EMR Chapters 6-8 Flashcards
(37 cards)
Direct Ground Lift
The direct ground lift is a standard move that can be used to move a patient from the ground or floor to a bed or stretcher. This move is not recommended for use on patients with possible neck or spinal injuries. Depending on the size of the patient, Two or three rescuers can accomplish this move. To accomplish a direct ground lift, the patient should be lying face up or supine, and the patient arms should be placed over their chest. You and your helpers should line up on one side of the patient. One rescuer should be at the patient’s head, another at his or her hips and thighs. Each rescuer should drop one to the ground and keep the other foot planted on the floor. The rescuer at the patient’s head should place one arm under the patient’s neck, and the grasp the far shoulder to cradle the head the other arm should be placed under the patient’s back, just above the waist. The second rescuer should place one arm above, and one arm below the patient’s thighs. On the signal of the rescuer at the head, both rescuer should lift the patient up to the level of their knees. then, on signal, the rescuers should roll the patient towards their chests. finally, on signal, everyone should stand while holding the patient. The patient cannot be moved, reversing the process, when it is time to place him or her in a supine position.
Extremity lift
An extremity lift requires two people. This lift is ideal for moving a patient from the ground to a chair or a stretcher. It also can be used to move a patient from a chair to a stretcher. It should not be performed, however, if there is a possibility of head, neck, spine, shoulder, hip, or knee injury, or any suspected fractures to the extremities that have not been immobilized.
The patient should be placed face up with knees flexed. You should kneel at the head of the patient, placing your hands under his or her shoulders. Have your helper stand at the patient’s feet and grasp his or her wrist. Direct your helper to pull the patient into a sitting position while you push the patient from the shoulder. do not have your helper pull the patient by the arms if there are any signs of suspected fractures. Slippery arms under the patient’s armpits and grasp the wrist. Once the patient is in a semi-sitting position, have your helper crouch down and grasp the patient’s legs behind the knees. Direct your helper, so you both stand at the same time. Then move as a unit to one carrying the patient. Try to walk out of step with your patient to avoid swinging the patient. The rescuer at the head should direct the rescuer at the feet when to stop the carry in one to place the patient down in a supine or seated position.
Direct carry method
The direct carry is performed to move a patient with no suspected spine injury from a bed, or from a bed level position to a stretcher. First, position the stretcher perpendicular to the bed, with the head end of the stretcher at the foot of the bed. Prepare the stretcher by unbuckling the straps and removing other items. Then, two rescuers should stand between the bed and the stretcher, facing the patient. The first rescuer should slide an arm under the patient’s neck and cup the shoulder, while the second rescuer slides a hand under the patient’s hip and lifts slightly. The first rescuer, then slides his or her other arm under the patient’s back, while the second rescuer, place his or her arms around the patient’s hips and calves. Finally, both rescuers should slide the patient to the edge of the bed, lift/curl him, or her toward their chests, and rotate and place the patient gently onto the stretcher.
Draw sheet method
The draw sheet method is an additional way of moving a patient with no suspected spine injury from a bed to a stretcher. This move may be performed from the side of the bed, or from either the head, or the foot of the bed, which ever gives you best access to the patient. To perform the draw sheet method from the side of the bed, begin by loosening the bottom sheet under the patient and positioning the stretcher next to the bed. Be sure to secure the stretcher, so it does not move while transferring the patient from the bed to the stretcher. next, adjust the height of the stretcher, to match the level of the bed, lower the rails, and unbuckle the straps. Both rescuers should reach across the stretcher and rule the sheet against the patient. Grasp the sheet firmly at the patient’s head, chest, hips, and knees. Finally, draw the patient onto the stretcher, sliding him or her in one smooth motion.
several devices have been developed in recent years to make the task of moving patients from stretcher to bed easier and safer. Devices such as slider boards, and slide bags are in the use of many hospitals and nursing care homes.
Single-operator stretcher
A type of wheeled stretcher, which is the typical equipment used for packaging and loading a patient and is the most appropriate device for moving a patient over smooth, terrain. This type of stretcher allows a single operator to load the stretcher into the ambulance, without the assistance of a second individual. The undercarriage is designed to collapse and fold up as the stretcher is pushed into the ambulance.
Dual-operator stretcher
Another type of wheeled stretcher that requires a second individual to lift the undercarriage prior to pushing it into the ambulance.
Electric/pneumatic stretcher
Another type of wheel stretcher that is equipped with an electric or pneumatic mechanism that will lift and lower it at the touch of a button. It minimizes the need for rescuers to lift a stretcher with a patient on it, thereby significantly reducing the risk of back injury.
Bariatric stretcher
Another type of wheel stretcher that is designed to accommodate oversized patients up to a maximum of 1600 pounds. It is wider and stronger and can be loaded into the ambulance with a specialized winch system.
Other types of equipment for transportation: portable stretcher
This type of stretcher is also known as a folding stretcher or flat stretcher. It is much lighter than a standard wheel stretcher, and it makes the task of moving a patient downstairs or out of tight spaces much easier. Portable stretchers are typically a combination of canvas and aluminum, and they usually fold or collapse for easy storage.
Flexible stretcher
This stretcher is made of rubberized canvas or other flexible material, such as heavy plastic, often with a wooden slats sewn into pockets. The flexible stretcher usually has three carrying handles on each side. Because of its flexibility, it can be useful in restricted areas or narrow hallways .
