Lifeguard Academy. Day

Transcription

1 Lifeguard Academy Day

2 Inspection

3 Oxygen Administration

4 Resuscitation Mask Video 4:43

5 Oxygen Delivery Video

6 Resuscitation Mask

7 Resuscitation Mask Resuscitation masks are flexible, dome shaped devices that cover the victim s s mouth and nose and allow you to breathe air into the victim without making mouth to mouth contact. Resuscitation masks come in various sizes. Pediatric masks are available for children and infants. If a pediatric mask is not available, an adult mask can be used, but you must ensure an adequate seal. On some masks you can place the narrow end of the mask over the infant s s mouth to create an adequate seal.

8 Benefits of Resuscitation Mask Reducing the possibility of disease transmission. Creating a seal over both the victim s s mouth and nose. Delivering air to the victim more quickly though both the nose and mouth. Connecting the device to emergency oxygen if the device has an oxygen inlet, thus increasing the oxygen concentration the victim receives.

9 Recommended Features Easy to assemble and use. Made of transparent, pliable material that allows you to make a tight seal over the victim s s mouth and nose. A one way valve for releasing exhaled air. A standard 15 mm or 22 mm coupling assembly (the size of the opening for the one way valve). An inlet for delivering emergency oxygen. Works well under different environmental conditions, such as extreme heat or cold.

10 Bag Valve Mask

11 Bag Valve Mask A BVM is primarily used to ventilate a victim in respiratory arrest. It can also be used for a victim in respiratory distress. s. The BVM consists of a self inflating bag, a one way valve and a mask. The BVM is highly effective when used correctly by two rescuers. BVMs come in various sizes. Pediatric BVMs should be used for children and infants. Your facility must make this equipment available in order to be properly prepared. In an emergency, if a pediatric BVM is not available, an adult mask can be used by placing the narrow end of the mask over the mouth. Be sure not to use as much force when squeezing the bag. Use just enough force to make the chest clearly rise.

12 Advantages of BVM Increase oxygen levels in the blood by using the air in the surrounding environment (ambient air) instead of the air exhaled by the rescuer. Can be connected with emergency oxygen. Protect against disease transmission.

13 Emergency Oxygen An injured or ill victim can benefit greatly from receiving air with a higher oxygen concentration. The air a person normally breathes contains approximately 21 percent oxygen. The concentration of oxygen delivered to a victim through rescue breathing is 16 percent.

14 Without adequate oxygen, hypoxia will occur. Signs and symptoms of hypoxia include: Increased breathing and heart rate. Changes in consciousness. Restlessness. Cyanosis (bluish lips and nail beds). Chest pain.

15 When to Use Emergency Oxygen Always if patient needs it Emergency oxygen should be considered if: An adult is breathing fewer than 12 breaths per minute or more than 20 breaths per minute. A child is breathing fewer than 15 breaths per minute or more than 30 breaths per minute. An infant is breathing fewer than 25 breaths per minute or more than 50 breaths per minute.

16 Variable Flow Rate Oxygen Requirements To deliver emergency oxygen using a variable flow rate oxygen system, you need: An oxygen cylinder. A regulator with pressure gauge and flow meter. A delivery device, such as a resuscitation mask with oxygen inlet

17 Oxygen Cylinder Oxygen cylinders are labeled U.S.P. U.S.P. and marked with a yellow diamond that says Oxygen. Oxygen. U.S.P stands for United States Pharmacopeia and indicates the oxygen is to be used for medical purposes. In the Unites States, oxygen cylinders typically have green markings. However, the color scheme is not regulated, so different manufacturers and other countries may use different color markings. Oxygen cylinders contain gas under high pressure. If mishandled, cylinders can cause serious damage. Oxygen cylinders come in different sizes and have various pressure capacities

18 Tank Cylinder Components On / off valve and handle 3 pin indexing Assures oxygen regulator is properly attached Specific to oxygen tanks 18

19 Regulator with Pressure Gauge and Flow Meter The regulator reduces the pressure of the gas coming from the cylinder to a level that is safe for delivering oxygen to a victim. The pressure gauge shows the pressure in the cylinder in pounds per square inch (psi). A flow meter controls the amount of oxygen administered in liters per minute (LPM)

