Open wounds break the skin and result in various amounts of bleeding. There are four common types of open wounds: abrasions(scrapes), lacerations (cuts), avulsions (skin torn away), and punctures. A major open wound is one with severe bleeding, deep destruction of tissue, or a deeply embedded or impaled object. Do not waste time washing the wound. Apply a sterile dressing, immediately apply direct pressure and elevation. If the bleeding does not stop, find the indirect pressure point on an artery supplying blood to the injured limb, and apply pressure to that point. If an object is impaled in a victim, DO NOT REMOVE it. By removing the object you can cause more damage to the surrounding tissues. Apply a bulky dressing to stabilize the impaled object and control bleeding. |
| March 6 | *** Musculoskeletal Injuries --Extremities Lab |
| March 8 | *** Musculoskeletal Injuries --Extremities Lab Cont. |
| March 11-19 | Spring Break |
| March 29 |
***Sudden Illnesses. At anytime, you may encounter a person having a medical emergency. This category includes diabetic emergencies, strokes, heart attacks, seizures, poisoning, and more. A change in level of consciousness, dizziness, nausea, vomiting, difficulty breathing, abnormal pulse or skin temperature are all indicators of a medical emergency. Fainting is a common sudden illness characterized by partial or complete loss of consciousness. Fainting is caused by a temporary reduction of blood flow to the brain and is actually classified as a type of shock. The victim will often exhibit signs of shock --- dizziness, sweating, nausea, and cool, moist, pale skin. When adequate blood flow is returned to the brain, the patient's level of consciousness usually improves. Fainting does not harm the patient, but the cause of the fainting, and injuries associated with fainting can hurt the patient. Position a person who feels faint, or who has fainted, on a the ground. Elevate their legs to help increase blood flow to the brain and core. Check and manage the victim's Airway, Breathing, and Circulation. Loosen any restrictive clothing and look for medic alert tags. Diabetes mellitus is a very common cause of medical emergency. Diabetes is brought about by decreased insulin production or by the inability of the body's cells to use insulin properly. The most common diabetic emergency is hypoglycemia (low blood sugar). This can occur when the patient takes too much insulin, skips a meal, over exercises, or vomits a meal emptying the stomach of its sugar source. When the blood sugar is reduced it directly affects the brain causing an altered level of consciousness and can eventually lead to unconsciousness (diabetic coma) if not properly cared for. The onset of hypoglycemia is very quick and is characterized by abnormal behavior and pale, cool, moist skin. The second type is hyperglycemia, or high blood sugar. This usually has a slower onset and is characterized by warm, red, dry skin, thirst, nausea, vomiting, abdominal pain, and fruity-smelling breath. Although a hyperglycemic victim has too much blood sugar, their condition is not as immediately detrimental as hypoglycemia. For this reason, it is recommended that sugar be given to any patient who is suspected to be having a diabetic emergency. You must be very careful when assessing a person for diabetes. The altered mental status that quickly arises with hypoglycemia can be misleading and appear that the victim is drunk. Look for medic tags and ask the person and any associated person if they have a medical condition such as diabetes. Give the victim sugar in the form of fruit juice, candy, non diet soft drinks. If the patient's condition is caused by low sugar, the candy will help very quickly, and if the patient has hyperglycemia, the excess sugar will do no further harm. If the patient is unconscious at anytime, do not put anything into their mouth, monitor ABC's, and call EMS immediately.
