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American Red Cross
When Help Can’t Wait
Emergency Response
Copyright © 2000 by the American National Red CrossAll rights reserved
EMERGENCY RESPONSETRAINING
American Red Cross
When Help Can’t Wait
Emergency Response
Copyright © 2000 by the American National Red CrossAll rights reserved
Emergency Response Training Instructors Books Facilities Certificates upon completion Schedule Tests Participation Hands-on training Physical requirements
TM2
American Red Cross
When Help Can’t Wait
Emergency Response
Copyright © 2000 by the American National Red CrossAll rights reserved
Chapter 1The First Responder
Components of the EMS system Roles and responsibilities of the First
Responder Medical Oversight Statutes and regulations
American Red Cross
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Links in the Chain of Survival
TM1
1. Citizen Response
2. Early activation of EMS
3. First Responder Care
4. Advanced Out-of-Hospital Care
5. Hospital Care
6. Rehabilitation
Pg 5-11
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First Responders Fire fighters Law enforcement personnel Lifeguards Ski patrollers Industrial response team Athletic trainers Disaster team members First aid station attendants
TM2 Pg 12-14
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VideoThe First Responder
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First Responder Characteristics Maintains caring and professional attitude Controls fears Presents professional appearance Maintains skills and knowledge Stays healthy Recognizes and keeps victim’s needs as
priority
TM3 Pg 12-13
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Primary Responsibilities of First Responders
Ensure safety of self and others Gain access to victim Identify life-threatening conditions Summon more advanced medical personnel
when necessary Provide care Assist more advanced medical personnel
TM 4Pg 13-14
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Secondary Responsibilities ofFirst Responders
Summon additional help. Control and direct bystanders. Keep records. Reassure others at scene.
TM 5Pg 13-14
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Medical Oversight Includes medical director Direct medical control Indirect medical control
protocols standing orders
TM 6Pg 14
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Chapter 2First Responder Well-Being
Recognizing Stress Emotional Reactions Scene Safety Protective Equipment
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Emotional Aspects of Emergency Care
Stressful Situations Death and Dying The Grieving Process Helping the Victim and the Family
Pg 18-20
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Stress ManagementWarning Signs of Stress
Irritability Inability to concentrate Difficulty sleeping/nightmares Anxiety Guilt Loss of interest in work
Managing Stress Healthy physical and mental habits Diet Balance of work, recreation, family and health Seek professional help if necessary
TM 7Pg 20
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Critical Incident Stress Strong emotional reaction that interferes
with ability to function Can build-up over days, weeks, months or
years May require counseling See Pages 442-443
TM 8Pg 20-22
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CIS Management Pre-incident stress education On-scene peer support Critical Incident Stress Debriefing (CISD) Critical Incident Stress Defusing Family support Know when to Access CISD
Pg 21
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The Emergency Scene Scene Safety Personal Safety Safety of Others Be aware of special emergency situations
Hazardous Materials Motor Vehicle Crashes
Pg 22-25
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At the Scene, Evaluate - Location Problems Dangers Number of victims Behavior of victims/bystanders Need for additional assistance
TM 9Pg 22-25
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Evaluate the scene
CT 3Pg 23
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Ensure Your Safety By- Evaluating potential dangers. Wearing proper gear. Doing what you are trained to do. Summoning additional resources.
TM 10Pg 23
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Possible Dangers at an Emergency Scene
Unstable structures or vehicles
Natural disasters Multiple victims Hostile situations Suicide Hostage situations
TM 11
Crime Traffic Fire Electricity Water/ice Hazardous materials
Pg 29-33
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EnrichmentSpecific Emotional Crisis
Suicide Assault
Sexual Assault Physical Assault
Crisis Intervention Dealing with Emergency Situations at the
Scene
Pg 26-29
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Chapter 3Disease Transmission
How the immune system works How diseases are transmitted Conditions required for disease
transmission Body Substance Isolation Exposure control and documentation OSHA requirements
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VideoPreventing Disease Transmission
Part I
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OSHA Regulations Occupational Safety and Health
Administration regulations regarding “blood borne pathogens” Apply to employers whose employees, as a
result of job requirements, have potential exposure to blood borne pathogens.
Provide safeguards to reduce disease transmission
Pg 45-46
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Potentially Infectious Body Fluids Semen Vaginal Secretions Cerebrospinal fluid Synovial fluid Pleural fluid Pericardial fluid Amniotic fluid Peritoneal fluid
Pg 36-37
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How Infections OccurDisease-causing Agents
Viruses (Hepatitis, measles, mumps, meningitis, colds, HIV, herpes)
Bacteria (Tetanus, meningitis, tuberculosis, diphtheria, food poisoning)
Fungi (Athlete’s foot, ringworm) Protozoa (Malaria, dysentery) Rickettsia (Typhus, Rocky Mountain spotted
fever)
Pg 37-38
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The Body’s Defenses Immune system (antibodies)
Acquired immunity Specific immunity by Immunization
Understanding how diseases spread Taking precautions (BSI)
Pg 38-39
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Conditions Necessary for Disease Transmission
Pathogen present
TM 12Pg 39
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Conditions Necessary for Disease Transmission
Pathogen present
TM 12
Sufficient Quantity
Pg 39
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Conditions Necessary for Disease Transmission
Pathogen present
TM 12
Sufficient Quantity
Susceptibility to the disease
Pg 39
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Conditions Necessary for Disease Transmission
Pathogen present
TM 12
Transmission Site
Susceptibility to the disease
Sufficient Quantity
Pg 39
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How Pathogens Enter the Body
TM 13
Direct
Pg 40
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How Pathogens Enter the Body
TM 13
Direct Indirect
Pg 40
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How Pathogens Enter the Body
TM 13
Direct Indirect
Airborne
Pg 40
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How Pathogens Enter the Body
TM 13
Direct Indirect
Airborne Vector
Pg 40
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VideoPreventing Disease Transmission
Part II
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Diseases that Cause Concern Herpes Simplex Meningitis Tuberculosis (TB) Hepatitis HIV
Pg 41-44
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Meningitis• The bacteria are spread
through the exchange of respiratory and throat secretions (i.e., coughing, kissing)
Tuberculosis (TB)• TB is spread from
person to person through the air.
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Viral Meningitisthrough direct contact with respiratory
secretions (saliva, sputum, or nasal mucus) of an infected person. By shaking hands with an infected person or touching something they have handled, and then rubbing your own nose, mouth or eyes. The virus can also be found in the stool of persons who are infected.
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VideoPreventing Disease Transmission
Part III
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Exposure Control Plan Exposure determination Schedules and methods for implementing
OSHA standard Procedures for evaluation exposures Immunizations
TM 14Pg 44-51
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Standard Precautions (BSI) to Prevent Disease Transmission
Protective equipment Personal hygiene practice Engineering controls Work practice controls
TM 15Pg 49-51
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If an exposure occurs …
Wash any area of contact Document the situation. Most employers
have protocols for reporting infectious disease exposure
Notify your superior and any necessary medical personnel immediately.
Pg 51-52
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VideoRemoving Gloves
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Practice SessionWorkbook Page 21
Removing Gloves
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Chapter 4Legal and Ethical Issues
First Responder responsibilities Victim’s rights Special populations (Enrichment)
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Legal Considerations Scope of PracticeScope of Practice Standard of CareStandard of Care Duty to ActDuty to Act CompetenceCompetence ConsentConsent
Expressed (Informed)Expressed (Informed) ImpliedImplied
Advance DirectivesAdvance Directives/DNR Orders …./DNR Orders ….
TM 16Pg 56-62
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• Refusal of CareRefusal of Care•BatteryBattery•AbandonmentAbandonment•NegligenceNegligence•Good Samaritan LawsGood Samaritan Laws•ConfidentialityConfidentiality•Evidence PreservationEvidence Preservation•DocumentationDocumentation
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Obtain Consent Before Providing Care
Identify yourself State level of training Explain what you observe Explain what you plan to do
TM 17Pg 57
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Four Components of Negligence Duty Breach of Duty Cause Damage
TM 18Pg 60
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EnrichmentSpecial Populations
The Elderly Victim Victims with Physical or Mental
Disabilities Visually Impaired Hearing Impaired Physically Disabled Developmentally Disabled
Pg 63-67
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Chapter 5Human Body Systems
Describe the various body systems and how they interact.
Anatomical terms (Enrichment)
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Major Body Systems Respiratory Circulatory Nervous Musculoskeletal Integumentary (skin)
TM 19
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VideoHuman Body Systems
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The Body Systems
Cells performing a common function form tissues. Different tissues work together to form organs.
CT 5Pg 70
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The Circulatory System
CT 9Pg 72-74
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The Nervous System
Images courtesy of theEMTB Anatomy Review
Pg 74-76
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The Muscular System
CT 11Pg 76-79
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Muscle Groups
CT 12Pg 78
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The Skeletal System
CT 13Pg 79
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The Integumentary System
Pg 79-80
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EnrichmentAnatomical Terms (positions)
Anatomical Position is face forward with palms front
Medial/Lateral Proximal/Distal Anterior/Posterior Superior/Inferior Right/Left refer to victims right/left
Pg 81-83
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EnrichmentAnatomical Terms (cavities)
Cranial Spinal Thoracic Abdominal Pelvic
CT 16Pg 83-85
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EnrichmentThe Digestive System
Images courtesy of theEMTB Anatomy Review
Pg 84-87
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EnrichmentThe Endocrine System
Images courtesy of theEMTB Anatomy Review
Pg 87
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EnrichmentThe Genitourinary System
Images courtesy of theEMTB Anatomy Review
Pg 87-88
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Interrelationships of Body Systems
Body systems work together to maintain a healthy state
Systems do not work independently. Injury or disease is rarely restricted to one system
Significant injury or illness may result in shock The more systems involved the more serious the
emergency Basic care may be all that is needed until more
advanced care is available.
