24 Emergency Medical Care. 2 Objectives (1 of 2) Describe the steps needed to provide infection...

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Emergency Medical Care

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Objectives (1 of 2)

• Describe the steps needed to provide infection control for victims and for fire fighters.

• Describe the steps needed to perform cardiopulmonary resuscitation (CPR) on adult, child, and infant victims.

• Describe the steps used to manage shock.

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Objectives (2 of 2)

• Explain the steps needed to control external bleeding.

• Discuss triage at a mass-casualty incident.

• Describe how to assure safety at emergency medical services incidents.

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Introduction

• Basic knowledge of emergency medical care skills is important.

• The skills and knowledge covered in this chapter are not meant to replace formal courses.

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Infection Control

• Understanding of the most common infectious disease is important so that you can protect yourself from unnecessary exposure.– AIDS– HBV– HCV– Tuberculosis– SARS

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Universal Precautions

• Always wear gloves.

• Always wear protective eyewear.

• Wash your hands.

• Place needles in “sharps” container.

• Use a protective barrier if a victim needs resuscitation.

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Immunizations

• Certain immunizations are required for emergency medical care providers.– Tetanus– Hepatitis B

• Medical director will determine the appropriate immunizations.

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Airway

• Airway care and rescue breathing are two important lifesaving skills.

• The skills of CPR are as easy as A, B, C– “A” is airway– “B” is breathing– “C” is circulation

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Anatomy and Function of the Respiratory System (1 of 4)

• The respiratory system

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• Anatomy of the respiratory system

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• The exchange of gases occurs in the alveoli of the lungs

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• Normal mechanical act of breathing.

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“A” Is for Airway

• An injured or ill person may not be able to protect the airway.

• You must take steps to check the condition of the victim’s airway.

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Check for Responsiveness

• Ask the victim “Are you okay?”

• If no response, gently shake the victim’s shoulder.

• Repeat your question.

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Correct the Blocked Airway

• Open airway with head tilt-chin lift or jaw thrust.

• Check for fluids, foreign bodies, and dentures.

• Perform a finger sweep.• Maintain the airway.• Place victim in recovery

position.

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“B” Is for Breathing

• After correcting victim’s airway, you should check and correct victim’s breathing.

• Look for signs of normal and abnormal respirations.

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Signs of Adequate Breathing

• Look:– for rise and fall of chest

• Listen:– for sounds of air passing into or out of

victim’s nose and mouth

• Feel:– air moving on the side of your face

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Signs of Inadequate Breathing

• Noisy respirations

• Wheezing

• Gurgling

• Rapid or gasping respirations

• Victim’s skin pale or blue

• Respiratory arrest

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Causes of Respiratory Arrest

• Heart attack (most common)• Mechanical blockage or obstruction• Vomitus• Foreign objects• Illness or disease such as heart attack or

severe stroke• Drug overdose/poisoning• Severe loss of blood• Electrocution

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Check for the Presence of Breathing

• Look for the rising and falling of the victim's chest.

• Listen for the sound of air moving in and out of the victim’s nose and mouth.

• Feel for the movement of air on the side of your face and ear.

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Correct the Breathing

• You must rescue breathe for a victim who is not breathing.

• Pinch nose and blow into victim’s mouth for 2 seconds.

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Rescue Breathing

• Mouth-to-mask– Uses a mask that fits over the victim’s face with a

one way valve and rescuer mouth piece

• Mouth-to-barrier– Uses a protective barrier that covers the victim’s

face

• Mouth-to-mouth– Rescuer does not use protective barrier or mask.

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Rescue Breathing for Children

• A child is between the age of one and eight.

• The steps for determining responsiveness, correcting airway, and breathing are the same as an adult.

• The rate is 12 rescue breaths per minute.

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Rescue Breathing for Infants

• An infant is under one year of age.

• Must be gentle when checking responsiveness

• Blow gently into the infant’s mouth and nose.

• The rescue rate is 20 breaths per minute.

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Foreign Body Airway Obstruction (1 of 2)

• Causes– Tongue– Injury– Swelling– Object

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Foreign Body Airway Obstruction (2 of 2)

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Partial Airway Obstruction

• The victim can cough or gag.

• The victim may be able to speak.

• Encourage the victim to cough.

• Monitor victim carefully while awaiting transport.

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Complete Airway Obstruction

• The victim is unable to breathe in or out.

• The victim cannot talk.

• Victim will lose consciousness in 3 to 4 minutes.

• Treat with the Heimlich maneuver.

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Management of Foreign Body Airway Obstructions (1 of 3)

• In a conscious adult:– Use Heimlich maneuver.

• In an unconscious adult:– Use abdominal thrusts.

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• In a conscious or unconscious child:– Steps are similar to adult– Exceptions

• Only perform finger sweep if object is seen.• If you are alone, attempt removal of foreign

body for 1 minute before activating EMS.

