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Basic Life Support (BLS/BAA)

Study Notes

Basic Life Support (BLS/BAA)


Table of Contents
Medical Terminology ................................................................................................................................... 6
Prefixes Direction & Quantity .............................................................................................................................................. 6
Combining Words What Organ or Substance ....................................................................................................................... 6
Suffixes Whats Going On..................................................................................................................................................... 6
Examples ............................................................................................................................................................................. 6
Planes of the Body .................................................................................................................................................................. 7
Directional Terms ................................................................................................................................................................... 7
Movement Terms ................................................................................................................................................................... 7
Anatomical Positions .............................................................................................................................................................. 7

Body Systems ............................................................................................................................................... 8


Cardiovascular System............................................................................................................................................................ 8
Heart................................................................................................................................................................................... 8
Electrical Cycle..................................................................................................................................................................... 9
Stroke Volume ..................................................................................................................................................................... 9
Cardiac Output .................................................................................................................................................................... 9
Peripheral Vascular Resistance ............................................................................................................................................ 9
Blood Pressure..................................................................................................................................................................... 9
Pulse Points ......................................................................................................................................................................... 9
Heart Rate........................................................................................................................................................................... 9
Nervous System .................................................................................................................................................................... 10
Central Nervous System ..................................................................................................................................................... 10
Brain ................................................................................................................................................................................. 10
Peripheral Nervous System ................................................................................................................................................ 11
Reflex Arch ........................................................................................................................................................................ 11
Digestive System .................................................................................................................................................................. 12
Muscular-Skeletal System ..................................................................................................................................................... 12
Muscles ............................................................................................................................................................................. 12
Skeleton ............................................................................................................................................................................ 13
Respiratory System ............................................................................................................................................................... 14
Upper Respiratory Tract ..................................................................................................................................................... 14
Lower Respiratory Tract ..................................................................................................................................................... 14
Gaseous Exchange ............................................................................................................................................................. 14
Lungs ................................................................................................................................................................................ 15
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Breathing .......................................................................................................................................................................... 15
Integumentary System ......................................................................................................................................................... 16
Urinary System ..................................................................................................................................................................... 16
Gastrointestinal System........................................................................................................................................................ 17
Reproductive System ............................................................................................................................................................ 17
Maternity .......................................................................................................................................................................... 17
Child Birth ......................................................................................................................................................................... 18
Maternity Pack .............................................................................................................................................................. 18
Stages of Labour ............................................................................................................................................................ 18
Antenatal Haemorrhage ................................................................................................................................................ 19
Post-partum Haemorrhage ............................................................................................................................................ 19

Patient Assessment .................................................................................................................................... 20


Primary Survey ..................................................................................................................................................................... 20
Hazards ............................................................................................................................................................................. 20
Hello.................................................................................................................................................................................. 20
Help .................................................................................................................................................................................. 20
Airway ........................................................................................................................................................................... 20
Breathing ...................................................................................................................................................................... 21
Circulation ..................................................................................................................................................................... 22
Secondary Survey ................................................................................................................................................................. 23
SAMPLE History ................................................................................................................................................................. 23
Vital Signs ......................................................................................................................................................................... 23
Head to Toe Survey ............................................................................................................................................................ 24

Assessment of Emergencies ....................................................................................................................... 25


Respiratory Emergencies (pg 369 397) ............................................................................................................................... 25
APE (acute pulmonary edema) ........................................................................................................................................... 25
COPD (chronic obstructive pulmonary disease) ................................................................................................................... 25
Asthma.............................................................................................................................................................................. 26
Pnumothorax..................................................................................................................................................................... 26
Anaphylactic Reaction ....................................................................................................................................................... 26
Hayfever............................................................................................................................................................................ 27
Pleural Effusion ................................................................................................................................................................. 27
Choking ............................................................................................................................................................................. 27
Pulmonary Embolism ......................................................................................................................................................... 27
Hyperventilation Syndrome................................................................................................................................................ 28
General Respiratory Problems ............................................................................................................................................ 28
Cardiovascular Emergencies (pg 402 437) .......................................................................................................................... 29
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Angina Pectoris ................................................................................................................................................................. 29


AMI (acute myocardial infarction)...................................................................................................................................... 30
Congestive Heart/Cardiac Failure ....................................................................................................................................... 30
Left Ventricular Failure................................................................................................................................................... 30
Right Ventricular Failure ................................................................................................................................................ 31
Neurological Emergencies (pg 440 479) ............................................................................................................................. 31
Cerebrovascular Accident (CVA) or Stroke .......................................................................................................................... 31
Transient Ischemic Attack .................................................................................................................................................. 32
Convulsions Seizures ....................................................................................................................................................... 32
Status Epilepticus........................................................................................................................................................... 32
Causes of Unconsciousness ............................................................................................................................................ 32
Acute Abdomen (pg 466 479) ............................................................................................................................................. 33
Diabetic Emergencies (pg 482 497) .................................................................................................................................... 34
Environmental Emergencies (pg 546 581) .......................................................................................................................... 35
Hypothermia ..................................................................................................................................................................... 35
Hyperthermia .................................................................................................................................................................... 35
Submersion (Drowning) ..................................................................................................................................................... 36
Near Drowning .................................................................................................................................................................. 36
Diving Injuries.................................................................................................................................................................... 36

Paediatrics ................................................................................................................................................. 37
Ages ..................................................................................................................................................................................... 37
Medical Problems ................................................................................................................................................................. 37
Epiglottitis ......................................................................................................................................................................... 37
Croup ................................................................................................................................................................................ 37

Trauma (pg 630 911) ............................................................................................................................... 38


Mechanism of Injury ............................................................................................................................................................. 38
Shock .................................................................................................................................................................................... 39
Hypovolemic Shock ............................................................................................................................................................ 39
Cardiogenic Shock ............................................................................................................................................................. 39
Neurogenic Shock .............................................................................................................................................................. 39
Septic Shock ...................................................................................................................................................................... 39
Anaphylactic Shock ............................................................................................................................................................ 39
Stages of Shock..................................................................................................................................................................... 40
Bleeding ............................................................................................................................................................................... 41
Soft Tissue Injuries ................................................................................................................................................................ 41
Abdominal Injuries ............................................................................................................................................................... 42
Abdominal Injuries............................................................................................................................................................. 42
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Facial Injuries ....................................................................................................................................................................... 43


