Feb 5, 2019, 06:39 PM
Hello there!
Welcome to my guide about medicalRP for the job 'Paramedic'.
Why should you bother reading this guide? Well you don't have to if you don't want to, you can be the boring paramedic that just goes to a call, heals people and goes back to doing nothing. Or you can pretend to be a pro!
Rules of Engagement for Paramedics:
1. Scene safety, you can't help if you're dead.
2. Keep the patient calm, inform them of everything you do, unknown things are scary if you've just been hurt.
3. Scene safety.
1. Your kit.
As a paramedic in an emergency response vehicle (Ambulance or Rapid Response Car) you should have acces to the
following:
ABCDE: The most used assesment, means Airway, Breathing, Circulation, Disability, Exposure
Airway: Is their airway clear? Is it blocked by anything such as blood, vomit or foreign objects?
Breathing: Are they breathing? Are they breathing evenly with both lungs?
Circulation: How's their blood circulation? Are they pale? Are they bleeding?
Disability: Examine the pupils (size, equality and reaction to light).Make a rapid initial assessment of the patient’s conscious level using the AVPU method: Alert, responds to Vocal stimuli, responds to Painful stimuli or Unresponsive to all stimuli. Check their glucose levels to ensure they're not suffering from hypoglycemia (Low blood sugar).
Exposure: To examine the patient properly full exposure of the body may be necessary. Respect the patient’s dignity and minimise heat loss.
-----
AVPU: Used for conciousness level, means Alert, Responds to Verbal, Responds to Pain, Unconcious / unresponsive.
-----
SAMPLE method, for basic assessments of a person during a (medical) incident.
(S)ymptoms
What symptoms have you been noticing before, during or after the incident? Have you had these symptoms before?
(A)llergies
Do you have any allergies? Have you always had these allergies or did you develop them over time?
(M)edication
Did you take any medicine before or after the incident? Do you always take this medication? Was this the first time you took this medication?
(P)ast
Are there any (similar) incidents in your past? Do you have a medical history that I need to know of that might help my assessment?
(L)ast meal
What was the last thing you ate before the incident? Did you eat something after the incident?
(E)vent
What exactly happened that caused the incident?
3. Your job as a paramedic.
Your job is simple, to ensure your patient doesn't injure themselves further and stabilise them until you can get them to hospital.
4. Differential diagnosis
On many cases you'll get a bunch of values that can be caused by a million things.
Blood pressure:
If they have low blood pressure, (Below 90/60) it can be because of:
Hypovolaemia (Low amount of fluid in the body, both blood and otherwise)
Medication such as beta blockers and anti-depressants.
Heart conditions
Sepsis (Severe infection)
If they have high bloodpressure (Above 140/90) it can be because of:
Your inability to record it properly (Removing clothing from the upper arm will help)
Acute pain
Anxiety
Pregnancy and birth control
Chronic Kidney disease
Hormonal disorders
Prescription and recreational drugs (stimulants)
-----
Oxygen saturation: In the pre-hospital environment (Where you as a paramedic work), you measure the oxygen saturation through a pulse oximeter, which sends a small red beam into the skin and out onto the other side of the pulse oximeter, measuring the amount of oxygen in your blood. Regular levels are about 95-100%
If they have low oxygen saturation it can be because of:
. Scenario 1: Patient fell on their bike, minor injuries. Code 2 response.
You get a call, "Male fell off bike, minor injuries, Code 2 response to Local PD parking please."
Code 2 means go there no lights and sirens (But swiftly!), you arrive to see a patient in their mid-thirties, his jeans are ripped and he has some small cuts on his arms along with some abrasions. He's talking to a bystander who called for the ambulance.
Already on arrival we know two things.
- The patient is awake, has clear airway and has steady breathing as they're talking to someone.
- The scene is safe-ish.
Next up is scene safety! Making sure you and the patient don't die. You put on your lights if necessary and get them to the side of the road if possible, moving the bike well away from your patient to prevent any further damage.
Once the scene is safe, grab your BLS bag and defibrilator and go to your patient and say. "Hi, my name is <First name>, I'm a paramedic with <County> Ambulance Service, what's your name?"
