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Skills 2 Flashcards

1
Q

Knowledge of all meds

A
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2
Q

Fluid adminatration

A

lifepack 15 trouble shoots

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3
Q

SCOOP STRETCHER

A
  1. Don PPE (gloves, safety goggles, and, if required, mask).
  2. Inform the patient of the procedure.
  3. Delegate a partner to manually stabilize the patient’s head in a neutral position until spinal motion
    restriction is complete.
    NOTE: hold the patient’s head and neck from behind.
  4. Apply an appropriately sized rigid cervical collar.
  5. Assess pulses, movement and sensation in all 4 extremities.
  6. Place the scoop stretcher next to the patient and adjust the length of the stretcher so that it is
    suitable for the height of the patient.
  7. Align the patient’s jugular with small lateral holes on the stretcher.
  8. Arrange yourself and your partner at the foot and head of the stretcher. Open the stretcher by
    pressing the buttons on the TSL system, longitudinally separating the two sides of the stretcher.
  9. Position the 2 longitudinal parts under the patient, starting with the head end.
  10. Close the head end via the TSL.
  11. As your partner maintains manual stabilization, proceed to complete locking the foot end using the
    TSL.
  12. Strap your patient to the scoop stretcher using the following:
    * 2 chest restraints from above shoulders to hips in a criss-cross configuration
    * 1 strap horizontally across the upper legs
    * 1 strap in a figure-eight configuration around the feet
  13. Fill all hollow spaces with padding or blankets.
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4
Q

KED

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. Delegate a partner to manually stabilize the patient’s head in a neutral position until spinal motion
    restriction is complete.
    NOTE: Hold the patient’s head and neck from behind.
  4. Apply an appropriately sized rigid cervical collar.
  5. Assess pulses, movement and sensation in all 4 extremities.
  6. Slip the Kendrick Extraction Device (KED) behind the patient and center it.
  7. Properly align the device, then wrap the vest around the patient’s torso.
  8. When the device is tucked well up into the armpits, secure the chest straps in this order:
    middle, bottom, legs, head, top.
  9. Bring each leg strap around the ipsilateral (same side) leg and back to the buckle on the same
    side. Fasten snugly.
  10. Secure the patient’s head with the Velcro head straps or tape. Apply padding as needed to
    maintain a neutral position.
  11. Tie the hands together or secure arms and hands to side of patient with straps if altered LOC.
  12. Turn the patient and KED as a unit, then lower the patient onto a stretcher or long spine board.
  13. Loosen the leg straps and allow the legs to extend out flat.
  14. Finally, secure the patient and KED to the LSB or stretcher.
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5
Q

