BLS Flashcards
patient assessment standard: these types of calls typically warrants cardiac monitor?
-VSA
-unconsious or altered level of consiousness
-collapseor syncope
-suspecetd cardiac ischemia
-moderate to severe shortness of breath
-CVA (stroke)
-overdoese
-major or multisystem trauma
-electrocution
-submersion injury
-hypothermia,heat
exhaustion
-abnormal vital signs
oxygentherapy standard continously administer high concentration oxygen for?
(paragraph 2)
-confirmed or suspected carbon monoxide toxicity or gas exposure
-upper airway burns
-scuba diving related disorders
-ongoing cardiopulmonary arrest (VSA)
-complete airway obstruction
-sickle cell anemia with suspected vaso occlusive crisis
oxygen therapy standard:
If pulse oximetry equipment is not working administer high oxygen to all patientsin paragraph 2 and as well as the ones with these critical findings
-age specific hypotention
-respiratory distress
-cyanosis, ashen colour, pallor
-altered level of consiousness
-abnormal pregnancy or labour
oxygen therapy and COPD
-titrate oxygen administration to achieve saturation 88-92%
-if pulse oximetry not working,administer oxygen by nasal cannula with with oxygen flow at 2 litres per minute above the patients home oxygen, or 2 Litres per minute if patient not on home oxygen.
-maintain oxygen flow rate at the level of the patients status improves
-increase 2 L a minutes above starting level every 2-3 minutes if the patient deteriorates or feels worse
-be prepared to ventilate
FTT standard ( field trauma triage)
Physiological criteria: paragraph 1 and paragraph 2
Paragraph 1
1: patient does not follow commands
2:systolic pressure <90mmHg
3: RR <10 or > or equal to 30 breaths per minute or need for ventilatory support
Paragraph 2
If the patient meets the physiological criteria listed in paragraph 1 AND land transfer time to LTH is < 30 minutes then take them there
FTT ( if the patient does not meet the criteria in paragraph 1&2 assess for these anatomical criteria
Paragraph 3
- any penetrating injuries to the head neck or torso and extremities proximal to elbow or knee
-chest wall instability or deformity eg: flail chest
-two or more proximal long bone fractures
- crushed, de gloved, mangled or pulseless extremity
-amputation proximal to wrist or ankle
-pelvic fractures
-open or depressed skull fracture
-Paralysis
Paragraph 4
If the patient meets the criteria in paragraph 3 and land transport time is < 30 minutes to LTH then take them there.
FTT paragraph 5 : if unable to secure patients airway or survival to LTH is unlikely despite paragraph 1&2 what do you do?
Take the patient to the closest ED
FTT paragraph 6: despite paragraph 5 what to do if patient has a penetrating trauma to the head neck or torso and if they are VSA
Take the to LTH provided land transport time is < 30 minutes
FTT standard: if the patient does not meet the anatomical and physiological criteria then this mechanism of injury should be looked at and if land transfer time is < 30 minutes to LTH then they should go there
Paragraph 7
Falls: adults falls > or equal to 6 metres and children ( <15) falls > or equal to 3 metres two to three times their height
High risk auto crash:
-Intrusion > or equal to 0.3 metres occupant side > or equal to 0.5 metres any site including the roof
-ejection partial or complete from automobile
-death in the same passenger compartment
-vehicle telemetry data consistent with high risk injury
- pedestrian or bicyclist throwing. Run over or struck with significant impact > or equal to 30 km/hr by an automobile
Motorcycle crash > or equal to 30km/hr
FTT in conjunction with the physiological, anatomical and mechanism of injury criteria, consider the following special criteria and if the land transfer time is < 30 minutes to LTH then should take them there
Age
Risk of injury/death increases after age of 55
SBP< 110 may represent shock after age 65
Anticoagulation and bleeding disorders
Burns with trauma mechanism
Pregnancy > or equal to 20 weeks
SMR standard a must for this mechanism of injury
paragraph 1
-any trauma associated with complaints of neck or back pain
–sports accidents (impaction, falls)
-diving incidents and submersion injuries
-explosions
-falls (eg: stairs)
-pedestrian struck
-electrocution
-lightning strikes
-penetrating trauma to head neck and torso
SMR standard, If the patient meets the criteria listed in paragraph 1, determine if any of these are present. Which would be paragraph 2
-neck or back pain
-spine tenderness
-neurologic signs or symptoms
-altered level of consciousness
-suspected drug or alcohol intoxication
-a distracting painful injury
-anatomic deformity of the spine
-high mechanism of energy, such as:
a: fall from elevation greater than 3 feet/5 stairs
b: axial load to the head (eg: diving accidents)
c: high speed motor vehicle collisions (> or equal to 100/hr), rollover, ejection,
d: hit by bus or large truck
e: motorized/ATV recreational vehicles collision, or
f: bicyclist struck or collision
g: age or equal to 65 years old including falls from standing height
paragraph 3
If the patient meets the criteria of paragraph 1 but does not meet the criteria of paragraph 2 do not apply SMR
paragraph 4
subject to paragraph 6 below, if the patient meets the requirements of paragraph 2 above, apply SMR
SMR standard, if the patient has penetrating trauma to the head, neck torso, determine if the patient has ALL of the following (paragraph 5)
-no spine tenderness
-no neurologic signs or symptoms
-no altered level of consciousness
-no evidence of drug or alcohol intoxication
-no distracting painful injury
-no anatomic deformity of the spine
paragraph 6
