BLS Flashcards
When must you auscultate a patients lungs?
if exhibiting signs of resp/cardio or neurological decline
When must you put a cardiac monitor on a patient?
if showing signs of resp/cardio or neurological decline
What situations warrant a cardiac monitor?
- VSA patients
- altered LOA
- syncopal
- cardiac ischemia
- major trauma/multi system
- electrocution
- submersion injury
- hypothermia
- heat illness
- abnormal vitals
- if requested by sending facility
How often must you assess vitals?
every 30 mins at minimum, or more often based on patient condition
For inter facility transfer, what 5 things must you get? (if can)
- name of sending doctor
- treatment orders from sending doctor
- transfer paper
- name of facility staff and equipment coming with pt
- name of receiving doctor/facility
How to extricate patients?
CTAS 1/2 - most appropriate lift or carry transported to and from ambulance by stretcher
CTAS 3/4/5 - most appropriate lift/carry or ambulatory assistance in cases of transfers - move pt by stretcher
What happens if patient deteriorates on route during transfer?
- go to closest facility
- alert dispatch and get them to notify receiving facility
Refusals - patient has capacity
- inform pt of condition, what happens if they refuse, advise them to go to hospital
- confirm they have mental capacity to refuse
- advise patient to call 911 if needed
- gather documentation/signatures (note: pt can refuse to sign document)
Transport of incapable pt with no consent
- pt has no capacity and delaying transport to find someone to consent on their behalf will lead to suffering
- pt currently suffering/at risk for prolonged issues if not transported
Transporting capable person without consent
- pt is suffering or at risk of
- pt unable to give consent due to language barrier or has disability preventing them from doing so
- means to find communication for consent has taken place
- delay to find proper consent will lead to further suffering for pt
- no reason to believe pt does not want to be transported
When patching to BH what are things to include?
- your level of certification
- provide report with relevant info on pt condition
- provide any other info they request
- confirm direction/orders given after BH gives them
Normal oxygen therapy standard for patients:
92-96%
What patients would you continuously provide oxygen for?
- confirmed poisoning (carbon monoxide, cyanide)
- upper airway burns
- scuba diving disorders
- cardiopulmonary arrest
- complete airway obstruction
- sickle cell anemia with vasoocclusive crisis
If pulse oximetry not working, who do we give O2 to?
- hypotensive pts
- resp distress
- pallor/ashen skin
- cyanotic
- altered LOA
- pregnancy or labour
- as well as everything above
Oxygen standard for pts with COPD
- keep oxygen between 88-92%
- if pulse oximetry not working administer oxygen at 2lpm above persons home oxygen
- if not on home oxygen, start at 2lpm and titrate by 2lpm every 2-3 mins as needed until condition improved
What are the 4 steps in field trauma triage?
- physiological
- anatomical
- mechanism
- special consideration
FTTS - Physiological criteria
1st step in determining if transporting to LTH
- if pt can not follow commands
- BP <90mmHg
- RR < 10 or >30 or <20 for infant under 1
- and less than 30 minutes to LTH
FTTS - Anatomical criteria
If they do not meet physiological, look @ following types of injuries present:
- penetrating injury to torso/head/neck/extremities proximal to elbow or knee
- chest wall instability
- crush injuries/deglovings/pulseless extremities
- pelvic fractures
- two or more proximal long bone fractures
- open/depressed skull fracture
- paralysis
If patient has unstable airway but meets criteria 1/2 for FTTS?
transport to closest hospital instead of LTH
Penetrating injuries with FTTS
if vital signs absent and no TOR granted and less than 30 mins transport to LTH regardless if airway is stable
FTTS - Mechanism of Injury criteria
- falls over 6m for adults or 3m for children
- intrusion into vehicle of 0/3m on pt side or 0.5m on any side
- ejection from vehicle or death in same compartment
- pedestrian or bicyclist struck at 30km/hr or greater
- motorcycle crash at 30km/hr or greater
What are special criteria to consider in FTTS when choosing to go to LTH?
- risk of injury increases after 55 - BP under 110 can mean shock if 65+
- if they have bleeding disorders
- burns (if trauma mechanism)
- pregnancy >= 20 weeks
Is the max time for LTH transport 30 mins?
yes unless service says otherwise
What is the general rule for utilizing air?
meet one operational and one medical criteria
What are the 4 operational criteria for calling air?
- land will take more than 30 mins to reach the scene and air can get there faster
- by land it will take longer than 30 mins to get to best hospital for pt and air can reach scene and transport quicker
- if land and air have equal times for transport, but patient needs higher level of care
- multiple pts who meet criteria and land ambulances are all utilized
What are the medical criteria to utilize air?
- shock (hypotensive, altered)
- acute stroke
- GCS under 10
- acute resp distress/failure
- lethal rhythms/STEMI
- ROSC pt
- unstable airway/airway obstruction
- abnormal pregnancy (cord prolapse, breech, limb presentation)
- twin pregnancies with active labour
- significant vaginal bleed
Any other additional reasons to call air?
