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Paramedic Principles

Definition of: Quality of life The level of quality towards someone's life
What is 'burnout syndrome'? Risk that develops from emergency work. Related to exhaustion, detachment and lack of accomplishment
What is 'Compassion Fatigue'? Traumatic stress that develops from helping people. Results in depression, and anxiety
What is 'Compassion Satisfaction'? The satisfaction that someone receives from helping people who are suffering
What is 'Clinical Reasoning'? The cyclical process that paramedic use when assessing and treating a patient.
What is Deductive Reasoning? Starting with a theory and using experience to prove/disapprove it
What is Inductive Reasoning? Using observations and experience to make generalisations and infer an explanation
Definition of Heuristic Enabling someone to learn for themselves
Definition of Epistemology The theory of knowledge, it allows for distinguishing justified belief from opinion
Definition of Ethics Morals that direct our judgement and our treatment of a patient
Definition of Laws Policies made by the government and other officials that lead to negative consequences if the laws are not followed correctly.
Definition of Duty of Care The legal duty that a person withholds when treating a patient to ensure the best possible outcome for the patient, until they are either handed off to another medical professional or are better and no longer unwell and require treatment.
Definition of Consent The legal right that a patient must give to a paramedic for treatment, without consent from patient, a paramedic is unable to give treatment
What is Autonomy The legal right that a patient has to choose what happens to their body
What is Beneficence Decisions are made in the best interest of the patient
What is Non-Maleficence Do the person no harm
What is an ACD? Advanced Care Directive - Includes legal documents such as, DNR. It is a legally binding document that paramedics must follow if it is in date and legit.
Definition of Competency Competence requires a health practitioner to assess whether the patient is able to; comprehend the treatment information, believe the information, weigh up the risks and benefits to the treatment
Definition of Capacity patients ability to understand the nature and effect of their decision
What is a Paramedics Code of Conduct? - integrity - respect -responsibility - competence - consent of patient care - confidentiality - research - ethical review
When can someone refuse treatment? If they have competency and capacity
How can infection be transmitted? - airborne - contaminated food or objects - skin to skin contact - contact of bodily fluids.
What is the chain of infection? - infectious agent - reservoirs - portal of exit - means of transmission - portal of entry - susceptible host
What is Justice? Everybody receives equal care regardless of their gender, social status, etc.
What are some of the factors can influence a persons competency and capacity? - intoxication - disabilities - head trauma -
What are the steps of risk management? - recognise risky situations - analyse the risk - identify the controls - report the hazards - monitor the impact - employ accountability
What is PPE? Personal Protective Equipment
What are some examples of PPE? - gloves - face mask - goggles - uniform - high visibility vest - safety boots
What is the importance of wearing a uniform? - Identifies that you are part of the profession - Protects you partly from patient body fluids - Protects from sunburn/exposure - Reduces abrasions to body and limbs - Insulation in poor weather
What is the purpose of the primary Survey? A systematic approach to exclude or manage immediate life threatening situations
What does a primary survey include? Danger, Response, Airway, Breathing, Circulation, Disability, Expose, Extricate, Expedite
What is Stay and Play When definitive treatment can be provided by us paramedics our focus is on providing the required treatment immediately
What is Load and Go? Some conditions require care we cannot provide, we then prioritise urgent transport and provide the hospital with pre-notification to allow them to prepare for the patient
Definition of Life Threatening? immediate threat to their life
what is systolic pressure? The pressure exerted against the wall of an artery following the CONTRACTION of a ventricle
Definition of Limb Threatening? The patient is at risk of losing their limb/s. Does the limb have; - movement - feeling - blood flow
What are some common life threatening & time critical situations? - snake bite - drug overdose - excessive bleeding
What does AVPU stand for? Alert Verbal Pain Unresponsive
How can you determine a persons level of consciousness? AVPU and GCS
What are some common reasons for a person to be unconscious? - inadequate supply of the brains metabolic needs - chemically induced alteration of the brain function - direct trauma to the brain tissue - alterations in brain function or structure
What are the sections of a GCS? - eyes - verbal - motor response
What are sections within the 'Eyes' section of a GCS ? 1. Nil 2. Pain 3. Voice 4. Alert
What are sections within the 'Verbal' section of a GCS ? 1. Nil 2. Incomprehensible Words 3. Single Words 4. Confused 5. Oriented
What are sections within the 'Motor' section of a GCS ? 1. Nil 2. Decerebrate 3. Decorticate 4. Withdrawals 5. Localises 6. Obeys commands
When is a person oriented? When they are situated to time, place, person, situation
Definition of Alert? Referring to a state in which an individual is awake and appropriately responding to questions about who they are, where they are, and what day and time it is.
