Transcript Review

Comprehensive Review
EMCA Review
The home stretch!
Analyze this :
Calculate the following
a.
Want to run an IV at 120 cc’s an hour.
If you have a 10 drop set, how many
gtts/min do you set the IV rate?
20
gtts/min
b.
You want to give a 15Kg child
epinephrine for anaphylaxis. What is
the dose of 1:1000 epi that you give?
0.15mg
Question
Under what 4 conditions can only 1
shocks be delivered to a patient?
1.
2.
3.
4.
Blunt trauma
Hypothermia
Airway obstruction
After stopping enroute with rearrest
Question
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What are the indications for epinephrine
for anaphylaxis?
Indications
Exposure to a probable allergen
AND
Signs and or symptoms of a moderate to severe allergic reaction (inc
Anaphylaxis)
Question
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What are four purpose of IV therapy?
Restore and maintain fluid balance
Restore and maintain electrolyte balance
Provide medications and route for them
Transfuse blood and blood products
Deliver parenternal nutrients and nutritional supplements
Question
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What is an isotonic solution?
Same conc solute inside and out-no
net movement of water
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What IV fluids are hypotonic?
D5W
What are three causes of
severe SOB?
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Acute severe asthma-usually secondary
to ?
CHF
Tension pneumothorax
Pulmonary emboli
Explain the concept of
cerebral perfusion pressure!
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CPP=MABP-ICP
Need minimum
pressure for cerebral
function
Things that affect flow rates
for IV’s (at least 5)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Patient positioning – 3ft above
Vein spasms
Pheblitis/Thrombi
Type of fluid (viscosity)
Amount of fluid in bag
Height
Tubing kinked
Catheter size
Catheter position
infiltration
What is an OASIS number?
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Where is it normally used?
Why is it important to take the
pulse within 1 minute of
patient contact? What
information can be obtained?
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Perfusion
Rate too high or too low
Blood pressure (roughly)
Psychological (touch)
Pulse alternans
irregularities
Name 6 Dispatch centers in
Ontario
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Toronto
Renfrew
Ottawa
Georgian
Lindsay
Kingston
London
Oshawa
Windsor
Sudbury
North Bay
Kenora
Timmins
Cambridge
Hamilton
Mississauga
What does the tachometer
measure and where is it
located?
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Speed, stopping
Use of lights
Use of sirens
24 clock
Located either behind drivers seat or in
side compartment of ambulance
If applicable, does the medics write on
it?
5 Causes of crackles upon
chest auscultation
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CHF
Cardiogenic shock
Hemothroax
Pneumonia
Atelactasis
PE
ARDS
tumour
What are four reasons for a
Incident Report
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VSA
Crime Scene
Child Abuse
Domestic dispute
Equipment failure
Ambulance delay (critical)
Person taking notes on scene!
What are 5 classes of
antihypertensives
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Ca channel blockers
B blockers
ACE inhibitors
Nitrates
Diuretics
Alpha blockers
Give one example of each
Give three examples of
anticonvulsants
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Depekene
Dilantin
Valium
Lorazepam
phenobarbital
What are the receptors
located in the autonomic
nervous system?
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Alpha
Beta 1 and beta 2
Explain the mechanism behind
the development of a tension
pneumothorax?
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Air gets trapped in between parietal and
visceral pleura, with each breath, if it
not allowed to escape, it builds up
pressure, collapsing the lung.
Eventually, the pressure is so high it
stops venous return to heart
(compression of vena cava) and bp
drops, HR increases and heart may
arrest
Toronto, 9145 is 10-8,
765 McLaughlin Rd south?
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What does this transmission mean?
10 Causes of Chest pain
please!
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Angina
MI
CHF
Emboli
Esophagitis
Regurg
Myocarditis
endocarditis
pneumo
aneurysm
fractured rib
chondritis
pleurisy
muscle strain
Explain the development of
arthersclerotic disease?
Explain the theory of relativity
or say “Patient Care” in the
phonetic alphabet
What does CTAS stand for?
Canadian triage and acuity scale
Why does a patient with a
thoracic aneurysm complain of
back pain?
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Tearing of the layers of the aneurysm
5 Signs and Symptoms of a
tension pneumothorax?
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Decreased BP
Increased HR
Resp distress
Absent air entry on affected side
JVD
Tracheal shift
cyanosis
How does lasix work, and how
is it supplied? Normal dose?
