Cardiac Arrest

APPARATUS: [checkbox name="APPARATUS" value="MEN 1.|MEN 2.|MEN 3.|MEN 4.|MEN 5.|MEN 6.| MEN 7.| MEN 8.| MEN 9.| MEN 10.|MEN 11.| MEN 12.|MEN 13.| MEN 14.| MEN 15.|AM-17.| AM-60.| MEDIC 25. "][text name="APPARATUS" default=" "]
RESPONSE: 
[checkbox name="RESPONSE" value="EMERGENT.|NONEMERGENT.|LIGHTS/SIRENS.|LIGHTS NO SIRENS.|NO LIGHTS NO SIRENS.|UPGRADED TO EMERGENT.|DOWNGRADED TO NONEMERGENT|INTERFACLTY TRANSFER."]
DISPATCHED TO:[textarea name="dispatch" default=" "]
CHIEF COMPLAINT: [text name="CC" size = 55 default=" "]
SECONDARY COMPLAINT(s):[text name="CC" size = 55 default=" "]
ATF, [text name="variable_1" default="sample text"] year old 
[select name="variable_1" value=" MALE|FEMALE|"]:[textarea name="arrived" default=" "]
PAST MEDICAL Hx: [textarea name="pmhx" default=" "]
[text name="variable_1" default="was this a witnessed arrest"]
[checklist name="witness arrest" value="YES|NO"]
[select name="by who" value="family|bystander|other"]

[text name="[NEURO] - unresponsive, no palpable pulses, GCS , pupils not reactive"]

[textarea name="variable_1" default="Blood Glucouse"]

Initial ABC's:

-Airway: [checkbox name="airway" value="airway open.|airway patent.|no airway obstructions.|Normal.|airway positioned to open.|airway not patent.|airway required suctioning.| obstructions to airway.|requires airway adjunct.|requires advanced airway.|requires artificial ventilation.|OPA.|NPA."][text name="airway" default=" "]

-Breathing: [checkbox name="breathing" value="breathing spontaneously.|breathing regular.|adequate respirations.|Normal.|not breathing spontaneously.|irregular respirations.|inadequate respirations.|apparent life threats to breathing. |no apparent life threats to breathing."][text name="breathing" default=" "]

-Circulation: [checkbox name="circulation" value="no obvious bleeding.|pulses intact.|skin color appropriate.|cap refill <2 seconds.|no life treats to circulation.|normal.|hemorrhage present.|hemorrhage controlled.|TQ applied.|pulses not intact.|skin color not appropriate.|cap refill >2 seconds.|life threatening concerns with circulation."][text name="ros_constitutional" default=" "]
PHYSICAL EXAM:	
-General: [checkbox name="pe_general_check" value="Alert & oriented X3.|Alert to time.|Alert to place.|Alert to person.| in no acute distress.|Alert, but confused.|Well appearing.|malnourished.|in acute distress."][text name="pe_general" default=" "]
-HEENT: [checkbox name="pe_heent_check" value="normocephalic.|atraumatic.|PEARL.|white sclera.|conjunctiva pink/red.|no fluid noted in or around ears.|no bleeding.|bleeding.|positive HALO test.|negative HALO test.|dry mucous membranes.|extra salivation. |normal mucous.|normal pharynx.|no trauma to mouth.|Normal.|trauma to face.|trauma to mouth.|patient denies vision changes.| patient denies ear pain.|no nasal congestion.| patient denies sore throat.|no cough."][text name="pe_heent" default=" "]
Nose:
[checkbox name="nose" value="nares patent bilaterally|septum midline|mucosa pink & moist|mucosal edema|clear discharge|active septal hemorrhage|clotted blood"][textarea cols=70 rows=1]
Mouth:
[checkbox name="mouth" value="normal inspection|moist oral mucosa without lesions or injury|no dental injury|upper denture|lower denture|mucosal laceration|dental injury|tongue deviation|dental decay"][textarea cols=70 rows=1]
Throat:
[checkbox name="throat" value="normal voice|patent pharynx w/o swelling or exudates|uvula midline"][textarea cols=70 rows=1]
NECK:
[checkbox name="neck" value="no gross deformity or misalignment.|no vertebral tenderness.|pain with movement.|vertebral point-tenderness."][textarea cols=70 rows=1]
Chest/Lungs:
[checkbox name="lungs" value="normal work of breathing, symmetrical chest expansion.|non-tender.|clear and equal breath sounds bilaterally.|bruising|tenderness.|poor effort.|coughing.|-fail chest noted."][textarea cols=70 rows=1]
Abdomen:
[checkbox name="abd" value="normal visual inspection, no distension.|soft non-tender|protruding.|surgical scar.|umbilical hernia.|diffuse tenderness over entire abdomen."][textarea cols=70 rows=1]
-Neuro: [checkbox name="pe_neuro_check" value="Grossly oriented X 4.|gait normal.|sensation intact.|normal reflexes.|smile normal.|speech not slurred.|Normal.|Neuro not grossly intact.|gait abnormal.|sensation absent.|no reflexes.|smile not symmetrical.|slurred speech."][text name="pe_neuro" default=" "]
IV Attempt times [select name="variable_1" value="1|2|3"] 
Good Flash, Good Flush. Site covered with [select name="variable_1" value="with tape in two spots|foam strips from Tegaderm package in two spots|"]
Unable to start IV. Upon cannulation of the vein, [select name="variable_1" value="the site above became swollen|the patient complained of pain|"] [select name="variable_1" value="no flash|unable to flush|"] When IV removed no blood from the puncture site. Site covered with (1) folded 2X2 and secured with tape.
[textarea name="variable_1" default="Defib pads applied and first analysis performed"]
[textarea name="variable_1" default="Second analysis"]
[textarea name="variable_1" default="Third anaysis"]
[text name="variable_1" default="Call to for field termations orders.Report Dr. order for terination granted"]