20 Delivery Devices Resuscitation Mask Bag Valve Mask Non-Rebreather Mask Nasal Cannula

21 Resuscitation Mask A resuscitation mask with an inlet valve may be used with emergency oxygen to give rescue breaths to breathing and non- breathing victims. The recommended flow rate when using a resuscitation mask is 6 to 15 LPM. Most masks in the park district DO NOT have supplemental oxygen inlet valve

22 Bag Valve Mask Can provide up to 100% oxygen when hooked to supplemental oxygen at 15+ liters per minute Need two lifeguard in order to use

23 Non Rebreather Mask

24 Non Rebreather Mask A non-rebreather mask is an effective method for delivering high concentrations of oxygen to a breathing victim. Non-rebreather masks consist of a face mask with an attached oxygen reservoir bag and a one way valve One way valve prevents the victim s s exhaled air from mixing with the oxygen in the reservoir bag. The flow rate when using this device is 10 to 15 LPM. A non-rebreather mask can deliver an oxygen concentration of 90+%.

25 Non Rebreather Tips Because young children and infants may be frightened by a mask being placed on their faces, consider a blow by technique. The rescuer, parent or guardian should hold a non-rebreather mask approximately 2 inches from the child s s or infant s s face. This will allow the oxygen to pass over the face and be inhaled. The reservoir bag should be sufficiently inflated (about two-thirds thirds full) by covering the one way valve with your thumb before placing it on the victim s s face. If it begins to deflate with the victim inhales, increase the flow rate of the oxygen to refill the reservoir bag

26 Nasal Cannula

27 Nasal Cannula A nasal cannulas is a plastic tube with two small prongs that are inserted into the victim s nose. The device is used to administer oxygen to a breathing victim with minor breathing problems. Oxygen is normally delivered through a nasal cannula at a low flow rate of 1 to 6 LPM. Nasal cannulas also can be used if the victim does not want a mask on his or her face. 24%-44% 44% oxygen is delivered with nasal cannula.

28 Oxygen Administration Care and handling Weakest part of tank is valve Weakest part of regulator is pressure gauge Oxygen dangers Supports combustion Never use petroleum products on parts High pressure system Keep equipment clean Inspect regularly 28

29 Protocols Indications - signs and symptoms Decreased level of consciousness Pale, blue or ashen skin Moist skin Short of breath (SOB) Mechanism of injury 29

30 Medicals Protocols 2 lpm by nasal cannula (may go lpm with nasal cannula if there is a good reason) If patient exhibits severe respiratory distress or pulmonary edema switch to NRB mask at 15 lpm Trauma 15 lpm by NRB 30

31 Oxygen Administration Contraindications Chronic Obstructive Pulmonary Disease (COPD) Breathing drive determined by levels of oxygen as opposed to carbon dioxide in healthy individuals Stay alert for respiratory depression but do not withhold oxygen 31

32 Precautions Always make sure that oxygen is flowing before placing the delivery ery device over the victim s s mouth and nose. Do not use oxygen around flames or sparks. Oxygen causes fire to to burn more rapidly. Do not use grease, oil or petroleum products to lubricate or clean the pressure regulator. This could cause an explosion. Do not stand oxygen cylinders upright unless they are well secured. ed. If the cylinder falls, the regulator or valve could become damaged or cause c injury. Do not drag or roll cylinders. Do not carry a cylinder by the valve or regulator. Do not hold only protective valve caps or guards when moving or lifting cylinders. Do not deface, alter or remove any labeling or makings on the oxygen cylinders. Do not attempt to mix gases in an oxygen cylinder or transfer oxygen from one cylinder to another. If defibrillating, make sure that no one is touching or is in contact with the victim or the resuscitation equipment. Do not defibrillate someone with around flammable materials, such h as gasoline or free flowing oxygen.

33 Skill: Oxygen Administration

34 Blood Borne Pathogens

35 How infection occurs Video 4:00

36 Exposure Control plan Video 2:00

37 Personal Protective Equipment Video 3:08

38 Engineering and work practice controls Video 4:05

39 Exposure Incidents Video 1:50

40 Lifeguard Academy Day

41 Inspection

42 Questions

43 Oxygen Administration

44 Resuscitation Mask Video 4:43

45 Resuscitation Mask Resuscitation masks are flexible, dome shaped devices that cover the victim s s mouth and nose and allow you to breathe air into the victim without making mouth to mouth contact. Resuscitation masks come in various sizes. Pediatric masks are available for children and infants. If a pediatric mask is not available, an adult mask can be used, but you must ensure an adequate seal. On some masks you can place the narrow end of the mask over the infant s s mouth to create an adequate seal.

