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At what rate are chest compressions done?
At least 100/minute
What are two things to keep in mind when doing chest compressions?
Push hard, push fast.
What is the ratio of chest compressions to breaths for an adult?
30 chest compressions to 2 breaths.
What are you looking for when ventilating a patient?
What is the ratio of chest compressions to breaths for a child?
- 30 compressions to 2 breaths for a single rescuer
- 15 compressions to 2 breaths for 2 rescuers
What is the ratio of chest compressions to breaths for an infant?
- 30 compressions to 2 breaths for a single rescuer
- 15 compressions to 2 breaths for 2 rescuers
What is normal blood pressure for an adult?
120 over 80
What is normal blood pressure for a child?
90 over 50
What is normal blood pressure for an infant?
80 over 40
What are normal respirations for an adult?
Approximately 1 every 5-6 seconds (12-20/minute)
What are normal respirations for a child?
Approximately 1 every 3-5 seconds (16-24/minute)
What are normal respirations for an infant over 28 days old?
Approximately 1 every 2 seconds (30-40/minute)
What are normal respirations for an infant under 28 days old?
Approximately 1 every second (40-60/minute)
Which organization does HFD follow for CPR and defib?
Heart and Stroke
Which organization does HFD follow for all medical other than CPR and defib?
After how long without oxygen does brain damage occur?
Approximately 4 to 6 minutes
How deep should chest compressions in adults be?
At least 2"
How deep should chest compressions be in children?
How deep should chest compressions be in infants?
Approximately 1/3 to 1/2 the depth of the chest (1 1/2")
When is rescue breathing done?
When a pulse is present but ventilations are inadequate
How long should a pulse check be done for?
No more than 10 seconds
What are some things to keep in mind while performing compressions?
- Elbows straight/arms locked
- Position yourself directly above the patient
- Push hard, push fast (at least 100/minute)
- Hand placed on the center of the lower part of the breastbone
- Count out loud (when you get to 25ish)
Can an adult defibrillator pad be used on a child or infant?
Yes, if there is no child/infant defibrillator pads available
Can child/infant defibrillator pads be used on adults?
What is something to keep in mind while performing a pulse check?
Always check on the same side of the patient you are on.
When should you not use a bag valve mask?
When you are by yourself
What are the circumstances where a defibrillator would not be hooked up?
- Obvious death (rigor mortis, transection, decapitation, gross charring, etc.)
- Penetrating trauma (person is bleeding out because of wounds)
When is only 1 AED analysis allowed?
- Blunt force trauma
Where is a pulse check performed on infants?
Arm by bicep (brachial pulse)
Where is a pulse check performed on children and adults?
Neck (carotid pulse)
How is the airway opened/maintained on a VSA adult?
Head tilt/chin lift OR modified jaw thrust if spinal/head injury suspected
How is the airway opened/maintained on an infant?
- Slide hands under shoulder blades to avoid hyperextending the neck
- Only move head as far as the "sniffing position"
What is your first action when dealing with an adult choking victim who is still conscious?
Encourage them to cough it out, or if necessary place fist above abdomen and perform abdominal thrusts until the object is displaced or patient goes unresponsive
What is the CPR protocol for a choking victim who has gone unresponsive?
Same as normal except with a look inside the airway between each set of compressions to determine if obstructing object can be seen. Never use blind finger sweeps, if you can see the object attempt to remove it.
What are some things to keep in mind in cases of pediatric cardiac arrest?
- Usually secondary to other conditions
- Oxygen is critical, get them ventilated and oxygenated ASAP
What 4 things must be present to make a DNR valid?
- Patient's name
- Signed by medical professional
- Wishes of individual filled in/checked off
What 4 things must be present to make a DNR form valid?
- OFM emblem
- Ministry of Health and Long-Term Care emblem
- Serial number
- Must be Ontario DNR form
What are the 7 fundamental principles of the Red Cross?
- Voluntary service
What are protocols?
Standardized procedures to follow when providing patient care
What is implied consent?
A scenario where the law would assume the patient wants care (unresponsive, VSA, etc.)
What should you do if a patient refuses care?
- Honour their wishes
- Try to get them to stick around until advanced care or police arrive
- Have a witness hear the refusal if at all possible
When can you stop performing CPR?
