BLS Section 2 AI Flashcards
What are the bases on which specific standards in Section 2 – Medical Standards have been developed?
Specific standards are developed based on:
* chief complaint as stated by the patient/bystanders
* presenting problem as indicated by the patient/bystanders
* immediately obvious primary survey critical findings
What should paramedics be aware of regarding a patient’s condition?
Paramedics should be aware of a patient’s potential to deteriorate and prepare accordingly.
What particular attention should paramedics pay to in patient care?
Particular attention should be paid to potential compromises to:
* airway
* breathing
* circulation
* seizures
* emesis
What factors should paramedics determine when gathering history?
Paramedics shall determine:
* provoking factors
* quality
* region/radiation/relieving factors
* severity
* timing of the chief complaint or presenting problem
What must a paramedic ensure when providing patient care according to Section 2 – Medical Standards?
A paramedic shall ensure that the patient simultaneously receives care in accordance with the ALS PCS.
What should a paramedic consider in cases of abdominal pain of non-traumatic origin?
A paramedic shall consider potential life/limb/function threats, such as:
* leaking or ruptured abdominal aortic aneurysm
* ectopic pregnancy
* diabetic ketoacidosis
* pulmonary embolism
* perforated or obstructed hollow organs
* acute pancreatitis
* testicular torsion
* pelvic infection
* strangulated hernia
What minimum assessment should be performed for abdominal pain?
A minimum secondary survey to assess the abdomen for:
* pulsations
* scars
* discolouration
* distention
* masses
* guarding
* rigidity
* tenderness
What action should be taken if a pulsatile mass is discovered during abdominal assessment?
Do not initiate or discontinue further abdominal palpation.
What should be done if abdominal aneurysm is suspected?
Palpate femoral pulses for weakness/absence.
What signs should be observed for in abdominal pain assessments?
Observe for:
* melena
* hematemesis
* frank rectal bleeding (hematochezia)
What should a paramedic do in cases of airway obstruction?
Perform assessments and obstructed airway clearance maneuvers as per current Heart and Stroke Foundation of Canada Guidelines and attempt to clear the airway using oropharyngeal/nasopharyngeal suction.
What conditions should be considered for potential airway obstruction?
- Smoke inhalation
- Anaphylaxis
- Epiglottitis
- Foreign body aspiration
- Oropharyngeal malignancy
In cases of an allergic reaction, what threats should a paramedic consider?
Potential life/limb/function threats, such as anaphylaxis.
List common allergens that should be considered in allergic reactions.
- Penicillin and other antibiotics in the penicillin family
- Latex
- Venom of bees, wasps, hornets
- Seafood - shrimp, crab, lobster, other shellfish
- Nuts, strawberries, melons, eggs, bananas
- Sulphites (food and wine preservatives)
What is the minimum assessment required for a patient with a known or suspected allergic reaction?
Perform a secondary survey to assess:
* The site of allergic reaction, if applicable
* Lungs for adventitious sounds through auscultation
* Skin for erythema, urticaria, and edema.
What body system manifestations indicate potential anaphylaxis?
- Respiratory: Dyspnea, wheezing, stridor or hoarse voice
- Cardiovascular: Tachycardia or hypotension/shock
- Neurological: Dizziness, confusion, or loss of consciousness
- Gastrointestinal: Nausea, vomiting, abdominal cramps, or diarrhea
- Dermatological/mucosal: Facial, orolingual, or generalized swelling/flushing/urticaria
What historical findings should be considered as evidence of suspected anaphylaxis?
- Difficulty swallowing/tightness in the throat
- Difficulty breathing/feeling of suffocation
- Fearfulness, anxiety, agitation, confusion, or feeling of doom
- Generalized itching
- History of any body system involvement listed previously.
What potential problems should paramedics prepare for in cases of allergic reactions?
- Cardiac arrest
- Airway obstruction
- Anaphylaxis
- Bronchospasm
- Hypotension
True or False: A paramedic should only consider anaphylaxis if there is a single body system manifestation.
False
Fill in the blank: Common allergens include seafood such as shrimp, crab, and _______.
lobster
What should a paramedic attempt to determine in a patient with a suspected acute altered level of consciousness?
