FINAL

Rule of 9s

1. For adults each section is 9% of the body: head and neck, each upper extremity, chest, abdomen, upper back , lower back and buttocks, front of each lower extremity, back of each lower extremity, last 1% is genital region

Rule of Palm

Use to estimate the extent of a burn. Palm and fingers of patient’s OWN hand which make up about 1 percent of body’s surface area, are compared with patient’s burn to esitmate how size

How to treat hypothermia ( TOO COLD)

• Remove from environment

• Passvie

  • Remove all wet clothing and cover them with blankets (anything dry)

  • Ensure that head and feet and covered

• Active

  • Oxygen

  • Apply external heat source slowly

  • If alert, slowly give them warm liquids

  • You immerse limbs of body in lukewarm water ( 105 degrees F max) to rewarm

How to treat Hyperthermia (TOO HOT)

• Remove from environment

• May have to remove clothing

• Apply cold packs to neck, groin and armpits

  • Cover ice packs with a cloth first

• High concentration Oxygen

  • Cool them off

signs and symptoms of Hypoglycemia

• Pale cool and diaphretic (sweaty) skin

• Tachycardia

• Rapid breathing

• Seizures

• Rapid breathing

• Seizures

• Abnormal behavior mimicking a drunken stupor

Hypoglycemia

• low blood sugar (acute rapid onset)

Causes of hypoglycemia

• too much insulin

• Overexcercising or overexertion

• Vomiting

• Increased metabolic rate

• Too little sugar intake

Hyperglycemia

high blood sugar (much slower)

Signs of Hyperglycemia

• Dry, blushed skin (warm)

• Chronic thirst and hunger

• Increased urination

• Nausea

• Dehydration

• Cells are starving bc theres no glucose

• Caused by insulin deficiency

Pathophysio of Insulin

• Insulin: used to transfer glucose molecules across cell membrane

  • Key ( Insulin) that unlocks the door (cell membrane) to deliver the package

• (glucose)

When should an impaled object be removed

Impaled objects SHOULD NEVER BE REMOVED unless they come in the way of CPR

How to treat an impaled object

• BSI

• PENMAN

• Your GI should be obvious, along with the chief complaint

• ABCDE’s

  • May need to expose the patient depending on location

  • If object is restricting the need for CPR then it can be removed, but keep in mind it’s gonna LEAK

  • Obviously the blood will be part of C

•  Look for an exit wound

• Make sure the patient doesn’t move a ton

• Control profuse bleeding via direct pressire

• Apply everal layers of bulky dressing so dressing surrounds the object on all sides and bandage them in

• Secure the object, care for shock

  • If it’s the eye, cover the other eye as they move in tandem

• And DRIVEEEEEE

Definition of syncope

• Brief loss of consciousness with spontaneous recovery

  • Falling unconscious with style (fainting)

  • Vasovagal syncope

    • Simple fainting due to stimulation of vagus nerve (normally due to stress)

What causes syncope

• Hypoxia

• Hypoglycemia

• Hypovolemia

• Tachycardia or bradycardia (cardiovascular)

• GI bleed

• Stroke

• Carbon monoxide poisoning

How to open an airway for trauma and non trauma patient

•  Start with jaw Thrust

• Suction if needed

• OPA or NPA

• Put on C-collar if needed

Blunt Trauma definition

• An injury caused by a non-penetrating force that impacts the body

  • Can break bones, cause internal bleeding etc

S of SLUDGEM

salivation

L of SLUDGEM

lacrimation

U of SLUDGEM

urination

D of SLUDGEM

defecation

G of SLUDGEM

GI upset

E of SLUDGEM

Emesis

M of SLUDGEM

miosis

What is SLUDGEM used for

When a person has been exposed to a nerve agent

Definition of Evisceration

an intestine or other internal organ protruding through a wound in the abdomen

Treatment of evisceration

• Soak a sterile dressing with sterile saline

• Place moist dressing over wound, can use multiple to make sure organ doesn’t dry out

• Apply occlusive dressing over moist dressing, cover wound to maintain warmth and secure dressing

B of BELFAST

Balance: is the pts balance or gait off

E of BELFAST

Eyes: One pupil will be blown (dialated)

L of BELFAST

 Late symptom

F of BELFAST

Facial droop: one side will not respond

A of BELFAST

arm drift: will not be able to control arm as it falls completely

S of BELFAST

Speech: Slurred speech

T OF BELFAST

• Time: How long has it been going on for

  • If less than 3-4 hours, doctors can give clot buster medications

What is Belfast for

Accessing for stroke

Treatment for stroke

• Give oxygen

• Give reassurances

• To give anti-clot medication

  • Onset of stroke less than 3 hours prior

  • CT scan showing no evidence of hemorrhagic stroke

  • Blood pressure that is not excessively hypertensive

    • Document exact time of symptom onset

• AND VROOM VROOM AWAY

Types of stroke

Hemorrhagic and Ischemic

Ischemic stroke

caused by a blockage that occurs due to a clot or embolism obstructing an artery

Hemorrhagic stroke

is caused by bleeding from a ruptured blood vessel in brain

What is a TIA

miniature strokes: transient ischemic attack (T I A), the patient exhibits stroke signs that