Types of Injuries................................................................................................................................................................. 43
Eye Injuries ........................................................................................................................................................................... 44
Types of Injuries................................................................................................................................................................. 44
Chest Injuries ........................................................................................................................................................................ 45
Pneumothorax................................................................................................................................................................... 45
Haemothorax .................................................................................................................................................................... 45
Pericardial Tamponade ...................................................................................................................................................... 45
Flail Chest.......................................................................................................................................................................... 46
Contusions......................................................................................................................................................................... 46
Fractures .............................................................................................................................................................................. 46
How to Treat ..................................................................................................................................................................... 47
Head Injuries ........................................................................................................................................................................ 48
Concussion ........................................................................................................................................................................ 48
Inter-cranial Haemorrhage ................................................................................................................................................ 48
Base of Skull # ................................................................................................................................................................... 48
Raised Intracranial Pressure............................................................................................................................................... 49
Poison, Bites and Stings ........................................................................................................................................................ 49
Snakes............................................................................................................................................................................... 49
Organophosphates ............................................................................................................................................................ 49
Burns .................................................................................................................................................................................... 50

Page 5

Medical Terminology
Prefixes Direction & Quantity
a, an

absence

ab

away from

ad

adduction

bi

two

tri

three

brady

slow

tachy

fast

hemi

half

peri

around

Combining Words What Organ or Substance


cardio

heart

cerebro -

brain

cephalo -

head

dermo -

skin

gastro -

stomach

neuro

nerves

myo

muscle

osteo

bone

pneumo -

air

rhino

nose

thoraco -

chest

Suffixes Whats Going On


emia

in the head

itis

inflammation of

paresis -

weakness

plegia

paralysis

uria

urine

rrhea

profuse

Examples
pneumothorax = pneumo (air) + thorax (chest) : air in the chest
pharyngitis = pharynx + (g)itis : inflammation of the pharynx
acute myocardial infarction = heart attack

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Planes of the Body


anterior

front surface

posterior

back surface

midline

an imaginary line dividing left & right

midclavicular line -

a line middle of the clavicle parallel to midline

midaxillary line

vertical line middle of axilla (armpit) parallel to midline

Directional Terms
left & right

patients left & right

superior

top half of body

inferior

lower half of body

lateral

away from midline

bilateral

both sides of midline

medial

towards midline

superficial

on the top

Movement Terms
flexion

bending (of a joint)

extension

extending (of a joint)

abduction

motion away from midline

adduction

motion towards midline

Anatomical Positions
prone

lying face down

supine

lying face up

Fowlers Position -

sitting up with knees bent

recovery position -

patient lying lateral with head resting on arm and one leg bent

shock position

lying flat with just inferior body raised 15 30cm

Trendelenburgs Position -

body lying flat with feet raised 15 30cm above head

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Body Systems
Cell

Tissue

Organ

System

Cardiovascular System: heart, veins and arteries

Nervous System: brain, spinal cord and nerves

Digestive System: stomach and intestines

Muscular-skeletal System: muscles and skeleton

Endocrine System: hormones

Respiratory System: lungs and diaphragm

Integumentary: skin

Urinary System: kidneys and bladder

Gastrointestinal System: lower abdomen

Reproductive System: genitals

Lymphatic/Immune System

Cardiovascular System
This system consists of:
Heart
Blood Vessels (veins & arteries)
Blood

Heart

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Electrical Cycle

Bundle of His

Pukinje Fibres

Stroke Volume
This is the amount of blood that the heart pushes out through the ventricles per contraction measured in millilitres.

Cardiac Output
The amount of blood being pushed out by the ventricles per minute measured in millilitres.
CO = SV x HR (cardiac output = stroke volume x heart rate)

Peripheral Vascular Resistance


The resistance of the blood in the veins. It is directly related to blood pressure.

Blood Pressure
Systolic Pressure: Maximum pressure against arterial walls when the heart contracts.
Diastolic Pressure: Minimum pressure in the arteries when the heart is at rest.
Hypotension: When systolic pressure is below 90mmHg
Hypertension: When diastolic pressure is above 90mmHg

Pulse Points
Carotid: 50mmHg systolic
Femoral:60mmHg systolic
Brachial:70mmHg systolic
Radial: 80mmHg systolic
Pedal: 90mmHg systolic

Heart Rate
Adult heart rate should be between 60 100bpm (<60 = bradycardia / >100 = tachycardia)

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Nervous System
Consists of the brain, spinal cord, nerves and sense organs.
Cells within these organs use electro-chemical signals called nerve impulses. These impulses communicate with muscles
and glands.
The nervous and endocrine systems maintain homeostasis the balance within the body.

Central Nervous System

Brain

Spinal cord
Meninges
Cerebrospinal fluid

Brain
Cerebrum (Grey Matter)
o Largest part
o Divided into 2 hemispheres (right: controls left body, left: controls right body)
o Corpus callosum (multitasking)
o Divided into 4 lobes:
Frontal lobe
controls voluntary movement

concentration

planning and problem solving


Temporal lobe
memory
hearing
Parietal lobe
sensations of touch, temperature and pressure
Occipital lobe
vision

Cerebellum
o Little brain
o Consists of two hemispheres
o Helps maintain posture
o Aids with fine motor skills (writing, knitting, kicking a ball, etc.)
Brain Stem
o The brain stem connects the brain to the spinal cord
o Consists of the:
pons
these work together
to control respiration
medulla oblongata

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Meninges (pg 874)


o Dura mater closest to the scull
o Arachnoid mater middle layer
o Pia Mater closest to the brain
o Cerebrospinal fluid
bathes the brain and spinal cord
acts as a shock absorber
filters impurities

Peripheral Nervous System

Somatic nervous system


Autonomic nervous system

Cranial nerves (12 pairs)


Spinal nerves (31 pairs)

Peripheral Nervous System

autonomic
nervous system

somatic
nervous system

sympathetic
nervous system

parasympathetic
nervous system

fight, flight, fright

rest & digest

afferent:
takes messages
to the brain

efferent:
takes impulses away
from the brain

Reflex Arch

Sensory nerve
Connecting nerve

Motor nerve

reflex arch

This occurs when an automatic reflex response takes place. A nerve itself basically decides to initiate a response based on
information it receives and triggers the skeletal muscles to react if it thinks the brain will take too long to respond. Eg. placing a
finger on a hot plate and removing it before it really gets burned.

