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EMR Slideshow 1
Modules 1 to 10 - basic EMR course
63
Medical
Not Applicable
07/17/2013
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Term
History taking - what do these mean?
- AMPLE
- OPQRSTA
 Definition
- Allergies, Medication, Past medical history, Last (oral intake, menstrual period, bowel motion), Event leading to incident
- Onset, Provoking factors, Quality, Radiation, Severity (1 less to 10 more), Time (and whether constant or variable), Alleviating factors
Term
In trauma assessment - look, what do these mean?
- DCAPP
- BTLS
 Definition
- Deformity, Contusion, Abrasion, Puncture, Penetration
- Burns, Tenderness, Laceration, Swelling
Term
In trauma assessment - feel, what do these mean?
- TIC
- DRT
 Definition
- Tenderness, Instability, Crepitus (crackling/ crunching)
- Distension, Rigidity, Tenderness (abdominal examination)
Term
What is the classification of the type of ambulance if a paramedic is working alongside an EMR in Alberta?
 Definition
A paramedic and an EMR together operate as a BLS unit
Term
What are the 4 levels of EMS care providers recognised by the Canadian Medical Association?
 Definition
 EMR – Emergency Medical Responder
 PCP – Primary Care Paramedic
 ACP – Advanced Care Paramedic
 CCP – Critical Care Paramedic
Term
What are the 3 levels of training of prehospital care practitioners in Alberta?
 Definition
1. Emergency Medical Responder (EMR)
2. Emergency Medical Technician (EMT)
3. Emergency Medical Technologist – Paramedic
(EMT-P / Paramedic)
Term
How many hours of training for an EMT and an EMT- P?
 Definition
EMT - 500 hours
EMT-P - 3000 hours
Term
Who is responsible for 1. Online and 2. Offline Control?
 Definition
1. Online control: is when the EMS practitioner speaks directly with the doctor at the receiving hospital via telephone or radio
2. Offline control: consists of protocols/standing orders under the control of the Medical Director of the ambulance service
Term
Name the 6 items that are paramount to appropriate patient care by an EMS practitioner
 Definition
1. Personal Safety
2. Patient Assessment & Treatment
3. Safe Lifting & Moving of Patients
4. Transport & Transfer of Care
5. Record Keeping & Data Collection
6. Patient Advocacy & Confidentiality
Term
What is the document used to record clinical encounters?
 Definition
You must document all findings and care that the patient receives on the Patient Care Report – PCR
Term
When is the secondary survey of a case usually done?
 Definition
Usually en route to hospital
More in-depth, focused physical exam
Only if time and patient's condition allows
Term
Describe a detailed physical exam of the head
 Definition
 Look DCAPP-BTLS
 Eyes: is the sclera white and conjunctiva pink
 Bruising around the eyes or behind the ears
 Fluids: coming from ears, eyes, mouth or nose
 Trauma to the mouth or nose
 Unusual breath odors
 Pupils EARRL
 Skin Color / Condition / Temperature
 Palpate for TIC
Term
Describe detailed exam of the neck
 Definition
- Look DCAPP-BTLS
 Subcutaneous emphysema
 Flat or distended neck veins (JVD)
 Tracheal deviation
Medical alert tags
- If they have a C-Collar on, check the best you can
- Palpate for TIC
Term
Describe a detailed exam of the chest
 Definition
- Look DCAPP-BTLS
 Retractions / Accessory muscle use
 Barrel chestedness
 Paradoxical motion
 Surgical scars
 Medication patches
 Subcutaneous emphysema
 Auscultate for any adventitious breath sounds
 Assess at the apices of the lungs bilaterally
 Assess at the bases of the lungs bilaterally
- Palpate for TIC
Term
Describe a detailed exam of the abdomen
 Definition
- Look DCAPP-BTLS
 Pulsating masses
 Surgical scars
 Needle marks
 Eviscerated organs
- Palpate for DRT
 Always palpate all 4 quadrants if possible
Term
Describe a detailed exam of the pelvis
 Definition
- Look DCAPP-BTLS
 Incontinence
 Vaginal bleeding or Priapism
- Palpate for TIC
Term
Describe a detailed exam of the arms and legs
 Definition
- Look DCAPP-BTLS
- Medic alert tags
- Look for pitting edema (although this can also be felt for, in a scenario we look for it)
- Palpate for TIC
- Assess for CMS:
 Circulation (use distal pulses)
Motor function
 Sensory Function
Term
What are the positive and negative aspects of the 'fight or flight' response to stress with regard to an EMR's decision making ability?
