Paramedic Principles
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| Definition of: Quality of life | The level of quality towards someone's life
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| What is 'burnout syndrome'? | Risk that develops from emergency work. Related to exhaustion, detachment and lack of accomplishment
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| What is 'Compassion Fatigue'? | Traumatic stress that develops from helping people. Results in depression, and anxiety
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| What is 'Compassion Satisfaction'? | The satisfaction that someone receives from helping people who are suffering
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| What is 'Clinical Reasoning'? | The cyclical process that paramedic use when assessing and treating a patient.
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| What is Deductive Reasoning? | Starting with a theory and using experience to prove/disapprove it
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| What is Inductive Reasoning? | Using observations and experience to make generalisations and infer an explanation
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| Definition of Heuristic | Enabling someone to learn for themselves
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| Definition of Epistemology | The theory of knowledge, it allows for distinguishing justified belief from opinion
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| Definition of Ethics | Morals that direct our judgement and our treatment of a patient
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| Definition of Laws | Policies made by the government and other officials that lead to negative consequences if the laws are not followed correctly.
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| 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.
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| 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
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| What is Autonomy | The legal right that a patient has to choose what happens to their body
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| What is Beneficence | Decisions are made in the best interest of the patient
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| What is Non-Maleficence | Do the person no harm
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| 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.
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| 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
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| Definition of Capacity | patients ability to understand the nature and effect of their decision
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| What is a Paramedics Code of Conduct? | - integrity
- respect
-responsibility
- competence
- consent of patient care
- confidentiality
- research
- ethical review
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| When can someone refuse treatment? | If they have competency and capacity
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| How can infection be transmitted? | - airborne
- contaminated food or objects
- skin to skin contact
- contact of bodily fluids.
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| What is the chain of infection? | - infectious agent
- reservoirs
- portal of exit
- means of transmission
- portal of entry
- susceptible host
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| What is Justice? | Everybody receives equal care regardless of their gender, social status, etc.
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| What are some of the factors can influence a persons competency and capacity? | - intoxication
- disabilities
- head trauma
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| What are the steps of risk management? | - recognise risky situations
- analyse the risk
- identify the controls
- report the hazards
- monitor the impact
- employ accountability
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| What is PPE? | Personal Protective Equipment
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| What are some examples of PPE? | - gloves
- face mask
- goggles
- uniform
- high visibility vest
- safety boots
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| 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
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| What is the purpose of the primary Survey? | A systematic approach to exclude or manage immediate life threatening situations
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| What does a primary survey include? | Danger, Response, Airway, Breathing, Circulation, Disability, Expose, Extricate, Expedite
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| What is Stay and Play | When definitive treatment can be provided by us paramedics our focus is on providing the required treatment immediately
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| 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
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| Definition of Life Threatening? | immediate threat to their life
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| what is systolic pressure? | The pressure exerted against the wall of an artery following the CONTRACTION of a ventricle
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| Definition of Limb Threatening? | The patient is at risk of losing their limb/s. Does the limb have;
- movement
- feeling
- blood flow
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| What are some common life threatening & time critical situations? | - snake bite
- drug overdose
- excessive bleeding
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| What does AVPU stand for? | Alert
Verbal
Pain
Unresponsive
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| How can you determine a persons level of consciousness? | AVPU and GCS
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| 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
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| What are the sections of a GCS? | - eyes
- verbal
- motor response
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| What are sections within the 'Eyes' section of a GCS ? | 1. Nil
2. Pain
3. Voice
4. Alert
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| What are sections within the 'Verbal' section of a GCS ? | 1. Nil
2. Incomprehensible Words
3. Single Words
4. Confused
5. Oriented
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| What are sections within the 'Motor' section of a GCS ? | 1. Nil
2. Decerebrate
3. Decorticate
4. Withdrawals
5. Localises
6. Obeys commands
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| When is a person oriented? | When they are situated to time, place, person, situation
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| 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.
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| 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
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| What structures are in the upper airway? | - nose and mouth
- Pharynx
- Epiglottis
- Larynx
- Cricoid Cartilage
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| What structures are in the lower airway? | - Trachea
- Major Bronchi
- Bronchioles
- Alveoli
- Diaphragm
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| What is tidal Volume? | the volume of air moved by inspiration and expiration
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| What is Minute volume? | Volume of air moved within a minute
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| What is the most common obstruction of the airway? | Tongue
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| How do we assess the airway? | Look for any obstructions
Listen for sounds
Feel for airway movement
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| What does a snoring sound indicate? | Upper airway is partially obstructed from relaxation of the tongue
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| What does a stridor sound indicate? | Upper airway obstruction from swelling or foreign body
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| What is an OPA and how do we measure it? | Orophyrangeal Airway - measured from corner of mouth to earlobe
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| What is an NPA and how do we measure it? | Nasopharyngeal Airway - measured from tip of the nose to the tragus
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| When do we use and NPA? | when a person has;
- trismus
- facial damage
- gag relex
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| When do we use an OPA? | when a person is unconscious, has a stridor, and does not have a gag relax
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| What are some manual airway manoeuvres | - head tilt
- jaw thrust
- chin lift
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| When is suction used? | When fluids must be removed to allow for airway to become patent.
