Medical Standards Flashcards
Abdominal Pain (non-Traumatic) Standard
What LIFE/LIMB/FUNCTION threats are you going to consider?
What do you do if you discover a pulsatile mass?
What do assess the abdomen for?
leaking or ruptured abdominal aortic aneurysm
ectopic pregnancy
other non-abdominal disorders that may present with abdominal pain including:
- diabetic ketoacidosis
- pulmonary embolism perforated or obstructed hollow organs with or without peritonitis
acute pancreatitis,
testicular torsion
pelvic infection
AND
strangulated hernia
Do not continue with further abdominal palpation
Pulsations
scars
discoloration
distention
massess
guarding
rigidity
tenderness
Abdominal Pain (non-Traumatic) Standard
What should you do if you suspect an AAA?
What else should you be observing when using this standard?
Palpate the femoral pulses for weakness/absence
Melena
Hematemesis
Frank rectal bleeding
Airway Obstruction Standard
Perform assessments and obstructed airway clearence maneuvers as pe ?
Consider airway obstruction for what kind of pts?
Attemp to ?
Current Heart and Stroke Foundation of Canada Guidelines
Smoke inhalation
Anaphylaxsis
Epiglottitis
Orophryngeal malignancy
Clear the airway using oropharyngeal/nasopharyngeal suction
Allergic Reaction (Known or Suspected) Standard
What potential LIFE/LIMB/FUNCTION threats are you considering?
What are common allergens?
Anaphylaxsis
Penicillin and other antibiotics in the penicillin family
Latex
Venom of bees, wasps, hornets
Seafood - shrimp, crab, lobster, other shellfish
Nuts, strawberries, melons, eggs, bananas
Sulphites (food and wine preservatives)
Allergic Reaction (Known or Suspected) Standard
What and where do you assess at a minimum as a secondary survey?
The site of allergic reaction - if applicable
The lungs - for adventitious sounds through auscultation
AND
The skin - for erythema, urticaria, and edema
Allergic Reaction (Known or Suspected) Standard
What are the 2 or more body manifestations you’re going to be looking for?
What are the historical findings you should use, in conjuction with the body systems mentioned above, as evidence towards anaphylaxis?
Respiratory - Dyspnea, wheezing, stridor or hoarse voice
Cardiovascular - Tachycardia or hypotension/shock
Neurological - Dizziness, confusion, or loss of consciousness
Gastrointestinal - Nausea, vomiting, abdominal cramps, or diarrhea
Dermatological/mucosal - Facial, orolingual, or generalized swelling/flushing/urticaria
Difficulty swallowing/tightness in the throat
Difficulty breathing/feeling of suffocation
Fearfulness, anxiety, agitation, confusion, or feeling of doom
Generalized itching
History of any of the body system involvement listed above/before
Allergic Reaction (Known or Suspected) Standard
What potential problems are you preparing for?
Cardiac arrest
Airway obstruction
Anaphylaxis
Bronchospasm
Hypotension
Altered Level of Consciousness Standard
What should you attempt to determine?
What should you do if the pt has an unproteced airway or is apneic?
What should you perform?
If there’s a specific cause (AEIOUTIPS)
Use an OPA/NPA
AND
Vetilate the pt as per ‘Respiratory Failure Standard’
A secondary survey to assess the pt from head-to-toe
AND
Trauma assessments if trauma is obvious/suspected/can’t be ruled out
Back Pain (Non-Traumatic) Standard
What potential LIFE/LIMB/FUNCTION threats are you considering?
Guideline - what if TAA (thoracic aneurysm) is suspected?
What do you assess in the secondary survey?
abdominal/thoracic aortic aneurysm
acute spinal nerve root(s) compression
intra-abdominal disease (e.g. pancreatitis; peptic ulcer)
AND
possible occult injury (e.g. pathologic fracture)
Perform a bilateral blood pressure
back - for abnormal appearance/findings
chest - as per Chest Pain (Non-Traumatic) Standard
abdomen - as per Abdominal Pain (Non-Traumatic) Standard
distal pulses
AND
extremities - for circulation, sensation, and movement.
Cardiac Arrest Standard
What are the 6 steps to follow in the standard?
What should you do if you have to plan to interupt CPR?
How do you perform CPR on a pt who is approx GREATER then 20 weeks gestation?
1 - Position the pt on a firm, flat surface
2 - initiate CPR inncluding the defib
3 - establish an airway
4 - consider reversible causes initiating further assessment/management
5 - minimize CPR disruptions
6 - Continue all meaures of cardiac resus until TOR granted
Perform CPR and have a partner perform left uterine dislacement
reinitiate CPR as quickly as possible at a predetermined point
Cardiac Arrest Standard
CPR - chest compressionists should
What intervention application should you have ready to use?
what device should be in use aswell?
