SOG 430 Flashcards
No ALS procedures are authorized in other jurisdiction, unless
as stated herein or under situations in which such procedures are necessary to prevent imminent death or serious harm to the Pt.
Personnel discovering an abandoned neonate shall:
1) asses neonate per neonate/pediatric resuscitation protocols
2) Notify law enforcement agency
3) Transport neonate to nearest appropriate receiving facility.
A Pt is considered to give informed consent when any of the following occur:
- Pt gives verbal permission to treat
- Pt gives written permission to treat
- Pt does not object as you begin assessment
The documented refusal is only valid with an appropriate witness signature: in order of preference
Spouses Relatives Law Enforcement Friends Other JFRD
Cooperation with law enforcement.
Who has the final authority and accountability when the pt is under their arrest.
Law enforcement
When not to remove taser probes.
are implanted in sensitive areas.
Face Throat Eye Groin Breast Hands Feet
Pt who have been tased should be transported to the hospital under the following circumstances:
- History of delirium, mania or irrational bizarre behavior before being tased
- Persistent abnormal vital signs
- Amphetamine or hallucinogenic drug use
- Cardiac hx
- AMS or aggressive
- Hypothermia
- Abnormal CP, SCB, nausea or headaches
- Probes in sensitive area
- In doubt on how to remove probe
Physical restraints are permitted for Pt who are at immediate risk for harming themselves or others because of impaired judgment due to any combination of the following:
- Drugs/alcohol
- Psychiatric illness
- Head injury
- Metabolic, CNS infection, hypoglycemic
- Dementia
Dealing with restrained Pt shall be placed in what position?
- Supine
- Fowler’s
- Semi Fowler’s
When restraints are in use.
Circulation to the extremities shall be elevated at least every?
10 min
Excited delirium Pt that were combative Pt who became suddenly ______ should raise a red flag.
quiet
Excited delirium can mimic several medical conditions including:
- Hypoxia
- Hypoglycemia
- Stroke
- Intracranial bleeding
Signature instructions for non-transport
the officer in charge to sign the Pt are
report under ______. The following report
types:
“Responsibility Puts”
- DOA
- Law enforcement
- Pronouncement of death
- Transfer to another EMS agency
Every ______ months completed refusals will be forwarded to the QIC at HQ.
6 months
When transport is refused in suspicion of abuse the following needs to be done:
- Request law enforcement at scene
- Stay with Pt until law enforcement arrival
- Notify the Rescue Chief
Reporting abuse following procedure are:
- Report to ER Doc
- Call 1-800-962-2873 name and ID# or contact person
- Rescue Chief
- Email Division Chief Rescue within 24 hours via email
Unquestionable death criteria, meets the following DOS:
- Unresponsive
- Apheic
- Pulseless
- In addition to above must meet at least one:
- Inactive
- Body decay
- Rigor mortis
- Open cranium with exposed brain matter
- Decapitated or severed trunk
- Multi system trauma Pt - asy stroke.
Blunt chest trauma death criteria, following is met for DOS:
- Unresponsive
- Apneic
- Pulseless
- No heart sounds or cardic activity asystole confirmed in two leads or wide complex ventricular rhythm of 30 or less without pulse.
The following situations will require transport of the Pt to the hospital by rescue:
- Life threatening emergencies
- Chest or abdominal pain in adult Pt
- Dyspnea
- Pregnancy
- AMS
- All near drowning
- Pt with alerts
- Ped 15 years or younger symptomatic
- Elderly 65 years or older
- Pt who received ALS treatment
- Conditions exacerbated improper handling/transport
The following situations will not require transport of the Pt to the hospital by rescue: however they must be documented:
- No emergency exits
- Injuries superficial or minor nature
- Require transport to mental health resource or detox facility
- Private provider or private vehicle
- Pt refuse transport
- DOS
- Hospice Pt - Pt disposition
Family, friends or other passengers will not be routinely transported unless required for the continuation of Pt care:
- Ped Pt requiring a parent or guardian
- Geriatric Pt requiring a guardian or care giver
- Pt with language barriers requiring a translator
- Pt with speech disabilities requiring some one proficient in sign language
Pt will not be transported to stand alone ER:
- Any alerts
- Pt with abdominal or pelvic cavity pain/discomfort
- Pt who are under arrest or “Acts”
Arrival at receiving facility:
Medical staff assess Pt within ______ of arrival if not notify ______
15 min
notify charge nurse, nurse manager, Rescue Chief
Rescue with transfer Pt to hospital stretcher in ______, or notify ______.
