Transcript File

CPR/AED
Chain of Survival
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The chain of survival are five steps to help
increase the chances of an injured person
of surviving a cardiac arrest.
Chain of Survival – step one
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After determining that there is an injury needing
advanced care; if unconscious tap and shout.
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Call 911
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Questions you will need to answer:
Nature of the emergency?
Where are you?
How many are hurt?
Ages of who is/are hurt
Who are you?
Has treatment started?
Only hang up when instructed to do so by operator.
Chain of Survival – step two
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Begin CPR
Most adult cardiac arrests (CA) victims heart is in
ventricular fibrillation (VF) - Abnormal chaotic heart
rhythm that prevents the heart from pumping
blood.
CPR will not usually stop VF but plays an important
part in pushing oxygenated blood to the brain and
heart and prolonging VF so that an AED will be
useful.
CPR can double or triple the victims survival rate
For every passing minute without CPR; rate of
surviving drops 7-10%.
With CPR there is only a 3-4% drop each minute
Chain of Survival – step three
Use an AED
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The use of the AED will stun the fibrillating
heart, if the heart is still viable the normal
pacemakers in the heart will begin firing and
start a normal rhythm.
If used within 5 min; chances of survival is
49-75%.
Using an AED is simple.
Chain of Survival – step four
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Advanced Care – EMS
– Response time is 7-8 minutes – CPR is
extremely important.
Chain of Survival – step five
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Integrated post-cardiac arrest care.
How to recognize major
emergencies
Heart Attack
Myocardial infarction
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Coronary heart disease is the leading cause of death in
our nation.
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During MI - part of heart muscle is starting to die.
Caused by a blockage of an artery (coronary) due to
buildup of cholesterol deposits or a blood clot.
Victims are usually awake and can talk but feels
severe pain
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Most critical time is within the first 30
minutes after Sx begin.
Heart Attack
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Most common symptoms
Pain or pressure in the center of the chest – which last more than 3-5 minutes.
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Pain might feel pressure, fullness, squeezing, or heaviness
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Pain might spread to shoulder, neck, lower jaw and down arm (usually the right).
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Pain lasts 3-5 minutes. Sometimes will stutter, stop momentarily but then begin again.
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Other Sx – lightheadedness, fainting, sweating without fever, nausea, shortness of
breath
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Most victims will downplay symptoms, you must take action!!!
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Call 911, get the nearest AED, and have the person rest in a position that is comfortable
where they can breathe easily.
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Put them in an area that you can get them to the floor easily and paramedics can get in .
Cardiac Arrest
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When the heart stops beating. Usually
caused by VF, which begins where the heart
muscle is injured.
Without blood flow and no pulse the person
becomes unconscious and stops breathing
and collapses.
VF and cardiac arrest may be the only
symptom of a heart attack.
AED is only thing that will stop a VF
Stroke
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Its is a rapid onset of neurological problems
like weakness, paralysis in one or more limbs,
difficulty speaking, visual problems, intense
dizziness, facial weakness, altered
consciousness, and severe headache.
Two causes
blood vessel to brain is blocked by a blood clot
blood vessel to brain breaks
#3 cause of death and #1 cause of serious
disability among Americans
Stroke
Most signs overlooked;
three major signs to
observe
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facial droop
arm weakness – most
obvious when victim
attempts to extend arms
with eyes closed – one or
both may not move very
well
speech difficulties –
slurring of words and
sentences
Call 911 immediately if
see signs of stroke
Provide CPR if needed
Foreign body obstruction
Usually caused by food, but can be caused by many
objects
Major signs
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Universal choking signal
poor ineffective coughs
inability to speak
high pitched sounds while inhaling
increased difficulty breathing
Blue lips or skin (cyanosis)
Loss of consciousness and responsiveness
Heimlich maneuver in conscious victim
CPR in unconscious victim
CPR - adult
Step one
Make sure area is safe
Check unresponsiveness – tap and
shout – “Are you alright”
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If no response – call 911 or send someone
directly to call
Grab AED if one present or send
someone to get one.
Step two
If possible place
victim supine and
on a hard surface.
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If victim is prone –
roll over
Try protecting the
neck as much as
possible if you
suspect neck injury
Begin CAB’s
– C = Circulation
 If not breathing or see abnormal breathing begin chest
compressions
– Agnal breathing – gasps that occur at the beginning of CA – not
efficient – act as they are not breathing
– Check for pulse or signs of circulation (at least 5sec nomore
than 10sec) just go straight to CPR
– Place one palm on the chest between the nipple line
– Interlock your other hand on top of the hand on the chest
– Bring your shoulder over the top
– Make sure you have a wide base (knees spread just outside your
shoulders)
– Press down 2 inches at a rate of at least 100 compressions per minute
– hard and fast
– Make sure chest recoils completely
– Complete 30 compressions and then give two breaths.
