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WFR Flash Cards 2
| Question | Answer |
|---|---|
| Upon Entering the scene first 5 steps | 1. I'm #1 (scene size up) 2. What's up with you? 3. None on me (PPE) 4. Are there more? 5. What's the vibe? |
| Step 2 after scene size up | -ID Self -Gain Consent -Spine stabilization? - ABC (blood sweep) DE |
| Step 3 | Head to toe / vitals / SAMPLE (DASH) / OPQRST |
| CSM (Step 4) | hands and feet which toe am i touching? Do they feel warm? Any tingling sensations? Feet -- car push up and down Hands -- fists rev like motorcycle/ squeeze |
| Step 5 | Vitals / FSA / Usability |
| SOAP Report (s) | This is ___ with patient report /evac request. Located at ___ I have (age, sex) with chief complaint of ____. MOI is ____ LOR is ___ |
| SOAP Report (o) | Patient has ___ injuries. Patient vitals are ____. SAMPLE history includes ___. Pertinent negatives ____ |
| SOAP Report (a) | suspect the following problems |
| SOAP Report (p) | Treatment, EVAC, Anticipated Problems |
| Vitals | LOR, HR, RR, SCTM, BP, Pupil Response rate, Temperature |
| Patient History | Age, sex, chief complaint, MOI/history of present illness, SAMPLE History |
| SAMPLE | symptoms, allergies, medications, pertinent medical history (DASH), last intake/output, event leading up |
| LOR | 1. Name 2. Place 3. Time 4. Event Can be A+ox__ or V (verbal), P (pain), U (unresponsive) |
| Normal HR | 50-100 bpm |
| Normal RR | 12-20 for adults, kids can be higher |
| SCTM | Color: pink/ashen/red Temp: warm/cool/hot Moisture: dry/moist/wet Want to be pink/warm/dry |
| OPQRST(u?) | -Onset (sudden/gradual) -provocation (what makes it better or worse) -Quality (words to describe) -Radiates (location, does it move) -Severity (1-10) -Time/Trend (how long? Better or worse?) -Understanding (patients understanding of condition) |
| Mechanisms for Spinal injury | -Trauma to head with loss of responsiveness/ altered mental state - High velocity impact - Falls from grater than 3ft landing on the head/butt (axial load) - Falls for a patient greater than 65 years old |
| S/S Spinal injury | - Pain/tenderness/obvious injury along spinal column - Altered distal sensation -Weakness/paralysis - Respiratory Difficulty - Loss of bowel/bladder -Shock |
| Treatment for Spinal | 1. stabilize head 2. check CSM's before moving 3. Protect Spine 4. CSM's after moving 5. EVAC |
| When to do a FSA | -Patient has MOI for spinal injury but no signs/symptoms - Reliable patient (A+Ox3/4 +sober) -Normal CSM's in all extremities - Patient denies pain/tenderness on the spine |
| S/S Fractured Ribs/Clavicle | -Point tenderness - Anatomical splinting - pain on inspiration, shallow breath - shortness of breath on exerction |
| S/S Unstable chest wall | - Pain/Tenderness - Deformity to chest - Respiratory distress - Possible paradoxical respiration - S/S shock |
| Rx Unstable chest wall | 1. stabilize (sling/swath) -- immobilize/occlusive dressing 2. Support breathing 3. Pain mgmt 4. monitor for short of breath 5. Admin O2 6. Consider Evac |
| 4 types of Pneumothorax | -Closed (air enters pleural space through tear in pleural linings , typically secondary to rib fracture) -Open (air enters through open chest wound) -Tension (air compresses lung +major vessels) -Spontaneous (air enters spontaneous tear in pleura) |
| what is a pneumothorax | mix of air/blood in pleural space |
| hemothorax | blood enters pleural space |
| S/s lung injury | -Short of breath (esp at rest) - Pain + Tenderness - wounds, bruises, deformity, instability of chest wall - Shock like vitals - Subcutaneous emphysema (air bubbles under skin) - Diminished breath sounds/wet sound |