What is the Primary Function of the airway? - transports 02 from atmosphere to alveoli - transports the 02 into the pulmonary capillary bed - Attaches haemoglobin - transports the cells through the body
What structures are in the upper airway? - nose and mouth - Pharynx - Epiglottis - Larynx - Cricoid Cartilage
What structures are in the lower airway? - Trachea - Major Bronchi - Bronchioles - Alveoli - Diaphragm
What is tidal Volume? the volume of air moved by inspiration and expiration
What is Minute volume? Volume of air moved within a minute
What is the most common obstruction of the airway? Tongue
How do we assess the airway? Look for any obstructions Listen for sounds Feel for airway movement
What does a snoring sound indicate? Upper airway is partially obstructed from relaxation of the tongue
What does a stridor sound indicate? Upper airway obstruction from swelling or foreign body
What is an OPA and how do we measure it? Orophyrangeal Airway - measured from corner of mouth to earlobe
What is an NPA and how do we measure it? Nasopharyngeal Airway - measured from tip of the nose to the tragus
When do we use and NPA? when a person has; - trismus - facial damage - gag relex
When do we use an OPA? when a person is unconscious, has a stridor, and does not have a gag relax
What are some manual airway manoeuvres - head tilt - jaw thrust - chin lift
When is suction used? When fluids must be removed to allow for airway to become patent.
How do we assess breathing? Look for rise and fall of chest Listen for air moving in and out Feel for rise and fall of chest
What must we consider when assessing breathing? Is the rate and depth adequate to sustain life
What are some abnormal airway sounds and what do they indicate? Crackles - air moving through fluids Wheezes - narrowed airway Snoring - partially obstructed upper airway
What conditions require high flow of 02? - shock - trauma - drowning - Sepsis - cardiac Arrest
What conditions require moderate levels of 02? - asthma - pneumonia - lung cancer - acute heart failure
What conditions require low flow of 02? - COPD - Obesity - Neuromuscular Disease
When does 02 become harmful? When they don't need it as it causes vasoconstriction
How do we assess Circulation? - pulse (rate, strength) - capillary refill (should be under 2 seconds) - perfusion
What is aspiration? A condition in which food, liquids, saliva or vomit is breathed into the airways.
What is dyspnoea? the feeling of having difficulty breathing
What are the four types of hypoxaemia and tissue hypoxia? - Hypoxic hypoxia - Anaemic hypoxia - Stagnant hypoxia - hystotoxia hypoxia
What is Hypoxic hypoxia ? caused by either diminished oxygen content in the atmosphere or decreased gaseous exchange in the lungs due to respiratory disease.
What is Anaemic hypoxia ? reduced oxygen carrying capacity of the blood due to blood loss or reduction in haemaglobin content of the blood.
What is Stagnant hypoxia ? The circulation of blood is reduced due to cardiac failure or local circulatory failure
What is hystotoxia hypoxia ? The cells ability to utilise the oxygen is diminished due to chemical or metabolic processes
What are some of the clinical signs and symptoms of hypoxia? - Respiratory rate and effort - more than 29 and less than 8 - Tachycardia - Changes in mental function (drowsiness, confusion and finally coma) – these changes occur with SpO2 < 80%. This is the most sensitive indicator of cerebral hypoxia.
When should a BVM be used? in all non-breathing and hypoventilating patients.
When should a nasal cannula be used? in patients with moderate hypoxemia and who are able to breathe through their nose
When should a Nebulisation mask be used? to administer aerosolized medications and saline to patients requiring bronchodilators or humidification of thick secretions.
What is hypo fusion caused by? Loss of body fluids in the vascular system (eg bleeding) Failure of the heart to adequately pump blood Dilation of the blood vessels in the body
What defines adequate perfusion? normal blood flow around the body when their skin is pink, and rosy. cap refill is less than 3 seconds
How do we recognise medical shock Changes in level of awareness (confusion etc) Tachycardia or bradycardia (severe shock) Pale or mottled, clammy, cold skin Reduced blood pressure (late sign)
What are some conditions that we look for when assessing disability in the primary survey Stroke Hypoglycaemia Defibrillation required Life threatening injuries
What does 'Exposure' entail? removing clothing so that we can assess for injuries and symptoms, while considering and protecting the person's dignity, and protecting against environmental factors
What is the purpose of a patient interview to identify and correct any life threatening conditions
What are some good questioning techniques? open ended questions, active listening, positioning in yourself in an open position, eye contact, and get on their level.
