Pocket Prep 0 Flashcards
mnemonics
- OPQRST
- SOAP
- DCAP-BTLS
OPQRST: Onset > Provocation > Quality > Radiation / Region > Severity > Timing
SOAP: Subjective > Objective > Assessment > Patient care
Subjective: only be identified by the person giving that statement → ie chief complaint and past medical history
Objective: finding that can be seen, heard, felt, smelled, or measured
DCAP-BTLS: Deformities Contusions Abrasions Punctures Burns Tenderness Lacerations Swelling
define the following:
- symptom
- sign
- tachycardia
- bradycardia
Symptom: subjective finding that the patient feels and that can be identified only by the patient
Sign: objective finding that can be seen, heard, felt, smelled, or measured
Tachycardia: abnormally high heart rate
Bradycardia: abnormally low heart rate
what is in the upper airway vs lower
Upper airway: vocal cords, nose, mouth, jaw, oral cavity, pharynx (incl naso, oro, and laryngo)
Lower: trachea, and more
RESUSCITATION / CPR STANDARDS
for a one person CPR on adults
Compressions: rate of 100 to 120 per minute
Sternum should be depressed 2 to 2.5 inches (5 - 6 cm)
After 30 chest compressions (approx 17 s), two ventilations of 1 sec each are given
Repeat until AED is available, and the rhythm is being analyzed
what is gastric distension and how do you address it
condition in which air is forced into the stomach secondary to artificial ventilations.
Prevent this by ensuring the airway is appropriately positioned and ventilate at an appropriate rate and volume.
Alleviate by repositioning head and watching for rise / fall of chest wall with ventilations.
3 methods of providing oxygen to a patient
- what are they
- rate
- percentage
Bag valve mask: should be used on a patient in severe respiratory distress / failure
- 15 liters / minute
- 100% oxygen
Nonrebreather: should be used on a patient with adequate breathing but has suspected / obvious signs of hypoxia (ie <94%)
- 10 to 15 liters / minute
- 95% oxygen
Nasal Cannula: used in patients that are intolerant of a mask
- 1 to 6 liters / minute
- 24% to 44% oxygen
what is the appropriate tidal volume of an adult
should be enough to cause a noticeable rise of the patient’s chest over one second
Adult: about 600 mL
treatment of bleeding
- Direct pressure
- Pressure dressing
- Tourniquet: placed in groin for lower extremities; armpit (aka axillary) for upper
Open pneumothorax
aka “sucking chest wound” requires emergent care and transport
After ensuring a patent airway and oxygenation, SEAL WOULD W OCCLUSIVE DRESSING to prevent air from being sucked into it; three sides to simulate flutter valve, thus allowing air to escape but not re-enter the chest cavity.
Pneumothorax
- spontaneous
- tension
partial or complete accumulation of air in the pleural space
Spontaneous: no identifiable cause but is associated w certain conditions (ie patients w ephysema / asthma or that are tall / thin men) → symptoms: dyspnea, pleuritic chest pain, absent / decreased breath sounds on the affected side are common ⇒ can progress into a life threatening condition
Tension: more likely caused by blunt trauma to the best; can also be spontaneous but very rare → symptoms: chest pain, respiratory distress, decreased lung sounds, tachycardia, signs of shock
More on Occlusive Dressing (6)
Serves to prevent air and liquids from entering / exiting a wound
Used in chest wounds to prevent tension pneumothorax from developing
Used in abdominal eviscerations to prevent mesenteric necrosis and hypothermia
Used in penetrating back wounds to prevent peritonitis
Used in neck injuries to prevent mediastinitis
Can be used together w sterile gauze that is moistened with sterile saline solution in situations with an open abdomen → open abdomen can lose body heat and fluid rapidly, thus must keep the organs warm and moist
coronary arteries
Coronary arteries provide oxygenated blood from the heart to the rest of the body, and are branches from the aorta.
