emergency patient care
DESCRIPTION
Emergency Patient Care. S.F.A, E.F.A, I.F.R, E.M.F.R.- March 2010 Compiled by: Joe Draper PCP. The Law. Consent (ask permission ) Implied Consent ? Can I be sued ? Gross Negligence Abandonment ? Good Samaritan Act. Health System in Ontario. Governing Bodies: - PowerPoint PPT PresentationTRANSCRIPT
EMERGENCY PATIENT CARE
S.F.A, E.F.A, I.F.R, E.M.F.R.- March 2010Compiled by: Joe Draper PCP
The Law
Consent (ask permission )
Implied Consent ? Can I be sued ? Gross Negligence Abandonment ? Good Samaritan Act
2
Health System in OntarioGoverning Bodies: Ministry of Health (MOH) Base hospitals Ambulance service
LEVELS OF CARE• Primary Care Paramedic•Advanced Care Paramedic•Critical Care Paramedic**FLIGHT/LAND
CTAS= Canadian Triage Acuity ScaleEvery patient is assigned a number between 1-5 regardingtheir level of severity. ie: VSA=1, hurt toe=5
Primary Assessment1. Assume control of the situation/scene:
E- EnvironmentM- Mechanism of injury/illnessC- Number of casualtiesA- Assistance from other resources
3. Establish a baseline level of awareness:
A- Alert V- Alert to VERBAL stimulusP- Alert to PAINFUL stimulusU- Unresponsive
PROTECT C-SPINE UNTIL RULED OUT!!!
2. Introduction:Approach, and introduce yourselfObtain consent, and explain your procedures
Primary Assessment Con’t
4. Assess the Airway:Open and inspect the airway for obstructions, or potential obstructions, and listen for quality of the air exchange.
5. Assess the breathing:Inspect/listen/feel for chest wall movementAuscultation of air movement in all fieldsInspect for signs of respiratory distress: cyanosis, tracheal movement, accessory muscle use, etc.
6. Assess the cervical spine:Palpate and inspect the posterior neck for deformity, pain, or spasm.
Primary Assessment Con’t
7. Assess the circulatory status:Palpation of radial or central pulseObtain a blood pressureInspection for any gross bleedsDetermine need for defibrillate and cardiac monitoring***Look for ANY “signs of life”
8. Assess the following for life threatening injuries/problems:ChestAbdomenPelvisFemurs
Assessment ToolsCLAPS(D)=
C- contusionsL- lacerationsA- abrasionsP- penetrationsS- symmetryD- deformity/distention
TICS(D)=
T- tendernessI- instabilityC- crepitusS- subcutaneous emphysemaD- deformity/distention
SAMPLE=S- signs and symptomsA- allergiesM- medicationsP- past medical historyL- last oral intakeE- events preceding incident/illness
Use these AFTER all life threateningProblems have been corrected!!!
SIGN vs SYMPTOM?
M.O.I.- Mechanism Of Injury/Illness
What Happened / why ? Witnessed or Un-
witnessed? Medical vs. Trauma? Trauma ? – C-Spine ! What is the patients
chief complaint? Signs and Symptoms History of Illness or
Injury10
AirwayHead Tilt - Chin Lift
or Modified jaw thrust
One Hand on the Lower Jaw
One Hand on the Forehead
Insert oral airway or Nasal airway
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Breathing Assess for rate, rhythm
and quality of respirations. If not present:
Head Tilt, Chin Lift Lift the jaw forward Take a normal breath Use a barrier device. Give two breaths of 1
second in duration with enough volume to
make the chest rise. Don't over inflate
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TO AVOID GASTRIC DISTENTION
Circulation
•Assess for rate, rhythm, quality of pulse•Check BP•If possible- listen for heart sounds•Stop any gross bleeds•If pulse not present- START CPR!
Rt Atrium
Rt Ventricle
Lt Atrium
Lt Ventricle
BLOOD PRESSURES
Blood Pressure is the amount of pressure exerted from the heart, that is measured within the arteries.
SYSTOLE:-The contraction phase-The UPPER number
DIASTOLE:-The relaxation phase-The BOTTOM number
WHAT IS A “NORMAL” BLOOD PRESSURE?
C.P.R. GuidelinesPatient Age
(yrs) Ratio Depth Of Chest Rate
Adult 8 + 30 : 2 1½ to 2 inches 100/min
Child 1 – 8 15 : 1 1/3 to 1/2 Depth of
chest 100/min
Infant 28days – 1 15: 1
1/3 to 1/2 Depth of chest
120+/min
REMEMBER- PUSH HARD! PUSH FAST!
