Trauma
These are the components to the primary survey.
What are the ABC's!! - ABCDE
Airway (with C-spine Control), Breathing, Circulation, Disability, and Exposure
CThe classic description of the chest pain in patient having an acute myocardial infarction is
What is crushing, substernal chest pain; pressure; "like an elephant is sitting on my chest".
A blood sugar below this level is considered hypoglycemia.
What is less than 60.
This is the normal range for a respirator rate.
What is 12 - 20 breaths per minute
<12 is bradypnea
>20 is tachypneic
0 = apneic
What does CVA stand for and what is the more common term for it?
What is cerebral vascular accident and the more common name is a stroke?
This is the class of medication we are concerned about that will increase a patient's blood loss.
What are blood thinners and anti-platelets!
These include:
Anti-platelets: ASA, Plavix, Brilinta, and Effient
Blood Thinners: Warfarin (Coumadin), Xarelto, Pradaxa, Eliquis (these are the MC meds)
The two medications that we as EMTs can give to a patient experiencing chest pain are
What are Nitroglycerin and Aspirin
An acute hypoglycemic episode can mimic this other medical emergency.
*Hint: it's another category on the board ;)
What is a stroke?
These are the different methods to deliver oxygen and the amount of oxygen each method can deliver.
What is a nasal cannula from 2-6 LMP (usually anything above 6 is uncomfortable for the patient), Non re-breather (NRB) Mask 10-15 LMP.
Other O2 delivery methods are BVM, CPAP, BiPAP, HFNC.. but we dont really need to worry about these right now.
These are the two types of strokes and their differences.
*Bonus: describe a TIA and how it differs from a stroke
Ischemic: An emboli traveled to the brain and occluded an artery feeding the brain causing death of brain tissue.
Hemorrhagic: brain bleed!
Bonus: TIA is a TRANSIENT ischemic attack. Therefore, it's brief focal neurological deficits with resolution of symptoms. Often caused by an emboli that causes a brief. occlusion of the vessels then gets broken up or passes through causing the resolution of the symptoms. Considered a warning
These are the external symptoms of shock.
What are low blood pressure (SBP <90), weak pulse, tachycardia.
In traumas, we are mostly concerned about hypovolemic shock (consideration to obstructive shock). This is caused by large volume loss, like with hemorrhage (internal or external). It's important to recognize the signs and symptoms of shock because those patients need ALS and rapid transport to a trauma center. As EMS, we can assist in the treatment of shock by providing starting CPR if necessary, applying a tourniquet if there is arterial bleeding, providing oxygen or ventilations, keeping the patient war,, and monitor vitals signs. DON'T FORGET THE ABC's!
What is the maximum dose of aspirin that EMS can assist the patient with?
What is 325 mg?
(Therefore, if the patient takes a baby aspirin daily, then they can *chew* 3 more 81 mg tablets. Baby aspirin is 81 mg and a patient can have 4 of these if they did not already take some. An adult ASA dose is 325mg)
**ASA needs to be CHEWED in this setting.
These are the contraindications for oral glucose
What is blood glucose >60, unconscious patient, unable to follow commands.
Describe wheezing and stridor.
What is:
Wheezing is bronchoconstriction and indicates a lower airway obstruction. Seen with asthmatics, COPDers, anaphylaxis. Mostly present during expiration.
Stridor is an upper airway obstruction (the larger airway). Present during inspiration. Seen with aspiration and choking!
This is the acronym for a stroke and the meaning fo each of the letters and how to test them.
What is FAST?
F- Facial drooping
A- Arm Weakness
S- Speech
T- Time
These are some considerations to make when considering to fly or drive on a trauma call.
What is ground time to the nearest trauma center (distance, traffic congestion), helicopter ETA, transfer time, and flight time to trauma center, whether multiple patients are involved?
These are the contraindications of nitroglycerin
What are a known sensitivity/allergy to NTG, taking erectile dysfunction medications within the past 24 hrs, hypotension (<90 SBP), increased intracranial pressure.
These are the signs and symptoms of HYPOglycemia
What are shakiness, dizziness, tachycardia, nausea, confusion, diaphoresis, LOC?
These are some of the signs and symptoms of respiratory distress.
What are tachypnea, cyanosis, nasal flaring, tripod position, retractions, accessory muscle use, diaphoresis, grunting.
These are some risk factors for a stroke.
What are high blood pressure, cigarette smoking, diabetes, high cholesterol, heaving drinking, obesity, and lack of exercise. Cardiac arrhythmias such as atrial fibrillation is a risk factor for embolic stroke. Hemorrhagic stroke risk factors include trauma (falls), and Aneurysms/AVMs.
These are some of the criteria to transport to a trauma center with ALS.
(You do not need all of the criteria to get points!) Just give me a few :)
What is : (Listed are all the requirements/recommendations)
Physiology: GCS +/- 12 or AVPU = P or U; SBP <90; HR <60 or >130; RR <10 or >29
Anatomy: Penetrating injuries; flail chest; Fractures (more than one involving a long bone); Pelvic Fractures; Paralysis or evidence of spinal cord injury; Amputation above the wrist or ankle; Burns in combo with other injuries; high voltage electrical injury
MOI: Ejection from vehicle; Extrication >20 mins with an injury; Falls >20 feet; Unrestrained passenger in a roll over; Pedestrian, motorcyclist or pedal cyclist thrown or run over
Two part question:
This is the mechanism of action of aspirin and nitroglycerin?
What is:
Aspirin: anti-platelet
NTG: Vasodilator
This is the hormone that drives glucose into the body's cells.
*bonus: what organ is it make in?
What is insulin?
The treatment for hyperglycemia is insulin as it drives glucose into the cells, lowering the concentration in the blood.
*bonus: it is made in the pancreas!
Scenario: You have a 68 year old female with a past medical history of COPD presenting with SOB, cough, dyspnea. First impression of the patient reveals tripod position, tachypnea with accessory muscle use, slight cyanosis of the lips, restlessness, and inability to speak full sentences. How would you handle this patient?
What is call for medics and ZOOM ZOOM to the hospital :)
This patient presents with respiratory distress (Oh no!). Management of this patient will be prompt history taking WHILE packing the patient for transport. Vitals are important (like always) to assess the need for oxygen as well as the delivery of the oxygen (NC vs NRB vs BVM). The scary part of respiratory distress is the impending respiratory failure; this is why medics are very important and prompt delivery to the hospital is crucial. However, do NOT wait on scene for medics, try to rendezvous.
This is the name of medication hospitals give to patients suffering from an ISCHEMIC stroke.
What is tPA or tissue plasminogen activator?
TPA is known as the clot-busting drug! There are certain indications/contraindications that qualify a patient to receiving this medication. the most important one for EMS to know is that the medication has to be given 3 hours from last time known well (Some studies is pushing this number to 4.5 hours). Therefore, it's important to quickly package and transport the patient (safely) to the nearest facility, hopefully with ALS onboard.