formulating a pre-hospital general impression july 2010 ce condell medical center ems system...

Formulating a Pre-hospital General Impression

July 2010 CEJuly 2010 CECondell Medical Center EMS System Condell Medical Center EMS System

Prepared by: FF/PMD Michael MountsPrepared by: FF/PMD Michael MountsLake Forest Fire DepartmentLake Forest Fire Department

Reviewed/revised by: Sharon Hopkins, RN, BSN, EMT-PReviewed/revised by: Sharon Hopkins, RN, BSN, EMT-P

Objectives

Upon successful completion of this module, the Upon successful completion of this module, the EMS provider will be able to:EMS provider will be able to:

Review critical thinking concepts.Review critical thinking concepts. Identify a patient with a medical emergency. Identify a patient with a medical emergency. Identify a patient with a cardiac emergency.Identify a patient with a cardiac emergency. Identify a patient with a CVA.Identify a patient with a CVA. Identify a patient with traumatic injuries.Identify a patient with traumatic injuries. Identify a pediatric patient with a medical Identify a pediatric patient with a medical

emergency.emergency.

Objectives cont.

Identify a geriatric patient with a medical Identify a geriatric patient with a medical emergency.emergency.

Review documentation components for Review documentation components for discussed conditions.discussed conditions.

Demonstrate treatment during patient Demonstrate treatment during patient scenario.scenario.

Demonstrate use of cardiac equipment.Demonstrate use of cardiac equipment. Demonstrate use of bandaging techniques.Demonstrate use of bandaging techniques.

Critical Thinking Review (June CE)

EMS personnel must be knowledgeable in EMS personnel must be knowledgeable in the specific components, stages, and the specific components, stages, and sequences associated with the critical sequences associated with the critical thinking process.thinking process. Concept formationConcept formation Data interpretationData interpretation Application of principleApplication of principle EvaluationEvaluation Reflection on actionReflection on action

Concept Formation

Multiple elements gathered to form a Multiple elements gathered to form a general impressiongeneral impression The “what” of the patient storyThe “what” of the patient story

Scene assessmentScene assessmentChief complaintChief complaintPt history & affectPt history & affectInitial assessmentInitial assessmentPhysical examPhysical examDiagnostic testDiagnostic test

Data Interpretation

Information gatheringInformation gathering ““Working phase” of patient careWorking phase” of patient care Quality of interpretation depends on Quality of interpretation depends on

knowledge of A & P and experienceknowledge of A & P and experience Obtaining a complete “picture”Obtaining a complete “picture” Success greatly affected by attitude and Success greatly affected by attitude and

patient interactionpatient interaction

Application of Principle

Patient care after impression and working Patient care after impression and working diagnosis/general impressiondiagnosis/general impression Treatments & InterventionsTreatments & Interventions

Based on SOP or Medical ControlBased on SOP or Medical Control

Evaluation

Ongoing assessmentOngoing assessment Effectiveness of interventionsEffectiveness of interventions Revision of impressionRevision of impression Review of protocol or ordersReview of protocol or orders Revision of treatments and/or interventionsRevision of treatments and/or interventions

Reflection on Action

After the event or incidentAfter the event or incident CritiqueCritique

Provides EMS with avenue to add or Provides EMS with avenue to add or modify experience related to future callsmodify experience related to future calls

Thinking Under Pressure

Mental checklistMental checklist Stop and thinkStop and think Scan the situationScan the situation Decide and actDecide and act Maintain clear and concise controlMaintain clear and concise control Regularly and continually evaluate the patientRegularly and continually evaluate the patient

Not reassessment… think constant Not reassessment… think constant assessment!assessment!

Thinking Under Pressure cont.

Plenty of information can be ascertained in a Plenty of information can be ascertained in a very short amount of timevery short amount of time Once on scene, you start assessing long Once on scene, you start assessing long

before you are told anythingbefore you are told anything Utilize all of your senses during size-upUtilize all of your senses during size-up

The following video slide illustrates this point…The following video slide illustrates this point… Check volume level pleaseCheck volume level please

Click anywhere on video picture to play…

Thinking Under Pressure cont.

