Hemorrhage
You see a spurting blood wound from pt leg with a pool around the site. How do you stop it?
Apply a tourniquet, 2"-3" above site, above junctional site. Ensure all bleeding has stopped and pulses are no longer felt.
Easiest way to improve a pt Airway
Position the pt.
- Sniffing position
- Jaw thrust
- C-Spine Consideration (C1-5 keeps you alive)
- Head tilt
What is our average breathing rate for a pt?
Adult?
Ped?
adult: 12-20
Ped:
Birth-1Year: 30-60
1-6 years: 22-40
6-13 years: 18-30
Heart Rate for Adult and Ped
Adult: 60-100
Ped:
1-2 years: 75-190
2-10 years: 60-140
What is meant by checking Disability?
What is a robust mongaloid?
Check for neurologic status
- Motor status
- Pupils
- Mental status
You see a spurting blood wound coming from pt neck. What are your next steps?
Use Hemostatic gauze unless not available, then use normal gauze. May place an occlusive dressing (chest seal)
What is something that we can use to gain basic access to an airway?
4 things
Suction
NPA
OPA
Forceps
When attaching a cannula, what is my max flow rate?
NRB?
BVM? (& PEEP)
Cannula: 6
NRB: 10-15
BVM: 10-15 (PEEP 5-10)
What is your appropriate MAP and what is your blood pressure minimum if you have a radial pulse for an adult pt. Carotid?
a MAP of 65 is best but 60 is lowest we want to see. Radial pulse will be a SBP of at least 80. Carotid will be 60.
What are some things that you can do to treat for cold environment?
Take pt out of enviroment
Warm pt in ambulance (crank the heart)
Hot packs
Warm fluids
Blankets
Remove wet clothing
You have a pt intestines spilled into their arms. What are your next steps?
Apply a sterile gauze wetted with Normal Saline over the pt intestines. Never place them back into the pt abdomen. Keep intestines moist.
If there is only a laceration, you may place a chest seal over the wound to keep intestines in.
What may lead to Airway compromise?
Allergic reaction leading to Anaphylaxis (swelling)
Secretions (vomit, blood, water, other fluids)
Physical objects (kids taste the world)
You hear diminished to no lung sounds on the left side of the pt chest. What are your next steps?
Trauma + Signs of Shock
Confirm sounds
Check for Hypotension, difficulty breathing, diminished/ absent lung sounds
You cannot get an IV and pt blood pressure is dropping below lowest acceptable. What are your next steps. Walk through the process.
Fill line with lidocaine. Drill an IO site, either humoral or proximal tibial. Stop when pop, secure, finish slow pushing lidocaine and flush line, then draw back.
When pushing fluids, attach to pressure bag.
You have an 82 yo pt on blood thinners who fell and hit their head with no visible signs of external injury, yet you suspect an internal hemorrhage. What is your target Blood Pressure?
Open head injury?
Closed head injury: 110SBP
Open head injury: 90SBP
What is your lowest acceptable blood pressure for newborn to adult
Neonate (age 0-30 days of birth): 60SBP
30days to 1 year: 70SBP
1 year to 10 years: 70+(agex2)
You come across an unconscious pt lying on the ground with their mouth in their own vomit. What are your next steps?
You have a newborn pt who is not breathing/ crying. Upon inspection, pt has secretions in their airway. What are your next steps?
Dont suction deeper than you can see. Avoid stimulation of the vagus nerve.
Use a size 8 french soft catheter and insert. Upon pulling out, use a twisting motion no longer than 10 seconds.
Suction to depth of tip of nose to the earlobe. Use 1-2 drops NS in each nare to lube.
You have a pulseless pt with significat full body trauma. What are your next steps?
Control severe hemorrhage with appropriate measures.
2 Needle D's
Pelvic Binder
Manage Airway
You have a pt whos blood pressure has decreased below the lowest acceptable. What are your next steps?
Adult: push 500mL NS up to 2L
Push dose epi: 10-20 mcg
Ped: push 60mL/kg NS up to 3L
Push dose epi: 1mcg/kg up to 50 mcg
You have a patient whos leg was trapped in a logging accident. It takes you 45 minutes to get there. You find the pt alert and oriented X3 and complaining of pain. What are your next steps?
After X,A,B,C, treat for a crush injury by administering 1 L of NS before movement.
What is our adult and ped TXA dose? Indications?
Ped: 15mg/kg in 100ml
Over 10 minutes
You are working a Cardiac Arrest and see the stomach distending. What are your next steps?
After ensuring a secure airway, apply a stomach tube. Measure from the sternum to the pt ears and wrap around. This is the distance you should go to.
What is the rate we bag pt at?
Adult
Ped
Infant
Neonate
Adult 1:6
Ped 1:2-3
Infant 1:2
Neonate 1:1
How much fluid does the human body have in it?
How much can a human afford to lose?
You can lose .34/.45 gallons (1.5/2L)
Hypoxia (too cold)
Hyrigeon ion acidosic (acid build up)
Coaguloapathy (Blood Clotting)
Hypovolemia (Low Volume)