Spinal Motion Restriction- Long spine board

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. Delegate a partner to manually stabilize the patient’s head in a neutral position until spinal motion
    restriction is complete.
    NOTE: Hold the patient’s head and neck from behind.
  4. Apply the appropriately sized rigid cervical collar.
  5. Assess pulses, movement, and sensation in all four extremities.
  6. Place the patient’s arms straight down their sides (if possible).
  7. Position rescuers:
    * One rescuer should be on the patient’s uninjured side at the level of the patient’s chest.
    * One rescuer should be on the patient’s uninjured side at the level of the patient’s lower legs near the
    patient’s knees.
  8. At the signal of the rescuer at the patient’s head, the other two rescuers in position should reach to
    the far side of the patient.
    * One rescuer should position their hands on the patient’s far shoulder and hip.
    * One rescuer should position their hands on the patient’s far thigh and lower leg below the patient’s
    knee.
  9. On the rescuer at the head’s count “one, two, three”, all rescuers should roll the patient onto the
    uninjured side.
    NOTE: This is a good time to assess the patient’s back if it has not already been done.
  10. A fourth rescuer should push the board under the patient’s back.
    NOTE: If no fourth rescuer is available, one of the rescuers at the side may lean over the patient, grab
    the backboard, and pull it under the patient.
  11. On the rescuer at the patient’s head’s signal, “one, two, three”, all rescuers should roll the patient
    back down onto the long spine board.
    * NOTE: If the patient is not is not in the middle of the spine board, gently pull the patient down and
    up again until he/she is straight on the board. Always use the signal from the rescuer at the head
    “one, two, three.”
    * This is done at the patient’s shoulders and hips and by pulling in alignment with the long axis of the
    patient’s spine.
    NEVER PUSH A PATIENT OVER TO THE MIDDLE OF THE BACKBOARD.
  12. Reassess pulses, motor and sensation in all 4 extremities.
  13. Pad the spaces between the patient and the spine board:
    * Adults: anywhere along the length of the body to maintain neutral alignment and provide comfort.
    * Children/Infants: pad under the shoulders, avoiding any extra unnecessary movement.
  14. Secure the patient to the long spineboard in the following fashion:
    * First: immobilize the torso ensuring the straps go over top the patient’s shoulders in a “crisscross”
    fashion over top the shoulders to hip at same level on each side. Secure to the backboard. DO
    NOT TIGHTEN.
    * Second: immobilize the patient’s legs in a “crisscross” fashion from just above the patient’s hips to
    the patient’s knees at same level on each side. TIGHTEN BY FEEDING THE STRAPS< DO NOT
    PULL.
    * Third: secure the patient’s feet with a triangular bandage in a “figure eight” pattern.
    * Fourth: TIGHTEN BY FEEDING THE STRAPS< DO NOT PULL.
    * the chest straps. Tighten one strap at a time encouraging the patient to take a deep breath. When
    the deep breath is taken, tighten the strap. Ensure the patient can breathe appropriately post
    tightening each strap.
  15. Place the head roll under the patient’s head:
    * Have one rescuer hold the patient’s head from the front and gently lift encouraging the patient to
    “not help” if conscious.
    * Have another rescuer place the head roll under the patient’s head and lower the patient’s head
    when the head roll is in place.
  16. Secure the patient’s head with 2 pieces of cloth tape:
    * 2 pieces of tape in a star pattern over the patient’s forehead attached to the backboard
  17. Reassess LOC, ABCs and vitals.
  18. Document procedure and any notable changes.
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6
Q

Stair Chair: Descent

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. Prepare for move:
    * Secure patient to equipment with straps.
    * Feet on the foot rest.
    * Have patient cross arms across chest to prevent loss of balance due to shifting weight.
    * Move patient to the top of the stairs by pushing the patient as if in a wheelchair.
  4. Extend top handle(s) as long as possible and locked into position. Keep bottom handles short
    and locked into position.
  5. Track engaged and locked into position.
  6. Position rescuers:
    * First rescuer should be at the top position, pulling chair back until in the dolly position.
    * Second rescuer should be facing patient one stair down ready to take bottom handles grasping in a
    power grip.
  7. Rescuers communicate with one another and using proper ergonomics, enter stairwell, descend
    slowly, placing weight of the patient on the track, the track hitting the lip of each stair in a smooth
    motion.
  8. Third rescuer if possible, will be positioned lowest on the stairs, securing one hand on second
    rescuer’s belt/back to steady descent and verbally communicating to team the position on the stairs.
    * Providing pertinent information such as remaining number of stairs.
  9. Special attention should be given to stairs that are exposed to adverse weather conditions or debris
    blocking stairs.
  10. Transfer patient to waiting stretcher. Reassess LOC and ABCs after move.
  11. Document procedure and any notable changes.
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7
Q

Stair Chair: Ascent

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. Prepare for move:
    * Secure patient to equipment with straps.
    * Feet on the footrest.
    * Have patient cross arms across chest to prevent loss of balance due to shifting weight.
  4. Keep top handle(s) short and locked into position. Make bottom handles long and lock into
    position.
  5. Track NOT engaged.
  6. Position rescuers:
    * First rescuer should be at the top position, second rescuer should be at the bottom position grasping
    handles in a power grip.
  7. Rescuers communicate with one another and using proper ergonomics, and lifting at the same time
    on first rescuer’s count enter stairwell, ascend slowly one step at a time.
  8. Third rescuer, if possible, will be positioned lowest on the stairs, securing one hand on second
    rescuer’s belt/back to steady descent and verbally communicating to team the position on the
    stairs.
    * Provide pertinent information such as remaining number of stairs.
  9. Special attention should be given to stairs that are exposed to adverse weather conditions or debris
    blocking stairs.
  10. Transfer patient to waiting stretcher, Reassess LOC and ABCs after move.
  11. Document procedure and any notable changes.
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8
Q

