5/2/2018. Notice. Putting Humpty Dumpty Back Together Again

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Notice All EMS Live@Nite presentations will be recorded (both audio and video) and available for

By participating in EMS Live@Nite, you consent to audio and video recording and its/their release and

1 Notice All EMS presentations will be recorded (both audio and video) and available for public viewing online. By participating in EMS you consent to audio and video recording and its/their release and or publication. You have been fully informed of your consent and release prior to your participation. Putting Humpty Dumpty Back Together Again Amber Jones, AEMT, SEI Spokane County EMS 1

Back To The Basics NREMT Assessment BSI/Scene Safety Scene Size-up Primary Survey History (If able/time) Secondary Assessment Reassessment Scene Size-Up MOI Number of patients More resources?

2 Back To The Basics NREMT Assessment BSI/Scene Safety Scene Size-up Primary Survey History (If able/time) Secondary Assessment Reassessment Scene Size-Up MOI Number of patients More resources??? Consider spinal immobilization per your local protocol Primary Survey General impression LOC/GCS Life threats/chief complaint ABC s Manage any life-threat ASAP Recognize Shock Transport priority 2

body has lost the ability to adequately provide blood/oxygen to organs and tissues Compensated: Body can

3 Secondary Assessment Head to toe assessment Look, listen, touch DCAP-BTLS Manage secondary injuries as appropriate (if time permits) Reassessment ABC s Vitals GCS Injuries/Patient Complaints Let s talk Shock The body has lost the ability to adequately provide blood/oxygen to organs and tissues Compensated: Body can maintain Decompensated: Body can not maintain Irreversible: Loss of profusion to vital organs Untreated shock = DEATH 3

4 Signs/Symptoms Altered LOC Pale, Cool, Diaphoretic Nausea/Vomiting Changes in vital signs Anxiety Feeling of impending doom Cardiogenic Inadequate pumping of the heart MI CHF/Pulmonary Edema Bradycardia Tachycardia Irregular Heart beat Cardiac Tamponade Chest injury causing blood to build up in the sac around the heart, impairing the ability to pump blood Becks Triad????? Muffled heart tones JVD Narrowing blood pressure Rapid transport Treat for Shock 4

5 Sepsis Spine Injury Anaphylactic Reactions Neurogenic/Distributive Shock Spinal Precautions per your protocol CMS All extremities Include pulses, skin CTC, sensation, movement Skin temp above/below injury site Appropriate size c-collar Pad Voids/Under Patient Rapid transport to appropriate facility Spinal Cord Injuries NREMT Spinal Motion Restriction Recommendation as of September 1,2016 Should be considered to include individuals who have sustained blunt trauma through a highenergy mechanism and any of the following: Altered level of consciousness Drug or alcohol intoxication Inability to communicate Spinal column pain and/or tenderness Neurologic complaints (e.g., numbness or motor weakness) Anatomic deformity of the spine Distracting injury (injuries so severely painful that neck examination is unreliable, [e.g., severe thoracic trauma, long bone fractures, crush injuries, large burns]) 5

6 Hypovolemic/Hemorrhagic Burns Bleeding Crush Injuries Systolic BP <90? Peripheral pulses? Bleeding you can see? Color? Flow? Location? Burns Remove any burning/smoldering clothing. Remove any jewelry as necessary ABC s Oxygen if needed, reassess airway Estimate severity, cover with dry, sterile dressing Treat for Shock Prevent heat loss Transport to appropriate facility 6

7 Crush Injuries Compartment syndrome? Tissue/vessels are constricted within a space from swelling or tight dressing Causes tissue/cell death Fracture or crush causes bleeding and swelling Treat for shock, ALS, IV, EKG, Splinting, Rapid Transport, Tourniquet needed? Fractures/Splinting Don t Splint to Death CMS prior to and after splint/bandage application If injury is found with CMS then treat, if CMS is not found place in anatomical position if able Splint in position of function 7

8 Fractures/Splinting Open Wounds Abrasions Scratches/Scrapes Clean any debris out Avulsions Tearing away or tearing a flap of skin Clean area If still attached place flap back in place and wrap with moist dressing Open Wounds Amputations Surgical or traumatic removal of a body part Control bleeding If severe, apply tourniquet Treat for shock Rapid transport Take the amputated part with you if possible 8

9 Open Wounds Lacerations Cuts Treat based on severity and type of bleeding Punctures- object tears through the skin and destroys underlying tissue Manage bleeding Do not remove impaled object that is still in place Secure object prior to transport Open Wounds Perforating Trauma that is associated with an entrance and exit wound Stop the bleeding! Do not stick your finger in the holes Treat with occlusive dressing if open chest wound Watch for compromise/change in respiratory status/vitals Diminished lung sounds are common Tracheal Deviation and JVD = LATE SIGNS Post Test 1. Which is not part of the Primary Survey? a. Chief Complaint b. Level of consciousness c. Number of patients d. General Impression 9

10 Post Test 2. Becks Triad can happen with Cardiac Tamponade. a)true b)false Post Test 3. Which vital sign might suggest Hypovolemic Shock? a. BP 88/62 b. BP 104/65 c. BP 96/64 d. BP 100/54 Post Test 4. Capillary bleeding always requires a tourniquet. a. True b. False 10

11 Post Test 5. Spinal Immobilization is required for all trauma patients with a penetrating injury. a. True b. False Secret Question Special thanks to Sheila Crow Stitchin Dreams Embroidery wcsocrow@yahoo.com For providing our Secret Question prize 11

Secret Question Winners Were you the first to answer tonight s Secret Question? Get your prize!

We would like to feature you and your agency in next months presentation, so please also send in anything you would like

Rosters & Certificates All EMS Live@Nite materials including roster, handouts and certificates are available on the

12 Secret Question Winners Were you the first to answer tonight s Secret Question? Get your prize! If so, please healthtraining@inhs.org with your name and sponsoring agency address. We would like to feature you and your agency in next months presentation, so please also send in anything you would like to share about your organization including upcoming events, recent calls, employment opportunities, etc. Rosters & Certificates All EMS Live@Nite materials including roster, handouts and certificates are available on the following INHS Health Training website: LiveatNite-Courses/ Please fax or documents to or healthtraining@inhs.org. Thank Thank You You 12

12/12/2017. Notice. Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection.

12/12/2017. Notice. Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. Notice All EMS Live@Nite presentations will be recorded (both audio and video) and available for public viewing online. By participating in EMS Live@Nite, you consent to audio and video recording and its/their