Pg 89
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Chapter 6Lifting and Moving
Body mechanics Safety Precautions Emergency and non-emergency moves Special equipment
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VideoLifting and Moving
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Safety Precautions when Moving a Victim
Consider the following: The distance the victim must be moved Dangerous conditions at the scene The size of the victim Your physical ability Whether others can help you The victim’s condition Any aids to transport at the scene
TM 20Pg 92
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Basic Guidelines for Moving a Victim
Only move a victim you can safely handle Bend at knees and hips Lift with your legs, not your back Take short steps Move forward when possible Look where you are walking Protect victim’s head, neck and back Communicate clearly and frequently with your partner, the
victim, and other EMS providers Tell the victim what is expected of them
TM 20Pg 92
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Emergency Moves General Considerations
Only perform an Emergency Move when - the victim is in immediate danger access must be gained to another victim
with life-threatening conditions the victim must be moved to provide proper
care
Pg 92-93
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MovesEmergency Moves
TM 21
Non-urgent MovesWalking AssistFire fighter’s carryPack-strap carryTwo-Person Seat CarryClothes DragBlanket DragShoulder DragFoot Drag
Direct liftExtremity liftDirect carryDraw sheet method
Pg 93-98
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Practice SessionWorkbook Pages 45-50
Walking Assist (One or Two Rescuers) Fire Fighter’s Carry Pack-Strap Carry Two-person Seat Carry Clothes Drag Direct Carry
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As you approach a scene ...
CT 17
… have a plan in mind.
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Scenario 1
TM 22
Emotional Aspects of Emergency Medical Care:Death of a Child
You are summoned to respond to a call for injuries from a fall. You arrive to find a child lying motionless on the ground. He has fallen from a third story window. Two women are standing by the fallen child. One woman rushes to you and starts to tell you it happened 10 minutes ago. The child’s mother is kneeling next to her child, crying and screaming. It appears the child is dead. As you try to get close to the child to perform an initial assessment, the mother refuses to let you near, screaming at you to stay away. How do you respond?
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Scenario 2
TM 23
Unconscious Victim, Bleeding:Possible Crime Scene
A vehicle has struck a pedestrian. The victim is lying motionless in the street, bleeding from a wound on the thigh. Bystanders are surrounding the car, claiming the driver had started to drive away. The driver is still in the car. He is shouting out the window and looks extremely upset. How do you respond?
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Scenario 3
TM 24
Conscious Victim:Dangerous Scene
You and another rescuer are searching for a missing hiker. At the bottom of a dry gully, you find the victim who has an injured leg resulting from a fall. He is in severe pain and unable to walk. The sides of the gully are very steep. You can see a rapidly approaching storm and realize that it is going to rain very shortly and the gully will flood. How do you respond?
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Scenario 4
TM 25
Legal and Ethical Issues
You arrive at a scene where a man is lying on the sidewalk. He has one leg that appears to be bleeding, but not profusely. He is very pale, in pain and is breathing heavily. He is conscious and able to speak. When you approach him, he waves you off and yells at you to go away. When you explain who you are and that you are trained and want to help him, he says he doesn’t want any help. His friends will take care of him. How do you respond?
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Chapter 7Assessment
Components of a scene size-up Initial Assessment
CABC Physical Exam SAMPLE history On-going assessment Common mechanisms of injury Taking vital signs
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Assessment - Scene Size-Up Scene safety Mechanism of injury/nature of illness Number of victims Resources needed
TM 26Pg 106
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VideoPerforming an Initial Assessment
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Assessment - Initial Assessment Form a general impression Assess level of consciousness Assess airway Assess breathing Assess circulation (pulse, severe bleeding,
and skin characteristics)
TM 27Pg 109-116
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Levels of Consciousness - AVPU
TM 28
Level Characteristic Victim Behavior
Alert
Verbal
Painful
Unresponsive
Is able to respond to you
Only responds to verbal commandsOnly responds to a painful stimulusDoes not respond
Pg 110
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Airway Assessment May need to position the head and neck to
open the airway Tongue can sometimes block the airway To open airway-
For illness use head-tilt/chin-lift For injury use jaw-thrust without head-tilt
(protects neck and back) Inspect for obvious obstructions
Pg 111
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Breathing Assessment Look, listen and feel Determine rate and quality of breathing,
note any abnormal sounds of distress If not breathing provide rescue breathing
Pg 112
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Circulation Assessment Check pulse rate and quality Check skin color, temperature and moisture Check for severe bleeding Record victim’s age, gender, chief
complaint, LOC and status of airway, breathing and circulation. Note the time.
Pg 113
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Signs of Circulation Breathing Coughing Any type of body movement Pulse
Pg 113
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Circulation Assessment
CT 18Pg 114
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Other Indications of Circulation Skin Color – pale, ashen or flushed Skin Temperature – hot or cold Skin Moisture – moist or dry (Pale or bluish skin that feels cool and moist
indicates poor blood flow. Persons with darker skin will appear ashen.)
Capillary refill – normal or slow. Use for infants and children. Less than 2 seconds unless cold temperature.
Pg 114-116
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VideoPerforming a Physical Exam and
SAMPLE History
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Assessment - Physical Exam Gather information about problem Identify signs and symptoms Check victim from head to toe Look and palpate (feel) for signs of
injury - (DOTS)
TM 29Pg 116-119
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Deformity Open injuries Tenderness Swelling
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Assessment - SAMPLE History
Signs and symptomsAllergiesMedicationsPertinent past historyLast oral intakeEvents leading up to injury or illness
TM 30Pg 120
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Ongoing Assessment Repeat and record vital signs
-every 5 minutes for serious problem (unstable) -every 15 minutes for non-serious problem
Pg 120
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Practice SessionWorkbook Pages 59-65
Performing an Initial Assessment Performing a Physical Exam and SAMPLE
History
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When to Summon More Advanced Medical Personnel
Unconscious or altered LOC Breathing problems Persistent chest or abdominal pain or pressure No pulse Severe bleeding Vomiting or passing blood Suspected poisoning Seizures, severe headache or slurred speech Suspected or obvious injuries to head or spine Painful, swollen or deformed areas(when in doubt, summon the help)
Pg 121-122
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VideoMeasuring Blood Pressure
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Measuring Blood Pressure
TM 31
Systolic Pressure
Diastolic Pressure
Palpation
Auscultation
Reflects pressure in arteries when heart is working/contractingReflects pressure in arteries when heart is resting/refilling
Measures only the Systolic pressure by feeling for the radial pulse. Record as palpated (eg. BP120p). Announce as “BP <pressure> by palpation”Measures both Systolic and Diastolic pressures by listening for the pulse with a stethoscope. Record as <systolic>/<diastolic> (eg. BP 120/80). Announce as “BP <systolic> over <diastolic>”.
Pg 123-126
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VideoBlood Pressure Practice
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Practice SessionWorkbook Pages 66-70
Blood Pressure Measurement (Palpation) Blood Pressure Measurement
(Auscultation)
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Chapter 8Breathing Emergencies
The Breathing Process Respiratory Distress
Illness causing respiratory distress Respiratory Arrest Airway Obstruction
Anatomical Mechanical
Care for choking victims
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Respiratory System Review
Images courtesy of theEMTB Anatomy Review
The body requires a constant supply of oxygen. Various illnesses and accidents can cause breathing emergencies.
