Emergency Procedures Module 1 for the Chiropractic Practice and Beyond

1. Emergency Procedures Module 1for the Chiropractic Practice and Beyond Dr. Laney Nelson Logan College of Chiropractic

2. Why Emergency Procedures? • Liability as a business owner • Patient risk factors present emergent possibilities • Sports Chiropractic – risks may be higher for acute injuries • Most highly trained health professional on site • Assist in natural disaster triage

3. Why get involved • Nonfesance • Something you are trained to do, but you do nothing • Malfesance • Something you are trained to do but, you do it wrong • Misfesance • You do something you are not trained to do

4. ABpCDE • Airway • Blood • Pressure • Consciousness • Disfigurement • Evaluation

5. Principle Goals of your Actions • Recognize life threatening situations • Activate EMS • Supply artificial ventilation & circulation • Control Bleeding • Care for other life threatening conditions • Minimize further injury and complications • Prevent infection • Make the victim comfortable

6. What to do before you chant… • Observe the scene • Keep yourself safe • Keep the scene un cluttered, turn off engine etc • Activate EMS • Gain access to the victim, • NOW CHANT: ABpCDE

7. Control the scene Gain access to victim Open airway Rescue breath CPR Control bleeding Treat shock Detect and Care for Soft tissue injuries Detect and care for Heart attack, stoke, diabetic, seizures Treat superficial and deep burns, smoke inhalation Heat and cold injuries Childbirth and newborn care Psychological support for victims of disasters Perform emergency maneuvers First Aid Skills

8. Legal Aspects • Do not interfere with other first aid being performed • Follow directions of police officer • Do not force help • If you start, you are responsible • Follow acceptable procedures • HIPAA laws apply • Victim at crime scene, preserve evidence and report criminal incidents

9. Duty to Act • Legal obligation to perform first aid • Pre existing responsibility – established relationships (camp counselor) • Employment requires it • If you have started, you must continue until your have done all you can do • Legally expected to provide care consistent with your training

10. Good Samaritan Law • They protect your ability to perform first aid unless you are found negligent • Negligence • Victim was injured • Your lack of action caused or contributed to injury • You had a duty to act • You acted unusually, unreasonablely or imprudently

11. Reasonable Man Test • Did you act in the same way a normal prudent man would? • The burden of proof falls on the victim if a claim is made

12. Implied vs. Actual Informed Consent • Actual = you need to explain yourself and the care you are going to provide • Implied = victim is unconscious • Gray areas • Minors • Disabled youth • If deign consent, and you feel life threatening then get the police

13. Infectious Diseases • Droplet • Blood Contact • Open wounds / tissue contact • Hepatitis B, C • HIV • Herpes • TB • Meningitis

14. Accident Scene Triage Victim Assessment • Analyze safety of the scene • Move smoothly and quickly • Establish leadership and control • Personal protection • Numbers victims • Determine if victims are ill or injured • Determine what resources are needed before activating EMS.

15. Establish Victim Rapport and Control • Competence • Confidence • Compassion

16. Primary Assessment ABpCDE Airway & Spine Secondary Survey History, Vitals, BP, Temp, Skin color DOTS (deformity, open wounds, tenderness, swelling) Examination Regional, global Respiration Below 8 Above 40 Not enough air into lungs to sustain life Concussion Altered status Decreased O2 consumption Medical Triage

17. Secondary Survey • DOTS • Face, Mouth, Ears, Nose • Skull and Neck • Chest • Abdomen • Pelvic • Back • Lower and Upper extremities

18. Red Cross Head tilt chin lift Jas thrust not recommended 1 breathe / 5 seconds Adult 1 breathe 3 seconds Child 1 second / breath American Hearth Assoc Head tilt chin lift Jaw thrust if ventilators used 8-10 breathes / minute Adult 12-20 breathes / minute Child 1 second / breath CPR

19. Respiratory Distress vs. Arrest • Distress • Asthma, injury , anaphylactic shock, hyperventilation • Arrest: • Electrical shock, drowning, suffocation, toxic gas inhalation, head and chest, drug overdose, allergic reaction

20. Rescue Breathing • Mouth to Mouth • Compression alone are acceptable for CPR until EMS arrives • Mostly likely to perform on family members • Mouth to barrier ventilation • Mouth to Nose • Mouth to Stoma

21. Ventilating Infants and Children • Position victim on back • Tilt head to neutral positioning • Mouth over nose and mouth • I breath for every 3 seconds

22. Obstructed Airway Emergencies • Weak ineffective cough • High pitch wheeze • Clutching at throat • Can’t speak, flared nostrils, strained neck muscles • Can’t get air in with rescue breaths

23. Abdominal Thrust Maneuver • Standing – Heimlich • Sitting • Performing on unconscious victim • Bend them over a chair • Bend them over a rail • Back Slaps • Inferior sternum chest compression 100 minute

24. Obstruction in Infants • Place Child over arm and run….. • 5 back slaps • Abdominal thrust below sternum • Alternate Abdominal /Chest thrust and Back Slaps • Sweep mouth

25. Oral / Nasal pharyngeal Airways • Corner of mouth to tip of ear • Point goes into mouth straight up • Twist as enters

26. Basic Life Support • Obtain the AED • Review AED Procedures • Deliver Chest Compressions • Open Airway begin ventilations • Determine Pulselessness • Deliver Chest Compressions

27. Mistakes in CPR • Failing to tip head back far enough • Failing to maintain head tilt • Failing to maintain adequate seal • Not giving slow full breaths • Failing to watch for exhilaration • Bending at elbows • Shoulders not over hands • Not Deep or Fast enough • Lifting hands between compressions

28. Complications of CPR • Fractures ribs and sternum • Separations of Rib Cartilage • Pneumothorax • Hemothorax • Bruising of the lung • Laceration of Liver