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Ambulance Operations Theory (Sem 2) > CTAS (W9) > Flashcards

CTAS (W9) Flashcards

1
Q

CEDIS

A

Canadian emergency dept information system

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2
Q

What is the purpose of CEDIS

A

Identify c/c through 18 categories

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3
Q

CTAS

A

Canadian triage acuity scale

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4
Q

What is the purpose of CTAS

A

To warn the ED of acutely incoming patients

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5
Q

What are the steps to assign CTAS

A

Step 1: conduct quick look (CTAS 1?)
Step 2: determine actual c/c (CTAS 1?)
Step 3: apply first order modifiers (CTAS 1??)
Step 4: apply second order modifiers (CTAS 1? If not: CTAS 2-5?)

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6
Q

What are the four first order modifiers

A

Respiratory distress, hemodynamic status, LOC, temp

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7
Q

Severe respiratory distress

A

Fatigue from excessive WOB, cyanosis, 1 word dyspnea, upper AW obstruction, lethargy, confusion, SpO2 <90% (CTAS 1)

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8
Q

Moderate respiratory distress

A

Increased WOB, clipped sentences, significant/increasing stridor but the AW is still protected, SpO2 <92% (CTAS 2)

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9
Q

Mild/moderate respiratory distress

A

Dyspnea, tachypnea, SOB on exertion, no obvious WOB, able to speak in sentences, stridor without any obvious obstruction, SpO2 92-94% (CTAS 3)

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10
Q

S/S of hypoperfusion

A

Confusion/agitation/decreased LOA, mottling, cold extremities, marked pallor, decreased O2 on RA, BP <90mmHg)

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11
Q

Hemodynamics status is based on

A

Skin colour, temp, moisturizer, and pulse (we are looking at perfusion status)

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12
Q

Shock

A

Evidence of severe end-organ hypoperfusion, marked pallor, cool skin, diaphoresis, weak or thready pulse, HoTN, postural syncope, significant tachy/bradycardia, ineffective ventilation or oxygenation, decreased LOC, pt could also appear flushed, febrile, in septic shock (CTAS 1)

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13
Q

Hemodynamic compromise

A

Evidence of borderline perfusion, pale, history of diaphoresis, unexplained tachycardia, postural hypotensive by history, feeling faint sitting or standing, suspected HoTN which may very by pt (CTAS 2)

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14
Q

Moderate hemodynamic compromise

A

VS at the upper/lower end of normal, VS differing from pts normal (CTAS 3)

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15
Q

LOC is based on

A

Assessing neuro function, look for responses outside pts from normal

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16
Q

Unconscious

A

Unable to protect AW, response to pain or loud noise only without purpose, continuous seizure or progressive deteriorate in level of consciousness, GCS 3-9 (CTAS 1)

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17
Q

Altered LOC

A

Response inappropriate to verbal stimuli, loss of oriented to person, place, or time, new impairment of recent, altered behaviour, GCS 10-13 (CTAS 2)

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18
Q

Normal

A

Other modifiers are used to define, GCS 14-15 (CTAS 3-5)

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19
Q

Temperature is based on

A

> 38.5 degrees C in adult pt, based on SIRS for sepsis identification

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20
Q

SIRS

A

Systemic inflammatory response syndrome

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21
Q

SIRS criteria

A

Temp above 38, HR over 90BPM, RR over 22BPM, white cell count of 12,000

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22
Q

Immunocompromised

A

Neutropenia (or suspected), chemotherapy or immunosuppressive, drugs including steroids (CTAS 2)

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23
Q

Looks septic

A

Pt has evidence of infection, have 3 SIRS criteria positive or show evidence of hemodynamic compromise, moderate respiratory distress or altered LOC (CTAS 2)

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24
Q

Looks unwell

A

Pt has <3 SIRS criteria positive but appears ill-looking, ie flushed, lethargic, anxious or agitated (CTAS 3)

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25
Q

Looks well

A

Pt has fever as their only positive SIRS criteria, and appears comfortable/in no distress (CTAS 4)

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26
Q

When do you apply second order modifiers

A

After c/c has been determined ad first order modifiers have been applied, AND PT IS NOT CTAS 1!