 Definition
- Positive:
 Enhanced visual and auditory acuity
 Improved reflexes and muscle strength
- Negative:
 Impaired critical-thinking skills
 Diminished concentration and assessment ability
Term
What are the 9 vital signs that you must assess?
 Definition
 Skin
 LOC
 Eyes
 Respirations
 Pulse
 Temperature
 Blood pressure
 Blood Glucose (BGL)
 Pulse Oximetry (SPO2)
Term
How do you assess the skin in a vital sign assessment?
 Definition
Using the back of your un-gloved hand on the patient’s forehead (or abdomen if a child)
Looking for -
Color: Red, flushed, pink, cyanotic, pale, ashen
Condition: Diaphoretic, clammy, dry
Temperature: Hot, warm, cool, cold
Term
How do you assess the eyes in a vital sign assessment?
 Definition
Shining light into one eye, then the other observing reactivity (pupils normally constrict when you shine a light in them).
Assess for PEARRL & size:
 P: Pupils
 E: Equal
 A: And
 R: Round
 R: Reactive to
 L: Light
 and what size
Size is measured in millimeters,normal varies based on ambient light
Term
How do you document respiration in a vital sign assessment?
 Definition
Documented by writing:
16 N/R/Unlabored
(16 per min, normal, regular, unlabored)
Count number of breaths in 15 secs and multiply by 4
Term
What factors which limit a pulse oximeter?
 Definition
 Environmental
 Large amounts of ambient light
 Equipment Failure
 Improper size sensor for the patient
 Improper positioning of the sensor
 Patient movement
 Dysfunctional Hemoglobin
 Carbon dioxide / anemia
 Dark nail polish
 Medications
(I think they are wrong with carbon dioxide - it ought to be carbon monoxide)
Term
What are normal ranges for the 9 vital signs?
 Definition
Skin P/W/D
LOC A + Ox4
Eyes PEARRL @ 4mm
Resps 12-20 N/R unlabored (for adults)
Pulse 60-100 S/R (for adults)
Temp 37.0 oC (+/- 1 oC)
BP 120/80 (+/- 20 pts)
BGL 3.8 to 7.0 mmol/L Pulse Ox 95% and up
Term
What is the difference between biological and clinical death?
 Definition
Clinical death is when patient is unresponsive, with no cardio-respiratory function
Biological death implies no brain activity (remember B means B)
Term
What are the definitive signs of death?
 Definition
DRIED:
- Decapitated
- Rigor mortis
- Incinerated
- Eviscerated
- Decomposing
Term
What do CISM and CISD stand for in the field of helping adjustment after experiencing a disturbing event?
 Definition
CISM: critical incident stress management
CISD: critical incident stress debriefing
Term
What does BSI stand for in EMR terminology?
 Definition
Body Substance Isolation
Term
What are the critical timescales of damage to different vital tissues when deprived of blood flow and oxygen?
 Definition
0-1 min: cardiac irritability
0-4 mins: brain damage unlikely
4-6 mins: brain damage possible
6-10 mins: brain damage likely
>10 mins: brain damage irreversible
Term
When should BLS not be started?
 Definition
 Rigor mortis or stiffening of the body
 Dependent lividity
 Putrefaction or decomposition of the body
 Evidence of a nonsurvivable injury
 Existing DNR or no-CPR order
Term
What does a 'patent' airway mean?
