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PRIMARY CARE PARAMEDIC 2021/22 > EMER 109 Patient Assessment > Flashcards

EMER 109 Patient Assessment Flashcards

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1
Q

<p>Patient Assessment Order</p>

A

dispatch

windshield survey (POPP)

general appearance

initial assessment (loc, abc, skin)

chief complaint

focused assessment (sample, opqrst, vitals)

interventions (can be provided as focused assessment is being performed)

decision and transport

reassessment of patient (initial, c/c, injuries, tx)

complete head to toe exam ongoing (if not necessary, must state why and complete a focused exam)

adapt patient care plan to changes in the patients condition

radio patch ER

report given to receiving facility

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2
Q

<p>Dispatch will provide the following</p>

A

Number of pts (will you require additional EMS response)

Special considerations (identified hazards that require you to stand down)

Additional response (do you require assistance of Police or Fire)

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3
Q

<p>POPP: people</p>

A

Number of patients
Number and state of bystanders
Mechanism of injury

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4
Q

<p>POPP: odours</p>

A

Are there any odours that would indicate hazards ?

Are there any odours that would indicate poor living conditions or self care?

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5
Q

<p>POPP: pets</p>

A

Are there any pets present?
Are they secured?
Are they a threat?

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6
Q

<p>POPP: pathways</p>

A

Where is the pt located?

Do you have direct access to patient and/or scene?

Do you need additional resources to gain access to the patient?

How big is the area the patient is in located?

Will you have enough room to get yourself, partner and equipment in the room and still be able to care for the patient?

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7
Q

<p>what should you look for besides POPP during scene survey</p>

A 
patient location
patient environment
hot or cold
lifestyle
number of pts
MOI
evaluate need for additional resources
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8
Q

<p>what do you do upon entry to someones home</p>

A

<p>announce prescenceindoor scene assessment</p>

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9
Q

<p>why is allergy history important</p>

A

<p>helps determine if problem is an allergic reaction helps you avoid any meds or items such as latex gloves in treatment plan help you determine if it is a true allergy versus a medication side effect</p>

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10
Q

<p>2 types of medication history</p>

A

<p>Primary medication history the best possible medication history</p>

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11
Q

<p>Primary medication history</p>

A

<p>Quickly captures a list of medications. Determines the relationship between dosage and frequency of administration with respect to the patient’s complaint. Is created without other reliable sources of information</p>

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12
Q

<p>Complete documentation of a primary medication history includes:</p>

A

<p>Drug name Dosage Route Frequency</p>

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13
Q

<p>Best Possible Medication History (BPMH)</p>

A

<p>Is a systematic process of interviewing the patient/family. Is a review of at least one other reliable source of information to obtain and verify all of a patient’s medication use</p>

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14
Q

<p>Medication Reconciliation</p>

A

<p>a complete list of each patient’s current medications is obtained every time the patient enters the health care organization and is then communicated to subsequent providers in or out of the same health care organization</p>

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15
Q

<p>goal of Medication Reconciliation</p>

A

<p>prevent adverse drug events that could occur by allergic reactions, omissions, substitutions, and/or duplications</p>

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16
Q

<p>primary goal of the incident history interview</p>

A

<p>identify the patient’s chief complaint</p>

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17
Q

<p>Questioning the patient during the interview should focus on</p>

A

<p>specific symptoms or important medical information that will facilitate reaching an accurate diagnosis</p>

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18
Q

<p>O - Onset</p>

A

<p>“What were you doing, when the symptom/pain began?”"did it start suddenly"</p>

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19
Q

<p>P - Provocation</p>

A

<p>"Does anything make it better or worse ?”</p>

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20
Q

<p>Q - Quality</p>

A

<p>“What does the pain feel like?""can you describe what it feels like?"</p>

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21
Q

<p>R - Radiation/Region</p>

A

<p>“Does the pain move anywhere?""Do you have any other pain with this?”</p>

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22
Q

<p>S - Severity FOR PAIN</p>

A

<p>“On a scale of 0-10; 0 being no pain or completely pain-free, and 10 being the worst pain ever, how would you rate the pain?”</p>

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23
Q

<p>S - Severity FOR SOB</p>

A

<p>"would you say your shortness of breath is mild moderate or severe?"</p>

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24
Q

<p>T - Time</p>

A

<p>“What time did the symptom/pain begin?”</p>

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25
Q

<p>S – Signs and Symptoms</p>

A

<p>sign: what you seesymptoms: what they feelex: "what's going on?""what are you feeling?""what is hurting?""where does it hurt?"</p>

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26
Q

<p>A – Allergies</p>

A

<p>" do you have any allergies?""what happens if you come in contact with the allergen?"</p>

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27
Q

<p>M – Medications</p>

A

<p>prescriptions over the counter herbal remedies vitamins/supplements"are you compliant with your meds"</p>

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28
Q

<p>P – Past Medical History</p>

A

<p>(“The Big 7”) Respiratory problems Diabetes Seizures Cardiac problems Strokes Syncope Hypertension/Hypotension</p>

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29
Q

<p>L – Last Oral Intake</p>

A

<p>What was it? Was it normal?</p>

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30
Q

<p>E – Events Leading up to Current Event</p>

A

<p>"what happened""what caused this""what were you doing""do you remember what you were doing""is that something you often do"</p>

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31
Q

<p>why is last oral intake important</p>

A

<p>provide great insight into what their life has been like in last the 24 hours Inquire if they’ve had any recent changes in their dietary patterns (diets) In the event that surgery is required, the last oral intake may influence surgical times provide some indication of the patients’ underlying complaintcan be particularly important in the presence of diseases such as diabetes</p>

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32
Q

<p>what is a Primary Assessment</p>

A

<p>first assessment that you will perform on every patient contact identify life threats It is to be performed quickly on every call upon patient contact</p>

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33
Q

<p>Components of a Medical initial/Primary Assessment</p>

A

<p>General Impression LOCABCSkin</p>

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34
Q

components of general impression

A

*Signs of distress (does patient track, accessory muscle use, too sob to speak)
*Pts colour
*Positioning
*deadly bleeds
Body type
Personal hygiene/Body odour Signs of abuse
Speech
Mood
Movement

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35
Q

<p>components of Level of Consciousness (LOC)</p>

A

AVPU
Alert and Oriented questions
GCS scale

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36
Q

<p>AVPU</p>

A

<p>alert- do they track you, are they alert and oriented x4Verbal- Do they respond to verbal stimuli? Pain- Do they only respond with painful stimuli? Unresponsive- Are they unresponsive to all stimuli?</p>

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37
Q

<p>Alert and Orientated x4 questions</p>

A

<p>personplacetimeevent"what is your name""where are you""what month is it""what happened"</p>

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38
Q

airway

A

Quickly identify airway status

Is airway open and patent?

