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Severe Hypothermia temp?
s/s of Severe Hypothermia <32°?
- Muscle activity decreases
- Shivering stops
- Coordinated finger movement stops
s/s of Severe Hypothermia <29°?
- Lose interest in keeping warm
- Removal of clothes
- LOC drops
- Rigid limbs
s/s of Severe Hypothermia ~27°?
- Vitals drop
- Pulse drops
- BP drops
s/s of Severe Hypothermia <27°?
- Cardiorespiratory activity ceases
- NOT dead!
If hypothermia suspected, how long to check for pulse?
Hypothermia pt. precautions?
- Be gentle!
- Don’t over stimulate the heart!
Management of cold pt.?
- Remove pt. from cold enviro
- Remove wet clothes
- Prevent conductive heat loss (cold floors etc)
- Prevent convective heat loss (wind)
- Insulate cold bits of body
- Handle gently
- Provide O2
Gangrene vs infarction?
- Gangrene: death of the tissue in considerable mass, usually associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction.
- Infarction: development or presence of an infarct (a localized area of ischemic necrosis produced by occlusion of the arterial supply or venous drainage of the part)
Frostbite Tx (vs frostnip)
- DO NOT: Rub
- DO NOT: apply heat
- DO NOT: allow them to walk on frostbitten feet.
- Cover with sterile dressing
- Remove jewelry
Def of Hyperthermia?
muscle spasms => loss of large amount of salt and water through exercise. Heat cramps are associated with cramping in the abdomen, arms and calves
Heat Cramp Tx?
- Remove pt. from enviro
- Rest muscles
- Provide fluids (50/50 water & Gatorade would be good)
Tx for heat exhaustion?
- Remove excess clothes
- Remove pt. from enviro
- Pt. lies down
- Iff pt. alert: drink water
- If N/V: no water + LLR or RLR
- Cover with wet sheets
- Fan the pt.
Def of Heat Stroke?
body temperature of greater than 41 °C
In lightning strikes: treat those whom appear dead 1st
Rattle snake Tx?
- Reassure Pt.
- Supine position
- Clean bite area (no ice): treat as puncture wound
- Splint if limb
- Watch for N/V
- Nil by mouth
- Monitor Vx
- Mark swelling with a pen to assess spread
- Tx for shock
- Bring dead snake
- Dose in vinegar/isopro alcohol
- Scrape with CCard
- Soak in hot water
Def and s/s of Heat exhaustion?
- Hypovolemic shock => of dehydration
- Cold clammy skin
- Rapid pulse
Pulse drops => of submersion in cold water
Good question for suicidal pt.?
- Do they have any vacation plans? Suicidal pt.s don’t look to the future.
- Also, ask to borrow some money.
Biggest factor behind attempted suicide?
Positioning for drowned pt.
LLR: helps to drain upper airway
Average fetal gestation?
Gravida vs Para?
- Gravida: Total # of pregnancies
- Para: Total # of live births
Braxton-Hicks contractions vs real? 5 things
- BHC: irregular with no increase of frequency or intensity
- REAL: regular + ^ of freq & intensity
- BHC: Pain in lower abdomen & contractions stay there
- REAL: Pain in lower back that wraps around to lower abdomen
- BHC: if bloody show; brown
- REAL: if bloody show; pink/red
- BHC: Moving Pt. position helps
- REAL: Moving Pt. position doesn’t help
- BHC: If fluids, usually urine
- REAL: If fluids, usually sweet smell + continuous
Pregnancy induced hypertension
Seizures => of Pregnancy induced hypertension
Supine Hypotensive Syndrome?
- Foetus compresses inferior Vena Cava
- Tx: LLR
- Iff supine on back board: Towels under right side of board
Childbirth transport decision?
Load ‘n’ go, unless baby crowning and coming out, or ass-out breech
Neonatal Apgar score?
- Appearance: pink not cyanotic
- Pulse: has one
- Grimacing: Grumpy is good
- Activity or Muscle Tone: not floppy
- Respirations: regular & Rapid
- Scoring: 2 for perfect, 1 for medium, 0 for absent
Clinical vs Biological death?
- Clinical: Absence of respiratory or circulatory function in unresponsive pt.
- Biological: Absence of brain activity
DRIED definitive signs of death?
- Rigor Mortis
- Eviserated (of Heart/Brain etc)
5 steps of grieving?
3 variations btwn child/adult?