What about mechanical CPR devices?
Switch every 2min if available
Suction in case of emesis
End-tidal carbon dioxide (ETCO2) monitoring should be considered.
You can use mechanical CPR devices IF there are limited rescuers available and the CPR monitoring is prolonnged in ambulance
Cardiac Arrest Standard
What O2 should the pt receive if they have a ROSC? What if they’re apneic?
Always remember to keep
What should you do in conjunction with the ‘Patient Assessment Standard’?
Maintain O2 sat at 94-98% BUT if they’re apneic then continue to ventilate
Cardiac monitoring
Obtain vital signs at least every 15min after the 1st hour
AND
Every 30min after the 1st hour OR if there’s a change in pt status
Cardiac Arrest Standard
What do you do if en-route the pt re-arrests?
Resume CPR
Cerebrovascular Accident (CVA, ‘Stroke’) Standard
What potentially serious conditions can mimic a stroke?
What do you assess on the head/neck for?
What do you assess the cenral nervous system for? Is there anything else you want to assess for?
drug ingestion (e.g. cocaine)
hypoglycemia
severe hypertension
hypertensive emergency
OR
central nervous system (CNS) infection (e.g. meningitis)
Speech abnormalities
Stiff neck
Pupils size, ERLA
Facial Symmetry
Pupillary size, ERLA
Speech abnormalities
Stiff neck?
Abnormal motor function, eg. hang grip strength, arm/leg movement or drift
AND
Sensory loss
Also assess for incontinence of urine/stool
Cerebrovascular Accident (CVA, ‘Stroke’) Standard
What should you ensure during movement and/or transport?
What potential problems should you prepare for?
That there is adequate support for the pt’s body/limbs AND that there is extra padding beneath the affected limbs for support
possible airway obstruction (if loss of tongue control, gag reflex)
decreasing LOC
seizures
AND
agitation, confusion, or combativeness
Cerebrovascular Accident (CVA, ‘Stroke’) Standard
What are the signs of cerebral herniation?
What should you attempt to maintain ETCO2 values at?
What should you do if signs of cerebral herniation are present?
Deteriorating GCS <9 with
dilated and unreactive pupils
OR
asymmetric pupillary response
OR
a motor response that shows either unilateral or bilateral
decorticate/decerebrate posturing
35-45mmHg
Attempt to hyperventilate the pt with ETCO2 values of 30-35mmHg
Cerebrovascular Accident (CVA, ‘Stroke’) Standard
If you don’t have ETCO2 monitoring then how do you hyperventilate an Adult pt?
Child pt?
Infant that is LESS then 1y old pt?
approx 20 breaths/min
approx 25 breaths/min
approx 30 breaths/min
Cerebrovascular Accident (CVA, ‘Stroke’) Standard
What if the LAMS score is GREATER/EQUAL to 4?
What else do you do for a secondary screen of LVO using LAMS?
Then classify the pt as a CTAS 2
Inform the receiving hospital whether the LAMS screen was +or-
AND
Document the LAMS screen for pts presenting with CVA/Stroke symptoms 0-24h from symptom onset
Chest Pain (Non-Traumatic) Standard
What potential LIFE/LIMB/FUNCTION threats rae you considering?
ALWAYS?
acute coronary syndrome/acute myocardial infarction (e.g. ST-segment elevation myocardial infarction [STEMI])
dissecting thoracic aorta
pneumothorax, tension pneumothorax/other respiratory disorders (e.g. pneumonia)
pulmonary embolism
AND
pericarditis
aquire a 12-lead electrocardiogram
Excited Delirium Standard
Give particular attention to ?
Wha if the the pt is or is suspected to be violent/agressive?
Recoginize the need for ? (2) ?
personal safety as per the general measures standard
Refer to the Violent/Aggressivve Patient Standard
Police in conjunctino with the ‘Police Notification Standard’
AND
The potential need for advanced patient care as per the ALS PCS
Chest Pain (Non-Traumatic) Standard
Perform a secondary suvery to assess at a minimum:
Chest - TIASSSU
- subcutaneous emphysema
- accessory muscle use
- urticaria
- indrawing
- shape
- symmetry
- tenderness
Lungs - for decreased air entry and adventitious sounds (e.g. wheezes, crackles), through auscultation
abdomen, as per the Abdominal Pain (Non-traumatic) Standard
neck - for tracheal position and JVD
AND
extremities - for leg/ankle edema
Dysphagia Standard
What potential LIFE/LIMB/FUNCTION threats are you going to consider?
