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OCHT Term II > PCTH - CTAS > Flashcards

PCTH - CTAS Flashcards

1
Q

What are the 5 CTAS levels?

A

CTAS 1 - Resuscitation

CTAS 2 - Emergeny

CTAS 3 - Urgent

CTAS 4 - Less Urgent

CTAS 5 - Non urgent

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2
Q

What are the intial first order modifiers? These are the ones that are applied first, once the presenting complaint has be determined.

A
  1. Respiratory Distress modifier (using RR, SpO2 if available, and respiratory effort)
  2. Hemodynamic Stability modifier (using HR, BP, and signs of perfusion)
  3. Level of Consciousness modifer (using general LOC and GCS)
  4. Temperature (if available)
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3
Q

What is the second group of first order modifiers?

A
  1. Pain
  2. Bleeding Disordesr
  3. Mechanism of Injury (MOI)

*Note: these applied are related to specific conditions or Sx and should be applied after chief complaint has been determined and the first group of first order modifiers have been applied.

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4
Q

What are the rules for CTAS?

A

1) CTAS applied 3 times (arrival, departure, destination)
2) Departure CTAS is the one reported to dispatch and destination, and if patient’s condition changes en route, re-evaluate and update receiving facility
3) when taking into account the patient’s response to treatment departure CTAS level should not be any greater than 2 levels below arrival CTAS level (i.e. if patient was CTAS 1 on arrival and respond to treatment, you can max transport them at CTAS 3)
4) Any patient who is VSA on arrival and who is resuscitate will remain CTAS 1 regardless of how well the patient recovers
5) if TOR is obtained, arrival level will be assigned appropriately. it received prior to departing scene, departure level will be documented as 0. IF received en route, arrival and departure will be assigned appropriately but destination level will be 0

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5
Q

CTAS 1 - Cardiovascular

A
  • Cardiac arrest - traumatic and non-traumatic
  • Pre-arrest - severe end-organ hypoperfusion (e.g. tachycardia, hypotension)
  • Patients with a return of spontaneous circulation (ROSC) following a cardiac arrest
  • Chest pain with cardiac features - severe end-organ hypoperfusion
  • Severe dehydration
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6
Q

CTAS 1 - Environment

A
  • Chemical burn - ≥25% body surface area
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7
Q

CTAS 1- Mental Health

A
  • Violent/homicidal behaviour - imminent harm to self or others or specific plans
  • Bizarre behaviour - uncontrolled
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8
Q

CTAS 1 - Neurological

A
  • Unconscious - GCS 3-9
  • Seizures - actively seizing
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9
Q

CTAS 1 - OBGYN

A

Pregnancy ≥20 weeks - presenting fetal parts, prolapsed cord

Pregnancy ≥20 weeks - vaginal bleeding in 3rd trimester

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10
Q

CTAS 1 - Respiratory

A

Respiratory arrest

Shortness of breath - severe respiratory distress

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11
Q

CTAS 1 - Trauma

A

Major trauma - severe hemodynamic compromise (shock)

Traumatic amputation of an extremity

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12
Q

CTAS 2 - Cardiovascular

A
  • Chest pain with cardiac features - borderline perfusion (e.g. tachycardia with low blood pressure)
  • Hypertension - SBP ≥220 or DBP ≥130 with symptoms
  • Syncope - history of new onset dysrhythmia/irregular pulse and/or known/suspected change in rate
  • Moderate dehydration
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13
Q

CTAS 2 - ENT

A
  • Dental avulsion
  • Sore throat - drooling or stridor, obvious edema/swelling of lips, tongue or oropharynx
  • Neck pain - neck stiffness/meningismus +/-fever
  • Epistaxis - uncontrolled despite appropriate pressure
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14
Q

CTAS 2 - Environmental

A
  • Frostbite/cold injury - cold pulseless limb
  • Hypothermia with severe symptoms
  • Chemical exposure - eye(s)
  • Chemical exposure - major burns to hand(s), feet, groin or face
  • Allergic reaction - previous severe reaction
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15
Q

