Emergency Care Midterm

five criteria to distinguish first aid

1. usually administered after the injury or illness occurs at the location where it occurred

2. consists of one-time or short-term treatment

3. treatments are simple and require little or no technology

4. can be administered by people with little training and even by the ill/injured person

5. administered to keep the condition from worsening while the injured or ill person is awaiting medical treatment

role of the first aid provider

1. recognize the emergency

2. decide to help

3. take the appropriate actions - size up the scene and ask if you may help

4. determine what is wrong with the person

5. give first aid

3 components of evidence based practice

best research, patient values, and clinical experience

why evidence based practice is important

something that is discovered today via research that is useful for clinical practice

life and death

needs care within 45 minutes

significant injuries that need immediate medical intervention

sprains, strains, contusions, and fractures

minor injuries/illnesses that need care

cold, flu, etc

injury

• occurs during a scheduled game, practice, or conditioning session

• needs the care of a medical personnel

• misses at least one day of activity

3 grades of ankle sprains

mild, moderate, and severe

first aid competencies

• recognizing, assessing, and prioritizing the need for first aid

• providing care by using appropriate knowledge, skills, and behaviors

• recognizing limitations and seeking additional care when needed

standard of care

the level of care required of a first aid provider

requirements to meet the standard of care

• do what is expected of someone with first aid training and experience

• treat the person to the best of your ability

skilled first aid

means the difference between life and death, rapid recovery and long hospitalization, or a temporary disability and a permanent one

ACL injury rate of females

4-8x more than males

recruitment order for males vs females

males: hamstrings, quads, gastroc

females: quads, hamstring, gastroc

the 3 e’s

EAP, equipment, experience

important parts of the EAP

• communication

• making sure all the equipment is ready

• making sure everyone is prepared

all call

everyone on the medical staff from both teams comes out onto the field

code leader

person who is in charge

airway management specialist

only job is to open up an airway

unaffiliated neurologist

neurologist on the field; neutral

physically active

refers to traditional athletes, youth sports, military, industrial, and general population

causes of sudden death in the physically active

cardiac arrest, head injuries, heat stroke, external sickling, asthma, anaphylaxis, direct trauma, lighting, and hyponatremia

things the EAP should include

• key personnel

• phone numbers and address of building

• location of emergency equipment/what equipment is available

• emergency and non-emergency situations

best possible outcomes

preparation, teamwork, communication, and flexibility

calling for help

• location

• the location phone number

• what happened/is happening

• details of victims needing help

• victim condition

• what is being done for the victims

best practices for the EAP

• parents with no medical training should review the document

• coaches should review the document

• document should be written at eighth grade level

• no grey area about role delination

weak points in the EAP

• communication

• back up plan

• equipment breakdown

• role breakdown

survey the scene

• look for dangers/hazards

• assess how many people need help

• what is wrong with the victim

• what happened to the victim

• is anyone available to help

primary survey

• check for responsiveness

• check for breathing and a pulse

• call 911

• get an AED

when to call 911

• if the condition is life threatening

• is the condition could get worse on the way to the hospital

• if moving the person could cause further injury

• if the person requires the help of EMS

• if there would be a delay in getting the person to a hospital

level of consciousness

• A - alert

• V - respond to verbal stimulus

• P - responsive to painful stimulus

• U - unresponsive to any stimulus

signs of breathing

• visible - chest rise and fall

• felt - on ear from mouth or hand on chest

• heard

• mirror steams

legal duties to act

• employment requires it

• preexisting relationship exists

good samaritan laws

• acting with good intentions

• providing care without expectation of compensation

• acting within the scope of your training

• not acting in a grossly negligent manner

personal protective equipment

• disposable medical exam gloves (latex-free)

• eye protection (goggles or face shield)

• mouth-to-barrier device when giving CPR

• face covering to prevent disease transmission

victim consent

• implied in an unconscious victim, child/infant, and medically handicapped

• must get consent from a conscious adult or if a child’s parent is present

• victims can refuse consent

universal precautions

theory of treating all blood or blood tainted fluids/materials as if infected with HIV or HBV

checking an unresponsive person

• tap and shout

• call 911

• check for breathing

  • if breathing, put in recovery position

• get an AED

• begin CPR

• control bleeding if needed

• check for identification tag

checking a responsive person

• ask if they are okay

• introduce yourself

• obtain consent

• ask the person for location and date

• check for breathing difficulty

• check for bleeding

• shout for help

• look for medical identification tag

SAMPLE

S - symptoms

A - allergies

M - medications

P - pertinent past medical problems

L - last food or drink

E - events leading up to the injury/illness

DOTS

D - deformity (looks abnormal)

O - open wounds (bleeding is seen)

T - tenderness (ask about pain)

