FRONTLINE FIRST AID & EMERGENCY TRAINING 250 · PDF fileFRONTLINE FIRST AID & EMERGENCY...

EMR CHEAT SHEET

FRONTLINE FIRST AID & EMERGENCY TRAINING

250-470-0205

[email protected]

www.frontlinefirstaid.ca

mailto:[email protected]

http://www.frontlinefirstaid.ca/

http://www.frontlinefirstaid.ca/

Frontline First Aid EMR Cheat Sheet

Page 1 of 12 2018-03-29 www.frontlinefirstaid.ca | 250-470-0205 | [email protected]

Table of Contents Assessment Model ................................................................................................................................................................. 2

Glasgow Coma Scale ............................................................................................................................................................... 3

APGAR ..................................................................................................................................................................................... 3

CPR Compression: Ventilation Ratios .................................................................................................................................... 3

CPR with Airway Obstruction................................................................................................................................................. 3

CPR in transport - Treatable CPR ........................................................................................................................................... 4

Dynamic CPR / CPR on the Move ........................................................................................................................................... 4

Oxygen Cylinder Calculations................................................................................................................................................. 4

Oxygen Flow Rates ................................................................................................................................................................. 4

Common Units of Measurement ........................................................................................................................................... 4

6 “Rights” of Medication ........................................................................................................................................................ 5

ASA & Nitro ............................................................................................................................................................................. 5

KED Strapping Sequence ........................................................................................................................................................ 5

Simple Triage and Rapid Treatment (S.T.A.R.T.) ................................................................................................................... 6

Urgent Transport Critical Interventions Requiring History and/or Vital Signs .................................................................... 6

Critical Findings ...................................................................................................................................................................... 6

IV Drip Set Calculations .......................................................................................................................................................... 7

Common IV Solutions ............................................................................................................................................................. 7

Common IV Complications ..................................................................................................................................................... 7

Assisted Ventilations .............................................................................................................................................................. 7

Rescue Breathing .................................................................................................................................................................... 7

Cushing’s Triad ....................................................................................................................................................................... 7

Lund & Browder Burn Estimation Sheet ................................................................................................................................ 8

Relevant S-A-M-P-L-E and Mechanism of Injury Information .............................................................................................. 9

Head to Toe Assessment Mnemonics .................................................................................................................................... 9

Entonox Mnemonics ............................................................................................................................................................ 10

Entonox Protocol .................................................................................................................................................................. 10

Sager Traction Splint ............................................................................................................................................................ 11

Administration of Glucogel to an Unresponsive Patient .................................................................................................... 11

BCAS Treatment Guidelines compared to ........................................................................................................................... 12

PAC National Occupational Skill Competency Profiles ....................................................................................................... 12

Canadian Red Cross Certification & BC EMALB Licensing ................................................................................................... 12

http://www.frontlinefirstaid.ca/index.html



Assessment Model 1. SCENE SURVEY

H Hazards Is there anything in the area that could cause problems or injuries

E Environment Is the area hot…cold…toxic…unstable…etc

M Mechanism of Injury What happened to cause the injury or condition

P Number of Patients How many people require assistance or transport

A Additional Resources Are more personnel needed? Ambulance, FD, hazmat, poison control, tech rescue, etc

2. PRIMARY SURVEY

D Delicate Spine Is spinal motion restriction needed? Yes or No Critical Interventions Quickly manage life threatening problems as you find them

LOC AVPU Alert…Verbal stimulus…Pain stimulus…Unresponsive

A Airway With “Cheater Carotid Check” and OPA if unresponsive

B Breathing Oxygen or Assisted Ventilations if needed

C Circulation Radial Pulse, Skin and Rapid Body Survey - Blanket

Main Concerns What are the most potentially life-threatening problems?

Initial Transport Decision Urgent or Delayed…Notify Medical Control

3. SECONDARY SURVEY Interview

S Signs and Symptoms What is hurting or causing discomfort

O Onset Did this happen suddenly or gradually

P Provokes Is there anything that makes the pain better or worse

Q Quality Sharp…dull…throbbing…aching…stabbing…burning…crushing…squeezing…tingling…etc…

R Radiating Where is the pain; and does it stay in one spot or move to other areas

S Severity How bad is the pain on a scale of 1-10

T Timing When did the pain start; and does is come and go or stay constant

A Allergies Are you allergic to anything…and have you been recently exposed

M Medications Do you take medication…did you take too much…too little…missed…new ones

P Previous Medical History Medical conditions or past incidents; diabetes…high BP…asthma…COPD…etc