If not, immediately intervene

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39
Q

Breathing

A

look, listen feel

Identify quality and effectiveness of breathing

speed: fast/slow
regularity: regular/irregular
volume: shallow/deep

relative rate

effort: laboured/non laboured
- number of words spoken in a sentence

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40
Q

Circulation

A

speed:fast/slow
strength:strong/weak
regularity:regular/irregular
relative rate
present or not

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41
Q

skin

A

Colour (normal, pale, grey, ashen, cyanotic or mottled)

Temperature (warm, cool, or hot)

texture (dry, diaphoretic, moist

other findings (rashes, burns)

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42
Q

unstable patient would be:

A

Altered level of consciousness

Airway compromise

Absent breathing or
inadequate breathing

Pulse that is absent or inadequate

Skin findings that indicate circulation compromise

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43
Q

Head to toe check: head and neck

A

Jugular vein distention (JVD)
Wounds
Tracheal deviation

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44
Q

Head to toe check: chest

A 
Assess for: 
Asymmetry 
Contusions 
Penetrations 
Tenderness 
Instability 
Crepitus

Listen to:

  • The chest in 2 places to assess if equal (if unequal perform percussion)
  • Heart tones
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45
Q

Head to toe check: abdomen

A 
look for:
Contusions 
Penetrations 
Evisceration 
Distention 
Tenderness 
Rigidity
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46
Q

Head to toe check: pelvis

A

Tenderness
Instability
Crepitus

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47
Q

head to toe check: Upper/lower extremities

A

Obvious swelling or deformity

Motor and sensation

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48
Q

head to toe check: posterior

A

Obvious wounds
Tenderness
Deformity

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49
Q

head to toe check: If altered mental status

A

Brief neurological exam

Pupil size, reactivity, equality

Glasgow coma scale

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50
Q

DCAP BLS TIC

A

deformities
contusions
abrasions
penetrations

burns
lacerations
swelling

tenderness
instability
crepitus

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51
Q

what is a secondary assessment

A

After primary assessment and after treated life threats

guided by the patient’s primary complaint

allows you to focus your assessments on a specific illness or injury

patient history and vital signs

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52
Q

Cardiac/ Respiratory Focused Assessment: NECK

A

Jugular vein distention (JVD)
Accessory muscle use
Tracheal deviation

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53
Q

Cardiac/ Respiratory Focused Assessment: CHEST

A 
Look for: 
Any visible trauma  
Pacemakers 
Medication patches 
Surgical scars 
Accessory muscle use 
Hyperinflation

Listen to:

  • The chest in four places to assess if breathing is clear and equal
  • Upper lobes (middle clavicular line below collar bones)
  • Lower lobes (Fifth intercostal space)
  • Have patient take two deep breaths when assessing each area

Palpate:

  • Chest to assess if patient has any pain
  • If there is pain, does the pain change (increase on palpation/inspiration or no change at all)
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54
Q

Cardiac/ Respiratory Focused Assessment: ANKLES

A
  • Check for pedal edema (swollen)
  • Push down and count how long it takes to rebound (ex: edema x 2 secs)
  • If edema is present check if pitting edema is present in one or both ankles
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55
Q

Neurological Focuses Assessment: FACE/HEAD

A

check for facial droop (have patient smile)

trauma

pupillary changes

  • constriction/dilation
  • unequal\reaction to light
  • pearl (pupils equal and reactive to light)

note clarity of speech (slurred speech, inability to speak)

ask if they have a:

  • headache
  • dizzy/lightheaded
  • blurred vision
  • double vision
  • hard time remembering events
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56
Q

Neurological Focuses Assessment: UPPER EXTREMITIES

A

do a comparison of both hands assessing movement, sensation, and equality
-grip strength

test arm drift

numbness or tingling in the extremities

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57
Q

Neurological Focuses Assessment: LOWER EXTREMITIES

A

check movement

sensation

colour

temperature

are pulses present in the lower extremities?

Strength should be assessed by having patients push and pull with their feet

Numbness or tingling in the extremities

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58
Q

Neurological Focuses Assessment: if they have a:

  • headache
  • dizzy/lightheaded
  • blurred vision
  • double vision
  • hard time remembering events
A

BGL
Stroke assessment
GCS Scale

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59
Q

Stroke assessment

A 
FAST 
Facial droop 
Arm drift 
Slurred speech  
-Ask if slur is normal 
Time
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60
Q

Gastrointestinal/genitourinary focused assessment: ABDOMEN

A

look for:

  • distention
  • bruising
  • surgical scars
  • visible masses
  • pulsating masses

palpate:
- start at the opposite side of where the patient has pain
- rigidity
- rebound tenderness
- guarding
- DO NOT palpate any pulsating masses

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61
Q

Gastrointestinal/genitourinary focused assessment: PELVIS

A

continent or incontinent

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62
Q

Gastrointestinal/genitourinary focused assessment: LOWER EXTREMITIES

A

check color and temperature

check pulses if suspecting abdominal aortic aneurysm (AAA)

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63
Q

Gastrointestinal/genitourinary focused assessment: QUESTIONS YOU NEED TO ASK

A

urinary frequency/complications/changes

bowel movements- any noticeable changes

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64
Q

Eyes, Ears, Nose, Mouth and Throat (EENT) Focused Assessment: EYES

A

inspect the external portions including sclera, cornea and iris

inspect structures around the eyes including eyelids, lashes and tear ducts

test visual acuity at varying distances in each eye separately

test peripheral vision (confrontation test)

test eye movement
-Have patient follow finger as you move it in a figure of z or h pattern

Test pupil size and reaction to light

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65
Q

Eyes, Ears, Nose, Mouth and Throat (EENT) Focused Assessment: EARS

A

Visual inspection for wounds, infection discharge and excessive cerumen

Test hearing with voice test or similar

Palpate external structures if applicable

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66
Q

Eyes, Ears, Nose, Mouth and Throat (EENT) Focused Assessment: NOSE

A

Inspect the nose

  • Is there any discharge (color?)
  • Look for symmetry, color and structural abnormalities

Palpate if applicable and test nasal patency (sniff test)

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67
Q

Eyes, Ears, Nose, Mouth and Throat (EENT) Focused Assessment: MOUTH/THROAT

A

Inspect the mouth including lips, teeth, gums and tongue

Inspect the throat including tonsils, uvula and pharyngeal wall for redness and swelling

Breath odour

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68
Q

Unconcious/unkown Focused Assessment: FACE/HEAD

A

facial droop

trauma

pupillary changes (constricted or dilated)

equality

reaction to light

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69
Q

Unconcious/unkown Focused Assessment: NECK

A

jugular vein distension

accessory muscle use

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70
Q

Unconcious/unkown Focused Assessment: CHEST

A

look for:

  • any visible trauma
  • pacemakers
  • medication patches
  • surgical scars
  • use of accessory muscles

listen to:

  • the chest in four places to assess if the breathing is clear and equal
  • have the patient take two deep breaths when assessing each area

palpate:
- the chest to assess if the patient has any pain
- if there is pain, does the patients pain change (increase on palpation/inspiration or no change at all)

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71
Q

Unconcious/unkown Focused Assessment: ABDOMEN

A

look for:

  • distention
  • bruising
  • surgical scars
  • visible masses
  • pulsating masses

palpate:
- start the opposite side of where pain is
- rigidity
- rebound tenderness
- guarding
- DO NOT palpate any pulsating masses

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72
Q

Unconcious/unkown Focused Assessment: PELVIS

A

Look for trauma and evidence of urinary and bowel incontinence

Palpate the pelvis to check stability or crepitus

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73
Q

Unconcious/unkown Focused Assessment: UPPER EXTREMITIES

A

Asses movement and sensation

Hand grips and do a comparison in both hands for equality of strength

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74
Q

Unconcious/unkown Focused Assessment: LOWER EXTREMITIES

A

Check movement

Sensation

Colour

Temperature

Prescence of pulse in the
lower extremities

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75
Q

Unconcious/unkown Focused Assessment: BACK

A

Check for any visible or palpable abnormalities

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76
Q

R’s of Medication

A

right patient

right medication
expiry date

right dose

right route

right time

right documentation

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77
Q

CTAS (Canadian triage and acuity scale)

A

method of categorizing patient severity and level of distress pre-hospital is with the use of the Pre-CTAS system

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78
Q

Pre-CTAS level 1 TRANSPORT

A

patients should be transported to the closest emergency department.