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Digestive System
In descending order:

Mouth
Saliva

mastication
breaks down food

Bolus

ball of food

Tongue

helps swallow bolus

Oesophagus
Cardiac sphincter Stomach
-

Pyloric sphincter valve to small intestines


small intestines
o ileum
o jejunum
o duodenum
large intestine
o cecum
o ascending colon
o transverse colon
o descending colon

peristalsis (muscle wave) to move food down


valve before stomach
hydrochloric acid breaks down food and stores food

rectum
anus

Muscular-Skeletal System
Consists of the muscles and skeleton.
Hold the body together to provide structure

Muscles
Used for:

Movement

Protection

Stabilisation

Types of muscles:

Skeletal: lie parallel to each other

Smooth: group together

Cardiac: attach to each other

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Skeleton
Used for:

Protection

Structure

Attachment point for muscles

Erythropoesis

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Respiratory System
The respiratory centre consists of the following structures:

medulla oblongata respiratory system in the brain


phrenic nerve branch of nerves that control breathing (C3C4C5 keep the diaphragm alive)
upper and lower respiratory tract
lungs
diaphragm expand and contract the lungs and does 70% of breathing
intercostal muscles expand and contract chest area and control other 30% of breathing

Upper Respiratory Tract


In descending order:

mouth and nose

nasopharynx

oropharynx
laryngopharynx
epiglottis

Lower Respiratory Tract


In descending order:

larynx (voice box)

trachea
carina

primary bronchi
secondary bronchi

tertiary bronchi (bronchioles)


alveoli (for gas exchange)

Gaseous Exchange

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Lungs

Pleura (x2)
o parietal (around chest cavity)
o visceral (around the lungs)
o pleural space (between layers)

Breathing

12 20 breaths per minute


< 12bpm = bradypnea
> 20bpm = tachypnea

masks:
o
o
o
o
o

nebuliser
venturi
rebreather
non-rebreather
BVMR

40% @ 4 6lpm
40% @ 8lpm
60% @ 10 12lpm
95% @ 10 12lpm
100% @ 15lpm

when assessing breathing, check:


o rate (how fast)
o rhythm (whether its regular or not)
o volume (how much air shallow or deep)

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Integumentary System
Used for:
Protection from elements
Temperature regulation (by sweating)
Production of vitamin D
Consists of:

Epidermis:
o Outer layer of skin
o Has 5 layers of cells

Dermis:
o Hair follicles
o Sweat glands
o Nerves
o Sebaceous glands (oil)
o Blood vessels (capillaries)
Hypodermis/Subcutaneous Layer:
o Fatty tissues

Urinary System
Consists of:
o 2x kidneys
o 2x ureters
o bladder
o urethra
The kidneys sit in the posterior abdominal wall at the level of T12 L2
o Each kidney contains around 1 million filter units known as nephrons.
o Blood is filtered through the kidney to remove waste and produce urine from it.
o Lying above each kidney is an adrenal gland.
The ureters carry urine from the kidney to the bladder and are about 30cm long.
The bladder lies in the pelvic cavity.
o Its muscular walls can dilate to store more urine and contracts to expel it.
The urethra provides a passage for urine to the exterior.

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Gastrointestinal System
Approximate organ locations:

RUQ

LUQ

Liver
Gallbladder
Kidney
Large & small intestine

Stomach
Spleen
Pancreas
Kidney
Large & small intestine

RLQ

LLQ

Appendix
Bladder
Reproductive
Large & small intestine

Bladder
Reproductive
Large & small intestine

Reproductive System

Function is to reproduce

Maternity

40 weeks = full term


3 trimesters:
o 1st: 1 12 weeks
breasts get tender
morning sickness (hypermesisgravaduram)
fatigue
amenorrhea
uterus enlargement
lower abdominal cramping
lower BP higher HR

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2nd: 13 28 weeks
breast enlargement
abdominal enlargement
organs start moving
heartburn
constipation
cravings
rd
3 : 29 40 weeks
(possible) morning sickness
more everything
fundus drops
lactation

Child Birth

Maternity Pack

sterile gloves

blanket
linen savers
cord clamps
surgical blade

bag (for afterbirth)

mucus extractor

sterile gauze
plastic apron

safety glasses
sanitary towels

Stages of Labour

Stage 1:
o onset of contractions, until full dilation of cervix
o 10 30secs mild contractions
o 15 20mins contraction interval
o membranes rupture
o bloody show

Stage 2:
o crowning, until full delivery of baby
o 60 90secs contractions
o 60sec interval

Stage 3:
o delivery of placenta
o 5 30mins

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Antenatal Haemorrhage

Placenta Abruptia:
o dark red blood
o severe abdominal pain
o placenta separates from uterus wall
o can lose between 500ml 2000ml blood
o check vitals
Placenta Previa
o partially or completely covers the cervix
o bright red blood
o no pain, no contractions
Pre-eclampsia:
o 20th + n weeks
o can cause hypertension
o 140/90mmHH
o affects kidneys
o high concentration of protein in urine (proteinuria)
o blurred vision, headaches, abdominal pain
Eclampsia:
o 20th + n weeks
o 160/110mmHG
o can cause eclamptic seizures
o urine test +++ ++++
o youll want an ALS backup
o transport lateral (to prevent pressure on inferior vena cava)

Post-partum Haemorrhage

This is any bleeding after birth/placenta

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Patient Assessment
Primary Survey

Hazards
Make scene safe for you and your partner, patient, infection and protection.
SETUP
o
o
o
o
o

Stop: and think


Environment: night/day, rain/sun, hot/cold?
Traffic: protect against cars and human traffic (barrier tape if needed)
Unexpected: expect the unexpected and plan for it (eg: remove animals)
Protection: gloves, safety glasses, boots, helmet, reflective gear, etc.

Hello
Approach patient from the front
AVPU

Alert: do they follow with their eyes


o Verbal: do they respond to verbal communication
o Pain: do they react to pain (tap on shoulder/pinch ear)
o Unresponsive: patient has no response
o

If conscious:
o Introduce/identify yourself
o Ask if you can help them (expressed consent)
If unconscious:
o Adult: treat immediately (implied consent)
o Minor: get guardian permission if possible, if not, treat (implied consent)

Help
Call for backup:
o ILS, ALS, SAPS, Traffic, Fire, Hazmat, NSRI, AMS, Disaster Management, etc.
AABC
o Align spine
o Airway
o Breathing
o Circulation

Airway

Open airway:
o Head-tilt, chin-lift (if no suspected c-spine injuries)
o Jaw-thrust manoeuvre (if suspected c-spine injuries)
Maintain airway:
o Insert OPT (if unconscious)
o Suction (if needed)
Protect airway:
o Turn patient lateral (if possible)

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Breathing

Look, Listen, Feel


o Look for any chest rising
o Listen for chest sounds
o Feel for breath
o Unconscious:
10secs
head close to patient and looking at chest
o Conscious:
15, 30 or 60secs
dont tell patient youre looking at breathing (eg. just pretend to take pulse while assessing)
Rate:
o how fast is breath:
< 12bpm bradypnea: needs ventilation
12 20bpm normal: no intervention required, just administer oxygen
> 20bpm tachypnea: needs breath coaching (if conscious)
Rhythm:
o is the rhythm steady:
check for abnormal breaths
normal = 1 breath every 5-6 seconds
Volume:
o how much air:
check that the chest rises and falls sufficiently enough
Oxygenate patient (if safe to do so)

