EMR CHEAT SHEET

FRONTLINE FIRST AID & EMERGENCY TRAINING

250-470-0205

[email protected]

www.frontlinefirstaid.ca
Frontline First Aid
EMR Cheat Sheet

Table of Contents
Assessment Model ................................................................................................................................................................. 2
CPR Compression to Ventilation Ratios................................................................................................................................. 3
High Performance “Pit Crew” CPR ......................................................................................................................................... 3
CPR in transport - Treatable CPR ........................................................................................................................................... 3
Oxygen Cylinder Calculations................................................................................................................................................. 3
Oxygen Flow Rates ................................................................................................................................................................. 4
Glasgow Coma Scale............................................................................................................................................................... 4
APGAR ..................................................................................................................................................................................... 4
6 “Rights” of Medication ........................................................................................................................................................ 5
RTC Critical Interventions Requiring History and/or Vital Signs........................................................................................... 5
Common Units of Measurement ........................................................................................................................................... 5
Assisted Ventilations .............................................................................................................................................................. 7
Lund & Browder Burn Estimation Sheet ................................................................................................................................ 7
BCEHS Treatment Guidelines compared to ........................................................................................................................... 8
PAC National Occupational Skill Competency Profiles ......................................................................................................... 8
Critical Findings ...................................................................................................................................................................... 8
KED Strapping Sequence ........................................................................................................................................................ 8
Entonox Mnemonics .............................................................................................................................................................. 9
Entonox Administration ......................................................................................................................................................... 9
Sager Traction Splint ............................................................................................................................................................ 10
Glucogel Administration ...................................................................................................................................................... 10
Head to Toe Assessment Mnemonics .................................................................................................................................. 11
Average Vital Signs ............................................................................................................................................................... 11
Hypotension (Low Blood Pressure)...................................................................................................................................... 11
Relevant S-A-M-P-L-E and Mechanism of Injury Information ............................................................................................ 12
IV Drip Set Calculations ........................................................................................................................................................ 12
Common IV Solutions ........................................................................................................................................................... 12
Common IV Complications ................................................................................................................................................... 12
Terminology .......................................................................................................................................................................... 13
NEXUS SMR Decision Matrix for Injuries with Spinal Mechanism ..................................................................................... 14

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Frontline First Aid
EMR Cheat Sheet
Assessment Model
SCENE ASSESSMENT
H Hazards - BSI/PPE Are there any Hazards? Are you wearing Body Substance Isolation PPE?
E Environment What are your surroundings? Is it safe to stay?
M Mechanism What is going on and how did it happen? Form a general impression of the situation
P Patients/People How many people require assistance? Are there any bystanders?
A Additional Resources Are more people or equipment needed?
PRIMARY ASSESSMENT
Chief Complaint What is the patient’s biggest concern?
SMR? Are Spinal Motion Restriction measures needed as you conduct your assessment?
LOR A B C RBS General
Responsiveness Airway Breathing Circulation Rapid Body Survey Impression
Alert What are your
Airway Clear? Adequate?  Radial Pulse  Skin
Verbal most urgent
Carotid and OPA if O2 needed?  Cap Refill  Major bleeding
Pain concerns at this
unresponsive. Assisted Vents?  SpO2  Obvious injuries
Unresponsive point?
Critical Interventions Quickly find and manage obvious life threatening problems. Treat for Shock.
Initial Transport Decision Rapid or Delayed transport/relocation. Continue/Discontinue SMR.
Reassess & Communicate Continuously Reassess. Call Medical Oversight as needed. Check ABCs after movement.
SECONDARY ASSESSMENT
Interview
S A M P L E
Signs/
Allergies Medications Past Medical Hx Last Oral Intake Events Leading Up
Symptoms
What is Are you allergic Take medication? Past conditions What were you
What & when
causing you to anything? Wrong dose? or incidents. doing when it
last eat /drink?
discomfort? Exposed? New Meds? Ie…Diabetes started?
O P Q R S T
Onset Provoke/Palliate Quality Region/Radiate Severity Timing
Did this happen What makes the Type of pain? Pain radiate When did it start?
How severe on
suddenly or pain worse or Squeezing, sharp, from one region Constant or come
a scale of 1-10?
gradually? better? dull, throbbing? to others? and go?
Vital Signs (every 5 minutes if Unstable or 15 minutes if Stable)
GCS Blood Pressure Respiration Pulse SpO2 Pupils CapBgl
Glasgow • Palpation Rate Rate Equal and Glucose meter
Pulse
Coma and/or Rhythm Rhythm Reactive to when
Oximeter
Scale • Auscultation Character Character Light appropriate
Head to Toe
Skin Color, Feel, Moisture, Core Temperature
Palpate Slowly, thoroughly and methodically feel for injuries
Auscultate Listen to the Chest when appropriate
Distal Extremities Assess bilateral pulses or capillary refills. Check for motor and sensory deficits.
ONGOING ASSESSMENT
Treatment Provide treatment and interventions for injuries and conditions as they are found.
Documentation Ensure patient care report is accurate. Pass information to higher levels of care
Reassessment Continuously monitor and re-evaluate the patient, the circumstances, and your decisions.
S-B-A-R Transfer S Situation B Background A Assessment R Results / Recommend

