EMS 9-11

management

environment

hazards

violence

additional recourses

precaution

multiple patients

Scene safety

• Scene _____________

- Impact of the _____________on patient care

- Addressing _____________

- _____________

-Need for _____________ or specialized _____________

-Standard _____________

-_____________-_____________situations

primary assessment

•______ _________ for all patient situations

-Level of consciousness

-ABCs

-Identifying life threats

-Assessment of vital functions

-Initial general impression

- Begin interventions needed to preserve life

- Integration of treatment/procedures needed to preserve life

consciousness

ABC

lift threats

vital

impression

preserve life

treatment/procedures

•Primary assessment for all patient situations

-Level of ________

-________s

-Identifying _______ _________

-Assessment of ________ functions

-Initial general ________

- Begin interventions needed to _________ _______ - Integration of ________/________needed to preserve life

airway

breathing

circulation

ABCs stands for

chief complain

injury/nature

signs symptoms

investigation

medical history

History Taking

•Determining the ______ ______

•Mechanism of ______ /______ of illness

•Associated ______ and ______

•______ of the chief complaint

•Past ______ ______

•Pertinent negatives

secondary assessment

______ ______

•Performing a rapid full-body scan

•Focused assessment of pain

•Assessment of vital signs

•Techniques of physical examination

-Respiratory system

Presence of breath sounds

•Techniques of physical examination (cont'd)

-Cardiovascular system

-Neurologic system

-Musculoskeletal system

All anatomic regions

vein

intermediate

intravenous (route of admin)

- injection into the _____

- Fastest delivery but cannot be used for all medications

- rate: _________

full body scan

pain

vital signs

physical examination

respiratory

cardiovascular

neurologic

musculoskeletal

secondary assessment

•Performing a rapid _____ -_____ _____

•Focused assessment of _____

•Assessment of _____ _____

•Techniques of _____ _____

-_____ system

Presence of breath sounds

-_____ system

-Neurologic system

-_____ system

All anatomic regions

monitoring devices

•Obtaining and using information from patient _______ _____ including (but not limited to):

-Pulse oximetry

-Noninvasive blood pressure

scene size up

primary assessment

history taking

secondary assessment

reassessment

5 main parts of assessment process

- order depends of patients condition when found

- may be necessary to change the order and prioritize care of certain conditions

symptoms

_______: subjective condition the patient feels and tells you about

- cannot be felt or observed by others.

signs

______: objective conditions that can be seen, heard, felt, smelled, or measured by you or others.

symptoms

patient assessment

- The treatment EMTs provide patients is based on _________, not an exact diagnosis.

- The ______ _______ process is the foundation upon which all levels of EMT education are built and is the starting point for all patient care.

status

underlying problem

•Rarely does one sign or symptom show you the patient's ______ or ______ _______

scene size up

_____ ____-____

your evaluation of the conditions in which you will be evaluating

- maintain situational awareness

situational awareness

_________ __________paying attention to the conditions and people around you at all times and the potential risks those conditions or people pose.

situation conditions

information

observation

•Scene size-up combines:

-An understanding of the ______ and ______ prior to responding

-Dispatcher's __________

-______ of the scene

additional resources

If a scene is not safe for you and your team to enter the scene and approach and manage the patient, do what you can to make it safe or call for ______ _____.

a. Firefighters

b. Utility workers

c. Hazardous materials technicians

d. Law enforcement personnel

high visibility vest

traffic incident management

•Issues can range from minor difficulties to major dangers.

•Do not enter until the scene is safe for you and your team.

•Typically, the way you enter an area is the way you will leave.

•Wear a ______-_______safety ______on roadways.

difficult terrain

traffic safety

environmental conditions

ensure scene safety:

•Consider _____ ____

•Consider____ ____ issues.

•Consider ______ _____.

bystanders

extreme weather

physical violence

safe location

•If appropriate, help protect ______ from becoming patients.

•Hazards range from _____ _____ conditions to the threat of _____ _____.

•An emergency scene is a dynamically changing environment.

-If the scene is unsafe, make it safe if possible.

-If this is not possible, move to a _____ ____.

hazards

Some forms of ______:

a. Environmental

b. Physical (sharp metal, broken glass, slip-and-fall hazards)

c. Chemical (hazardous materials)

d. Electrical

e. Water

f. Fire

g. Explosions

mechanism of injury/MOI

-Type or amount of force

-How long it was applied

-Where it was applied to the body

Traumatic injury

_____ ______ is the result of physical forces applied to the outside of the body, usually from an object striking the body or the body striking an object.

a. Classified according to the type or amount of force, how long it was applied, and where it was applied to the body

b. This is described as the mechanism of injury (MOI).

force

long

where

MOI

-Type or amount of ______

-How _____ it was applied

-______ it was applied to the body

brain

spinal cord

eyes

•Fragile and easily injured areas include the _____ , _____ _____ , and _____ .

blunt trauma

_____ ______

-The force occurs over a broad area.

