Hypovolemia Hypoxia Hydrogen ion (acidosis) Hyperkalemia/Hypokalemia Hypothermia Tablets (drug overdose) Tamponade (cardiac) Tension pneumothorax Thrombosis – Thrombosis –
ENVIRONMENTAL EMERGENCY 209 Radiation/Hazmat Special Note: Personnel safety is the highest priority. Do not handle the patient unless they have been decontaminated. All EMS treatment should occur in the Support Zone after decontamination of the patient. Appropriate PPE will be utilized. Assessment Extent of radiation/chemical exposure (number of victims, skin vs. inhalation exposure) Nature of exposure Symptoms exhibited by patient Neurologic status (LOC, pupil size) General appearance (dry or sweaty skin, flushed, cyanotic, singed hair) Associated injuries Decontamination prior to treatment If eye exposure, irrigate for a minimum of 20 minutes with NS associated injuries (LSB, limb immobilization, wound treatment) Supportive care per burn protocol Oxygen and airway maintenance appropriate to the patient’s condition EMR STOP Pulse oximetry (keep sats >94%) EMT STOP INT or IV NS/LR, if hypotensive 20 mL/kg (peds 20 mL/kg) AEMT STOP 12 Lead EKG, transmit
SHOCK / TRAUMA 414 Traumatic Cardiac Arrest Assessment Cardiac arrest secondary to trauma Oxygen and airway maintenance appropriate for the patient’s condition CPR EMR STOP Pulse oximetry EMT STOP IV NS/LR give 20 mL/kg bolus Consider second IV access AEMT STOP 12 Lead EKG, transmit if appropriate Treat cardiac rhythms per specific protocols If suspected pneumothorax, perform needle chest decompression Consider viability of patient prior to transport
REFERENCE OBSTETRICAL EMERGENCIES APGAR Scoring Clinical Sign 0 Points 1 Point 2 Points Appearance Blue/Pale Body Pink Extremities Blue Completely Pink Absent Below 100/minute Above 100/minute Grimace No response Grimace Activity Limp Some flexion of extremities Action motion Respiratory Absent Slow/Irregular Good strong cry The APGAR score should be calculated after birth of the infant. The five (5) clinical signs are evaluated according to the scoring detailed above. Each sign is assigned points to be totaled. A total score of 10 indicates that the infant is in the best possible condition. A score of 4 to 6 indicates moderate depression and a need for resuscitative measures. DO NOT delay resuscitation efforts to obtain APGAR score. Obtain APGAR at 1 and 5 minutes after delivery.
REFERENCE Mini Mental Status Exam Orientation to time – time of day, day, week, month, year 5 pts max Orientation to place – building, street, city, state, country 5 pts max Say “boy, dog, ball” and have the patient repeat it 3 pts max Ask the patient to spell would backward, or do serial 3s backward from 20 5 pts max Without repeating the words, ask them to repeat the previous three words (boy, dog, ball) 3 pts max Ask the patient to do the following after you have completed the request “stick out your tongue and touch your right hand to your left ear” 3 pts max Ask the patient to identify your pen and watch 2 pts max Ask the patient to read the following sentence then do as it says “Shut your eyes” 1 pt Ask the patient to write a sentence 1 pt Ask the patient to draw two overlapping pentagons (show them an example) 1 pt A score of 21 or better is considered mentally competent by most psychiatrists for a patient to make reasonable decisions.
