Acute Care: Exam 1

Why is first aid important?

It is better to know first aid and not need it than to need first aid and not know it
First aiders do NOT diagnose

Who needs first aid?

Intentional and unintentional injuries constitute a major threat to public health and are referred to as the neglected epidemic.

4 Minute delay

a delay of as little as XX when a person's heart stops can mean death

Value of Self

Allows one to care for his or her injuries.
Allows one to direct others in proper care if they are too seriously injured.
Helps develop safety awareness and promote injury prevention.

Value of Others

Allows the trained person to offer proper assistance to family members, coworkers, acquaintances, and strangers.

Value in remote areas

Some settings demand that people be prepared to give first aid for an extended time:
-Urban areas after a disaster
-Remote occupations
-Remote communities
-Developing countries
Extra skills are sometimes required when delivering first aid in remote locati

First Aid

the immediate, temporary care given to an ill or injured person until professional medical care can be provided
Does NOT take place in proper medical care

First Aid and Law

A first aider can be sued, but the risk can be minimized.
-Obtain the victim's consent.
-Follow the guidelines in Advanced First Aid, CPR, and AED.
-Do not exceed your training level.
-Explain any first aid you are about to give.
-Once starting to care fo

Consent

Consent is permission that the victim must give before first aid can be given.
-It is unlawful to begin first aid without the victim's consent.
-Touching another person without his or her consent is known as battery.

Expressed Consent

Consent must be obtained from every alert, mentally competent person of legal age.
A nod of the head or verbal indication is acceptable.

Implied Consent

It is assumed or implied that an unresponsive victim would consent to lifesaving interventions.
An alert victim who does not resist the administrations of a first aider is also assumed to have given implied consent.

Consent: Children and Mentally Incompetent Adults

It is assumed or implied that an unresponsive victim would consent to lifesaving interventions.
An alert victim who does not resist the administrations of a first aider is also assumed to have given implied consent.
A police officer is the only person wit

Refusing Help

An alert and mentally competent adult can reject help. If this happens:
explain his or her condition to the victim, what you intend to do, and why it is necessary.
call 9-1-1.
try again to persuade the victim to accept care.
make sure you have witnesses o

Abandonment

Once you have responded to an emergency, you must not leave a victim who needs continuing first aid until another competent and trained person takes responsibility for the victim.

Negligence

Failure to follow the accepted standards of care, resulting in further injury to the victim

Having a Duty to Act

You do not have to help a stranger unless you have a legal obligation to that person, or you were involved in the events that led to the victim's injuries.
You have a duty to act if you...
-are designated by your employer as the person responsible for pro

Omission

is the failure to do what a reasonably prudent person with the same or similar training would do in the same or similar circumstances.

Commission

is doing something that a reasonably prudent person would not do under the same or similar circumstances.

Confidentiality

Only discuss information about the victim with those who have a medical need to know.
The law requires reporting rape, abuse, and gunshot wounds.

Good Samaritan Laws

Encourage people to assist others in distress by granting them immunity against lawsuits.
Good Samaritan laws protect the rescuer:
-acting during an emergency.
-acting in good faith with good intentions.
-acting without compensation.
-not guilty of malici

Injury Prevention

It is easier to prevent an injury than it is to treat one.
Effective prevention uses a combination of the 3 Es.
Education interventions attempt to change behavior through information.
Enforcement tries to reduce dangerous behaviors through the enforcement

Haddon Matrix

Strategy for identifying interventions; can be applied to any type of illness or injury
-Preevent phase: Interventions that attempt to stop or hinder
-Event phase: Interventions that attempt to modify the consequences
-Postevent phase: Focuses on returnin

Preevent phase

Interventions that attempt to stop or hinder

Event phase

Interventions that attempt to modify the consequences

Postevent phase

Focuses on returning the victim to the fullest of functioning

Victim Assessment

is a sequence of actions that helps determine what is wrong.