-Skin is usually not broken.

-Tissues and organs below the area of impact may be damaged.

broad

not broken

tissues organs

blunt trauma

-The force occurs over a _____ area.

-Skin is usually _____ _____

-_____ and _____ below the area of impact may be damaged.

penetrating trauma

_____ _____

- force of injury occurs at small point of contact between skin and the object

- open wound with high potential for infection

small

skin object

open wound

penetrating trauma

- force of injury occurs at ______ point of contact between ______ and the ______

- ______ ______ with high potential for infection

nature of illness/NOI

•For medical patients, determine the ____ _____ ____/_____

•Talk with the patient, family, or bystanders.

•Use your senses to check for clues.

carbon monoxide poisoning

•Be aware of scenes with more than one patient with similar signs or symptoms.

-Example: ____ _____ _____

-Could indicate an unsafe scene for the EMT as well

MOI NOI

trauma medical

•Considering the ____ or _____ early can be of value in preparing to care for the patient.

•You may be tempted to categorize the patient immediately as either _____ or ______.

-Fundamentals of good patient assessment are the same.

personal protective equipment/PPE

•Wear ____ _____ _____ (____).

-Should be adapted to the prehospital task at hand

- includes clothing or specialized equipment

- type will depend on specific duties during patient care interaction

objects

blood

body fluids

communicable disease

•Standard precautions have been recommended for use in dealing with:

-______

-______

-______

-Other potential exposure risks of ______ ______

blood

body fluids

nonintact

mucous membrane

The concept of standard precautions assumes that all _____ , _____ _____ (except sweat), _____ skin, and _____ _____ may pose a substantial risk of infection.

a. This includes * and other potentially infectious materials that are dried because some diseases can live outside the body for days.

gloves

glasses mask

•When you step out of the EMS vehicle, standard precautions must have been already taken or initiated.

-At a minimum, _____ must be in place.

-Consider _____ and a _____ .

number

additional resources

•During scene size-up, accurately identify the total ______ of patients.

-Critical in determining the need for _____ _____

command system

number

triage

when there are multiple patient

- use the incident ____ ____

- identify the ______ of patients

- then begin _____

triage

_____ is the process of sorting patients based on the severity of each patient's condition.

incident command

____ ____ system is a flexible system implemented to manage a variety of emergency scenes.

ALS

air medical

fire departments

law enforcement

•Specialized resources include:

-_____ (abrv)

-___ ____ support

-____ ____ , who may handle high-angle rescue, hazardous materials, or water rescue

-____ ____ to assist with traffic or scene control, should be first to enter crime scenes and hostile environments

threat

how many

have resources

•To determine if you require additional resources, ask yourself:

-Does the scene pose a _____ to me, my patient, or others?

-_____ _____ patients are there?

-Do we _____ the _____ to respond to their conditions?

primary assessment

_____ ______

•Begins when you greet your patient

•The goal is to identify and initiate treatment of immediate or potential life threats.

•Physically examine the patient and assess:

-LOC

-ABCs

greet

identify initiate treament

LOC

ABC

Primary Assessment

•Begins when you _____ your patient

•The goal is to _____ and _____ treatment of immediate or potential life threats.

•Physically examine the patient and assess:

-_____

-_____s

level of consciousness

LOC stands for

general impression

form a _____ ______

•Formed to determine the priority of care

•First part of primary assessment

•Make a note of the person's:

-Age, sex, and race

-Level of distress

-Overall appearance

priority

primary assessment

age sex race

distress

appearance

form a general impression

•Formed to determine the _____ of care

•First part of _____ _____

•Make a note of the person's:

-_____ , _____ , and _____

- level of _____

-Overall _____

position

standing over

name

introduce

chief complaint

life threats

general impression

•Note the patient's _______.

•Avoid _______ _______the patient.

•Address the patient by _______.

•_______ yourself.

•Ask about the _______ _______.

Address _______-_______immediately

stable

potentially unstable

unstable

•Determine if the patient's condition is:

-_____

-Stable but _____ _____

- _____

level of consciousness/LOC

•The ____ ____ ____ can tell you a great deal about the patient's neurologic and physiologic status.

