Waterous Flot Pump (Notes)



Waterous Floto-Pump

(Updated through 8/7/04)

▪ The floto-pump will supply a 1 1/2" line flowing approximately 90 gpm.

▪ The floto-pump can be used to supply a line or to fill booster tanks.

▪ A mixture of 1/3 pint, No. 30 outboard oil per 1 gallon of gasoline is required for the floto-pump.

▪ Fuel tank capacity of the floto-pump is 5 quarts.

▪ With strong winds, attach a rope to the pump to secure it in place.

▪ The engine on the floto-pump should be started before placing it in the water.

▪ The vent in the fuel tank cap should be opened by turning counterclockwise.

▪ The throttle is automatically kept in idle position until the floto-pump is in the water.

▪ The pull start rope should be pulled part way through stroke to bleed off some compression prior to starting.

▪ The choke should be opened after starting by moving it toward the engine.

▪ The throttle may be opened manually by lifting the throttle control float for short bursts, however, prolonged use of this lever may result in damage.

▪ The floto-pump should be placed in the water slowly to prevent stalling.

▪ Turn ignition switch to "off" position to stop the floto-pump.

▪ The fuel tank vent should be closed (turned clockwise) before transporting.

▪ If the floto-pump stalls under a load, the "idle mixture" may be too lean.

▪ If the floto-pump stalls when the pump primes, the "high speed" adjustment may be too lean.

▪ All adjustments should be made by shop personnel.

▪ If engine fails to start, check spark plug for intensity, and if spark plug is dry and working, remove the air intake and pour in 1 tablespoon of fuel mixture.

▪ The spark plug gap for floto-pumps should be 0.030.

▪ With an empty hose attached the pump will prime quickly.

▪ With a hose kinked near the discharge or with a hose partially full of water, the pump may take 30 seconds or more to prime.

▪ Floto-pumps should not be operated in less than 6 inches of water.

Stihl 044 Chain Saw

(Updated through 8/7/04)

▪ Chain saws with displacements of 3.8 cubic inches or more must have at least 1 device to reduce kickback (ANSI standard).

▪ The 3/8" carbide chain and 20" hard tipped bar of OCFD chain saws does not meet reduced kickback standards, but is recommended for fire service use.

▪ The Stihl 044 Chain Saw has 2 brakes, manual and inertia.

▪ Chain saws have been used for ventilation for 20-30 years.

▪ Fire Service chain saws should have a displacement of at least 4 cubic inches.

▪ Replacement of carbide chains should occur when 3 cutters in a row OR 6 in the whole chain are missing.

▪ A chain saw with carbide chain provides better feel for penetration through a roof, cuts faster, does not bind, and does not require standing directly over it, like a K12.

|KICKBACK, PUSHBACK, & PULL-IN |

|Type |When it Occurs |Reaction |Situations |

|Kickback |Upper quadrant of bar NOSE contacts solid object|UP & BACK motion of bar toward |When incorrectly beginning a |

| |or is pinched |operator |plunge cut |

|Pushback |Chain on top of bar is suddenly stopped when |Drives saw straight BACKWARD toward |When top of bar is used for |

| |pinched, caught, or encounters a foreign object |operator |cutting. |

| |in roof | | |

|Pull-In |Chain on bottom of bar is suddenly stopped when |Pulls saw FORWARD |When bottom of bar is used to cut|

| |pinched, caught, or encounters a foreign object | |and not at full speed before |

| |in roof | |contacting material |

▪ Forces involved in a kickback include:  chain speed, speed at which bar contacts object, angle of contact, condition of chain, and other factors.

▪ The inertia brake can either be activated manually by hand or by inertia (if left hand is not behind front hand guard) during a severe kickback.

▪ Activation of the inertia brake results in brake latch being unlatched and brake band clamping around the clutch drum to stop and lock the chain saw.

▪ The hand guard must be moved toward the nose of the bar to activate.

▪ The chain brake can only be engaged while idling.  To release the brake, the hand guard is pulled back toward handlebar.

▪ The hexagonal nut for the sprocket cover should be tightened securely after tensioning of the chain.  Never start with sprocket cover loose.