| S/S worse lung injury | - Respiratory distress - Cyanosis - Jugular vein distention - Tracheal deviation |
| Lung Rx | 1. Stabilize (immobilize/occlusive) 2. support breathing 3. consider pain mgmt 4. monitor for shortness of breath 5. admin O2 6. Consider Evac |
| Hypovolemic shock | decrease fluid volume from bleeding, sweating, vomiting, diarrhea, severe burns (dehydration) |
| Cardiogenic Shock | Failure of heart to adequately pump blood |
| Vasogenic Shock | Loss of vascular tone resulting in increased vascular space |
| Stages of shock | 1. Compensatory (vasoconstriction, up HR, up RR) 2. Decompensatory (efforts begin to fail, BP down, brain no longer O2 Blood) 3. Irreversible (organs begin to die) |
| Early stages of shock | LOR: anxious, restless, disoriented HR: rapid (110-120), RR: rapid/shallow SCTM: pale/cool/clammy -dizzy, nausea, vomiting, thirst |
| Late stages of shock | LOR Deteriorates, eventually unresponsive, HR (rapid/weak/slows), RR up and more shallow to slowing, SCTM eventually cyanotic/ashen, BP down, pupils slower to respond |
| Shock Rx | 1. treat cause 2. keep patient calm 3. maintain normal temp (keep warm) 4. keep patient flat with legs elevated approximately 2in 5. consider fluids 6. admin O2 7. monitor vitals |
| S/S mild head injury | -brief change in LOR, temp blurred/starry vision, nausea, headache, dizzy, lethargic, personality change, amnesia |
| Rx mild head injury | monitor, physical/cognitive rest for at least 24 hrs |
| S/S serious head injury | -vision disturb, excessive sleepiness, ataxia (balance issues), seizure - LOR= disoriented, irritable, combative, unresponsive - HR= decrease/bounding -RR = hyperventative/erratic -SCTM= warm/flused - BP up - Pupils unequal |
| S/S skull Fracture | -depression in skull/visible crack - fluid/blood leaking from ears/nose - open head inj - bruising around eyes, behind ears |
| Rx serious head injury | 1. Manage airway, breath, circulation, consider patient on side 2. control bleeding with bulky dressing 3. admin O2 4. Protect spine (elevate head 6-8in) 5. EVAC immediately *give tylenol if needed |
| Musculoskeletal RX | 1. assess (look, ask, feel/check CSM/ Acute or chronic MOI/ usability) 2. manage pain (ice, elevation, compress, pain meds) 3. heat for spasm/strain 4. joint/muscle movement may help decrease swelling 5. support/check CSM's |
| Usability Test | 1. passive ROM 2. Active ROM 3. Weight bearing 4. preform essential functions |
| RX obvious fractures/unusable musculoskeletal injuries | 1. assess (LAF, CSM/ Acute or chronic/usability) 2. Gentle traction in line 3. splint 4. If fracture open: irrigate, traction in line to get bone under skin, protect exposed bone, pack/dress wound, rapid EVAC 5. Manage pain |
| Splint | padded, rigid, adjustable, CSM in tact, immobilize above/below |
| Compartment syndrome | increased pressure in a muscle secondary to fractures, crush injury, burn, most common inn lower leg/forearm, but can occur in hand/foot/thigh/upper arm |
| S/S Compartment syndrome | -Pain out of proportion to injury stimulated by stretching/mvmt - pallor: pale/cyanotic -Pulseless, muscle tight, full - Rapid EVAC |
| Techniques to control big bleeds | - Manual direct pressure/elevation - wound packing - pressure dressing (roll and twist over wound) - Tourniquet |
| Single rescuer roll | -Hold head, ask patient to bring arm closest above head - Place hand under patient head -Patient cross far arm and leg over body - Grab hip and continue to support head and roll forward/back |
| When to do a FSA/steps | -Completed head2toe, vitals, history - No evidence spinal/in remote location 1. A+Ox? 2. Any pain meds, alcohol, drugs, sober? 3. Distracted? 4. Check CSM's in hands and Feet 5. Walk fingers down spine 6. Decision |
