1 First Aid Dr. Abdul-Monim Batiha Assistant Professor Critical Care Nursing Philadelphia university

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First AidFirst Aid

Dr. Abdul-Monim BatihaDr. Abdul-Monim BatihaAssistant ProfessorAssistant ProfessorCritical Care NursingCritical Care Nursing

Philadelphia university Philadelphia university

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WHAT IS FIRST AID?WHAT IS FIRST AID?It is the immediate It is the immediate assistance or care given to assistance or care given to a person who has been a person who has been injured or suddenly injured or suddenly became ill, from the became ill, from the moment of the accident moment of the accident until availability of until availability of specialized medical care.specialized medical care.Note:Note:First Aid is not restricted First Aid is not restricted to physical but also to physical but also involves psychological involves psychological support as well.support as well.

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Who needs First Aid?Who needs First Aid?

Cardiac and Respiratory ArrestCardiac and Respiratory Arrest Electric ShockElectric Shock WoundsWounds BleedingBleeding BurnsBurns Fractures and Traumatic InjuriesFractures and Traumatic Injuries PoisoningPoisoning Drowning Drowning Snake bitesSnake bites

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In calling for an ambulance In calling for an ambulance make sure you give: make sure you give:

or address form which you are callingor address form which you are calling The nature of emergencyThe nature of emergency The number of people involveThe number of people involve The precise location of the emergencyThe precise location of the emergency Don’t hang up until you certain that the Don’t hang up until you certain that the

person on the line has all the necessary person on the line has all the necessary information and you telephone number information and you telephone number

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Goals of first aid Goals of first aid

To restore and maintained vital To restore and maintained vital functions (ABC)functions (ABC)

To prevent further injury or To prevent further injury or deterioration deterioration

To reassure the victim and make him To reassure the victim and make him or her as comfortable as possible or her as comfortable as possible

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Goals of first aidGoals of first aid

Assess victims for signs of life Assess victims for signs of life Restore respirationRestore respiration Restore heart actionRestore heart action Stop bleedingStop bleeding Treat the shock Treat the shock

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Transporting the victim Transporting the victim The victim should not be moved but The victim should not be moved but

should be treated where he lies.should be treated where he lies. In certain circumstances injured person In certain circumstances injured person

must be moved to prevent further injury must be moved to prevent further injury from fire , an expulsion…etc. from fire , an expulsion…etc.

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Equipment and suppliesEquipment and suppliesStandard First Aid Boxes Standard First Aid Boxes

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Various dressings, wire splints, tape, Various dressings, wire splints, tape, Band-Aids, tourniquets, skin pencils, Band-Aids, tourniquets, skin pencils, and other first aid supplies are and other first aid supplies are included in these boxes. Each box is included in these boxes. Each box is secured with a wire or plastic seal secured with a wire or plastic seal that can be easily broken. that can be easily broken.

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The seals are used to identify whether the The seals are used to identify whether the kit has been opened. A broken seal indicates kit has been opened. A broken seal indicates that the first aid box must be that the first aid box must be inventoried( inventoried( complete list of first aidcomplete list of first aid) and restocked. ) and restocked. The standard first aid box has three The standard first aid box has three compartments. Each compartment should compartments. Each compartment should have a plastic bag that is complete with the have a plastic bag that is complete with the basic first aid supplies. Take one of these basic first aid supplies. Take one of these bags with you on your way to the casualty. bags with you on your way to the casualty. Failure to take a bag to the scene( Failure to take a bag to the scene( location at which location at which

an event or action happensan event or action happens )may result in you having to )may result in you having to go back for supplies. go back for supplies.

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The box does not contain needles, The box does not contain needles, syringes, or medications; but does syringes, or medications; but does contain the proper supplies needed to contain the proper supplies needed to render first aid until medical assistance render first aid until medical assistance arrives. First aid boxes are for arrives. First aid boxes are for emergency use only! Report all broken emergency use only! Report all broken seals to medical personnel as soon as seals to medical personnel as soon as possible. It is important that you know possible. It is important that you know the contents and locations of these the contents and locations of these boxes. boxes.

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DressingsDressings

A dressing is a protective covering for a A dressing is a protective covering for a wound and is used to control bleeding and wound and is used to control bleeding and prevent contamination of the wound. A prevent contamination of the wound. A compress is a sterile pad that is placed compress is a sterile pad that is placed directly on the wound. A bandage is material directly on the wound. A bandage is material used to hold a compress in place. When used to hold a compress in place. When applying a dressing, ensure that it remains as applying a dressing, ensure that it remains as sterile as possible. The part of the dressing sterile as possible. The part of the dressing that is placed against the wound must never that is placed against the wound must never touch your fingers, clothing, or any un-sterile touch your fingers, clothing, or any un-sterile object. If you drop, a dressing across the object. If you drop, a dressing across the casualty's skin or it slips after it is in place, casualty's skin or it slips after it is in place, the dressing should not be used. the dressing should not be used.

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Battle Dressings Battle Dressings

Battle dressings are used most often Battle dressings are used most often aboard ship and in the field. Each aboard ship and in the field. Each dressing is complete (no other materials dressing is complete (no other materials are needed) with four tabs which help in are needed) with four tabs which help in applying and securing the dressing. They applying and securing the dressing. They have "other side next to wound" marked have "other side next to wound" marked on the outer side. This will help you in on the outer side. This will help you in (Fig. 5-2) placing the sterile side against (Fig. 5-2) placing the sterile side against the wound. Unless contraindicated, to the wound. Unless contraindicated, to assist in controlling the bleeding, tie the assist in controlling the bleeding, tie the knot of the dressing over the wound. knot of the dressing over the wound.