- When equal or more advanced medical care takes over
- When a patient becomes responsive
- When a doctor/medical health professional declares the patient as dead
- When it becomes unsafe to do so
What does OPQRST stand for and when is it used?
- When a painful area/condition is found, use OPQRST to get patient to describe pain.
- Onset - when did it start?
- Provoke - what caused it?
- Quality - describe (shooting, crushing, etc.)
- Regionalized/Radiating - only in chest, goes down left arm, etc.
- Severity - 1 to 10 scale, compared to childbirth, broken bone, etc.
- Time - how long has it been going on?
What does SAMPLE stand for and when is it used?
- Used to interview patients and/or bystanders on medical calls.
- Signs/Symptoms - observations rescuer makes, reported symptoms from patient
- Allergies - patient have any allergies?
- Medications - patient on any meds?
- Previous medical history - happened before?
- Last meal - when did patient eat least?
- Events - what happened leading up to incident?
What does DOTS stand for and when is it used?
- Used during secondary head to toe full body assessment.
- Open wounds
What are you checking when you check vitals?
- Pupils (equal in size and reactive to light)
- Pulse (quality, rate and rhythm)
- Respirations (quality, rate and rhythm)
- Blood pressure (normal pressure for adult/child/infant)
- Skin (colour, condition and temperature)
What does AVPU stand for and when is it used?
- When determining a patient's level of consciousness.
- Verbal - respond to verbal stimuli
- Painful - respond to painful stimuli
What are you checking for during your primary survey?
- Assessing if C-spine is necessary
- Level of consciousness
- Severe bleeding
When is a patient classified as a "load and go"?
- Altered level of consciousness
- Inadequate pulse
- Inadequate ventilations
- Severe bleeding
When is C-spine utilized?
- Unknown injury
- Head/spine injury suspected
During full head to toe examination what are you looking/feeling for on the head and neck?
- Any discharges/fluids
- Softness around eyes, cheeks or jaw
- Airway unobstructed
During full head to toe examination what are you looking/feeling for on the chest and back?
- Breathing difficulties
During full head to toe examination what are you looking/feeling for in abdominal area?
- Hardness or swelling
During full head to toe examination what are you looking for around the pelvis?
Moves correctly on all 3 planes
During full head to toe examination what are you looking for on the extremities?
- Circulation (capillary refill)
- Sensation (squeeze fingers/move toes)
What are the first things you should do when arriving at a medical alarm?
- 1)Assess scene safety
- 2)Don all necessary PPE
- 3)Notify dispatch that you are 10-12 and report:
- a) number of patients
- b) apparent mechanism of injury
- c) additional resources needed
What does the primary assessment at a medical alarm consist of?
- Assess whether C-spine is necessary
- Assess level of consciousness
- Assess CAB's
- Interventions (oxygen, orophyrangeal airway, bandages, etc.)
- Rapid body search looking for severe bleeding
- Transport decision (load and go or not)
- Update dispatch
What does the secondary assessment consist of at a medical alarm? (medical illness, NOT traumatic injury)
- -Interview patient/bystanders using SAMPLE while performing a vitals check
- -Do full head to toe using DOTS and if painful area/condition is found, use OPQRST to describe pain
- -Provide ongoing care and transfer to paramedics when they arrive
- -Pass on all relevant info to paramedics
What does a secondary assessment consist of at a medical alarm? (traumatic injury, NOT medical illness)
- -Full head to toe using DOTS and if painful area/condition is found, use OPQRST to describe pain
- -Interview patient/bystander using SAMPLE while checking vitals
- -Provide ongoing patient care and transfer to paramedics when they arrive
- -Pass on all relevant information to paramedics
What are the 6 rights when dealing with medications?
- Right person
- Right medication
- Right dosage
- Right time
- Right route (administered correctly)
- Right documentation (time, dose, route, effect)
What 4 things must you do to obtain consent?
- Identify yourself
- State your level of training
- Explain what you think may be the problem
- Explain what you plan to do
Where can a pulse be taken?
- Neck (carotid)
- Upper arm by bicep (brachial)
- Wrist (radial)
- Thigh (femoral)
- Foot (pedal)
What type of a surface should be used to perform CPR?
Rigid, dry, non-metallic
What are some requirements when placing AED pads on a patient?
- Need bare skin (shave hair if necessary)
- Skin needs to be dry (wipe with towel if necessary)
- Ensure correct placement the first time
How are oropharyngeal airways sized?
