PowerPoint Presentation - First Aid for the First Responder

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First Aid for the First Responder

• As a firefighter, you are already a part of a
  proud tradition. Members of the fire service have
  always stood at the ready to save lives and to
  protect property. You will receive training that
  will enable you to assess patients and provide
  first aid in the challenging out-of-hospital
  environment. You will still be a firefighter, but
  you will also become a competent and valuable
  part of the Emergency Medical Services ( EMS )
  system.

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Roles and Responsibilities

• Your ultimate responsibility will be to provide
  excellent patient care. To fulfill this
  responsibility, there are a number of different
  duties you must perform.

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Roles and Responsibilities cont.

• Assuring personal safety- remember that you
  cannot carry out your responsibilities of caring
  for a patient if you yourself are injured.
  Keeping yourself safe is your first
  responsibility.
• Assuring the safety of the patient, or other
  firefighters and emergency care providers, and of
  bystanders at all times.
• Performing patient assessments in order to
  determine what care is necessary.
• These are the top three responsibilities of the
  first responder

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Roles and Responsibilities cont.

• Lifting and moving the patients in a fashion that
  is safe for the patient and minimizes the risk of
  related injuries to yourself and the crew.
• Providing for the safe transport of the patient
  or the smooth transition of patient care to those
  who will transport him.
• Providing complete, accurate, and appropriate
  documentation of your patient as required by your
  department.
• Respecting the patient as another human at all
  times.
• Acting as a patient advocate this means that
  you must at all times speak up for the patients
  rights and needs and do what you can to assure
  his well being.

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Infection control
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Bloodborne pathogens

• The federal government established standards (
  title 29 Code of Federal Regulation 1910-1030) in
  1991 under the authority of the Occupational
  Safety and Health Administration ( OSHA )
  regarding the exposure of emergency care workers
  to bloodborne pathogens.
  
  
  
• Infectious diseases are those that spread from
  person to person. They are called pathogens.
  These microorganisms include bacteria and
  viruses. The Federal Government has developed
  guidelines aimed at preventing the spread of
  disease through contact with blood and body
  fluids. These safeguards involve a form of
  infection control known as body substance
  isolation( BSI ).
• Handwashing is a simple measure that can be of
  great help in guarding against the spread of
  disease.BSI precautions involves the use of
  personal protective equipment( PPE ). This
  includes gloves, masks, goggles, and-when
  appropriate-gowns for protection against
  exposures.

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PPE

• Gloves- should be worn on every EMS call where
  there is a possibility of the exposure to blood.
  Vinyl or latex specifically for patient care
  settings are the type most commonly used.
• Eye protection- to be used in cases where there
  is a possibility that blood could come into
  contact with the eyes. In these cases, wear
  goggles or glasses with side protectors designed
  to prevent such contact.
• Masks- are designed to prevent blood and body
  fluids from coming into contact with the mouth
  and nose.
• Gowns- should be of the single-use, disposable
  to provide a barrier to blood and body fluids and
  should be worn whenever possible.

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Cleaning and disinfection of equipment

• Any equipment designed for single use should be
  disposed of properly after each use. Materials
  contaminated with blood or body fluids, such as
  gloves, gauze, or bandages should be disposed in
  a red bag or container marked with a biohazard
  seal. Needles and other sharp objects should be
  disposed in a puncture proof container, sometimes
  called a sharps container. Once placed in the
  appropriate container, dispose of according to
  your departments guidelines for hazardous waste.
• Non-disposable equipment used during a call, that
  may have come into contact with blood or body
  fluids must receive cleaning, disinfection, or
  sterilization.
• Cleaning-refers to the washing of an object with
  soap and water.
• Disinfection-includes cleaning, but also involves
  use of disinfectant to kill many of the
  microorganisms that may be on objects.
• Sterilization- is the use of chemical or physical
  methods to kill all microorganisms on an object.

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Legal aspects of the EMS system
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Every time you respond to a call, you will be
faced with some aspect of medical/legal issues.
The issue may be as simple as making sure that
the patient will accept help or as complex as a
terminally ill patient who refuse care.
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Legal aspects cont.

• You are governed by many medical, legal, and
  ethical guidelines. This collective set of
  regulations and considerations may be referred to
  as a scope of practice because it defines the
  scope, or extent and limits that you may perform.

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Legal aspects cont.

• Before you treat any patient you must first
  obtain consent to treat that patient. Most of the
  time the patient or their families will have
  called for your assistance and will readily
  accept it.

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Legal aspects cont.

• Consent can be either expressed or implied.
• Expressed consent- the consent given by adults
  who are of legal age and mentally competent to
  make a rational decision in regard to their
  medical well-being.
• Implied consent- in the case of an unconscious
  patient, consent may be assumed. The law states
  that rational patients would consent to treatment
  if they were conscious. In this situation, the
  law allows EMS personnel to provide treatment, at
  least until the patient becomes conscious and
  able to make rational decisions.