Rapid Body SurveyAssess Head to Toe For: Severe Bleeding Check skin temperature Soft tissue injuries Burns Medic Alert Anything assessed that looks abnormal!
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Treat For Shock
Shock
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Signs & SymptomsAnxietyConfusionRapid breathingNausea and vomitingCool, clammy or mottled skinRapid heart and breathing rateUnconscious ?
SHOCK 02
VESSELS VOLUME
PUMP
SHOCK= a state when there is widespread reduction of tissue perfusion resulting in: decreased oxygenation of cells, and inadequate removal of toxic byproducts.
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ShockTypes of Shock Examples
Septic:: Severe illness caused by overwhelming infection of the bloodstream Hemorrhagic:: Large amount of blood loss externally and/or internallyObstructive: Airway obstruction, Chest wound causing collapse of lungCardiogenic: Heart attack, Sudden cardiac arrest.Anaphylaxis: Severe allergic reaction causing airway swelling. Neurological: Neurological system or spinal shock.
MILD MODERATE SEVERE Fast HR >100 Fast HR>120 Slow HR <60 Fast RR >16 Fast RR >20 Slow RR <12 Normal skin Pale, cold skin Pale, cold, clammy
Restless Confusion Unconsciousness
Secondary Assesment
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Upon completion of primary exam, and all life threats have been corrected…Assess the following:
•Head•Neck/spine•Chest/back•Abdomen•Pelvis/hips•Arms•Legs
IF AT ANY POINT THE PATIENTS CONDITION CHANGESRE-START YOUR PRIMARY EXAM!!!
Medical AbbreviationsAMI- Acute Myocardial InfarctionAEMCA- Advanced Emergency Medical Care AssistantALS- Advanced Life SupportAPGAR- American Pediatric Gross Assessment RecordPRN- As requiredBVM- Bag Valve MaskBLS- Basic Life SupportPO- By MouthCA- CancerCACC- Central Ambulance Communications CentreCNS- Central Nervous SystemCVA- Cerebrovascular Accident (stroke)COPD- Chronic Obstructive Pulmonary DiseaseCHF- Congestive Heart Failure
Medical Abbreviations Con’t
CTAS- Canadian Triage & Acuity ScaleDNR- Do Not ResuscitateGCS- Glascow Coma ScaleJVD- Jugular Vein DistentionLOA- Level Of AwarenessMCI- Mass Casualty IncidentPEARL- Pupils Equal And Reactive to LightROSC- Return Of Spontaneous CirculationSAED- Semi Automatic External DefibulatorTIA- Transient Ischemic AttackUTI- Urinary Tract InfectionVSA- Vital Signs Absent
Cardiovascular Disease Over 78,000 deaths per year in Canada, ages 40-65. (66% occur outside the hospital)
40,000 from Coronary Artery Disease
20,000 from Sudden Cardiac Arrest
16,000 from Strokes Risk Factors Smoking, High Blood Cholesterol, High BP, Stress, Heredity, Age, Diabetes & Lack of Regular Exercise
Controllable Risk Factors ?
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Progression of Atherosclerosis
Chest PainCardiac Pain “crushing”, “heavy” pain Often radiates to
neck/arm Pain does not change with
palpation or inspiration Shortness of Breath Pale, sweaty Nausea/vomiting Agitated/anxious
NON- Cardiac Chest Pain Other descriptions ie: “stabbing”,
“sharp” Usually localized pain Pain often changes with
palpation/inspiration Often, no other symptoms beside
the pain besides anxious
So where is the pain coming from?How do we treat these?
Does being a woman change things???
Stroke
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Signs & Symptoms Sudden Headache Dizziness/Confusion Facial Drooping Slurred Speech Arm Drift Weakness/Paralysis T. I. A. ( Mini Stroke)
Emboli
ThrombusBlood Flow from the heart
Hemorrhage
Respiratory EmergenciesSigns & Symptoms Rate/Depth Accessory Muscles Pale, Bluish Skin Coughing, Choking Restlessness Shortness of Breath
Noisy Breathing25
Respiratory Diseases1. Asthma2. Emphysema3. Bronchitis4. Pneumonia5. Congestive Heart Failure
ALWAYS GIVE O2!!!!!HOW MUCH THOUGH?
