BLS & ALS Flashcards
BLS required Baseline Vitals (7)
1) HR
2) RR
3) BP
4) SP02
5) GCS
6) Pupils
7) Skin Colour & Condition
Initiate Cardiac Monitoring For Problems With which Systems (3)
Signs or Symptoms of compromised
1) Cardiovascular
2) Respiratory
3) Neurological
Call Types Typically Warranting Cardiac Monitor (13)
1) VSA (except Obviously dead)
2) Unconcious or Altered LOA
3) Collapse or Syncope
4) Suspected Cardiac Ischemia
5) CVA (Stroke)
6) Moderate to Severe SOB
7) Overdose
8) Major or Multi-system Trauma
9) Electrocution
10) Submersion Injury
11) Hypothermia or Heat Illness
12) Abnormal vital Signs (ALS PCS)
13) Requested by Sending Facility staff
Patching To Receiving Facility; Steps (3) & Information Required (10)
Steps 1) CTAS 1-2 information report en route 2) Confirm Receiving Facility ACO Acknowledges Report 3) CTAS changes provide additional report Info 1) Unit # 2) Patient Age 3) Patient Sex 4) CTAS Level 5) Chief Complaint 6) Pertinent History 7) Pert Assessment Findings 8) Pert Management & Response to 9) Abnormal Vitals 10) ETA
Patch To Base Hospital Physician; Steps/reasons (3) & Information Required during Patch (4)
Steps 1) Initiate required patch OR 2) Initiate Patch if Uncertain 3) Document During Patch CRAC 1) Certification 2) Report which includes info necessary to convey PT's Condition, situation, or circumstance which requires input 3) Answer all Physians questions 4) Confirm direction, authorization & orders
02 Therapy Sp02 Goals
Normal - 92-96%
COPD - 88-92%
Continuous High Concentration 02 for which PT (6)
CUSCCS
1) Confirmed/Suspected Carbon Monoxide, cyanide, or Noxious Gas Exposure
2) Upper Airway Burns
3) Scuba related Disorder
4) Cardiopulmonary Arrest
5) Compete Airway Obstruction
6) Sickle Cell Anemia Crisis
COPD Treatment 02 standard
1) Nasal Cannula, 2 litres above home Level
2) 2 Litres if not on Home 02
3) Reassess min every 10 min
4) 88-92% = Maintain
5) Deteriorating - add 2 Litres every 2-3 min
6) Be Prepared to Ventilate
Continuous High Concentration 02 required for (5) Critical Findings
ARC AA
1) Age-specific Hypotension
2) Respiratory Distress
3) Cyanosis, Ashen Colour Skin, Pallor
4) Altered LOA
5) Abnormal Pregnancy or Labour
Field Trauma Triage Physiological Criteria (4)
1) Unable to Follow Commands
2) SBP <90mmHg
3) RR <10 or >=30 or BVM Needed
( <1 year = <20)
AND Transport <30 min
Field Trauma Triage Anatomical Criteria (9)
1) Open/Depressed Skull Fracture
2) Penetrating Injury to Head, Neck, Torso, Extremities Proximal to elbow and knee
3) Chest wall Instability/ Deformity
4) Pelvic Fractures
5) Two or more proximal long bone fractures
6) Amputation proximal to wrist and ankle
7) Crushed, degloved, mangled, or pulseless extremity
8) Paralysis
AND
9) Transport Time <30 min
LTH criteria that must go to the closest ED?
The exception to this rule?
