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54 Cards in this Set
- Front
- Back
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List the basic differences between Wilderness Medicine and Urban Medicine
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Five factors: Time (extended time with patient), Environment, Improvisation, Communication and Decision-making and Prevention.
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List the major medical legal issues
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Negligence (an injury occurred to patient due to breach of caregiver's duty), Good Samaritan Law, Consent, Assault/Battery, Abandonment and Confidentiality.
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Scene Size Up
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Survey, MOI, BSI, # of patients and general impression of patient
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Initial Patient Assessment
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Get Consent. Stabilize Spine. A B C D and E
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Head To Toe Exam
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Feel and look for any abnormalities and pain response. Also look for med tags.
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Vital Signs
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NOTE THE TIME!
LOR, HR, RR, SCTM, BP, Pupils, Temp if possible. |
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Patient History
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Chief Complaint: OPQRST
MOI S A M P L E |
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SOAP Note
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Age, Subjective, Objective, Assesment, Plan, Anticipated Problems.
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Types of Chest (ribs) Injuries
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Fractured Ribs or Clavicle, Flail Chest
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Fractured Ribs S/Sx and Tx
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Point tenderness (no more than 3 places), pain on breathing (is it a breathing problem or does it just hurt?), patient will be in protective position. Treatment: encourage deep breath and occasional cough, sling and swathe. Evac depends.
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Flail Chest S/Sx and Tx
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signs: point tenderness in 4 or more places, tenderness. Treatment: secure bulky dressing. position on injured side or position of comfort. Evac. Monitor.
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Types of Lung Injuries
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Pneumothorax closed and open
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Open Pneumothorax S/Sx and Tx
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This is a sucking chest wound. impediment that was pulled out created hole which is bleeding. Difficulty breathing. This is a B stop and fix. Treatment: cover hole, preferably patient covering with own hand. create occlusive dressing (plastic with tape to seal). EVAC immediately.
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Closed Pneumothorax S/Sx and Tx
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Ribs are punctured from within usually after Flail Chest wound. Patient can't take a deep breath. Support patient in position of comfort, request immediate evacuation and O2
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Types of Shock
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Hypovolemic, Cardiogenic, Vasogenic
All three can be in Decompensatory stage or Irriversable Stage. |
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Shock S/Sx and Tx
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Vomiting, nausia, anxiousness, LOR changes, Thirst, increased HR and RR, pale cool and clammy skin. Best treatment is to catch it early and treat the cause (ie bleeding). Legs up, keep warm, monitor. If patient worsens, EVAC
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Types of Head Injuries
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Skull Fracture and Closed Head Injury (mild, moderate and severe)
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Skull Fracture S/Sx and Tx
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Decompression or deformity in skull, bleeding on outside or blood pooling under ears and eyes. Cerebral fluid leaking from ears and nose. Treatment: diffused dressing and slight pressure on head, monitor vitals and RAPID EVAC
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Mild Closed Head S/Sx and Tx
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Temporarily unresponsive. LOR change brief. Seeing stars, dizzy. all symptoms are brief and mild. Treatment: monitor, can let them sleep but wake every 2 hours. Pain meds are ok and hydrate.
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Moderate Closed Head S/Sx and Tx
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Disorientation, A and O drops, HR decreases and bounding, red, flushed and warm skin especially in head. EVAC these people and monitor ABC's. Elevate torso.
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Severe Closed Head injury S/Sx and Tx
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Disoriented, irritable, combative (DIC head), can be unresponsive, same as moderate but worse. RAPID EVAC with monitor ABC's and vitals. Immobilize spine.
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Types of Spine Injuries
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Distraction (stretch) Contortion (torque) Axial Loading, Penetration (stabbing) and Sudden Decompression
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S/Sx and Tx for Spine Injuries
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Altered CSMs, Pain upon spinal palpation, Lack of pain, deformities in spine, Incontinence, MOI. HR and RR go up. Treatment: keep spine immobile, request backboard and EVAC. monitor.
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Focused Spine Assessment
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Are the Reliable LOR and Sober? Normal CSMs unless otherwise explainable by injury or illness, denial of pain and tenderness on spine palpation.
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Top 3 goals with Wound Management
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Stop bleeds, Prevent Infections and Promote Healing!
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Stop Bleeding?
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Apply Direct Pressure and elevate above the heart. Last resort is a Tourniquet.
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Cleaning a wound less than 1/2 inch
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Make sure you and your instruments are as sterile as possible. Clean around wound with soap and water. rinse. Remove debris. Irrigate with disinfected water. Cover wound with cleanest dressing avalible and bandage. coat with antibiotic ointment or transparent film. Keep dressings clean and dry, change as needed.
