Unit G Emergency Care Skills

2H07.01 Acquire Certification in Cardiopulmonary Resuscitation

2H07.01 Acquire Certification in Cardiopulmonary Resuscitation

A. Principles of providing first aidB. Basic facts about CPRC. Performing CPR, one-person rescue D. Performing CPR, two person rescueE. Performing CPR, infants and childrenF. Obstructed airway, conscious adultG. Obstructed airway, unconscious victimH. Use of AED

2H07.02 Provide Basic First Aid

Emergency Care

• Patients always have the right to refuse care. Call 911 and stay a reasonable distance from the victim.

A. Bleeding and Wounds

Abrasion- the skin scraped off, bleeding is

limited.

Puncture

Caused by sharp object

(pin, nail, etc.) External

bleeding minimal, may

lead to infection or

Tetanus.

Laceration

A tearing of tissues from

excessive force, jagged

edges, bleeding may be

heavy. Deep lacerations

may become infected.

Incision

A cut with sharp object

such as a knife, scissors,

razor blade, etc., if cut is

deep, bleeding can be

heavy, also can have

damage to muscles &

Nerves.

Avulsion

Tissue torn or separated from the body, bleeding is heavy, important to preserve the body part because a surgeon may be able to reattach it.

AmputationAmputation

Body part cut off or separated from the body, bleeding can be extensive, important to preserve separated part for reattachment.

Wrap part in cool, moist dressing (sterile water or saline

preferred) and place in plastic bag. Keep bag cool or in ice water and transport with the

victim. (Don’t place the body part in direct contact with the

ice.)

Arterial & VenousArterial

bleeding is bright red in color and life

threatening Venous bleeding is slower and dark

red.

Control Bleeding

1. Direct Pressure

2. Elevation

3. Pressure Bandage

4. Pressure points

Use protective barrier to control bleeding (gloves)

or thick layers of dressings. Avoid direct contact

with blood. Wash hands after providing first aid.

Signs of Internal Bleeding

1. Vomiting or coughing up blood.

2. Tender, swollen, bruised areas or hard lumps on the body.

3. Confusion, faint, drowsy or unconscious.

Infection

Signs and symptoms of wound infection:

• Swelling• Heat• Redness• Pain• Fever• Pus• Red Streaks

Tetanus- bacterial infection, most common in puncture wounds, be sure to find out when victim last had tetanus

shot, advise to consult medical professional about tetanus booster.

Closed Wounds

• If a bruise, apply cold• Signs of internal bleeding-

pain, tenderness, swelling, deformity, cold and clammy skin, rapid and weak pulse, uncontrolled restlessness, excessive thirst, vomiting blood, blood or urine in feces.

Shock

When caring for bleeding/wounds, or any other injury or illness, be alert for signs of shock.

Clinical set of signs and symptoms associated with inadequate supply of blood to body organs, especially the brain and heart.

[ If not treated shock can lead to death, even when the victim’s injuries are not life threatening.]

Shock

Caused by:

• Hemorrhage• Excessive pain• Infection• Heart attack• Poisoning by chemicals, drugs or gases• Lack of oxygen• Psychological trauma• Dehydration from burns, vomiting, or diarrhea

Symptoms

Skin pale or cyanoticSkin cool to touchDiaphoresisPulse rapid and weakRespirations rapid and shallowHypotensionVictim weak, listless, confused and eventually unconsciousVictim anxious and extremely restlessVictim may complain of excessive thirstVictim may experience nausea and VomitingVictim may complain of blurred vision – s shock progresses, eyes may appear sunken and have vacant, confusedexpression, pupils dilate

Get medical help right away. If possible:

1. Eliminate the cause of shock

2. Improve circulation to the brain and heart

3. Provide oxygen

4. Maintain body temperature

Positioning patient depends on injuries:

If neck or spinal injury suspected:

-do not move the victim

How would you position the following victims?

• Victim has a broken arm, no other apparent injuries.