An exception to this would be a designated trauma center, a stroke center, or pediatric hospital. 

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79
Q

Pre-CTAS level 2 TRANSPORT

A

patients should be transported to the nearest appropriate emergency department based on the patient’s chief complaint.

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80
Q

Pre-CTAS level 3, 4, and 5 TRANSPORT

A

patients are stable, and a destination can be determined based on several criteria including; chief complaint, emergency department busyness, or patient request.

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81
Q

CTAS Level 1

A

resuscitation

Conditions that are a threat to life, limb or imminent risk of deterioration and require immediate intervention

Obvious signs of distress and unstable or abnormal vital signs

Immediate risk of significant deterioration or death

Examples:

  • Cardiac arrest
  • Active seizure
  • Respiratory arrest
  • Majour trauma with sings of shock
  • Severe respiratory distress
  • Alters LOC with GCS 9 or less
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82
Q

CTAS Level 2

A

emergent

Conditions that are potential threat to life or limb and require rapid intervention

Vital signs are abnormal

Examples:

  • Moderate respiratory distress altered LOC with GCS of 10-13\severe abdominal pain with a rating of 8-10/10
  • Fever with temp greater than 38 or signs of sepsis
  • Chest pain with cardiac features
  • Chest pain with non-cardiac features
  • Hypertension with systolic greater than 220 and diastolic greater than 130 with symptoms
  • Hypothermia with a core temp of 32 degrees or les
  • Headache that is sudden and severe
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83
Q

CTAS level 3

A

urgent

Conditions that could potentially progress to a serious problem that require rapid intervention

Vitals are typically in the normal range

Examples:

  • Mild respiratory distress
  • Moderate abdominal pain with a rating of 4-7/10
  • Post seizure with normal level of alertness
  • Diarrhea
  • Hypertension with systolic greater than 220 and diastolic greater than 130 with no symptoms
  • Headache with moderate pain rated as 4-7/10
  • Upper extremity with obvious deformity
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84
Q

CTAS Level 4

A

less urgent

Conditions that relate to patient age, distress or potential for the deterioration that would benefit from intervention

Typically have normal vitals

Examples:

  • UTI complaints and symptoms
  • Constipation with mild pain rated as less than 4/10
  • Chronic confusion
  • Laceration or puncture that requires sutures
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85
Q

CTAS Level 5

A

non urgent

Conditions that are acute but non urgent

May be part of chronic problem with no signs of deterioration

Intervention or investigation can be delayed or referred

Examples:

  • Mild diarrhea with. No dehydration
  • Minor bites
  • Dressing change with normal vitals
  • Medication request
  • Laceration or puncture with no sutures required
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86
Q

Pulse Locations

A 
Carotid 
Femoral 
Brachial 
Radial 
Posterior tibial 
Dorsalis pedis pulse
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87
Q

Pulse Rate Assessment

A

rate, rhythm, and quality

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88
Q

factors that can affect Radial pulse

A

Medications
Medical history
Age
Exercise

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89
Q

Normal Pulse Rates

A

Infant
100-160 bpm

Toddler
90-150 bpm

Preschool-aged child
80-140 bpm

School-age child
70-120 bpm

Adolescent
60-100 bpm

Adult
60-100 bpm

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90
Q

Factors that influence pulse quality

A

low blood pressure, shock and underlying medical conditions

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91
Q

Normal findings for a skin assessment

A

pink, warm, and dry
or
good color, warm and dry

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92
Q

possible causes: RED SKIN

A

Fever
Hypertension
Allergic Reaction
Carbon monoxide poisoning

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93
Q

possible causes: PALLOR SKIN

A

Excessive blood loss
Fear
Shock

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94
Q

possible causes: CYANOSIS SKIN

A

Hypoxemia

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95
Q

possible causes: MOTTLED SKIN

A

Cardiovascular compromise

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96
Q

possible causes: HOT, DRY SKIN

A

Excessive body heat

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97
Q

possible causes: COOL, DRY SKIN

A

Reaction to increased internal or external temperature

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98
Q

possible causes: COOL, WET SKIN

A

Expose to cold

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99
Q

possible causes: TENTING SKIN

A

Dehydration

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100
Q

most reliable site for assessing for changes of skin colour

A

areas of least pigment, such as under the tongue, the buccal mucosa, the palpebral conjunctiva, and the sclera

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101
Q

what can assessment of skin give insight to

A

the function of the cardiovascular system, respiratory system and overall physiological well-being

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102
Q

what can assessment of pupils give insight to

A

the status of cerebral perfusion, oxygenation, and overall condition

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103
Q

parasympathetic nerve fibers

A

make pupils constrict (miosis)

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104
Q

sympathetic nerves

A

make pupils dilate (myotises)

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105
Q

look for the following when assessing pupils

A

Are the pupils constricted or dilated?
What size are they in millimetres?
Are the pupils equal or unequal to each other?
Do the pupils respond to light?
At what speed do they respond to light? Are they brisk or sluggish?

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106
Q

Pupil Responses: midbrain dysfunction

A

midposition and fixed

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107
Q

Pupil Responses: Pontine dysfunction

A

pinpoint

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108
Q

Pupil Responses: Dysfunction of the tectum (roof) of the midbrain

A

large “fixed” hippus

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109
Q

Pupil Responses: metabolic imbalance

A

small, reactive and regular

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110
Q

Pupil Responses: Diencephalic dysfunction

A

small and reactive

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111
Q

pupil responses: Dysfunction of third cranial nerve

A

sluggish, dilated and fixed

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112
Q

GSC Scale Tips:
ESPN
Our Country WIN
Can’t Live Without FANs

A 
Eye response 
Mnemonic ESPN 
-eye opening spontaneously 
-to sound  
-to pain 
-no response 
verbal response 
mnemonic Our Country WIN 
-our- oriented 
-country- confused 
-W- words (inappropriate) 
-I- incomprehensible sound 
-N- No response  
Motor Response 
Mnemonic Can’t Live Without FANs 
-Can’t- obeys Commands 
-Live- localizes to pain  
-Without- withdraws to pain 
-F- flexion (decorticate) 
-A- abnormal extension (decerebrate) 
-N- no response
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113
Q

factors that can affect respirations

A

Meds
Anxiety
Exercise

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114
Q

Assessing respiration

A

Regular resp count for 30 seconds

Irregular count for full 60 secs

Note depth: Shallow, normal or deep

Rhythm: should be regular and uninterrupted

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115
Q

Patterns of Respiration: NORMAL

A

regular and comfortable

12 to 20 per minute

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116
Q

Patterns of Respiration: ATAXIC

A

significant disorganization with irregular and varying depths of respiration

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117
Q

Patterns of Respiration: BRADYPNEA

A

slower than 12 per min

Sleep
OD
Head trauma
Strokes

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118
Q

Patterns of Respiration:

