Final Review (1) (1).docx

Final Review Know the following definitions Abandonment Assault and/or battery Negligence Good Samaritan law Duty to act Scope of practice Informed/expressed consent Implied consent DNR (Do not resuscitate) What is a “5150” and what type of patient may be placed under a 5150? Danger to self Danger t...

Final Review Know the following definitions Abandonment Assault and/or battery Negligence Good Samaritan law Duty to act Scope of practice Informed/expressed consent Implied consent DNR (Do not resuscitate) What is a “5150” and what type of patient may be placed under a 5150? Danger to self Danger to others Gravely disabled Know the suspected child abuse reporting requirements Mandatory reporter San Diego County protocol S-411 Know you BLS CPR guideline Compression to ventilation ratios Hand placement How to handle FBAO (complete and incomplete) Pulse checks Defibrillation use Know the anatomy of the heart and blood flow through the heart Superior Inferior Vena Cavae Right atrium Tricuspid valve Right ventricle Pulmonic valve Pulmonary artery Lungs (alveoli) Pulmonary vein Left atrium Bicuspid valve Left ventricle Aortic valve Aorta Arteries Arterioles Capillaries Venules Veins When do coronary arteries receive their blood supply? Diastole Know the terms Systole Diastole Know the components of the scene size up BSI Personal/personnel safety Environment Number of patients Mechanism of injury/nature of illness Additional resources Need for extrication Need for c-spine Know the components of the primary survey General impression Age Position Skin color Sex AVPU Chief complaint Airway Open Clear Maintainable Need for suction Breathing Rate Depth Ease Circulation Major bleeding Pulse Skin color, temp, condition Cap refill Transport Priority Know the components of Secondary Survey OPQRST SAMPLE history Modified physical or rapid physical exam Vitals Interventions Know the components of you Ongoing Assessment Reassess vitals (looking for trends) Reassess interventions Manage any secondary injuries or chief complaints When assessing a patient for a traumatic injury, be able to identify the primary concerns based on where the injury is located. For example: Facial injuries Airway compromise Neck injuries Airway compromise Breathing compromise Neuro compromise Chest injuries Breathing compromise Bleeding compromise Abdominal injuries Bleeding compromise Sepsis Pelvic injuries Bleeding compromise Extremities Femurs bleeding compromise Threat to limb Back Bleeding compromise Breathing compromise Neuro compromise Know the following terms prone supine recumbent distal proximal superior inferior Know when to utilize a BRIM altered level of consciousness Breathing Response Eyes (pupils) Movement Know what the GCS score is and how to add up the numbers Know the appropriate vitals for an infant, pediatric and adult patient I know there is a lot of discrepancy in the book so just be able to identify what is out of range What are signs and symptoms of a basilar skull fracture bleeding from the ears or nose Possible ALOC Battles signs Raccoons eyes What are signs and symptoms of an epidural bleed Possible loss of consciousness initially then awakens with a lucid interval followed by loss of consciousness No loss of consciousness with a lucid interval followed by loss of consciousness. What are signs and symptoms of increasing intracranial pressure Altered level of consciousness Rising blood pressure Irregular respirations (cheyne stokes) Bradycardia Unequal pupils Posturing (decorticate or decerabrate) What is Cushing’s Triad? Hypertension with widening pulse pressures Bradycardia Irregular respirations Know your respiratory conditions, signs, symptoms and treatment Emphysema (COPD) Usually thin Sometimes a pink color to their skin (polycythemia) Pursed lip breathing (creating positive end expiratory pressure (PEEP) Wheezing or diminished lung sounds Dry cough May see home O2 May have a history of smoking Chronically short of breath Chronic Bronchitis Usually heavier Sometimes a bluish color to their skin Excessive sputum production May see home O2 Chronically short of breath Rhonchi or diminished lung sounds Pulmonary Embolism Acute onset of UNEXPLAINED shortness of breath Clear or possibly crackles for lung sounds Recent history of surgery, sedentary life style or birth control pill Pneumonia Fever Productive cough Diminished or rhonchi for lung sounds Recent history or illness Green or yellow sputum production Painful to breath tacypnea Pulmonary edema May have a history of heart disease Acute onset of shortness of breath Crackles for lung sounds Pink frothy sputum in severe cases May suffer from orthopnea (inability to lay flat) May also see JVD (congestive heart failure) May also see pedal edema (congestive heart failure) Exertional dyspna Tachypnea tachycardia Asthma acute onset of shortness of breath history of asthma wheezing lung sounds (ominous if you hear no lung sounds) tripoding accessory muscle use tachypnea tachycardia Pneumothorax Shortness of breath Pinpoint pain Diminished lung sounds Usually caused by penetrating trauma but can be a result of blunt force trauma Tacypnea Tachycardia Tension Pneumothorax JVD Tracheal deviation Absent lungs sounds Hypotension Poor skin