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Consent cont.

• Children and mentally incompetent adults are not
  legally allowed to provide consent or to refuse
  medical care and transportation. For these
  patients, their parents and legal guardians have
  the legal authority to give consent. In
  life-threatening incidents, when a parent or
  guardian is not present, care may be given based
  on implied consent.

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When a patient refuses care, several conditions
must be fulfilled.

• The patient must be mentally competent and
  oriented.
• The patient must be fully informed.
• The patient must sign a release form, aka an
  AMA(against medical advice).

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It will only be a matter of time before you come
upon a patient who has a do not
resuscitate(DNR)order. This is a legal document,
usually signed by the patient and his physician,
which states that the patient has a terminal
illness and does not wish to prolong life through
resuscitation efforts.
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More legal aspects.

• There are more legal aspects that you should know
  before hand. If a legal situation arises that
  could possibly involve you or your department,
  certain things need to be found. These are was
  there negligence, was there a duty to act, was
  the patients confidentiality violated, and was
  the patient abandoned.

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negligence

• Negligence is the finding of failure to act
  properly at a situation in which there was a duty
  to act, needed care as would reasonably be
  expected of the first responder was not provided,
  and harm was caused to the patient as a result.

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Duty to act

• Duty to act is an obligation to provide care
  to a patient.

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confidentiality

• Confidentiality is the obligation not reveal
  information obtained about a patient except to
  other health care professionals involved in the
  patients care, or under subpoena, or in a court
  of law, or when the patient has signed a release
  of confidentiality.

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abandonment

• Abandonment is when the first responder
  leaves the patient after care has been initiated
  and before the patient has been transferred to
  someone with equal or greater medical training.

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Good Samaritan Laws have been developed in all
states to provide immunity to individuals trying
to help people in emergencies
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Special Situations

• A patient may wear a medical identification
  device. This device is worn to alert the first
  responder that the patient has a particular
  medical condition. Examples of these conditions
  are
• Heart conditions
• Allergies
• Diabetes
• Epilepsy

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Special Situations cont.

• You may also respond to a call to find that a
  patient is an organ donor. An organ donor is a
  patient who has a completed legal document that
  allows for donation of organs and tissues in the
  event of their death.

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Crime scenes

• A crime scene is identified as the location where
  a crime has been committed or any place that
  evidence relating to a crime may be found. Once
  police have made the scene safe, the priority of
  the first responder is to provide patient care.
  While providing patient care you should take
  care to preserve evidence, but first you need to
  know what evidence is.

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Examples of evidence at a crime scene

• The condition of the scene
• The patient
• Fingerprints and footprints
• Microscopic evidence
• Remember that your first priority is patient
  care. But you should also remember what you touch
  and minimize your impact on the scene. You should
  work with the police on any crime scene, you may
  be needed to provide a statement about your
  actions or observations at the scene

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Vital Signs
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Vital signs are outward signs of what is going on
inside the human body. They include pulse
respirations skin color, temperature, and
condition pupilsand blood pressure.
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Pulse

• The pumping action of the heart is normally
  rhythmic, causing blood to move through the
  arteries in waves-not smoothly and continuously
  at the same pressure like water flowing through a
  pipe. A finger tip held over an artery where it
  lies close to the surface can be felt as a
  beat. this is what is called the pulse. The
  pulse rate is the number of beats per minute.
  Pulse rates vary among individuals depending on
  the their age, physical condition, degree of
  exercise just completed, medications and other
  substances being taken, blood loss, stress, and
  body temperature.

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Pulse cont.

• The normal rate for an adult at rest is between
  60 and 100 beats per minute. Any pulse rate above
  100 beats per minute is a rapid pulse. A rapid
  pulse is called tachycardia. Any pulse below 60
  beats per minute is a slow pulse. A slow pulse is
  called bradycardia. Two factors determine pulse
  quality rhythm and force. Pulse rhythm reflects
  regularity, while pulse force refers to the
  pressure of the pulse wave. Pulse rate and
  quality can be determined at a number of points
  throughout the body. You should initially find a
  radial pulse in patients 1 year of age and older.
  In an infant less than 1 year of age you should
  find the brachial pulse. If you are not able to
  measure the radial or brachial pulse, you should
  find the carotid pulse. Count the pulsations for
  30 seconds and multiply by 2 to determine the
  beats per minute.

