First Responder Course.docx

**[Wednesday]** =========================== ### **Chapter 1** Professional Responders and Pre-Hospital Care System EMS (Emergency Medical System) Definition: Network of community resources and medical personnel providing emergency care to patients with injuries or illnesses requiring highly trai...

**[Wednesday]** =========================== ### **Chapter 1** Professional Responders and Pre-Hospital Care System EMS (Emergency Medical System) Definition: Network of community resources and medical personnel providing emergency care to patients with injuries or illnesses requiring highly trained professional care. - Components of Pre-Hospital Care System - Communication - Transportation - Facilities - Medical Control - Trauma Systems - Public Information and Education - Human Resources - Resource Management - Emergency Medical Responder (EMR) - Recognized emergency care and transportation training program. - Often associated with volunteer emergency services in rural and remote communities. - Primary Care Paramedic (PCP) - Completed recognized education programs in paramedicine at the PCP level. - May be volunteers or career paramedics. - Capabilities include: - IV cannulation - Administration of some medications - Advanced Care Paramedic (ACP) - Completed recognized education programs in paramedicine at the ACP level. - Provide enhanced levels of assessment. - Utilize advanced techniques to manage life-threatening problems affecting airway, breathing, and circulation. - May implement invasive or pharmacological measures. - Critical Care Paramedic (CCP) - Highest level of paramedics in Canada. - Responsibilities depend on organization\'s operational, administrative, or training requirements. - Medical Oversight - Medical Director: Physician responsible for hospital emergency medical care. Provides oversight for all emergency care. - Medical director delegates acts and care given in a pre-hospital cycle. - Professional Conduct - Not responsible for delivering distressing news to patients or their families. - Effective communication and mutual respect within the team. - Self-care is crucial: manage fears and anxieties, maintain a safe and healthy lifestyle. - Primary Responsibilities of First Responders - Safety: - Ensure your safety and avoid putting yourself in danger. - Ensure the safety of bystanders, distance people from hazards. - Access and Assessment: - Gain access to the patient unless the scene is too dangerous. - Determine life-threatening injuries using primary assessment (Airway, Breathing, Circulation). - Request advanced medical care if needed. - Provide Necessary Care: - Stay within your scope of practice. - Direct bystanders if needed, maintain confidentiality, and reassure family or friends without disclosing sensitive information. - Interpersonal Communication - Be conscious of non-verbal communication (body language, eye level, eye contact). - Listen to the patient and those around them for valuable information. - Be respectful of cultural or religious considerations. - Legal Principles - Duty of Care: - Athletic therapists, physiotherapists, and medical first responders have a duty to provide care. - Failure to provide care could result in legal action. - Consent: - Obtain consent from individuals before providing care. - Identify yourself, state your level of training, explain the situation, and ask for consent to help. - Use implied consent for unresponsive, confused, or seriously ill individuals. **Chapter 2** Responding to the Call - Preparing for an Emergency Response - Considerations: - Equipment - Plan of Action - Communications - Training - Psychological Preparation - Equipment - Ensure all equipment is stocked, maintained, and inspected. - Common Equipment: - Trauma Response Kit: Check regularly and restock immediately after use. Keep an inventory list. - AED: Check batteries daily and replace every five years. - Portable Oxygen: Keep full and check regularly. - Plan of Action - Develop specific plans for different situations or locations. - Familiarize yourself with surroundings and resources (equipment, human resources). - Review EAP (Emergency Action Plan) with opponents\' medical staff. - Rehearse as a team to ensure everyone knows their roles. - Communications - Ensure the ability to contact specialized and advanced personnel. - Ensure communication systems are working properly with backups in place. - Check cell phones for functionality, charge, and signal before games or practices. - Training - Keep skills and knowledge up to date through practice and professional development. - Medical First Responder certificate is valid for three years; BLS CPR certificate for one year. - Regularly review and practice learned skills. - Psychological Preparation - Mentally prepare for emergency scenes to remain professional and effective. - Focus on self-care to maintain mental and physical health. - Scene Safety - Assess the Scene: - Request additional personnel if needed. - Wear appropriate personal protective equipment (PPE). - Perform only skills within your training and scope of practice. - Manage Hazards: - Be aware of obvious and hidden hazards. - Ensure your safety and the safety of others, including the patient. - Avoid putting yourself in dangerous positions. - Special Emergency Scenes - Crime Scene: - Prioritize your safety and the patient\'s. - Avoid compromising the scene; touch only necessary items. - Handle patient clothing minimally. - Drug Lab: - Do not enter; let authorities handle it. - Hostile Bystander: - Request law enforcement and wait until the scene is safe. - Hostage Situation: - Prioritize your safety. - Specific Scene Hazards - Hazardous Materials: - Look for clues indicating their presence. - SDS (Safety Data Sheets) provide important information. - Water and Ice: - Requires specialized training. - Include ice management in the EAP - Downed Electrical Lines: - Do not touch vehicles in contact with power lines. - Inform occupants to stay inside and remain calm. - Notify the fire department and power companies immediately. - Fire: - Only firefighters should approach - Traffic Hazards: - Position your vehicle to prevent traffic from entering the scene. - Be aware of surrounding traffic and ensure your safety. **Chapter 3** Infection Prevention and Control - Pathogens - Bacteria - Single-celled microorganisms - Examples: Tetanus, Meningitis, Strep Throat, Food Poisoning. - Treatment: Often requires antibiotics. - Viruses - Depend on other organisms to live and reproduce. - Examples: Common Cold, Measles, Influenza, HIV/AIDS. - Fungi - Single-celled or multi-celled organisms. - Examples: Athlete\'s Foot, Ringworm. - Treatment: Anti-fungal creams. - Protozoa - Single-celled organisms that divide within a host. - Example: Malaria. - Rickettsia - Microorganisms similar to viruses. - Examples: Typhus, Rocky Mountain Spotted Fever. - Parasitic Worms - Live on or inside a host, deriving nourishment from the host. - Modes of Transmission - Direct Contact - Person touches bodily fluids from an infected person. - Indirect Contact - Person touches an object that has touched infected bodily fluids. - Examples: Soiled dressings, equipment, workstations, needles. - Airborne Transmission - Person breathes in droplets that become airborne when an infected person coughs or sneezes. - Vector-Borne - Pathogen transmitted through a bite from an animal or insect. - Examples: Rabies, Lyme Disease. - Infection Factors - Pathogen presence. - Sufficient quantity of pathogen to cause disease. - Susceptibility of the person to the