
|
|
Peritoneum
|
membrane lining the abdominal cavity and covering the organs
|
|
Renal Colic
|
Passing of kidney stone
|
|
PID
|
Pelvic inflamatory disease in women
|
|
Aneurysm
|
Swelling in the arterial wall
|
|
Hernia
|
Portrusion of an organ through a hole
|
|
Without Insulin...
|
glucose from food remains in blood and rises to high levels (hyperglycemia)
|
|
Insulin
|
hormone that is produced by endocrine glands on pancreas enabling glucose to enter cells
|
|
Type 1 Diabetes
|
Insulin dependent, usually from birth, more likely extended problems
|
|
Type 2 diabetes
|
appears later in life, non insulin dependent, but need assistance
|
|
Hyperglycemic when...
|
>200mg/dL, lots of water loss
|
|
Hyperglycemic symptoms:
|
Polyuria: frequent urination
Polydipsia: freq. drinking Polyphagia: freq. eating Diabetic Coma |
|
When burning fats, ketones and fatty acids effect...DKA s/s?
|
blood tissue, lead to acidosis, lot os acidosis = DKA
S/S Kussmaul respirations (rapid), vomit, abdominal pain, fruity breath |
|
Hypoglycemia S/S
|
Pale, clammy, rapid RR, dizzy, headache, low BP
|
|
Insulin Shock
|
Significant Hypoglycemia:
Mistaken for drunkeness, cool, rapid RR, clammy |
|
emesis
|
vomitting
|
|
diverticulitis
|
inflamation of small pockets in the colon
|
|
retroperitoneal space contains
|
pancreas, kidneys, ovaries
|
|
Acute Abdomen Symptoms
|
Local/diffuse pain
Silence, shock rapid, shallow breathing referred, distant pain Fever Hypotension |
|
ileus
|
paralysis of muscular contractions
|
|
Ectopic pregnancy
|
emergency situation, egg implanted in f tubes, when large enough ruptures tube, causing hypovolemic shock
|
|
Local cold injuries
|
frostbite = tissues freeze
frostnip immersion foot |
|
T/X for hypothermic patient?
|
stablize vitals, rewarm, prevent further heat loss
|
|
Heat Illness: Cramp, exhaustion, stroke?
|
Heat Cramp: painful muscle spasms that occur with excerise
Heat Stroke: life threatening, dry, high temp Heat Exhaustion: Hypovolemic shock via dehydration, cold clammy |
|
Air embolism
|
air bubbles (scuba)
|
|
Breathholding syncope
|
loss of conscioussness caused by decreased breathing
|
|
Embolism S/S
|
Blotching
Pink froth severe pain dyspnea dizziness |
|
Cannot lose more than ___ % of total blood
|
20
|
|
Bleeding is serious if:
|
serious MOI
bad look shock rapid blood loss |