| Taping an ankle | -landmark 2" above ankle - 3 stirrups under arch to landmark - Secure with tape around landmark - 3 J's: under arch, across top of foot, back to start - 3 Figure 8's: under arch, over top, behind achilles, across top, under arch |
| Stress injury | acute stress response as part of a physiological defense system that helps us respond quickly to dangerous situation |
| Goals of Psychological 1st aid | -re-engage neocortex immediately following stress incident, - listen, assure safety and basic needs are met, decrease stress, aid engagement with support groups |
| Principles of Psych 1st aid | 1. safety 2. calm 3. self/collective efficacy 4. connection 5. hope |
| Hypoxia | lack of O2 to the brain |
| S/S hyperventilation | - sensation of suffocation, dizzy, tingling/numb hands/feet/face, rapid HR/RR, hand and foot cramps, chest pain, possible loss of responsiveness with transient respiratory arrest |
| Rx hyperventilation | -calm patient - assist in slowing breath -- evac if unable |
| S/s mild asthma | -chest tightness - wheezing + coughing - short of breath - up HR/RR - Up mucus - fatigue |
| S/S severe asthma | - short of breath at rest - use of accessory muscles to breathe - diminished breath sounds progressing to absence of wheezing - Speak in 1-2 word clusters -sleepy - cyanosis |
| Asthma Rx | -calm patient - begin treatment promptly - support plan if patient has one - maintenance = 2puff/hr ; aggressive = 4-8 puff/20min for up to 4 hours |
| Pulmonary embolism | a clot (usually leg vein) breaks loose and lodges in blood vessel of lung. Caused by decreased mobility, smoking, recent surgery |
| S/S pulmonary embolism | -sharp chest pain, respiratory distress, cough (blood?), shock --EVAC |
| Testicular Pain | -epididymitis (inflammation of epididymis) - Torsion (twisting of testicle that can cut off blood supply) |
| CPR Flowchart | 1. scene size up/ shake+shout 2. check for circulation, if unresponsive/ no pulse/ bo breath start compressions 3. airway open and look for obstructions 4. continue until AED, EMT, wakes up |
| Child CPR | -Use 1 or 2 hands to compress at least 2" deep - Preform 5 cycles of CPR if emergency unwitnessed - If witnessed and sudden call 911 and go get AED then return |
| Infant CPR | - Tap foot and shout - Check for breathing for no more than 5 sec - no norm breath --> 2 fingers below nipple line and compress/breathe - after 5 cycles call 911 |
| Burn Depths | -superficial (red, painful, swollen) - partial thickness (red, painful, swollen and blistered (evac if 10%) - Full thickness: painless, without blisters, charred/pale (EVAC) |
| Burn Rx | -cool burn - cover with clean dressing - pain mgmt - hydrate -monitor |
| s/s Stress response | -up RR/Hr -SCTM: pale/cool/clammy - Trouble focusing - dizzy/trembling - stomach distress -chest tightness/pain - tingling sensation -excessive fear reaction - possible fight/flight/freeze |
| Mild hypothermia | impaired ability to perform complex tasks, fine motor shivering, slurred speech, "umbles" |
| Moderate hypotehrmia | uncontrollable violent shivering, worsening "umbles" stumbling, change in LOR |
| Severe | shivering stops, muscular rigidity, decrease mental status to unresponsive, decrease pulse/RR, ventricular fibrillation |
| Rx mild hypothermia | 1. change environment 2. insulate patient 3. add heat packs/hot water bottles 4. add calories 5. exercise if tolerated 6. maintain temp 7. may req 24hrs rest, hydration, food to recover |
| Rx Severe hypothermia | 1. handle gently, keep horizontal as possible 2. admin warm, humid, O2 3. prevent further heat loss 4. package hypothermia wrap 5. add heat packs or hot water bottles 6. avoid walking/standing 7. add calories if patient able to protect airway EVAC |