Chest Exam
Expose chest (after acquiring permission)
Inspect chest
o rise and fall
o check for paradoxical motion (opposite inflation/deflation)
o fractured ribs
o contusions (bruises)
o bleeding
o sucking chest wounds
o central cyanoses
o JVD (jugular vein distension)
Auscultate chest
o Listen for any abnormalities
o L & R apex (intersection of midclavicular line and Angle of Louis)
o L & R base (diagonal from nipple line on midaxillary line or bra strap)
o Heart sounds
Palpate chest
o fractures: crepitus
o subcutaneous emphysema (air entrapment)
o tracheal deviation
Percuss chest
o hyperresonance (too much resonance, hollow sound)
o hyporesonance (too little resonance, liquid/solid sound)

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Circulation

Conscious patient: use radial pulse


Unconscious patient: use carotid pulse
Rate:
o how fast is heart rate:
< 60bpm bradycardia
60 100bpm normal
> 100bpm tachycardia
Rhythm:
o is the heart rate steady, no arrhythmias
Volume:
o is the heart rate shallow or strong
Check for any profuse bleeding

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Secondary Survey

SAMPLE History

Signs and Symptoms


Allergies
Medication
Past medical history
Last oral input/output
Events leading up to

Cardiac
Respiratory
Endocrine
Neurological
Surgeries
Occupation/Obstetrics

Ask if in pain:

Onset: what were you doing before it started?


Provocation/Palliation: what makes it better/worse?
Quality: what type of pain? crushing, stabbing?
Radiation/Region: where does it go? where is it?
Severity: how bad is it? (scale of 1 10: ask patient for work pain ever and base answer on that)
Timing: does it come and go or is it constant?

Vital Signs

Pulse: rate, rhythm, volume

Blood pressure
Pupils: PERRL pupils equal & round & responsive to light

Respiratory rate: rate, rhythm, volume

Haemoglucose Test (HGT): blood glucose level

Skin: temp, colour, condition


Capillary refill
SATS
Glasgow Coma Scale

Glasgow Coma Scale


Eye Opening:
o Spontaneous
o Verbal
o Pain
o None
Verbal Response
o Orientated
o Confused
o Inappropriate words
o Incomprehensible sounds
o None
Motor Response
o Obeys commands
o Localises pain
o Withdraws from pain
o Abnormal flexion
o Abnormal extension
o None

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4
3
2
1
5
4
3
2
1
6
5
4
3
2
1

Head to Toe Survey

Deformities
Contusions
Abrasions
Punctures
Burns
Tenderness
Lacerations
Swelling

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Assessment of Emergencies
Respiratory Emergencies (pg 369 397)
HHH
ABC
Look for cyanosis
o mucus membranes (nose, mouth)
o central (chest area)
o peripheral (fingers & extremities)
Shape of the chest
o barrel chest
o equilateral shape
Jugular vein distension (JVD)
o veins standing out in neck
Auscultate the chest:
o Rales caused by flow of air through liquid in the lungs
o Rhonchi course breath sounds, flow of air through mucus
o Stridor high pitched inspiratory sound (upper airway obstruction)
o Wheeze expiratory whistling breath sound, air travelling through narrow air passages (asthma, C.O.P.D.)

APE (acute pulmonary edema)


Definition
Cause

Signs & Symptoms

Treatment

Accumulation of fluid in the space between the alveoli and the pulmonary
capillaries.
congestive heart failure
heroin overdose
liver sclerosis
pneumonia
some forms of asthma
neurogenic shock/spinal shock
tachycardia
dyspnea
rales
pink sputum from nose and mouth
oxygenate
take HGT
place in Fowlers position

COPD (chronic obstructive pulmonary disease)


Definition
Cause
Signs & Symptoms
Treatment

A slow process of dilation and disruption of the alveoli and airways, caused by
chronic bronchial obstruction.
smoking
constant inhalation of toxic gasses
Chronic bronchitis with mucus lasting more than 3 months within 2 years.
low-flow oxygen or nasal cannular
reassure patient can become combative
transport to hospital

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Asthma
Definition
Cause

Signs & Symptoms

The narrowing of bronchioles and build-up of mucus in alveoli forming a mucus


plug.
allergens
dust
smoking
wheezing on inspiration
severity:
MILD
MODERATE
SEVERE
use of accessory
muscles
colour of skin
wheezing
speech

Treatment

none

abdomen

all muscles used

normal
+ wheezing by
auscultation only
speaks in
sentences
none
20-30bpm
any

flushed
++ audible by ear

blue/pale
+++ audible by
ear
speaks in words

speaks in phrases

anxiety
anxious
respiratory rate
30-40bpm
position of pt. on
tripod
arrival
level of care
BAA/AEA
AEA
patient knows their treatment best
nebulise with 5ml saline, oxygen @ 4-6lpm for 10min
reassess (auscultate)
nebulise again if necessary
take HGT
transport in semi-Fowlers position

panic
40-60bpm
tripod/supine
CCA

Pnumothorax
Definition
Cause
Signs & Symptoms

Treatment

Partial or complete accumulation of air in the plural space (collapsed lung).


With coughing, the visceral pleura gets thinner and then ruptures allowing air
into the pleural space. (usually found in asthma patients or those with COPD)
sudden onset of dyspnea/shortness of breath
chest pain (pleuratic, not heart)
on auscultation youll hear decreased or absent air entry
on percussing youll hear hyperresonance/hollow sound
high flow oxygen
TLC
transport in semi-Fowlers or lateral on affected side

Anaphylactic Reaction
Definition
Cause
Signs & Symptoms

Treatment

Severe allergic reaction to a substance.


as above
airway swelling
wheezing
blood vessels dilate low blood pressure
obvious dyspnea
uticeria/rash
hives/welts
severe itching
ALS backup
nebulise
calm & reassure
get to hospital PFQ

Page 26

Hayfever
Definition
Cause
Signs & Symptoms
Treatment

Irritation of upper airway


mild allergic reaction to a substance (usually pollen)
itchy and watering eyes
itchy nose
anti-histamine

Pleural Effusion
Definition
Cause

Signs & Symptoms

Treatment

Fluids collect in pleural space usually due to infection.


infection
cancer
congestive heart failure
decreased or absent air entry on affected side
on percussing youll hear hyporesonance/solid sound
dyspnea
high flow oxygen
transport in semi-Fowlers position

Choking
Definition
Cause
Signs & Symptoms

Treatment

Blockage of airway
as above
obvious discomfort
hands to throat
use of all muscles to breathe
Heimlich manoeuvre
CPR if unconscious