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• In a conscious infant:– Airway structures are small and more

easily injured.– Use combination of back blows and chest

thrusts.

• In an unconscious infant:– Use same sequence of back blows and

chest thrusts.

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Gastric Distension

• Occurs when air is forced into stomach instead of lungs

• Increases chance of victim vomiting

• Preventable by breathing slowly

• Better to prevent then to cure results

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Dental Appliances

• Do not remove firmly attached appliances.

• Loose appliances may occlude airway.

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Airway Management in a Vehicle

• Use jaw-thrust technique if victim is lying on the seat or floor.

• Stabilize victim’s cervical spine.

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Anatomy and Function of the Circulatory System (1 of 5)

• Consists of heart, blood vessels, and blood

• Heart consists of four chambers.

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• Four major arteries are– Brachial– Carotid– Radial– Femoral

• Pulse is the pressure wave generated by pumping action of heart.

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• Capillaries are the smallest pipes in system.

• Veins carry blood back to heart.

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• Blood has several components.– Plasma– Red blood cells– White blood cells– Platelets

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Cardiac Arrest (1 of 2)

• Occurs when heart stops contracting

• Without supply of blood, cells will die because they cannot get oxygen or nutrients.

• As cells die, organ damage occurs.

• Brain damage occurs within 4 to 6 minutes.

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Cardiac Arrest (2 of 2)

• Causes can be:– Diseased blood vessel or heart– Respiratory arrest, if untreated– Medical emergencies – Drowning– Suffocation– Trauma and shock due to blood loss

• Regardless of cause, initial treatment is the same: CPR.

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Components of CPR

• Check victim for pulse.

• If there is no pulse, begin external chest compressions.– By depressing victim’s sternum, you can

change the pressure in the chest and force enough blood through the system to sustain life for a short period of time.

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Cardiac Chain of Survival

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When to Start CPR

• When to start– Start on all nonbreathing, pulseless victims, unless

they are obviously dead.

• Exceptions– Valid DNR– Decapitation– Rigor mortis– Tissue decomposition– Dependant lividity

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When to Stop CPR

• Discontinue if circulation and ventilation is restored.

• Reliable criteria for death are recognized.

• You are too exhausted, or environmental hazards endanger your safety or others.

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External Cardiac Compression in an Adult

• Victim is unconscious and not breathing.– Check and correct airway.– Check and correct breathing.– Check circulation by feeling carotid artery.

• Victim must be on a firm surface.• Must maintain proper hand placement• Compressions must be rhythmic and

continuous.

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External Chest Compressions on an Infant

• Victim is unconscious and not breathing.– Check and correct airway.– Check and correct breathing.– Check circulation by feeling brachial pulse.

• If there is no pulse, begin chest compressions.

• Compressions must be rhythmic and continuous.

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External Chest Compressions on a Child

• Victim is unconscious and not breathing.– Check and correct airway.– Check and correct breathing.– Check circulation by feeling carotid pulse.

• If there is no pulse, begin chest compressions.

• Compressions must be rhythmic and continuous.

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One-Rescuer Adult CPR

• Establish level of consciousness.• Call 9-1-1.• Check for ABCs and correct as needed.

– Apply 15 compressions at a rate of 100 per minute.

– Ratio between chest compressions and breathing is 15 to 2.

– Chest compressions are 1 1/2" to 2".

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Two-Rescuer Adult CPR




– Chest compressions are 1 1/2" to 2".

• Second rescuer can do chest compressions while first rescuer breathes for victim.

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One-Rescuer Infant CPR




– Chest compressions are 1/2" to 1".

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One-Rescuer Child CPR




– Chest compressions are 1" to 1 1/2".

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Signs of Effective CPR

• Second rescuer feels carotid pulse on chest compressions.

• Victim’s pupils constrict on exposure to light.

• Victim’s color improves (blue to pink).

• Independent breathing occurs.

• Independent heartbeat occurs.

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Complications of CPR

• Broken bones

• Vomiting

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Creating Sufficient Space for CPR

• To perform CPR correctly, you need 3' to 4' of space on all sides of victim.

• To make room:– Rearrange furniture– Drag victim into area

that has more room

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CPR Training

• Fire fighters should successfully complete a CPR course through a recognized agency.

• Fire fighters should regularly update CPR skills through a recognized recertification course.

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Legal Implications of CPR

• Living wills, advanced directives, and DNR orders are legal documents specifying victim’s wishes.

• Abandonment is discontinuing CPR without the order of a licensed physician or without turning the victim over to someone as qualified as you.

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Shock

• Defined as failure of the circulatory system

• Three primary causes of shock:– Pump failure– Pipe failure– Fluid loss

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Pump Failure

• Cardiogenic shock occurs if the heart cannot pump enough blood to supply the needs of the body.– Inadequate pumping of the heart can

cause blood to back up in the vessels of the lungs, resulting in congestive heart failure (CHF).