- if land ambulance can not reach patient (geographic etc.) or if reports of injuries seem severe before confirming criteria
When can you wait for air?
if they are seen on the final stretch to scene
When can you meet wtih air on route?
- if they can meet along direct route of land
- if it would result in significant decrease in transport time
When can air not be used?
- at night unless landing at airports or designated helipads
- for search and rescue calls
Under what circumstances should SMR be considered?
- trauma associated with back/neck pain
- diving accidents
- explosions
- electrocution
- pedestrian struck
- penetrating trauma to head/neck/torso
- falls
- sport accidents
If patient meets mechanism for SMR, what is the next criteria to consider?
symptoms such as:
- neck/back pain
- neurological symptoms/altered LOA
- intoxication
- any distracting injuries
- high energy mechanism (falls from 3ft, load to the head, high speed MVC - 100km/hr, rollover, ejections - person hit by car)
With SMR what is important to remember in terms of elderly?
65+ falls from standing height are eligible for SMR
Use of spinal boards:
- goal to remove them once on stretcher via log roll if possible
- device can remain under pt if transport less than 30 mins
- patients with pelvic fracture should remain on spinal board/scoop
SMR and agitated patients
if patient is agitated leading to harm for pt or paramedic, apply SMR if needed to best of ability and document
When can a DNR be overlooked?
- if patient expresses the wish prior to death
- if pt states wishes that are vague and leads to question about what pt wants
- if power of attorney says otherwise
Signs of obvious death
- decapitation, transection, visible decomposition, putrefaction or
- absence of vital signs and:
- a grossly charred body
- an open head or torso wound with gross outpouring of contents
- gross rigor mortis
- dependent lividity
In all cases of death…
- confirm they are dead, treat patient and family with dignity
- follow police notification standard if foul play present
- if applicable, follow rules by coroner or person appointed by coroner
- if TOR happens en route continue to facility unless otherwise told
- document time of obvious death
In cases of unexpected death…
- notify dispatch if no police/coroner on scene
- remain at scene till coroner or police are on scene
- if police are present and have secured scene, can depart once documentation completed
In case of expected death
- advise dispatch
- get responsible person present to notify doctor or palliative care team member
- if responsible person unable, notify dispatch who will try to get doctor/member on scene
- wait on scene till they arrive or if responsible person seems okay can depart after documentation
- if police on scene and will wait can depart
- if no doctor or team member coming and no responsible person on scene, notify dispatch who will notify coroner/police
- wait till police/coroner arrive
With children, what are some important things to look for:
- change in appetite/behaviours
- excessive drooling
- inconsolable crying
- work of breathing increased
- lethargic
- increase in wet diapers
What is duty to report?
if suspicion of child in neglect/danger must tell Children’s Aid Society
- request police and do not leave child alone
What type of injuries to children should you look for?
- submersion injuries
- burns
- ingestions
- falls
- multiple bruises (unusual areas - genitals, abdomen, chest)
- deformities (especially if child under 2)
- signs of malnutrition/unkempt
- signs of shaking syndrome (blood shot eyes, marks on neck/shoulders, head injury signs)
Scene observations to note if suspected child neglact/harm
- dirty living situation
- evidence of violence (broken items…)
- animal abuse
- evidence of substance use/abuse
What are some non-physical signs to look out for in terms of child abuse?
- stories changing often
- parents vague, hostile, not caring towards child
- nature of injury inconsistent with story, child too young to get that type of injury
- recurrent injury hx
- child may be fearful of parents or protect one parent
What to do if suspecting child abuse?
- do not lead on to parents your suspicions
- transport child in all cases
- contact CAS/police
- let hospital know the situation (PHIPA overrided)
Things to remember in terms of elderly
- can present atypically
- more subject to adverse medication affects
- diminished responses to things like pain/heat
- more easily susceptible to injuries (skin tears, bruising)
When can a paramedic monitor an IV line?
- thiamine, multivitamins
- max flow rate infused up to 2ml/kg/hr up to max of 200ml/hr
- drugs within cert
- KCL for pts 18+ to max of 10mEq in 250ml bag
When can a paramedic not monitor a line without escort?
- if blood product
- if KCL given to pt under 18
- if given meds not in cert
- that needs electronic monitoring, central line or fluid infuser pump
- for neonate or child under 2
When should IV bag be changed?
with 150ml left
When would you consider possible airway obstruction?
- smoke inhalation
- anaphylaxis
- foreign body aspiration
- pharyngeal malignancy
How often do you take vital on a ROSC pt?
every 15 mins for first hour than every 30 mins after that
What are some conditions that mimic stroke?
- hypoglycemia
- drug ingestion
- infection
- hypertension emergency
For stroke patient, what should end tidal be maintained at?
35-45mmHg