Module 2

Question 1

Shock

Answer 1

-Any serious illness or injury has the potential to cause shock
~If not treated early, it can get worse and become life threatening
~Early signs can be difficult to detect
*Person may begin to appear uneasy restless, or worried
~More serious signs can emerge gradually
*Person may become confused
*Skin may become pal, cool, and sweaty
-Inadequate tissue perfusion
~Results when the tissue does not receive adequate blood supply
-Problem can be
~Pump-Heart
~Pipes-Blood Vessels
~Fluid-Blood Volume
~Signal-Nerves

Question 2

General Causes of Shock

Answer 2

-Decreased Blood Volume
~Bleeding
~Vomiting
~Diarrhea
-Heat Failure
~Heart Attack
~Sever heart Disease
-Vessel Changes
~Damage to Brain or Spinal Cord
~Allergies and/or Drugs

Question 3

Shock

-Early recognition, treatment, and activation of EMS are essential for survival

Answer 3

-Help body maintain adequate oxygen
~Ensure open airway, confirm normal breathing, control external bleeding
~If no difficulty breathing, lay person flat on the ground
-Maintain a normal body temperature
~Insulate on top and underneath
~Be careful not to overheat
-Give nothing to eat or drink
-Keep as comfortable and calm as possible

Question 4

Internal Bleeding

Answer 4

-A significant blow can create injury and bleeding inside the body
~Especially true for blood vessels and organs in chest and abdomen
~Internal bleeding can be difficult to detect
~Suspect it if chest or abdomen was hit hard
~Signs of shock may be earlier indication that internal bleeding is occurring

Question 5

Control of Bleeding

Answer 5

-Bleeding occurs when blood vessels are damages
~Bleeding
*Arterial
**Bright red and spurts from wound
8vein
**Dark red, flowing steadily
*Can overwhelm clot-forming fibers
*Reduces oxygen delivered to body
*Heavy or uncontrolled, can become life threatening
~Pressure applied directly until bleeding stops is standard method
~Activate EMS immediately for heavy bleeding
~Exposes you to body fluids, use disposable gloves or improvised barrier

Question 6

Tourniquets

Answer 6

-Utilize simple binding method around limb to stop blood flow
~Commercial tourniquets are easy to use
*Compressing band is placed around limb inches about open injury
*A solid handle is twisted to tighten band evenly around limb until bleeding stops
*Handle is secured in place to maintain constriction
~Improvised tourniquets can be created with materials such as triangular bandages and something solid to twist with
~Tourniquet can be considered primary step to control severe limb bleeding if direct pressure can’t be applied effectively

Question 7

Hemostatic Dressings

Answer 7

-If injury located where a tourniquet or direct pressure is ineffective
~Impregnated with an agent that speeds up the clotting process
~Packed into an open wound and held in place with direct pressure or pressure bandage
~Pressure maintained until bleeding has stopped
~Training is essential to learn the proper application

Question 8

Using Commercial Tourniquet

Answer 8

-Always follow manufacture’s directions
~Loop compressing band around injured limb
~If unable to loop over, unfasten band, wrap it around, and refasten
~Place band a few inches above wound site, not over joints
~Hand tighten band firmly around limb
~Twist handle to compress
~Lock handle, using mechanism provided

Question 9

Using Improvised Tourniquet

Answer 9

-To improvise tourniquet using a triangular bandage
~Fold bandage lengthwise ~2 inches
~Place center a few inches above wound site, not over a joint
~Wrap around limb, bring both ends back to top, make sure bandage remains flat
~Tie half a knot over the top of bandage
~Place stick on top of half-knot and tie full knot over it
~Twist stick to compress band until bleeding stops and secure

Question 10

Tourniquets

-If using commercial or improvised tourniquets

Answer 10

• Document time and provide to EMS

- Do not loosen or remove tourniquet unless directed by qualified medical personnel

Question 11

Amputation

Answer 11

-Is the complete detachment of a body part
~If an amputation has occurred, quickly assess for and control any severe bleeding
~Have person sit or lie down, even if it is on the ground
~Activate EMS
-Once person is stable, locate severed part
~Wrap it in a sterile or clean cloth
!Place in tightly sealed plastic bag or waterproof container
~Cool bag or container with ice or cold pack
~Do not soak part in water and do not put directly on ice
~Give to EMS for transport to hospital
-Calm, comfort, and reassure the person
~Reassess regularly until EMS takes over

