Pulse/Pressure Points

Wilderness First Aid

Reference Cards
Carotid

Brachial

Prepared by:
Andrea Andraschko, W-EMT Radial
October 2006

Femoral

Posterior
Dorsalis
Tibial
Pedis

Abdominal Quadrants Airway Anatomy

(Looking at Patient)

RIGHT UPPER: LEFT UPPER:

ANTERIOR: ANTERIOR:
GALL BLADDER STOMACH
LIVER SPLEEN

POSTERIOR: POSTERIOR:
R. KIDNEY PANCREAS
L. KIDNEY

RIGHT LOWER:
ANTERIOR:
APPENDIX
CENTRAL

AORTA
BLADDER

Tenderness in a quadrant suggests potential

injury to the organ indicated in the chart.
 Patient Assessment System SOAP Note Information (Focused Exam)
Scene Size-up BLS Pt. Information Physical (head to toe) exam: DCAP-BTLS,
MOI Respiratory MOI OPQRST
• Major trauma • Air in and out Environmental conditions
• Environmental • Adequate Position pt. found Normal Vitals
• Medical Nervous Initial Px: ABCs, AVPU Pulse: 60-90
Safety/Danger • AVPU Initial Tx Respiration: 12-20, easy
Skin: Pink, warm, dry
• Move/rescue patient • Protect spine/C-collar
SAMPLE LOC: alert and oriented
• Body substance isolation Circulatory
Symptoms
• Remove from heat/cold exposure • Pulse Possible Px: Trauma, Environmental, Medical
Allergies
• Consider safety of rescuers • Check for and Stop Severe Bleeding Current Px
Medications
Resources Anticipated Px
STOP → THINK: Past/pertinent Hx
• # Patients Field Tx
A – Continue with detailed exam Last oral intake
• # Trained rescuers S/Sx to monitor
VPU – EVAC NOW Event leading to incident Evac level
• Available equipment (incl. Pt’s)

Patient Level of Consciousness (LOC) Shock Assessment

Reliable Pt: AVPU Hypovolemic – Low fluid (Tank)
Calm A+ Awake and Cooperative Cardiogenic – heart problem (Pump) Comment:
Cooperative A- Awake and lethargic or combative Vascular – vessel problem (Hose) If a pulse drops but does not return
Sober V+ Responds with sound to verbal to ‘normal’ (60-90 bpm) within 5-25
Alert stimuli Volume Shock (VS) early/compensated minutes, an elevated pulse is likely
V- Obeys simple commands with verbal caused by VS and not ASR.
• ↑pulse
Causes of Abnormal Consciousness: stimuli • Pale skin
Sugar P+ Pulls away from source of pain Tx: Stop visable bleeding, elevate legs,
• ↑respiration rate keep warm, manage psychological
Temperature P- Moves toward source of pain
• Normal AVPU factors, ventilate if respirations are
Oxygen U Totally unresponsive
Volume Shock late/decompensated inadequate, give O2 and IV fluids if
Pressure • ↑↑↑pulse available and appropriately trained.
Electricity • Pale skin
Altitude • ↑↑↑respiration rate
Toxins • ↓AVPU
 Acute Stress Reaction Head Injuries
Sympathetic (fight or flight) Parasympathetic (rest and digest) Concussion: ↑ICP:
• ↑pulse • ↓pulse Patient must be awake, cooperative, S/Sx – early
• Pale skin • Pale skin improving, and have amnesia. • Patient is A- or lower
• ↑respiration rate • ↓respiration rate • C/O headache
S/Sx
• Normal AVPU • May feel light headed, dizzy, • Persistent vomiting
nauseous, faint, anxious • Patient is awake now
• Pain masking • Ataxia
(neumonic = PASR = passout) • Amnesia S/Sx – late
• Looks like early VS
(neumonic = SASR = Spin up) • Can’t have S/Sx of ↑ICP • Patient is VPU
• Nausea/vomiting (once) 2° to • Vomiting persists
Tx: For either condition, calm patient and remove stressors as much as possible P-ASR
• Seizure
• Headache
• Coma
• Tired
• Cardiac and respiratory arrest

Spine Ruling Out Process (WFR or WEMT) Wound Cleaning

Patient must: Motor Exam: Compare strength in both Partial thickness: Full thickness, high risk:
• Be reliable hands and feet. Have pt. resist: • Soap and water wash Clean as previous, PLUS:
• finger squeeze; pushing down on • Scrub to remove particles • Remove dead skin and tissue
• Report no pain when focused on
spine hand • 10% P.I. • Remove foreign material
• push ‘gas pedal’; pull up on foot • Keep moist • Finish flushing process with 1% P.I.
• Report no tenderness when spine
• Dress lightly solution (strong tea or amber beer)
palpated
Sensory Exam: compare pt’s ability to • Do not close in field
• Have normal motor exam
distinguish between pin prick and soft Full thickness, low to moderate risk: • Pack with thin layers of gauze
• Have normal sensory exam
touch on back of hand and shin • Clean w/in 2 hours of bleeding end soaked in 1% P.I. Remove and
• Report no shooting, tingling or repack bid
• Use pin to prick • Clean around area with 10% P.I.
electric “pain” radiating from • Dress with several layers of gauze.
• Use cloth for soft touch • Pressure flush with drinkable water in
extremities May place 10% P.I. between layers,
short bursts along axis
In cases where the spine can’t be ruled out but the injury can be localized to the • Bring edges toward(not touching) each but not directly on wound
lumbar area, consult medical direction regarding need to continue c-spine other and hold in place with an occlusive • Consider splinting if wound is over a
stabilization. dressing and/or steri-strips etc. joint.
 Common Causes of Pulse Changes Focused Survey Acronyms
Strong, Slow: Strong, fast: From Patient: Observed by Rescuer:
• Normal sleep • Early heat stroke
• Simple fainting • Fever SAMPLE = Signs/Symptoms, CMS = Circulation, Motion,
• Early ↑ICP • Hyperthyroid Allergies, Medications, Sensation
• Well-conditioned athlete • Early shock Previous Injury, Last Meal/Drink,
OPQRST = Onset, Provocation,
• Hypothyroid • ASR Events
Quality (dull, sharp), Radiation,
• Strenuous physical activity Severity (1-10), Time
Weak, slow: Pt = Patient
• Hypothermia Weak, fast: Hx = History DCAP-BTLS = Deformities,
• Late ↑ICP • Overwhelming infection Px = Problem Contusions, Abrasions,
• Late heat stroke S/Sx = Signs/Symptoms Punctures/Penetrations,
Irregular:
• Late shock Tx = Treatment Burns/Bleeding, Tenderness,
• Sinus arrhythmia Lacerations, Swelling
• Diabetic coma
• Heart disease
• Some types of heart disease