Anaphylaxis
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AllergensPeanutsSeafoodInsect BitesMedicationsLatexOthers?
Anaphylaxis
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Abdominal cramps, vomiting, diarrhea
Signs & Symptoms
What does EPI do?
Bleeding and Wound Types
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Laceration Contusion Abrasion
Partial or full Amputation Avulsion Impaled Object
Bleeding Nose
Spinal Cord Injury
Mechanism of Injury Amnesia to event Neck/Back Pain Paralysis Weakness Numbness Obvious Head Injury Loss of consciousness Priapism
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When to suspect a Spinal Injury!
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12
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Head & Brain Injuries
Internal/External Types concussion scalp wound fractures intracranial hemorrhage
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Head & Brain Injury
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Mechanism of Injury Falls, blunt impact Signs & Symptoms Facial injuries, Bleeding or
bruising to the head Vomiting Confusion Abnormal behavior Loss of, or changes in levels of Consciousness
SeizuresCauses Epilepsy Stroke Febrile (children) Others?
Signs & Symptoms1. A taste or smell prior to. 2. may appear
daydreaming.3. uncontrollable muscle
movement.4. Loss of bowel/bladder
33D
Heart Rhythms
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NORMAL SINUS RHYTHM VENTRICULAR FIBRILLATION
Shockable RythmsNon-Shockable Rhythms
VENTRICULAR TACHYCARDIAASYSTOLE
Penetrating chest wound: Pneumothorax
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Treatment The Approach Cover holes Valve Reassure the patient!
Signs & SymptomsShortness of BreathBleedingCoughing up blood.Pain at the injury siteEngorged neck veins
Abdominal/Pelvic Injuries
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PELVIS
Blunt or Penetrating Trauma may cause:Int./Ext. BleedingPain & Tenderness
to the affected areaGuardingDistentionPainful urination
Potential for significant blood loss
Musculoskeletal Injuries
: Rest Immobilize (splinting)
Cold compress Elevate (if applicable)
37D S
Burns Types
Flush the affected area with large amounts of water
Look for entrance and exit wound
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Chemical? – Electrical? - Radiation?Cool the burn area and treat accordingly
Diabetes
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BRAINB L O O D S U G A R
INSULIN
SUGAR
SUGAR
PANCREAS
Diabetic Emergencies
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Hypoglycemic or Hyperglycemic?
Hypoglycemia:*Fast onset*Too much insulin/not enough sugarSigns and Symptoms:•Drunk in appearance•Pale and very sweaty•Seizures/agression•CBG <4 mmolsTreatment:Conscious?- Give food, juice etc.Unconscious?- ABC’s, full assessment
Hyperglycemia:*Slow onset*Too much sugar/not enough insulinSigns and Symptoms:•CBG >15mmols•Acetone breath•Fast breathing•Dry/Red skinTreatment?
Environmental Emergencies
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Hyperthermia
Hypothermia
TreatmentKeep patient warmRemove wet clothsGive Warm FluidsRecovery Position
TreatmentCool PatientRemove From SunGive Cool FluidsRecovery Position
Poisoning
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Poison Control1-800-267-1373 English-French, toll- free Ontario
CALL LOCAL POISON CONTROLOR CALL 911OR CALL O FOR OPERATORDo not administer anything by mouth unless advised to do so by a poison control center
EMS MEDICATIONSWhat Medications do BLS Medics carry?•Nitroglycerin•Ventolin•ASA•Glucagon•Oral Glucose•Dextrose•Epinephrine•Benadryl (diphenhydramine)•Gravol (dimenhydrinate)
WHAT IS SYMPTOM ASSIST?
Medication AssistanceThe 5 Rights of Medication
Administration• The right medication• The right person• The right dose/amount• The right route• The right time
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Obstetrical Emergencies As the baby's head comes out, support it with one hand. Do not
pull on the baby. If the umbilical cord is around the baby's neck, gently loosen and
unwrap it. Protect the baby's airway by keeping the mouth and nose clear
of mucus or fluids. Allow the delivery to progress, but support the baby as they can
be slippery upon complete delivery. Insure the baby has an airway, is breathing (or crying), and has
a pulse. Do NOT cut the umbilical cord. Wrap the baby in clean clothes and keep the baby warm. Document the time of birth!
If the baby has no pulse, proceed with the CPR guidelines for an infant!
***DON’T FORGET ABOUT MOM!