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27
Q

What are the three second order modifiers

A

Pain score, bleeding disorders, MOI

28
Q

How is pain used for CTAS differentiating

A

Pain severity is matched w how serious problem could become, and if the pain rating changes at all throughout the duration of care

29
Q

Central vs peripheral pain

A

Central (head/chest/abd) is higher then peripheral pain in limbs

30
Q

Acute vs chronic pain

A

New onset pain is typically more severe than chronic (acute exacerbations of chronic pain included)

31
Q

What are things we would look for as “bleeding disorders”

A

Actual bleeding disorders (DIC, hemophilia A), severe liver failure, is taking anticoagulants

32
Q

MOI is most commonly differentiated by the

A

Transfer of energy using the traumatic event

33
Q

CTAS 2: motor vehicle collisions

A

Ejection (complete or partial), rollover, extrication over 20 mins, significant intrusion into vehicle (>.3m from occupant site, >.5m any site including roof), death in the same passenger compartment, unrestrained impact above 40km/h, restrained impact above 60km/h, head striking the windshield resulting in head injury, high vehicle accident resulting in neck injury

34
Q

CTAS 2: motorcycle collision

A

Impact w vehicle >30km/h (especially if person is separated from vehicle)

35
Q

CTAS 2: Fall

A

From <6m (one story is 3m), head/neck injury from fall above 1m/5stairs

36
Q

CTAS 2: penetrating injury

A

To head/neck/trunk/extremities proximal from the elbow/knee

37
Q

CTAS 2: assault

A

Head injury due to blunt object other than fist or feet, heck injury due to axial load to the head

38
Q

CTAS rule 1 (minimum of 2)

A

A minimum of 2 CTAS scores will be applied (arrival & departure - which is the one recorded to the receiving facility)

39
Q

CTAS rule 2 (second!)

A

CTAS level reported to receiving institution is the level at departure from the scene, or if the pt condition deteriorates after transportation has been initiated

40
Q

CTAS rule 3 (no more than me)

A

When taking into consideration the pt’s response to tx new CTAS can only deviate downwards by 2

41
Q

CTAS rule 4 (VSA 1)

A

For a pt who is VSA at any point during care, they are a CTAS 1

42
Q

CTAS rule 5 (pt not alive)

A

If paramedics receive a TOR while managing a pt, they must assign an arrival CTAS level, but the departure CTAS will be 0

43
Q

CTAS rule 6 (ObviOusly dead)

A

In cases where it is determined on arrival that a pt is ‘obviously dead’ no CTAS level at all s required, documented as )s on ACR

44
Q

CTAS 1 definition

A

Resuscitation: life/limb threatening condition (needs help ASAP)

45
Q

CTAS 1 specifications

A

Pre/post arrest, problem w ABCs, unstable vitals, mental health (imminent threat to self/others; specific plan), burn 25% TBSA, any AW burns, unconscious, GCS <10, active seizure, near death asthma, third trimester (bleeding/baby showing/abd pain)

46
Q

CTAS 2 definition

A

Emergent: potential threat to life/limb/function (needs help in 15 mins)

47
Q

CTAS 2 specifications

A

Serious injury/illness, requires prompt tx, ALS in field, congestive defects outside pt’s norm, headache (w pain/N/V/confusion), LOC >5mins, abnormal VS w/o hypoperfusion, chemical in eye/acute vision loss, visceral CP (& hx of PE, MI, angina), OD, suicide (clear plan and ideation), severe anxiety/agitation/known psychosis/pt in restraints, SBP >220, DBP >180, abd pain 8-10, visceral/constant ache/pressure/burning/squeezing with abnormal VS, vomiting lots of blood/coffee ground emesis with abnormal VS (no hypoperfusion), anaphylaxis, hypothermia/frostbite, heavy vag bleeding (in pregnancy, can have abnormal Vs but no hypoperfusion), l’about over 20w contractions 2 mins apart, pregnancy >20w w HTN, (+/-) s/s pre-eclampsia, abd pain