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Battle Dressing Battle Dressing

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CompressesCompresses

Emergencies may occur when it is not Emergencies may occur when it is not possible to obtain a sterile compress. possible to obtain a sterile compress. During these situations, use the cleanest During these situations, use the cleanest cloth available, a freshly laundered cloth available, a freshly laundered ((washedwashed) handkerchief () handkerchief (square of cloth or absorbent papersquare of cloth or absorbent paper), ), towel, or shirt. Unfold the material towel, or shirt. Unfold the material carefully so that you do not touch the carefully so that you do not touch the part that will be placed against the part that will be placed against the wound. The compress should be large wound. The compress should be large enough to cover the entire wound and enough to cover the entire wound and extend at least 1 inch beyond its edges. extend at least 1 inch beyond its edges.

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If a compress is not large enough, the If a compress is not large enough, the edges of the wound will become edges of the wound will become contaminated. Materials that will contaminated. Materials that will stick to a wound or may be difficult to stick to a wound or may be difficult to remove should never be used directly remove should never be used directly on a wound. Absorbent cotton, on a wound. Absorbent cotton, adhesive tape, and paper napkins are adhesive tape, and paper napkins are examples of materials that should examples of materials that should never come in contact with a wound. never come in contact with a wound.

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BandagesBandages

Bandages are strips or rolls of gauze or other Bandages are strips or rolls of gauze or other materials that are used for wrapping or materials that are used for wrapping or binding any part of the body and to hold binding any part of the body and to hold compresses in place. It is not necessary to compresses in place. It is not necessary to take time to ensure that the bandage take time to ensure that the bandage resembles the textbook pictures. However, it resembles the textbook pictures. However, it is important that the dressing controls the is important that the dressing controls the bleeding, prevents further contamination, and bleeding, prevents further contamination, and protects the wound from further injury. Some protects the wound from further injury. Some of the most commonly used bandages are the of the most commonly used bandages are the roller bandage and the triangular bandage. roller bandage and the triangular bandage.

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Roller Bandages Roller Bandages

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The roller bandage consists of a long strip The roller bandage consists of a long strip of material (usually gauze, or elastic) that of material (usually gauze, or elastic) that is rolled and is available in several widths is rolled and is available in several widths and lengths. Most are sterile, so pieces and lengths. Most are sterile, so pieces may be used as a compress on wounds. A may be used as a compress on wounds. A strip of roller bandage can be used to strip of roller bandage can be used to make a four-tailed bandage by splitting make a four-tailed bandage by splitting the cloth from each end, leaving as large the cloth from each end, leaving as large a center as needed. This type of bandage a center as needed. This type of bandage is used to hold a compress (Fig. 5-4B) on is used to hold a compress (Fig. 5-4B) on the chin, or (Fig. 5-4C) the nose. the chin, or (Fig. 5-4C) the nose.

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Four Tailed Bandage Four Tailed Bandage

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Triangular BandagesTriangular Bandages

Triangular bandages (Fig. 5-5) are Triangular bandages (Fig. 5-5) are usually made of muslin (usually made of muslin (thin cotton cloththin cotton cloth). ). They are useful because they can be They are useful because they can be folded in a variety of ways to fit folded in a variety of ways to fit almost any part of the body. Padding almost any part of the body. Padding can be added to areas that may can be added to areas that may become uncomfortable. become uncomfortable.

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Cravat Bandage Cravat Bandage

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The triangular bandage can be The triangular bandage can be folded to make a cravat bandage, folded to make a cravat bandage, which is useful in controlling which is useful in controlling bleeding from wounds of the scalp or bleeding from wounds of the scalp or forehead. To make a cravat bandage, forehead. To make a cravat bandage, bring the point of the triangular bring the point of the triangular bandage bandage

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The uses of the roller, The uses of the roller, triangular, and cravat triangular, and cravat

bandage. bandage.

Roller Bandage for the Hand and Wrist

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Roller Bandage for the Roller Bandage for the Ankle and Foot Ankle and Foot

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Triangular Bandage for Triangular Bandage for the Head the Head

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Triangular Bandage for Triangular Bandage for the Chest the Chest

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- Cravat Bandage for the - Cravat Bandage for the Elbow or Knee Elbow or Knee

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Cravat Bandage for the Cravat Bandage for the Arm, Forearm, Leg, or Arm, Forearm, Leg, or

Thigh Thigh

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The three primary The three primary objectives are (ABC) for objectives are (ABC) for

first aidfirst aid ) (1) to maintain an open airway,) (1) to maintain an open airway, (2) maintain breathing, and (2) maintain breathing, and (3) to maintain circulation. During (3) to maintain circulation. During

this process you will also:this process you will also: control bleeding, andcontrol bleeding, and reduce or prevent shock. reduce or prevent shock.

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You must respond rapidly, stay calm, You must respond rapidly, stay calm, and think before you act. Do not and think before you act. Do not waste time looking for ready-made waste time looking for ready-made materials, do the best you can with materials, do the best you can with what is at hand. Request what is at hand. Request professional medical assistance as professional medical assistance as soon as possible. soon as possible.

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Initial AssessmentInitial Assessment

When responding to a casualty When responding to a casualty (victim), take a few seconds to (victim), take a few seconds to quickly inspect the area. Remain quickly inspect the area. Remain calm as you take charge of the calm as you take charge of the situation, and act quickly but situation, and act quickly but efficiently. Decide as soon as possible efficiently. Decide as soon as possible what has to be done and which one of what has to be done and which one of the injuries needs attention first. the injuries needs attention first.

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During your initial During your initial assessment, consider the assessment, consider the

following: following: 1. 1. SafetySafety - Determine if the area is - Determine if the area is

safe. If the situation is such that you or safe. If the situation is such that you or the casualty is in danger, you must the casualty is in danger, you must consider this threat against the consider this threat against the possible damage caused by early possible damage caused by early movement. If you decide to move the movement. If you decide to move the casualty, do it quickly and gently to a casualty, do it quickly and gently to a safe area where proper first aid can be safe area where proper first aid can be given. You cannot help the casualty if given. You cannot help the casualty if you become one yourself. you become one yourself.