Control External Hemorrhage: CAT tourniquet (one person method)

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Identify indications and contraindications.
  3. Inform the patient of the procedure.
  4. Remove all clothing from the affected area as soon as possible.
  5. Delegate a partner to apply direct pressure to control deadly bleeding as soon as it is found and to
    maintain direct pressure until the tourniquet effectively stops the bleeding.
  6. Prepare the tourniquet:
    * Route the free running end of the band through both slots of the friction buckle.
  7. While maintaining direct pressure as best as possible, slide the affected extremity into the
    tourniquet through the loop that was created with the previous step:
    * Avoid excessive or rough movement.
    * Ensure the windlass rod, clip and strap are easily visible and accessible once placed on the patient.
    * Position the tourniquet so that the word “time” on the windlass strap can be easily read.
    NOTE: The tourniquet must be at least 5 cm proximal to the wound. Do not place over joints.
  8. Hold the friction buckle “up” while pulling the tail of the strap tight against the patient’s skin and
    fasten it back on itself.
    * Do not attach the self-adhering band past the windlass clip.
    NOTE: The device should be snug enough so there is no bunching of the device or skin when the
    rod is twisted.
  9. Twist the windlass rod until the bleeding has stopped.
    WARNING: Do not over-tighten!
  10. Lock the windlass rod in place with the windlass clip.
    TIP: Maintain tension on the rod so the band does not loosen when placing the rod in the clip.
  11. Reassess the affected site to ensure bleeding is still controlled.
  12. Place the self-adhering band over the rod prior to moving the patient.
  13. Secure the windlass rod with the windlass strap prior to moving the patient.
  14. If bleeding remains uncontrolled post application of the first tourniquet, consider applying a second
    tourniquet.
    WARNING: LEAVE THE FIRST TOURNIQUET IN PLACE. NEVER REMOVE A TOURNIQUET IN
    A PREHOSPITAL SETTING.
    Apply the second tourniquet following the same steps 5-12. Place it 5 cm proximal to the first
    tourniquet.
  15. Leave the tourniquet uncovered.
  16. Reassess pulse, movement and sensation distal to the injury site.
  17. Compare and document time and location of tourniquet.
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9
Q

Control External Hemorrhage: CAT tourniquet (2 person method)

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. Remove all clothing from the affected area as soon as possible.
  4. Delegate a partner to apply direct pressure to control deadly bleeding as soon as it is found and to
    maintain direct pressure until the tourniquet effectively stops the bleeding.
  5. Prepare the tourniquet:
    * Route the free running end of the band through both slots of the friction buckle.
  6. While one rescuer maintains direct pressure as best as possible, the other rescuer places the
    tourniquet 5 cm proximal to the site of injury.
    NOTE: Avoid placing tourniquet over any joint.
  7. Pull the free end of the self-adhering band out of both slots of the friction buckle, ensuring the free
    end is loose.
  8. Place the free end of the self-adhering band through the inside slot of the buckle.
  9. Place the free end of the self-adhering band through the outside slot of the buckle
  10. Hold the buckle and self-adhering band while pulling the free running end when reducing the
    slack.
  11. Twist the windlass rod until the bleeding has stopped.
    WARNING: Do not over-tighten!
  12. Lock the windlass rod in place with the windlass clip.
    TIP: Maintain tension on the rod so the band does not loosen when placing the rod in the clip.
  13. Reassess the affected site to ensure bleeding is still controlled.
  14. Place the self-adhering band over the rod prior to moving the patient.
  15. Secure the windlass rod with the windlass strap prior to moving the patient.
  16. If bleeding remains uncontrolled after applying the first tourniquet, consider applying a second
    tourniquet.
    WARNING: LEAVE THE FIRST TOURNIQUET IN PLACE. NEVER REMOVE A TOURNIQUET
    IN A PREHOSPITAL SETTING.
    Apply the second tourniquet following steps 5-12. Place it 5 cm proximal to the first tourniquet.
  17. Leave the tourniquet uncovered.
  18. Reassess pulse, movement and sensation distal to the injury site.
  19. Compare and document time and location of tourniquet.
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10
Q