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Frontline First Aid
EMR Cheat Sheet

CPR Compression to Ventilation Ratios

Adult Child Infant Neonate
(over 9) (1-8) (1mo -1 yr) (under 28 days)
One Rescuer 30:2 30:2 3:1
30:2 • No AED
Two Rescuer 15:2 15:2 • CPR if below 60 bpm
• If patient is Hypothermic: Check pulse 45-60 seconds before starting CPR, and one AED shock max
• Once compressions have been started, continue CPR until Return of Spontaneous Circulation (ROSC)

High Performance “Pit Crew” CPR

CPR (Airway Clear) CPR (Airway Obstructed)

 Readjust & try 2nd Ventilation

 Compressions Ventilation doesn’t go in  Compressions
 AED  AED
 2 successful Ventilations  Look in Mouth
 OPA  Finger Sweep if object visible
 Compressions & Ventilations  Attempt Ventilation
 Repeat until…  Repeat until either…
 ROSC (obvious signs of life) 2 Ventilations go in…OPA • 2 successful Ventilations
• ROSC (obvious signs of life)

CPR in transport - Treatable CPR

Condition Causes Action
Hypoxia Asthma, COPD, CHF, Anaphylaxis or Tension Pneumothorax
Hypovolemia Caused by Trauma, GI bleed, ruptured abdominal aortic arch
Known Acidosis Sepsis, Diabetic Ketoacidosis, Post Workout
Hyperkalemia Kidney failure, Pressure Sores, Crush Injury, Burns Consult
Hypothermia Submersion, Cold Weather, Found on floor Medical
Toxins Ingestion, Injection, Inhalation Oversight
Cardiac Tamponade Post Cardiac Surgery, Infectious, IV Drug User, Trauma (CliniCall)
Tension Pneumothorax Trauma, COPD, Asthma, Marfan’s
Pulmonary Thrombosis Sudden Death, IVDU, Pregnancy, Fractures, Flights, Bed Rest, Cancer
Coronary Thrombosis Sudden Death, Coronary Artery Disease

Oxygen Cylinder Calculations

Duration of Flow = (gauge pressure -200 psi) x C
Flow Rate (lpm)
C = Cylinder Constant
D-Cylinder: C = 0.16 L/psi
E-Cylinder: C = 0.28 L/psi M-Cylinder: C = 1.56 L/psi
(most commonly used on scene)