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| April 3 |
***Sudden Illnesses Cont. When the normal activity of the brain is interrupted by injury, disease, fever, or infection, the normal electrical activity becomes irregular and can cause a sudden loss of body control. This is known as a seizure. A seizure is usually preceded by a visual hallucination, a strange sound, taste, or smell, or a feeling of impending doom. These warning signs are known as an aura. Seizures range in severity from mild black-outs to uncontrolled muscular contractions that may last for minutes. A chronic seizure disorder commonly controlled with medication is known as epilepsy. If you are on the scene of a person having a seizure, absolutely DO NOT try to restrain them. Protect the person from injury, remove nearby objects (furniture, etc), and try to protect the head. Do not hold any part of the patient down, and never place anything in their mouth. When the seizure is over, position the patient on their side to allow for drainage of any fluids that might cause obstruct the airway and endanger the patient further. In caring for the patient after the seizure, realize that they may be very embarrassed. It is possible, in this lapse of mental control, for them to loose control of bodily functions as well as speech, etc. When the person stops seizing, they will be drowsy and disoriented. Be reassuring and comforting while you do a secondary survey and look for any injuries. It is necessary for you to call EMS if the seizure lasts for longer than a couple of minutes. When the seizure is happening, the person is not getting adequate oxygen. If they seize for an extended period of time, there can be devastating effects. Likewise, if the person seizes repeatedly, they are in the same dangerous position. EMS should also be activated if the person is severely injured, if you are uncertain about the cause of the seizure, if the victim is pregnant, a known diabetic, an infant/child, or if the victim fails to regain consciousness. A stroke is a condition of altered function caused when an artery in the brain is blocked or ruptured, causing the necessary supply of oxygenated blood to be disrupted or causing bleeding in the brain. Known also as a cerebrovascular accident, a stroke causes irreparable damage to the tissues of the brain. A stroke is, more or less, a heart attack of the brain that is most commonly caused by a blood clot that lodges in an artery of the brain and prevents adequate passage of oxygenated blood to the cells. When the blood flow is reduced to the brain, a patient may have a transient ischemic attack (TIA). This is a mini-stroke and often a warning sign. A stroke victim will appear or feel ill. They make exhibit some of the following signs: sudden weakness/numbness generally to one side of the body (face, hands, legs). They may have difficulty speaking, blurred vision, severe headache, dizziness, confusion, loss of consciousness, or ringing in the ears. In short, you can suspect a stroke 90% of the time if the patient exhibits facial palsy (droopy, paralyzed, or asymetrical appearance of the face), arm weakness (difficulty lifting extremity or squeezing hand), or trouble speaking. As with other sudden-onset illnesses, you must primarily care for the ABC's, immediately activate EMS, position patient to one side to allow for drainage of fluid and vomit from the mouth ( keep the airway clear). There is now a newly found clot-busting drug that can help an individual experiencing a stroke if the medication is administered fast enough. It is essential that a stroke patient go to the hospital immediately. For more information on STROKES and to evaluate your personal risk level look at this site. Poisoning is a sudden illness that is brought about by external substances entering the body. Over two million poisonings occur annually in the US. Although some of these cases are murders and suicide attempts, most are accidental incidents often involving young children. A poison is any substance that can harm the body sometimes even seriously enough to create a medical emergency. We often think of poisons as being synthesized substances that have been ingested. It is possible that this may be the case, but living organisms also produce substances that are poisonous to humans. These are known as toxins and can be equally as deadly as store-bought chemicals. Poisons are classified into four types depending on the way they enter the body: ingested, injected, inhaled, or absorbed. Ingested poisons, poisons that are swallowed, can include many household/industrial chemicals, medications, plant materials, etc. Inhaled poisons enter the body upon inspiration through the forms of vapors, gases, and sprays. Absorbed poisons are taken into the body through unbroken skin and may or may not visibly damage the skin. Many are corrosives or irritating substances that can injure the skin, enter the blood stream, and then cause widespread damage to the tissues of the body. Many common insecticides and agricultural chemicals are absorbed poisons. Injected poisons are those that are inserted through the skin. These may include illicit drugs and venom injected by snake bites or insect stingers. Signs of poisoning include: nausea, vomiting, abdomen/chest pain, burns around the mouth, difficulty breathing, altered mental status, and seizures. Often the scene itself is the best indicator of what poisoning may have occurred. Follow these steps: **survey the scene, remove the victim from the source of the poison (remember not to become contaminated), do a primary survey, care for life-threatening conditions until EMS arrives, and follow any advice given to you by a Poison Control Center (PCC). The majority of poisonings happen within the home so stay alert to clues of the cause of the sickness. Preventing poisoning is the best thing to do. Keep products in their original containers, dispose of out-of-date products, use proper safety precautions, use symbols to identify poisonous substances, and KEEP all household chemicals and medication OUT OF THE REACH OF CHILDREN. To find the nearest Poison Control Center.
