Cardiovascular Emergencies Part I (1.5 Hours) |
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Assessing the Cardiac PatientThe scene size-up is an overall assessment of the scene to which an EMT or Paramedic has been called to gain useful information that includes ensuring scene safety; determining whether a patient is suffering from trauma or a medical problem; determining the total number of patients and whether additional resources are needed to handle them. First we make sure the scene is safe to approach the patient, if it is not safe, we do something to make it safe (like call PD, Fire Department). Once the scene has been made safe, we figure out what caused the incident to occur in the first place (this is called the mechanism of injury or nature of illness). In this case, the nature of illness will give us clues as to the severity and nature of the illness. When dispatched to a cardiac call, it’s usually just one patient. Nevertheless, we must determine early on whether or not we will need any additional responses. The initial assessment is defined as the portion of patient assessment conducted immediately following scene size-up for the purpose of discovering and treating immediately life-threatening conditions. The initial assessment begins with EMT or Paramedic developing a general impression of the patient (or how the patient looks when the EMT or Paramedic walks in the room). From this general impression, you might gather that the patient is suffering from an obviously life-threatening condition that you could immediately treat. Moving forward, we assess the patients’ level of consciousness using the AVPU scale. Next we assess the airway. If the patient is able to speak, we can usually assume the airway is clear. If the patient does not speak, we open the airway with an appropriate technique (jaw thrust for trauma or otherwise head-tilt-chin-lift). If the patient was unable to speak, we assess the patency of the airway be observing air movement, if no or inadequate air movement is found, we ventilate with a bag-valve-mask. If, during our attempt to ventilate the breaths do not go in, we re-position the airway. If re-positioning fails to allow a breath to pass through the airway, we assume the airway is obstructed and begin AHA BLS for HCP airway maneuvers. If at this point you are not ventilating the patient, you should assess the patients’ respiratory status by determining rate, rhythm, and quality. If required, begin ventilations or administer supplementary oxygen with a non-rebreather or nasal cannula. After assessing respiratory status, we assess the patients’ pulses (comparing the distal pulses to central) and observe the patient to determine if there is any obvious and life threatening blood loss. Finally, it is time for us to make a transport decision. At this point, what we are deciding is do we transport now or later (this decision is based on mechanism of injury, level of consciousness, or other findings of the initial assessment). |
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The scene survey is always completely performed prior to beginning your initial assessment. The scene survey is comprised of which of the following elements:
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