What if the pt does have epiglottitis?
What should your secondary survey be assessing?
anaphylaxis
AND
upper airway infections (e.g. epiglottitis)
Do NOT open the mouth to inpect the airway!
head/neck, for
- drooling
- hoarse voice or cough
- nasal flaring
- swelling or masses
- tracheal deviation
AND
lungs - for adventitious sounds through auscultation
Dysphagia Standard
What if oxygen administration is indicated?
How should you position the pt?
What potential problem should you prepare for?
You should attempt to minimize agitation.
Position the pt in a sitting or semit-sitting position
Complete airway obstruction
Excited Delirium Standard
Provide pt care based on ?
What potential problem are you preparing for?
presenting signs and symptoms as per the standards
Rapid deterioration
Epixtaxis (Non-Traumatic) Standard
What potential LIFE/LIMB/FUNCTION threats are you going to consider?
What potential problems are you going to prepare for?
What does your secondar survey assess? - attmept to??
Upper airway obstruction
airway compromise
Hypotension
for estimated blood loss (e.g. hemorrhage duration, rate of flow, presence of clots, quantity of blood-soaked materials at scene, quantity of blood vomited)
AND
head/neck - for foreign bodies in nares, and headache
attempt to control the bleeding
Excited Delirium Standard
What potential LIFE/LIMB/FUCNTION threats are you considering?
What are the symptoms of excited delirium?
Asphyxia
Cariopulmonary arrest
AND
Dysrhythmias
Impaired thought processes, e.g. disorientation, acute paranoia, panic, or
hallucinations
Unexpected physical strength
Significantly decreased sensitivity to pain
Sweating, fever, heat intolerance, or, dry/hot skin with no sweating despite
extreme agitation
Sudden tranquility after frenzied activity
Extremity Pain (Non-Traumatic) Standard
What potential LIFE/LIMB/FUNCTION threats are you considering?
What should attempt to be doing?
What should your secondary survey be assessing with respect to the affected extremity compared to the unaffected extremity?
acute spinal nerve root(s) compression
possible occult fracture
soft tissue and joint infections
AND
vascular occlusion (e.g. peripheral vessel, intra-abdominal vessel, intrathoracic vessel)
keep movement to a minimum AND protect from further injury
distal pulses
circulation, sensation, and movement
skin colour, temperature, and condition
AND
swelling, deformity, and tenderness
Fever Standard
What are the potential LIFE/LIMB/Function threats you’re considering?
What’s a known fever temp?
What do you do for the pt after asessing them?
Overdose
Sepsis
Meningitis
Heat-related illness
>38.5°C
remove excess layers of clothing to promote passive cooling
AND
do NOT actively cool the pt
Fever Standard
What are you assessing in your secondary survey?
What potential problems are you preparing for?
lungs - for adventitious sounds through auscultation
skin - for jaundice, rash, and signs of dehydration
head/neck - for photophobia, scleral jaundice, stiff neck, and headache
AND
abdomen - as per the Abdominal Pain (Non-Traumatic) Standard
AND
Temperature
Febrile children
Suspected serious disorders-meningitis adult
Seizures
Headache (Non-Traumatic) Standard
What potential LIFE/LIMB/FUNCTION threats are you considering?
What potential problems are you preparing for?
What S+S indicate underlying disorder or cause?
intracranial/intracerebral events (e.g. hemorrhage, thrombosis, tumour)
central nervous system or other systemic infection
severe hypertension
AND
toxic event/exposure (e.g. carbon monoxide poisoning)
Seizures
Sudden onset of severe headache with no previous medical hx of headache
Recent onset headache (days, weeks) with sudden worsening
Change in pattern of usual headaches
Any of the above accompanied by one or more of the following:
- Altered mental status
- Decrease in LOC
- Neurologic deficits
- Obvious nuchal rigidity and fever or other symptoms of infection
- Pupillary abnormalities (inequality, sluggish/absent light reactivity)
- Visual disturbances
Headache (Non-Traumatic) Standard
What are you assessing for in your secondary survey?
head/neck - for pupillary size, equality, and reactivity
CNS for
- abnormal motor function (e.g. hand grip strength, arm/leg
movement/drift)
- sensory loss
Heat-Related Illness Standard
What potential LIFE/LIMB/FUCNTION threats are you going to consider?
What should you do for the patient?
What are you assessing in the secondary survey?
Heat stroke
Hypovolemic shock
remove heavy/excess layers of clothing
move the pt to a cooler area
AND
remove heavy/excess layers of clothing
central nervous system
mouth, for state of hydration
skin, for temperature, colour, condition, state of hydration
extremities, for circulation, sensation, and movement
temperature
Heat-Related Illness Standard
If the pt is conscious, cooperative, able to understand directions and is not nauseated or vomiting AND there is some available at the scene, what should you give the pt?