Carotid goes to the head, located in neck
Cerebral goes to the brain, located in skull
Femoral goes to lower extremities, located in thigh
Oral glucose
medication for diabetic emergencies; contraindication is the inability to swallow and/or unconsciousness (due to aspiration)
Conscious patient who does not really need glucose will not be harmed by it
signs of a mild / partial airway obstruction
- how to treat
Wheezing, stridor, and coughing
Monitor for adequate oxygenation and progression of obstruction; patient may present w ineffective cough / stridor / increased difficulty breathing / cyanosis.
If obstruction is visible, do a (gloved) index finger sweep. Suction may be used to assist w this procedure as well as to maintain a clear airway.
If not visible and are exchange is adequate, administer oxygen and rapidly transport.
lung sounds to know (4)
Stridor: brassy, crowing sound that is most prominent on inspiration;; most often heard before auscultating and is likely indicative of an airway obstruction
Rhonchi: low pitched sound that is prominent on expiration; indicative of mucus in the lungs and is often accompanied by a productive cough
Wheezing: high pitched whistling sound, louder on expiration; obstruction or narrowing of the lower airway will commonly cause wheezing
Crackles: wet, crackling breath sounds heard on inspiration and expiration that may be the result of fluid within the lungs
ventilation rates for adults vs children
Ventilations should be given to adult patients every 5-6 seconds; child patients every 3 seconds.
Provide ventilations just enough to see chest rise and fall + avoid gastric distension (result of rapid ventilation; may lead to vomitus and subsequent aspirate)
how to transport heavy patients
Any patient who weighs >250 lbs should be lifted w no fewer than four providers.
Stair chair can be used BUT still needs additional personnel.
Alternatively, can use a backboard BUT never a stretcher.
Gastroenteritis
typically involve infection combined w gastrointestinal complaints
Common signs: abdominal pain, nausea, vomiting, diarrhea, anorexia, fever
Dehydration can occur if diarrhea or vomiting persists. Shock is also possible.
Gastrointestinal hemorrhage
Melenda (dark, tarry stools) commonly occur due to a bleed in the upper gastrointestinal tract
Common pneumonia symptoms
dyspnea, wheezing, coughing, fever, cyanosis, dry skin, chest pain, musculoskeletal pain, tachycardia, hypotension
normal glucose levels
+ hypoglycemia
+ hyperglycemia
Normal blood glucose level is btwn 80 and 120 mg / dL
Hypoglycemia: aka low blood glucose levels
- Rapid onset: pale / cool / clammy skin, shallow breathing, hypotension, rapid / weak pulse, altered mental state, diaphoresis (moist skin or sweating, esp to an unusual degree)
- Treatment: oral glucose (remember contraindications)
Hyperglycemia: aka high blood glucose levels:
– Gradual onset: intense thirst / hunger, increased urination (aka polyuria), abdominal pain, vomiting, rapid / weak/ thready pulse; restlessness w progression to coma, slurred speech, unsteady gait
Diabetic ketoacidosis symptoms
- symptoms
ketoacidosis and hyperglycemia; can present in less than 24 hours
Signals: sweet / fruity breath due to exhaled acetone, deep / Kussmaul respirations; incl symptoms of hyperglycemia
– Kussmaul respirations / hyperventilation occurs as an attempt by the body to reduce the acidity by releasing more carbon dioxide (which is an acid, thus heavy breathing will decrease carbon dioxide levels within the body)
Can progress to coma and death
Hyperosmolar hyperglycemic state
severe hyperglycemia; evolves over several days to weeks
Found in patients with type 2 diabetes mellitus when hyperglycemia is uncontrolled
Type 1 Diabetes Mellitus
autoimmune disorder where antibodies are created against pancreatic beta cells ;; Insulin subsequently inadequate / absent
Common signs and symptoms for NEW ONSET: polyuria (increased urination), polydipsia (increased fluid intake due to thirst); polyphagia (increased food intake due to hunger); fatigue; weight loss
Injectable insulin or other means of external insulin use is REQUIRED for survival in patients who have autoimmune diabetes mellitus
Acute coronary syndrome (ACS)
caused by myocardial ischemia; hallmark symptom is chest pain that it described as pressure or heaviness (but not all patients have chest pain during ACS or an AMI).