▪ If using a leg lock device while using a chain saw, 2 firefighters must be employed.

▪ NEVER plunge the nose of the chain saw bar into a roof to avoid kickback.

▪ NEVER drop start a chain saw.

▪ The Stihl 044 Chain Saw operates at about 13,000 rpm.

▪ Shut off chain saw engine before putting on ground, floor, or roof.

▪ Do not operate the Stihl 044 chain saw with the starting throttle lock engaged.

▪ Always cut at full throttle.

|Stihl 044 Chain Saw Master Control Lever Positions |

|A position |uppermost position |STOP |Engages a spring that cuts the ignition system, selected only from B |

| | | |position |

|B position |next to top position |RUN |run position |

|C position |next to bottom position |WARM START |Returns to "RUN" position upon squeezing the throttle after starting |

|D position |bottom position |COLD START |Choke shutter is closed and throttle trigger is set to the starting |

| | | |throttle position |

▪ The Stihl 044 Chain Saw should be started by engaging chain brake (push towards bar nose), set master control lever to "cold start" if cold or "warm start" if warm, place left hand on front handle, place right foot into rear handle (flat roofs only), pull rope until starter is felt, give a brisk pull.

▪ Warm start should be used if the engine has been running but is still cold.

▪ When using cold start, move the control to warm start when engine begins to fire and continue to crank until started.

▪ When in warm start, blip the throttle trigger so the master throttle lever moves to "RUN" and engine moves to idle speed.

▪ If engine is not returned to idle speed after starting, the clutch can be damaged.

▪ Chain tension, in cold condition, is correct when chain fits snugly against the underside of the chain saw bar.

▪ When warm, the saw chain expands and sags noticeably.

▪ Saw chains must be re-tensioned when drive links come out of groove on underside of bar.

▪ To re-tension the saw chain, back off hexagon nuts, pull bar guide by the nose until chain is a close fit, tighten hexagon nuts.

|Stihl 044 Chain Saw Carburetor Settings |

|High Speed |Screw H |Back off 1 turn |

|Low Speed |Screw L |Back off 1 turn |

|Fine tune engine |Clockwise=LEAN, Counterclockwise=RICH |

▪ A certain amount of oil is left in the oil tank when fuel is empty.

▪ The Stihl 044 Chain Saw oil pump is controlled by chain speed.

▪ Oil tank should be refilled when refueling.

|Stihl 044 Chain Saw Specs |

|Engine Type |1 cylinder - 2 stroke |

|Displacement |4.31 cubic inches |

|Ignition |Breakerless |

|Fuel Tank Capacity |1.69 pints |

|Fuel Mixture |Stihl Oil 50:1 (1 gallon gasoline to 2.56 ounces oil) |

|Chain Lubrication |Fully automatic |

|Oil Tank Capacity |0.7 pints |

|Oil Type |14oF-50oF use SAE 20 50oF-104oF use SAE 30 |

|Weight |12.8 lbs. |

▪ The choke is activated by the Master Control Lever.

▪ The bar should be turned over, every time the chain is replaced, for even wear.

▪ If wear marks on sprockets are deeper than 0.02 inches deep, they should be replaced.

▪ The brake should be applied manually when starting the chain saw.

▪ The engine speed should not be revved with brake engaged.

▪ The manual brake should not be applied while the chain is moving, except in an emergency.

DEFINITIONS

▪ FRONT HANDLE - Handle bar for the left hand at front of saw.

▪ SPARK PLUG TERMINAL - Connects the spark plug with ignition wire.

▪ TWIST LOCK - Lock for carburetor box cover.

▪ CARBURETOR ADJUSTING SCREWS - For tuning carburetor.

▪ HANDLE HEATING SWITCH - For switching the electric handle heating on or off.

▪ REAR HANDLE - The support handle for the right hand, located at or toward the rear of the saw.

▪ REAR HAND GUARD - Give's added protection to the operators right hand.

▪ FRONT HAND GUARD - Provides protection against projecting branches and helps prevent the left hand from touching the chain if it slips off handle bar.

▪ CHAIN BRAKE - A device to stop the rotation of the chain if activated in a kick back situation by the operator's hand or by inertia.