L Last Meal What and when did you last eat or drink…is that normal for you

E Events Leading Up To What were you doing when the pain or discomfort started

Vital Signs

LOC Glasgow Coma Scale

Respirations Rate…Rhythm…Character

Pulse Rate…Rhythm…Character

SpO2 Pulse Oximeter – Blood Oxygen Level

Blood Pressure Palpation…Systolic/P or Auscultation…Systolic/Diastolic

Skin Color…Temp…Moisture - Measure body core temperature if relevant

Cap Bgl? Measure Capillary Blood Glucose Level if relevant

Head to Toe

Pupils Pupils Equal and Reactive to Light – compare size and reactivity of each pupil

Palpation Feel for injuries

Auscultation Listen to the Chest if relevant

Distal Circulation Assess bilateral pulses and check motor and sensory function in extremities

4. ONGOING SURVEY

Record Data Ensure patient care report is complete and accurate…Pass information to higher levels of care

Reassess Vitals every 5 minutes if life-threatening…every 15 minutes if non-life-threatening

Communicate Notify Medical Control of significant decisions or changes

S-B-A-R Transfer S Situation B Background A Assessment R Results / Recommend




Glasgow Coma Scale

Eye Opening

Best Verbal Response

Best Motor Response

6 Obeys commands

5 Oriented 5 Localizes to pain

4 Spontaneously 4 Confused 4 Withdraws to pain

3 To voice 3 Inappropriate words 3 Flex to pain (Decorticate)

2 To pain 2 Incomprehensible sounds 2 Extend to pain (Decerebrate)

1 No response 1 No response 1 No response

Eye + Verbal + Motor = GCS (3-15) GCS less than 13 is life threatening

APGAR 0 1 2

Activity Limp Some extremity flexion Active Movement

Pulse Absent Below 100 bpm 100 bpm or higher

Grimace No response Grimace Cough, sneeze, cry

Appearance Body/Extremities Blue/Pale Body Pink – Extremities Blue Completely pink

Respiration Absent Slow and Irregular Strong, crying

7-10 is “Normal … 4-6 is “Fairly Low” … 0-3 is “Critically Low”

CPR Compression: Ventilation Ratios Adult over 9 Child 1-8 Infant under 1

One Rescuer 30:2 30:2 30:2

Two Rescuer 30:2 15:2 15:2

Infant with pulse less than 60 bpm = Start CPR

Check pulse 30-45 seconds if patient is Hypothermic

CPR with Airway Obstruction CPR with Obstruction

CPR

1 Ventilation does not go in Attempt 2nd Breath

30 Compressions

AED as soon as Possible

Look in Mouth

Finger Sweep if object visible

Attempt Ventilation

Repeat until

• 2 Ventilations go in

• Or Signs of Life

30 Compressions

2 Ventilations

AED as soon as possible

Repeat until

• Signs of Life

Remove OPA

2 Ventilations go in

Re-insert OPA

•




CPR in transport - Treatable CPR 3 Consecutive No-Shocks

Consult Medical Control

Hypothermia

Cardiac Tamponade

Pulmonary Embolism

Tension Pneumothorax

Severe Blood Loss

Overdose

Airway Obstruction

Dynamic CPR / CPR on the Move

• Plan your exit route on the way in

• Have suction ready in case of vomiting during turns or lifts

• Watch for subtle vomiting inside the mouth or mask

• Reassess patient after every move or pause

• Secure patient AND equipment before moving

• Pocket mask may be more reliable than BVM during movement

• Set stretcher at a height that allows for effective compressions

Oxygen Cylinder Calculations Duration of Flow = (gauge pressure -200 psi) x C

Flow Rate (lpm)

C = Cylinder Constant

D-Cylinder: C = 0.16 L/psi (most commonly used on scene)

E-Cylinder: C = 0.28 L/psi M-Cylinder: C = 1.56 L/psi

Oxygen Flow Rates

Device BC EMALB Paramedic Association of Canada

(Canadian Red Cross Emergency Care Manual) O2 %

Simple / Standard Mask 6 – 15 lpm N/A 35-55 %

Non-Rebreather Mask 8 – 15 lpm 10+ lpm 90+ %

Bag Valve Mask 15 lpm 10+ lpm 90+ %

Nasal Canula 2 – 4 lpm 1 – 4 lpm 24-36 %

Resuscitation Mask (Pocket Mask) N/A 6+ lpm 35-55 %

Normal Room Air

20.7 – 21 %

Exhaled Air 16%

Common Units of Measurement Unit Abbreviation Used for measuring…

Milligrams of Mercury mmHg Blood Pressure

Millimoles per Litre mmol/L Blood glucose levels

Milligrams mg Medications such as ASA and Nitro

Drips per millilitre or Drips per minute gtts/ml or gtts/minute Dripset sizes and IV solution drip rates