Question 12

Impaled Object

Answer 12

-An object that penetrates a body part and remains embedded
~DO NOT remove an impaled object
*Can act like a plug, helping to prevent serious blood loss
~Movement of object or body part could create additional injury
~Cut away clothing to confirm skin penetrated
~Look for any serious bleeding
-Keep affected body part immobilized to prevent movement
~Activate EMS for significant impaled object or if doubt about severity
~Use clean pads to apply direct pressure straight down around base
~DO NOT apply pressure to the object itself
~Place bulkier padding around it for stabilization
~Hold padding in place with your gloved hand or a bandage

Question 13

Impaled Object

Answer 13

-Impalement on larger, immovable object requires additional care
~Support person’s weight to relieve pressure
~Use padding to stabilize
~Reassure person
~Reassure person and injury until EMS takes over

Question 14

Impaled object in the Eye

Answer 14

-Is likely caused by a small object being propelled at a high rate of speed
~Activate EMS
~DO NOT allow person to rub the eye
~Never try to remove embedded object
~Stabilized a large object with a clean pad
*Place protective cover over object
*Cover uninjured eye with pad
*Bandage over both eyes
~With smaller objects, loosely cover both eyes with pads and bandage
~Calm, comfort, and reassure

Question 15

Open Chest Injury

Answer 15

-A penetrating injury through the chest wall can disrupt the chest’s ability to draw air into the lungs
~Expansion of chest during breathing creates suction pulling outside air through airway into lungs
~An open wound on chest wall will allow air to be drawn into chest
*Will get progressively worse and significantly impair breathing
-Condition could deteriorate quickly
-Activate EMS immediately

Question 16

Open Chest Injury

-Treatment

Answer 16

• Remove clothing to expose injury site
• Check for exit injury, treat more serious injury first
• Do not seal open wound with airtight dressing
• If possible, allow person to assume a comfortable position for breathing
• Regularly assess person and injury until EMS providers assume care
• Be prepared to perform CPR if breathing stops

Question 17

Open Abdominal Injury

Answer 17

-Injury to abdomen may result in evisceration, in which abdominal organs protrude through an open wound
~Protect organs from further injury activate EMS
~Allow person to assume position of comfort
~Cover protruding organs with a thick , moist dressing
~DO NOT push organs back inside body
~DO NOT apply direct pressure on wound or exposed internal parts
~Regularly asses until EMS arrives

Question 18

Spinal Injury

Answer 18

-Injury to the spinal cord can result in temporary or permanent paralysis
~Paralysis of chest muscles can result in loss of breathing
~Movement can result in additional injury to spinal cord or surrounding tissue
~Suspect spinal injury when
*Obvious injuries to head, neck, or back
*Numbness, tingling, burning, or a loss of sensation in arms, hands, legs, or feet
~Lack of symptoms or obvious injury doesn’t mean spine is not injured
*Best to assume a spinal injury exists
*Stabilize head with your hands

Question 19

Spinal Injury

-Establishing airway is a higher priority that protecting suspected spinal injury

Answer 19

-Tilt head and lift chin to maintain open airway or give rescue breaths
-When head, neck, or back injury suspected, best to leave in position found
~If airway threatened, quickly roll person as needed to clear and protect
~Keep head, shoulders, and torso from twisting as best as you can
-If you need to leave person to get help, place in a recovery positions to protect airway before you go

Question 20

Brain Injury

Answer 20

-Significant swelling or bleeding inside the skull can result in increased pressure that damages delicate brain tissue
~Suspect brain injury when blow to head results in diminished level of responsiveness
~Activate EMS
~Stabilize head with your hands
~DO NOT attempt to stop flow of blood or fluid from ears or nose

Question 21

Brain Injury

-If seizure occurs, protect head and prevent from bumping into nearby objects

Answer 21

• DO NOT restrain person tightly nor place anything in mouth
• Seizures generally last for a few minutes
• When seizure stops, assess person’s breathing and ability to respond
• Provide CPR if necessary