HYPERPNEA

A

faster than 20 per min

** deep breathing

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119
Q

Patterns of Respiration: SIGHING

A

frequently interspersed deeper breaths

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120
Q

Patterns of Respiration: AIR TAPPING

A

increasing difficulty in getting breath out

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121
Q

Patterns of Respiration: BIOT RESPIRATIONS

A

irregularity interspersed periods of apnea in disorganized sequence of breaths

CNS insults (especially infections)

122
Q

Patterns of Respiration: CHEYNE- STROKES BREATHING

A

varying periods of increasing depth interspersed with apnea

Brain stem insult
Increase ICP

123
Q

Patterns of Respiration: KUSSMAUL

A

rapid
deep
laboured

Metabolic acidosis and DKA

124
Q

Patterns of Respiration: TACHYPNEA

A

faster than 20 per min
Shock
Panick
Fear

125
Q

Normal Respiratory rates

A

Infant
30-60 bpm

Toddler
24-40 bpm

Preschool-aged child
22-34 bpm

School-age child
18-30 bpm

Adolescent
12-16 bpm

Adult
10-20 bpm

126
Q

factors that affect respiratory rate

A

high fever, anxiety, pain, excitement, and underlying medical and traumatic conditions

127
Q

Signs of Inadequate Breathing

A

Slow or fast respirations for patient’s age

Shallow breathing

Adventitious: abnormal breath sounds like wheezing, crackling or stridor

Altered mental status

Cyanosis

128
Q

methods for obtaining body temp

A 
Oral 
tympanic
axillary
temporal
rectal
129
Q

hypothermia temps

A

Core temperature less than 35°C
Mild: 32-35°C
Moderate 28-32°C
Severe: Less than 28°C

130
Q

fever temps

A

increase in temperature above 38°C
Can be a response to infection, inflammation, or drug therapy
Hypothalamus still functioning normally

131
Q

hyperthermia

A

Core temperature is greater than 40°C

Body temperature is out of control

132
Q

normal body temp

A

Range of 35.8-37.3°C considered normal range for oral temperature

133
Q

Factors that can Affect Temperature: OVULATION

A

Increased body temperature

134
Q

Factors that can Affect Temperature: TIME OF DAY

A

Increased temperature in evening; lower temperature in the early morning

135
Q

Factors that can Affect Temperature: AGE

A

Young and old; poor thermoregulation

136
Q

Factors that can Affect Temperature: EXERCISE

A

Increase body temperature

137
Q

Factors that can Affect Temperature: THYROID

A

Increase metabolic rate so corresponding increase in body temperature

138
Q

Core body temperature

A

found in blood supplying organs such as the brain, abdominal, and thoracic cavities

139
Q

Core temperature is affected by

A

internal factors

140
Q

True core temperature readings can only be measured by

A

invasive methods such as placing a probe in the esophagus, pulmonary artery, or bladder

141
Q

Peripheral temperature

A

the temperature of tissues, such as the skin

greatly influenced by environmental factors

not as reliable a source

142
Q

Blood pressure

A

is the force blood exerts on the vessel wall

143
Q

Systolic pressure

A

the maximum pressure felt during left ventricle contraction

144
Q

Diastolic pressure

A

the pressure exerted during the relaxation phase

145
Q

Pulse pressure

A

the difference between the two values

146
Q

BP Palpation

A

systolic blood pressure (BP)

rough BP estimate quickly without the use of a stethoscope

underestimated by 5–10 mmHg

Find radial pulse
Fill cuff till pulse disappears
Release some air slowly
When pulse returns number is systolic pressure

147
Q

BP Auscultation

A

Inflate cuff to 30 over usual pressure
Slowly release pressure valve 2-3 mmhg per second
Note when you hear the first clear sound (systolic pressure)
When sound disappears (diastolic pressure)

148
Q

Factors that affect blood pressure

A

Age: BP rises with age

Gender: Males have a higher BP than females but after menopause the reverse is true

Ethnic background: Those of African descent typically have a higher BP

Time of day: BP is typically higher later in the day and into the evening

Weight: BP is higher in obese individuals

Exercise: BP increases during exercise

Emotions: BP rises with anger, fear, and pain due to a sympathetic response

Stress: BP is higher in those that are under chronic stress

149
Q

Factors that can cause inaccurate blood pressure results

A

The cuff is not of the proper size

The cuff is positioned too loosely

The patient’s arm is not positioned properly

The patient is not seated properly

The cuff is inflated slowly

If the cuff is re-inflated immediately after an initial reading

150
Q

non-invasive blood pressures (NIBP) monitors

A

uses the  oscillometer  measurement technique

151
Q

the  oscillometer  measurement technique

A

measures the changes in pressure pulses that are caused by the flow of blood through the artery

152
Q

trouble shooting when using a non-invasive blood pressure monitor:

The monitor measures a pulse, but there is no oxygen saturation or pulse rate

A

Excessive patient motion

Patient perfusion may be too low

153
Q

trouble shooting when using a non-invasive blood pressure monitor:

SpO2: NO SENSOR DETECTED message appears

A

Sensor not connected to patient or cable disconnected from monitor/defibrillator

Damaged cable or sensor

154
Q

trouble shooting when using a non-invasive blood pressure monitor:

No SpO2 or SpCO, or SpMet value (—) is displayed

A

Sensor may be too tight
Patient is in cardiac arrest or shock

Oximeter may be performing self-calibration or self-test

Defibrillator shock just delivered

High-intensity lights (such as pulsating strobe lights) may be interfering with performance

Damaged cable or sensor

155
Q

trouble shooting when using a non-invasive blood pressure monitor:

Different SpCO or SpMet measurements on same patient

A

Every measurement, even on the same patient, can be different

156
Q

trouble shooting when using a non-invasive blood pressure monitor:

XXX appears in place of SpO2 reading

A

SpO2 module failed

nternal cable failed

157
Q

Explain Mean Arterial Pressure

A

the average pressure in a patient’s arteries during one cardiac cycle (averaged BP)

158
Q

A MAP of ——-mmHg or greater is believed to be needed to maintain adequate tissue perfusion

A

60

159
Q

usual MAP range

A

70-110 mmHg

160
Q

MAP formula

A

[(Diastole × 2) + systole ] ÷ 3

161
Q

Indications for blood glucose monitoring as defined by the Saskatchewan Paramedic Clinical Practice Protocols include:

A
  1. Seizure
  2. Sick pediatric patients
  3. Decreased level of consciousness
  4. Syncope
  5. Abnormal behaviour
  6. Any patient suspected of being hypoglycemic
162
Q

Factors that Affect Accuracy of Glucometric Testing

A

Outdated strips

Incompatible strips

Dirty skin at the site of the sample

Temperature changes – always store strips and monitor at manufactures recommended temperature range

Wet finger

Poor test sample

Poor monitor maintenance

163
Q

normal blood glucose range

A

4-7 mmol/L

164
Q

When levels drop below —– mmol/L, or with extreme highs, we may start to see a change in LOC

A

4

165
Q

Below —– mmol/L, we will see severe confusion and unconsciousness

A

2

166
Q

When the level drops even further to below — mmol/L, the brain is unable to function and if not treated quickly it may be fatal

A

0.6

167
Q

Factors that can influence an individuals blood glucose levels

A 
Increased/decreased body temperatures. 
Increased metabolism. 
Trauma. 
Shock. 
Childbirth/pregnancy. 
Medications. 
Chronic disease. 
Alcohol.
168
Q

two basic methods for monitoring glucose levels

A

urine

serum glucose

169
Q

two ways to measure the level of serum glucose in the blood

A

the use of glucose reagent strips (visual method)

the use of an automated glucose monitor

170
Q

steps to perform glucose

A

Prepare the equipment

Prepare the patient

Wear PPE

Prepare the monitor and strip

Prepare the patient’s skin

Obtain blood sample and glucose reading

Record the glucometer reading

Dispose of all contaminated materials 

171
Q

troposphere

A

First layer extending from the earth’s surface to 8–14.5 km high.