Stair chair
The stair chair helps rescuers move seated medical patients down stairways, and through tight spaces where I traditional stretcher will not fit. Most stair chairs are made of sturdy folding frames with either canvas or hard, plastic seeds, and are easy to store. They have a wheels that allow rescuers to roll them over flat surfaces. Some models have a tractor tread mechanism that allows them to easily slide down stairways just by tilting them.
Basket stretcher
This device is sometimes referred to as a Stokes basket. It is most commonly used for wilderness or cliff rescue situations. Used in rescue situations and to transport over rough terrain.
Scoop stretcher
This device is typically made of hard plastic or aluminum. It is called a scoop stretcher, because it splits vertically into two pieces, which can be used to “scoop”the patient up. these stretches are ideal for moving patients in the position in which they are found.
Long spine board
Spine boards are also known as backboards. The long spine board is used for patients who are suspected of having a significant spinal injury. Backboards have been proven to cause pain, agitation, and respiratory compromise in some patients. Current research suggests more discretion with the use of long back boards, with their use reserved for patients with the following:
- Blunt trauma and altered level of consciousness
- Spinal pain or tenderness
- Neurologic complaint, such as numbness or motor weakness
- Anatomic deformity of the spine
- High energy mechanism of injury, and any of the following: Drug or alcohol, intoxication, inability to communicate, or a distracting injury. A distracting injury is the one that prevents the patient from realizing pain in the neck or spine, such as a significant injury to the forearm or chest.
Vest-type extrication device
The extrication vest is used to help immobilize and remove patients found in a seated position in a vehicle. It wraps around the patient’s torso, stabilize the spine and has an extended section above the vest with side flaps for stabilizing, the patients head and neck. Rescuers, secure the patient’s head, neck, and torso with straps and padding. The vest has handles that aid in lifting the patient out of the vehicle and onto a long spine board.
Full-body immobilization device
The most common type is the full body vacuum splint. It consists of a large airtight bag filled with tiny beads. As the patient is placed on the device, it can be molded to fit the shape and contours of the patient’s body. Once it is in place, a portable vacuum is activated to remove the air from the bag. This result is a hard, cast like splint that immobilizes the patient.
Pedi-board
Special, spinal immobilization boards are made to fit infants and children. The back of a child’s head is a larger proportionately than an adults, so boards have a depression in the head and to fit. However, it is still necessary to pad, the child body from the shoulders to the heels to ensure the airway is in a neutral position, while the child is secured on the board.
Log roll
To move a prone patient to a supine position and ensures stability of the head and spine, where in injury is suspected, perform a log roll. A log roll can also be used for transferring a supine patient onto a long backboard when there is a likelihood of neck or back injury. However, the lift and slide technique has been shown to cause the less movement of the neck and spine during transferred to a long backboard. A log rule can be accomplished with as few as two rescuers, but three is ideal to minimize twisting of the patient’s spine during the procedure.
Lift-and-slide technique
The lift and slide technique was shown to result in less movement of the head and spine during transfer onto a long backboard. Performing this maneuver requires a minimum of five and often six rescuers. One rescuer maintains manual stabilization of the head, while a cervical collar is placed. the other four rescuers position themselves on either side of the patient and, on the count of the rescuer at the head, lift the patient a few inches off the ground. An additional rescuer or bystander may be necessary to carefully position the backboard or stretcher beneath the patient. On the counter, the rescuer at the head, everyone carefully lowers the patient down onto the backboard. The patient is then secured to the backboard.
Patient Restraint
Attempting to restrain a patient is dangerous and can place you, your fellow, rescuer, and the patient at risk for injury. Consider all your options such as verbal de-escalation, or waiting for law-enforcement to arrive before attempting restraint, and always follow local protocols. Follow these guidelines when attempting to restrain a patient:
- Ensure that you have adequate assistance of at least four people, including yourself
- clearly planned the action so all participants are clear about their responsibilities
- stay outside of the patient’s range of motion until ready to act
- Once the plan is clear, act immediately
- Approach the patient all at once, with each assistant assigned to control a particular limb.
- Talk to the patient calmly during the restraining process
- Secure all limbs with the appropriate restraining equipment
- Do not secure the patient face down
- Following restraint, check the patient’s airway, breathing, and circulation often.
- Clearly document the reason for restraining the patient as well as the procedure and equipment used.
- Ensure that the group uses only the force required to effectively restrain the patient.
Communication
The sharing, or exchanging of information or news. It is extremely important that you understand the characteristics of good communication and what to do when it goes bad. The following is a list of some of the individuals you are likely to communicate with on a regular basis:
- patients
- your partner
- other EMS personnel
- fire personnel
- law enforcement personnel
- hospital personnel
- bystanders
- family members
- friends of patients
Types of communication
- verbal. Words and sounds that make up the language we speak.
- nonverbal. Body language, eye contact, and gestures.
-written. The use of letters and words to express the language we speak. - visual. Signs, symbols, and designs.
The communication process
For any communication activity to be effective, it must have the following components: there must be a sender or one who introduces a new thought or concept, or initiates the communication process. There is the message, which is the thought, concept, or idea being transmitted. There is the receiver or the one for whom the message is intended.
Transmitting the message
Research suggests that 55% of communication is delivered by way of body language, which includes gestures, expressions, posture, and many other physical manifestations. About 38% of the message is transmitted by way of the voice or its quality, tone, and inflections, which all express important pieces of the message. Only 7% of any given message is transmitted by this specific words used (verbal).