If your patient says 'I don't remember' chance is they're concussed and should get checked out at hospital. For the scenario we'll say the patient is called Mike.
What you want to do now is what's called taking basic Obs, basic observation of the patients vitals, meaning blood pressure and sp02 measurement, you do these by opening the pouches on either side of your defibrilator, wrapping the cuff around his upper arm (Removing any clothing covering the overarm, either by cutting it or getting the patient to remove it), tell him to take a few deep breaths and not to talk while you're taking the BP measurement, then press the BP button on your defibrilator, it'll the inflate and deflate before displaying a measurement on the monitor.
** 160/90 **
You make a note of it and grab the Pulse oximeter. Say to the patient: "Just need to check your oxygen levels too, can I pop this on one of your fingers on your left hand?" You pop it onto his finger, a brief moment later, the monitor shows a saturation of.
** 98% **
Now that the basics are out of the way, you can clean up the cuts and scratches he has, use some saline to clean the wound then bandage it. Once done, get another blood pressure measurement.
** 130/70 **
Within normal parameters again, you get the chap onto the ambulance and sit him on the stretcher, he's then taken to the hospital where you give the following handover.
"This is Mike, Mike fell on his bike around <time>, fully concious throughout, alert upon our arrival, Airway and breathing were both clear, BP was a little high but final measurement before transport was 130/70. Some cuts and scratches that were cleaned and bandaged but apart from that we haven't found any other injuries. No pain relief given."
No longer than that. It needs to take a minute at most for a handover, the quicker you get it done, the quicker the ER staff can take over.
Rest of the guide is WIP, constructive criticism is welcome.
Welcome to my guide about medicalRP for the job 'Paramedic'.
Why should you bother reading this guide? Well you don't have to if you don't want to, you can be the boring paramedic that just goes to a call, heals people and goes back to doing nothing. Or you can pretend to be a pro!
Rules of Engagement for Paramedics:
1. Scene safety, you can't help if you're dead.
2. Keep the patient calm, inform them of everything you do, unknown things are scary if you've just been hurt.
3. Scene safety.
1. Your kit.
As a paramedic in an emergency response vehicle (Ambulance or Rapid Response Car) you should have acces to the
following:
- BLS bag (Basic Life Support bag): Contains diagnostic equipment, airway management and basic first aid items.
- Oxygen tank with regulator
- ALS bag (Advanced Life Support bag) containing diagnostic equipment, airway management and medications. Also carries Saline for Intravenous access.
- ECG Defibrilator with Blood Pressure cuff and Sp02 (Oxygen saturation) meter
- Suction device (Automatic and manual)
- Carry Chair (Ambulance only)
- Stretcher (Ambulance only)
- Scoop stretcher (Ambulance only)
- Spineboard with blocks (Ambulance only)
- BLS bag (Basic Life Support bag): Contains diagnostic equipment, airway management and basic first aid items.
ABCDE: The most used assesment, means Airway, Breathing, Circulation, Disability, Exposure
Airway: Is their airway clear? Is it blocked by anything such as blood, vomit or foreign objects?
Breathing: Are they breathing? Are they breathing evenly with both lungs?
Circulation: How's their blood circulation? Are they pale? Are they bleeding?
Disability: Examine the pupils (size, equality and reaction to light).Make a rapid initial assessment of the patient’s conscious level using the AVPU method: Alert, responds to Vocal stimuli, responds to Painful stimuli or Unresponsive to all stimuli. Check their glucose levels to ensure they're not suffering from hypoglycemia (Low blood sugar).
Exposure: To examine the patient properly full exposure of the body may be necessary. Respect the patient’s dignity and minimise heat loss.
-----
AVPU: Used for conciousness level, means Alert, Responds to Verbal, Responds to Pain, Unconcious / unresponsive.
-----
SAMPLE method, for basic assessments of a person during a (medical) incident.
(S)ymptoms
What symptoms have you been noticing before, during or after the incident? Have you had these symptoms before?
(A)llergies
Do you have any allergies? Have you always had these allergies or did you develop them over time?