ANY PATIENT COMPLAINING OF NON TRAUMATIC CHEST PAIN SHOULD BE ASSUMED TO HAVE AN AMI UNTIL IT IS RULED OUT BY A PHYSICIAN.
signs and symptoms of ACS / AMI
weakness, dyspnea, nausea / vomiting, lower jaw / arm / back / abdominal / neck pain, sweating without an obvious cause, pink frothy sputum (indicating possible pulmonary edema), irregular cardiac rhythm, syncope, sudden death
define the following:
- stable angina pectoris
- unstable
- acute myocardial infarction
Stable angina pectoris: cardiac chest pain alleviated by rest
Unstable angina pectoris: cardiac chest pain NOT alleviated by rest
Acute myocardial infarction; aka AMI; death of myocardial tissue
Prehospital care of electrical injuries
- steps
- other concerns
- Remove the patient from the contact with the source, using rubber or wood; do not touch patient directly
- Assess need for CPR, as ventricular defibrillation is the most common arrhythmia
- Transport
Electrical currents can cross the chest and cause cardiac arrest or dysthymia; however, cardiac arrest is unlikely to develop if not seen on initial assessment.
- Check for entrance and exit wounds when dealing with electrical burns.
- Internal bleeding can occur, either immediately or delayed; however, thrombosis is more common and can result in organ damage.
- Cardiac arrhythmia is a greater concern in the pre-hospital setting but Respiratory arrest is also possible.
PRIMARY ASSESSMENT
after scene size up
- General impression of patient
- Assess LOC
- Assess airway / breathing / circulation / any life threats via
Every patient needs to be assessed and examined prior to any treatment.
Nitroglycerin
+ common side effects
Nitroglycerin should be given to a patient that is having chest pain, especially one w a history of angina. This medication dilates the coronary arteries and improves blood flow thru them, in the efforts of decreasing pain.
Common side effects of taking nitroglycerin:
- Hypotension
- Headache
- Changes in heart rate (tachycardia or bradycardia)
contraindications to nitroglycerin (7)
Systolic blood pressure of less than 100 mmHg
Heart rate less than 60
Have not been prescribe this medication (6 rights)
Are pediatric (under 13 years of age)
Have taken medication for pulmonary artery hypertension within the previous 48 hours (ie Adcirca, Revatio)
Have taken medications for erectile dysfunction within the previous 48 hours (ie Viagra / sildenafil, Levitra / vardenafil, Cialis / tadalafil)
Have already taken their maximum doses (typically 3)
Four person log roll
effective method for moving a patient from the ground to the long backboard; Rescuer at head should direct all movements
- Maintain inline stabilization and assess neurovascular status of extremities
- Apply a cervical collar
- Logroll patient onto backboard
- Secure patient with belts / etc
- Reassess neurovascular status of extremities
Epinephrine symptoms (when delivered via metered-dose inhaler)
+ alternatives
Tachycardia: abnormally rapid heart rate
Hypertension
Restlessness
Albuterol and metaproteronol are alternatives to epinephrine inhalers w fewer side effects, and thus are more commonly used.
