Diver First Responder (DFR) Module D: Diving Emergencies 3 Emergency Care DFR JAN 2011: MODULE D:...

Diver First Responder Diver First Responder (DFR)(DFR)

Module D: Diving Emergencies 3Module D: Diving Emergencies 3

Emergency CareEmergency Care

DFR JAN 2011: MODULE D: EMERG CARE

DFR CourseDFR Course

Module Title Content

A PHECC CFR Course Basic Life Support & AED

B Diving Emergencies 1 Barotrauma

C Diving Emergencies 2 Non-Pressure Related Emergencies

D Diving Emergencies 3 Emergency Care

E Oxygen Treatment Theory and Practice

2DFR JAN 2011: MODULE D: EMERG CARE

In Module D: we will CoverIn Module D: we will Cover

• Emergency CareEmergency Care– Initial Patient Assessment Initial Patient Assessment – Recognise the signs & symptoms of ShockRecognise the signs & symptoms of Shock– Describe & demonstrate care for ShockDescribe & demonstrate care for Shock– Recognise the 3 types of bleedingRecognise the 3 types of bleeding– How to care for bleedingHow to care for bleeding– Dealing with other emergenciesDealing with other emergencies– HypothermiaHypothermia


Common TerminologyCommon TerminologyTerm Definition

Indication Uses for a medication / drug

Contra-indication Circumstances where a medication should not be given

Medical Emergency Acute injury or illness that poses an immediate risk to a person's life or long term health

Symptom What the patient experiences

Sign What the care-giver sees


Four Causes of Sudden DeathFour Causes of Sudden Death(Ref. PHECC CFR DVD)(Ref. PHECC CFR DVD)

1.1. Respiratory Arrest*Respiratory Arrest*2.2. Cardiac Arrest*Cardiac Arrest*3.3. BleedingBleeding4.4. Shock Shock

* CFR Course* CFR Course


Initial Patient AssessmentInitial Patient Assessment

• Review of CFR Initial Assessment ….Review of CFR Initial Assessment ….

• Is it safe to approach the patient ?Is it safe to approach the patient ?

• Check Check AAirwayirway – Head Tilt/Chin Lift – Head Tilt/Chin Lift • Check Check BBreathingreathing – Look, Listen & Feel – Look, Listen & Feel• Check Check CCirculationirculation – Look for signs of – Look for signs of

bleeding bleeding


ShockShock


Shock – Failure of the Circulatory System Shock – Failure of the Circulatory System

• Pump Failure Pump Failure (heart) (heart) • Fluid Loss Fluid Loss (blood)(blood)• Pipe Failure Pipe Failure (blood vessels)(blood vessels)

• Permanent damage if untreatedPermanent damage if untreated• Present with every sudden injury or illnessPresent with every sudden injury or illness• Treat for Shock EarlyTreat for Shock Early


Signs and Symptoms of ShockSigns and Symptoms of Shock

• Pale, Cold & Clammy SkinPale, Cold & Clammy Skin• Rapid BreathingRapid Breathing• Nausea & VomitingNausea & Vomiting• Altered Mental StatusAltered Mental Status• UnresponsiveUnresponsive


Treatment for ShockTreatment for Shock

• Reassure patientReassure patient• If possible treat injuriesIf possible treat injuries• If possible, lay patient downIf possible, lay patient down• If appropriate / comfortable - raise legsIf appropriate / comfortable - raise legs• Keep patient warm Keep patient warm • Administer O2, Monitor A-B-C Administer O2, Monitor A-B-C • Alert EMSAlert EMS


SHOCK: SUMMARYSHOCK: SUMMARY• CausesCauses

– Pump Failure / fluid lossPump Failure / fluid loss

• Signs and SymptomsSigns and Symptoms– Pale, Cold & Clammy Skin / Rapid BreathingPale, Cold & Clammy Skin / Rapid Breathing– Nausea & Vomiting / Altered Mental StatusNausea & Vomiting / Altered Mental Status

• TreatmentTreatment– Treat early to prevent long term damageTreat early to prevent long term damage– Lay patient down / raise legs / keep warmLay patient down / raise legs / keep warm– Administer O2, Monitor A,B,C, / Alert EMSAdminister O2, Monitor A,B,C, / Alert EMS


BleedingBleeding


Bleeding - 3 TypesBleeding - 3 Types

Capillary (oozing)Capillary (oozing)

Venous (flowing)Venous (flowing)

Arterial (spurting)Arterial (spurting)


Self ProtectionSelf Protection

Always wear Always wear gloves when gloves when dealing with:dealing with:

• Blood Blood • Body fluidsBody fluids


Treatment of BleedingTreatment of Bleeding

• ReassureReassure• Make comfortable Make comfortable • Expose and examine woundExpose and examine wound• Cover with dressingCover with dressing• Apply direct pressureApply direct pressure• Elevate area bleedingElevate area bleeding• Secure dressing with bandageSecure dressing with bandage


Treatment of BleedingTreatment of Bleeding

• Treat for ShockTreat for Shock• Monitor ABC / Administer 100% oxygenMonitor ABC / Administer 100% oxygen• Alert Emergency Medical Services (EMS)Alert Emergency Medical Services (EMS)

• If blood soaks through the first dressing: If blood soaks through the first dressing: place new dressing over the existing oneplace new dressing over the existing one


Wounds that need Special Wounds that need Special AttentionAttention

• Embedded objects (impaled)Embedded objects (impaled)• AmputationsAmputations


Treatment of Embedded (impaled) Treatment of Embedded (impaled) ObjectsObjects

• Expose area Expose area • Control bleeding around the objectControl bleeding around the object• Stabilise the objectStabilise the object• Do not remove the objectDo not remove the object