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2. 2. Mechanism of injuryMechanism of injury - - Determine the extent of the illness Determine the extent of the illness or injury and how it happened. If the or injury and how it happened. If the casualty is unconscious, look for casualty is unconscious, look for clues. If the casualty is lying at the clues. If the casualty is lying at the bottom of a ladder (bottom of a ladder (stepssteps), suspect ), suspect that he or she fell and may have that he or she fell and may have internal injuries. internal injuries.

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3. 3. Medical information devicesMedical information devices - - Examine the casualty for a MEDIC ALERT Examine the casualty for a MEDIC ALERT (Fig. 1-1) necklace, bracelet, or (Fig. 1-1) necklace, bracelet, or identification card. This medical tag, identification card. This medical tag, provides medical conditions, medications provides medical conditions, medications being taken, and allergies about the being taken, and allergies about the casualty. The VIAL OF LIFE, a small, casualty. The VIAL OF LIFE, a small, prescription-type bottle, also contains prescription-type bottle, also contains medical information concerning the medical information concerning the casualty. This bottle is normally located in casualty. This bottle is normally located in the refrigerator. the refrigerator.

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4. 4. Number of casualtiesNumber of casualties - Look - Look beyond the first casualty, you may find beyond the first casualty, you may find others. One casualty may be alert, others. One casualty may be alert, while another, more serious or while another, more serious or unconscious, is unnoticed. In a unconscious, is unnoticed. In a situation with more than one casualty situation with more than one casualty limit your assessment to looking for an limit your assessment to looking for an open airway, breathing, bleeding, and open airway, breathing, bleeding, and circulation, the life-threatening circulation, the life-threatening conditions. conditions.

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5. 5. BystandersBystanders - Ask bystanders to - Ask bystanders to help you find out what happened. help you find out what happened. Though not trained in first aid, Though not trained in first aid, bystanders can help by calling for bystanders can help by calling for professional medical assistance, professional medical assistance, providing emotional support to the providing emotional support to the casualty, and keeping onlookers casualty, and keeping onlookers from getting in the way. from getting in the way.

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6. 6. Introduce yourselfIntroduce yourself - Inform the - Inform the casualty and bystanders who you are casualty and bystanders who you are and that you know first aid. Prior to and that you know first aid. Prior to rendering first aid, obtain the rendering first aid, obtain the casualties consent by asking is it casualties consent by asking is it "OK' to help them. Consent is "OK' to help them. Consent is implied if the casualty is implied if the casualty is unconscious or cannot reply. unconscious or cannot reply.

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General RulesGeneral Rules

1. Keep the casualty lying down, 1. Keep the casualty lying down, head level with the body, until you head level with the body, until you determine the extent and determine the extent and seriousness of the illness or injury. seriousness of the illness or injury. You must immediately recognize if You must immediately recognize if the casualty has one of the following the casualty has one of the following conditions that represent an conditions that represent an exception to the above. exception to the above.

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a. Vomiting or bleeding around the a. Vomiting or bleeding around the mouth - If the casualty is vomiting or mouth - If the casualty is vomiting or bleeding around the mouth, place bleeding around the mouth, place them on their side, or back with them on their side, or back with head turned to the side. head turned to the side. Special Special care must be taken for a casualty care must be taken for a casualty with a suspected neck or back with a suspected neck or back injury.injury.

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b. Difficulty breathing - If the b. Difficulty breathing - If the casualty has a chest injury or casualty has a chest injury or difficulty breathing place them in a difficulty breathing place them in a sitting or semi-sitting position. sitting or semi-sitting position.

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c. Shock - To reduce or prevent c. Shock - To reduce or prevent shock, place the casualty on his or shock, place the casualty on his or her back, with their legs elevated 6 her back, with their legs elevated 6 to 12 inches. to 12 inches. If you suspect head If you suspect head or neck injuries or are unsure of or neck injuries or are unsure of the casualty's condition, keep the casualty's condition, keep them lying flat and wait for them lying flat and wait for professional medical assistance.professional medical assistance.

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2. During your examination, move 2. During your examination, move the casualty no more than is the casualty no more than is necessary. Loosen restrictive necessary. Loosen restrictive clothing, at the neck, waist, and clothing, at the neck, waist, and where it binds. Carefully remove where it binds. Carefully remove only enough clothing to get a clear only enough clothing to get a clear idea of the extent of the injuries. idea of the extent of the injuries. When necessary, cut clothing along When necessary, cut clothing along its seams (its seams (line of stitchingline of stitching). ).

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Ensure the casualty does not Ensure the casualty does not become chilled, and keep them as become chilled, and keep them as comfortable as possible. Inform the comfortable as possible. Inform the casualty of what you are doing and casualty of what you are doing and why. Respect the casualty's modesty, why. Respect the casualty's modesty, but do not jeopardize( but do not jeopardize( put at riskput at risk) ) quality care. Shoes may have to be quality care. Shoes may have to be cut off to avoid causing pain or cut off to avoid causing pain or further injury. further injury.

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3. Reassure the casualty that his or 3. Reassure the casualty that his or her injuries are understood and that her injuries are understood and that professional medical assistance will professional medical assistance will arrive as soon as possible. The arrive as soon as possible. The casualty can tolerate pain and casualty can tolerate pain and discomfort better if they are discomfort better if they are confident in your abilities. confident in your abilities.