CTAS 2 - Gastrointestinal

A
  • Vomiting blood - active or significant hematemesis
  • Rectal bleed - large amount of melena or rectal bleeding
  • Abdominal pain (severe pain)
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16
Q

CTAS 2- Mental Health

A
  • Attempted suicide or clear suicide plan
  • Severe anxiety/agitation
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17
Q

CTAS 2 - Neurologic

A
  • Altered level of consciousness - GCS 10-13
  • Headache - sudden, severe, worst ever
  • Headache - visual acuity disturbance +/- eye pain
  • Seizure - post-ictal
  • CVA - time of symptom onset <6 hours
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18
Q

CTAS 2 - OBGYN

A
  • Vaginal bleeding - heavy +/- pregnancy
  • Pregnancy ≥20 weeks - active labour (contractions <2 minutes apart)
  • Pregnancy ≥20 weeks - complex hypertension +/- headache +/-edema +/-abdominal pain
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19
Q

CTAS 2- Ophthalmology

A

Acute vision loss

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20
Q

CTAS 2- Respiratory

A
  • Shortness of breath - moderate respiratory distress
  • Foreign body obstruction - drooling or stridor, hoarseness or dysphagia
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21
Q

CTAS 2 - Trauma

A
  • Significant Mechanism of Injury - all patients with injuries, symptoms and complaints related to trauma
  • Penetrating head, chest or abdomen
  • Neurovascular compromise of an extremity
  • Burns - ≥25% body surface area
  • Abdominal pain (severe central pain)
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22
Q

CTAS 3 - Cardiovascular

A
  • Chest pain, non cardiac features - acute onset, ongoing
  • Hypertension - SBP ≥220 or DBP ≥130 with no symptoms
  • Hypertension - SBP 200-220 or DBP 110-130 with symptoms
  • Mild dehydration
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23
Q

CTAS 3 - Environmental

A

Frostbite/cold injury - blanching of skin

Hypothermia - moderate symptoms

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24
Q

CTAS 3 - Gastrointestinal

A

Vomiting blood - “coffee-ground” emesis, small amount

Rectal bleed - melena, small amount

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25
Q

CTAS 3 - Mental Health

A
  • Depression/suicidal (suicidal ideation, no plan)
  • Moderate anxiety/agitation
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26
Q

CTAS 3 - Neurologic

A
  • Seizures - resolved, normal level of alertness
  • CVA - onset of symptoms ≥6 hours or resolved
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27
Q

CTAS 3- OBGYN

A
  • Menorrhagia
  • Pregnancy ≥20 weeks (active labour, contractions ≥2 minutes apart)
  • Pregnancy ≥20 weeks - possible leaking amniotic fluid (≥24 hours)
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28
Q

CTAS 3 - Respiratory

A
  • Shortness of breath - mild/moderate respiratory distress
  • Foreign body obstruction - no distress but with difficulty swallowing
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29
Q

CTAS 3- Trauma

A

• Burns - 5-25% body surface area

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30
Q

CTAS 4 - Cardiovascular

A
  • Hypertension - SBP 200-220 or DBP 110-130 with no symptoms
  • Potential for dehydration
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31
Q

CTAS 4- Environmental

A

Hypothermia - mild with normal vital signs

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32
Q

CTAS 4- Gastrointestinal

A
  • Rectal Bleeding - small amount
  • Constipation (mild pain < 4/10)
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33
Q

CTAS 4 - Genitourinary

A

UTI complaints/symptoms (mild dysuria)

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34
Q

CTAS 4 - Neurologic

A

Confusion - chronic, no change from usual state

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35
Q

CTAS 4 - Mental Health

A

Mild anxiety/agitation

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36
Q

CTAS 4- OBGYN

A

Non pregnant vaginal bleeding - minor/spotting

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37
Q

CTAS 4 - Trauma

A
  • Burns - <5% body surface area
  • Laceration/puncture (sutures required)
  • Upper extremity injury
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38
Q

CTAS 5 - Environmental

A
  • minro bites (+/- mild pain <4)
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39
Q

