BC EMR Evaluation Checklist Femur Fracture

Transcription

1 Call Details: Called to the parking lot at Home Depot for a 33 year old male hit by a car. Instructions to role players: You are a 33 year old male who was putting bags in your truck when another car backed into you, pinning your upper legs against the tailgate of the truck. The car then pulled forward, and you fell to the ground in severe pain, unable to support your weight with your legs. Participant s name: Time Started: Scene Survey Hazards Traffic in parking lot Gloves, Goggles, Cones MOI Pinned between cars # of Patients 1 Additional Resources Traffic control RCMP Needed Treat as crime scene Approach Identify self Introduce yourself What Happened? Please do not move (if applicable) C-Spine (if necessary) LOC (AVPU) Airway Breathing Circulation Skin Check RBS Critical Oxygen Blanket Bleeding Position Oximeter 92 Putting bags in truck when car backed into legs Not needed Alert Open, Clear 20; effective Pale and moist Present Severe pain, swelling and deformity mid-third femur; no blood Ask person not to move Primary Survey Quickly stabilize leg with helper/sandbags 10 lpm; Simple Mask Cover with blanket Keep still Apply pulse oximeter Transport Decision Rapid Transport - deferred Prepare Equipment Recorded with Vitals Page 1 of 7

2 History Signs and Symptoms Allergies Medications Past medical Hx Last Meal Events leading up Onset Provoke Quality Region/Radiate Severity Time Vital Signs Glasgow Coma Scale Eye Opening Verbal Respirations Rate Rhythm Quality Rate Rhythm Quality Left Leg pain and deformity Lactose, Hay Fever ASA; headache earlier Healthy 1 hour ago Pinned by car Sudden Movement Sharp Thigh into Knee 9/10 8 minutes ago Full 135 Weak 15 Secondary Survey Second set of Vitals 16 Full 120 Weak Skin Condition Pale; Moist Pale; Dry Blood Pressure 106/68 110/64 Pupils 4 mm; Equal; Reactive 4 mm; Equal; Reactive Blood Glucose N/app N/app 96% Simple Mask 10 lpm 15 Oxygen Saturation If Inaccurate Difference greater than 10 bpm Compare pulse rate on Oximeter to palpation or auscultation Difference of less than 10 bpm considered accurate Remove from finger Use warmer finger Remove nail polish Use Toe or earlobe if appropriate Re-apply oximeter and compare 95% Page 2 of 7

3 Vital Signs Cont. Check IV site Correct Solution Monitor IV Amount remaining Calculate Flowrate Check Flowrate If started by IV- Endorsed Paramedic IV Complications Change IV Bag Interstitial Circulatory Overload Thrombosis or Thrombophlebitis Catheter Embolism Site Infection Allergic Reaction Air Embolism Requested by IV- Endorsed Paramedic 50 ml or less remaining Glass to plastic before altitude Standard=15gtts/ml Macro=10gtts/ml Micro=60gtts/ml Gtts/min=volume to be infused x gtts/ml Infusion time(minutes) Discontinue TKVO, Semi-sit, O2 Discontinue Discontinue, Retain catheter Discontinue TKVO / Discontinue Left side, head down 30 degrees, check IV for leaks, O2 Wash hands Wear gloves Turn off flow control clamp Gently remove dressing and tape from IV site Hold sterile gauze over puncture site Grasp hub of catheter and pull straight back Pressure for 3-5 minutes Bandage when bleeding stopped Inspect catheter for completeness Document time and volume used IV started before 3 rd set of Vitals IV Documentation Time Started and Discontinued Amount of solution infused Type of solution Complications Page 3 of 7

4 Entonox Protocols Indications Contraindications Cautions Completed before administration Proper Storage Pain Inability to comply with instructions Enclosed area without ventilation Suspected Air Embolism or Pneumothorax Nitroglycerin taken in last 5 minutes Suspected Inhalation Injury and O2 saturation less than 100% Suspected Carbon Monoxide Poisoning; even if O2 saturation reads 100% Decompression sickness Depressant Drugs Shock Distended Abdomen COPD Maxillo-facial Injuries Primary Survey Investigation of Pain (OPQRST) Vital Signs including O2 saturation completed Contraindications ruled out Shake bottle if stored improperly Adequate ventilation secured (vehicle ventilation system activated if available) Not left unused over long periods Not stored below -6 Celcius Not stored vertically Instructions to Patient Begin administration of Entonox Self-administered using mask/bite stick Mask/bite stick operation Pain should be relieved May feel: o Light-headed o Giddy o Drowsy o Nauseous Stop or start at any time Use until pain relieved or Adverse effects felt Notify you if adverse effects felt Page 4 of 7

5 Entonox Cont. Monitor for Adverse Effects Cyanosis: Discontinue Patient unable to self-administer: Discontinue Aggravation/Increased Pressure in middle ear Decreased Cardiac Output Dizziness Decreased Level of Consciousness Amnesia Vomiting Nausea Giddiness Drowsiness Once pain is relieved Discontinue Entonox Non-Rebreather; 15 lpm Entonox Documentation Start and Stop time Patient Response Completed with other Documentation Traction Splint Assess Injured Leg Apply Traction Secure Splint Assess Injured Leg Left mid-third femur deformed, bruised, swollen; Left leg rotated outward and shorter than right leg No pedal pulse L foot No movement of L foot Place splint beside injured leg Have helper secure splint at thigh Apply ankle harness above malleoli Apply traction of 10% body weight 15 lbs maximum Position supine and realign left leg Do not apply cold due to poor distal circulation Ensure adequate padding 3 straps around splint; above and below injury Secure thigh strap Secure Figure 8 strap Reassess all splint straps and Traction Gauge Open fracture: 5 lb max Page 5 of 7 Left leg in line with body; same length as R leg Pedal pulse present; L foot No movement of L foot Load and Go Notify Hospital Re-check A-B-Cs 2 nd set of Vitals See above

6 Head to Toe Head Neck Chest Listen/Auscultate Abdomen Pelvis Lower Extremities Upper Extremities Back Monitor Oxygen Saturation Appropriate Treatment Documentation JVD present Equal-Bilateral L thigh deformity L thigh swelling Pedal pulse present; L foot No movement of L foot Present Normal Normal 96% Use lowest flowrate needed to maintain 95% saturation More advanced care needed Adjust up or down by 1 lpm each minute Within minimum and maximum flowrates for delivery method Check Vitals every 5 minutes Check I.V. with vitals if started by advanced care Completed Treat the patient NOT the oximeter Page 6 of 7

7 Time Ended Yes No Successful Comments: Participant s Name: Date: Participant s Signature: Evaluator s Name: Date: Evaluator s Signature: Page 7 of 7