Albuterol
beta-agonist medication that dilates bronchioles; often used in setting of dyspnea ;; commonly found with patients who have asthma, bronchitis, and chronic obstructive pulmonary disease
Side effects: tachycardia, nervousness, muscle tremors, slight coughing after inhalation
Obstructive shock
+ causes
mechanical obstruction of cardiac muscle, yielding a decrease in cardiac output
Common causes: tension pneumothorax, cardiac tamponade, pulmonary embolism → beck’s triad, seen in cardiac tamponade: jugular vein distension + narrowing pulse pressures + muffled heart sounds
Chronic obstructive pulmonary disease
+ symptoms
haracterized by persistent, progressive airflow limitation, which arises from structural lung changes due to chronic inflammation as a result of inhaling noxious particles or gases
Categorized based on the degree of irreversible airway obstruction (emphysema) and the presence of significant inflammation (chronic bronchitis), with or without reversible airway disease (asthma)
Symptoms: dyspnea, poor exercise tolerance, chronic cough with/out sputum production, wheezing, respiratory failure or cor pulmonale
STROKES
+ common signs / symptoms
cerebral vascular accident (CVA) or stroke, should be considered in any patient presenting w acute neurologic deficit or altered mental status
Common signs / symptoms: sudden onset loss of motor or sensory control in the body, affecting primarily one side ;; loss of vision / double vision / deficits of the visual field / nystagmus ;; difficulty swallowing or speaking ;; facial droop ;; sudden difficulty walking or standing ;; sudden alteration of mental status, or decrease in level of consciousness
ischemic strokes
- definition only
ESTABLISH A TIMELINE !!! characterized by the sudden loss of blood circulation to an area of the brain, resulting in the corresponding loss of neurologic function ;; treatment within 3 hours of onset in a hospital setting is effective (but there are some treatments that are effective within 6)
hemorrhagic stroke
bleeding occurs directly into the brain tissue; one common mechanism is thought to be from damage due to chronic hypertension
More common symptoms of Hem vs Isch: severe headache, altered mental status, seizures, nausea and vomiting, and / or marked hypertension
ischemic strokes
- acute
- transient
Acute: caused by thrombotic or embolic occlusion of a cerebral artery ;; super common (approximately 85% of CVA patients)
Transient: brief episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction ;; often labeled as “mini stokes” due to relatively benign immediate consequences BUT can also indicate the likelihood of a coming stroke → approx 33% of people who have a transient ischemic stroke have a more severe stroke within the following year
migraine
+ symptoms
complex disorder characterized by recurrent episodes of headache, most often unilateral and in some cases associated w visual or sensory symptoms, aka an AURA
Symptoms: throbbing / pulsating headache that intensifies w movement or physical acticity, nausea (80% of patients) and vomiting (50%), incl anorexia and food intolerance, lightheadedness, and sensitivity to light and sound (aka photophobia)
Ventricular tachycardia
rapid heart rhythm, usually btwn 150 to 200 bpm ;; electrical activity begins in the ventricle instead of the atrium, thus there is not sufficient time for the ventricle to fill w blood, leading to a subsequent drop in blood pressure
Patients may complain of weakness or lightheadedness, or may be unresponsive
Some cases may deteriorate into ventricular fibrillatio
SWIMMING POOL SITUATIONS
Patients in diving accidents will likely have head and / or spinal injuries. These patients should be immobilized WHILE IN THE WATER prior to removal.
DROWNING PATIENTS
Inhaling small amounts of water irritates the larynx and can initiate a muscular spasm (laryngospasm) as a mechanism to prevent further entry of fluid; laryngospasm can prevent assisted ventilation
When drowning person loses consciousness, the spasm relaxes, allowing further entry of water into the lungs → after rescue, this can also obstruct assisted ventilation due to water
PROFESSIONS OF EMERGENCY HEALTHCARE:
EMR aka emergency medical responder: first trained professionals (ie police, firefighters, lifeguards) to arrive at the incident to provide initial medical assistance
EMT aka emergency medical technician: training in BLS (ie AED), use of definitive airway adjuncts, and the assistance of patients w certain meds
AEMT aka advanced EMT: training in specific aspects of ALS (ie intravenous therapy and administration of certain emergency meds)
Paramedic: extensive training in ALS (ie endotracheal intubation, emergency pharmacology, and cardiac monitoring)
PREGNANCY SITUATIONS
- when should you deliver at scene
- multigravida vs primigravida