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Frontline First Aid
EMR Cheat Sheet
Oxygen Flow Rates
Canadian Red Cross
Device BC EMALB O2 %
Emergency Care Manual
Standard (Simple) Mask 6 – 15 lpm 6-10 lpm 40-60 %
Non-Rebreather Mask 8 – 15 lpm 10+ lpm 90+ %
Bag Valve Mask 15 lpm 10+ lpm 90+ %
Nasal Canula 2 – 4 lpm 1 – 4 lpm 24-36 %
Resuscitation Mask (Pocket Mask) N/A 6+ lpm 35-55 %
Normal Room Air 20.7 – 21 %
Exhaled Air 16%

Glasgow Coma Scale

Best Motor Response
Best Verbal Response
Eye Opening 6 Obeys commands
5 Oriented 5 Localizes to pain
4 Spontaneously 4 Confused 4 Withdraws to pain

3 To voice 3 Inappropriate words 3 Flex to pain (Decorticate)

2 To pain 2 Incomprehensible sounds 2 Extend to pain (Decerebrate)

1 No response 1 No response 1 No response

Eye + Verbal + Motor = GCS (3-15) GCS 13 or less is Rapid Transport
Abnormal Flexion (Decorticate) Abnormal Extension (Decerebrate)

APGAR
0 1 2
Activity Limp Some extremity flexion Active Movement

Pulse Absent Below 100 bpm 100 bpm or higher

Grimace No response Grimace Cough, sneeze, cry

Appearance Body/Extremities Blue/Pale Body Pink – Extremities Blue Completely pink

Respiration Absent Slow and Irregular Strong, crying

7-10 is “Normal … 4-6 is “Fairly Low” … 0-3 is “Critically Low”

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Frontline First Aid
EMR Cheat Sheet
6 “Rights” of Medication
1 Person Does this person have a prescription

2 Medication Have they had it before…no Contraindications…is this their Medication

3 Time When was the last dose taken…is it needed now

4 Dose How much should they take

5 Route How should they take/use it

6 Documentation Record the time and effects of each dose

Emergency Medical Responders licensed in British Columbia

Administer… Do not Administer, but might Assist with…
1. Entonox 4. Acetylsalicylic Acid (ASA)  Epinephrine
2. Oxygen 5. Glucose  Ventolin
3. Nitroglycerin 6. Naloxone (Narcan)  Salbutamol/Atrovent/Albuterol

RTC Critical Interventions Requiring History and/or Vital Signs

Some patients may be RTC, but need critical interventions that require “Secondary” information before transport

Intervention Information Required

ASA for Chest Pains • S-A-M-P-L-E and O-P-Q-R-S-T
• S-A-M-P-L-E and O-P-Q-R-S-T
Nitroglycerin for Chest Pains
• full set of Vital Signs
• S-A-M-P-L-E
Glucogel for Unresponsive Diabetic
• full set of Vital Signs (including CapBgl)
• S-A-M-P-L-E
Naloxone for Opioid Overdose
• full set of Vital Signs

Common Units of Measurement

Unit Abbreviation Used for measuring…
Millimeters of Mercury mmHg Blood Pressure

Millimoles per Litre mmol/L Blood glucose levels

Milligrams mg Medications such as ASA and Nitro

Litres per minute lpm Oxygen flow rates

Drips per millilitre gtts/ml How many droplets it takes to make 1 ml (Dripset Size)

Drips per minute gtts/minute How many droplets go through the dripset in one minute

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Frontline First Aid
EMR Cheat Sheet
ASA & Nitro
ASA NITRO
Indications Indications
Must be “Yes” (✓) to all to Administer Must be “Yes” (✓) to all to Administer
Prescribed Nitro Not Prescribed Nitro
Cardiac Chest Pain
Cardiac Chest Pain Cardiac Chest Pain
Systolic >100mmHg
Safely taken ASA in the past Systolic >90mmHg HR >50 & <150
CliniCall Permission

ASA Indications Met? Nitro Indications Met?

