EMT 205 - Exam 3
Content
Jonathan Sarmiento February 19, 2008 Exam 3 Objectives Chapter Seven: 3-1 2 !ommon ha"ar#s $oun# on scene inc%u#e #o&ne# %ines, vehic%es on $ire, ha"ar#ous materia%s, cro&#s, an# anima%s 3-1 ' !ommon mechanisms o$ injury inc%u#e $a%%s, vehicu%ar co%%isions (hea#-on, rear-en#, si#eim)act, ro%%over, rotationa% im)act*, )enetratin+ trauma (#irect )rojecti%e #ama+e, cavitation*, an# b%unt-$orce trauma 3-1 , -t is im)ortant to i#enti$y the number o$ )atients on scene because this &i%% he%) #etermine i$ a##itiona% su))ort or resources are necessary 3-1 . -t is im)ortant to ascertain i$ a##itiona% he%) is necessary in or#er to ca%% $or he%) imme#iate%y Chapter Eight: 3-2 2 /enta% status can be assesse# by as0in+ 1uestions an# notin+ the ty)e o$ res)onse -$ there are no res)onses to verba% stimu%i the a )ain$u% stimu%us such as a sterna% rub can be +iven to assess a res)onse 2o res)onse in#icates an unres)onsive )atient 3-2 3 For a )atient &ith a#e1uate breathin+, care shou%# be ta0en to ensure a )atent air&ay 3-2 8 For a )atient &ith ina#e1uate breathin+, the air&ay shou%# be 0e)t o)en &ith the a))ro)riate maneuver i$ necessary -$ res)irations $a%% be%o& norma%, venti%ate &ith 1004 oxy+en -$ they are above norma%, +ive 1004 oxy+en by nonrebreather mas0 3-2 9 5#e1uate breathin+ consists o$ 12-20 res)irations a minute an# is un%abore# -na#e1uate breathin+ $a%%s outsi#e this ran+e an# is ty)ica%%y %abore# &ith use o$ accessory musc%es 3-2 1' -t is im)ortant to assess the )atient $or externa% b%ee#in+ in or#er to )revent an# treat $or shoc0 3-2 19 5 )atient shou%# be )rioriti"e# $or care an# trans)ort in or#er to )rovi#e the most imme#iate care $or critica% )atients an# to avoi# &astin+ resources on non-emer+ency )atients 3-2 20 6he im)ortance o$ $ormin+ a +enera% im)ression o$ the )atient is necessary in #eterminin+ ho& serious the con#ition is an# a%%o&s )rioriti"ation o$ care an# trans)ort Chapter Ten: 3-3 1 6he mechanism o$ injury is so im)ortant that it must be reconsi#ere# because a secon# %oo0 a%%o&s the E/6 to revisit the to)ic &ith +reater $ocus in case as)ects &ere misse# at the $irst eva%uation 3-3 2 6he ra)i# trauma assessment a%%o&s the E/6 to #etect injuries that may be %i$e threatenin+ &hich &ere not #etecte# #urin+ the initia% assessment 3-3 ' 6he ra)i# trauma assessment entai%s surveyin+ the hea# (7!58-96:S ; cre)itation*, nec0 (7!58-96:S ; J<7, cre)itation*, chest (7!58-96:S ; )ara#oxica% motion, cre)itation, breath soun#s*, ab#omen (7!58-96:S ; $irmness, so$tness, #istention*, )e%vis (7!58-96:S ; )ain, ten#erness, motion*, extremities (7!58-96:S ; #ista% )u%se, motor $unction, sensation*, an# )osterior (7!58-96:S* 3-3 , 6he assessment may be a%tere# &hen it is necessary to )rovi#e care such as ban#a+in+ a &oun#, s)%intin+ a $racture, or any %i$e threatenin+ )rob%ems that are #iscovere# 3-3 . 5 $ocuse# history an# )hysica% exam is con#ucte# is to 1uic0%y #etermine the ty)e an# extent o$ imme#iate injury a%%o&in+ the E/6 to )rioriti"e care an# trans)ort o$ the )atient
