Lisbon Fire Department Standard Operating Guidelines and Policies

II

The following parameters will be assessed by the EMT and the presence or absence of findings documented on the EMT run report:

Parameters	Descriptive terms
Respiratory rate	30 seconds X2 (15 seconds X4 if regular)
Chest wall movement	Deep, shallow, normal
Lung/breath sounds	Clear, wet, decreased, absent, wheeze, congested
Presence of signs of dyspnea	Retractions, nasal flaring, grunting, stridor, drooling, pursed lip breathing, length of word strings

The patient in moderate respiratory distress will exhibit any of the following:	The patient in severe respiratory distress will exhibit any of the following:
Respiratory rate greater than 28	Respiratory rate less than8 or greater than 36
Able to speak in full sentences	Unable to speak in full sentences
Good aeration into bases of lung fields	Poor aeration into bases of lung fields
Presence of retractions	Presence of retractions
Use of accessory muscles	Use of accessory muscles
	Nasal flaring

The pediatric patient less than 1 year old in moderate respiratory distress will exhibit any of the following:	The pediatric patient less than 1 year old in severe respiratory distress will exhibit any of the following:
Respiratory rate 50-60	Respiratory rate less than20 or greater than 60
Retractions	Retractions
Good aeration in lung bases	Poor aeration in lung bases
Able to cry	Nasal flaring
	Grunting
	Cyanosis

The pediatric patient 1-2 years old in moderate respiratory distress will exhibit any of the following:	The pediatric patient 1-2 years old in severe respiratory distress will exhibit any of the following:
Respiratory rate 40-50	Respiratory rate less than20 or greater than 50
Retractions	Retractions
FairGood aeration in lung bases	Poor aeration in lung bases
	Grunting
	Cyanosis

The pediatric patient 2-5 years old in moderate respiratory distress will exhibit any of the following:	The pediatric patient 2-5 years old in severe respiratory distress will exhibit any of the following:
Respiratory rate 40-50	Respiratory rate less than20 or greater than 40
Retractions	Retractions
Fair  Good aeration in lung bases	Poor aeration in lung bases
Able to talk	Unable to speak
	Cyanosis
	Drooling

The pediatric patient 6-8 years old in moderate respiratory distress will exhibit any of the following:	The pediatric patient 6-8 years old in severe respiratory distress will exhibit any of the following:
Respiratory rate 40-50	Respiratory rate less than12 or greater than 36
Retractions	Retractions
Fair  Good aeration in lung bases	Poor aeration in lung bases
Able to talk	Unable to speak
	Cyanosis
	Drooling

The pediatric patient greater than 8 years old in moderate respiratory distress will exhibit any of the following:	The pediatric patient greater than 8 years old in severe respiratory distress will exhibit any of the following:
Respiratory rate 40-50	Respiratory rate less than8 or greater than 40
Retractions	Retractions
FairGood aeration in lung bases	Poor aeration in lung bases
Able to talk	Unable to speak
	Cyanosis
	Drooling

Parameters	Descriptive terms
Presence of heart tones	Present, absent, muffled
Presence and location of pulses	Full, weak, regular, irregular, absent
Blood pressure	Systolic, diastolic, palpated, orthostatic
Electrocardiogram	Monitoring and 12 leads as needed
Jugular vein distention (JVD)	Distended, flat
Capillary Refill Time (CRT)	In seconds
Skin temperature and color	Normal, hot, cool, diaphoretic, pale, flushed, cyanotic, jaundice
Hydration status	Dehydrated, normal
Presence and location of edema	Pitting edema will mean indentation into the tissue can be made with a finger and the “pit” is still visible after the finger is removed

Parameters	Descriptive terms
Level of consciousness Document with specific descriptions of the patient’s response to verbal or painful stimuli	Alert, oriented X3, altered, coma, ability to follow directions
Pupils	PERL, reactive, size (mid, dilated, pin)
Peripheral circulation, sensation, movement	Present, absent, numbness, weakness, paralysis

Initial and subsequent assessments of the level of pain should be made after each intervention intended to alter the level and at such other times as deemed necessary by the EMT.

Attempt to quantify the intensity of pain by asking the patient to “rate” it on a scale of 0 to 10 with 10 being the worst pain ever experienced. Subsequent assessment of the degree of pain should also be made on the 0 to 10 scale so increases and decreases in perceived pain can be assessed.

Parameters	Descriptive terms
Range of motion	Specific motions
Peripheral circulation, sensation, movement	Present, absent, numbness, weakness, paralysis, color
Signs of injury	Deformity, crepitus, soft tissue injury
Skin color and temperature	Normal, hot, cool, pale, flushed, cyanotic
Swelling	Location and description

Parameters	Descriptive terms
Associated symptoms	Nausea, vomiting, guarding
Elimination patterns	Urination, defecation
Presence of signs of pathology	Guarding, hematemesis, melena, distention, rigidity, bruise, penetrating trauma, scars

GYNECOLOGICAL	OBSTETRICAL
Vaginal bleeding, discharge (amount, odor, color)	Prenatal care
Last menstrual period (LMP)	Contractions (frequency, intensity)
Obstetrical history (number of pregnancies, live births, etc.)	Crowning
Previous surgery/problems	Complications Hypertension, toxemia Bleeding
	Chronic medical conditions: Cardiovascular Diabetes

GUIDELINE/STANDARD OF CARE