The temperature drops with ascent (dry adiabatic lapse rate is 10 °C/1,000 m and moist is 5–6 °C/1,000 m).

Water vapour reduces with the ascent.

Weather and turbulence are present.

Atmospheric pressure drops with the ascent.

172
Q

Stratosphere

A

The layer above troposphere extending to 50 km.

No water vapours.

The ozone layer is here.

Temperature is constant at -56 °C.

173
Q

Mesosphere

A

Just above the stratosphere and extends to approximately 85 km.

Temperature is -90 °C at the top of the layer.

174
Q

Thermosphere

A

Just above the mesosphere.

Satellites orbit here.

Northern lights are formed in this layer.

Height and temperature vary based on energy from the sun so the height can be anywhere from 500 and 1,000 km.

175
Q

Ionosphere

A

Not a distinct layer as it is overlapping into mesosphere and thermosphere.

Ultraviolet radiation strikes gas molecules causing the atoms of the gas to separate and become charged. This is ionization and provides the “reflector” layer for electromagnetic radio waves that strike this layer and are reflected back to earth.

UV rays combine with oxygen at 15 to 42 km yielding an irritating corrosive substance called ozone.

176
Q

Exosphere

A

The layer above thermosphere up to 100,000 km or more and gradually extending into outer space.

177
Q

Atmospheric pressure

A

is a product of the partial pressures of the total gases contained in the atmosphere

178
Q

the standard atmosphere has been given the following characteristics:

A

Air is absolutely dry and acts as a perfect gas.

The atmospheric pressure at sea level is 29.921 inches of mercury, 14.696 pounds per square inch or 760 millimetres of mercury.

The temperature at sea level is 15 degrees Celsius (59 degrees °F ).

Up to an altitude of 35,332 feet, the temperature will fall at a rate of 1 degree per 100 m.

Between 35,332 feet and approximately 80,000 feet, the temperature remains constant at -55 degrees Celsius (-67 degrees °F ).

179
Q

four variables that influence gases and their responses

A

Temperature, pressure, volume, and mass

180
Q

Boyle’s Law

A

The volume of a gas is inversely proportional to its pressure, the temperature remaining constant. (P1V1 = P2V2 where P is pressure and V is volume)

This law applies to all gases and explains why a weather balloon increases in size as it ascends in altitude.

181
Q

Boyle’s Law patient care

A

This phenomenon is the principle reason why intravenous (IV) containers made of glass cannot be used during air transport and why paramedics will use sterile water or saline to fill the balloon of the endotracheal tube rather than using air, which is the norm on the ground

gas in the gastrointestinal (GI) tract, sinuses, or the middle ear of the air medical personnel will expand with ascent

  • gas must be vented, or it will put pressure on tissues during expansion
  • reduce GI distention, air medical personnel should avoid chewing gum and the ingestion of gas forming/containing food or beverages
  • Gas expansion in the middle ear and/or sinuses may not be vented adequately resulting in pain, inflammation, and/or the possibility of rupture of the eardrum
182
Q

Charles’ Law

A

The volume of a gas is proportional to its absolute temperature when pressure and mass is constant.

183
Q

Universal Gas Law

A

combination of Boyle’s and Charles’ laws

describes relationship between Volume (V), Pressure (P), and Temperature (T) of gas in a more realistic environment similar to that of air medical transport

184
Q

Dalton’s Law

A

the total pressure of a gaseous mixture is equal to the sum of the partial pressures of the individual gases in the mixture.”

must understand the composition of the earth’s atmosphere and the effect of ascent in the atmosphere on barometric pressure

  • -Increasing altitude results in a drop in atmospheric pressure
  • -As total atmospheric pressure drops, the pressure of individual component gases also declines
  • -As a result, the availability of oxygen decreases with an ascent in altitude
185
Q

Dalton’s Law Patient Care Implication

A

To counteract this problem, oxygen delivery must increase with ascent to maintain the inspired oxygen concentration required by the patient.

186
Q

Environmental Flight Stressors

A

mnemonic, GHOSTBAND:

G —  Gravitational forces 
H —  Humidity/hyperventilation 
O —  Oxygen 
S —  Shakes/vibration 
T —  Temperature 
B —  Barometric pressure 
A —  Atmosphere 
N —  Noise 
D —  Disorientation
187
Q

Effects of flight on patients: GRAVITATIONAL FORCES

A

Patient positioning can alleviate some of the effects depending on the nature of the patient’s condition

A head forward position will be beneficial for patients with head injury or fluid overload problems and a feet forward position might be best for obstetrics patients or those suffering from hypovolemia

188
Q

Effects of flight on patients: HUMIDITY/HYPERVENTILATION

A

Humidity is a concern especially if the flight will be long and/or at higher altitudes

The concentration of water vapour decreases with ascent and the aircraft obtains fresh air from the external environment
can result in dehydration

On long transports, the patient may require oral fluids to keep the mouth moist, eye care for dry eyes, and humidified oxygen delivery

Hyperventilation may develop in the aircraft and is primarily caused by hypoxia, anxiety, or fear

189
Q

Effects of flight on patients: : OXYGEN

A

The availability of oxygen is reduced as the aircraft ascends which can lead to the development of hypoxia

190
Q

Effects of flight on patients: SHAKES/VIBRATIONS

A

can produce increased metabolic rates, (heart rate, respiratory rate, etc.) reduced concentration, fatigue, nausea, and chest or abdominal pain

Vibrations can also have a psychological effect on the patient and their perception of risk

191
Q

Effects of flight on patients: TEMPERATURE

A

Extremes in temperature can have physiological effects on both patients and flight crew members

These are rarely an issue as most aircraft have reliable heat sources and air conditioning units

192
Q

Effects of flight on patients: BAROMETRIC PRESSURE

A

has extensive implications to human physiology as discussed earlier

193
Q

Effects of flight on patients: ATMOSPHERE

A

The Atmosphere has extensive implications to human physiology as discussed earlier.

194
Q

Effects of flight on patients: NOISE

A

Noise or unwanted sound can have negative physiologic effects as well as make it difficult to assess and monitor the patient

can cause disorientation, increased fatigue, nausea, headache, and is capable of mild cardiovascular stimulation

195
Q

Effects of flight on patients: DISORIENTATION

A

Orientation is the individual’s recognition of body position in relation to the earth’s surface maintained through sight, balance and sensors in joints and skin

the motion of the craft greatly confuses the picture and provides the brain with misleading information leading to  disorientation

196
Q

Advantages of Air Transport

A

They can reduce transport time.

Highly trained personnel are on board.

Can provide access to remote locations.

Some hospitals allow for the direct landing of a helicopter thus decreasing time to definitive care.

197
Q

Disadvantages of Air Transport

A

Weather and environment may cause an inability to fly.