What should you ask about in a patient interview? - chief complaint - the history of the chief complaint - general medical history - social history - drugs and allergies
What are some good ways to build rapport? - introduce yourself, ask and remember their name, show empathy
What is a provisional diagnosis an educated guess about the most likely diagnosis.
What is a differential diagnosis ? more than one possibility for your diagnosis.
What is the difference between a sign and a symptom? Signs are the physical manifestation of the illness, injury or disease. It is objective, which can be measured. Symptoms are things that can only be felt by the patient. These are the things that a patient experiences about the illness, injury or disease
what is the purpose of a vital signs assessment measurements we use to assess the functioning of the patient’s essential body functions
What vital signs do we measure BP, Pulse, BGL, Sp02, Respirations, Level of consciousness, Skin condition, temperature
What are the low, normal and high rates for heart rate measurements? Low = <40 Normal = 60 - 100 High = > 100
What are the low, normal and high rates for respiratory measurements? Low = < 8 Normal = 12 - 20 High = > 22
What are the low, normal and high rates for BP measurements? Low = <90 systolic Normal = 100 - 140 systolic High = > 160 systolic
What are the low, normal and high rates for temperature measurements? Low = < 35.1 Normal = 36 - 38 High = > 38
What are the low, normal and high rates for Sp02 measurements? Low = < 94% Normal = 96% - 100%
What are the low, normal and high rates for BGL measurements? Low = < 3.3 mmol/L Normal = 4 - 7 mmol/L High = over 10 mmol/L
What does inspection include? exposing and looking at the area we are interested in
What does palpation include? feeling an area for abnormality (deformity, swelling, tenderness)
What does auscultation include? using a stethoscope to listen to an area for abnormal sounds (used on the chest and abdomen)
What does percussion include? tapping areas to elicit sounds (hollow or dull) to identify the presence of air or fluids.
How do we assess the head and neck of a patient ? pupil size and reaction time; facial symmetry; unusual breath odours; distended neck veins in the sitting patient; any swelling; unusual sounds from the airway.
How do we assess the chest of a patient ? Abnormal movement symmetry; breath sounds on auscultation – front, sides and back of the chest (normal, wheezing, crackles or absent); use of accessory muscles of the upper chest, neck and abdomen; presence and nature of cough;
How do we assess the abdomen ? Rigidity, tenderness, distension, pulsatile masses.
How do we assess the limbs of a patient ? Swelling, pulse quality, temperature to touch, grip or push strength, peripheral sensory assessment and reflexes.
How do we assess the back of a patient ? looking for injuries, deformity or bruising (in trauma), while taking spinal precautions
What is bradycardia ? a slow heart rate
What is tachycardia a fast heart rate
what is tachypnoea a fast respiration rate
what is bradypnoea a slow respiration rate
what is diastolic pressure the pressure exerted against the wall of an artery during the RELAXATION phase of the left ventricle
What is hypotension? A low blood pressure
What is hypertension? A high blood pressure
How do we conduct a chest auscultation? Listen to the six regions using a stethoscope and compare both sides while listening for abnormal breathing sounds
What is PEARL? pupils equal and reactive to light
What must we assess when checking a pulse? rate, rhythm, depth, volume
What is shallow and slow breathing called? hypo-ventilating
What is deep and fast breathing ? hyperventilating
what is a systems focused assessment ? it is when we assess certain aspects of the body that is based on the patient's chief complaint
what are the body focused systems that we assess? respiratory , circulatory , endocrine , neurological, Musculoskeletal, Gastrointestinal ,
What is included in a respiratory assessment? appearance , position , speech , breath sounds , respiratory rate/rhythm/depth , chest wall excursion , heart rate , skin , conscious state
what is included in a circulatory assessment ? heart rate/rhythm/depth , ECG 100, BP , skin , conscious state
what is included in a neurological assessment ? mental status , pupil reaction , motor function , sensory exam , BGL
what is included in a abdominal assessment ? inspect 4 sections , auscultate for bowel sounds , observe for distension , palpate for pain and tension , guarding
what is included in a Musculoskeletal assessment? motor and sensory function, distal pulses , comparison of limbs , swelling
what is included in an endocrine assessment ? BGL, Blood tests primarily
What does BLS stand for? basic life support
what is cardiac arrest? when normal circulation of the blood stops due to failure of the heart to contract in a co-ordinated way or stops completely
when does it become likely that a patient will sustain permanent brain injury after six minutes of untreated cardiac arrest
when do we not treat cardiac arrest if the person has a DNR or has undeniable signs of death
why do we perform CPR ? to keep blood circulating to the brain, heart and lungs and to hopefully restore heart function
what does the chain of survival include? 1. early recognition and call for help 2. Early CPR 3. Early defibrillation 4. post resuscitation care