- patient without urge to push
Delivery at the scene should be considered when delivery is imminent (ie crowning is present) or if transport is delayed by external factors (ie natural disaster, inclement weather)
Multigravida (previous pregnancy / ies) patients are more likely to have a short labor than those who are primigravida (first pregnancy)
A patient without an urge to push or who had a recent water breaking or bloody show is unlikely to have an imminent delivery; they are more likely in the first stage of labor (before full dilation of the cervix)
PREGNANCY SITUATIONS
- limb presentation
- prolapsed cord
- meconium
Limb presentation cannot be delivered in the field and requires surgical intervention ;; prolapsed cord (umbilical cord is the first presenting part) also requires hospital intervention
Meconium is the amniotic fluid that may lead to aspiration by the baby during delivery ;; indicated by the amniotic fluid being greenish ;; receiving hospital should be informed of the presence of meconium in the amniotic fluid
STAGES OF LABOR
First: uterine contractions and dilation of cervix; ends when cervix is fully dilated
Second: delivery of baby
Third: delivery of placenta
TYPES OF PREGNANCIES, or issues w pregnancies
- ectopic
- placenta previa
pregnancies usually last about forty weeks or nine months (normal gestation period)
Ectopic: pregnancy that occurs outside the uterus (most commonly in the fallopian tubes); medical emergency and should be evacuated in a hospital setting
- Risk factors: history of pelvic inflammatory disease, tubal ligation, previous ectopic pregnancy
- Symptoms: internal bleeding, sudden / severe unilateral lower abdominal pain
Placenta previa: development of the placenta over the cervical → heavy vaginal bleeding is common BUT abdominal pain is rare
TYPES OF PREGNANCIES, or issues w pregnancies
- preeclampsia
- nuchal cord
Preeclampsia: possible complication during pregnancy, typically found in primigravida patients; can develop after the twentieth week of gestation and is characterized by severe hypertension, headaches, visual abnormalities, edema, and anxiety → can progress into eclampsia, which is defined by the onset of seizures due to hypertension
Nuchal cord: umbilical cord wrapped around a baby’s neck on delivery; typically can be gently slipped over the baby’s head BUT if the cord is wrapped too tightly, the baby could be strangled, thus cord should be clamped in two places about two inches apart and cut btwn the clamps → delivery must be expedited as the baby will be no longer be receiving oxygen from the delivering mother
TYPES OF PREGNANCIES, or issues w pregnancies
- prolapse of umbilical cord
Prolapse of the umbilical cord: when the umbilical cord presents out of the vagina PRIOR to the fetus, thus creating a medical emergency bc the fetus’ head may compress the cord during birth and stop oxygen flow btwn the mother and fetus ;; commonly occurs early in labor after the amniotic sac ruptures
Patient should be in either a supine position w the foot of the cot raised 6-12 inches (15-30cm) higher than the head and the hips elevated on a pillow or folded sheet OR in the knee-chest position (kneeling and bent forward, face down) → these positions help keep weight of the fetus off the prolapsed cord
A sterile-gloved hand should be used to gently push the fetus’ head away from the umbilical cord; this position should be maintained until arrival at the hospital
Cord should be wrapped in a sterile towel that has been moistened w saline
High flow oxygen and rapid transport are appropriate
TYPES OF PREGNANCIES, or issues w pregnancies
- sudden infant death syndrome
Sudden infant death syndrome: death of an infant or young child that remains unexplained after the autopsy
Maternal factors: young maternal age (<20 years) ** , maternal smoking during pregnancy **, late or no prenatal care
Infant / environmental factors: preterm birth and / or low birth weight, prone sleeping position (lying flat on stomach), sleeping on a soft surface and / or with bedding accessories such as loose blankets and pillows ; bed sharing (sleeping in parent’s bed) ; overheating
HALLUCINOGENS (2)
Classic: typically produce visual and auditory hallucinations; may result in an altered sense of time and heightened sensory experiences ;; ie LSD, shrooms, peyote, DMT
Dissociative: produce feelings of detachment, such as derealization (where one is detached from reality or that things are not real) or depersonalization (the feeling that one is detached from one’s own physical body) ;; ie PCP, ketamine
SIX RIGHTS FOR ADMINISTRATION OF MEDICATION
Right client Right route Right drug Right dose Right time Right documentation
** Medical direction must be obtained for any intervention that is not allowed under standing local protocols.