Based on the inability to establish a safe landing zone or lack of airstrip, the aircraft may not be able to land.

There is a high cost.

Cardiac arrest patients are not suitable candidates due to response times and lack of space to perform CPR.

Lack of space in the cabin can create problems if trying to perform interventions.

198
Q

When to Activate Air Transport: GENERAL SITUATIONS

A

The patient requires critical care during transport.

The patient requires rapid transport.

If there are any potential delays associated with ground transport that may be detrimental to patient condition.

Use of ground transport would leave the local area without ambulance coverage.

199
Q

When to Activate Air Transport: TRAUMA SITUATIONS

A

Fall from greater than 6 feet.

Penetrating central injuries.

Scalping injury.

Severe hemorrhage.

Major burns to face or chest.

Injuries to face or neck that result in airway concern.

Multi-trauma pediatric patient.

Lengthy extrication where critical care team will benefit the patient by arriving at the scene.

The following mechanism of injury:

  • Ejected from a vehicle.
  • Another occupant of the vehicle died.
  • Thrown from a motorcycle.

Patient older than 55 with multiple injuries.

Adult patient with a respiratory rate under 10 or over 30, or heart rate of under 60 or greater than 120 bpm.

200
Q

When to Activate Air Transport: MEDICAL SITUATION

A

The patient was previously in cardiac or respiratory arrest (Not currently in cardiac arrest).

Respiratory failure was not responsive to intervention.

Patient requires continuous medication infusion or ventilation to maintain cardiac output.

Patient requires mechanical ventilation.

Hypothermia that requires immediate invasive therapy.

Respiratory rate is less than 10 or greater than 30.

Heart rate less than 50 or greater than 150 bpm.

BP less than 90 mm/Hg or greater than 200 mm/Hg systolic.

Acute MI, evolving stroke or dissecting or leaking aneurysm.

Pregnant patient with high-risk obstetrical condition.

201
Q

When to Activate Air Transport: PEDIATRIC PATIENTS

A

The patient is high risk for cardiac dysrhythmia or failure.

The patient is high risk for respiratory failure or arrest.

The patient requires invasive airway interventions or ventilation.

The patient is showing signs of shock.

The patient presents with any of the following:

  • Near-drowning.
  • Acute bacterial meningitis.
  • Acute respiratory failure.
  • Status epilepticus.
  • Hypothermia.
  • Multiple trauma.
202
Q

Patient Care Principles of Aeromedical Transport

A

stabilization of the patient prior to transport

The priority of patient care is airway management whether on the ground or in the air

Breathing must be assessed and assisted if inadequate

Respiratory emergencies (pulmonary edema, hemothorax, flail chest, and pneumothorax) must be managed on the ground before the flight

ardiac arrest, transport should not be initiated until circulation has been restored

Neurological status must be assessed for a spinal injury and for evidence of increased intracranial pressure

Nasogastric or orogastric tubes should be inserted in all intubated patients and in patients with gastric distention or gastrointestinal disorders

203
Q

Preparing for stars arrival

A

Select landing zone officer

Wear proper PPE

Select site

Set up landing zone

  • -Safe from hazards
  • -120 meters from accident
  • -Talk to stars through radio
204
Q

STARS arrival

A

Ensure landing zone is clear

Stand in middle of the upwind
side of the landing zone with your back to the wind

Give the all clear signal by raising arms straight up in air

Kneel as helicopter approaches

Do not move your spot

If not safe to land, wave your arms above head

205
Q

STARS departure

A

ensure landing zone is clear

Give pilot all clear signal

Maintain your position

If unsafe wave arms above head

206
Q

Highway landing STARS

A

2 way high way traffic stopped in both ways

Divided highway traffic control in unaffected lane officers discretion

207
Q

Crash Procedures STARS

A

Emergency access

Fuel shut off and location of fuel tank

How to operate safety belts

Oxygen shutoff

Activation of emergency locator transmitter

208
Q

Landing zone size

A

36meters by 36 meters

209
Q

Fixed wing aircraft

A

necessary due to the distances travelled because of the scattered population

faster over a longer distance than rotary wing, they are pressurized, and they can fly above weather patterns

210
Q

Rotary wing aircraft

A

used for shorter distances as they fly slower and are not pressurized which necessitates lower flying altitudes making them more susceptible to weather patterns

rotary wing aircraft can respond directly to the scene and in some jurisdictions transport the patient directly to the receiving facility

211
Q

Ramp Dangers for aircraft landing

A

noise

propellers

jet exhaust/engine intake

structural component

smoking

212
Q

Types of ambulances

A

Type I, Type II, and Type III

213
Q

Type I Ambulances

A

a modular box that is mounted on a truck chassis

allows for higher weight limits and can handle both rough terrain and urban streets

allows for more room in the patient compartment for equipment storage and movement during patient care

214
Q

Type II Ambulances

A

manufactured using a modern passenger or cargo van

 often used in larger urban centers due to the ease of navigating through heavy traffic

commonly used for  interfacility transports

215
Q

Type III Ambulances

A

modular with a van chassis

can handle both rough terrain and urban streets

allows for more room in the patient compartment for equipment storage and movement during patient care

more common ambulance types used in Saskatchewan

216
Q

Routine maintenance of an ambulance includes the following:

A

Regular oil changes

Yearly safety checks

Tire rotation

Seasonal tire changes

Daily mechanical check

completing daily mechanical and equipment checks

217
Q

Components of a Mechanical and Safety Check: TIRES

A

cuts

bruises

wear bars

intervals around the tire

inflation

218
Q

Components of a Mechanical and Safety Check: UNDER THE HOOD

A

belts

hoses

fluid leaks

219
Q

fluid colors

A 
Coolant—Green or yellow
Power steering—Clear
Brake—Clear or amber 
Washer fluid—Blue or yellow 
Transmission—Red or thick black 
Battery (acid)—Clear or white
220
Q

Components of a Mechanical and Safety Check: INTERIOR

A

loose items

seatbelt

steering

brakes

lights and sirens

communications equipment

pt care equipment

221
Q

Requirements for and ambulance to be fit for service

A

it must be able to Start, Stop, Steer and Stay Running

222
Q

Examples of Reasons to Remove an Ambulance from Service

A 
Battery failure 
Major fluid leaks 
Brake issues 
Steering issues 
Tire damage or wear 
seatbelt failure
223
Q

Brake issues

A

Brake fade—a sensation that you have lost brakes

Brake pull—steering wheel jerks in one direction when braking

224
Q

remember the following principles of emergency driving when lights and sirens are activated:

A

Stop at all controlled intersections.

Attempt to make eye contact with all drivers before proceeding.

Change the siren mode or air horn to alert nearby traffic.

Never pass a vehicle on the right. Always keep to the left to pass vehicles as the public

has been trained to pull to the right when they hear an emergency siren.

Never use the right-hand lane during an emergency unless you intend to turn right at the next intersection

225
Q

When proceeding through intersections:

A

Make a secondary stop before crossing the intersection.

Have your partner actively involved in watching for other vehicles and driver reactions.

If an intersection is impassable
- power down all lights & sirens.

