STARMedic
08-07-2006, 11:14 AM
This is the first step....
AIRWAY.......Someone without an AIRWAY is a corpse.....
If someone goes down, one of the most important steps apart from managing the cervical spine in the trauma setting, is to OPEN their AIRWAY....
You can either use the Head tilt Chin Lift, or the Jaw Thrust. The HTCL is to be used in non trauma situations (IE when they havent fallen or been struck above the shoulders) Can be done by placing the palm at the top of the head, the forefinger under the chin, and the thumb inside the lower mandible, with the palm, push the head up into a "sniffing" position as if they were sniffing flowers, with the thimb and forefinger pull the mandible down and up....inspecting to see if they have vomited, if they have, then you will need to roll them on their side and clear the airway....
The Jaw Thrust, should be used in the Trauma setting or in any instance where the person has fallen, shows injury above the shoulders and no one can verify as to whether or not the person has struck their head. This involves stabilization of the cervical spine and opening the airway. With the patient on their back, face up, place the blade of both palmar surfaces just at or below the ears of the victim, hold the head in a neutral inline position, take the little finger, ring finger, and middle finger, and place them, little and ring, just behind the mandibular notch (part where the jaw forms a right angle just in front of the ear lobe) middle finger goes just in front of mandibular notch, and forefinger acts as a guide offering no lift whatsoever. The thumbs should rest on the cheek bones. The movement is kind of akward, as its kind of a squeezing in and lifting starting with the back fingers. When performed you should see the tongue displace forward with the jaw.
Trust me when the jaw thrust is applied properly, you will know right away whether the patient is conscious or not cause it hurts tremendously.
Once again inspect and clear the airway as needed, in the trauma setting, once you have taken cervical spine immobilaztion YOU MUST NOT RELEASE IT, unless your life is in danger.....
Now that we have the airway open and clear, we will go on to the "B" in the chain....
BREATHING.......the bottom line is that in whatever given situation the patient may or may not be breathing, if they are, then count the number of breaths in one minute.....generally the magic number is 10-20...anything more than 20/min is "Tachypneic" anything less than 10 is "Bradypneic" or in simple terms too fast or too slow.....
If they arent breathing then it becomes necessary to breathe for them. Im not saying you have to perform mouth to mouth, but there are simple face masks out there that prevent pathogen transmission and vomitus from reaching the layperson thru a one way valve. These masks cost less than 20 dollars and should be part of every shops first aid kit.
Circulation deals with the blood going round and round.....If the blood is not going round and round properly then they may present as HR too fast, weak, thready, or slow and bounding.....The first thing you need to address is whether or not there are any arterial bleeds, in this you can do a rapid head to toe sweep, arterial bleeding will present as bright red and spurting. THESE BLEEDS MUST BE ADDRESSED FIRST, as it constitutes a life threat.
Direct pressure with a gloved hand.
gauze or padding over the wound in addition to direct pressure.
elevation of the extremity if possible.
tourniquet as a last resort.
Any wounds that present as bubbling (chest, neck) need an occlusive dressing, taped on three sides, one of the primary concerns apart from the escape of air en masse is the induction of air into the cavity causing embolus or collapse.
Venous bleeding will present as darker red and oozing....keep in mind in the presence of traumatic amputation the oozing can look a helluva lot like spurting, but its not. Address these with simple bandaging as needed. In treating bleeds never remove a dressing, add to it as needed, as the blood soaks thru, add more on top of the previous.
Kinda forgot to mention that in the presence of any emergency, have someone dial 911 immediately, if its only you and the patient dial 911 first, then begin the work....
This is kind of vague and I apologize but I hope it helps....
Bruce
AIRWAY.......Someone without an AIRWAY is a corpse.....
If someone goes down, one of the most important steps apart from managing the cervical spine in the trauma setting, is to OPEN their AIRWAY....
You can either use the Head tilt Chin Lift, or the Jaw Thrust. The HTCL is to be used in non trauma situations (IE when they havent fallen or been struck above the shoulders) Can be done by placing the palm at the top of the head, the forefinger under the chin, and the thumb inside the lower mandible, with the palm, push the head up into a "sniffing" position as if they were sniffing flowers, with the thimb and forefinger pull the mandible down and up....inspecting to see if they have vomited, if they have, then you will need to roll them on their side and clear the airway....
The Jaw Thrust, should be used in the Trauma setting or in any instance where the person has fallen, shows injury above the shoulders and no one can verify as to whether or not the person has struck their head. This involves stabilization of the cervical spine and opening the airway. With the patient on their back, face up, place the blade of both palmar surfaces just at or below the ears of the victim, hold the head in a neutral inline position, take the little finger, ring finger, and middle finger, and place them, little and ring, just behind the mandibular notch (part where the jaw forms a right angle just in front of the ear lobe) middle finger goes just in front of mandibular notch, and forefinger acts as a guide offering no lift whatsoever. The thumbs should rest on the cheek bones. The movement is kind of akward, as its kind of a squeezing in and lifting starting with the back fingers. When performed you should see the tongue displace forward with the jaw.
Trust me when the jaw thrust is applied properly, you will know right away whether the patient is conscious or not cause it hurts tremendously.
Once again inspect and clear the airway as needed, in the trauma setting, once you have taken cervical spine immobilaztion YOU MUST NOT RELEASE IT, unless your life is in danger.....
Now that we have the airway open and clear, we will go on to the "B" in the chain....
BREATHING.......the bottom line is that in whatever given situation the patient may or may not be breathing, if they are, then count the number of breaths in one minute.....generally the magic number is 10-20...anything more than 20/min is "Tachypneic" anything less than 10 is "Bradypneic" or in simple terms too fast or too slow.....
If they arent breathing then it becomes necessary to breathe for them. Im not saying you have to perform mouth to mouth, but there are simple face masks out there that prevent pathogen transmission and vomitus from reaching the layperson thru a one way valve. These masks cost less than 20 dollars and should be part of every shops first aid kit.
Circulation deals with the blood going round and round.....If the blood is not going round and round properly then they may present as HR too fast, weak, thready, or slow and bounding.....The first thing you need to address is whether or not there are any arterial bleeds, in this you can do a rapid head to toe sweep, arterial bleeding will present as bright red and spurting. THESE BLEEDS MUST BE ADDRESSED FIRST, as it constitutes a life threat.
Direct pressure with a gloved hand.
gauze or padding over the wound in addition to direct pressure.
elevation of the extremity if possible.
tourniquet as a last resort.
Any wounds that present as bubbling (chest, neck) need an occlusive dressing, taped on three sides, one of the primary concerns apart from the escape of air en masse is the induction of air into the cavity causing embolus or collapse.
Venous bleeding will present as darker red and oozing....keep in mind in the presence of traumatic amputation the oozing can look a helluva lot like spurting, but its not. Address these with simple bandaging as needed. In treating bleeds never remove a dressing, add to it as needed, as the blood soaks thru, add more on top of the previous.
Kinda forgot to mention that in the presence of any emergency, have someone dial 911 immediately, if its only you and the patient dial 911 first, then begin the work....
This is kind of vague and I apologize but I hope it helps....
Bruce