Pulmonary Embolism
Definition
Cause
Signs & Symptoms

Treatment

Foreign body in lung, can cause death or death of lung


can be from blood clots from broken bones, etc.
dyspnea
acute chest pain
haematosis/coughing up of blood
cyanosis
tachypnea
varying degrees of consciousness
high flow oxygen
ventilate if needed
transport to hospital

Page 27

Hyperventilation Syndrome
Definition
Cause

Signs & Symptoms

Treatment

Rapid or deep breathing that lowers blood carbon dioxide levels to below normal
panic attack
high sugar levels
OD on aspirin
severe infection
anxious
tachypnea
dyspnea
dizziness
numbness or tingling in hands and feet
take HGT
oxygenate
coach breathing
transport to hospital

General Respiratory Problems


Signs & Symptoms

Treatment

tracheal tugging
tripod position
recession
use of accessory muscles
paradoxical motion (uneven movement of chest)
anxiety
head bobbing
oxygenate
transport to hospital if needed

Page 28

Cardiovascular Emergencies (pg 402 437)

HHH
ABC
Brief SAMPLE history
Take note especially of OPQRST questions
Ask:
o had heart attack before
o has heart problems
o has risk factors: smoking, high blood pressure, high stress
o takes medication
Use AED if no pulse
Transport to hospital ASAP

Arteriosclerosis found in obese people, geriatrics, smokers


Ischemia lack of O2
Infarction death of tissue

Angina Pectoris
Definition
Types

Treatment

Brief period of time when the heart doesnt get enough O2


Stable Angina:
Sharp, stabbing pain
The patient will be doing something physical.
They will have a vasospasm of the arteries.
There will be a decrease in blood and O2 supply to the heart.
The nerves in the heart will become irritable causing chest pain.
The patient will take meds and/or rest.
There will be vasodilation increasing the blood and O2 supply to the
heart.
Nerves will relax and pain will subside.
Lasts about 15mins.
Unstable Angina:
The patient knows they suffer from angina.
They then get a tear in the plaque build-up.
Platelet aggregation takes place causing even more narrowing of the
already narrowed artery.
The patient will then have a decrease in blood and O2 supply to the
heart.
The pain doesnt go away.
There will be a change in pain to a crushing pain.
Treat as if patient is having a myocardial infarction.
Lasts longer than 15mins.
high flow oxygen
ALS backup
transport to hospital in semi-Fowlers position

Page 29

AMI (acute myocardial infarction)


Definition
Signs & Symptoms

Treatment

Sudden death of cells in the heart. After 30mins cells start to die, after 2hrs 50%
of cells are dead and after 4-6hrs 90% of cells are dead.
sudden weakness
sweating
crushing/squeezing chest pain
radiating pain on left arm, jaw and back
sudden arrhythmias causing syncope/fainting
shortness of breath
pulmonary edema
initially have tachycardia then possibly bradycardia
BP can be initially high, cardiac output can then cause low BP
dyspnea
appearance: greyish in colour
agonal agoni
if not treated ASAP = sudden death
high flow oxygen
ALS backup
use AED if necessary/if heart stops
transport to hospital PFQ

ANGINA
P
Q
R
S
T
associated
signs & symp.

AMI

exercise / rest, meds


sharp, stabbing, burning
jaw, left arm, neck
1-5/10
doing something
cold & clammy, pale skin, anxiety,
tachycardia, tachypnea

anytime / rest, meds


crushing
jaw, left arm, neck
10/10
anytime
diaphoesis, grey skin, agonal agoni,
dyspnea

Congestive Heart/Cardiac Failure

This occurs when the heart is damaged (due to AMI or hypertension) and unable to pump powerfully enough (and fast
enough) to empty the chambers.

Left Ventricular Failure


Information

Signs & Symptoms

damaged left ventricle leads to a decrease in stretch


right side pumps normally normal volumes of blood delivered to the pulmonary
circulation
left ventricle not able to pump out blood leading to a backup of blood therefore
pressure increases in the left atrium and pulmonary veins
this causes serum to leak into the alveoli
pulmonary edema occurs
decrease in exercise tolerance
shortness of breath
nocturnal dyspnea
Rales and Rhonchi
peripheral cyanosis
tachycardia & tachypnea
increased BP
frothy pink sputum

Page 30

Right Ventricular Failure


Information

Signs & Symptoms

often occurs as a result of left ventricular failure


blood backs up from left side of the heart into the lungs
right heart must now work harder to pump blood into the engorged pulmonary
vessels
right ventricle is unable to keep up leading to failure
blood begins to back up in the right atrium
increase in pressure in the systemic circulation
distended jugular veins
shortness of breath
pedal and sacral edema
tender liver

Neurological Emergencies (pg 440 479)

Cerebrovascular Accident (CVA) or Stroke


Definition
Causes

Types

Signs & Symptoms

Treatment

An interruption of blood flow to the brain that results in the loss of brain
function.
Thrombus: blood clot
Embolis: mobile thrombus, air, fibre, plastic
Aneurism: burst blood vessel
o disseminating aneurism: small tears form on the artery (from
meds), becomes weak and ruptures
o berry aneurism: the wall of the artery begins to bulge and as
the heart beats, it becomes larger and then bursts.
Hemorrhagic:
Bleeding in the brain; can be caused by disseminating or berry
aneurism.
With berry aneurism, patient gets super headaches.
With a disseminating aneurism, 90% of the time its fatal.
Ischemic Stroke:
Blood is cut off from an area of the brain; can be caused by thrombus or
embolism.
Pupil is dilated on affected side
Opposite side of body is affected/weakened
check motor response; one side
sight disturbances
weaker or paralysis
hearing disturbances
decreased level of consciousness
balance affected
convulsions
anesecoria/unequal pupils
hemiplegia
diaphoresis (profuse sweating)
facial drooping
skin colour change
dysphasia
pri-prism
paresis/weakening
loss of co-ordination
parasthesia/pins & needles
increased HGT
tachy/bradycardia
memory loss
high flow oxygen
cover with blanket
calm & reassure
transport lateral on affected side
NB: check HGT for hypo/hyperglycaemia as can cause CVA

Page 31

Transient Ischemic Attack


This is a blood clot that has gone to the brain but the body has resolved the problem by itself. It lasts about 24hrs, and then all
signs and symptoms disappear.
You should treat as if the patient has had a full ischemic attack but warn them to go to hospital.