Guideline - what are the signs that you should discontinue cooling procedures?
Provide water or electrolyte containing fluids in SMALL quantities
Skin temp feels nomal to touch
Generalized shivering develops
The pt’s LOC normalizes
Heat-Related Illness Standard
What are the next steps if working assessment indicates heat exhaustion?
Heat stroke?
move the patient to the ambulance
AND
remove as much clothing as possible
move the patient to the ambulance
remove as much clothing as possible
withhold oral fluids
cover the patient with wet sheets
AND
apply cold packs to the axillae, groin, neck and head.
Heat-Related Illness Standard
What are the chief complaints/presenting problems of heat-related illnesses?
Overdose of tricyclic anti-depressants, antihistamines and β-blockers, as well as cocaine, Ecstasy or amphetamine abuse may also lead to heat stroke
Heat syncope
Heat cramps: severe cramping of large muscle groups
Heat exhaustion: mild alterations in mental status, and non-specific complaints (headache, giddiness, nausea, vomiting, malaise), with excessive sweating in healthy adults; or hot, dry skin in the elderly
Heat stroke: severely altered mental status, coma, seizures, hyperthermia
≥40°C
Hematemesis/Hematochezia Standard
What potential LIFE/LIMB/FUNCTION threats are you condsidering?
What is hematochezia?
What is you suspect hemoptysis?
Esophageal varices
AND
Gastrointestinal Disease
Frank rectal bleeding
Attempt to ascertain the origin:
- lung tumours or other lung disease
Hematemesis/Hematochezia Standard
What are you assessing for in the secondary survey?
What other information are you looking for regarding hemorrhage?
How do you estimate blood loss?
chest, if hemorrhage is oral, as per the Chest Pain (Non-Traumatic) Standard
AND
abdomen, as per the Abdominal Pain (Non-Traumatic) Standard
The type - coffee-grounds emesis, melena, of hematochezia
Duration of hemorrhage
Rate of blood flow
Presence of clots
Quantity of blood-soaked/filled materials
Nausea/Vomiting Standard
What are the potential LIFE/LIMB/FUCNTION threats you’re considering? 10
What potential problem are you preparing for?
What is your secondary survey assessing?
acute coronary syndrome/acute myocardial infarction (e.g. STEMI)
anaphylaxis
increased intracranial pressure
toxicological emergencies
bowel obstructions
infection
acute pancreatitis
intra-abdominal emergencies
AND
uremia
airway compromise
the abdomen as per the ‘Abdominal Pain (Non-Traumatic) Stanard
Respiratory Failure Standard
Ventilate the pt as par the ?
Guideline - maintain ETCO2 to ?
Maintain ETCO2 for COPD pts GREATER 50?
What SHALL you do for the pt?
current ‘Heart and Stroke Foundation of Canada Guidelines’
35-45mmHg
COPD pts that had an initial ETCO2 of 50 should be 50-60mmHg
Observe chest rise and fall + auscultate lung fields to assess vetilation adequacy
Minimize the interruptions to ventilations
Continue assisted vetilations until pt’s spontaneous respirations are adequate
Seizure Standard
What potential LIFE/LIMB/FUNCTION threats are you considering in general?
In neonates? In pts GREATER/EQUAL to 50y old?
In pregnant pts? In young children?
Intracranial event
Hypoglycemia
Infection (e.g. CNS, meningitis)
Alcohol withdrawal including delirium tremens)
Drug ingestion/withdrawal
Known seizure disorder
Seizures
Trauma-delivery
Congenital disorders
Prematurity
Hypoglycemia
Brain tumour or orther intracranial event (e.g. hemorrhage, thrombosis)
Cardiac dysrhythmias
Cardiovascular disease
Cerebrovascular disease
Severe hypertension
Febrile convulsions realated to infection
Seizure Standard
What are YOU doing if the pt in in active seizure?
What potential problems are you preparing for?
Attempt to position the pt in recovery position
Attempt to protect the pt from injury
Observe for
- eye deviation
- incontinence
- parts of the body affected
- the type of seizure (full body, focal, etc.)
airway compromise
Recurrent seizures
post-ictal combativeness or agitation
Seizure Standard
What are you assessing in your secondary survey?
seizure related occurrences
Bleeding from the mouth
Incontinence
Secondary injuries resulting from the seizure
tongue injury
Shortness of Breath Standard
What Acute Respiratory Disorders are you considering? 7
What Other Causes are you considering? 3
What Acute Cardiovascular Disorders are you considering? 4
Partial airway obstruction
asthma
anaphylaxis
aspiration
inhalation of toxic gases or smoke
COPD
AND
respiratory infections
Cerebrovascular accident
Toxicological effects
Metabolic acidosis
acute coronary syndrome/acute myocardial infarction (e.g. STEMI)
Congestive heart failure
Pulmonary edema
AND
Pulmonary embolism
Shortness of Breath Standard
Assume ? about hyperventilation
What if the pf is on home O2?
