Chapter 4 Emergency Care

Platinum 10 Minutes

the critical interval during which emergency personnel assess the situation and decide to initiate treatment or transport immediately

-also known as “stay and play or load and go”

Golden Hour

the approximate time during which treatment of shock or traumatic injuries is most critical for emergency treatment to improve the patient’s chances of survival

Component of the Emergency Assessment

-scene size up

-initial assessment

-chief complaint or concern

-focused assessment

-reassessment

Scene Size Up

-rapid transport considerations

-ensure scene safety

-determine the MOI or NOI

-adhere to standard precautions

-triage patients: find life threatening illness or injury

-consider equipment needed and request additional help

Rapid Transport Considerations

-unresponsiveness

-responsive but not following commands

-mental status changes

-shock (hypo perfusion) or uncontrolled bleeding

-severe pain in abdomen, chest, with breathing

-choking

-coughing up or vomiting blood

-head injury

-ingestion of poisonous or toxic substance

-loss of consciousness

-shortness of breath

-spine injury

-vision changes or difficulty

-vomiting that is severe or persistent

Mechanism of Injury (MOI)

used to establish a trauma patient and help in performing rapid trauma exam

Nature of Illness (NOI)

specific to making a correct field diagnosis of an acute medical condition

Significant MOIs

-vehicle collision or ejection

-falls more than 20ft (adults), 10ft (children)

-blunt trauma to the chest

-penetrating wounds of the head, chest, or abdomen

-head trauma with intracranial lesion

-spinal cord injury

-exsanguinating or uncontrolled hemorrhage

Field Triage Guidelines: Physiologic

Glasgow coma scale: <14

systolic BP: <90 mmHg

respirations: <10 OR >29 per minute

Field Triage Guidelines: Anatomic

-penetrating injuries to the head and torso

-flail chest

-multiple long bone fractures

Field Triage Guidelines: Significant MOI

-fall from a height >20ft (adult)

-fall from a height >10ft or 2-3 times child’s height

-ejection from vehicle

Field Triage Guidelines: Special Scene or Patient

-age of patient

-pregnancy

-additional specific injuries

-judgement of pre-hospital care provider

Glasgow Coma Scale

eye opening: 1=none 4=open spontaneously

verbal stimulus: 1=none 5=oriented

motor stimulus: 1=none 6=obeys command

combined score: <8 are considered unresponsive or comatose

START

Simple Triage And Rapid Treatment

Red Triage

may survive with immediate medical attention; treatment can NOT be delayed

Yellow Triage

should survive with medial attention, injuries can wait

Green Triage

walking wounded; does not require rapid medical attention

Black Triage

seriously injured and unlikely to survive

RPM

respiration: after manually positioning airway >/= 30 breaths per minute

perfusion: presence of radial pulse or capillary refill <2 second

mental status: ability to follow commands

AVPU Scale

classification of mental status

-Alert: patient is fully awake (but not necessarily oriented)

-Voice: patient makes some kind of response when you talk

-Pain: patient responds to application of pain stimulus

-Unresponsive: patient gives no eye, voice, or motor response to voice or pain

Asses Circulation (Stable Patient)

every 15 minutes (pulse)

Assess Circulation (Unstable Patient)

every 5 minutes (pulse)

DCAP-BTLS

Deformities and Discolorations

Crepitus and Contusions

Abrasion and Avulsion

Penetrations and Punctures

Burns

Tenderness

Lacerations

Swelling and Symmetry

OPQRST Questions

Onset

Provocation

Quality

Region and radiation

Severity

Time

Pale or Mottled Skin

early-stage shock

Clammy (cool, wet/diaphoretic) Skin

uncompensated shock

Cyanotic Skin

late-stage shock

Red Skin

-anaphylatic shock

-poisoning

-overdose

-or other medical condition

Flushed Skin

-exercise

-sun exposure

-heat stroke

Yellow Skin

-jaundice

-liver disorder

Pale, White, Ashen or Gray Skin

-perfusion

-reduced peripheral circulation

-low oxygen saturation

Hot Skin

-fever

-heat exposure

-localized infection

Wam Skin

normal

Cool Skin

-inadequate perfusion

-shock

-cold exposure

Cold Skin

-hypothermia

-frostbite

Wet (diaphoretic) or Moist Skin

-shock

-sweating

-cardiac

-diabetic emergency

Abnormally Dry Skin

-severe dehydration

-spinal injury

Indication of Hypoxia

SpO2 </= 94%

SBAR Method for Patient Hand Off

Situation

Background

Assessment

Recommendation