Chapter 7 Acute injuries: Assessment and Disposition Flashcards
What are the components of an Emergency Action Plan or ERP?
The personnel with their qualifications needed to perform responsibilities in executing the plan
Equipment needed to carry out the tasks required in the event of an emergency
The mechanism of communication to the emergency care providers and the mode of transportation for the patient
The facilities to which the patient will be taken, including how and when those facilities will be notified in advance of the schedules event or contest
Documentation verifying the implementation and evaluation of the emergency plan, actions taken during the emergency, evaluation of the emergency response and institutional personnel training
Documentation of an annual review and rehearsal of the emergency plan and notations indicating whether the emergency plan was modified and if so how the plan was changed
What are some questions to address prior to events?
What emergency equipment must be available on site?
What equipment will be provided by the local EMS agency if in attendance at an event?
Who will be responsible for ensuring that the emergency equipment is operational?
What type of communication will be used to contact emergency personnel? Who will activate the facility’s emergency medical plan?
Who will assess the injured individual on site, and under what circumstances will a local EMS agency be called to the site?
If a physician is present, what are the responsibilities of other medical personnel?
If a physician is not present and the AT is evaluating the situation, what are the responsibilities of emergency medical technicians responding to the situation?
If it becomes necessary to stabilize and transport an individual to a medical facility, who will direct the stabilization and what protocol will be followed for the removal of protective equipment?
Who will supervise other participants of the AT is assessing and providing care to an injured individual?
Who will be responsible for the proper disposal of items and equipment exposed to blood or other bodily fluids?
What are considered emergency situations?
injuries that impair vital function of the CNS and cardiorespiratory system
What is the purpose of the primary assessment?
Determine level of responsiveness and assess airway, breathing and circulation
What are red flags that would lead to the activation of the ERP during the primary assessment?
Unconscious
Loss of consciousness in the presence of head trauma
Respiratory distress, failure or airway obstruction
No pulse
Severe chest or abdominal pains
Excessive arterial bleeding
Severe heat illness (core rectal temperature greater than 102F (39C) )
Severe shock
Suspected spinal injury
Fractures involving several ribs, the femur or the pelvis
Severe hypoglycemia
Collapse in response to sickling episode
Extreme ranges deviating from normal BP, pulse and respiration rates
What is triage?
rapid assessment of all injured patients followed by a return to the most seriously injured to provide immediate treatment
What is the purpose of the secondary assessment?
identify the type and extent of any injury and the immediate disposition of the condition, decisions made regarding on-field management
What are the on-field history Qs you need to ask?
Location and type of pain
Presence of abnormal neurological signs – NTB
MOI
Associated sounds – snap, pop?
History of injury
What are the on-field components to observation?
Surrounding environment
How the patient responded to the blow – immediate deformity or dysfunction
Body position – gross deformities, posturing of extremities in brain injuries
- Decerebrate rigidity – extension of all four
extremities
- Decorticate rigidity – extension of legs and
flexion of elbows, wrists and fingers
Movement of the individual – normal to hold injured body part
The level of responsiveness
AVPU
Alert – fully awake and spontaneously
engages
Voice – appears out of it and needs verbal
prompts to respond, may grunt/moan
Pain – response to painful stimulus
Unresponsive – no eye, voice or motor
response to painful stimulus
What does alert and oriented x4 mean?
Person is awake and oriented to name, time, location and event
What is the modified Glasgow Coma Scale?
Eye opening
4 = spontaneously
3 = to voice stimulus
2 = to painful stimulus
1 = no response
Verbal response
5 = normal conversation
4 = disoriented conversation
3 = words, not coherent
2 = no words, just sound
1 = no verbal response
Motor response
6 = follows command
5 = localizes painful stimulus
4 = withdrawal to pain
3 = abnormal flexion to stimulus (decorticate)
2 = abnormal extension to stimulus (decerebrate)
1 = no response
What are the ABCs?
Airway
Breathing
Circulation
Primary check
What are you looking for when inspecting a head trauma?
pupils = normal appearance, dilation/constriction PERRLA
Anisocoria = unequal pupils
Racoon eyes = ecchymosis under the eye
Battle sign = ecchymosis behind the ear
CSF/blood leaking
What should you do for an on-field palpation exam?
Bony palpation – possible fractures, crepitus
Soft-tissue palpation – swelling, deformity
Skin temperature – normally dry (sweating if intense practice/ game)
What are the components of on-field functional testing?
AROM- quantity and quality of movement, pain
Weightbearing or not
What is the on-field stress testing?
ligamentous integrity testing before muscle guarding and swelling
What is the on-field neurological testing
sensation, motor function (cranial nerve assessment), reflexes
What are the diagnostic signs that are taken?
Pulse – adult = 60-100 bpm, children = 120-14 bpm, sensation of contraction
Respiration – adult = 10-20 breaths/min, children 20-25 breaths/min, character
Pulse oximetry – 95-100%, low = 90-95%, less than 90% = hypoxemia, blow 80% = impairs brain and heart function
Blood pressure – systolic = 120 mmHg, diastolic = 70-80 mmHg
Temperature – 37 degrees Celsius
Skin colour – indication or blood flow or oxygen concentration
Pupils – PEARLA
What are vital signs?
Pulse
Respiration rate
BP
Temperature
What are injuries/conditions that are not life threatening but require immediate referral to physician for care?
Eye injuries
Dental injuries in which a tooth has been knocked loose or out
Minor/simple fractures
Lacerations that may require suturing
Injuries in which a functional deficit is noticeable
Loss of normal sensation or diminished or absent reflexes
Noticeable muscle weakness in extremities
Any injury if uncertain about severity/nature
What are the steps to managing bone injuries?
Detect fracture = palpation, percussion, tunning fork, compression, distraction
Deformity crepitus, swelling, increased pain
Remove clothes around injured site
Check PMSC before and after
Cover all wounds including open fractures
Pad splint
Immobilize above and below the fracture site
Splint in position found
What are equipment considerations to keep in mind?
Quick release if helmet has it
Unscrew or cut off 2 side snubbers to open face mask
Ideally done with electric drill
Screwdriver last resort
Shears for cutting
Chin strap removal
Cheek pad removal
Have something in fanny pack to help with removal
Handle of reflex hammer
Tongue depressors
Jersey Removal
Cut down the side, across shoulders and down front sleeves
Prepare for Pad Removal
Cut laces in middle of pads
Head immobilization
Either vice grip or cradle hold done by most qualified
Helmet removal
Shoulder pad removal
What is ambulatory assistance?
injured individual who is able to walk, one person on each side of the injured individual
What is manual conveyance?
injured individual unable to walk or far distance, chair carry