Pg 136
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AsthmaFacts Narrows air passagesTriggered by- Allergic reaction to pollen/food/a drug/insect
stings Emotional stress/physical activitySigns and symptoms Struggling to breathe Wheezing when exhaling
TM 32Pg 137
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EmphysemaFacts Lungs lose ability to exchange carbon dioxide and
oxygen effectivelyCaused by- Smoking: usually develops over many yearsSigns and symptoms Shortness of breath Possible coughing, cyanosis, or high fever Advanced cases: Restlessness, confusion,
weakness
TM 33Pg 138
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HyperventilationFacts Rapid breathing upsets body’s balance of oxygen and
carbon dioxideTriggered by- Fear/anxiety Injury to head/ severe bleeding/ illness Asthma ExerciseSigns and symptoms Shallow, rapid breathing Dizziness Numbness in fingers/toes
TM 34Pg 138
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Anaphylaxis(Severe Allergic Reaction)
Facts Swelling of air passages restricts breathingTriggered by- Food/ insect stings/ a drugSigns and symptoms Skin rash Tightness in chest/throat Swelling of face/ neck/ tongue
TM 35Pg 138
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Care for Respiratory Distress Have victim rest in comfortable position Keep victim from getting chilled or
overheated Reduce heat; add moisture If authorized, help victim take any
medications Summon more advanced medical personnel Monitor vital signs
TM 36Pg 139
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Key Points of Respiratory Arrest Life threatening Commonly caused by illness, injury or
choking Often preceded by respiratory distress Body systems will progressively fail
TM 37Pg 139-140
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Rescue Breathing Follow BSI precautions - use a barrier
Pg 140-141
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Rescue Breathing Check LOC If unconscious, open the airway and check
for breathing If not breathing, give two breaths Check for signs of circulation If circulation is present, continue with
rescue breathing Check for circulation every minute
Pg 141
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VideoFace Shields/Barriers
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Rescue BreathingSpecial considerations
Vomiting Mouth-to-nose breathing Mouth-to-stoma breathing Victims with dentures Suspected injury to the spine
Pg 141-144
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Airway ObstructionPartial Victim can still move air to and from lungs; can
cough, speak, breatheComplete Victim is unable to speak, breathe, cough; no air
movement
TM 40Pg 146-147
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Chapter 9Breathing Devices
Suctioning Airways
Oral Nasal
Barrier Shields Resuscitation Masks Oxygen (Enrichment section)
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VideoSuctioning
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Steps for Suctioning Turn head to side or roll body if head, neck,
or back injury suspected Open victim’s mouth Remove large pieces of matter Measure distance of insertion Insert suction device into back of mouth Suction for no more than 15 seconds at a
time
TM 41Pg 164
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Practice SessionWorkbook Pages 101
Suctioning
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VideoAirway Insertion
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Airway Adjuncts Two types of airways: Oral(oropharyngeal)
and nasal (nasopharyngeal) Available in various sizes Oral airways are only used on unresponsive
victims Nasal airways may be used on victims who
are responsive but need assistance keeping the tongue from obstructing the airway
Pg 165-166
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Inserting an Oral Airway Select airway of proper size Open victim’s mouth Insert airway with curved end along roof of
mouth Advance airway gently until resistance is
felt Rotate airway 1/2 turn Flange should rest on lips
TM 42Pg 166
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Inserting an Oral Airway
CT 20
Insert and advance Rotate
Pg 167
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Inserting a Nasal Airway Select airway of proper size Lubricate nasal airway Insert nasal airway into right nostril with
bevel toward middle of nose Advance airway gently, until flange rests on
nose
TM 43Pg 166
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Inserting a Nasal Airway
Pg 168
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Practice SessionWorkbook Pages 102-105
Inserting an Oral Airway Inserting a Nasal Airway
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VideoUsing a Resuscitation Mask
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Criteria for a Resuscitation Mask Transparent, pliable One-way valve 15mm or 22mm coupling assembly Able to deliver supplemental oxygen Able to withstand extreme temperatures Easily assembled and used
TM 44Pg 168
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Using a Resuscitation Mask Tilt head back Lift jaw Open mouth
TM 45Pg 169
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Practice SessionWorkbook Pages 106-107
Using a Resuscitation Mask
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VideoOxygen Delivery
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Supplemental Oxygen Delivery System Components
Oxygen cylinder Pressure regulator with flowmeter Delivery device
TM 46Pg 173-179
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Oxygen Delivery Devices
TM 47
Common OxygenDevice Flow Rate Concentration Function
Nasal 1-4 lpm 24-36% Breathing victims onlycannula
Resuscitation 6+ lpm 35-55% Breathing andnonbreathing victims
Bag-valve- 10+ lpm 90+% Breathing andmask nonbreathing victims
Nonrebreather- 15 lpm 90+% Breathing victims onlymask
Pg 177
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Precautions During Oxygen Delivery
Do not operate around flames/ sparks Do not stand cylinder upright Do not use grease/ oil/ petroleum products
to lubricate Check oxygen flow before placing delivery
device on victim
TM 48Pg 179
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Practice SessionWorkbook Pages 110-113
Oxygen Delivery
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Chapter 10Cardiac Emergencies
Heart Attack Cardiac Arrest CPR for Adults Cardiac Emergencies in Infants and Children CPR in Infants and Children Two-Rescuer CPR Preventing Cardiovascular Disease AED s
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The Heart Right atrium - receives
blood from body Left atrium - receives
blood from lungs Right ventricle - pumps
blood to lungs Left ventricle - pumps
blood to body
TM 49Pg 190
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VideoRecognizing a Heart Attack
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The Heart Attack Heart muscle does not get enough oxygen
through coronary arteries and dies Depending upon which heart muscle and
how much is affected, a heart attack may range from undetected to sudden cardiac death
Usually caused by Cardiovascular disease
Pg 192
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Signs and Symptoms of Heart Attack
Persistent chest pain or discomfort Breathing difficulty Changes in pulse rate Pale, bluish, or moist skin Nausea, vomiting Sweating General ill appearance
TM 50Pg 192-193
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Care for Heart Attack Stop victim’s activity Have victim rest in a comfortable position Summon more advanced medical personnel Be calm and reassuring Monitor breathing and pulse, look for
changes in victim’s appearance or behavior. Administer supplemental oxygen if it is
available and you are trained
TM 51Pg 194
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Controllable Risk Factors forCardiovascular Disease
Smoking Diet high in fat High blood pressure Obesity Lack of regular exercise
TM 52Pg 209-211
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Cardiac Arrest Cardiovascular disease is most common
cause but also caused by drowning, suffocation, drugs, injuries, loss of blood, electrocution or stroke
CPR will delay death Defibrillation might restart heart rhythm
Pg 209-211
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Time Without Breathing Until Brain Damage Occurs
Pg 198
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When to Stop CPR Another trained rescuer takes over You are too exhausted to continue Victim’s heart starts beating Scene becomes unsafe A defibrillator is available with trained user
present You are presented with a valid DNR order Advanced medical personnel order you to
discontinue
TM 53Pg 202
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Ways to Prevent Cardiac Emergencies in Children
Prevent injuries leading to cardiac emergencies Proper medical care Recognize early signs of respiratory emergency
Agitation Drowsiness Change in skin color Increased difficulty breathing Increased heart and breathing rates
TM 54Pg 202
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Special Resuscitation Situations Near drowning
Must seek follow-up care Electrocution
Insure personal safety Serious burns can occur along the entire path
from the entry to the exit sites. Identify both if possible.
Lightening strike Can cause severe burns and fractures, including
the spine.
From CPR-PR
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Special Resuscitation Situations Traumatic injury
Survival rate is poor, transport ASAP. Always suspect head/neck injury
Hypothermia Pulse is hard to find, check for 45 seconds Transport ASAP Warm slowly, handle gently
From CPR-PR
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Special Resuscitation Situations Difficult locations
Only move if unsafe or impractical to do CPR When transporting up or down stairs, perform
CPR for one minute on the landings, try not to interrupt CPR for more than 30 seconds
From CPR-PR
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As you approach a scene ...
CT 17
… have a plan in mind.
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Scenario 5
TM 55
Conscious Person,Difficulty Breathing
At work, you are summoned to assist a fellow worker who is ill. As you arrive, you notice the person lying on the ground, having obvious difficulty breathing. How do you respond?
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Scenario 6
TM 56
Conscious Person,Breathing, with Severe Bleeding
While hiking, a man strays from the path in search of more challenging terrain. The man loses his footing on loose rocks and slides approximately 15 feet down the rocky slope. When you arrive, you notice that he is bleeding badly from a deep wound on the lower leg. You notice that he appears pale, cool, and is sweating. He tells you he is feeling dizzy, nauseated, and thirsty. How do you respond?
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Scenario 7
TM 57
Unconscious Person,Breathing
A frantic neighbor is knocking at your door. She says that she cannot wake her sleeping roommate. She remembers that her roommate took some pills about two hours ago, but she is not sure what they were or where her roommate keeps them. You enter and see a woman lying face up on the couch, not moving. She has vomited. How do you respond?
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Scenario 8
TM 58
Unconscious Person,Not Breathing, Has Pulse
It’s early morning, and you are the lifeguard at a local pool. The pool is almost deserted. Only two people were swimming, but now they are finished and have gone to the locker rooms. It is time to lock up the pool, and you proceed to the locker rooms. You are startled to see a body lying motionless on the damp floor next to a row of lockers. You recognize the older woman who had been swimming laps earlier. How do you respond?
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Scenario 9
TM 59
Unconscious Person,Not Breathing, No Pulse
In the early morning, you respond to a call dispatched as a “heart attack.” You find an elderly man lying motionless on the floor. His wife tells you that he had been feeling ill for several hours and had vomited. She says that he emerged from the bathroom clutching his chest and in apparent pain, and suddenly collapsed on the floor. How do you respond?
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Scenario 10
TM 60
Unconscious Person,Breathing, With Severe Bleeding
You witness a bicyclist struck by a car. The bicyclist is thrown from the bike, striking her head. The driver of the vehicle gets out to help. As you approach, you see the bicyclist lying on her side, twitching. Blood is spurting from her thigh onto the pavement. You want to help. How do you respond?