In about 8 seconds, he was able to get basic In about 8 seconds, he was able to get basic visual info on 5 peoplevisual info on 5 people Oh and 4 rolls of paper, tooOh and 4 rolls of paper, too

Practice and experience will help you hone Practice and experience will help you hone these skillsthese skills

Always Remember… Initial AssessmentInitial Assessment

Airway/c-spine immobilizationAirway/c-spine immobilization BreathingBreathing CirculationCirculation Deficit/disabilityDeficit/disability

If cardiac complaint think “D” for If cardiac complaint think “D” for defibrillation and apply cardiac defibrillation and apply cardiac monitormonitor

Don’t forget ABC’s !!!

Patient Scenarios

Time to put ideas to workTime to put ideas to work Step by step verbal and practical application of Step by step verbal and practical application of

skillsskills Have crews review the following cases as if Have crews review the following cases as if

they were on the callthey were on the call Use as much equipment as possible to care for Use as much equipment as possible to care for

the patientthe patientUse the time to discuss your department’s Use the time to discuss your department’s

particular equipment (ie: monitor) and how it particular equipment (ie: monitor) and how it works including trouble shootingworks including trouble shooting

Scenario #1 Called for checkup of 45 year-old male that Called for checkup of 45 year-old male that

was driving erratically. Police have pt. sitting was driving erratically. Police have pt. sitting on roadside. Pt. is alert and oriented x2 and on roadside. Pt. is alert and oriented x2 and has slight ETOH odor. Pt stated had 2 beers a has slight ETOH odor. Pt stated had 2 beers a couple hours ago during a buffet dinner.couple hours ago during a buffet dinner.

Impression?Impression?

Scenario #1 cont. Vitals: Vitals:

BP: 158/86, P-76, R- 24, SpOBP: 158/86, P-76, R- 24, SpO22 97%, Wt 130 kg 97%, Wt 130 kg

History:History: HTN (hypertension), Asthma, gastric bypassHTN (hypertension), Asthma, gastric bypass

Pt. states he feels nauseous and has toPt. states he feels nauseous and has to

“ “pee real bad again”pee real bad again”

Same impression?Same impression? What else do you want to know?What else do you want to know?

Scenario #1 cont.

Blood sugar is 376Blood sugar is 376 Possible new onset, or worsening, of diabetesPossible new onset, or worsening, of diabetes

Large food intakeLarge food intake Polyuria (excessive urination)Polyuria (excessive urination) NauseaNausea Rapid respirationsRapid respirations Acetone odorAcetone odor

Scenario #1 Summary

Some signs are very similar to intoxicationSome signs are very similar to intoxication Not always “just another drunk guy”Not always “just another drunk guy”

Hyperglycemic Protocol (pg. 28)Hyperglycemic Protocol (pg. 28) If glucose reading >200If glucose reading >200

Fluid challenges - 200mlFluid challenges - 200ml

Hyperglycemia

So, why are fluids necessary?So, why are fluids necessary? Patient becomes dehydratedPatient becomes dehydrated

Large glucose molecule “stuck” in Large glucose molecule “stuck” in vascular spacevascular space

• Glucose drags fluid out of cells to Glucose drags fluid out of cells to dilute the high solute concentrationdilute the high solute concentration

• ““Where glucose goes so does water”Where glucose goes so does water”• Cells become dehydratedCells become dehydrated urination to rid body of excess urination to rid body of excess

glucose glucose eliminates excess fluid eliminates excess fluid

Hyperglycemia

Signs and symptoms of dehydration Signs and symptoms of dehydration Warm and dry skin; dry mouthWarm and dry skin; dry mouth Tachycardia & weaknessTachycardia & weakness Hypotension (fluid level down!)Hypotension (fluid level down!) Restless (unconscious with high levels)Restless (unconscious with high levels) Fruity breath - build up of ketone by-Fruity breath - build up of ketone by-

products from alternative fat metabolism products from alternative fat metabolism (fat used for energy instead of glucose)(fat used for energy instead of glucose)

