The nature of the force that produced physical injury

Anticipate need for additional resources (ambulances, air medical, manpower, supplies, extrication, etc...)

1. Ensure scene safety

2.protect the Patients

3. Protect bystanders

May require ICS or IMS

Environmental conditions:

Weather or exteme temps

Toxins and gases

Secondary collapses and falls

Unstable conditions

Motor vehicle collsions, Pt extrications- the environment, glass, air bags, sharp edges.

Roadways, traffic, position ambulance in a safe spot to shield the scene. Wear reflective vest ANSI Class II

Possibly include moving the Pt

Specialized resources- Fire

Rescue or extrication- Fire

Utilities- gas, power

Traffic control- law enforcement

ICS

Incident Command System

IMS

Incident Management System

A planned, deliberate, professinal act that involves the use of communication techniques to achieve two purposes:

1. A positive relationship with the pt and 2. A shared understanding of information between the pateint and medic. These two factors aid in the attainment of the desired pt care goals.

• Source; avoid confusion, use examples, repeat importan parts, no jargon, speak at appropriate pace, express simply

• Encoding; Use fromat that both sender and receiver understand. written/verbal, comes from the sender
• Message; information that is sent, sould be clear and organized
• Receiver; essentiall the DECODER, intended to Understand message
• Feedback; receiver's response to the sender's message
  

It is a planned act. It is also a professional act. The paramedic, working with the patient, obtains information that is used to meet patient care goals.

It can have several important effects. It can improve the paramedics's interaction with the pt, ensure better pt care, defuse potentially violent situations or prevent them from escalating and reduce the risk of lawsuits

Elements:

Message

Expressed by sender, sould be clear and organized. Done so in a manner familiar to the person receiving it. Includes both verbal and non verbal.

The more formats the more likely the receiver is to understand it.

-Fewer words -idea simply expressed -no vague phrases -us examples -repeat important parts -no jargon -speak at appropriate speed -no long pauses/or changing sub.

Voice inflection

facial expression

and body position

May reflect anger, fear or impatience. Can convey the insecurities of both the pt and paramedic.

Privacy,

interruptions,

eye contact

and personal dress

Echoing, pts' words allows them to clarify or expand on the info provided

interview technique

1. Put pt at ease by letting them know you are on their side; that is you respect their comments

2. Be alert and respond to visual clues that they need help

3. show compassion

4. Assess the pt's level of understanding and insight

5. Show expertise

Sensitive Issues

Alcohol

sexual subjects

suicide risk

Make sure privacy is maintained

confident, direct and firm w/Q's

Don't appologize for asking

Don't be judgemental

Use words that are understandable

have patience and proceed slowly

Observation; note pt's appearance, LOC, body movement, physical characteristics, dress, grooming

Conversation; reaveal if they know who they are, where they are, and day (oriented X3)

Exploration; way to assess the pt's emotions. mood; anxious, excited or depressed. Gage appropriateness of behaviors and ideas.

1. condition creates inability to talk

2. may fear talking, do to psycho, cultural, age

3. cognitive impairment

4. pt wants to deceive the medic

Prehospital setting, Pt's problem

1. Identify life threat conditions

potential and current

2. expanded to allow opportunities for pt education. As well as service referral to help with health care needs.

Urgent: is unstable

Emergent: is potentially unstable

non-emergent: is stable

Silence

Overly Talkative pts

Pt's w/multiple symptoms

Anxious pt's

False Reasurance

Anger and Hostility

Intoxication

Crying

Depression

Sexually attractive or Seductive Pts

Confusing Behavior or Histories

Developmental Disabilities

Communication Barriers

Pt appears stable?

Appears stable, but potentially unstable

Appears unstable

Based on pt and environment, involves vissual assesment as you approach.

1. Warm exchange, "hi my name is"

2. Pain stimuli, pt shoulder ->sternal rub

AVPU

Airway: make sure it is patent with good air exchange, if unresponsive it should be secured

vs

Breathing:

Responsive;1. Adequate rate and quality 2. too fast >24

3. To slow <8

Unresponsive; adequate, inadequate or absent

Cyanosis

distress w/dyspnes or hypoxia

asymmetrical chest wall movement

chest injury

tracheal deviation

distented neck veins

Pulse

Rate, and regularity

Rate: 60-100 bpm normal, +tachy or -brady

Absent rate or an irregular heart rate= hypoperfusion

Inspection

Palpation

Percussion

Ausculatation

Deformities & Discolorations

Contusions

Abrasions

Penetrations & Punctures

Burns

Tenderness

Lacerations

Swelling & Symmetry

Larger to smaller on inhalation, Smaller to larger on exhalation= louder exhalation sounds

Vesicular, Bronchovesicular, and Bronchial

Low pitched and soft, long inspiratory phase and a shorter expiratory phase

Heard over major bronchi, upper right posterior lung field.

Considered Medium pitch, heard throughout respiration.

Stridor

Cardiovasular insufficiency: breathing

pain: wincing, sweating, guarding

anxiety; restlessness, fidgety, cold moist palms

Vitals

Newborn

Pulse 120-160

Respirations 40-60

BP 80/40

Vitals

1yr

Pulse 80-140

Resp 30-40

82/44

3yrs

vitals

Pulse 80-120

resp 25-30

86/50

70-115 pulse

20-25 resp

90/52

Pulse 70-115

resp 20-25

94/54

70-115 pulse

15-20 resp

100/60

70-90 pulse

15-20 Resp

110/64

pulse 60-100

Resp 12-24

120/80

Two imaginary lines = four quadrants

Signs of cyanosis, pallor, jaundice, bruising, discoloratoin, swelling, masses and ortic pulations. Should be even round and symetrical. Asymetirical could be a hernia.

Lordosis (spine curve)

Mental status and speech

cranieal nerves

motor system

sensory system

Reflexes

1 Remain Calm

2. don't seperate child from parent

3. establish rapport with parents and child

4. Be honest

5. Have one medic work with child

6. observe the pt before exam

Not frightened by strangers, may have lusty cry, abdominal breathers

Fontanelles is particularly important. Sunken fontanelle is may indicate dehydratoin, bulge may indicate intercranial pressure.

Secondary, consist of physical examination techniques measurement of vital signs, body systems

Primary, icludes the paramedics general impression of pt, the assessment for life threats and id of prority pts requiring immediate care and transport

Read the Pt

Read the scene

React Reevaluate

Revise management plan

Review perfomance

Right dose

Right time

Right drug

Right Pt

Right route

c to f (C9/5)+32

f to c (F-32)(5/9)

SubCu 5/8'' 23 or 25gage

IM 1-2" 19 or 21 gage

Pediatric considerations 8

for IV

1. Positive relationship

2. Be honest

3. Allow child to help administer

4. When administering oral old the child

5. use mild physical restraint

6. enlist assistance of parents

7. stabilize enjection site

8. smaller child smaller margine of error