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Pulse rates
Adults 60 to 100
Infants and children
Adolescent 11 to 14 years 60 to 105
School age 6 to 10 years 70 to 110
Preschooler 3 to 5 years 80 to 120
Toddler 1 to 3 years 80 to 130
Infant 6 to 12 months 80 to 140
Infant 0 to 5 months 90 to 140
Newborn 120 to 160
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Pulse quality
Rapid, regular, and full Exertion, fright, fever,high blood pressure, first stage of blood loss
Rapid, regular, and thready Shock, later stages of blood loss
Slow Head injury, drugs, some poisons,some heart problems, lack of oxygen in children
No pulse Cardiac arrest( clinical death )
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Respiration

• The act of breathing is called respiration. A
  single breath is considered to be the complete
  process of breathing in( inspiration or
  inhalation ) followed by breathing out(
  expiration or exhalation ). The respiratory rate
  is the number of breaths a patient takes in in
  one minute. The rate of respiration is classified
  as normal, rapid, or slow. A normal respiration
  rate for an adult at rest is between 12 and 20
  breaths per minute. However, if you have an adult
  patient maintaining a rate above 24( rapid ) or
  below 8( slow ), you must administer high
  concentration oxygen and be prepared to assist
  with ventilations. Respiratory quality, the
  quality of a patients breathing, may fall into
  any of four categories normal, shallow, labored,
  or noisy. Respiratory rhythm is not important in
  most of the conscious patients you will see. If
  you observe irregular respirations in an
  unconscious patient you should report and
  document. To record respiratory rate, start
  counting respirations as soon as you have
  determined the pulse rate. Count the number of
  breaths taken by the patient during 30 seconds
  and multiply by 2 to obtain the respiratory rate.
  Be sure to keep in mind that brain cells will
  start to die off after 4 to 6 minutes without
  oxygen, from the time of the accident or illness.
  So, the faster you can assess the patients
  respirations the better the chance for a full
  recovery of the patient.

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Respiratory quality

• Normal means that the chest or abdomen moves an
  average depth with each breath and the patient is
  not using their accessory muscles.
• Shallow occurs when there is only slight
  movement of the chest or abdomen. This especially
  serious in the unconscious patient.
• Labored can be recognized by signs such as an
  increase in the work of breathing , the use of
  accessory muscles, nasal flaring, and retractions
  above the collarbones or between the ribs,
  especially in infants and children.
• Noisy is obstructed breathing. Sounds to be
  concerned with are snoring, wheezing, gurgling,
  and crowing. A patient with snoring respirations
  needs to have their airway opened. Wheezing may
  respond to prescribed inhalers or medications.
  Gurgling sounds usually mean that you need to
  suction the patients airway. Crowing(a noisy,
  harsh sound when breathing in ) may not respond
  to any treatment you give.

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Respiration
Adults 12 to 20 above 24 serious below 10 serious
Infants and children
Adolescent 11 to 14 years 12 to 20
School age 6 to 10 years 15 to 30
Preschooler 3 to 5 years 20 to 30
Toddler 1 to 3 years 20 to 30
Infant 6 to 12 months 20 to 30
Infant 0 to 5 months 25 to 40
Newborn 30 to 50
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Skin

• The color, temperature, and condition of the skin
  can provide valuable information about your
  patients circulation.the best places to assess
  skin color in adults are the nail beds, inside
  the cheek, and inside of the lower eyelids. In
  infants and children, the best places to look are
  the palms of the hands and the soles of the feet.
  In patients with dark skin you can check the lips
  and nail beds. The normal color in any of these
  places should be pink. Abnormal colors include
  pale, cyanotic( blue-gray ), flushed( red ), and
  jaundiced( yellow ).

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Skin cont.

• To determine skin temperature feel the patients
  skin with the back of your hand. A good place to
  do this is the patients forehead. Note if the
  skin feels normal( warm ), hot, cool, or cold. At
  the same time notice the skins condition, is it
  dry( normal ), moist, or clammy( both cool and
  moist ). Also look for goose pimples, which are
  often associated with chills.

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Skin color
Pink Normal in light skinned patients. Normal at the eyelids, lips, and nail beds
Pale Constricted blood vessels possibly resulting from blood loss, shock, hypotension, emotional distress
Cyanotic ( blue-gray ) Lack of oxygen in blood cells and tissues resulting from inadequate breathing or heart function
Flushed ( red ) Exposure to heat, high blood pressure, emotional excitement
Jaundiced ( yellow ) Abnormalities of the liver
Mottling ( blotchiness ) Occasionally in patients with shock
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Skin temperature
Cool, clammy Sign of shock, anxiety
Cold, moist Body is losing heat
Cold,dry Exposure to cold
Hot, dry High fever, heat exposure
Hot, moist High fever, heat exposure
goose pimples accompanied by shivering, chattering teeth, blue lips, and pale skin Chills, communicable disease, exposure to cold, pain, or fear
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Pupils

• The pupil is the black center of the eye. One of
  the things that can cause it to change is the
  amount of light entering the eye. When the
  environment is dim the pupil will dilate( get
  larger ) to allow more light in. when there is a
  lot of light the pupil will constrict( get
  smaller ). To check the pupil for reactivity you
  would shine a light into the patients eyes. You
  will need to look for three things size,
  equality, and reactivity. Both pupils are
  normally the same size, and when light is shined
  into them they react by constricting.