30 min
FRCC
Trauma scorecard methodology. Any one of the following conditions considered a trauma alert Pt.
- Airway - assistance beyond giving O2
- Circulation - lack radial pulse with heart rate greater than 120 beats BP systolic less than 90
- BMR - 4 or less - paralysis
- Cutaneous - 2nd or 3rd degree to 15% body amputation proximal wrist or ankle penetrating injury - head, neck, torso.
- Long bone fracture - two or more
Trauma scorecard methodology. Any two considered a trauma alert.
- Airway - respiratory rate 30 or greater
- Circulation - Pt sustained heart rate 120 or greater
- BMR - 5
- Cutaneous - major degloving injury or major flap avulsion greater 5 inch GSW to extremities
- Long bone fracture - from a MVA or fall 10’ or greater
- Age - 55 or greater
- MOI - ejected, steering wheel deformity
- 12 or less on GCS
Pediatric trauma, characteristics of a person 15 years of age or less. Trauma alert Pt criteria are identified any one are:
Airway - intubated, jaw thrust, suction, assist ventilatory efforts
Circulation - Faint or non-palpable carotid or femoral pulse or BP systolic is less than 50
-Consciousnesses - AMS, inability to follow command paralysis.
Fracture - open long bone, multiple fracture
Cutaneous - major degloving or flap avulsion 2nd or 3rd degree burns 10% BSA amputation proximal to the wrist or ankle penetrating injury head, neck, torso
Pediatric trauma, characteristics of a person 15 years of age or less. Trauma alert Pt criteria are identified any two are:
- Consciousness - amnesia, loss of consciousness
- Circulation - carotid or femoral pulse is palpable radial or pedal pulse are not BP systolic less than 90
- Fracture - single closed long bone fracture not wrist or ankle
- Size - 11kg or less or length is equivalent to this weight on a pediatric length and weight emergency type (33in)
EMT assessment/treatment
medical Pt assessment:
- Assess for responsiveness
- ABC’s - BLS/AED
- O2
- Assess level of consiousness - A.V.P.U. - GCS
- HPI - SAMPLE - OPQRST
- Initial signs: Respirations (rate, quality, rhythm), Pulse (rate, quality, rhythm) skin condition, BP, Pupillary conditions, Sp02, Attack ECG, BGL
- Head to toe - Focus Pt
- Calming and reassuring
EMT assessment/treatment
Trauma Pt assessment:
- Assess for responsiveness
- ABC’s - BLS/AED
- O2
- Assess level of consciousness - A.V.P.U. - GCS
- HPI - SAMPLE - OPQRST
- Trauma alert criteria
- Hemorrhage control
- Head to toe - Px
- Vitals: Respirations (rate, quality, rhythm), pulse (rate, quality, rhythm), skin condition, BP, Pupillary condition, Sp02, ECG, BGL, spinal immobilization, splint, calming and reassuring
Adult GCS
Eye opening: spontaneous 4 to speech 3 To pain 2 None 1
Best verbal response: oriented 5 confused 4 Inappropriate words 3 Incomprehensible sounds 2 None 1
Best motor response: Obeys 6 localizes 5 withdraws 4 abnormal flexion 3 abnormal extension 2 none 1
The goal of Pt care in trauma arrest Pt is:
“Load and go”
Limit scene time to 10 min unless extrication is required.