Deep, rapid respirations (blowing off Deep, rapid respirations (blowing off excess acid by-products)excess acid by-products)

Region X SOP – Hyperglycemia/Ketoacidosis Blood glucose determinant >200 and Blood glucose determinant >200 and

warm, flushed skin and warm, flushed skin and deep, rapid respirations deep, rapid respirations IV fluid challenges 200 mlIV fluid challenges 200 ml

May repeat IV fluid challenge May repeat IV fluid challenge 200 ml x 2 200 ml x 2

Transport Transport

DKA and Hyperkalemia

Patient in DKA prone to hyperkalemia due to shift Patient in DKA prone to hyperkalemia due to shift in potassium from inside cell to vascular spacein potassium from inside cell to vascular space

Potassium critical for normal function of muscles, Potassium critical for normal function of muscles, heart, & nervesheart, & nerves

Major electrolytes for transmission of electrical Major electrolytes for transmission of electrical signals throughout the nervous system of the bodysignals throughout the nervous system of the body

Increased levels result in abnormal heart rhythms, Increased levels result in abnormal heart rhythms, slowing of the heart rate, weakening of the pulse, slowing of the heart rate, weakening of the pulse, and suppression of all cardiac activityand suppression of all cardiac activity

EKG Effects of Hyperkalemia: Tall peaked T

waves

Documentation Keys

Results of blood glucose levels takenResults of blood glucose levels taken Amounts of fluid administered (in ml)Amounts of fluid administered (in ml) Cardiac monitor interpretationCardiac monitor interpretation

Mounted 6 second strip Mounted 6 second strip Copies with EMS “pink” and ED chart Copies with EMS “pink” and ED chart

Scenario #2

Called for a 56 year old female that Called for a 56 year old female that fell during a syncopal episode. Pt fell during a syncopal episode. Pt states she has had similar events in states she has had similar events in the past, but this one is different. the past, but this one is different. She denies any alcohol intake and She denies any alcohol intake and has eaten normally. She also states has eaten normally. She also states that she feels slightly out of breath.that she feels slightly out of breath.



BP: 116/68, P-70, R-12, SpOBP: 116/68, P-70, R-12, SpO22 96%, Wt 65 kg 96%, Wt 65 kg

History:History: Diabetes (diet controlled), runs every dayDiabetes (diet controlled), runs every day

Pt. states she can be “a klutz”Pt. states she can be “a klutz”


Scenario #2 cont. Pt. states she is starting to feel a little dizzyPt. states she is starting to feel a little dizzy

Would you do ECG monitoring?Would you do ECG monitoring?What rhythm is this?What rhythm is this?

• Normal sinus rhythmNormal sinus rhythm

Scenario #2 cont. Would you obtain a 12-lead?Would you obtain a 12-lead?

If so…If so… What’s going on?What’s going on?

ST elevation V1 –V4 (anterior-septal wall)

12-Lead EKG Format/Pattern

Lead ILateral wall

aVR not evaluated

V1

Septum

V4

Anterior wall

Lead II Inferior

wall

aVLLateral wall

V2

Septum

V5

Lateral wall

Lead III Inferior

wall

aVFInferior wall

V3

Anterior

V6

Lateral wall

Most Frequent Complications Related to MI Locations Lateral wall – I, aVL, V5, V6Lateral wall – I, aVL, V5, V6

Heart blockHeart block Inferior wall – II, III, aVFInferior wall – II, III, aVF

Hypotension (hold that NTG – call Medical Hypotension (hold that NTG – call Medical Control for permission to administer)Control for permission to administer)

Septal wall – V1 – V2Septal wall – V1 – V2 Heart blockHeart block

Anterior wall – V3 – V4 (The “widowmaker”)Anterior wall – V3 – V4 (The “widowmaker”) Lethal dysrhythmias, cardiogenic shockLethal dysrhythmias, cardiogenic shock

