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Osteoarthritis Arthritis?
Results from cartilage loss and ware and tear of the joints (common in the elderly)
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Sprain vs Strain?
- Sprain: The stretching or tearing of ligaments. Occurs at a joint, most commonly the knee and ankle
- Strain: The stretching or tearing of tendons or muscles. AKA: “muscle pull”
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Delegate in this order for trauma MOI?
- 1. C-Spine
- 2. Deadly Bleed
- 3. Fracture
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Rheumatoid Arthritis?
an autoimmune disorder that damages joints and surrounding tissues
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Closed fracture
A fracture that does not break the skin
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Open fracture
external wound associated with fracture
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Nondisplaced fracture
Simple crack of the bone with no deformity
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False motion?
Appearance of a joint where there shouldn’t be one
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Displaced fracture
Fracture in which there is actual deformity
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Kyphosis?
Hunch-back - unusual curvature of upper spineMinute fractures in the spine (usually as a result of osteoporosis) causes bone growth and change of spinal shape
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Broken limbs CMS?
Still do CMS, but for Motor limit it too "Can you wiggle your toes?"
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Scoliosis
An abnormal curvature of the spine, results in S-curving of the spine laterally
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How to Splint: RICE
- Rest
- Immobilize
- 1. Assess CMS function
- 2. Prepare equipment prior to Pt movement
- 3. 1 move allowed to position patient for splinting
- 4. If resistance is met or pain increases, splint in deformed position
- 5. Generously pad the splint
- 6. Splint above & below injury site
- 7. Immobilize the joint above & below
- 8. Cover the minimum amount of anatomy required, ensure visibility of deformity site
- 9. Reassess pulse, motor & sensory function
- 10. Requires one EMS practitioner to maintain stabilization as the other applies splinting materials
- Cold
- Elevate
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If circulation is impaired, attempt to reposition to anatomical position, any...?
- grossly deformed MID-SHAFT fractures of extremities
- Never EVER EVER EVER realign if it could be a JOINT
- Only 1 attempt can be made
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Mid-shaft is defined as:
- More than 1 hand-width (the patients hand!) away from the joint
- If they have a pulse - leave it in place!
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# Femur: Foot flops...
out (lateral)
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# Hip: Foot flops...
in (medial)
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Contraindications for traction of # femur?
- Hip, knee, lower-leg or ankle injury on affected side
- Inability to properly size the device (really tall Pt’s)
- Ensure the rear-ambulance doors to not impact the traction splint as it sticks out about 12” past the Pt’s heel (ouch!)
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In-line Traction Splinting of a?
- Used only for mid-shaft femur fracture, single or bilateral if you have a bilateral sager splint
- Injury must be located one hand-width distal to the hip joint and one hand-width proximal to the knee
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When tying triangular bandages, make sure the knot is on the?
outside - not touching the Pt.
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The following tissues/organs require a constant supply of blood:
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The following tissues/organs only require a supply of blood when active:
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For external bleeds only:
- Direct Pressure
- ↓
- Pressure dressing (same as above really, but a ∆ bandage holds the gauze - check CMS)
- ↓
- Pressure point (push on a pulse area - check CMS)
- ↓
- Elevation
- ↓
- Tourniquet (call medical control 1st!)
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If nose bleed (or any bleed really) lasts more than 10 mins?
Transport
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CSF from ears?
Gauze it to absorb, but don’t plug the leak - it could be a pressure relief response
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The reason we use moist dressings for burns is?
because it helps cool the wound & control their pain, not because the wounds are moist any way
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Burns get dealt with at what stage?
- during PRIMARY you get your partner to cool and deal with the burn.
- As it has been dealt with, you don’t need to do anything extra during secondary
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Significance of Bleeding?
- The body will tolerate a 10%loss of blood rapidly, or a 20%loss of blood over a period of time
- Adults: 10% is ≈ 500 mL
- Children: 10% is ≈ 150 mL
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Loss of blood over what the body can handle will result in?
- Re-prioritization of blood flow
- Radical change in vital signs
- BP DOWN (late finding in Decompensated shock)
- Increased Heart Rate
- Increased Respiratory Rate
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Dressing vs Bandage?
- Dressing: Thing next to the wound
- Bandage: Thing that holds the dressing onto the wound
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Subdural Bleeds?
Between brain and DuraS/S may not present for many days or even weeks (VENOUS bleed)
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Neck wounds?
Use occlusive dressing to stop air getting in (which'd cause air embolisms in the brain etc)
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Epidural Bleeds?
- Between Dura and Skull
- brief period of unconsciousness and headache, followed by a “lucid period” then rapid decline in LOC, to a point where the patient is unresponsive (ARTERIAL bleed)
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Intracerebral Bleed?
- In the brain itself
- Varies with location within the brain (stroke-like symptoms)
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Concussion?
- A blow to the head that causes a temporary loss or
- alteration of part or all of the brain’s abilities to function without actual physical damage to the brain
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Eye injuries?
- MOIST sterile dressing if they cant close their eye (say a
- pencil stuck through it) so it doesn't dry out.
- If they can close their eye then just use a dry dressing
- Don’t squish it!
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Scalp heavy bleeding?
If Skull # suspected don’t apply lots of pressure! You will force bits into the brain!
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In fact ALL CRITICAL INTERVENTIONS get fixed when?
in the Primary
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Rule of 9's for adult?
- HEAD: 9
- CHEST: 9
- ABDOMEN: 9
- UPPER BACK: 9
- LOWER BACK: 9
- EACH WHOLE ARM: 9
- EACH WHOLE LEG: 18
- GROIN: 1
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Rule of 9's for Child?
- HEAD: 18
- CHEST: 9
- ABDOMEN: 9
- UPPER BACK: 9
- LOWER BACK: 9
- EACH WHOLE ARM: 9
- EACH WHOLE LEG: 14
- GROIN: 1
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your GREAT VESSELS?
The Aorta, Vena Cava, and Pulmonary Arteries
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Moving Prone Pt.s?
- Do Pt. Overview
- Delegate C-Spine
- Now flip 'em
- 1. C-Spine EMS holds head with thumbs facing in the direction of person is face
- 2. You at shoulders
- 3. One EMS at feet
- 4. You assess DCAPPBTLS and TIC Posterior
- 5. Move back board next to patient on side that they are facing away from (unless contraindicated by injuries to a side)
- 6. Keep backboard like one inch away from the Pt. to give them space to rotate onto the board
- 7. You and leg EMS knee on BBoard
- 8. At Head EMS's timing roll them onto their side
- 9. Get off the board one at a time
- 10. Roll onto back
- 11. V slide
- 12. Etc
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