Measure airway from earlobe to the corner of the mouth
What should you keep in mind when using suction on a patient?
Only place the suction tube down as far as you can see (can also measure from earlobe to the corner of mouth like an airway)
Which devices can be used to ventilate an unresponsive patient?
- Resuscitation mask
- Bag valve mask
Which device can be used to ventilate a responsive patient?
What is the most prominent sign of a heart attack?
Persistent chest pain
What information must be gathered prior to assisting with nitroglycerin administration?
- Blood pressure
- Pulse check
- Whether any ED medication has been taken in the last 48 hours
- 6 rights of medication
What are some necessary precautions/conditions when using an AED?
- No oxygen nearby (flammable)
- Patient not on a metal surface
- No one contacting patient when analyzing or shocking patient
How long should it take to give a breath to a patient?
Approximately 1 second
What does FAST stand for (stroke)?
- Facial numbness/weakness/droop
- Arm numbness/weakness, especially on 1 side
- Speech slurred or difficult
- Time is critical, get advanced care
What is shock?
A condition where the circulator system fails to adequately circulate oxygen-rich blood to all cells of the body
What care should be provided for treating shock?
- Assess CAB and provide necessary care
- Provide care for specific situations (bleeding, splinting, oxygen administration, etc.)
- Help patient rest comfortably
- Help patient maintain normal body temperature
- Provide ongoing care
What are the 4 main types of open wounds?
What are the 3 types of burns and what are their characteristics?
- Superficial - only on the surface (red, dry skin, painful)
- Partial-thickness - involve epidermis and dermis (red skin with blisters, often swollen, painful, may appear blotchy)
- Full-thickness - destroys both skin layers and possibly structures underneath like fat, bones, muscles, nerves, etc. (may be painless if nerve endings are destroyed, generally surrounded by painful partial-thickness burns, can appear black or brown with structures underneath appearing white, can be life-threatening)
What is the rule of 9s in reference to burns?
Method of estimating burn areas on children and adults (9 percent assigned to both arms and head, 18 percent assigned to each leg, 18 percent assigned to the front of torso and the rear of torso, and 1 percent assigned to crotch) as well as infants (18 percent assigned to head, 18 percent assigned to each side of torso, 9 percent assigned to each arm, 14 percent assigned to each leg)
What are some things to keep in mind for applying first aid to burns?
- If dealing with a dry chemical burn, use back of gloved hand to sweep off any chemical residue
- If dealing with full-thickness burns, place a dry sterile dressing over the burn
- If dealing with superficial or partial-thickness burns, if possible submerge the burn in cool water and then place a damp dressing over top
- Treat patient for shock
What is the care generally provided for musculoskeletal injuries?
What first aid should you administer for a sucking chest wound?
Three sided occlusive bandage (tape top and both sides, keep bottom open to allow for exhalation and drainage)
What first aid should you administer for exposed internal organs?
- Remove clothing from around the wound
- Apply moist, sterile dressings loosely over the wound
- Cover dressings lightly with a folded towel to maintain temperature
- Bend the knees to alleviate pressure on the abdomen
- Treat for shock
How can poisons enter the body?
What is the progression for clinical symptoms/signs of hypothermia?
- Mild - body temperature of 36 - shivering, increased metabolic rate, body still producing some heat
- Moderate - body temperature of 34-30 - impaired judgment and speech, slow/abnormal pulse
- Severe - body temperature below 30 - fixed and dilated pupils, loss of movement, heart stops
What is frostbite?
Freezing of body tissues, commonly occurs on fingers, toes, ears and nose
What are some symptoms of heat cramps?
- Body temperature is normal
- Severe muscle contractions
- Skin is moist
What are some symptoms of heat exhaustion?
- Normal or slightly elevated body temperature
- Cool, moist, pale skin
- Dizziness and weakness
What are some symptoms of heat stroke?
- Rapid, weak pulse
- Rapid, shallow breathing
- Hot, dry skin
- Progressive loss of consciousness
- High body temperature
What is the normal human body temperature?
37 degrees Celsius
What are the 4 stages of labour?
- Delivery of the baby
- Delivery of the placenta
Name the 5 considerations when lifting heavy objects
- Use your legs not your back
- Keep weight as close to you as possible
- Keep body aligned
- Reduce height or distance you need to move if possible
- Keep back, wrist and knees in normal alignment
What are the 4 categories used to classify patients during a multiple casualty incident?
