Emergency Procedures Mid Term
Terms
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- Basic Emergency Routine and Protocols
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A.Personal Safety
B.Use Universal Precautions
C. Confidence, competence, compassion - Personal Safety
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Survey the scene
Environmental Dangers
Personal Dangers - Universal Precautions
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PPE (Personal Protective Equipment)
a. Double latex gloves
b. Eye protection
c. Face Mask
d. Gown (could be anything)
* Wash hands after
* cover your mucous membranes and any open wounds - Confidence, competence, compassion
-
Introduce yourself
Get consent
Ask pt. name
Smoothly but swiftly
Turn over to paramedics - Emergency history taking mnemonic
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A SAMPLE
Age (gender, race)
Symptoms (brief OMPQRT)
Allergies
Meds (Include OTC)
Previous (other) Illness
Last Meal
Events prior to emergency - Legal mnemonic to keep you out of trouble
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RISKS
Recording
Informing
Solve problems
Keep up (cont. edu)
Stay in communication w. pt. - Informed Consent
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All risks and benefits disclosed to the pt
Usually written
Pt and Dr sign consent form - Expressed Consent
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Emergencies only
Verbal permission
No signature or consent form required - Implied Consent
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Emergencies only
unconscious adults or mentally incompetent people
minor unaccompanied by adult
assumes patient would give consent and can't respond - Minors consent
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Under 18
Consent from parent or legal guardian - Refusal of Care
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Patient refuses care and is mentally competent
Expain all risks
Calm them down, ask again
Still refuse sign something
Mentally ill or substance abuser = Grey area → call police - Before getting involved (6)
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1.Survey the scene
2. PPE
3.Shake/ Shout/ Introduce yourself/ Get consent
4.If no response, call 911.
5.Support / stabalize c-sp
6.Plug major blood loss - ABC DE of Life
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Airway
Breathing
Circulation
Disability (level of consc)
Expose and Examine - Airway Obstruction (causes)
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tongue (most common)
Laryngeal edema (upper airway swollen shut CAN'T CLEAR!)
Foreign body - Head tilt/ Chin lift maneuver
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superior hand is on their forehead
inferior hand is under the chin
Tilt / lift - How many minutes before brain damage from lack of O2?
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4-6 min
then hypoxia - Breathing key criteria (is the patient breathing?)
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Look (at chest)
Listen (for sounds)
Feel (your cheek to their mouth for air)
-Check the skin, change in color bluish/purple, sclera (eye), and mucus membrane color - Circulation key criteria (is blood flowing?)
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- Check carotid pulse (on your side)
- In child check brachial pulse - A Carotid pulse represents a presence of a minimum of __ mmHg systolic
- 60
- A femoral pulse represents a presence of a minimum of __ mmHg systolic
- 70
- A brachial pulse represents a presence of a minimum of __ mmHg systolic
- 70
- A radial pulse represents a presence of a minimum of __ mmHg systolic
- 80
- Disability (Level of Consciousness/ LOC)mnemonic
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AVPU
Alert
Voice Stimulation
Pain Stimulation
Unresponsive
More letters = worse pt. is - Alert criteria (by 4)
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1.Person (What is your name?)
2.Place (Where are you?)
3.Time (What time is it?)
4.Situation (What happened)
Confused = all right answers but still not fully there - Voice Stimulation criteria
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becomes partially or fully alert
Can move fingers, toes or blink eyes on command - Pain Stimulation criteria
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sternal rub or shake and shout gets a response
moan or groan - Most life threatening fractures
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1. femur ... 2 L bld internally
2. Posterior clavicle ... cuts subclavian artery - Emergency pulse protocal
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15 sec X 4
60 - 100 normal
3 fingers - no thumb - Café Coronary
- dentures + large bites of food + alcohol= choking obstruction of upper airway in a conscious person
- palpatory blood pressure protocal
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- taken when too noisy
- Palpate return of pulse as the air bladder is released.
- gives systolic only
- note as ---/P - Epiglottis in children
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treacheostomy or swelling of upper airway
intubation to treat - American Heart Association ... four links in their chain of survival
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a.Early access to the emergency response system
b.Early CPR
c.Early Defibrillation
d.Early advanced care - Chest pain with no muscular death
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angina pectoris
occurs if the cardiac artery has temporary vasospasm - heart stops completely
- cardiac arrest
- When the heart may transmit dysfunctional neurological signals resulting in fibrillations
- Cardiac failure
- General difficulty with the heart
- cardiac compromise
- when 1 or more of the cardiac arteries are occluded and can’t deliver blood to the cardiac muscle
- Heart attack = MI (myocardial infaraction)
- Contraindications to CPR
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-Patient has no pulse
-Obvious mortal wounds
-Decapitation
-Rigor mortis
-Obvious signs of death - Complications of CPR
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-Rib fractures
-Sternal fractures
-Costochondral separation
-Lung and heart contusions
-Pneumothorax
-Liver lacerations - When to terminate CPR
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-Patient is resuscitated
-Pulse returns
-Medics arrives and take over
-Patient is declared dead by EEG
-Your are 100% tired - CPR Recovery position
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- get person off their back
- roll to side, take top knee up, one hand under their face.
- With air in stomach they will probably vomit. -
Child CPR Motions (age 1-8 years old)
(after survey > look, listen, and feel) -
- 2 breaths
- check carotid pulse
- If pulse but no breathing perform rescue breathing 1 breath every 3 seconds
- no pulse do chest compressions 5:1
- may be arm compressions
- recheck breathing, and pulse
- 911