| S/S heat exhaustion | -fatigue -nausea - loss of appetitie -exercise associate with muscle cramps - LOR: Dizzy, fainting possible - HR and RR elevated - SCTM: pale/cool/clammy or flushed |
| RX Heat Exhaustion | 1. rest 2. hydrate 3. treat cramps with stretching 4. evac if not improving |
| S/S heat stroke | - LOR : disoriented, irritable, combative, unresponsive - Hallucination/seizure - Ataxia - HR/RR up - SCTM: hot, color and moisture can vary - Temp above 104 |
| Heat stroke Rx | 1. aggressively cool (spray with water/fan, immerse in cool water) 2. rapid evac |
| Rhabdomyolysis | breakdown of damaged muscle tissue that releases proteins and electrolytes into the blood which can damage heart and kidneys. Caused by exertion and heat stress |
| S/S rhabdomyolysis | -muscle cramps, aches, pains (more sever than expected) - inability to complete a workout routine due to exhaustion - tea or cola colored urine |
| Rhabdomyolysis rx | 1. hydration 2. removal from heat/exercise 3. evac |
| s/s dehydration | 1. thirst 2. weakness, headache, fatigue, lightheaded, irritable 3. dark, smelly urine 4. diminished urination 5. may show signs of shock/altered mental status |
| dehydration Rx | 1. drink water 2. takes a long time to develop and treat 3. mau hae electrolyte imbalance and must be evacuated |
| s/s hyponatremia | -heavy water intake - headache -unusual weakness/fatigue - swelling + bloating - nausea/vomit |
| Hyponatremia Rx | 1. no fluids 2. rest 3. salt |
| S/S mild altitude sickness | -headache with nausea, loss of appetite, fatigue, insomnia |
| Mild altitude sickness rx | 1. don't go up until symptoms subside 2. acclimatize (nutrition, exercise) 3. pain meds for headache okay 4. monitor for shortness of breath, ataxia, altered mental state |
| Severe altitude sickness (HACE) S/S | -ataxia -LOR disoriented, irritable, combative, unresponsive -headache may or may not be present - vision changes, hallucinations, seizure |
| Severe altitude sickness HAPE S/S | -deceased ability to exercise - persistent dry cough - short of breath at rest - HR/RR elevated - SCTM pale/cyanotic - wet lung sounds |
| Severe altitude sickness Rx | 1. descend 2. admin O2 3. use portable hyperbaric chamber 4. consider elevating head in patients unresponsive with HACE |
| Snake Bite Rx | 1. scene safety: don't create another patient by trying to capture snake 2. calm self and patient 3. immobilize the limb 4. transport to definitive care 5. document the size/location/time envenomation |
| S/s widow spider bite | -red, itchy, initially painless -pain and anxiety 10-60min after bite -muscular cramping - burning and numbness in feet - headache , nausea, vomiting, dizzy, sweaty |
| Widow spider Rx | 1. clean and ice the bite 2. consider main meds 3. EVAC |
| Brown recluse S/s | - red blisters appear 1-5 hrs after initially painless bite - blisters begin to develop in to a non healing wound -chills, fever, rash, weakness |
| Brown recluse rx | -clean, monitor, evac if symptoms become systemic ro will not heal |
| Scorpion S/S | -immediate pain, increased by tapping -swelling and redness - numbness and tingling -nausea, vomit, incontinence -slurred speech, difficulty swallowing, blurred vision, seizures -respiratory or cardiovascular involve |
| Scorpion Rx | 1. clean wound 2. ice 3. evac if patient has s/s of envenomation |
| Drowning Rx | 1. provide life support with supplemental o2 2. remove water and vomit from airway as needed 3. consider protecting the spine 4. treat for hypothermia 5. monitor |
| Angina | -Ischemic chest pain usually brought on by physical or emotional stress and may be relieved by rest or medication -Warning sign of myocardial infarction |