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4. Do not touch open wounds or burns 4. Do not touch open wounds or burns with your fingers or un-sterile objects with your fingers or un-sterile objects unless it is absolutely necessary. unless it is absolutely necessary. Place Place a barrier between you and the a barrier between you and the casualty's blood or body fluids, using casualty's blood or body fluids, using plastic wrap, gloves, or a clean, plastic wrap, gloves, or a clean, folded clothfolded cloth. Wash your hands with . Wash your hands with soap and warm water immediately after soap and warm water immediately after providing care, even if you wore gloves providing care, even if you wore gloves or used another barrier. or used another barrier.

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5. 5. Do not give the casualty Do not give the casualty anything to eat or drinkanything to eat or drink because it because it may cause vomiting, and because of may cause vomiting, and because of the possible need for surgery. If the the possible need for surgery. If the casualty complains of thirst, wet his casualty complains of thirst, wet his or her lips with a wet towel. or her lips with a wet towel.

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6. Splint all suspected, broken or 6. Splint all suspected, broken or dislocated bones in the position in dislocated bones in the position in which they are found. which they are found. Do not Do not attempt to straighten broken or attempt to straighten broken or dislocated bonesdislocated bones because of the because of the high risk of causing further injury. high risk of causing further injury. Do not move the casualty if you do Do not move the casualty if you do not have to. not have to.

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7. When transporting, carry the 7. When transporting, carry the casualty casualty feet firstfeet first. This enables the . This enables the back carrier to observe the casualty back carrier to observe the casualty for any complications. for any complications.

8. Keep the casualty comfortable 8. Keep the casualty comfortable and warm enough to maintain and warm enough to maintain normal body temperature. normal body temperature.

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Infectious DiseasesInfectious Diseases

You will probably render first aid to You will probably render first aid to someone you know - family member. For someone you know - family member. For this reason you will probably know your this reason you will probably know your risk of contracting an infectious disease. risk of contracting an infectious disease. Adopt practices that discourage the Adopt practices that discourage the spread of blood-borne diseases spread of blood-borne diseases (Hepatitis and HIV) and air-borne (Hepatitis and HIV) and air-borne diseases such as influenza when diseases such as influenza when performing first aid performing first aid

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1. Wear gloves or use another barrier.1. Wear gloves or use another barrier.2. Wash your hands with soap and warm 2. Wash your hands with soap and warm water immediately.water immediately.3. When possible, use a pocket mask or 3. When possible, use a pocket mask or mouthpiece during rescue breathing. mouthpiece during rescue breathing.

The risk of contracting infections from a The risk of contracting infections from a casualty is very remote (distant). Do not casualty is very remote (distant). Do not withhold rendering first aid because of withhold rendering first aid because of this rare possibility. this rare possibility.

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Patient AssessmentPatient Assessment

Scene assessmentScene assessment Primary surveyPrimary survey Secondary SurveySecondary Survey Reporting of dataReporting of data

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Scene AssessmentScene Assessment

Make a quick assessment of the Make a quick assessment of the overall situation at an accident overall situation at an accident scene. Concentrate on the big “big scene. Concentrate on the big “big picture.”picture.”

Consider three things:Consider three things: EnvironmentEnvironment HazardsHazards Mechanism of injuryMechanism of injury

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Look for anything that may threaten Look for anything that may threaten your safety and the safety of others, your safety and the safety of others, such as downed power lines, falling such as downed power lines, falling rocks, traffic, fire, smoke, etc.rocks, traffic, fire, smoke, etc.

Do not move a casualty unless he or Do not move a casualty unless he or she is in immediate danger, If you she is in immediate danger, If you must move the casualty, do so as must move the casualty, do so as quickly as possible.quickly as possible.

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Mechanism Of InjuryMechanism Of Injury

The mechanism of injury can alert you to The mechanism of injury can alert you to the possibility that certain types of the possibility that certain types of injuries may be present. For example, injuries may be present. For example, fractured bones are usually associated fractured bones are usually associated with falls and motor vehicle accidents, with falls and motor vehicle accidents, burns with fires, and soft tissue injuries burns with fires, and soft tissue injuries with gunshot wounds. with gunshot wounds.

Remember, however, that for every Remember, however, that for every obvious injury, there may be a number of obvious injury, there may be a number of hidden ones.hidden ones.

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Primary SurveyPrimary Survey

The primary survey is conducted The primary survey is conducted once dangers at the scene have been once dangers at the scene have been neutralized. It is the first step in the neutralized. It is the first step in the physical assessment and consists of physical assessment and consists of the following:the following:

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Check of Check of level of consciousness level of consciousness (LOC)(LOC) as you approach the patient. as you approach the patient.

Check of Check of DABCDABC ( (DDelicate spine, elicate spine, AAirway, irway, BBreathing, and reathing, and CCirculation)irculation)

Rapid body survey (RBS)Rapid body survey (RBS) for for external blood loss and deformitiesexternal blood loss and deformities

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While conducting the primary survey, While conducting the primary survey, you may discover life- threatening you may discover life- threatening emergencies such as obstructed emergencies such as obstructed airways, respiratory difficulties, airways, respiratory difficulties, external bleeding, and obvious shock. external bleeding, and obvious shock. Treat these problems immediately.Treat these problems immediately.

For your protection, wear disposable For your protection, wear disposable gloves whenever you might be handling gloves whenever you might be handling blood, body fluids, or secretions.blood, body fluids, or secretions.

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Perform A Primary SurveyPerform A Primary Survey

To perform a primary survey, you To perform a primary survey, you must be able to do the following:must be able to do the following:

Assess level of consciousness (LOC) Assess level of consciousness (LOC) using the AVPU method.using the AVPU method.

Manage a delicate spine.Manage a delicate spine.

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Open and maintain the airway.Open and maintain the airway.

Clear obstructions from the patients Clear obstructions from the patients mouth.mouth.

