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Emergency Patient Care

Emergency Patient Care. S.F.A, E.F.A, I.F.R, E.M.F.R.- March 2010 Compiled by: Joe Draper PCP. The Law. Consent (ask permission ) Implied Consent ? Can I be sued ? Gross Negligence Abandonment ? Good Samaritan Act. Health System in Ontario. Governing Bodies:

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Emergency Patient Care

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  1. Emergency Patient Care S.F.A, E.F.A, I.F.R, E.M.F.R.- March 2010 Compiled by: Joe Draper PCP

  2. The Law • Consent (ask permission ) • Implied Consent ? • Can I be sued ? • Gross Negligence • Abandonment ? • Good Samaritan Act

  3. Health System in Ontario Governing Bodies: • Ministry of Health (MOH) • Base hospitals • Ambulance service • LEVELS OF CARE • Primary Care Paramedic • Advanced Care Paramedic • Critical Care Paramedic • **FLIGHT/LAND CTAS= Canadian Triage Acuity Scale Every patient is assigned a number between 1-5 regarding their level of severity. ie: VSA=1, hurt toe=5

  4. Primary Assessment Assume control of the situation/scene: E- Environment M- Mechanism of injury/illness C- Number of casualties A- Assistance from other resources Introduction: Approach, and introduce yourself Obtain consent, and explain your procedures PROTECT C-SPINE UNTIL RULED OUT!!! 3. Establish a baseline level of awareness: A- Alert V- Alert to VERBAL stimulus P- Alert to PAINFUL stimulus U- Unresponsive

  5. Primary Assessment Con’t 4. Assess the Airway: Open and inspect the airway for obstructions, or potential obstructions, and listen for quality of the air exchange. 5. Assess the breathing: Inspect/listen/feel for chest wall movement Auscultation of air movement in all fields Inspect for signs of respiratory distress: cyanosis, tracheal movement, accessory muscle use, etc. 6. Assess the cervical spine: Palpate and inspect the posterior neck for deformity, pain, or spasm.

  6. Primary Assessment Con’t 7. Assess the circulatory status: Palpation of radial or central pulse Obtain a blood pressure Inspection for any gross bleeds Determine need for defibrillate and cardiac monitoring ***Look for ANY “signs of life” 8. Assess the following for life threatening injuries/problems: Chest Abdomen Pelvis Femurs

  7. Assessment Tools CLAPS(D)= C- contusions L- lacerations A- abrasions P- penetrations S- symmetry D- deformity/distention TICS(D)= T- tenderness I- instability C- crepitus S- subcutaneous emphysema D- deformity/distention SAMPLE= S- signs and symptoms A- allergies M- medications P- past medical history L- last oral intake E- events preceding incident/illness Use these AFTER all life threatening Problems have been corrected!!! SIGN vs SYMPTOM?

  8. M.O.I.- Mechanism Of Injury/Illness • What Happened / why ? • Witnessed or Un-witnessed? • Medical vs. Trauma? • Trauma ? – C-Spine ! • What is the patients chief complaint? • Signs and Symptoms • History of Illness or Injury

  9. Airway Head Tilt - Chin Lift or Modified jaw thrust • One Hand on the Lower Jaw • One Hand on the Forehead • Insert oral airway or Nasal airway

  10. Breathing • Assess for rate, rhythm and quality of respirations. If not present: • Head Tilt, Chin Lift • Lift the jaw forward • Take a normal breath • Use a barrier device. • Give two breaths of 1 second in duration • with enough volume to make the chest rise. • Don't over inflate TO AVOID GASTRIC DISTENTION

  11. Circulation Lt Atrium Rt Atrium Lt Ventricle Rt Ventricle • Assess for rate, rhythm, quality of pulse • Check BP • If possible- listen for heart sounds • Stop any gross bleeds • If pulse not present- START CPR!

  12. BLOOD PRESSURES Blood Pressure is the amount of pressure exerted from the heart, that is measured within the arteries. SYSTOLE: -The contraction phase -The UPPER number DIASTOLE: -The relaxation phase -The BOTTOM number WHAT IS A “NORMAL” BLOOD PRESSURE?

  13. C.P.R. Guidelines REMEMBER- PUSH HARD! PUSH FAST!

  14. Rapid Body Survey Treat For Shock Assess Head to Toe For: • Severe Bleeding • Check skin temperature • Soft tissue injuries • Burns • Medic Alert Anything assessed that looks abnormal!

