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Module 2 Emergency Procedures

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  1. Module 2 Emergency Procedures Dr. Laney Nelson Logan College of Chiropractic

  2. Controlling Bleeding • Direct Pressure • Pressure Points • Air Splints • BP cuff • Air casts • Tourniquets

  3. Common sign of Internal Bleeding • Bruising at site of injury • Coughing up Blood • Vomiting of blood • Bright red • Brown • Black Tarry Stools • Blood in urine

  4. Controlling internal bleeding • Restlessness • Anxiety • Cool clammy skin • Weak rapid pulse • Rapid breathing • Drop in BP

  5. Types of Shock • Hypovolemic • Cardiogenic • Distributive • Neurogenic • Psychogenic • Septic • Anaphylactic • Metabolic • Obstructive

  6. Pathophysiology of Shock • Decreased perfusion • Loss of fluid from circulatory system • Pump fails to keep up BP • Blood vessels dilate causing blood to pool • O2 is decreased • Severity is determined • Age (children progress fast) • Extent of injuries • Pregnancy • Pre existing conditions

  7. Management of Shock • Activate EMS • Secure Airway • Lay on back (if can) • If not half sitting • Control bleeding • Elevate legs no more than 8 inches • Splint Fractures • Keep warm • Keep quiet • Nothing by mouth • ABPCDE- shock cycle through

  8. Progression of Shock • Compensatory • Body tries to maintain control • Progressive • Shunts blood away from extremities to heart, brain • Irreversible • Shunts blood from liver and kidneys to heart and brain; organ death

  9. Anaphylactic Shock • Severe allergic reaction • Misdirected immune system against foreign proteins • flushing, watery eyes & nose, skin rash, airway swelling “tickle” or “lump” in throat, gastrointestinal complaints • Respiratory Obstruction • Circulatory Collapse

  10. Management of Anaphylactic Shock • Activate EMS • Open Airway • Begin rescue breathing • Epinephrine auto injector • If victim has one • If they do not? • Will epinephrine hurt if not needed?

  11. Open Soft Tissue Injuries • Incision • Avulsion • Puncture • Dog bites: puncture and crush • Abrasion • Laceration • Amputations: • Elastic vascularity sucks back in, limited bleeding

  12. Dog Bites • 9/10 dog bites are infected • Worst bites are in area with limited vascularity • Nates dog: • Ringo > 400 pd /in2 • Iron > 550 pd /in2

  13. Open Skin Wounds • Keep blood from your mucus membranes • ABPCDE • Direct, Indirect, Occlusive pressure • Activate EMS if: • Spurting blood • Embedded debris • Nerves, tendons exposed • Disfiguring scar could be outcome

  14. Preventing Infection • Circular wash with soap and water • Irrigate with clean tap • Pat dry / bandage • Remove Slivers • Remove fishooks • Point and barbs • Tape to skin if not used to removing them

  15. Chest and Abdominal Injuries • Chest Injuries • Occlusive dressing • Household plastic wrap • Abdominal Injuries • Cover with toweling or cloth • Not absorbent cotton or paper towels • Keep moist • Try not to reposition contents • Wrap abdomen with a bed sheet or large bath towel

  16. Impaled Objects • Remove clothing expose wound • Secure object to body with bulky padding, limit the impaled level arm • Control bleeding without pressure on object • Calm and reassure victim • Do not attempt to cut off unless can’t move them our of harms way • Activate EMS

  17. When to remove Impaled objects • In the cheeks, lips and throat • Affects collapse of airway • Blood into airway • More than 60 minutes from hospital

  18. Closed Soft Tissues Injuries • Contusion • Hematoma • Crush • Treatment: • RICE • Splint movement

  19. Amputations • Rinse the amputated part with clean water • Wrap in dry sterile sheet, gauze • Place wrapped part in a plastic bag • Place wrapped bag in cooler on ice • Do not bury part in ice

