Assessment Model Frontline First Aid: EMR Cheat Sheet Scene Survey H Hazards is there anything in the area that could cause problems or injuries E Environment is the area hot cold toxic unstable etc M Mechanism of Injury what happened to cause the injury or condition P Number of Patients how many people require assistance or transport A Additional Resources more personnel ambulance fire dept hazmat poison control tech rescue etc Primary Survey LOC D A B C Critical Interventions Stay & Play or Load & Go AVPU Alert Verbal stimulus Pain stimulus Unresponsive Delicate Spine Presumed or Ruled Out Airway with Cheater Carotid Check and OPA if unresponsive Breathing Oxygen or Assisted Ventilations if needed Circulation Radial Pulse, Skin and Rapid Body Survey - Blanket Quickly manage immediately life threatening conditions Transport decision and communication with Medical Control Secondary Survey Interview S Signs and Symptoms what is hurting or causing discomfort O Onset did this happen suddenly or gradually P Provokes is there anything that makes the pain better or worse Q Quality sharp dull throbbing aching stabbing burning crushing squeezing tingling etc R Radiating where is the pain; and does it stay in one spot or move to other areas S Severity how bad is the pain on a scale of 1-10 T Timing when did the pain start; and does is come and go or stay constant A Allergies are you allergic to anything and have you been recently exposed M Medications do you take medication have you taken too much too little missed them new ones recently P Previous Medical History relevant medical conditions or past incidents; diabetes high BP asthma COPD etc L Last Meal what and when did you last eat or drink is that normal for you E Events Leading Up To what were you doing when the pain or discomfort started LOC Respirations Pulse SpO2 Blood Pressure Pupils Body Core Temp? Cap Bgl? Palpation Auscultation Distal Circulation Vital Signs Glasgow Coma Scale Rate Rhythm Character Rate Rhythm Character Pulse Oximeter Blood Oxygen Level Palpation or Auscultation Record Systolic over Diastolic; or Systolic over P Pupils Equal and Reactive to Light compare size and reactivity of each pupil Measure body core temperature if relevant Measure Capillary Blood Glucose Level if relevant Head to Toe Feel for injuries Listen to the Chest if relevant Assess bilateral pulses and check motor and sensory function in extremities Page 1 of 8
Glasgow Coma Scale Eye Opening Best Verbal Response Best Motor Response 6 Obeys commands 5 Oriented 5 Localizes to pain 4 Spontaneously 4 Confused 4 Withdraws to pain 3 To voice 3 Inappropriate words 3 Flex to pain(decorticate) 2 To pain 2 Incomprehensible sounds 2 Extend to pain(decerebrate) 1 No response 1 No response 1 No response APGAR GCS less than 13 is life threatening 0 1 2 Activity Limp Some extremity flexion Active Movement Pulse Absent Below 100 bpm 100 bpm or higher Grimace No response Grimace Cough, sneeze, cry Appearance Body/Extremities Blue/Pale Body Pink Extremities Blue Completely pink Respiration Absent Slow and Irregular Strong, crying 7-10 is Normal 4-6 is Fairly Low 0-3 is Critically Low CPR Compression: Ventilation Ratios Adult over 9 Child 1-8 Infant under 1 One Rescuer 30:2 30:2 30:2 Two Rescuer 30:2 15:2 15:2 Infant with pulse less than 60 bpm = Start CPR Check pulse for full 60 seconds if patient is Hypothermic CPR in transport - Treatable CPR 3 Consecutive No-Shocks (after contacting physician) Hypothermia Cardiac Tamponade Pulmonary Embolism Tension Pneumothorax Severe Blood Loss Overdose Airway Obstruction Page 2 of 8