▪ BUMPER SPIKE - Toothed stop for holding saw steady against wood.

▪ GUIDE BAR NOSE - The exposed end of the chain saw.

▪ OILOMATIC SAW CHAIN - A loop of chain having cutters, tie straps, and drive links.

▪ CHAIN TENSIONER - Permits precise adjustment of chain tension.

▪ CHAIN CATCHER - Helps to reduce the risk of operator contact by a chain when it breaks or comes off the bar.

▪ CHAIN SPROCKET - The toothed wheel that drives the saw chain.

▪ CHAIN SPROCKET COVER - Covers the clutch and the sprocket.

▪ OIL QUANTITY CONTROL - Adjusting screw for matching chain oil feed to cutting conditions.

▪ CHAIN GUARD (Scabbard) - Covers the bar and chain when saw is not in use.

▪ MUFFLER - Reduces engine exhaust noise and directs exhaust gases.

▪ OIL FILLER CAP - For closing the oil tank.

▪ STARTER GRIP - The grip of the starter for starting the engine.

▪ SAFETY THROTTLE LOCK - Must be depressed before throttle trigger can be activated.

▪ THROTTLE TRIGGER - Controls the speed of the engine.

▪ MASTER CONTROL LEVER - Lever for choke control, starting throttle, and stop switch.

▪ FUEL FILLER CAP- For closing the fuel tank.

▪ CLUTCH - Couples engine to chain sprocket when engine is accelerated beyond idle speed.

First Responder Protocols

(Updated through 8/7/04)

Due to the nature of the way the Protocols are written, these notes may seem

excessive and awkward to read, however, all key points should be covered.

|Abbreviations used in notes:  Pt (patient), LOC (level of consciousness), BP (blood pressure), Tx (treatment), |

|Hx (history), Fx (fracture), CC (chief complaint), S/S (signs & symptoms), HR (heart rate), > (greater than), |

|< (less than), GSC (Glasgow Coma Scale), SOB (shortness of breath), yo (years old), Meds or Rx (medications), |

|JVD (jugular vein distention), MOI (mechanism of injury) |

SECTION I - ADMINISTRATIVE PROTOCOLS

PROTOCOL I.1  Communication Reports

|History |Objective Findings |Treatment |

|Pt. #/age/sex, C/C, S/S, Hx, Rx |Condition, LOC, vitals, localized findings |In progress, Response  to Treatment |

• Objective findings make take precedence over detailed Hx.

• Patient care decisions are made by the highest medically-trained first responder on scene until arrival of ALS.

PROTOCOL I.2  Code 1 Trauma Reports

• Early notification required for ALL patients.

• Notify hospital of Code 1 Trauma Patients as soon as possible.

• Multiple patients should be IMMEDIATELY triaged.

|Code 1 Trauma Patient Criteria |

|(Blunt/Penetrating Trauma w/ unstable vitals) |

|Hemodynamic |BP < 90 OR HR > 110 w/ cool/pale skin |

|Respiratory |< 10 b/m OR > 29 b/m |

|Mental Status |GCS ≤ to 12 |

|Code 1 Trauma Patient Criteria |

|(Anatomical Injury) |

|Penetrating head, neck, or torso.|2nd/3rd degree burns > 20% or involving face, |Amputation above wrist or ankle. |Paralysis |

| |airway, hands, feet, or genitalia. | | |

|Flail Chest |2 or more long bone Fx |Unstable pelvis or Fx |Open/depressed skull Fx |

|Significant altercation/assault |Tender and/or distended abdomen |

• Use closest COMPREHENSIVE treatment facility for Code 1 trauma patients.

PROTOCOL I.3  Multi-Patient Scene/Mass Casualty Incident/Triage

• A Multi-Pt. Scene (MPS) is < 5 critical or < 10 non-critical.

• A Mass Casualty Incident (MCI) is 5 or more critical or 10 or more non-critical.

• Triage tags identify severity of injury, location victim was found, and where victim was sent (approved by MCB).

• RED (Level I) is Critical, requires care within 0-30 min.

• YELLOW (Level II) is Urgent, requires care within 30-120 min.

