Health 4 Notes

Sir Daj

Patient Assessment

• Scene size-up• Initial assessment• Focused history and physical exam

– Vital signs– History

• Detailed physical exam• Ongoing assessment

Body Substance Isolation

• Assumes all body fluids present a possible risk for infection

• Protective equipment– Latex or vinyl gloves should always

be worn– Eye protection– Mask – Gown – Turnout gear

Scene Safety: Potential Hazards

• Oncoming traffic• Unstable surfaces• Leaking gasoline• Downed electrical

lines• Potential for violence• Fire or smoke

• Hazardous materials

• Other dangers at crash or rescue scenes

• Crime scenes

Develop a General Impression

• Occurs as you approach the scene and the patient

– Assessment of the environment

– Patient’s chief complaint

– Presenting signs and symptoms of patient

Obtaining Consent

• Introduce self.

• Ask patient’s name.

• Obtain consent.

Chief Complaint

• Most serious problem voiced by the patient

• May not be the most significant problem present

Assessing Mental Status

• Responsiveness– How the patient

responds to external stimuli

• Orientation– Mental status and

thinking ability

Testing Responsiveness• A Alert

• V Responsive to Verbal stimulus

• P Responsive to Pain

• U Unresponsive

Check Airway

• Labored breathing

• Accessory muscles

• Noisy breathing

• Cyanosis

• Rate and depth

• Air movement

• Choking

Unconscious?

Absence of Breathing? Absence of Breathing?

Perform BLS!! Perform BLS!!

Unresponsive but

BREATHING??

. . . Continue with the Assessment

Vital Signs

Pulse

Rapid/weak shock, diabetic coma

Rapid/strong heat stroke, hypertension

Slow/strong stroke, skull fracture

None cardiac arrest

Vital Signs

Respiration

Shallow shock

Irregular obstruction

Wheezing asthma

None cardiac arrest

Vital Signs

Blood Pressure

< 100 mmHg shock

> 135 mmHg hypertension

Skin Temperature

Hot dry heat exposure

Cool clammy shock

Vital Signs

Pupils

Constricted drugs, poison

Unequal concussion, stroke

Dilated shock, hemorrhage

Mechanism of Injury• Helps determine the possible extent

of injuries on trauma patients

• Evaluate:– Amount of force applied to body

– Length of time force was applied

– Area of the body involved

Nature of Illness

• Search for clues to determine the nature of illness.

• Often described by the patient’s chief complaint

• Gather information from the patient and people on scene.

• Observe the scene.

Opening The Airway

Head Tilt Chin Lift Jaw Thrust

FBAO

Foreign

Body

Airway

Obstruction

Types of Obstruction

Anatomical Mechanical

Partial Complete Partial Complete

Partial Complete

• weak cough

• wheezing

• strained breathing

• slight cyanosis

• inability to speak

• absence of breath sounds

• flared nostrils

• restlessness

• unresponsive

First Aid

• Back blows

• Heimlich Maneuver

• Chest Thrusts

Cardiovascular Emergencies

A rapid decline in heart function due to poor blood flow or electrical activity.

LIFE THREATENING!!

Examples are cardiac arrest, heart attack, and arrhythmia

THREE CONDITIONS OF CARDIAC ARRESTTHREE CONDITIONS OF CARDIAC ARREST1. Cardio Vascular Collapse

The heart is still beating but its action is so weak that is not being circulated through the vascular system to the brain body tissues.

2. Ventricular FibrillationOccurs when the individual fascicles of the heart beat independently rather than the coordinated, synchronized manner that produce rhythmic heart beat.

3. Cardiac standstillIt means that the heart has stopped beating.

Cardiovascular Emergencies

Heart attack is the death of the heart muscle due to deficient blood supply. Usually mistaken for angina pectoris.

What causes heart attack?

What are the symptoms?

First Aid?1. Check ABCs2. Call EMS3. If possible, give nitroglycerine4. If needed, use AED

Cardiovascular Emergencies

Arrhythmia is a broad classification of heart disorders that pertain to irregularity in the sinus rhythm

1. Bradycardia – too slow

2. Tachycardia – too fast

Chain of Survival

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

determine responsiveness

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

activate EMS

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

open the airway

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

determine breathlessness

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

give chest compressions

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

give rescue breathing

5 cycles in 2 minutes

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

defibrillate if available

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

recovery position

Patient has a valid “Do Not Attempt Resuscitation” (DNAR) order.

Signs of irreversible death: Rigor Mortis, Decapitation.

No physiological benefit can be expected because the vital functions have deteriorated despite maximal therapy.

When not to give CPR

When to S.T.O.P. CPR

SPONTANEOUSSPONTANEOUS signs of circulation are restored.signs of circulation are restored.

TURNEDTURNED over to medical services or properly over to medical services or properly trained and authorized personnel.trained and authorized personnel.

OPERATOROPERATOR is already exhausted and cannot is already exhausted and cannot continue CPR.continue CPR.

PHYSICIANPHYSICIAN assumes responsibility (declares assumes responsibility (declares death, take over, etc.).death, take over, etc.).

Adult Child Infant

Compression area

Lower half of the sternum 2 fingers from the substernal notch

Lower half of the sternum 1 finger from substernal notch

Lower half of the sternum 1 finger width below the imaginary nipple line

Depth Approximately 1½ - 2 inches

Approximately 1 – 1½ inches

Approximately ½ - 1 inch

How to Compress

Heels of 1 hand, other hand on top.

Heel of one hand

2 fingers (middle & ring fingertips)

Rate of Compression

Approximately 100/min

Approximately 100/min

At least 100/min

Automated External Defibrillators are medical devices that deliver a controlled shock through pads or electrodes placed in specific locations on the victim’s chest.

What is a fibrillation?

Special Situations

• if victim is a child . . .

• if victim is near water . . .

• if victim has pacemaker . . .

• if victim has patch over electrode site . . .

• if victim has hairy chest

Using an AED

1.Turn the power ON

2.Attach the electrodes to the victim’s bare chest

Using an AED3. Be sure no one is touching the victim and

press ANALYZE

4. Deliver a SHOCK if indicated