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Cleaning a wound more than 1/2 inch
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irrigate and clean as normal. Do not close wound. Pack a sterile gauze wet to dry into wound and bandage.
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Treatment for Infections
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clean out wound, change dressing and monitor by marking and tracking where the redness and swelling is at. For more severe you can do iodine/water soaks and if it is worse EVAC
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3 types of burns
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Superficial, Partial, Full
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For all burns you need to first
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COOL IT
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Superficial burns S/Sx and Tx
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After cooling burn will red, hurting. Treatment is to to take ibp, aloe vera, protect with sunblock and hydrate
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Partial and full burn S/Sx and Tx
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After cooling, burn will start to blister. full burns will look charred. Create a sterile 'zone' to treat the patient. prevent infection! keep warm and hydrate
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Frostbite S/Sx and Tx
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starts with tingling, numb, loss of function, 'denting' and for more severe it's wooden with no sensation. treatment for mild is thaw in hot water or skin to skin warming. prevent re-freezing and infection.
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non-freezing cold injury (trenchfoot) S/Sx and Tx
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area is swollen, cold, hurts and itches when warmed. treat by warming, elevation, skin-to-skin pain meds and hydration
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Heat Exhaustion S/Sx and Tx
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elevated HR and RR pale cool and clammy, strong pulse early and weak pulse late. headache, dizzyness nautia, thirsty, low urine. treatment includes stop the exercise, get in shade, rest, hydrate. evac if they don't stabalize
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Heat Stroke S/Sx and Tx
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lowered LOR, hallucinate, seizure, ataxia, skin dry red or moist, vomit. treatment includes aggressive cooling, manage airway and EVAC
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Hyponatremia is?
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Low salt in the blood
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Hyponatremia S/Sx and Tx
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looks like shock, LOR depends, slow to respond, elevated HR and shallow RR, muscle spasms, skin is P/C/C, muscle cramps, weakness, probably have had tons of water. basically they look like they are dehydrated but have had good water intake. Treatment is feed salty foods, no water. Evac if LOR is weird.
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AMS stands for
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Acute Mountain Sickness
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AMS S/Sx and Tx
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headache, nausea, vomiting, loss of apatite, insomnia, mild lassitude, fatigue and weakness. treatment is to stop climbing, rest, hydrate and feed simple carbs. monitor
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HACE stands for
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High Altitude Cerebral Edema
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HACE and S/Sx and Tx
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Subtle Ataxia is the biggest sign, DIC head and LOR changes, Neurological issues, splitter head ache. Treatment is to Go back down! O2 drugs to help them go back down
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HAPE stands for
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High Altitude Pulmonary Edema
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HAPE S/Sx and Tx
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shortness of breath, libs are blue, elevated HR RR, cough. treatment is to descend, o2 drugs, acetazolamide
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OPQRST
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Onset, Provokes/Palliates, Quality, Radiate/Region, Severity, Time (asked in S in SAMPLE)
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Angina is
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chest pain brought on by physical or emotional stress, relieved by rest.
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Angina S/Sx and Tx
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Chest pain, shortness of breath, anxiety, nausea and vomiting, lightheadedness, pale cool sweaty skin. Treatment is to reduce anxiety and activity, place in position of comfort, assist in admin of nitroglycerin if they good bp and no Viagra/Cialis for 48 hours. can administer asprin, monitor
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Myocardial Infarction is
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damage or death of heart muscle tissue due to prolonged hypoxia (lack of oxygen supply)
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Myocardial S/Sx and Tx
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all the same of angina, unrelieved by rest or medication. treatment includes reduce anxiety, poc, assist with nitroglycerin, asprin, monitor, evac.
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Pulmonary Embolism is
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A clot that has lodged in a pulmonary artery. S/Sx are sudden onset of sharp chest pain, respiratory distress, cough, shock signs. treatment is rapid evac.
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Stroke S/Sx and Tx
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memory loss, slurred speach, can't smile straight, incontinence. treat with emotional reassurance, poc, document time of onset, evac
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Things that cause the brain to stop?
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Toxins, Sugar/Seizure, Temperature, Oxygen and Pressure
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Acute Abdominal Red Flags (Evac if pain is acute and...)
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Blood in outs, High Fever, Goes from General to localized pain, S/Sx shock, Pregnancy, Positive heel Strike, Anorexia, Vomiting/Diarrhea
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