• GREEN (Level III) is Delayed, requires care within 12 hours.

• BLACK (Level IV) is Dead or near dead.

• Overall Incident Command at MCI or MPS scenes is the responsibility of the police/fire.

• On MPS, advise dispatch of Pt. #, units needed, hazardous conditions, best access, and staging area.

• The Medical Sector Coordinator at MPS shall manage patient care (NO hands on), establish communications, assign ambulances to specific pts, and maintain pt. worksheets.

• The Triage Officer at MPS shall perform rapid triage, tag pts, fill out pt. log w/ tag color and age/sex, relay triage info to MSC, update reports as needed, and assist treatment and transport teams after triage is completed.

• The 1st ALS unit at an MCI shall relay to dispatch:  location, incident type, environmental conditions, # or ALS rigs needed, immediate danger zone, staging area, best access, and # of pts.

• Vests and task cards should be used at MCI incidents.

• The Med. Director assumes Medical Command at an MCI on arrival and will coordinate activities of sectors (Triage, Treatment, Transportation, Communications).

• Colored tape should be used for triage in the Rescue Area and tags used in the Triage Area.

• Triage tags usually come 25 in a bundle.

• On first pass triage, only open airway if needed and tag.

• Attach triage tags string to body, NOT clothing (head or upper arm).

• Ambulatory patients (Green Tag) should be directed to the GREEN treatment area.

• Reports # of triages pts to Triage Officer upon completion.

• Confer w/ Med. Command for Treatment location.

• Personnel in Treatment sector will perform BASIC packaging and FWD pts to GREEN, RED, or YELLOW treatment areas.

• Tags should be filled out by treatment personnel (injuries on body diagram, BP, Pulse, Resp.)

• IV or IM drugs given to triages pts should be noted on the ADMIN side of the triage tag with time, date, pt. name, address, city, state, and past Hx/prescriptions.

• On the LAST line of the triage tag, the primary treating paramedic shall enter their name.

• The Red Cross symbol (contains tracking #) should be torn from triage tags prior to letting patient leave treatment area w/ # entered on run report.

• The tracking number on triage tags is found on the perforated corners, the main portion of the tag, and on each colored tear-off strip.

• No more than 1 category RED per ambulance.

• The Unit # and #/injury types of pts on board each ambulance that leaves the transportation sector should be relayed to Medical Command.

• Ambulatory pts may be loaded on buses.

• Prior to leaving the transportation sector, the AMBULANCE portion of the triage tag should be removed and notation of pt. name, age, condition (mandatory), and destination (mandatory).

• Ambulances arriving on scene for transport at an MCI should stay w/ their ambulance.

• The Communications Sector will maintain an MCI log using info from the Transportation Sector.

• Communications sector will request additional ambulances through Medical Command.

• When ambulances are ready for transport, relay #/injury types of pts on board to dispatch.  Dispatch will determine destination.

• The Communications Sector will notify each receiving hospital of the unit #s and types of pts on their way.

• The first paramedic on scene is in charge of overall patient care (no hands on).

• Transporting units should not contact the receiving hospital except for deteriorating patient condition and Medical Control contact is needed.

PROTOCOL I.4  No Code Orders and Discontinuance of CPR

• First Responders may accept a written statement from 2 physicians that patient is qualified for DNR.

• First Responders may discontinue or NOT start CPR if no pulse AND no respirations AND pupils fixed/dilated AND rigor OR decapitation decomposition OR lividity OR Directive/DNR.

• Blunt traumatic arrest w/out signs of life or shockable rhythm (AED) does not require CPR.

• If injuries are incompatible w/ life, rhythm does NOT have to be determined.

• Termination of treatment from a physician can be verbal or in writing.

• DNR orders are based on pts decision, terminal conditions, imminent death, or cardiovascular unresponsiveness.

• First Responders will carry out orders of the pt’s personal physician if on scene.

• On infants, children, young adults, and in cases of unexpected death, CPR should not be discontinued unless prolonged death is evident.

• Hypothermia pts must be given aggressive resucitative efforts if a significant factor in arrest.

PROTOCOL I.5  Patient Refusal or Non Transport

• Refusals should be evaluated f/ urgency of condition.