Open the airway.Open the airway. Correctly use an oral airway for Correctly use an oral airway for

unconscious.unconscious. Suction the mouth cavity if required.Suction the mouth cavity if required. Place unconscious patients and patients Place unconscious patients and patients

with compromised airways in the with compromised airways in the recovery position and monitor breathing.recovery position and monitor breathing.

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Assess and manage the Assess and manage the patient’s breathing.patient’s breathing.

Determine when a patient is not Determine when a patient is not breathing adequately.breathing adequately.

Use a pocket mask to ventilate Use a pocket mask to ventilate patients with inadequate breathing.patients with inadequate breathing.

Ventilate an infant using a pocket Ventilate an infant using a pocket mask, connected to oxygen, and mask, connected to oxygen, and mouth-to-mask ventilation's.mouth-to-mask ventilation's.

Use the bag-valve-mask-oxygen Use the bag-valve-mask-oxygen reservoir unit to ventilate patients reservoir unit to ventilate patients with inadequate breathing.with inadequate breathing.

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Assess and manage the Assess and manage the patients circulation.patients circulation.

Perform a rapid body survey (Perform a rapid body survey (RBSRBS).). Give oxygen at high flow (10 L/min) Give oxygen at high flow (10 L/min)

with a standard face mask.with a standard face mask. Describe the pathophysiology of Describe the pathophysiology of

hypoxic drive and the management hypoxic drive and the management of a COPD patient. of a COPD patient.

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Assess Level of Consciousness Assess Level of Consciousness (LOC) (LOC)

Check for Check for LOCLOC as you approach the as you approach the patient.patient.

The The A,V,P,UA,V,P,U method is a short and method is a short and simple way to assess the simple way to assess the LOCLOC::

AA - patient is - patient is AAlertlert VV - patient responds to - patient responds to VVerbal (erbal (VVoice) oice)

stimulistimuli PP - patient responds to - patient responds to PPain ain (Use a trapezoidal squeeze to (Use a trapezoidal squeeze to

administer a painful stimulus.)administer a painful stimulus.)

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UU - patient is - patient is UUnresponsive to nresponsive to verbal and painful stimuliverbal and painful stimuli

Expose—undressExpose—undress the patient to the patient to look for clues to injury or illness, look for clues to injury or illness, such as wounds or skin lesions. such as wounds or skin lesions.

A change in the level of consciousness A change in the level of consciousness is the first sign of a brain injury or is the first sign of a brain injury or other serious medical conditions.other serious medical conditions.

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Manage A Delicate SpineManage A Delicate Spine Always assume that the patient has a Always assume that the patient has a

neck or spine injury (delicate spine). neck or spine injury (delicate spine). You may rule it out after considering You may rule it out after considering the mechanism of injury, bur always the mechanism of injury, bur always check for a delicate spine if the check for a delicate spine if the patient must be moved.patient must be moved.

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If you suspect that the If you suspect that the patient has a delicate spine, patient has a delicate spine,

do the following:do the following: Approach the patient from the head.Approach the patient from the head. Tell the patient, “If you can hear me, don’t Tell the patient, “If you can hear me, don’t

move.”move.” Stabilize the head in the position found.Stabilize the head in the position found. Do not move the patient unless absolutely Do not move the patient unless absolutely

necessary to maintain an open airway.necessary to maintain an open airway. When using the various grips remember When using the various grips remember

to use the principles of STABLE to to use the principles of STABLE to UNSTABLEUNSTABLE

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Open and Maintain The Open and Maintain The AirwayAirway

Airway management involves three Airway management involves three things:things:

Opening the airwayOpening the airway Maintaining the open airwayMaintaining the open airway Helping the patient breathe Helping the patient breathe

effectively (ventilation)effectively (ventilation)

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LookLook, , listenlisten, and , and feelfeel for the for the movement of air at the mouth and/ movement of air at the mouth and/ or nose. After an injury, a patient’s or nose. After an injury, a patient’s airway may become closed or airway may become closed or blocked by teeth, the tongue, or blocked by teeth, the tongue, or foreign objects. “foreign objects. “check for 5 check for 5 seconds”seconds”

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Before taking steps to open the Before taking steps to open the airway, make sure you have ruled airway, make sure you have ruled out a delicate spine or protected the out a delicate spine or protected the neck. The technique you use will neck. The technique you use will depend on whether or not the depend on whether or not the mechanism of injury indicates a mechanism of injury indicates a delicate spine. delicate spine.

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To manage the airway, you To manage the airway, you must be able to do the must be able to do the

following:following: Clear obstructions from the patient's mouth.Clear obstructions from the patient's mouth. Open the airway.Open the airway. Correctly use an oral airway for Correctly use an oral airway for

unconscious patients.unconscious patients. Suction the mouth cavity if required.Suction the mouth cavity if required. Place unconscious patients and patients Place unconscious patients and patients

with compromised airway in the recovery with compromised airway in the recovery position and monitor breathing.position and monitor breathing.

Clear Obstructions From The Patient’s Clear Obstructions From The Patient’s Mouth And Throat.Mouth And Throat.

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Make sure your patient’s airway is Make sure your patient’s airway is clear before trying to open it. clear before trying to open it. Remove foreign materials such as Remove foreign materials such as broken teeth, vomitus, fluid and broken teeth, vomitus, fluid and mucus before attempting any further mucus before attempting any further treatment. Use a treatment. Use a crossed-over crossed-over fingerfinger technique to open the technique to open the patient's mouth, and do a visual patient's mouth, and do a visual check.check.

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Crossed-over Finger Crossed-over Finger TechniqueTechnique

Opening The AirwayOpening The Airway Open the airway after clearing Open the airway after clearing

foreign materials form the mouth. foreign materials form the mouth. The tongue can easily act as a lid, The tongue can easily act as a lid, closing down onto the back of the closing down onto the back of the throat and making breathing throat and making breathing impossible. To open your patient’s impossible. To open your patient’s airway, you must lift the tongue up airway, you must lift the tongue up and off the back of the throat.and off the back of the throat.