Never assume the vehicle’s lights, sirens, and air horns provide an absolute right-of-way or privileged immunity to proceed. You are only requesting the right-of-way, you must wait for others to grant it before you may proceed

226
Q

Ambulance Act 

A

Outlines how the operator may deploy employees and resources 
Outlines employee’s responsibility to the employer 

227
Q

Offensive driving

A

It is driving so that other motorists are aware of your presence and your intentions

228
Q

defensive driving

A

observing the presence and intentions of other drivers to avoid accidents. Anticipating other driver’s movements so that you can be prepared if you must take evasive action

229
Q

If law enforcement/fire service personnel have secured the scene, the ambulance should be parked:

A

about 30 meters past the accident scene (on the same side of the road)

Uphill (about 60 meters) and upwind if the presence of hazardous materials is suspected

230
Q

If the scene has not been secured by law enforcement/fire service personnel, the ambulance should be positioned:

A

approx. 15 meters in front of the scene in a “Fend-Off Position.”

231
Q

term bariatric is derived from the Greek words

A

“baros,” meaning weight, and “iatreia,” meaning medical treatment

232
Q

Bariatric care

A

branch of medicine that deals with causes, prevention, and treatment of obesity

233
Q

In determining if a patient meets the definition of a bariatric person, the following elements are evaluated:

A

Body mass index

Waist circumference/girth and weight distribution

Risk factor for diseases/conditions

234
Q

BMI categories

A

Underweight (BMI less than 18.5)
Healthy weight (BMIs 18.5 to 24.9)
Overweight (BMIs 25 to 29.9)
Obese (BMI 30 and over)

235
Q

Circumference Calculation

A

 waist measurement of greater than 40 inches in males and 35 inches in females is associated with greater health risk

236
Q

Pear-Shaped

A

Pear-shaped body types have adipose tissue accumulated below the waist in the buttock and thigh area

These patients may have difficulty bringing their knees together while sitting and the excess weight of the lower extremities may make rolling difficult

237
Q

Apple-Shaped

A

Apple-shaped body types have adipose tissue accumulation in the abdominal region

These patients tend to have poor endurance and usually prefer to have their head elevated as breathing may be difficult for them

Rolling, and moving from supine to seated, standing and leaning forward may be difficult due to larger abdominal mass

238
Q

Bulbous Gluteal (Enlarged Buttock Region)

A

Bulbous gluteal body types have  adipose  tissue accumulation in the buttocks

This body type may cause the patient to have difficulty with lying supine

hey may also have trouble sitting and rising from sitting to standing due to the excess bulk

239
Q

Anasarca

A

Severe Generalized Edema

usually caused by an overload of the lymphatic system

complication that may be seen in obesity

greater risk for congestive heart failure or positional respiratory distress

240
Q

Predisposing Physical Conditions related to obesity

A

improperly use insulin

buildup of plaque in arteries

Higher triglycerides  and  HDL

Sleep apnea increases vessel wall stiffness

Hypoventilation leading to structurally narrowed airways

Increased asthma-related hormones

Higher cholesterol synthesis leading to increased bile production

Increased volume of gastric and uric fluid

Decreased immune response and deactivation of macrophages

Increased risks of fatal cancers

Altered cartilage and bone metabolism in all joints

241
Q

Importance of knowing disease risk in obese patients:

A

To choose appropriate treatments and anticipate problems

Diseases seen in older population now seen in obese younger adults

The stigma of obesity can cloud real disease symptoms

242
Q

medical complications of obesity

A

idiopathic intracranial hypertension

stroke

cataracts

coronary heart disease

pancreatitis

cancer

gynecologic abnormalities

ostearthritis

nonalcoholic fatty liver disease

GERD

pulmonary disease

243
Q

Assessment Challenges for bariatric

A

Breath sound auscultation

Appropriately sized equipment

Cyanosis

BGL testing

Poor SPO2

244
Q

By definition, abuse

A

is any action or inaction which jeopardizes the health, well-being, or assets of an individual.

245
Q

Physical abuse

A

Any act or rough treatment directed toward an adult, regardless if physical injury results, including hitting, slapping, and the misuse of physical restraints.

246
Q

Sexual abuse

A

Any sexual behaviour directed toward an adult without the adult’s full knowledge and consent, including sexual assault, sexual harassment, or the use of pornography.

247
Q

Psychological or emotional abuse

A

Any act that may diminish an adult’s sense of identity, dignity and self-worth including humiliation, intimidation, verbal abuse, threats, infantilization, and isolation.

248
Q

Medication abuse

A

The misuse of an adult’s medications and prescriptions including withholding medication and the misuse of chemical restraints.

249
Q

Financial abuse

A

The misappropriation of an adult’s funds, resources, or property by fraud, deception, or coercion for purposes not intended by the owner including theft of property or personal effects, unauthorized cashing of pension cheques, selling an adult’s house or furnishings without permission, attempts to change a will, and abusing powers of attorney or property guardianship.

250
Q

Violation of civil and human rights

A

The unlawful or unreasonable denial of the fundamental rights and freedoms normally enjoyed by adults, including the denial of information, access to communication, privacy, visitors, religious worship, health care services or the opportunity to provide informed consent to medical treatment as well as interference with the mail, restriction of liberty, or unwarranted confinement in a hospital or institution.

251
Q

Active neglect

A

Deliberately withholding basic necessities or care.

252
Q

Passive neglect

A

The non-deliberate non-malicious withholding of basic necessities or care because of lack of experience, information, or ability.

253
Q

Self-abuse

A

Any self-inflicted act which may cause serious and significant harm to an adult’s health or well-being.

254
Q

Self-neglect

A

The failure of an adult to adequately care for his or her needs such that serious and significant harm may come to his or her health, well-being, or assets.

255
Q

significant challenges that we may encounter while providing care to obese:

A

Difficulty providing manual ventilation with a BVM due to increased airway resistance, heavy chest due to the presence of adipose tissue and extra  supraglottal  tissue.

Difficulty performing airway management due to distorted airway anatomy due to larger tongues, adipose tissue, and short thick necks.

An enlarged heart due to the strain that the heart must work under to provide oxygenation to the patient’s tissues.

Hypoventilation may occur due to the inability of the diaphragm to fully move down during inhalation.

Rapid oxygen deoxygenation may occur due to decreased functional residual capacity.

Thick layers of adipose tissue may result in poor visualization and palpation of veins for intravenous cannulation.

Pickwickian syndrome (obesity hypoventilation syndrome) may experience hypoxemia, hypercapnia, and polycythemia.

Laying supine may result in respiratory distress, consider sitting them up if p

256
Q

When moving a bariatric patient, the following guidelines/recommendations should be considered:

A

Ask the patient how he or she performs the task

Use gravity whenever possible

Use equipment/assistive devices to ease the load

Additional providers may be required

Depending upon the patient’s body type, the provider may have to support the abdomen

Watch for pinch or pressure points with equipment.

257
Q

Steps we can take to reduce obesity stigmas

A

Use people first language. Use the phrase “people living with obesity” rather than “obese people.”

Treat EVERYONE with respect and dignity.

Be aware of the bias that you have so that you can eliminate the use of negative comments and actions.

Don’t get tunnel vision. Not all medical complaints of those living with obesity are related to weight.

258
Q

culture

A

generally refers to the customary ways of thinking and behaving and the characteristics of a particular population

It is the combination of race, ethnicity, age, gender, language, education, religion, geography and even economic status. 

