Pre-hospital Care/First Responder
1. Information to relay to when making an emergency call (mnemonic: ETHANE)
E = Exact Location - The precise location of the incident
T = Type - The nature of the incident (trauma, non-trauma, heart atack, motor-vehicle accident), including how many vehicles, buildings etc. are involved
H = Hazards - Both present and potential (e.g., explosion, spillage of combustible materials, highly volatile hydrocarbons, chemicals, etc)
A = Access - Best route for emergency services to access the site, or obstructions and bottlenecks to avoid
N = Numbers - Numbers of Casualties, Dead and Uninjured on scene
E = Existing Emergency Services - Which services are already on scene, and which others are required - s0 as not to duplicate services, and for better utilization of services in other concurrently emergency happenings.
2. Focused History in Emergency Conditions/Trauma (mnemonic: SAMPLE)
S = signs and symptoms
A = allergies
M = medications
P = pertinent past medical history
L = last oral intake
E = events leading up to.
3. Things to look for in head-to-toe survey for trauma (mnemonic: DCAP - BTLS)
D = deformity
C = contusions
A = abrasions
P = punctures/penetrations
B = burns
T = tenderness
L = lacerations
S = swelling.
4. Signs to suspect fracture (mnemonic: DOTS)
D = Deformity
O = Open Wound
T = Tenderness
S = Swelling
Airway Management
1. Information to relay to when making an emergency call (mnemonic: ETHANE)
E = Exact Location - The precise location of the incident
T = Type - The nature of the incident (trauma, non-trauma, heart atack, motor-vehicle accident), including how many vehicles, buildings etc. are involved
H = Hazards - Both present and potential (e.g., explosion, spillage of combustible materials, highly volatile hydrocarbons, chemicals, etc)
A = Access - Best route for emergency services to access the site, or obstructions and bottlenecks to avoid
N = Numbers - Numbers of Casualties, Dead and Uninjured on scene
E = Existing Emergency Services - Which services are already on scene, and which others are required - s0 as not to duplicate services, and for better utilization of services in other concurrently emergency happenings.
2. Focused History in Emergency Conditions/Trauma (mnemonic: SAMPLE)
S = signs and symptoms
A = allergies
M = medications
P = pertinent past medical history
L = last oral intake
E = events leading up to.
3. Things to look for in head-to-toe survey for trauma (mnemonic: DCAP - BTLS)
D = deformity
C = contusions
A = abrasions
P = punctures/penetrations
B = burns
T = tenderness
L = lacerations
S = swelling.
4. Signs to suspect fracture (mnemonic: DOTS)
D = Deformity
O = Open Wound
T = Tenderness
S = Swelling
Airway Management
1. The 7"P"s of Rapid Sequence Intubation
1st P = Preparation
- Prepare what?
- Prepare: Patient, Physician, Pharmacology, Proper set of Equipments
- Patient - well connected to monitors, position of table at physician's elbow when flexed 90 deg or umbilical level
- Physician - comfortable position, mask & gown-up
- Pharmacology - for induction LOAD+Scoline for paralyzing agent
(see 3rd P for description of LOAD)
- Equipments: mnemonic - MEALSSS
- M = Mask - well fitting snugly
- E = ETT (appropriate size + 1 size above and 1 size below); for children, ETT size = (age/4) + 4 or child's little finger (less accurate)
- A = Airway gadgets in case of difficult airway or failed airway, e.g. Oropharyngeal airways, surgical airways, Quicktrach, cricothyrodotomy set, LMAs
- L = Laryngoscope blade: Straight (in BM, "L"urus, therefore, Mi"L"ler), "C"urved = Ma"C"intosh; good light source
- S = Syringe to test and inflate cuff balloon of ETT
- S = Stylet
- S = Suction catheter, Yankauer catheter
2nd P = Preoxygenation
Why pre-ox?
Administer FiO2 of as near possible as to 100% for 3 minutes - for denitrogenation, washing out N2 and replace with O2, improve apneic period before desaturation happens to less than 90%
3rd P = Premedications
"LOAD" up patient; basically to reduce risk of "tight brain" and "tight lungs"
- L = Lignocaine - obtund gag reflexes, reduce risk of increased ICP
- O = Opioids - to blunt sympathetic responses
- A = Atropine - to reduce risk of bradycardia esp for children given scoline
- D = Defasciculating dose of competitive NMB - can reduce intensity of fasciculation due to scoline
4th P = Paralysis
About 45 s - 1 min for scoline; about 1 min for Rocuronioum (0.9 -1.0 mg/kg iv)
Placement/passing of ET tube
5th P = Pressure on cricoid cartilage (Protection)
Sellick maneuver - the way to do it, is BURP! on cricoid cartilage
B = Backward
U = Upward
R = Rightward
P = Pressure
Why cricoid cartilage? it is the only structure with complete ring (signet ring shaped) - to press on vertebral body of C6
6th P = Placement of ET tube
Proper laryngoscope exam to visualize glottic opening; remember the axiom: tongue is an enemy, epiglottis is a friend in laryngoscopy exam
7th P = Post -intubation care
"Confirm" tube is in:
C = Clinical exam - 5 points auscultation: Right upper & lower, left upper & lower, & epigastric region
C = Clinical by direct laryngoscopy
C = Chest X-ray
C= Carbon dioxide (End-tidal) detector
C = Condensation of Et tube from direct visualization
Keep warm, maintain BP, drugs infusions, etc