- Airway size
- Blood loss coping
- Kids more prone to head injuries
Bodies reaction to stress?
- Alarm response
- Reaction & Resistance
- Recovery OR Exhaustion
Critical Incident Stress Management
Deadly bleeding acronym?
- Direct Pressure
Depth or CPR compressions @ age?
- Adult: 4-5 cm
- Child/Infant: 1/2 to 1/3 chest
Infant CPR landmarking
2 fingers place 1 finger below nipple line
Tx for mild choking
- Encourage coughing
- NRB @15 Lpm
Tx for severe conscious choking (normal person)?
- 5 J-Thrusts
- Ensure proper landmarking
- Repeat another set of 5 J-Thrusts
- GOTO 1
Tx for severe conscious choking (fatty or pregnant)?
Chest thrusts until object free or Pt. collapses
Tx for severe unconscious choking?
- 30 Compressions: as per CPR
- Check airway for obstruction: and remove with cross finger technique or sweeps (no blind finger sweeps)
- Ventilate: 2 PPVs. If 1st unsuccessful, reposition head.
- Repeat CPR prn
Tx for severe unconscious choking - INFANT?
- Hold sandwiched face down
- 5 back blows
- Switch infant face up resting on your thigh
- 5 CPR compressions
- Repeat prn
Pertinent Positive vs Pertinent Negative?
- PP: A finding (sign or symptom) that you would expect to find in a patient with this condition
- Example: substernal crushing chest pain in a patient suspected of having a heart attack
- PN: A finding (sign or symptom) that you would expect to find in a patient with a condition that is not present
- Example: no half-paralysis of a patient suspected of having a stroke
Weird breath sounds aka?
Adventitious Breath Sounds
- Apices: one inch below the mid-clavicle
- Bases: at the mid-axillary line lateral to the xiphoid process
Mask used if resps >30 or <10?
- >30: BVM if tolerated.
- If not tolerated: NRB & coached down
- <10: BVM if tolerated.
- If not tolerated: NRB & NO coaching
TIC of pelvis?
Inward NOT down
Stopwatch of O2 deprivation?
- 0-1 min: cardiac irritability
- 0-4 min: brain damage not likely
- 4-6 min: brain damage possible
- 6-10 min: brain damage very likely
- 10+ min: brain damage irrepressible
Simple face mask details?
- Not used much anymore
- 6-10 Lpm
- 35-60% inspired O2
O2 cylinder PSIs?
- 200 PSI: empty
- <500 PSI: not suitable in ambulance
O2 cylinder types & factors?
- D: 350L – factor 0.16
- E: 635L – factor 0.28
- M: 3000L – factor 1.56
How to calculate Tank Life?
(Tank Pressure – 200)(factor/flow rate)
Different flavours of Fowlers position?
- pt’s head is elevated...
- Low: 15-30 degrees
- Semi: 30-45 degrees
- Standard: 45-60 degrees.
- High: 80-90 degrees
3 layers of the skin?
2 sections of the skeletal system?
- Axial: Cranium, spine ribs
- Appendicular: everything else
Bones of the spinal sysyem?
- Total: 33
- Cervical: 7
- Thoracic: 12
- Lumbar: 5
- Sacrum: 5 fused
- Coccyx: 4 fused
Area just above angle of Louis?
Line formed by ribs below xiphoid?
3 parts of ankle/foot?
3 parts of wrist/hand?
5 specialised assessments?
- Medication Assessment
- Neurologic Assessment
- GI/GU Assessment
- Poisoning / OD Assessment
- OB/GYN Assessment
Divisions of nervous system?
- Central NS: Brain & Spinal cord
- Peripheral NS: Somatic & Autonomic
- Somatic: voluntary
- Autonomic: involuntary
- Autonomic: Sympathetic & Parasympathetic
- Sympathetic: Adrenogenic (Alpha & Beta receptors)
- Parasympathetic: Cholinergic
Function of SNS
- Sympathetic Nervous System
- Prepares your body for stressful events
- --- ^HR
- --- ^Resps
- --- Dilates pupils
- --- Constricts peripheral blood vessels
- --- Dilates coronary and skeletal muscle blood vessels
- --- ileus
Function of PNS?
- Parasympathetic Nervous System
- Returns the body to normal (or the reverse of above effects if over-stimulated)
Anatomy of Meninges?