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Chapter 11Bleeding and Shock
Blood and Blood Vessels When Bleeding Occurs
External Internal
Shock (Hypoperfusion)
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Blood Components Plasma
Liquid. Carries nutrients and waste products White Blood Cells
Disease fighting component. Aids in producing antibodies needed to fight infection
Red Blood Cells Transport Oxygen and Carbon Dioxide
Platelets Essential to the clotting process
Pg 222
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Major Functions of Blood Protects against disease Maintains constant body temperature Transports oxygen, nutrients and wastes
TM 61Pg 222
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Blood Vessels Arteries -
Systemic Arteries carry oxygen-rich blood from the heart to the rest of the body
Pulmonary arteries carry oxygen-poor blood from the heart to the lungs
Capillaries - Deliver oxygen and nutrients and remove waste products from the cells
Veins - Systemic Veins carry waste products from the cells to the
heart Pulmonary Veins carry oxygen-rich blood from the lungs to
the heart for delivery to the body
Pg 222-223
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When Bleeding Occurs Brain, Heart and Lungs attempt to compensate for
blood loss to maintain flow to vital organs Platelets collect to clot the blood, white blood
cells try to attack infections, body produces more red blood cells
Fluid is reabsorbed from the kidneys, lungs and intestines to maintain needed volume
Pg 223
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Bleeding Bleeding may be internal or external. Whichever
the case, uncontrolled bleeding is a life-threatening emergency
Pg 223-229
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Recognizing External Bleeding Visible blood Bleeding is serious when -
Blood is spurting from a wound Blood fails to clot after all measures have been taken
Arterial bleeding is bright red and oxygen rich. May spurt and be harder to control
Venous bleeding is dark and flows at a steady rate Capillary blood is dark red and “oozes”. Usually
clots spontaneously
Pg 223-226
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Care for External Bleeding Direct pressure Elevation Pressure bandageIf necessary- Use pressure points Summon more advanced medical personnel
TM 62Pg 226-227
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Practice Session
Bleeding control Direct pressure Elevation Pressure bandage Pressure points
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Recognizing Internal Bleeding Discoloration of the skin Soft tissues are tender, swollen or firm Anxiety or restlessness Rapid, weak pulse Rapid breathing Skin feels cool or moist or looks pale, ashen or bluish Nausea and vomiting Excessive thirst Declining level of consciousness (LOC) Drop in blood pressure
Pg 228
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Care for Internal BleedingIf minor injury- Apply ice or cold packIf serious injury Summon more advanced medical personnel Do no further harm Monitor ABCs and vital signs Have victim rest in a comfortable position Keep victim from getting chilled or over heated Reassure victim Provide care for other conditions Administer Oxygen if it is available and you are trained
to do so
TM 63Pg 229
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When the Body is Healthy …Three conditions are necessary to maintain
adequate blood flow – The heart must be working well An adequate amount of blood must be
circulating in the body The blood vessels must be intact and able to
adjust blood flow
Pg 229
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Shock The circulatory system fails to provide
oxygen-rich blood to all body parts Several types of shock - Anaphylactic,
Cardiogenic, Hemorrhagic, Metabolic, Neurogenic, Psychogenic, Respiratory, Septic
Three phases of shock - Compensated Decompensated Terminal
Care is the same in all cases
Pg 230-231
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Shock
Pg 231
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Signs and Symptoms of Shock Restlessness/irritability Rapid/weak pulse Rapid breathing Pale, ashen or bluish/cool/moist skin Excessive thirst Nausea and vomiting Drowsiness/loss of consciousness
TM 64Pg 232
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Stages of Shock
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Compensated Shock:
Pulse fast - Bounding Breathing rate increases Superficial blood vessels constrict Blood pressure maintained Increased diastolic Body sweats capillary refilling prolonged (2-4 seconds) Anxious
TM 65Pg 232
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Decompensated Shock:• LOC deteriorates
• Tachycardia
• Tachypnea and shallow
• Decreased systolic pressure
• Decreased diastolic pressure
• weak and thready pulse
• Blue/pale skin
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Terminal Shock:• Very low blood pressure
• dilation of peripheral blood vessels
• Unconscious
• death
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Care for Shock Do no harm Monitor ABCs Help victim rest in a position of comfort Keep victim from getting chilled or
overheated Reassure the victim Provide care for specific conditions
Pg 232-233
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Further Care for Shock Control any external bleeding as soon as
possible Elevate the legs about 12 inches if you do
not suspect head, neck or back injuries or injuries to the hips or legs
Administer Oxygen if available Give nothing to eat or drink Call advanced medical assistance
Pg 233
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Chapter 12Specific Injuries
Soft Tissue Injuries Closed Open
Burns Chest Injuries Injuries to the Abdomen
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VideoInjuries
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The Structure of the SkinThe epidermis provides a barrier to bacteria and other organisms that can cause infections and helps regulate the body’s temperature
The dermis contains structures of the nerves, the sweat and oil glands and the blood vessels
CT 29Pg 238
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Wounds Closed Open
Types Abrasion Laceration Avulsion Puncture Impaled Object Infection
TM 66Pg 239-243
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Wounds Closed
CT 29Pg 239
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Wounds Abrasion
CT 30Pg 240
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Wounds Laceration
CT 30Pg 241
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Wounds Avulsion
CT 31Pg 241
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Wounds Puncture
CT 31Pg 242
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Wounds Impaled Object
CT 31Pg 243
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Wounds Infection
CT 32Pg 249
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Dressings Dressings absorb blood and must be sterile.
Commonly 2” or 4” square Universal dressings cover very large
wounds Occlusive dressings do not allow air to pass
Pg 243
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Bandages Wrap or cover any part of the body to hold
dressings in place Adhesive bandages are small pads of nonstick
gauze and a strip of adhesive tape Bandage compresses can be tied in place Roller bandages are self adhering and are used to
cover dressings Elastic bandage keeps pressure on a body part but
must be used with caution Triangular bandages are used as slings
Pg 244-246
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Applying a Roller Bandage Elevate injured part Secure end of bandage Completely cover dressings Don’t cover fingers or toes Apply additional dressings if necessary
TM 70Pg 244
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Care for closed injuries Direct pressure Elevation Cold
Do not apply ice directly to the skin
Pg 247
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Care for severe open injuries Don’t waste time washing the wound Control the bleeding Control with direct pressure Summon more advanced medical care Use pressure points as necessary Wash hands after completing care
Pg 247-248
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Pressure Point Location
Pg 227
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VideoControlling External Bleeding
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Types of Burns Depth
Superficial Partial-thickness Full-thickness
Source Thermal Chemical Electrical Radiation
TM 67Pg 249-250
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Types of Burns Depth
Superficial Red and dry and usually painful Often cause swelling in the burn area Generally heal in a few days without scarring
CT 33Pg 250
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Types of Burns Depth
Partial-thickness Red and wet and may have blisters that may open and weep
clear fluid Are usually painful Often cause swelling in the burn area Generally heal in 3-4 weeks May result in scarring
CT 34Pg 250-251
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Types of Burns Depth
Full-thickness Appear brown or charred (black) with tissues underneath
sometimes appearing white May either be extremely painful or relatively painless if the
burn destroyed the nerve ending Take longer to heal Usually result in scarring
CT 35Pg 251-252
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Critical Burns Burns causing breathing difficulty Burns covering more than one body part Burns on the head, neck, hands, feet or
genitals Any partial- or full-thickness burns to
children or the elderly Burns from chemicals, explosions or
electricity
TM 68Pg 252
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The “Rule of Nines” Used to estimate the percentage of the body
affected by a burn Head = 9% Front of trunk = 18% Back of trunk = 18% Arm = 9% Leg = 18% Groin = 1%
Pg 253
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Care for Burns Cool burned area with cool water Cover burned area with dry dressings Minimize shock by keeping victim from
getting chilled or overheated If caused by a chemical have the victim
remove any contaminated clothes If an eye is burned by a chemical flush the
eye for at least 20 minutes
TM 69Pg 252-255
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Care for Electrical Burns Make sure the scene is safe Turn off electrical current before
approaching the victim During the physical exam, look for all entry
and exit wounds. All tissue between these areas may be affected
Pg 256
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VideoBandaging
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Practice SessionWorkbook Pages 158-163
Care for a Major Open Wound (Forearm) Care for a Major Open Wound (Leg) Care for a Wound with an Embedded
Object
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Signs and Symptomsof Chest Injury
Difficulty breathing Severe pain Obvious deformity Discoloration of skin Coughing up blood
TM 71Pg 258-259
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Types of Chest Injuries Rib Fractures
Flail Chest
CT 36Pg 259
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Types of Chest Injuries Puncture Injuries
CT 37Pg 260
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Types of Chest Injuries Sucking Chest Wound
CT 38Pg 261
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Care for Serious Chest Injury Summon more advanced medical personnel Position victim to aid breathing If ribs are broken, bind arm to injured side Cover sucking chest wound Administer oxygen Monitor breathing and pulse
TM 72Pg 259-260
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Practice Session(Not in the workbook)
Chest Injury
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Signs and Symptomsof Abdominal Injury
Nausea and vomiting Pale or ashen, moist skin Thirst Pain, tenderness or rigid abdomen Weakness Organs protruding from the abdomen
Pg 261-262
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Abdominal Organs
CT 39
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Care for Serious Abdominal InjuryOpen Wound
Do not put pressure on protruding organs or try to put them back inside
Position victim on back Remove clothing around wound Cover loosely with moist, clean dressing Cover dressing with plastic wrap Cover with folder towel to maintain warmth Administer oxygen
TM 73Pg 262
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Closed Wound Position victim on back Bend knees slightly Administer oxygen if available Minimize shock Summon more advanced medical personnel
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Signs and Symptomsof Pelvic Injury
Same as for abdominal injury with the addition of loss of sensation or movement in the legs, which sometimes occurs
Pg 261-264
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Care for Serious Pelvic Injury Summon more advanced medical personnel Minimize movement Control bleeding Administer oxygen if available Minimize shock
TM 74Pg 261-264
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Care for Open Wound to Genitalia
Cover with sterile dressing Control bleeding Do not put anything into the vagina
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Embedded Objects Do not remove objects in the eye, ear or
nose Remove objects from the cheek Remove objects from the chest if it will
interfere with chest compressions
Pg 263
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Amputations Wrap the part in a sterile dressing Wrap the dressing in plastic Pack in ice to cool, not freeze. Transport
with the victim.