46 Benefits of Resuscitation Mask Reducing the possibility of disease transmission. Creating a seal over both the victim s s mouth and nose. Delivering air to the victim more quickly though both the nose and mouth. Connecting the device to emergency oxygen if the device has an oxygen inlet, thus increasing the oxygen concentration the victim receives.

47 Recommended Features Easy to assemble and use. Made of transparent, pliable material that allows you to make a tight seal over the victim s s mouth and nose. A one way valve for releasing exhaled air. A standard 15 mm or 22 mm coupling assembly (the size of the opening for the one way valve). An inlet for delivering emergency oxygen. Works well under different environmental conditions, such as extreme heat or cold.

48 Bag Valve Mask A BVM is primarily used to ventilate a victim in respiratory arrest. It can also be used for a victim in respiratory distress. s. The BVM consists of a self inflating bag, a one way valve and a mask. The BVM is highly effective when used correctly by two rescuers. BVMs come in various sizes. Pediatric BVMs should be used for children and infants. Your facility must make this equipment available in order to be properly prepared. In an emergency, if a pediatric BVM is not available, an adult mask can be used by placing the narrow end of the mask over the mouth. Be sure not to use as much force when squeezing the bag. Use just enough force to make the chest clearly rise.

49 Advantages of BVM Increase oxygen levels in the blood by using the air in the surrounding environment (ambient air) instead of the air exhaled by the rescuer. Can be connected with emergency oxygen. Protect against disease transmission.

50 Emergency Oxygen An injured or ill victim can benefit greatly from receiving air with a higher oxygen concentration. The air a person normally breathes contains approximately 21 percent oxygen. The concentration of oxygen delivered to a victim through rescue breathing is 16 percent.

51 Without adequate oxygen, hypoxia will occur. Signs and symptoms of hypoxia include: Increased breathing and heart rate. Changes in consciousness. Restlessness. Cyanosis (bluish lips and nail beds). Chest pain.

52 When to Use Emergency Oxygen Always if patient needs it Emergency oxygen should be considered if: An adult is breathing fewer than 12 breaths per minute or more than 20 breaths per minute. A child is breathing fewer than 15 breaths per minute or more than 30 breaths per minute. An infant is breathing fewer than 25 breaths per minute or more than 50 breaths per minute.

53 Variable Flow Rate Oxygen Requirements To deliver emergency oxygen using a variable flow rate oxygen system, you need: An oxygen cylinder. A regulator with pressure gauge and flow meter. A delivery device, such as a resuscitation mask with oxygen inlet

54 Oxygen Cylinder Oxygen cylinders are labeled U.S.P. U.S.P. and marked with a yellow diamond that says Oxygen. Oxygen. U.S.P stands for United States Pharmacopeia and indicates the oxygen is to be used for medical purposes. In the Unites States, oxygen cylinders typically have green markings. However, the color scheme is not regulated, so different manufacturers and other countries may use different color markings. Oxygen cylinders contain gas under high pressure. If mishandled, cylinders can cause serious damage. Oxygen cylinders come in different sizes and have various pressure capacities

55 Tank Cylinder Components On / off valve and handle 3 pin indexing Assures oxygen regulator is properly attached Specific to oxygen tanks 55

56 Regulator with Pressure Gauge and Flow Meter The regulator reduces the pressure of the gas coming from the cylinder to a level that is safe for delivering oxygen to a victim. The pressure gauge shows the pressure in the cylinder in pounds per square inch (psi). A flow meter controls the amount of oxygen administered in liters per minute (LPM)

57 Delivery Devices Resuscitation Mask Bag Valve Mask Non-Rebreather Mask Nasal Cannula

58 Resuscitation Mask A resuscitation mask with an inlet valve may be used with emergency oxygen to give rescue breaths to breathing and non-breathing victims. The recommended flow rate when using a resuscitation mask is 6 to 15 LPM. Most masks in the park district DO NOT have supplemental oxygen inlet valve

59 Bag Valve Mask Can provide up to 100% oxygen when hooked to supplemental oxygen at 15+ liters per minute Need two lifeguard in order to use

60 Non Rebreather Mask A non-rebreather mask is an effective method for delivering high concentrations of oxygen to a breathing victim. Non-rebreather masks consist of a face mask with an attached oxygen reservoir bag and a one way valve One way valve prevents the victim s s exhaled air from mixing with the oxygen in the reservoir bag. The flow rate when using this device is 10 to 15 LPM. A non-rebreather mask can deliver an oxygen concentration of 90+%.

