community first responder induction training course

COMMUNITY FIRST RESPONDER

INDUCTION TRAINING COURSE

June 2015

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Contents

THE HUMAN BODY IN HEALTH ......................................................................................... 3

THE UNCONCIOUS PATIENT ............................................................................................. 8

ADULT BASIC LIFE SUPPORT ........................................................................................... 9

AIRWAY MANAGEMENT .................................................................................................. 12

RECOVERY POSITION ...................................................................................................... 18

DEFIBRILLATION ...................................................................................................... 19

PAEDIATRIC BASIC LIFE SUPPORT ............................................................................... 26

DNACPR INSTRUCTIONS ................................................................................................. 31

PATIENT ASSESSMENT ............................................................................................ 34

PULSE OXIMETRY ..................................................................................................... 40

OXYGEN ............................................................................................................................ 43

RESPIRATORY EMERGENCIES ....................................................................................... 48

CARDIAC and CIRCULATORY EMERGENCIES .............................................................. 55

USE OF ASPIRIN ....................................................................................................... 58

STROKES/CVI ................................................................................................................... 62

SEIZURES .......................................................................................................................... 63

HEAD INJURY ................................................................................................................... 65

DIABETIC EMERGENCIES ................................................................................................ 66

PHYSIOLOGICAL SHOCK ................................................................................................ 68

ANAPHYLAXIS ........................................................................................................... 69

BURNS and SCALDS ........................................................................................................ 71

HAEMORRHAGE ........................................................................................................ 73

SKELETAL SYSTEM EMERGENCIES .............................................................................. 75

SPINAL INJURIES ............................................................................................................. 77

GLOSSARY OF TERMS .................................................................................................... 78

June 2015

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The Human Body in Health

June 2015

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Skeletal System

The Functions of the Skeletal System

• Support for the soft tissues, giving

shape and form and to provide a

point of attachment

• Protection of the vital organs

• Movement is facilitated by the

bones and joints which act as

levers to the attached muscles

• Mineral Storage which is then

distributed to other parts of the

body as required

• Blood Cells created within the

marrow of certain bones. Some are

red and carry oxygen and some

white that help fight infection

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Respiratory System

The Functions of the Respiratory System

• Extracts oxygen from the atmosphere and transfers it to the bloodstream

• Excretes waste carbon dioxide, other gases and water vapour

• Ventilate the lung

• Maintain the chemical balance within the body

• The breathing process is a three stage process consisting of:

� Breathing in (active)

� Breathing out (passive)

� Pause

• A process that is normally involuntary but we can override this (for a limited

period)

• Adults have average breathing rate of 12 -20 breaths per minute (b.p.m.)

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Circulatory System

• Oxygenated blood is supplied to the

heart muscle via the coronary

arteries

• A disruption to this blood supply

can lead to either angina or a heart

attack (MI)

• The heart beats approximately 60-

100 times per minute

• The left hand side pumps

oxygenated blood to the cells of

the body

• The right hand side pumps

deoxygenated blood to the lungs

• Blood carries oxygen and

nutrients to the cells and removes

waste products

• Blood travels through arteries,

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Nervous System

The Autonomic Nervous System automatically regulates

• The heart and blood vessels

• Respiration

• Coughing & Swallowing

• Sneezing

• Vomiting

The Functions of the Brain

• Stores information

• Controls mood and emotion

• Manages Intellect

• Communication to the body and organs

using electrical impulses via the spinal

cord and nerves

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The Unconscious Patient

An unconscious person is someone who is hard to rouse or can't be made aware of

his or her surroundings; this may be caused by illness, injury or emotional shock.

There are many levels of unconsciousness with some more serious than others.

Different levels may present as:

• Brief – Such as fainting or blacking out.

• Extended – Where the victim is incoherent when roused.

• Prolonged – A person in a coma, for example, can be motionless and not at all

aware of his or her surroundings for a very long time.

Management of unconsciousness

• Scene management

• Patient assessment (D.R.A.B.)

• Recovery position

• Where possible, treat the cause

• Provide oxygen therapy

• Monitor and record patient

condition

• Await arrival of ambulance

response

Causes of Unconsciousness

• Faint

• Imbalance of heat

• Shock

• Head injury

• Stroke

• Heart Conditions

• Asphyxia

• Poisoning (including

alcohol)

• Epilepsy

• Diabetes

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Adult Basic Life Support

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Basic Life Support

BREATHING

Look, Listen and Feel for 10

seconds

Is it adequate?

AIRWAY

Check the airway is open

Use head tilt & chin lift manoeuvre

If inadequate or no breathing effort – commence CPR at a rate of 30 compressions

to 2 breaths

1. Place hands in centre of the chest/breastbone

2. Compress chest to a depth of 5-6cm

3. Compress & release in one smooth, controlled

movement

4. Aim for a tempo of 100 - 120 compressions

per minute

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Adult Basic Life Support Protocol

Head Tilt/Chin Lift Method

Remember, in case of spinal injury use the

jaw thrust method

Sequence starts with chest compressions

Place hands in the centre of the chest and

compress to 1/3 depth of the chest.

