MPDS Test Flashcards
Priority Symptoms (ACDS)
- abnormal breathing
- chest pain/discomfort if any
- DLOC
- serious Hemorrhaging
Ineffective breathing descriptors
when mentioned use breathing verification diagnostic
EXCEPT UNCONSCIOUS
can’t breath at all
not breathing
barely breathing
gasping for air
fighting for air
making funny noises
just a little
turning blue or purple
if mentioned go to 10 (chest pain/ discomfort non traumatic)
heart attack symptoms
also found in arms, jaws, neck, upper back , this is how women perceive
women are also less likely to call in for heart attacks due to higher pain tolerance and the pain are not neccesarily on chest but the ones mentioned above
- aching pain
- constricting band
- chest pain/discomfort (now gone)
- crushing discomfort
- heaviness
- numbness
- pressure
- tightness
equivalent fo chest pain and handle on 10
Stroke (CVA)/ TIA symptoms
keywords are sudden and onset
- speech problems
- weakness, numbness, paralysis of face arm or leg on one side of body
- loss of balance or coordination
- trouble seeing in one or both eyes
- severe headache with no known cause
numbness on hand only is NOT a stroke symptoms
review legend of symbols
see last page of pilot guide
axioms/ use key words below to rephrase
UNCERTAIN BREATHING
2nd party
considered NOT BREATHING
until proven otherwise
UNCERTAIN BREATHING status indicated a 2nd party caller who has seen the patient and is still unsure. this is considered NOT BREATHING until proven otherwise.
because we are leveling up the response “just in case”, and if patient is UNCONS, do not use breathing verification diagnostic
axioms/ use key words below to rephrase
unknown breathing
3rd/4th party
unknown breathing status indicates a 3rd or 4th party caller who cannot personally verify the patient’s status.
due to lack of info/ not at scene
axioms/ use key words below to rephrase
ECHO
completing all case entry and CC KQ
safety issues
after an ECHO response, completing all Case Entry and CC key questions ensures that the proper knowledge regarding safety issues and the appropriate warnings and/or advice are immediately and always passed on the responders and potential scene helpers.
send ECHO first to help patient, then gather scene safety info/warning/advices to protect crew/bystanders/volunteers.
relating to “scene safety” CC selection rule
axioms/ use key words below to rephrase
prompt recognition
AGONAL BREATHING
MEDICAL arrest PAIs (aka CPR)
immediately after ECHO send
when unconscious patient
INEFFECTIVE or UNCERTAIN breathing
prompt recognition of AGONAL BREATHING is critical to the treatment of cardiac arrest because it reduces time to compressions and defibrillation. MEDICAL arrest PAIs should be instituted immediately after ECHO coding and associated PDIs when an unconscious patient’s breathing status is INEFFECTIVE or UNCERTAIN (Breathing verification diagnostic use is NOT neccesary)
uncons patient DO NOT USE breathing verification diagnostic when breathing is uncertain or ineffective
Pilot Guide rules/ use key words below to rephrase
dynamic and often conflicting priorities
critical safety instructions
further attempt to locate by street,hwy, direction, intersection, or objects
the EMD must weight the dynamic and often conflicting priorities of obtaining and verifying a useful location versus helping the caller get to safety. if initial efforts to identify an exact location fail, it is essential that critical safety instructions be provided without further delay. further attempts to locate can then be made to determine the street or highway of travel, direction of travel, and last cross street or identifiable objects seen.
emphasis on “patient safety”
hence on DLS link under Danger “get to safety first then call us back”
also relocate to safe location would mean have to verify exact address anyways.
Pilot Guide rules/ use key words below to rephrase
critical patient care instructions
priori to “send” point
scene safety concerns
must be addressed before instructions
some critical patients care instructions may be necessary prior to the “send” point. Any significant scene safety concerns take precedene and must be addressed before the provision of instructions.
eg, run away from animals, assualts, fire, water…etc
before “send” point.
