Download Patient Assessment

Wilderness
First Aid
Wilderness
First Aid
HS 223
Midterm test Review
Introduction
Wilderness
First Aid
Definition: Wilderness medicine protocols are in effect when
you are more than one hour from definitive
medical care.
Differences between Wilderness and Urban setting:
Time with patient: This can be anywhere from an hour to
days at a time
Environment: You may be dealing with extreme
environments in addition to the
injured or ill patient.
Improvisation: You may need to create tools for treatment
and evacuation from what is available
Communications: May be limited or unavailable
Introduction
Wilderness
First Aid
When are you required to render First Aid?
• Job requires it and you are working
• Preexisting Relationship
• Once you start rendering First Aid
Negligence/Good Samaritan Laws:
Good Samaritan laws are designed to protect individuals
that render first aid. They will be in effect as long as the
first aider does what a normal, reasonable person with the
same level of training would do.
Legal Issues
Wilderness
First Aid
Consent:
There are 2 basic types of consent:
•Informed Consent: When a reliable patient gives consent
to treatment after being informed of
the risks and benefits
•Implied Consent: A legal assumption that an unreliable
patient would want help during an
I must get back
to my ship or
emergency situation. An unreliable
Captain Ahab
will go fishing
patient is considered to be any patient
without me
who is not fully alert and oriented as to
who or where they are. Implied consent
also applies to minors(under18) whose
parents are not available to give consent
Legal Issues
Wilderness
First Aid
General Guidelines:
•Try to know basic medical history of traveling companions
•Only do that which you know
I’m sure glad that
Walmart has started
training it’s employees
in exercise ECG’s
•Make sure patients level of care does not decrease
•Write down everything you do and
observe while treating patient (documentation)
•Periodically take a refresher course in Wilderness First Aid
•Emphasis should always be on PREVENTION
Legal Issues
Wilderness
First Aid
Blood Pressure
Normal Adult Blood Pressure
120/80
Systolic:
The pressure of the blood against the artery
walls when the heart is contracted
Diastolic: The pressure of the blood against the artery
walls when the heart is relaxed
SYSTOLIC
DIASTOLIC
SOUND
FREE FLOW
Blood
Pressure
FLOW STOPPED
EQUAL
FREE FLOW
Wilderness
First Aid
Blood Pressure
Estimated Blood Pressure from Pulse Points
Can only determine Systolic Number
Carotid……….…….50
Brachial……………60
Femoral……………70
Radial………………80
Pedal…………….…90
Blood
Pressure
Wilderness
First Aid
Body Systems Approach
Circulatory
Respiratory
CRITICAL
SYSTEMS
Nervous
Musculoskeletal
Skin
Endocrine
General
Concepts
Need to know:
Structure
Function
Problems
Wilderness
First Aid
Circulatory
Structure:
Heart -Pump
Vessels-Arteries, veins, capillaries
Volume- Blood,
cells, other fluids
Function:
Maintaining adequate
perfusion pressure
Problem:
Shock
General
Concepts
Perfusion:
Forcing fluid across
tissue under pressure
Wilderness
First Aid
Respiratory
Structure:
Neuro drive
Upper Airway -Lips to Larynx
Lower Airway- Larynx to Alveoli
Alveoli
Diaphragm and Chest Wall
Function:
O2 in, CO2 out
Problem:
Respiratory distress/failure
General
Concepts
Wilderness
First Aid
Nervous
Structure:
Central Nervous System
•Brain & Spinal Cord
Peripheral Nervous System
•Nerves extending from Spinal Cord
Function:
System Integration
Voluntary/Involuntary
Problems:
Spinal Cord Injury
Increasing ICP
(Intra-Cranial Pressure)
General
Concepts
Wilderness
First Aid
Musculoskeletal
Structure:
Muscle TypesStriated (skeletal)
Smooth (Blood Vessels)
Cardiac
Bone TypesProblems:
Long bones
Stable/Unstable
Joints
injuries
Function:
Protection
Support
General
Concepts
Wilderness
First Aid
Skin
Structure:
Epidermis
Dermis
Adipose Tissue (FAT)
Sweat Glands
Blood Vessels
Muscle
Function:
Protection
Thermoregulation
General
Concepts
Problems:
Loss of Integrity
Wilderness
First Aid
Endocrine
Structure:
Pituitary
Parathyroid &Thyroid Glands
Thymus
Adrenal Glands
Pancreas
Ovaries
Testes
Function:
Hormone Regulation
Problems:
Increased/Decreased Production
General
Concepts
Wilderness
First Aid
Compensation Mechanisms
•
The body continually tries to maintain homeostasis
Homeostasis- Relative constancy in the internal environment of the body…
•
In a wilderness context you must weigh the short term
gains versus the long term damage or consequences
Examples of ways the body compensates:
Shivering
Sweating
Changes in heart rate
Changes in breathing rate
Shell/Core effect
Core/Shell effect
General
Concepts
Wilderness
First Aid
Level of Consciousness
Brain is comparable to an onion in that they
both have layers that can be peeled away (Injured)
=
Outer Layers- Higher function (Reasoning skills, Fine motor skills)
Inner Layers- Basic life functions (Lizard Brain)
(Breathing, Heartbeat, Compensation mechanisms)
General
Concepts
Wilderness
First Aid
Ischemia/Necrosis
Ischemia…..Inadequate Local Perfusion
Necrosis…....Tissue Death
Intravascular
•Embolism
•Clot
Extravascular
•Swelling
•Angulation
•Pinched/Crushed
Swelling Curve
Anything that irritates the body will cause swelling
Bleeding
Majority of swelling occurs in first 6 hours
Edema (Abnormal Fluid Accumulation)
Can continue to swell for up to 24 hours
General
Concepts
Hours 1
6
12
18
24
Wilderness
First Aid
Determining Level of Consciousness
AAAAVPU-
General
Concepts
Alert and oriented to Person, Place, Time and Events (A+Ox4)
Alert and Oriented to Person, Place and Time (A+Ox3)
Alert and Oriented to Person and Place (A+Ox2)
Alert and Oriented to Person (A+Ox1)
Responds to Verbal Stimulus (V)
Responds to Painful Stimulus (P)
Unresponsive (U)
Wilderness
First Aid
Patient Assessment
Why:
•Gather Information
•Organize a Response
•Anticipate Problems That May Develop over a Period of Time
•Treat Patient as a Human Being
•Learn and use their name
•One of the main objectives is to calm the patient down
Patient
Assessment
Wilderness
First Aid
Patient Assessment
Scene
Survey
Initial
Assessment
Focused History
& Physical Exam
Patient
Assessment
Wilderness
First Aid
•Self
Patient Assessment
Safety
Universal Precautions
•Rescuers
•Bystanders
•Patients
M.O.I.