Contraindications Contraindications
Must be “No” (X) to all to Administer Must be “No” (X) to all to Administer
Cialis within the past 48 hours
ASA has previously triggered Asthma
Viagra/Levitra within the past 24 hours
Known hypersensitivity to nitrates
Gastric Bleeding such as an ulcer
Uncorrected Hypovolemia
Severe Anaemia
Unresponsive (ie…likely to choke on tablet)
Constrictive Pericarditis/Pericardial Tamponade

ASA Contraindications Ruled Out? Nitro Contraindications Ruled Out?

Indications Met + Contraindications Ruled Out = ASA Indications Met + Contraindications Ruled Out = Nitro

Administer ASA? Administer Nitro?

(CliniCall? 1-833-829-4099)

If Yes… If Yes…
First Spray
• Before transport
When? When? • Before transport
• Before Vitals Signs
• After first set of Vital Signs

• 0.4 milligrams (one spray = 0.4mg)

• Q3-5 (every 3-5 minutes)
162 mg
How • Two 81 mg tablets How if pain persists & Systolic BP remains
Much? Much? above contraindication level
• Chewed thoroughly
• Consult CliniCall for more than 3 doses
1 (833) 829-4099

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 Frontline First Aid
EMR Cheat Sheet
Assisted Ventilations
Ventilation Rate
Problem
Adult Child / Infant
Respirations Absent but Pulse Present
Timed between or with
Breathing too Fast 1 breath 1 breath patient’s own breaths
• greater than 30 breaths per minute
every every
Breathing too Slow OPA/NPA after first 2
5-6 seconds 3-5 seconds Ventilations
• less than 10 breaths per minute

Signs of Hypoxia or Respiratory Distress

Lund & Browder Burn Estimation Sheet

Area Age
0 (infant) 1 year 5 years 10 years 15 years Adult

A = half of head 9.5% 8.5% 6.5% 5.5% 4.5% 3.5%

B = half of one thigh 2.75% 3.25% 4% 4.5% 4.5% 4.75%

C = half of one
2.5% 2.5% 2.75% 3% 3.25% 3.5%
lower leg

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Frontline First Aid
EMR Cheat Sheet

BCEHS Treatment Guidelines compared to

PAC National Occupational Skill Competency Profiles
BCEHS Treatment Guidelines PAC NOCP
Guideline
(What we follow in BC) (Red Cross Emergency Care Manual)

Minimum Systolic B.P. to give Nitro 90 mmHg (100 if no Prescription) 100 mmHg (Prescription mandatory)
Nitro Dose Frequency Every 3-5 minutes (Q3-5) Every 5 minutes (Q5)

Nitro…Maximum Dosage Consult CliniCall after 3rd dose Limit of 3 doses

Realigning Gross Deformity If transport/circulation compromised Only if more than 30 minutes to care

Open Chest Wound Treatment Vented-Occlusive Dressing Non-Occlusive Dressings Only

Hyperglycaemia 11 mmol/L or higher 8 mmol/L or higher

Burn Percentage Calculations Lund & Browder Chart Rule of Nines

Burn Cooling On-Scene 1-2 minutes At least 10 minutes

CPR with Hypothermia Check Pulse for 45 seconds Check pulse for 60 seconds

Critical Findings
Finding Implication/Condition Intervention
GCS 13 or less Decreased LOC OPA / NPA and RTC
Breathing over 30 times/minute Tachypnea Assist Ventilations
Breathing less than 10 times/minute Dyspnea Assist Ventilations
Adult Blood Pressure less than 80 mmHg Systolic Hypotension Position Supine
Blood Glucose less than 4 mmol/L Hypoglycemia Glucose
Blood Glucose over 11 mmol/L Hyperglycemia Notable. Monitor closely
Oxygen Saturation (SpO2) less than 95% Hypoxia / Hypoxemia Increase O2 intake
Neonatal pulse less than 60 bpm Equivalent to Absent Begin CPR
Body core temperature below 35 - 36 C Mild Hypothermia Rewarm slowly
Body core temperature below 30 - 34 C Moderate Hypothermia Rewarm slowly
Body core temperature below <30 C Severe Hypothermia Rewarm slowly
Body core temperature above 37 C Hyperthermia Cool rapidly
APGAR below 4 Unresponsive RTC
Pulseless, angulated limb (over 30 minutes to hospital) Limb Threatening RTC One attempt to realign
Adult Pulse Rate over 160 bpm Urgent Tachycardia RTC
Adult Pulse Rate below 60 bpm Bradycardia Consider underlying causes
Adult Pulse Rate slower than normal but > 60 bpm Brachycardia Consider underlying causes