61 Non Rebreather Tips Because young children and infants may be frightened by a mask being placed on their faces, consider a blow by technique. The rescuer, parent or guardian should hold a non-rebreather mask approximately 2 inches from the child s s or infant s s face. This will allow the oxygen to pass over the face and be inhaled. The reservoir bag should be sufficiently inflated (about two-thirds thirds full) by covering the one way valve with your thumb before placing it on the victim s s face. If it begins to deflate with the victim inhales, increase the flow rate of the oxygen to refill the reservoir bag

62 Nasal Cannula A nasal cannulas is a plastic tube with two small prongs that are inserted into the victim s nose. The device is used to administer oxygen to a breathing victim with minor breathing problems. Oxygen is normally delivered through a nasal cannula at a low flow rate of 1 to 6 LPM. Nasal cannulas also can be used if the victim does not want a mask on his or her face. 24%-44% 44% oxygen is delivered with nasal cannula.

63 Oxygen Administration Care and handling Weakest part of tank is valve Weakest part of regulator is pressure gauge Oxygen dangers Supports combustion Never use petroleum products on parts High pressure system Keep equipment clean Inspect regularly 63

64 Protocols Indications - signs and symptoms Decreased level of consciousness Pale, blue or ashen skin Moist skin Short of breath (SOB) Mechanism of injury 64

65 Medicals Protocols 2 lpm by nasal cannula (may go lpm with nasal cannula if there is a good reason) If patient exhibits severe respiratory distress or pulmonary edema switch to NRB mask at 15 lpm Trauma 15 lpm by NRB 65

66 Precautions Always make sure that oxygen is flowing before placing the delivery ery device over the victim s s mouth and nose. Do not use oxygen around flames or sparks. Oxygen causes fire to to burn more rapidly. Do not use grease, oil or petroleum products to lubricate or clean the pressure regulator. This could cause an explosion. Do not stand oxygen cylinders upright unless they are well secured. ed. If the cylinder falls, the regulator or valve could become damaged or cause c injury. Do not drag or roll cylinders. Do not carry a cylinder by the valve or regulator. Do not hold only protective valve caps or guards when moving or lifting cylinders. Do not deface, alter or remove any labeling or makings on the oxygen cylinders. Do not attempt to mix gases in an oxygen cylinder or transfer oxygen from one cylinder to another. If defibrillating, make sure that no one is touching or is in contact with the victim or the resuscitation equipment. Do not defibrillate someone with around flammable materials, such h as gasoline or free flowing oxygen.

67 Skill: Oxygen Administration

68 Blood Borne Pathogens

69 How infection occurs Video 4:00

70 Exposure Control plan Video 2:00

71 Personal Protective Equipment Video 3:08

72 Engineering and work practice controls Video 4:05

73 Exposure Incidents Video 1:50

74 Lunch Lunch Until 1305 Do Not Be Late

75 East Bay Regional Park District Lifeguard Academy Day 6 Afternoon

76 Inspection

77 Emergency Care for Muscle and Bone Injuries Practice body substance isolation. After controlling any life threatening injuries, allow the victim to remain in a comfortable position. Apply a cold pack to the area of a painful, swollen, deformed extremity to reduce swelling and pain. Support the area above and below an injury. Cover open wounds with a sterile dressing. Pad the area to prevent pressure and discomfort to the victim. When in doubt, manually stabilize the injury. Do not intentionally reposition protruding bones

78 Specific Injuries Upper Extremity Injuries Shoulder Upper Arm Elbow Forearm, Wrist and Hand Injuries Lower Extremity Injuries Thigh and Leg Knee Ankle and Foot

79 Shoulder Injuries- Clavicle The clavicle is the most frequently injured shoulder bone; typically from a fall. Victims usually attempt to ease the pain by holding the arm against the chest.

80 Shoulder Injuries-Scapula To break the scapula takes great force, so fractures in this area are not common. If a fracture does occur, suspect other serious injuries. Dislocations are more common and more painful and often produce obvious deformity.