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pupils
Dilated Fright, blood loss, drugs, treatment with eye drops
Constricted Drugs( narcotics ), treatment with eye drops
Unequal Stroke, head injury, eye injury, artificial eye
Lack of reactivity Drugs, lack of oxygen to brain
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Blood pressure

• Each time the ventricle ( lower chamber ) of the
  left side of the heart contracts, it forces blood
  out into the circulatory system. This force of
  blood against the walls of the blood vessels is
  called blood pressure. The pressure created
  during contraction is called the systolic blood
  pressure. When the heart relaxes, the pressure
  remaining in the blood vessels is called the
  diastolic blood pressure. These pressures vary,
  just like with the pulse, from person to person,
  depending on their lifestyle and medical history.

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Blood pressure cont.

• To measure blood pressure, you would use a
  sphygmomanometer cuff ( blood pressure cuff )
  with gauge. Position yourself at the patients
  side and place the cuff around the patients upper
  arm, the cuff should cover two-thirds of the
  upper arm. Take care as to not put the cuff on
  the patients arm if you suspect an injury to that
  arm. The center of the bladder inside of the cuff
  needs to be centered over the brachial artery,
  the major artery in arm. There are two common
  ways to measure the blood pressure with a blood
  pressure cuff auscultation and palpation.
  Auscultation requires using a stethoscope to
  listen for characteristic sounds. Palpation of
  the blood pressure requires using you fingers to
  feel the pulse as it starts when pressure is
  released from the cuff. Palpation is not as
  accurate as auscultation.

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Blood pressure ( auscultation )

• To measure the blood pressure using the
  auscultation method, you would, after putting the
  cuff on the patients arm , put the stethoscope on
  the patients arm above the brachial artery. Begin
  inflating the cuff to a point 30mm above the
  point that you last heard pulse sounds. Begin to
  slowly deflate the cuff by releasing the air in
  the bladder, at a rate of 5 to 10 mm per second.
  Listen for the sounds of the pulse to obtain the
  systolic reading. Continue deflating the cuff
  until you no longer hear the pulse sounds, at the
  point that you last hear pulse sounds will be
  your diastolic reading. Record the measurement
  and the time at which it was taken.

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Blood pressure ( palpation )

• To measure the blood pressure using the palpation
  method , you would first out the blood pressure
  cuff on the patients arm just as you would for
  auscultation. Next, you will need to find the
  radial pulse. After finding the radial pulse,
  begin inflating the blood pressure cuff to a
  point 30 mm above where you last feel the pulse.
  Then slowly begin deflating the cuff, noting the
  point where the radial pulse returns.

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Blood pressure
Blood pressure normal ranges Systolic Diastolic
Adults 90 to 150 60 to 90
Infants and children Approx. 80 2 x age ( years ) Approx. 2/3 systolic
Adolescent 11 to 14 years Avg.114 ( 88 to 140 ) Average 59
School age 6 to 10 years Avg. 105 ( 80 to 122 ) Average 57
Preschooler 3 to 5 years Avg. 99 ( 78 to 116 ) Average 55
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The SAMPLE History
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SAMPLE history

• When you obtain a patients medical history, you
  are gathering information that will help shape
  your subsequent assessment and treatment. The
  most effective way of taking a patients history
  is to use the SAMPLE format. The elements of the
  SAMPLE history are as follows
• Signs/Symptoms
• Allergies
• Medications being taken
• Pertinent past history
• Last oral intake
• Events leading up to the illness or injury

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Signs/Symptoms

• Signs are objective findings that you can see,
  hear, feel, or smell without having to question
  the patient
• Symptoms are subjective findings. You cant
  observe them you only know about them because
  the patient tells you

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Allergies

• Determine, if possible, if your patient is
  allergic to any medications, foods, or
  environmental agents, such as bee stings or
  molds. Also check to see if your patient is
  wearing a medical identification device that
  might list any allergies.

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Medications

• Determine if the patient is taking any
  medications. This information can give important
  clues about the patients past medical history and
  the reasons for the illness. To determine what
  medications the patient is taking, ask do you
  take any medications on a regular basis?. As a
  rule, avoid using the word drugs when
  questioning the patient. Some patients may have
  several medical conditions, and they may have
  many medications. Rather than sorting through
  these large collections, gather them in a bag and
  send with the patient to the hospital.

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Pertinent past history

• To obtain the patients past medical history, ask
  such as these
• Have you had any medical problems in the past?
• Have you had any recent injuries?
• Have you ever been hospitalized?
• Are you currently under the care of a doctor for
  any problems? Have you recently seen a doctor?
  What is your doctors name?
• Have you ever had_______( chest pain, shortness
  of breath, etc.) like this in the past?