Convulsions Seizures
Definition
Causes

Types

Phases of Grand
Mal Seizure

Treatment

Uncoordinated muscular activity that can last several minutes.


congenital epilepsy
febrile sudden high temperature
structural head injuries, tumours, infections (meningitis)
metabolic abnormal blood chemistry
hypoglycaemia
alcohol
drugs
poisons
focal localisation
general whole body patient is aware
petit mal blank out, no muscle contractions
grand mal full muscle contractions, patient is not aware
1) Aura blurred vision, heightened senses
2) Tonic flexion
patients muscles are affected, including the
3) Clonic extension
diaphragm and intercostals
patient is not aware
can last 10sec 5mins
sphincters relax
skeletal muscles are affected
4) Post Ictal:
recovery stage
unconscious conscious
sleepy
emotional
embarrassed
aggressive
hot
confused
turn lateral in recovery position
high flow oxygen
take HGT
transport to hospital

Status Epilepticus
This is when seizures last longer than 30mins or the patient has many consecutive seizures in a short space of time.

Causes of Unconsciousness

Head Injury
Anoxia
Bleeding
Infection
Temperature
Seizure

Cardiac/CVA
Hyper/hypoglycaemia
Allergies/Alcohol
Medical
Poison

Page 32

Acute Abdomen (pg 466 479)


Definition
Types

Causes

Signs & Symptoms

Treatment

A condition of sudden onset of pain within the abdomen.


Parietal:
somatic, sharp, localised pain
spinal cord nerve that also supplies the skin of the abdomen. Can
perceive some sensations: pain, touch, pressure, cold, etc.
patient can identify and locate source of irritation
Visceral:
colicky, dull, poorly localised pain
supplied by autonomic nervous system
pain results from stretch of nerve fibres that surrounds the hollow
organs (dissention/contraction)
Referred Pain: pain felt at a location away from diseased organs
kidney stones
peritonitis inflammation of layer surrounding intestines
liver jaundice
bladder cystitis
reproductive gynae
aorta aneurism (can have visible pulse in abdomen)
guarding
pain
distention
tenderness
nausea
vomiting
loss of appetite
diarrhoea
constipation
fever
hypotension
rebound tendinitis - appendicitis
nothing to eat or drink
high flow oxygen
transport to hospital

Page 33

Diabetic Emergencies (pg 482 497)


Definition

Types

Developing Signs

Differences

Treatment

Full name: diabetes mellitus (sweet diabetes)


Metabolic disorder in which the body cannot metabolise (energy made
use of for the organism) glucose usually because of a lack of insulin.
The result: wasting of glucose in the urine
If left untreated, will lead to wasting of body tissue and death
Type I:
insulin dependent diabetes mellitus
onset: child
the body doesnt produce any insulin
patient takes daily injections of synthetic insulin and on a special diet
keeps the person in a hyperglycaemic state
this can cause damage to the nerve endings and blood vessels
Type II:
Non-insulin dependent diabetes mellitus
onset: adult
the pancreas does produce insulin but not enough for the body to
function properly
controlled by diet
may require non-insulin medication to stimulate the pancreas to
produce more insulin
polyphasia/excessive eating
polydepsia/excessive drinking
polyuria/excessive urinating
diabetic keytone acidosis/eating of own fatty acids
vomiting
abdominal pain
Kussmauls respiration
if untreated, unconscious diabetic coma, then death
normal sugar levels: 3.5 7.2mmol/l HGT
< 3.5 = hypoglycaemic
> 7.2 = hyperglycaemic
Diabetic Coma:
this is hyperglycaemia (too much glucose)
takes hours/days to go into a coma
cause: insufficient insulin, drinking of alcohol, overexertion
signs & symptoms: dehydration, sunken eyes, sweet fruity odour, rapid
weak pulse, varying degrees of consciousness
Insulin Shock:
this is hypoglycaemia (too little glucose)
cause: lack of insulin, vomiting after meal, not eating
signs & symptoms: normal rapid pulse, cold clammy skin, altered mental
state, hunger, seizures, weakness on one side.
DIABETIC COMA
INSULIN SHOCK
skin
hot, flushed, dry
pale, cold, clammy
breath
keto (smells like acetone
normal
nail polish remover)
HGT
> 7.2mmol/l
< 3.5mmol/l
respiration
Kussmauls
normal
time of coma
hours days
mins days
mental state
aggressive
combative/anxious
pulse
rapid, weak (thread) pulse tachycardia
BP
normal to low
normal to low
Diabetic Coma: high flow oxygen, transport to hospital
Insulin Shock: 25ml/g glucogel in oral mucosa, wait 5mins, reassess HGT, if still
low, another 25ml/g glucogel, call for backup

Page 34

Environmental Emergencies (pg 546 581)

Hypothermia

Loose heat by
o Radiation
o Convection
o Conduction
o Respiration
o Evaporation
Stages
o 35-33C shivering
o 33-30C lethargic, slow/stop shivering, cyanosis
o 30-<27C coma, hypotensive, bradycardia, everything slows down
Treatment
o Warm them up slowly
o remove from area
o remove clothing
o cover patient
Levels of damage
o frost nip
chilly, red skin no cell damage
o frostbite
superficial or deep
dead/damaged tissue/cells
wrap extremities individually
o gangrene
dead cells, irreversible damage
black in colour

Hyperthermia

Heat Cramps
o lack of electrolytes or the lack of distribution
o give water, stretch out muscles

Heat Exhaustion
o > 38C
o non-ventilated areas
o mines
o become very dehydrated
o tachycardia
o dizziness
o remove from area
o fan/cool them

Heat Stroke
o 40C
o dry and flushed skin
o hypotensive
o tachycardia
o possibly decreased LOC
o call for ALS backup
Page 35

Submersion (Drowning)
panic wave hits more panic swallow water laryngospasm hypoxia decreased LOC glug glug glug dead...

Near Drowning
As above, but patient survives.
Concern for secondary drowning where the salt content now in the lungs draws water from body into lungs causing pulmonary
oedema.

Diving Injuries

760mmHg = 1atmos.
every 10m decent in water is +1atmos.

Dangers:
o Decent:
tympanic membrane rupture (ear drum)
mask compression on face
o Bottom:
no real dangers
o Ascent:
air embolus
decompression illness (bends)

Page 36

Paediatrics

when arriving on scene, remove unnecessary gear


when approaching child, go down to their level
leave them with a parent or someone they know
give them a toy to play with
control your tone of voice, and keep calm
let them look at your equipment before using it on them
warm up your steth
explain everything to them in the most simple terms and make it fun for them
build up as much trust as possible

Ages

few hours: new born


1 day 1 month: neonate

1 month 1 year: infant


1 3 years: toddler
3 5 years: pre-schooler

6 12 years: primary schooler


13 19 years: adolescent

Medical Problems

Epiglottitis

Inflammation of the epiglottis


Night sweat, fever/pyrexia

Present like cold and flu in first 6-8hrs


Drooling
Red and inflamed

Stridor sounds when breathing

Abdominal muscle use, nasal flaring

Can go cyanotic
If left untreated, can die
Use nebuliser @ 5ml saline for 10mins

Croup

Trachea, larynx, bronchi


6 months and up
Dry cough (sounds like dog barking)