Scenario #2 Summary Remember categories for vague Remember categories for vague

cardiac symptomscardiac symptoms FemalesFemales Long standing diabeticsLong standing diabetics ElderlyElderly Watch out for the “triple threat”Watch out for the “triple threat”

This patient only contained the first twoThis patient only contained the first two ACS Protocol (pg. 12)ACS Protocol (pg. 12)

I.V., Monitor (12-lead), OI.V., Monitor (12-lead), O22, ASA, Nitro, ASA, Nitro

Region X SOP - ACS

Stable – alert, warm & dry, B/P Stable – alert, warm & dry, B/P >>100100 Aspirin 325 mgAspirin 325 mg

Withhold if reliable and taken within past 24 Withhold if reliable and taken within past 24 hourshours

If consistently takes aspirin and takes 1 If consistently takes aspirin and takes 1 baby per day, contact Medical Control for baby per day, contact Medical Control for guidanceguidance

• May not add additional dosesMay not add additional doses– Drug level is already establishedDrug level is already established

Region X SOP – ACS cont

NitroglycerinNitroglycerinFor pain control and to reduce the workload For pain control and to reduce the workload

of the heartof the heartScreen for use of Viagra type drugs within Screen for use of Viagra type drugs within

past 24 hourspast 24 hoursMay repeat a dose in 5 minutesMay repeat a dose in 5 minutesAfter 2 doses, consider advancing to After 2 doses, consider advancing to

MorphineMorphine• Medical Control may have you continue Medical Control may have you continue

to alternate Nitro with Morphineto alternate Nitro with Morphine

Region X SOP – ACS cont

MorphineMorphine Used as pain relieverUsed as pain reliever Also dilates blood vessels decreasing Also dilates blood vessels decreasing

blood flow volume returning to the heartblood flow volume returning to the heartWatch for hypotensionWatch for hypotension

2 mg IVP slowly over 2 minutes2 mg IVP slowly over 2 minutesMay repeat every 2 minutes up to a May repeat every 2 minutes up to a

total dose of 10 mgtotal dose of 10 mg

Documentation Keys

Full assessment following OPQRST processFull assessment following OPQRST process OOnset, nset, pprovocation/rovocation/ppalliation, alliation, qquality, uality,

rradiation, adiation, sseverity, everity, ttimeime Obtain and record B/P before administering Obtain and record B/P before administering

NitroglycerinNitroglycerin When obtaining a 12 lead EKG, document When obtaining a 12 lead EKG, document

findings related to ST elevationfindings related to ST elevation If present, state in which leads viewedIf present, state in which leads viewed

Scenario #3

Called for a 5 year-old with trouble breathing in Called for a 5 year-old with trouble breathing in a school lunchroom. a school lunchroom.

Onset happened during her meal just after gym Onset happened during her meal just after gym class. class.

Pt A&O x3 and in moderate to severe distress. Pt A&O x3 and in moderate to severe distress. Teacher tells you this happens from time to time.Teacher tells you this happens from time to time.


Pediatric Assessment Triangle

Assess from the doorwayAssess from the doorwayAppearanceAppearanceWork of breathingWork of breathingCirculationCirculation


BP: 88/56, P-112, R-28, SpOBP: 88/56, P-112, R-28, SpO2 2 91%, Wt 40 lbs91%, Wt 40 lbs Hx:Hx:

Asthma, seasonal allergies, & some food Asthma, seasonal allergies, & some food allergiesallergies

Patient states she traded part of a sandwich with Patient states she traded part of a sandwich with her friend.her friend.


Scenario #3 cont.