– Do not stop unless and AED is available, victim moves, or you
substituted out (if two rescuers are available – switch every five cycles
of 30:2 – approx two minutes) – reduces fatigue
– A = Airway
 Head tilt and Chin lift
– B = Breathing
 If you do not detect normal breathing – give two
breaths lasting 1 second each (may use barrier)
 Watch chest rise, allow exhalation before next
breath.
 If breaths do not go in – reposition head and try
again.
 Practice
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Practice
– Practice compressions 30 times twice –
alternate with partner – no breaths
– 60 sec test – just compressions – try to get
95-105 compressions – allows to learn
rhythm. Perform 1-2 times or as needed
– Two minute test – performing 30:2 (includes
breath) - should complete five cycles in that
time.
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During the beginning stages of CA – chest compressions
are more important than breaths. Oxygen level will stay
high for the first few minutes but blood is not moving to
due to the heart not pumping.
– Breathing becomes as important as the length of CPR continues
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Very important to limit interruptions of chest
compressions.
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Be mindful not to give to many breaths, too much breath
or too forceful – may cause gastric filling and the
resultant complications, and/or cause diminished blood
flow and reduce survival.
Vomiting/other breathing
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If someone does throw up – do not panic.
– Roll victim towards you. Use your body to hold them.
– Clean out the mouth – roll back and continue.
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Mouth to nose
– Use when it is impossible to use the mouth due to
injury.
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Face shields and masks – may be used -
– Very little chance of transfer of bodily fluids if perform
mouth to mouth without mask.
– Using shield or mask can slow down the CPR process
– “Chest compression only” CPR is more beneficial than
no CPR at all.
Recovery position
If victim begins breathing and having a
pulse then turn victim to their side with
lower arm in front.
 No position is perfect- just make sure they
are stable, near a true lateral position, and
there is no pressure on the chest to impair
breathing
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Potential neck injury
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If two or more responders
– One stabilizes the neck – they will be in charge if
victim needs to be moved
– Place hands on the sides of the head and neck, using
your hands to cup around the neck.
– Place pressure on head with forearms near the ears
– Elbows should be on the ground, wrists in ulnar
deviation so that they come in contact with the head.
 This will limit the amount of movement that will occur if you
have to move your body, for example moving so that CPR
can be administered or when EMS puts on a neck brace.
– If movement is necessary then move body as one.
CPR – Child and infant
Child CPR (ages 1-Puberty)
Child AED (ages 1-8yrs)
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Similarities with single rescuer Adult CPR
– Location on chest for compressions is the same – nipple line
– Ratio of compressions to breaths the same – 30:2
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Differences with Adult CPR
– In the chain of survival-If arrest is unwittnessed you will perform
CPR first for two minutes performing five cycles of 30:2 – then
call 911 (if you are alone)
 Reason is that most child and infant cardiac arrests are due from
asphyxiation, so they will benefit more from the CPR.
– The depth you use for compression is 2 inches or 1/3 depth of
the chest. Use one or two hands – which ever is more
comfortable.
– Compression/respiration ratio 15-2
Infant CPR
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Similarities with single rescuer adult CPR
– 30:2 ratio of compressions to breaths
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Similarities with Child
– Perform CPR first in the Chain of Survival, for the same reasons.
 If small enough you may carry to phone with you after completing the five cycles –
use speaker phone
– Depth of compressions 1/3 depth of the chest or 1 1/2 inches or 4 cm
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Differences with CPR
– Check responsiveness by thumping or slapping the foot
– Check pulse in the upper arm / brachial artery
– If no pulse or if the pulse is present but below 60bpm you initiate compression
– You will perform chest compressions one finger below nipple line
– You will only puff air in
– If unsure if it is a child or not, if it can fit on your arm, then treat as an infant
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2-rescuer – thumb-encircle chest; compression/resp ratio 15-2
Remember… Do Not tilt an infants head too far or it will actually occlude the airway.
For infant mouth to mouth respiration you cover the mouth and nose with your mouth.
Foreign Body Airway
Obstruction (FBAO)
Heimlich Maneuver
Choking
Universal sign of choking – hand around
throat
Ask questions
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Are you choking? Can you speak? May I
help you? – Very important.
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If they say no leave them alone until they pass
out – then it is assumed they want help.
If a person can speak or can cough do not help
Abdominal thrusts
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Place yourself behind victim scissor you legs
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Place hands on navel
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place hands on chest if woman is pregnant or victim is severely
overweight
Pull in and up
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Front leg between victims legs
Slightly bend knees
continue until object is out or they pass out
Use chest thrusts if you are unable to circumvent the abdomen
If pass out lower them carefully to the floor begin CPR
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Only difference with CPR is you check mouth for object before
breaths.