Primary Check determines

will determine if:
-there is illness or injury.
-whether the victim is responsive or unresponsive.
-if a life-threatening condition exists

Assessment Steps

Scene size-up
Primary check
Secondary check
SAMPLE history
Reassessment

Scene Size-up

-Look for hazards.
-Notice the potential for violence.
-Be observant of weapons.
-Reduce exposure to potentially dangerous body substances.
-Determine whether the problem is an injury or an illness

Primary Check

Identify life-threatening conditions so that you can immediately take action to treat the conditions.
-Responsiveness
-Circulation
-Breathing
-Severe bleeding

Alert Victim's Memory

Evaluate ability to remember
-What is your name?
-Do you know where you are?
-What are the month and year?
-What happened

Unresponsive Victim

RAP-CAB
R-Responsive
A-Activate Emergency Medical Services (EMS)
P-Position the victim on his or her back
C-CPR; start with 30 chest compressions if the victim is not breathing
A-Airway; open airway
B-Breaths; give two breaths and continue CPR

Responsive Victim

RAP-ABC
R-Responsiveness
A-Activate EMS
P-Position
A-Airway
B-Breathing
C-Circulation

Checking for breathing

Chest movement
Normal and abnormal breath sounds
Feeling adequate air movement

Checking for Severe Bleeding

Check for a large amount of blood.
-Around the victim
-On the victim's clothing
Control bleeding.
Wear exam gloves.

Positioning the victim

Most victims should not be moved.
Exceptions:
-Unsafe location
-Victim is face down and needs -CPR.
-Victim has difficulty breathing from vomit or secretions.
-First aider is alone and must leave to get help.

High arm in endangered spine (HAINES)

Keep left arm straight, extended above the head with upper part of the arm next to the head.
Bring right arm across the chest.
Place back of right hand against the left cheek and hold it there.
Bend the far leg at the knee and pull the bent leg to roll th

Left Side Advantages

Keeps the airway open
Delays vomiting
Delays a poison's effect
Relieves pressure on a pregnant woman's vena cava

Secondary Check Determines

Determine whether the cause or mechanism of injury was significant.
Assume a victim with a head injury also has a spinal injury.

Secondary Check responsive Victim

Ask if he or she can feel or wiggle the fingers and toes.

Secondary Check Unresponsive Victim

Check spinal cord with Babinski reflex test.

Signs

See
Feel
Hear
Smell

Symptoms

Things the victim feels
Things the victim can describe
Chief complaint

DOTS

Deformity
Open Wounds
Tenderness
Swelling

Finding the significant cause of injury

Check the head.
Check eyes (PERRL).
Check the ears.
Check the nose.
Check the mouth.
Check the neck.
Check the chest.
-Gently press inward.
Check the abdomen.
-Gently press on all four quadrants.
Check pelvis.
-Gently press inward on tops of hips.
-Press

Skin condition

Color
Temperature
Moisture

Hot and Dry or Moist skin

Excessive Body heat (heat stroke, high fever)

Cool and Moist (clammy) skin

Poor circulation, hear exhaustion, shock, acute stress reaction

Cold and moist skin

body is losing heat

Cold and dry skin

exposure to cold and has lost considerable heat (hypothermia)

Pink skin

normal color in non-pigmented areas regardless of skin complexion - lining of the eyelids, inside mouth, fingernail beds

Red (flushed) skin

dilated blood vessels; excess circulation to that part of the body

White (pale)

Constricted blood vessels from blood loss, shock, hypothermia, emotional distress

Blue (cyanosis) skin

lack of oxygen in the blood from breathing or heart problems

Yellow (jaundice)

liver disease or failure

Capillary refill test

Press fingernail or toenail for a few seconds and release.

Exposed Injury

Explain what you are doing.
Maintain privacy.
Prevent exposure to cold.

Medical Identification

Check the following for
Wallet
Purse
Necklace
Bracelet

SAMPLE History

symptoms, allergies, medications, past medical history, last oral intake, events leading up to the illness or injury

Recheck

Serious illness or injury: every 15 minutes
Unresponsive victim: at least every 5 minutes

Triage

process of prioritizing multiple victims
-immediate care
-delayed care
-"walking wounded"
-dead