Cards made from pocket prep

What is the fowler position?

45-60 degree angle is formed from the stretcher

• Indicated when patient has chest pain or respiratory distress

• Without spinal immobilization or hypotension

What is the first check in the GCS?

Eye opening:

4. Spontaneous

3. Sound

2. Pain

1. Unresponsive

What is the second check of GCS?

Verbal Response

5. Oriented

4. Confused

3. Inappropriate

2. Incomprehensible

1. Unresponsive

What is the third check of GCS

Motor Response

5. Obeys command

4. Localizes

3. Decorticate

2. Decereberate

1. Unresponsive

   

In an MCI, if a patient is able to walk and and have no major injuries what do you label them?

Green

In an MCI, you check RPM,

• R: respirations → none after tilt-chin-lift?

  • → yes after tilt-chin lift?

  • Over 30?

• P: perfusion → radial pulse absent →

• M: mental status → unable to follow commands →

All others →

R: BLACK. RED

• RED

P: RED

M: RED

All others: YELLOW/ DELAYED

What are the common nerve agents and what is used to stop them?

• VX

• Tabun

• Sarin

• Soman

  • What to use after exposure to nerve agent

  • Mark 1 and DuoDote

What are the common vesicants?

Vesicants: blister agents

• Lewisite

• Mustard gas

What is the AHA chain of survival?

In children, what are the early and late signs of respiratory distress?

Sign that respiratory problems are impending: Bradypnea

Early: Agitation

Late: Cyanosis, Bradycardia

Signs of Anti-cholinergic (bendaryl) poisoning

HRDBM hardBM →

• Hot as a hare

• Red as a beet

• Dry as a bone

• Blind as a bat

• mad as a hatter

Causes of altered mental status:

AEIOU-TIPS

• Alcohol

• Epilepsy

• Insulin

• Opiates

• Uremia

• Trauma, Temperature

• Infection

• Poisoning

• Shock

Stroke assessment:

FAST

• Face

• Arms

• Speech

  • Time

Signs of Intracranial pressure increase

Cushing’s triad

• Irregular respiration

• Widened pulse pressure

• Bradycardia

  • Pressure on ocular nerve leads to possible change in pupil size

Sign of Abdominal aortic aneurysm

the aorta pops →

• Loss of blood pressure

• Loos of perfusion → cool skin

How to be safe when entering a helicopter

• wait for the pilot to let you know it is safe

• Enter from positions 10 and 2

• Has important info about transported hazardous material

• On a highway transport truck

• Bill of Lading:    

Chain of command:

Medical director

Incident commander

Liason+Public information officers

Pulmonary edema vs Asthma vs Pulmonary embolism:

1. Pulmonary edema: Jugular vein distention + Bilateral lower extremity edema

2. Asthma: prolonged expiratory phase + expiratory wheezing

3. Pulmonary embolism: Chest pain + shortness of breath

Hypoglycemia symptoms

• Hypo→ less

  • Slow breathing

  • Weak pulse → leads to faster beat so tachycardia

  • Pale, cool skin

  • Altered mental status and rapid onset of symptoms

Acute coronary syndome (ACS): which conditions are categorized in this?

• Acute myocardial infarction

• Stable and Unstable Angina pectoris

How to perform secondary assessment in 3 steps

• SAMPLE OPQRST

• Baseline vital signs

• Focus on chief complaint physical exam

What is the occlusive dressing for?

• prevent air and liquids from entering or exiting a wound

• Uses:

  • To prevent Tension pneumothorax (chest wound)

  • To prevent mesenteric necrosis and hypothermia (abdominal evisceration)

  • Prevent peritonitis (Open back wounds)

  • Prevent mediastinitis (Neck injuries)

What should you first do if you have a patient who is profusely bleeding? 3 steps optional

• Apply direct pressure

• Apply a pressure dressing

• Apply a tourniquet proximal to the injury

Cardiac tamponade

• Why does it happen?

• What are symptoms of this?

Fluid buildup around the sac of the heart

• Associated with chest trauma

• Muffled heart tones, jugular venous distension and hypotension

  • Can’t pump as well → Can’t hear it pumping, Veins cannot drain blood into the heart, so it backs up, and lack of blood in arteries leads to less pressure.

Nitroglycerine administration and contraindications

• List side effects

Vasodilator

• Contraindicated for patients with systolic BP less than 90 mmHg

• Side effects: Headaches, Hypotension, Tachycardia OR Bradycardia.

Cullen’s sign?

Bruising around the umbilicus,

• sign of intraperitoneal hemorrhage

• Pancreatitis or ectopic pregnancy

• “Umbilicullen”

Grey-Turner’s sign?

bruising of the flanks

• Sign of retro peritoneal hemorrhage

• SEVERE pancreatitis

• Turn to your side

Murphy’s sign

Pain upon palpation of right upper quadrant (RUQ) during inspiration

• cholecystitis—inflammation of the gallbladder

Kehr’s sign?

Pain at the tip of the left shoulder

• Intra-abdominal bleeding affecting the spleen

• Blood or other fluid enters the peritoneal cavity, irritating diaphragm and then the shoulder

• Kehr-bear gives a hug on top of shoulder→ah! my spleen!