  15. Shock SHOCK= a state when there is widespread reduction of tissue perfusion resulting in: decreased oxygenation of cells, and inadequate removal of toxic byproducts. PUMP Signs & Symptoms • Anxiety • Confusion • Rapid breathing • Nausea and vomiting • Cool, clammy or mottled skin • Rapid heart and breathing rate • Unconscious ? SHOCK  02 VESSELS VOLUME

  16. Shock Types of ShockExamples Septic:: Severe illness caused by overwhelming infection of the bloodstream Hemorrhagic:: Large amount of blood loss externally and/or internally Obstructive:Airway obstruction, Chest wound causing collapse of lung Cardiogenic:Heart attack, Sudden cardiac arrest. Anaphylaxis:Severe allergic reaction causing airway swelling. Neurological:Neurological system or spinal shock.

  17. Secondary Assesment • Upon completion of primary exam, and all life threats have been corrected… • Assess the following: • Head • Neck/spine • Chest/back • Abdomen • Pelvis/hips • Arms • Legs IF AT ANY POINT THE PATIENTS CONDITION CHANGES RE-START YOUR PRIMARY EXAM!!!

  18. Medical Abbreviations AMI- Acute Myocardial Infarction AEMCA- Advanced Emergency Medical Care Assistant ALS- Advanced Life Support APGAR- American Pediatric Gross Assessment Record PRN- As required BVM- Bag Valve Mask BLS- Basic Life Support PO- By Mouth CA- Cancer CACC- Central Ambulance Communications Centre CNS- Central Nervous System CVA-Cerebrovascular Accident (stroke) COPD- Chronic Obstructive Pulmonary Disease CHF- Congestive Heart Failure

  19. Medical Abbreviations Con’t CTAS- Canadian Triage & Acuity Scale DNR- Do Not Resuscitate GCS- Glascow Coma Scale JVD- Jugular Vein Distention LOA- Level Of Awareness MCI- Mass Casualty Incident PEARL- Pupils Equal And Reactive to Light ROSC- Return Of Spontaneous Circulation SAED- Semi Automatic External Defibulator TIA- Transient Ischemic Attack UTI- Urinary Tract Infection VSA- Vital Signs Absent

  20. Progression of Atherosclerosis Cardiovascular Disease • Over 78,000 deaths per year in Canada, ages 40-65. (66% occur outside the hospital) • 40,000 from Coronary Artery Disease • 20,000 from Sudden Cardiac Arrest • 16,000 from Strokes • Risk FactorsSmoking, High Blood Cholesterol, High BP, Stress, Heredity, Age, Diabetes & Lack of Regular Exercise • Controllable Risk Factors ? PREVENTION IS KEY!

  21. Chest Pain Cardiac Pain • “crushing”, “heavy” pain • Often radiates to neck/arm • Pain does not change with palpation or inspiration • Shortness of Breath • Pale, sweaty • Nausea/vomiting • Agitated/anxious NON- Cardiac Chest Pain • Other descriptions ie: “stabbing”, “sharp” • Usually localized pain • Pain often changes with palpation/inspiration • Often, no other symptoms beside the pain besides anxious How do we treat these? So where is the pain coming from? Does being a woman change things???

  22. Hemorrhage Emboli Thrombus Stroke Signs & Symptoms • Sudden Headache • Dizziness/Confusion • Facial Drooping • Slurred Speech • Arm Drift • Weakness/Paralysis • T. I. A. ( Mini Stroke) Causes ? Blood Flow from the heart

  23. Respiratory Emergencies Signs & Symptoms • Rate/Depth • Accessory Muscles • Pale, Bluish Skin • Coughing, Choking • Restlessness • Shortness of Breath • Noisy Breathing Causes?

  24. Respiratory Diseases • Asthma • Emphysema • Bronchitis • Pneumonia • Congestive Heart Failure ALWAYS GIVE O2!!!!! HOW MUCH THOUGH?

  25. Anaphylaxis Causes ? Facial Swelling Hives Wheezing Allergens • Peanuts • Seafood • Insect Bites • Medications • Latex • Others? Histamines

  26. Anaphylaxis Signs & Symptoms What does EPI do? Abdominal cramps, vomiting, diarrhea

  27. Bleeding and Wound Types Bleeding Nose Laceration Contusion Abrasion Partial or full Amputation Avulsion Impaled Object

  28. Spinal Cord Injury • Mechanism of Injury • Amnesia to event • Neck/Back Pain • Paralysis • Weakness • Numbness • Obvious Head Injury • Loss of consciousness • Priapism When to suspect a Spinal Injury! 7 12 5 Treatment?