If unable to secure Airway or Survival is unlikely with current transport time
Exceptions - Penetrating Trauma to Head, Neck, Torso
AND BOTH
1) VSA & Not Subject to TOR
2) Transport Time to LTH <30 min
Field Trauma Triage MOI Criteria (5)
1) Falls
- Adult - >=6m (2 Stories)
- Child (<15) - >=3m or 2 times height
2) Auto-Crash
- Intrusion >=0.3m next to PT or >=0.5m anywhere else
- Ejection
- Death in the same Compartment
- Telemetry indicates high-risk injury
3) Bike or Pedestrian Struck or runover (>=30km/hr)
4) MotorCycle Crash >=30km/hr
AND
5) Transport <30 min
Field Trauma Triage Special Criteria (5)
1) Age - risk increase over 55 & SBP<110 can be shock at 65
2) Anticoagulation and Bleeding disorders
3) Burns
4) Pregnancy >=20 weeks
5) Transport <30 min
Air Ambulance Utilization
to be continued…..pg.27
SMR Consideration MOI Criteria (9)
PLEEDS For PT
1) Penetrating Trauma to Head, Neck, Torso
2) Lightning
3) Electrocution
4) Explosion
5) Diving/ Submersion injury
6) Sports accident
7) Falls
8) Pedestrian Struck
9) Trauma Associated with neck/back Pain
SMR MOI Criteria Present Check Risk Criteria (8)
1) >=65
2) Neck or Back Pain
3) Spine Tenderness or Deformity
4) Neuro Signs/Symptoms
5) Altered LOA
6) Suspected Drug/Alcohol
7) Distracting Painful Injury
8) High-energy MOI
SMR - 5 Examples of High Energy MOI
1) Fall >3feet/5 stairs
2) Axial load to the head
3) MVC >=100km, rollover, ejection
4) Hit by Bus/Truck
5) Bicyclist struck or collision
Obviously Dead Criteria (4)
1) Grossly Charred Body
2) Open head or torso Wound with Outpouring contents
3) Gross Rigor Mortis
4) Dependant Lividity
Stroke Bypass Symptoms (4)
IS (voice) UU(body)
1) Inappropriate words/mute
2) Slurred Speech
3) Uni Arm/Leg weakness or drift
4) Uni Facial Droop
Stroke Bypass Contraindications (7)
1) CTAS 1 or ABC Issues
2) GCS <10
3) BGL <3mmol
4) Stroke Symptoms Correct before arrival
5) Seizure at onset or Witnessed by PCP
6) Terminally ill/ Palliative care
7) Transport exceed 2 hrs or ETA over 6 from the onset
LAMS Scoring System
Face - 1 side = 1 Arms - 1 Side = 2 Grip - 1 side= 2
- N/A= 0 - 1 side weak =1 - 1 Weak=1
- N/A = 0 - N/A= 0
LAMS Score Interpretation
Out of 5
>=4 = LVO (Large Vessel Occlusion)
LVO = EDT (Endovascular Therapy) Thrombectomy
<4 = TPA (tissue plasminogen activator)
Stroke Mimics (4)
1) Hypoglycemia
2) Drugs
3) Severe Hypertension (DBP >110, SBP >180
4) CNS infection
1) Stroke Respiration (if Apneic or inadequate) ETCO2 Goals With Monitor
2) Exception
1) 35-45 mmHg
2) Exception If signs of Cerebral Herniation
- Attempt to Hyperventilate ETC02 30-35 mmHg
Signs of Cerebral Herniation (3)
1) Dilated & Unreactive Pupils
2) Asymmetric pupillary response
3) Motor shows uni or bilateral decorticate/decerebrate posturing
Hyperventilation rates for suspected Cerebral Herniation without ETCO2 Monitoring
Adult - 20 BPM, 1-3 sec
Child - 25 BPM, 1-2.5 sec
Infant - 30 BPM, 1-2 sec
Chest Pain (non-Trauma) differential Diagnoses
1) Acute Coronary Syndrome (NSTEMI, STEMI, Unstable Angina)
2) Dissecting Thoracic Aorta
3) Pneumothorax/ Tension Pneumo/ Other Respiratory Disorders
4) Pulmonary Embolism
5) Pericarditis
Chest Pain (non-Trauma) Secondary Survey must include 7 chest criteria and 4 other assessments (Other than the Mandatory 12 LEAD).
