Phase 3 Final Studying

Which hospitals are STEMI centers?

All but El Camino Los Gatos, St Louise, PAV.

Comprehensive stroke centers?

Stanford, El Camino Mountain View, Kaiser Santa Clara, Good Samaritan, Regional Medical Center.

Psych Centers?

ALL.

VAD Centers?

Stanford, Kaiser Santa Clara

Labor & Delivery Center?

ALL but Regional and PAV.

Advanced Pediatric Centers?

Kaiser Santa Clara, Stanford, VMC

General Pediatric Patient Receiving Centers?

ALL but El Camino Los Gatos, PAV

SAFE Centers?

St Louise, VMC, Stanford

Approved out of county hospitals? (Not under SDO29)

Dominican Hospital

Kaiser Fremont

Kaiser Redwood City

Sequoia Redwood City

Washington Hospital

Watsonville Hospital

What is criteria for advanced pediatric center transportation?

DRESS BP!

D – Dysrhythmia
Cardiac dysrhythmia

R – Respiratory distress/ROSC
Severe respiratory distress (retractions, stridor, etc.)

E – Evidence of poor perfusion
Pallor, cyanosis, delayed cap refill, etc.

S – Stroke-like symptoms
Facial droop, slurred speech, unilateral weakness

S – Status epilepticus,
Ongoing seizure without return to baseline

B – BRUE / Abuse
Brief Resolved Unexplained Event or Suspicion of child abuse (double-duty "B")

P – Persistent AMS / Paramedic discretion
Persistent altered mental status or Paramedic discretion

In-Extremis criteria?

1. A breech presentation or protruding limb during a delivery.

2. Uncontrollable bleed

3. The inability to be ventilated adequately following the use of appropriate

BLS & ALS adjuncts and procedures.

What treatment can BLS do for trauma?

Head-to-toe Assessment (Determine if Red/Yellow)

Apply SMR

ABCS

Occlusive Dressing

Head 30 degrees for increased ICP (Cushing Triad)

If patient is Major Trauma Victim, ALL care except SMR/Airway to be completed Enroute.

Red Trauma Criteria Injury Pattern? (Anatomical?)

Penetrating to head, neck, torso, proximal extremity

Skull deformity/fracture

Suspected spinal injury with new motor or sensory loss

Chest wall instability, deformity, or suspected flail chest

Suspected pelvic fracture

Suspected fracture of two or more proximal long bones

Crushed, degloved, mangled, or pulseless extremity

Amputation proximal to wrist or ankle

Active bleeding requiring a tourniquet or wound packing w/ pressure

Red Trauma Criteria Mental Status & Vital Signs

Unable to follow commands (motor GCS <6)

RR < 10 or > 29

Respiratory distress or need for respiratory support

Room-air pulse oximetry < 90%

UNDER 10 Y/O: SBP less than 70 mmHg + 2 x (Patients’ Age)

OVER 10 Y/O: Systolic BP less than 90 mmHg

OVER 10 Y/O: Heart rate is greater than Systolic BP

OVER 65 Y/O: BP Less than 110 mmHG Systolic

Trauma Yellow Criteria? (MECHANISM)

Auto crash with partial or complete ejection

Auto crash with need for extrication

Death in passenger compartment

Vehicle telemetry data consistent with severe injury

Rider separated from transport vehicle with significant impact (eg. Motorcycle, ATV, horse etc.)

Rollover with unrestrained occupant

Pedestrian/bicycle rider thrown, run over, or with significant impact

Fall from height > 10 feet (all ages)

Burn Criteria?

Burns greater than 10% TBSA

Burns that include the face, hands, feet, genitalia, perineum, or major joints

Full thickness burns

SEPSIS Criteria?

< 96F > 100.4F

> 90HR

> 20RR

< 25 ECO2

Advanced notification to hospital of suspected sepsis if 2 or more criteria are met.

What things do you need when arriving at the hospital?

Face sheet, Nurse signature

What to get before arriving on scene to the call?

Upload the call on the CAD from dispatch before getting on scene

ALS TO BLS Criteria Vital Signs?

RR < 10 or RR > 24

<93% O2 OR below with supplemental oxygen.

SBP > 90 mmHg.

Sustained BP > 180/100 mmHg, (either systolic or diastolic).

Sustained HR > 120

HR < 60 and symptomatic.

BGL > 400 mg/dl.

<95°F or >103.0°F

What is the ALS TO BLS temperature? v.s. What is the SEPSIS temperature?

Sepsis: 96F to 100.4F

ALS: 95F to 103F

What’s the Red trauma criteria pulse ox vs the ALS TO BLS Pulse ox?

ALS TO BLS: <93% O2 OR below with supplemental oxygen.

RED TRAUMA: Room-air pulse oximetry < 90%

ALS TO BLS Criteria impressions?

Foreign body airway obstructions.

Abdominal pain (associated with fever, syncope, severe pain, possible ectopic pregnancy).

Acute cardiac dysrhythmias.

Suspected cardiac chest pain.

Overdose or poisoning.

Seizures or postictal.

Suspected sepsis.

Hypoglycemia (less than 60 mg/dl)

Altered mental status (altered for the patient).

Any specialty care alert (Trauma meeting “Red Criteria”, Stroke, STEMI, Burns, Advanced Pediatrics).

Water related submersion incidents.

Pregnancy related complications.

Need for ALS medication administration.

Can BLS pronounce death? What criteria?

Yes Based on:

• Obvious death: Rigor Mortis, Dependent Lividity, Decapitation, Total Incineration, Decomposition, Separation of heart, brain, lungs.

• Pulseless Apneic w/: DNR, POLST, Adv Directive

• End of Life Option Act.