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Emergency Medical Operations

Emergency Medical Operations . First Aid. Objectives. Prepare yourself Your Safety and Scene Safety Basic CPR (you have already done) Basic Airway Obstruction “choking” (you have already done) Head to Toe Assessment and Casualty Assessment. Objectives cont:.

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Emergency Medical Operations

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  1. Emergency Medical Operations First Aid

  2. Objectives Prepare yourself • Your Safety and Scene Safety • Basic CPR (you have already done) • Basic Airway Obstruction “choking” (you have already done) • Head to Toe Assessment and Casualty Assessment

  3. Objectives cont: • Treatment / Care Soft Tissue Injuries • Cuts • Abrasion • Lacerations…ect…. • How to Control Bleeding • Burns • Strains, Sprains and Fractures to extremities • Cold/Heat Emergencies • Treatment / Care of Shock

  4. First Aid Equipment Bandages “Kling” Dressings “4X4” Medical/cloth Tape Band-aids Scissors Trauma Pad Hot/Cold Packs Triangle Bandage Splints Home Stuff Boxes Mop Handle/boards Sheets/towels/drapes Pillows Magazines, newspaper tampons Duct tape Masking tape “Sharpie Marker” Etc… Prepare Yourself Equipment Issues

  5. Definitions • Dressing – material (preferably sterile) that is placed directly on a wound • Bandage – material that is used to hold a dressing in place

  6. Anticipate the need for BSI Always have BSI equipment Gloves Eye protection Mask Prevent exposure to you and your patient Don’t over do it. Body Substance Isolation

  7. Public Health Considerations • Need to avoid the spread of disease • Primary concerns include: • Maintaining proper hygiene • Maintain proper sanitation. • Purify water (if necessary).

  8. Public Health Considerations • Maintaining proper hygiene • wash hands frequently using soap & water • Wear personal protective equipment • wear medical gloves at all times (changing after every patient, if possible) • mask • goggles • keep dressings and bandages sterile • avoid contact with body fluids

  9. Maintaining Sanitation • Control disposal of bacterial sources. • Put waste products in plastic bags, tie off, and mark as medical waste. • Bury human waste.

  10. How to Don a Particulate Respirator (N-95) • Place over nose, mouth and chin • Fit flexible nose piece over nose bridge • Secure on head with elastic • Adjust to fit • Perform a fit check – • Inhale – respirator should collapse • Exhale – check for leakage around face

  11. How to Remove Gloves (1) • Grasp outside edge near wrist • Peel away from hand, turning glove inside-out • Hold in opposite gloved hand

  12. How to Remove Gloves (2) • Slide ungloved finger under the wrist of the remaining glove • Peel off from inside, creating a bag for both gloves • Dispose of properly

  13. Do’s and Don’ts of Glove Use Limit opportunities for “touch contamination” - protect yourself, others, and the environment • Don’t touch your face or adjust PPE with contaminated gloves • Don’t touch other items except as necessary during patient care

  14. Glove Use (cont’d) • Change gloves • During use, if torn and when heavily soiled (even during use on the same patient) • After use on each patient • Discard in appropriate receptacle • Don’t wash or reuse disposable gloves unless resources are limited

  15. Hand Hygiene • Perform hand hygiene immediately after removing PPE. • If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE • Wash hands with soap and water or use an alcohol-based (>65%) hand rub

  16. Public Health Considerations • Water disinfection • when drinking water supply is used up or contaminated. • heat to rolling boil for ten minutes, cool • water purification tablets – follow package directions • unscented liquid bleach – let sit for 30 minutes

  17. Public Health Considerations • Sterile water, saline, or potable water should be used on wounds • Bottled water can be used in emergencies • Mineral • Spring • distilled

  18. Public Health Considerations • Make sure to decontaminate before leaving site • Dispose of medical wastes • Wash hands • Check out with Incident Command • DO NOT EAT at the site of the emergency

  19. Scene Safety • Safety for the rescuer -YOU • Unsecured Crime Scene • Toxic Substance • Location (roadway, body of water, fire, Haz-Mat, etc…) • Crash / Rescue Scene • Unstable surface (ice, rocks, etc…) • Safety of Bystanders • Help keep bystanders from becoming patients • Mark boundary of the scene

  20. Scene Sizeup • Location of patient • Position patient found in • What materials are around patient? • victim found under collapsed building material or heavy debris? Chemicals ?

  21. Casualty Assessments • Permission to treat • ask permission to treat if patient able to talk (expressed consent) • Patients have a right to refuse • Can assess and treat if patient is unconscious (implied consent)

  22. Conducting Assessment A head-to-toe assessment: • Determines the extent of injuries. • Confirm classification. • Documents injuries.