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Pipe Failure (1 of 2)

• Caused by the expansion (dilation) of the capillaries

• Blood pools in the capillaries instead of circulating throughout the system.

• Blood pressure falls and shock results.

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Pipe Failure (2 of 2)

• Three types of shock caused by capillary expansion:– Shock induced by fainting– Anaphylactic shock– Spinal shock

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Fluid Loss

• Blood loss (hemorrhage) shock– Fluid loss by excessive bleeding through

wounds

• Average adult has 12 pints of blood.

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Signs and Symptoms of Shock

• Confusion, restlessness, or anxiety

• Cold, clammy, sweaty, pale skin

• Rapid breathing and rapid weak pulse

• Increased capillary refill time

• Nausea and vomiting

• Weakness or fainting

• Thirst

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General Treatment for Shock

• Position victim.• Maintain ABCs.• Treat cause of shock if possible.• Maintain body temperature.• Do not allow victim to eat or drink anything.• Assist with other treatments.• Arrange for prompt transport to a medical

facility.

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Treatment for Shock Caused by Pump Failure (1 of 2)

• Keep victim lying down, unless breathing is easier in a sitting position.

• Maintain ABCs.

• Maintain body temperature.

• Do not allow victim to eat or drink.

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Treatment for Shock Caused by Pump Failure (2 of 2)

• Keep victim quiet and do any necessary moving for him or her.

• Provide reassurance.

• Arrange transport to a medical facility.

• Provide high-flow oxygen.

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Treatment for Shock Caused by Pipe Failure

• Examine victim for injuries.

• Keep victim lying down, with legs elevated.

• Maintain ABCs.



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Treatment for Anaphylactic Shock

• Keep victim lying down, and elevate legs.• Maintain ABCs.

– Airway may swell in victims experiencing anaphylactic shock.

• Maintain body temperature.• Provide reassurance.• Arrange for transport to a medical facility.

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Treatment for Shock Caused by Fluid Loss (1 of 2)

• Control bleeding.

• Keep victim lying down, and elevate legs.

• Maintain ABCs.



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Treatment for Shock Caused by Fluid Loss (2 of 2)



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Treatment for Shock Caused by Internal Blood Loss (1 of 2)

• Keep victim lying down, elevate legs.

• Maintain ABCs.




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Treatment for Shock Caused by Internal Blood Loss (2 of 2)

• Keep victim quiet and do any necessary moving for him or her.

• Provide high-flow oxygen.

• Monitor vital signs.


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Bleeding (1 of 2)

• Three types of external blood loss:– Capillary– Arterial– Venous

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Bleeding (2 of 2)

• To control bleeding:– Use direct pressure.– Elevate.– Use pressure points.

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Wounds

• Wounds are injuries caused by any physical means that leads to damage of a body part.

• Two kinds of wounds:– Open (skin is disrupted)– Closed (skin remains intact)

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Principles of Wound Treatment (1 of 2)

• Minor bruises need no treatment.

• Open-wound treatment– Control bleeding.– Prevent further contamination of wound.– Immobilize injured part.– Stabilize impaled object.

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Principles of Wound Treatment (2 of 2)

• Apply dressing and bandages as needed.– Do not apply

dressings too tightly—may cut off circulation.

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Mass-Casualty Incidents

• Any calls involving multiple victims or that place a great demand on available equipment and personnel

• Triage– Sorting of two or more victims ranked in level of

severity– Triage should be done with color coding.– Transportation Sector Officer decides the order in

which victims are transported.

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Violent Situations

• Safety of you and your team is primary concern.

• Evaluate scene for potential violence upon arrival.

• Law enforcement must secure scene.

• You may need to wait for scene to be safe before beginning treatment.

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Behavioral Emergencies

• Most people with mental problems are not violent.

• Look for indicators that may be associated with violence.– Past history– Posture– Vocal activity– Physical activity

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Summary (1 of 3)

• Body substance isolation prevents spread of disease.

• The steps for performing CPR involve:– Determining responsiveness– Checking and correcting the airway– Checking and correcting breathing– Checking and correcting circulation

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Summary (2 of 3)

• The steps for performing CPR and relieving an airway in adults, children, and infants are similar, but modifications must be made for children and infants.

• Bleeding can be controlled by using:– Direct pressure– Elevation– Pressure points

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Summary (3 of 3)

• Fire fighters must be able to recognize the signs of shock and treat a victim suffering from shock appropriately.

• Your safety, the safety of other rescuers, the safety of victims, and safety of bystanders are all critical.

• Triage is used at mass-casualty incidents to provide the best treatment to large numbers of victims.

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24 Emergency Medical Care. 2 Objectives (1 of 2) Describe the steps needed to provide infection...

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