Pilot Guide rules/ use key words below to rephrase
1st party caller
sinking vehicle
should not delay PAIs
attempts to locate can be following/during critical safety instructions
for a 1st party caller in a sinking vehicle. obtaining an exact location, when not immediately available, should not delay PAIs, further attempts to locate can be made following/during critical safety instructions as time/circumstance permits.
get patient out of sinking vehicle first then address everything else later.
Pilot Guide rules/ use key words below to rephrase
must complete case entry questions
after “send, PDIs & returning to questioning”
case entry questioning must always be completed after PDIs when directed by the “send, PDIs & return to questioning” symbol (hanging, strangulation, suffocation, underwater, choking, person on fire)
review legend of symbols
mentioned above are all ECHO response aka “fast track” in ProQA
Pilot Guide rules/ use key words below to rephrase
NO breathing diagnostic
UNCERTAIN/ INEFFECTIVE BREATHING with uncons
use of the breathing verification diagnostic is not neccesary when UNCERTAIN BREATHING or INEFFECTIVE BREATHING is associated with unconsciousness.
EMMA! why do we worry about breathing when patient’s heart stopped pumping/ cardiac arrest. Get started on CPR asap
Pilot Guide rules/ use key words below to rephrase
1st party callers
further assess ability to speak, level of distress or agitation, airway noises.
ranges of breathing effectiveness
when i doubt, err on side of patient safety
1st party callers using phrases like “i can’t breathe” or “i can barely breathe” may be further assessed by their ability to speak normally or in complete sentences, their level of apparent distress or agitation, and the presense of airway noises (i.e., stridor, wheezing, gasping, etc.) breathing effectiveness ranges from normal breathing to mild SOB to DIFFICULTY SPEAKING BETWEEN BREATHS to fighting for air (INEFFECTIVE BREATHING) when in doubt, the EMD should err on the side of patient safety.
we take what callers tell us, since we are not doctors and we cannot diagnose over the phone, in case of judgment error from audio cues, choose responses that level up response (err on side of patient safety)
CC selection rule/ use keywords below to rephrase
sudden, unexplained collapse
unconsciousness
even as ground level fall
MEDICAL cardiac arrest
a sudden, unexplained collapse resulting in unconsciousness, even with reported as a ground-level fall, should be considered a MEDICAL cardiac arrest until proven otherwise.
could be a MEDICAL cardiac arrest that leads to ground level fall
CC selection rule/ use keywords below to rephrase
cardiac arrest
TRAUMATIC
best fits scene safety &
mechanism of injury
when cardiac arrest appears to be TRAUMATIC in nature, choose the Chief Complaint Protocol that best fits scene safety concerns and the mechanism of injury.
CC selection rule/ use keywords below to rephrase
scene safety
best addresses those issues
if the complaint description includes a scene safety issues, choose the Chief Complaint Protolcol that best addresses those issues.
e.g Protocol 4,8….etc
CC selection rule/ use keywords below to rephrase
TRAUMA
mechanism of injury
If the complaint description suggests TRAUMA, choose the Chief Complaint protocol that best addresses the mechanism of injury.
CC selection rule/ use keywords below to rephrase
MEDICAL
foremost symptom
consideration given to priority symptoms
if the complaint description appears to be MEDICAL in nature, choose the CC protocol that best fits the patient’s foremost symptom, with consideration given to priority symptoms.
CC selection rule/ use keywords below to rephrase
abdominal pain/ cramping
pregnancy
contractions
abdominal pain/cramping anytime during pregnancy should be considered contractions until proven otherwise.
espcially when patient is in denial “baby is too early to be born”
CC selection rule/ use keywords below to rephrase
traumatic injury or constriction
non-venomous(unquestionable) snake
go to 3, if not go to 2
3 Animal bites/ attacks
if the complaint is traumatic injury or constriction involving a non-venomous (unquestionable) snack, go to protocol 3.
if unkown or unsure, go to protocol 2.