notwithstanding paragraph 4 above, if the patient meets the criteria of paragraph 5, do not apply SMR
Respiratory failure standard
1: ventilate the patient - 1 breath every 5-6 seconds
Guideline:
if using ETCO2 monitoring, attempt to maintain ETCO2 values of 35-45mmHg unless indicated otherwise in the standards for COPD or asthma patients who have an initial ETCO2 of >50mmHg, attempt to maintain to maintain ETCO2 between 50-60 mmHg
2: observe chest rise and fall and auscultate
3: minimize interruptions to ventilations
4: continue assisted ventilations until patients spontaneous respirations are adequate
Seizure standard paragraph 1, consider potential life threats and/or underlying disorders such as
-intracranial event
-hypoglycemia
-in pregnant patients or recent post partum patients, eclampsia
-in patients > or equal to 50 years of age with new onset or recurrent seizures
a: Brain tumor or other intracranial event eg: hemorrhage thrombosis
b: cardiac dysrhythmias
c: cardiovascular disease
d: cerebrovascular disease
e: severe hypertension
-in neonates
f: traumatic delivery
g: congenital disorders
h: prematurity
i: hypoglycemia
- in young children febrile convulsions associated with infection
- infection (eg: central nervous system, meningitis)
- alcohol withdrawal (including delirium tremens)
- Drug ingestion/withdrawal
- known seizure disorder
Seizure standard paragraph 2, if patient is in active seizure what to do
- attempt to position the patient in a recovery position
- attempt to protect the patient from injury and
-observe for:
a: eye deviation
b: incontinence
c: parts of body affected
d: type of seizure (eg full body, focal)
seizure standard paragraph 3, perform at a minimum a secondary survey to assess for seizure related occurrences such as
- bleeding from the mouth
-incontinence
-secondary injuries resulting from the seizure
-tongue injury
seizure standard paragraph 4, prepare for potential problems including
-airway compromise
-recurrent seizures
-post-ictal combativeness or agitation
CVA - stroke standard, paragraph 1, consider other potentially serious conditions that may mimic a stroke such as
-drug ingestion
-hypoglycemia
-severe hypertension
-central nervous system (CNS) infection (eg: meningitis)
CVA - stroke standard, paragraph 2, perform at a minimum a secondary survey to assess
- head and neck for
a: facial symmetry
b: pupillary size, equality and reactivity
c: abnormal speech
d: presence of stiff neck - Central nervous system for
a: abnormal motor function eg: hand grip strength, arm/leg movement
b: Sensory loss
c: incontinence of urine or stool
CVA -stroke standard paragraph 3, ensure adequate support for the patients body/limbs during patient movement and place extra padding beneath affected limbs
paragraph 4, prepare for potential problems including ?
- possible airway obstruction (if loss of tongue control)
- decreasing level of consciousness
- seizures
- agitation, confusion or combativeness
CVA - stroke paragraph 5, ventilate the patient if patient is apneic or respirations are inadequate
- If ETCO2 monitoring is available
a: attempt to maintain ETCO2 values of 35-45 mmHg
b: But if signs of cerebral herniation are present after measures to address hypoxemia and hypotension, hyperventilate the patient to attempt to maintain ETCO2 values of 30-35mmHg. Signs of cerebral herniation include a deteriorating GCS <9 with any of the following
1: dilated and unreactive pupils
2: asymmetric pupillary response
3: a motor response that shows either unilateral or bilateral decorticate or decerebrate posturing
-If ETCO2 monitoring is unavailable and measures to address hypoxemia and hypotension have been taken and the patient shows signs of cerebral herniation, hyperventilate the patient as follows
1: adult approximately 20 breaths per minute
2: child approximately 25 breaths per minute
3: infant <1 year old approximately 30 breaths per minute
CVA - stroke paragraph 6, perform a screen for LVO stroke using the Los Angeles motor scale (LAMS) for all probable stroke patients presenting within 24 hours of stroke symptom onset
- if LAMS is greater than or equal to 4, classify the patient as CTAS 2
-inform the receiving hospital whether “LVO clinical screen is positive or negative” - document LAMS screen for patients presenting with CVA/stroke symptoms 0-24 hors from symptom onset
CVA - stroke, acute stroke bypass protocol paragraph 1 and 2
1: assess the patient to determine if he/she has one or more of the symptoms consistent with the onset of an acute stroke, as follows
a: inappropriate words or mute
b: slurred speech
c: unilateral arm weakness or drift
d: unilateral facial droop
e: unilateral leg weakness or drift
2: if the patient meets the criteria in paragraph 1, determine if the patient can be transported to a stroke center within 6 hours of clearly determined time of symptom onset or time the patient was last seen in his/her usual state of health
CVA - stroke, acute stroke bypass protocol paragraph 3, if the patient meets the criteria in paragraph 1 and 2, assess the patient to determine if he/she has any of the following contraindications
a: CTAS 1 and /or an uncorrected airway, breathing or circulation issue
b: stroke symptoms resolves prior to the paramedics arrival or assessment
c: blood glucose level <3 mmol/L
d: seizure at the onset of symptoms or that is observed by the paramedic
e: Glasgow coma scale <10
f: terminally ill or in palliative care
g: duration of transport to the stroke center will exceed 2 hours
Paragraph 4
If the patient does not meet any of the contraindications in paragraph 3, perform a secondary screen for a large vessel occlusion (LVO) stroke using LAMS