CTAS 5 - Gastrointestinal

A

Diarrhea (mild, no dehydration)

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40
Q

CTAS 5 - General and Minor

A

Dressing change (plus normal vital signs +/- mild pain <4)

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41
Q

CTAS 5- Respiratory

A

Sore throat/upper respiratory illness - no respiratory symptoms/compromise

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42
Q

CTAS 5 - Trauma

A

Minor contusions, abrasions or lacerations (not requiring closure by any means)

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43
Q

First Order Modifier Respiratory Distress - Severe

A

CTAS 1

  • Fatigue from excessive work of breathing
  • cyanosis
  • single-word speech
  • unable to speak
  • upper airway obstruction
  • lethargic or confused
  • SpO2: <90%
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44
Q

First Order Modifier Respiratory Distress - Moderate

A

CTAS 2

  • increased work of breathing
  • speaking phrases or clipped sentences
  • significant or worsening stridor but the airway is protected
  • SpO2: <92%
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45
Q

First Order Modifier Respiratory Distress - Mild/Moderate

A

CTAS 3

  • Dyspnea
  • tachypnea
  • shortness of breath on exertion
  • no obvious increased work of breathing
  • able to speak in sentences
  • stridor without any obvious airway obstruction
  • SpO2: 92-94%
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46
Q

Modifier - Hemodynamic Status - Shock

A

CTAS 1

Evidence of severe end-organ hypoperfusion: Marked pallor, cool skin, diaphoresis, weak or thready pulse, hypotension, postural syncope, significant tachycardia or bradycardia, ineffective ventilation or oxygenation, decreased level of consciousness. Could also appear as flushed, febrile, toxic, as in septic shock.

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47
Q

Modified - Hemodynamic Compromise

A

CTAS 2

Evidence of borderline perfusion: pale, history of diaphoresis, unexplained tachycardia, postural hypotension (by history), feeling faint on sitting and standing, or suspected hypotension (lower than normal blood pressure or expected blood pressure for a given patient).

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48
Q

Modified - Hemodynamic Status - CTAS 3

A

Vital signs at the upper and lower ends of normal as they relate to the presenting complaint, especially if they differ from the usual values for the specific patient.

49
Q

Hemodynamic Status - Normal vital signs is CTAS ________.

A

4,5

50
Q

Modifier - Level of consciouness

A

CTAS 1: Unconscious - GCS 3-9

CTAS 2: Altered LOC - GCS 10-13

CTAS 3, 4, 5: Normal: GCS 14-15

51
Q

SIRS criteria

A

The response is manifested by two (2) or more of the following conditions (only the first three (3) can be assessed in the prehospital care setting):

  • temperature ≥38.5°C or <36°C
  • heart rate ≥90 beats/minute
  • respiratory rate ≥20 breaths/minute
  • PaCO2 <32 torr (<4.3 kPa)
  • WBC ≥12000 cells/mm3. <4000 cells/mm3 or ≥10% immature (band) forms
52
Q

Sepsis vs severe sepsis

A

Sepsis: systemic response to infection, manifested by two (2) or more of the SIRS criteria as a result of infection

Severe sepsis: sepsis associated with organ dysfunction, hypoperfusion or hypotension; hypoperfusion and perfusion abnormalities may include but are not limited to lactic acidosis, oliguria or an acute alteration in mental status

53
Q

Temperature Modifier - Immunocompromised

A

CTAS 2: neutropenia (or suspected), chemotherapy or immunosuppressive drugs including steroids

54
Q

Temperature Modifier - Looks Septic

A

CTAS 2: patient has evidence of infection, have 3 SIRS criteria positive, or show evidence of hemodynamic compromise, moderate respiratory distress or altered level of consciousness

55
Q

Temperature Modifier - Looks unwell

A

CTAS 3: patient has <3 SIRS criteria positive but appear ill- looking (i.e. flushed, lethargic, anxious or agitated)

56
Q

Temperature modifiers - Looks well

A

CTAS 4- patient has fever as their only positive SIRS criteria and appear to be comfortable and in no distress

57
Q

Pain severity

A

Severe: 8-10/10

Moderate: 4-7/10

Mild: 0-3/10

58
Q

Central pain vs peripheral pain

A

Central pain: originates within a body cavity or organ and may be associated more frequently with life threatening conditions

Peripheral pain: originates in the skin, soft tissues, axial skeleton or superficial organs where dangerous diagnoses are less likely to be missed.