CC selection rule/ use keywords below to rephrase
back pain
non traumatic or
non recent trauma
as stated in name of protocol 5
back pain should only be selected as CC when it is initially clear on case entry that the cause is NON-RECENT traumatic or NON-TRAUMATIC back pain. if unclear, go to protocol 30.
Protocol 30- Traumatic injuries (specific)
CC selection rule/ use keywords below to rephrase
breathing-related tracheostomy
conscious patient
go to 6
when the complaint description is breathing-related tracheostomy (trach or stoma) problems in the conscious patient, go to protocol 6.
6 breathing problems
CC selection rule/ use keywords below to rephrase
both NON-TRAUMATIC chest pain/ HEART ATTACK symptoms and breathing problems
choose foremost symptom
ECHO takes precedences
when the complaint description involves both NON-TRAUMATIC chest pain/ HEART ATTACK symptoms and breathing problems, choose the Chief Complaint protocol that Best fits the patient’s foremost symptom, with ECHO-level condition taking precedence. (>/ 16, alert, not pregnant, no reported stroke symptoms) use the Aspirin Diagnostic & instruction Tool on either protocol as appropriate.
Exceptions of using
ASA tool
- > / 16
- alert
- not pregnant
- no reported STROKE symptoms
CC selection rule/ use keywords below to rephrase
severe thermal burns to eyes
protocol 7
since several thermal burns to the eye almost always affect the face or head, go to protocol 7 for these incidents.
won’t be 16! because most likely it will affect airway
CC selection rule/ use keywords below to rephrase
hazardous materials (toxic substances)
threat
protocol 8
If the complaint description involves a hazardous materials (toxic substances) that pose a threat to bystanders or responders, go to protocol 8.
example of scene safety rule
CC selection rule/ use keywords below to rephrase
both chest pain/ HEART ATTACK symptoms and STROKE symptoms
go to 10
**NO ASA TOOL **
if the complaint description involves both chest pain/ HEART ATTACK symptoms AND STROKE symptoms, go to protocol 10 but do not utilize ASA tool.
Protocol 10 is generic and “pure medical”and ProQA will try to filter. do not use ASA because patient report of stroke symptoms which is one of the exceptions.
CC selection rule/ use keywords below to rephrase
GENERALIZED seizure
go to 12
if atypical go to 9
when the complaint description strongly suggests GENERALIZED seizure, go to protocol 12 regardless of consciousness and breathing status. If the scenario is atypical of GENERALIZED seizure, and is ore typical of sudden cardiac arrest, go to protocol 9.
CC selection rule/ use keywords below to rephrase
POSTPARTUM hemorrhage
21
for a complaint description of POSTPARTUM hemorrhage only, go to protocol 21 (no complications with baby and placenta has been delivered)
because we are focusing on bleeding rather than baby
CC selection rule/ use keywords below to rephrase
DANGEROUS, uncontrolled hemorrhage
excludes scene safety
go to 21
for DANGEROUS, uncontrolled hemorrhage (neck armpit, or groin), excluding scene safety complaints, go to protocol 21
DANGEROUS hemorrhage: neck, armpit, groin
CC selection rule/ use keywords below to rephrase
- vomit with coffee grounds appearance
- unusally dark or black and tar like poop
- go to 21
- signs of GI bleeding
very specific signs
if the complaint description involves vomit (emesis) with a coffee grounds appearance, or unusually dark or black and tar-like fecal matter (stool), go to protocol 21 as these are signs of gastrointestinal bleeding
CC selection rule/ use keywords below to rephrase
suicide attempt
overdose, carbon monoxide, stab or gsw
go to specific protocol
if the actual type of suicide attempt is deteremined to be overdose, carbon monoxide, stab or gunshot wound, go to and dispatch from that more specific protocol.
because 8, 23,27 put heavy emphasis of scene safety
CC selection rule/ use keywords below to rephrase
recreational inhalation
23
for recreational inhalation of potentially harmful substances, go to protocol 23.
eg. hairspray, marijuana, gas fumes…..etc
CC selection rule/ use keywords below to rephrase
attempt by jumping from height
INTENDING/IMMINENT/ or already jumped
go to 25
when the complaint description involves a suicide attempt by jumping from a height (INTENDING SUICIDE, IMMINENT SUICIDE POTENTIAL, or already jumped), go to protocol 25.