  23. Head-to-Toe Assessment • Head • Neck • Shoulders • Chest • Arms • Abdomen • Pelvis • Legs • Back

  24. What to Look for • anything that doesn’t look/feel right • anything that may indicate an injury DON’T FORGET TO ASK

  25. Assessment of body: D - deformity C - contusion (bruise) A - abrasion P - puncture B - burns T - tenderness L - lacerations S - swelling Signs of Possible Injury

  26. Signs of Possible Injury • Mechanism of injury • Signs of shock • Airway obstructions • Labored, shallow or difficulty breathing • Excessive bleeding

  27. EXERCISE • Break into teams • Get with a partner • Practice head to toe assessments

  28. BREAK

  29. Three types of death from trauma • Within minutes – overwhelming irreversible damage • Several hours – excessive bleeding • Days/weeks – infection/multi-system failure

  30. Treatment Life Threats First The “Killers”: • Airway obstruction • Excessive bleeding • Shock

  31. Airway and Breathing • Obstruction – anything that hinders O2/CO2 exchange • Brain and heart affected very quickly • After 4 minutes brain damage starts from oxygen starvation • Time is critical

  32. Airway and Breathing • Most common obstruction = Tongue • Technique to use = Head-tilt/Chin-lift • Goal = Keep airway open

  33. Bleeding • Uncontrolled bleeding leads from shock to death • 5 liters of blood in the average adult (1L=1 quart, 15%=750 ml=3 cups) • 0-15% loss-victim still alert • 16-30% loss-victim becomes confused, skin becomes pale • 31-40% loss-beginning signs of shock • >40% loss-patient becomes drowsy, beginning of organ failure and ultimately, death

  34. Bleeding • Infants/children can lose up to 1/3 of their blood volume before signs of shock appear • Critical to control bleed in shortest amount of time

  35. External Bleeding • Arterial • rhythmic spurting of bright red blood • high pressure , can lose a great deal in short time • difficult to clot

  36. External Bleeding • Venous • slow and steady flow of dark red blood • low pressure • easier to control

  37. External Bleeding • Capillary • slow oozing • usually clots by itself • major concern is infection

  38. Bleeding • Procedures for controlling bleeding • Direct local pressure • Pressure dressing and bandage • Elevation • Pressure points

  39. Bleeding • LAST RESORT – Tourniquet • “Life or limb” • Either the patient bleeds to death or we cut off circulation to the extremity. • Document date & time on patient and in VBCERT paperwork • DO NOT REMOVE!!! • Removal of tourniquet introduces accumulated toxins into bloodstream (tourniquet shock/compartment syndrome)

  40. Rules of Dressing • In the absence of active bleeding, remove dressing and flush, check wound at least every 4-6 hours. • Be careful not to pull scab. • If there is active bleeding, redress over existing dressing and maintain pressure and elevation.

  41. Shock • Result of inadequate circulation • Compensation mechanisms : • pulse rate weakens and increases • respiration increases • blood shunts to core of body

  42. Shock • Observable symptoms • Rapid, shallow breathing • Cold, pale skin • Failure to respond to simple commands • Poor general appearance • anxiety can be early sign of shock • DO NOT WAIT for observable signs of shock in infants/children!

  43. Shock • Treatment • Maintain airway • Lay on back, elevate feet • “Face is red raise the head, face is pale raise the tail” • Control bleeding; treat and splint any injuries • Maintain body temperature (warmth) • Treat with TLC • Nothing to eat or drink

  44. Head, Neck, Spine Injury • do no harm • minimize head and neck movement • all unconscious patients should be suspected as having a closed head injury

  45. Head, Neck, Spine Injury • change in consciousness • paralysis • severe pain or pressure • extremity tingling or numbness • difficulty breathing • nausea and vomiting

  46. Head, Neck, Spine Injury • vision difficulty • heavy bleeding, bruising or deformity • blood, fluid in the nose/ears

  47. Head, Neck, Spine Injury • bruising behind the ears = “battle signs” • “raccoon eyes” • seizures

  48. Head, Neck, Spine Injury • Treatment: • only treatment VBCERT members provide is in-line stabilization • may need to get creative • Head Tilt /Chin Lift is considered appropriate for opening the airway in disaster patients

  49. Amputations • Main treatments: • Control bleeding • Treat for shock • Save tissue parts

  50. Amputations • If tissue part is found: • wrap in clean material • place in plastic bag • keep cool • keep tissue part with victim

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