81 Treatment of Shoulder Injuries Control any external bleeding with direct pressure and apply a pressure bandage in a figure eight pattern. Allow the victim to support the arm in a comfortable position. Splint the arm in that position. Use a pillow or rolled blanket to fill any gaps between the arm and chest. A sling and binder are usually effective means of immobilization. Check and recheck circulation, apply cold and minimize shock.

82 Upper Arm Injuries-Humorous The humorous is the longest bone in the arm and can be fractured at any point, although it is most commonly broken at the upper end near the shoulder or in the middle. Most humorous fractures are very painful and prevent the victim from moving the arm. They may have considerable deformity.

83 Treatment for Upper Arm Injuries Control external bleeding and immobilize the upper arm from the shoulder to elbow. If possible, place the arm in a sling and bind it to the chest with cravats. Use a short board to give the arm more support. Check circulation in the hand and fingers before and after splinting. Apply cold and minimize shock.

84 Elbow Injuries Because of the large number of nerves and blood vessels in the elbow, injuries in this area can be made worse by movement. Do not move an injured elbow. Check circulation at the wrist. Immobilize the arm from the shoulder to the wrist in the position n in which you find it. Control external bleeding with direct pressure and a figure eight pressure bandage. The arm may be placed in a sling and secured to the chest with cravats. If the elbow is bent, apply a splint diagonally across the inside e of the arm. Make sure the splint extends several inches beyond both the upper arm and the wrist. Recheck circulation, summon more advanced care, apply cold, and care for shock.

85 Forearm, Wrist and Hand Injuries To bandage a hand, apply a pressure bandage using a figure eight pattern To immobilize an injured upper extremity: Place a roll of gauze in the palm. Place a rigid support under the forearm. Secure with cravats or a roller bandage. Put the arm in the sling. Secure it to the chest. Use a soft splint to immobilize hand or finger injuries. Splint an injured finger by taping it to an adjacent finger. Air splints may be used to immobilize the hand or forearm. If an air splint is properly inflated, you should be able to make a slight dent in the surface of the splint with your thumb. Monitor circulation in the limb and proper inflation of the splint.

86 Lower Extremity Injuries Open fractures are common in the lower leg because both bones lie close to the skin. Bones are often angulated. With some fractures of the fibula, the victim is still able to walk on the leg.

87 Lower Extremity Injuries-Femur Most femur fractures: Involve the upper end of the bone. Are often called hip fractures, even though the hip joint is not involved. A leg with a broken femur may appear shorter than the other leg because the thigh muscles contract in and cause the bone ends to overlap. The injured leg may also be turned outward. Femur fractures can cause serious internal bleeding, which may result in life threatening shock. Take steps to care for shock administer oxygen and monitor vital signs regularly. A traction splint may be used.

88 Care for Lower Extremity Injuries- Leg When advanced care is readily available, sometimes it is best not t to splint. Keep the victim from moving and control external bleeding until advanced care arrives. You can immobilize an injured leg by binding the injured leg to the uninjured one with several cravats. A pillow or rolled blanket may m be placed between the legs. If rigid splints are available, apply one padded splint to the outside o of the injured leg, extending from the hip to beyond the food. Place a shorter one on the leg, extending beyond the foot. Secure both snugly with cravats. Commercial splints, such as air splints or vacuum splints may also be used. Check and recheck circulation and apply cold to reduce pain and swelling.

89 Lower Extremity Injury-Knee The knee is very vulnerable to injury. Deep lacerations in the area can cause joint infections later. Sprains, fractures, and dislocations are especially common with athletic injuries. Violent force can cause fractures to the kneecap.

90 Treatment for Knee Injuries To care for open wounds to the knee, control external bleeding with direct pressure and a figure eight pressure bandage. If the knee is straight or can be straightened without pain, splint the leg as you would for any other leg injury. If it is bent and painful to straighten, splint it in the position in which you find it. Apply cold, treat for shock, and summon more advanced medical help.

91 Lower Extremity Injuries-Ankle and Foot It can be difficult to distinguish between minor and sever foot and ankle injuries. Care for all injuries as if they were serious. Pain, swelling, and inability to walk on a foot all indicate a need for further medical attention. Individuals may fracture the foot or ankle as well as injured other parts of the body, such as the back, from falls in which they land on the heel of the foot.

