Medical Scenarios
You are dispatched to an unknown medical problem. Caller reports that their family member just collapsed. Upon arrival you find a 68 year old male not conscious and not breathing. What are your next actions.
Call for additional help if needed
Begin CPR (ratio depends on # of rescuers)
Establish an airway (Igel, Combi tube, King)
Apply AED when available
You are dispatched for a pt who is said to be shaking uncontrollably. You arrive to find a pt that is unresponsive but breathing. Bystanders report that the shaking lasted for 1 min. Based on the information on hand, what medical condition is the pt experiencing?
Seizure
You are called for a pt who is experiencing abdominal pain. Once on scene, you obtain a set of vitals, review their SAMPLE history. Pt's vitals are within normal limits.
Due to being a wide array of abdominal issues, treatment for abdominal pain is symptomatic care. Provide comfort to the pt and await arrival of the transporting ambulance.
First thing you consider when arriving on a scene
scene safety
CHF
Congestive Heart Failure
You are dispatched for a 78 year old female who is complaining of right side weakness, trouble talking, and fell earlier in the day. Once on scene what are your next steps.
Assure scene is safe
Systematic patient assessment
Complete Cincinnati Prehospital Stroke Scale
Determine time of symptom onset (important for hospital to know)
Assist with rapid transport
You are dispatched for a 6 year old female pt who is having trouble breathing. Once on scene you find the pt to have wheezing in her lung sounds. What medical condition do you think the pt is dealing with
Asthma Attack
You have a pt with trouble breathing, what treatment option are available to you for this pt.
Ensure air way is clear
Reposition
Remove restrictive clothing
Place pt on O2
Assisting pt with breathing techniques (pursed-lip)
Easiest data piece we can collect for diabetic patients
blood sugar
AAA
Abdominal Aortic Aneurysm
You are dispatched for a 64 year old pt complaining of chest pain. Dispatch was disconnected with the caller so no other information is available. Once on scene what are your next steps.
BSI/Scene safety
Make contact with patient
ABC/SAMPLE/Vitals
If pt is alert, determine location/duration/intensity of the pain. Determine if pt has taken any medication prior to arrival (aspirin or nitroglycerin).
If pt is in cardiac arrest, begin CPR, apply AED, establish airway, communicate with incoming resources, and determine if other resources are needed.
12 Lead EKG is an option for some EMR agencies prior to ambulance arrival
You are dispatched to a pt who is having chest pain. When you arrive on scene, your pt states that he took a nitro but it didn't help. Pt states the pain goes from their chest into the left arm. Pt is sweaty and pale in color. What medical condition do you think this pt is dealing with?
Heart Attack
You are dispatched for a pt who is experiencing stroke like symptoms. Upon arrival you have a positive Cincinnati stroke scale, what treatment can you provide to the pt.
Maintain an open airway
Provide O2 if service allows
Watch for signs of a seizure and treat appropriately
Provide emotional support to the pt
Try to obtain time of onset of symptoms as it is important due to whether they can receive special medications at the hospital.
What would the pneumonic AVPU be used for to assess a patient
Mental status
COPD
Chronic Obstructive Pulmonary Disease
You are called for a 16 year old male who has trouble breathing at a soccer game. In route, dispatch advises pt has a history of asthma. What is your action plan for this pt once you arrive on scene.
BSI/Scene safety
ABC/Sample/Vitals
Make sure pt is in a comfortable position
Loosen any restrictive clothing
Administer O2 if approved by your service
Pt can attempt pursed-lip breathing
Continue to reassure the pt and keep them clam until the ambulance arrives, they can then administer medication to make breathing easier for the pt.
You are called for a 78 year old male who woke up and the wife noticed right side facial droop. Upon arrival, you assessment finds pt has a facial droop, trouble speaking, and right side weakness. Per your assessment, what medical condition is the pt experiencing
Stoke
You are called for a patient who just had a seizure, upon your arrival the patient begins to have another seizure, what can you do to treat this pt? (multiple possible answers)
Can't stop the seizure once started
Protect them from any dangerous objects
Loosen restrictive clothing that may obstruct breathing
Don't force anything between their teeth
Post seizure, turn pt to the side and maintain unobstructed airway
If pt is not is not breathing post seizure, preform rescue breathing
History acquisition model that will provide needed information about the patient
S: Signs and Symptoms
A: Allergies
M: Medications
P: Pertinent past medical history
L: Last oral intake
E: Events leading up to illness/injury
AVPU
Alert
Responsive to Verbal Stimuli
Responsive to Pain
Unresponsive
You are dispatched for a 36 year old female pt who is confused, weak, and just not feeling well. Once on scene, husband reports pt was fine just prior to calling 911. What are your initial steps for this pt.
BSI/Scene safety
ABC/SAMPLE/Vitals
after obtaining your SAMPLE history and learning pt is a diabetic, obtain a blood sugar.
Blood sugar is 28, if pt is alert enough to swallow, provide oral glucose (tablet or gel)/high sugar drink, or something else with a high sugar content. If patient is unconscious, monitor airway and wait for the ambulance so they can administer an IV.
If you are able to give the pt some form of glucose or sugar, reassess the blood sugar to make sure it is improving.
AAA (Abdominal Aortic Aneurysm)
You are called for a pt who is having an issue with hypoglycemia, pt has a blood sugar of 45, pale, dizzy, and diaphoretic. Pt is alert at this time. What type of treatment will you be able to provide this pt.
have the pt eat/drink something high in sugar content. If they become unresponsive, do not force anything into their mouth as they can choke on it.
Pre-Hospital assessment for a stroke pt
Cincinnati Stroke Scale
SAMPLE
Signs and Symptoms
Allergies
Medications
Pertinent past medical history
Last oral intake
Events leading up to illness or injury