*Note: If a patient presents with pain in a location that would be usually considered a peripheral site but it is suspected that the patient has a potential life or limb threatening condition (e.g. necrotizing fasciitis, peripheral or vascular occlusion) the pain should be scored as central pain.

59
Q

Pain modifier

A
60
Q

Bleeding modifier applies to:

A
  • Patients with congenital bleeding disorders (e.g. hemophilia, Von Willebrand’s Disease).
  • Patients with severe liver failure.
  • Patients taking anticoagulants (e.g. coumadin, warfarin, dalteparin)
61
Q

Bleeding modifier - CTAS 2

A
  • Head (intracranial) and neck
  • Chest, abdomen, pelvis, spine
  • Massive vaginal hemorrhage
  • Iliopsoas muscle and hip
  • Extremity muscle compartments
  • Fractures or dislocations
  • Deep lacerations
  • Any uncontrolled bleeding
62
Q

Bleeding modifier - CTAS 3

A
  • Moderate, minor bleeds
  • Nose (epistaxis)
  • Mouth (including gums)
  • Joints (hemathroses)
  • Menorrhagia
  • Abrasions and superficial lacerations
63
Q

MOI Modifier - General Trauma

A

CTAS 2

Motor Vehicle Collisions

  • Ejection (partial or complete) from vehicle
  • Rollover
  • Extrication time ≥20 minutes
  • Significant intrusion into passenger’s space (≥ 0.3 metres occupant site;
  • ≥0.5 metres any site, including roof )
  • Death in the same passenger compartment
  • Impact ≥40 km/h (unrestrained) or impact ≥60 km/h (restrained)

Motorcycle Collision: Impact with a vehicle ≥30 km/h, especially if rider is separated from motorcycle

Fall: From ≥6 metres (one storey is equal to 3 metres)

Penetrating Injury: To head, neck, torso or extremities proximal to elbow and knee

64
Q

MOI Modifier - Head Trauma

A

CTAS 2

Motor Vehicle Collision

  • Ejection (partial or complete) from vehicle
  • Unrestrained passenger striking head on windshield

Pedestrian: Struck by vehicle

Fall: From ≥1 metre or 5 stairs

Assault: With blunt object other than fist or feet

65
Q

MOI Modifier - Neck trauma

A

CTAS 2

Motor Vehicle Collision

  • Ejection (partial or complete) from vehicle
  • Rollover
  • High speed (especially if driver unrestrained)

Motorcycle Collision

Fall: From ≥1 metre or 5 stairs

Axial Load to the Head

66
Q

Second order modifiers

A
  • blood glucose
  • hypertension
  • dehydration
  • selected adult second order modifiers
  • obstetrics ≥20 weeks gestation
  • mental health
67
Q

BGL Modifier - CTAS 2

A

1) <3mmol/L with confusion, seizure, diaphoresis, behavioural change, acute focal deficits
2) ≥18 mmol/L with dyspnea, tachypnea, dehydration, thirst, weakness, polyuria

68
Q

BGL Modifier - CTAS 3

A

1) < 3 mmol/L no symptoms
2) ≥18 mmol/L no symptoms

69
Q

Hypertension/Blood pressure modifier

A
70
Q

Dehydration modifier

A
71
Q

Select Second Order Adult Modifiers

A
72
Q

Modifier: Obstetrics ≥ 20 weeks Gestation - CTAS 1

A
  • presenting fetal parts of prolapsed umbilical cord
  • vaginal bleeding in third trimester
73
Q

Modifier: Obstetrics ≥ 20 weeks Gestation - CTAS 2

A
  • active labour (contractions <2 min apart)
  • no fetal movement or no fetal heart sounds
  • complex hypertension +/- headache +/- edema +/- abdo pain
  • post delivery (mother and infant)
74
Q