Dynamic CPR / CPR on the Move Plan your exit route on the way in Have suction ready in case of vomiting during turns or lifts Watch for subtle vomiting inside the mouth or mask Reassess patient after every move or pause Secure patient AND equipment before moving Pocket mask may be more reliable than BVM during movement Set stretcher at a height that allows for effective compressions 6 Rights of Medication EMR s in BC can ADMINISTER Nitro & ASA and ASSIST with other Medications 1 Person Does this person have a prescription 2 Medication Have they had it before no Contraindications 3 Time When was the last dose taken is it needed now 4 Dose How much should they take 5 Route How should they take/use it 6 Documentation Record the time and effects of each dose Chest Pain Protocol Nitro Not prescribed Nitro Cialis - 48 hrs Viagra/Levitra 24 hrs BP 100 mmhg (PAC) BP < 90 mmhg (BCAS) Contraindications ASA Never had ASA before Allergic to ASA Already taken daily dose Can t chew/swallow Active Peptic Ulcer or Gastrointestinal Bleeding Pediatric Patient Nitro and/or ASA Procedure: If previously prescribed Nitro, with no Contraindications: give one 4-microgram spray If ASA is not Contraindicated have patient chew two 81 mg ASA or one 325 mg ASA If pain persists recheck contraindications and administer 2 nd and 3 rd Nitro doses waiting 3-5 minutes between doses Begin Entonox protocol if pain persists 5 minutes after 3rd dose; or right away if Nitro is contraindicated Start Nitro protocol from beginning if pain goes away then returns with a limit of 3 doses in a 30 minute period. Page 3 of 8
Load and Go Criteria Life threatening conditions found Serious injuries with multiple traumas Absent or unstable ABCs or Neurological status Decreased Level of Consciousness Ongoing Seizures Chest Pain if disorder or heart attack suspected Burns with suspected inhalation injuries Extensive burns Abdominal distension/tenderness Unstable pelvis injury Fractured femurs Amputations / Limb Threatening Injuries Pregnancy related conditions Environmental mishaps Critical Findings Finding Implication Action GCS less than 13 Decreased LOC OPA / NPA Breathing over 30 times/minute Tachypnea Assist Ventilations Breathing less than 10 times/minute Dyspnea Assist Ventilations Blood Pressure less than 80 mmhg Systolic Hypo-tension Position Supine Blood Glucose less than 4 mmol/l Hypoglycemia Glucose Oxygen Saturation (SpO2) less than 95% Hypoxia / Hypoxemia Increase O2 intake Infant pulse less than 60 bpm Equivalent to Absent Begin CPR Body core temperature below 35-36 C Mild Hypothermia Rewarm slowly Body core temperature below 30-34 C Moderate Hypothermia Rewarm slowly Body core temperature below <30 C Severe Hypothermia Rewarm slowly Body core temperature above 37 C Hyperthermia Cool rapidly APGAR below 4 Unresponsive Load and Go Pulseless, angulated limb Limb Threatening Load and Go Attempt to realign Adult Pulse Rate over 160 bpm Urgent Tachycardia Load and Go Oxygen Cylinder Calculations Duration of Flow = (gauge pressure -200 psi) x C Flow Rate (lpm) C = Cylinder Constant D Cylinder = 0.16 L/psi E Cylinder = 0.28 L/psi M Cylinder = 1.56 L/psi Page 4 of 8
Oxygen Flow Rates Frontline First Aid: EMR Cheat Sheet Device BC EMALB Paramedic Association of Canada (Canadian Red Cross Emergency Care Manual) Simple / Standard Mask 6 15 lpm N/A Non-Rebreather Mask 8 15 lpm 10 + lpm Bag Valve Mask 15 lpm 10 + lpm Nasal Canula 2 4 lpm 1 4 lpm Cushing s Triad 3 concurrent conditions commonly associated with Congestive Heart Failure or Head Injury Increased Systolic Blood Pressure Slow Heart Rate Irregular Breathing Diastolic Blood Pressure remains Normal IV Drip Set Calculations Standard / Regular = 15 gtts/ml Macro / Adult = 10 gtts/ml Micro / Mini = 60 gtts/ml Gtts / min = volume to be infused x gtts/ml Infusion time (minutes) Common IV Solutions Solution Commonly Used For Ringer s Lactate Blood loss D5W / D10W Hypoglycaemia Normal Saline Dehydration 2/3 1/3 Dehydration Common IV Complications Interstitial Circulatory Overload Thrombosis and Thrombophlebitis Catheter Embolism Infection of Catheter Site Allergic Reaction Air Embolism Page 5 of 8