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Last oral intake

• To determine the patients last oral intake, ask
  when was the last time you had anything to eat
  or drink today? What did you eat or drink then
  ?. Of all the SAMPLE history you will gather,
  this is the least crucial to out-of-hospital care.

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Events leading up to the illness or injury

• Determining the events leading up to the onset of
  a medical emergency or injury is a crucial part
  of the patient history. Knowing what the patient
  was doing prior to an incident began can be very
  helpful in a patient assessment.

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Cardiac emergencies

• Any problem with the heart that causes symptoms
  such as chest pain or shortness of breath is
  referred to as cardiac compromise. Some of the
  signs and symptoms can include the following
• pain, pressure, or discomfort in the chest, upper
  abdomen, neck, or left shoulder.
• Difficulty breathing ( dyspnea )
• Palpitations.
• Sudden onset of heavy sweating ( diaphoresis )
• Nausea and/or vomiting.
• Anxiety or irritability.
• feelings of impending doom.
• Abnormal pulse.
• Abnormal blood pressure.

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Use these questions when obtaining information
from a cardiac compromise patient.
Onset When did the pain start and what were you doing when it started?
Provocation What makes the pain worse?
Quality What does the pain feel like?
Radiation Does the pain move anywhere?
Severity On a scale between 1 and 10, with 10 being the worst, how bad is your pain?
Time How long have you had this pain?
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Cardiac Arrest

• The most serious form of cardiac compromise is
  cardiac arrest. When a patient is in cardiac
  arrest, their normal heart beat stops or is
  replaced by a different kind of electrical
  activity. The American Heart Association has
  identified four key factors that affect the
  chances of successful resuscitation of cardiac
  arrest patients.
• Early access- having a means of early contact of
  EMS providers.
• Early CPR- can increase the patients chances of
  survival.
• Early defibrillation- since the likelihood of
  successful resuscitation decreases by
  approximately 10 percent with each minute
  following the onset of cardiac arrest, early
  defibrillation is critical.
• Early advanced cardiac life support(ACLS)- by
  having advanced EMS personnel responding with
  you, early ACLS( paramedics, doctors, and
  hospital staff) can further the chances of
  survival. Remember, you are the first responder
  and you are usually the first on scene.

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How to know if CPR is effective

• If possible have someone else feel for carotid
  pulse during compressions and watch to see the
  patients chest rise during ventilations
• Listen for exhalation of air, either naturally or
  during compressions
• Pupils constrict
• Skin color improves
• Heartbeat returns spontaneously
• Spontaneous, gasping respirations are made
• Arms and legs move
• Swallowing is attempted
• Consciousness returns

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Environmental emergencies
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Exposure to the cold

• Hypothermia- when cooling affects the entire
  body. Exposure to cold reduces body heat. With
  time, the body is unable to retain its core(
  internal) temperature. If not treated
  immediately, can lead to death.

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Hypothermia

• Signs and symptoms
• Shivering in the early stages
• Numbness
• Stiff or rigid posture
• Drowsiness
• Rapid breathing
• Loss of coordination
• Decreased level of consciousness
• Cool abdominal skin temperature
• Skin may appear red in early stages

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Hypothermia- cont.

• Treatment of a hypothermic patient, is the
  re-warming of the patient.
• There are two ways to re-warm a hypothermic
  patient
• Passive re-warming- allows the body to re-warm
  itself by simply covering the patient with a
  blanket and removing the patients wet clothes.
• Active re-warming- includes the application of an
  external heat source to the body plus steps in
  passive re-warming.

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Exposure to heat

• The body generates heat as a result of its
  internal chemical process. Hyperthermia is an
  abnormally high body temperature.
• Heat cramps- are painful muscle cramps caused by
  continued sweating. As the body sweats salts are
  lost. Treatment would be to remove the patient to
  a cool area and replenish with fluids.
• Heat exhaustion- develops when the bodys fluid
  volume is depleted, this can occur as a result of
  excessive sweating and the patients failure to
  drink enough fluids. Early signs may include
  fatigue, light-headedness, nausea, vomiting, and
  headache and will present with moist and pale
  skin.treatment would include to remove to a cool
  area and loosen clothing allowing to cool.
• Heat stroke- usually develops over several days
  and most often affects the very young and the
  elderly. The patients skin will likely feel hot
  and dry or moist. Patient will have an altered
  mental status. Treatment would include rapid
  cooling.

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Shock
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Shock ( hypoperfusion )

• Shock ( hypoperfusion )- inadequate perfusion of
  the cells and tissues of the body caused by
  insufficient flow of blood through the
  capillaries.
• There are three major causes of hypoperfusion
  failure of the heart to pump correctly failure
  of the blood vessels to constrict normally and
  loss of blood or other body fluids
• Shock that results from blood loss is termed
  Hemorrhagic or Hypovolemic shock.