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| April 5 |
***Substance Misuse and Abuse. As a Citizen Responder, you may encounter many situations involving a patients use or abuse of alcohol or other substances. Although alcohol is a legal substance, it must not be forgotten that it is still a drug that affects the central nervous system and causes an altered mental status. Substance misuse and abuse are forms of poisoning and should be treated in much the same manner. When mind altering substances are involved, as with other medical emergencies (diabetic), it is possible for the patient to be aggressive and uncooperative when you try to help them. Provide what care you can only if you feel that you are not in danger. For care, follow the steps detailed above (**) for general poisoning conditions. If the patient becomes combative at anytime, withdraw immediately from the scene. A drug is classified as any chemical, natural or synthetic, that affects the functions of the body or mind when taken into the body or applied to the surface. When a drug is misused, it is either used for unintended purposes or used for appropriate purposes but in the wrong dosage. Excessive or persistent use of a drug without regard the medical implications is considered drug/substance abuse. If someone abuses drugs for a long period of time, they may become dependent on the drug. There are intertwined physical and psychological affects of drug dependence. After an extended period of use, the body requires the drug and likewise, there is a strong habitual attachment of the mind. After repeated exposures to a drug, the body becomes tolerant to its effects and requires larger doses. If one drug is combined with another, there may be a synergistic effect, something that cannot be achieved by either drug alone and multiplies the effects of both. Many of these factors, physical and psychological dependence, tolerance, and compulsive drug use, all combine to make an addiction. There are several categories of drugs that are necessary to mention here. Stimulants affect the nervous system to excite the user. Also known as 'uppers', stimulants directly affect the CNS, increase mental and physical activity, suppress appetite, and prevent fatigue. They increase the pulse and breathing rates, dilate the pupils, cause warm, flushed, and often sweaty skin. Examples include caffeine, amphetamines, and cocaine. Hallucinogens are substances that cause changes in mood, sensation, thought, emotion, and self-awareness. These drugs are known to excite the user, and distort the user's perception of time and space. they increase the pulse, dilate the pupils, and affect the patient so that she does not have an accurate concept of real time. Examples of hallucinogens are as follows: LSD, PCP, STP, and mushrooms. Depressants (downers) directly affect the CNS to create a relaxed state of consciousness. These include alcohol, barbiturates, Valium, and methaqualudes. Narcotics are drugs capable of producing an intense state of relaxation. These are often used to relieve pain and to quiet coughing. Many drugs are legitimately used for these purposes, but they are also abused. They affect the nervous system and change many of the normal activities of the body to create a feeling of well-being and sleepiness. Most narcotics are found in pill form, but heroin, a commonly abused narcotic is injectable. Substances such as opium, morphine, and heroin all fit into this category decreasing the heart rate and respirations, constricting the pupils, and having a potentially synergistic effect with alcohol. Examples include: codeine, demerol, morphine, and opium. Alcohol is the most widely abused and misused depressant. It affects the body by creating a relaxed feeling, decreases motor skills, and creates a false sense of warmth. Abuse of this drug leads to cirrhosis of the liver, memory loss and apathy as well as possible physical and psychological dependence. An alcoholic patient may not be under the influence of alcohol, but rather they may be in withdrawal from alcohol. This can cause a severe reaction when the patient has not had a drink, is too sick to drink, or has suddenly decided to quit drinking. A major symptom complex of withdrawal is delirium tremens (DT's) where the patient may experience seizures. This is a condition characterized by sweating, trembling, anxiety, and hallucinations. There is a high fatality rate associated with DT's. Marijuana (cannabis) also known as pot, grass, weed, reefer, ganja, tea, and dope is the most widely used illicit drug in the United States. This is a nonhallucinogenic, mind altering substance that creates a feeling of elation, distorts perceptions, and impairs judgment. It effects the body by increasing the pulse, causing visibly red eyes, throat irritation, and increased appetite. Marijuana can be smoked or made into food, but either way it contains the active ingredient THC. Smoking one joint is the equivalent of smoking one pack of cigarettes in terms of tar. It contains carcinogenic substances in high concentrations and highly affects the perceptions of the body. Drugs in General. When you are dealing with a person who is under the influence of a mind altering substance be sure that the scene is safe. It may be hard to detect their influence, so look for bottles, syringes, pills, drug paraphernelia, etc. Ask the victim and talk to people on the scene. Check the mouth for pills and breath odors that might be an indicator. Here are 6 Danger Signs that can be considered EMERGENCY INDICATORS of the victim's status: 1) Unconsciousness - if the person cannot wake up or is awakened and then goes right back out. 2) Breathing difficulty-weak, shallow breathing, or cyanosis (blueness) around the lips, in the mouth, eye lids, or nail beds. 3) Fever -- above 100 degrees. 4)Abnormal Pulse rate -- above 100 or below 60 beats per minute. Or if the rhythm is not regular. 5) Vomiting while decreased level of consciousness. 6) Convulsions or Seizures. If the person is experiencing any of these or combinations there of, EMS should be activated. General Care includes management of the ABC's, provide comfort and TLC, check responsiveness and level of consciousness, treat for shock, watch for vomiting, and position the patient on their side. Remain with the victim to prevent self injury, and if you are not sure of the substance that has been ingested consider calling a Poison Control Center for advice. Try to keep the victim awake and conscious. It is important to remember that many medical emergencies ( diabetes, epilepsy, etc) present symptoms similar to the signs of drug overdose. Do not make the mistake of jumping to conclusions about the person. Do not assume that the stuporous, slurry-speeched person is under the affect of drugs.