Litres per minute lpm Oxygen flow rates




6 “Rights” of Medication 1 Person Does this person have a prescription

2 Medication Have they had it before…no Contraindications…is this their Medication

3 Time When was the last dose taken…is it needed now

4 Dose How much should they take

5 Route How should they take/use it

6 Documentation Record the time and effects of each dose

Emergency Medical Responders licensed in British Columbia

Administer… 1. Entonox 2. Oxygen 3. Nitroglycerin 4. Acetylsalicylic Acid (ASA) 5. Glucose

Do not Administer by might commonly Assist with… • Epinephrine

• Ventolin

• Salbutamol

• Atrovent

• Albuterol

KED Strapping Sequence My Middle strap first Yellow

Baby Bottom strap second Red

Looks Leg straps third Black

Hot Head straps fourth White

Tonight Top strap last Green

ASA & Nitro

ASA

NITRO Indications

(all must be “Yes” to administer)

Signs & Symptoms of a possible Heart Attack

Safely taken ASA in the past

Indications (all must be “Yes” to administer)

Signs & Symptoms of a possible Heart Attack

Prescribed Nitroglycerin

Contraindications (all must be “No” to administer)

Allergic to ASA

Asthma

Gastric Bleeding such as an ulcer

Unresponsive (ie…likely to choke on tablet)

Contraindications (all must be “No” to administer)

Systolic Blood Pressure below 90 mmHg

Cialis within the past 48 hours

Viagra/Levitra in the past 24 hours

Administer if…

• Indications are met (all “Yes”) and

• Contraindications are ruled out (all “No”)

Administer if…

• Indications are met (all “Yes”) and

• Contraindications are ruled out (all “No”)

Chew…

• two 81 mg tablets or

• one 325 mg tablet

Administer as soon as possible…before Vital Signs

• 0.4 milligrams (one spray = 0.4mg)

• Q3-5 (every 3-5 minutes) confirming pain persists and Systolic BP remains > 90mmhg




Simple Triage and Rapid Treatment (S.T.A.R.T.) Dead / Non-Salvageable (BLACK) Not Breathing

Immediate (RED)

Breathing > 30 per minute

Breathing with absent radial pulse

Decreased LOC

Delayed (YELLOW)

• Unable to walk

Minor (GREEN)

• Able to walk

Breathing Normal

Radial Pulse Present

Normal LOC

Urgent Transport Critical Interventions Requiring History and/or Vital Signs In some cases a patient may need Urgent Transport…AND…Critical Interventions which require information not normally acquired until the Secondary Survey.

In these cases…make an effort to efficiently gather the minimum information required without delaying transport any longer than necessary.

Intervention Information Required

Nitroglycerin for Chest Pains • Full set of vitals (particularly Blood Pressure)

• S-A-M-P-L-E and O-P-Q-R-S-T

ASA for Chest Pains • S-A-M-P-L-E and O-P-Q-R-S-T

• Administer as soon as possible…before Vital Signs

Glucogel for Unresponsive Diabetic • Full set of vitals (particularly CapBgl)

• S-A-M-P-L-E

Critical Findings Finding Implication Intervention

GCS less than 13 Decreased LOC OPA / NPA

Breathing over 30 times/minute Tachypnea Assist Ventilations

Breathing less than 10 times/minute Dyspnea Assist Ventilations

Blood Pressure less than 80 mmHg Systolic Hypo-tension Position Supine

Blood Glucose less than 4 mmol/L Hypoglycemia Glucose

Oxygen Saturation (SpO2) less than 95% Hypoxia / Hypoxemia Increase O2 intake

Infant pulse less than 60 bpm Equivalent to Absent Begin CPR

Body core temperature below 35 - 36 C Mild Hypothermia Rewarm slowly

Body core temperature below 30 - 34 C Moderate Hypothermia Rewarm slowly

Body core temperature below <30 C Severe Hypothermia Rewarm slowly

Body core temperature above 37 C Hyperthermia Cool rapidly

APGAR below 4 Unresponsive Load and Go

Pulseless, angulated limb Limb Threatening Load and Go Attempt to realign

Adult Pulse Rate over 160 bpm Urgent Tachycardia Load and Go




IV Drip Set Calculations

Drip Set Sizes • gtts = “drips”

