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Emergency Medical Care Procedures

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Emergency Medical Care Procedures

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  1. Emergency Medical Care Procedures A presentation by: HM2 AUSTIN VERN SONGER NAVEDTRA 14295 Hospital Corpsman

  2. What is emergency care? • Professional care of the sick and injured before in-depth medical attention can be obtained. • Purpose is to save life, to prevent further injury, and to preserve resistance and vitality. These measures are not meant to replace proper medical diagnosis and treatment procedures. NAVEDTRA 14295 Hospital Corpsman

  3. General First Aid Rules • Get organized, recall first aid steps • Unless otherwise indicated, examine the patient in the position you find them • For multi-victim incidents, only do ABCs first • If massive bleeding and compromised airway are both present, first treat the bleed quickly, then move to the airway • Brain damage in 4-6 minutes NAVEDTRA 14295 Hospital Corpsman

  4. General First Aid Rules • Examine for fractures, don’t move prematurely • Remove clothing as necessary, but respect victim’s modesty • Be confident, reassure patients • Avoid touching open wounds with ungloved hand • If semi or unconscious, and if not contraindicated, place victim on side • Carry patients on litter feet first NAVEDTRA 14295 Hospital Corpsman

  5. Triage - “to sort” • Two types: Tactical and Non-tactical • Triage is dynamic: always match life-saving measures to realistic expectations and supply limitations • Try to do the maximum good for the maximum number of people NAVEDTRA 14295 Hospital Corpsman

  6. Tactical Triage • Used in BAS or ship battle dressing stations where no helo or rapid evac is available • Class I, II, III, or IV • Class I -Patients whose injuries require minor professional treatment that can be done on an outpatient or ambulatory basis. These personnel can be returned to duty in a short period of time. NAVEDTRA 14295 Hospital Corpsman

  7. Tactical Triage • Class II - Patients whose injuries require immediate life-sustaining measures or are of a moderate nature. Initially, they require a minimum amount of time, personnel, and supplies. • Class III - Patients for whom definitive treatment can be delayed without jeopardy to life or loss of limb. • Class IV Patients whose wounds or injuries would require extensive treatment beyond the immediate medical capabilities. Treatment of these casualties would be to the detriment of others. NAVEDTRA 14295 Hospital Corpsman

  8. Non-Tactical Triage • Priority I - Patients with correctable life-threatening illnesses or injuries such as respiratory arrest or obstruction, open chest or abdomen wounds, femur fractures, or critical or complicated burns. • Priority II - Patients with serious but non-life threatening illnesses or injuries such as moderate blood loss, open or multiple fractures (open increases priority), or eye injuries. NAVEDTRA 14295 Hospital Corpsman

  9. Non-Tactical Triage • Priority III - Patients with minor injuries such as soft tissue injuries, simple fractures, or minor to moderate burns. • Priority IV - Patients who are dead or fatally injured. Fatal injuries include exposed brain matter, decapitation, and incineration. NAVEDTRA 14295 Hospital Corpsman

  10. Before Arrival on the Scene • Gather equipment based on what info you have at that time NAVEDTRA 14295 Hospital Corpsman

  11. Arrival at the Scene • Gather information as quickly as possible • Scene survey • Patient info • Bystanders • Medical ID bracelet • Mechanism of injury • Deformities/Injuries • Signs NAVEDTRA 14295 Hospital Corpsman

  12. Primary Survey • Used to detect and treat life-threatening injuries • “Treat as you go” • ABCDEs of emergency care: airway, breathing, circulation, disability, and expose. • Cell death occurs 10 minutes after breathing has stopped • Status decision and transport decision • All of these above should be done in 10 min. NAVEDTRA 14295 Hospital Corpsman

  13. Secondary Survey • Used for non-life threatening injuries • Note injuries and treat at the end of the survey • Medical illness vs. Injury: Trauma Assessment vs. Medical Assessment • Trauma assessment is 80% exam, 20% questions • Medical assessment is 80% questions, 20% exam NAVEDTRA 14295 Hospital Corpsman

  14. Patient Interview • Be close to patient • ID yourself, reassure patient • Learn patient name • Patient age • Find out what’s wrong • PQRST – Provoke, Quality, Region, Referral, Relief, Severity, Time • AMPLE – Allergies, Meds, Prior hx, Last meal, Events NAVEDTRA 14295 Hospital Corpsman

  15. Objective Examination • Get patient’s consent • Notify patient of what you’re doing • Assume patients have spinal injuries NAVEDTRA 14295 Hospital Corpsman