• OR: Imagine a K on the patient. One line radiates the shoulder. One line goes the to spleen.

What does RICES stand for?

Rest, ice, compression, elevation, splinting

How should a patient be transported while in shock?

Supine

How should a pregnant patient be transported?

On her left side

When is the traction splint mainly used?

Mid-femur fracture

What are the sympathomimetics?

Mimic the Sympathetic nervous system (Dilate pupils, tachycardia, hypertension, seizures, agitation, hyperthermia)

• Cocaine

• MDMA (ecstasy)

• Methamphetamine

• Caffeine

Treatment for acute abdomen:

Supplemental oxygen, and Lay on left side to prevent aspiration of vomitus.

• Oxygen for possible shock due to internal bleeding.

What is in the LUQ of the abdomen?

Stomach, spleen and part of the pancreas

What is in the RUQ of the abdomen?

Liver, gallbladder, duodenum, and part of the pancreas

What is in the LLQ of the abdomen?

Descending colon and left half of transverse colon

Small intestine

What is in the RLQ of the abdomen?

Appendix, Ascending colon, and right half of transverse colon

Small intestine

How much blood is in the human body?

• How much loss results in hypovolemic shock?

  • Tell Me some signs of Hypovolemia:

6 Liters

• 10% is generally well-tolerated (tachycardic compensation)

• 20-25% leads to loss of compensatory mechanism

• 40% is overt shock (hypotension, decrease cardiac output)

  • Tachypnea, tachycardia (weak), Hypotension, AMS, cyanosis, cool & clammy skin

Difference between Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS)?

DKA: Normally happens to type 1 diabetics

• Blood glucose concentration is lower and ketones are present

HHS: Normally happens to type 2 diabetics due to insulin resistance

• Blood glucose concentration is higher and ketones are absent

What is the use of Aspirin?

• What is the max dose?

In a patient presenting with suspected acute coronary syndrome, Aspirin inhibits platelet aggregation, which can limit the progression of coronary artery thrombosis and reduce myocardial damage.

• 324 mg

• Do not give it to children

• Don’t give it to asthmatics, causes bronchoconstriction

What is the use of Nitroglycerin?

• What is the max dose?

Used for ischemic chest pain relief. It is contraindicated for patients who have taken phosphodiesterase inhibitors (PDE5) like cialis or viagra

• 1.2 grams or three 0.4 mg tablets

What are the signs of a Basilar Skull Fracture?

Cerebrospinal Fluid Otorrhea (Clear fluid from ears)

Hemotympanum (blood behind tympanic membrane

Retroarticular Ecchymosis (Battle Sign or Mastoid bruising)

Periorbital Ecchymosis (Raccoon eyes)

CHRP → “Chirp” → With the ears that were fractured in the petrosal, you hear a chirp

What are the signs of a Hemothorax

Diminished breath sounds

Asymmetrical chest movement

Tachycardia

Shortness of breath

“DATS a hemothorax”

What are some signs of Hypoglycemia?

Neuroglycopenic symptoms due to insufficient glucose in the brain:

• Confusion

• Slurred speech

  • Also: Seizures, coma, irritability, difficulty speaking

Adrenergic activation:

• Pale, Cool, Diaphoretic Skin

  • Tremors, anxiety, tachycardia

What are some signs of hallucinogenic intoxication?

Dilated pupils

Hypertension

Warm, Dry skin

• Also: Tachycardia

When should you start CPR on an unresponsive infant?

When there is no palpable pulse or when the pulse is less than 60 bpm

What is the bends and the squeeze?

Scuba diving condition:

• The bends: Decompression sickness

• The squeeze: descent pains

Compare the airway of a pediatrics and adults

Children: have smaller trachea, faster respirations, Larger tongue, rely on diaphragm more to breath

Adults: Use chest muscles more for breathing

What is the target oxygen saturation of these three conditions?

• ACS:

• Stroke:

• Post-cardiac arrest:

ACS: 90%

Stroke: 95% to 98%

Post-cardiac arrest: 92% to 98%

What are causes of obstructive shock?

Tension pneumothorax

Cardiac tamponade (Fluid buildup prevents heart from filling with blood)

Pericardial effusion (Just fluid buildup)

What is the operations section of the ICS?

Manages tactial, hands on activities during an incident

• Traige, treatment, transport, rescue

What is the command staff section of the ICS?

Handles information, safety, and inter-agency coordination

• Liaison officer

• Incident commander

• Public information officer

• Safety officer

The command staff has a lisp

What is the planning section of the ICS?

Analyzes document information, tracks resources and status, and produces the Incident Action Plan (IAP).

• Decision making

What is the Finance/Adminstration section of the ICS?

Manages costs, timekeeping, contracts/procurement, and reimbursement/claims

What is burn shock and when does it occur?

Capillary leakage leads to poor perfusion

• After 30% of total body surface area (TBSA) is affected by burns.

• Pulse becomes weak

  • Normal response to full-thickness burn would be leathery but not weak pulse.