92 Treatment for Ankle or Foot Injuries Care for injuries to the foot or ankle by controlling external bleeding and immobilizing the injury the best way possible. Commercial splints, such as air splints, are very effective, although you may improvise with a pillow or a rolled blanket. Secure the improvised splint with two or three cravats or roller bandage. Elevate the injured foot and apply ice.

93 Skill: Splinting Extremities (Shoulder, Elbow, Wrist, Knee and Ankle)

94 Injuries to Head, Neck and Back

95 Although injuries to the head and back account for a small percentage of all injuries, they cause more than half the fatalities. Motor vehicle collisions account for about half of all head and back injuries. Other causes include falls, sports and recreational activities, and violent acts such as assaults. Nearly 80,000 victims are permanently disabled each year in the United States as a result of head and back injuries.

96 What Makes Head, Neck and Back Injuries So Dangerous? Injuries to the head and back can damage both bone (skull, vertebrae) and soft tissue (brain, spinal cord). Head injuries may be open or closed. Open injures may present with bleeding. Closed injuries may present with swelling or depression of skull bones. Scalp injuries may bleed more than expected because of the large number of blood vessels in the scalp. Control bleeding with direct pressure. Injuries to the head can affect the brain. Bleeding in the skull can occur rapidly or slowly over a period of days.

97 Consider Head, Neck and Back Injury if A fall from a height greater than the victim s s height. Any motor vehicle collision. A person found unconscious for unknown reasons. Any injury that penetrates the head or trunk. A motor vehicle crash involving a driver or passengers not wearing safety belts. Any person thrown from a motor vehicle. Any injury n which a victim s s helmet is broken, including a motorcycle, football or industrial helmet.

98 Signs and Symptoms Changes to the level of consciousness. Severe pain or pressure in the head, neck or back. Tingling or loss of sensation in the extremities. Partial or complete loss of movement of any body parts. Unusually lumps or depressions on the head or spine. Blood or other fluids in the ears or nose. Profuse external bleeding of the head, neck, or back. Seizures. Impaired breathing or vision as a result of injury. Nausea or vomiting. Persistent headache. Loss of balance. Bruising of the head, especially around the eyes or the back of the ears.

99 Assessing for Injury- Responsive Patient Ask about the mechanism of injury. Ask the victim: Does your head, neck or back hurt? What happened? Where does it hurt? Can you move your hands and feet? Can you feel me touching your fingers? Can you feel me touching your toes?

100 Assessing for Injury- Unresponsive Patient Look for the mechanism of injury. Maintain airway and breathing. Stabilize the head, neck and back manually in the position the victim is found. Ask bystanders about the mechanism of injury and the victim s s mental status before you arrived.

101 While waiting for more advanced medical personnel to arrive, always care for head, neck and back injures as follows Minimize movement of the head and spine. Maintain an open airway using the modified jaw thrust. Monitor level of consciousness (LOC) and breathing. Maintain normal body temperature. Control any external bleeding.

102 General Injuries to Head Generally, injuries involving only soft tissue damage to the head, neck or back should be cared for like other wounds. Control bleeding with direct pressure.

103 Eyeball Injuries One exception, however, is an injury involving the eyeball. Never palace pressure directly on the eyeball. For an embedded object in the eye, stabilize the object. This can be done using a paper cup to cover the eye.

104 Skull Fracture Another exception is a scalp injury that involves a depressed segment. This could indicate a skull fracture, so pressure should not be applied to the depressed area.

105 Nosebleed For a nosebleed, pinch the nostrils and, if possible, have the person lean slightly forward.

106 Knocked Out Teeth For teeth that are knocked out, control any bleeding and save the teeth. Place the teeth in milk or water until they can be replanted by a medical professional (dentist or physician).

107 Skill: Caring for Head Injuries

108 Suspected Spinal Injury-Initial Initial Care Practice body substance isolation (BSI). Remember that scalp injuries may bleed more than expected because of the large number of blood vessels in the scalp. Control bleeding with direct pressure. Maintain the victim s s airway, perform rescue breathing if needed, and provide supplementary oxygen if it is available and you are trained to use it. Closely monitor the level of consciousness (LOC) Excessive movement of the head, neck and back can damage the spinal cord irreversibly. Keep the victim as still as possible, using the technique called in line stabilization.