A specific cause for the altered level of consciousness
This involves gathering detailed patient history and context to inform further assessment.
What type of survey should a paramedic perform on a patient with altered consciousness?
A secondary survey to assess the patient from head-to-toe
This ensures a comprehensive evaluation of the patient’s condition.
What should be done if trauma is obvious, suspected, or cannot be ruled out in a patient with altered consciousness?
Perform trauma assessments
This is crucial for identifying any life-threatening injuries.
What airway management should be performed if the patient has an unprotected airway?
Insert oropharyngeal airway/nasopharyngeal airway
This is essential to maintain airway patency in patients with altered consciousness.
What action should be taken if a patient is apneic or has inadequate respirations?
Ventilate the patient in accordance with the Respiratory Failure Standard
Proper ventilation is critical to ensure adequate oxygenation in such scenarios.
What should a paramedic consider in cases of non-traumatic back pain?
Potential life/limb/function threats such as:
* abdominal/thoracic aortic aneurysm
* acute spinal nerve root(s) compression
* intra-abdominal disease (e.g. pancreatitis; peptic ulcer)
* possible occult injury (e.g. pathologic fracture)
These conditions could indicate serious underlying issues requiring immediate attention.
What is the minimum assessment required for a patient with non-traumatic back pain?
A secondary survey to assess:
* back for abnormal appearance/findings
* chest, as per Chest Pain (Non-Traumatic) Standard
* abdomen, as per Abdominal Pain (Non-Traumatic) Standard
* distal pulses
* extremities for circulation, sensation, and movement
This thorough assessment helps identify any critical conditions.
What should be done if a thoracic aneurysm is suspected?
Perform bilateral blood pressures
This helps in assessing the severity of the condition.
What is the first action a paramedic should take in a cardiac arrest situation?
Position the patient on a firm surface
Proper positioning is crucial for effective CPR.
What are the key steps in initiating CPR for a cardiac arrest patient?
Initiate CPR (including defibrillation)
Early CPR and defibrillation significantly increase survival chances.
What should be done when two or more CPR-certified rescuers are available?
Attempt to switch chest compressors approximately every two minutes
This helps to maintain effective compressions during resuscitation.
What equipment should be readily available during CPR?
Suction equipment in preparation for emesis
This ensures the airway remains clear during resuscitation.
When can mechanical CPR devices be considered?
When limited rescuers are available, for prolonged CPR, or in a moving ambulance
These devices can assist in maintaining effective CPR when manual efforts are challenging.
What monitoring may be considered during cardiac arrest resuscitation?
End-tidal carbon dioxide (ETCO2) monitoring, if available
ETCO2 can provide valuable information about the effectiveness of CPR.
What should be done if CPR must be interrupted?
Plan to reinitiate CPR as quickly as possible at a predetermined point
Minimizing interruptions is critical to maintaining circulation.
What are the actions to take if a patient has a spontaneous return of circulation?
Continue to ventilate if apneic or respirations are inadequate; administer oxygen to maintain saturation 94-98%; obtain vital signs every 15 minutes for the first hour; continue cardiac monitoring; resume CPR if cardiac arrest recurs
These steps ensure the patient remains stable after regaining circulation.
What special consideration should be taken when performing CPR on a pregnant patient?
Have a second paramedic attempt to manually perform left uterine displacement if the uterine height is at or above the umbilicus
This technique helps improve blood flow to the fetus and the mother during CPR.
What is another term for cerebrovascular accident?
Stroke
What should a paramedic consider when assessing a patient with a CVA?
Other potentially serious conditions
Such conditions may include drug ingestion, hypoglycemia, severe hypertension, or CNS infections.
List four conditions that may mimic a stroke.
- Drug ingestion (e.g. cocaine)
- Hypoglycemia
- Severe hypertension
- CNS infection (e.g. meningitis)
What is the minimum assessment that should be performed on a patient suspected of having a stroke?
A secondary survey
What should be assessed in the head/neck during a secondary survey?