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Preload reducer and diuretic
Comes 40mg/4ml
Depends on patient 40-160mg
What are the conditions under
which you would inspect the
perineum in a obstetrical patient
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Ruptured membranes
Prolapse cord
Urge to push
“baby’s coming”
Near term, decreasing LOC and history
is unknown
Vag bleeding with shock
What three rhythms would get
cardioverted?
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SVT
Rapid a fib
Vtach with a pulse
You just turn on the LP after
applying the pads and see
asystole on the monitor. How
do you get to see the rhythm
through the paddles (2 ways)
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Press analyze (fastest)
Flip to paddles
What are the contraindications
to ASA administration?
 18 years of age
• alert
 NOT have an allergy to ASA or other
NSAID
 not have current active bleeding (GI or other
disorders)
 have no evidence of CVA or head injury
within 24 hours prior to Primary Care
Paramedic assessment
 have a history of previous use of ASA with no
adverse reaction if a known asthmatic
How do you differential
between MI and angina?
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Time of chest pain
What makes it better
12 lead changes
Quality of pain
Past history
What is the difference between
epiglottis and croup?
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Croup = Laryngotracheobronchitis
URI symptoms
barking cough
hoarseness
inspiratory stridor
low-grade fever
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Epiglottis- Haemophilus influenzae type B most common
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odynophagia
fever
irritability
stridor
rapidly progressive
What is the difference in
terms of vital signs between
an anterior MI and an inferior
MI?
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Low and slow –inferior
High and fast -anterior
What is the indications of
giving epi for croup?
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Any patient who is < 8 years of age who
presents with:
1.
A current history of an upper respiratory
infection with a “barking” cough
AND
2.
Stridor at rest, or an altered level of
consciousness or cyanosis
What is the importance of the
cover letter in a resume?
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Job target
The ‘ask’
Why you’re the one
Specific about the job-connection
Outline the pathophysiology
behind acute asthma!
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Adrenergic stimulation or irritation of
the bronchioles resulting in
bronchoconstriction.
Mucous production
Histamine release from mast cells
How long would a D tank last
at 12 lpm for a NRB mask?
(Leaving the residue)
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2000-500 =(1500) x 0.16 divided by 12
L min
=240/12
=20 minutes
What are 6 signs of raised ICP
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Seizure
Combativeness
Decreased LOC
Pupil changed
Resp change –ataxic
Triade called …..?
Rising BP
etc
Signs and symptoms of acute
anaphylaxsis
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Physical Examination shows any of the following:
Wheezing
Stridor
Generalized Urticaria
Generalized edema
Systolic BP <90
Decreased LOC
Airway compromise
Tell me how a KED is applied
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Immobilize head-collar applied
Undo far leg strap
Slide Ked behind patient
Pull up under arms.
My –middle strap
Baby- bottom
Looks- legs
Hot- head (pad behind head, top then chin)
Tonight- top strap-”deep breath”
Haul!
What is the chest landmark for
a needle decompression?
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2rd intercostal space, midclavicular line,
above the 3rd rib
On the affected side!!
What patients would get
intubated?
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VSA
Unconscious GCS<8-10
Severe SOB (CHF, asthma, )
CHI trauma
Airway protection –burns etc
Seizure
Respiratory support
What are the Criteria to rule
out for the CVA protocol?
1.
2.
3.
4.
5.
6.
7.
CTAS Level 1 or uncorrected A,B,C problem
Symptoms of the stroke resolved prior to arrival or
assessment
Blood sugar <3 mmol/L
Seizure at onset or observed by paramedics
GCS <10
Terminally ill or palliative
Duration of out of hospital will exceed 2 hours
What is this?
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Aortic
valve
Give the trade name for the
following:
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AcetaminophenPropanolol
RantididineDimenhydrinateSertraline -
Tylenol
Inderal
Zantac
Gravol
Zoloft
What are some options if some refuses
care and you want to convince them to
go?
Advise Dispatch (possible delay)
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Physician contact
(Studies have found a significant number of
patients will accept transport when advised to do
so by a physician)
 Police involvement
 Obtain witnesses signatures to refusal and
explanation provided to the patient (if witnessed)
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Trace the blood from the vena
cava to the carotid arteryinclude valves
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Vena cava, R atrium, tricuspid, R
ventricular, pulmonary valve, pulmonary
artery , lungs, pulmonary vein, Left
atrium, mitral valve, left ventricle, aortic
valve, aorta, carotid artery
What features help the
myocardium depolarized so
that all the myocardium
contracts together
“Functional
Syncitium”
Intercalated discs
Gap junctions
Desmesomes
What is this?