• EMSA FOS must be contacted f/ refusals where service is requested, pt contact is made AND pt has acute medical condition AND age 55 OR chest pain OR S.O.B. OR ?LOC OR Trauma OR Diabetes OR Seizures OR all NON-emancipated minors OR any pt which paramedic thinks refusal would hurt be detrimental to pt.

• The FOS will explain the condition, risks, alternatives to Tx, and assumption of risks to the pt on a recorded line.

• NON-transport form must include:  C/C, vitals, & paramedic assessment.

•  Leave pt instruction sheet f/ refusals.

• Documentation f/ refusal form include:  pt statements, options given, paramedic’s observations, & pt signature.

PROTOCOL I.6  Physician on Scene

• The MCP should be contacted if a NON-MCP requests procedures against protocols.

• If a NON-MCP goes against the MCP, they must sign the medical record & if NOT riding w/ pt to hospital, they must contact the MCP for transfer of care.

• Physicians on scene can be verified by their license f/ the OK State Board of Medical Licensure & Supervision.

• Orders f/ a pts personal physician on scene should be followed unless they go against protocol, if so, contact MCP.

PROTOCOL I.7  Staging

• Stage 2 city blocks or at a 120o angle f/ violent scenes (outside “Danger Zone”).

PROTOCOL I.8  Crime Scene Management Policy

• Only units assigned will respond to crime scene.

• On arrival at crime scene, protected by law enforcement, first responders will request entry to determine life status of pt.

• If law enforcement at a crime scene does NOT allow entry by first responders, complete incident report & forward it to supervisor.

• Only one first responder should enter a crime scene to minimize disturbance of scene.

• Victims of penetrating trauma at crime scene should be checked f/ pupil reactivity, carotid pulse, & respirations.

• Head, neck, or truncal penetrating wounds w/ pupils fixed/dilated & carotid pulse/respirations absent:  DO NOT WORK.

• Isolated EXT wounds w/ pupils fixed/dilated & carotid pulse/respirations absent: continue BLS until rhythm verified, if asystolic, DO NOT WORK.

• Victims of blunt traumatic arrest w/OUT signs of life OR shockable rhythm (AED):  DO NOT WORK THEM.

• If injuries incompatible w/ life, determination of rhythm NOT necessary.

• If verifying rhythm on a prone pt, apply electrodes to appropriate back locations (L. Arm, R. Arm, & Lower Back).  Fast Patches may also be used (Upper R Back, Lower L Back).

• If NO signs of trauma w/ no signs of life AND either rigor, decapitation, decomposition, lividity, Directive, OR DNR, do not attempt resuscitation.

• If pt at crime scene has signs of life, initiate resuscitative efforts by:  keeping equipment close, staying close to pt, keep hands out of pooled blood, do NOT wander around scene, minimize destruction of pt clothing (don’t cut through holes).

• At a crime scene DO NOT go through pts effects (if expired), cover body w/ sheet (if expired), move/take/handle objects, clean body of blood, wander around scene, or litter crime scene w/ equipment, dressings, bandages, etc.

• Victims at crime scenes should be taken to the ambulance f/ stabilization if possible.

• Information pertaining to a crime relayed by pt during transport should be given to police at once.

PROTOCOL I.9  Care of Minors Protocol

• If on scene w/ a minor & no parents/guardian, paramedics can treat if given consent by minor AND reasonable attempt has been made to contact parents/guardian.

• If a minor refuses treatment and parent/guardian is not present AND cannot be reached, and pt IS in need of further evaluation, contact OCPD to put them in protective custody.

• If a minor has significant illness/injury OR ?LOC OR post-altered LOC OR impaired decision-making capability, do not leave pt without a parent/guardian.

• Have minor patients sign refusal form and leave instruction sheet if not in need of medical evaluation.

• A minor can NOT revoke consent after giving it.

• Minor – any person < 18yo, except persons on active duty or who has served in military (considered Adult).

• Emancipated Minor – any minor who is married, has a dependent child, pregnant, or emancipated (separated & not supported by parents/guardian)-TREATED AS ADULTS.