Manage an Amputation

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Control the hemorrhage using direct pressure, tourniquet or hemostatic agents as required.
  3. Rinse the amputated part free of debris with cool, sterile saline.
  4. Wrap the part loosely in saline-moistened sterile gauze.
  5. Seal the amputated part in a plastic bag and place it in a cool container. Keep it cool, but do not
    allow it to freeze.
  6. Record the time of the injury on the bag.
  7. Transport the patient and amputated part as expeditiously as possible.
  8. Patch. Commented [CI17]: Is there more to this instruction?
    Commented [KP18R17]: No just patch
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11
Q

Treat Penetrating Wound: Eye injury

A
  1. Don PPE (Gloves, safety goggles and, if required, mask.
  2. Identify indications and contraindications.
  3. Inform the patient of the procedure.
  4. Delegate one rescuer to gently manually stabilize the object and hold it in place, preventing any
    further movement.
  5. Avoid any direct pressure to the globe of the eye.
    Avoid any pressure directly on the impaled object.
  6. Using a bulky dressing, stabilize the object:
    * Surround the entire object with the bulky dressings, packing around the impaled object.
  7. Tape the bulky dressings in place.
  8. Cover both eyes to limit unnecessary movement from either eye.
  9. Document findings following industry standards
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12
Q

TREAT PENETRATING WOUND: STABILIZE AND DRESS (IMPALED OBJECT)

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Identify indications and contraindications.
  3. Inform the patient of the procedure.
  4. Delegate one rescuer to manually stabilize the object in place to prevent any further movement.
    NOTE: Only remove the impaled object under the following circumstances:
    * If they obstruct the patency of the airway in the neck or the cheek.
    * If they interfere with providing CPR.
  5. Remove all clothing from the affected area as soon as possible.
  6. Control any bleeding with direct pressure to the edge of the wound:
    * Avoid any pressure directly on the impaled object.
  7. Using a bulky dressing, stabilize the object:
    Surround the entire object with the bulky dressings by packing around the impaled object.
  8. Tape the bulky dressings in place.
  9. Reassess LOC, ABCs and vital signs.
  10. Document findings and treatments.
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13
Q

EVISCERATED ORGANS

A
  1. Don PPE.
  2. Remove clothing to fully expose the injury.
  3. Do not push any abdominal contents protruding from a wound back into the abdomen
  4. Gently cover any organ or viscera protruding from a wound with sterile gauze moistened with saline or
    water.
  5. Apply (over the wet gauze) a non-adherent material such as:
    * Plastic wrap
    * Aluminum foil
  6. Document the procedure following industry standards.
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14
Q

OPEN PNEUMOTHORAX

A
  1. Don PPE.
  2. Consider spinal motion restriction measures (SMR).
    NOTE: SMR is not indicated in patients with isolated penetrating chest and abdominal trauma, unless
    it involves the body spine.
  3. Ensure appropriate management of LOC and ABCs.
  4. Seal the wound (as soon as identified) with your gloved hand.
  5. Place a commercial chest seal (Asherman Chest Seal Device) over the defect.
    If no commercial device available, use the following measures:
    * Make a seal from a sterile occlusive dressing.
    * Tape the dressing on 3 sides only (leave the bottom of the dressing un-taped).
  6. Document the procedure following industry standards.
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15
Q