109 Inline Stabilization In line stabilization is done by simply placing your hands on both sides of the victim s s head. Gently position the head, if necessary, in line with the body, and support it in that position until more advanced medical personnel arrives. This can be done for victims lying down, sitting or standing

110 Do Not Position Head Inline If When the victim s s head is severely angled. When the victim complain of pain, pressure, or muscle spasms on initial movement of the head. When the rescuer feels resistance when attempting to move the head (In these circumstances, support the victim s s head in the position in which it is found.)

111 Suspected Spinal Injury-Further Care Further care requires additional assistance and equipment that includes i a cervical collar, backboard, head immobilization device (blanket or commercial device), and straps. While in line stabilization is applied by one person, a second person p applies a cervical collar. Slide the collar around the victim s s neck. When the collar is fastened, the victim s s chin should rest in the designated chin portion of the collar and the head maintained in line with the body. b Using several people, log roll the victim onto a backboard. One the victim s s body is on the board, secure it to the board using straps. Begin with the chest. Next, secure hips and legs. Once the body is secured, the secure the head. If the victim s s head does not appear to be resting in line with the body, place a small amount of padding (1 inch), such as a small folded towel or part of a blanket under the head. Wrap or fold a blanket around the victim s s head and secure it in place with cravats or tape. As an option, you may use a commercial head immobilizer to secure the head in place.

112 Special Situations-Helmet Removing a helmet Sometimes someone wearing a helmet, such as a motorcyclist or an athlete, suffers a serious injury. In rare occasions you may have to remove a helmet of a victim to secure an airway. The only time you should remove a helmet is if it interferes with care. Helmet removal should be done with two people. One to support the head in line and the other to remove the helmet.

113 Special Situations-Water Injury Water related spinal injury Each year in the United States, about 1,000 disabling neck and back injuries occur. Always try and have a lifeguard or other trained professional present before touching a victim with a possible back injury. There are several ways to stabilize a victim s spine in the water. Hip and shoulder support. Head Splint. With the help of others, you can place a victim on a backboard in different ways.

114 Preventing Spinal Injury Wearing safety belts. Wearing helmets and protective eyewear. Safeguarding against falls. Taking safety precautions in sports and recreation. Avoiding inappropriate use of alcohol and drugs. Inspecting equipment Thinking and talking safety.

115 Skill: Immobilizing Head, Neck or Back Injury

116 Break

117 Medical Emergencies

118 Medical emergencies are generally illnesses that come on suddenly, although some may develop over time. Medical emergencies often cause both confusion on the part of the rescuers and lost time in summoning more advanced medical professionals. This need not be the case.

119 Specific Conditions Some specific medical conditions include altered mental status, seizures, stroke, heat and cold emergencies, poisoning and heart attack. All illnesses exhibit some of the generic signs and symptoms previously discussed, and have similar general care steps.

120 Altered Mental Status Altered mental status is a common medical emergency characterized by a change in a person s s level of consciousness, including partial or complete loss of consciousness.

121 Causes of Altered Mental Status Altered mental status can result from a variety of causes, including: Fever. Infection. Poisoning, including substance abuse or misuse. High or low blood sugar or insulin reactions. Head injury. Any condition that results in decreased blood flow of oxygen to the brain. Conditions resulting from mental, emotional, or behavioral disorders.

122 Fainting A person who faints has experienced an altered level of consciousness. The brain is deprived of its normal flow of blood. The victim will commonly display shock like signs and symptoms dizziness, nausea, and cool, moist, pale or ashen skin. Fainting usually resolved by itself when normal blood flow to the brain is restored, for example, when the person is in a horizontal position. Fainting by itself does not usually harm the victim, but injury may occur from falling. Fainting does, however, have an underlying cause that should be explored by more advanced medical personnel.

123 Care for Altered Mental Status Do an initial assessment, a physical exam, and SAMPLE history as needed. Elevate the legs 8 to 12 inches if you do not suspect any injury to the spine or lower extremities. Do an ongoing assessment. Check the airway and put an unconscious victim in the recovery position. Loosen any restrictive clothing. Do not give the victim anything to eat or drink or splash water in the victim s s face. Have suction equipment available. Summon more advanced medical personnel, since you cannot be certain why a person has experienced a change in the level of consciousness. Comfort and reassure a conscious victim.

124 Seizures When normal functions of the brain are disrupted by injury, disease, fever or infection, the electrical activity of the brain becomes irregular. This irregularity can cause sudden loss of body control known as a seizure. The chronic form of seizure is known as epilepsy. Although epilepsy is usually controlled with medication, some people with epilepsy have seizures from time to time.