- Dura Mater
- Arachnoid Layer
- Pia Mater
Produces numerous hormones to control and regulate other glands
- Produces thyroxin
- Regulates growth and metabolism
Produces parathormone which regulates serum calcium
- Located in the abdominal cavity and retroperitoneal cavity
- Produces insulin (via beta cells) and glucagon (alpha cells)
- Regulates blood sugar levels
- Top of the kidneys
- Produce adrenalin which regulates the stimulation of the SNS
+ve vs –ve Feedback Loop?
- +ve is least common type: causes itself to produce more and more of the effect until the stimulus is stopped
- Examples: clotting, childbirth (uterine contractions)
- -ve is the most common type: loop continues to produce the hormone until the stimulus is gone (fear factor return to zero)
- Examples: “adrenalin rush”
Electrical parts of heart?
- SA: SinoAtrial Node
- AV: AtroVentricular Node
- Purkinje fibres: nice
Erythrocyte vs leukocyte?
RBC vs white BC
RBC vs white BC?
Erythrocyte vs leukocyte
Enteral vs Parenteral?
- Enteral: via intestines
- Parenteral: any other way
OR/NG enteral administration?
- OR: Orogastic
- NG: Nasogastic
- Both: not in EMR scope
Define the lobes of the lungs
- Right: 3 lobes
- Left: 2 lobes
Thrombus vs Embolus?
- Thrombus: clot which has formed at a specific location
- Embolus: A thrombus that has broken loose and is travelling through the vascular system
- the lack of gas exchange within alveoli, due to alveolar collapse or fluid consolidation. It may affect part or all of one lung.
- It is a condition where the alveoli are deflated.
- Acute respiratory distress syndrome: life-threatening lung condition that prevents enough oxygen from getting into the blood.
- Severe lung disease caused by a variety of direct and indirect issues.
- Very similar to pulmonary edema
Pink Puffer vs Blue Bloater?
- Pink: Emphysema => more RBCs as compensation
- Blue: Cyanosis + barrel chestedness
- Respiratory Syncytial Virus: A virus which causes lower airway illnesses like bronchiolitis or
- pneumonia and possibly respiratory failure
- Highly contagious!
Acute Stress reaction: hyperventilation freak out
Hemiparesis vs Hemiplegia
- Hemiparesis: Weakness on one side
- Hemiplegia: Paralysis on one side
Tonic vs Clonic?
- Tonic: Sustained muscle contractions
- Clonic: Jerky violent movement
Jacksonian / Focal Motor seizures?
- Jacksonian: involve a progression of the location of the seizure in the brain, which leads to a "march" of the motor presentation of symptoms often beginning in the fingers moving proximally
- Focal Motor: seizure of hands and face
ICP / Cushings triad Tx?
- BVM 15 Lpm 1:3
- Head raised 15°-20°
Blood in vomit
Hematemesis vs hemoptysis?
- Hematemesis: Blood in vomit
- Hemoptysis: coughing up blood
Blood in urine
- Black tarry stool
- Blood has run most of GI tract
Red runny stool
- Abdominal Aortic Aneurysm
- Pathophysiology: The descending aorta ruptures due to a weakening in the aortic wall, usually due to atherosclerosis or congenital precondition
- Blood leaking from the aorta pools around the peritoneum
2 chemicals released in allergic reactions?
- Histamines: trigger the inflammatory response & increas the permeability of the capillaries to white blood cells and some proteins, to allow them to engage pathogens
- Leukotrienes: sustain inflammatory reactions & trigger contractions in the smooth muscles lining the trachea
5 classes of allergen?
- Insect stings, bites & animals
- Analgesic - mild to moderate pain
- Relieves coughs
- “China White”
- Analgesic - for chronic pain
- 100 times more potent than morphine
- rapid onset and short duration of action
opiate versus opioid?
- Opiate: derived from poppy
- Opioid: synthetic & binds to opiod receptors
- semi-synthetic opioid drug synthesized from morphine
brand of a time-released formulation of morphine sulfate
- Analgesic - for acute & chronic pain
- opioid analgesic medication
- Analgesic - moderate to moderately severe acute or chronic pain
brand name of a time-release formula of oxycodone
s/s of Cholinergic agents?
- e.g.: Organophosphates
- Lacrimation (tears)
- GI irritant
Delirium vs Dementia?
- Delirium: rapid onset, temp change of cog status => of an outside factor (eg booze)
- Dementia: progressive change in Mental Status over years
What’s the MHA form 10 about?
Mental Health Act: laws relating to consent from a crazy person
AED for moderate/severe Hypothermia?