PROVIDE ROUTINE WOUNDCARE

A
  1. Don PPE.
  2. Apply appropriate handwashing technique.
  3. Consider which technique is required for wound care management:
    * Clean technique (shower/bath, clean receptacle, forceps and clean dressings)
    * Sterile technique (sterile water/saline, new dressing tray, sterile gloves, sterile metal probes/Q-tips)
  4. Assess wound, noting:
    * Location, depth, diameter
    * Color, eschar, granulation
    * Drainage: amount, color, odor, viscosity
  5. Provide wound care management:
    * Obtain physician orders for removal of any sutures, clips or drains.
    * Wash hands and gather supplies.
    * Remove old dressings and use clean or sterile technique to cleanse the wound and reapply the
    dressing.
    * Place old dressing and used disposable supplies in plastic garbage bags.
    * Wash re-usable equipment with soap and water, rinsing well and storing in a clean area.
  6. Document procedure.
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16
Q

FRACTURE MANAGEMENT: LOWER EXTREMITIES CLOSED

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. Delegate a partner to manually stabilize the affected site above and below the injury in the position
    found, avoiding the site of injury.
  4. Expose the injured leg fully:
    * Cut away clothing if necessary.
    * Remove any jewelry.
  5. Assess pulse, movement, and sensation distal to the injury site prior to splinting. Mark distal pulse
    with a pen.
  6. Consider applying gentle traction to straighten the injury if the following 3 criteria
    are met:
    * Extremity is extremely angulated.
    * Pulses are absent.
    * Long transport is likely (if hospital is close, splint in the position found).
    NOTE: If you encounter significant resistance, splint the leg in the position found.
  7. Apply a splint that will immobilize the joints above and below the fracture site.
    * Use tape, triangular bandages or cling avoiding the site of injury.
    * Leg: Consider a rigid splint.
    * Knee: Consider two padded long boards and a pillow under the knee.
    * Ankle/foot: Consider a pillow and triangular bandages.
  8. Pad the splint well in any area where skin defects or bony prominences might press against the
    splint and cause additional injury to the skin.
  9. Support the injured site to minimize any further movement.
  10. Reassess pulse, movement and sensation distal to the injury site post splinting the leg.
  11. Provide ice pack ensuring it does not make direct contact with the patient’s skin.
  12. Elevate the affected limb and support appropriately with blankets or pillows considering patient
    comfort.
  13. Reassess pulse, movement and sensation distal to the injury site.
    * Compare and document any findings and note any changes.
17
Q

FRACTURE MANAGEMENT: LOWER EXTREMITIES OPEN

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. If bleeding is not controlled with direct pressure, an appropriate tourniquet should be applied
    immediately. If the dressing becomes blood soaked, remove the dressing and redress once to be
    sure direct pressure is being placed on the area of bleeding. Consider using a hemostatic dressing
    in this case (QuikClot).
    Note: Avoid applying any pressure to broken bone ends.
  4. Delegate a partner to manually stabilize the affected site above and below the site of injury in the
    position found avoiding the site of injury.
  5. Expose the injured leg fully:
    * Cut away clothing if necessary.
    * Remove any jewelry.
  6. Assess pulse, movement, and sensation distal to the injury site prior to splinting. Mark distal pulse
    with a pen.
  7. Consider applying gentle traction to straighten the injury if the following 3 criteria
    * are met:
    * Extremity is extremely angulated.
    * Pulses are absent.
    * Long transport is likely (if hospital is close, splint in the position found).
    NOTE: If you encounter significant resistance, splint the leg in the position found.
  8. Cover any open wounds with a moist, sterile dressing:
    * Use sterile dressings only.
    * Add padding to either side of the injury to protect the bone ends.
  9. Apply a splint that will immobilize the joints above and below the fracture site:
    * Use tape, triangular bandages or cling avoiding the site of injury.
    * Leg: Consider a rigid splint.
    * Knee: Consider two padded long boards and a pillow under the knee.
    * Ankle/foot: Consider a pillow and triangular bandages.
  10. Pad the splint well in any area where skin defects or bony prominences might press against the
    splint and cause additional injury to the skin.
  11. Support the injured site to minimize any further movement.
  12. Reassess pulse, movement and sensation distal to the injury site post splinting the leg.
  13. Provide ice pack ensuring it does not make direct contact with the patient’s skin.
  14. Reassess pulse, movement and sensation distal to the injury site.
  15. Compare and document any findings and note any changes.
18
Q

