EMRG1242 final- theory Flashcards
Routine practice
Infection prevention and control that is used with every patient prevent transmission of micro-organisms
Risk assessment, hand hygiene, appropriate cleaning
Contact precaution (direct contact)
Used in addition to routine practices
gloves and surgical mask
Droplet precaution
In addition to routine precaution for patients with infections that are transmitted through respiratory droplets
Gloves, surgical mask, eye wear, gown
Airborne precautions
In addition to routine precautions for patients with illnesses transmitted through air
N95, gloves, gown, eye protection
Good Samaritan law
legal protection against individuals who provide care to injured people from being liable for any harm caused while attempting help
Speed splint
Fast immobilization
Used for hands, wrists, arm, foot, ankle, lower leg, knee
X-ray safe
Needs to be padded
Malleable splint
Strong enough for pre/post cast care while being light/ portable
Can bend back to previous form or remolded
Buddy Splint
Quick splinting when no times available
Femurs, fingers, toes
AVPU
Alert Verbal Pain Unresponsive
Triangular splint
Collar bone, shoulder dislocation
Used to sport in place to remove tension
Pillow splint
Limits movement of injured area
Ankles, knees, wrist, lower legs, arms, elbows
Needs to be secured around the injury
Penetrating object
Build a log cabin around it
Don’t remove unless compromises breathing
can cut object if stuck but stabilize remaining piece
EMCA
Environment, Mechanism, casualties, Additional resources
Compression ratio for a neonate
3 compression 1 breath
How deep do you go during CPR for a neonate
1/3 diameter of the chest
Compression ratio for an infant
30:2 or 15:2
Compression ratio for a paediatric aged child
30:2 or 15:2
Compression rate for an adult
30:2 or 15:2
What is the age for a neonate
<30 days
What is the age group for an infant
> 30 days to <1 year
What is the age group for paediatric
1 year until puberty
What is the age group for an adult
Puberty and older
How many compressions per minute for an adult
100-120 compressions per minute
Obvious signs of death
Rigor mortis, dependent lividity, transection, decomposition, DNR
What is the sizing for adult pads and paediatric pads
adult: >8 years
pediatric: <8
What are body mechanics
The way the body moves during daily activities
Can help to avoid injuries and muscle fatigue and increase amount of weight lifted
What are the principles of body mechanics
Assess environment, plan the move, avoid stretching/ twisting, ensure proper body stance, stand close to object being moved, face direction of movement, avoid lifting, reduce friction b/w surfaces, bend knees, push objects rather than pull, use assistive devices, work with others
Portable stretcher
Not on land ambulances, easy to clean, portable, max weight of 350lbs, back rest has 8 positions
Scoop stretcher
Can hold 500lbs, wipeable, 4 required straps with 4 adjustable positions, easy storage, good for SMR and pelvic injuries, MOH mandated
Manta mat
No SMR, can hold 800lbs, fire retardant, wipeable, minimum 4 carriers but up to 6-8, good for confined spaces and bariatric patients
Canvas stretcher
max weight 350lbs, needs to be laundered, No SMR, hard to maneuver in tight spaces
Stair chair
Can hold 500lbs, wipeable, 5 adjustable bars, straps to restrain patients
Proflexx stretcher
Can hold 700lbs- bariatric 1100lbs, 9 adjustable heights w/ adjustable head b/w 0-65 degrees, wipeable, 5 point harness and two leg straps
fore and aft
one medic behind patient grabbing opposite wrists while other grabs below knees and lifts
Stand and pivot
patient must be able to stand (no stroke/fractures) and doesn’t violate BLS
Sheet pull
transfers pt from stretcher to bed.