KED Strapping Sequence Frontline First Aid: EMR Cheat Sheet My Middle Baby Bottom Looks Legs Hot Head Tonight Top Simple Triage and Rapid Treatment (S.T.A.R.T.) Dead / Non-Salvageable (BLACK) Immediate (RED) Not Breathing Breathing > 30 per minute Breathing with absent radial pulse Decreased LOC Delayed (YELLOW) Unable to walk Minor (GREEN) Able to walk Breathing Normal Radial Pulse Present Normal LOC Sager Traction Splint Assess injured leg Look/Feel Pulse Motor-Sensory Apply Traction Secure Splint Assess Injured Leg Look Feel Pulse Motor-Sensory Suspected Fracture of Femur or Tib-Fib Remove and adjust saddle to ensure short side of saddle hinge is down Nestle saddle against injured leg (short hinge down) Have helper stabilize splint and apply small thigh strap Apply ankle harness above malleoli Apply traction of 10% body weight 15 lbs maximum per limb 5 lbs maximum for open fractures and upper or lower third fractures 5 lbs maximum for Pediatric patients 30 lbs maximum for Bi-Lateral fractures (15 lbs per leg) Ensure adequate padding 3 straps around splint; above and below injury Secure thigh strap; then the other two straps Secure Figure 8 Strap Reassess all splint straps and Traction Gauge Ensure Leg in line with body; same length as other leg Note presence or absence of Pedal Pulse Ensure no movement / aggravation of injured limb Page 6 of 8
Entonox Contraindications - Acronym D Decompression Altitude sickness I Inability must be able to follow instructions and self-administer V Ventilation the area must be well ventilated I Inhalation of Carbon Monoxide or Smoke N Nitro taken Nitroglycerin in the past 5 minutes E Embolism possible air bubbles in lungs or blood stream (Pneumothorax) Entonox Protocol Indications Pain Contraindications (D-I-V-I-N-E) Inability to comply with instructions Enclosed area without ventilation Suspected Air Embolism or Pneumothorax Nitroglycerin taken in last 5 minutes Suspected Inhalation Injury and O2 saturation less than 100% Suspected Carbon Monoxide Poisoning; even if O2 saturation reads 100% Decompression sickness Cautions Completed before administration Proper Storage Instructions to Patient Depressant Drugs Shock Distended Abdomen COPD Maxillo-facial Injuries Primary Survey Investigation of Pain (OPQRST) Vital Signs including O2 saturation completed Contraindications ruled out Shake bottle if stored improperly Adequate ventilation secured (vehicle ventilation system activated if available) Not left unused over long periods Not stored below -6 Celcius Not stored vertically Self-administered using mask/bite stick Mask/bite stick operation Pain should be relieved May feel: o Light-headed o Giddy o Drowsy o Nauseous Stop or start at any time Use until pain relieved or Adverse effects felt Notify you if adverse effects felt Page 7 of 8
Relevant S-A-M-P-L-E Information (History) MVA Patient Location of patient Which vehicle patient was in How many vehicles involved Impact speed Exterior damage Interior damage Type of restraints Initial position of patient Condition of patient Loss of consciousness Condition of other patients Wearing a seat belt? Fall Where from Height Free fall or hit other objects Landing surface Position of patient at impact What hit first Position Found Loss of consciousness Cause of fall Pedestrian Struck What hit them Size and weight of object Velocity of vehicle Vehicle part that hit patient Damage to vehicle Distance patient thrown Loss of consciousness Condition of patient Condition of Vehicle Occupants Shooting Type of firearm Range and Angle Loss of consciousness Type of bullet Entrance and exit wounds Initial position and condition of patient Stabbing Type and size of weapon Loss of consciousness Type of wound Number of wounds Other injuries Initial position and condition Lund & Browder Burn Estimation Sheet Area Age 0 1 5 10 15 Adult A = half of head 9.5% 8.5% 6.5% 5.5% 4.5% 3.5% B = half of one thigh 2.75% 3.25% 4% 4.5% 4.5% 4.75% C = half of one lower leg 2.5% 2.5% 2.75% 3% 3.25% 3.5% Page 8 of 8