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| April 10 |
***Heat Related Emergencies. The body is a machine that operates with only 25% efficiency. It generates heat as a result of constant internal chemical processes. Some of this metabolic heat is needed to maintain normal body temperature (Av. 98.6 degrees F.), and some of it is lost to the environment. If the body is unable to regulate the amount of body heat given off, then an abnormally high body temperature (hyperthermia) results. Heat, sun exposure, and humidity often cause this potentially fatal situation. When the body gets too hot, excessive heat is removed by blood vessels in the skin dilating. Sweating is also a mechanism that the body uses to cool itself. In a humid environment, evaporation of perspiration is much slower. Since evaporative heat loss is thus reduced, then the moist heat can have dramatic effects on the body in a short amount of time. Hot humid environments tire people quickly forcing them to stop frequently. Thus, they avoid overexertion. Hot dry weather conditions often deceive people. They continue to work and remain exposed to the sun and heat for long periods of time - far beyond their body's tolerance. There are two types of heat emergencies. Heat exhaustion occurs when a victim is exposed to excessive heat for a prolonged period of time. The victim will appear pale and will have moist, cool, clammy skin. The individual perspires heavily and will drink lots of liquids, but their excessive sweating leads to a deficiency of salt in the body. This deficiency then causes heat cramps that involve painful muscular spasms. The best thing to do for such a patient is to move them from the heat to a cool, shaded area. Have them drink water and eat something to replenish the lost salts. Place cool, moist cloths over any spasming muscle to reduce the pain. If the person's skin appears to be hot and dry/moist this is an indication that the body's temperature-regulating mechanisms have failed. The body can no longer rid the body of its excess heat, and the person is essentially baking. This is a more severe form of heat emergency known as heat stroke. When the skin is hot, it is a true emergency. The victim will be breathing rapidly. They will have a full, rapid pulse, little to no perspiration, dilated pupils, and possibly an altered mental status. Immediately remove the patient from the hot environment. Remove excess clothing, and apply cool packs to the neck, groin, and underarms. Sponge the skin with wet towels and fan them aggressively. Note that young children and the elderly are at a much greater risk of heat and cold related injuries. Their heat regulating mechanisms are not as developed or as adequate as ours. When cooling an over-heated infant or child, start with lukewarm water and gradually decrease the temperature. |
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***Cold Related Emergencies.In a cold environment, the body can loose heat even faster than it is generated. The body adjusts for this by constricting the blood vessels in the periphery, shutting down perspiration, and increasing muscular activity (shivering) and the rate of metabolism. When the cooling affects the entire body, a condition called hypothermia (low body temp.) results. Over time the body will not be able to maintain an adequate core temperature possibly resulting in a fatality. Signs of hypothermia include: shivering (or lack thereof in the late stages), vague, slow, slurred speech, incoherence, numbness, apathy, and decreased level of consciousness and motor function. To care for hypothermia, call EMS and rewarm the victim. Remove all wet clothing. Place the victim in dry blankets in a warm environment, and give warm fluids (nonalcoholic) to an alert patient. You must gradually rewarm the person; if you rewarm them too quickly, cardiac problems may arise. The person may be in denial, but listen to the symptoms(not the victim) in this case. Localized cold injuries, also known as frostbite, affect only a specific portion of the body. This occurs in varying degrees and must be recognized by progressive symptoms. First, exposed skin reddens (light-skinned individual) or blanches (darker-skinned individual), and then it takes on a gray/white blotchy appearance. The exposed skin becomes numb because of reduced circulation, and then, as the freezing process continues, all sensation is lost and the skin becomes dead white. To care for a localized cold injury, first get the victim into a warm environment. Do not rewarm a limb that is going to refreeze. Rewarm the area. Do not rub or massage, and do not re-expose the limb to the cold. If the limb is frozen, await for EMS to immediately transport the victim to a hospital. At this point, there are ice crystals at the capillary level. Do Not rub the area as this will further damage the tissues. Do not let the person walk on the affected limb.