Can have respiratory distress or cyanosis


Pyrexia
Use nebuliser @ 5ml saline for 10mins

Page 37

Trauma (pg 630 911)


Mechanism of Injury

What happened
Scene: where are you
o Car:
damage where?
wearing seatbelt?
airbags deployed?
windshield condition
steering column damaged?
pedal conditions
o Motorbike:
helmet damage?
clothing damage?
General Environment
o rain/shine
o day/night
Index of Suspicion
o the gut feeling as to what is wrong
When to Immobilise:
o MVA
frontal impact (whiplash, etc.)
rear impact
roll-over (most dangerous)
t-bone
o PVA
legs hit first
can have other upper body injuries
o Fall from a height
mostly leg injuries
o Sport injuries
high tackle (rugby)
stepping wrong
o Blunt force trauma
cricket/baseball bats, pots, etc
o Penetrating trauma
knives
guns
o Environmental
diving
lightning

Page 38

Shock
The inability of the microcirculation to adequately perfuse the organs due to a breakdown of the cardiovascular system.
A breakdown in the heart, blood vessels, or fluid in the blood can lead to shock.
Signs & Symptoms:
o weak, tachycardia
o cold, clammy skin
o pale
o hypotensive/drop in BP
sympathetic nervous system
o cyanosis
o delayed capillary refill
o pupils dilated
o anxious (depending on LOC)

Hypovolemic Shock
The loss of volume in the vessels due to:

blood loss (can be internal or external)


diaphoresis (profuse sweating)

diarrhoea
emesis (vomiting)

Cardiogenic Shock

Basically an AMI

Neurogenic Shock
The loss of volume in the vessels due to spinal cord damage (usually) in the cervical area.

Above injury:
o cold & clammy
o sympathetic nervous response

Below injury:
o flushed & dry
o parasympathetic nervous response
o vessels dilate
bradycardia
possible pria prism

Septic Shock
The vessels dilate due to damage to vessel walls from toxins in the blood. Vessels then begin to leak causing:

low BP

tachycardia
yellow skin colour (liver cant filter toxins)

Anaphylactic Shock
This is due to an allergic reaction. Bronchioles constrict causing wheezing and dyspnea.
Treatment: call for ALS and nebulise

Page 39

Stages of Shock

INITIAL
hypoxia
damage to cell
membrane
metabolic acidosis
organs deprived of O2

COMPENSATING
hyperventilation to rid
body of CO2 levels
hypotension leads to
adrenaline &
noradrenalin release
leading to
increase in HR and
vasoconstriction leading
to
increase in BP

Page 40

DECOMPENSATING
failure of bodys
mechanisms
vital organs are
compromised
endotoxic shock due to
bacteria
HR + BP decrease
less perfusion

REFRACTORY/IRREVERSABLE
brain damage
cell infarction
death due to vital organ
failure

Bleeding

Internal
o Cavities
chest
abdomen
femur
pelvic
External
o Anything out of the body
Types of Bleeding
o Arterial
bright red
pulsates
o Venous
dark red
flows
o Capillary
red
oozes
To stop Bleeding:
o direct pressure
o indirect pressure (bandages)
pressure bandage
first aid dressing/trauma pad
roller bandages
gauze
o elevation
o pressure points
o tourniquet
Basically stop the red stuff from coming out!

Soft Tissue Injuries

Abrasion (graze)
o painful, burns, epidermal layer is removed

Contusion (bruise)
o capillaries under the skin break

Laceration (cut)
Avulsion
o a flap of skin
o often from head injuries (scalp)
Puncture (hole)

Haematoma
o severe contusion (more vessels are broken)
o swelling involved
Eccymosis
o mastoid process/head injuries
o small blue contusion
o a.k.a.: battle signs
Bites
Page 41

Abdominal Injuries

Hollow organs
o stomach, intestines, ureters, bladder

Solid organs
o liver, spleen, pancreas, kidneys

Abdominal Injuries

Closed
o peritonitis
soft organs spill contents into peritoneal cavity
intense inflammatory reaction and possible infection
intense pain
tenderness
muscular spasm
can become life threatening
o blunt abdominal wounds
severe bruising
laceration of liver or spleen
intestine rupture
kidney rupture or avulsion from arteries and other vessels
bladder rupture (especially if distended at time of injury)
intra-abdominal haemorrhage
be ready to treat for shock (hypovolemic)
seatbelt injuries (rib fractures, organ compression)
airbag injuries
Open
o penetrating injury
usually have obvious external bleeding
suspect large amounts of internal bleeding
very painful
nausea, vomiting
be ready to treat for hypovolemic shock
o abdominal evisceration
organs or fat protrude through the wound
never try to replace
cover with moist sterile gauze and secure in place with bandages and tape
keep the organs as warm as possible
get to hospital asap
Genitalia
o always very painful
o rarely life threatening, but can be a great concern to the patient
o managing blood loss is top priority
o calm and reassure patient, make them feel as comfortable as possible
Rectal bleeding
o can be caused by sexual assault, haemorrhoids, colitis or ulcers in the intestine tract or stomach
o large amounts of blood loss can lead to hypovolemic shock

Page 42

Facial Injuries

Facial injuries usually lead to partial or complete obstruction of the airway


Can lead to clotting in the airway

Take note of false teeth/dentures


Usually profuse bleeding
Suspect brain and/or spinal injuries

Treatment
o control & manage breathing as far as possible (OPT, lateral, etc.)
o control bleeding
o transport to hospital

Types of Injuries

Nose
o
o

epistaxis (nosebleeds) can occur spontaneously or as a result of trauma


two types of epistaxis:
anterior

originate from the septum


slow bleeding

self-limiting and resolves quickly


posterior
blood can drain into the throat

can cause vomiting and nausea


if there is major nasal deformity you should suspect fractures of the basilar skull and possibly cervical spine
injuries

o
o
o
o

provides sense of hearing and balance


tympanic membrane rupture can occur when the inner and outer ear pressures are not equal
usually no liquid comes from ear when damaged, if liquid is present, test for CSF and suspect cranial damage
ear can become avulsed

Ear

Facial Fractures
o usually a result of blunt force trauma
o most major blows to the facial region results in fractures
o possible signs & symptoms of facial fractures:
bleeding in the mouth
inability to swallow or talk
absent or loose teeth
movable bone fragments
patient says it doesnt feel right
o bleeding can cause respiratory problems
o swelling can cause airway obstruction
o remove dislodged teeth and/or dentures (false teeth) and transport in container with patient

Throat/Neck
o Blunt injuries:
usually involve the trachea or larynx
cartilage does not spring back after crushing therefore major airway obstruction
subcutaneous emphysema can occur if air leaks into the soft tissue
o Penetrating injuries:
can cause profuse bleeding (carotid artery & jugular vein) or air embolism
always maintain cervical spine stabilisation
Page 43