Trauma arrest Pt assessment history:
- Mechanism of injury (blunt or penetrating)
- Blunt trauma - amount and direction of force
- Penetrating trauma - weapon, size of object, trajectory, caliber of bullet
- MVA - condition of vehicle, dashboard steering wheel: Speed of impact, seat belt use, deployment airbags, amount of intrusion, Pt trajectory
- Description of scene
- Treatment prior to arrival
- Drug or alcohol use
- medical illness
- Current meds
- Allergies
Trauma arrest
Pt signs and symptoms
- Skin:
- Cyanosis
- Pallor
- Mottling
- Number of Wounds
- Cool Clammy
- Subcutaneous emphysema
- Respiratory
- Abnormal breath sounds
- Apnea
- Tracheal shift
- Abnormal Chest Wall Movements
- Paradoxical
Trauma Arrest
EMT Treatment
Multi-System Trauma EMT Treatment
- EMT Assessment Treatment Protocol
- Consider unquestionable and/or blunt chest trauma death criteria
- Declare “trauma red”
- Airway Protocol: Ventilate with 100% O2
- Consider SAM Pelvic splint for pelvic fracture
- Consider PASG as an air splint for pelvic or multiple lower extremity long bone fracture
Shock/Trauma
EMT Treatment:
- EMT Ass Treatment Protocol
- Airway Protocol
- Administer 100% O2
- Maintain body warmth
- Place pt in shock position (Trendelenburg position)
- Determine underlying causes of shock
- Prepare for rapid transport
Head Trauma
History Assessment:
- Time of injury
- Mechanism of injury (blunt or penetrating)
- Estimate of force involved
- Helmet use and type
- LOC (duration and progression)
- Amnesia to events
- Medical illness
- Current Meds
- Allergies
- Drug or alcohol use
Head Trauma
Signs and Symptoms:
- Nausea/vomiting
- Neck pain
- Headache
- Diplopia
- Unsteady gait
- Numbness or tingling of the extremities
- Paralysis of the extremities
- Vital sign; Hypotension or Tachycardia indicative of internal hemorrhage
- Skin; Contusions, abrasions, lacerations
- HEENT: ETOH, CSF, pupillary size
- Neck: Tenderness
- Neurologic LOC, AVPU. GCS, seizures
Head Trauma
EMT Treatment:
- EMT assessment treatment protocol
- Airway protocol
- 100% O2
- Spinal immobilization protocol
- Control bleeds
- Treat co-existing injuries
Chest Trauma
EMT Treatment
Best treatment is rapid transport
-EMT assessment treatment protocol
-100% O2
-Flail chest: Positive pressure ventilation BVM
-Sucking chest wound: Vaseline type gauze occlusive dressing, plastic or aluminum foil taped on three sides:
Tension pneumothorax develops, release occlusive dressing
-Penetrating trauma: Stabilize impaled objects in place, do not remove
Abdominal Trauma
EMT Treatment:
Mechanism of injury is the most important indicator of abdominal trauma
Best treatment is rapid transport:
-EMT Assessment Protocol
-Airway Protocol
-100% O2
-Abdominal Evisceration: Never replace replace abdominal viscera: Sterile dressing moisten w/NS:
Wet dressing, cover with large dressing to keep area warm
Traumatic Injury of Pregnant PT
EMT Treatment:
SS May be delayed due to maternal blood volume
- EMT assessment protocol
- Airway protocol
- 100% O2
- LSB elevated on right side is about 15 degrees or 6 inches displacing uterus to left side of vena cava
- LSB cannot be elevated manually displace uterus to left maintain displacement throughout transport
Extremity Injuries
EMT Treatment:
-EMT assessment treatment protocol
-Airway protocol
-O2 95-100%
-Dressing and Pressure bandage, apply tourniquet
- Splint areas of tenderness or deformity
-Splint dislocation and joint injuries in the position found
-Consider ice packs to reduce swelling