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NO NECK INJURY:NO NECK INJURY:

Use the Use the Head-Tilt/Chin-Lift MethodHead-Tilt/Chin-Lift Method

Do not use this procedure on any Do not use this procedure on any patient with neck or spinal injuries.patient with neck or spinal injuries.

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NECK INJURY SUSPECTED:NECK INJURY SUSPECTED:

Use the Use the jaw thrustjaw thrust or or modified jaw modified jaw thrustthrust

If you suspect a neck injury, take care If you suspect a neck injury, take care not to move the neck.not to move the neck.

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Modified Jaw Thrust Modified Jaw Thrust MethodMethod

Oral AirwaysOral Airways Once the airway passage is clear and Once the airway passage is clear and

open, you must keep it open, especially open, you must keep it open, especially if the patient is unconscious and if the patient is unconscious and cannot do it himself or herself. The cannot do it himself or herself. The oral airway oral airway (oropharyngeal airway)(oropharyngeal airway), , a hard plastic tube, is the ideal tool for a hard plastic tube, is the ideal tool for this. Inserted correctly, it prevents the this. Inserted correctly, it prevents the tongue from falling back and blocking tongue from falling back and blocking

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Oral Airways For Oral Airways For Unconscious PatientsUnconscious Patients

Moving PatientsMoving Patients A general principle for First Responders is that A general principle for First Responders is that

patients should be cared for in the position patients should be cared for in the position found. This principle is based on the found. This principle is based on the assumption that certain conditions or injuries assumption that certain conditions or injuries (such as a neck fracture in an unconscious (such as a neck fracture in an unconscious patient) can be hidden so that it is missed patient) can be hidden so that it is missed during initial assessment, and unnecessary during initial assessment, and unnecessary movement may make the situation worse. movement may make the situation worse. However, there are three situations in which However, there are three situations in which you, the First Responder, will have to move the you, the First Responder, will have to move the patient: patient:

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Repositioning the patient to manage Repositioning the patient to manage immediate ABC’s.immediate ABC’s.

Moving patients as quickly as Moving patients as quickly as possible out of hazardous areas.possible out of hazardous areas.

Rescuing and transporting patients. Rescuing and transporting patients.

Repositioning The Patients To Repositioning The Patients To Manage Immediate ABC’sManage Immediate ABC’s

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Many patients are found in unusual Many patients are found in unusual or difficult positions. It may be or difficult positions. It may be necessary to move them in order to necessary to move them in order to effectively assess or manage their effectively assess or manage their ABC’s. ABC’s.

If you must move a patient, follow If you must move a patient, follow these principles: these principles:

Moves are best done with the help of Moves are best done with the help of two or more people.two or more people.

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Although managing the ABC’s is always Although managing the ABC’s is always a priority, try to minimize movement a priority, try to minimize movement during urgent repositioning.during urgent repositioning.

Movement of the neck and spine is Movement of the neck and spine is potentially more dangerous than potentially more dangerous than moving an extremity.moving an extremity.

In an awake patient, increased pain In an awake patient, increased pain with movement should limit your with movement should limit your repositioning.repositioning.

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Positioning The PatientPositioning The Patient

In most cases, positioning of the In most cases, positioning of the patient is determined by patient patient is determined by patient comfort. If possible, the patient comfort. If possible, the patient should be left in the position found. should be left in the position found. However, if moving the patient However, if moving the patient results in better patient care, results in better patient care, consider the following options:consider the following options:

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Semi-sittingSemi-sitting Shortness of breath; obese patients; Shortness of breath; obese patients;

chest pain.chest pain. SupineSupine Suspected neck injuries; patient with no Suspected neck injuries; patient with no

radial pulse; hip fractures.radial pulse; hip fractures. Prone or Recovery PositionProne or Recovery Position All unconscious patients with no neck All unconscious patients with no neck

injury.injury. All patients with airway problems that All patients with airway problems that

cannot be controlled by suctioning.cannot be controlled by suctioning.

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SuctionSuction

Suctioning the mouth cavity is Suctioning the mouth cavity is another procedure used to keep the another procedure used to keep the airway clear. Secretions and other airway clear. Secretions and other debris are removed by applying debris are removed by applying negative pressure through a hollow negative pressure through a hollow tube. If you do not remove the tube. If you do not remove the debris, you may force it into the debris, you may force it into the patient’s lungs during ventilation.patient’s lungs during ventilation.

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Assess And Manage The Assess And Manage The Patient’s BreathingPatient’s Breathing

A patient may be breathing on his or A patient may be breathing on his or her own but not doing so adequately. her own but not doing so adequately. Do not wait for respiratory arrest Do not wait for respiratory arrest before ventilating the patient.(below before ventilating the patient.(below 10, and over 30).10, and over 30).

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To assess and manage the To assess and manage the patient’s breathing, you patient’s breathing, you must be able to do the must be able to do the

following:following: Determine when a patient is not Determine when a patient is not breathing adequately.breathing adequately.

Use a pocket mask to ventilate Use a pocket mask to ventilate patients with inadequate breathing.patients with inadequate breathing.

Ventilate an infant using pocket Ventilate an infant using pocket mask, connected oxygen, and mouth-mask, connected oxygen, and mouth-to-mask ventilation's.to-mask ventilation's.

Use the bag-valve-mask-oxygen Use the bag-valve-mask-oxygen reservoir unit to ventilate patients reservoir unit to ventilate patients with inadequate breathing. with inadequate breathing.