Pg 263
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Chapter 13Muscle and Bone Injuries
Musculoskeletal System Review Injuries to Bones and Joints Immobilization The Skeletal system Types of Musculoskeletal injuries Caring for specific injuries
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Musculoskeletal System Review
Images courtesy of theEMTB Anatomy Review
Muscles attach to bones with tendons
Joints are held together by ligaments
Pg 277
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Musculoskeletal System ReviewBones are different shapes and sizes
Pg 287
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Musculoskeletal System ReviewBones can fracture or separate in various ways
Crack
Broken Through
Chip
Separation
Pg 289
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Common Signs and Symptomsof Musculoskeletal Injury
Pain Swelling Deformity Discoloration Bone protruding from wound Inability to use affected part Grating bones Snapping or popping sound Cause of injury, such as fall from a height
TM 75Pg 278-279
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VideoImmobilizing Muscle and Bone
Injuries
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Care for Muscle and Bone Injury Rest Ice Elevation ImmobilizationOr Rest Ice Compression Elevation
TM 76Pg 280
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Immobilization - Types of Splints Soft Rigid Anatomic Traction Air splints- precautions Vacuum
Pg 281
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VideoSplinting
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Emergency Care for Muscle and Bone Injuries -
Take BSI precautions Control life-threatening injuries Allow victim to rest in comfortable position Apply cold to reduce pain and swelling Support area above and below injury Cover open wounds with sterile dressing Do not reposition protruding bones
TM 77Pg 279-283
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Types of Muscle and Bone Injuries
Fracture Dislocation Sprain Strain
Pg 288-289
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Caring for Specific Injuries to Bones and Muscles
Upper Extremity injuries Shoulder -
The clavicle is the most frequently injured, typically from a fall
Great force is required to break the scapula. Suspect other injuries is this occurs
Splint in position. Use a pillow or rolled blanket to fill any gaps between the arm and chest
Pg 290-292
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Caring for Specific Injuries to Bones and Muscles
Upper Extremity injuries Upper Arm
the humerus is the longest bone in the arm and can be broken at any point
Injury may be very painful and may have considerable deformity
Control external bleeding and immobilize the upper arm from the shoulder to elbow
Sling and bind to the chest
Pg 295-296
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Caring for Specific Injuries to Bones and Muscles
Upper Extremity injuries Elbow
Injuries are made worse by movement Immobilize from the shoulder to the wrist in the
position found Splint and secure to the body If the elbow is bent, splint diagonally across the
inside of the arm
Pg 296
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Caring for Specific Injuries to Bones and Muscles
Upper Extremity injuries Forearm, Wrist and Hand
Apply a pressure bandage in a figure-eight Place a roll of gauze in the hand Put the arm in a sling and secure to the chest If fingers are broken, splint to an adjacent finger
Pg 297-299
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Caring for Specific Injuries to Bones and Muscles
Lower Extremity injuries Thigh
Many femur fractures involve the upper end of the bone and are called hip fractures
A leg with a broken femur may appear shorter than the other leg and be turned outward
Femur fractures can cause serious internal bleeding which may result in life-threatening shock. A traction splint may be used for mid-shaft fractures
Pg 299-302
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Caring for Specific Injuries to Bones and Muscles
Lower Extremity injuries Lower Leg
Open fractures are common. With some fractures of the fibula the victim may still be able to walk
Immobilize using a rigid splint or anatomical splint
Pg 299-302
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Caring for Specific Injuries to Bones and Muscles
Lower Extremity injuries Knee
Very vulnerable to injury. Sprains, fractures and dislocations are especially common with athletic injuries
Violent force may fracture the kneecap If the knee can be straightened, splint as with any
other leg injury. If bent, splint in the position found
Pg 303-304
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Caring for Specific Injuries to Bones and Muscles
Lower Extremity injuries Ankle and Foot injuries
It can be difficult to distinguish between minor and severe foot and ankle injuries. Treat as if they were serious
Victims of a fall may injure the foot or ankle as well as other parts of the body, such as the back. Do a full physical survey
Pg 304
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Practice SessionWorkbook Pages 176-183
Applying a Rigid Splint Applying a Sling and Binder Applying an Anatomic Splint Applying a Soft Splint Applying a Traction Splint
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Chapter 14Head, Neck and Back Injuries
Recognizing Serious Head, Neck and Back Injuries
Injury Situations Care for these injuries Immobilizing the victim Preventing Head, Neck and back injuries
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Head, Neck and Back Injury Although a small percentage of injuries
they account for over half of the fatalities Nearly 80,000 victims are permanently
disabled each year in the U.S. Prompt care can prevent some injuries from
becoming more serious Bleeding in the skull can occur rapidly or
slowly over a period of days
Pg 313
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Head, Neck and Back Injury
Injuries to the skull can cause bleeding inside the skull or brain which can result in severe pain, headaches or changes in level of consciousness
Pg 313-314
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Head, Neck and Back InjuryThe spine consists of individual vertebrae which protect the spinal cord while allowing flexibility. The disks are separated by compressible disks and individual nerves or nerve bundles exit between the vertebrae.
Pg 314-315
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When to Suspect a Head, Neck or Back Injury
Any fall greater than victim’s height Any motor vehicle collision A person found unconscious for unknown reasons Any injury that penetrates the head or trunk A motor vehicle crash involving a driver or
passengers not wearing safety belts Any person thrown from a motor vehicle Any injury in which a victim’s helmet is broken
TM 78Pg 314
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Signs and Symptoms of SeriousHead, Neck or Back Injuries
Change in level of consciousness Severe pain/pressure in head/neck/back Tingling/loss of sensation/movement in
extremities Unusual lumps/depression on head/spine Blood/fluids in the ears/nose…….
TM 79Pg 314-317
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Profuse external bleeding of head/neck/back
Seizures Impaired breathing/vision Nausea/vomiting Persistent headache Loss of balance Bruising of head: around eyes/back of head
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Assessing a victim with aHead, Neck or Back Injury
Responsive victim Ask about the mechanism of injury Ask the victim-
Does your head, neck or back hurt? What happened? Where does it hurt? Can you move your hands and feet? Can you feel me touching your fingers Can you feel me touching your toes?
Pg 317
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Unresponsive victim Look for the mechanism of injury Maintain airway and breathing Stabilize the head, neck and back manually
in the position the victim is found
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VideoImmobilizing Head, Neck
and Back Injuries
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Care for Head, Neck and Back Injuries
Minimize Movement In-line stabilization unless contra-indicated
Maintain an open airway Complete physical assessment and on-going
assessment Control external bleeding Keep victim from getting chilled or
overheated
Pg 317-319
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Additional Care for Head, Neck and Back Injuries
Head injury may include a concussion, which is a temporary impairment of the brain function
Never place pressure on the eyeball. For an embedded object, stabilize with a paper cup
For a nosebleed, pinch the nostril and have the person lean forward
For teeth knocked out, control the bleeding and save the teeth. They can be replanted
Pg 319-325
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Practice SessionWorkbook Pages 194-196
Bandaging an Eye with an Embedded Object
Pg 322
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When Not to UseIn-line Stabilization
When victim’s head is severely angled When victim complains of pain, pressure or
muscle spasms on initial head movement When rescuer feels resistance when
attempting to move head
TM 80Pg 317
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Specific Injuries Concussion Scalp Cheek Injury Nose Injury Eye Injury Ear Injury Mouth, Jaw and Neck Injury
Pg 319-324
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Immobilizing the Victim Hold in-line stabilization Apply a cervical collar Secure the body to a backboard Secure the head (last!)
Note: Only remove helmets if they interfere with breathing or breathing assistance. ER will want helmet with the victim
Pg 326-328
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Ways to Prevent Head, Neck and Back Injuries -
Wear safety belts Wear helmets and protective eyewear Safeguard against falls Take safety precautions in sports and recreation Avoid improper drug use Inspect equipment Think and talk safety
TM 81Pg 334-336
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Practice SessionWorkbook Pages 194-196
Immobilizing a Head, Neck or Back Injury
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Chapter 15Medical and Behavioral Emergencies
Medical Emergencies Altered Mental Status Seizures Stroke Diabetic Emergency Heat and Cold Exposure
Behavioral Emergencies
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General Signs and Symptomsof Medical Emergencies
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General Signs and Symptomsof Medical Emergencies
Change in level of consciousness Headache/lightheaded/dizzy/weak Nausea/vomiting Change in breathing, pulse, or skin temperature, color or moisture
TM 82Pg 341-342
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VideoMedical Emergencies
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Altered Mental StatusCan Result From -
Fever Infection Poisoning, including substance abuse or misuse High or low blood sugar or insulin reactions Head injury Any condition that results in decreased blood flow
to the brain Conditions resulting from mental, emotional, or
behavioral disorders
TM 83Pg 341
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Altered Mental Status A person who faints has experienced an altered
level of consciousness. The brain was deprived of its normal flow of blood
Fainting usually resolves itself when the blood flow is restored
Fainting by itself does not usually harm the victim but injury may occur from falling
Fainting does have an underlying cause that should be explored
Pg 341
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Care for a Victim of an Altered Level of Consciousness Do initial assessment, physical exam,
and SAMPLE history as needed Elevate legs Do ongoing assessment Check airway; …….
TM 84Pg 342
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put unconscious victims in recovery position
Loosen any restrictive clothing Do not give victim anything to eat Have suction equipment available Summon more advanced medical
personnel Reassure victim
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Causes of Seizures Fever Infection Chronic medical conditions Poisoning Low blood sugar Head injury Any condition causing decreased Level Of
Consciousness (LOC) Pregnancy complications
TM 85Pg 342
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Seizure Indications The chronic form of seizure is known as epilepsy Before a seizure, the victim may experience a
warning called an aura. This is an unusual sensation or feeling such as a visual hallucination; strange sound, taste or smell; or an urgent need to get to safety
Seizures may range from mild blackouts that appear to be daydreaming to sudden uncontrolled muscular contractions lasting several minutes
Pg 342-343
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To Care for a Seizure Victim - Summon more advanced medical personnel Do not try to stop seizure or restrain victim Protect victim from injury Protect victim’s modesty Manage airway by rolling victim onto his or her
side Remove nearby objects and protect victim’s head Do not place anything between teeth When seizure is over, do physical exam and care
for any injuries found
TM 86Pg 343
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For a Seizure Victim, Call if - The seizure lasts more than a few minutes The victim has repeated seizures The victim appears to be injured You are uncertain about the cause of the seizure The victim is pregnant The victim is a known diabetic The victim is an infant or child The seizure takes place in water The victim fails to regain consciousness after the
seizure
Pg 343
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Those at Greatest Riskfor Heat-related Illness
Young children and the elderly Those involved in strenuous activity in a
hot environment Those with pre-existing health problems Those using illicit drugs or medications Those who have had a heat-related illness in
the past
TM 89Pg 343-346
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Signs and Symptomsof Heat-related Illness
Headache Cool, moist, pale or ashen skin (early stages) Dry, red, hot skin (later stages) Nausea Exhaustion Progressive loss of consciousness Rapid, weak pulse (later stages) Rapid, shallow breathing (later stages) High body temperature (later stages)
TM 90Pg 347-348
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Care for Heat Exposure Remove victim from hot environment Give small amounts of cool water to conscious
victim Have victim lie down in a cool or shady area
and elevate legs if possible Loosen or remove clothing Apply cool, wet towels or cold packs to wrists,
armpits, groin and legs Fan victim
TM 91Pg 348
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Scenario 11
TM 92
Heat Emergency
You are involved with a fire-fighting training exercise involving a burning structure. It has been a really hot day, with temperatures in the 90s. You and others have been wearing you heavy turnout gear for hours. Suddenly, someone collapses. You notice that her skin is hot, flushed and wet. Her pulse is very fast. How do you respond?