125 Seizures Before a seizure occurs, the victim may experience a warning called an aura. This is an unusual sensation or feeling such as a visual hallucination; a strange sound, taste, or smell; or an urgent need to get to safety. Seizures may range from mild blackouts that others mistake for daydreaming to sudden uncontrolled muscular contractions lasting several minutes.

126 Causes of Seizures Fever. Infection. Chronic Medical Conditions. Poisoning. Low Blood Sugar. Head Injury. Any condition causing decreased level of oxygen. Pregnancy complications.

127 Care for Seizures Summon more advanced medical personnel. Do not try to stop the seizure or restrain the victim. Protect the victim from injury. Protect the victim s s modesty. Use only the minimum number of bystanders necessary to help you care for the victim. Manage the airway by rolling the victim onto his or her side (recovery position). This will help keep the airway clear if there is fluid such as saliva, blood, or vomit in the victim s mouth. Do this only if you do not suspect neck or back injury. Remove nearby objects and protect the victim s s head. Do not place anything between the teeth. When the seizure is over, the victim will be drowsy and disoriented. Do a physical exam to check and care for any injuries. Be reassuring and comforting as you await the arrival of more advanced medical personnel.

128 Stroke A stroke occurs when there is a disruption of blood flow to a part of the brain that is serious enough to cause brain damage. It is most commonly caused by a blood clot that forms or lodges in the arteries that supply blood to the brain. Another cause is bleeding from a ruptured artery in the brain.

129 Transient Ischemic Attack A transient ischemic attach (TIA) is a temporary episode that is like a stroke sometimes called a mini stroke. Like a stroke, TIA results in reduced blood flow to the brain.

130 Stroke Symptoms A victim of stroke will appear or feel ill or will exhibit abnormal behavior. Signals include: Sudden weakness and numbness of the face, arm or leg, often on only one side of the body. Difficulty talking or understanding speech. Blurred or dimmed vision. A sudden severe headache, dizziness, confusion, ringing in the ears, or loss of consciousness.

131 Treatment for Stroke As with other sudden illnesses, the priority is checking the ABCs. If there is fluid or vomit in the victim s s mouth, position him or her on one side to allow any fluids to drain out of the mouth. You may have to clear the airway of debris with your finger or suction. Call more advanced medical personnel immediately monitor the ABCs until they arrive.

132 Diabetic Emergency Insulin is a hormone that takes the sugar from the bloodstream to the cells, where it is used as an energy source. The condition in which the body does not produce enough insulin is called diabetes mellitus. A person with this condition is diabetic.

133 Diabetes Anyone with diabetes must carefully monitor his or her diet and exercise. Insulin dependent diabetics must also regulate their use of insulin. When a diabetic fails to control these factors, one of two problems can occur two much or too little sugar in the bloodstream. This imbalance causes illness, which in some situations, can occur rapidly.

134 Hyperglycemia There is too much sugar and too little insulin in the blood. Without insulin, body cells cannot get the sugar they need, even though there is abundant sugar present. To meet energy needs, the body breaks down other food sources. This results in a person becoming ill over a period of time, as excess waste products build up in the body. It can result in a serious form of diabetic emergency diabetic coma

135 Hypoglycemia There is adequate insulin, but too little sugar in the bloodstream. The small amount of sugar is used rapidly. When the brain gets too little sugar to function, it results in an acute condition called insulin reaction.

136 Both conditions, too much or too little sugar can result in a diabetic emergency

137 Symptoms of Diabetic Emergency Changes in the level of consciousness. Rapid breathing and pulse. Feeling and looking ill.

138 It is not important to differentiate between the two conditions in order to provide care.

139 Treatment for Diabetic Emergencies Care for any life threatening conditions you find. If the victim is conscious and there are no life threatening conditions, do a physical exam and SAMPLE history. Look for a medical alert tag, and ask if the victim has a medical condition (such as diabetes). If the victim is conscious and able to swallow, give the victim sugar in the form of fruit juices, candy, or non-diet soft drinks. If the victim s s condition is caused by low sugar, the sugar you give will help quickly. If caused by high sugar, the excess sugar will do no further harm. If unconscious, do not give anything by mouth. Monitor the breathing and pulse and keep the victim from getting chilled or overheated. Call more advanced medical personnel because unconsciousness is a serious problem.

140 Break Out

141 Wrap Up