Modifier: Obstetrics ≥ 20 weeks gestation - CTAS 3

A
  • active labour (contractions ≥ 2 mins apart)
  • possible leaking amniotic fluid (≥24h)
75
Q

Modifier - Mental Health CTAS 1

A

Voliment or Homicidal behaviour - imminent harm to self or others, or specific plan

Bizarre behaviour - uncontrolled

76
Q

Modifier - Mental Health CTAS 2

A

Depression/Suicidal or deliberate self harm

  • attempted suicide, clear plan
  • active suicide intent
  • uncertain flight or safety risk

Anxiety/Situational Crisis

  • Severe anxiety/agitation
  • uncertain flight or safety risk

Hallucination/Delusions

  • acute pyschosis
  • severe anxiety/agitation
  • uncertain flight or safety risk

Violent or Homocidal Behaviour

  • uncertain flight or safety risk
77
Q

Modifier - Mental Health CTAS 3

A

Depression/Suicidal or deliberate self-harm - suicidal ideation, no plan

Anxiety/Situational Crisis - mod anxiety/agitation

Hallucinations or Delusions - mod anxiety/agitation or with paranoia

Violent or Homicidal Behaviour - violent or homicidal ideation, no plan

Social Problem - abuse physical, mental, high emotional stress

78
Q

Modifier - Mental Health CTAS 4

A

Depression/Suicidal or deliberate self harm - depressed, no suicidal ideation

Anxiety/Situational Crisis - mild anxiety/agitation

Hallucinations/Delusion - mild agitation/stable

Insomnia - acute

79
Q

Modifier - Mental Health CTAS 5

A

Insomnia - Chronic

Bizarre Behaviour - chronic, non urgent

80
Q

A 42 year old psychiatric patient wandered away from his group while they were out looking at Christmas lights. The facility chaperones found the patient after 2 hours in the cold. Although the patient had been wearing appropriate clothing he presents with some frost bite on his cheeks and moderate symptoms of hypothermia.

A

CTAS 3

81
Q

A 55 year old female patient was playing recreational volleyball when she began to experience shortness of breath and collapsed to the ground. Upon arrival you found teammates performing CPR. You confirm that the patient is VSA and deliver 3 shocks before packaging the patient on the stretcher. There is no response to treatment by the time you leave scene.

A

CTAS 1

82
Q

You respond to an office where you find a 29 year old female patient who called because she has noticed a small amount of blood in her stool. It appears dark in colourand has a distinct odour. She denies any abdominal discomfort and her vitals are unremarkable. She states there is a history of bowel cancer in her family. She appears moderately upset about the incident.

A

CTAS 3

83
Q

An 80 year old nursing home patient had been complaining of nausea and abdominal cramping prior to collapsing to the ground. Staff immediately called 911 and you find the patient semi-prone on the floor with a GCS of 8. He is pale/diaphoretic, you cannot feel radial pulses and his carotid pulse is 122 I/W.

A

CTAS 1

84
Q

You respond to a local Tim Hortons where a worker has spilled a pot of coffee on her wrist. The area (~10%), has become reddened and blisters have begun to form. Although the patient is in considerable discomfort her vital signs are unremarkable

A

CTAS 3

85
Q

You have responded to a request from the local police department to deal with a patient who was threatening to jump from the roof of her house. The patient appeared quite agitated initially stating she wants to kill herself because of the lack of support she’s been receiving from her family. The police were able to talk her off of the roof and although now willing to go to hospital, the patient still appears anxious and while en route, asks you if you know how high the roof at the hospital is.

A

CTAS 2

86
Q

You have been called to a local fast food restaurant for a patient who was slicing tomatoes for the lunch rush. The patient has laceration to her thumb ~ 1” in length. The bleeding is controlled however you believe that the wound will require sutures to close it.