Signs of TIA

• Resolve within 24 hours

• Small clots temporarily block circulation to part of the brain and cause stroke-like symptoms

• Symptoms resolve when the clots break up

• The period of hypoxia is short and there is no permanent damage

• The patient is at risk of a full-blown stroke and should be evaluated as soon as possible

What is a full stroke

condition of altered function caused when an artery in the brain is blocked or ruptured, disrupting the supply of oxygenated blood or causing bleeding into the brain ( can be hemorrhagic or ischemic)

How to treat OD of opiates

• Give them Narcan and step back

• Check pupils and breathing

How to treat OD of antidepressants

Activated charcoal

How to suction a small infant or child

• Suction mouth first, THEN nose

• Use with french catheter or bulb syringe

  • Infants, 5 second max

  • Children 10 second max

• Will most likely need oxygen

Epiglottitis

infection causing swelling around and above epiglottis. Can cause airway obstruction

Signs and Symptoms of Epiglottitis

• Sore throat, painful or difficult swallowing

• Tripod position

• Sickly looking

• Muffled voice

• Fever

• Drooling

• Stridor

Treatment for Epiglottitis

• Keep patient calm and comfortable

• Do NOT inspect throat

• Give Oxygen if possible

• Transport

  • Wear a mask

Croup

caused by viral illnesses that result in inflammation of larynx, trachea, and bronchi. Tissues of upper airway can become swollen and restrict the passage of air

Signs and symptoms of Croup

• Loud barking cough ( the SEAL)

• Hoarse voice

• Breathing difficulty is less when sitting upright

• Inadequate breathing 

  • Signs of hypoxia (cyanosis, altered mental status)

• Signs of breathing diffculty

  • Inspiratory stridor ( Stridor when they inhale)

Treatment of croup

• If there are signs of inadequate breathing, initiate artificial ventilation and immediate transport

• Allow patient to remain in position of comfort

• If patient is in respiratory distress but is breathing okay, call ALS and initiate gentle transport

Cardiogenic shock

• caused by inadequate pumping of blood by the heart

Hypovolemic shock

low blood volume leads to reduced pressure in cardiovascular system, low oxygen quality, and then DIE

Distributive shock

• caused by uncontrolled dilation of blood vessels due to

• anaphylactic, neurogenic, or septic causes

Septic shock

• occurs when these hanges result in shock and hypotension that do not respond to intravenous fluids

  • Lactic acid and other chemicals accumulate in bloodstream, causing vasodilation and increased capillary permeability( leaky capillaries) which leads to hypotension

Anaphylactic shock

 a severe allergic reaction that causes blood vessels to dilate, and bronchoconstriction -> hypotension

Neurogenic shock

• hypoperfusion caused by spinal cord injury that results in systemic vasodilation

  • Blood pressure drops and systemic vasodilation dominates

Obstructive shock

caused by obstructed blood flow from the heart due to conditions such as cardiac tamponade, pulmonary embolism, or tension pneumothorax

Compensated shock

•  Fight or flight response

  • Makes body work harder, needing more energy and oxygen to maintain the rate and leads to failed compensation when it can’t keep up

  • Symptoms:

    • Increased heart and respiratory rate

    • Delayed cap refill

    • Pale skin that is cool and moist to touch

Decompensated shock

•  Hypotensive shock. Body’s attempts to work harder begin to fail as organs and muscles can no longer keep up and begin to fail

  • Symptoms:

    • Decreased blood pressure

    • Slow heart and respiratory rate

    • Altered mental status

    • Leads to irreversible shock where oxygens are starved of oxygen and start to die

P of PPEBBLE

Paragravita: how many children do you have and how many times have you been pregnant?

P2 of PPEBBLE

• Prenatal care: Is the mom under the care of a doctor?

  • If not just expect that there’s gonna be problems

E of PPEBBLE

Expected due date: When is the baby expected?

B1 of PPEBBLE

Bag of water: has the water broken? How long ago did it break? And what color was it?

What is meconium staining

• indicates that there may be fetal distress

  • Feces of child from amniotic sac (Often due to poor lifestyle choices of mother[smoking, drugs, drinking, etc])

B2 of PPEBBLE

Baring down: Is mom ready to push?

L of PPEBBLE

• Length of contractions

  • When they last 30 seconds-1 minutes and are 2-3 minutes apart, delivery of baby is imminent

E of PPEBBLE

Expected complications: Does the mom know if she’s going to have complications?