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| April 17 |
***Emergency Childbirth. The birthing process includes three main stages and a recovery stage. The first stage begins with the first contraction and ends when the cervix is fully dilated. Stage two begins when the top of the baby's head emerges and ends when the baby is born. The third stage begins when the baby is born and ends with the delivery of the afterbirth (placenta, umbilical cord, etc.). This will normally happen within 30 minutes following the birth of the baby. After this is the recovery phase including uterine contractions to control bleeding. If you massage the lower abdomen of the mother, you will help to stop the bleeding as well.
Delivery is a very emotional event for all involved. Your most important role is to provide emotional support for the mother. It may be important also to position the mother so that she is most comfortable for delivery. If you are present for a birth, it is important to have, at a bare minimum, clean towels and sheets, a plastic bag (for the placenta), and latex gloves. A bulb syringe and gauze pads are also important. When the infant emerges, support the head. Do not pull, but gently guide the baby as it moves through the cervix. Have a clean towel present to 'catch' the baby when it is born. After birth, clear the baby's airway, and help to maintain a normal body temperature by covering the baby in blankets. You may lay the baby on the mother's abdomen. Place a sanitary napkin or towel over the mother's vagina and massage the uterus to control the bleeding. Note the time of the birth. There are several complications that may arise during pregnancy. A prolapsed cord is a condition that occurs when a loop of the umbilical cord protrudes from the vagina while the baby is still in the birth canal. As the baby moves through the canal, it will compress the umbilical cord. This will cut off its blood supply, oxygen, and nutrients it needs for survival. If this happens, raise the mother's buttocks with pillows and have her pull her knees to her chest. A breech birth occurs when the infant's buttocks or feet present first. Or, the mother could have multiple births in which she will deliver more than one child. In this case, assist with the delivery of the other babies, and be sure to note the time of birth of each. If the mother is bleeding just treat for shock by keeping her warm (see shock above).
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| April 19 |
***Rescue Moves -- Lab.
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| April 24 |
***Special Needs; Delayed Help. For different patients, it is important to consider their special needs. Children, adolescents, the elderly, and people with disabilities sometimes require different care. Children are often shy and frightened by strangers. Begin your assessment for injuries at the toe, instead of the head, and go up. Use appropriate language so that they can understand you. Bend down so that you are at their eye level, and talk to the child as well as their parents. The Elderly are a growing population in the United States. In 1950, the average life span was 49 yrs. In 1996, the average life expectancy was 75 yrs. These individuals are often on medications, and they are more likely to have special conditions such as diabetes and high blood pressure. Also, as they get older, the aged have declining body functions. They are often cold, and they can become hypothermic in a room that feels just a bit chilly to us. This is especially an issue if an elderly person falls and is on a cold floor for an extended period of time. The elderly have slower reflexes, their eyesight and hearing are failing, and they have unsteady balance. This makes them at a great risk for falling and hence fracturing bones. Also, there are many factors that lead to increased confusion and increased risk of falling -- head injury, insufficient oxygen, stroke, and improper medication are some such factors. Due to their decreased capabilities, the elderly tend not to eat or drink enough. This leads to dehydration and malnutrition. People with disabilities are also a special needs group. In evaluation of any injuries or situations, just use common sense. Remember that they are capable until proven otherwise.
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| April 26 |
***Healthy Living. Eating properly, exercising, and paying attention to your body are all essential for healthy living. Here are some web sites of interest:
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| May 2 - May 4 |
***Finals. April 29th is the final practical exam, and May 4th is the final written exam. GOOD LUCK!!! |