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Determine When A Patient Is Determine When A Patient Is Not Breathing AdequatelyNot Breathing Adequately

A patient is not breathing adequately if A patient is not breathing adequately if he or she has fewer than 10 respirations he or she has fewer than 10 respirations per minute and/ or shows some or all of per minute and/ or shows some or all of the following signs of hypoxia (low the following signs of hypoxia (low oxygen level in the blood):oxygen level in the blood):

agitationagitation irritabilityirritability drowsinessdrowsiness headacheheadache

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decreased level of consciousnessdecreased level of consciousness rapid pulserapid pulse labored breathinglabored breathing abdominal breathing abdominal breathing bluish skin color bluish skin color irregular heartbeatirregular heartbeat

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Perform A Rapid Body Survey Perform A Rapid Body Survey (RBS).(RBS).

The rapid body survey will help you to The rapid body survey will help you to locate and expose injury sites, stabilize locate and expose injury sites, stabilize fractures, and control bleeding. fractures, and control bleeding.

You should be able to accomplish the You should be able to accomplish the following:following:

Perform a rapid body survey.Perform a rapid body survey. Give oxygen at high flow (10 L/min) with a Give oxygen at high flow (10 L/min) with a

standard face mask.standard face mask. Describe the pathophysiology of hypoxic Describe the pathophysiology of hypoxic

drive and the management of a COPD drive and the management of a COPD patient.patient.

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Rapid Body SurveyRapid Body Survey

Check for bleeding, deformity, and Check for bleeding, deformity, and your patient’s response to pain by your patient’s response to pain by systematically running your hands systematically running your hands over and under the following:over and under the following:

head and neckhead and neck chest and abdomenchest and abdomen backback lower extremitieslower extremities upper extremitiesupper extremities

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You should take no more than 30 You should take no more than 30 seconds to perform a rapid body seconds to perform a rapid body survey. It should be interrupted only survey. It should be interrupted only long enough to provide intervention long enough to provide intervention for life-threatening injuries.for life-threatening injuries.

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Oxygen Flow RatesOxygen Flow Rates

5 Litres per minute5 Litres per minute COPD Patients COPD Patients (No Trauma)(No Trauma) 10 Litres per minute10 Litres per minute All trauma patientsAll trauma patients Medical emergenciesMedical emergencies 15 Litres per minute15 Litres per minute Smoke and/ or gas inhalationSmoke and/ or gas inhalation Carbon monoxide poisoningCarbon monoxide poisoning

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Equipments for oxygen Equipments for oxygen deliverydelivery

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BBag-ag-VValve-alve-MMask (ask (BVMBVM))

Assist patients with inadequate Assist patients with inadequate respiration's.respiration's.

Hyperventilate unconscious patients Hyperventilate unconscious patients with head injuries with head injuries

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Circulation - Radial PulseCirculation - Radial Pulse Circulation - Carotid PulseCirculation - Carotid Pulse Pocket MaskPocket Mask CPR-on-the-move.CPR-on-the-move. Infant ventilation's.Infant ventilation's. when resuscitation from BVM does when resuscitation from BVM does

not create an effective seal.not create an effective seal.

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Non-Rebreather MaskNon-Rebreather Mask

Victims of smoke and/ or gas Victims of smoke and/ or gas inhalation.inhalation.

Victims of carbon monoxide Victims of carbon monoxide poisoningpoisoning

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Full Face MaskFull Face Mask

Patients with adequate respiration's.Patients with adequate respiration's.

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OxygenOxygen

As a first responder, you should use As a first responder, you should use a standard a standard face maskface mask to give to give oxygen at 10 L/min to:oxygen at 10 L/min to:

All trauma patientsAll trauma patients All medical patients except those All medical patients except those

with a history of chronic obstructive with a history of chronic obstructive pulmonary disease (pulmonary disease (COPDCOPD) )

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Oxygen therapy for the Oxygen therapy for the non-non-traumatictraumatic COPDCOPD patient is 5 L/min patient is 5 L/min through a standard adult oxygen through a standard adult oxygen mask. But at a 10 L/min flow for mask. But at a 10 L/min flow for traumatictraumatic COPDCOPD patient’s. patient’s.

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COPD PatientsCOPD Patients

In normal people, the breathing reflex is In normal people, the breathing reflex is triggered by high level of carbon dioxide (CO2) triggered by high level of carbon dioxide (CO2) in the blood. Patients with emphysema, chronic in the blood. Patients with emphysema, chronic bronchitis, and chronic asthma may have a bronchitis, and chronic asthma may have a condition know as condition know as CChronic hronic OObstructive bstructive PPulmonary ulmonary DDisease isease (COPD).(COPD). They retain CO2 They retain CO2 and thus have a chronically high level of this gas. and thus have a chronically high level of this gas. Their breathing reflex is triggered only when the Their breathing reflex is triggered only when the oxygen level in their blood is low. This oxygen level in their blood is low. This mechanism is known as mechanism is known as hypoxic drivehypoxic drive. By giving . By giving COPD patients oxygen, you may suppress their COPD patients oxygen, you may suppress their breathing reflex.breathing reflex.

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Give the patient with Give the patient with COPDCOPD, 5 L/min , 5 L/min through a standard adult oxygen through a standard adult oxygen mask. Closely monitor the patient’s mask. Closely monitor the patient’s respiratory rate, depth, and volume. respiratory rate, depth, and volume. Assist the patient’s ventilation's if Assist the patient’s ventilation's if necessary.necessary.

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Perform A Secondary SurveyPerform A Secondary Survey

The purpose of a secondary survey is The purpose of a secondary survey is to identify problems that, while not to identify problems that, while not immediately life-threatening, may immediately life-threatening, may threaten the patient’s survival if left threaten the patient’s survival if left undetected. undetected.