FRACTURE MANAGEMENT: UPPER EXTREMITIES CLOSED

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. Delegate a partner to manually stabilize the affected site above and below the site of injury in the
    position found avoiding the site of injury.
  4. Expose the injured leg fully:
    * Cut away clothing if necessary.
    * Remove any jewelry.
  5. Assess pulse, movement, and sensation distal to the injury site prior to splinting. Mark distal pulse
    with a pen.
  6. Consider applying gentle traction to straighten the injury if the following 3 criteria are met:
    * Extremity is extremely angulated.
    * Pulses are absent.
    * Long transport is likely (if hospital is close, splint in the position found).
    NOTE: If you encounter significant resistance, splint the leg in the position found.
  7. Apply a splint that will immobilize the joints above and below the fracture site.
    * Use tape, triangular bandages, or cling avoiding the site of injury.
    Clavicle: Consider a sling and swathe.
    Shoulder: Attempt a sling and swathe and pad the void between the body and the arm (if the
    patient allows) with blankets, pillows or even trauma dressings.
    Humerus: Consider a rigid splint to the outside of the arm and pad the voids. Then apply a sling
    and swathe.
    Elbow: Splint in the position found. Do not attempt to straighten.
    * If arm is bent at the elbow, consider a sling and swathe.
    * If the deformity is large, use a large pillow or blanket wrapped around the limb and secured to the
    chest with a strap
    * If the elbow is straight, splint the entire arm from the armpit to the fingertips on two sides.
    Forearm/Wrist: splint from elbow to the fingertips with a short arm board and then a sling and
    swathe.
    Hand/Fingers: tape the injured finger to the uninjured finger beside it OR use a tongue depressor
    and tape around the injured finger.
    NOTE: If more than one finger involved, immobilize the entire hand in a position of function (palm
    down, fingers curled around roller gauze and then wrap the entire hand and place on an arm board to
    immobilize the wrist.
  8. Pad the splint well in any area where skin defects or bony prominences might press against the
    splint and cause additional injury to the skin.
  9. Support the injured site to minimize any further movement.
  10. Reassess pulse, movement, and sensation distal to the injury site post splinting the leg.
  11. Provide ice pack ensuring it does not make direct contact with the patient’s skin.
  12. Reassess pulse, movement and sensation distal to the injury site.
  13. Compare and document any findings and note any changes.
19
Q

FRACTURE MANAGEMENT: UPPER EXTREMITIES OPEN

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. If bleeding is not controlled with direct pressure, an appropriate tourniquet should be applied
    immediately. If the dressing becomes blood soaked, remove the dressing and redress once to be
    sure direct pressure is being placed on the area of bleeding. Consider using a hemostatic dressing in
    this case (QuikClot).
    NOTE: Be mindful to avoid applying any pressure to broken bone ends.
  4. Delegate a partner to manually stabilize the affected site above and below the site of injury in the
    position found avoiding the site of injury.
  5. Expose the injured leg fully:
    * Cut away clothing if necessary.
    * Remove any jewelry.
  6. Assess pulse, movement, and sensation distal to the injury site prior to splinting. Mark distal pulse
    with a pen.
  7. Consider applying gentle traction to straighten the injury if the following 3 criteria are met:
    * Extremity is extremely angulated.
    * Pulses are absent.
    * Long transport is likely (if hospital is close, splint in the position found).
    NOTE: If you encounter significant resistance, splint the leg in the position found.
  8. Cover any open wounds with a moist sterile dressing:
    * Use sterile dressings only.
    * Add padding to either side of the injury to protect the bone ends.
  9. Apply a splint that will immobilize the joints above and below the fracture site.
    Use tape, triangular bandages, or cling avoiding the site of injury.
    Clavicle: Consider a sling and swathe.
    Shoulder: Attempt a sling and swathe and pad the void between the body and the arm (if the patient
    allows) with blankets, pillows or even trauma dressings.
    Humerus: Consider a rigid splint to the outside of the arm and pad the voids.
    * Then apply a sling and swathe.
    Elbow: Splint in the position found. Do not attempt to straighten.
    * If arm is bent at the elbow, consider a sling and swathe.
    * If the deformity is large, use a large pillow or blanket wrapped around the limb and secured to the
    chest with a strap.
    * If the elbow is straight, splint the entire arm from the armpit to the fingertips on two sides.
    Forearm/Wrist: Splint from elbow to the fingertips with a short arm board and then a sling and
    swathe.
    Hand/Fingers: Tape the injured finger to the uninjured finger beside it OR use a tongue depressor
    and tape around the injured finger.
    NOTE: If more than one finger involved, immobilize the entire hand in a position of function (palm down,
    fingers curled around roller gauze and then wrap the entire hand and place on an arm board to immobilize
    the wrist.
  10. Pad the splint well in any area where skin defects or bony prominences might press against the
    splint and cause additional injury to the skin.
  11. Support the injured site to minimize any further movement.
  12. Reassess pulse, movement, and sensation distal to the injury site post splinting the leg.
  13. Provide ice pack ensuring it does not make direct contact with the patient’s skin.
  14. Reassess pulse, movement and sensation distal to the injury site.
  15. Compare and document any findings and note any changes.
20
Q