High injury rate due to the unnatural leaning when pulling
Transfer/slider board
thin flexible board good for heavier pts that’s found in all ERs- use like a sheet pull just slide board underneath sheet
Helmet removal
take it off for head assessments (are they alert, talking, breathing?), airway management, secure c-spine, and apply collar
Log roll
To check the back and then move to spinal board
Stabilize c-spine then roll pt to the side and check back and then slide a board on an angle under back and put pt back on the ground and strap pt in
Wheel chair transfer
like a stand and pivot but from a wheelchair
why must medics be careful with the elderly
if they are handled rough they can get skin tears, fractures (severe arthritis), and dislocations (shoulders most common)
Stryker power stretcher
Complies with MOH equipment
Max weight of 700lbs
Siderails have 7 locking positions
Rescue seat
In place of fore and aft
Easy to clean and resists blood/bodily fluids
Can remain under patient to avoid additional transfer
Not MOH mandated
PediMate
Used for patients 10-40lbs
5 point harness that attaches to the stretcher
Wipeable
Cervical Collar
Keeps neck/head/spine in neutral alignment for suspected c-spine injuries
Sizing a collar
Put your hand in a salute motion and place hand on the base of the patient’s shoulder- pinky down) and count amount of fingers, measure against the collar for sizing
KED
Great for tough extrications
Color coded straps
Wipeable
Radiolucent
good choice for patients who can’t lie flat (asthma/dyspnea/kyphosis (curvature of the spine in the neck))
When can you not use a KED
on an unstable patient
How to decide to use a KED, Scoop, Spinal board
KED: SMR, can’t lie flat, conscious/stable, tough extrication, confined space
Scoop: SMR, pelvic fracture, multi system trauma, no roll req’d
Spinal board: roll req’d, visualizes back, basic SMR
What is a rapid Ex
Technique used to move a patient from sitting in a car to lying supine on a backboard in approx. 2 minutes
When would you use a Rapid Ex
Load and go: critical pts requiring immediate intervention in supine and transportation
Scene safety: scene is unsafe and you can get pt out without risking medics
Multiple patients: limited resources, pt. condition, pt blocks access to another seriously injured pt.
Common pelvic fractures
Lateral compression: most common and occurs when lateral forces are applied to the pelvis
AP compression: disrupts symphis pubis and dangerous as pelvic volume increases- stores more blood
Vertical shear: most unstable and often associated with axial loading injuries
Symptoms of pelvic fractures
Pain, swelling/ bruising, broken skin, instability with palpation, blood in urine, difficulty urinating, incontinence, bleeding from rectum or vagina
what is hemodynamically unstable
hypotension, altered LOC, increased heart rate
in how many pelvic fractures does hemodynamic instability occur
10%
what other injuries can occur from a pelvic fracture
neurological and urologic
what urologic injuries happen from pelvic injuries
Approx 5% of pelvic fractures
Assess for blood
What amount blood loss occurs
500-1500ml
symptoms of a femur fracture
pain, limb shortening, potential open skin, edema, bruising, crepitus, muscle spasm
Hip fractures
Involves femoral head, femoral neck, inter trochanter area or femoral shaft
Fall is leading MOI
Symptoms of hip fractures
pain, inability to bear weight, heard/felt snap, external rotation/ shortening to leg, tenderness on palpation, swelling, deformity
treatment for hip fractures
support injured extremity in position found, minimize movement, assess for analgesia, no sager
posterior hip dislocation
hip rotates inwards
anterior hip dislocation
hip rotates outwards
external bleeding
occurs due to break in the skin, extent and severity is often a function of the type of wound/ types of blood vessels, managed with direct pressure, arterial bleeding can take more than >5 minutes to form a clot
signs and symptoms of internal bleeding
pain, tenderness, tachycardia, pallor, hypotension
how much acute blood loss can the body not handle
body cannot tolerate an acute loss of more than 20% of total blood volume
what are the load and go findings in advanced wounds
airway obstruction, cardiac arrest/respiratory arrest, de creased LOA with inadequate respirations, sucking chest wounds, impaled objects, external hemorrhage, unstable pelvis
types of wounds
amputations, penetrations, eviscerations, burns, avulsion, flail chest
amputations/avulsions
assess site for distal pulses, circulation, sensation, movement
how long do you hold the hemostatic dressing on to see If bleeding stops
3 minutes
signs and symptoms of a sucking chest wound
hemoptysis, decreased/absent breath sounds, SOB, anxiety, bubbling at the site, unequal chest movement, cyanosis, tachycardia, tachypnea
