Overview
The American College of surgeons or state authorities designate that These facilities have to have certain capabilities 24 hours per day including trauma surgeons, for surgical capabilities, and diagnostic equipment available at all times? pg. 419
Trauma Centers
If the primary assessment reveals a patient with severe bleeding, what should be treated before we address the airway? pg. 423
Bleeding/Circulation is a Life Threat
Shock is generally divided into 4 main types, can you name them? H, D, O, C pg. 434
Hypovolemic, Distributive, Obstructive, Cardiogenic
Find the mistakes. pg. 435
1. Cardiogenic shock has to do with a Volume Problem
2. Distributive shock is a Vascular Tone Problem
3. Hypovolemic shock is a Pump Problem
4. Obstructive shock is an Obstruction Problem
1. Cariogenic-Pump
3. Hypovolemic-Volume
Fill in the Blanks. pg 439
Arterial bleeding is _______ red and ______ from the wound
Venous bleeding is _______ red and ______ from the wound
Bright Red/Spurts (oxygenated)
Dark Red/Flows steadily (de-oxygenated)
How many decisions are made in the Scene Size up, and what are they? pg. 420
(5)
Scene Safety, Standard Precautions, MOI/NOI, Number of Patients, Resources needed
This type of exam is used to identify injuries the patient may have sustained? pg. 424
Head to toe exam
T/F, the consistent delivery of blood to adequately oxygenate cells is called Shock?
False, Perfusion
The early stages of shock were minimum perfusion is maintained through actions of the body such as increased heart rate and constriction of blood vessels? pg. 437
Compensated shock
Bleeding occurs under the skin and is not visible, often occurs into the body such as the abdominal cavity? pg. 440
Internal Bleeding
The MOI gives you an idea of how serious or critically injured a patient may be. Alone it may not be enough, but helps the EMS provider develop this? pg. 421
Index of Suspicion
What does DOTS stand for? pg. 424
Deformity, open wounds, tenderness, swelling
What are the three components of the circulatory system? pg. 432
Heart (pump), Blood vessels, and Blood/products
In this stage of shock, the body can no longer make up for increasing lack of oxygen delivered to vital organs and methods to fix the problem begin to fail? pg. 437
Decompensated shock
The process of controlling external bleeding can be thought of as a series of steps. List from least invasive to most invasive, how the first responder can control external bleeding? pg. 443/444
Direct Pressure (min. 5 minutes)
Elevation with Direct Pressure
Hemostatic agents/wound packing
Tourniquet
You should never start providing care to a patient until this is accomplished? pg. 423
Scene Size up
Standard precautions for a very severe bleeding should include? pg. 421
Gowns, Eye/Face Protection and Gloves
System that delivers oxygen and nutrients to the cells, removes waste products? pg. 432
Cardiovascular System
The brain is particularly sensitive to an adequate supply of oxygen. As a result it is common to see evidence of this in the patients? pg. 437
Mental Status.
Combative, restless, anxious, etc.
Steps/considerations for controlling a Nose Bleed? (4) pg. 447
1. Sit patient upright/slightly forward
2. Pinch nostrils/direct pressure-avoid checking to see if it's working
3. Consider ice packs to face/nose
4. Discourage patient from "blowing" their nose if bleeding stops
Falls from these heights (Adults/Kids) are considered by be life threatening and should be transported to a Trauma Center? pg. 422
Adults >20'
Kids>10' or 2x height
The patients rapid pulse and clammy skin, may be signs that the patient has shock, and treatment would involve this from the EMS provider? pg. 423
Supplemental Oxygen
What does GCS stand for, and what are the 3 components. Max of 15? pg. 426
Glascow Coma Scale
Determine persons level of consciousness
Eye opening (4)
Verbal response (5)
Motor Response (6)
T/F, blood pressure is the best indicator of shock. Most people cannot maintain a normal blood pressure when there is massive blood loss or serious shock? pg. 438
False.
The EMR should learn to identify shock through the larger patient presentation, and never rely solely on blood pressure to indicate shock
EMR steps for caring for a patient with shock? (4) pg. 448
Lay patient flat
Supplemental High flow 02
Keep patient warm, remove wet clothing
Supportive care, reassurance while waiting for ALS