signs Severe shortness of breath Tacypnea Tachycardia Know the different types of shock and signs, symptoms, treatment and causes (look at the attached hand out) Hypovolemic (fluid issue) Fluid loss Blood loss (hemorrhagic) Burn Obstructive (obstruction) Pulmonary embolism Tension pneumothorax Pericardial tamponade Cardiogenic (pump issue) Distributive (vessel issue) Anaphylaxis Neurogenic Septic Appropriate PPE to wear based on situation gloves only gloves and goggles gloves, mask gloves, mask and goggles gloves, mask, goggle and gown Please define “infectious disease” Best way to prevent the spread of infection a. wash your hands Know you different oxygen adjuncts and when and HOW to use them OPA (maintains the airway) NPA (maintains the airway) Nasal cannula (2-6 lpm, considered low flow oxygen) Non rebreather mask (10-15 lpm, considered high flow oxygen) Bag Valve Mask (10-25 lpm, assisting ventilations) Myocardial infarction Chest discomfort Non provoked Shortness of breath Nausea and/or vomiting Unrelieved with rest Unrelieved with NTG Poor skin signs Hypotension Pulmonary edema JVD Angina Pectoris Chest discomfort Provoked by exertion Relieved with rest Relieved with NTG Nitroglycerine indication contraindication side effects Dose (SD county and NR) Metered Dose inhaler indication contraindication side effects dose (SD county and NR) Oral glucose indication contraindication side effects dose (SD county and NR) Signs, symptoms and treatment of hypoglycemia ALOC/unresponsive Pale, cool, skin Known diabetic Labored respirations Low blood sugar (<60) Caused by to much insulin Signs, symptoms and treatment of hyperglycemia May be altered Warm dry skin Kussmaul respirations Fruity odor on breath Polyuria Polydypsia Polyphagia High blood sugar Caused by not enough insulin Diabetic Ketoacidosis symptoms same as hyperglycemia but blood sugar is above 600 Signs , symptoms and treatment of a stroke (Cerebral Vascular Accident, CVA) ALOC Slurred speech Unresponsive Severe headache New onset of seizures Hemiparesis Blurred vision Nausea vomiting Facial droop May have airway compromise Signs, symptoms and treatment of a TIA slurred speech facial droop hemiparesis blurred vision symptoms relieved within 24hrs but usually within minute Charcoal (Activated Charcoal) both San Diego county and NR protocols Indication Contraindication Side effects Dose Signs symptoms and treatment for seizures tonic/clonic type movement (grand mal) “gazing off into space” if a baby, may be described as becoming “stiff” and turning “blue” may be febrile in nature protect the airway provide oxygen cool down if febrile in nature may be cause by trauma or CVA Status epilepticus Life threatenting Seizure lasting 5 or more minutes or occur consecutively without regaining consciousness Manage their airway and breathing Know the different ways a poison can enter the body and signs, symptoms and treatment of each: absorption (dry chemicals) ingestion (caustic substances, or narcotic overdose) injection (heroin overdose) inhalation (carbon monoxide, huffers) Placenta Previa (know the treatment) Painless vaginal bleeding Occurs in third trimester May see excessive bleeding for may see signs of hemorrhagic shock Abruptio Placentae (know the treatment) constant abdominal pain with vaginal bleeding pain in the lower back constant uterine contraction tender abdomen treat for shock Ectopic pregnancy (know the treatment) Acute onset of lower quadrant abdominal pain on the affected side Should pain Vaginal bleeding that could be heavy or light Hypotension Treat for shock Spontaneous abortion vaginal bleeding with abdominal pain in the first trimester may present with expulsion of tissue Pre eclampsia (know the treatment) Hypertension Sudden weight gain Swelling of face, fingers, legs or feet Persistent headache Persistent vomiting Eclamptic seizure (know the treatment) Symptoms as above but patient begins to seize LIFE THREATENING FOR MOM and BABY Signs, symptoms and treatment of the following Breech presentation Limb presentation Prolapsed cord Multiple births Know the stages of labor First stage (dilation) Second stage (expulsion) Third stage (placental) Compensated shock tachycardia tachypnea restless GOOD BP Decompensated shock Tachycardia Tachypnea Altered/agitated POOR BP (hypotensive) Best way to control venous bleeding Direct pressure Bandage Treat for shock Best way to control arterial or any major hemorrhage direct pressure tourniquet Pneumatic Antishock Garment (PASG) indications contraindications only National Registry. Is not used in San Diego Co. Know the following terms tendon ligament cartilage Know the different types of fractures greenstick transverse pathological Know the signs, symptoms and treatment of the following abdominal emergencies abdominal aortic aneurysm appendicitis Know the signs and symptoms of imminent delivery Know the APGAR!!!!!!!!!!! Know the signs, symptoms and treatment of the following: croup epiglottitis febrile seizure shock child abuse SIDS (sudden infant death syndrome) Definition of a drowning Complications of a drowning pulmonary edema hypothermia chemical imbalances (washout of surfactant) Responsibilities of an OSHA trained Haz Mat at “first responder awareness” level Protocol for