| Myocardial Infarction | damage or death of heart muscle tissue due to prolonged hypoxia |
| S/S myocardial infarction | -Persistant chest pain: crushing, tight, pressing, vise like, constricting - Pain radiating to arms/jaw -short of breath -anxiety/denial -nausea/vomiting -lightheaded/dizzy -pale, cool, sweaty -Rapid, slow, weak, irregular heart rate |
| Myocardial Infarction Rx | 1. Reduce anxiety/activity 2. Place in position of comfort 3. admin O2 4. support patient with personal meds (Nitroglycerin at .4mg under tongue, Aspirin at usual dose every 24hrs) 5. EVAC |
| Ischemia | reduced blood flow |
| Infarction | Tissue death (can be caused by ischemia) |
| Pneumonia | Inflammation and accumulation of fluid within alveolar spaces |
| S/S Pneumonia | -history of upper respiratory infection - Fever, sweating, chills - productive colorful cough - Pain on inspiration/coughing -Short of breath -Wet lung sound -Malaise/fatigue |
| Pneumonia Rx | 1. Encourage patient to cough and breathe deep 2. Consider fever reducing meds 3. Admin O2 4. Evac |
| Transient Ischemic Attack (TIA) | temporary stroke, s/s identical to s/s of cerebrovascular accident or stroke. Last less than 24hrs |
| Cerebrovascular Accident (CVA) or stroke | result of interruption of blood supply to a portion of the brain by blood clot or ruptured blood vessel. S/S vary with part of brain affected |
| S/S CVA/Stroke | -Altered mental status -headache -Inability to speak -one side weak -facial paralysis -incontinence -vision changes BE FAST (balance, eyes, face drop, arm drift, speech, time) ER NOW |
| CVA/Stroke Rx | 1. Preform a focused stroke assessment (face droop, arm weak, speech difficult) 2. Provide emotional reassurance 3. Place in position of comfort 4. Admin O2 5. Document time of onset 6. Repidly evac |
| Seizure | sudden episode of uncontrolled electrical activity in brain |
| Causes of seizure | -overstimulation of brain -eclampsia (complicaion of pregnancy) -high fever/heat stroke -brain injury -HACE -Alc or drug withdrawal or overdose -Diabetic hypoglycemia |
| S/S seizure | -aura -unexpected and unexplained collapse -localized or full body convulsion or temporary disconnection with present -Post seizure recovery phase (takes time to return to A+Ox4) |
| Seizure Rx | 1. Protect from harm, do not restrain 2. Do not place anything in mouth 3. Place on size during post seizure recovery phase 4. Perform complete patient assessment 5. Protect dignity -EVAC if diff from normal/unkown orgin |
| Things that cause the brain TO STOP | -TOxins -Sugar/seizure/shock -temp -oxygen -pressure |
| Altered mental status Rx | 1. Protect spine 2. Manage airway 3. Look for clues 4. Sugar? 5. Consider narcan 6. Monitor LOR for changes |
| Syncope | brief loss of postural tone followed by a spontaneous and complete recovery (fainting). Often caused by decreased blood flor to brain. May be do to severe pain, strong emo, urination, dedication, vomit, dehydration, carotid sinus stimulation. |
| S/S Syncope | -Prodromal symptoms: dizzy, vision change, warmth, light head -Faint or collapse which may include seizure like activity - Pallor, diaphoresis |
| Syncope Rx | 1. lay flat, elevate legs, make comfy 2. Complete PAS, Assess for residual s/s |
| Hyperglycemia | -Too much sugar not enough insulin -Patient become dehydrated -Appears gradually |
| Rx Hyperglycemia | 1. Check blood sugar 2. Give sugar 3. hydrate 4. EVAC |
| Hyperglycemia S/S | -LOR altered -HR weak rapid -RR up -SCTM: warm, pink. dry -Increased hunger, up thirst, up urination, tired -breath odor: sweet/acetone -Persistent high blood sugar levels |
