practical.txt

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dodgybarnet
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96341
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practical.txt
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2011-08-07 18:16:27
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EMR
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Practical
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  1. PRACTICAL: Scene survey?
    • BSI PPE
    • Time?
    • I am surveying the scene, do I see, hear or smell anything dangerous to myself, my partner or my patient? Do the bystanders or patient appear dangerous?
    • I am surveying for MOI / NOI and asking bystanders what happened.
    • How many patients are there? I am looking for evidence of others & asking bystanders.
    • How many assistants do I have? (Police, Fire, First Aid etc)
    • Do we need more help or specialized equipment? Decision is based on the number of patients & circumstances.
    • I am requesting back up now
  2. PRACTICAL: PATIENT OVERVIEW?
    • As I approach the patient are their eyes open and tracking?
    • What is their skin colour?
    • Do they appear to be in any respiratory distress?
    • Do I see any deadly bleeding or obvious fractures or dislocations?
  3. PRACTICAL: PRIMARY SURVEY?
    • C-Spine Control (if indicated)
    • I am delegating C-Spine control to my partner, fire, or law enforcement.
    • LOC
    • ABCs
    • Critical interventions
    • Rapid physical assessment
    • Transport decision
  4. PRACTICAL: LOC?
    • My name is __________; I am with EMS.
    • Please do not move until we have checked you for injuries.
    • We are here to help:
    • can you tell me your name?
    • can you tell me where you are right now?
    • can you tell me today’s date?
    • can you tell me what happened?
    • can you take a deep breath?
    • do you hurt anywhere?
    • did you hit your head or lose consciousness at any time?
    • If the patient does not respond I am assessing their response to voice and pain.
    • The patient's LOC is AO X___.
  5. PRACTICAL: ABCs?
    • AIRWAY
    • Alert: The patient is talking so I assuming the airway is clear.
    • Not Alert: I am performing a head-tilt/chin-lift OR a modified jaw-thrust if required.
    • *I am looking to see if the airway is clear. I am listening and looking for fluids or gurgling.
    • *I am suctioning the airway if required.
    • *If the patient is not alert I am checking for an eyelash flicker (gag-reflex) and sizing and inserting an OPA / NPA
    • BREATHING
    • *I am assessing respirations for 10 seconds.
    • *I am checking the rate, rhythym and depth of respirations.
    • *If the patient is not breathing I am ordering 2 ventilations immediately.
    • *If the patient's respiration rate is over 30 or under 10 I am ordering assisted ventilations.
    • *I am ordering my partner to apply O2 to the patient. I am stating the O2 flow rate & delivery device used.
    • CIRCULATION
    • *I am assessing circulation at the radial and carotid pulses. I am checking the rate, rhythm & quality of the pulse.
    • *If the patient is pulseless I am initiating AED protocols and/or CPR.
    • *I am checking skin colour, condition and temperature with the back of my ungloved hand.
    • *I am performing a rapid wet-check, for any significant bleeding or loss of body fluids.
    • Critical Interventions
    • *I am checking all critical interventions I have completed.
  6. PRACTICAL: Rapid physical assessment?
    • Head
    • *I am visualizing the head, do I see any DCAPP-BTLS?
    • *I am palpating the head, do I feel any TIC?
    • Neck
    • *I am exposing and visualizing the neck, do I see any DCAPP-BTLS?
    • *I am looking for any medic-alert tags.
    • *Are the neck veins flat or distended? Is the trachea mid-line?
    • *I am palpating the neck, do I feel any TIC?
    • *I am sizing and applying a cervical collar now (if required)
    • Chest
    • *I am exposing and visualizing the chest do I see any DCAPP-BTLS?
    • *I am looking for any retractions or accessory muscle usage, any
    • barrel-chestedness or paradoxical chest movement.
    • *I am auscultating for breath sounds bilaterally; are they present and equal at the apices & bases?
    • *I am palpating the chest, do I feel any TIC?
    • Abdomen
    • *I am exposing and visualizing the abdomen do I see any DCAPP-BTLS?
    • *I am palpating the four quadrants of the abdomen, do I feel any distention, rigidity or tenderness?
    • Chest
    • *I am exposing and visualizing the chest, do I see any DCAPP-BTLS?
    • *I am looking for any retractions or accessory muscle usage, any barrel-chestedness or paradoxical motion.
    • *I am looking for any surgical scars, medication patches or any subcutaneous emphysema.
    • *I am auscultating for breath sounds; are they present and equal at the apices & bases bilaterally? I am palpating the chest, do I feel any TIC?
    • Abdomen
    • *I am exposing and visualizing the abdomen, do I see any DCAPP-BTLS?
    • *I am looking for any pulsating masses, eviscerations, needle marks or surgical scars.
    • *I am palpating the four quadrants of the abdomen, do I feel any DRT?
    • Pelvis
    • *I am exposing and visualizing the pelvis, do I see any DCAPP-BTLS?
    • *Do I find any incontinence, priapism or vaginal bleeding.
    • *I am palpating the iliac crests, do I feel any TIC?
    • Lower Extremities
    • *I am exposing and visualizing each lower extremity, do I see any DCAPP-BTLS?
    • *I am looking for medic-alert tags.
    • *I am palpating the lower extremities, do I feel any TIC?
    • *I am assessing CMS bilaterally by asking the patient to push and pull with their foot against my hand and asking if they can feel where I am touching.
    • Upper Extremities
    • *I am exposing and visualizing each upper extremity, do I see any DCAPP-BTLS?
    • *I am looking for any medic-alert tags.
    • *I am palpating the upper extremities, do I feel any TIC?
    • *I am assessing CMS bilaterally by asking the patient to push and pull with their hand against my hand and asking if they can feel where I am touching.
