Intro to paramedicine tri 1 yr 1

What does DRSABC stand for?

DRSABC is an acronym used in emergency care that stands for Danger, Response, Send for Help, Airway, Breathing, and Circulation.

How to check for Danger in an area?

Use the POP method - people, objects, place, ensuring the area is safe to enter for both you and the patient

What are the levels of responsiveness?

AVPU - Alert, responds to voice, responds to pain, unresponsive.

How to tell that someone has a clear airway?

A clear airway is indicated by the absence of obstruction, the patient is able to speak or breathe without difficulty, and there is no unusual noise like stridor or wheezing.

What are the 2 airway manoeuvres?

Triple - Jaw thrust, chin lift, head tilt

Double - Jaw thrust, chin lift, NO HEAD TILT

When to use a double airway maneouvre?

When there is a suspected spinal injury or it is a paediatric case

How is an OPA measured?

From the angle of the jaw to the middle of the mouth

How is an NPA measured?

From the tip of the nose to the earlobe.

What is a normal breathing pattern?

12-20 breaths per minute

Regularly spaced breaths

Chest expanding on inspiration and retracting on expiration

What are the 2 wrist pulses and which should you check?

The radial and ulnar pulses; check the radial pulse.

What does the secondary survey allow for? (4 points)

1. formulate differential diagnosis

2. formulate provisional diagnosis

3. formulate management plan

4. decide on transportation pathway

What is a differential diagnosis?

List of conditions that may be causing the presentation

What is a provisional diagnosis?

The most likely condition causing the presentation

What is NILDOCAAFIAT for?

it is the history of the presenting complaint, the first part of the secondary complaint

What does NILDOCAAFIAT stand for?

Nature, Intensity, Location, Duration, Onset, Contributing, Aggravating, Alleviating, Frequncy, Impact, Treatment

NILDOCAAFIAT - Nature, what is it for and 2 Q’s

To assess the characteristics of the complaint and a description of the symptom, trying to get it in their own words and be as specific as possible

• Can you describe the pain?

• What does it feel like? Stabbing, aching, cramping etc.

NILDOCAAFIAT - Intensity, what is it for and 2 Q’s

To see how bad the symptom is, using a scale so the pain is easy to understad

• How bad is the pain from 1-10?

• For people with impairments/ children use 3 examples:

  • Mild, moderate, severe?

  • Easier to understand

NILDOCAAFIAT - Location, what is it for and 2 Q’s

Important to identify where it is happening, where it began and where it has progressed to, how big the area of the pain is

• Where is the pain?

• Is it radiating to anywhere?

NILDOCAAFIAT - Duration, what is it for and 1 Question

To assess how long the symptom has been present, whether it is chronic or has only just started happening

• How long has it been like this?

NILDOCAAFIAT - Onset, what is it for and 2 Q’s

Identify what time it started today/ the most recent time, important for things such as heart attacks and strokes, important to get as close as possible, a time is necessary

• What time did the pain begin?

• Was it before or after lunch?

NILDOCAAFIAT - Contributing, what is it for and 2 Q’s

Figure out what they were doing when the symptoms began to determine if a specific event caused the symptom

• What were you doing when this all started?

• What do you think is contributing to the pain?

NILDOCAAFIAT - Aggravate, what is it for and 1 Question

In some instances, they may resport some things that make toe symptom worse, and sometimes the paramedic may try and illicit the reaction by using this to their advantage

• Have you noticed if anything makes it worse?

NILDOCAAFIAT - Alleviate, what is it for and 1 Question

Same as aggravate, but it is important to identify what makes the symptom better

• Have you noticed anything that makes the symptom better?

NILDOCAAFIAT - Frequency, what is it for and 2 Q’s

Determines how often these episodes occur or if it a single episode, also to determine when these occur or if there is a cause

• Is the pain all the time, or is it coming and going?

• Has this happened before?

NILDOCAAFIAT - Impact, what is it for and 2 Q’s

Has to establish what sort of impact the symptom has had on the patient’s life, and will give you a clearer picture on the severity of the symptom

• How has this impacted your daily living?

• Have you been able to go to the toilet by yourself today? etc.

NILDOCAAFIAT - Attribute, what is it for and 2 Q’s

It is sometimes helpful to ask if the symptom may be due to a known medical condition, or a recent event.

• Do you have an idea of what you think this might be?

• Is there anything that you think could be causing this?