PROTOCOL I.10  Use of Helicopter Within the Regulated Service Area

▪ Helicopter is NOT used on the following pts:  Cardiac arrest w/o spontaneous return of circulation, Trauma pts w/ trauma score 4 or less, Trauma pts no meeting Code 1 Trauma criteria, and pts w/ stable vitals and no serious illness/injury.

▪ Use helicopter within 10 mile radius of helicopter hospital ONLY for impassable road conditions, multiple patients, and lengthy extrication (delayed by ground).

▪ EMSA can request helicopter through dispatch, first responder must get ETA from EMSA before dispatching helicopter.

▪ Fire or law enforcement is responsible for safe landing zone.

▪ All helicopter dispatches are reviewed by Office of the Medical Director (MCB).

SECTION II - TREATMENT PROTOCOLS

Initial Arrival at the Scene

▪ If pt condition is unknown, take PPE, trauma bag, BVM or demand valve mask, suction unit, BP cuff/stethoscope, and AED to scene.

▪ Guidelines for requesting additional EMSA units include:  2 or more critical pts or 3 or more non-critical pts.

▪ Take a complete set of vitals and repeat every 5-10 minutes.

Trauma Patient Assessment - Primary Survey

▪ Trauma pt assessment consists of environmental assessment (hazards, # of pts, MOI, surroundings), and primary survey.

|Primary Trauma Survey Components (ABCDEs) |

|Airway |Air movement |

| |C-Spine |

| |Airway obstructions (blood, vomitus, trauma) |

|Breathing |JVD |

| |Chest movement |

| |Rate |

| |Open/sucking wounds, flail segment |

| |Auscultate:  crackles (wet sounds), wheezes |

| |Palpate:  crepitus, tenderness, fractures, unequal chest rise (flail) |

|Circulation |Note strong/weak |

| |Radial pulse = systolic BP >80 |

| |Femoral pulse = systolic BP >70 |

| |Carotid pulse = systolic BP >60 |

| |Cap refil should be 2 sec. or less |

| |Skin color/condition |

| |Control hemorrhage |

|Responsiveness |AVPU |

|(Disability) |Body position/extremity movement |

| |PMS in 4 extremities |

|Expose |Remove clothes to check for injury, if appropriate |

Trauma Patient Assessment - Ongoing Survey

▪ Ongoing assessment is the systematic assessment of the entire pt (head-to-toe, look for non-life threatening problems).

▪ Ongoing survey is performed after initial survey and stabilization of life-threatening ABC problems.

|Ongoing Trauma Survey Components (ABCDEs) |

|Head & Face |Observe/palpate for deformity, tenderness, crepitus, bleeding |

| |Check pupils, nose, ears |

|Neck |Check deformity, tenderness, medical alert tags, tracheal shift |

|Chest |Observe, palpate, auscultate (symmetry, pain, air leaks, wounds) |

|Abdomen |Observe/palpate all 4 quadrants (tenderness, rigidity, distention) |

|Pelvis |Palpate/compress lateral pelvis and symphysis pubis |

|Shoulders/Arms |Observe, palpate, check PMS |

|Legs |Observe, palpate, check PMS |

|Back |Logroll to observe/palpate (keep c-spine); may occur in primary survey |

▪ Record 2 or more sets of vitals/neuro assessments prior to transport.

▪ Pts can NOT be called stable without at least 2 sets of vitals with similar normal readings.

|Adult Trauma Score |

|Glasgow Coma Scale |Systolic BP |Resp. Rate |Points Assigned |

|13-15 |>89 |10-29 |4 |

|9-12 |76-89 |20kg |10-20kg |90 |>90-50 |>50 |

|CNS (LOC) |Awake |Obtunded |Coma/decerebrate |

|Open Wound |None |Minor |Major/penetrating |

|Skeletal |None |Closed |Open/multiple Fx |

Medical Patient Assessment

▪ Initial survey (ABCDEs) are done on medical and trauma patients.

