Ch 05-2: Full Scenario Flashcards
1
Q
Scenario - Repeat Aloud
A
Scene Assessment: PPE Gloves Eyewear Gown Face Shield Reflective Clothing
S P E R M Safety: Are there any obvious hazards in the scene? Do I have clear access to the patient? Patient: How many patients are there? What is the general behaviour of people on scene?
Environment: What is the weather? Where is the scene located? Is it lit? Is it Cold/Hot
Resources: 4 EMR's ALS / BLS Fire Police Hazmat Poison Control
Mechanism of Injury: Are there any obvious clues to the mechanism of injury? Bystander Information
General Impression Are their eyes tracking Difficulty breathing Deadly bleeds Obvious fractures or dislocations C-spine Age / Gender
C – Spine Rule: I will take c-spine precaution Rule – Out: I will rule out trauma to the head and spine
Primary Survey:
Introduction
Don’t move / Hello,
My name is Sable, I am an EMR.
Gain Consent May I help you? C – Spine Delegate C-spine precaution to partner
L O C Alert / Oriented What is your name? Do you know where we are? Do you know what time it is? Do you know what happened? Verbal Pain Unresponsive
A B C D D Airway Open airway Choking / Suction / OPA / NPA
Breathing Rate 12 – 20 Rhythm Depth Effort Apply Oxygen Non-rebreather Mask, 15 lpm BVM, 15 lpm Rescue Breathing Less than 8 greater than 30 1 every 5 – 6 seconds
Circulation Pulse Radial Carotid Bracheal Rate 60 – 100 bpm Rhythm Quality Skin Color and Condition CPR
Deadly Bleeding Checking for any deadly bleeding Fix Deadly Bleeds Transport Decision Load and Go Stay and Stabilize
Primary Survey Head Looking For: Deformities Contusions Abrasions Penetrations Burns Lacerations Swelling
Feeling For: Tenderness Instability Crepitus
Also checking for: Battle Signs Racoon Eyes Fluid Soot Missing Teeth
Neck Checking For: DCAP BLS TIC
Also Checking For: Jugular Vein Distention Tracheal Deviation Accessory muscle use Apply C-Collar
Chest Checking For: DCAP BLS TIC Also Looking For: Paradoxical Movement Medication Patches Pace Makers Needle Marks Scars Treatment: Sucking chest wound Put a gloved hand on wound 3 sided occlusive dressing Flail Chest Put Gloved hand over it Bulky dressing and tape over just top bottom
Auscultating the Lung Sounds: Apeces - Mid Clavicular Level Baces - Mid Auxiliary Level Air is present, Clear, Equal Bilaterally
Abdomen Looking For: DCAP BLS Pulsating Masses Eviscerations
Palpating the four quadrants for: Tenderness Rigidity Distention Is there any Guarding? Eviscerations Moist, sterile dressing Occlusive dressing Blanket Pelvis Looking For: DCAP BLS Feeling inward then down for: TIC Is the pelvis stable? Also checking for: Priapism Incontinence Bleeding
Lower Extremities Hand over hand Bilaterally I am checking for: DCAP BLS TIC Edema Needle Marks Scars
Also checking the feet for: Motor Function Press on my hand downward / Press upward Sensation while also checking capillary refill Which toe am I pinching Pulse Pedal Pulse If you find a break Manual Stabilization
Upper Extremities Hand over hand Bilaterally I am checking for DCAP BLS TIC Edema Needle Marks Scars I am also checking the hands for: Motor Function Can you squeeze my fingers with both hands?
Sensation while also checking capillary refill Which finger am I pinching? Pulse Radial Pulse
Back Checking the Back Doing a log roll at my partners count to check the back for DCAP BLS TIC Use a scoop if pelvis issues Immobilize Put on spine board
Getting them into the Ambulance
Final Transport Decision
Load and Go
Load Log roll onto a spine board securing the body, legs, then head with head blocks Extremity lift Scoop Driver One of the EMRs is driving
Take along One family member / Bystander Personal belongings Medication DNR EMR's
Oxygen Switch the Oxygen tank from the D tank to the M tank Leave I am off scene
History
Reassess LOC and ABCD’s
S A M P L E Signs and Symptoms What are you feeling right now? Allergies Do you have any allergies? Medications Are you currently taking any medications? Prescription Over the Counter Herbal Recreational Drugs Erectile Disfunction Past Medical History What is your most important past medical history
Last Oral Intake What was the last thing you had to eat? When was the last time you went to the bathroom? Events Prior What happened before you got hurt / sick?
O P Q R S T Onset of pain When did the pain start? Provoke / Alleviate Does anything make it better or worse? Quality Describe how the pain feels Radiate Where does it hurt? Severity On a scale of one to ten, what would you rate the level of pain you are feeling? Time When did the pain start?
Vitals Blood Pressure Blood Glucose Level Blood Oximetry Body Temperature Breathing Rate Pulse Pupils equal and reactive to light Level of Consciousness Skin Color and Condition
Medications 6 Rights Patient Medication Route Dose Time Documentation
4 C's and E Color Concentration Clarity Condition Expiry Date
Medical Direction Poison Control Educate and consent Give / Assist Redo Vitals
Types of Medication Oral Glucose – Monosaccharide Give 1 25ml Tube orally 1 tube q 3 -5 minutes as needed Hypoglycemic, BGL less than 4
Acetylsalicylic Acid – Aspirin Give 1 160mg or 325mg tablet orally Once Do not have asthma, no bleeding ulcers
Salbutamol – Ventolin Assist 100 mcg / spray 6 sprays q 10 minutes; Maximum 20 metered dose inhaler Shake for half a minute before handing to patient
Ipratroprium Bromide – Atrovent Assist 20 mcg / spray 2 – 4 sprays q 10 minutes; Maximum 10 metered dose inhaler Only give after Ventolin, never alone Epinephrine – Epi Pen Assist 0.3mg / injection 1 every 10 minutes intramuscular Confirm anaphylaxis, no pulmonary edema, not elderly
Nitroglycerin - Nitrostat Assist 0.4mg / spray 1 spray q 5 minutes; maximum of 3 Sublingual Must not have taken erectile dysfuntion medications, Blood Pressure over 100 Systolic
Secondary Survey Head DCAP BLS TIC Battle Signs Racoon Eyes Fluid Soot Missing Teeth
Neck DCAP BLS TIC Tracheal Deviation Jugular Vein Distention Accessory Muscle Use
Chest DCAP BLS TIC Paradoxical Motion Sucking Chest Wounds Medication Patches Pace Makers Medic Alert Scars
Lung Sounds Apeces - Mid Clavicular Level Baces - Mid Auxiliary Level Air is Present, Clear, Equal Bilaterally
Abdomen DCAP BLS TRD Evisceration Pulsating Masses Needle Marks Scars
Pelvis Is the pelvis still stable? DCAP BLS TIC Priapism Incontinence Bleeding
Lower Extremities Hand over hand Bilaterally I am checking for DCAP BLS TIC Motor Function Sensation Cap Refill Pedal Pulse Edema Needle Marks Scars
Upper Extremities Hand over hand bilaterally I am checking for DCAP BLS TIC Motor Function Sensation Cap Refill Radial Pulse Edema Needle Marks Scars
Back As best I can I am checking for DCAP BLS TIC
Ongoing Care Reassess LOC ABCD's Vitals every 5 minutes Checking my Vitals Give medication if you couldn't before Check any interventions Cover with a blanket I want my vitals again
Patch the Hospital C H A T Chief Complaint History Assessment Estimated Time of Arrival
I want to be at the Hospital
