Paramedic National Registry Review and Answers Already Passed

Paramedic National Registry Review and Answers Already Passed Assessment Sequence BSI Scene Size Up Scene Safety MOI/NOI Number of Pt. Additional Resources Consider C-Spine Primary Survey General Impression AVPU Chief Complaint/Life Threats Airway, Breathing, Circulation Treatment/Transport Medical Assessment History of Present Illness Past Medical History Secondary Assessment Vitals Field Impression Interventions Reassessment Verbal Report Trauma Assessment SAMPLE Secondary Assessment Assess baseline vitals Manage secondary injuries Reassess Stridor, Snoring, Gurgling Stridor - harsh, high-pitched sound, swelling, foreign body in upper airway. Snoring - tongue Gurgling - fluids in upper airway, suction CDC Trauma Guidelines for Transport IF YES TO STEP ONE OR TWO TRANSPORT TO A LEVEL 1 TRAUMA CENTER Step 1: Physiological Criteria GCS below 14 Systolic below 90 Respirations <10 or >29 (<20 under 1yr) Ventilation assistance needed Step 2: Anatomic Criteria Penetrating wounds head, neck, torso, high extremities Chest wall instability Amputation proximal to wrist/ankle Longbone fx x2 Crushed/devolved/mangled/pulseless extremity Pelvic fx Open/depressed skull fx Paralysis IF YES TO STEP THREE OR FOUR TRANSPORT TO TRAUMA CENTER, NOT NECESSARILY LEVEL ONE Step3: MOI Criteria Adult falls >20' / Children >10' or 2x height Vehicle intrusion >12" occupant side or 18" anywhere Partial or complete ejection Death in same passenger compartment Vehicle data consistent with high injury risk Auto vs. Bed thrown, run over or >20mph Motorcycle crash >20mph Step 4: Special Considerations Elderly falls <55yrs Systolic <100 in >65yrs Pediatric Trauma Bleeding and anticoagulants Burns Pregnancy >20 weeks EMS Judgement IF BURNS WITH NO FURTHER TRAUMA USE A BURN CENTER GCS Eyes - 4 spont, 3 speech, 2 pain, 1 absent Verbal - 5 orient, 4 not orient, 3 inapp, 2 incomp, 1 absent Motor - 6 obeys, 5 pain loc, 4 pain withdraw, 3 flexion (decorticate), 2 extension (decerebrate), 1 absent Decorticate Elbows, wrists, fingers flexed Legs extended and internally rotated Decerebrate Worse condition consistent with brain stem injury Extended and internally rotated elbows and legs, trismus, legs stiff and feet extended Babinski's Response Signifies CNS Problems Big toe moves upward and other toes fan out when stroking bottom of foot Pupils Symptoms Dilated (mydriasis) - cardiac arrest, shock, cerebral hypoxia, cocaine, epinephrine, amphetamines Constricted (miosis) - narcotics, CNS disorders, glaucoma meds, bright light Unequal - brain injury, bring tumor, stroke, artificial eye, some eye medications, eye injury or disease Anisocoria - normal unequal pupils Nystagmus - rapid involuntary movements of the eye(s) JVD Best seen at 45 deg angle May be caused by: diaphragmatic rupture, tension pneumothorax, cardiac tamponade, right heart failure, traumatic asphyxia, chronic bronchitis Flat Neck Veins Best seen supine May be caused by hemothorax, dehydration, shock Apneustic Breathing CNS Injury or Shock Long, deep breaths that are stopped during inspiration then a period of apnea Biot's