  20. Injuries to Eyes • Only three things to evaluate • Globe • Color • lacerated • Pupil • Size • Shape • Equality • Movement • Paralysis of gaze

  21. Management of Eye • Never direct pressure • Do not irrigate unless chemical burn or foreign object • 30-60 minutes • Inside to outside of eye • Do not remove blood clots • Do not force eye lids open • Have victim lie down • Patch good eye to restrict movement • Nothing by mouth

  22. Removing Objects • Hard and soft contacts • Squeeze and pinch • Fold Eye Lid Back • Flush with cold water • Use Cotton Swab • If becomes embedded then splint in position • Paper cups: not styrofoam • Cool moist bandages • No pressure • Sand bag head

  23. Eye ball Injuries • Impaled into socket • Stabilize head • Cover eye ball with clean moist dressing • Keep eyeball moist • Protect movement • Dress into place • Treat for shock Why fishing is dangerous…

  24. Face Injuries • ABPCDE • Protect the airway • Remove chocking hazard • Vascular will bleed • If bone and scalp exposed • Moist clean dressing • Inside and outside of cheek • Fractured jaw • Towels, cervical collar • Fractured nose • Ice,

  25. Nosebleeds • Pinch the nose • Ice the nose 20 minutes • Pressure inferior to nose • Absorbent nose plugs • Objects into nose • Pull out if you can • Squeeze may work • Tickle to sneeze • If no go then calm and protect airway do not lie on back

  26. Ear • Never pack ear allow to bleed • Foreign objects in kids are clear • Seeds, gum, beans • Irrigate makes bean swell • Bugs, attached to light, pull ear down and shine a light, • Drown bug with garlic or vegetable oil then irrigate • Use nose suction device to suck out

  27. Throat • Crushed cartilage • Maintain airway • Raspy voice • Loss of voice • Throat cut • Pressure above and below the laceration from the side • Venous or arteriole • Airtight plastic dressing

  28. Teeth • Chipped and broken • Check for fracture jaw • Ice for pain and swelling • Knocked out • Replant if within 30 minutes • 1% decrease every 1 minute delay • Do not touch the root • Save a tooth • Cold whole milk

  29. Chest • Fracture ribs • Traumatic asphyxia • Blood back flow in the vessels • Flail chest • Paradoxical movement • Collapsed lung • Trachea deviation • Lay victim against wall or semi sitting if blood pooling Tracheal deviation

  30. Hemothorax, Tension Pneumothorax, Open Pneumothorax • Shootings and stabbings • Tension • Seconds count • Secure Flutter value • Open the space • Open • Sucking chest wound • Flutter value • Position to breath easy

  31. Abdominal • Shootings and stabbings • Look for exit wound • If abdominal injury probably a chest injury also • Lie side posture with knees flexed into chest • Handle bars, bulls and horses hoofs • Stiff belly guarding, • Nausea, shallow panting breathing • Shoulder pain • Weak peripheral pulse • Abp drop of 10 mm

  32. Abdominal Evisceration • Clean moist dressing • No paper towel • No open fiber dressing • Use bed sheet • Keep moist • Wrap in plastic

  33. Male Genitalia • Not life threatening • Lacerations, avulsions, abrasions, penetrations, contusions • If bleeding wrap penis in soft sterile dressing • Indirect pressure above sight • Caught in Zipper….. Figure 1: Giant scrotal and penile lymphedema showing edematous and thickened scrotal skin with disfigured penis

  34. Female Genitalia • Very vascular will bleed • Use direct pressure • May have to pack if hemorrhage • Stabilize impaled objects • If sexual assault • Do not allow bath or douche • Do not allow to wash hair or hands • Do not clean wounds if possible • Handle clothing as little as possible • Put all clothing in separate bag • Try not to use plastic is blood Pessary-Induced Traumatic Vaginal Evisceration Following A Motor Vehicle Crash