  16. Head-to-toe Survey • Look for discolorations, deformities, penetrations, wounds, and any unusual chest movements • Feel for deformities, tenderness, pulsations, abnormal hardness or softness, spasms, and skin temperature • Listen for changes in breathing patterns and unusual breathing sounds • Smell for any unusual odors coming from the patient’s body, breath, or clothing. NAVEDTRA 14295 Hospital Corpsman

  17. Head-to-toe Survey • C-Spine • Neck • Scalp • Skull/face • Eyes • PERRLA • Eyelids • Ears/nose • Mouth • Smell breath • Chest • Chest fractures • Equal expansion of chest • Equal air entry • Inspect/palpate abdomen • Lower back • Pelvis • Priapism • Lower extremities • Distal pulse/ cap refill • Nerve function • Upper extremities • Distal pulse/ cap refill • Nerve function • Back and buttocks NAVEDTRA 14295 Hospital Corpsman

  18. Vital Signs • Pulse • Respiration • Blood pressure • Temperature NAVEDTRA 14295 Hospital Corpsman

  19. Pulse • Rate and character • Normal 60-80 • >100 tachycardia • <60 bradycardia • Athletes may be in the 40s or 50s • Pulse character=rhythm and force • Pulse rhythm= regular or irregular NAVEDTRA 14295 Hospital Corpsman

  20. Respiration • Normal is 12-20 per minute • > 28 is rapid • < 10 is slow • Too rapid/slow indicates the need for medical attention • Respiration character - rhythm, depth, ease of breathing, and sound • Sounds of respiration include snoring, wheezing, crowing (birdlike sounds), and gurgling NAVEDTRA 14295 Hospital Corpsman

  21. Blood Pressure • Systolic over diastolic • Systolic is the pressure created in the arteries when the heart pumps blood out into circulation • Diastolic is the pressure remaining in the arteries when the heart is relaxed • Normal range is 90/60 to 150/90 • High is hypertension • Low is hypotension • Measured in millimeters of Mercury (mm/Hg) NAVEDTRA 14295 Hospital Corpsman

  22. ABC • Airway • Breathing • Circulation NAVEDTRA 14295 Hospital Corpsman

  23. Upper Airway Obstruction • A very common cause of obstruction with both adults and children is improperly chewed food that becomes lodged in the airway (an event commonly referred to as a “cafe coronary”) • In unconscious patients, tongue can fall back into pharynx • Partial airway obstruction allows for slight airway exchange, usually “crowing” takes place • If patient can’t cough, partial may become a total blockage NAVEDTRA 14295 Hospital Corpsman

  24. Opening the Airway • Head-tilt/ chin-lift • Jaw-thrust for trauma victims NAVEDTRA 14295 Hospital Corpsman

  25. Heimlich Maneuver • Position one fist inside of other hand between the victim’s navel and below the xiphoid process • Thrust in and up until victim becomes unconscious or object is expelled • For obese or pregnant victims, position hands on middle of sternum and perform thrusts NAVEDTRA 14295 Hospital Corpsman

  26. Breathing • Breathlessness assessed by looking, listening, and feeling for breath signs • If no breathing present, perform artificial ventilation 1:5 (1 ½ - 2 seconds/breath) for adults • 1:3 for children • If patient has lockjaw or severe maxillofacial wounds, then use mouth-to-nose breathing • Also mouth-to-stoma and mouth-to-mask • Be careful of gastric distention NAVEDTRA 14295 Hospital Corpsman

  27. Abdominal Thrusts • Straddle victim and perform inward, upward abdominal thrusts by clasping hands as in CPR • Perform 5 thrusts and then sweep for foreign object, then repeat cycle NAVEDTRA 14295 Hospital Corpsman

  28. CPR • Know procedure!! • Depress sternum 1 ½ - 2 inches for adults (1 -1 ½ for children) • 15:2 ratio for one or two-man CPR • 80-100 compressions per minute • Perform assessment at first minute, then every few minutes afterwards • Check carotid artery in adults, brachial in infants • Breaths are for 1 - 1 ½ seconds for infants • Depress ½ - 1 inch in infants NAVEDTRA 14295 Hospital Corpsman

  29. Shock • Hypovolemic shock - caused by the loss of blood and other body fluids • Neurogenic shock - caused by the failure of the nervous system to control the diameter of blood vessels • Cardiogenic shock - caused by the heart failing to pump blood adequately to all vital parts of the body. • Septic shock - caused by the presence of severe infection • Anaphylactic shock - caused by a life-threatening reaction of the body to a substance to which a patient is extremely allergic • Hemorrhagic shock – a type of shock caused by excessive bleeding NAVEDTRA 14295 Hospital Corpsman

