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MODULE 1: PREPARATORY MODULE 2: AIRWAY MODULE 3: PATIENT ASSESSMENT MODULE 4: EMERGENCIES & OB/GYN MODULE 5: TRAUMA MODULE 6: INFANTS AND CHILDREN MODULE 7: OPERATIONS MODULE 8: ADVANCED AIRWAY MISCELLANEOUS
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Skin Pink (palm and sole), Warm and dry. Fast Capillary refill (under 2 sec male adults and children, 3 for females, and 4 in the elderly). Pupils Normal and equal in size. Respond to light. Blood Pressure: 120 / 80 (systolic / diastolic) in adults. Higher in the elderly and lower in children. Pulse Oximetry: 97-100%
Pulse
Patient Adult Elderly Slow Normal Rapid (bradycardia) (at (tachycardia) if below rest) if above 60 60-80 100 90 60-105 105 60-120 120
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Pulse characteristic
Normal rate, regular rate, and strong Normal person at rest (full) pulse Exertion, fright, fever, high Rapid, regular and blood pressure, initial strong response to injury and bleeding Rapid, regular and weak (also called Indication of shock regular and thready) Head injury, drug use (barbiturate or narcotic), Slow poisons, possible cardiac problem No pulse Cardiac arrest Pulsus paradoxus Severe cardiac or (decrease in pulse respiratory injury, illness or strength during blood loss inhalation) Pulses can be located in the major arteriesCarotid (neck), Femoral (groin), Radial (wrist), Brachial (arm), Popliteal (behind knee), Posterior Tibial (ankle), Dorsalis Pedis (foot).
Skin
Temperature Hot: fever, exposure to heat, localized infection. Warm: normal. Cool: inadequate circulation, shock, or exposure to cold. Cold: extreme exposure to cold. Condition Abnormally Dry: severe dehydration or spinal injury. Dry: normal. Wet or Moist: shock, or heat, cardiac, or diabetic emergencies.
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Clammy (cool and wet / diaphoretic): indication of shock. Color Pale or mottled: onset of shock. Cyanotic: late sign of shock. Red: anaphylactic or vasogenic shock, poisoning, overdose or other medical condition. Yellow: jaundice, liver problems. Capillary Refill: more reliable for children under 6. Slow cap refill = possible hypoperfusion.
Pupils
Dilated: cardiac arrest, use of stimulant drugs like cocaine, amphetamine, LSD. Constricted: central nervous system disorder, use of narcotics. Unequal: Stroke, head injury, artificial eye, eye drops. Nonreactive: Cardiac arrest, brain injury, drug influence.
Blood Pressure
Normal blood pressures Patient Adult Male Systolic (mmHg) 100 + age up to 40 Diastolic (mmHg) 60-85
Adult female 90 + age up to 40 60-85 Adolescent 90 and above 2/3 systolic Child (1-10 80 + (2 x age) 2/3 systolic yrs) +/- 10 Infant (1-12 70 and above 2/3 systolic mo) Hypertension: high blood pressure in an adult is considered over 140 / 85. Pulse pressure: the difference between systolic and diastolic pressure. Normally falls between 25 % and 50 % of systolic pressure. Narrow (low) pulse pressure: shock, cardiac tamponade (blood filling the pericardial sac, compressing the heart), tension pneumothorax (injury to one lung, causing pressure on the heart
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and the other lung). Wide (high) pulse pressure: head injury. Measuring blood pressure: Using a sphygmomanometer (wrapped around the arm), applying pressure (by pumping) over the brachial artery until a radial pulse can no longer be detected. Over pump 30 mmHg, then slowly release the pressure. Detect for a return of pulse by either auscultation or palpation. Auscultation: listening with a stethoscope for the return of the brachial pulse. The first sound marks the systolic pressure and the last sound (either a disappearance or a notable drop in volume) marks the diastolic pressure. Palpation: palpating for the radial pulse. When the radial pulse returns, this is the systolic pressure. The palpation technique cannot measure diastolic pressure (a "P" is noted in place of the diastolic pressure). The systolic pressure measured is approximately 7 mmHg lower than those obtained by auscultation. Do not over pump more than what is needed- it can be very painful for the patient. Orthostatic Vital Signs Test (Tilt Test): Measures heart rate and blood pressure for a patient while supine and while standing up. A positive result occurs when the heart rate increases 10-20 bpm and the blood pressure decreases 10-20 mmHg up standing up. This indicates significant blood loss.
Pulse Oximetry
Measured over the tip of the index finger, can detect hypoxia, which can be treated by applying oxygen via a nonrebreather mask. Limitations: Directly measures hemoglobin saturation, not oxygen level. Therefore, false readings can occur during carbon monoxide poisoning. Errors in reading can also occur from nail polish and excessive finger movement.
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something? What was it?" A diabetic patient who hasn't consumed anything for 8 hours may be hypoglycemic. Events leading up to the injury or illness: "What happened? How did this happen?" The events leading up to the injury provide clues for the underlying cause.
Document all pertinent findings from the SAMPLE history on the PCR (Prehospital care report)
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