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Signs and symptoms of shock

• Altered mental status, including anxiety,
  confusion, restlessness, or combativeness
• Weakness, faintness, or dizziness
• Marked thirst
• Nausea or vomiting
• Dilated pupils that are sluggish to respond to
  light
• Increased breathing rate
• Shallow, labored, or irregular breathing
• Rapid, weak pulse
• Pallor( pale or gray skin )
• Cyanosis( bluish discoloration ) of the lips or
  conjunctiva of eyes
• Capillary refill of greater than 2 seconds in
  infants and children
• A low or falling blood pressure

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Emergency Care- Hypovolemic Shock

1. Assure scene safety
2. Take appropriate BSI precautions
3. Maintain an open airway
4. Administer high flow oxygen
5. Control any external bleeding
6. Use the PASG, if appropriate conditions apply
7. Elevate the lower extremities approximately 8 to
   12 inches
8. Splint any suspected bone or joint injuries
9. Prevent additional heat loss from the patient
10. Provide immediate transportation to the emergency
    department
11. Continue to monitor the patient

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Poisonings and Allergic reactions
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Poisonings and allergic reactions

• Poison- is any substance that can harm the body.
• Allergens- substances known to set off an
  exaggerated response in the bodys immune system.
  This exaggerated response is called an allergic
  reaction and can potentially life-threatening.

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Poisons

• There are thousands of substances that are
  considered poisonous. There are four routes of
  poisons into the human body ingestion,
  inhalation, injection, and absorption.
• Ingestion ( swallowing a poison )- can be
  anything from pills, household cleaners,
  toiletries, and plants.
• Inhalation ( breathing in a poison )- the most
  common cause of inhalation poisoning is carbon
  monoxide, but can also be cleaning fluids or
  sprays.
• Injection ( inserting a poison through the skin
  through the use of a sharp object )-can be an
  insect, snake, or intravenous needles or drugs.
• Absorption ( taking a poison in through the
  unbroken skin or mucous membranes including the
  eyes, nose, or mouth )- can be in the form of
  plants, insecticides, or industrial and
  agricultural chemicals.

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Assessment and emergency care-poisoning by
ingestion

• Signs and symptoms
• History of ingesting a poisonous substance
• Nausea
• Vomiting
• Abdominal pain
• Altered mental status
• Chemical burns around the inside of the mouth
• Unusual odors on the breath

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Assessment and emergency care-poisoning by
inhalation

• Signs and symptoms
• History of inhalation of toxic substances.
• Difficulty breathing
• Chest pain.
• Cough.
• Hoarseness.
• Dizziness.
• Headache.
• Altered mental status.
• Seizures.

74
Assessment and emergency care-poisoning by
injection

• Signs and symptoms
• A history of injection of a harmful substance
• Weakness
• Dizziness
• Chills
• Fever
• Nausea
• Vomiting
• Tiny, pinpoint pupil
• Altered mental status
• Chest pain
• Inadequate breathing

75
Assessment and emergency care-poisoning by
absorption

• Signs and symptoms
• History of exposure
• Liquid or powder on the patients skin
• Excessive saliva production
• Excessive tear production
• Uncontrolled diarrhea
• Burns
• Itching
• Skin irritation
• Redness of the skin

76
Allergic reactions

• A severe allergic reaction can be
  life-threatening. The major physiologic change
  that makes this so dangerous is that the bodys
  blood vessels lose their normal tone and ability
  to contain fluids. Leaking from these vessels
  produces the swelling of the face, neck, and
  tongue, which are common characteristics of a
  severe allergic reaction. The leaking can also
  cause swelling in the linings of the bronchioles
  of the lungs and upper airway structures, which
  can lead to the narrowing of the airway passages,
  as well as fluid loss sufficient enough to cause
  hypoperfusion( shock ). Hypoperfusion that
  results from a severe allergic reaction is
  commonly referred to as anaphylactic shock.

77
Allergic reactions

• Allergic reactions can range from watery eyes and
  runny nose of hay fever to severe hypoperfusion
  and respiratory failure. A wide variety of
  different substances can cause an allergic
  reaction.
• Venom from insect bites and stings, especially
  those of bees, wasps, hornets, and yellow
  jackets.
• Foods, including nuts, shellfish/crustaceans,
  peanuts, milk, eggs, chocolate, etc.
• Plants, including contact with poison ivy, poison
  oak, and pollen from ragweed and grasses.
• Medications, including penicillin and other
  antibiotics, aspirin, seizure medications, muscle
  relaxants, etc.
• Other causes include dust, latex, glue, soaps,
  make-up, etc.

78
Assessment of the patient with an allergic
reaction

• Controlling the patients airway is the top
  priority during the initial assessment and
  subsequent care. Quickly obtain information about
  the allergic reaction, if the patient is unable
  to help you , try to obtain the information from
  family members.
• does the patient have a prior history of allergic
  reactions?
• What substance was the patient exposed to?
• How long ago did the exposure occur?
• What symptoms has the patient experienced?
• Have the symptoms progressed?
• Has the patient taken any medications, such as
  Benadryl or an epinephrine auto-injector?
• Has any other care been provided for them?

