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CHAPTER 7 Scene Size-Up. 2 Overall Assessment Scheme Scene Size-Up Initial Assessment TraumaMedical...
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Transcript of CHAPTER 7 Scene Size-Up. 2 Overall Assessment Scheme Scene Size-Up Initial Assessment TraumaMedical...
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Overall Assessment SchemeScene Size-UpScene Size-Up
Initial AssessmentInitial Assessment
TraumaTrauma MedicalMedical
Physical ExamPhysical Exam
Vital Signs &Vital Signs &SAMPLE HistorySAMPLE History
SAMPLE HistorySAMPLE History
Physical ExamPhysical Exam& Vital Signs& Vital Signs
DetailedDetailedPhysical ExamPhysical Exam
OngoingOngoingAssessmentAssessment
HOSPHOSP
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Body Substance Isolation
Anticipate the need for BSI.
Always have BSI equipment available.
Use appropriate equipment to prevent exposure.
Body Substance Isolation Review
• Body substance include blood, saliva, urine, feces and any other body fluids or contents
• Virus/Bacteria can enter your body through eyes, nose, mouth, and other openings in the skin
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BSI Review: GlovesBSI Review: Gloves
Should be worn on every call to protect both yourself and the patient.
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BSI Review: Mask and Eye Protection BSI Review: Mask and Eye Protection (goggles eyeshield, etc…)(goggles eyeshield, etc…)
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Scene Safety
Protect Self – is it safe to approach patient
Crash/rescue scenes
Toxic Substances – low oxygen areas
Crime Scenes – potential for violence
Unstable Surfaces – slope, ice, water
Protect patient (further injury, environmental)
Protect bystanders (prevent them from becoming patients).
Never enter an unsafe scene; make scene safe or call for someone who can.
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Minimum 50’ around scene, further if:
Fuel spill
Fire
Hazardous materials
Downed power lines
Danger Zone
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Use scene clues:
Fighting
Loud voices
Alcohol/drug use
Unusual silence
Prior experience
Scene Violence
Scene Size-Up
Key Term
Determining any threats to your own safety or to the safety of your patients or bystanders, to determine the nature of the call, and to decide if you will need additional help; ALWAYS DO YOUR OWN SCENE SIZE-UP even if police, fire, etc… are already there
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Nature of Illness: Medical Patient
Nature of illness – determine from the patient, family or bystanders why EMS was activated; find out what is or what may be wrong with the patient from:
Scene
Patient
Family and bystanders
Determine the total number of patients. If there are more than the responding unit can effectively handle, initiate a mass casualty plan
Obtain additional help prior to contact with patients: law enforcement, fire, rescue, ALS/ILS, utilities because once you are involved with patient care you are less likely to call for help
Begin triage
Mechanism of Injury
Determine from the patient, family or bystanders, and inspection of the scene the physical event that caused an injury (fall, motor vehicle accident, etc.)
Key Term
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Mechanism of Injury: Trauma Patient
Significant Mechanisms of Injury:
Ejection from vehicle
Death in same passenger compartment
Falls of more than 15 Feet or 3 times the patient’s height
Rollover of vehicle
High-speed vehicle collision
Vehicle-pedestrian collision
Motorcycle Crash
Unresponsive or altered mental status
Penetrations of the head, chest, or abdomen, (stab/gunshot wounds)
Additional Mechanisms of Injury for a Child:
Falls from more than 10 feet
Bicycle collision
Vehicle in medium speed collision
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Rotational
May have multiple impacts, especially
If unbelted
Mechanism of Injury: Motor Vehicle Collision–Rotational
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Ejection
Deformed windshield, steering wheel, etc.
Amount of vehicle deformity
Seat belt use
Mechanism of Injury: Motor Vehicle Collision
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Motorcycles
All-terrain vehicles
Snowmobiles
Jet-Ski
Mechanism of Injury: Motor Vehicle Collision–Motorized Vehicle
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Distance patient fell
Part of body that struck surface
Type of surface landed on
Did anything break the fall?
Mechanism of Injury: Falls
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Velocity
Low velocity–knife
Medium velocity–handgun, shotgun
High velocity–rifle
Body region penetrated
Exit wounds
Mechanism of Injury: Penetrating Trauma
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Adequacy of Resources
Number of patients?
If there are more than the responding unit can effectively handle, initiate a mass casualty plan – try to anticipate the maximum number of patients and radio for help accordingly
Obtain additional help prior to contact with patients because you are less likely to call for help once involved with care
If you can manage the situation, consider spinal precautions and continue care
Hazardous materials?
Fire or rescue?
Unusual situations?