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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
Looks well
Pt has fever as their only positive SIRS criteria, and appears comfortable/in no distress (CTAS 4)
26
When do you apply second order modifiers
After c/c has been determined ad first order modifiers have been applied, AND PT IS NOT CTAS 1!
27
What are the three second order modifiers
Pain score, bleeding disorders, MOI
28
How is pain used for CTAS differentiating
Pain severity is matched w how serious problem could become, and if the pain rating changes at all throughout the duration of care
29
Central vs peripheral pain
Central (head/chest/abd) is higher then peripheral pain in limbs
30
Acute vs chronic pain
New onset pain is typically more severe than chronic (acute exacerbations of chronic pain included)
31
What are things we would look for as “bleeding disorders”
Actual bleeding disorders (DIC, hemophilia A), severe liver failure, is taking anticoagulants
32
MOI is most commonly differentiated by the
Transfer of energy using the traumatic event
33
CTAS 2: motor vehicle collisions
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
CTAS 2: motorcycle collision
Impact w vehicle >30km/h (especially if person is separated from vehicle)
35
CTAS 2: Fall
From <6m (one story is 3m), head/neck injury from fall above 1m/5stairs
36
CTAS 2: penetrating injury
To head/neck/trunk/extremities proximal from the elbow/knee
37
CTAS 2: assault
Head injury due to blunt object other than fist or feet, heck injury due to axial load to the head
38
CTAS rule 1 (minimum of 2)
A minimum of 2 CTAS scores will be applied (arrival & departure - which is the one recorded to the receiving facility)
39
CTAS rule 2 (second!)
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
CTAS rule 3 (no more than me)
When taking into consideration the pt’s response to tx new CTAS can only deviate downwards by 2
41
CTAS rule 4 (VSA 1)
For a pt who is VSA at any point during care, they are a CTAS 1
42
CTAS rule 5 (pt not alive)
If paramedics receive a TOR while managing a pt, they must assign an arrival CTAS level, but the departure CTAS will be 0
43
CTAS rule 6 (ObviOusly dead)
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
CTAS 1 definition
Resuscitation: life/limb threatening condition (needs help ASAP)
45
CTAS 1 specifications
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
CTAS 2 definition
Emergent: potential threat to life/limb/function (needs help in 15 mins)
47
CTAS 2 specifications
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
CTAS 2 specific VS
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
CTAS 3 definition
Urgent: conditions that could potentially progress seriously requiring emergency intervention (discomfort/feeling affecting ability to function daily)
50
CTAS 3 specifications
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
CTAS 3 specific VS
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
CTAS 4 definition
Less urgent: condition relates to comorbidity (help in 1-2hr)
53
CTAS 4 specifications
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
CTAS 5 definition
Non urgent: acute but not that acute
55
CTAS 5 specifications
Minor trauma (0-8/10), CLAPS alone, sore throat/URI, chronic psychiatric disorders (depression, trouble coping, impulse control)
56
Why is recognition in symptoms/presentation more important than diagnosis in pediatric patients
No matter the diagnosis, the patient’s presentation can change rapidly therefore noticing them early can assist in preparing tx plans
57
What does a ‘key look’ include in pediatric pts
Sight, hearing, seeing, smelling
58
PAT
General appearance, WOB, circulation
59
General appearance (men invent cool looking sounds)
Muscle tone, interactiveness, consolability, look/gaze, speech/crying
60
WOB (after babies pee having read gossip girls no)
Abnormal breath sounds, position, had bobbing, retractions, grunting, nasal flaring
61
Circulation (3p, 2b, 2m, 2t, 1c)
Palpable pulses, pallor, bleeding, blood pressure, mucous membranes, mottling, temp, turgor, cyanosis
62
In infants tachycardia is a late finding of what
Hypovolemia or HoTN
63
Pediatric CTAS 1
Resuscitation (requiring really aggressive tx)
64
Pediatric CTAS 2
Emergent/unstable child (cap refill >4 sec, fever for >3 months, temp >38, immunocompromised, dehydration, altered LOA, HoTN, child abuse, serious infection)
65
Pediatric CTAS 3
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
Pediatric CTAS 4
Less urgent/pt can wait much longer (ear ache)
67
Pediatric CTAS 5
Non emergent/pt likely does not need help

Ambulance Operations Theory (Sem 2) (8 decks)

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