Things you need to memorize

Why should you collar?

1. Patient with significantly painful distracting injury

2. Significant multi system trauma

3. Severe Head or Face Trauma

4. Any fall with the evidence of striking head

5. Spinal Pain or tenderness (including neck pain with a history of trauma)

6. Numbness or weakness in any extremity after trauma

7. Found in a position of trauma with altered mental status and no available history

8. Loss of consciousness after trauma

Why should you call a channel?

1. Altered Mental Status

2. Dementia

3. SI/HI

4. ETOH

5. Head Injury

6. Abnormal Vitals

7. Respiratory Distress

8. Intervention by a healthcare provided

9. Summoned by a healthcare provider

10. ALS recalled

11. Minor

When is it not necessary to call a channel for a refusal?

1. Hypoglycemia

2. Overdoses

3. Taser Probe Removal

AEIOU TIPS (Special considerations for causes of AMS)

A- Alcohol and Abuse

E- Epilepsy, Electrolytes, Encephalopathy

I- Insulin

O- Opiates, Overdose

U- Uremia

T- Trauma, Temperature

I- Infection

P- Poison, Psychogenic

S- Shock, Seizure, Stroke, Space occupying lesions, Subarachnoid Hemorrhage (SAH)

Injuries incompatible with life

1. decapitation

2. body fragmentation

3. severe crush injury to the head (without vital signs)

4. severe crush injury to the chest (without vital signs)

5. severe thermal burns (without vital signs)

6. gunshot wounds to the head lateral entrance wound and an opposite side exit wound (without vital signs)

signs of decomposition of the body

1. skeletalization

2. severe bloating (without vital signs)

3. skin slough (without vital signs)

when should CPR efforts be witheld:

1. resuscitation would place provider at significant risk of physical injury

2. patient is pulseless and apneic (without vital signs), cold in a warm environment, with dependent lividity

3. injuries incompatible with life

4. decomposition of the body

PAT

use during pediatric patient care

• Appearance (the way they act - consolability/interactiveness)

• Work of Breathing (retractions, nasal flaring, rapid breathing, etc)

• Circulation (skin appearance - pallor, cyanosis, mottling)

5 reasons to CPAP

• Tachypnea (RR>24)

• Tachycardia (HR>100)

• Hypertension (BP>120)

• Hypoxia (SpO₂<90)

• Labored breathing resulting in patient not being to finish a sentence

3 reasons not to CPAP

1. When intubation or surgical airway might be preferred

2. If patient doesnt improve or continues to deteriorate despite CPAP administration (BVM follows)

3. Respiratory distress secondary to trauma (possible pneumo)

when to get BGL

• Syncope

• Stroke

• Seizures

• Sepsis

(not necessary on ETOH but do to rule it out)

SIRS Criteria

systemic inflammatory response syndrome

* suspicion of infection + suspicion of 2 or more of these meets criteria (must contact med control for SEPSIS alert)

• temp greater than 38C or 100.4F - less than 36C or 96.8F

• HR>90

• RR>20

• Systolic BP<90

request ALS?

Risk factors for infection

• Elderly Patients with AMS from baseline

• Nursing home patients

• Chronic disease

• Immunosuppresion

• Indwelling catheters and central lines

VAN negative and LKW less than 4.5 hrs

go to nearest certified stroke center

VAN positive and LKW less than 4.5 hrs

contact local medical control to discuss destination

VAN positive and LKW greater than 4.5 hrs (including wake up stroke or unkown LKW) or considering hemorrhagic stroke

transport to certified Thrombectomy capable or comprehensive stroke center

what do you need to communicate to the receiving facility when you have a stroke patient

use of anticoagulants

NSAIDS

spinal motion restriction algorithm

• Neuro exam (focal deficit?)

• Significant mechanism of injury

• Alterness (AMS?)

• Intoxication (Evidence?)

• Distracting Injury

• Spinal Exam (tenderness?)

when to contact ALS regarding burns

• Singed facial or nasal hairs

• hoarse voice or stridor

• Difficulty breathing

• carbonaceous sputum

• burns on face

Adult GCS

Eyes

1. No response

2. To pain

3. To verbal

4. Spontaneous

Verbal

1. No response

2. Incomprehensible

3. Inappropriate

4. Confused

5. Oriented

Motor

1. No response

2. Extension (Decerebrate)

3. Flexion (Decorticate)

4. Withdraws to pain

5. Localizes pain

6. Obeys commands

Pediatric GCS

Eyes

1. No response

2. to painful

3. to verbal

4. spontaneous

Verbal

1. no response

2. inconsolable, agitated

3. inconsistently consolable/moans

4. consolable cry

5. coos, babbles

Motor

1. No response

2. extension (decerebrate)

3. flexion (decorticate)

4. withdraws to pain

5. withdraws to touch

6. normal spontaneous movement