When to do APGAR and what it is

• 1-3 scale where appearance, pulse, grimace, activity, and respiratory rate

  • If baby has pulse less than 100 bpm, do rescue breathing 1 every 2-3 seconds for 2 mintues and reacess

  • If pulse rate is less than 60 bpm, do CPR for 2 mins then reacess

  • If not crying, start stimulating baby ( rubbing feet or back)

  • Done in the first minute and after 5 minutes

Stage 1 of labor

• Starts with regular contractions and ends when cervix is fully dilated

  • Contracts get closer and shorter

    • Last 30 seconds - 1 mintue at 2-3 minutes apart

  • Amniotic sac breaks

Stage 2 of labor

• Baby enters and exits birth canal

  • Mother will start pushing

Stage 3 of labor

• Begins after baby is born and ends when placenta is delivered

  • After baby is born, contractions start again and end when placenta comes out 

    • 10-20 minutes

Aerobic metabolism

• produces efficient amounts of energy and minimal waste products

  • WHEN OXYGEN IS PRESENT

Anaerobic metabolism

• produces less energy and more waste products like lactic acid, and makes body acidotic

  • OXYGEN IS NOT PRESENT

SIgns and symptoms of Upper GI bleed

coffee ground vomit

Signs and symptoms of lower GI bleed

frank blood from rectum, or tarry dark colored stool

First degree burn

•  involves only epidermis and characterized by reddening of skin and some swelling. Ex: Sunburn

  • AKA superficial burn

Second degree burn

•  a burn in which the epidermis is burned through and the dermis is damaged. Causes reddening, blistering, and mottled appearance

  • AKA partial thickness burn

Third degree burn

• a burn in which all the layers of the skin are damaged. There are usually charred areas that can black, or dry and white. Might require skin grafting to fix and causes dense scarring. May damage muscle, bone and underlying organs 

  • AKA Full thickness burn

How to treat anaphylaxis

Treat via EPI (duh)

signs and symptoms of anaphylaxis

• Vasodilation (arteries get bigger)

• Bronchoconstriction (bronco tubes close)

• Swelling of airways, lips tongue and throat

Behavioral emergency

• when a patient’s behavior is not typical for the situation

  • Patient’s behavior is unacceptable or intolerable to the patient, the patient’s family or community

  • When patient may harm themself or others

Physical emergency

• sudden, serious injury or illness requiring immediate medication attention

  • Heart attack, severe injury, difficulty breathing

what the peripheral nervous system consists of

consists of sensory and motor nerves that enter and leave the spinal cord and travel between the brain and organs without passing through spinal cord

What can trauma to the peripheral nervous system cause

• Loss of sensation

• Paralysis

• Loss of coordination

• Chronic pain

Distance for no apparent hazards on scene

50 feet in every direction

Apparent hazards

100 feet in every direction

what does the medulla oblongata do

In control of respiratory control, heart rate and blood pressure

implied consent

patient has altered level of consciousness and the assumption is that they want to be treated

• Expressed consent

• the patient is informed and agrees to be treated

• Scope of practice

• what you can do based on protocol

• Duty to act

• an obligation to provide emergency care to the patient

• Breach of duty

failing to fulfill your legal obligation to assist someone and give the required standard of care

Negligence

• finding there was a failure to act properly in a situation in which there was a duty to act resulting in damage or harm to the patient

  • Basically, you fucked up and shouldn’t have

 power of attorney

AKA medical proxy: a person who legally has the power to make medical decisions on the patient’s behalf

what HIPPA is and how it can be violated

• HIPAA: Health Insurance Portability and Accountability Act, which includes the privacy rule protecting the privacy of patient-specific health care information and providing the patient with control over how this info is used and distributed

• Basically don’t say what you’re not supposed to

what DNR is and how it can be voided

• DNR: Do not resuscitate

  • Can be voided if patient with DNR wants you to save them (expressed consent)

  • Can be voided if the Medical proxy demands you to save them

 what AMA is and how it can be voided

• Against medical advice

  • Patient refuses medical care after being fully informed of what could happen (complications up to death)

  • Must be legally able to consent, awake, orientated

    • Must tell them they can call us back

• Can be voided: If the patient needs to be treated under implied consent

  • EX: Signs AMA but then has a heart attack

 who you are allowed to pass patient care to

• Patient care can be released to anyone of equal or greater medical training

 how to talk to family members when the outcome isn’t good

• Do not tell them everything’s okay (because it clearly isn’t) 

• Do not tell them you know how they feel (BC you probably don’t)

• Tell them that you are doing your best

• Don’t have judgement, show empathy and sympathy

• Be honest and gentle

• Use simple language

Ryan white Care Ac

• allows EMS providers to figure out if they have been exposed to potentially life-threatening diseases while providing patient care

  • It is a third-party entity, so there is patient confidentiality, and the liaison will contact the employer on your behalf to get you workman’s comp without giving any details regarding your condition