• ml = “milliliters”

• gtts / ml = “how many drips add up to one milliliter”

Standard (Regular) 15 gtts / ml

Macro (Adult) 10 gtts / ml

Micro (Mini) 60 gtts / ml

gtts / minute (drips per minute) = volume (expressed in milliliters) to be infused X gtts / ml

Infusion time (expressed in minutes)

Common IV Solutions

Solution Commonly Used For…

Ringer’s Lactate Blood loss

D5W / D10W Hypoglycaemia

Normal Saline Dehydration

2/3 – 1/3 Dehydration

Common IV Complications Interstitial

Circulatory Overload

Thrombosis and Thrombophlebitis

Catheter Embolism

Infection of Catheter Site

Allergic Reaction

Air Embolism

Assisted Ventilations

Problem Ventilation Rate

Adult Child / Infant

Timed between or

with patient’s

own breaths

Breathing too Fast

• greater than 30 breaths per minute 1 breath

every

5-6 seconds

1 breath

every

3-5 seconds

Breathing too Slow

• less than 10 breaths per minute

Signs of Hypoxia

Signs of Respiratory distress

Rescue Breathing

Problem Ventilation Rate

Adult Child / Infant

Respiratory Arrest…but PULSE PRESENT 1 breath every 5-6 seconds 1 breath every 3-5 seconds

Cushing’s Triad 3 concurrent conditions commonly associated with Congestive Heart Failure or Head Injury

1 Increased Systolic Blood Pressure while Diastolic Blood Pressure remains “Normal”

2 Slow Heart Rate 3 Irregular Breathing




Lund & Browder Burn Estimation Sheet

Area Age

0 (infant) 1 year 5 years 10 years 15 years Adult

A = half of head 9.5% 8.5% 6.5% 5.5% 4.5% 3.5%

B = half of one thigh 2.75% 3.25% 4% 4.5% 4.5% 4.75%

C = half of one lower leg

2.5% 2.5% 2.75% 3% 3.25% 3.5%




Relevant S-A-M-P-L-E and Mechanism of Injury Information MVA

Location of patient Which vehicle patient was in How many vehicles involved

Impact speed Exterior damage Interior damage

Type of restraints Initial position of patient Condition of patient

Loss of consciousness Condition of other patients Wearing a seat belt?

Fall

Where from Height Free fall or hit other objects

Landing surface Position of patient at impact What hit first

Position Found Loss of consciousness Cause of fall

Pedestrian Struck

What hit them Size and weight of object Velocity of vehicle

Vehicle part that hit patient Damage to vehicle Distance patient thrown

Loss of consciousness Condition of patient Condition of Vehicle Occupants

Shooting

Type of firearm Range and Angle Loss of consciousness

Type of bullet Entrance and exit wounds Initial position and condition of patient

Stabbing

Type and size of weapon Loss of consciousness Type of wound

Number of wounds Other injuries Initial position and condition

Head to Toe Assessment Mnemonics Why might a patient have an altered level of consciousness?

A Alcohol

T Trauma

E Epilepsy I Infection

I Insulin (Diabetic) P Psychiatric

O Overdose P Poison

U Uremia S Stroke

During a Head to Toe assessment…watch for:

B Burns

C Contusions

S Swelling

O Open Wounds A Abrasions C Crepitus

L Lacerations P Penetrations R Rigidity

D Deformity

I Instability

P Punctures

T Tenderness

S Subcutaneous Emphysema




Entonox Mnemonics Contraindications Precautions

C Ability to COMPLY S SHOCK

D DECOMPRESSION sickness A ABDOMINAL distension

C Altered level of CONSCIOUSNESS D DEPRESSANT drugs

P PNEUMOTHORAX C COPD

A AIR emboli F FACIAL Injuries

I INHALATION injury

• Ruling out Contraindications involves Chest Auscultation

• Contraindications mean you cannot administer.