3-, 1 6he #etai%e# )hysica% exam consists o$ the same areas as the ra)i# trauma assessment (see ans&er to 3-3 '* as &e%% as the $ace (7!58-96:S*, ears (7!58-96:S*, eyes (7!58-96:S ; #isco%oration, une1ua% )u)i%s, $orei+n bo#ies, b%oo# in anterior chamber*, nose (7!58-96:S ; #raina+e, b%ee#in+*, an# mouth (7!58-96:S ; %oose or bro0en teeth, objects that cou%# cause obstruction, s&e%%in+ or %aceration o$ the ton+ue, unusua% breath o#or, #isco%oration* 3-, 3 5##itiona% care is )rovi#e# in the course o$ the #etai%e# )hysica% exam &hen %i$e threatenin+ )rob%ems are i#enti$ie# 3-, ' 6he #etai%e# )hysica% exam is inten#e# more $or trauma )atients than it is $or me#ica% )atients because there are usua%%y $e& si+ns an E/6-9 can $in# in the )hysica% exam o$ a me#ica% )atient that are si+ni$icant or about &hich you can or shou%# #o anythin+ Chapter Eleven: 3-' 1 5n in#ivi#ua% &ith a s)eci$ic com)%aint an# no 0no&n )rior history has not been un#er )rior treatment $or this )rob%em an# #oes not have any me#ications that you can assist in a#ministerin+ 3-' 2 5n in#ivi#ua% &ith a s)eci$ic com)%aint an# 0no&n )rior history a%%o&s the E/6 to )re)are $or )ossib%e interventions 5%so, i$ they have me#ications use# in the treatment o$ this con#ition then the E/6 can assist in its a#ministration 3-' 3 5n unres)onsive )atient is $irst assesse# $or their 59!s $o%%o&e# by a ra)i# )hysica% exam, base%ine vita% si+ns, S5/8:E history $rom $ami%y an# bystan#ers $o%%o&e# by interventions an# trans)ort 3-' ' 6he assessment $or a res)onsive )atient be+ins &ith the 59!s, $o%%o&e# by history o$ the )resent i%%ness, a S5/8:E history, $ocuse# )hysica% exam an# then base%ine vita% si+ns, then interventions an# trans)ort Chapter Twelve: 3-. 1 6he initia% assessment is re)eate# to rechec0 $or %i$e-threatenin+ )rob%ems that may have #eve%o)e# since the $irst assessment 3-. 2 6he on+oin+ assessment consists o$= 1* >e)eat the initia% assessment, 2* >eassess an# recor# vita% si+ns, 3* >e)eat the $ocuse# assessment re%ate# to s)eci$ic com)%aints or injuries, an# '* !hec0 interventions 3-. 3 6ren#in+ is the #etermination o$ chan+es in a )atient?s con#ition over time, such as s%o&in+ res)irations or risin+ )u%se rate, that may sho& im)rovement or #eterioration, an# that can be sho&n by #ocumentin+ re)eate# assessments 3-. . 6ren#in+ is va%uab%e to other hea%th )ro$essiona%s that assume care o$ the )atient to %et them 0no& i$ the )atient?s con#ition is im)rovin+ or #eterioratin+ Chapter Thirteen: 3-3 2 6he )ro)er se1uence $or #e%ivery o$ )atient in$ormation is= 1* @nit i#enti$ication an# %eve% o$ )rovi#er, 2* Estimate# time o$ arriva%, 3* 8atient?s a+e an# sex, '* !hie$ com)%aint, ,* 9rie$, )ertinent history o$ the )resent i%%ness, .* /ajor )ast i%%nesses, 3* /enta% status, 8* 9ase%ine vita% si+ns, 9* 8ertinent $in#in+s o$ the )hysica% exam, 10* Emer+ency me#ica% care +iven, 11* >es)onse to emer+ency me#ica% care, 12* !ontact me#ica% #irection i$ re1uire# or i$ you have 1uestions 3-3 ' 6he essentia% com)onents o$ the verba% re)ort are= 1* chie$ com)%aint, 2* history that &as not +iven )revious%y, 3* a##itiona% treatment +iven en route, an# '* a##itiona% vita% si+ns ta0en en route