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Finger sweep only if you see object.
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Practice
Infant FBAO
Infant –
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Conscious – place infant on forearm with babies
mouth between fingers – back blows to upper
back
Unconscious –
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after back blows - five compressions –
look for object
give breath
repeat cycle – back blows, compressions, look and
breaths
Finger sweep if see object
Practice
Automated External
Defibrillator
AED
What is an AED?
Automated external defibrillator – is an computerized
defibrillator
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it can analyze heart rhythm
recognize shockable rhythm
advise the operator whether the rhythm should be shocked
very easy to use
AED’s computer chips analyze the rate, size and wave
shape of human cardiac rhythm.
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will not shock a properly functioning heart
will not shock a heart that has stopped – VF is not present
Universal steps of AED use
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Place AED parallel to patients left ear
Power on the AED first
Some automatically turn on when opened
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Attach the AED to the patients chest with electrode pads
Remove clothing – to bear chest
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Be kind to females
Dry patient or shave chest in area of electrode placement if needed
Place one pad above right nipple and one to the side and below the left
nipple. (CPR is continued up to the point when the AED says
analyzing rhythm stand clear)
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Analyze rhythm
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Make sure everyone is clear (must say “stand clear of the victim”). No
contact
Push analyze (in necessary) some machine analyze automatically.
Charge AED if shock is required (some machine charge automatically)
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Shock if indicated – (after checking everyone is clear
again) Press the shock button.
Begin CPR for five cycles then analyze again
If shock is advisable again you clear everyone and shock
If shock is not advisable – continue with CPR
If victim has pulse and is breathing put into recovery
position.
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DO NOT take off pads or turn off AED until prompted by EMS
Special Considerations
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Water
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Metal surfaces
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Remove patch and wipe clean before attaching AED pads
Implanted pacemakers and defibrillators
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Children 8 and older use as soon as possible
Children 1-8 – CPR for two minutes before using AED
Transdermal medications
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Is victim lying on metal surface? – if so move victim
The metal surface may cause the shock form the AED to hit you.
Children
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Must remove victim from water or wet surface
Dry before attaching pads
Do not place an AED electrode directly over implanted device.
Move at least one inch to the side of device
Practice
How CPR Works
Effective CPR provides 1/4 to 1/3
normal blood flow
 Rescue breaths contain 16% oxygen
(21%)
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Start CPR Immediately
Better chance of survival
 Brain damage starts in 4-6
minutes
 Brain damage is certain after 10
minutes without CPR
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Do Not Move the Victim
Until CPR is Given and
Qualified Help Arrives…
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unless the scene dictates otherwise
threat of fire or explosion
 victim must be on a hard surface
 Place victim level or head slightly
lower than body
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Even With Successful CPR,
Most Won’t Survive Without
ACLS
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ACLS (Advanced
Cardiac Life
Support)
ACLS includes
defibrillation,
oxygen, drug
therapy
Survey The Scene,
then: RAP
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RResponsiveness
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Tap shoulder and
shout “Are you
ok?”
RAP
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A - Activate EMS ( if unresponsive)
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YOU - call 911 – come back and let me know
what they said (another can stay by the phone)
You may have to make the call
RAP
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P - Position on back
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All body parts rolled over at the
same time
Always be aware of head and
spinal cord injuries
 Support neck and spinal column
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When Can I Stop
CPR?
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Victim revives
Trained help arrives
Too exhausted to continue
Unsafe scene
Physician directed (do not resuscitate orders)
Cardiac arrest of longer than 30 minutes
 (controversial)
Checking for CPR
Effectiveness
Does chest rise and fall with rescue
breaths?
 Have a second rescuer check pulse
while you give compressions
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Why CPR May Fail
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Delay in starting
Improper procedures (ex. Forget to pinch
nose)
No ACLS follow-up and delay in
defibrillation
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Only 15% who receive CPR live to go home
Improper techniques
Terminal disease or unmanageable disease
(massive heart attack)
Injuries Related to CPR
Rib fractures
 Laceration related to the
tip of the sternum
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Liver, lung, spleen
Complications of CPR
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Vomiting
Aspiration
 Place victim on left side
 Wipe vomit from mouth with
fingers wrapped in a cloth
 Reposition and resume CPR
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Stomach
Distension
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Air in the stomach
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Creates pressure against the lungs
Prevention of Stomach Distension
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Don’t blow too hard
Slow rescue breathing
Re-tilt the head to make sure the airway is open
Use mouth to nose method
Mouth to Mouth Barrier
Devices
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Masks
Shields
If You Are Afraid to Perform
CPR
Call EMS
 Open the airway
 Give chest compressions
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First Aid
Medical emergencies
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Breathing difficulties
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Anaphylaxisis
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Asthma problems are increasing
Most have medicines
May need assist victim is administrating
If symptoms continue to get worse call 911
Severe reaction to allergen
Victim may have epinephrine injector
May need to administer
Call 911 if medicine is not administered
Seizures
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General rules – 1) Prevent injury 2) ensure open airway 3) maintain open
airway after seizure is completed – place in recovery position
Never try to restrain victim, place anything in the mouth.