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| 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
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| What must we consider when assessing breathing? | Is the rate and depth adequate to sustain life
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| What are some abnormal airway sounds and what do they indicate? | Crackles - air moving through fluids
Wheezes - narrowed airway
Snoring - partially obstructed upper airway
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| What conditions require high flow of 02? | - shock
- trauma
- drowning
- Sepsis
- cardiac Arrest
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| What conditions require moderate levels of 02? | - asthma
- pneumonia
- lung cancer
- acute heart failure
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| What conditions require low flow of 02? | - COPD
- Obesity
- Neuromuscular Disease
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| When does 02 become harmful? | When they don't need it as it causes vasoconstriction
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| How do we assess Circulation? | - pulse (rate, strength)
- capillary refill (should be under 2 seconds)
- perfusion
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| What is aspiration? | A condition in which food, liquids, saliva or vomit is breathed into the airways.
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| What is dyspnoea? | the feeling of having difficulty breathing
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| What are the four types of hypoxaemia and tissue hypoxia? | - Hypoxic hypoxia
- Anaemic hypoxia
- Stagnant hypoxia
- hystotoxia hypoxia
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| What is Hypoxic hypoxia ? | caused by either diminished oxygen content in the atmosphere or decreased gaseous exchange in the lungs due to respiratory disease.
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| What is Anaemic hypoxia ? | reduced oxygen carrying capacity of the blood due to blood loss or reduction in haemaglobin content of the blood.
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| What is Stagnant hypoxia ? | The circulation of blood is reduced due to cardiac failure or local circulatory failure
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| What is hystotoxia hypoxia ? | The cells ability to utilise the oxygen is diminished due to chemical or metabolic processes
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| 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.
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| When should a BVM be used? | in all non-breathing and hypoventilating patients.
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| When should a nasal cannula be used? | in patients with moderate hypoxemia and who are able to breathe through their nose
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| When should a Nebulisation mask be used? | to administer aerosolized medications and saline to patients requiring bronchodilators or humidification of thick secretions.
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| 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
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| What defines adequate perfusion? | normal blood flow around the body
when their skin is pink, and rosy.
cap refill is less than 3 seconds
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| 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)
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| What are some conditions that we look for when assessing disability in the primary survey | Stroke
Hypoglycaemia
Defibrillation required
Life threatening injuries
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| 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
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| What is the purpose of a patient interview | to identify and correct any life threatening conditions
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| 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.
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| 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
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| What are some good ways to build rapport? | - introduce yourself, ask and remember their name, show empathy
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| What is a provisional diagnosis | an educated guess about the most likely diagnosis.
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| What is a differential diagnosis ? | more than one possibility for your diagnosis.
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| 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
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| what is the purpose of a vital signs assessment | measurements we use to assess the functioning of the patient’s essential body functions
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| What vital signs do we measure | BP, Pulse, BGL, Sp02, Respirations, Level of consciousness, Skin condition, temperature
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| What are the low, normal and high rates for heart rate measurements? | Low = <40
Normal = 60 - 100
High = > 100
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| What are the low, normal and high rates for respiratory measurements? | Low = < 8
Normal = 12 - 20
High = > 22
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| What are the low, normal and high rates for BP measurements? | Low = <90 systolic
Normal = 100 - 140 systolic
High = > 160 systolic
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| What are the low, normal and high rates for temperature measurements? | Low = < 35.1
Normal = 36 - 38
High = > 38
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| What are the low, normal and high rates for Sp02 measurements? | Low = < 94%
Normal = 96% - 100%
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| 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
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| What does inspection include? | exposing and looking at the area we are interested in
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| What does palpation include? | feeling an area for abnormality (deformity, swelling, tenderness)
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| What does auscultation include? | using a stethoscope to listen to an area for abnormal sounds (used on the chest and abdomen)
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| What does percussion include? | tapping areas to elicit sounds (hollow or dull) to identify the presence of air or fluids.
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| 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.
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| 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;
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| How do we assess the abdomen ? | Rigidity, tenderness, distension, pulsatile masses.