pathogen. - Route of entry into the body. - Preventing Disease Transmission - Personal Protective Equipment (PPE) - Personal Hygiene - Wash hands regularly; use disinfectant with at least 70% alcohol if washing isn\'t possible. - Cleaning and Disinfecting Equipment - Following Workplace Procedures - Personal Protective Equipment (PPE) During COVID-19 - Recommendations: - Disposable gloves. - Mask. - Protective eyewear. - Face shield (especially in sporting environments). - Change clothing or jacket after working with each athlete to avoid droplet transmission. - Donning and Doffing PPE - Donning PPE: - Wash hands. - Put on gown. - Put on mask. - Put on protective eyewear. - Put on disposable gloves. - Additional steps for COVID-19: - Wash hands/hand sanitize after each step. - Doffing PPE: - Remove disposable gloves. - Remove gown. - Wash hands. - Remove protective eyewear. - Wash hands. - Remove mask. - Wash hands. - Glove Removal - Remove gloves by turning them inside out starting at the wrist. - Hook the inside of the second glove at the wrist and peel off. - Avoid touching soiled surfaces with bare hands. - Wash hands with soap and water for 30 seconds after removal. - Waste Disposal - Store waste in appropriate containers with warning labels (e.g., biohazard) until disposal or disinfection. **Chapter Four** Your Anatomy and Physiology - Anatomical Terminology and Position - Basic terms for body regions and their parts. - Anatomical position: - Midline - Proximal to distal - Medial to lateral - Anterior (front) to posterior (back) - Superior (above) to inferior (below) - Ventral (front) to dorsal (back) - Cephalic (toward the head) - Major Body Cavities - Cranial Cavity - Located in the head, protected by the skull. - Spinal Cavity - Extends from the skull to the lower back, protected by the spine. - Thoracic (Chest) Cavity - Located between the diaphragm and neck, protected by the rib cage and upper spine. - Abdominal Cavity - Located between the diaphragm and pelvis. - Pelvic Cavity - Located in the pelvis, protected by pelvic bones and lower spine. - Abdominal Quadrants - Four quadrants, stated from the patient\'s perspective. - Respiratory System - Supplies oxygen and removes carbon dioxide. - Lungs protected by **12 pairs of ribs** (10 attached to the sternum, 2 floating attached only to the spine). - Conditions affecting the respiratory system: Asthma, Bronchitis, Pneumonia, Pulmonary Edema, Airway Obstruction, Hemothorax, COPD. - Respiratory emergencies caused by choking, illness, electrocution, shock. - Agonal Respirations: - Inadequate breathing pattern associated with cardiac arrest, requiring immediate intervention. - Circulatory System - Works with the respiratory system to transport oxygen and carbon dioxide. - Components: - Heart: Pumps blood. - Blood Vessels: **Arteries** (oxygenated blood), **Veins** (carbon dioxide), **Capillaries** (exchange of gases, waste, nutrients). - Blood: Liquid (plasma) and solid components (red blood cells, white blood cells, platelets). - Nervous System - Most complex and delicate system. - Components: - Central Nervous System (CNS): Brain and spinal cord. - Brain Functions: Sensory, motor, integrated (responsiveness, memory, emotion, language). - Nerves: Transmit information as electrical impulses. - Injury to the brain can cause permanent loss of functions. - Musculoskeletal System - Comprised of over 200 bones. - Bones protect organs and support the body. - Types of Bones: - Long: Humerus, Femur. - Short: Carpals, Tarsals. - Flat: Scapula, Skull bones. - Irregular: Vertebrae, Sesamoid bones. - Muscles: - Skeletal Muscles: Voluntary, attached to bones by tendons. - Involuntary Muscles: Heart, diaphragm (controlled by the brain). - Integumentary System - Includes skin, hair, and nails. - Skin: Largest organ. - Two layers: - Dermis (nerves, glands, blood vessels), Epidermis (superficial, barrier to bacteria). - Contains hair roots, oil glands, sweat glands. - Blood supply affects skin color (flushed red or pale/blue). - Digestive System - Breaks down food. - Components: Stomach, Liver, Small Intestine, Large Intestine. - Interrelationships of Body Systems - Each system plays a vital role in survival. - Systems adapt to changes (e.g., increased oxygen demand during exercise). **Chapter Five** Assessment, broken down into four separate presentations: - Scene Assessment - Gather Information Before Approaching the Patient: - Identify hazards in the environment. - Formulate a hypothesis on the mechanism of injury and chief complaint. - Determine the number of patients and if additional resources are needed. - Form General Impression: - Done while donning PPE if not already on. - Includes patient's chief complaint, whether they are injured or ill, and their demographics. - Primary Assessment - Introduction and Initial Assessment: - Introduce yourself to the patient. - Assess level of responsiveness (LOR) using the AVPU scale: - Alert - Verbal - Painful - Unresponsive - Airway, Breathing, and Circulation (ABCs)\*\*: - Airway: Check if the patient is speaking, crying, or moaning (indicates open airway). Use head tilt-chin lift or modified jaw thrust if unresponsive. - Breathing: Look, listen, and feel for chest rise and breathing sounds (only look and listen in COVID times). Assess for quality and presence of agonal respirations. - Circulation: Check radial artery in adults, brachial in children or infants. Assess for up to 10 seconds. - Skin: Check for abnormalities in color, condition, or temperature using the back of your hand. - Pulse Oximetry: - Place pulse oximeter on the patient's finger to measure oxygen saturation. Consider nail polish and other factors that might affect readings. - Normal readings: 95-100% for non-smokers, 94-96% for smokers, and as low as 90% for chronic lung disease patients. - Rapid Body Survey (RBS): - Hands-on check for life-threatening injuries. Pause for critical interventions if necessary. - Assess head, neck, chest, abdomen, pelvis, lower extremities, upper extremities, and back for DCAP-BTLSIC (Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling, Instbaility, Crepitus). - Transport Decision and Patient Positioning: - Decide if rapid transport or stabilization is needed based on findings. - Keep the patient in the found position if safe, or move to a position of comfort. - Secondary Survey - Interview and Acronym SAMPLE: - Signs and Symptoms: What's bothering the patient? - Allergies: Any known allergies? - Medications: Current medications taken or on-hand (e.g., EpiPen). - Past Medical History: Existing medical conditions. - Last Oral Intake: Time of last food or drink. - Events Prior: What happened to cause the incident? - Vital Signs: - LOR (AVPU scale) - Breathing/Respiration - Pulse/Circulation - Skin characteristics - Pupil response to light and equality - Blood pressure - SPO2 (pulse oximetry) - Blood glucose level (if applicable) - Head-to-Toe Physical Examination: - Detailed examination: Head, shoulders, collarbones, chest, abdominal quadrants, pelvis, hips (avoid iliac crests), legs, feet, toes, arms, and fingers. - Appropriate Treatments or Interventions: - Begin with the most pressing injury or condition. - Includes splinting, cleaning, and dressing wounds. - Ongoing Assessment - Continuous Reassessment: - Scene: Monitor for changes or new hazards. - Patient: Reassess condition regularly. - Transport Decision: Adjust based on patient's status and new findings. - Adjustments as Needed: - Be prepared to call an ambulance if the patient's condition worsens or if new hazards arise