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How do you set the traction
on the sager splint?
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10% body weight up to maximum of 15
lbs
Traction manually until traction applied
by splint
Distal neurovascular before and after
Why does someone in a Vtach
with a pulse get chest pain?
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Decreased diastolic filling time
Increased MvO2 due to speed of
contraction!
Therefore treat the rate by..?
How does insulin work in the
body?
What are the questions for the
aid to capacity section?
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That the patient can understand
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The condition for which the treatment is
proposed
The nature of the proposed treatment
The risks and benefits of the proposed
treatment
The alternatives to the treatment presented
by the paramedic including the alternative
of not having the treatment
That the patient can appreciate the risks and
benefits of treatment/non treatment
Why does someone with
GERD get chest pain
sometimes?
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Referred pain up the esophagus
through the cardiac spincter!
(Gets better with a “pink lady” lidocaine
and maalox)
How does ASA work to help
prevent further necrosis in a
MI
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Inhibit thromboxane A2 which is a
potent platelet aggregator
Which blood type is the
universal donor and why?
O RH negative
Because there are no antigens on the RBC’s
no A
No B
No RH
Name 3 kinds of WBC’s
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Neutrophils
Eosinophils
Macrophages (monocyctes)
Mast cells
Basophils
What are the differences in a
pediatric airway?
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Long floppy epiglottis
Large occiput
Narrowest below the
cords
Large tongue
Small nares
Semi rigid tracheal rings
What are three important
questions to ask someone in
labour?
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What is the expected date of
confinement (EDC) or how many weeks
she is at?
Has the membranes ruptured
Previous pregnancies-length and result
Colour of fluid
Any problems with pregnancy
What are the components of
the APGAR score and when
are they done?
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Appearance
Pulse
Grimace (tone)
Activity
Respiration
Done at 1 minutes and 5 minutes
Explain what occurs in the
development of type II
diabetes in adults
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Overstimulation of the pancreas and the
release of insulin, so that there is
decreased sensitivity of the insulin
receptors to it
Down regulation eventually of insulin
receptors on the body cells
What is the GCS of a person
who opens eyes to pain,
extends and has only moaning
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Eyes- 2
Verbal- 2
Motor –2
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-total 6
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What are the suction levels for
adults, children and infants?
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Adults 500 mmHg
Children 200 mmHg
Infants delee or bulb suction (80-120)
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An organophosphate overdose is an example
of stimulation of
a.
inhibition of cholinergic fibers
b. adrenergic fibers
c. sympathomimetics
d. release of acetylcholine
e. the CNS
What happens when a patient
is acidotic?
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The person begins to blow off CO2 and
increase the rate and depth of
respiration in an attempt to drive the
equation
H20 + CO2 =H2CO3 =H+ HCO3
Why does a person with
severe Anemia present SOB?
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Anemia is the low RBC count
The HGB is the what carries the O2 so
when the RBC count is low, the PaO2 in
the body drops and the person
becomes hypoxic, and presents with
SOB
A patient is on dimenhydrinate, Percocet,
and coumadin. What is the history?
a. Pain, nausea and blood clots
b. Atrial fibrillation, Depression and hives or
allergies
c. Hypertension, nausea and depression
d. Depression, hypertension and allergies
e. None of the above
What are 15 “load and go”
situations?
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Large sucking chest wound
Large flail chest
Tension pneumothorax
Major blunt chest injury
Asthma
CHF
Seizure (ongoing)
AMI
Burns with inhalation
Shock
Ectopic pregancy with shock
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Overdose with decreased LOC
Aortic aneurysm
Cardiac arrest
Head injury
stroke
Obstructed airway
Tender abdoment
Bilateral fractured femurs
Pelvis fracture
Amputation of thumb/limb etc
Multiple births
What are signs and symptoms
of cardiac tamponade?
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Muffled heart sounds
SOB
JVD
Pulses alternans
Chest pain
What are signs of smoke
inhalation and upper airway
burns?
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Smoky breath odour
Facial hair burned
Sooty sputum
Cough, drooling, stridour
Hoarse voice
Decreased a/e,
wheezing
Explain the signs and
symptoms of hyperglycemia
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Fruity breath due to presence of
ketones
Frequent urination due to increased
osmolarity of blood
Also cause of polydipsia (drinking)
Conversion of fats to sugar
Hunger due to cells starving
What is the danger of CO?