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| How do we assess the limbs of a patient ? | Swelling, pulse quality, temperature to touch, grip or push strength, peripheral sensory assessment and reflexes.
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| How do we assess the back of a patient ? | looking for injuries, deformity or bruising (in trauma), while taking spinal precautions
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| What is bradycardia ? | a slow heart rate
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| What is tachycardia | a fast heart rate
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| what is tachypnoea | a fast respiration rate
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| what is bradypnoea | a slow respiration rate
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| what is diastolic pressure | the pressure exerted against the wall of an artery during the RELAXATION phase of the left ventricle
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| What is hypotension? | A low blood pressure
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| What is hypertension? | A high blood pressure
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| 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
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| What is PEARL? | pupils equal and reactive to light
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| What must we assess when checking a pulse? | rate, rhythm, depth, volume
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| What is shallow and slow breathing called? | hypo-ventilating
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| What is deep and fast breathing ? | hyperventilating
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| 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
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| what are the body focused systems that we assess? | respiratory ,
circulatory ,
endocrine ,
neurological,
Musculoskeletal,
Gastrointestinal ,
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| What is included in a respiratory assessment? | appearance ,
position ,
speech ,
breath sounds ,
respiratory rate/rhythm/depth ,
chest wall excursion ,
heart rate ,
skin ,
conscious state
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| what is included in a circulatory assessment ? | heart rate/rhythm/depth ,
ECG 100,
BP ,
skin ,
conscious state
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| what is included in a neurological assessment ? | mental status ,
pupil reaction ,
motor function ,
sensory exam ,
BGL
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| what is included in a abdominal assessment ? | inspect 4 sections ,
auscultate for bowel sounds ,
observe for distension ,
palpate for pain and tension ,
guarding
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| what is included in a Musculoskeletal assessment? | motor and sensory function,
distal pulses ,
comparison of limbs ,
swelling
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| what is included in an endocrine assessment ? | BGL,
Blood tests primarily
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| What does BLS stand for? | basic life support
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| 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
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| when does it become likely that a patient will sustain permanent brain injury | after six minutes of untreated cardiac arrest
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| when do we not treat cardiac arrest | if the person has a DNR or has undeniable signs of death
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| why do we perform CPR ? | to keep blood circulating to the brain, heart and lungs and to hopefully restore heart function
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| what does the chain of survival include? | 1. early recognition and call for help
2. Early CPR
3. Early defibrillation
4. post resuscitation care
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| when do we start compressions ? | when the person;
- has abnormal breathing
- unconscious
- no signs of obvious death
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| when is death undeniable ? | - decapitation
- dependant lividity
- rigor mortis
- incineration
- decomposition
-
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| what factors influence the quality of CPR | full recoil of chest and
50/50 duty cycle
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| human factors that influence CPR | situational awareness.
decision making,
teamwork,
task management ,
fatigue,
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| Common causes of cardiac arrest | in adults - primary cardiac arrest (heart attack) and secondary to respiratory arrest (drowning)
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| Prevention of OOH cardiac arrest | - education
- monitoring
patient assessment
- measuring of vital signs
- using ECG
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| 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
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| what is systole? | is the compression and is for the brain, and is when the ventricles contract
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| what is diastole? | is the release of the chest and allows the heart to fill with blood
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| what are complications of incomplete release of the chest? | reduces venous return and cardiac output
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| what is ROSC? | return of spontaneous circulation.
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| what must you do if ROSC occurs | reassess the patient's pulse and respirations
provide ventilation
transport to appropriate facility ASAP
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| what is defibrillation? | a high energy shock that is delivered to a patient in cardiac arrest to restart the heart.
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| What are some deteriorating factors that could possibly lead to cardiac arrest? | - chest pain,
- dysrhythmias,
severe breathing problems or choking,
severe trauma
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| 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.
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| 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
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| Before we undertake any treatment action what must we consider? | The risk:benefit ration
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| What is included in the clinical reasoning triad? | Knowledge,
Cognition,
Metacognition
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| what is knowledge ? | raw information that we learn through self learning and experience
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| what is cognition | our ability to receive, memorise, store and retrieve information on a conscious level
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| what is metacognition? | the ability to monitor one's thinking
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| what is reflect IN action? | reflecting on the situation as it occurs
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| what is reflect ON action ? | reflecting on a situation after it has happened
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| 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
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| What is trauma | any injury caused by external forces
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| what are the common categories of energy transfer | blunt,
penetrating,
thermal / chemical
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| 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
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| Trends of trauma | majority happens within cities,
highest incidence within males aged between 25 and 44,
falls are the biggest cause of injury
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| what is the definition of kinematics | the study of motion of objects
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| what is mechanism of injury | the way or patterns of injury that occur
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| How can injuries occur? | 1. mechanical forces
2. heat
3. chemicals
4. electricity
5. lack of oxygen
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| how do we calculate energy | energy = mass x velocity squared / 2
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| what are ballistics | the study of projectiles (bullets, explosives etc.)