Hypothermia Heat Related Symptoms

98.6° to 90°: <90°: If heat is identified as a potential MOI Heat exhaustion:
Pt will be A to A-, shivering, have Pt will be V, P or U; shivering will stop; and patient exhibits irrational behavior: A-(irritable), temp. 99°-104°, pale
↑urine output, ↓coordination and HR and respirations will decrease; Pt
dexterity may appear dead 1) ALWAYS COOL PATIENT FIRST Heat stroke (early):
2) Assess hydration status A- (irritable, combative), temp. >105°,
Tx: Tx: • If dehydration is established, pale if dehydrated, flushed if hydrated
Active rewarming – give food (carbs Passive rewarming – add insulating hydrate with electrolyte solution
first), liquids, remove from elements, layers (hypowrap), handle with care, • If hx includes copious H2O, give Heat stroke (late):
exercise, shelter, layers, add external no rapid warming or movement, no CPR electrolytes only V,P or U, seizures, coma, death
heat (heat packs or hot water bottles) (AED may be used). PPVs may be 3) Complete focused survey
given. 4) Treat symptoms as indicated by Electrolyte Sickness:
survey; continue to support cooling A-, V, P or U; Hx of H2O but no food;
mechanisms can rapidly progress to ↑ICP
Patient SOAP Note Rescuer: Past relevant medical Hx = relate to MOI
Patient Information Name:
Age: Weight: Male Female
Address: Phone: Last food & fluids = intake & output
Date: H2O Calorie Electrolyte
Time: Urine color Urine output Stool
Contact: Phone: Events = Patient’s description of what happened Amnesia Yes / No
Scene Size-Up: Major Trauma Environmental Medical
Describe MOI

Describe Environmental Conditions

Objective Information = What you see
Physical Exam = look for discoloration, swelling, abnormal fluid loss & deformity. Feel for
Position Patient Found Initial Px A V P U on arrival tenderness, crepitus & instability. Check ROM and CSM.
R / L side Front / back No respirations No pulse Unstable spine Time
Laying / Sitting / Standing Severe Bleeding Vomiting Blocked Airway
Initial Tx

Subjective Information = What the patient tells you

Symptoms = Describe onset, cause & severity (1-10) of chief complaints
Time

Allergies = Local or systemic, cause, severity & Tx

Vital Signs = get a baseline, then record changes
Time Pulse Resp BP Skin Temp AVPU
Medications = Rx, OTC, herbal, homeopathic & recreational

Drug Reason Dose Current

Yes / No
Yes / No
Notes
 Assessment = What you think is wrong Plan = what you are going to do
Possible Px Time Current Px Anticipated Px Field Tx Monitor
Trauma
Ç ICP / Concussion
Respiratory Distress
Volume Shock
Unstable Spine
Trunk Injury
Unstable Extremity Injury
Stable Extremity Injury
Wounds
Environmental
Dehydration / Low Na
Hypothermia / Cold
Heat Stroke / Exhaustion
Frostbite / Burns
Local / Systemic Toxin
Local / Systemic Allergy
Near Drowning
Acute Mountain Sickness
Lightning Injuries
SCUBA / Free Diving
Medical S/Sx
Evacuation
Circulatory Level 1 2 3 4
Respiratory GPS / Grid Coordinates
Request ALS: Yes / No
Nervous
Endocrine
Genitourinary
Musculoskeletal
Skin / Soft Tissue
Ears/Eyes/Nose/Throat
Teeth / Gums
 Additional Notes Radio Report

Base, this is_______________________________with ______________

I have a ________ year old male/female whose chief complaint is:______
___________________________________________________________
___________________________________________________________
as a result of:________________________________________________
___________________________________________________________
Patient is currently A V P U and was found Laying/Sitting/Standing
on R/L/Front/Back side. Patient exam revealed _____________________
___________________________________________________________
___________________________________________________________
Spinal assessment revealed____________________________________
Patient states _______________________________________________
___________________________________________________________
Initial vitals were: HR:_____ RR:_____ Skin:_____ BP:_____
Current vitals are: HR:_____ RR:_____ Skin:______ BP:_____
Treatments given are:_________________________________________
___________________________________________________________
___________________________________________________________
Anticipated problems during transport are:_________________________
Additional vitals ___________________________________________________________
Time Pulse Resp BP Skin Temp AVPU ___________________________________________________________
Evacuation priority is: 1 2 3 4
We require: Litter / More People / Helicopter / ALS / _________________
Our evacuation plan is ________________________________________
___________________________________________________________
Our GPS coordinates are:______________________________________
LZ GPS coordinates are:_______________________________________