during reassessment. **[Saturday]** ========================== **Chapter 19:** Reaching, Lifting, and Extracting Patients As a responder, you may encounter emergencies where the patient is inaccessible, such as being unconscious in a locked vehicle or building. In these situations, you must gain access quickly and safely to provide appropriate care. Below are procedures and considerations for various scenarios. - Gaining Entry into Buildings - Locked Doors: Many buildings may have multiple stages of entry (e.g., lobby with pass card/key, stairwell/elevator access, unit entry). - Legal Implications: Breaking into buildings requires specific procedures. Always consider legal ramifications. - Contact Dispatch: Dispatch will attempt to contact the person who placed the call to open doors. - Forcible Entry: If necessary, police may be required for forcible entry. - Safety First: Always prioritize your safety when attempting to gain entry. - Motor Vehicle Accidents - Inaccessible Patients: Locked or crushed doors and rolled-up windows can make patients inaccessible. - Unstable Vehicles: Vehicles involved in collisions may be unstable, posing a risk to occupants and responders. - Fire and Downed Power Lines: These factors may prevent access to patients. Do not approach vehicles near downed power lines. - Patient Entrapment: This occurs when patients cannot exit the vehicle. Extrication requires specialized training and equipment. Request additional personnel if you lack the necessary training. - Scene Assessment: Always perform a full scene assessment to identify dangers before attempting extrication. - Stabilizing Vehicles - Environmental Factors: Ice, water, snow, and hills can make stabilization difficult. - Chocking Technique: Place blocks or wedges against wheels to reduce rolling. - Overturned Vehicles: Require more technical stabilization techniques. Do not attempt extrication without proper stabilization. - Steps for Stabilization: - Ensure the gear shift is in park or neutral. - Turn off the ignition and activate the emergency brake. - Place keys on the dashboard or hand them to the officer in charge. - Check doors to see if they are unlocked before breaking glass. - Use proper PPE when breaking windows. - Moving Patients - Risks: Moving patients with injuries without proper splinting can worsen their condition. - Situations Requiring Movement: - Unsafe scenes. - Gaining access to other patients. - Providing proper treatment. - Considerations Before Moving: - Scene assessment for dangerous conditions. - Size of the patient and your physical ability. - Availability of assistance. - Patient\'s condition. - Lifting Techniques - Proper Body Mechanics: - Use legs, not the back. - Keep weight close to your body. - Maintain body alignment. - Avoid lifting and reaching more than 20 cm in front. - Reduce lift height in stages. - Use as many people as possible. - Never twist while lifting. - Keep the back straight. - Patient Extrication Techniques - Walking Assist: - Suitable for moving a responsive patient with one or two responders. - Support the patient on the injured or weaker side. - Two-Person Seat Carry: - For responsive patients unable to walk. - Place one arm under the patient\'s thighs and the other across the back. - Interlock arms with the other responder and lift. - Clothes Drag: - For patients with suspected head or spinal injury. - Cradle the patient\'s head and pull to safety. - Blanket Drag: - Similar to the clothes drag but uses a blanket. - Roll the patient onto the blanket and drag. - Extremity Lift: - For lifting patients from the floor to a chair or stretcher. - Not suitable for patients with suspected head, spinal, pelvic, or limb injuries. - Stretchers and Lifting Devices - Scoop Stretcher: - The rigid stretcher that separates into two pieces. - Suitable for lifting a patient without rolling. - Backboard: - Long, rigid board used for extrication. - Becoming less common due to the potential for injury during prolonged use. - Basket Stretcher: - Metal or plastic frame with wire mesh liner and raised sides. - Suitable for transporting a patient or another stretcher. - Multi-Level Stretcher: - Adjustable height, equipped with wheels and safety rails. - Commonly used in ambulances. - Stair Chair: - It is used to transport patients in a seated position through tight spaces. - Useful in small elevators or staircases. - Army-Type Stretcher: - Simple stretcher with wooden poles and canvas. - Commonly used in soccer in Europe. **Chapter 22:** Pharmacology Pharmacology is the study of drugs and how they interact with the body. Drugs can be given locally or systemically and tend to have actions at multiple sites. The administration of drugs is not part of the scope of practice of a professional responder; however, we can assist with medication administration. - Administration vs. Assisting - Administration: Making the decision to give a medication to a patient and then introducing the drug into their body. - Assisting: Following a patient\'s specific direction to help with medication, which can include locating the drug, helping the patient prepare it, guiding the patient in taking it, reading the packaging to the patient, etc. - Examples of assisting: - Opening a pill bottle and placing the pills in the patient\'s hand. - Opening an epinephrine auto-injector. - Unwrapping a transdermal patch. - Reading a medication label out loud. - Pushing pills out of a blister pack. - Examples of administering: - Injecting the medication. - Placing the medication in a patient\'s mouth. - Placing a transdermal patch on the patient\'s skin. - Spraying medication into the patient\'s nose. - The Six Rights of Medication - When administering or assisting a patient with medication, the responder has a responsibility to know the benefits, side effects, indications, and contraindications and must keep the Six Rights of Medication in mind: - **Right Person:** Ensure the patient receiving the medication is the one whose name is on the label of the medicine container. - **Right Medication**: Read the label and confirm the name of the medication. - **Right Dosage**: Accurately measure the indicated quantity of medication. - **Right Time:** Give the medication at the correct time. - **Right Route**: Read the directions carefully and administer the medication via the correct method. - **Right Documentation**: Completely document your actions and findings, including time, dosage, route, and effect. - Routes of Drug Administration - Oral: Drugs swallowed and absorbed through the digestive system. - Sublingual: Drug delivered under the tongue and rapidly absorbed into the blood. - Buccal: Drug placed between the cheek and gum, absorbed through mucous membranes. - Rectal: Suppositories that dissolve with body heat. - Intravenous (IV): Directly into a vein. - Endotracheal: Restricted to advanced life support practitioners. - Subcutaneous: Drug administered into a layer of fat between muscle and skin. - Intradermal: Drug administered into the dermis. - Intramuscular (IM: Drug administered into a large muscle. - Inhalation: Drug reaches lower airways and passes into general circulation. - Intranasal: Drug administered into the nostril in mist form. - Assisting with Medication - Ensure that you are following the Six Rights of Medication: - Right Person: Verify it is the correct patient. - Right Medication: Confirm the name and type of medication. - Right Dosage: Ensure the correct amount is administered. - Right Time: Administer at the correct time. - Right Route: Use the correct method of administration. - Right