Transcript First Aid for the First Responder - Evfd

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.
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.
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
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.
Infection control
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.
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.
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.
Legal aspects of the EMS
system
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.
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.
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.
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.
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 lifethreatening incidents, when a parent or guardian is not
present, care may be given based on implied consent.
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).
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.
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.
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.
Duty to act
Duty to act is an obligation to provide care
to a patient.
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.
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.
Good Samaritan Laws have been
developed in all states to provide
immunity to individuals trying to
help people in emergencies
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
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.
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.
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
Vital Signs
Vital signs are outward signs of what is going on
inside the human body. They include pulse;
respirations; skin color, temperature, and condition;
pupils;and blood pressure.
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.
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.
Pulse rates
Adults
Infants and children
60 to 100
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
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 )
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.
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.
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
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 ).
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.
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
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 Chills, communicable disease,
shivering, chattering teeth, blue lips, exposure to cold, pain, or fear
and pale skin
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.
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
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.
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.
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.
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.
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
School age 6 to 10
years
Avg.114 ( 88 to
140 )
Avg. 105 ( 80 to
122 )
Average 59
Preschooler 3 to 5
years
Avg. 99 ( 78 to 116 Average 55
)
Average 57
The SAMPLE History
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
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 can’t observe them;
you only know about them because the patient tells you
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.
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.
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?”
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.
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.
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.
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?
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.
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
Environmental emergencies
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.
Hypothermia
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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
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.
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 body’s 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.
Shock
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.
Signs and symptoms of shock
•
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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
Emergency Care- Hypovolemic Shock
1.
2.
3.
4.
5.
6.
7.
Assure scene safety
Take appropriate BSI precautions
Maintain an open airway
Administer high flow oxygen
Control any external bleeding
Use the PASG, if appropriate conditions apply
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
Poisonings and Allergic
reactions
Poisonings and allergic reactions
Poison- is any substance that can harm the body.
Allergens- substances known to set off an exaggerated
response in the body’s immune system. This exaggerated
response is called an allergic reaction and can potentially
life-threatening.
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.
Assessment and emergency carepoisoning 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
Assessment and emergency carepoisoning by inhalation
Signs and symptoms:
• History of inhalation of toxic substances.
• Difficulty breathing
• Chest pain.
• Cough.
• Hoarseness.
• Dizziness.
• Headache.
• Altered mental status.
• Seizures.
Assessment and emergency carepoisoning 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
Assessment and emergency carepoisoning 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
Allergic reactions
A severe allergic reaction can be life-threatening. The major
physiologic change that makes this so dangerous is that the
body’s 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.
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.
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?
Indications of a patient with a severe
allergic reaction
• Skin- swelling of the face, lips, tongue, neck, hands- hivesitching-red skin
• Respiratory system- cough- rapid breathinglabored/inadequate breathing- noisy breathinghoarseness- stridor- wheezing
• Cardiovascular system- increased heart rate- decreased
blood pressure- signs of hypoperfusion( cool, clammy skin
)
• Decreased mental status
• Generalized symptoms- itchy, watery eyes- headachesense of impending doom- runny nose
Musculoskeletal injuries
There are three main functions of the
musculoskeletal system:
* To give the body its shape.
* To protect vital internal organs.
* To provide body movement.
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.
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.
Example:the 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.
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.
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.
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.
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.
Open and closed musculoskeletal injuries
Signs and symptoms of a
musculoskeletal injury
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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
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.
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
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
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
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
Assessment for spinal injury patients
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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
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 )
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
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
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.
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