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Factors Affecting Normal Body Temperature
Air temperature Humidity Wind Clothing Intensity of activity Body’s ability to adapt (physical fitness
level)
TM 93Pg 348
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Those at Greatest Risk for Cold Exposure
Young children and elderly Those without adequate equipment,
clothing or training for cold environment Those with health problems Those using illicit drugs, medications or
alcohol
TM 94Pg 345-346
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Signs and Symptomsof Hypothermia
Cool skin Shivering Numbness Decreasing level of consciousness (LOC) Poor coordination Difficulty speaking Rigid posture
TM 95Pg 348-350
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Care for Hypothermia Summon more advanced medical personnel Reassure victim Handle victim gently Remove victim from cold environment Have victim stop all activity and rest Remove wet clothing Place victim in dry blankets or clothing and wrap
in plastic if available Protect from any further heat loss
TM 96Pg 348-349
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FrostbiteSuperficial frostbite Most common form of frostbite Skin is frozen, underlying tissues are not Involves loss of feeling and sensation Person feels tingling sensation when rewarmedDeep frostbite Skin is white and waxy Skin is firm when palpated Swelling and blisters may be present When rewarmed, skin appears red with areas of
purple and blue
TM 97Pg 349
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Care for Localized Cold Injury Handle the affected area gently Remove wet clothing and any jewelry from the
affected area Cover the affected area with dry dressings and
bandage loosely Do not rub the area or break any blisters Do not re-expose the injury to cold Do not apply heat
Pg 349
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To Prevent Overexposure Emergencies
Do not work in the hottest or coldest part of the day
Take frequent breaks Replenish body with food and fluids Reduce work intensity Wear clothing appropriate for task and
environment
TM 98Pg 350
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Behavioral EmergenciesA behavioral emergency is a situation in which a
person exhibits abnormal behavior that is unacceptable or intolerable. Common causes for the behavior alteration include -
Pg 350-351
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Situational stress Illness or injury resulting in lack of oxygen
or low blood sugar Substance abuse Mental illness, including crises involving
panic, agitation, self destructive behavior, and/or violence.
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Actions Indicating a Behavioral Emergency
Threatening posture Possessing a weapon(s) Threatening harm to others or self Being verbally abusive Speaking in a nonsensical manner Withdrawing deeply Hallucinating
TM 99Pg 351
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To Calm a Victim of a Behavioral Emergency -
Assume non-threatening posture Acknowledge that victim appears upset Get in front of victim and at eye level Avoid unnecessary contact Do not threaten, challenge or argue with victim Involve others that victim trusts Encourage victim to discuss whatever is troubling
him/her
TM 100Pg 351-352
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Diabetic Emergencies
Too much Sugar Too much Insulin
Pg 354-359
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Hyperglycemia Too much sugar and too little insulin in the
blood stream Without insulin the body cells can not
convert the available sugar into energy Without sugar the body breaks down other
food sources The result can be a diabetic coma
Pg 354-359
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Causes of Hyperglycemia• Eating too much food relative to the amount
of insulin injected • Missing an insulin injection • Blockage in insulin pump tubing • Disconnected insulin pump infusion set • Illness or stress hyperglycemia caused by insufficient insulin
can lead to diabetic ketoacidosis.
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Symptoms of Hyperglycemia
• Frequent urination
• Frequent thirst
• Blurry vision
• Dry mouth
• Fatigue
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Hypoglycemia Adequate insulin Too little sugar Sugar is used rapidly Also called insulin reaction
TM 87Pg 355
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Signs and Symptoms of Diabetic Emergencies
Change in level of consciousness (LOC) Rapid breathing and pulse Feeling and looking ill
TM 88Pg 359
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Signs and Symptoms of Hyperglycemia
• Frequent urination
• Frequent thirst
• Blurry vision
• Dry mouth
• Fatigue
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Signs and Symptoms of Hypoglycemia
• Grouchiness
• Shakiness
• Sweating
• Fast heart rate
• Pale skin
• Dizziness
• Yawning….
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• Confusion
• Poor coordination
• Inability to cooperate
• Slurred speech
Severe
• Unconsciousness
• Convulsions …
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Care for Diabetic Emergencies
If conscious, ask victim about medical conditions
Do a SAMPLE history. (Important to know when medication and food were last taken)
If conscious and able to swallow, give sugar in some liquid form
If no improvement in 5 minutes, summon advanced medical personnel
Pg 359
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For Hyperglycemia
• Drink lots of water
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EnrichmentStroke
Called a Cerebrovascular Accident (CVA) Caused by a disruption of blood flow to a
part of the brain Can be caused by a blood clot lodging in an
artery or a ruptured artery A Transient Ischemic Attack (TIA) is a
short-term stroke
Pg 359-360
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EnrichmentStroke
Pg 360
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EnrichmentSigns and Symptoms of a Stroke Ill appearance Changes in LOC Sudden weakness and numbness in face,
arm or leg, usually on one side Difficulty speaking or understanding speech Pupils of unequal size, blurred vision Headache, confusion, change in mood
Pg 360
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EnrichmentCare for a Stroke Victim
Care for life-threatening conditions Summon advanced medical help Comfort and reassure victim Administer Oxygen if available Nothing to eat or drink Prompt medical attention is critical Do NOT give aspirin
Pg 360-362
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Chapter 16Poisoning
How Poisons Enter the Body Care for Poisoning
Inhaled Poisons Ingested Poisons Absorbed Poisons Injected Poisons
Anaphylaxis Substance Abuse
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How Poisons Enter the Body
TM 101
Ingestion
Injection
Inhalation
Absorption
Pg 367
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Clues of Poisoning Odors Flames or smoke Containers that are open or out of place Plants partially eaten or disturbed
TM 102Pg 367
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Signs and Symptomsof Poisoning
Nausea or vomiting Chest or abdominal pain Breathing difficulty Altered consciousness Seizures Burns sometimes found on or around the
mouth
Pg 368
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Poisoning Severity The type and amount of poison How and when it entered the body Victim’s size, weight and age
TM 103Pg 369
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General Principle forPoisoning Emergencies
Conduct scene size-up Remove victim from source of poison Conduct initial assessment Conduct physical exam and SAMPLE history Summon more advanced medical personnel Contact PCC (as per local protocols) 1-800-222-1222 Do not give anything to eat or drink
TM 104Pg 369
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When NOT to Induce Vomitingfor Ingested Poisons
Victim is unconscious Victim is having a seizure Victim is pregnant Victim has ingested corrosive substance or
petroleum product Victim is known to have heart disease
TM 105Pg 371-372
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Care forInhaled Poisons
Conduct scene size-up, toxic fumes may be colorless, odorless and tasteless.
Remove victim from source of poison if possible
Administer Oxygen Care for life-threatening conditions Call for advanced medical personnel
Pg 370-371
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Care forAbsorbed Poisons
Brush off dry chemicals using gloved hand or cloth. Keep out of eyes and eyes of victim and bystanders
Flush area with large amounts of cool running water, remove jewelry if necessary
Summon advanced medical personnel
Pg 372-374
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Care forInjected Poisons
Remove stinger, scrape it away with a card or knife
Wash the site, cover it and apply cold to reduce the pain and swelling
Monitor for anaphylaxis Specific care depends on source. Know the
local risks
Pg 374
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Care forTick bites
Rocky Mountain spotted fever is a serious tick-borne disease. Another is Lyme disease
Deer ticks are difficult to see. They can attach themselves without your knowledge
If you find an embedded tick, pull it off with a fine-tipped tweezers and seek treatment
Pg 374-378
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Deer Tick
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Female deer tick with dime for size comparison.
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Care forSpider and Scorpion bites
In the United States the two spiders to be careful of are the Black Widow and the Brown Recluse
Spiders prefer dark places where they are seldom disturbed. Bites occur usually on the hands or arms
Antivenin is available for the black widow. Those bit by the Brown Recluse should seek medical treatment
Pg 378-380
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Black Widow
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Brown Recluse
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Guidelines forInitial Snakebite Care
Take victim to medical care immediately Wash wound if possible Immobilize affected part Minimize victim’s movement Keep affected part lower than heart Summon more advanced medical personnel Consider using a commercial suction kit if advanced
medical care is more than 30 minutes away.
TM 106Pg 380-381
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Guidelines forInitial Snakebite Care
DO NOT apply ice DO NOT cut the wound DO NOT apply a tourniquet DO NOT use electric shock
Pg 380-381
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Guidelines forMarine Life Injuries
Some marine life such as jellyfish can inflict painful injuries Care for injuries from jellyfish, sea anemone and Portuguese
man-of-war by soaking the injured part in vinegar. If the sting was from a sting ray, sea urchin or spiny fish soak
the affected area for 30 minutes in non-scalding hot water Summon advanced medical personnel if the victim has a
history of allergic reactions to marine life stings, is stung on the face or neck or develops any severe problems such as difficulty breathing.
Pg 381
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Guidelines forAnimal Bites
The most serious result is from a wild animal with rabies Rabies is fatal if not treated. Anyone bitten must get
medical attention Get the victim away from the animal safely Get a description of the animal and the area in which it
was last seen. Do not try to restrain or capture the animal For minor wounds, wash with soap and water. For serious
bleeding control the bleeding and summon more advanced medical personnel
Local laws may require a report to be filed
Pg 382
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Human Bites May be highly contaminated with bacteria Require professional medical care
immediately Need to be washed with soap and water Can bleed if severe; control severe bleeding
TM 107Pg 383
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Substance Abuse Can be intentional or unintentional Drug use can lead to dependency and
addiction Unavailability can lead to withdrawal Drugs can be stimulants, Hallucinogens,
Depressants, Narcotics, Inhalants, Cannabis products, steroids or OTC (Over The Counter) medications
TM 108Pg 384-388
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Stimulants Stimulants affect the central nervous system
by increasing physical and mental activity They produce temporary feelings of
alertness and prevent fatigue Stimulants can be ingested as pills, but
some can be absorbed or inhaled Cocaine and Crack are the most publicized
and powerful stimulants
Pg 388
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Hallucinogens Hallucinogens have physical effects similar
to stimulants. They are classified differently because of the other mind-altering effects including - Panic, paranoid delusions, vivid hallucinations,
profound depression, tension and anxiety The most widely used are LSD,
mushrooms, PCP and mescaline, ecstasyketamine
Pg 389
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Depressants Depressants decrease physical and mental activity
and are commonly used for medical purposes Common depressants are alcohol, barbiturates,
benzodiazepines, narcotics and inhalants Depressants will -
Relieve anxiety Alter consciousness Promote sleep Depress respiration Relieve pain Relax muscles Impair coordination and judgement
Pg 390
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Narcotics Narcotics work on the central nervous
system to reduce pain. All are illegal without a prescription. Some are not prescribed at all.