types of pneumothorax’s
closed pneumothorax, open pneumothorax, tension pneumothorax
flail chest
3 or more ribs broken in 2 or more places that creates a free floating sections of ribs
Paradoxical bleeding is the common sign
Treat with an internal splint via BVM
how to cover an evisceration
cover with moist, sterile, bulky dressings or plastic wrap
burns
dress digits individually, remove jewelry, leave finger/toe tips exposed, elevate
how to transport a pt with an eye injury
semi sitting (head elevated to 30 degrees)
required vital signs
heart rate, respiratory rate, blood pressure, GCS, skin, pupils, SPO2, temperature
normal heart rate for adults
60-100
respiratory rate can be altered by:
fever, illness, chronic conditions, drugs/alcohol
bradypnea
slow RR
tachypnea
fast RR (>28)
blood pressure
the force of blood against he artery walls during contraction/relaxation of the heart
systolic
pressure in he heart when the artery contracts and pumps blood
diastolic
pressure inside the artery when the heart relaxes and fills with blood
Adult BP ranges
Hypotension: <90mmHg
Normotension: >100mmHg
pediatric BP ranges
Hypotension: SBP <70mmHG + (2 x age)
Normotension: SBP > 90mmHG = (2 years)
what causes an abnormal pupillary response
drugs, trauma, stroke, brain/ brain stem injury, inadequate perfusion/ oxygenation
temperature
36.1-37.2 degrees C
fever is >38 degrees celsius (>38.5 for medics)
what can alter an SPO2 reading
nail polish, hypovolemia, CNS depression, respiratory distress, respiratory disease
lung sounds are assessed in 4 fields:
upper (apices) left, upper (apices) right, lower (base) left, lower (base) right
abnormal lung sounds
Rhonchi, wheezing, stridor,, crackles, pleural rub
Rhonchi
continuous low pitched sounds w/ expiration that’s associated w/ presence of mucus
wheezing
continuous high pitched hissing sounds as air passes through a narrow space
can be inspiratory or expiratory
stridor
continuous high pitched whistle or squeaking sound usually with inspiration
pleural rub
rough grating sounds of lungs on the lining, heard w/ inspiration or expiration
crackles
generally discontinuous rattling, bubbling, or clicking sounds that can be fine or coarse. associated with fluid
what does the cardiac monitor monitor?
cardiac rhythm, BP, ETCO2, SPO2, defibrillator
NIBP
MOH states must need adult and paediatric
SPO2
indication of oxygenation (measures % of O2 bound to hemoglobin) and is found as a finger probe or tape/sticker
ETCO2
measures amount of CO2 in expired air in real time
measured by nasal prongs or inline with BVM
4 lead
limb leads: white right arm, black left arm, green right leg, red left leg
ensure not to place on bone, dry skin, no excessive hair, and good contact with skin
lead 11 for rhythm interpretation
12 lead
must have 4 lead + additional 6 wires
used on calls for chest pain, SOB, weakness/dizziness, syncope, any call ,edits think hearts involved
placement of the 12 lead wires
RA- right forearm/wrist
LA- left forearm/wrist
LL- left lower leg
RL- right lower leg
V1- 4th intercostal right of sternum
V2- 4th intercostal left of sternum
V3- midway b/w V2 and V4
V4- 5th intercostal mid clavicular line
V5- anterior axillary line straight w/ v4
V6- mid axillary line in straight w/ v4/v5
D tank
425L of air
2000-2200 PSI
needs regulator
M tank
3450 L compressed air
2000-2200 PSI
secured in ambulance- not portable
PISS
pressure index safety system
portable flow meter
allows adjustments from 0.5 LPM to 25LPM
connected to regulator
safe residual pressure
MOH states 500 PSI
common practice:
M tank: 200 PSI
D tank: 500 PSI
standard tank conversion factors
D tank: 0.16
M tank: 1.56
formula for oxygen tank life
tank PSI- safe residual pressure X factor/ litre flow = tank duration in min
oxygen concentrations formula
FiO2=(l/min x4%) + 21%
low flow oxygen devices
21-50% oxygen
nasal cannula- 1-6 lpm, don’t use on pts w/ apnea or severe dyspnea
simple face mask- 6-10 lpm,
nebulizer- 4-6 lpm, exception of croup
high flow oxygen devices
50-100% O2
NRB- 12-15 LPM 90-100% O2
filtered O2 mask- low flow high concentration mask that delivers 30-99% O2
OPA
Holds tongue of posterior wall of the pharynx
Used on patients with no gag reflex needing airway ventilatory support
BVM air volumes
Adult: 1600 ml
Child: 500 ml
Infant: 300 ml
Tidal volumes
Adult: 500 cc/breath
Child: 8 ml/kg
Infant: 4-6 ml/kg
Ventilation rates
Adult: 1 every 6 seconds
Child: 1 every 3 seconds
Infant: 1 every 3 seconds
Oral suctioning pressures
Adult: 500-550 mmHg
Child: 200-220 mmHg
Infant: 80-100 mmHg
Deep suctioning pressures
Adult: 100-150 mmHg
Child: 100-120 mmHg
Infant: 60-100 mmHg
definition of a tracheostomy reinsertion
insertion of the cannula into the tracheostomy
what degree is the patient sitting in for a trach reinsertion
30-90 degrees