A

CTAS 4

87
Q

A 18 year old male was playing basketball in gym class when he twisted his ankle after taking a jump shot. The gym teacher said the patient did not strike his head when he fell but immediately began complaining of pain in his left ankle. They haven’t taken his shoe off but did apply ice. The teacher said its school policy to call anytime there is an injury to a student. There is no obvious and the patient states the initial “tingling” that was present has subsided. He says he has full sensation but when he attempts to stand it he feels a pain of 3/10.

A

CTAS 5

88
Q

You are attending a scene with the local police department at a local bar. A patient has been threatening patrons at the bar accusing them of sleeping with his wife. He states that he is going to kill anyone he believes has “done the dance with no pants” with his wife Lavern. The patient is quite agitated and is well known to police. They state the patient does not have a wife but does have a history of schizophrenia. The police officers have restrained the patient and will accompany you to hospital. En route to hospital, the patient continues to show agitation and threatens you and the officers on board.

A

CTAS 1

89
Q

A 26 year old electrician was wiring up a new hot tub when the homeowner inadvertently turned on the breaker. The patient was thrown ~ 10 feet and landed on his back. On arrival you note that the patient has been incontinent and presents with decerebate posturing. His GCS is 4, pulse is irregular at 68 beats per minute and respirations are irregular at 6. His work boots have been blown off and he has an entry wound on his left hand and exit would on his right foot.

A

CTAS 1

90
Q

You respond to a local skate park for a 37 year old male who fell off of a skateboard while trying to show his son how to do some tricks. He did not strike his head and appears to have some minor abrasions to his hands and elbows. He says he wants to be assessed in the ER because “its better to be safe than sorry.”

A

CTAS 5

91
Q

A 40 year old male patient was shoveling his driveway when he began to feel a sharp pain in his lower back. Once completing the task, the patient went inside but found he was unable to untie his boots. His wife called 911 when he began to describe the discomfort as a 7/10 sharp pain. His pulse is 92 R/F, Resp 16 R/F, BP 142/60. The discomfort does not radiate anywhere else and he feels relief when he doesn’t move around too much.

A

CTAS 3

92
Q

A 29 year old female was cleaning out her garage when she began to experience some shortness of breath. In broken sentences she explains that the garage was quite dusty and it exacerbated her asthma. She attempted to use her Salbutamol MDI but it is not helping. You note accessory muscle use in her chest which displays her increased work of breathing. Her resp rate is 32 R/S, Pulse 112 R/F, SpO2 91%. There is no cyanosis and her GCS is 15.

A

CTAS 2

93
Q

A 43 year old female patient experienced a 2 minute seizure while in a local restaurant. The staff called 911 and you arrive to find her in a post ictal state. Her vitals are unremarkable but when you load her onto the stretcher, she begins to seize again and continues to do so en route to the hospital. You are able to control her airway but the seizure activity make any other treatment or assessment impossible.

A

CTAS 1

94
Q

You have responded to a local park where a patient was reported as being VSA. Prior to your arrival a park employee applied a PAD and delivered 2 shocks. When you make patient contact, you find that the patient has a pulse of 62 R/W and respirations of 4 L/S. You begin ventilation and prepare for transport.

A

CTAS 1

95
Q

A 66 year old male has called 911 because of a nagging cough. He states he has had a sore throat with cough for 2 weeks and his incompetent doctor can’t prescribe the right medication to cure it. He does not complain of any shortness of breath and does not have a fever. The cough is not productive and he wants to go to the ER to see someone who knows what they are doing.

A

CTAS 5

96
Q

A 23 year old female patient has collapsed in a parking lot at the local Walmart. Witnesses state she experienced seizure like activity lasting ~ 2-3 minutes. On arrival you note that the patient appears conscious but lethargic, consistent with the symptoms of being post ictal. Her condition does not change by the time you are ready to transport

A

CTAS 2

97
Q

You arrive at a local restaurant where a man called 911 after his wife began experiencing difficulty speaking. He states that she was staring at her menu for a prolonged amount of time before she began to speak with inappropriate words. When he looked up from his
own menu he states she presented with facial droop. On the way to the restaurant he states the patient had been complaining of a headache. She has a history of a-fib and hypertension.