The some are morphine, opium, heroin and codeine. Others, like demerol and percodan are synthetic
Pg 390
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Inhalants Produce mood-altering effects and depress
the central nervous system. Inhalants will damage the heart, lungs,
brain and liver Solvents such as acetone, toluene and
butane may be inhaled for their effects The user will appear drunk
Pg 391
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Cannabis Products Products include marijuana, THC and
hashish Marijuana is the most widely used illicit
drug in the United States Cannabis products produce feelings of
elation, distorted perceptions of time and space and impaired judgement and motor coordination
Pg 391
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Designer Drugs Variations of other substances, designer
drugs do not fit neatly into any of the other categories
A user will experience a variety of unpredictable and dangerous effects. Signs and symptoms range from stimulant-like effects to hallucinogenic effects and erratic mood swings
Pg 391
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Signs and Symptomsof Substance Abuse
Stimulants - Sweating, chills, nausea, vomiting, fever, headache, dizziness, rapid pulse, rapid breathing, high blood pressure, chest pain, respiratory distress, disruption of normal heart rhythms
Hallucinogens - Sudden mood changes, claiming to see or hear things not present, acting anxious or frightened
Depressants - Drowsiness, confusion, slurred speech, slow heart and breathing rates, poor coordination
Alcohol - Unconscious, hard to arouse, vomiting violently, confused, restless, trembling and experiencing hallucinations.
Pg 394
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Care for SubstanceMisuse and Abuse
Your initial care does not require you to know the substance
Care as you would for poisoning.
TM 109Pg 396
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Preventing Substance AbuseContributing factors include – A lack of parental supervision The breakdown of the traditional family structure A wish to escape unpleasant surroundings and stressful
situations The widespread availability of substances Peer pressure and the basic need to belong Low self-esteem, including feelings of guilt or shame Media glamorization, especially of alcohol and tobacco,
promoting the idea that using substances enhances fun and popularity
A history of substance abuse in the home or community environments
Pg 396
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Preventing Substance Misuse Read the product information and use only as
directed Ask doctor or pharmacist about the intended use
and side effects of prescription and over-the-counter medications. If taking more than one medication ask about possible interactions.
Never use another person’s prescribed medications Always keep medications in their appropriate,
marked containers Discard all out-of-date medications. Keep medications out of reach of children
Pg 397
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Scenario 12
TM 110
Substance Abuse
A 25-year-old woman has several drinks at a party. She later says that she feels dizzy and nauseated. She goes into another room. Soon after, someone enters shouting that the woman has collapsed to the floor and is unconscious. Among the object scattered on the floor from her open purse are several containers of pills. One is marked “Valium.” How would you help the woman? In terms of providing initial care, does it matter that she may have become unconscious because of substance abuse or misuse?
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Signs and Symptomsof Anaphylaxis
Hives Itching Rash Weakness Nausea/vomiting Dizziness Trouble breathing
TM 111Pg 383-384
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Care for Anaphylaxis Summon more advanced medical personnel
immediately Position victim in the most comfortable
position that aids breathing Administer supplemental oxygen Have victim use anaphylaxis kit if one is
available
TM 112Pg 384
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As you approach a scene ...
CT 17
… have a plan in mind.
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Scenario 13
TM 113
Conscious PersonSerious Head and Back Injury
At work, you are summoned to assist another employee who has been injured in a nine-foot fall from a ladder. As you arrive, you see the person lying on the ground. She is trembling and moaning in pain. A bystander says that she landed on her back. The victim has not moved from this position. She says that she has tingling and numbness in her lower legs and feet and pain in her back. She also has a two-inch laceration on the side of her head. How do you respond?
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Scenario 14
TM 114
Serious Extremity Injury
You are summoned to the scene of a collision between a bicyclist and skateboarder. Both were thrown to the pavement. Both were wearing helmets and other protective padding and both are conscious and in pain. The skateboarder was struck on the outside of his leg by the bike. The leg is bent, and his knee has an obvious deformity. The bicyclist was thrown over the handle bars, landing on her arms. She is bleeding from abrasions on both forearms and her wrist has an obvious deformity. How do you respond?
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Scenario 15
TM 115
Conscious VictimLimb Injury
You are a spectator at your child’s Little League baseball game. The pitcher is struck with a line drive to the forearm and falls to the ground. The victim is crying and in pain, unable to move the limb. Swelling and deformity are present. The nearest hospital is only a few blocks away. The player’s parents are not at the game. How do you respond?
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Scenario 16
TM 116
Medical Emergency
An elderly woman loses her balance and collapses to the floor in a supermarket. When you arrive, she is not fully conscious. Her eyes are open and the left side of her face appears to be drooping. She is making mumbling sounds but you can not tell what she is saying. She has also vomited. How do you respond?
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Scenario 17
TM 117
Substance AbuseA dangerous ritual is about to begin - 21 drinks for the 21st birthday. A group of close friends has gathered for a special party for the “birthday boy.” Everyone knows it is a dangerous game, but because each of these friends when through it, they believe it is a rite of passage into adulthood. The activities begin and the guest of honor is soon “chugging beers” and downing shots of liquor at a rapid pace. Four hours after the drinking began you are summoned to assist the guest of honor who is vomiting violently in the bathroom. He slumps to the floor and begins violent convulsions, followed by unconsciousness. He seems to stop breathing and then takes a deep breath. How do you respond?
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Scenario 18
TM 118
Hypothermia
You have been involved in a search for a lost six-year-old child. The search is now into its third day. The child became lost when he wandered away from his mountain campsite. He has already spent two nights in the wilderness in cold, rainy weather. When the child is discovered, he is disoriented. His clothing is wet. His face and hands are cold to the touch. He is shivering. How do you respond?
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Chapter 17Childbirth
The Birth Process Preparing for Delivery Assisting with Delivery Caring for the Newborn and Mother Possible Complications
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The Labor Process
TM 119
Stage One - Woman’s body prepares for childbirthPreparation Time period: From first contraction until
uterus is fully dilatedStage Two - Crowning occursDelivery of Delivery of the babythe BabyStage Three - Occurs within 30 minutes after birthDelivery of Placenta separates from the uterine wallthe Placenta and exits through the vaginaStage Four - Recovery and stabilization of motherStabilization Lasts approximately 1 hour
Uterus contracts to control bleeding
Pg 403-404
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Assessing Labor First pregnancy? Amniotic sac ruptured? Contraction?
Are they close together? Are they strong?
Blood discharge? Urge to bear down?
TM 120Pg 404
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Preparing for Delivery Use complete BSI protection Provide as sanitary an environment as
possible Reassure the mother STAY CALM
Pg 404
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Assisting with Delivery Time the contractions. If less than 3
minutes apart, be prepared to help with delivery of the baby
Have bulb syringe, gauze pads and plastic bag available
Support the head, allow to emerge slowly Use a towel to catch the baby. If possible
note the time
Pg 405
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Assisting with Delivery
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Assisting with Delivery
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Caring for the Newborn Open the airway Stimulate the baby if crying does not occur Keep infant warm Record first set of vital signs Evaluate the following a 1 and 5 minutes after
birth - Appearance Pulse Grimace (response to stimuli) Activity and muscle tone (not floppy or limp) Respirations
Pg 407-409
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0 1 2 A ppearance Blue/Pale Body pink, hands blue Pink P ulse Absent Below 100 Above 100 G rimace None Grimace Cough, sneeze, cry A ctivity Flaccid Some Active motion R espiration Absent Weak, slow Good, crying
Assess APGAR Score at 1 and 5 minutes after birth
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Caring for the Mother Allow mother to nurse newborn Prepare for delivery of the placenta within
30 minutes. Place in a bag or wrap in a towel for transport to the hospital
Gently clean the mother Gently massage the lower abdomen Monitor vital signs and maintain body
temperature
Pg 407-409
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Scenario 19
TM 121
Childbirth
A car pulls into the firehouse. The driver jumps out screaming for help for his wife who is in the back seat. The woman is 35 years old and full term in her pregnancy. Her contractions are less than 2 minutes apart. She says that “the baby is coming” and she feels the need to push. Her husband tells you this will be their fourth child. How do you respond?
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Practice Session
Childbirth
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Possible complications Prolapsed cord
Do not allow cord to wrap around infants neck
Pg 410
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Possible complications Breech birth
Be prepared to provide airway
Pg 411
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If baby is delivering:– Do not hurry or slow delivery– Suction infant with bulb syringe (mouth,
then nose) as soon as head is delivered– If cord wrapped around neck, attempt to
unwrap the cord. If unsuccessful, double clamp and cut the cord at least 4” from baby between clamps
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Chapter 18Infants and Children
Communicating with children Anatomical and Physiological concerns Common problems Child abuse awareness
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Steps to Gain a Child’s Trust Approach child slowly Get to eye level Smile Ask the child’s name Talk slowly and distinctly using words the
child understands Ask simple, clear questions Reassure child
TM 122Pg 414
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Steps to Gain a Child’s Trust Infants less than 6 months old are fairly easy to approach Infants over 6 months show “stranger anxiety”. Conduct the
assessment in the caregivers arms or lap Toddlers between 1-2 need reassurance that they will not be
separated from a parent or caregiver Preschool between 3-5 need assurance that the first responder
will not leave them. Let them inspect equipment and demonstrate on a doll or stuffed animal
School-aged children are self-conscious about their bodies. Respect their modesty
Adolescents between 13-18 behave much like adults and are more comfortable with same gender rescuers. Earn their trust by speaking to them and not the parents or caregivers
Pg 414
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Anatomical and Physiological Concerns
Infant and children have smaller airways than adults. Airways are easily blocked by secretions and swelling.