25 put emphasis of “jumper”
CC selection rule/ use keywords below to rephrase
pregnant
“illness” as primary complaint
26
If pregnant patients have “illness” as primary complaint go to protocol 26 unless the problem concerns vaginal bleeding, labour, miscarriage, or waters broken.
if problem concerning vaginal bleeding, labour, miscarriage, or waters broken. we worry about status of baby which goes to 24
CC selection rule/ use keywords below to rephrase
sickle cell crisis….
etc
if the complaint description involves sickle cell crisis/thalassemia, automatic dysreflexia/hyperreflexia, or acute adrenal insufficiency/adrenal crisis/ addisonian crisis/ addison’s disease, go to protocol 26.
unusual diseases go to 26
CC selection rule/ use keywords below to rephrase
abdominal
thoracic eviscerations
27
for abdominal and thoracic eviscerations, go to protocol 27
think of broken stitches after surgery “multiple wounds” and penetrating trauma
CC selection rule/ use keywords below to rephrase
insignificant or peripheral
puncture wounds
go to 21or 30
protocol 27 should not be used for insignificant or peripheral puncture wounds such as household pins, needles, tacks, or stepping on nails. go to protocol 21 or 30 as appropriate.
go to 21 to control bleeding or 30 to treat specific traumatic injuries
CC selection rule/ use keywords below to rephrase
ANY traumatic chest pain
go to 30
for chest pain due to trauma (current or non-recent) go to protocol 30.
because non traumatic non recent chest pain we go to 10
CC selection rule/ use keywords below to rephrase
ground level fall
fainting,near fainting or dizziness
go to 31
for ground-level falls caused by fainting, near fainting or dizziness, go to protocol 31.
CC selection rule/ use keywords below to rephrase
consciouness and/or
breathing unknown
initially (3rd party caller)
go to 32
if the CC and status of consciousness and/or breathing are unknown initially (3rd party caller), go to protocol 32
due to lack of info we err on patient side of safety.
for example if coded life status questionable we give DELTA code
NOT BREATHING SITUATIONS
- not breathing at all
- UNCERTAIN BREATHING
- hanging
- strangulation
- suffocation
- COMPLETE obstruction
- drowning arrest (out of water)
- under water (non specialized rescue)
- narcotic/opioid arrest (obivious)
- not breathing at all 9-E-1
- UNCERTAIN BREATHING 9-E-2
- hanging 9-E-3
- strangulation 9-E-4
- suffocation 9-E-5
- COMPLETE obstruction 11-E-1
- drowning arrest (out of water) 14-E-1
- under water (non specialized rescue) 14-E-2
- narcotic/opioid arrest (obivious) 23-E-1
OBVIOUS EXTREME RESPIRFATORY DISTRESS
1st party
1st party caller including but not limited to
* fighting for each breath, using single words or syllables to express
* expressing extreme desperation
* complete respiratory exhaustion
* thought of impending death
ECHO, 6-E-1, breathing problems
Breathing Verification Diagnostic
go SLOW when reading espcially the verbiage of “GO”
> / 8 sec. interval
AGONAL
check for maximum of 4 breaths
AGONAL BREATHING
ineffective, deteriorating breathing
lingers after the heart has essentially stopped pumping blood to brain
literally “taking last breath of air”
UNCERTAIN BREATHING
2nd party caller
uncertain, unsure, indefinite or ambiguous when asked if patient is breathing