REFERENCE Quality Improvement Document Criteria Documentation on all patients must include the following and any other information pertinent to patient care: OPQRST and SAMPLE are the acronyms for the United States DOT EMS and Paramedic patient assessment curriculum O – Circumstance surroundings on the onset of complaint P – What provoked (or provokes) the complaint? Environment Q – Describe the quality burning, stabbing counter etc.) of the complaint? R – Where does the pain radiate? S – Describe the severity of the pain on a 1-10 scale 1 (minimal) – 10 (maximum) T – Time of S – symptoms, physical exam findings A – Allergies to medications or the environment M – Medications, prescription or over the counter P – Past medical history L – Last oral intake E – Event, what happened to the patient All patients transported by EMS should have at least two sets of vital signs assessed and documented. Initial set of vitals will include blood pressure (systolic/diastolic), pulse rate, respiratory rate, pulse oximetry and blood glucose if indicated, and the time they were assessed must be recorded. All medications by the patient should be listed on the report. If medications are taken to ER document in narrative who the medications were left with. When documenting the presumed presence of alcohol that is based solely upon breath odor, do so in the following manner: “Patient’s breath has the odor that is commonly associated with the consumption of alcohol.” ABDOMINAL PAIN/PROBLEMS Location of pain Distension Tenderness/radiation Nausea/Vomiting/Diarrhea Urinary complaints LMP if applicable Vaginal bleeding/discharge if applicable Treatment/reassessments Report and signature of RN ALCOHOL INTOXICATION Patient’s breath has odor of ETOH Patient admits to drinking (type, amount, time Speech (normal, slurred) Gait (normal, unsteady) Any obvious injuries Blood glucose level Level of consciousness Treatment/reassessments Report given and signature of RN ALTERED MENTAL STATUS OPQRST, SAMPLE as appropriate ETOH/Substance use Any obvious injuries noted Blood glucose level Normal mental status EKG and strip attached Treatment/reassessments Report and signature of RN OPQRST, SAMPLE as appropriate Method of assault Any obvious injuries or pain Loss of consciousness, how long Treatment/reassessments Report given and signature of RN
pain/dyspnea Nausea/vomiting Headache/mental status Neuro Assessment Treatments/Reassessments Report and signature of RN Approximate ambient air temperature Estimate exposure time Type of environment (inside, outside, wet) Loss of consciousness Fluid intake Skin turgor/condition ETOH/Substance abuse Treatments/reassessments Report and signature of RN INHALATION INJURY (TOXIC GAS/SMOKE) Type of gas Duration of exposure Area of exposure (enclosed room) Heated environment Burns/singing (oral, nasal, facial area) Treatments/reassessments Report given and signature of RN POISONING/DRUG INGESTION Name of substance Amount Route of intake How long ago Vomiting since ingestion as appropriate Intentional vs. Unintentional ETOH/substance use Oral mucosa burns if appropriate Treatments/reassessments Report and signature of RN PREGNANCY/OB DELIVERY Separate report required for mother and each delivery Non-Delivery Abdominal Pain Gravida/Para/Abortion Length of gestation/estimated due date Edema (pedal)/BP/Headache/Visual Disturbance Vaginal bleeding/discharge – if yes, describe Treatments/reassessments Report given and signature of RN Last time movement REFUSALS Documentation of: Competency MMSE Lack of Trauma Situation Ability to make good decisions Safety of patient is assured by caretakers, family, etc. Delivery Multiple fetuses Mucous plug resented Membranes ruptured – if yes, is amniotic fluid clear? Crowning as appropriate SEIZURES OPQRST and SAMPLE as appropriate Obvious injures head, tongue) Duration and number of events Incontinence of consciousness (postictal) Treatments/reassessments Report given and signature of RN NEONATE Time of birth STROKE/CVA/TIA OPQRST and SAMPLE as appropriate