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CO binds with higher affinity to HGB
and displaces O2
Patient gets hypoxic
Get cherry red appearance
What are resources to identify
chemicals you may have to
deal with?
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CANUTEC guide
WHIMIS
Poison control
Dangerous goods placard
Bystanders at a company
dispatch
What is the reason that
infections can cause septic
shock?
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Bacteria release endotoxins
Endotoxins cause histamine release and
vasodilation
The drop in SVR causes drop in BP
What are two causes of
ipsilateral pupil dilation
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Stroke
Tumour
Nerve palsy
trauma
What are 10 physiological
changes with age
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Decreased lung elasticity
Higher blood pressure
Changes in AV node
Temp regulation is impaired
Vision and hearing loss
Gait and balance
Dry mouth
Decreased sphincter tone
Diminished renal function
Higher bank balances
Skin thins
Bones weakened
More people to take you out for dinner
Immune function diminished
How do you manage a
frostbitten foot?
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Cover and protect the foot
Do not rub or massage the foot
Leave blisters intact
Bandage toes separately
Elevate and splint the foot
Describe the various levels of
frostbite
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Frostnip- mild blanching of skin
Superficial- waxy/white skin
Deep- cold, hard and wooden
What is the normal blood
pressure of a 4 year old?
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2 x age plus 80
8 + 80=88 systolic
2/3 of that is diastolic
What are some ways to
immobilize pediatric patients?
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KED
Pedimate
BB with lots of padding
What is naloxone
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A narcotic antagonist
NARCAN
What are some differences
between left and right lungs?
What are some drugs used for
heart failure?
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Diuretics
ACE inhibitors
Cardiac glycosides (when assoc with A
fib)
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You arrive on scene to find your patient post-ictal.
The patient's medical history, gathered from the
family, includes depression for which the patient is
medicated. Which of the following antidepressant
classes have seizures as a common adverse reaction
to?
a.
selective serotonin reuptake inhibitors
b.
tricyclics
c.
benzodiazepines
d.
antipsychotics
What is the difference
between ventilation and
respiration (think anatomy)
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Ventilation is the mechanical aspect of
getting O2 down to the lungs and CO2
out
Respiration is either internal (at the
cells) or external (at the lungs)
What are four kinds of heat
related injuries?
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Heat syncope
Heat cramps – large muscles
Heat exhaustion – non specific
unwellness
Heat stroke- severe altered mental
status
What are 10 signs and
symtoms of hypogylcemia
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Combativeness
Seizures
Confusion
Slurred speech
Ataxia
Tremours
Hunger
Syncope
Weakness
lethargy
What are some history questions you
would want to ask someone you suspect
may have the ‘bends”
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Number, depth and duration of dive
Water temperature,pollution
When symptoms occurred (underwater,
upon surfacing (gas emboli) or > 10
minutes(DCS)
Rate of ascent
Treatment rendered
What are signs and symptoms
of eclampsia?
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Seizure
Generalized edema
Light sensitivity, altered sensation
Headache
Abdo pain
Hypertension > diastolic 110
Protein in urine
Which of the following is correct?
a. decreasing chronotrophy causes increased HR
b. increasing dromotrophy means conduction through
AV node in increased
c. decreasing preload means more blood back to the
heart so increased blood pressure
d. increased chrontrophy means increased SV
Explain Boyles law
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PV=nRT
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Or
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Pressure is inversely proportional to V
What do you do if there is a cord
prolapsed and the woman is in
labour?
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Carefully insert gloved hand into the
vagina and attempt to relieve pressure
on the cord
Have the women lying in trendelenburg
position as much as possible
Keep cord moist
Drive like MAD!!
What is important to
remember when ventilating
infants?
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Towel or something under the should
Neutral position
Mask fitting well over mouth and nose
Gentle ventilation for good chest rise
Rate ?
What would make you suspect
child abuse in a call?
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Injuries that don’t fit description
Presence of many old bruises
Finger marks on child
Burns to buttocks or soles of feet,
circumphrenia burns
Inappropriatge interaction b/t caregivers and
child/ each other
Signs of physical neglect (severe diaper rash,
dirty, dehydration with extreme pallor etc)
Signs of use of object (belt, cigarette etc)
If you use a restraint on a
patient what must you
document?
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Reason for restraint
Name and order of person ordering
restraint (MD, police, EMA)
Method of restraint
Consequences and effects of restraint
Good luck!