• Victim is vomiting and bleeding profusely from a lacerated tongue.

• Victim has broken ribs and is dyspneic.

Shock

Cover the patient with blankets or additional clothing. Blankets may also be placed between the ground and the victim.

Avoid giving the patient anything to eat or drink. A wet cloth may be used to moisten the lips and mouth.

If help wont arrive for more than an hour and dehydration is evident, provide fluids.

Poisoning• If you suspect that a conscious

person has been poisoned you should call the Poison Control Center & follow the advice given.

• If not available call EMS.• Save the label or container of the

substance taken.• If it is helpful to know-estimate

how much was taken and the time the poisoning occurred.

• If the victim vomits, save a sample.• If the victim is unconscious check

for breathing. Provide rescue breathing is the victim is not breathing. If victim is breathing, turn victim on his-her side.

Lead poisoning

Dioxin poisoning

Poisoning

• DO NOT induce vomiting if:- The victim is unconscious- The victim swallowed acid of

alkali.- The victim swallowed petroleum.- The victim is convulsing.- The victim has burns on the lips

or mouths.

                     

•If the poison control center tells you to induce vomiting:1. Give syrup of ipecac2. Tickle the back of the victims throat3. Administer warm salt water

Poisoning

• Vomiting only removes half of the poison, so you may need to administer activated charcoal to counteract the remaining poison.

• If poisoning is due to gas inhalation…remove victim from area

Carbon Monoxide Poisoning

• Odorless and colorless gas

• Before entering the area, take a deep breath and don’t breathe the gas while removing the victim from the area

• After the rescue, check for breathing and administer CPR if needed

• Obtain medical help immediately

Chemicals or Poisons that come in Contact with Skin

• Wash with large amounts of water

• Remove clothing or jewelry that contains the substance

• If poisonous plant, wash with soap and water- use Calamine or Caladryl (or paste made from baking soda and water.)

• Obtain medical help

For insect bite, sting or snakebite…

• If possible, hold part below level of the heart.

• Remove the stinger and wash the area with soap and water.

• Apply sterile dressing and cold pack

• If person is allergic call 911 & wait until help arrives.

• Monitor the victim and give CPR if needed.

• Watch for allergic reaction• Treat for shock

BURNS

First Degree Burns

• Involves only the epidermis

• Heals in 5-6 days• No scarring• Skin red, mild swelling• Victims feels pain• Usually cause by the

sun, hot objects or steam, or exposure to weak acid-alkali

Second Degree Burns

• Epidermis and dermis• Blister or vesicle forms• Skin red an mottle with

swelling • Surface appears wet• Very painful• Usually cause by the

sun, sunlamp, contact with hot or boiling liquids, contact with fire

Third Degree Burns

• Injury to all layers and underlying tissue

• Area has white or charred appearance

• Can be extremely painful or painless (if nerve endings destroys)

• Usually caused by flames, prolonged contact with hot objects, contacts with electricity, immersion in hot or boiling liquids

Treatment

• Remove source of heat• Stop the burning• Cool affected skin area with large amounts of H2O.• Cover the burn• Relieve pain• Observe pain• Observe and treat for shock• Medical care should be obtained in more than 15% of

adult body burned (10% of a child)

Treatment• DO NOT apply cotton, tissues,

ointment, powders, oils, grease, butter, or other substances to the burned area unless you are instructed to do so by a physician

• DO NOT break open blister• Call for help immediately if 3rd

degree burns• Dehydration can occur quickly

with burns• Be alert for signs of shock• Remain calm and reassure burn

victim

BONE AND JOINT INJURIES

Fracture-is a break in a bone!!

• TYPES• Closed or green stick- does not

break the skin• Spiral is a twisted break• Comminuted- is where the bone is

crushed• Compound or open-accompanied

by open wound• Common signs and symptoms

include deformity, limited (loss of) motion, pain and tenderness at fracture site, swelling and discoloration, protrusion of bone ends

• Victim may have heard a snap or feel a grating sensation

• Treatment includes immobilizing above and below fracture, treat for shock

SPLINTS

• Splints and casts support and protect injured bones and soft tissue, reducing pain, swelling, and muscle spasm. In some cases, splints and casts are applied following surgery.

