Case 107
Dispatch Information
PROCTOR: EMS 10, respond to a 3-year-old male who is having a seizure.
Pre-scene Action (BSI)
Student: I am Wearing nonlatex gloves and safety glasses
PROCTDR: Noted.
Scene Size-up
- Scene Safety
Student: Is the scene safe?
PROCTOR: Yes.
- Mechanism of Injury/Nature of illness
Student: What is the nature of the illness?
PROCTDR: The patient had a seizure and has gone limp.
- Number of Patients
Student: how many patients are there?
PROCTOR: one.
- Additional Resources
Student: I would c-all for advanced life support (ALS) assistance.
PROCTOR: Noted.
- C-Spine Stabilization
Student: I would not stabilize the cervical spine (c-spine) if there was no trauma
PROCTOR: Noted.
Initial Assessment
- General Impression
Student: my general impression is that the patient's condition is stable.
PROCTOR: Noted.
- Responsiveness/Level of Consciousness
Student: What is the patients level of consciousness?
PROCTO R: Sleepy with snoring respirations.
Student: I will open the airway with a head-tilt chin-lift or recovery
position per protocol.
PROCTOR: Noted.
- chief Complaint Apparent Life Threats
Student: What is the patient’s chief Complaint?
PROCTOR: The patient is sleepy.
- Assess the Airway and Breathing
Student: I will open the child’s airway. Is the child breathing?
PROCTOR: Noted. The child is breathing.
• Assessment
Student: What are the rate and the quality of breathing?
PROCTOR: Rate: Bradypneic (Clear once opened by the responder)
Quality: Snoring (clear once opened by the responder).
Student: I will position the ail-way.
PROCTOR: Noted.
• Provide oxygen
Student: I am applying oxygen at 15 L/min via pediatric non- rebreathing mask.
PROCTOR: "Noted.
• nsure Adequate Ventilation
Student: The patient has adequate ventilations at this time.
PROCTOR: Noted.
- Assess Circulation
Student: I am assessing the patient’s circulation.
PRDCTORI Noted.
• Assess for and Control Major Bleeding
Student: Do l find any major bleeding?
PROCTORI N0.
• Assess the Pulse
Student: What are the rate and the quality of pulses?
PROCTOR: Rate: Within normal limits. Quality: Bounding.
• Assess the Skin
Student: I am assessing the skin. What are the color, temperature
and condition of the skin?
PROCTOR: Color: Flushed. Temperature: Hot. Condition: Dry.
- Identify Priority Patients Make Transport Decision
Student: The patient is no longer having a seizure, so he is a low
priority and does not require immediate transport.
PROCTOR: Noted.
Focused History and Physical Examination/Rapid
Assessment
• Select the Appropriate Assessment (Focused or Rapid)
Student: I am selecting the focused assessment.
PROCTOR: noted.
• SAMPLE History
Student: At this time I will gather 2. SAMPLE history from the patient or family. what are the patients signs and symptoms?
PROCTOR: filtered mental status.
Student: Describe the episode.
PROCTOR: The patient has had the flu for a few days.
Student: onset: What was he doing when this started?
PROCTOR: Watching TV.
Student: Duration: how long has this been going on?
PROCTOR: 2 minutes.
Student: Are there any associated symptoms?
PROCTOR: Yes, he is worn out.
Student: Is there any evidence of trauma?
PROCTOR: NO.
Student: Interventions: Pies the patient or his parents done anything to make this better?
PROCTOR: The patient and his parents have taken no actions.
Student: Have there been any seizures?
PROCTOR: Yes, just this one.
Student: Has there been any fever?
PRDCTOR: YES, 1O2.5°F (39.2°C).
Student: Allergies?
PROCTOR: No allergies.
Student: Medications?
PROCTOR: Children’s Tylenol about 20 minutes ago.
Student: Pertinent past medical history?
PROCTOR: No pertinent medical history
Student: Last oral intake?
PROCTOR: The patient has been drinking Kool-Aid.
Student: Events leading up to the incident?
PROCTOR: The patient was watching W
- Perform the Focused Physical Examination
Student: l am performing the focused physical examination.
PROCTOR: Noted.
Student: What is the patient’s level of consciousness, at this time?
PROCTOR: He is tired but responds to verbal stimuli. .
Student: Are there any injuries from the seizure?
PROCTOR: There are-no obvious injuries.
Student: What is the patient’s blood glucose level?
PROCTOR: lt is 94 mg/dl
- Baseline Vital Signs
Student: What are the patient’s baseline vital signs, including blood Pressure, pulse, respirations, pulse oximetry, blood glucose level, and level of consciousness?
PROCTOR: Blood pressure, NIA; pulse, 132 beats/min; respirations,
32 breaths/min; pulse oximetry reading, N/A; blood glucose level,
94 mg/dL and the patient are tired.
- interventions
Student: I will apply oxygen, monitor the airway, and cool per local proctor
PROCTOR: Noted.
I will apply basic life support (BLS) interventions, plus the following: establish IV access.
ALS Proctor: Noted.
- Reevaluate Transport Decision
Student: This patient does not require immediate transport.
PRDCTOR: Noted.
- Detailed Physical Examination
Possible Answer #1
Student: I would not do a detailed physical exam.
PROCTOR: Noted. (Go to “Radio Report.")