TRACTION SPLINT: SUSPECTED FEMUR FRACTURE ONLY

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Inform the patient of the procedure.
  3. Delegate a partner to manually stabilize the affected leg above and below the site of
    * injury in the position found.
  4. Expose the injured leg.
  5. Assess pulse, movement and sensation distal to the injury site.
  6. Prepare the traction splint:
    * Place the splint to the inside of the patient’s injured leg with the padded bar fitted snuggly against
    the pelvis in the groin.
    * Secure the pubic strap over the groin and high over the thigh.
    * Open and position the Velcro straps along the splint.
  7. Apply the ankle hitch to the injured leg.
  8. Apply and maintain gentle traction (manual traction):
    * No more than 10% of the patient’s body weight OR max 15l bs.
    * Apply traction until pain and muscle spasms are relieved.
    * Maintain manual traction until mechanical traction takes over.
  9. Fasten the ankle hitch to the traction strap.
  10. Secure the remaining Velcro straps around the leg avoiding covering the site of injury.
  11. Reassess pulse, movement and sensation distal to the injury site.
  12. Transport the patient on a firm surface (long spine board) so the splint is supported.
  13. Compare and document any findings and note any changes.
21
Q

TRAUMA MANAGEMENT: PELVIC BINDING: IN HOSPITAL METHOD (FLAT SHEET)

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Identify indications/contraindications/complications of pelvic binding.
  3. Gather all required equipment:
    * A bed sheet or flannel sheet
    * 4 green clamps
    NOTE: Do not use a fitted bed/cot sheet in place of a bed/flannel sheet.
  4. Inform the patient of the procedure.
  5. Ensure the patient is placed centrally on the sheet:
    * Ensure the sheet should extend from above the patient’s iliac crest to the top of the femurs.
    * Be gentle.
    * If the patient is on a spine board, gentle move the sheet into place by sliding it under the patient to
    the proper position.
  6. With another rescuer, while pulling the sheet:
    * Lift up on one side, maintain tension, and cross one side of the sheet over the patient.
    * Do not rotate the sheet (keep it flat).
    * Do not disrupt central lines, urinary catheters, etc.
    * Ensure there are no folds or creases in the sheet once placed.
    NOTE: There should be enough sheets on the one side of the patient so that the sheet just rests at
    the bottom of the patient’s thighs.
  7. Hold the sheet in place until the other side is securely fitted over the pelvis.
  8. Pull and lift the sheet up on the opposite side while maintaining tension, then cross the sheet over
    itself.
  9. Tighten the sheet to achieve the appropriate amount of stabilization.
  10. Using the 4 green clamps, secure the sheets together.
  11. Reassess pulses, motor and sensation in lower extremities.
  12. Reassess LOC, ABC and vitals.
  13. Document procedure and any notable changes.
    Note:
    * Reassess regularly the pelvic wrap to ensure it does not loosen with patient
    movement and transport.
    * Do not remove the wrap during transport.
22
Q