A

CTAS 2

98
Q

A 19 year old female patient calls 911 because of abdominal discomfort. She states she has been experiencing an abnormally “large” menstrual flow which is causing her discomfort. She states she is not sexually active and there is no chance of pregnancy. V/S are pulse of 88 R/F, Resp 12 R/F, BP 102/66.

A

CTAS 3

99
Q

You are called to a nursing facility for a patient who was struck in the nose during an altercation with another resident. The patient had marked all four corners of his Bingo card and thought he won, but another resident claimed it wasn’t a “real” Bingo rule and struck the patient in the nose with his cane during the ensuing argument. The nose is not deformed but is bleeding uncontrollably. There is no airway compromise and his vitals are unremarkable. The patient’s med list includes a blood thinner. The epistaxis has been ongoing for 20 minutes.

A

CTAS 2

100
Q

A 9 year old boy was playing in the yard with a BB gun. He was aiming at a target when the BB ricocheted off a solid object striking him in the eye. You exam the boys face and although you cannot see any trauma to the surround tissue the patient tells you he cannot see anything out of the eye. His vital signs are unremarkable but the patient is emotionally upset and states that he should have heeded everyone’s warnings about shooting his eye out!

A

CTAS 2

101
Q

A 18 year old male was at a friends party where he consumed some alcohol before jumping into the pool. After 10 minutes in the water his friends reminded him about the cast he had on his foot. The patient had broke his foot the previous weekend at another friends party. He has called 911 because his cast in now ruined and will require replacement.

A

CTAS 5

102
Q

A 36 year old male patient has taken an unknown amount of Gravol and Lyrica. His sister called 911 after she found him on the couch of his apartment. He has been drinking but is conscious with some mild confusion. Vital signs are unremarkable. He states he does not want to deal with the stress of life anymore. As you assist him to the stretcher his sister provides you with a note that he had left on the fridge stating his wish to end his life.

A

CTAS 2

103
Q

You respond to a run down farmhouse where you find an elderly couple. The wife states her husband was diagnosed with dementia 8 months ago and is becoming increasingly more difficult to manage. The patient presents with confusion to person place and time, which his wife states is normal. She wants him taken to hospital because she cannot care for him adequately at home. His vitals are unremarkable

A

CTAS 4

104
Q

A 23 year old male was fighting with police when he was pepper sprayed in the eyes. The patient immediately complied with the officers and is not violent anymore. The patient allows you to exam him. The officers state they flushed his eyes with water from a near
by puddle but he still complains of burning. You continue to flush the patient’s eyes with water and note that his vital signs are unremarkable. The patient states his vision is blurry but improving. You transport the patient to the hospital along with a police escort.

A

CTAS 2

105
Q

You are called to a local church for a female patient who experienced a sudden onset of a headache. The patient has a history of migraines but states that this is not of her typical pattern. She says she can barely keep her eyes open due to the pain, and when she does open them, her vision is blurred. Her pulse is 88, resps are 20 and BP is 160/44. She complains of nausea and vomits on your partner on the way to the stretcher.

A

CTAS 2

106
Q

You have responded to a homeless shelter for a patient who is complaining of blurred vision. While moving the patient to the stretcher, she collapses and experiences a seizure. The seizure activity continues en route to hospital and you spend the entire time maintaining the patients airway.

A

CTAS 1

107
Q

You respond to a local hospice for a patient who complains of feeling generally unwell. The patient states she feels she may have picked up “a bug” when she went for her chemo treatment yesterday. Today she woke with a temp of 39 degrees and is feeling generally weak. All of her other vitals are unremarkable

A

CTAS 2

108
Q

A 23 year old developmentally challenged female has called 911 because of pain when she urinates. She is unable to rate the discomfort. She states it started yesterday and today she also notes that her urine appears cloudy. She denies any fever or nausea. Vitals are unremarkable.

A

CTAS 4

109
Q

You are called to a local bar where one of the “regulars” has vomited on the floor. The bartender tells you that this patient is a daily visitor and came in today complaining of some abdominal pain. The emesis on the floor appears dark in colourand very “grainy”. The patient vomits 2 more times before you reach the back of the truck. Pulse 96 R/F, Resp 12 R/F, Temp 37.2, BP 102/88.

