Based off chapter 14,15,16 of Nancy Carolines Emergency Care in the streetsPatient assessment, Critical thinking, Communications/documents
The person at fault
Access and exit routes
Environmental conditions
Overall safety of the situation
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Vital signs
Chief complaint
HIV status
Age and sex
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Logroll the patient on a long backboard
Assess the integrity of the 12 cranial nerves
Ventilate the patient at 12-20 breaths/min
Apply a properly sized rigid cervical collar
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Determine how fast the patient's condition is deteriorating and whether cardiac arrest is imminent
Assess trends and to reassess whether the patient's condition is stabilizing, getting better, or getting worse
Quantify that the patient's condition is stabilizing, even if he or she has an altered level of consciousness
Determine what body is in dysfunction, which will further facilitate the provision of specific care
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Confer with online medical control to confirm his/her working diagnosis
Always keep part of the thought process open to other possibilities
Implement a treatment plan based solely on the working diagnosis
Remain confident that his or her working diagnosis is an accurate one
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Restrict intravenous fluids, even if the patient is hypotensive
Position the patient supine and carefully monitor breath sounds
Give nitroglycerin if the systolic BP is greater than 100 mmHg
Obtain a 12 lead ECG and look for signs of cardiac compromise
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Provide aggressive care
Quantify how sick he or she is
Contact online medical control
Transport him or her immediately
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Apply pressure to the eyes to elicit pain
Remove any dentures if they are present
Avoid palpating any cranial depression
Pack the eyes if blood drainage is present
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Has not experienced a traumatic injury
Has a glasgow coma scale score of 15
Will likely not require medication therapy
Does not have a life-threatening injury
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First responders contact an emergency dispatcher
A bystander notifies the dispatcher via telephone
A sick or injured patient presents to your EMS station
Law enforcement requests assistance via two-way radio
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Are revised or updated too frequently
Are often overridden by medical control
Only address classic patient presentations
Discourage contact with medical control
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The dispatcher
Bystanders
Medical control
Your partner
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Intubate the trachea
Insert an airway adjunct
Suction the oropharynx
Ventilate with a bag-mask device
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Emergency department physicians have become less trusting of the paramedic's ability to interpret an ECG, and would rather interpret it themselves
By law, a licensed physician must evaluate a patient's ECG tracing before the paramedic can administer any medications other than supplemental O2
The american heart association recommends the acquisition and transmittal of a 12 lead ECG to the receiving facility for all patients with potential acute coronary syndrome
Numerous reports and studies indicate that paramedics have an unacceptable high rate of ECG misinterpretation, which has resulted in appropriate care of cardiac patients
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Cyanotic
Flushed
Mottled
Pale
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Lethargic
Confused
Obtuned
Semiconscious
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Duplex
Simplex
Repeater
Encoder
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Dispatch law enforcement to the scene
Give pre-arrival instructions to the caller
Ask the caller to put the patient on the phone
Obtain the caller's name and physical address
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Baseline vital signs
12 lead ECG acquisition
Capillary bleeding control
Full spinal motion restriction
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Clarity
Accuracy
Calmness
Thoroughness
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Unruly patient
Moving traffic
Broken glass
Hazardous materials
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Noting a patients heart rate before you administer any medication
Obtaining a room air pulse oximetry reading before applying oxygen
Reassessing a patients blood pressure after administering nitro
Administering aspirin and then immediately applying a cardiac monitor
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Transport the patient to the closest medical treatment facility
Move the patient to the ambulance as expeditiously as possible
Perform a detailed assessment to narrow your differential diagnosis
Decide what care is needed at the scene versus en route to the hospital
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Pale, cool, clammy skin
Obvious respiratory distress
A complain of chest pressure
Blood pressure of 110/60 mm Hg
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Heart failure
Pneumonia
Pneumothorax
Toxic inhalation
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Painful injuries should be treated as soon as you discover them
Open fractures should be splinted immediately upon discovery
Grossly obvious injuries are often not the most life threatening
Most traumatic injuries are complicated by a medical condition
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Warm and dry
Hot and dry
Pale and hot
Hot and moist
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An anatomic airway obstruction
Secretions or blood in the airway
Swelling of upper airway structures
Severe inflammation of the epiglottis
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Slow
Bounding
Thready
Rapid
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May be acutely hypoglycemic
Mandates air-medical transport
Often requires a cricothyrotomy
Should be placed on his or her side
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Your ems systems patient care protocols or standing orders
Your previous experience with patients who had a similar condition
Direct orders from the physician at the receiving medical facility
A combination of your and your partners knowledge and experience
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Regularly be treating patients who can only be diagnosed at the hospital
Have difficulty providing supportive care secondary to medical ambiguity
Regularly be able to formulate a definitive diagnosis of the patient's current condition
Not be able to stabilize the patient's condition adequately in the field setting
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Provides for a continuum of patient care upon arrival at the hospital
Is a legal document and should provide a brief description of the patient
Should only include the paramedic's subjective findings or personal thoughts
Is only held for a period of 24 months, after which it legally can be destroyed
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Always begin transport within 10 minuts
Contact medical control as soon as possible
Qualify and quantify the patients condition
Perform a detailed physical examination
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An elaboration of the chief complaint
A clinically significant physical finding
The patients most significant problem
The reason why the patient called 911
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Somatic
Referred
Radiating
Visceral
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Are of no value unless they are repeated every 5 minutes
Provide difinitive information about the patients problem
Provide comparative data regarding the patients condition
Establish a baseline to which further vital signs are compared
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Cellular and landline telephones overcome problems caused by overcrowded EMS radio frequencies
Cellular phones are more expensive than radios and give a weaker signal
Landline phones are more expensive than radios and give a weaker signal
Cellular phones do not rely on a repeater to increase the coverage distance
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Muscle tremors
Loose electrodes
Severe tachycardia
Distant transmission range
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A rigid abdomen and signs of shock
An elderly patient with prolonged asystole
A driver who passed out and then struck a tree
Isolated tibia/fibula fracture from minor trauma
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Unilateral pulse deficit and pallor
Bilaterally diminished pedal pulses
Warm, flushed skin to the extremity
Inability to feel or move the extremity
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The systolic BP increases and the diastolic BP decreases when going from a lying to a sitting position
The heart rate increases by 20 beats/min or more when going from a supine to a standing position
The respiratory rate becomes fast and the depth becomes shallow when he or she suddenly stands up
He or she experiences chest pain and a rapid, irregular heart rate when going from a seated to a standing position
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Use 10-codes whenever possible
Allow the patient to hear the report
Answer questions with the word "yes"
Not be sitting right next to the patient
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Two days of vomiting, heart rate of 110 beats/min, warm dry skin
38 weeks gestation, crowning, history of htn, tachycardia
250 mL external blood loss, systolic BP of 130 mm Hg, moderate pain
Chest discomfort, heart rate of 104 beats/min, systolic BP of 90 mmHg
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Paints a mental picture for the receiving physician
Is used to help substantiate delayed on scene times
Will help justify the patient care decisions you make
Provides legal immunity if the patient decides to sue
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Chief complaint
Nature of illness
General impression
Differential diagnosis
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Duplex
Simplex
Low-band
Multiplex
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Vehicle-pedestrian collision
Penetrating injury to the head
Ejection from a cars backseat
Fall from greater than 10 feet
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