79
Indications of a patient with a severe allergic
reaction

• Skin- swelling of the face, lips, tongue, neck,
  hands- hives-itching-red skin
• Respiratory system- cough- rapid breathing-
  labored/inadequate breathing- noisy breathing-
  hoarseness- stridor- wheezing
• Cardiovascular system- increased heart rate-
  decreased blood pressure- signs of hypoperfusion(
  cool, clammy skin )
• Decreased mental status
• Generalized symptoms- itchy, watery eyes-
  headache- sense of impending doom- runny nose

80
Musculoskeletal injuries
81
There are three main functions of the
musculoskeletal system To give the body its
shape. To protect vital internal organs. To
provide body movement.
82
One of the most serious types of trauma the
musculoskeletal system can sustain is a break or
a fracture to the bone.A break or fracture can
also cause serious bleeding, some from the bone
itself. This bleeding can lead to substantial
swelling of the injured area. Breaks and
fractures can also affect nearby nerves, which
can be damaged or compressed due to the
trauma.The combination of loss of structure,
internal bleeding, and involvement of nerves
leads to the classic finding associated with
musculoskeletal injuries- a painful, swollen, and
deformed area.All injuries that result in a
painful, swollen, and deformed area are presumed
to be serious and require appropriate
immobilization with splinting.
83
Mechanisms of injury- direct force

• Direct force injuries are forces that are applied
  directly to the bone or other structure. The
  injury occurs where the force is applied.
• Examplethe forearm being struck with a pipe
  during an assault, or an unrestrained driver in a
  head-on-collision where the driver strikes the
  steering wheel with their chest or head.

84
Mechanisms of injury- indirect force

• Indirect force is when energy is applied to one
  area of the body and transmitted through the bone
  to another, causing injury to the other site.
• Example head-on-collision where the jams their
  knees against the dash and the force is
  transferred to the hips causing a dislocation to
  the pelvic area.

85
Mechanism of injury- twisting force

• Twisting force is a variation of indirect force,
  the weight and motion of the body itself
  contributes to the application of abnormal strain
  on the bones and joints of the body.
• Example skier falls on a slope, twisting in the
  opposite direction of their lower extremities,
  causing an injury to the lower leg.

86
Types of injuries

• There are four types of injuries associated with
  musculoskeletal injuries
• Fracture- when a bone is broken or is simply
  cracked, can produce severe bleeding, great pain,
  and the potential for long-term disability. The
  risk of disability is greater when the fracture
  is at the end of the bone.
• Dislocation- is he disruption of the normal
  structure of a joint where it connects with
  another bone. The extreme flexion or extension of
  a joint is what usually renders a joint
  dislocated.
• Sprain- is the stretching or tearing of the
  ligaments that surround of support a joint.
• Strain- an injury that results from the abnormal
  stretching of tendons that connect muscles to
  bones.

87
Open and closed musculoskeletal injuries

• Open musculoskeletal injury- when the skin
  overlying a painful, swollen, and deformed
  extremity is broken.
• Closed musculoskeletal injury- when there is no
  break in the skin of a painful,swollen, deformed
  extremity.
• Pre-hospital personnel assume that an injury is
  closed unless otherwise informed.
• Open injuries are of particular concern because
  they may have resulted from a fractured bone
  puncturing the skin from within rather than from
  an external object breaking the skin. These
  injuries are a high risk for development of
  limb-threatening infections in the exposed bone.

88
Open and closed musculoskeletal injuries
89
Signs and symptoms of a musculoskeletal injury

• Deformity or abnormal angulation of an extremity
• Pain and tenderness at the site of the injury
• Swelling
• Bruising or discoloration at the site
• The sensation or sound of grating at the site if
  the limb is moved
• Open wounds or exposed bone at the site of the
  injury
• A joint that no longer moves normally or is
  locked into position
• Paleness, coolness, or lack of pulse in the limb
  distal to the injury

90
Spinal injuries

• Spinal injuries are very serious, and failure to
  handle them properly can have long-term, even
  fatal consequences for patients. The most feared
  consequence of spinal injuries is damage to the
  spinal cord. This damage can result in the loss
  of voluntary muscle control. The vertebrae of the
  spinal column surround, and protect the spinal
  cord. Damage to the bones of the spinal column
  does not by itself cause paralysis or the other
  signs and symptoms of spinal cord injury.