-Reduce dislocations or fractures (open or closed) by axial traction for the following:
Absence of distal pulses: Proper immobilization
-Elevate the extremity when practical
-Monitor distal pulses, sensation and motor function before and after splinting
Extremity Injuries
EMT Treatment:
Consider Specific Treatment;
- Amputation: Place amputated part in sterile gauze, moisten with NS, place in container, keep cool not freeze
- Dress and splint partial amputations in alignment with extremity, avoid torsion
- Do not clamp vessels
- Apply tourniquet
- Alert hospital for possible reattachment
Crush Syndrome Assessment
Pathophysiology:
- Blood flow is restored, multiple processes begin
- Hypovolemia, hypotension, hypovolemic shock
- Increase in serum potassium makes ventricular fibrillation more likely
- Release of myoglobin, uric acid to kidneys and blood directly and indirectly kidney failure
- Reperfusion injury in all tissues
Crush Syndrome Assessment
Morbidity and Mortality:
- Primary cause of death in crush syndrome: Hypovolemia, dysrhythmia, renal failure
- Other causes of death: Adult respiratory distress syndrome (ARDS), sepsis, electrolyte disturbances, ischemic organ injury (gangrene)
Crush Syndrome
Clinical Manifestations
Prior to Release from Entrapment:
- Generally no pain in crushed extremity may sense hyperesthesia or anesthesia
- Degree of pain seems disproportionate for amount of visible tissue damage
- Distal pulses may or may not be present; however they are usually present
Crush Syndrome
Clinical Manifestations
After Release from Entrapment
- Agitation is common
- Hyperesthesia or anesthesia, severe pain in the crushed extremity
- Passive movement of the affected limb results in pain
- Muscle function decreases rapidly and leads to limb paralysis due to direct muscular dysfunction
- Aggressively marked swelling of the affected area
- Systemic manifestations of crushed syndrome can be seen in seconds to minutes to hours. Depends on the amount of muscle involved
Acute Compartment Syndrome
Signs and Symptoms
Five P’s Associated:
- Pain
- Parasthesis: pins and needles
- Pressure
- Passive stretching
- Pulselessness
Acute Compartment Syndrome
EMT Treatment:
- EMT Assessment Treatment Protocol
- Airway Protocol: 100% O2
- Determine the underlying cause of injury
- Splint and immobilize all suspected limb fractures
- Do not elevate or apply cold pack
- Prepare for rapid transport
Burns
Severity Classifications
Major Burn:
- Partial thickness greater than 25% BSA in adults; greater than 20% BSA in children
- Full thickness greater than 5% BSA
- All partial or full thickness burns of hands, feet, face, eyes, ears or genitalia
- Inhalation injury
- Electrical burns
- Burns complicated by fractures or other major trauma
- High risk pt : Very young, elderly, pt with chronic medical problems
Burns
Severity Classifications
Moderate Burn:
- Partial thickness 15-25% BSA in adults, 10-20% BSA in children
- Full thickness 2-5% BSA
Burns
Severity Classifications
Minor Burns:
- Partial thickness less than 15% BSA in adults; less than 10% BSA in children
- Full thickness less than 2% BSA
Burns
Trauma Alert Criteria:
- Adults
- Partial/full thickness (2nd/3rd degree) burns equal to or greater than 15% of the BSA
- Pediatric
- Partial/full thickness (2nd/3rd degree) burns equal to or greater than 10% of the BSA
Burns
EMT Treatment:
- EMT Assessment Treatment Protocol
- Airway Protocol 95 and 100%
- Consider hyperbaric facility for CO poisoning
- Remove all clothing and jewelry
- Assessment type and percent of BSA, use Rule of Nine!