  30. Degrees of Shock NAVEDTRA 14295 Hospital Corpsman

  31. Signs and Symptoms of Shock • Restlessness and apprehension, apathy • Eyes may be glassy and dull, pupils dilated • Breathing rapid or labored • The face and skin pale or ashen • The lips are often cyanotic • The skin feels cool and clammy • The systolic pressure drops below 100, while the pulse rises above 100 • A point comes, however, when decompensation will occur • Nausea, vomiting, and dryness of the mouth or thirst • Surface veins may collapse NAVEDTRA 14295 Hospital Corpsman

  32. Hypovolemic Shock • Hypovolemic shock is also known as oligemic or hematogenic shock. The essential feature of all forms of hypovolemic shock is loss of fluid from the circulating blood volume, so that adequate circulation to all parts of the body cannot be maintained NAVEDTRA 14295 Hospital Corpsman

  33. Hemorrhagic Shock • In cases where there is internal or external hemorrhage due to trauma (hemorrhagic shock), there is a loss of whole blood, including red blood cells. This results in reduction of oxygen transported to the tissues (hypoxia); reduction of perfusion, the circulation of blood within an organ; and reduction of waste products transported away from the tissue cells. NAVEDTRA 14295 Hospital Corpsman

  34. Neurogenic Shock • Neurogenic shock, sometimes called vasogenic shock, results from the disruption of autonomic nervous system control over vasoconstriction. • Simple fainting (syncope) is a variation of neurogenic shock. • It often is the result of a temporary gravitational pooling of the blood as a person stands up. • Shell shock and bomb shock are other variations of neurogenic shock that are important to the Hospital Corpsman. NAVEDTRA 14295 Hospital Corpsman

  35. Cardiogenic Shock • Cardiogenic shock is caused by inadequate functioning of the heart, not by loss of circulating blood volume. • If the heart muscle is weakened by disease or damaged by trauma or lack of oxygen (as in cases of pulmonary disease, suffocation, or myocardial infarction), the heart will no longer be able to maintain adequate circulatory pressure, even though the volume of fluid is unchanged. NAVEDTRA 14295 Hospital Corpsman

  36. Septic Shock • Septic shock usually does not develop for 2 to 5 days after an injury and the patient is not often seen by the Corpsman in a first aid situation. • Septic shock is the result of vasodilation of small blood vessels in the wound area, or general vasodilation if the infection enters the bloodstream. • This type of shock carries a poor prognosis and should be treated under the direct supervision of a medical officer. NAVEDTRA 14295 Hospital Corpsman

  37. Anaphylactic Shock • Anaphylactic shock occurs when an individual is exposed to a substance to which his body is particularly sensitive. In the most severe form of anaphylactic shock, the body goes into an almost instantaneous violent reaction. NAVEDTRA 14295 Hospital Corpsman

  38. General Treatment Procedures • Intravenous fluid administration • An electrolyte solution may be prepared by adding a teaspoon of salt and half a teaspoon of baking soda to a quart or liter of water. • Maintain an open airway. • Control hemorrhages. • Check for other injuries • Place the victim in a supine position, with the feet slightly higher than the head • Conserve the patient’s body heat. • Vital signs q 15 minutes NAVEDTRA 14295 Hospital Corpsman

  39. Pneumatic Counter Pressure Devices (MAST) • Indications for use: • Diastolic blood pressure is less than 80 mm Hg, systolic blood pressure is less than 100 mm Hg, and the patient exhibits the classic signs of shock • Fracture of the pelvis or lower extremities is present • When applying the garment, inflate sufficiently so the patient’s systolic blood pressure is brought to and maintained at 100 mm Hg • Contraindicated in pulmonary edema NAVEDTRA 14295 Hospital Corpsman

  40. Airway Information • Size E O2 cylinder holds 650 PSI • Use of O2 to avoid hypoxia • Oropharyngeal is placed hard palate, soft palate, measured by length from ear to mouth (unconscious victim) • Nasopharyngeal measured by length from ear to nose (conscious victim, not for basal skull fx.) • Bag-valve-mask can keep O2 in high concentration for extended time period (1 liter of air per squeeze) • If O2 hooked up to bag-valve-mask, 15 LPM provides 90% O2 • Pocket mask used for barrier device • Suction can be applied with proper device for a few seconds only NAVEDTRA 14295 Hospital Corpsman

  41. Cricothyroidotomy • A cricothyroidotomy, often called an emergency tracheotomy, consists of incising the cricothyroid membrane, which lies just beneath the skin between the thyroid cartilage and the cricoid cartilage. NAVEDTRA 14295 Hospital Corpsman

