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from sir daj yehey
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Patient Assessment
• Scene size-up• Initial assessment• Focused history and physical exam
– Vital signs– History
• Detailed physical exam• Ongoing assessment
Body Substance Isolation
• Assumes all body fluids present a possible risk for infection
• Protective equipment– Latex or vinyl gloves should always
be worn– Eye protection– Mask – Gown – Turnout gear
Scene Safety: Potential Hazards
• Oncoming traffic• Unstable surfaces• Leaking gasoline• Downed electrical
lines• Potential for violence• Fire or smoke
• Hazardous materials
• Other dangers at crash or rescue scenes
• Crime scenes
Develop a General Impression
• Occurs as you approach the scene and the patient
– Assessment of the environment
– Patient’s chief complaint
– Presenting signs and symptoms of patient
Chief Complaint
• Most serious problem voiced by the patient
• May not be the most significant problem present
Assessing Mental Status
• Responsiveness– How the patient
responds to external stimuli
• Orientation– Mental status and
thinking ability
Testing Responsiveness• A Alert
• V Responsive to Verbal stimulus
• P Responsive to Pain
• U Unresponsive
Check Airway
• Labored breathing
• Accessory muscles
• Noisy breathing
• Cyanosis
• Rate and depth
• Air movement
• Choking
Vital Signs
Pulse
Rapid/weak shock, diabetic coma
Rapid/strong heat stroke, hypertension
Slow/strong stroke, skull fracture
None cardiac arrest
Vital Signs
Blood Pressure
< 100 mmHg shock
> 135 mmHg hypertension
Skin Temperature
Hot dry heat exposure
Cool clammy shock
Mechanism of Injury• Helps determine the possible extent
of injuries on trauma patients
• Evaluate:– Amount of force applied to body
– Length of time force was applied
– Area of the body involved
Nature of Illness
• Search for clues to determine the nature of illness.
• Often described by the patient’s chief complaint
• Gather information from the patient and people on scene.
• Observe the scene.
Partial Complete
• weak cough
• wheezing
• strained breathing
• slight cyanosis
• inability to speak
• absence of breath sounds
• flared nostrils
• restlessness
• unresponsive
Cardiovascular Emergencies
A rapid decline in heart function due to poor blood flow or electrical activity.
LIFE THREATENING!!
Examples are cardiac arrest, heart attack, and arrhythmia
THREE CONDITIONS OF CARDIAC ARRESTTHREE CONDITIONS OF CARDIAC ARREST1. Cardio Vascular Collapse
The heart is still beating but its action is so weak that is not being circulated through the vascular system to the brain body tissues.
2. Ventricular FibrillationOccurs when the individual fascicles of the heart beat independently rather than the coordinated, synchronized manner that produce rhythmic heart beat.
3. Cardiac standstillIt means that the heart has stopped beating.
Cardiovascular Emergencies
Heart attack is the death of the heart muscle due to deficient blood supply. Usually mistaken for angina pectoris.
What causes heart attack?
What are the symptoms?
First Aid?1. Check ABCs2. Call EMS3. If possible, give nitroglycerine4. If needed, use AED
Cardiovascular Emergencies
Arrhythmia is a broad classification of heart disorders that pertain to irregularity in the sinus rhythm
1. Bradycardia – too slow
2. Tachycardia – too fast
Basic Life Support
A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.
determine responsiveness
Basic Life Support
A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.
activate EMS
Basic Life Support
A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.
open the airway
Basic Life Support
A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.
determine breathlessness
Basic Life Support
A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.
give chest compressions
Basic Life Support
A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.
give rescue breathing
5 cycles in 2 minutes
Basic Life Support
A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.
defibrillate if available
Basic Life Support
A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.
recovery position
Patient has a valid “Do Not Attempt Resuscitation” (DNAR) order.
Signs of irreversible death: Rigor Mortis, Decapitation.
No physiological benefit can be expected because the vital functions have deteriorated despite maximal therapy.
When not to give CPR
When to S.T.O.P. CPR
SPONTANEOUSSPONTANEOUS signs of circulation are restored.signs of circulation are restored.
TURNEDTURNED over to medical services or properly over to medical services or properly trained and authorized personnel.trained and authorized personnel.
OPERATOROPERATOR is already exhausted and cannot is already exhausted and cannot continue CPR.continue CPR.
PHYSICIANPHYSICIAN assumes responsibility (declares assumes responsibility (declares death, take over, etc.).death, take over, etc.).
Adult Child Infant
Compression area
Lower half of the sternum 2 fingers from the substernal notch
Lower half of the sternum 1 finger from substernal notch
Lower half of the sternum 1 finger width below the imaginary nipple line
Depth Approximately 1½ - 2 inches
Approximately 1 – 1½ inches
Approximately ½ - 1 inch
How to Compress
Heels of 1 hand, other hand on top.
Heel of one hand
2 fingers (middle & ring fingertips)
Rate of Compression
Approximately 100/min
Approximately 100/min
At least 100/min
Automated External Defibrillators are medical devices that deliver a controlled shock through pads or electrodes placed in specific locations on the victim’s chest.
What is a fibrillation?
Special Situations
• if victim is a child . . .
• if victim is near water . . .
• if victim has pacemaker . . .
• if victim has patch over electrode site . . .
• if victim has hairy chest