Quiz 11, 12, 13 Flashcards
scene size-up
steps taken when approaching the scene
(checking scene safety, taking standard precautions, noting injury)
Nature of the call
Determining why EMS has been called
– Mechanism of injury
– Nature of illness
Mechanism of Injury
- Force(s) that may have caused injury
- Understanding forces can predict injury patterns.
- Can be very useful in predicting injuries associated with
certain types of motor vehicle crashes
Mechanism of Injury
* Motor-vehicle collisions
– Head-on collisions
▪ Up-and-over injury pattern
▪ Down-and-under injury pattern
clues of this can be windshield damage
– Rear-end collisions
– Side-impact collisions (broadside or “T-bone”)
– Rollover collisions
– Rotational impact collisions
▪ Cars are struck then spin.
▪ Initial impact often causes subsequent impacts.
Mechanism of Injury
Falls
– Adult
▪ More than twenty feet
– Child under fifteen years
▪ More than ten feet (two to three times child’s height)
What are the steps of scene size-up?
- Check scene safety
- Taking standard precautions (BSI)
- Note mechanism of injury or nature of illness
- Determine number of patients
- Decide what additional resources are needed
What should you do when approaching the scene?
- Look and listen for other emergency vehicles
- Look for signs of collision-related power outages
- Look for traffic flow
- Look for smoke in the direction of the collision
What should you do when within the sight of the scene?
- Look for things that signify HAZMAT
- Look for collision victims on/near road
- Look for smoke
- Look for broken utility poles and downed wires
- Look for people walking around scene
- Look for signals of police and other EMS providers
What should you do as you reach the scene?
- Wear appropriate PPE
- Follow instructions of incident commander
How should you establish the danger zone?
Evaluate hazard and restrict it based on on threat level (different levels of danger require bigger danger zones)
What should you do when there are downed power lines?
Establish the danger zone beyond each intact pole for a full span and to the sides for the distance that the severed wires could reach. Stay out of danger zone until utility company has deactivated the wires or rescuers have moved and anchored them.
What should you do when a vehicle is on fire (no other hazards involved)?
Park ambulance at least 100 feet away and park upwind
What should you do when there is hazardous material threatened by a fire?
The size of danger zone is determined by the type of material. Use binoculars to read the placard on the truck and refer to Emergency Response Guidebook. Park upwind.
What should you do when there is spilled fuel?
Park upwind from direction of spill. If not possible, park as far away from possible, avoiding anything that may carry the spill to the parking site.
How hot is the ambulances catalytic converter?
1,000 F
What should you do when there is HAZMAT?
Park upwind. If the type of material is known, seek advice through CHEMTREC through the incident commander
What should you look for when evaluating for threat of violence?
- Fighting/Loud voices
- Weapons
- Signs of alcohol/drug use
- Unusual silence
- Knowledge of prior violence
What is the nature of the call?
Why EMS has been called
1. Mechanism of injury
2. Nature of illness
What is the mechanism of injury?
The forces that caused the injury (can predict possible injuries)
What injuries often occur in a head-on collision?
Up and Over injury pattern
Down and Under injury pattern
What are the types of motor vehicle collisions?
Head-on
Rear-end
Rollover
Rotational
What 5 things should you look for in any motor vehicle accident?
- Ejection
- Deformaties in the vehicle
- Amount of vehicle deformities
- Seatbelt use
- Airbag deployment
What is considered a severe fall?
Adults: More than 20 feet
Children under 15: More than 10 feet or 2-3X child’s hight
What are 4 important factors to consider regarding falls?
- Hight which the patient fell from
- Surface patient fell onto
- Part of patient that hit the ground
- Anything that interrupted fall
What is important to consider when there are low velocity injuries?
- Damage limited to area penetrated
- May be multiple wounds
What are medium-velocity injuries?
Handgun/Shotgun
arrow or ballistic knife
What are high-velocity injuries?
Rifle
What are some possible damages from velocity injuries?
Damage from bullet itself and damage from cavitation
What is blunt-force trauma?
An injury caused by a blow that strikes body but does no penetrate. Signs are often hard to pick up on
What should you consider when evaluating the number of patients?
How many patients are there?
Are there enough resources to care for all the patients?
What special resources may you need to contact? (6)
- Fire
- Technical Rescue
- HAZMAT response
- Highway dept (DPW)
- Light Department
- Police
according to the book, what is the primary assessment?
the first element in the patient assessment; steps taken for the purpose of discovering or dealing with any life-threatening problems. the six parts are:
- forming general impression
- assessing mental status
- assessing airway
- assessing breathing
- assessing circulation
- determining priority for treatment and transport
what are some general considerations to take into account when deciding the sequence of your primary assessment?
vomit that may choke the patient
life-threatening bleeding
breathing
evaluate for shock
if the person has an altered mental status, what are possible causes you should be aware of during the primary assessment?
hypoxia, diabetes, overdose, seizure, vomitus blocking airway
what is a general impression?
impression of the patient’s condition formed on first approaching the patient, based on the patient’s environment, chief complaint, and appearance
during the primary assessment, a patient appears anxious, pale, and sweaty. these indicate what?
shock, rapid pulse and respirations
what is Levine’s sign?
the classic sign of chest pain, a fist clenched over chest
what is the chief complaint?
the reason EMS was called, usually in the patient’s own words
what is clinical judgement?
judgement based in experience in observing and treating patients
what is a patient’s mental status?
level of responsiveness
what does AVPU and when should you do it?
primary assessment
alert, verbal response, painful response, unresponsive
what are solutions to a compromised airway?
suction, adjunct, jaw-thrust, head-tilt chin-lift, oro or nasopharyngeal airway
if the patient is in respiratory arrest with a pulse, you should…
perform rescue breathing
if the patient is not alert and their breathing is inadequate, you should…
provide positive pressure ventilations with 100% O2
if the patient has some level of alertness and inadequate breathing, you should…
assist with ventilations with 100% O2, synchronize ventilations with patient’s own respirations so they are working together
if the patient’s breathing is adequate but there are signs and symptoms suggesting respiratory distress or hypoxia, you should…
provide O2 based on need, the patient’s complaint and level of stress, and pulse oximetry readings
what are high priority conditions?
poor general impression
unresponsive
responsive, but not following commands
difficulty breathing
shock
complicated childbirth
chest pain consistent witih cardiac problems
uncontrolled bleeding
severe pain anywhere
how long should capillary refill take on a child?
less than 2 seconds, keep in mind environment - if it is cold, may take longer
what pulse is considered tachycardic?
above 100 beats per min
what pulse is considered bradychardic?
less than 60 beats per min
what is the normal pulse for an adult?
60-100 bpm
in an emergency, it is not uncommon for an adult’s pulse to be between…..
100-140 bpm
in an emergency, if the pulse stays above ____ or below ____ consider immediate transport
120, 50
on an infant or child, is a high or low pulse worse? what can it mean?
low pulse, cardiac arrest imminent
if the pulse rate, rhythm, or force is not normal, you should…
take the pulse for a whole minute
what special considerations are there for someone with a ventricular assist device?
can’t fell pulse or BP because it is pumping blood constantly
if the respirations are above _____ or below ____ for an adult, it is serious
24, 10
what does a patient with snoring respirations need?
airway opened
gurgling respirations mean…
patient needs suction
wheezing during breath means the patient may need…
help with medication (asthma)
where are the best places to evaluate skin on adults?
insides of cheeks, nail beds, and the inside of the lower eyelids
where are the best places to evaluate skin on children and infants?
palms of hands and soles of feet
where is the best place to evaluate skin on someone with dark skin?
lips and nail beds