ACUTE ON-FIELD CARE

Question 1

you are being called because there’s an unconscious person in the hallway just outside the AT clinic. upon approach what are your steps?

Answer 1

assume c-sp and distance obvs of area
check for safety hazards
remove anything surrounding the person
if there are bystanders ask them what happened
- approach patient, introduce yourself, state qualifications, ask for consent to help out

contact EMS immediately

Question 2

is a person who is unconscious and IS BREATHING (w/ no other life-threatening things to account for) what should you do with this person until EMS arrives?

Answer 2

put them into the recovery position on their left side

Question 3

for how long should you be checking to establish breathing and circulation?

Answer 3

10 sec

Question 4

if you were to use a suction device for a patient who has vomited, what are your measurements before you use it?

Answer 4

corner of mouth to earlobe

Question 5

before putting an OPA in an unconscious patient, what must you check first?

Answer 5

gag reflex - flicker the eyelid and if there’s no movement, you may proceed

measurements - corner of mouth to corner of same side earlobe

Question 6

for what kind of patients can you use an NPA for? what must you do first before inserting it into the nostrils

Answer 6

unconscious and responsive unconscious adults

must lubricate first and measure - nostrils to same side earlobe

it shouldn’t produce a gag reflex unless the the apparatus is too long

DO NOT USE FOR ANYONE WITH SUSPECTED HEAD TRAUMA

Question 7

for a patient who is not breathing but has a pulse - what is the most appropriate course of action?

Answer 7

rescue breaths

1 breath/ 5 sec - up to 2 mins

Question 8

what are the flow rates for each assistive breathing tool?

what also must you consider before administering oxygen?

Answer 8

(updated as of 2019):

nasal cannula (for person who can breath on their own) : 4 lpm

Resuscitation mask (unconscious patient): 6+ lpm

BVM (conscious or unconscious patients): 15 + lpm

NRB (conscious patients ONLY): 15 + lpm

regional specifications on administering oxygen (may need a physicians clearance to do or may face litigation)

Question 9

explain the protocol for obstructed airway management for a conscious patient

Answer 9

encourage coughing
if no sounds are coming out - proceed with back blows and abdominal thrusts

if you got a preggo lady or bigger person - chest thrusts at tall kneeling height

Question 10

explain the protocol for obstructed airway management for a unconscious patient

Answer 10

30 compressions and check airway for obstruction (no pulse check or breathing)

dislodge object until they can breathe on their own

Question 11

if there is hemorrhaging, how can you tell what vessels have been affected?

Answer 11

venous blood:
dark red

capillary:
reddish

arterial:
bright red and is coming out in spurts

Question 12

if direct pressure on a wound doesn’t stop hemorrhaging, what other options do you have?

Answer 12

go to pressure points (11 pressure points):

dorsalis pedis (wounds for feet) 
popliteal (wounds for lower leg) 
femoral (wound of thigh) 
femoral triangle 
radial and ulnar (wound of hand) 
brachial 
axillary 
subclavian (upper arm wounds) 
**carotid (DO NOT PUT PRESSURE ON THIS - COULD CAUSE CARDIAC ARREST)*
fascial (wound under eyes) 
temporal (wounds of the temple and scalp)

Question 13

internal hemorrhaging - what are the typical signs?

mng?

Answer 13

distention or “pressure build up” at area of discomfort

vitals: low BP

weakness (especially on affected side)

tx for shock

Question 14

an athlete comes to you super dehydrated and feeling a weakness and wooziness - they look pale, skin is cool and clammy - you suspect them in shock, but what type of shock?

Answer 14

hypovolemic - because they’re dehydrated, not enough water in the plasma to get blood to the extremities

associated with also low BP

Question 15

s/s of respiratory shock

Answer 15

decrease in ability to breathe - may be secondary to injury that impedes breathing

Question 16

what type of shock is likely to have occurred when there’s enough blood vessel dilation to cause syncope

Answer 16

psychogenic shock

Question 17

normal human body temp

Answer 17

36.8- 37 C

Question 18

s/s of shock

how to mng?

Answer 18

pale, cool, clammy skin 
weak, rapid pulse
pupils may be dilated 
shallow- rapid breathing rate 
low BP 
restlessness/excitement 

maintain body temp
comfort patient 
elevate legs (**depends on the injury)

Question 19

for a dark-skinned person, where would you look to see if there are indications from their skin as what is going on?

Answer 19

inside mouth and tongue

if they are in shock:
skin around mouth, nose and tongue would have a gray-ish cast)

Question 20

if a dark-skinned person is going through shock due to a hemorrhage, what could indicate that?

Answer 20

inside of mouth and tongue - becomes light gray

Question 21

if a dark-skinned person has a fever what other skin indications can reveal that?

Answer 21

the tips of their ears would be flushed with red

Question 22

when is compression for an acute injury contraindicated?

Answer 22

acute lower leg compartment syndrome

Question 23

you run down to the field to an athlete who’s gone down holding his arm - you arrive on the scene and suspect a humeral fracture, what are your next steps?

what must you also be concerned about with a humeral fracture?

Answer 23

get someone to bring the splint and call EMS as you stabilize the arm in the position found

check PMS before splinting

splint

check PMS after

tx for shock if necessary

additional concerns: laceration or damage to the radial nn - patient presents with a wrist drop

Question 24

when fitting a crutch on an athlete, what are the key points for proper crutch fittings?

Answer 24

1. foot of crutch is ~ 6 inches lateral of shoe and ~2inches up
2. arm pad below armpit should be 1 inch below the armpit
3. athlete should be holding the crutches such that the elbow is bent at 30 degrees of flexion

Question 25

where would you measure for adjusting the height of a cane?

Answer 25

crease of the wrist

Question 26

if the first dose of nitroglycerin is administered and there is no change in the patient’s perception of chest pain - what is another option?

Answer 26

recommended to get 160 - 325 mg of aspirin (only done once)

Question 27

what must you do first in order to assist in the administration of nitroglycerin?

Answer 27

take their BP (anything below 100 systolic is contraindicated) - this for EVERY ROUND OF NITRO GIVEN

have them semi-reclined or seated on the floor (just in case their BP goes too low)

Question 28

max dosage for nitroglycerin

Answer 28

3 doses within a 30 minute period (5 min in between dosages)

Question 29

precautions for usage of an epi-pen

Answer 29

pregnancy (can induce labour)

Question 30

the person who has already had 3 doses of nitroglycerin has another episode of chest pain - mng?

Answer 30

check BP and administer another 3 doses (considered a new episode)

Question 31

what are the rules of nines?

Answer 31

estimates the amount of body surface that has been burned (when communicating with advanced medical personnel) - measured in %

Question 32

which regions and their numerical values are considered in the rule of nines for adults

Answer 32

head - 9% 
arms - 9 % each 
trunk - 18 % 
legs - 18 % each 
lady/man parts - 1% 

*palm is considered 1%

Question 33

which regions and their numerical values are considered in the rule of nines for children?

Answer 33

head - 18 %
trunk - 18 %
arms - 9 % each
legs 14 % each

Question 34

when transporting a patient on a stretcher, what should you be leading with?

Answer 34

patient’s feet first (unless going up a hill or up stairs)

Question 35

what to look for a suspected electrical burn?

Answer 35

typically has an entry and exit wound - cover burns with non-stick sterile dressing and tx for shock