 Definition
It means that the airway is open allowing air to pass - gained by Head-Tilt / Chin-Lift or Modified Jaw Thrust / Manual Jaw Thrust
Term
At what rate do you ventilate in artificial respiration in an adult, child and infant? How long should it take to inflate the lungs?
 Definition
Adult: 1 second inflation every 5 secs i.e. 12 per minute
Child and infant both: 1 second inflation every 3 secs i.e. 20 per minute
Term
What is the approved ratio of cardiac compressions to inflations in CPR?
 Definition
30 compressions : 2 breaths
Term
What 2 Acts have defined the status of EMRs? One superseded the other in 2006.
 Definition
The Health Disciplines Act was superseded by the Health Professions Act in 2006.
Term
What deaths require to be investigated under the Fatality Inquiries Act?
 Definition
 Deaths that occur mysteriously
 Deaths that occur unexpectedly when the deceased was in apparent good health
 Deaths that occur as the result of violence, accident or suicide
Maternal deaths that occur during or following pregnancy and that might reasonably be related to pregnancy
 Deaths that are the result of poisoning
 Deaths that may have occurred as the result of, or improper or negligent treatment by any person
 During an operative procedure
 Within 10 days after an operative procedure
 While under anesthesia
 Any time after anesthesia that may reasonably be attributed to that anesthesia
 Deaths that occur while under the care of a physician
 Deaths that occur while in the custody of a peace officer or as a result of the use of force by a peace officer while on duty
 Deaths that are related to:
 Any disease or ill-health contracted or incurred by the deceased
 Any injury sustained by the deceased
 Any toxic substance introduced into the deceased as a direct result of the deceased’s employment or occupation or in the course of one or more of the deceased’s former employments or occupations
Term
Describe the patient assessment process
 Definition
1. Assess dispatch information
2. Scene Assessment
3. Patient Overview
4. Provide spinal motion
restriction
5. Primary survey
6. Apply O2
7. Transport decision
8. Vital signs and history
9. Special assessments and treatments
10. Secondary survey
11. Reassess vital signs
12. Ongoing assessment and care
Term
What are the 5 components to the patient overview?
 Definition
 Assess if eyes are open and tracking
 Assess their skin color and condition
 Assess respiratory distress / work of breathing
 Assess for deadly bleeding
 Assess for obvious deformities/ fractures
Term
What does the Primary Survey consist of and when does it start?
 Definition
Begins once you introduce yourself to the patient;
1. LOC
2. Airway
3. Breathing
4. Circulation
5. Head-to-toe primary survey
6. Transport decision
Term
What are the signs of airway compromise?
 Definition
 Two- to three-word sentences
 Use of accessory muscles / retractions / indrawing
 Nasal flaring and use of accessory muscles in children
 Labored breathing / noisy breathing
Term
What are the signs of airway obstruction in an unconscious patient?
 Definition
 Obvious trauma, blood, or other obstruction
 Noisy breathing such as gurgling, wheezing, stridor, snoring or other abnormal sounds
 Extremely shallow or absent breathing
Term
How do you describe orientation? Give an example of the abbreviation you would record LOC and orientation
 Definition
Orientation is recorded for each of the four
- person
- place
- time
- event
LOC is recorded as AVPU scale so an example might be:
A+Ox4
Term
At what respiratory rates do
You consider the use of a bag- valve mask?
 Definition
<10 or >30 per minute
Term
What are examples of priority patients?
 Definition
- Poor general impression
- Unresponsive with no gag or cough reflexes
- Difficulty breathing
- Signs of poor perfusion
- Childbirth
- Uncontrolled bleeding
- Severe pain
- Severe chest pain
- Problems with motor or
sensation
Term
What is the 'Golden Hour'? What are its subdivisions?
 Definition
20 mins: Discovery and activation of EMS
10 mins: EMS initial assessment and intervention (Golden 10 minutes)
10 mins: EMS packaging and transport
20 mins: initial hospital stabilization
Term
What is the definition of a significant fall?