TRAUMA MANAGEMENT: PELVIC BINDING: PRE-HOSPITAL
METHOD (TWISTED SHEET)

A
  1. Don PPE (gloves, safety goggles and, if required, mask).
  2. Identify indications/contraindications/complications of pelvic binding.
  3. Gather all required equipment:
    * A bed sheet or flannel sheet
    * 4 green clamps
    NOTE: Do not use a fitted bed/cot sheet in place of a bed/flannel sheet.
  4. Inform the patient of the procedure.
  5. Delegate a partner to manually stabilize the patient’s pelvis.
  6. Do not palpate the area if:
    * Obvious deformities, contusions/hematomas or swelling noted in the region of the pelvis/pubic
    symphysis or the patient complains of pain.
    Palpate the area if:
    * No signs or symptoms of pelvic trauma exist.
    * Exert gentle manual lateral to medial and anterior to posterior compression at the iliac crests on both
    sides of the pelvis.
  7. Remove all the patient’s clothing, focusing on the area around the pelvis:
    * Ensure belts, buckles and underwear are removed.
    * Consider the patient’s privacy.
  8. Assess pulses, movement, and sensation in the lower extremities.
  9. Fold the chosen sheet to the appropriate width.
    * The sheet should extend from above the patient’s iliac crest to the top of the femurs.
  10. Prepare the spine board and scoop stretcher.
    * Place the sheet/flannel blanket on a spine board beside the patient.
  11. Place the patient on a scoop stretcher and gently move the patient to the spine board.
    NOTE: Variations for moving the patient may exist so be sure to use your best clinical judgement.
  12. Place the scoop stretcher onto the backboard so the top of the sheet on the backboard is directly at
    the top of the patient’s iliac crests, and the head of the trochanter lies in the middle of the sheet.
  13. With another rescuer:
    * Pull the sheet/flannel blanket firmly together.
    * Both rescuers should apply equal pressure to both sides of the sheet.
    NOTE: Ensure neither of the rescuers rock the unstable pelvis.
    * Pull up on the sheet together.
  14. After pulling the sheet upwards, both rescuers should:
    * Cross the sheet over the patient.
    * Hand your end of the sheet to the other rescuer.
    NOTE: When passing the sheet, keep it low over the patient’s pelvis to keep proper pressure on the
    pelvis.
  15. Once a knot has been created, gently pull the sheet tightly and create compression over the pelvis.
  16. Twist the sheet at the midline and tighten to provide stabilization.
  17. Fan loose ends of the sheet on both sides.
  18. Using the 4 green clamps, secure the sheets together.
  19. Tuck in all loose ends of the sheet.
  20. Reassess pulses, motor and sensation in lower extremities.
  21. Reassess LOC, ABCs and vitals.
  22. Document procedure and any notable changes.
23
Q

OBTAIN A 12 LEAD

A
  1. Identify indications for 12-lead monitoring.
  2. Perform a maintenance check to ensure proper functioning of the cardiac monitor.
  3. Prepare the patient prior to attaching the cardiac monitor. Position the patient properly:
    * Semi-Fowler Position (45 degrees)
    * arms at side
    * legs uncrossed
  4. Attached the electrodes to the appropriate locations on the patient:
    V1 4th Intercostal space to the right of the sternum
    V2 4th Intercostal space to the left of the sternum
    V3 Midway between V2 and V4
    V4 5th Intercostal space at the midclavicular line
    V5 Anterior axillary line at the same level as V4
    V6 Mid-axillary line at the same level as V4 and V5
    RL Anywhere above the ankle and below the torso
    RA Anywhere between the shoulder and the elbow
    LL Anywhere above the ankle and below the torso
    LA Anywhere between the shoulder and the elbow
  5. Input patient information into LP15.
  6. Obtained a legible ECG tracing.
  7. Ask the patient to:
    * Remain still
    * Not talk for 10 seconds
    * Breathe calmly for 10 seconds
  8. Interpreted the cardiac rhythm.
  9. Documented the procedure and assessment findings.

LAB Skills (3 decks)

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