Documentation: Accurately record all relevant details, including time, dosage, route, and the effect of the medication. **Chapter 8:** Airway management and respiratory emergencies Respiration requires an open airway for the lungs to receive sufficient oxygen and to inflate and deflate rhythmically. Respiratory emergencies can arise from various causes, including trauma, inhaled toxins, low oxygen environments, airway obstructions (such as swelling, foreign bodies, or anaphylaxis), and neurological injuries or conditions. These issues can disrupt normal breathing and lead to critical respiratory distress. - Signs and Symptoms - **Dyspnea**: Labored breathing or struggling to breathe. - **Abnormal** **Breathing Sounds**: High-pitched noise. - **Abnormal Respiratory Rate**: Either too fast or too slow. - **Abnormal Skin**: Unusually moist or discolored. - **Emotional Effects**: Restlessness or anxiety. - **Neurological Effects**: Tingling. - **Patient Position**: Unusual positions such as the tripod position. - Airway Obstruction - Types of Airway Obstruction: - **Partial Obstruction**: - More effective to dislodge the item while seated and leaning forward. - Partial choking can cause high anxiety. - **Complete Obstruction**: - The patient is unable to speak, breathe, or cough effectively. - Requires immediate intervention to open the airway, typically through creating pressure in the thoracic cavity to push the obstruction out. - **Anatomical Obstruction**: - Blockage by an anatomical structure such as the tongue or swollen tissue (e.g., from injury or anaphylaxis). - Most common obstruction in an unconscious patient is the tongue. - Foreign-Body Airway Obstruction (FBAO: - Interventions: - **Back Blows**: Stand behind the patient, ensure a stable stance, and deliver five firm back blows between the shoulder blades. - **Abdominal Thrusts**: Perform quick upward thrusts into the abdomen. - **Chest Thrusts**: Recommended for pregnant women, performing thrusts directly back towards you. - If the patient becomes unresponsive, perform chest compressions, check for the obstruction, and attempt ventilations. - Anaphylaxis - Definition: A life-threatening allergic reaction causing air passages to constrict. - Causes: Extreme allergy to substances such as food, medication, or insect venom. - Signs and Symptoms: - Swelling of the face - Dizziness - Confusion - Distress - Fainting - Coughing/wheezing - Tightness in the chest - Treatment: Assist with an epinephrine auto-injector to slow the harmful reaction by constricting blood vessels and increasing heart rate. - **Chronic Obstructive Pulmonary Disease (COPD**) - Definition: A condition characterized by a loss of lung function. - Components: - Emphysema: Alveoli lose elasticity and become distended with trapped air. - Chronic Bronchitis: Inflammation of the bronchial tubes with excessive mucus secretions. - Bronchospasm: Constriction of air passages. - Asthma - Definition: Condition that narrows air passages and makes breathing difficult. - Triggers: Allergic reactions, emotional distress, cold weather, exercise. - Signs and Symptoms: - Wheezing during exhalations - Enlarged chest appearance due to trapped air - Treatment: Use of a metered-dose inhaler or nebulizer. - Pneumonia - Definition: Lung infection with fluid or pus-filled alveoli. - Causes: Bacteria, virus, smoke, vomit. - Signs and Symptoms: - Dyspnea - Tachypnea (rapid breathing) - Chest pain - Productive cough with pus or mucus - Fever and chills - Acute Pulmonary Edema - Definition: Fluid buildup in the alveoli due to heart or lung damage. - Causes: Congestive heart failure, pneumonia, smoke inhalation, drug overdose, high altitude. - Treatment: Encourage patient to sit up and dangle legs to pool fluid in legs. - Pulmonary Embolism - Definition: Blockage of a pulmonary artery by a clot or other material. - Symptoms: - Shortness of breath - Coughing - Pain - Anxiety - Fainting - Low blood pressure - Shock - Fever - Distended neck veins - Hyperventilation - Definition: Rapid breathing that upsets the balance of oxygen and carbon dioxide. - Causes: Anxiety, trauma, high fever, heart failure, lung disease, diabetic emergencies. - Signs and Symptoms: - Shallow, rapid breathing - Feeling of suffocation - Dizziness - Tingling in fingers and toes - Treatment: Slow the patient\'s breathing and have them focus on your breath. - Assisted Ventilations - Purpose: Deliver atmospheric air or oxygen into a patient's lungs when their breathing is inadequate. - Indications: Respiratory arrest or need to regulate respiratory rate. - Techniques: - Maintain an open airway with a head tilt-chin lift or modified jaw thrust. - Provide one ventilation every 5-6 seconds for an adult, every 3-5 seconds for a child or infant. - Use resuscitation masks or bag valve masks, especially with supplemental oxygen. - Special Considerations for Assisted Ventilations - Air in the Stomach: - Can cause vomiting and further complications. - Caused by excessive air, too much force, or too rapid ventilation rate. - Stoma Breathing: - Assess breathing through the stoma. - Place mask over the stoma and seal nose and mouth. - Patients with Dentures: - Remove dentures only if they obstruct the airway or make ventilation difficult. - Resuscitation Masks - Placement: - Position the mask with the \'V\' over the nose. - Lower rim should sit between the lower lip and the chin. - Ensure the upper rim covers the nose adequately. - Use both hands to maintain a tight seal. - Methods: - Head Tilt-Chin Lift: Used to open the airway by tilting the head back and lifting the chin. - Jaw Thrust: Used when spinal injury is suspected, thrust the jaw forward without moving the neck. - Selection Criteria: - Material: Should be transparent to monitor the patient\'s face. - Valve: Must have a one-way valve to direct exhaled air away. - Biofilter: Prevents fluids from entering the valve. - Oxygen Inlet: For supplemental oxygen delivery. - Durability: Should function well in various environmental conditions and be easy to assemble. - Bag Valve Mask (BVM) Resuscitators - Components: - Bag: Used for squeezing to provide ventilations. - One-way Valve: Prevents exhaled air from returning to the bag. - Mask: Fits over the patient's face. - Oxygen Reservoir Bag: For supplemental oxygen. - Usage: - One responder maintains a seal, the other squeezes the bag. - Suitable for patients with or without breathing. - Squeezing the bag forces air through the valve into the lungs; releasing refills it with air. - Supplemental Oxygen - Importance: - Normal air contains 21% oxygen. - For hypoxia (insufficient oxygen in the blood), supplemental oxygen is crucial. - Precautions: - Highly combustible: avoid flames or sparks. - Remove oxygen before using an AED to prevent sparks. - Prohibit smoking around supplemental oxygen. - Secure cylinders to prevent falls or projectile hazards. - Do not use oil/grease on pressure regulators. - Indications: - SpO2: Levels less than 95%. - Conditions like carbon monoxide exposure, decompression sickness, asphyxiation, dyspnea (difficulty breathing), hypoxia (blue lips or mouth). - Oxygen Cylinders and Regulators - Identification: - Cylinders are green or white with a yellow diamond \"oxidizer\" marking. - The regulator has a pressure gauge indicating oxygen levels. - Attachment Steps: - Attach the pressure regulator to the cylinder. - Insert the gasket into the pressure regulator. - Ensure correct pin index alignment. - Hand tighten the screw and use a wrench to turn on the oxygen. - Oxygen Delivery Devices - Types: - Nasal Cannula: 1-4 L/min, up to 36% oxygen concentration. - Resuscitation Mask: 6-10 L/min, 35-55% concentration. - Non-Rebreather Mask: 10-15 L/min, up to 100% concentration. - Bag Valve Mask (BVM) with O2 Reservoir: 15 L/min, up to 100% concentration. - Airway Adjuncts - Oropharyngeal Airway (OPA: - For unresponsive patients without a gag reflex. - Size from the earlobe to the corner of the mouth. - Insert using a cross finger technique, rotate 180 degrees into position. - Nasopharyngeal Airway (NPA: - Suitable for responsive patients or those needing airway support without gagging. - Size from earlobe to nostril tip. - Insert into the right nostril, bevel facing the septum, with lubrication. - Suction Devices - Types: - Tonsil Tip: Rigid device for mouth and throat. - French Catheter: Flexible tube for nasal suction. - Usage: - Measure for correct depth (earlobe to mouth corner). - Insert to depth, apply suction while withdrawing in a circular motion. - Respiratory Distress and Arrest - Distress: - Recognize symptoms like shortness of breath, wheezing, and cyanosis (blue skin). - Position patient upright, loosen tight clothing, keep calm, assist with prescribed medication if available. - Arrest: - Characterized by cessation of breathing, life-threatening. - Initiate assisted ventilations immediately, reassess every two minutes. **Chapter 7**: Circulatory Emergencies Circulatory emergencies are sudden and dramatic medical conditions affecting the heart or vascular system. These emergencies can be life-threatening and may stem from underlying issues present for months or years. - Cardiovascular Disease (CVD) - Cardiovascular disease is a broad term for conditions affecting the heart and blood vessels. It is a leading cause of death globally. Examples include: - Coronary Heart Disease (CHD: Affects the blood vessels supplying the heart muscle. - Cerebrovascular Disease: Affects blood vessels supplying the brain. - Congenital Heart Disease: Genetic heart defects present at birth. - Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE: Blood clots, typically in the leg, which can move to the heart or lungs. - Peripheral Arterial Disease (PAD): Reduces circulation to extremities, especially the legs. - Risk Factors for CVD: - Uncontrollable: Gender (males at higher risk), family history, and age. - Controllable: Smoking, diet, blood pressure, weight, and exercise level. - Angina Pectoris - Angina is intermittent chest pain or pressure caused by reduced blood flow to the heart, usually triggered by exertion or stress. - Types of Angina: - Stable Angina: Follows a predictable pattern with exertion. - Unstable Angina: Less predictable, can last longer, and may not respond to medication. It\'s a warning sign of a myocardial infarction (MI). - Myocardial Infarction (MI) - MI, or heart attack, occurs when one or more coronary arteries are blocked, leading to myocardial necrosis (death of heart muscle cells). - Symptoms: Persistent chest pain, pressure, or discomfort, often radiating to the neck, jaw, or arms. - Immediate Care: Keep the patient comfortable, administer aspirin (160-325 mg), and assist with nitroglycerin if prescribed. Monitor blood pressure and signs of cardiac arrest. Transport rapidly to medical facilities. - Cardiac Arrest - Cardiac arrest occurs when the heart stops circulating blood. - Signs: Unresponsiveness, no pulse, and cessation of breathing. - Immediate Care: Perform CPR and use an AED if available. - Cerebrovascular Accident (CVA) or Stroke - A CVA is a disruption of blood flow to the brain, causing brain tissue damage. - Types: - Ischemic Stroke: Caused by a blocked artery. - Hemorrhagic Stroke: Caused by a ruptured artery. - Transient Ischemic Attack (TIA: A \"mini-stroke\" that serves as a warning for a potential full stroke. - Symptoms: Sudden weakness or numbness, difficulty speaking, blurred vision, severe headache, dizziness, or confusion. - Immediate Care: Use the FAST acronym (Face, Arm, Speech, Time) to assess symptoms and transport rapidly. - Conclusion - Understanding and recognizing circulatory emergencies, such as cardiovascular diseases, angina, myocardial infarctions, cardiac arrest, and strokes, are crucial. Immediate and appropriate responses, including the use of medications like aspirin and nitroglycerin, performing CPR, and utilizing AEDs, can save lives. Recognizing symptoms early and seeking prompt medical care are vital in managing these emergencies effectively. **Cardiopulmonary Resesitation** -------------------------------- - Basic Life Support (BLS) CPR - CPR Overview: - Definition: CPR combines assisted ventilations and chest compressions to artificially replicate the functions of the lungs and heart. - Purpose: Increases survival chances by keeping the body supplied with oxygen until advanced medical care is available. - Components: Consists of cycles of compressions and ventilations. - Basic Ratio: **30 compressions to 2 ventilations** (may vary based on age and number of responders). - CPR Execution: - Uninterrupted Process: Once CPR starts, it should only be interrupted for critical interventions or changes in the patient\'s condition. - Chest Compressions - Purpose: Move blood through the circulatory system by creating pressure within the chest cavity. - Compression Fraction: The percentage of total CPR time the patient receives compressions. Minimize off-chest time. - Hand Position: - Center of the chest, lower half of the sternum. - Interlock hands and maintain right angles with pressure going straight downwards. - Responder Position: - Kneeling beside and facing the patient. - Arms straight, shoulders above elbows, elbows above hands. - Use upper body weight to create the necessary force. - Chest Recoil: Ensure complete chest recoil after each compression. - Compression Depth: - Adults: 5-6 cm (2-2.4 inches). - Children/Infants: At least one-third the diameter of the chest. - Compression Rate: 100-120 compressions per minute. - Age-Specific Guidelines - Adults: - Hands Position: Two hands on the sternum. - Compression Depth: 5-6 cm. - Ratio: 30 compressions to 2 ventilations. - Children: - Hands Position: One or two hands on the sternum (based on size). - Compression Depth: One-third chest depth. - Ratio: 30:2 (one responder), 15:2 (two responders). - Infants: - Hands Position: Two fingers on the sternum or thumbs using the encircling method. - Compression Depth: One-third chest depth. - Ratio: 30:2 (one responder), 15:2 (two responders). - High-Performance CPR (Team Approach) - Feedback: Responder B provides feedback on the effectiveness of Responder A\'s compressions. - Role Distribution: - Responder A: Starts CPR, performs chest compressions, and ventilates using BVM until Responder B returns. - Responder B: Retrieves defibrillator (AED), assists with airway management, and ensures proper BVM seal. - Position Switching: Every 2 minutes or 5 cycles, switch roles to maintain effectiveness and reduce fatigue. - Automated External Defibrillators (AED) - Deployment: Apply AED as soon as cardiac arrest is confirmed. Aim for deployment within 90-120 seconds. - Placement: - Adults: Standard placement. - Children/Infants: Use adult pads on the front and back if pediatric pads are unavailable. - Preparation: - Ensure patient is dry. - Remove excessive hair for good contact. - Operation: - Attach pads, plug in, turn on AED. - Follow AED instructions, pausing CPR only during analysis. - Resume CPR immediately after shock delivery. - Special Situations and Precautions - Pregnant Women: Place a cushion under the right hip. - Transdermal