Transcript Document

The following (1st) page of the flowsheet Justin has been
developing, is meant to be used initially as you either receive a
patient into your med room or aid station, or arrive at a more
secure area that you will be sitting at for a while. This allows you to
do an initial assessment and list all the injuries you find in order to
form a preliminary plan.
Name: _________________________________ Age:___
Weight: _______Lbs _______Kg
Allergies: ______________________________________
Past Med Hx:___________________________________
Past Surg Hx:___________________________________
Incident History: I have (# patients), stable/unstable,
Incident occurred: ______________________________
Mechanism of injury was _________________________
______________________________________________
I am expecting to evac the patient to:________________
______________________________________________
Estimated time to evacuation is now: ________________
ETA at definitive care is: __________________________
CASEVAC POC is: ________________________________
Tourniquet Time:__________ Time Converted:___________
Problem List
1
2
3
4
5
6
7
8
9
10
Page 1 of 6
Plan
The following (2nd and 3rd ) pages are meant to be used in series,
one after you fill the other, in order to extend the amount of time
you are able to trend vital signs.
TIME
→
BP
˅
220
˄
200
180
HR
160
●
140
120
Respirations
R
100
80
ET CO2
o
60
40
20
Eyes
4
Verbal
5
Motor
6
GCS
15
Fluid IN
Output ml/hr
DOSE:
KETAMINE
TIME:
DOSE:
VERSED
TIME:
DOSE:
FENTANYL
TIME:
OTHER DRUGS
DOSE:
OTHER DRUGS
DOSE:
TIME:
TIME:
Page 2 of 6
TIME
→
BP
˅
220
˄
200
180
HR
160
●
140
120
Respirations
R
100
80
ET CO2
o
60
40
20
Eyes
4
Verbal
5
Motor
6
GCS
15
Fluid IN
Output ml/hr
DOSE:
KETAMINE
TIME:
DOSE:
VERSED
TIME:
DOSE:
FENTANYL
TIME:
OTHER DRUGS
DOSE:
OTHER DRUGS
DOSE:
TIME:
TIME:
Page 3 of 6
The next 4th Page are excerpts taken directly from the nursing care portion
of the SOF Med Handbook to remind the medic of the nursing care he
should be doing.
Pt Comfort / Positioning
TALK TO THE PATIENT – orient to time and place, explain procedures, elevate HOB,
Baby-wipe bath, pad: occiput, spine, sacrum, elbows, heels, Reposition Q2H, insert wedges and pillows,
Vital Signs
Q 15, report as a trend, trend full GCS if applicable, pulse ox is 3-4 minutes old info
Tubes
ET placement – cuff pressure esp. IN FLIGHT! Place NG & remove contents, secure Foley
Pulmonary status
Supplemental O2, monitor SpO2, Lung sounds, can he posture/position on his own? Pursed lip breathing
Ventilations
Reinforce BVM principles with helpers, end point is patient comfort, just enough to expand the chest, one hand!
Hydration
Maintenance fluids 125cc/h, Measure In and outs
Wounds and dressings
Irrigate and dress, replace wet to dry, inspect for rashes and sores, antibiotics
Splints
circulation check, tighten or loosen
Bladder care
Last void, distended? Clean Foley site
Eye Care
Contacts? Tape eyes? Drops or Ointment
Mouth
Loose teeth, mucous membranes moisturized, cleaning/ brushing
Skin
Pressure sores? Maceration due to incontinence, diaper rash?
DVT
Calf massage every Hr
Head injury
MACE Card
Acts of daily living: breathing, swallowing, coughing, drinking, eating, re-positioning, toileting, hygeine
Nursing care items: Blankets, pillows, gowns, towels, sheets, basins, trash bags, irrigation water
Page 4 of 6
The 5th page originally only had the GSC cheat sheet and a lot of white
space so I added the Telemedicine script and recommendation prompts.
Glasgow Coma Scale
Eye Opening Response
Best Verbal Response
Best Motor Response
TIME
Spontaneous
4
To Verbal Command
3
With Painful Stimulus
2
No Response
1
Oriented
5
Confused
4
Inappropriate words
3
Incomprehensible Sounds
2
No Response
1
Obeys Commands
6
Localizes Pain
5
Withdraws (Pain)
4
Flexion (Pain)
3
Extension (Pain)
2
No Response
1
TeleMed Recommendations:
Call script:
“THIS IS _________________, (JOB/POSITION):___________________.
I HAVE A PATIENT WITH ___________ WHO I THINK HAS ___________,
AND I NEED _____________________________________________________.”
CHIEF COMPLAINT: ______________________________________________
BRIEF HISTORY:__________________________________
PE: VITALS: HR:____________ BLOOD PRESSURE: _________________
RESPIRATION RATE: _________ OXYGEN SATURATION: ____________
TEMPERATURE: _________ MENTAL STATUS (AVPU): ______________
BRIEF EXAM: ____________________________________________________
_________________________________________________________________.
“I NEED _______________.” (CONSULTATION, HELP, ADVICE,
TRANSPO…)
1.Fluids/Meds:
2.Interventions:
3.Procedures:
4.Red Flags:
5.Other:
Page 5 of 6
The last page originally only had the “Plan” section. I later added the
section that allows prioritizing of the treatments.
It can be used to either specifically prioritize treatments, interventions and
nursing care after the initial procedures are identified or can be used
separately after the first sheet has been filled out and checked off.
I personally have multiple copies of the last sheet printed off and
laminated so that I can update the plan every few hours and hang it for
everyone to see. I also use this in conjunction with the 2 sided PFC
Casualty Card I have personally been developing.
Problem
List
1
2
3
4
5
6
7
8
9
10
Page 6 of 6
Plans
Priority of Procedures
All 6 Pages Laminated for Continuity
And Z-Folded for ease of Transport
Will work well if no walls are available
Laminated for use on the wall