Infant’s and children’s tongues are large in relation to the jaw and can block the airway
Infants normally breathe through the nose so suctioning nasal secretions can improve problems
Injured or ill infants or children are at risk for generalized cold exposure
Pg 415-417
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Maintaining an Airway with Children
Do not hyper-extend the head and neck to open the airway
Placing a folded towel under the shoulders will help to maintain good airway position
During suctioning, take care not to stimulate the back of the throat and activate the gag reflex
Oral airway adjuncts are not used for initial ventilation efforts. Nasal airways are not commonly used by first responders
Pg 416
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Maintaining an Airway with Children
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Child and Infant Assessment When you have an injured child or infant,
you have an injured family Calm the family and obtain consent Observe the child before touching. Look
for signs of life-threatening problems Whenever possible, do not separate the
child from the parent or caregiver Begin at the toes and work up
Pg 417-418
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Signs of Partial Airway Obstruction in Infants or Children
Stridor Retraction on breathing in Good circulation causing skin to become
very pink
TM 123Pg 418
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Signs of Complete Airway Obstruction in Infants or Children
Inability to cough, cry or speak Cyanosis Loss of consciousness Altered mental status
Pg 419
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Signs of Respiratory Distress in Infants or Children
Infants: respiratory rate > 60 per minute Children: respiratory rate > 30/40 per minute Nasal flaring Use of neck muscles and muscles between and
below margin of the ribs to aid breathing Stridor Cyanosis Altered mental status Grunting
TM 124Pg 419
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Signs of Respiratory Arrest in Infants or Children
Infants: respiratory rate <10 per minute Children: respiratory rate <20 per minute Limp muscle tone Unresponsiveness Slow or absent heart beat Weak or absent distal pulses Cyanosis
Pg 419
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Other Common Problems withInfants and Children
Circulatory Failure Indicated by increased heart rate, unequal central and distal pulses,
poor skin circulation (slow capillary refill) and mental status change Illness Fever - may develop into febrile seizure Poisoning Altered Mental Status
May be caused by low blood sugar, poisoning, post seizure, infection, head trauma or decreased oxygen levels
Sudden Infant Death Syndrome (SIDS)
Pg 419
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Signs and Symptoms of Febrile Seizure
Sudden rise in body temperature Change in level of consciousness Rhythmic jerking of head and limbs Confusion Drowsiness Crying out Becoming rigid Holding breath Upward rolling of eyes
TM 125Pg 419
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Trauma in Children Injuries are the #1 cause of child death in
the United States. Many are from motor vehicle accidents
Use equipment of the proper size Do not move an injured child from a safety
seat unless you must to provide further care
Pg 420-422
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Trauma in Children The head is often injured, as is the chest
cavity or abdominal cavity The most important objective is to ensure
an open airway Children have pliable ribs. There may be
significant injuries without external signs Abdominal injuries often are not obvious
Large amounts of blood may distend the abdomen and not be visible
Pg 420-422
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Signs of Child Abuse Injury that does not fit description of cause Cigarette burns, whip marks or hand prints Fractures in children less than 2 years old Injuries in various stages of healing, especially
bruises and burns Unexplained lacerations, especially to mouth, lips
and eyes Injuries to genitalia More injuries than are typical for child of same age Repeated calls to same address
TM 126Pg 422-423
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Signs and Symptoms of Neglect Lack of adult supervision Malnourished appearance Unsafe living conditions Untreated chronic illness Untreated soft tissue injuries
TM 127Pg 423
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Responder Debriefing Even when uneventful, calls involving
infants and children are some of the more stress producing situations for first responders
Care for infants and children with the same principles as with adults but keep in mind the differences in developmental characteristics and anatomy
Pg 423
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As you approach a scene ...
CT 17
… have a plan in mind.
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Scenario 20
TM 128
Preparing for Childbirth
You are called to respond to a pregnant woman who is in labor. During your assessment you find that this is the mother’s third pregnancy and her contractions are 2 minutes apart. The baby’s head is not yet crowning, but the mother feels the urge to move her bowels. How do you respond?
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Scenario 21
TM 129
Delivering the Baby
After you have prepared the mother and yourself for the imminent delivery of the baby, the mother tells you that she feels an urge to push. When you inspect the vaginal area, you note that the baby’s head is crowning. What should you do next?
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Scenario 22
TM 130
Care of the Newborn
You are called to the scene of a mother who is in active labor. As you arrive on scene, the baby has just emerged from the birth canal. What steps would you take to care for the newborn?
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Scenario 23
TM 131
Post Delivery Care of the Mother
After you have assisted with the unscheduled delivery of a newborn and ensured that the baby’s condition is normal, list the steps in the post delivery care of the mother
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Scenario 24
TM 132
Assessment of the Child
On your way home from work, you approach your neighborhood and see a group of people gathered in the playground. As you approach the scene you hear someone say that a child fell off the jungle gym, a height of approximately 10 feet. As you get closer, you see a child of 8 years old lying on the ground, crying and you notice blood coming from a laceration on his forehead. Demonstrate how to assess the child.
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Chapter 19EMS Support and Operations
Phases of a Response Air-Medical Considerations Multiple Casualty Incidents
Incident Command Structure Triage
Fundamentals of Rescue Operations Hazardous Materials Water Rescues
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The EMS Response Preparation for emergency call Dispatch En route to scene Arrival at scene Transferring victim to ambulance En route to receiving facility Arrival at receiving facility En route to station Post run
TM 133Pg 428-431
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Air Medical Considerations First responders may have to assist with air
medical transport Considerations
Victim preparation Landing zone Safety
TM 134Pg 431
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Multiple Casualty Incidents Some emergency situations may overwhelm
local responding groups The Incident Command System approaches an
emergency in an organized manner Triage is the process of sorting victims
according to how ill or injured they are The START system is an often used triage
method. The letters stand for Simple Triage And Rapid Treatment
Pg 431-433
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S.T.A.R.T.
Simple Triage And Rapid Treatment
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Incident Command System (ICS) The ICS manages a group of people to
achieve a common goal ICS clearly defines who is in charge, the
scope of authority and responsibility, the goal and objectives to meet the goal
Pg 433
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Advantages of ICS Use of common terms One big “boss” – Incident Commander Unified command structure Integrated communications system Small, easily managed units
TM 135Pg 433
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ICS Incident Commander -
Directs the response Appoints chiefs
Operations Section Officer - Puts together plan Coordinates actions of other leaders
Planning Section Officer - Gather/analyzes information/resources Provides updates
Logistics Section Officer - Finds resources Establishes communications Coordinates crowd control Evaluates scene if necessary
TM 136Pg 434-435
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The START System Injured are rapidly prioritized to receive
adequate care Save more lives by sacrificing some victims
who are very severely injured Classify victims as -
Immediate treatment - Red Tag Delay Care - YellowYellow Tag Minor - Green Tag Dead or non-salvageable - Black Tag
Pg 436
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The START System
CT 58Pg 437
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Fundamentals of Extrication First responders administer necessary care to
minimize further injury Care precedes extrication unless delayed
movement would endanger the victim or rescuer
Personal safety is the #1 priority. Wear appropriate clothing and safety equipment.
Pg 438-439
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Gaining Access to VictimSimple Access No equipment needed Try to open each door Have victim roll down the windows Have victim unlock doorsComplex Access Use of tools and equipment
TM 137Pg 440
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Hazardous Materials A HAZMAT is any material that can pose a
threat to the health, safety and property Dealing with HAZMAT requires special
training Primary concern is the safety of the crew,
victim(s) and bystanders Safely obtain as much information as
possible
Pg 445
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General Procedures for HAZMAT Situations
Stay upwind and uphill from incident Be alert to wind changes Stay away from area Keep people away from the danger zone Look for clues indicating hazardous materials Never enter a HAZMAT area unless you are
trained
TM 138Pg 446
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Scenario 25
TM 139
Gaining Access
You arrive on the scene of an automobile collision involving one vehicle that has struck a guard rail head-on. The car is still running. The driver did not have on a safety belt and struck the steering column. He is seated behind the steering wheel, conscious and complaining of chest and abdominal pain. The other passenger also was not wearing a safety belt. She is lying motionless, facedown on the floor of the vehicle. You see blood around her body. She is unconscious and not breathing. You are unsure if she has a pulse.
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Water Rescues Throw, row ... then go Do not endanger yourself, do not attempt in-
water rescue unless trained Distressed swimmer may be too tired to get to
shore but can float and call for help Active drowning victim may thrash to get out
of the water but can’t call for help If water has entered lungs, near-drowning
victims must go to hospital
Pg 448-451
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Throwing Assists Keep your balance Secure any line attached to device to be
thrown Throw device beyond victim Consider wind and current Once victim grasps device, pull him or her
slowly to safety
TM 140Pg 451
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As you approach a scene ...
CT 17
… have a plan in mind.
American Red Cross
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VideoPutting it all Together
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Scenario 26
TM 141
Extrication
You arrive at a scene in which a car has plunged down an embankment, landing on one side at the bottom. You can see at least two people in the car, one of whom appears to be conscious. Several bystanders have just arrived and are staring at the car. The doors appear to be undamaged, but you are unable to open them. How should you respond?
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Scenario 27
TM 142
Multiple Casualty Incident
A small commuter airplane carrying eight people and crew has made a crash landing in a cornfield. Witnesses say the plane managed to land without burning, with no smoke visible. When you reach the scene, fire fighters and other rescue personnel have already arrived. The plane is severely damaged but is not of fire. There appear to be survivors. What should you do?
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Scenario 28
TM 143
Multiple Casualty Incident - Triage
You are at the scene of a train derailment. Two cars have been severely damaged and you are helping with the victims. The incident commander has assigned you four victims to triage as rapidly as possible, using the START system. One of the victims is standing, leaning against a tree. He says he can walk. Another victim is lying on the ground moaning. You can see blood around her body. The third victim is lying on the ground motionless, making no sound. When you check for his pulse, you cannot find it. The fourth victim is also lying on the ground unconscious, but she has a pulse. When you open her airway, she begins to breathe. How would you proceed?