Injury emergencies
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Bleeding
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Direct pressure best way
If bleeding continues add more gauze or cloth; do not
remove gauze or cloth
Use elastic bandage to apply pressure to gauze and hold it in
place.
The use of tourniquets should be avoided unless in extreme
matters
The efficacy of elevation and pressure points is inconclusive;
if used, use only in conjunction with direct pressure and
when there is no apparent fracture or other underlying injury.
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Wounds and abrasions
Irrigate wounds until free of any foreign matter.
 Small wounds and abrasions should be cleaned
thoroughly then have triple antibiotic ointment
placed on it and covered.
 Larger wounds need to also be cleaned then covered
and taken to doctor for possible stitches
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Burns
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Thermal burns
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Cool burn with cold water until pain ceases
Do not cool for more than 10 min. Can lead to further damage
Burn blisters cover with loose gauze, but keep intact – breaking them
can lead to infection
Electrical burns
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Make sure electrical current is shut off before trying to help victim.
CPR and defibrillation may be needed as well as burn treatment
All electrocution injuries should be checked out by a physician
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Spine stabilization
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Suspect possible spinal injury if…
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Car accident
Injured from fall greater than their height
Complains of neck pain, tingling, or extremity weakness
Is not fully alert
Appears to be intoxicated
Appears frail or is >65 yrs old
Has sustained a head injury
- Manually stabilize the neck until help arrives.
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Musculoskeletal trauma – sprains, strains, contusions,
fractures
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For sprains, strains, contusions – apply ice for 20.
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Sprains elevate and place compression bandage
R.I.C.E. – rest, ice, compression, elevation
If victim has aversion to cold – place wet cloth between ice and skin
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Young kids and elderly especially susceptible
Contusion you want to stretch the injury as well as ice
If you are unsure of the injury suspect fracture – do not
move or straighten injury. Place ice on area and splint in
position, send to ER.
If suspect dislocation – splint as is and send to ER.
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Dental injuries
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Avulsed tooth
Hold onto by the crown not the root (part embedded into
gum
 Rinse off with water (do not scrub)
 Either place back into socket or place in glass of milk and
see a dentist immediately
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Clean bleeding wound with saline solution or tap
water
 Use cotton to apply pressure to stop bleeding
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Environmental injuries
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Snakebite
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Do not suck wound, it will only exasperate the problem
In case of Coral snake – wrap a bandage around the extremity of the bite – it will help slow
the poison – then get to medical facility immediately.
Coral snake bites and sucks
Other snake bites, wash area with soap and water, try not to move extremity very much and
get to medical facility.
Cold injuries
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Hypothermia
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Immediately begin re-warming – remove wet clothes and wrap body surface with anything at hand;
get to medical facility immediately
If far from medical facility you begin active warming – placing near heat source, placing in warm
(not hot) water.
Frostbite
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Remove wet clothing, usually occurs on extremities, do not re-warm if there is any chance it could
freeze again or you are close to a medical facility.
Use luke-warm water if you are far from medical facility
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Heat Injuries
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Heat cramps – muscle cramping, usually due to extreme loss of fluids
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Heat exhaustion
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Get to cooler area
Replace fluids
Ice and stretch area
Dizziness, could have flushed skin or cool and clammy, disoriented, nausea,
headache
Get victim to cool area immediately
Place ice on side of neck (carotid artery), arm pits, and groin area
Replace fluids
Watch for shock; could lead into heat stroke
Heat Stroke – medical emergency – call 911 immediately
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Extreme disorientation, possible unconsciousness, very little sweating,
internal temperature of >105.
Cool down by any means
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Drowning
 Get victim out of water as soon as possible
 Begin CPR immediately
 If you are alone – finish five cycles of CPR before calling 911
Poisons
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Poison control center – 1-800-222-1222
Chemical Burns
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Brush off any powder and remove all contaminated clothing
Alki or acid exposure – rinse with copious amounts of water.
Ingested poisons
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Do not ingest any medication; milk, activated charcoal, syrup
of ipecac unless instructed by poison control
Shock
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Develops when there is not enough blood flowing to the cells of the body
Causes in adults;
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Symptoms
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loss of blood
heart attack,
allergic reaction
feel cold and shiver,
feel weak, faint, or dizzy,
restless,
vomit,
feel thirsty
Treatment
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Call 911
Put victim on their back
If not leg injury or pain raise legs 12 inches
Cover victim with blanket
If bleeding is visible – use direct pressure