KED Strapping Sequence

My Middle strap first Yellow
Baby Bottom strap second Red
Looks Leg straps third Black
Hot Head straps fourth White
Tonight Top strap last Green

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Frontline First Aid
EMR Cheat Sheet

Entonox Mnemonics
Contraindications Precautions
C ability to Comply S Shock
D Decompression sickness A Abdominal distension
C altered level of Consciousness D Depressant drugs
P Pneumothorax C COPD
A Air embolism F Facial Injuries
I Inhalation injury
N Nitroglycerin in the last 5 minutes  Ensure the area is adequately ventilated,
including turning on the vent system in the back
Or … of the Ambulance
S SCUBA recently with decompression sickness
P Pneumothorax  Auscultate the Chest to rule out Pneumothorax
I Inhalation injuries
D Distended Abdomen (grossly)  Contraindications mean you cannot administer.
E Emphysema (bullous)
 Precautions mean you need to fix something
R Refuses to follow instructions
first, or monitor closely to ensure the Entonox is
M Mental status altered
not creating/exasperating any problems
A Air embolism
N Nitroglycerin in the past 5 minutes  2 Precautions = Contraindicated

Entonox Administration
Indications  Significant Pain
Rule out Contraindications  C-D-C-P-A-I-N or S-P-I-D-E-R-M-A-N
 S-A-D-C-F
Note Precautions
 Nasal canula may be utilized to mitigate mild shock symptoms
 SAMPLE, OPQRST and Vital Signs
Completed before  Contraindications ruled out (requires Chest Auscultation)
administration  Mix bottle if stored improperly
 Adequate ventilation secured (vehicle ventilation system activated if available)

 Not left unused over long periods

Proper Storage  Not stored below -6 Celcius
 Stored horizontally (not vertically, which can cause component separation)
 Self-administered using mask/bite valve
 “Pull” Entonox out of the bottle by inhaling through bite valve
 Pain should be relieved
Instructions to Patient
 May begin to feel light-headed, giddy, drowsy or nauseas
 Stop or start at any time
 Use until pain is relieved or adverse effects are felt
After Discontinuing
 Supplemental Oxygen with Non-Rebreather Mask at 15 lpm
Entonox
 Consider Entonox to relieve chest pain if Nitro is contraindicated and has not been
Cardiac Chest Pain
administered in the past 5 minutes

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Frontline First Aid
EMR Cheat Sheet
Sager Traction Splint
Utilized for suspected Femur Fractures not involving the hip or knee
 Distal Pulse – check for presence or absence Saddle
Assess S
 Motor-Sensory check Hinge side down
injured leg
 Look and feel to determine exact location and extent of injury

 Adjust saddle to ensure short side of saddle hinge is down

 Nestle saddle against injured leg (short hinge down) T Thigh strap
 Have helper stabilize splint
 Apply small thigh strap check distal circulation
Apply  Apply ankle harness above malleoli
Traction  Apply traction of 10% body weight A Ankle Strap
o 15 lbs maximum per limb
o 5 lbs maximum for open fractures
o 5 lbs maximum for Pediatric patients P Pull Traction
 30 lbs maximum for Bi-Lateral fractures (15 lbs per leg)
check distal circulation
 Ensure adequate padding
 3 straps around splint…above and below injury L Leg Straps
Secure Splint
 Secure thigh strap…then the other two straps
 Secure Figure 8 Strap check distal circulation

