Emergency Procedures Module 3

1. Emergency Procedures Module 3 Dr. Laney Nelson

2. Dressings • Occlusive • Air tight seal for chest wounds • Compressive • Thick usually sterile for blood control • Trauma • 5 X 36 thick absorbent sterile, serious widespread injury • Adhesive Strips • Band aide • Adhesive Tape • Steri strip's

3. Gauze Pads • 2 X 2 • 4 X 4 • 4 X 8 • Pads and Rolls • Rolls usually non sterile

4. Bandages • Can use anything that has the capability to • Hold dressing in place • Apply pressure to dressing • Hold the edges of a wound together • Support a injured part in place • Prevent and reduce swelling

5. Pressure bandages • Always begin distal to bleeding • Always use bottom up philosophy • Capability refill technique • If bandage is painful its to tight • Appendage beyond bandage if cold to tight • Skin beyond bandages Is tingling • Victim cannot move fingers or toes

6. Cravat Bandages • Use any material and fold into a 4” bandage • Multiple layers to increase and evenly distribute pressure on wound

7. Triangle Bandages • Can be apply to just about any body part • Can also be folded to create a cravat • Examples of evenly applied cravat to body parts

8. Bandages Soaking Though • Add another bandage on top so as not to disturb clot • Spread out next layer to distribute more pressure • Make sure not to loose so to slip and disturb clot • No lose ends so it doesn't get caught on debris • Tips of fingers and toes showing to check for refill

9. Splints • Always bandage into the position you want the body part to remain • Anatomical positioning

10. Improvisation is Required • Hand inside shirt • Pillows / pillow cases • Towels • Bed sheets • Sanitary napkins • Diapers • Belts / neckties • Shirt tails pinning • Electrical wire wraps

11. Pressure Dressing • Big and bulky • Extend beyond the wound • Evenly distributed pressure • Small bandages • wires • Monitor pain, numbness and discoloration

12. Slings • Keep in anatomical position if possible • Keep apex at fulcrum of joint • Avoid increased angular velocity if moving • Make sure support of top strap is on uninjured side

13. Scalp Cravat

14. Shoulder Cravat

15. Chest or back Cravat

16. Head or Eye Cravat

17. Hand and fingers

18. MSK Injuries • ABpCDE • MNOPQR • RICE • Rest, Ice, Compression, elevation to heart level • Dislocation vs. Fracture • Manage all Dislocations as fractures

19. All traumatic Dislocation • Have a fracture somewhere • Therefore splint to protect the unseen • Rule is always a fracture until proven differently

20. Application of Ice • Immediately apply ice to a MSK wound • If no ice then cold or ice water for 20-30 minutes every 2 hours • Continue for 24-48 hours • Huntington's response • ice and heat at 20 minutes • Chemical activated cold pack • Caution for frost bite

21. Raynaud’s or Circulatory Disease • Ice is Contraindicated • victim has prior cold sensitivity • Prior Frost bite • Cold allergy • If you do not know then add ice

22. Dislocations • As Chiropractors do you posses a firm knowledge of all joint movement and function? • If you find yourself in a compromised position delivering emergency aid without a distal pulse what are you going to do? • What if they slip and fall outside your office

23. Finger Fracture / Dislocation

24. Dislocated Navicular

25. Dislocated Scaphoid

26. Metacarpal bone fractures • Nail bed is turned to side • Dislocation will always carry a flick of bone with it • Splint by “buddy tape” • Anatomical Snuff Box • Scaphoid

27. Boxers Fracture

28. Priority of Fractures • Spinal • Fractures of head and rib cage • Pelvic Fractures • Lower Limb Fractures • Upper Limb Fractures

29. LeFort’s Fractures

30. Blow Out Fractures

31. Sinus Fractures

32. Mandibular Fractures

33. Ear Trauma

34. Traumatic Exopthalmos

35. Eye Injuries

36. Fractures • Open • Closed • Observational Signs • Shortening of bones • Angular deformity • Shape and swelling • Pain and increased temperature at site • Crepitus • Joint Lock • Victim will guard

37. Multiple Trauma Victims • Bull riders drug hung up in the rope • Tornado Victims • Car pedestrian accidents • Motorcycle accidents • Be on the look out for more than one fracture

38. Pelvic Fracture • High Percentage of Fracture to the spine • Splint before ice • Splint before elevation • Keep closed from becoming open • Minimize damage to soft tissue • Diminish pain which reduce shock

39. Pelvic Fracture

40. What is you have not distal pulse? • Cut Clothing at seams without movement • Remove jewelry without movement • Wipe away any dirt or debris • Irrigate exposed bone with clean water • Cover any open wounds • Assess blood and neuro levels • Accelerator test, squeeze tests • Pulse and capillary refill • Decide angular deformity then apply traction • Do not correct deformity, restore blood flow

41. Positioning for blood flow • Do not push bones back into skin • Avoid excess pressure on the skin • You are not correcting deformity, you are restoring blood flow • 2-3 hours without blood flow will result in survival of limp • Do not attempt to unlock a joint

42. Testicular Torsion

43. Blue Dot sign

44. Testicular Torsion

45. Colles’s and Smith • Collies: • Fall on palm with the wrist extended • Smith’s: • Fall on the back of hand with the wrist flexed • Use SAM splints • Splint writs and elbow • Capillary refill a must • Usually fracture carpal bone

46. No splint if increased pain Immobilize joint above and below In position you found it in Remove clothes Remove jewelry Cover all wounds Position for pulse Irrigate open bone ends Never replace protruding bones Splint to prevent pressure Longer than appendage When in doubt splint Rules for splinting long bones

47. Rules for Splinting Joints • News papers • Magazines • Pillows

48. Fractured Femur

49. Sports and Recreational Injuries • Fractured Clavicle • Figure 8 • Colles’s & Smith’s • AC separation • Grade 1,2,3 • Dislocated Shoulder • Dislocated Elbow

50. Shoulder Dislocations • Shoulder and arm longer • Outside of shoulder is flattened • Can’t lift the arm • Head of humerus in armpit