3-3 3 -nter)ersona% s0i%%s in communicatin+ &ith the )atient inc%u#e= 1* @se eye contact, 2* 9e a&are o$ bo#y )osition an# bo#y %an+ua+e, 3* @se %an+ua+e the )atient can un#erstan#, '* 9e honest, ,* @se the )atient?s )ro)er name, an# .* :isten 3-3 9 6o the scene A con$irm recei)t o$ %ocation $o%%o&e# by action (en routeBstan#by*, 5t the scene A ra#io #is)atch an# announce arriva% on scene, 6o the $aci%ity A ra#io #is)atch an# announce &hich $aci%ity you are hea#e# to, 5t the $aci%ity A ra#io #is)atch an# announce arriva% at $aci%ity, 6o the station A ra#io #is)atch an# announce en route to station, 5t the station A ra#io #is)atch an# announce arriva% at station Chapter Fourteen: 3-8 1 !om)onents o$ the &ritten re)ort are #ata e%ements such as run #ata (a+ency name, unit number, #ate, times, run or ca%% number, cre& names, cert %eve%s, an# numbers*, )atient #ata ( )atient?s name, a##ress, 7O9, a+e, sex, bi%%in+ an# insurance in$o, nature o$ ca%%, /O-, %ocation &here )atient &as $oun#, treatment a#ministere# be$ore arriva%, si+ns an# sym)toms, vita% si+ns, S5/8:E history, care a#ministere#, an# chan+es in con#ition*, chec0 boxes, an# narrative (objective an# )ertinent subjective in$ormation, )ertinent ne+atives* 3-8 3 6he in$ormation in each section is out%ine# in the ans&er above -n$ormation shou%# be entere# in %e+ib%y, avoi#in+ ra#io co#es an# non-stan#ar# abbreviations, s)e%%e# correct%y an# the correct usa+e o$ me#ica% termino%o+y 3-8 ' S)ecia% consi#erations concernin+ )atient re$usa% are in the )ro)er an# com)%ete #ocumentation o$ ste)s ta0en to )ersua#e the )atient to +o to the hos)ita%, the use o$ a )atient re$usa% $orm, an# the inc%usion o$ a%% )ertinent in$ormation in the narrative 3-8 10 5n accurate an# synchronous c%oc0 is necessary to #ocument an actua% tren# so that the times on the re)ort match u) &ith the times in the #is)atcher?s recor#
3-, 1 6he #etai%e# )hysica% exam consists o$ the same areas as the ra)i# trauma assessment (see ans&er to 3-3 '* as &e%% as the $ace (7!58-96:S*, ears (7!58-96:S*, eyes (7!58-96:S ; #isco%oration, une1ua% )u)i%s, $orei+n bo#ies, b%oo# in anterior chamber*, nose (7!58-96:S ; #raina+e, b%ee#in+*, an# mouth (7!58-96:S ; %oose or bro0en teeth, objects that cou%# cause obstruction, s&e%%in+ or %aceration o$ the ton+ue, unusua% breath o#or, #isco%oration* 3-, 3 5##itiona% care is )rovi#e# in the course o$ the #etai%e# )hysica% exam &hen %i$e threatenin+ )rob%ems are i#enti$ie# 3-, ' 6he #etai%e# )hysica% exam is inten#e# more $or trauma )atients than it is $or me#ica% )atients because there are usua%%y $e& si+ns an E/6-9 can $in# in the )hysica% exam o$ a me#ica% )atient that are si+ni$icant or about &hich you can or shou%# #o anythin+ Chapter Eleven: 3-' 1 5n in#ivi#ua% &ith a s)eci$ic com)%aint an# no 0no&n )rior history has not been un#er )rior treatment $or this )rob%em an# #oes not have any me#ications that you can assist in a#ministerin+ 3-' 2 5n in#ivi#ua% &ith a s)eci$ic com)%aint an# 0no&n )rior history a%%o&s the E/6 to )re)are $or )ossib%e interventions 5%so, i$ they have me#ications use# in the treatment o$ this con#ition then the E/6 can assist in its a#ministration 3-' 3 5n unres)onsive )atient is $irst assesse# $or their 59!s $o%%o&e# by a ra)i# )hysica% exam, base%ine vita% si+ns, S5/8:E history $rom $ami%y an# bystan#ers $o%%o&e# by interventions an# trans)ort 3-' ' 6he assessment $or a res)onsive )atient be+ins &ith the 59!s, $o%%o&e# by history o$ the )resent i%%ness, a S5/8:E history, $ocuse# )hysica% exam an# then base%ine vita% si+ns, then interventions an# trans)ort Chapter Twelve: 3-. 