 Reassess all splint straps and Traction Gauge E Evaluate Traction

Reassess
 Ensure Leg in line with body…same length as other leg
Injury
 Recheck presence or absence of Distal Pulse S Stirrup Strap
 Ensure no movement / aggravation of injured limb
check distal circulation

Glucogel Administration
Indications  CapBgl < 4mmoL

Completed before  SAMPLE, OPQRST and Vital Signs

administration  Confirm capBgl < 4mmol with when there is potential/suspected Hypoglycemia

 Patient self-administers Glucogel

Responsive Patient
 Other sugars/juice/food may be appropriate
 Support in ¾ prone/recovery position
 Remove OPA/NPA if required
 Prepare manual suction device
Unresponsive Patient
 Apply 15 mg (half a tube) of Glucogel gradually
 Usually into the buccal pouch of the lower cheek with a tongue depressor
 Observe closely for signs of choking/aspiration
 Unresponsive patients require urgent transport
Transport Decision
 Usually after the first dose of Glucogel, if doing so does not cause undue delay
 Remeasure capBgl every 5 minutes
Remeasure CapBgl  Apply another 15 mg of Glucogel if still below 4 mmol
 Repeat for up to 4 doses (2 tubes) then consult Medical Supervision

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Frontline First Aid
EMR Cheat Sheet

Head to Toe Assessment Mnemonics

Why might a patient have an altered level of consciousness?
A Alcohol T Trauma
E Epilepsy I Infection
I Insulin (Diabetic) P Psychiatric
O Overdose P Poison
U Uremia S Stroke

During a Head to Toe assessment…watch for:

B Burns C Contusions S Swelling
O Open Wounds A Abrasions C Crepitus
L Lacerations P Penetrations R Rigidity
D Deformity I Instability
P Punctures
T Tenderness
S Subcutaneous Emphysema

Average Vital Signs

Resting Respiratory Systolic Blood
Weight Resting Heart Rate
Age Rate Pressure
Kilograms (kg) Beats/minute (bpm) Respirations/minute mmHg
Neonate (<28 days) <3 100-160 40-60 Difficult to measure
3 Months 2-3 100-180 30-45 65-100
6 Months 3-4 100-180 25-35 70-110
12 Months 10 100-180 20-30 70-110
2 Years 12 80-160 18-30 70-110
3-4 Years 14-16 70-130 18-24 75-110
5-6 Years 18-20 70-110 18-22 80-110
7-8 Years 22-24 70-110 18-22 80-110
9-10 Years 26-28 70-110 18-22 80-110
11-12 Years 30-32 70-110 16-20 90-120
13 Years & older >32 60-100 12-20 120+

Hypotension (Low Blood Pressure)

Age Range Systolic Blood Pressure considered clinically Low/Hypotensive
1 month – 1 year Below 70 mmHg
1 – 10 years Below 70 + (2 x age-in-years) mmHg
11 years - Adult Below 90 mmHg
Anaphylaxis generally causes Systolic blood pressure to drop 30% or more

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Frontline First Aid
EMR Cheat Sheet
Relevant S-A-M-P-L-E and Mechanism of Injury Information
MVA
Location of patient Which vehicle patient was in How many vehicles involved
Impact speed Exterior damage Interior damage
Type of restraints Initial position of patient Condition of patient
Loss of consciousness Condition of other patients Wearing a seat belt?
Fall
Where from Height Free fall or hit other objects
Landing surface Position of patient at impact What hit first
Position Found Loss of consciousness Cause of fall
Pedestrian Struck
What hit them Size and weight of object Velocity of vehicle
Vehicle part that hit patient Damage to vehicle Distance patient thrown
Loss of consciousness Condition of patient Condition of Vehicle Occupants
Shooting
Type of firearm Range and Angle Loss of consciousness
Type of bullet Entrance and exit wounds Initial position and condition of patient
Stabbing
Type and size of weapon Loss of consciousness Type of wound
Number of wounds Other injuries Initial position and condition