A

CTAS 3

110
Q

You are called to a residence for a wheelchair bound patient who states he has an open ulcer on his right foot. The VON that typically comes to his house to perform his dressing change called in sick today and no one can come to change the bandage. He wants to be taken to the ER for a dressing change to avoid developing an infection. Vitals are stable and he complains of 2/10 discomfort in the affected area.

A

CTAS 5

111
Q

A 63 year old grandfather developed sub-sternal chest discomfort while playing soccer with his grandson. He complains of some mild dyspnea but is not obviously short of breath. He has a previous history of a MI but states this pain is not quite as intense. His pulse is 110 R/F, Resp. 24 R/F, BP is 156/88. He has taken 2 sprays of nitro with some relief.

A

CTAS 2

112
Q

A 18 year old male patient has been pushed down a flight of stairs at a local high school. The patient struck his head on the concrete floor when he landed at the bottom. Bystanders state he was initially conscious before wetting his pants and “falling asleep”. You find the patient with a GCS of 5, dilated left pupil, BP 200/110, Pulse 50 I/W, Resp 4 L/S

A

CTAS 1

113
Q

You have been called to the locker room of a local YMCA. You find a 19 year oldfemale who is emotionally upset. Through your assessment you find that the patient is feeling a little anxious due to a recent breakup with her boyfriend. She is irritated because no one understands her point of view and just wants everyone to leave her alone. Vitals are unremarkable.

A

CTAS 4

114
Q

A 26 year old male has fallen on the ice after attempting to show his daughter how to perform a triple Sal chow. He states he couldn’t stick the landing and fell onto his outstretched arm. He has obvious deformity to his left radius and ulna. No neuro deficits are present but he states the pain is 8/10. Vitals are unremarkable.

A

CTAS 3

115
Q

You are called to the local high school for a patient with abdominal discomfort. You are led to the women’s washroom where you find a 16 year old female patient who is 6 months pregnant. She states that she came into the washroom with the urge to urinate but immediately noticed that she was bleeding bright red blood. She has had one miscarriage last year and this pregnancy has been unremarkable. She is not having any abdominal cramping. Pulse is 68 R/F, Resp 20 R/F, BP 98/60.

A

CTAS 2

116
Q

You are called to a residence for a patient complaining of flu like symptoms. You find a 32 male patient who states he has “the chills” and can’t seem to get warm. The patient’s wife presents you with a lengthy list of medications, which includes immunosuppressants. When questioned, the patient states he received a liver transplant 6 months ago at which time he began taking this regime of medication. His pulse is 88 R/F, Resp 16 R/F, BP 108/66, Temp 38.6

A

CTAS 2

117
Q

A 68 year old female patient was eating dinner with her husband when she began choking. Her husband states that his wife was able to clear her airway within seconds with forceful coughing but immediately complained about a sore throat. The patient does not appear to be in any severed distress but states that she still feels discomfort in her throat. Her vitals are unremarkable but she is convinced that something is still stuck in her throat.

A

CTAS 3

118
Q

You have responded to local machine shop where a worker was involved in an accident. A piece of sheet metal fell off of forklift while being transported from one area of the shop to another. The sharp edge of the metal sliced through the sleeve of worker driving the forklift amputating his hand proximal to the wrist. The bleeding at the site is controlled and the coworkers have wrapped the amputated hand in a bag. Pulse is 128 R/W, Resp 24 R/F, BP 96/50. The patient is conscious but emotionally upset.

A

CTAS 1

119
Q

You find yourself in the bedroom of a 55 year old female patient who says she can’t get out of bed due to back pain. She said that the cold temperatures lately has caused her “back issues” to flare up. She has been using Tylenol and the power of prayer to help get rid of the pain, but without success. She says the discomfort is 3/10 and is typical of previous episodes of discomfort. She has “flare ups” several times a year, especially in the winter. She can ambulate with assistance.

A

CTAS 5

OCHT Term II (31 decks)

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