 Definition
>15 or 20 feet
or >2 or 3 times patient's height
Term
Describe trauma assessment using four sets of letters
 Definition
DCAPP, BTLS, TIC and DRT
Term
What does DCAPP stand for?
 Definition
Deformity
Contusion
Abrasion
Puncture
Penetration
Term
What does BTLS stand for?
 Definition
Burns
Tenderness
Laceration
Swelling
Term
What does TIC stand for and when is it used?
 Definition
Tenderness
Instability
Crepitus
(used in musculoskeletal trauma assessment)
Term
What does DRT stand for and when is it used?
 Definition
Distension
Rigidity
Tenderness
(used in abdominal assessment)
Term
What are the Load and Go criteria?
 Definition
 Any altered LOC or
memory loss, including any history of any alteration in mentation prior to EMS arrival
 Any complication with airway, breathing, circulation
 Bilateral femur fracture
 Unstable pelvis
 Abdominal problems
 Thoracic trauma
(isolated spinal cord injury is NOT a load and go situation)
Term
How frequently do you assess vital signs?
 Definition
Load and Go patient every 5 mins
Stay and stabilise every 15 mins
Term
What are the vital signs that must be checked frequently?
 Definition
9 of them:
- skin
- LOC
- eyes
- respiration
- pulse
- temp
- BP
- blood glucose (BGL)
- pulse oximetry (O2%)
Term
How do you record respiration in an abbreviated format?
 Definition
16N/R/unlabored
Rate e.g. 16 N (number per minute)
Rhythm e.g. regular or irregular
Depth e.g. shallow, normal, deep, laboured
Term
What is the normal range of temperature? What is hypothermia and what is high and low grade fever?
 Definition
Normal: 37 C + or - 1
Hypothermia: <35 C
Low grade fever: 38 to 39.5 C
High grade fever: >39.5 C
Term
What is the normal blood glucose range?
 Definition
3.8 to 7 mmol/litre
Term
What is the normal pulse oximetry reading?
 Definition
> or = 95%
Term
What factors limit pulse oximetry?
 Definition
 Environmental: strong ambient light,
 Equipment Failure: improper size sensor for the patient, improper positioning of the sensor, patient movement
 Dysfunctional hemoglobin due to carbon dioxide (should be carbon monoxide) or anemia
 Dark nail polish
 Medications
 Cold extremities
 Peripheral vasoconstriction
 Impeded venous return
 Blood pressure cuff / tourniquet
 Hemodynamic compromise
 Poor peripheral perfusion
 Edema
 Clenched fists / hypertonicity
Term
In two person CPR, how frequently should you swap positions?
 Definition
Every 2 minutes
Term
How do you assess circulation in an infant?
 Definition
Palpate the brachial artery
Term
Describe how you would perform CPR on an infant
 Definition
 Place on firm surface and maintain airway
 Place two fingers, one finger below the nipple line
 Use two fingers to compress the chest about 1/3 -1/2 at a rate of 100+/min
 Allow sternum to return briefly to its normal position between compressions
 Coordinate rapid compressions and ventilations in a 30-2 ratio
 Reassess the infant for return of breathing and pulse every 2 minutes ( 5 cycles)
Term
Describe single rescuer child CPR
 Definition
 Place on firm surface and maintain airway with one hand
 Place heel of other hand over lower half of the sternum (avoid the xiphoid)
 Compress chest about 1/3 - 1/2 at a rate of 100/min
 Coordinate compressions with ventilations in a 30-2 ratio, pausing for ventilations
 Reassess for breathing and pulse every 2 minutes
 If the child resumes effective breathing, place child in recovery position
Term
How do you recognise 1. mild and 2. severe airway obstruction?
 Definition
Mild:
 Some air exchange
 Able to speak

Severe:
 Inadequate air exchange
 Some high-pitched wheezing may be noted
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