- Facial symmetry
- Pupillary size, equality, and reactivity
- Abnormal speech
- Presence of stiff neck
What are the components to assess in the central nervous system during a secondary survey?
- Abnormal motor function
- Sensory loss
What should be ensured during patient movement?
Adequate support for the patient’s body/limbs
What potential problems should be prepared for when dealing with a CVA patient?
- Possible airway obstruction
- Decreasing level of consciousness
- Seizures
- Agitation, confusion, or combativeness
What should be done if the patient is apneic or has inadequate respirations?
Ventilate the patient
What are the target ETCO values for monitoring during ventilation?
35-45 mmHg
What should be done if signs of cerebral herniation are present?
Hyperventilate the patient to maintain ETCO values of 30-35 mmHg
What does a deteriorating GCS of less than 9 indicate?
Possible signs of cerebral herniation
List the signs of cerebral herniation.
- Dilated and unreactive pupils
- Asymmetric pupillary response
- Motor response showing decorticate or decerebrate posturing
What is the breathing rate for an adult when hyperventilating a patient?
Approximately 20 breaths per minute
What is the breathing rate for a child when hyperventilating a patient?
Approximately 25 breaths per minute
What is the breathing rate for an infant under 1 year old when hyperventilating a patient?
Approximately 30 breaths per minute
What screening tool should be used for LVO stroke assessment?
Los Angeles Motor Scale (LAMS)
What classification is given if LAMS is greater than or equal to 4?
CTAS 2
What information should be communicated to the receiving hospital regarding LVO screening?
Whether ‘LVO Clinical Screen is positive or negative’
What should be documented for patients presenting with CVA/Stroke symptoms?
LAMS screen
Fill in the blank: A secondary survey should assess for incontinence of ______.
urine/stool
What are the symptoms consistent with the onset of an acute stroke?
- Inappropriate words or mute
- Slurred speech
- Unilateral arm weakness or drift
- Unilateral facial droop
- Unilateral leg weakness or drift
These symptoms are critical for assessing a potential stroke patient.
What is the time frame for transporting a patient to a Designated Stroke Centre after symptom onset?
Within 6 hours of a clearly determined time of symptom onset or the last time the patient was seen in his/her usual state of health
This is crucial for effective stroke treatment.
What are the contraindications for transporting a stroke patient to a Designated Stroke Centre?
- CTAS 1 and/or an uncorrected airway, breathing or circulation issue
- Stroke symptoms resolved prior to paramedic arrival or assessment
- Blood Glucose Level <3 mmol/L
- Seizure at the onset of symptoms or observed by the paramedic
- Glasgow Coma Scale <10
- Terminally ill or in palliative care
- Duration of transport to the Designated Stroke Centre will exceed two hours
Assessing these contraindications is essential before transport.
What screening tool is used for assessing a Large Vessel Occlusion (LVO) stroke?
Los Angeles Motor Scale (LAMS)
This tool helps determine the severity and type of stroke.
True or False: If a patient’s symptoms improve during transport to a Designated Stroke Centre, transport should be continued.
True
Continuous transport is necessary regardless of symptom improvement.
What should be done after assessing the LAMS score?
Inform the CACC/ACS of the LAMS score to assist in determining the closest or most appropriate Designated Stroke Centre
This communication is vital for timely patient care.
Fill in the blank: A Designated Stroke Centre includes a ________.
[Regional Stroke Centre, District Stroke Centre, Telestroke Centre]
These centers may or may not have EVT capability.
What should a paramedic consider when attending to a patient with non-traumatic chest pain?
Potential life/limb/function threats such as:
* Acute coronary syndrome/acute myocardial infarction (e.g. STEMI)
* Dissecting thoracic aorta
* Pneumothorax, tension pneumothorax/other respiratory disorders (e.g. pneumonia)
* Pulmonary embolism
* Pericarditis
These threats are critical to assess to ensure timely intervention.
What is the minimum requirement for a secondary survey in chest pain cases?
Assess the following:
* Chest for subcutaneous emphysema, accessory muscle use, urticaria, indrawing, shape, symmetry, tenderness
* Lungs for decreased air entry and adventitious sounds
* Abdomen as per Abdominal Pain Standard
* Neck for tracheal position and jugular vein distension
* Extremities for leg/ankle edema
A comprehensive secondary survey is crucial for identifying underlying conditions.