91
Mechanism of injury

• Flexion- the bending forward of the spine
• Extension- the bending backwards of the spine
• Lateral bending- is the bending of the spine to
  one side or the other
• Rotation- is the twisting of the spine
• Compression- is the application of force directly
  onto the spine from either a superior or inferior
  direction
• Distraction- is the application of force that
  results in the spinal cord and vertebrae being
  stretched or pulled apart
• Penetration- this occurs when some object enters
  the spinal cord or spinal column

92
Assessment for spinal injury patients

• Emergency scenes that involve those mechanisms
  include the following
• Motor vehicle crash
• Motorcycle crash
• Pedestrian vs. automobile collision
• Falls
• Blunt trauma
• Sporting injuries
• Hangings
• Diving accidents or near drownings
• Penetrating trauma

93
Assessment for spinal injury patients

• If the patient is responsive, perform a brief
  neurological exam to test for sensation and motor
  function in all four extremities
• Ask patient if they can move their fingers or
  toes
• Ask patient to grip your fingers with both hands
  and squeeze
• Ask patient to push their feet against your hands
• Ask patient if they can feel you touching their
  fingers or toes

94
Assessment for spinal injury patients

• Keep the following in mind when conducting the
  rapid assessment
• Assume that any unresponsive patient with a
  mechanism of injury that suggests the possibility
  of spinal injury has one
• Remember that patients who deny having tenderness
  in the area of the spine may still have a spinal
  injury
• Never ask the patient to move their spine in
  order to test for pain with motion

95
Assessment for spinal injury patients

• Signs and symptoms of spinal injury
• Tenderness of the spine in the area of injury
• Deformity of the spine
• Soft tissue injuries associated with spinal
  injuries
• - injury to the head and/or neck
• - injury to the shoulders, back, or abdomen
• - injury to the pelvis or lower extremities
• Loss of sensation or paralysis below the level of
  the injury
• Loss of sensation or weakness in the upper
  extremities
• Priapism, a persistent and emotionally
  unjustified erection of the penis
• Evidence of bowel or bladder incontinence
• Impaired breathing
• Pain, either with or without movement, along the
  spinal column
• Pain, either constant or intermittent, in the
  buttocks and legs

96
Immobilization and spinal injuries

• Immobilization is the key element in emergency
  care of patients with suspected spinal injuries,
  and is performed in conjunction with other
  interventions that may be necessary such as
  maintaining an open airway. There are many
  different types of spinal immobilization devices.
• Manual in-line stabilization
• Cervical collars
• Short spinal immobilization devices( short, rigid
  spine board and vest type extrication devices )
• Full body spinal immobilization devices( spine
  boards or back boards )

97
Injuries to the head

• Injuries to the head fall into two general
  categories injuries to the brain and injuries to
  the other soft tissue and the bony structures of
  the head.
• Scalp and facial injuries are less serious than
  to the brain itself.although injuries to the
  facial structure can cause serious complications.
  Can produce partial or complete obstruction of
  the airway.
• The skull, like all other bones, can be fractured
  if enough force is applied. Because the skull is
  in such close proximity to the brain, fracture
  are often associated to the brain itself. Signs
  of a skull injury include
• Mechanism of injury that generates substantial
  force
• Severe contusions, deep lacerations, or
  hematomas( swelling ) of the scalp
• Deformities of the skull such as depressions or
  sudden step offs on the surface of the skull
• Blood or clear fluid leaking from nose or ears
• Bruising around the eyes ( raccoon eyes )
• Bruising behind the ears over the mastoid process

98
Injuries to the head

• Injuries to the brain can vary widely. Sometimes
  the brain tissue itself can be damaged or the
  brain tissues can be damaged at the level of the
  cells. An open soft tissue injury that reaches
  down through the skull to the level of the brain,
  is termed an open head injury. Signs and symptoms
  of traumatic brain injuries are
• Decreasing mental status
• Deformity of the skull
• Drainage of spinal fluid or blood from nose or
  ears
• Discoloration around the eyes
• Disorientation or confusion
• Unconsciousness or coma
• Unequal pupils or pupils that do not respond to
  light
• Respiratory or circulatory changes
• Total or partial paralysis

99
Head injuries- special considerations

• The assessment of a patient with a possible head
  injury can be complicated if the patient is
  wearing a helmet. Some instances where you would
  find a patient wearing a helmet are motorcycle
  drivers and passengers, bicycle riders, football
  players, ice hockey players, skiers, construction
  workers, and firefighters.

100
Helmet removal

• Indications that the helmet can be left in place
• The helmet does not interfere with assessment and
  monitoring of the airway and breathing
• There are no current or impending airway or
  breathing problems
• Removal of the helmet would risk further injury
  to patient
• The patient can be adequately immobilized with
  helmet in place
• The patients head rests snugly within the helmet,
  assuring that there will be little to no movement
  of the patients head once secured to long board

• Indications that the helmet should be removed
• the helmet prevents assessment and monitoring of
  airway and breathing
• The helmet interferes with efforts to manage the
  airway or breathing
• The design of the helmet prevents adequate spinal
  immobilization
• The patients head moves too freely inside of the
  helmet
• The patient is in respiratory or cardiac arrest