when do we start compressions ? when the person; - has abnormal breathing - unconscious - no signs of obvious death
when is death undeniable ? - decapitation - dependant lividity - rigor mortis - incineration - decomposition -
what factors influence the quality of CPR full recoil of chest and 50/50 duty cycle
human factors that influence CPR situational awareness. decision making, teamwork, task management , fatigue,
Common causes of cardiac arrest in adults - primary cardiac arrest (heart attack) and secondary to respiratory arrest (drowning)
Prevention of OOH cardiac arrest - education - monitoring patient assessment - measuring of vital signs - using ECG
What is the correct procedure for CPR? - hand placement in the centre of chest (bottom of sternum) - shoulders over the patient - 1/3 of the chest in depth - 100 to 120 compressions per minute
what is systole? is the compression and is for the brain, and is when the ventricles contract
what is diastole? is the release of the chest and allows the heart to fill with blood
what are complications of incomplete release of the chest? reduces venous return and cardiac output
what is ROSC? return of spontaneous circulation.
what must you do if ROSC occurs reassess the patient's pulse and respirations provide ventilation transport to appropriate facility ASAP
what is defibrillation? a high energy shock that is delivered to a patient in cardiac arrest to restart the heart.
What are some deteriorating factors that could possibly lead to cardiac arrest? - chest pain, - dysrhythmias, severe breathing problems or choking, severe trauma
what is the Horrendous principle ? it is a principle that we work with to treat the worst possible condition first and eliminate it, and continue.
what are the steps of the clinical reasoning cycle? 1. consider patient situation 2. collect cues and information 3. process information 4. identify problems 5. establish goals 6. take action 7. evaluate outcomes 8. reflect on process
Before we undertake any treatment action what must we consider? The risk:benefit ration
What is included in the clinical reasoning triad? Knowledge, Cognition, Metacognition
what is knowledge ? raw information that we learn through self learning and experience
what is cognition our ability to receive, memorise, store and retrieve information on a conscious level
what is metacognition? the ability to monitor one's thinking
what is reflect IN action? reflecting on the situation as it occurs
what is reflect ON action ? reflecting on a situation after it has happened
What some examples for someone being unconscious ? A - alcohol E - epilepsy I - insulin O - overdose U - under dose T - temperature, trauma I - infection P - psychosis S- septic, shock, stroke
What is trauma any injury caused by external forces
what are the common categories of energy transfer blunt, penetrating, thermal / chemical
what are the differences in the assessments between a medial and a trauma patient ? 1. primary survey order 2. visual observations 3. time critical 4. pain as primary symptoms
Trends of trauma majority happens within cities, highest incidence within males aged between 25 and 44, falls are the biggest cause of injury
what is the definition of kinematics the study of motion of objects
what is mechanism of injury the way or patterns of injury that occur
How can injuries occur? 1. mechanical forces 2. heat 3. chemicals 4. electricity 5. lack of oxygen
how do we calculate energy energy = mass x velocity squared / 2
what are ballistics the study of projectiles (bullets, explosives etc.)
what is the Trauma primary survey D R C A B C D E
how do we control haemorrhaging ? through direct or indirect compression and the use of a tourniquet
How do we perform a secondary survey in trauma ? 1. patient history 2. level of consciousness 3. head to toe survey
Definition of ACTUAL time critical ? At the time the patient assessment is undertaken, the patient is in actual physiological distress.
Definition of EMERGENT time critical ? At the time the patient assessment is undertaken, the patient is not physiologically distressed but does have a Pattern of Injury which is known to have a high probability of deteriorating to actual physiological distress
Definition of POTENTIAL time critical ? At the time the patient assessment is undertaken, the patient is not physiologically distressed and there is no significant “Pattern of actual Injury”, but does have the potential to deteriorate to actual physiological distress.
What is pain? an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
what is somatic pain ? (localised and sharp) e.g. injury to muscles, bones or skin
what is visceral pain ? Deeper in the body from organs, poorly localised, diffuse or radiating). E.g. cardiac type chest pain, abdominal pain, headache
what is phantom pain ? after amputation, pain may be felt in a body part that has been removed – due to brain pain map still present despite physical removal of body part.
what is referred pain? different parts of the body may share a common set of nerves (e.g. neck & jaw share same nerves as heart). In these cases, we may feel pain in a different location to actual area of injury.
what is chronic pain ? permanent state of pain in an area despite healing. Has a strong psychological component – management is thus complex. Still real pain.