REFERENCE Common Medical Abbreviations a = before AED = Automated External Defibrillator AOX3 = alert and oriented to person place and time Abd = Abdomen Ab. = Abortion ac = antecubital AF = atrial fibrillation ARDS = Adult Respiratory Distress Syndrome AT = atrial tachycardia AV = atrioventricular b.i.d. = twice a day BSA = Body Surface Area BS = sugar and/or Breath Sounds c = with CC or C/C = Chief Complaint CHF = Congestive Heart Failure CNS = Central Nervous System c/o = complains of CO = Carbon Monoxide CO2 = Carbon Dioxide D/C = discontinue DM = diabetes mellitus DTs = delirium tremens DVT = deep venous thrombosis Dx = Diagnosis ECG/EKG = electrocardiogram EDC = estimated date of confinement EJ = external jugular ENT = ear, nose, and throat ETOH = the abbreviation of Ethanol (grain alcohol) fl = fluid fx = fracture GB = gall bladder Gm/g = gram gr. = grain GSW = Gunshot Wound gtt. = drop GU = genitourinary GYN = gynecologic h/hr = hour H/A = headache Hg = mercury H&P = History and Physical Hx = history ICP = intracranial pressure JVD = jugular venous distension KVO = keep vein open LAC = laceration LBBB = left bundle branch block MAEW = moves all extremities well NaCl = sodium chloride NAD = No apparent distress/no acute distress NPO = Nothing by mouth NKA = No known allergies OD = overdose O.D. = right eye O.S. = left eye PERL = pupils equal and reactive to light PID = pelvic inflammatory disease p.o. = by mouth 1° = primary, first degree PTA = prior to arrival pt. = patient q = every q.h. = every hour q.i.d. = four times a day RBBB = right bundle branch block R/O = rule out ROM = range of motion Rx = take, treatment s = without S/S = signs and symptoms TIA = transient ischemic attack t.i.d. = three times a day V.S. = signs y.o. = years old
REFERENCE – PEDIATRIC Age, Weight, and Vitals Chart Age Weight (kg) Normal Diastolic BP Normal Systolic BP Heart Rate Per Minute Respiratory Rate Per Minute Birth 3.5 56 – 70 66 – 90 110 – 160 30 – 60 6 mons 7.0 56 – 70 70 – 104 100 – 140 30 – 50 1 year 10.0 56 – 76 80 – 104 100 – 140 24 – 34 2 years 13.0 56 – 76 80 – 104 90 – 110 20 – 30 3 15.0 56 – 76 80 – 104 90 – 110 20 – 30 4 years 17.0 56 – 76 90 – 110 80 – 110 20 – 30 5 years 19.0 56 – 76 90 – 110 80 – 110 20 – 30 6 years 23.0 56 – 76 90 – 110 70 – 100 16 – 30 7 years 25.0 56 – 76 90 – 110 70 – 100 16 – 30 8 years 28.0 60 – 76 90 – 110 70 – 100 16 – 30 9-10 years 30.0 64 – 76 90 – 114 70 – 90 10 – 20 11-12 years 37.0 64 – 80 90 – 120 70 – 90 10 – 20 13-15 50.0 64 – 80 110 – 124 60 – 80 10 – 20 16-18 years 65.0 64 – 90 110 – 134 60 – 80 10 – 20 Size ETT = 16 + (age in years) 4 REFERENCE – PEDIATRIC Age and Weight Related Pediatric Equipment Guidelines Premature 3 kg Newborn 3.5 kg 6 Months 7 kg 1 – 2 years 10 – 12 kg 5 years 16 – 18 kg 8 – 10 years 25 – 36 kg C – Collars Small Small Small Medium O2 Masks Premature or Newborn Newborn Pediatric Pediatric Pediatric Adult BVM Infant Infant Pediatric Pediatric Pediatric Pediatric or Adult Laryngoscopes 0 1 1 1 2 2 – 3 ET Tubes 2.5 – 3.0 3.0 – 3.5 3.5 – 4.5 4.0 – 4.5 5.0 – 5.5 5.5 – 6.5 Suction Catheters 6 – 8 Fr 8 Fr 8 – 10 Fr 10 Fr 14 Fr 14 Fr Oral Airways Infant Infant or Small Small Medium Medium or Large IV Equipment 22 – 24 angio 22 – 24 angio 22 – 24 angio 20 – 22 angio 20 – 22 angio 20 – 22 angio BP Cuffs Newborn Newborn Infant or Child Child Child or Adult