• Splints should be snug, but not so tight that is slows circulation.

Dislocation• When the end of bone moves

out of the joint• Usually accompanied by

tearing-stretching of ligaments• Signs and symptoms include

deformity, limited of abnormal movement, swelling, discoloration, pain, tenderness, shortening or lengthening of affected arm or leg

• Treatment similar to fractures- immobilize affected area, do not attempt to reduce the dislocation

Sprain

• Injury to tissues surrounding a joint when the part is forced beyond its normal ROM

• Ligaments, tendons and other tissues stretched or torn

• Usually ankle or wrist• Symptoms similar to fracture

and dislocation• Treatment includes

application of cold, elevation of affected part, and rest

Strain

• Overstretching of muscle- frequently the back

• Signs-symptoms include sudden pain, swelling and-or bruising

• Treatment aimed at resting affected muscle

SUDDEN ILLNESS

Frostbitten Hands• Get out of the cold & in a warm

environment.

• Warm your hands by tucking them under your arms. If your nose, ears or face is frostbitten, warm the area by covering it with dry, gloved hands.

• Don't rub the affected area. Never rub snow on frostbitten skin.

• If there's any chance of refreezing, don't thaw out the affected areas. If they're already thawed out, wrap them up so they don't refreeze.

• Get emergency medical help if numbness remains during warming. If you can't get help immediately, warm severely frostbitten hands or feet in warm — not hot — water. You can warm other frostbitten areas, such as your nose, cheeks or ears, by covering them with your warm hands or by applying warm cloths.

Heart Attack• Blood supply to heart is

blocked• If heart stops beating CPR must

be performed• Signs/symptoms- chest pain or

pressure, pain radiating to shoulders, arms, neck or jaw

• Shortness of breath• Cyanosis• Victim weak and apprehensive• Nausea, vomiting, loss of

consciousness• Encourage victim to relax,

place in comfortable position, and obtain medial help

Heat Exhaustion• Can develop after several

days of exposure to high temperatures & inadequate or unbalanced replacement of fluids.

• Warning signs are: heavy sweating, paleness,muscle cramps, tiredness,weakness, dizziness, headache, nausea, vomiting& fainting. Get the person out of the heat & into a cooler place.

Stages of Heat Emergencies

• 1.) Heat Cramps

The muscle contractions,

usually in the gastrocnemius

or hamstring muscles (the

muscles at the back of the

calves). These contractions

are forceful and painful.

2.) Heat Exhaustion

• Result of excessive heat and dehydration. The signs of heat exhaustion include paleness, dizziness, nausea, vomiting, fainting, and a moderately increased temperature (101-102 degrees F).

3.) Heat Stroke

• Most dangerous, warm, flushed skin, and you do not sweat. usually has a very high temperature (106 degrees F or higher), and may be delirious, unconscious, or having seizures.

CVA-Cerebrovascular Accident (Stroke)

• A blockage of blood flow to the brain caused by a clot in a cerebral artery.

• Signs/symptoms- numbness, paralysis, pupils unequal size, mental confusion, slurred speech, nausea, vomiting, difficulty breathing and swallowing, and loss of consciousness

• Remember that although the patient/victim may be unable to speak or may be unconscious, he/she may be able to hear and understand what is going on.

FAST

• FACE    Ask the person to smile. Does one side of the face droop?

• ARMS    Ask the person to raise both arms. Does one arm drift downward?

• SPEECH  Ask the person to repeat a simple sentence. Are the words slurred?  Can he/she repeat the sentence correctly? TIME    If the person shows any of these symptoms, time is important. 

Call 911 or get to the hospital fast. Brain cells are dying.