What are the criteria for assessing a patient suspected of having a STEMI?
The patient must meet the following indications:
* ≥18 years of age
* Chest pain consistent with cardiac ischemia or myocardial infarction
* Time from onset of pain <12 hours
* 12-lead ECG indicating acute myocardial infarction/STEMI
Specific ECG criteria include ST-elevation in contiguous leads.
What are the contraindications for transporting a STEMI patient?
Contraindications include:
* CTAS 1 with airway or ventilation issues
* 12-lead ECG indicating LBBB, ventricular paced rhythm, or STEMI imitators
* Transport time to PCI center ≥60 minutes
* Complications requiring PCP or ACP diversion
These criteria help ensure patient safety during transport.
What should be communicated to the PCI center when transporting a STEMI patient?
Provide the following information:
* Patient is a ‘STEMI patient’
* Patient’s initials
* Patient’s age
* Patient’s sex
* Paramedic’s concerns regarding clinical stability
* Infarct territory and/or findings on ECG
* Estimated time of arrival
* Patient pickup catchment area
Clear communication is vital for effective patient handover.
What actions should a paramedic take upon arrival at the PCI center?
In addition to Transfer of Responsibility requirements, provide:
* Time of symptom onset
* Time of ROSC, if applicable
* Hemodynamic status
* Medications given and procedures performed
* History of acute myocardial infarction/PCI/CABG if applicable
* Copy of the qualifying ECG
* Copy of the Ambulance Call Report
This information aids in continuity of care.
True or False: Once a STEMI is confirmed, the paramedic should stop following the STEMI Hospital Bypass Protocol if the ECG normalizes.
False
The protocol should continue to be followed despite changes in the ECG.
What should be assessed in a patient with dysphagia?
Assess for:
* Drooling
* Hoarse voice or cough
* Nasal flaring
* Swelling or masses
* Tracheal deviation
These signs can indicate serious underlying conditions.
What potential problems should a paramedic prepare for when dealing with dysphagia?
Prepare for potential problems including:
* Complete airway obstruction
Airway management is critical in these situations.
What is the primary concern when addressing a patient with epistaxis?
Consider potential life/limb/function threats such as upper airway obstruction
Airway management is essential in cases of significant bleeding.
What should be assessed in a patient with epistaxis?
Assess for:
* Estimated blood loss
* Foreign bodies in nares
* Headache
Understanding the extent of blood loss is crucial for treatment.
What are the main threats to consider in a patient with excited delirium?
Consider potential threats such as:
* Asphyxia
* Cardiopulmonary arrest
* Dysrhythmias
These threats can arise from the acute agitation and physiological responses associated with excited delirium.
List symptoms of excited delirium.
Symptoms include:
* Impaired thought processes
* Unexpected physical strength
* Decreased sensitivity to pain
* Sweating, fever, heat intolerance
* Sudden tranquility after frenzied activity
Recognizing these symptoms is vital for appropriate intervention.
What should a paramedic consider when assessing a patient with extremity pain of a non-traumatic origin?
Potential life/limb/function threats including:
* Acute spinal nerve root(s) compression
* Possible occult fracture
* Soft tissue and joint infections
* Vascular occlusion
What is the minimum assessment a paramedic must perform for a patient with extremity pain?
A secondary survey comparing the affected extremity with the unaffected extremity, assessing:
* Distal pulses
* Circulation, sensation, and movement
* Skin colour, temperature, and condition
* Swelling, deformity, and tenderness
What actions should a paramedic take for a patient with extremity pain?
Attempt to keep movement to the affected extremity to a minimum and protect from further injury
What temperature indicates a known fever in a patient?
Greater than 38.5°C
What potential life/limb/function threats should be considered for a patient with a fever?
Consider:
* Overdose
* Sepsis
* Meningitis
* Heat-related illness
What findings indicate sepsis in a febrile patient?