(Mechanism of Injury)
Scene
Survey
•Trauma (Tends to happen from Speed)
•Medical (Tends to develop over time)
•Environmental
•Spinal (Is it enough to cause Spinal Injury)
Patient
Assessment
• # of Patients
• # of Rescuers
• # of Resources
• Triage
Numbers
Wilderness
First Aid
Patient Assessment
Circulatory
Rules:
•
•
•
Treat as you Find
5 Minute Rule
•Pulse
•Severe Bleeding
What do they have that will
kill them in less than 5 minutes
Quick Body Check
(If M.O.I. Is due to Trauma)
Initial
Assessment
Respiratory
•Breathing
•Airway
Patient
Assessment
Nervous
•Brain/AAAAVPU
•Spine Stabilization
Wilderness
First Aid
Patient Assessment
Rules:
•
Complete and then treat
History
Finish everything before you do anything
Vital Signs
O nset
P rovocation
Q uality
R adiate
S everity
T ime
Symptoms
A llergies
M edications
Pertinent History
Last Intake/Output
Events preceding Incident
Focused History
& Physical Exam
Pulse: Rate, Rhythm, Quality (Adult 60-90)
Physical Exam
Respirations: Rate, Sounds, Rhythm (Adult 12-20)
Head-to-Toe
(Inspect, Palpate, Auscultate)
Blood Pressure: Method of Measurement
Checking for:
Skin: Color, Temperature, Moisture
Deformities, Contusions, Swelling, Tenderness, Wounds
AAAAVPU
Temperature
Patient
Assessment
Check:
Head, Neck, Chest, Abdomen, Pelvis, Extremities, Posterior Body
Wilderness
First Aid
Shock
Shock occurs when the tissues or organs of the body are inadequately
supplied with oxygenated blood.
Types of Shock:
Hypovolemic: Loss of fluid from bleeding, sweating, vomiting, diarrhea and/or severe burns.
Cardiogenic: Failure of the heart to adequately pump blood.
Vasogenic: Loss of vascular tone resulting in an increased vascular space.
( Spinal Cord Injury, Sepsis, Anaphylaxis)
Stages of Shock:
Compensatory:
Shock
Peripheral vasoconstriction, increased HR and increased
respiratory rate to keep blood pressure within normal
limits to maintain adequate perfusion pressure.
Decompensatory:
Blood pressure starts to drop and inadequate perfusion begins
Irreversible:
Organs begin to die from inadequate perfusion
Wilderness
First Aid
Shock
Signs & Symptoms:
Early: LOC: Anxious, restless, disoriented
HR:
Rapid, weak and, thready
RR:
Rapid and shallow
SCTM: Pale, Cool and clammy (may be pink and warm with vasogenic shock)
Symptoms: Patient may feel nauseated and may vomit, and
may complain of dizziness and/or thirst.
Late:
BP:
Falls, Radial pulse weakens and eventually disappears
Pupils: Progressively slower to respond
Treatment:
Don’t wait for shock. Treat before serious signs develop
Look for and treat underlying causes
Reassure the patient, keep them physically and emotionally calm,
maintain AIRWAY
Keep patient warm
Keep the patient flat with legs elevated no more than 12 inches when appropriate
Administer fluids orally if care is extended and the patient can tolerate them.
Monitor the patient closely for deteriorating vital signs.
Shock
Wilderness
First Aid
Shock
ASR (Acute Stress Reaction)
Sympathetic
Speeds up critical systems
Parasympathetic
Slows down critical systems
Temporary vascular dilation
Patient will usually faint
Problems:
ASR mimics true shock
Pain masking
ASR is a temporary condition controlled by the Autogenic nervous system
Differences between True Shock and ASR:
ASR goes away after a short period
Blood Pressure will increase in ASR (Sympathetic)
ASR can trigger other medical conditions
i.e. Epilepsy, Diabetes, Heart Disease
Shock