  42. Wounds • ABRASIONS - made when the skin is rubbed or scraped off • INCISIONS - commonly called cuts, are wounds made by sharp cutting instruments such as knives, razors, and broken glass • LACERATIONS - are torn, rather than cut. They have ragged, irregular edges and masses of torn tissue underneath. • PUNCTURES - are caused by objects that penetrate into the tissues while leaving a small surface opening. • AVULSIONS - is the tearing away of tissue from a body part. • AMPUTATIONS – traumatic amputation is the nonsurgical removal of the limb from the body. NAVEDTRA 14295 Hospital Corpsman

  43. Control of Hemorrhage • Direct pressure • Pressure point • Elevation • Tourniquet • Capillary blood is usually brick red in color; blood oozes out • Blood from the veins is dark red. Venous bleeding is characterized by a steady, even flow. • If an artery near the surface is cut, the blood, which is bright red in color, will gush out in spurtsthat are synchronized with the heartbeats. NAVEDTRA 14295 Hospital Corpsman

  44. Pressure Points NAVEDTRA 14295 Hospital Corpsman

  45. Tourniquets • A tourniquet is a constricting band that is used to cut off the supply of blood to an injured limb. • Use a tourniquet only as a last resort • Don’t loosen a tourniquet after it has been applied. • Using crayon, skin pencil, or blood, mark a large “T” and the time the tourniquet was applied on the victim’s forehead or on a medical tag attached to the wrist. NAVEDTRA 14295 Hospital Corpsman

  46. Soft Tissue Injury S & S • Hematemesis (vomiting bright red blood) • Hemoptysis (coughing up bright red blood) • Melena (excretion of tarry black stools) • Hematochezia (excretion of bright red blood from the rectum) • Hematuria (passing of blood in the urine) • Nonmenstrual (vaginal bleeding) • Epistaxis (nosebleed) • Pooling of the blood near the skin surface • Pale, moist, clammy skin • Subnormal temperature • Rapid, feeble pulse • Falling blood pressure • Dilated, slowly reacting pupils with impaired vision • Tinnitus • Syncope • Dehydration and thirst • Yawning and air hunger • Anxiety, with a feeling of impending doom NAVEDTRA 14295 Hospital Corpsman

  47. Tx of Soft Tissue Injuries • 1. Treat for shock. • 2. Keep the victim warm and at rest. • 3. Replace lost fluids with a suitable blood volume expander. DO NOT give the victim anything to drink until the extent of the injury is known for certain. • 4. Give oxygen, if available. • 5. Splint injured extremities. • 6. Apply cold compresses to identifiable injured areas. • 7. Transport the victim to a medical treatment facility as soon as possible. NAVEDTRA 14295 Hospital Corpsman

  48. Special Considerations inWound Treatment • Immediate treatment to prevent shock. • Infection should be a concern: Look for inflammation and signs of abscess. • Symptoms of inflammation include redness, pain, heat, swelling, and sometimes loss of motion. • Inflammation should be treated by the following methods: • Remove the irritating cause. • Keep the inflamed area at rest and elevated. • Apply cold for 24 to 48 hours to reduce swelling. • Once swelling is reduced, apply heat to soft tissues, which hastens the removal of products of inflammation. • Apply wet dressings and ointments to soften tissues and to rid the area of the specific causal bacteria. NAVEDTRA 14295 Hospital Corpsman

  49. Abscesses • A furuncle (boil) is an abscess in the true skin caused by the entry of microorganisms through a hair follicle or sweat gland • A carbuncle is a group of furuncular abscesses having multiple sloughs, often interconnected under the true skin. • DO NOT squeeze! • Use aseptic techniques when handling. • Relieve pain with aspirin. • Apply moist hot soaks/dressings (110°F) for 40 minutes, three to four times per day. • Rest and elevate the infected body part. • Antibiotic therapy may be ordered by a physician. • Abscesses should be incised after they have localized (except on the face) to establish drainage. Abscesses in the facial triangle (nose and upper lip) should be seen by a physician. NAVEDTRA 14295 Hospital Corpsman

  50. Eye Injuries • DO NOT UNDER ANY CIRCUMSTANCES ATTEMPT TO REMOVE AN OBJECT THAT IS EMBEDDED IN THE EYEBALL OR THAT HAS PENETRATED THE EYE! • Try to wash the eye gently with lukewarm, sterile water. • Gently pull the lower lid down, and instruct the victim to look up. If you can see the object, try to remove it with the corner of a clean handkerchief or with a small moist cotton swab. You can make the swab by twisting cotton around a wooden applicator, not too tightly, and moistening it with sterile water. NAVEDTRA 14295 Hospital Corpsman