| Hypoglycemia | -too much insulin/not enough sugar -quick/req immediate treatment |
| S/s Hypoglycemia | -LOR: weak, disoriented, irritable, progressing to unresponsive/seizure -HR: Rapid -RR: normal/shallow -SCTM: pale, cool, clammy -BP: no change or slightly elevated -Breath odor: no change -Blood sugar less than 80mg/dl |
| Hypoglycemia Rx | 1. Check blood sugar 2. give sugar 3. give a more hearty snack once recovered 4. Rapid evac |
| S/S Ectopic pregnancy | -s/s pregnancy -abdominal pain -vaginal spotting/bleeding -fainting -Shock EVAC Immediately |
| S/S vagnitis | -vaginal itching -redness -up discharge |
| Vaginitis Rx | -wash area thoroughly -air dry -consider antifungals -evac if does not respond |
| S/S UTI | -increased frequency, burning, pain on urination -fatigue -blood in urine -fever |
| UTI Rx | -hydrate -considder urinary tract analgesic -consider antibiotics -rest -evac if not respond to rx or develops tenderness in kidney reigon |
| Ingested Poison rx | -Call 1-800-222-1222 for advice -Induce vomiting if poison is non corrosive and non petroleum based and patient full responsive and less than 30 min from ingestion -consider evac |
| Inhaled poison rx | -remove from exposure -admin O2 -Evac carbon monoxide poisoning patientes who have altered LOR |
| Absorbed Poison rx | -watch out for own safety -remove contaminated clothing -flush area with water/soap repeat |
| Injected poison rx | -beware of and treat anaphalytic reactions -watch for changes in LOR, manage airway |
| Questions to ask if someone is having suicidal thoughts | 1. Are you thinking of harming or killing yourself 2. have you planned how you would do this 3. Do you have the means with you now to carry out this plan 4. when are you thinking of doing this 5. do you have a history of any past suicide attempts |
| Mental health patient Treatment principles | -Complete PAS -Decide: can you manage this patient? Is there danger to self, patient, others |
| Evac Guidelines mental health concerns | -Harm to expedition outweighs benefit to patient -condition beyond responders ability -patient danger to self/others -unsafe or unable to continue |
| Toothache Rx | 1. brush teeth nd flush mouth with water 2. cover/fill holes with cavit, wax, sugarless gum 3. consider pain mgmt 4. evac if pain persistent or debilitating |
| Broken tooth rx | 1. assess inside of mouth with light ,bite, if teeth don't come together may be jaw fracture 2. look for broken dental fragments 3. seal expoed nerves 4. if biting causes pain consider rolled up gauze on back molars 5. pain meds 6. evac? |
| tooth knocked out or loose rx | 1. irrigate 2. attempt to replace in socket 3. if can't be replaced should be kept in Hanks balanced slat solution, milk , or saliva 4. pain meds 5. evac for dental care |
| Periodontal abscess s/s | -pain, swell -redness or darkening of skin -pocket of pus -fever |
| Periodontal abscess rx | -clean and floss teeth to remove trapped food -gargle with warm water 3-4x daily -consider pain meds -consider antibiotics -consider evac |
| Acetaminophen | air caused by headache, cold, flue, discomfort, minor muscle and joint discomfort, cramps. Reduction of fever. Does not control inflammation. Do not use if hypersensitivity, alcoholic, liver disease, hepatitis |
| Aspirin | Relief of pain due to headache, cold/flu, muscle and joint discomfort, menstrual cramp. Reduction of fever. Use with cardiac chest pain. Do not give if bleeding disorder. |
| Ibuprofin | Relief of pain with headache, colds, flu, frostbite, epididymitis, toothache, arthritis, burn, cramps. Reduce fever. Reduces inflammation. Do not give is ulcer, bleeding disorder, hypersensitivity to asprin |
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bouzianeju