Question 22

Concussion

Answer 22

-A brain injury that results in less immediate or obvious signs
~Suspect concussion when person
*Unable to recall events just before or after incident
*Moves clumsily
*Answer questions slowly
*Shows a change in mood or personality
~Additional signs
*Looking stunned or dazed
*Headache
*Nausea
*Dizziness
*Difficulty in balance
*Visual problems

Question 23

Concussion

-No current evaluation process for those trained in first aid

Answer 23

• If suspected, person should be evaluated by heath care provider or EMS as soon as possible
• Because of potential progressive nature of concussion, best to not allow person to perform actions that could pose risk for additional injury until assessed by heath care professionals

Question 24

Types of Injuries to Bone and Joints

Answer 24

-Sprain
~Damage to ligaments
~Bone to bone connection
-Strain
~Damage to tendons
~Muscle to bone connection
-Fracture
~Break in a bone
~Open vs Close
-Dislocation
~Misalignment of a joint

Question 25

Signs and Symptoms

Answer 25

- Pain - Swelling - Non-weight bearing - Limited range of motion - Point tenderness

Question 26

Red Flags

Answer 26

- Limited circulation, sensation, movement - Open Fracture (Fx) - Significant swelling - Angulation - Multiple Fracture - Fracture to a long bone or pelvis

Question 27

Types of Fractures

Answer 27

``` -Closed ~Suspected or known Fx with skin intact -Open ~Fx with break in skin over it ~Bone may or may not be protruding ~High risk for infection ```

Question 28

Fractures can be life threatening`

Answer 28

- Bones are extremely vascular - Fractures to the femur and/or pelvis can result in hypovolemic shock - Look for other injuries

Question 29

Assessment of Bone injury

Answer 29

- Don't get distracted - Consider mechanism of injury - Expose, observe for wounds - Assess for Circulation, Movement, and Sensation - Ask about popping, cracking, etc. - Consider splinting options - Look for other complaints related to injury

Question 30

Femur Fx

Answer 30

- Stabilize - Manage for shock - Be aware of other injuries - Request ALS (advance life support)

Question 31

Pelvic Fx

Answer 31

``` -Life threating ~7.6 to 19% mortality rate ~50% if open book -Pelvic wrap is essential -Manage shock -Request EMS or ALS -Immediate evacuation ```

Question 32

Signs and Symptoms

Answer 32

- Pain - Unstable pelvis - Length discrepancy or rotational deformity of lower limb - Bruising, swelling

Question 33

Compartment Syndrome

Answer 33

``` -Normal ~Cross-section through calf showing muscle compartments -Swollen ~Swelling of muscles causing compression of nerves and blood vessels -SxS (Signs and symptoms) ~Pain out of proportion ~Pain with passive flexion ~Swelling ~Paresthesia *Pens and needles/ numbness ~Decreased PMS (Pulse, motor, sensation) ```

Question 34

Dislocated Shoulder

Answer 34

- Most commonly dislocated large joint - Usually dislocated anteriorly - Is difficult to immobilize

Question 35

Dislocated Knee

Answer 35

-Very serious injury ~High rate of amputation -Evacuate Immediately

Question 36

Management

Answer 36

``` -Splint, splint, and splint ~Reduces pain, damage, potential for reinjury -Check CMS before and after ~Ensure it is not too tight -Position of Function -Immobilize the joint above and below the injury -Consider transport time -Ability to splint -Circulation, Movement, Sensation -Recognize increased risk -Early is better ```

Question 37

Management | -RICE

Answer 37

- Rest - Ice - Compression (should you do this) - Elevation

Question 38

Review of Skin | Integumentary System

Answer 38

``` -Largest organ of the body ~Function of the skin *Protection from pathogens *Sensation *Maintain fluid within body *Thermoregulation ```

Question 39

Thermal Burns

Answer 39

-Causes include contact with hot liquid, flames, hot gases or hot object as well as radiant heat from a hot environment or extended exposure to the sun ~Most only require basic care ~More serious require additional care *Deep with blistering or broken skin *Larger with shallow depth *Burns of face, neck, hands, genitals, and feet can result in complications *Difficulty breathing from inhaling hot air indicates serious injury in airway ~All serious burns should be evaluated by health care provider

Question 40

How much area does it cover?

Answer 40

-The greater the surface area affected, the worse it is ~Greater than 15% body surface area, consider it a sever burn ~One palm = 1% of body surface area ~Don't count 1st degree burns when assessing surface area

Question 41

Other Severe Burns

Answer 41