suspected child abuse (written and verbal report) Components of the pediatric assessment triangle Appropriate treatment for a suspected SIDS patient with and without signs of lividity and rigor mortis) What are some concerning statements, signs and symptoms regarding a geriatric patient syncopal episode (dehydration, GI Bleed, MI, stroke) new onset of confusion or ALOC (possible stroke) sharp, tearing, ripping abdominal pain (AAA) generalized weakness that is unprovoked (all sorts of things) unprovoked shortness of breath (PE) “I just don’t feel good” denial of pain (possible MI) Superficial burns Red or pink skin NO blisters Partial thickness Red or pink skin BLISTERS Very painful Full thickness White leathery skin that is hard to the touch Charred looking skin No pain to the full thickness burn site Sloughing of the skin Electrical burns cardiac arrhythmias (think AED) significant burns with entrance and exit wounds may cause fractures 12. Chemical burns (per National Registry) flush with copious amounts of water (just go with it, I know we had a great discussion in class with this) A child’s anatomy and the increase risk of trauma/illness pliable ribs and chest muscles weak abdominal muscles (less protection for internal organs) smaller airways larger tongue Proportionally larger skin surface area (hypothermia) Proportionally larger head (especially the occiput) Smaller blood volume Hypotension only after 30% blood loss Rate dependent High metabolic rate burning through O2 and sugar Bradycardia with hypoxia Death with hypoxia Rule of nines Adult Pediatric Rule of Palms Heat cramps signs and symptoms cramping to large muscle groups caused by loss of sodium Heat exhaustion signs and symptoms moist, pale-normal to cool skin dizziness weakness nausea/vomiting Heat stroke signs and symptoms ALOC Hot skin that is moist or dry Seizures Hypothermia via Conduction Convection Respiration Radiation Evaporation Stages of grief Bargaining Denial Anger Acceptance Depression Signs and symptoms of a stroke vs. TIA Signs and symptoms of hypovolemic shock in a pediatric patient listless pale, cool skin tachycardia no longer producing tears or wet diaper tachypnea history of trauma or N/V Signs and symptoms of suspected child abuse bruising of multiple stages stories that don’t make sense a fearful child Inhalation burns soot around nose or mouth singed eyebrows, hair, facial hair hoarse speech shortness of breath stidor Why are circumferential burns so dangerous? chest arms legs Cold water drowning vs. warm water drowning better survival mammalian diving reflex Signs and symptoms of early hypothermia shivering difficulty speaking Signs and symptoms of moderate hypothermia Stupor develops (ALOC) Shivering ceases Cardiac dysrhythmias Be careful with movement (why?) Signs and symptoms of severe hypothermia V-fib Bradycardia Significant hypotension Be careful with movement (why?) Signs and symptoms of profound hypothermia Death Not dead till they are warm and dead Characteristic of a Pit Viper (rattlesnake) Triangular head Rattles Pits in the face Treatment of a venomous snake bite extremity left at or below level of the heart no constricting band per SD county Most common cause of trauma in the elderly Falls Most common cause of trauma in pediatric patients motor vehicle accidents Critical burn criteria Full thickness burns to hands, face, feet or genitalia circumferential burns burns with respiratory involvement partial thickness covering more than 25% BSA in adults and 20% in children and adults over 50 chemical or high voltage burns burns complicated by trauma Treatment for heat exhaustion active cooling measures if awake and alert (cold packs) passive cooling measure if altered STOP cooling measures if they begin to shiver Treatment for hypothermia active warming for alert and oriented (get wet clothes off, blankets, heat packs) passive warming for altered (blankets, get wet clothes off) Decompression Illness Type 1 Pain Itching Swelling Skin rash Decompression Illness Type 2 The bends The shakes The chokes Arterial Gas Empolism Severe shortness of breath Frothy blood in mouth Severe chest pain Boyles Law (effects hollow organs) 100. Henrys Law (effects nitrogen gas in the blood stream) 101. Croup a. low grade fever b seal bark cough 102. epiglottitis a. stridor b. drooling c. high grade fever 103. Complications of burns a. Shock b. Hypothermia c. Infection 104. What is Kyphosis and how would you immobilize a person with kyphosis 105. According to Haz Mat protocol what is the a. Hot zone b. Warm zone c. Cold zone 106. Characteristics of a Black Widow bite vs. a Brown Recluse 107. Seizures in children a. Fever b. Meningitis c. Tumor d. Electrolyte imbalances 108. What is a Hazardous Material 109. Most helpful questions to ask the elderly a. how do you feel this week compared to last week? 110. Ambulance operations a. must operate with due regard b. major accidents usually occur at intersections 111. If you notice an IV has infiltrated a. clamp the line with the drip regulator and document 112. IV solution that is used in the pre hospital environment in San Diego County a. 0.9% normal saline 113. Know when to use and provide examples of each of the following: a. Emergent move b. Urgent move c. Non-urgent move