How can we determine pain ? O - onset P - provokes Q - quality R - radiation S - site of pain T - time
What are some ways of measuring pain ? 1 - 10 scale, faces, none - agonising pain
what should be considered when giving pain relief ? timeliness, effectiveness, potential side effects
what are some examples of non-pharmaceutical pain relief splinting, reassurance, dressings, hot and cold packs
how can medications be delivered enteral, parenteral
what are the enteral routes of delivering medications oral, sublingual, nebuliser, inhaler, endotracheal, transdermal patches
what are the parenteral routes of delivering medications intravenous, intramuscular, subcutaneous, intraossesous
what are some types of analgesic drugs ? Inhalation analgesics (Methoxyflurane - Penthrox), Oral analgesics: eg. Paracetamol, Parenteral analgesics
What are the 6 R's and when are they used Right Time, Right Person, Right Drug, Right dose, Right route, Right documentation. It is used whenever a drug is administered to a patient
how do we calculate the energy of colliding forces add the speeds together
how does the MOI help us? forms a pattern of likely injury, helps us plan our assessment and potential interventions
what is Compression trauma ? when organs and structures are compressed
what is shearing trauma traumatic brain injury. May leave the brain cells spinning and tear apart
what is penetrating trauma ? caused by knives and guns. We must consider the body, organ structure, depth of penetration
Low velocity of penetrating trauma caused by stab wounds. The injury is localised and in a straight line
Medium and high velocity of penetrating trauma caused by a gun shot.
what are common causes of blunt trauma ? MVC Falls assaults
what are the types of haemorrhages ? arterial, venous, capillary
what compensation mechanisms does the body have to manage bleeding ? the sympathetic nervous system responded by increasing the heart rates, vasoconstriction, and clotting of the blood.
what are some of the signs of internal haemorrhaging ? look for swelling, redness, bruising
what are some of the sources of internal bleeding ? vasular damage, organ rupture, fractures
what should we look for when conducting a secondary survey? S - swelling T - tenderness D - deformity C - contusions A - abrasions L - lacerations L - leaks
what pain medications should be used for different severities of pain? Mild ( 1 - 3 ) paracetamol and ibuprofen Moderate (4 - 7) methoxyflurane Severe ( 8 - 10) morphine and fentanyl
What are some barriers to communication? physical - hearing loss, noise, and distance pyscho-social - attitudes, feelings, bias technique related
what are some ways we communicate ? verbal - speaking etc. non verbal - body language and gestures etc. symbolic communication
what are some ways to practice effective communication ? active listening
What is active listening ? not just hearing but understanding what the other person is trying to communicate
What is the purpose of a patient handover ? Continuity of Care, Correct prioritisation of patient needs, Fulfil legal and ethical obligations, Entry into Medical Records (hospital)
What are some common approaches for a handover? I - identify S - situation B - background A - assessment R - recommendation or I - identification M - mechanism of injury I - injuries S - signs and symptoms T - treatment A - allergies M - medications O - other
what is the other requirement for a hospital handover? a hospital pre-notification
What does a situation report include? use the mnemonic of METHANE M = major incident E = exact location T = type of incident H = hazards at the scene A = access N = number of casualties E = emergency services required
when is a situation report necessary ? when situation is complex and more resources are required or specialist help to manage hazards:
What makes up evidence based practice? 1. Clinical expertise 2. patient values 3. best research evidence
What are some causes of VF? 1. lack of blood flow 2. sepsis 3. cardiomyopathy
What are some signs of Cardiac Arrest? 1. Loss of responsiveness 2. No normal breathing 3. chest pain
What is sepsis ? An infection within the blood
What are some examples of COPD? 1. emphysema 2. bronchitis 3. chronic asthma
What is Arterial Fibrillation ? an irregular and rapid heart beat that can lead to heart failure
What are some causes of AF? 1. High blood pressure 2. Coronary Heart disease 3. Valvular Heart Disease
What is Anuria ? Kidneys failing to produce urine
What is distal circulation? Blood that flows furthest away from the body
What is haematemesis? Vomiting of blood
What are some signs of someone in respiratory distress? 1. increased respiratory rate 2. blue in colour 3. sweating 4. wheezing 5. in tripod position
Created by: sophielass



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