General Patient Care 2.1

Scene Arrival & Size Up

1. Consider BSI

2. Consider PPE

3. Scene Safe

4. # of Pts

5. Additional Resources

Patient Approach

1. MOI/NOI

2. Begin triage/MCI procedures

3. Consider language line

Initial Assessment is meant to?

Develop a general impression on first contact.

Signs of a clinically unstable patient.

Any patient in extremis or wither imminent risk for deterioration to arrest.

Examples of a patient in extremis/clinically unstable.

1. New onset of altered mental status

2. Airway compromise

3. Acute respiratory distress

4. Signs of poor perfusion

5. Any other patient judged by the clinician to be in extremis or at risk for deterioration or cardiac arrest

What do you do if you have a clinically unstable patient.

1. Stop all movement o f patient

2. Do not initiate transport

3. Proceed to critically unstable patient protocol immediately

Pediatric Assessment Triangle involves what?

1. Appearance

2. Work of Breathing

3. Circulation to Skin

A in AVPU

Alert

V in AVPU

Responds to Verbal Stimuli

P in AVPU

Responds to painful stimuli

U in AVPU

Unresponsive

Foreign Body airway Obstruction for conscious patients 1 year of age or older should:

Alternate 5 back blows followed by 5 abdominal thrusts until the object becomes expelled or the patient becomes unresponsive.

Foreign Body Airway Obstruction for Conscious Infants less than one year of age.

Alternate 5 back blows and 5 abdominal thrusts using the heel of one hand, until the object os expelled or the patient becomes unresponsive.

Unconscious patients of all ages.

Begin HP-CPR immediately.

If object is seen in mouth, use finger sweep.

If patient air way ________ established, the patient must be transported to the closest appropriate hospital faced emergency dept, or designated freestanding emergency medical facility.

Cannot be

If patients ventilations are not adequate, provide assistance with 100% oxygen using _______.

Bag Valve Mask

Ventilations for patients 13 years of age or older:

1 breath every 6 seconds (10 breaths per minute)

Ventilations for neonates and patients less than 13 years of age:

Deliver 1 breath every 3 seconds (20 breaths per minute)

Ventilations for newly born patients (first hour after delivery), refer to:

The universal algorithm for the newly born

Supplemental oxygen is not needed of SpO2 is greater than or equal to _____, unless the patient is in respiratory distress.

94%

Unless in resp distress, avoid administration of high flow O2 patients presenting with the following conditions:

1. Stemi/Angina

2. CVA/Stroke

3. Post arrest

CO exposure should apply 100% oxygen via _____.

NRB mask

94%-100% is considered ______

Normal

91%-93% is considered ________.

Mild Hypoxic

O2 Saturation between 86%-90% is considered _______.

Moderate Hypoxia

How do you treat moderate hypoxia?

Give 100% oxygen, assisting ventilations if necessary.

Oxygen saturations less than or equal to 85% is considered _________.

Severe Hypoxia

How to treat severe hypoxia.

Give 100% oxygen. Assist ventilations if indicated and intubate.

Hypothermia, Hypoperfusion, CO Posioning, Hemoglobin Abnormality, Anemia, Vasoconstriction, and Dark Skin Color

Examples of what can cause inaccurate SpO2 readings

Hyperventilation rates for Adults (13 Years of older):

20 breaths per minute

Hyperventilation rate for child (1-12 years):

30 breaths per minute

Hyperventilation rate for infants (less than 1 year of age):

35 breaths per minute

Significant head injuries should maintain an ETCO between _____ for any patient with significant head injury.

35-40 mmHg

For pts with significant head injury and signs of herniation, adjust ventilations to achieve ETCo2 of ________.

30-35 mmHg.

HPCPR Compression/Ventilation Ratio w/o advanced airway for Adults and adolescents.

1 breath per every 10 compressions on the recoil of the 10th compression .

1 rescuer HPCPR Compression/Ventilation Ratio w/o advanced airway for children and infants less than 1 year.

30:2

2 rescuer HPCPR Compression/Ventilation Ratio w/o advanced airway for children and infants less than 1 year.

15:2

Compression/ventilation with advanced airway for adults and adolescents.

Continuous compressions at a rate of 100-120 bpm. Give 1 breath every 6 seconds.

Compression/ventilation with advanced airway for children and infants less than 1 year.

Continuous compressions at a rate of 100-120 bpm. Give 1 breath every 3 seconds

Compression depth for Adults and Adolescents

At least 2 inches, no more than 2.4 inches

Compression depth for children.

At least 1/3 anterior-posterior diameter chest. About 2 inches.

Compression depth for infants.

At least 1/3 anterior/posterior diameter of chest . About 1 ½ inches.

HPCPR compression rate.

100-120 bpm

Mechanical CPR may be used for patients _____of age and older only.

13 years

Managing profuse bleeding should involve:

1. Direct Pressure

2. Wound Packing

3. Hemostatic Gauze

4. Tourniquet or junctional tourniquet

Infant or child’s seats ______ be used as a spinal immobilization device for the pediatric patient.

May not

Priority 1

Critically ill or injured person requiring immediate attention; unstable patients with life threatening injury or illness.

Priority 2

Less serious condition yet potentially life threatening injury or illness, requiring emergency medical retention, but not immediately endangering the patients life.

Priority 3

Non emergent condition, requiring medical attention but not on an emergency basis.

Priority 4

Does not require medical attention.

Preemie heart rate

160

Preemie resp rate

Greater than 40

Preemie systolic

60

New born HR

130

Newborn RR

40

Newborn Systolic

70

3mo - 4 year systolic

90

6-8 year systolic

95

10-12 year systolic

100

Adult systolic

120

Adult HR

80

Adult RR

80

Meds used to treat fevers greater than 100.4

Acetaminophen

Reassess unstable patients at a minimum of:

Every 5 minutes

Reassess stable patients every

15 minutes

All requests for scene helicopter transports shall be made through:

SYSCOM

DCAPBTLS

Deformities

Contusions

Abrasions

Punctures

Burns

Tenderness

Lacerations

Swelling

SAMPLE

Signs and symptoms

Allergies

Medications

Pertinent History

Last oral intake

Events prior

OPQRST

Onset

Provocation

Quality

Radiation

Severity

Time

Indications of a critically unstable patient.

1. New onset of altered mental status

2. Airway compromise

3. Acute resp distress

4. Signed of poor perfusion

Patient is defined as:

Any person encountered by in-service rescue or emergency medical personnel with an actual or potential injury or medical problem.

A minor patient is defined as:

A patient who has not reached their 18th birthday, and is no

• Married

• Parent of a child

• Requesting treatment for drugs or alcohol

• Treatment for sti or contraception

• Treatment for Rape injuries or sexual offense

• Pregnancy related symptoms

If the authorized decision maker refuses to permit the EMS clinician to examine a minor to determine the severity of the illness or injury , ______________.

Consider contacting law enforcement