NILDOCAAFIAT - Treatment, what is it for and 1 Question

Determine whether the patient has taken something for their symptom, as it may impact their treatment

• Have you taken anything for your treatment?

What is the acronym for collecting patient hx? (Including the meaning)

CHAMP AIR

Complaint, History, Admissions, Makor procedures, Prescriptions, Allergies, Immunisations, Reactions

What is the cartoid pulse

Large central pulse felt over the cartoid artery in the neck, used if the patient is unconscious

What is the brachial pulse

A medium, central pulse felt above the antecubital fossa, used when finding where to put the blood pressure cuff

What is the radial pulse

Small, peripheral pulse felt over the radial artery on the wrist, above the thumb, used to find the primary pulse

What is the dorsalis pedis pulse

Small, peripheral pulse felt over the dorsalis pedis arteries on the dorsum of the foot, used to check the distal circulation to the patient’s feet

Palpation meaning

Feeling a pulse is known as palpating a pulse - physically assess through touch

3 things to note when taking a pulse

The rate, rhythm, and strength of the pulse.

3 things to note on condition on patient’s skin

the color, temperature, and moisture of the skin.

Blood pressure definition

The force of circulating blood against the walls of blood vessels, typically measured in millimeters of mercury (mmHg).

Systolic blood pressure definition

Maximum pressure which is exerted when the ventricles of the heart contract and pump blood through the arteries during each heartbeat.

Diastolic blood pressure definition

Lowest pressure in the arteries when heart is resting throughout contractions

Textbook blood pressure

120 / 80

Hypertension range

Above 140 / 90

Hypotension range

Under 90 / 60

5 Korotokoff sounds

1. Clear tapping sounds (systolic)

2. Softening and swishing

3. Increased tapping sharpness an volume

4. Muffled sounds

5. Silence (diastolic)

What is the normal diagnostic quality for Corpuls

Filter: 0.05-150 Hz

Paper speed: 25mm/s

Amplitude: 10 small boxes

What is the normal diagnostic quality for Lifepak

Filter: 0.05-40Hz

Paper speed: 25mm/s

Amplitude: 10 small boxes

Normal, high and low respiratory rate (with names)

Normal - 12-20 breaths/ min

Bradypnea - 12 breaths/ min

tachypnea - above 20 breaths/ min

4 features that should be considered when assessing breathing

1. The rate per minute

2. The depth of each inspiration (normal, deep, shallow)

3. The regularity, or rhythm of the breaths (regular, irregular)

4. The effort of each inspiration and expiration (accessory muscle use)

Normal oxygen saturation and below name

94% and above is normal

Below is hypoxia

Glascow coma scale

a scale from 3-15 which gives clinitians a way to describe and identify the level of neurological function in patients with head injuries

GCS eye responses 1-4

1. No eye opening

2. Opens to Pressure

3. Opens to Sound

4. Opens spontaneously

GCS verbal responses 1-5

1. No response

2. Incomprehensible sounds

3. Inappropriate words

4. Confused

5. Oriented

GCS motor responses 1-6

1. No response

2. Extension to pain

3. Flexion to pain

4. Withdrawal from pain

5. Localizes pain

6. Obeys commands

What does PERRLA stand for

Pupils

Equal

Round

Reacting

Light

Accommodation

Normal pupil size

4-6mm

Normal temperature range for an adult

35.9 - 37.6

Normal, low and high glucose levels (with names)

Normal - 2-8mmol/L

Hyperglycaemia - over 8mmol/L

Hypoglycaemia - under 2mmol/L

Perfusion definition

The flow of blood through the capillaries, amount of blood which flows to organs determines whether or not the organs are well or poorly perfused

5 key components to a perfusion status assessment

1. skin status

2. pulse rate

3. systolic blood pressure

4. consciousness

5. capillary refill

Assessment of skin status points

• look for signs such as pallor (paleness), decreased temp, clamminess

• skin changes paired with inc. heart rate is a sign of reduced perfusion

Assessment for pulse rate points

• increases in response to decrease in BP in order to maintain cardiac output

• high pulse rate can be an early indication of changes to perfusion

• reduced pulse rate can be a late sign whih indicates compensation is failing, and the patient may be deteriorating

Systolic blood pressure points

• If the blood pressure is too low, the blood will not be pumped into the capillar bed of the distal circulation

• blood pressure alone is not an adequate indicator of perfusion

Capillary refill timestamps

Normal - 2 seconds or less

Delayed - 2-4 seconds (may indicate poor perfusion)