IV Drip Set Calculations

Drip Set Sizes
• gtts = “drips”
Standard (Regular) 15 gtts / ml
• ml = “milliliters”
Macro (Adult) 10 gtts / ml
• gtts / ml = “how many drips add up to one milliliter”
Micro (Mini) 60 gtts / ml

gtts / minute (drips per minute) = volume (expressed in milliliters) to be infused X gtts / ml
Infusion time (expressed in minutes)

Common IV Solutions
Solution Commonly Used For…
Ringer’s Lactate Blood loss
D5W and D10W Hypoglycaemia
Normal Saline Dehydration
2/3 – 1/3 Dehydration

Common IV Complications
Interstitial
Circulatory Overload
Thrombosis and Thrombophlebitis
Catheter Embolism
Infection of Catheter Site
Allergic Reaction
Air Embolism

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Frontline First Aid
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Terminology

Term/Phrase Meaning

Premature separation of the placenta from the uterus. Signs/Symptoms include uterine
Abruptio Placentae
contraction, bleeding, fetal distress

Aspiration The inhalation of solids/liquids (such as food, vomit or blood) into the lungs

Boiling Point The temperature at which liquid changes into a vapor/gas

Body Substance Isolation equipment such as gloves and safety glasses. Also commonly
BSI
referred to as Personal Protective Equipment (PPE)

CHEMTREC Provider of emergency Hazardous Materials (HazMat) support

Flashpoint The lowest temperature at which vapors ignite when exposed to an ignition source

Also known as the Outer Perimeter. An area far enough from the hazardous material that
HazMat - Cold Zone
risk of contamination is eliminated.

Also known as the Contaminated Area. The area immediately contaminated by a hazardous
HazMat – Hot Zone
material.

Also known as the Inner Perimeter. An area outside the hot zone, which carries a reduced
HazMat - Warm Zone
risk of contamination. Typically where responder decontamination procedures occur.

Ignition Temperature Lowest temperature at which a substance spontaneously ignites without an ignition source.

Material Safety Data Sheet which contains information about the potential hazards of a
MSDS
chemical product used in the workplace. Also referred to as Safety Data Sheet (SDS)

Palliate Ease or lessen discomfort

Occurs when the baby’s placenta partially or completely covers the mother’s cervix, which is
Placenta Previa
the outlet for the uterus. Signs/Symptoms include severe bleeding

Priapism Sustained erection caused by spinal cord injury

Status Asthmaticus Acute asthma that remains unresponsive to treatment with bronchodilators

The volume of air moved into and out of the lungs during each ventilation
Tidal Volume
cycle. Approximately 500ml per inspiration in a normal healthy adult.

A diamond shaped sign that identifies the class of dangerous goods/hazardous materials on
Vehicle Placard
large containers and vehicles.

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Frontline First Aid
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NEXUS SMR Decision Matrix for Injuries with Spinal Mechanism

Any confusion or uncertainty
1. Multiple Trauma

Yes Full SMR

Patient has two or more significant
traumatic injuries? • Collar
• Lifting Device
• Head Secured
No

2. Nexus Criteria

Midline Tenderness? Simple SMR

Altered LOC? Yes • Collar applied
New focal neurological deficits? to any
• Head not taped
Intoxicated?
• Supine on mattress/cot
Major Distracting Injury?
• No clamshell/spine-board
• 30° if Head Injury
No

3. High Risk Group

Age over 65 or under 16? Thoracolumbar Injuries

Osteoporosis? • Dangerous Mechanism of Injury
• Fall from height above 3 meters
Pre-existing Spinal Injury/Condition?
• Axial load to head or base of spine
• MVA 100 km/hr or faster
No • Rollover MVA
• Pre-existing Spinal Pathology
• New back deformity or bruising
• Bony midline tenderness
SMR not required
SMR not required, but do not sit
upright or raise head of stretcher
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