S - swelling (larger than usual)

secondary survey order

1. eyes and ears - check for CSF

2. head and neck

3. shoulders

4. chest and abdomen

5. hips

6. legs and feet

7. arms and hands

PEARLA

pupils equal and reactive to light and accommodating

recognition of sudden cardiac arrest

• should be suspected in any athlete who is collapsed and unresponsive

• should be suspected in any non-traumatic collapse

• brief seizure-like activity is common after collapse

• occasional gasping after collapse

emergency planning for SCA

• written EAP

• emergency communication system

• trained responders in CPR/AED

• AED location

• early defibrillation (3-5 mins)

left ventricular cardiomyopathy

#1 cause of sudden death in athletics; enlargement of the walls of left ventricle

commotio cordis

hit in the chest causes heart to go into irregular rhythm

components of the rhythm strip

• ECG paper

• wave forms

• wave complexes

• wave segments

• wave intervals

sinus rhythm

• originate in SA node

  • NSR - normal sinus rhythm

  • sinus bradycardia

  • sinus tachycardia

  • sinus arrhythmia

• inherent rate of 60-100

• base all other rhythms on deviations from sinus rhythm

secondary survey

• physical exam

• occurs after primary survey and life-threatening conditions are ruled out

• history, vitan signs, and head to toe examination

• conditions you can see, hear, and feel

• skin temp, respiration, bleeding, crepitus, deformity

• should take ~60 seconds

decerbrate posturing

curled fists/wrists

decorticate posturing

arms on chest

shallow breathing

shock, bleeding, or heat exhaustion

deep, gasping, or labored breathing

airway obstruction, chest injury, or heart disease

no breathing

respiratory arrest

bright frothy blood coughed up

lung damage, rib fx, or penetrating injury

cool and moist skin

shock, bleeding, or heat exhaustion

cool and dry skin

exposure to cold

hot and dry skin

heat stroke or high fever

white skin

shock or poision

blue skin

lack of oxygen

red skin

body temperature

medical history

• what hurts/ problem (chief complaint)

• allergies or medications

• pre-existing illness

• food eaten - allergy or poisoning

• events prior to injury/illness

• pain

concussion

• a traumatic brain injury

• rapid head movement causes chemical changes and positive stretching of brain cells

greatest challenge with a concussion

you cannot prove your symptoms; subject to patient

concussion symptoms

• headache

• tinnitus

• nausea

• dizziness

• blurred vision

• photophobia

• tenderness

• numbness

level of consciousness

• alert

• lethargic

• stuporous

• semicomatose

• comatose

functional testing

exertional tests performed to seek evidence of early post-concussion healing

down athlete

injured athlete during game, practice, or function

1 quart

the amount of blood loss in an adult that can be fatal

2-5 minutes

time it takes to bleed to death

management of bleeding

1. apply pressure with hands

2. apply dressing and press

3. apply tourniquet

APAIL

• abrasion

• puncture

• avulsion

• incision

• laceration and amputation

abrasion

• capillary bleeding

• painful

• cleanse with water

• bandage

• moist wound healing

laceration

• jagged edges

• venous bleeding

• sutures or skin closures

• scarring

incision

• clean cut by sharp object

• profuse bleeding

• shock

punctures

• removal in ER

• control bleeding

• shock

• high infection rate

avulsion

• part of the skin loose or torn

• control bleeding, needs to be cleaned and debrided

• medical referral

amputation

• treat shock

• place recovered part in a sterile/waterproof bag and pack on ice

arterial

• spurting, bright red blood

• most serious and life threatening

• wound unlikely to clot

RICE

Rest

Ice

Compression

Elevate

inflammation is good

• first stage of healing

• protects us from foreign invaders

• removes debris in preparation for tissue repair

• initiates and controls the repair process

inflammation is bad

• involved in most human diseases

• increases tissue damage

signs of inflammation

• redness

• heat

• swelling

• pain

• loss of function

role of inflammation

• defends body against foreign substances

• dispose of dead/dying tissue

• isolates the injury site

• triggers repair and regeneration

injury

any event that impairs tissue structure or function to cause the inflammatory response

mactrotrauma

impact or contract

microtrauma

overuse, cyclic loading, or friction

mast cells

• located adjacent to capillaries

• release histamine in chemical mediators

• signal the neutrophils to injury site

permeability changes

• histamine and bradykinin increase vessel permeability

• contraction of vessel walls leaves gaps allowing leukocytes to move out

• protein-rich fluids escape through the gaps and enters

chemotaxis

chemical signaling

neutrophils

• first to arrive at the site of trauma

• cannot reproduce

• contribute to the injury site

• “suicide and friendly fire”

macrophages

• arrive once the beachhead has been established

• continue the battle

• clean up the dead and dying

• initiate repair and regeneration

angiogenesis

builds new blood vessels

granulation tissue

builds up new tissue; collagen

shock

hypoperfusion; state of depressed body function in which body tissues do not get enough oxygenated blood

causes of shock

• pump failure - heart attack or injury

• fluid loss - bleeding, burns, sweating, diarrhea, vomiting

• pipe failure - dilate: anaphylaxis, fainting, spine injury

cardio

heart’s ability to push oxygenated blood throughout body

neurogenic

enlarged blood vessels and inability to fill them after CNS damage