What did she eat?What did she eat? Sandwich was peanut butter & jellySandwich was peanut butter & jelly

Peanut allergy?Peanut allergy? Many kids have this nowMany kids have this now

Most know about it due to history of severe Most know about it due to history of severe reaction, but be preparedreaction, but be prepared

Can go into anaphylaxis very quicklyCan go into anaphylaxis very quickly

Anaphylaxis

Key difference between allergic reaction Key difference between allergic reaction and anaphylaxis is:and anaphylaxis is:

HYPOTENSIONHYPOTENSION Both patients can look “bad” and both can Both patients can look “bad” and both can

have wheezinghave wheezing Note: Need a 1Note: Need a 1stst exposure for the body to exposure for the body to

develop antibodies to antigens to be able to develop antibodies to antigens to be able to react to subsequent exposuresreact to subsequent exposures

Scenario #3 Summary

Peds Allergic reaction (pg. 70)Peds Allergic reaction (pg. 70) Stable Stable with with airway involvementairway involvement

Epi 1:1000 SQ 0.01 mg/kgEpi 1:1000 SQ 0.01 mg/kgBenadryl 1 mg/kg IVP slowlyBenadryl 1 mg/kg IVP slowlyAlbuterol 2.5mg/3 ml nebulizedAlbuterol 2.5mg/3 ml nebulized

Again, be prepared for worseningAgain, be prepared for worsening

Medications

Benadryl – antihistamineBenadryl – antihistamine Stops further release of histaminesStops further release of histamines

Epinephrine – sympathomimeticEpinephrine – sympathomimetic Stimulates vasoconstriction to support Stimulates vasoconstriction to support

blood pressure; bronchodilates to ease blood pressure; bronchodilates to ease breathingbreathing

Albuterol – bronchodilatorAlbuterol – bronchodilator To ease breathing by dilating bronchiolesTo ease breathing by dilating bronchioles

Documentation Keys

SpOSpO22 room air and after oxygen initiated room air and after oxygen initiated

Pertinent negativesPertinent negatives Effort of breathingEffort of breathing

Use of accessory musclesUse of accessory muscles Positioning (ie: tripoding)Positioning (ie: tripoding) Ability to speaking full sentencesAbility to speaking full sentences

Scenario #4

You are called to the scene for an unknown You are called to the scene for an unknown medical emergency. The scene is secure. Your medical emergency. The scene is secure. Your patient is a 54 year-old male who ispatient is a 54 year-old male who is having having trouble communicating. Patient’s speech is clear, trouble communicating. Patient’s speech is clear, but responses are not to anything you are saying to but responses are not to anything you are saying to him.him.



BP: 188/96, P-76, R-12, SpOBP: 188/96, P-76, R-12, SpO22 98%, Wt 184 lbs 98%, Wt 184 lbs Hx:Hx:

HTN, diabetic, depression, & alcoholismHTN, diabetic, depression, & alcoholism Pt. appears to be “favoring” right side and still Pt. appears to be “favoring” right side and still

having trouble following direction.having trouble following direction.


Scenario #4 cont.

Attempt to do Cincinnati Stroke Scale TestAttempt to do Cincinnati Stroke Scale Test Mild right side arm drift notedMild right side arm drift noted Determine time of onsetDetermine time of onset

Treat for CVA (pg. 26)Treat for CVA (pg. 26)

Is comprehension problem an issue or Is comprehension problem an issue or symptom?symptom? Yes, positive for Receptive AphasiaYes, positive for Receptive Aphasia

i.e. Wernicke’s Aphasiai.e. Wernicke’s Aphasia

Scenario #4 cont. Wernicke’s AreaWernicke’s Area

Controls speech comprehensionControls speech comprehension Brocca’s AreaBrocca’s Area

Controls speech productionControls speech production Both on left side of brainBoth on left side of brain

If either of the above speech If either of the above speech areas are noted to be affected, areas are noted to be affected,

see if right sided weakness see if right sided weakness is also presentis also present

Speech and motor problems will be Speech and motor problems will be reflected on opposite sides of the reflected on opposite sides of the bodybody