``` -If you see these, they are true emergencies ~Circumferential Burns *Wrap around body or extremity *Can inhibit blood flow *Can inhibit respiration ~Face Burns *Airway is a REAL concern *Even if it seems alright at first, can drastically worse ```

Question 42

Thermal Burns | -Make sure situation is safe for you to help

Answer 42

- If clothes or other materials are burning or on fire, act immediately to put fire out - Direct to stop, drop, and roll - Smother burning material with coat, rug, or blanket, or douse material with water - Activate EMS if necessary

Question 43

Thermal Burns | -Expose burned areas by removing, cutting, or tearing clothing away; if stuck to burn, cut around it

Answer 43

-If small (less than 10%), cool burn with water ASAP for at least 10 minutes ~Use clean, cool or cold dressing when water not available *Never use ice or frozen compress ~Gel-soaked burn dressings to promote cooling of burn ~Watch for signs of overcooling especially in children ~Remove jewelry near burned area

Question 44

Thermal Burns | -After Cooling

Answer 44

-Separate fingers or toes with sterile dressings or pads ~Leave blisters intact ~Loosely cover with dry, clean pad or sheet to keep clean and protected ~Avoid natural remedies ~Never apply butter, ointment, lotion, or antiseptic to serious burns -Give person NOTHING to eat or drink -REASSESS PATIENT ~Things can get worse

Question 45

Electrical Burns

Answer 45

-Be Safe ~Turn off electrical current before touching person ~If cannot stop flow of electricity, do not enter area or attempt to give care ~Electric shock can cause an abnormal heart rate ~When safe, perform CPR and use an AED if one available

Question 46

Electrical Burns -When body part contacts exposed electrical source, electricity can travel from point of contact to a second point of contact that is grounded

Answer 46

- Hands and feet are common points of contact - If responsive and no longer in contact with source, look for burns at suspected points of contact - Cool burn as with a thermal burn - Person should seek professional medical care, serious internal injuries can occur

Question 47

Chemical Burns

Answer 47

-Some chemicals can damage skin tissue on contact ~Priority is to quickly remove chemical to minimize damage ~Immediately flood affected area with large amounts of water *Brush off any dry powder with a gloved hand or cloth prior to flushing *Do this carefully to avoid additional exposure to injured person or yourself -Carefully remove contaminated clothing while continuing to flush area for at least 15 minutes -Some chemicals take longer than others to be flushed away ~If still painful, resume flushing ~If no longer painful, cover visible burns loosely with a dry, clean dressing -Seek further medical attention

Question 48

Chemicals in the Eyes

Answer 48

-Corrosive chemicals splashed into an eye can quickly damage eye tissue ~Affected eyes will become painful and appear red and watery ~Immediately flood eye with large amounts of water ~Hold eye open and flush continuously for at least 15 minutes or until EMS takes over -Flush outward from nose side of affected eye ~If wearing contacts, have person try to remove as flushing continues ~If water not available, normal saline or commercial eye irrigating solution can be used ~Activate EMS as quickly as possible ~Contact Poison Help line at 1-800-222-1222 for treatment advice *If not available, talk to EMS dispatcher or medical provider

Question 49

Nosebleeds

Answer 49

-Occur when small blood vessels inside the nostrils are ruptured ~Have person sit up straight with head tilted forward, chin down ~Pinch soft portion of nose with thumb and index finger and hold for ~10 minutes ~Do not tilt head back or lie person down ~Have person spit out any blood that collects in mouth ~Ongoing bleeding or developing shock; seek further medical help

Question 50

Injured Tooth

Answer 50

- Immediate reimplantation is greatest chance of tooth survival - Be sure there is not airway compromise!!! - Control bleeding, have person gently bite down on clean absorbent pad - Handle tooth only by chewing surface - Do not touch root, never scrub tooth or remove tissue fragments

Question 51

Injured Tooth | -Alternatives that are more effective for storage of tooth than saliva

Answer 51

-Keeping tooth moist helps extend time for reimplantation -At a minimum, have the person spit into a cup and place tooth in the saliva; avoid storage in water -Other solutions ~Hank's Balanced Salt Solution ~Egg whites ~Coconut water ~Whole milk