What if the pt is apneic or respirations are inadequate?
That all hyperventilation is due to an underlying disorder
elicit hx regarding changes in use
then ventilate as per the ‘Respiratory Failure Standard’
Shortness of Breath Standard
What are you assessing during your secondary survey?
How should you position the pt?
The chest as per the ‘Chest Pain (Non-Traumatic) Standard’
Head/neck for
- cyanosis
- nasal flaring
- excessive drooling
- tracheal deviation
- JVD
The extremities for
- cyanosis
- edema
In a sitting or semi-sitting position
Syncope/Dizziness/Vertigo Standard
What potential LIFE/LIMB/FUNCTION threats are you considering? (9)
How should you position the pt?
What are the potential porblems you’re preparing for?
Hypoglycemia
Cardiac dysrhythmias
CVS/Transient Ischemic Attack
Hypovolemia
Toxicological effects
Heat-related illness
Anemia
Renal failure
Sepsis
Supine or in recovery position
Cardiac dysrhythmias
Hypotension
Seizures
Decreased LOC
Toxicological Emergency Standard
Attempt to determine ?
In cases which the agent is the prescription medication you should ?
What if the pt’s LOC is decreased or they’re unconcious?
Agent(s)
Quantity
Time
Route - absorption, inhalation, ingestion, or injection
identify the date of prescription and remainder of prescription amount
Refer to the ‘Altered Level of Consciouness Standard’
Toxicological Emergency Standard
What potential problems are you preparing for?
Always attemp to refer to (2) ?
Assume carbon monoxide poisoning where the pt, or multiple pts, exhibit what S+S?
Cardiac arrest
Airway obstruction
Respiratory arrest
Respiratory distress
Altered/changing LOC
Sudden violent behaviour
Hyperthermia
Seizures
Emesis
Poison control resources - don’y delay
A Material Safety Data Sheet
Altered mental status
Cardiac Dysrhythmias
Emesis
Headache
Light-headedness
Nausea
Seizures
Syncope
Weakness
VSA
Vaginal Bleeding Standard
Vaginal Bleeding Standard
What potential LIFE/LIMB/FUNCTION threats are you considering in post-menopausal women and 1st trimester complications?
2nd and 3rd trimester complications?
Tumours
AND
Spontaneous abortion
Ectopic pregnancy
Gestational trophoblastic disease
Spontaneous abortion
Placental abruption
Placena Previa
Ruptured Uterus
Vaginal Bleeding Standard
What are you assessing at a minimum during your secondary survey?
What if you suspect assult?
What should you attempt to determine if the pt it pregnant?
The abdomen as per the ‘Abdominal Pain (Non-Traumatic) Standard’
if the pt is pregnant Note uterine height and palpate for contractions
AND
note fetal movements
Refer to the ‘Sexual Assault (Reported) Standard’
If bleeding is painless or associated with abdominal pain/cramping
the number of prior episodes and cause (if known)
Vaginal Bleeding Standard
When you’re assessing bleeding characteristics, what should you attempt to determine?
How much can a normal sized pad or tampon hold? menstrational bloodlos?
What do you do if bleeding is profuse (what problems are you preparing for)?
Blood loss
Fetal parts
Other tissues
AND
Presence of clots
10-35mL
5mL
Shock
Place an abdominal pad under the perineum and replace pads as required
Document # of pads used on the Ambulance Call Report
Visual Disturbance Standard
What potential LIFE/LIMB/FUNCTION threats are you considering?
What are you assessing in your secondary survey?
Intracranial, intracerebral or retinal hemorrhage/thrombosis
Acute glaucoma
The eyes for
- Pupillary size, ERLA
- Abnormal movements
- Positioning
- Redness
- Swelling
- Tearing
AND
- Presence of contact lenses
The eye-lids for ptosis (upper eyelid droops over the eye)
AND
Vision for
- distortion/diplopia (double vision)
- loss
- visual acuity
Visual Disturbance Standard
How do you minimize movement and assist with pt comfort?
What potential problems are you preparing for? 3
Considering patching the eyes
Alterations in LOC
Neurological Deficits
Emesis
