EMT Bleeding, Musculoskeletal, Head and Spine

Arteries

Carries blood away from the heart. Normally oxygenated (except pulmonary and umbilical arteries)and are responsible for supplying oxygen and nutrients to tissues throughout the body

Aorta

Largest artery, originates at left ventricle and extends to abdomen. Distributes oxygenated blood to all parts of the body

Pulmonary

Carries deoxygenated blood from the heart to the lungs

Brachial

Inside upper arm artery that supplies blood to the arm and hand.

Radial

In the wrists

Carotid

Located in the neck

Femoral

Medial portion of femur

Veins

Carries blood towards the heart. Most carry deoxygenated blood back to the heart (except pulmonary vein and umbilical veins, carrying oxygenated blood to the heart)

Capillaries

Only one cell thick enables the exchange of water, oxygen, carbon dioxide, and many other nutrients and waste chemical substances between blood and surrounding tissues

Detailed Order of Blood Flow:

1. Superior/Inferior Vena Cava: Deoxygenated blood returns to the heart.

2. Right Atrium: Chamber receiving oxygen-poor blood.

3. Tricuspid Valve: Valve between right atrium and right ventricle.

4. Right Ventricle: Chamber pumping blood to the lungs.

5. Pulmonary Valve: Valve leading to the pulmonary artery.

6. Pulmonary Artery: Carries blood to the lungs for oxygenation.

7. Lungs: Blood picks up oxygen and releases carbon dioxide.

8. Pulmonary Veins: Carry oxygen-rich blood back to the heart.

9. Left Atrium: Chamber receiving oxygen-rich blood.

10. Mitral (Bicuspid) Valve: Valve between left atrium and left ventricle.

11. Left Ventricle: Chamber pumping oxygen-rich blood to the body.

12. Aortic Valve: Valve leading to the aorta.

13. Aorta: Largest artery, distributing oxygenated blood to the body.

Perfusion

Circulation Within Tissues In Adequate Amount To Meet Cells Need For Oxygen

Shock (hypoperfusion)

Failure To Provide Adequate Circulation (Blood Is Not Circulating)

Cardiogenic

- Heart Loses Ability To Pump Blood/Not Circulating Blood & O2

Septic

Infection (Usually Bacterial) Of Blood -> Usually The Appendix (Appendicitis)

Anaphylaxis

Severe allergic reaction

Hypovolemic

Decreased Water Volume -> Blood Gets Thicker And Slower

Hemorrhage

Bleeding

Hemorrhagic Shock

Low Blood Volume Results In Inadequate Perfusion

Average Amount of Blood in an Adult

6 Liters

Maximum blood loss tolerated for an adult

no greater than 20%

Signs and Symptoms of Being Hemorrhagic

Rapid, Weak (Thready) Pulse

Clammy (Moist, Sticky, Cold) Skin

Rapid And Shallow Respirations 

Hypothermia (Due To Decreased Perfusion And Evaporation Of Sweat)

Shivering stops and temperature decreases quickly (Enzymes can function under 94 degrees F)

Thirst and Dry Mouth

EMS Treatment for Hemorrhaging

Control bleeding

Elevate feet (if no suspected neck injury)( getting blood out of/away from the injury)

Cover with blanket (if body is too cold, patient becomes unconscious)

Oxygen (15 Liters Per Minute via Non Rebreather)

Characteristics of Bleeding

(Order from most to least dangerous)

Arterial: bright red spurting blood

Venous: dark red non-spurting blood

Capillary: easily controlled oozing blood

Control Bleeding

Direct pressure with bandage

Elevate injury

Bleeding continues, add more dressings (don't remove the dressings, pile them on instead)

Use pressure points (joints) to control

Tourniquet (Last Resort to Control Life Dangering Bleeding)

Wrap bandage around injury, twist and tie

Write TK and time applied on patients forehead

(May lose a limb if bleeding doesnt stop/tourniquet on for too long)

MAST Pants (Military Anti-Shock Trousers) or PASG (Pneumatic Anti-Shock Garments)

Stabilizes and controls blood loss in fractures of pelvis and femur

puts pressure on the wound which limits blood flow + limits amount of pain

(made due to the Vietnam War)

Nose Bleed Directions

Have pt lean forward and pinch nostrils

Apply gauze under pts upper lip

Apply ice over nose

Hematoma (bruise/contusion)

Capillaries are damaged allowing blood to seep into tissue

Hematemesis

blood in vomit (pools up in the stomach)

Hemoptysis

Coughing Up Blood

Internal Bleeding Signs

pain, tenderness, bruising, swelling, broken ribs, bruises on chest distended abs

Skeletal System

Protects internal organs, contains 206 bones

Pelvis

Connects the base of the spine to the rear limbs

Lower Extremity (Legs)

Includes foot, thigh, and hip regions

Upper Extremity (Arms)

The deltoid region to the hand

Mechanism of Injury (MOI)/ How the Injury Happened

Used to determine how likely it is that a serious injury has occured

Direct blow? Indirect blow? Twisting force? High-energy injury?