Unconscious

altered

unaltered

categories of LOC

-______

-Conscious with an ______ LOC

-Conscious with an ______ LOC

airway

breathing

circulation

unconsciousness

•Assessment of an unconscious patient focuses on _____, _____, and _____.

-Sustained _____should warn you of a critical respiratory, circulatory, or central nervous system problem.

altered

perfusion

Conscious with an _______ LOC may be due to inadequate _____ (circulation of blood within an organ or tissue.)

- Could also be caused by medications, drugs, alcohol, or poisoning

Signs Symptoms

Allergies

Medications

Pertinent Past History

Last Oral Intake

Events Leading to Injury or Illness

sample stands for

awake alert

verbal stimuli

pain

unresponsive

To assess for responsiveness, use the mnemonic AVPU

- ____ and _____

- responsive to ____ ____

- responsive to ______

- ________

awake and aleart

AVPU

The patient is aware of you and is responsive to the environment.

verbal stimuli

AVPU

The patient is not alert and awake. The patient's eyes open to loud ____ ____, and he or she is able to respond in some meaningful way when spoken to.

painful

AVPU

. The patient does not respond to your questions but moves or cries out in response to _____ stimulus.

unresponsive

AVPU

The patient does not respond spontaneously or to a verbal or painful stimulus.

No cough or gag reflex

painful stimulus

Stimulus tests determine whether a patient who does not respond to verbal stimuli will respond to a _____ _____

These tests include:

- pinch skin

- apply pressure along orbital rim

- rub sternum

mental status

•Orientation tests ____ _____.

•Evaluates a patient's ability to remember:

-Person

-Place

-Time

Event

Altered mental status

_____ ____ _____

-Any deviation from alert and oriented to person, place, time, and event

-Any deviation from the patient's normal baseline

obstruction

failure

arrest

shock

bleeding

cardiac arrest

•Conditions that cause sudden death:

-airway _____

-Respiratory _____

-Respiratory _____

-_____

-Severe _____

- Primary _____ _____

ABCS

When a patient is in cardiac arrest, the ______ should be assessed simultaneously to minimize the time to first compression

circulation airway breathing/CAB

When a patient has life-threatening bleeding, it is more appropriate to address life threats to circulation first, following a sequence of _____, _____, and _____ (_____)

airway obstruction

•Moving through the primary assessment, stay alert for signs of _____ _____

Ensure the airway remains open (patent) and adequate

responsive

•_______ patients

-Patients who are talking or crying have an open airway.

-Watch and listen to how patients speak.

-If you identify an airway problem, stop the assessment and work to clear the patient's airway.

unresponsive

•_________patients

-Immediately assess the airway.

-Use the jaw-thrust technique when necessary.

-Use the head tilt-chin lift technique when necessary.

-Relaxation of the tongue muscles is a cause of airway obstruction.

airway

jaw thrust

head tilt chin lift

tongue

•Unresponsive patients

-Immediately assess the ______.

-Use the ______-______technique to open airway .

- if previous did not work, Use the ______ ______-______ ______ technique when necessary.

-Relaxation of the tongue muscles is a cause of airway obstruction.

airway obstruction

tongue

Another cause of _____ _____ in an unconscious patient could be relaxation of the ______ muscles, allowing the it to fall to the back of the throat.

obstruction

•Signs of ______ in an unconscious patient:

-Obvious trauma, blood, or obstruction

-Noisy breathing (snoring, bubbling, gurgling, crowing, abnormal sounds)

-Extremely shallow or absent breathing

breathing

adequately

hypoxic

•Make sure the patient's airway is open.

•Make sure the patient's breathing is present and adequate.

•Ask yourself:

-Is the patient ______?

-Is the patient breathing ______?

-Is the patient ______?

positive pressure ventilations

airway adjunct

•Consider providing _____-______ _______with an _____ ______when:

-Respirations exceed 28 breaths/min

-Respirations are fewer than 8 breaths/min

•The goal for oxygenation for most patients is an oxygen saturation of approximately 94% to 99%.