48
Q

CTAS 2 specific VS

A

CBG <3mmol/L (w confusion/seizure/diaphoresis/behavioural changes/acute focal deficits)
CBG >18mmol/L (w dyspnea/tachypnea/dehydration/thirst/weakness/polyuria)
SBP >220/DBP >130 (w any other symptoms like headache/CP/SOB/N)

49
Q

CTAS 3 definition

A

Urgent: conditions that could potentially progress seriously requiring emergency intervention (discomfort/feeling affecting ability to function daily)

50
Q

CTAS 3 specifications

A

Normal VS, moderate pain, sharp local CP (worse w deep breaths/coughs/movement/palpation), not pains associated w SOB, SOB, normal vs possible wheeze (asthma/COPD hx), asthma/COPD pt unable to lie down w/o s/s (SpO2 >92%), direct blow/fall >3ft, LOC <5mins, isolated trauma (broken bones w severe pain and normal neuro exam), not active GI bleed w normal VS, pregnant pts (w mild pain/normal VS/1st trimester), brief seizure <5mins (stable pt protecting own AW), uncertain of threat pt poses to self or others, stable dialysis pt

51
Q

CTAS 3 specific VS

A

CBG <3mmol/L no s/s
CBG >18mmol/L no s/s
SBP >220/DBP >130 no s/s
SBP 200-220/DBP 110/130 (w any symptoms, ie headache, CP, SOB, nausea)

52
Q

CTAS 4 definition

A

Less urgent: condition relates to comorbidity (help in 1-2hr)

53
Q

CTAS 4 specifications

A

Minor head injury (no LOC, GCS 15, no ASSPN), mild anxiety/agitation, no distress, CP 4-7(no SOB, normal VS), SBP 200-220/DBP 110-130 (w other normal VS), acute pain 0-3/10 (pt looks well), congestion/cough/aches/sore throat/fever/no respiratory s/s

54
Q

CTAS 5 definition

A

Non urgent: acute but not that acute

55
Q

CTAS 5 specifications

A

Minor trauma (0-8/10), CLAPS alone, sore throat/URI, chronic psychiatric disorders (depression, trouble coping, impulse control)

56
Q

Why is recognition in symptoms/presentation more important than diagnosis in pediatric patients

A

No matter the diagnosis, the patient’s presentation can change rapidly therefore noticing them early can assist in preparing tx plans

57
Q

What does a ‘key look’ include in pediatric pts

A

Sight, hearing, seeing, smelling

58
Q

PAT

A

General appearance, WOB, circulation

59
Q

General appearance (men invent cool looking sounds)

A

Muscle tone, interactiveness, consolability, look/gaze, speech/crying

60
Q

WOB (after babies pee having read gossip girls no)

A

Abnormal breath sounds, position, had bobbing, retractions, grunting, nasal flaring

61
Q

Circulation (3p, 2b, 2m, 2t, 1c)

A

Palpable pulses, pallor, bleeding, blood pressure, mucous membranes, mottling, temp, turgor, cyanosis

62
Q

In infants tachycardia is a late finding of what

A

Hypovolemia or HoTN

63
Q

Pediatric CTAS 1

A

Resuscitation (requiring really aggressive tx)

64
Q

Pediatric CTAS 2

A

Emergent/unstable child (cap refill >4 sec, fever for >3 months, temp >38, immunocompromised, dehydration, altered LOA, HoTN, child abuse, serious infection)

65
Q

Pediatric CTAS 3

A

Urgent/normal VS but c/is concerning (pain 4-7 in cavity, head injury w GCS 13-15 or N/V, moderate dyspnea by pneumonia/bronchiolitis/croup/etc, stabilized seizure activity)

66
Q

Pediatric CTAS 4

A

Less urgent/pt can wait much longer (ear ache)

67
Q

Pediatric CTAS 5

A

Non emergent/pt likely does not need help

Ambulance Operations Theory (Sem 2) (8 decks)

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