(A low-speed fender-bender in a parking lot is much less likely to cause a life-threatening injury than a rollover accident on the freeway.)

Significant Mechanisms of Injury

Ejection from vehicle

Death in same passenger compartment

Falls over 20 feet

Roll-over of vehicle

High-speed vehicle collision

Vehicle-pedestrian collision

Motorcycle crash

Unresponsive or altered mental status

Penetrations of the head, chest, or abdomen

Fracture

Broken Bone

Closed Fracture

Does not break skin

Open Fracture

External Would from Fracture

Signs of Fractures

Deformity, tenderness, guarding(holding/protecting it), swelling, bruising, etc

Dislocation

Disruption of a joint

Sprain

Joint Injury; tearing of a ligament

Strain

Stretching or tearing of a muscle

Emergency Care

To evaluate injured limb check for CMS

Circulation (pulse and capillary refill), Motor function, and Sensation

Cover wound; apply splint; apply ice if swollen

Rules of Splinting

Remove clothing from the affected area

Note CMS (neurovascular) status

Immobilize the joints/bones above and below injured area

Traction Splint

Legs only

Hazards of Improper Splinting

Damage nerves, tissues and blood vessels

Reduced distal (blood flow in vessels farthest from the heart)circulation

Aggravate the injury

REMEMBER: ULNA IN, TIBIA TUCKED (CLOSER TO THE INNER SIDE OF THE BODY)

Spinal Column

Vertebrae protects spine

Cervical and lumbar are most susceptible to injury

Cervical (anything related to the head)

Thoracic (ribs)

Lumbar (lifting)

Sacrum

Coccyx

(Descending Order)

Extra facts

Cartilage can shift/swell and cause a cartilage disc

Movement of head or neck could make the head/spine injury worse

Effects of nerve damage depends on nature and location of the injury

Assessment of Spinal Injuries

MOI: MVA (Motor Vehicle Accident); fall; trauma; hanging; etc.

If patient is conscious ask the following:

Does your neck or back hurt?

What happened?

WHere does it hurt?

Can you move your hands and/or feet?

Can you feel me touching your fingers and/or toes?

Medical Care I

Restore airway using spinal precautions

Manually immobilize cervical spine

Medical Care II

Apply cervical collar

Medical Care III

Immobilize patient on long board with head blocks

Signs and Symptoms of Head Injuries

Visible skull fractures

Bruising around eyes and behind ears

Failure of pupils to respond to light

Unequal pupils

Unconsciousness

Loss of sensation or numbness

Nausea and Vomiting

Combative or abnormal behavior

Heachache

Clear fluid from nose or ears (CSF: cerebral spinal fluid)

Stiff neck

Inability to move any body part

Tingling

Medical Care IIII

Manually stabilize the head and neck

Establish airway (jaw-thrust if needed)

Control bleeding (no direct pressure on skull fracture)

Apply C-collar and immobilize patient

Oxygen (15 LMP via NRB)

Monitor vital signs

Skull Fracture Care

Emergency Care for Spinal Injuries

Supports head position as found if cannot move

Cervical Collar

Helmets

Leave the helmet in place if it does not compromise airway or prevent improper immobilization

Removing a Helmet

Remove a helmet only to care for life-threatening condition

Remove helmet, following local protocol, when face guard prevents giving ventilations

With many helmets, faceguard can be removed/pivoted so helmet is left on for ventilations

For athletic helmets, first unsnap and remove jaw pads

Removing Helmets with Non-pivoting Faceguard

Requires two rescuers

First rescuer slides one hand under neck to support base of skull and holds lower jaw with other

Second rescuer tilts helmet back slightly as first rescuer prevents head movement

Second rescuer pulls helmet back until chin is clear of mouth guard

Second rescuer tilts helmet forward slightly moving helmet back past base of skull, then slides it straight off

Backboarding

Backboarding PT2

Positioning Patients on a Long Backboard

Three or more rescuers needed

Position long backboard beside patient

One rescuer maintains head in line while other rescuers take position (head line rescuer is in charge of the operation)

On cue from rescuer at patients head, other rescuers roll the patient towards them as a unit

Slide backboard next to patient

On cue, other rescuers roll patient as a unit

Patient is secured to backboard using straps

Concussion

Traumatic Brain Injury (Temporarily interferes with the way your brain works, and it can affect memory, judgement, reflexes, etc.)(brain bounces back and forth in the skull)

Signs and Symptoms

Drowsiness

Confusion

Headache

Loss of consciousness

Memory loss (amnesia)

Nausea and Vomiting

Seeing flashing lights

Alarming Signs and Symptoms

Changes in alertness and consciousness

Convulsions (seizures)

Muscle weakness on one or both sides

Repeated vomiting

Unequal pupils

Unusual eye movements

Walking problems