259
Q

ethnicity

A

is concerned with patterns of thought and behaviour such as marriage customs, kinship organization, political and economic systems, religion, folk art, music, and the ways in which these patterns differ in contemporary societies

260
Q

Cultural Competence, Humility and safety

A

Working with diverse cultures and understanding the role that culture plays in healing and health

261
Q

Cultural competence

A

the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs

providers are encouraged to develop a respectful partnership with each client through client-focused interviewing, exploring similarities and differences between her/his own and each client’s priorities, goals, and capacities

262
Q

Why is Cultural Competence Important?

A

Understanding the impact of a patient’s culture on their lives is important when we are trying to help them

263
Q

cultural humility

A

being willing to accept and appreciate that we cannot possibly know everything about another’s lived cultural experiences; we are all unique and therefore have unique, complex histories related to our culture.

Developing a respectful curiosity towards each individual’s own cultural understanding

Using the knowledge gained to assist the client in their healing journey.

264
Q

Cultural Safety

A

describes a means by which to appreciate diversity in the helping relationship. However, as compared to cultural competence, cultural safety is an end goal.

265
Q

three key elements of cultural safety

A

 cultural awareness, cultural sensitivity, and cultural safety

266
Q

Cultural Awareness

A

Is a beginning step toward understanding that there is a difference. Many people undergo courses designed to sensitize them to formal ritual and practice rather than the emotional, social, economic, and political contexts in which people exist.

267
Q

Cultural Sensitivity

A

Alerts practitioners to the legitimacy of difference and begins a process of self-exploration as the powerful bearers of their own life experience and realities and the impact this may have on others.

268
Q

“Us versus Them” paradigm

A

reinforces existing power relations that are premised on inequality

It sets the norms of the dominant groups as the “normal” way to do things and then categorizes cultural minority groups as “the others”.

269
Q

Describe Cultural Diversity

A

An important aspect of demonstrating respectful care is cultural competency

270
Q

Multiculturalism

A

Recognizes and affirms the diversity of people living in society.

271
Q

Components of Culture

A

Include language, customs, and material artifacts. Include shared systems of attitudes and feelings, and are learned and transmitted from generation to generation.

272
Q

Acculturalism

A

The transfer of one culture from one group to another.

A process of change experienced by members of a minority group as they adapt to a majority group’s culture.

273
Q

Assimilation

A

The cultural absorption of a minority group into the main cultural body.

274
Q

“Colour Blindness”

A

In counselling, is the belief that “race should not matter” in how individuals are treated. This implies that we ignore racial differences because it should not matter. It is often confused with “race does not matter”

275
Q

Cultural Barriers

A

Anything that prohibits or interferes with the ability of one culture to interact in another culture. Some barriers include language, beliefs, appearance, clothing, and customs.

276
Q

Ethnocultural Competence

A

The ability to accept, accommodate, and assist people of different cultures in achieving what they desire or need. The ability to successfully communicate with people of other cultures.

277
Q

Ethnic

A

[from Ethnos, Greek] Tribe or people with distinctive cultural identities.

278
Q

Race

A

Categorizes people into groups based on inherited characteristics, such as skin colour, facial features, hair, etc.

279
Q

Diversity

A

A variety, a state of being different refers to multiculturalism—the ideology that includes acceptance of people of a variety of cultural backgrounds.

280
Q

Prejudice

A

Pre-judging; making a decision before becoming aware of, for example, relevant facts about a case, event, or person.

281
Q

Discrimination

A

The behaviour of treating people unequally.

282
Q

Stereotype

A

he generalization of existing characteristics to reduce complexity.

283
Q

Royal Proclamation, 1763

A

established a treaty making process between the Crown and the Indian people which recognizes the existence of Indigenous rights such as rights to land—to hunt, fish and gather, self-government, and others

284
Q

Inuit

A

generally applies to those Indigenous peoples who occupy the Arctic.

285
Q

Métis

A

mixed European and First Nations ancestry

they are not defined by the Government, but rather are self-identified.

286
Q

Indigenous beliefs and values

A

developed in response to ecologically specific rhythms, patterns and events derived from their experiences on their traditional territories

287
Q

Communications challenges related to culture: ATTITUDES TOWARD FEELINGS AND EMOTIONS

A

How acceptable is it to have feelings and express them? What feelings can or cannot be expressed (e.g., anger, joy)? How are they expressed?

288
Q

Communications challenges related to culture: BODY LANGUAGE, PERSONAL DISTANCE AND USE OF TOUCH

A

Is it acceptable, for example, to bow, break bread, make eye contact, greet, place chairs in a certain way, or shake hands?

289
Q

Communications challenges related to culture: FORMING RELATIONSHIPS

A

What period of time is considered appropriate to develop rapport, make friends, or discuss a personal issue?

290
Q

Communications challenges related to culture: GENDER ROLES AND SEXUAL ORIENTATION

A

What roles do men and women play? Are they equitable? How are men and women expected to relate to each other? How are gays and lesbians viewed? What is the relationship of gays and lesbians to the larger social group?

291
Q

Communications challenges related to culture: AGE, FAMILY AND SOCIAL GROUP

A

What privileges or limits do people have at certain ages? What is the role of the family? Who has what responsibilities within the family? How do family members interact with each other? How do they interact with the larger social group? What is the role of the social group? What are the components of the group? How are group members expected to relate to one another?

292
Q

Communications challenges related to culture: PERSONAL AND SOCIAL BOUNDARIES

A

What rules define what is private and what is public? What rules govern what may or may not be discussed, and with whom and in what context issues may be discussed? For example, sexuality may be openly discussed with members of both sexes within a family, but not with members of the same sex outside the family.

293
Q

Communications challenges related to culture: VALUES

A

What things are valued (e.g., education, material goods, money, relationships, success at work)? To what extent are they valued? For example, is a PhD considered the ultimate accomplishment? If yes, why? Is it because a group has been marginalized that its members feel the need to have their children succeed?

294
Q

Communications challenges related to culture: TIME

A

What kind of timekeeping is valued (e.g., punctuality, flexibility)?

295
Q

Communications challenges related to culture: LANGUAGE, INCLUDING INTONATION AND USE OF HUMOUR AND METAPHORS

A

Why are certain tones stressed? Why is something funny? Why are certain words or descriptions chosen? Why are certain images or references used?

296
Q

top 10 problems faced by immigrants

A 
Language barriers 
Employment opportunities 
Housing 
Access to local services 
Transportation issues 
Cultural differences 
Raising children 
Prejudice 
Isolation 
The weather
297
Q

Transmission oximetry

A

deploys the LED and photodetector on opposite sides of a tissue bed (e.g., digit, nares, and ear lobe) such that the signal must traverse tissue

298
Q

Reflectance oximeters

A

position the LED and photodetector side by side on a single surface and can be placed in anatomic locations without an interposed vascular bed (e.g., forehead)

299
Q

According to Saskatchewan College of Paramedic, Paramedic Clinical Practice Protocols, SPO2 monitoring should be performed on the following patients:

A

Patients in respiratory distress.

All critically ill patients.
Patients that require oxygen concentrations of 40% or greater.

Stable patients at risk from sudden deterioration.
Patients that are being intubated or suctioned.

300
Q

Pulse oximeters have a number of important physiologic and technical limitations that influence bedside use and interpretation

A

sensor location

motion

signal degradation

physiologic range

dyshemoglobinemia

intravenous dye

PRIMARY CARE PARAMEDIC 2021/22 (12 decks)

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