Eye Injuries

Normal, uninjured eyes:


o round
o equal in size
o react equally when exposed to light
o move simultaneously

Types of Injuries

Foreign objects
o Small: e.g. sand, dust, etc.
can cause severe irritation
usually stuck in the conjunctiva causing redness and swelling
eyes begin to water to flush object out
irrigate with saline solution (from nose outward)
o Large: e.g. metal, fish hook, pencil, etc.
severe pain and irritation
must be removed by a professional (doctor)
stabilise object and transport to hospital

Burns
o

Chemical
caused by acid/alkali substance
flush eye with saline for 5-20mins asap (depending on strength of substance)
transport to hospital
continue flushing with saline during transport if possible
Thermal
eyes usually closed in fire but eyelids burnt
do not attempt to do anything with the eye
cover with moist, sterile dressing
transport to hospital immediately
Light burns (e.g. sunlight, laser, infrared)
damages sensory cells
usually no pain, but permanent damage to vision usually occurs
apply moist, sterile dressing
transport to hospital
Lacerations
do not apply pressure
cover with moist, sterile gauze
transport to hospital
Blunt trauma
usually forms a black eye (bleeding into the orbits)
may see hyphema (bleeding into the anterior chamber of the eye)
transport to hospital if patient experiences pain, double vision or decreased vision

Page 44

Chest Injuries

Blunt
Penetrating

Pneumothorax
Cause
Signs & Symptoms

Treatment

Air in the pleural space surrounding the lungs


dyspnea
pain
tachycardia
decreased BP
JVD
tracheal deviation
palpating: will hear subcutaneous emphysema
auscultation: will hear decreased or absent air entry
ALS/ILS backup
use a 3-way pad over the wound with the opening in the direction of gravity

Haemothorax
Cause
Signs & Symptoms

Treatment

Due to ruptured blood vessels and blood entering the pleural space. There is
more blood than air. Usually caused by fractured ribs piercing pleura and vessels.
decreased air entry
hyporesonance
can become hypovolemic
hypotension
tachycardia
ALS backup
transport to hospital

Pericardial Tamponade
Cause
Signs & Symptoms

Treatment

Fluid leaking into the space between the myocardium and pericardium.
tachycardia
Becks Triad:
narrowing pulse pressure
muffled heart sounds
JVD
ALS backup
oxygenate
transport to hospital

Page 45

Flail Chest
Cause
Signs & Symptoms

Treatment

Two or more fractures in two or more places on two or more adjacent ribs.
paradoxical motion
intense pain
contusions
crepitus
very shallow dyspnea
guarding
oxygenate
transport to hospital
take careful note of haemo or pneumothorax

Contusions

Pulmonary Contusion:
o haemoptysis
o pain
o dyspnea

Myocardial Contusion:
o irregular rhythm
o some chest pain

Fractures

Compound # - bone sticking out/skin broken


Closed # - internal
Types:
o hairline
o greenstick
o comminuted
o pathologic
o epiphyseal

Signs & Symptoms


o
o
o
o
o
o
o
o
o

Please
Drop
Six
Cents
In
Uncle
Teds
Cup
Dankie

- Pain
- Deformation
- Swelling
- Crepitus
- Inflammation
- Unequal
- Tenderness
- Contusions
- Discolouration

Page 46

How to Treat

expose
check open/closed
check for distal pulse
capillary refill

sensation

motor response

skin colour
temperature

realign only if limb is threatened (i.e. no pulse/sensation)


shape/measure splint
splint above and below fracture
reassess vitals

Mid-shaft femur fractures:

there will be:


o

medial rotation

shortening of the leg/unequal lengths

treatment:
o

same assessment

check size and shape of splint

apply traction to leg

apply traction splint

traction first

then strap

reassess vitals

Page 47

Head Injuries

Concussion
Cause
Signs & Symptoms

Treatment

due to brain contusion or swelling


confused
slurred speech
headache
anesecoria
nystagmus (flutter of eyes)
amnesia
immobilise
oxygenate
full vitals
transport to hospital
TLC
keep them calm

Inter-cranial Haemorrhage
Cause
Signs & Symptoms

Treatment

subdural haematoma (below the dura mater)


epidural haematoma (above the dura mater)
patient can become aggressive/combative
vomiting
dizziness
anesecoria
potential seizures
confusion
immobilise
oxygenate
place lateral

Base of Skull #
Cause
Signs & Symptoms

Treatment

trauma to the head


ottorrhoea (blood coming out of the ears)
rhinorrhoea (blood coming out of the nose)
eccymosis of the mastoid process (battle signs)
periorbital haematomas (racoon eyes) (can happen up to 14hrs later)
decorticate/decerebrate movements
immobilise
oxygenate

Page 48

Raised Intracranial Pressure


Cause
Signs & Symptoms

coup/contra-coup motion
Cushings Reflex:
decrease in pulse rate
increased blood pressure
irregular respiration
oedema
increased cranial pressure
bleeding
decreased LOC
projectile vomiting
seizures
hypoxia

Treatment

oxygenate
transport to hospital PFQ

Poison, Bites and Stings

no legs: snakes, sharks


2 legs: humans

4 legs: dogs, cats, etc.

6 legs: scorpions, bees, insects


8 legs: spiders, ticks
many legs: centipedes

Snakes

Cytotoxic
o Causes blood cells do stop doing their job and begin disintegrating causing intense pain and swelling

Neurotoxic
o This causes neurons in the brain to die causing the body to stop functioning. The first system to shut down is
usually the respiratory system (located at the top of the spinal cord).
Haemotoxic:
o Prohibits the forming of platelets and the clotting of blood. Its an anti-coagulant that basically liquidises the
internal organs.

Organophosphates

Over stimulate the sympathetic nervous system causing:


o miosis
o bradypnea
o bradycardia
Signs & Symptoms
o Defecation
o Urination
o Miosis
o Bradypnea, bradycardia, bronchorrhoea
o Excitation
o Lacrimation
o Salivation
Treatment:
o call hazmat
o remove clothing and rinse patient for 5 20mins
o double glove
o often have to use BVMR
Page 49

Burns

Ways of being burnt


o chemical
o thermal burns (direct heat)
o electrical
o radiation

Types
o superficial (epidermis red, sore)
o partial thickness (epidermis + dermis red, blisters, very sore)
o full thickness (all layers charred, site of burn not sore (no nerves))
Critical locations
o hands
o feet
o inhalation
o genetailia
o 20 30% full thickness (based on rule of 9s)
Treatment
o 1. Burnshield
o 2. Saline
o 3. Water

Page 50