Chest 1) SubQ
2) Accessory muscle use
3) Urticaria
4) Indrawing
5) Shape
6) Symmetry
7) Tenderness
Other 1) Ausultate for Airentry & adventitious sounds
2) Abdomen
3) Leg/Ankle EdemaSTEMI Bypass Criteria (4)
1) >=18 Years
2) Chest Pain OR Equivalent consistent with Cardiac Ischemia/MI
3) Onset <12 hrs
4) 12 Lead Indicates STEMI/MI
STEMI Bypass 12 Lead Criteria (3)
1) 2mm ST-Elevation in V1-V3 in 2 Contiguous Leads
AND/OR
2) 1mm ST-Elevation in 2 other Anatomically Contiguous Leads
OR
3) ECG Computer deems STEMI & Paramedic Agrees
Contraindications for STEMI Bypass (5)
1) CTAS 1 AND unable to secure Airway or Ventilate
2) 12-Lead STEMI mimic (LBBB, Paced, ETC)
3) Transport to PCI center is >=60 min from PT contact
4) PT Experiences Complication needing Diversion
5) PT Experiencing Complication requiring ACP Diversion (ACP not Adequate)
Contraindications for STEMI Bypass Because of the need for Diversion (3)
Diversion
1) Moderate-Severe Respiratory Distress/Use of CPAP
2) Hemodynamic Instability
3) VSA and no ROSC
Contraindications for STEMI Bypass that should be consulted about still permitting PT to Interventional Program at PCI center (2)
1) CTAS 1 AND unable to secure Airway or Ventilate
2) 12-Lead STEMI mimic (LBBB, Paced, ETC)
If PT Eligible for STEMI Bypass Inform CACC/ACS of need to Transport to PCI center & provide PCI Center with Information (8)
1) STEMI PT
2) PT Initials
3) Age
4) Sex
5) Concerns regarding Clinical Stability
6) ECG Findings
7) ETA
8) Catchment Area of PT pickup
After Confirming STEMI Positive, First Priority is
PUT ON PADS
Cardiac Ischemia Medical Directive Indications and Conditions for ASA(3) and Nitro(5)
ASA 1) >=18 Nitro 1) >=18
2) Unaltered 2) Unaltered
3) Chew & Swallow 3) SBP Normotension(>=100)
4) HR 60-159 BPM
5) Hx Nitro or IV Access
Cardiac Ischemia Medical Directive Contraindications for ASA(4)
ASAS - ASA
1) Asthma & no Prior use
2) Sens/Allerg
3) Active Bleed (obvious & stool/Vomit)
4) Stroke/TBI in Previous 24hrs
Cardiac Ischemia Medical Directive Contraindications for Nitro(4)
RAPS - Nitro
1) Right Ventricular MI
2) Allerg/Sens
3) Phosphoesterase Inhibitor use (48hrs)
4) SBP Drops 1/3 of the initial value after First Dose
Cardiac Ischemia Medical Directive ASA Dose
Route - PO
Dose - 160-162mg (2 Tablets)
Max Dose - 1
Cardiac Ischemia Medical Directive Nitro Doses
SBP >=100mmHg & no RVMI & Hx of use Route - SL Dose - 0.3mg or 0.4mg Dose Interval - 5 min Max Dose for STEMI Negative - 6 Max Dose for STEMI - 3
ACPE Indications (2)
1) Moderate to Severe Respiratory Distress
AND
2) Suspected ACPE
ACPE Conditions for Nitro (3)
1) >=18
2) HR 60-159 BPM
3) NormoTension (>+=100mmHg)
ACPE Contraindications for Nitro (3)
1) Allerg/Sens
2) Phosphodiesterase Inhibitor (48hrs)
3) SBP drops 1/3 of the Initial Value after First Dose
ACPE Nitro Doses with NO Hx use or IV
SBP >=140mmHg Route - SL Dose - 0.3mg or 0.4mg Dose Interval - 5min Max Doses - 6