• Monitor ABC / Administer 100% oxygenMonitor ABC / Administer 100% oxygen• Alert Emergency Medical Services (EMS)Alert Emergency Medical Services (EMS)


• Control BleedingControl Bleeding• Treat for Shock earlyTreat for Shock early• Recover amputated part & place in plastic bag or Recover amputated part & place in plastic bag or

wrap in gauze, keep coolwrap in gauze, keep cool– Avoid direct contact with iceAvoid direct contact with ice– Keep with patientKeep with patient

• Monitor ABC / Administer 100% oxygenMonitor ABC / Administer 100% oxygen• Alert Emergency Medical Services (EMS)Alert Emergency Medical Services (EMS)

Treatment of AmputationsTreatment of Amputations


Dressings and BandagesDressings and Bandages• Functions of DressingsFunctions of Dressings

– Control bleeding / Prevent infection Control bleeding / Prevent infection – Protect wound / Absorb bloodProtect wound / Absorb blood

• Function of BandagesFunction of Bandages– Hold dressing in placeHold dressing in place– Apply pressure to control bleedingApply pressure to control bleeding– Prevent or reduce swellingPrevent or reduce swelling– Support and stabilise an extremity or jointSupport and stabilise an extremity or joint

• Dressings maybe packaged with ‘conforming’ bandage Dressings maybe packaged with ‘conforming’ bandage attachedattached


Signs that bandage is too tightSigns that bandage is too tight

• Blue tinge found on finger/toenailsBlue tinge found on finger/toenails• Blue or pale skin colourBlue or pale skin colour• Tingling/Pins & Needles or loss of sensationTingling/Pins & Needles or loss of sensation• Cold hands / feetCold hands / feet• Ensure patient is comfortable with bandage (not Ensure patient is comfortable with bandage (not

too tight/loosetoo tight/loose))


HypothermiaHypothermia


Cold, Wet, Wind, Fatigue = HypothermiaCold, Wet, Wind, Fatigue = Hypothermia

26

Survival expectancy related to water temperature without InsulationSurvival expectancy related to water temperature without Insulation

Time inTime inwaterwater(hours)(hours)

Water temp (°C)Water temp (°C)


Hypothermia (revision)Hypothermia (revision)


• Body core temperature drops below 37°C

• Water has 25 times greater heat conduction than air

• Water requires 1,000 times more energy to heat than air

• Any dive, regardless of location, can lower diver’s core body temperature



Signs and Symptoms

•Increased secretion of urine

•Goose pimples

•Vasoconstriction

•Metabolism increased

•Shivering



Clinical Features

•36.5°C Blue pallor, numbness•36°C Violent shivering•35°C Confusion, uncontrollable shivering•34°C Clumsy, loss of co-ordination •33°C Shivering ceases / loss of movement•32°C Victim appears drunk or drugged•30°C Loss of Consciousness•28°C Heartbeat /breathing stops.. death



Treatment

•Remove from cold water / dress in dry clothing •Keep victim in “Huddle” position•Re-warm with survival bag / body heat•Warm drinks, e.g. Soup / no alcohol•Monitor A-B-C, Administer 100% oxygen•Alert EMS

Dealing with any other Dealing with any other Sudden Injury or IllnessSudden Injury or Illness


Sudden Injury or Illness: TreatmentSudden Injury or Illness: Treatment

• Avoid moving patient unnecessarilyAvoid moving patient unnecessarily• Let patient sit/lie in comfortable positionLet patient sit/lie in comfortable position• Treat for ShockTreat for Shock• Monitor ABC / Administer 100% oxygenMonitor ABC / Administer 100% oxygen• Alert EMSAlert EMS


Module D: Diving Emergencies 3Module D: Diving Emergencies 3

• Has coveredHas covered– Different types of bleedingDifferent types of bleeding– How to care for bleedingHow to care for bleeding– Signs and symptoms of ShockSigns and symptoms of Shock– How to care for a patient in ShockHow to care for a patient in Shock– Signs & symptoms fro HypothermiaSigns & symptoms fro Hypothermia– How to treat HypothermiaHow to treat Hypothermia– How to deal with other emergenciesHow to deal with other emergencies


PRACTICAL SKILLSPRACTICAL SKILLS


Bleeding: ScenarioBleeding: Scenario• While preparing shot-line, a diver in the boat has

cut his/her lower arm with a diving knife

• Diver is pale, cold, clammy sweat and feels weak, the bleeding is flowing from the right lower arm?

• Show what you would do …..


Bleeding: Practical SessionBleeding: Practical Session• Gloves on• Make patient comfortable• Expose and examine wound• Apply direct pressure• Elevate area if possible • Secure dressing with bandage• Check patient is comfortable with bandage• Treat for Shock/ABC/ Administer Oxygen• Contact EMS


Shock: ScenarioShock: Scenario• A diver stands on the pontoon to watch out for

dive bubbles – slips and falls heavily against bottle rack

• States that he’s OK – but a few minutes later he begins to show signs of shock. You suspect that he has sustained internal injuries from his fall …..


Shock: Practical SessionShock: Practical Session• Reassure patient• If possible treat injuries• Depending on nature of injuries, consider treating

the patient lying down with legs raised• Keep patient warm • Monitor A-B-C / Administer 100% oxygen• Alert EMS


Diver First Responder (DFR) Module D: Diving Emergencies 3 Emergency Care DFR JAN 2011: MODULE D:...

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