- Burning agent is chemical - irrigate with NS or sterile water for 20 minutes ( do not use water on lime, carbolic acid, sulfuric acid, solid potassium or sodium metals)
Burns
EMT Treatment
Specific Treatment
Superficial Burns:
- Immerse in cool sterile water or apply cool sterile compresses to the burn site
- Burned hands or feet may be soaked directly in cool sterile water
- Towel soaked in cool sterile water may be applied to burns of the face or trunk
- Maintain body warmth: Apply a dry sheet or blanket over wet dressing to minimize heat loss
Burns
EMT Treatment
Specific Treatment
Partial-Thickness Burns:
- For minor burns, wrap burned area with sterile cloths or sheets cooled in ambient temperature NS or sterile water, or utilize burn gel treatment
- Cool burn area with NS or sterile water in sufficient quantities to relieve heat penetration in lieu of burn gel treatment
- Moderate and major burns - cover with dry sterile dressing
- Leave blisters intact
- Maintain temperature control and body warmth, do not allow PT to become hypothermic; shivering further complicates shock
Burns
EMT Treatment
Specific Treatment
Full Thickness Burns:
- Wrap burned area in dry sterile dressing, clothes or sheets
- Remember do not allow pt to become hypothermic; shivering further complicates shock
Burns
EMT Treatment
Specific Treatment
Electrical Burns
- Remove pt from electrical source if no danger to rescuer
- Assess and dress entrance and exit wounds
- Follow electrical injury protocol
- Spinal immobilization
Burns
EMT Treatment
Specific Treatment
Chemical Burns
- Wear appropriate PPE
- Flush burn area w/NS or sterile water for 20 minutes
- After flushing, cover wound w/dry sterile dressing
- if Pt remains symptomatic after initial care, continue irritation throughout transport
For Eyes
- Irrigate eye with lukewarm NS or sterile water as needed for 20 minutes
- After irrigation, bandage both eyes with dry sterile dressing
Electrical Injuries
EMT Treatment
-On lightening strike scenes where there are multiple pt, reverse triage shall be applied and pt in cardiac arrest shall be worked first
-EMT Assessment Treatment Protocol
-Airway Protocol
-O2 assessment and 95% -100%
-Treat co-existant injuries
Head trauma
Extremity Injury Protocol
Subs Tissue Injury
Burns
Eye Emergencies
EMT Treatment
Assess Nature of Opthalmologic Emergency
Direct Trauma
- Direct trauma
- Patch both eyes gently without pressure to the globes.
- Maintain pt in supine position to reduce leakage of fluids from the eye
- If blood is noted in anterior chamber (hyphema), elevate head of the pt below 40 degrees. If on LSB, elevate LSB 40 degrees
- Dim lights to pt comfort
Eye Emergencies EMT Treatment Assess Nature of Opthalmologic Emergency Chemical Trauma Atraumatic
-Chemical trauma
-Irrigate affected eye w/lukewarm NS or sterile water for 20 minutes
-Apply dry sterile dressings to both eyes
-Dim lights for pt comfort
Remove contact lenses when applicable
Atraumatic
-Patch both eyes gently without pressure to the globes
-Dim lights for pt comfort
-Transport diagnosed central retinal artery occlusion
-100% O2
Place pt in shock position
Chest Pain/Discomfort
Assessment
History:
- Chest pain
- Onset and duration
- Location and radiation
- Quality (pleuritic, heavy, crushing)
- Pain/discomfort rating 0-10
- Activity at the onset and relieving factors
- Medical illness
- Smoking
- Recent cardiac-related surgery
- Current meds
- Allergies
Chest Pain/Discomfort
Assessment
Signs and Symptoms
-Diaphoresis
-Shortness of breath
-Cough and sputum production
-Nausea/vomiting
-Fever
-Chills
-Vital signs - vary
-Skin
Diaphoresis
Cyanosis
Peripheral edema
-Respiratory
Rales
Rhonchi
Wheezing
Chest wall tenderness
-Cardiac Neck vein distention pain/discomfort clutching of chest irregular pulse numbness/tingling differerence in BP between the two arms
Chest Pain Discomfort
EMT Treatment
- EMT Assessment Treatment Protocol
- Airway Protocol
- SP O2 less then 95%, O2 at 2-4 LPM via nasal cannula; to maintain SP O2 at 95% or greater
- If room air SP O2 is 95% or greater, do not administer O2
Acute Stroke
EMT Treatment
- EMT Ass Treatment Protocol
- Airway Protocol
- SPO2 less than 95%, O2 at 2-4 LPM via nasal cannula to maintain SPO2 at 95% or greater
- If room SPO2 is 95% do nothing
- Head elevated to 30 degrees if tolerated
- Obtain BP on both arms
- Complete stroke checklist
- Do not administer any oral meds
CHF/Pulmonary Edema
EMT Treatment
-EMT Ass Treatment Protocol
-Airway Protocol
-O2 100%
Place the pt in full Fowler’s position
Hypertensive Urgency
Is What?
Systolic BP greater than 220 mm Hg
Diastolic BP greater than 120 mm Hg