    • Posterior (may be checked before rolling onto a backboard)
    • *I am exposing and visualizing the posterior, do I see any DCAPP-BTLS?
    • *I am palpating the posterior, do I feel any TIC?
  7. PRACTICAL: TRANSPORT DECISION BLURB
    • immobilize all injuries before rolling/moving
    • *The patient's chief complaint is XXX
    • *This patient is a "Load and Go" or a "Stay and Stabilize".
    • *Spinal Motion Restriction Procedure (if indicated)
    • *If "Load & Go" we are loading the patient into the ambulance, switching to the main oxygen and leaving the scene. We are bringing a pertinent bystander, the pts. personal effects & medications. I am having a fire fighter drive. I am reassessing ABC’s and LOC.
  8. PRACTICAL: SAMPLE OPQRSTA
    • A: Do you have any allergies?
    • M: Are you on any prescription, OTC, recreational, herbal or other medications?
    • P: Do you have any previous medical conditions? Heart, respiratory, diabetic, other?
    • L: When was the last time you had anything to eat and drink?
    • E: What were you doing before this started? How did you feel B4 the event occured?
    • Onset: Did the pain come on suddenly or gradually?
    • Provoke: What provokes it or makes it worse?
    • Quality: Describe how does the pain feels?
    • Radiation: Does the pain radiate or move anywhere?
    • Severity: On a scale of zero to ten, ten being the worst, how does this pain rate right now?
    • Time: How long has this been going on? Is it constant or intermittant?
    • Aleve: Does anything make this better?
  9. AEIOUTIPS?
    • Alcohol, Apnea, Anaphylaxis
    • Epilepsy, Environmental
    • Insulin
    • Overdose
    • Underdose
    • Trauma
    • Infection, Ischemia
    • Psychiatric, Poisoning
    • Stroke, Shock
  10. PRACTICAL: CRITICAL INTERVENTIONS?
    • *Is the OPA/NPA still inserted and being tolerated
    • *Is the O2 still flowing, no kinks in the hose and bag still 2/3 full
    • *C-Spine Control still being held/Check straps and rolls for Spinal Motion Restriction
    • *Bandages still in place/functioning/sealed, have bandages bled through, impaled objects still stablized.
    • *Fractures/Dislocations still stabilized.
    • *Bee stinger removed
  11. SPECIALIZED ASSESSMENTS: Medical?
    • Confirm indications & no contraindications
    • amount of medication already taken by pt.
    • Medication Verified (6 rights) medication, dose, route, time, patient, documentation
    • Confirm 3 C’s and E : Color, Clarity, Concentration, Expiry Date
    • Vitals taken before administration
    • Inform patient of side-effects
    • Confirm online direction or protocols
    • Administer or assist with medication (follow local protocols)
    • Right documentation: time, dose, route, effect
    • Reassess vital signs within five minutes of administration
  12. SPECIALIZED ASSESSMENTS: Neurological?
    • *Assess Level of Consciousness (AVPU)
    • *Assess CMS x4
    • *Assess pupils for EARRL and size (mm)
    • *Consider AEIOU-TIPS
  13. SPECIALIZED ASSESSMENTS: Gastrointestinal / Genitourinary?
    • *"When was your last bladder and bowel movement?"
    • *"Was there any bleeding or anything unusual about your last bladder or bowel movement?"
    • *"Have you been coughing up blood?" (coffee-ground like appearance)
    • *"Is there any chance you could be pregnant?"
  14. SPECIALIZED ASSESSMENTS: Poisoning / Overdose?
    • *"What have you taken? How much did you take?"
    • *"When did you take it?"
    • *"What else have you taken?"
    • *"How much do you weigh?"
  15. SPECIALIZED ASSESSMENTS: Obstetrical?
    • *"How long have you been pregnant? When are you due?"
    • *"How many children do you have? How many times have you been pregnant?"
    • *"Are you having contractions? How far apart are they? How long do they last?"
    • *"Do you feel as though you have to push or move your bowels?"
    • *"Have you had any spotting or bleeding? Any gushing of fluid from the vagina?"
    • *"Have you had a complicated pregnancy in the past?"
    • *"Is there any possibility of a multiple birth?"
    • *"Does your doctor expect any complications?"
  16. PATCH TO HOSPITAL / ALS UNIT?
    • Age
    • Gender
    • MOI
    • C/C
    • Tx
    • Vitals
    • ETA
  17. PRACTICAL: BASELINE VITAL SIGNS?
    • *I am ordering my partner to take and document my patient's vital signs.
    • Skin: What is the color, condition, and temperature of the skin?
    • LOC: What is the LOC of the Patient?
    • Eyes: Are the pupils EARRL (Equal & Round, Regular in size, react normally to Light) & what's their size in mm?
    • Resp: What is the rate, rhythm and depth of their respirations?
    • Pulse: What is the rate, rhythm and quality of their pulse?
    • Temp: What is their temperature, measured via tympanic thermometer?
    • BP: What are the systolic and diastolic pressures?
    • BGL: What is the blood glucose level (in mmol/l)
    • Pulse Oximetry: What is their SpO2 reading?
  18. PRACTICAL: Mega-Outline of practical?
    • Scene Survey
    • Pt Overview
    • Primary Survey (C-spine, LOC, ABCs, Crit Inter, Rapid physical assessment, Trans decision)
    • Enroute 1st set of Vitals
    • Sample History
    • OPQRSTA
    • Specializes Survey(s)
    • Crit Inter
    • Secondary Survey (detailed physical exam)
    • 2nd set of vitals
    • Pain reassessment (OPQRSTA)
    • Specializes Survey(s) if necessary
    • Crit Inter
    • Hospital Patch
    • Profit

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