QI Health4 Notes

8/6/2019 QI Health4 Notes

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Health 4

First Aid/Emergency Medicine

I. Goals:a. To prolong lifeb. Alleviate suffering/painc. Prevent further injuries

II. History and importance:a. Henry Dunant

i. Battle of Solferinoii. Red Cross

1. Geneva, Switzerland2. St. Johns Ambulance

b. Still necessary?i. Yes, accidents still happen

ii. Control is an illusioniii. Increasing # of lifestyle diseases:

1. Heart Disease (69.8)2. Vascular Disease (54.1)3. Pneumonia (47.1)4. Accidents (39.9)5. Cancer (37.5)

c. Paramedicsi. 1970s; Miami, Florida; Department of Transportation

ii. First Responderiii. Dispatcher

1. 117iv. EMT (Emergency Medical Technicians (?))

d.

First Aideri. Scene Management/Safety1. Oncoming traffic2. Unstable surfaces3. Leaking gasoline4. Downed electrical lines5. Potential for violence6. Fire/smoke7. Hazardous materials8. Other damages at crash/rescue scenes9. Crime scenes

ii. Assessment (& Evaluation)1. Scene size-up2. Initial assessment3. Focused history & physical exam

a. Vital signsb. History

4. Detailed physical exam5. On-going assessment

iii. Management (or Appropriate Care)

Because of necessity brought

about by war


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iv. Develop General Impression1. Occurs as you approach the scene & the patient

a. Assessment of the environmentb. Patients chief complaintc. Presenting signs and symptoms of patient

i. Signs able to be perceived through the 5 sensesii. Symptoms feelings of patient

v. Obtaining Consent1. Introduce self2. Ask patients name3. Obtain consent (Expressed/Implied?)

a. Good Samaritan Law provides immunity from liability to a firstresponder who stops and helps at the scene of the emergency

provided they do all they can, within their knowledge, to sustain

life and prevent further injury

Trauma

-Damage caused by an external energy force that dissipated at a faster rate than the bodys ability to

withstandI. Blunt? Penetrating (disruption of homeostasis)?

a. Temperature regulation (normal: 36.5oC 37.5oC)b. pH balancec. H2O level

II. Chief complainta. Most serious problem voiced by the patientb. May not be the most significant problem presentc. Signs/Symptoms:

i. Painii. Tendernessiii. Breathingiv. Pulsev. Behaviourvi. Temperature

vii. Appearance injured and uninjured sideviii. Others (those that appear in my notebook, but I dont know where to classify):

1. Tachycardia2. Brachycardia3. 110 blood sugar -> normal4. Hypoglycaemia

ix. Assessing Mental Status1. Responsiveness

a. Response to external stimulib. Glasgow coma scalec. Testing:

i. AAlertii. V responsiveness to Verbal stimuliiii. P responsiveness to Painiv. U - Unresponsiveness

2. Orientation


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a. Mental status and thinking abilityx. Check Airway

1. Laboured breathing2. Accessory muscles3. Noisy breathing4. Cyanosis5. Rate and depth6. Air movement7. Choking:

a. Mechanicalb. Anatomicalc. Vomitousd. Completee. Partialf. For pregnant people: middle of chest, intersection of sternum

line and line connecting nipples

g. Solution:i. Heimlich maneuver

1. Abdominal thrust2. Intrathoracic pressure

Cardiovascular System

-regulates body temperature

-fights off infection

-acid-base buffer system

-transport O2 and nutrients:

Heart Blood vessels Bloodif

AV valves (tricuspid and bicuspid) if damaged, Stroke volume(SV)

Sinoatrial(SA) node

RA

RV LV

LA

Superior vena cava

Inferior vena cava

Tricuspid valve Bicuspid valve

Atrioventricular(AV) nodedelays contraction to allow diastolic phase


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Blood vesselso If enlarged:

If athelete, GOOD! If not, bigger BV; stress and hypertension; chamber size, muscle of LV,

cardiac output; DIE EARLY!!!!

Coronary artery (in aorta) blood directly to the heart Normal ECG reading: 60-90 spikes/minute Arrhythmia

o Irregularity of electrical conduction systemo skip a heartbeat

Brachycardia (slow heart rate) Tachycardia (elevated/fast heart rate) Lub -> AV Valves; Dub -> semilunar valves Cardiac arrest:

o Cardiac standstill Sudden death Oxygen-deprived heart

o Cardiac collapse Activation of Parasympathetic Nervous System (PNS) conserves energy,

activity, heart activity

Propofol (strong sedative) VS. Epinephrine (activate Sympathetic NervousSystem (SNS))

o Ventricular fibrillation Heart -> very, very fast 200-300 beats No more diastolic phase cardiac output

Nervous System

-Peripheral nervous system (PNS)-Central nervous system (CNS; brain + spinal cord)

-brain:

-cerebrum

-cerebellum

-diencephalon

Trauma Genetics O2 deprived Infection Cerebrovascular accidents:

o Stroke -> paralysis Test:

Smile test Talk test Arm test

Types: Ischemic strokeBV obstructed

o 80% of strokes -> this kindo Embolic scar tissue -> motile

Causes of complications with the brain


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Arteriosclerosis + scar tissueo Thromboticblood clotting

Medication: aspirin Hemorrhagic stroke BV ruptured

o Aneurysm Rupture of one of the arteries supplying the

brain

Leads to stroke/internal bleedingo Concussion

Temporary absence/disturbance of neurologicalfunction

Symptoms: headache, balance problem,confusion

o Blood surrounds the brain: intracranial pressure Leading to intracranial hematoma (either

epidural or subdural)

Symptoms: headache, dizziness andvomiting; signs: heart rate, BP,racoon eyes, battles sign,

Cerebrospinal fluid(CSF) leak

o Skull fracture Trauma to the bony structure that protects the brain; break in the

continuity of the skull

Could be linear, comminuted(jigsaw puzzle), depressed or basilar(baseof skull -> circle of willis)

Watch out for complications Signs and symptoms: crushings triad, nausea and CSF leak

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QI Health4 Notes