- Black - dead/non-salvageable
- Red - require immediate attention
- Yellow - require attention but not immediately
- Green - can walk on their own
What criteria would make a patient at a multiple casualty incident classified as "black"?
Not breathing/obviously dead
What criteria would make a patient at a multiple casualty incident classified as "red"?
- Breathing over 30 times/minute
- Breathing normal, radial pulse absent
- Abnormal level of consciousness
What criteria would make a patient at a multiple casualty incident classified as "yellow"?
Breathing, radial pulse and level of consciousness normal but they cannot walk away on their own
What criteria would make a patient at a multiple casualty incident classified as "green"?
Patient can walk
What do we look for to decide if a patient is classified as a child or adult?
Signs of puberty (roughly around age 8)
What is the medical terminology to describe front and rear?
Anterior and posterior
What is the medical terminology to describe away from and towards?
Distal and proximal
What is the medical terminology to describe higher and lower?
Superior and inferior
What should the rescuer giving breaths do periodically during CPR?
Check for signs of circulation (cap refill, colour, pulse, etc.)
What are the two rhythms which the AED will advise to shock?
- Ventricular fibrillation
- Ventricular tachycardia
What are the two rhythms the AED will not shock?
- Asystole (flat-lined)
- Normal heart rhythm
What are the steps to follow when checking blood pressure by palpation?
- Have patient sitting and at rest, no talking
- Find the radial artery
- Put on the cuff
- Inflate cuff to roughly 40 mmHg above the point where you lose the radial pulse
- Slowly release air from the cuff
- The point where you get the first indicator of a pulse back is the systolic pressure
What are the two different airway obstructions?
- Anatomical (tongue, swollen tissue, etc.)
- Mechanical (food, toy, etc.)
When would you place a patient in the recovery position?
If they are unresponsive but breathing, no suspected head/spine injury, and you have completed the primary and secondary surveys
What is the difference between an unconscious and unresponsive patient?
- Unresponsive - no response to verbal or painful stimuli, no muscle control, often signs of incontinence are present
- Unconscious - usually respond to painful stimuli, still have control of their muscles (gag reflex)
What type of patient gets an oral airway inserted?
An unresponsive patient
How is an oral airway inserted into a patient?
- Adult - Upside down to start (tip touching the roof of the mouth), rotate 180 degrees when you get roughly halfway in and "corkscrew" it into place
- Infant - To the side to start (tip touching the cheek), rotate 90 degrees when you get roughly halfway in and "corkscrew" it into place
How long does a size "D" oxygen cylinder last?
- 29 minutes at 10 lpm
- 72 minutes at 4 lpm
What is the difference between a bandage and a dressing?
- Dressing - applied directly to wound
- Bandage - holds dressing(s) in place
What are some potential causes for a stroke?
- Blood clot/rupture
- Head injury
- Hypertension (high blood pressure)
What are the 4 types of musculoskeletal injuries?
What are the 4 different types of splints?
Rigid, soft, anatomical, traction
What should you always do before and after administering a splint?
Take a distal pulse
What is the difference between an open and closed fracture?
The skin is broken on an open fracture
What is the maximum time you should perform suction for?
How is a nasal airway measured?
From the tip of the nose to the earlobe
What steps should be followed to insert a nasal airway?
- Size airway appropriately
- Apply lubrication to airway
- Insert airway into the right nostril with the pointed end towards the septum
- Administer 1-4 LPM of supplemental oxygen
What should you do when bandaging frostbitten appendages?
Put dry gauze between them.
How do blood vessels near the skin's surface help to dissipate heat?
In what would you place teeth to transport with patient to hospital?
Milk or patient's saliva
How is a cervical collar measured?
The space between the trap muscle and a line drawn straight down from the chin (generally done with fingers)
What is a KED used for?
Stabilize a patient who is in the sitting position (generally to help extricate from an MVC)
In what order are the straps of a KED fastened?
- My Baby Looks Hot Tonight
What are the 4 phases of a seizure?
Aura (signs which sometimes let a patient know a seizure is coming), tonic (rigid), clonic (spasm), post-ictal (unaware of surroundings, gradually coming to).
What is a poison?
A foreign substance which enters the body.
What is a Sager (sp.) and what is it used for?
Splint used to provide traction in the event of a broken femur.