Only zap once!
- Premature separation of placenta from uterine wall
- s/s: bleeding & Pain
- Placenta partially or fully covers the cervix
- s/s: bleeding & NO Pain
3 stages of childbirth?
- 1st: Dilation of cervix
- 2nd: Baby coming out
- 3rd: Delivery of placenta
Height of a “significant” fall?
Max weight 2 EMS can lift?
New term for “Spinal Immobilization”?
Spinal motion restriction
Everytime you move a Pt (eg onto backboard)?
- Spinal shock
- Damage to nerves affects control of muscle tone & therefore blood vessels too
- Neurogenic shock
- Damage to nerves affects control of muscle tone & therefore blood vessels too
- Severe chest injury / airway obstruction
- => Hypoxia
- Pt. freaks out causing generalized vascular dilation
- => Syncope
Electrolyte imbalance causes arrhythmia & neuro disfunction
3 stages of shock?
4 fracture classifications?
- Greenstick: fracture in a young, soft bone in which the bone bends and partially breaks.
- Comminuted: broken into 2 or more pieces
- Pathological: => of weakened / diseased bone (eg: osteoporosis)
- Epiphysial: occurs during bone growth in a child
- compression of nerves, blood vessels, and muscle inside a closed space (compartment) within the body.
- leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure within the compartment.
- Because the connective tissue that defines the compartment does not stretch, a small amount of bleeding into the compartment, or swelling of the muscles within the compartment, can cause the pressure to rise greatly.
purple discoloration of the skin => of a bruise
Procedure for splinting (mnemonic)?
- Inflammation of paranasal sinuses (above & around ears & nose)
- s/s: Headache / tenderness of upper jaw & teeth / Ear ache
Separating various layers of soft tissue
- Pool of blood under damaged tissue
- Big ass bruise
6 burn related injuries?
- Superficial: (1st) only epidermis
- Partial thickness: (2nd) epidermis & Dermis. Super ouchy.
- Full thickness: (3rd) no pain @ 3rd, plenty @ 2nd
- Chemical: wet / dry
- Electrical: bzzzt
Definition of “Critical” Burns?
- FT: to hands
- FT: to feet
- FT: to face
- FT: to airway
- FT: to genitals
- FT: >10% of body area
- PT: >30% of body area
- Burns: with respiratory emergencies
Definition of “Moderate” Burns?
- FT: >2% of body area
- PT: 15% to 30% of body area
- SF: >50% of body area
Definition of “Minor” Burns?
- FT: <2% of body area
- PT: <15% of body area
Tx for burns?
- Immerse or run under cool sterile water / saline
- <20% BSA = Wet Dressing
- >20% BSA = Dry Dressing
- Shock Tx
Retrograde vs Anterograde memory loss?
- Anterograde amnesia: loss of the ability to create new memories after the event
- Retrograde amnesia: loss of memories created prior to the event
Bleeding in anterior chamber of the eye
fracture of the walls or floor of the eye orbit: Intraorbital material may be pushed out into one of the paranasal sinuses.
One lung collapses & compresses heart and other lung
Paper bag syndrome?
- Traumatic Asphyxia: sudden, severe compression of the chest causing a massive increase in intrathoracic pressure resulting in a reversal of blood flow through the circulatory system (possibly damaging heart valves)
- Often caused by holding your breath before impact
- Pericardial Tamponade
- -> JVD
- -> Narrowing pulse pressures
- -> Muffled heart sounds
Membranous folds attaching intestines to the body cavity
Respiratory Syncytial Virus: lower airway illness
Effects of hypo- & hyperventilation?
- Hypoventilation: respiratory acidosis & < hemoglobin affinity to O2
- Hyperventilation: respiratory alkalosis & ^ hemoglobin affinity to O2
Excess CO2 in blood
OPA & NPA measurement?
- OPA: corner of mouth to earlobe
- NPA: tip of nose to tragus, diameter bit smaller than pinky finger of pt, right nostril
Most common cause of airway obstruction?
SPO2 & bag choice?
- >95%: OK
- 91%-94%: NC
- 86%-91%: NRB
- <85%: BVM
To reduce the risk of gastric inflation that might lead to regurgitation and aspiration of stomach contents?
recommend reductions in both volume and speed at which rescuers provide ventilations, but only if supplemental oxygen is provided.
Compliance of lung tissue?
It’s stiffness or flexibility
Low blood pressure & poor perfusion
What would you like to do?
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