Indications of sepsis include:
* Presence of fever >38.5°C
* Possible infection suspected
* Presence of:
* SBP <90
* Respiratory rate ≥22 breaths/minute
* Acute confusion or reduced level of consciousness
What is the minimum assessment for a patient with a fever?
A secondary survey assessing:
* Lungs for adventitious sounds
* Skin for jaundice, rash, and signs of dehydration
* Head/neck for photophobia, scleral jaundice, stiff neck, and headache
* Abdomen as per the Abdominal Pain Standard
* Temperature
What should a paramedic do to promote passive cooling in a febrile patient?
Remove excess layers of clothing if required
What is the guideline regarding active cooling for a febrile patient?
Do not actively cool the patient
What should a paramedic prepare for in a febrile child or adult with suspected serious disorders?
Prepare for potential problems, including seizures
What life/limb/function threats should be considered for a patient with a headache of a non-traumatic origin?
Consider:
* Intracranial/intracerebral events
* CNS or systemic infection
* Severe hypertension
* Toxic event/exposure
What signs and symptoms can indicate a serious underlying disorder in patients with headaches?
Look for:
* Sudden onset of severe headache
* Recent onset headache with sudden worsening
* Change in pattern of usual headaches
* Accompanied by altered mental status, neurologic deficits, or fever
What is the minimum assessment for a patient with a headache?
A secondary survey assessing:
* Head/neck for pupillary size, equality, and reactivity
* CNS for abnormal motor function and sensory loss
What life/limb/function threats should be considered for a patient experiencing a heat-related illness?
Consider:
* Heat stroke
* Hypovolemic shock
What are the chief complaints associated with heat-related illnesses?
Presenting problems include:
* Heat syncope
* Heat cramps
* Heat exhaustion
* Heat stroke
What actions should a paramedic take for a patient with heat-related illness?
Perform a secondary survey assessing:
* CNS
* Mouth for hydration
* Skin for temperature and condition
* Extremities for circulation, sensation, and movement
* Temperature
What should a paramedic do if a patient is experiencing heat exhaustion?
Move the patient to the ambulance and remove as much clothing as possible
What should a paramedic do if a patient is experiencing heat stroke?
Actions include:
* Withhold oral fluids
* Cover with wet sheets
* Apply cold packs to axillae, groin, neck, and head
What indicates that cooling procedures for a heat-related illness should be discontinued?
Skin temperature feels normal to touch, generalized shivering develops, or the patient’s level of consciousness normalizes
What are the potential life/limb/function threats associated with hematemesis and hematochezia?
- Esophageal varices
- Gastrointestinal disease
These conditions can lead to significant complications if not addressed promptly.
What is the minimum assessment required for a patient with hematemesis?
- Secondary survey of the chest
- Secondary survey of the abdomen
This assessment follows the Chest Pain (Non-Traumatic) and Abdominal Pain (Non-Traumatic) Standards.
What factors should be considered when estimating the degree of blood loss?
- Duration of hemorrhage
- Rate of flow
- Presence of clots
- Quantity of blood-soaked materials
Assessing these factors is crucial for determining the severity of the situation.
What are some potential life/limb/function threats when a patient presents with nausea and/or vomiting?
- Acute coronary syndrome/acute myocardial infarction
- Anaphylaxis
- Increased intracranial pressure
- Toxicological emergencies
- Bowel obstructions
- Infection
- Acute pancreatitis
- Intra-abdominal emergencies
- Uremia
Identifying these threats is essential for providing appropriate care.
What is the primary action to take for a patient in respiratory failure?
Ventilate the patient as per current guidelines.
Guidelines from the Heart and Stroke Foundation of Canada should be followed.
What ETCO2 values should be maintained for COPD or asthma patients?
Between 50-60 mmHg if initial ETCO2 is >50 mmHg.
This is important to avoid respiratory distress.
In a patient experiencing a seizure, what should be assessed during the secondary survey?
- Bleeding from the mouth
- Incontinence
- Secondary injuries from the seizure
- Tongue injury
These assessments help gauge the impact of the seizure on the patient.
What are the potential problems to prepare for in a patient who has had a seizure?