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| what is the Trauma primary survey | D R C A B C D E
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| how do we control haemorrhaging ? | through direct or indirect compression and the use of a tourniquet
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| How do we perform a secondary survey in trauma ? | 1. patient history
2. level of consciousness
3. head to toe survey
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| Definition of ACTUAL time critical ? | At the time the patient assessment is undertaken, the patient is in actual physiological distress.
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| 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
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| 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.
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| What is pain? | an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
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| what is somatic pain ? | (localised and sharp) e.g. injury to muscles, bones or skin
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| what is visceral pain ? | Deeper in the body from organs, poorly localised, diffuse or radiating). E.g. cardiac type chest pain, abdominal pain, headache
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| 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.
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| 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.
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| 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.
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| How can we determine pain ? | O - onset
P - provokes
Q - quality
R - radiation
S - site of pain
T - time
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| What are some ways of measuring pain ? | 1 - 10 scale,
faces,
none - agonising pain
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| what should be considered when giving pain relief ? | timeliness, effectiveness, potential side effects
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| what are some examples of non-pharmaceutical pain relief | splinting,
reassurance,
dressings,
hot and cold packs
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| how can medications be delivered | enteral,
parenteral
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| what are the enteral routes of delivering medications | oral,
sublingual,
nebuliser,
inhaler,
endotracheal,
transdermal patches
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| what are the parenteral routes of delivering medications | intravenous,
intramuscular,
subcutaneous,
intraossesous
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| what are some types of analgesic drugs ? | Inhalation analgesics (Methoxyflurane - Penthrox),
Oral analgesics: eg. Paracetamol,
Parenteral analgesics
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| 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
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| how do we calculate the energy of colliding forces | add the speeds together
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| how does the MOI help us? | forms a pattern of likely injury, helps us plan our assessment and potential interventions
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| what is Compression trauma ? | when organs and structures are compressed
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| what is shearing trauma | traumatic brain injury. May leave the brain cells spinning and tear apart
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| what is penetrating trauma ? | caused by knives and guns. We must consider the body, organ structure, depth of penetration
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| Low velocity of penetrating trauma | caused by stab wounds. The injury is localised and in a straight line
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| Medium and high velocity of penetrating trauma | caused by a gun shot.
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| what are common causes of blunt trauma ? | MVC
Falls
assaults
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| what are the types of haemorrhages ? | arterial,
venous,
capillary
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| 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.
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| what are some of the signs of internal haemorrhaging ? | look for swelling, redness, bruising
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| what are some of the sources of internal bleeding ? | vasular damage,
organ rupture,
fractures
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| what should we look for when conducting a secondary survey? | S - swelling
T - tenderness
D - deformity
C - contusions
A - abrasions
L - lacerations
L - leaks
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| 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
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| What are some barriers to communication? | physical - hearing loss, noise, and distance
pyscho-social - attitudes, feelings, bias
technique related
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| what are some ways we communicate ? | verbal - speaking etc.
non verbal - body language and gestures etc.
symbolic communication
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| what are some ways to practice effective communication ? | active listening
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| What is active listening ? | not just hearing but understanding what the other person is trying to communicate
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| 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)
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| 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
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| what is the other requirement for a hospital handover? | a hospital pre-notification
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| 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
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| when is a situation report necessary ? | when situation is complex and more resources are required or specialist help to manage hazards:
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| What makes up evidence based practice? | 1. Clinical expertise 2. patient values 3. best research evidence
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| What are some causes of VF? | 1. lack of blood flow 2. sepsis 3. cardiomyopathy
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| What are some signs of Cardiac Arrest? | 1. Loss of responsiveness 2. No normal breathing 3. chest pain
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| What is sepsis ? | An infection within the blood
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| What are some examples of COPD? | 1. emphysema 2. bronchitis 3. chronic asthma
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|
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| What is Arterial Fibrillation ? | an irregular and rapid heart beat that can lead to heart failure
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| What are some causes of AF? | 1. High blood pressure 2. Coronary Heart disease 3. Valvular Heart Disease
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| What is Anuria ? | Kidneys failing to produce urine
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|
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| What is distal circulation? | Blood that flows furthest away from the body
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|
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| What is haematemesis? | Vomiting of blood
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|
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| 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
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|
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