GCS
What is the "EYES" Section of GCS
4 - Open Spontaneously
3 - Open to Verbal Stimuli
2 - Open to Painful Stimuli
1- Unresponsive
What is your "Approach and Scene Size up?"
1. Personal protective equipment
2. Environment
3. Mechanism of injury/illness
4. Counts all patients
5. Additional resources
PEMCA
Tachycardia? Bradycardia?
Heartrate >100 bpm.
Heartrate <60 bpm (ALS - <50 bpm)
Diastolic?
Force of blood against the arterial wall when the ventricles RELAX
What are the 4 ways to assess a patient?
Inspection
Palpation
Percussion
Auscultation
What is the "TALKS" Section of GCS
5 - A&O x4 - Oriented
4 - Confused/Disoriented
3 - Inappropriate words
2 - Incomprehensible sounds
1 - Unresponsive
What is part of your "Primary Survey?"
1. AVPU
2.Airway
-Manual C-Spine
-Assess for Patent Airway
-Appropriate Tx
3. Breathing
-Look Listen Feel
-Assess adequacy of respirations (rate, rhythm, volume)
-Appropriate Tx.
4- Circulation
-Assess Adequacy of Pulse
-Gross Bleed Check
-Skin Check (Color, Temp, Condition)
-Appropriate Tx
Hypertension? Hypotension?
SBP > 140mmHg. Hypertensive emergency if DBP > 130mmHg.
SBP < 90mmHg
Systolic?
Force of blood against the arterial wall when the ventricles CONTRACT
What is CSM?
Circulation (Check pedal pulse, capillary refill), Sensation (Don’t look, which toe am I touching?), Motor (Can you wiggle your toes for me?).
What is the "MOTORS" Section of the GCS?
6 - Obeys commands
5 - Localizes pain
4 – Flexes/withdraws from pain
3 - Decorticate Posturing
2 - Decerebrate Posturing
1 - Unresponsive
DCAPBLSTIC?
Tachypnea? Bradypnea? Eupnea? (BONUS)
Respiration rate > 20 rr (ALS - >28 bpm)
Respiration rate < 12 rr
Normal breathing pattern.
What is clubbing?
When the angle of the nail between nail and base reaches 180 degrees or more. Due to chronic respiratory distress.
What is the difference between bilateral chest rise/fall and paradoxical movement?
Bilateral chest rise/fall is equal movement of the chest up and down on both sides of the chest. If there is unilateral chest rise you may suspect a pneumothorax (collapsed lung) on one of the sides.
Paradoxical movement is when a portion of the chest wall moves opposite to the normal movement of the chest. Usually due to a flail chest segment (broken ribs).
You are dispatched to a single-vehicle rollover on a rural highway. A 22-year-old male is found lying supine on the gravel shoulder after being ejected from the vehicle. On approach, you note significant bleeding from a scalp wound, shallow respirations, and poor skin colour. You attempt to engage him verbally, but he does not respond. When you apply a sternal rub, he slowly opens his eyes but does not maintain them. When you ask him his name, he produces only unintelligible sounds and groans without forming actual words. When you apply pain stimulus to his hand by pressing firmly on the nail bed, he withdraws his arm away from you but does not localize the pain.
The patient’s Glasgow Coma Scale score is calculated as follows: he opens his eyes only to painful stimulation, which scores a 2 for eye opening. His verbal response consists of incomprehensible sounds and groaning, which scores a 2 for verbal response. His motor response is withdrawal from painful stimulus, which scores a 4. When added together, this gives him a total GCS of 8 out of 15
SAMPLE/OPQRST?
HISTORY (SAMPLE)
1. Signs & symptoms –
2. Allergies -
3. Medications -
4. Past Med History –
5. Last oral intake -
6. Events prior -
HISTORY (OPQRST)
1. Onset –
2. Provoke/Palliate –
3. Quality-
4. Region/Radiation
5. Severity –
6. Time –
What is the BP equation?
BP = CO (SV x HR) X SVR
What is stroke volume?
Amount of blood leaving the heart every contraction.
What drug would you suspect in a patient that was constricted pupils?
What drug would you suspect in a patient that has dilated pupils?
Constricted Pupils= **Fentanyl, heroin, morphine, codeine etc...
Dilated Pupils = **Cocaine, LSD, amphetamines etc...
You are dispatched to a downtown assault where a 35-year-old male has reportedly been struck multiple times in the head with a blunt object. When you arrive, he is seated against a wall, supported by bystanders. His face is swollen and there is blood around his nose and mouth. You approach and introduce yourself, but he does not answer your questions. After repeated prompting, he opens his eyes briefly when you speak to him but then closes them again. When asked his name, he replies with confused and inappropriate words, stating, “I want to go home” when you ask what happened. When you apply pressure to his shoulder to test pain response, he pushes your hand away with purpose, localizing the source of the pain.
This patient’s Glasgow Coma Scale score is 11 out of 15. He opens his eyes to speech, which is scored as a 3. His verbal response is inappropriate but intelligible words, which scores a 3. His motor response is purposeful localization of pain, which scores a 5. Together this gives him a total score of 11
Define Mechanism of Injury as per your Slide Show?
“The combined strength, direction and nature of forces that injured your patient”
Hypothermia?
Decrease in CBT, </= 35 C.
Outline the process of maintaining an airway from least invasive to most invasive.
Head/tilt, chin/lift, jaw thrust, NPA (Nasopharyngeal airway), OPA (Oropharyngeal airway), SGA (Supraglottic airway).
What does CTAS stand for?
Canadian Triage Acuity Scale