> 29

< 8

94 99

•Consider providing positive-pressure ventilations with an airway adjunct when:

-Respirations ____ ____ breaths/min

-Respirations are _____than _____ breaths/min

•The goal for oxygenation for most patients is an oxygen saturation of approximately ____% to ___%.

tidal volume

excursion

Shallow respirations can be identified by little movement of the chest wall (reduced ____ ____ ____ ) or poor chest ______.

retractions

accessory

flaring

two to three word dyspnea

tripod

sniffing

labored

•Observe how much effort is required for the patient to breathe:

-____

-Use of ____ muscles

-Nasal ____

-____ -____ -____ -____ ____

-____ position

-____ position

-____ breathing

respiratory distress

______ _____

- increased work of breaking

- increased effort and rate

work

effort

rate

respiratory distress

-Increased ______ of breathing

-Increased ______ and ______

respiratory failure

-Occurs when the blood is inadequately oxygenated or ventilation is inadequate to meeting the oxygen demands of the body

-The ultimate result of _____ _______ if it is not corrected

oxygenated ventilation

•Respiratory failure

-Occurs when the blood is inadequately ________ or ______ is inadequate to meeting the oxygen demands of the body

-The ultimate result of respiratory failure if it is not corrected

circulation

______ is evaluated by assessing the patient's mental status, pulse, and skin condition.

pulse

-_____ is the pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries.

- palpate

-If you cannot palpate a *** in an unresponsive patient, begin CPR.

CPR

-If you cannot palpate a pulse in an unresponsive patient, begin CPR.

color

temperature

moisture

capillary refill

assess circulation

•Skin condition

-Evaluate the patient's skin ______, ______ , ______ , and ______ ______ .

-A normally functioning circulatory system perfuses the skin with oxygenated blood

blood circulating

pigment

peripheral circulation

bluish

chronic illness

•Skin color

-Determined by the _____ ____ through vessels and the amount and type of _______ present in the skin

-Poor ______ _______ will cause the skin to appear pale, white, ashen, or gray.

-When blood is not properly saturated with oxygen, it appears _______.

-Changes in skin color may result from _____ ____.

98.6

•Skin temperature

-Normal skin will be warm to the touch (______°F).

-Abnormal skin temperatures are hot, cool, cold, and clammy.

dry

wet moist

dry hot

•Skin moisture

-______skin is normal.

-Skin that is ______, ______, or excessively ______and ______suggests a problem.

capillary refill

______ _____

-Evaluated to assess the ability of the circulatory system to restore blood to the capillary system

-Press on the patient's fingernail.

-Remove the pressure.

-The nail bed should restore to its normal pink color.

restore blood

fingernail

pressure

pink

2

capillary refill

-Evaluated to assess the ability of the circulatory system to ____ _____ to the capillary system

-Press on the patient's ____ .

-Remove the ____ .

-The nail bed should restore to its normal _____ color within ____ seconds

external bleeding

before

steady

spurting

•Assess and control ______ ______ in trauma patients.

-Should occur ______ addressing airway or breathing concerns.

-Bleeding from a large vein is characterized by a _______ flow of blood.

-Bleeding from an artery is characterized by a _______ flow of blood.

direct pressure

tourniquet

•Controlling external bleeding can be simple.

-Apply _____ _____.

-. If ^^^^^ is not quickly successful or if there is an obvious arterial hemorrhage of an extremity, apply a __________.

direct pressure

arterial hemorrhage

apply a tourniquet if _____ ______ is not quickly successful

•Obvious ______ ______ of an extremity

rapid scan

_____ ____

•Scan the body to identify injuries that must be managed or protected before the patient is transported.

-Take 60 to 90 seconds to perform.

-Not a systematic or focused physical examination

manged protected

60 90

systematic focused

rapid

•Scan the body to identify injuries that must be ______ or _____ before the patient is transported.

-Take ____ to ____seconds to perform.

-Not a ______ or ______ physical examination

Primary assessment

•______ ______assists in determining transport priority.

•High-priority patients include those with any of the following conditions:

-Unresponsive

-Poor general impression

Difficulty breathing

transport priority

•Primary assessment assists in determining ____ _____.

unresponsive

general impression

breathing

bleeding

follow comnands

chest pain

pale perfusion

childbirth

pain

•High-priority patients include those with any of the following conditions:

-________

-poor ________ ________

- difficulty ________

-Uncontrolled ________

- responsive but unable to ________ ________

-Severe ________ ________

-________ skin or other signs of poor ________

-Complicated ________

- Severe ________ in any area of the body

golden hour/golden period

the _____ ____/the ____ ____: time fron injury to definitive care

-Treatment of shock and traumatic injuries should occur.

Aim to assess, stabilize, package, and begin transport to the appropriate facility within 10 minutes after arrival on scene ("Platinum 10')

injury definitive care

shock traumatic

he golden hour/the golden period time from ______ to _______ ______

-Treatment of _____ and ________ injuries should occur.

Aim to assess, stabilize, package, and begin transport to the appropriate facility within 10 minutes after arrival on scene ("Platinum 10')