Possible Answer #2
Student: I am conducting the detailed physical exam. I am looking
For DCAP-BTLS. This acronym stands for deformities, contusions,
Abrasions, punctures, penetrations, paradoxical motion in the
Chest, and bums, tenderness, lacerations, and swelling.
PROCTOR: Noted. The detailed physical exam will be performed during transport.
• Assess the Head
Student: I am assessing the head. Do I find any DCAP-BTLS ? Do I
find any evidence of Battles sign or raccoon eyes?
PROCTOR:No.
- Inspect and Palpate the Head and Ears
Student: I am assessing the head and ears.
PROCTOR: There are no obvious injuries.
• Assess the Eyes
Student: I am assessing the eyes. Are the pupils equal, round, and regular in size, and react properly to light (PEARRL)?
PROCIOR: They are slow to react.
• Assess the Facial Area Including Oral and Nasal Areas
Student: I am assessing the face, nose, and mouth. Do lsee any
discharge or hear any obstructions?
PROCTOR: The airway is clear once it is opened by the rsponder.
• Assess the Neck
-Inspect and Palpate the Neck
Student: I am assessing the neck for DCAP-BILS.
PROCTOR: There are no obvious injuries.
-Assess for jugular Vein Distention
Student: Do I find any jugular vein distention (JVD)? PROCTOR: N0.
• Assess for Tracheal Deviation
Student: Do I see any tracheal deviation? -
PROCTOR: NO
• Assess the Chest
Student: I am assessing the chest for DCAP-BTLS.
PROCTOR: Noted.
• Inspect
Student: What do I see when I look at the chest?
PRUETOR: There are no obvious injuries.
Student: Is the chest symmetric?
PROCTOR: Yes.
• Palpate
Student: When I touch the chest, do I feel crepitus or a flail segment?
PROCTOR: NO
• Auscultate
Student: Are lung sounds present in all fields?
PROCTOR: Yes.
Student: Do I hear any sucking sounds from the chest?
PROCTOR: NO
* Assess the Abdomen/Pelvis
- Assess the Abdomen
Student: I am assessing the abdomen for DCAP-BTLS. I am assessing all Io ur quadrants. Do I find any problem ?
PROCTOR: No.
- Assess the Pelvis
Student: I am assessing the pelvis for DCAP-BTLS. Is the pelvis stable?
PROCTOR: Yes
• Assess the Genitalia/Perineum as Needed (Verbalize in Training)
Student: I am assessing the genitalia/perineum as necessary for DCAP-BTLS.
PROCTOR: The area is unremarkable.
* Assess the Extremities
- Inspect
Student: I am assessing the lower and upper extremities for DCAP-BTLS. Do I find anything?
PROCTDR: No.
- Palpate
Student: Do I feel anything unusual?
PROCTOR: No.
- Assess Motor, Sensory, and Circulatory Function
Student: I am checking for DCAP-BTLS, motor and sensory function, and pulses. Right leg?
PROCTOR: Negative DCAP-BTLS. Motor and sensory functions are present. Pulses are present.
Student: Left leg?
PROCTOR: Negative DCAP-BTLS. Motor and sensory functions are present. Pulses are present.
Student: Right arm?
PRUCTUR: Negative DCAP-BTLS. Motor and sensory functions are present. Pulses are present.
Student: Left arm?
PROCTU R: Negative DCAP-BTLS. Motor and sensory functions are present. Pulses are present.
- Assess the Posterior
Student: We will check the back.
PROCTOR: Noted.
- Assess the Thorax
Student: I am assessing the thorax. Do I find injuries?
PROCTOR: No. '
- Assess the Lumbar Area
Student: I am assessing the flanks and lumbar area. Do I find injuries?
PROCTOR: NO.
- Assess the Entire Backside
Student: I am assessing the entire backside. Do I find injuries?
PROCTOR: No.
- Manage Secondary Injuries/wounds
Student: I would direct my partner to maintain the airway.
PROCTOR: Noted.
- Reassess Interventions
Student: I will reassess my interventions; airway, breathing, oxygen, and cool per local protocol.
PRODTOR: Noted.
ALS student: I will reassess BLS interventions, plus the following: IV access.
ALS Proctor: Noted.
- Radio Report
(Provided by the student.)
PROCTOR: Noted.
Ongoing Assessment
- Repeat the Initial Assessment
Student: I will repeat the initial assessment.
PROCTOR: Noted. (Reflected in “Repeat Vital Signs")
- Repeat Vital Signs
Student: l will reassess vital signs and mental status.
PROCTOR: Blood pressure, N/A ; pulse, 128 beats/min; respirations,28 breaths/min; pulse oximetry reading, N/A; and the patient is tired.
Student: The vital signs have not changed significantly.
PROCTOR: Noted.
- Check Interventions
Student: I will check my interventions: airway, breathing, oxygen, and cool per local protocol. .
PROCTOR: Noted.
ALS student: l will check BLS interventions, plus the following: IV access.
ALS Proctor: Noted.
- Repeat the Focused Assessment
Student: l will repeat the focused assessment.
PROCTOR: Noted.
- Handoff Report to Emergency Department Staff
Student: There was no change during transport.
PROCTOR: Noted.
- Critical Criteria
(Inform the student of items missed, if any.)