- Airway compromise
- Recurrent seizures
- Post-ictal combativeness or agitation
These complications can arise immediately following a seizure.
What are some potential life/limb/function threats for a patient with shortness of breath?
- Acute respiratory disorders
- Acute cardiovascular disorders
- Other causes (e.g., cerebrovascular accident)
Identifying these threats is crucial for effective intervention.
What should be done if a patient is on home oxygen and presents with shortness of breath?
Elicit history regarding changes in use.
This information can provide insight into the patient’s current condition.
What are the potential life/limb/function threats associated with syncope, dizziness, or vertigo?
- Hypoglycemia
- Cardiac dysrhythmias
- CVA/Transient Ischemic Attack
- Hypovolemia
- Toxicological effects
- Heat-related illness
- Anemia
- Renal failure
- Sepsis
Recognizing these threats can guide further assessment and treatment.
In a toxicological emergency, what information should the paramedic attempt to identify?
- Agent(s)
- Quantity
- Time of administration
- Route of administration
This information is vital for effective treatment.
What are some symptoms of carbon monoxide poisoning?
- Altered mental status
- Cardiac dysrhythmias
- Emesis
- Headache
- Light-headedness
- Nausea
- Seizures
- Syncope
- Weakness
- VSA
Exposure to fuel-burning devices in enclosed areas can lead to these symptoms.
Fill in the blank: In cases of suspected hemoptysis, the paramedic should attempt to ascertain the _______.
[origin]
Understanding the origin can help determine the underlying cause of hemoptysis.
True or False: A secondary survey is not necessary for a patient with nausea and/or vomiting.
False
A secondary survey is critical to assess the abdomen.
What should a paramedic consider in a patient with vaginal bleeding regarding life/limb/function threats?
Life/limb/function threats include:
* Tumours in post-menopausal women
* First trimester complications:
* Spontaneous abortion
* Ectopic pregnancy
* Gestational trophoblastic disease
* Second and third trimester complications:
* Spontaneous abortion
* Placental abruption
* Placenta previa
* Ruptured uterus
Consideration of these threats is critical to ensure patient safety.
What is the minimum assessment a paramedic should perform for a patient with vaginal bleeding?
A minimum secondary survey to assess:
* Abdomen
* In pregnant patients:
* Uterine height and contractions
* Fetal movements
This assessment is essential to evaluate the patient’s condition.
What characteristics should be assessed in vaginal bleeding?
Assess the following bleeding characteristics:
* Blood loss
* Fetal parts
* Other tissues
* Presence of clots
Understanding these characteristics aids in determining the severity of the situation.
If bleeding is profuse, what actions should be taken?
Actions include:
* Place an abdominal pad under the perineum
* Replace pads as required
* Document the number of pads used on the Ambulance Call Report
These steps are crucial for managing heavy bleeding.
What should be prepared for if vaginal bleeding is profuse?
Prepare for expected problems including:
* Shock
Recognizing the potential for shock is vital in emergency situations.
What should a paramedic consider in cases of acute visual disturbances?
Consider threats to life/limb/function such as:
* Intracranial, intracerebral or retinal hemorrhage/thrombosis
* Acute glaucoma
These conditions can have severe implications for the patient’s health.
What assessments should be included in a secondary survey for visual disturbances?
Assess the following:
* Eyes:
* Pupillary size, equality, and reactivity
* Abnormal movements
* Positioning
* Redness
* Swelling
* Tearing
* Presence of contact lenses
* Eyelids for ptosis
* Vision for:
* Distortion/diplopia
* Loss
* Visual acuity
A thorough assessment is essential to identify the cause of visual disturbances.
What potential problems should be prepared for in patients with visual disturbances?
Prepare for potential problems including:
* Alterations in level of consciousness
* Neurological deficits
* Emesis
Being prepared for these complications can improve patient outcomes.
Fill in the blank: A soaked normal sized pad can hold approximately ______ mL of blood.
5 mL
This information helps in estimating blood loss.
Fill in the blank: Normal blood loss during menstruation is ______ mL.
10-35 mL
Understanding normal ranges assists in evaluating abnormal bleeding.