ACPE Nitro Doses with Hx use or IV
SBP <=100mmHg to <140mmHg Route - SL Dose - 0.3mg or 0.4mg Interval - 5min Max Doses - 6
SBP >=140 mmHg
Dose - 0.6 or 0.8 mmHg
Rest is same as above
Medical Cardiac Arrest Conditions for Manual Defibrillation
Age >=30 days
LOA - Altered (GCS3)
VF or Pulseless VT
Medical Cardiac Arrest Conditions for Medical TOR
TORS are the WORST
1) Witnessed by NO EMS
2) Origin believed to be CARDIAC
3) ROSC NOT Achieved
4) Shock NOT Delivered
5) TOR is Indicated if 18
Medical Cardiac Arrest Doses
Dose - 1 Shock
Interval - 2min
Max Dose - 4
> =30 to <8 years
1st shock - 2j/kg
Sebsequent - 4j/kg
>8 120j 150j 200j 200j
Medical Cardiac Arrest Clinical Considerations for Early Transport After 1st Analysis(6)
1) Pegancy >=20 weeks (fundus above umbilicus, uterus displaced to left)
2) Hypothermia
3) Airway Obstruction
4) Suspected Pulmonary Embolus
5) Overdose
6) Other Reversible Causes
Medical Cardiac Arrest Clinical Considerations for Early Transport After 3rd Analysis (2)
1) Refractory Ventricular Fibbulation
AND
2) Pediatric Cardiac Arrest
Trauma Cardiac Arrest Indications and Treatment
Indications - Cardiac Arrest Secondary to Severe Blunt or Penetrating Trauma
Treatment
- 1 Analysis/Shock
-Transport OR PATCH for TOR
Trauma Cardiac Arrest Conditions (4) and Contraindication (1)for TOR
Conditions 1) >=16 Years 2) No Palpable pulses AND No Shock AND 3) HR=0 (Asytole) OR 4) HR>0 (PEA) with ED >=30min Contraindications 1) HR >0 (PEA) & ED <30 min
Hypoglycemia Medical Directive Indications (4)
Double ASS
1) Agitation OR
2) Altered LOA OR
3) Seizure OR
4) Stroke Symptoms
Hypoglycemia Medical Directive Conditions (2) & Contraindications (2) for Glucagon IM
Conditions 1) Altered LOA 2) HypoGlycemic Contraindications 1) Allerg/Sens 2) Pheochromocytoma
Hypoglycemia Medical Directive Conditions (2) & Contraindication for Dextrose IV
Conditions 1) >=2 years 2) Altered LOA 3) Hypoglycemia Contraindication 1) Allerg/Sens
Hypoglycemia BGL
<2 Years - <3.0 mmGh
>=2 Years - <4.0 mmGh
Pheochromocytoma Definition
(Usually) Benign tumor arising from catecholamine producing chromaffin cells in the adrenal medulla causing too much release of Epi & Norepi
Hypoglycemia Medical Directive Glucagon IM Doses
<25kg (8years/55lbs)
Dose - 0.5 mg
Dose Interval - 20 min
Max Doses - 2 (2nd BLG before 2nd dose)
> =25kg
Dose - 1 mg
Dose Interval - 20 min
Max Dose - 2 (2nd BLG before 2nd dose)
Hypoglycemia Medical Directive Dextrose IV Doses
D10W Dose - 0.2g/kg(2 ml/kg) Max Single Dose - 10g (100ml) Dose Interval - 10 min Max Doses - 2
D59W Dose - 0.5g/kg (1ml/kg) Max Single Dose - 25g (50ml) Dose Interval - 10 min Max Doses - 2
Hypoglycemia Clinical Considerations (3)
1) If PT responds well to Dextrose or Glucagon, may receive oral glucose or simple carbs
2) Only Mild Sign Exhibited - May Skip to oral glucose or simple carbs
3) If PT Initiates informed refusal of transport, attempt final set vitals & BGL