Medication Patches: Avoid placing AED pads over patches. - Pacemakers and ICDs: Position pads at least one inch away from device scars. - Jewelry: Remove if within one inch of pads. - Water and Wet Environments: Dry patient thoroughly before applying AED. - Post-Cardiac Arrest Care: - Monitor pulse and readiness to resume CPR. - Continue ventilation if respiration has not resumed. **Chapter 8: Shock** -------------------- - Overview - Shock is a life-threatening condition where vital organs do not receive adequate oxygen-rich blood, leading to compromised functionality. The body\'s response to maintain blood flow to essential organs results in a series of signs and symptoms characteristic of shock. - Causes of Shock - Shock can result from various causes, but fundamentally it stems from one or more of the following issues: - **Cardiogenic Shock**: The heart is not functioning effectively, causing inadequate blood circulation. This can occur in cardiac arrest. - **Hypovolemic Shock**: There is too little blood volume circulating. The body can compensate for minor blood loss, but severe injury can cause rapid blood loss exceeding the body\'s ability to compensate. - **Distributive Shock**: Blood vessels fail to constrict properly, causing a drop in blood pressure even though blood volume remains unchanged. - Types of Shock - **Septic Shock**: A form of distributive shock due to severe infection, where toxins cause vessel dilation. - **Hypovolemic Shock**: Caused by significant blood loss. - **Obstructive Shock**: Physical blockage prevents the heart from filling or emptying effectively, e.g., pulmonary embolism. - **Neurogenic Shock**: A form of distributive shock from loss of nervous system control over blood vessel constriction. - **Anaphylactic Shock**: A severe allergic reaction causing hypovolemic shock. - Stages of Shock - **Compensated Shock**: The body attempts to restore normal circulation by constricting blood vessels. Symptoms include slow capillary refill, pale and cool skin, increased heart rate, and respiration. - **Decompensated Shock**: The body\'s compensation fails, leading to hypoxia in tissues. Symptoms include confusion, unresponsiveness, shallow and irregular respiration, weak and rapid pulse, dropping blood pressure, decreased body temperature, dilated pupils, excessive sweating, and extreme thirst. - :**Irreversible Shock**: The vascular system fails to maintain internal pressure, blood pools in the extremities, and survival is not possible despite intervention. - Care for Shock - **ABCs**: Ensure the airway is clear, breathing is adequate, and circulation is supported. - **Positioning**: Help the patient into a recovery or supine position to improve blood flow to vital organs. - **Elevation**: Elevate the patient\'s feet about 8-12 inches unless a head injury is suspected. - **Temperature Maintenance**: Keep the patient warm to maintain normal body temperature. - **Avoid Eating or Drinking**: Do not give anything to eat or drink, especially if the patient's level of responsiveness is affected. **[Sunday]** ======================== **Chapter 11:** Chest, Abdominal and pelvic injuries ---------------------------------------------------- - Overview - Injuries to the chest, abdomen, and pelvis can be life-threatening due to the presence of vital organs and major blood vessels in these areas. Understanding the types, signs, and appropriate care for these injuries is crucial. - Chest Injuries - Chest injuries result from blunt or penetrating trauma and can cause significant respiratory and circulatory issues. - Common Causes: - Motor vehicle accidents (MVAs) - Industrial accidents - Falls - Intentional violence - Signs and Symptoms: - Respiratory distress or arrest - Pain at the injury site, worsening with deep breaths or movement - Obvious deformity - Unequal or paradoxical chest movement - Signs of shock (flushed, pale, or bluish skin) - Coughing up blood - Types of Chest Injuries: - **Rib Fractures**: - [Caused by] external blunt force. - [Signs]: Painful, shallow, and labored respiration; patient may lean toward the fracture or stabilize it with their hand. - [Care]: Position for comfort, support with soft or bulky objects, provide respiratory distress interventions (e.g., oxygen). - **Flail Chest**: - [Multiple rib fractures] cause a section to break free, resulting in paradoxical movement. - [Care]: Stabilize the flail segment with a bulky dressing, secure with tape. - **Hemothorax**: - [Blood accumulates] in the pleural space, causing lung collapse. - [Signs]: Respiratory distress, shock, decreased breath sounds on the affected side. - [Care]: Provide respiratory distress interventions and assisted ventilations if necessary. - **Pneumothorax**: - [Air enters the pleural space], causing lung collapse. - Signs: Chest pain, dyspnea, decreased breath sounds, subcutaneous emphysema. - Care: Same as for hemothorax, monitor for tension pneumothorax. - **Tension Pneumothorax**: - [Continuous air leak into the pleural space] increases pressure, collapsing the lung. - [Signs]: Tachycardia, hypotension, hypoxia, jugular vein distension. - [Care]: Provide necessary respiratory interventions. - **Penetrating Chest Wound:** - [Creates a hole in the chest,] potentially leading to tension pneumothorax. - [Care]: Use a non-occlusive dressing taped on three sides to allow air to escape, replace saturated dressings. - Abdominal Injuries - The abdomen contains vital organs and is more susceptible to injury as it lacks protective bones. - Vital Organs: - Liver (upper right quadrant): Severe bleeding, bile leakage causing infection. - Spleen (upper left quadrant): Easily ruptured, leading to significant blood loss. - Stomach: Internal hemorrhage, food contents causing infection. - GI Tract: Internal hemorrhage, contents causing infection. - Signs and Symptoms: - Pain, bruising, external bleeding, signs of internal bleeding - Nausea, vomiting, signs of shock (pale, moist skin) - Thirst, distension, rigidity, tenderness - Care for Abdominal Injuries: - Position patient supine; bend knees if not painful. - Control external bleeding. - Prepare for rapid transport. - Evisceration: - Severe injury with protruding organs. - Care: Remove clothing around the wound, apply a moist sterile dressing, cover with a towel, avoid touching or re-inserting organs. - Pelvic Injuries - Pelvic injuries require significant force and can be life-threatening due to the risk of internal hemorrhage. - Signs and Symptoms: - Pain, pelvic instability, crepitus - Numbness in legs, decreased range of motion, paralysis - Rectal, urethral, or vaginal bleeding, hematoma - Care for Pelvic Injuries: - Keep patient supine, avoid movement. - Immobilize pelvis if trained. - Prepare for rapid transport. - Pelvic Binding Technique: 1. Remove outer clothing, bring legs together. 2. Place an 8-12 inch sheet across the stretcher. 3. Place padding between knees and ankles. 4. Insert sheet from under the knees, slide towards the pelvis. 5. Ensure top of sheet is level with iliac crest. 6. Cross ends of sheet anteriorly, twist to desired tension. 7. Secure binding to maintain tension. 8. Tuck loose ends. 9. Reassess circulation and sensation. 