Abnormal - 4 seconds or more

Features of dequate perfusion

Skin: warm, pink, dry

Pulse: 60-100/min

Systolic blood pressue: more than 100mmHg

Conscious state: Alert and orientated in time and place

Capillary refill: 2 seconds or less

Features of borderline perfusion

Skin: Cool, pale, clammy

Pulse: 50-100/min

Systolic blood pressure: 80-100mmHg

Conscious state: Alert and orientated in time and place

Capillary refill: more than 2 seconds

Features of inadequate perfusion

Skin: Cool, pale, clammy

Pulse: Less than 50 or more than 100/min

Systolic blood pressure: 60-80mmHg

Conscious state: Could be alert and orientated in time and place or have altered consciousness

Capillary refill: more than 2 seconds

Features of extremely poor perfusion

Skin: Cool, pale, clammy

Pulse: Less than 50 or more than 110

Systolic blood pressure: less than 60mmHg

Conscious state: altered consciousness or unconscious

Capillary refill: more than 2 seconds

Features of no perfusion

Skin: Cool, pale clammy

Pulse: Absent

Systolic blood pressure: unrecordable

Conscious state: unconscious

Capillary refill: none

Difference between breathing and respiration

Breathing refers to the physical act of inhaling and exhaling air, while respiration is the process where cells use oxygen to produce energy and release carbon dioxide.

9 steps of assessing respiration status

1. general appearance

2. speech

3. breath sounds

4. respiratory rate

5. respiratory rhythm

6. respiratory effort

7. pulse rate

8. skin status

9. consciousness

4 abnormal respirartory sounds (with definitions)

1. Stridor - wheezing sound in the upper airway during inhalation, suggests narrowing of the larynx or partial obstruction

2. Wheeze - high pitched sound during expiration, suggests narrowed or inflamed airways

3. Crackles - heard at the base of the lungs during expiration, suggests fluid, mucus, or pus in the small airways or alveoli

4. Pleural rub - heard in the lower anterior chest during inspiration and expiration, suggests inflamed pleura rubbing together

Normal respiratory status features

General appearance: Calm, quiet

Speech: Clear, steady sentences

Breath sounds: Quiet, no abnormal breath sounds

Respiratory rate: 12-16/min

Respiratory rhythm: regular, even cycles

Respiratory effort: Normal chest movement

Pulse rate: 60-100

Skin status: Pink, warm, dry

Conscious state: Alert

Mild respiratory distress features

General appearance: Calm or mildy anxious

Speech: Full sentences

Breath sounds: Cough, mild expiratory wheeze, some basal crackles

Respiratory rate: 16-20/min

Respiratory rhythm: normal or slightly prolonged expiratory phase

Respiratory effort: Increased normal chest movements

Pulse rate: 60-100

Skin status: Pink, warm, dry

Conscious state: Alert

Moderate respiratory distress features

General appearance: Distressed or anxious

Speech: Short phrases only

Breath sounds: Cough, expiratory wheeze and/ or inspiratory wheeze, basal to mid zone crackles

Respiratory rate: less than 20/ min

Respiratory rhythm:Prolonged expiratory phase

Respiratory effort: Marked chest movement and/ or accessory muscle use

Pulse rate: 100-120

Skin status: pale, clammy

Conscious state: normal or altered consciousness

Severe respiratory distress features

General appearance: fighting to breathe, exhausted

Speech: Words only or unable to speak

Breath sounds: Unable to cough, expiratory and inspiratory wheeze, full field crackles, inspiratory stridor, reduced breath sounds

Respiratory rate: more than 20/min or less than 8/ min

Respiratory rhythm: Prolonged expiratory phase

Respiratory effort: Marked accessory muscle use, intercostal recession, tracheal tug

Pulse rate: more than 120. bradychardia (late sign, imminent arrest)

Skin status: Pale, sweaty, cyanosis (late sign, severe)

Conscious state: altered consciousness or unconscious

5 neurological status assessment factors

1. levels of consciousness (GCS)

2. pupils

3. motor functions

4. sensory function

5. vital signs

Stroke assessment (FAST)

F - Face, assessing their face for symmetry (smile, stick your tongue out)

A - Arms, assess the patient’s strength, movement and sensation in their arms (reach up and squeeze both of your hands)

S - Speech, when the patient is talking, listen for any slurring in their speech

T - if a member of the public notices the stroke, time is their cue to call for help (establish when the symptoms started)