Cincinnati Stroke Scale or FAST

F – look for F – look for ffacial droopingacial drooping Have patient smile large enough to see Have patient smile large enough to see

teethteeth A – check for A – check for aarm driftrm drift

Patient holds hands out in front for 10 Patient holds hands out in front for 10 seconds with eyes closed, palms upseconds with eyes closed, palms up

S – check for slurred S – check for slurred sspeechpeech T – teach patients to call 911 – T – teach patients to call 911 – ttime is ime is

essential essential

Scenario #4 Summary

With someone having trouble understanding, With someone having trouble understanding, you may have to treat as a language barrieryou may have to treat as a language barrier

Person with trouble speaking will look and act Person with trouble speaking will look and act visibly frustrated with themselves. They can visibly frustrated with themselves. They can hear and comprehend the strange things they hear and comprehend the strange things they are saying.are saying.

Using hand signals or other forms of Using hand signals or other forms of communication may come in handycommunication may come in handy

Region X SOP- Stroke/Brain Attack Determine time of onsetDetermine time of onset Obtain blood glucose levelObtain blood glucose level Perform Cincinnati Stroke ScalePerform Cincinnati Stroke Scale Alert Medical control earlyAlert Medical control early If rapid neurological deterioration ventilate with If rapid neurological deterioration ventilate with

BVMBVM Adult once every 3 seconds (20/minute)Adult once every 3 seconds (20/minute) Child once every 2 seconds (30/minute)Child once every 2 seconds (30/minute) Infants once every 1.7 seconds (35/minute)Infants once every 1.7 seconds (35/minute)

Documentation Keys

Time of onset of signs and/or symptomsTime of onset of signs and/or symptoms Results of Cincinnati Stroke ScaleResults of Cincinnati Stroke Scale

Right, left or no facial droopRight, left or no facial droop Right, left, or no arm driftRight, left, or no arm drift Clear speech or notClear speech or not

Notification made to receiving hospitalNotification made to receiving hospital

Scenario #5 Called for a 89 year-old female Called for a 89 year-old female

with chest pain. Patient stated with chest pain. Patient stated she had pain going on for about she had pain going on for about an hour and “just got scared”. an hour and “just got scared”. Pt seems very anxious and Pt seems very anxious and states she does want to go to the states she does want to go to the hospital and doesn’t want to hospital and doesn’t want to die.die.



BP: 186/102, P-102, R-16, SpOBP: 186/102, P-102, R-16, SpO22 100%, Wt 55kg 100%, Wt 55kg Hx:Hx:

HTN, asthma, & anxietyHTN, asthma, & anxiety Pt. states her pain was a 10/10 and substernal.Pt. states her pain was a 10/10 and substernal. Pt. also states she has a long history of heart and Pt. also states she has a long history of heart and

lung issueslung issues..


Scenario #5 cont. ECG monitorECG monitor

Lead II shows…Lead II shows…

Sinus rhythm with junctional bigeminySinus rhythm with junctional bigeminy

Scenario #5 cont. 12-lead – no ST elevation noted (look at sinus beats)12-lead – no ST elevation noted (look at sinus beats)

Scenario #5 Summary

Could be cardiac or anxietyCould be cardiac or anxiety Treat as ACS to be safe (pg. 12)Treat as ACS to be safe (pg. 12)

I.V., Monitor (12-lead), OI.V., Monitor (12-lead), O22, ASA, Nitro, ASA, Nitro

Some elderly patients are very lonely and Some elderly patients are very lonely and scared to ask for helpscared to ask for help EMS must gain and keep their trustEMS must gain and keep their trust Don’t be quick to judge or treat as lesser illness Don’t be quick to judge or treat as lesser illness

and/or injuryand/or injury

Documentation Keys

If St elevation is noted or not on 12 lead If St elevation is noted or not on 12 lead EKGEKG

If St elevation is noted, in which leadsIf St elevation is noted, in which leads Detailed assessment covering OPQRST Detailed assessment covering OPQRST

promptspromptsOnsetOnset ProvocationProvocationQualityQuality RadiationRadiationSeveritySeverity TimeTime

Scenario #6

Your 34 year-old patient received a GSW to the Your 34 year-old patient received a GSW to the right upper abdomen. They are conscious and right upper abdomen. They are conscious and alert; bleeding is minimal. Patient in moderate alert; bleeding is minimal. Patient in moderate amount of pain.amount of pain.