10. Periodically reassess binding. **Chapter 12:** Head Injuries and Spinal Injuries ------------------------------------------------- - Overview - Significance: Head and spinal injuries can damage the central nervous system, causing paralysis, impaired mental function, or death. - Prompt Care: Early recognition and care are critical to minimize damage. - Mechanism of Injury (MOI) - Common Indicators: - Unresponsive patients with unknown causes - Falls \> 1 meter - Motor vehicle accidents - Damaged/broken helmets - Severe blunt force - Penetrating injuries - Diving accidents - Electrocution - Head vs. Brain Injuries - **Head Injury**: Superficial, like cuts to the face or scalp. - **Brain Injury**: Involves trauma to the brain. - Skull Fractures - Signs & Symptoms: - Visible scalp damage, skull deformity - Pain, swelling - Clear/pinkish fluid from nose, ears, mouth - Unusual pupil size, raccoon eyes, Battle's sign - Precautions: Spinal motion restrictions needed. - Orbital Fractures - Types & Symptoms: - Double/decreased vision - Numbness above eyebrow/cheek - Fluid discharge from nose - Paralysis of upward gaze - Impaled Objects in Skull - Procedure: - Leave in place, stabilize with bulky dressing - Only remove if it impedes airway - Brain Injuries - Symptoms: - Changes in consciousness - Muscle flaccidity - Unequal facial movements - Ringing in ears, loss of balance - Rapid/weak pulse, high blood pressure - Cushing's Reflex: Deep/irregular respiration, increased blood pressure, bradycardia - Concussions - Mechanism: Brain shaking inside skull, can cause swelling/bleeding - Symptoms: Should be examined by physicians immediately - Cerebral Hematomas - Types - **Epidural**: Arterial bleed between skull and dura mater, quick onset - **Subdural**: Venous bleed, violent impact, gradual symptoms - **Subarachnoid**: Arterial bleed in subarachnoid space, severe headaches, vomiting, seizures - **Intracerebral**: Blunt/penetrating trauma, damage to brain blood vessels - Spinal Injuries - Risks: Fractured vertebrae, ligament sprains, potential spinal cord damage - Symptoms: - Changes in responsiveness - Neck/back pain - Tingling/loss of sensation in extremities - Breathing irregularities - Motion Restriction: Essential for suspected spinal injuries - Canadian C-Spine Rule - Assessment Steps: 1. Determine high-risk factors (age \> 65, extremity anesthesia, dangerous MOI) 2. If no high-risk factors, assess range of motion 3. If patient can rotate head 45 degrees without pain, spinal motion restriction not needed - Care for Serious Injuries - Procedures: - Rapid transport, spinal motion restriction - Control external bleeding - Monitor responsiveness and prepare for respiratory/cardiac interventions - Inline Stabilization: - Manual stabilization until chin aligned with body - Application of cervical collar without causing further injury - Helmet and Equipment Removal - Criteria: - Remove if it interferes with assessment or airway management - Remove shoulder pads if they hinder interventions - Preparation: Proper removal ensures the patient is ready for hospital interventions. - Methods for Manual Spinal Motion Restriction - Techniques: - Head grip, trapezius squeeze, modified trapezius stabilization, sternal forehead grip, sternal spinal grip - Used to prevent additional spinal damage during movement and transport. **Chapter 13:** Acute and Chronic Illness ----------------------------------------- - Overview - Illness Categories: Acute and chronic, both can lead to medical emergencies. - Assessment: Perform standard primary, secondary, and ongoing assessments. - Syncope (Fainting) - **Cause**: Reduced blood flow to the brain. - **Triggers**: Pain, emotional shock, drop in blood pressure, prolonged standing, heat exposure. - Care: - ABCs (Airway, Breathing, Circulation) - Supine position - Do not allow eating or drinking immediately - Gather information quickly - Diabetic Emergencies - **Diabetes Mellitus**: Insufficient insulin production/use. - **Type 1**: Insulin-dependent (daily injections) - **Type 2**: Insulin/non-insulin dependent - Monitoring: Know the type of diabetes and have access to insulin or glucose monitors. - **Hyperglycemia**: High blood glucose due to low insulin. - Symptoms: Decreased responsiveness, tachypnea, tachycardia - **Hypoglycemia**: Low blood glucose due to high insulin. - Symptoms: Similar to hyperglycemia - Treatment: Administer glucose (tablets or sugar packets). - Seizures - Causes: Injury, disease, fever, infection, metabolic disturbances. - Types: - **Petit Mal**: Brief loss of awareness. - **Generalized Tonic-Clonic**: Full-body convulsions. - **Febrile**: Due to high fever. - **Status Epilepticus**: Prolonged seizures, needs rapid transport. - Care: - Prevent further injury - Manage airway post-seizure - Rapid transport if necessary - Other Illnesses - **Migraines**: Severe headaches, can last up to 3 days. - **Peritonitis**: Inflammation of abdominal lining, rapid transport required. - **Appendicitis**: Inflamed appendix, needs surgical removal. - **Bowel Obstruction**: Intestinal blockage, rapid transport required. - **Gastroenteritis**: Inflammation of GI tract, often viral. - **Kidney Stones**: Mineral concentrations in kidneys, needs medical assessment Chapter 14: Poison ------------------ - Definition and Entry Routes - Poison: Substance causing injury, death, or impairment through chemical action (solid, liquid, gas). - Entry Routes: Ingestion, inhalation, absorption, injection. - General Care for Poisoning Emergencies - Scope of Training: Act within your scope. - PPE: Don appropriate PPE. - Poison Control: Contact the nearest poison control center for guidance. - Avoid Oral Intake: Do not give anything orally unless instructed. - Vomiting Sample: Save a sample of vomit if possible. - Oxygen: Administer as needed. - Ingestion - Examples: Contaminated food, excessive alcohol. - Symptoms: Burns around mouth, unusual breath odor, salivation, abdominal pain, vomiting, diarrhea, dizziness, seizures, unresponsiveness. - Care: Follow poison control instructions, possibly induce vomiting. - Inhalation - Examples: Chemical fumes, carbon monoxide. - Symptoms: Respiratory distress, cyanosis, dizziness, vomiting, unresponsiveness. - Care: Ensure personal safety, request specialized assistance, rapid transport. - Absorption - Examples: Poison ivy, oak, sumac. - Symptoms: Skin irritation, rash, itching, swelling, blisters. - Care: Wash area with cool water, keep clean and dry, apply cream or ointment, consult a physician. - Injection - Examples: Insect stings, spider bites, IV drug use. - Symptoms: Vary by species; may include localized pain, swelling, redness, systemic reactions. - Care: - Insects: Remove stinger by scraping, avoid forceps. - Spiders: Identify the spider, seek medical attention for black widow or brown recluse bites. - Ticks: Remove with forceps, treat the wound, monitor for Lyme disease signs. - Substance Abuse and Misuse - Categories: - **Stimulants**: Increase alertness (e.g., cocaine, caffeine). - Symptoms: Moist skin, sweating, fever, rapid pulse and breathing. - **Depressants**: Slow down CNS (e.g., alcohol). - Symptoms: Drowsiness, confusion, slurred speech, slow pulse and breathing. - **Hallucinogens**: Cause mood and sensory changes. - **Opiate** **Overdose**: Use Naloxone (injection or spray). - Symptoms: Reduced responsiveness, constricted pupils, slow or absent pulse, low oxygen levels. - Treatment: Follow poisoning steps, contact EMS and poison control. - Crowd Management Agents - Care: - Full PPE precautions. - Remove contaminated clothing. - Wash skin and eyes thoroughly. - Remove contact lenses. **Chapter 15**: Environmental illness ------------------------------------- - Body Temperature Regulation - Normal core temperature: \~37°C. - Heat generation: Food to energy conversion and muscle contractions (exercise and shivering). - Cooling/Heating Mechanisms: - **Radiation**: Heat loss/absorption