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The secondary survey consists The secondary survey consists of the:of the:

Medical history (Medical history (chief complaint and chief complaint and history of chief complainthistory of chief complaint))

Vital signs (Vital signs (LOC, pulse, respiration's, LOC, pulse, respiration's, and skin colour and temperatureand skin colour and temperature))

Head-to-toe physical examination (Head-to-toe physical examination (if if time permitstime permits))

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The information you gather here will The information you gather here will be vital for the patient’s later care. be vital for the patient’s later care. You should be able to report it You should be able to report it accurately and concisely to accurately and concisely to ambulance personnel when they ambulance personnel when they arrive.arrive.

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Chief ComplaintChief Complaint

The chief complaint is what the The chief complaint is what the patient says is wrong with him or patient says is wrong with him or her. Record and report it using the her. Record and report it using the patient’s own words. This will help patient’s own words. This will help you avoid interpreting what was you avoid interpreting what was said, which may obscure or change said, which may obscure or change the nature of the problem.the nature of the problem.

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Most chief complaints are Most chief complaints are characterized by pain or abnormal characterized by pain or abnormal function. Find out what is bothering function. Find out what is bothering the patient most. For example, a the patient most. For example, a victim of a motor vehicle accident victim of a motor vehicle accident may have an obvious leg fracture but may have an obvious leg fracture but his chief concern may be,”I can’t his chief concern may be,”I can’t breath.” This may help you discover breath.” This may help you discover an unsuspected chest injury.an unsuspected chest injury.

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History Of The Chief History Of The Chief ComplaintComplaint

The history of the chief complaint The history of the chief complaint examines the chief complaint in examines the chief complaint in greater detail. Get a description of greater detail. Get a description of the events that caused the chief the events that caused the chief complaint. If pain is the chief complaint. If pain is the chief complaint, use the complaint, use the PQRSTPQRST method method to help you organize your to help you organize your questioning.questioning.

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History Of The Chief History Of The Chief ComplaintComplaint

Ask the following:Ask the following: PPosition of the pain.osition of the pain. QQuality of the pain.uality of the pain. Does the painDoes the pain RRadiate?.adiate?. SSeverity of the pain. everity of the pain. TTiming of the pain.iming of the pain.

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PP - - PositionPosition Where is it located? Can you point to it?Where is it located? Can you point to it? QQ - - QualityQuality What does it feel like? Is it sharp, dull, What does it feel like? Is it sharp, dull,

throbbing, or crushing?throbbing, or crushing? R R - - RadiationRadiation Does it radiate anywhere? or Does it Does it radiate anywhere? or Does it

stay in one place or move around? Does stay in one place or move around? Does anything relieve it? What makes it anything relieve it? What makes it worse?worse?

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S S - - SeveritySeverity How would you rate the pain on a How would you rate the pain on a

scale of 1 to 10 scale of 1 to 10 (10 being the worst)?(10 being the worst)? TT - - TimingTiming When did it start? What brought it When did it start? What brought it

on? Have you had it before? How on? Have you had it before? How long does it last?long does it last?

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Guidelines When Guidelines When Interviewing A PatientInterviewing A Patient

Allow the patient to answer in his or her own Allow the patient to answer in his or her own words. words.

Avoid suggesting answers. (“Avoid suggesting answers. (“What provoked What provoked the painthe pain?” Not “?” Not “Does the pain come after Does the pain come after exertionexertion?”) ?”)

Use open-ended questions. Avoid asking Use open-ended questions. Avoid asking questions that can be answered with yes or no. questions that can be answered with yes or no.

To pinpoint responses, give the patient To pinpoint responses, give the patient alternatives. (alternatives. (Does the pain stay in one place Does the pain stay in one place or does it move aroundor does it move around??

Reassure the patient frequently.Reassure the patient frequently.

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Baseline Vital SignsBaseline Vital Signs

Baseline vital signs are one of the Baseline vital signs are one of the most important aspects of patient most important aspects of patient assessment. They are taken after the assessment. They are taken after the primary survey and the medical primary survey and the medical history. history.

Based on them, ambulance Based on them, ambulance personnel and receiving hospital personnel and receiving hospital staff can tell whether or not the staff can tell whether or not the patient’s condition is deteriorating.patient’s condition is deteriorating.

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As a First Responder you should As a First Responder you should record the following:record the following:

LOC (using the AVPU method)LOC (using the AVPU method) Skin - colour, condition and Skin - colour, condition and

temperature temperature Pulse - rate, rhythm, and strengthPulse - rate, rhythm, and strength Respiration's - rate, rhythm, and Respiration's - rate, rhythm, and

volume (quality)volume (quality)

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Monitor the LOC, take the pulse, and Monitor the LOC, take the pulse, and count the respiration's count the respiration's every five every five minutes.minutes.

Check whether the patient’s skin is:Check whether the patient’s skin is: cool or warmcool or warm moist or drymoist or dry pale or normal in colourpale or normal in colour conditioncondition

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Recording And Reporting Recording And Reporting DataData

Recording and reporting data is the Recording and reporting data is the last major component of the patient last major component of the patient assessment model. Your report will assessment model. Your report will help guide the ambulance personnel help guide the ambulance personnel and hospital staff in treating the and hospital staff in treating the patient.patient.

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Report your findings orally Report your findings orally to responding ambulance to responding ambulance

personnel. Your oral report personnel. Your oral report should include the should include the

following:following: Mechanism of injuryMechanism of injury Chief complaintChief complaint History of chief complaintHistory of chief complaint LOC, pulse, respiration's, and skin LOC, pulse, respiration's, and skin

colour and temperaturecolour and temperature Treatment givenTreatment given All relevant physical findingsAll relevant physical findings

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Follow up your oral report with a Follow up your oral report with a completed copy of the First completed copy of the First Responder Report. (within 24 hours Responder Report. (within 24 hours of the incident)of the incident)

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