• Precautions mean you need to fix something first, or monitor closely to ensure the Entonox is not creating/exasperating any problems

• 2 Precautions = Contraindicated

N NITROGLYCERIN use within 5 minutes

Or…

D Decompression sickness

I Inhalation injuries

V Ventilation must be adquate

I Inability to comply with instructions

N Nitroglycerin spray in the last 5 minutes

E Embolisms in the lungs/chest/bloodstream

Entonox Protocol Indications Significant Pain

Rule out Contraindications

C-D-C-P-A-I-N or

D-I-V-I-N-E

Note Precautions S-A-D-C-F

Completed before administration

Primary Survey

Contraindications ruled out (requires Chest Auscultation)

Mix bottle if stored improperly

Adequate ventilation secured (vehicle ventilation system activated if available)

Proper Storage Not left unused over long periods

Not stored below -6 Celcius

Not stored vertically

Instructions to Patient

Self-administered using mask/bite valve

“Pull” Entonox out of the bottle by inhaling through bite valve

Pain should be relieved

May begin to feel: o Light-headed o Giddy o Drowsy o Nauseous

Stop or start at any time

Use until pain is relieved or adverse effects are felt

After Discontinuing Entonox

Supplemental Oxygen with Non-Rebreather Mask at 15 lpm




Sager Traction Splint

Utilized for suspected Femur Fractures not involving the hip or knee

Assess injured leg Distal Pulse – check for presence or absence

Motor-Sensory check

Look and feel to determine exact location and extent of injury

Apply Traction

Adjust saddle to ensure short side of saddle hinge is down

Nestle saddle against injured leg (short hinge down)

Have helper stabilize splint

Apply small thigh strap

Apply ankle harness above malleoli

Apply traction of 10% body weight o 15 lbs maximum per limb o 5 lbs maximum for open fractures and upper or lower third fractures o 5 lbs maximum for Pediatric patients o 30 lbs maximum for Bi-Lateral fractures (15 lbs per leg)

Secure Splint

Ensure adequate padding

3 straps around splint…above and below injury

Secure thigh strap…then the other two straps

Secure Figure 8 Strap

Reassess Injury

Reassess all splint straps and Traction Gauge

Ensure Leg in line with body…same length as other leg

Recheck presence or absence of Distal Pulse

Ensure no movement / aggravation of injured limb

Administration of Glucogel to an Unresponsive Patient

Assess Patient

If Hypoglycaemia is suspected or possible….Measure Capillary Blood Glucose Level as part of Vital Signs

CapBgl below 4 mmol/L requires administration of Glucogel

Protect Airway

Assemble Suction Unit and keep it ready

Place Patient in Recovery (Semi-Prone) Position

Remove OPA

Administer Glucogel

Place approximately half the tube of Glucogel on the inside of the lower cheek (Buccal Pouch)

• A tongue depressor may be utilized

Continue slowly until the entire tube of Glucogel has been absorbed

Monitor

Advise Medical Control

Monitor for changes

Re-measure CapBgl in 5 minutes

If CapBgl remains below 4 mmol/L

• Advise Medical Control and request permission to administer second tube




BCAS Treatment Guidelines compared to PAC National Occupational Skill Competency Profiles

Guideline BCAS Treatment Guidelines

(BC EMALB) These are ones we follow in BC

PAC NOSCP (Red Cross Emergency Care Manual)

Minimum Systolic B.P. to give Nitro 90 mmHg 100 mmHg

Nitro Dose Frequency Every 3-5 minutes (Q3-5) Every 5 minutes (Q5)

Nitro…Maximum Dosage No limit as long as Systolic BP>90 Limit of 3 doses in 30 minute span

Hyperglycaemia 11 mmol/L or higher 8 mmol/L or higher

Burn Percentage Calculations Lund & Browder Chart Rule of Nines

Burn Cooling On Scene 1-2 minutes Varies with extent of burns

CPR with Hypothermia Check Pulse for 30 seconds Check pulse for 45 seconds

Canadian Red Cross Certification & BC EMALB Licensing

3. License Application and Maintenance

Submit online License Application

Pay $450 Licensing Fee to EMALB after passing evaluations

EMALB will mail your License to the

address listed on your application

License valid for up to 5 years with

yearly “Continuing Competence”

Submit 20 Patient Contacts per year

Submit 20 Continuing

Education Credits per year

2. Complete BC EMALB EMR Evaluations (must be within ONE year)

You must submit an online

Request for Evaluation

You must select and confirm

Practical Evaluation dates

You must ask Red Cross to email

your Certificate to EMALB

1-877-356-3226

You must create an Online BCeID

You must complete the Jurisprudence Exam online

You must complete the Written Exam

online

You must successfully

complete

1 “Medical”

&

1 "Trauma"

Scenario

1. Complete Canadian Red Cross EMR Course & Certification

Frontline will notify you within 10 days that you have been

submitted to Red Cross

You’ll also get an email from Red Cross. Follow our instructions: frontlinefirstaid.ca/certificates

Access and print your Canadian Red Cross EMR Certificate through your MyRC profile

EMALB will only accept a PDF copy emailed directly from Red

Cross


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