  29. Head & Brain Injuries Internal/External Types • concussion • scalp wound • fractures • intracranial hemorrhage

  30. Head & Brain Injury Causes ? • Mechanism of Injury • Falls, blunt impact • Signs & Symptoms • Facial injuries, Bleeding or bruising to the head • Vomiting Confusion • Abnormal behavior • Loss of, or changes in levels of Consciousness

  31. Seizures Causes • Epilepsy • Stroke • Febrile (children) • Others? Signs & Symptoms • A taste or smell prior to. • may appear daydreaming. • uncontrollable muscle movement. • Loss of bowel/bladder Protect the Head & Airway D

  32. VENTRICULAR TACHYCARDIA NORMAL SINUS RHYTHM VENTRICULAR FIBRILLATION Heart Rhythms Non-Shockable Rhythms ShockableRythms ASYSTOLE

  33. Penetrating chest wound: Pneumothorax Signs & Symptoms • Shortness of Breath • Bleeding • Coughing up blood. • Pain at the injury site • Engorged neck veins Treatment • The Approach • Cover holes • Valve • Reassure the patient!

  34. PELVIS Abdominal/Pelvic Injuries Blunt or Penetrating Trauma may cause: • Int./Ext. Bleeding • Pain & Tenderness to the affected area • Guarding • Distention • Painful urination Potential for significant blood loss Treatment?

  35. Musculoskeletal Injuries : • Rest • Immobilize (splinting) • Cold compress • Elevate (if applicable) Treatment? D S

  36. Burns Types • Flush the affected area with large amounts of water • Look for entrance and exit wound Treatment Chemical? –Electrical?-Radiation? • Cool the burn area and treat accordingly

  37. Degree of Burns

  38. Hyperglycemia Hypoglycemia B L O O D S U G A R BRAIN S U G A R S U G A R PANCREAS INSULIN Diabetes Causes?

  39. Diabetic Emergencies Hypoglycemic or Hyperglycemic? • Hypoglycemia: • *Fast onset • *Too much insulin/not enough sugar • Signs and Symptoms: • Drunk in appearance • Pale and very sweaty • Seizures/agression • CBG <4 mmols • Treatment: • Conscious?- Give food, juice etc. • Unconscious?- ABC’s, full assessment • Hyperglycemia: • *Slow onset • *Too much sugar/not enough insulin • Signs and Symptoms: • CBG >15mmols • Acetone breath • Fast breathing • Dry/Red skin • Treatment?

  40. Hyperthermia 37 C Hypothermia Environmental Emergencies Treatment • Keep patient warm • Remove wet cloths • Give Warm Fluids • Recovery Position Treatment • Cool Patient • Remove From Sun • Give Cool Fluids • Recovery Position

  41. Poisoning Causes Treatment? • CALL LOCAL POISON CONTROL • OR CALL 911 • OR CALL O FOR OPERATOR • Do not administer anything by mouth unless advised to do so by a poison control center Ingestion Inhalation Injection Absorbsion Poison Control • 1-800-267-1373  English-French, toll- free Ontario

  42. EMS MEDICATIONS • What Medications do BLS Medics carry? • Nitroglycerin • Ventolin • ASA • Glucagon • Oral Glucose • Dextrose • Epinephrine • Benadryl (diphenhydramine) • Gravol (dimenhydrinate) WHAT IS SYMPTOM ASSIST?

  43. Medication Assistance The 5 Rights of Medication Administration • The right medication • The right person • The right dose/amount • The right route • The right time

  44. Obstetrical Emergencies • As the baby's head comes out, support it with one hand. Do not pull on the baby. • If the umbilical cord is around the baby's neck, gently loosen and unwrap it. • Protect the baby's airway by keeping the mouth and nose clear of mucus or fluids. • Allow the delivery to progress, but support the baby as they can be slippery upon complete delivery. • Insure the baby has an airway, is breathing (or crying), and has a pulse. • Do NOT cut the umbilical cord. • Wrap the baby in clean clothes and keep the baby warm. • Document the time of birth! If the baby has no pulse, proceed with the CPR guidelines for an infant! ***DON’T FORGET ABOUT MOM!

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