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°:
Pt will be A to A-, shivering, have
↑urine output, ↓coordination and
dexterity
Tx:
Active rewarming – give food (carbs
first), liquids, remove from elements,
exercise, shelter, layers, add external
heat (heat packs or hot water bottles)
<90°:
Pt will be V, P or U; shivering will stop;
HR and respirations will decrease; Pt
may appear dead
Tx:
Passive rewarming – add insulating
layers (hypowrap), handle with care,
no rapid warming or movement, no CPR
(AED may be used). PPVs may be
given.
If heat is identified as a potential MOI
and patient exhibits irrational behavior:
1) ALWAYS COOL PATIENT FIRST
2) Assess hydration status
• If dehydration is established,
hydrate with electrolyte solution
• If hx includes copious H2O, give
electrolytes only
3) Complete focused survey
4) Treat symptoms as indicated by
survey; continue to support cooling
mechanisms
Heat exhaustion:
A-(irritable), temp. 99°-104°, pale
Heat stroke (early):
A- (irritable, combative), temp. >105°,
pale if dehydrated, flushed if hydrated
Heat stroke (late):
V,P or U, seizures, coma, death
Electrolyte Sickness:
A-, V, P or U; Hx of H2O but no food;
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:_______________________________________