▪ Head-to-toe survey for medical pts follows initial assessment.

|Pediatric Patient Assessment |

|General |Alertness, eye contact, attention to surroundings |

| |Muscle tone |

| |Responsiveness to parents |

|Head |Trauma |

| |Fontanelle (depression/bulging) |

|Face |Pupils (brightness of eyes-hydration) |

|Neck |Stiffness |

|Chest |Stridor, retractions, depressions between ribs on inspiration |

| |Auscultate heart/lung sounds |

|Abdomen |Distention, rigidity, bruising, tenderness |

|Extremities |Brachial pulse |

| |Skin temp/color |

| |Muscle tone, guarding |

|Should include Neuro assessment |

|Vital Signs (Infants & Children) |

|Age |Weight (kg) |Heart Rate |Resp. Rate |Systolic BP |

|NB |3 |100-160 |30-60 |70-110 |

|6 mo |7 |90-150 |24-36 |70-110 |

|1 yr |10 |90-150 |22-30 |70-110 |

|3 yr |15 |80-120 |20-26 |80-120 |

|5 yr |20 |70-110 |20-24 |80-120 |

|10 yr |30 |60-90 |16-20 |90-120 |

|12 yr |40 |60-90 |16-20 |90-130 |

|14 yr |50 |60-90 |14-20 |90-140 |

|APGAR Scoring for Newborns |

|Clinical Sign |0 points |1 point |2 points |

|Appearance |Blue, pale |Extremities blue |Pink |

|Pulse |None |100 |

|Grimace |None |Grimace |Cries |

|Activity |None |Some flexion |Activity |

|Respirations |None |Slow, irregular |Good, strong cry |

 

|GLASGOW Coma Scale |

|Activity |Score |Infants |Child/Adult |

|EYE OPENING |4 |Spontaneous (both) |

| |3 |To Speech/Sound |To Speech |

| |2 |To Pain (both) |

| |1 |None (both) |

|VERBAL |5 |Appropriate words/sounds, smile,|Oriented |

| | |eyes follow | |

| |4 |Cries, but consolable |Confused |

| |3 |Irritable |Inappropriate words |

| |2 |Restless/agitated |Incomprehensible words |

| |1 |None (both) |

|MOTOR |6 |Spontaneous movement |Obeys commands |

| |5 |Localizes pain |

| |4 |Withdraws to pain |

| |3 |Abnormal FLEXion (decorticate) |

| |2 |Abnormal EXTension (decerebrate) |

| |1 |None (both) |

▪ Observe eyes for direction of gaze during neuro assessment.

▪ The lowest GLASGOW score is 3, NOT 0.

▪ Mild (noxious) painful stimuli used in neuro assessment includes:  light pinch, dull pin prick.

▪ Use several observers to elicit the best verbal response from children to avoid under-estimation of GLASGOW score.

Patient History

▪ Medical pt Hx should include chief complaint (CC), associated complaints, past medical Hx, allergies, medications/drugs, last oral intake.

▪ Trauma pt Hx should include CC, associated complaints, mechanism of injury (MOI), and mental status.

▪ For medical pts, Hx is commonly obtained during or before physical assessment.

|PROTOCOL II.1  GENERAL SUPPORTIVE CARE |

|Adult |PEDS |

|Assessment/Hx |Same as Adult except chest pain/COPD |

|2 sets of vitals | |

|Airway (patient positioning/manual maneuvers for patent airway) | |

|OPA/NPA if positioning/manual maneuvers do NOT work | |

|S/S of hypoxia (tachypnea, cyanosis, tachycardia, altered LOC, chest pain) | |

|Hypoxic pts get 10-15 lpm O2 by NRB, unless COPD (then 2 lpm by NC) | |

▪ Patients with chest pain or high-risk medical conditions should NOT be ambulated.

▪ Infants less than 4 mo. old are obligate nose-breathers (nasal congestion can cause resp. depression).

▪ Position of comfort is best for pt's breathing.

|PROTOCOL II.2  TRAUMA AND HYPOVOLEMIC SHOCK SUPPORTIVE CARE |

|Information Gathered |Treatment |

|Specific Info |MOI (forces, speed, trajectory) |Adult |PEDS |

|Needed |Pt complaints | | |

| |Car condition | | |

| |Past medical Hx. | | |

|Specific |Vitals:  pulse >120, BP ................
................

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