Fainting• Temporary reduction of blood

supply to the brain• Victim regains consciousness

after being in a supine position• Signs- dizziness, extreme

pallor, diaphoresis, coldness of the skin, nausea, numbness and tingling of hands and feet

• When signs occur, help the victim sit with the head at the level of the knees

• If victim loses consciousness, try to prevent injury, loosen clothing, maintain open airway

Convulsion/Seizure• Occurs in conjunction with high

body temperature, head injuries, brain disease, and brain disorders such as epilepsy.

• Body muscles become rigid followed by jerking movements.

• During seizure, victim may stop breathing, bite their tongue, lose bladder and bowel control, and injure body parts

• Face and lips develop a bluish color.

• Victim loses consciousness.• You should remove nearby objects

that might cause injury.

Diabetic Emergency• Caused by an increase or decrease

amount of glucose in a person’s blood.

• Diabetic Coma -A result of an excess intake of sugar, failure to take insulin, or insufficient production of insulin

• Signs: Confusion, weakness or dizziness, nausea or vomiting, rapid, deep respirations, flushed skin, and fruity smelling breath

• Victim will lose consciousness and die if not treated

• Obtain medical treatment as quickly as possible

Insulin Shock• Caused by an excess amount of

insulin (low level of glucose in bloodstream)

• A result of failure to eat or the body produces too much insulin.

• Signs: Muscle weakness, mental confusion, restlessness or anxiety, diaphoresis, pale, moist skin, hunger pains, palpitations

• If victim conscious, give sweetened drink or sugar

• Avoid giving victim hard candy if confused

• If victim loses consciousness, get medical help

Dressing and BandagesDressing= sterile covering over

wound or injured partBandages= materials to hold

dressing in place, secure splints, and support body parts

• Roller gauze bandages• Triangular bandage• Elastic (Ace) bandages

After bandage applied, check to be sure it is not too tight

(Check circulation by pressing lightly on nail beds lightly on nail beds to make them turn white. Color should return to nail beds immediately.)

Head/Neck or Back Injuries

• If someone has suffered a severe neck injury, call 911 for life support and help.

• Do not move the person, especially the head or neck unless failure to do so presents an immediate threat or urgent danger.

Remember the Cardiac Chain of Survival:

Early Recognition and Early Access

Early CPR

Early Defibrillation

Early Advanced Medical Care.

AED

• The automated external defibrillator (AED) is a computerized medical device. An AED can check a person’s heart rhythm. It can recognize a rhythm that requires a shock. And it can advise the rescuer when a shock is needed. The AED uses voice prompts, lights and text messages to tell the rescuer the steps to take.

CARDIAC ARREST/AED STEPS

• Turn on the AED 1st• Wipe the chest dry • Attach pads to bare chest • Plug in the connector, if necessary • Make sure no one, including you, is touching the person.

Tell everyone to "STAND CLEAR!" • Push the analyze button if necessary, let the AED analyze heart rhythm.

Shock advised. Charging. Stay clear of patient.• Before you push the button to deliver the shock, make sure no one is

touching the person, not even you.• Deliver shock now. Press the orange button now.• Shocking! Stand clear!• Shock delivered. It is safe to touch the patient. Begin CPR.• 1 and 2 and 3 and 4 and 5 and 6 and 7 and 8 ...to 30.• After a shock is delivered or if no shock is indicated, give 2 minutes of CPR

before analyzing the heart rhythm again.

AED Electrode Placement

• The AED electrodes should be placed on the upper right and the lower left of the chest.

AED Knowledge• After sudden cardiac arrest, chances of

survival decreases by 7-10 percent each minute that passes without defibrillation.

• The AED's save lives of more people in the cardiac arrest!

• The AED is an electrical shock that may help the heart to resume an effective rhythm to a person in sudden cardiac arrest.

• Never place AED electrode pads directly on top of medication patches, such as nitroglycerin, or EKG patches. Patches should always be removed with a gloved hand and the skin wiped dry before placing defibrillator pads on the skin.