(M)edication
Did you take any medicine before or after the incident? Do you always take this medication? Was this the first time you took this medication?
(P)ast
Are there any (similar) incidents in your past? Do you have a medical history that I need to know of that might help my assessment?
(L)ast meal
What was the last thing you ate before the incident? Did you eat something after the incident?
(E)vent
What exactly happened that caused the incident?
3. Your job as a paramedic.
Your job is simple, to ensure your patient doesn't injure themselves further and stabilise them until you can get them to hospital.
4. Differential diagnosis
On many cases you'll get a bunch of values that can be caused by a million things.
Blood pressure:
If they have low blood pressure, (Below 90/60) it can be because of:
Hypovolaemia (Low amount of fluid in the body, both blood and otherwise)
Medication such as beta blockers and anti-depressants.
Heart conditions
Sepsis (Severe infection)
If they have high bloodpressure (Above 140/90) it can be because of:
Your inability to record it properly (Removing clothing from the upper arm will help)
Acute pain
Anxiety
Pregnancy and birth control
Chronic Kidney disease
Hormonal disorders
Prescription and recreational drugs (stimulants)
-----
Oxygen saturation: In the pre-hospital environment (Where you as a paramedic work), you measure the oxygen saturation through a pulse oximeter, which sends a small red beam into the skin and out onto the other side of the pulse oximeter, measuring the amount of oxygen in your blood. Regular levels are about 95-100%
If they have low oxygen saturation it can be because of:
- COPD (including chronic bronchitis and emphysema)
- acute respiratory distress syndrome
- asthma
- collapsed lung
- anemia
- congenital heart defects
- heart disease
- pulmonary embolism
. Scenario 1: Patient fell on their bike, minor injuries. Code 2 response.
You get a call, "Male fell off bike, minor injuries, Code 2 response to Local PD parking please."
Code 2 means go there no lights and sirens (But swiftly!), you arrive to see a patient in their mid-thirties, his jeans are ripped and he has some small cuts on his arms along with some abrasions. He's talking to a bystander who called for the ambulance.
Already on arrival we know two things.
- The patient is awake, has clear airway and has steady breathing as they're talking to someone.
- The scene is safe-ish.
Next up is scene safety! Making sure you and the patient don't die. You put on your lights if necessary and get them to the side of the road if possible, moving the bike well away from your patient to prevent any further damage.
Once the scene is safe, grab your BLS bag and defibrilator and go to your patient and say. "Hi, my name is <First name>, I'm a paramedic with <County> Ambulance Service, what's your name?"
If your patient says 'I don't remember' chance is they're concussed and should get checked out at hospital. For the scenario we'll say the patient is called Mike.
What you want to do now is what's called taking basic Obs, basic observation of the patients vitals, meaning blood pressure and sp02 measurement, you do these by opening the pouches on either side of your defibrilator, wrapping the cuff around his upper arm (Removing any clothing covering the overarm, either by cutting it or getting the patient to remove it), tell him to take a few deep breaths and not to talk while you're taking the BP measurement, then press the BP button on your defibrilator, it'll the inflate and deflate before displaying a measurement on the monitor.
** 160/90 **
You make a note of it and grab the Pulse oximeter. Say to the patient: "Just need to check your oxygen levels too, can I pop this on one of your fingers on your left hand?" You pop it onto his finger, a brief moment later, the monitor shows a saturation of.
** 98% **
Now that the basics are out of the way, you can clean up the cuts and scratches he has, use some saline to clean the wound then bandage it. Once done, get another blood pressure measurement.
** 130/70 **
Within normal parameters again, you get the chap onto the ambulance and sit him on the stretcher, he's then taken to the hospital where you give the following handover.
"This is Mike, Mike fell on his bike around <time>, fully concious throughout, alert upon our arrival, Airway and breathing were both clear, BP was a little high but final measurement before transport was 130/70. Some cuts and scratches that were cleaned and bandaged but apart from that we haven't found any other injuries. No pain relief given."
No longer than that. It needs to take a minute at most for a handover, the quicker you get it done, the quicker the ER staff can take over.
Rest of the guide is WIP, constructive criticism is welcome.