Impression?Impression? Do you know you’re A & P?Do you know you’re A & P?

Category trauma?Category trauma?

Scenario #6 cont.

Vitals: Vitals: BP: 90/62, P- 120, R- 28, SpOBP: 90/62, P- 120, R- 28, SpO22 94%, Wt 85kg 94%, Wt 85kg

History:History: Denies any past history or medicationsDenies any past history or medications

Pt. denies any trouble breathing, but says it hurts Pt. denies any trouble breathing, but says it hurts when he breaths in deep. No other injuries noted.when he breaths in deep. No other injuries noted.

Pt is Category I traumaPt is Category I trauma


Scenario #6 cont. Make sure the scene is secured. Consider need Make sure the scene is secured. Consider need

for spinal immobilization. During assessment, for spinal immobilization. During assessment, consider thoracic injury in addition to abdominal consider thoracic injury in addition to abdominal injury depending on the angle of GSW.injury depending on the angle of GSW.

Examine for an exit wound Examine for an exit wound Check the back and the axillaCheck the back and the axilla Look for signs & symptoms of possible pneumoLook for signs & symptoms of possible pneumo

Prepare for the worst – assume the patient will Prepare for the worst – assume the patient will deteriorate before ED arrivaldeteriorate before ED arrival

Scenario #6 cont.

Repeat VS: B/P 80/; HR 140; R 32Repeat VS: B/P 80/; HR 140; R 32 Remains conscious and in painRemains conscious and in pain Cover the wound and watch for eviscerationCover the wound and watch for evisceration Fluid resuscitation – keep B/P at low levels; Fluid resuscitation – keep B/P at low levels;

the higher the B/P the faster the patient bleeds the higher the B/P the faster the patient bleeds outout

Scenario #6 cont. - Transfer Mode

Where does this pt. need to Where does this pt. need to be transported to?be transported to? Highest level Trauma Highest level Trauma

Center within 25 minutesCenter within 25 minutes How should they be How should they be

transported?transported? Ground or Aero?Ground or Aero?

Whichever you deem Whichever you deem necessary in the fieldnecessary in the field

Documentation Key Reminders

Remember…Remember… If you don’t write it, it didn’t happen!If you don’t write it, it didn’t happen!

Include pertinent negativesInclude pertinent negatives Make sure to use the proper abbreviationsMake sure to use the proper abbreviations

See Condell approved list See Condell approved list Available from your Medical OfficerAvailable from your Medical Officer

Fill out the proper doses on medsFill out the proper doses on meds Use ml not ccUse ml not cc

Documentation Keys cont. TraumaTrauma

Include results of inspection, auscultation, Include results of inspection, auscultation, palpationpalpation

Mechanism of injury Mechanism of injury DeformityDeformity Assessment of the general area (ie: contusions, Assessment of the general area (ie: contusions,

bleeding, swelling/distention, pain, powder bleeding, swelling/distention, pain, powder marks)marks)

Location of entrance and exit woundsLocation of entrance and exit wounds Size of wound(s)Size of wound(s) If distance & angle from weapon knownIf distance & angle from weapon known

Remember why we’re here…

Questions?

Bibliography Mosby’s Paramedic Textbook – Second EditionMosby’s Paramedic Textbook – Second Edition Movie clip: “Metro”. 1997.Movie clip: “Metro”. 1997. Various photos via BING search engineVarious photos via BING search engine Wikipedia – Brain photo & infoWikipedia – Brain photo & info Previous Condell CE’s – some patient info and treatmentsPrevious Condell CE’s – some patient info and treatments

formulating a pre-hospital general impression july 2010 ce condell medical center ems system...

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