1 6he initia% assessment is re)eate# to rechec0 $or %i$e-threatenin+ )rob%ems that may have #eve%o)e# since the $irst assessment 3-. 2 6he on+oin+ assessment consists o$= 1* >e)eat the initia% assessment, 2* >eassess an# recor# vita% si+ns, 3* >e)eat the $ocuse# assessment re%ate# to s)eci$ic com)%aints or injuries, an# '* !hec0 interventions 3-. 3 6ren#in+ is the #etermination o$ chan+es in a )atient?s con#ition over time, such as s%o&in+ res)irations or risin+ )u%se rate, that may sho& im)rovement or #eterioration, an# that can be sho&n by #ocumentin+ re)eate# assessments 3-. . 6ren#in+ is va%uab%e to other hea%th )ro$essiona%s that assume care o$ the )atient to %et them 0no& i$ the )atient?s con#ition is im)rovin+ or #eterioratin+ Chapter Thirteen: 3-3 2 6he )ro)er se1uence $or #e%ivery o$ )atient in$ormation is= 1* @nit i#enti$ication an# %eve% o$ )rovi#er, 2* Estimate# time o$ arriva%, 3* 8atient?s a+e an# sex, '* !hie$ com)%aint, ,* 9rie$, )ertinent history o$ the )resent i%%ness, .* /ajor )ast i%%nesses, 3* /enta% status, 8* 9ase%ine vita% si+ns, 9* 8ertinent $in#in+s o$ the )hysica% exam, 10* Emer+ency me#ica% care +iven, 11* >es)onse to emer+ency me#ica% care, 12* !ontact me#ica% #irection i$ re1uire# or i$ you have 1uestions 3-3 ' 6he essentia% com)onents o$ the verba% re)ort are= 1* chie$ com)%aint, 2* history that &as not +iven )revious%y, 3* a##itiona% treatment +iven en route, an# '* a##itiona% vita% si+ns ta0en en route
3-3 3 -nter)ersona% s0i%%s in communicatin+ &ith the )atient inc%u#e= 1* @se eye contact, 2* 9e a&are o$ bo#y )osition an# bo#y %an+ua+e, 3* @se %an+ua+e the )atient can un#erstan#, '* 9e honest, ,* @se the )atient?s )ro)er name, an# .* :isten 3-3 9 6o the scene A con$irm recei)t o$ %ocation $o%%o&e# by action (en routeBstan#by*, 5t the scene A ra#io #is)atch an# announce arriva% on scene, 6o the $aci%ity A ra#io #is)atch an# announce &hich $aci%ity you are hea#e# to, 5t the $aci%ity A ra#io #is)atch an# announce arriva% at $aci%ity, 6o the station A ra#io #is)atch an# announce en route to station, 5t the station A ra#io #is)atch an# announce arriva% at station Chapter Fourteen: 3-8 1 !om)onents o$ the &ritten re)ort are #ata e%ements such as run #ata (a+ency name, unit number, #ate, times, run or ca%% number, cre& names, cert %eve%s, an# numbers*, )atient #ata ( )atient?s name, a##ress, 7O9, a+e, sex, bi%%in+ an# insurance in$o, nature o$ ca%%, /O-, %ocation &here )atient &as $oun#, treatment a#ministere# be$ore arriva%, si+ns an# sym)toms, vita% si+ns, S5/8:E history, care a#ministere#, an# chan+es in con#ition*, chec0 boxes, an# narrative (objective an# )ertinent subjective in$ormation, )ertinent ne+atives* 3-8 3 6he in$ormation in each section is out%ine# in the ans&er above -n$ormation shou%# be entere# in %e+ib%y, avoi#in+ ra#io co#es an# non-stan#ar# abbreviations, s)e%%e# correct%y an# the correct usa+e o$ me#ica% termino%o+y 3-8 ' S)ecia% consi#erations concernin+ )atient re$usa% are in the )ro)er an# com)%ete #ocumentation o$ ste)s ta0en to )ersua#e the )atient to +o to the hos)ita%, the use o$ a )atient re$usa% $orm, an# the inc%usion o$ a%% )ertinent in$ormation in the narrative 3-8 10 5n accurate an# synchronous c%oc0 is necessary to #ocument an actua% tren# so that the times on the re)ort match u) &ith the times in the #is)atcher?s recor#