via electromagnetic waves. - **Conduction**: Heat transfer through direct contact. - **Convection**: Heat transfer via air movement. - **Evaporation**: Sweat evaporation removes heat from body. - Heat-Related Illnesses - **Heat Cramps**: Painful muscle spasms; first sign of heat overexposure. - **Heat Exhaustion**: Elevated body temperature, profuse sweating, fluid loss, potential shock. - **Heat Stroke**: Most severe, can lead to seizures, coma, death. Requires immediate treatment. - Treatment: Cool the patient (water, fans, immersion in cold water), replace electrolytes if possible, monitor for rapid transport if symptoms worsen. - Cold-Related Illnesses - **Hypothermia**: Core temperature drops below 35°C, progresses through cold stress to severe hypothermia. - **Cold Stress**: Shivering, normal mental status. - **Mild Hypothermia**: Vigorous shivering, decreased motor/sensory function. - **Moderate Hypothermia**: Weak or stopped shivering, impaired coordination/speech, confusion. - **Severe Hypothermia**: No shivering, unresponsiveness, tissue stiffening, shallow or absent respirations. - Treatment: Rapid transport, handle gently, horizontal position, wrap in blankets, provide sugary warm drinks if possible, seek advanced care. - **Frost Nip**: Minor frostbite, superficial skin condition. - Treatment: Warm area with skin-to-skin contact or warm water (30-40°C). - **Frostbite**: Freezing and swelling of body cells, can damage cells, blood vessels, nerves. - **Superficial/Deep Frostbite**: White or waxy skin, hard to touch, decreased sensation. - Treatment: Do not rub, thaw in warm water, protect blisters with sterile dressings, give warm sugary drinks if responsive. - Drowning and Cold Water Immersion - **Drowning**: Suffocation by water immersion. - Rescue Steps: Encourage self-rescue, throw a buoyant object, reach out with a rigid object. - **Cold Water Immersion Hypothermia**: Occurs faster than cold air exposure. - Phases: - **Cold Shock Response**: Rapid skin cooling, gasping, hyperventilation. - **Incapacitation**: Loss of coordination, weakness after 15 minutes. - **Hypothermia**: Mild hypothermia after 30 minutes. - **Circum-Rescue Collapse**: Symptoms range from fainting to cardiac arrest before, during, or after rescue. Chapter 16: Pregnancy, Labor, and Delivery Overview Responders may need to assist with emergency labor or delivery. The birth process typically follows four stages and generally takes 12 to 24 hours. - Stages of Labor - Preparation - Begins with the first contraction until the cervix is fully dilated (10 cm). Contractions become closer together as delivery approaches. - Delivery of the Baby - Starts when the cervix is fully dilated and ends with the baby\'s birth. Crowning indicates that delivery is imminent. - Delivery of the Placenta - Occurs within 20 minutes after the baby is born. The placenta must be inspected to ensure it is fully delivered. - Stabilization - Lasts about an hour; the uterus contracts to control bleeding, and the mother begins recovery. - Assessing Labor - Determine if the woman is in active labor. - Key questions: - Is this her first pregnancy? - Is she under physician\'s care or high risk? - Has the amniotic sac ruptured? - Describe the contractions (intensity, frequency). - Is there bloody discharge or an urge to push? - Preparing for Delivery - Ensure the expectant mother is comfortable. - During crowning, apply gentle counter-pressure to the baby\'s head. - Instruct the mother to breathe slowly and avoid pushing too forcefully. - Support the head, check for the umbilical cord around the neck, and never pull on the baby. - Document the birth time, do not pull on the cord, and clamp the cord 10-15 cm from the baby. - Complications - Prolapsed Cord - Umbilical cord protrudes before the baby, requiring the mother to assume a knee-chest position and rapid transport. - Breech Birth - Feet or buttocks first; support the baby\'s body and create an airway with your fingers if needed. - Limb Presentation - Limb comes out first, which is dangerous; guide the process and ensure rapid transport. - Multiple Births - Be prepared for more than one baby, emphasizing the importance of thorough questioning. Chapter 17 Special Populations Overview Special populations include children, geriatric, bariatric, and palliative patients, each with unique needs and considerations. - Children (Pediatric Patients) - Neonates (0-28 days - Extremely vulnerable, require rapid transport for injuries. - Infants (29 days-1 year - May have stranger anxiety. - Toddlers (1-2 years - Often uncooperative, best assessed on a parent\'s lap. - Preschoolers (3-5 years - Easier to examine with proper approach. - School-aged (6-12 years - Usually cooperative and communicative. - Adolescents (13-18 years - Similar to adults in assessment. - Bariatric Patients - Focuses on healthcare for those with obesity, a risk factor for diseases like diabetes, hypertension, and hyperlipidemia. Excess body mass can complicate assessments. - Geriatric Patients - Older adults often have multiple health issues requiring specialized care. - Palliative Patients - Patients with terminal illnesses, treatment aims to improve quality of life and comfort. Chapter 18: Crisis Intervention Overview As a responder, you will frequently encounter people in crisis, requiring empathy and professionalism. These situations often involve attempted suicide, assault, or sudden death, each with unique challenges. - Responding to Different Crises - Sexual Assault - Provide emotional support, control your reaction, cover the patient, discourage bathing, and interact with responders of the same gender if possible. Clear bystanders and notify authorities. - Suicide - Leading cause of death among ages 15-19. Stay calm and empathetic, and support family and friends who may be in emotional crisis. - Assault - Ensure authorities are notified, call EMS and police, and support the victim emotionally. - Key Points - Show empathy and maintain professionalism. - Protect patient privacy and dignity. - Notify appropriate authorities promptly. Chapter 21: Multiple Casualty Incidents (MCIs) Overview MCIs involve two or more patients, potentially on a large scale. The Incident Command System (ICS) is crucial for organizing resources and triaging patients effectively. - Key ICS Roles 1. Treatment Officer: Sets up treatment areas and supervises care. 2. Triage Officer: Oversees patient assessment, tagging, and transportation. 3. Transportation Officer: Manages patient transfer, tracking priorities, identities, and destinations. 4. Staging Officer: Distributes resources as needed. 5. Safety Officer: Ensures scene safety by identifying potential hazards. - Triaging Patients - Simple Triage and Rapid Treatment (START) System: - Green: Minor (walking wounded) - Yellow: Delayed care (injuries but stable) - Red: Immediate care (requires urgent transport) - Black/Grey: Deceased or non-salvageable - Assessment Process 1. Respiration: a. Not breathing → Open airway → If still not breathing, mark as black/grey. b. If breathing → Continue assessment. 2. Circulation: c. Check radial pulse for presence. 3. Level of Responsiveness (LOR: d. Alert → Yellow. e. Alert to verbal/painful stimuli → Red. - CBRNE Emergencies - CBRNE stands for Chemical, Biological, Radiological, Nuclear, and Explosives, involving weapons of mass destruction. These events require specific responder actions: - Control emotions and actions. - Focus on tasks while monitoring hazards. - Take breaks, eat regularly, and stay hydrated. - Support fellow responders.