Check for Danger & Check Response (AVPU)

Check for 10 seconds

Rescue breaths to last 1 second each

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Airway Management Equipment

Pocket Masks

• May be used on patient’s of any age, fit according to size of patient

• Position mask and apply an even pressure to form a complete seal

• Provide two effective rescue breaths

• Chest should rise, take mouth away between breaths & watch chest fall

before commencing the second breath

Adult/Older Child Baby/Infant

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Bag, Valve and Mask Resuscitation Device (BVM)

Uses

• May be used on any patient who is over

8 years of age and not breathing

• Provides a controlled artificial ventilation

to the patient

• May be connected to high flow oxygen

for greater effectiveness

Possible Complications

• Poor mask placement

• Inadequate seal (use secure grip)

• Poor ventilation technique

• Over/under inflation

• Inflation of stomach (may induce

vomiting)

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Oropharyngeal Airways (OPA)

Not to be used on:

• Conscious Patients

• Unconscious patients with a gag reflex

• A patient suffering with clenched teeth (Trismus)

• Prevents the tongue from obstructing the

airway

• Sizes used:

1. White

2. Green

3. Orange

4. Red

• Sized to individual patient (not age specific)

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Inserting an Oropharyngeal Airway

General points

• Ensure the airway is clear before inserting an OPA (consider suction)

• Do not continue to insert an OPA if the patient shows any signs of rejecting it

• Once inserted check that air is flowing through the OPA

• Ensure regular checks of the OPA to ensure it does not become blocked

Measure either:

• From the centre of the lips to the

angle of the jaw or

• From the corner of the mouth to the

ear lobe

To insert:

• Insert with the tip pointing towards

roof of patient’s mouth

• Rotate the OPA when it is inserted

halfway

• Advance the OPA forward until it

rests outside of the lips

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Suction

Indications for use

• Vomit or regurgitated material by

the unconscious patient

• Patients over 8 years of age

• Excessive sputum or saliva (for a

patient with reduced swallow

function)

• Blood (from facial/head injury,

nasal or gastric bleeding)

Possible Complications

Failure to use suction may lead to:

• Airway obstruction

• Stomach contents entering the

lungs (aspiration)

• Pneumonia (bacterial infection

of lungs)

• Collapsed lung (pnuemothorax)

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Suction

Using the equipment

• Wear appropriate PPE

• Assemble component parts ready for

use

• Measure the catheter for use (as

OPA’s) always suction under direct

vision

• Hold the catheter in the middle, do

not touch the end which will be

inserted into the patient’s mouth

• Rotate the catheter during suction to

avoid adherence to the soft tissues of

the mouth

• Never over insert the catheter,

ensure that you always keep sight of

the tip

General Points

Do not over insert the catheter

Do not overfill the aspirate receptacle

Carry out regular serviceability checks (repairs should only be

carried out by the manufacturer/ authorised repairers)

Consider retaining a sample of the aspirated material in cases of

unknown poisoning or in suspicious circumstances

After Use

• Dispose of all single use items

and the used receptacle as clinical

waste

• Use appropriate hard surface

wipes to clean the pump handle

• Check that the equipment is

serviceable after replacement of

collection container and catheter

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The Recovery Position

What is the Recovery Position?

• A safe position for the patient as it maintains an open airway

• It allows body fluids to drain from the mouth i.e. vomit, blood etc

• A patient may be left in this position should you need to leave them

• A patient can be constantly monitored in this position

• Pregnant ladies must only be put on their left hand side

• If appropriate, patients should be turned after 20 mins

In the case of spinal injury, the patient may be left on their back,

providing the airway is open (using jaw thrust method), not obstructed

and they are not left unattended.

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Automated External Defibrillation

June 2015

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Automated External Defibrillation

In the UK approximately 30,000 people sustain cardiac arrest outside hospital and

are treated by the ambulance service each year. Automated external defibrillation

(AED) is well established as the only effective therapy for cardiac arrest caused by

either ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).

The scientific evidence to support early defibrillation is overwhelming; the delay from

collapse to delivery of the first shock is the single most important determinant of

survival. If defibrillation is delivered promptly, survival rates as high as 75% have

been reported, however the chances of successful defibrillation decline at a rate of

about 10% with each minute of delay and whilst basic life support will help to

maintain a shockable rhythm but is not a definitive treatment.

The Chain of Survival

Early Access: Somebody has to witness the event and dial the emergency services

immediately.

Early CPR: CPR must be carried out right away, this can extend the time a person in

cardiac arrest is able to recover by supplying oxygenated blood to vital organs until

their heart can be re-started.

Early Defibrillation: In a lot of cardiac arrest victims, the heart goes into ventricular

fibrillation (VF), this is where the heart muscles are contracting too fast and they lose

their rhythm. Defibrillation by shocking the heart causes the heart muscles to "reset"

themselves and start beating in rhythm again. This is the single most important link

in the chain when the other links are all in place.

Early ACLS: Early advanced cardiac life support is provided by the ambulance crew

on arrival, although this is a very important link in the chain if the patient is to

recover, it has limited effect if earlier links in the chain are not in place.

June 2015

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Electrical Pathways of the Heart

The heart beats approximately 60-100 times per minute, with the left hand side

delivering oxygenated blood to the cells of the body and the right hand side pumping

deoxygenated blood to the lungs for re-oxygenation and waste removal.

For this process to happen, the heart muscle is made to contract by an organised

pattern of electrical activity originating within the brain.

Impulses received from the brain are passed to the first area of the heart, the

Sinoatrial (SA) Node, this passes impulses across the top two chambers (atrium)

causing these to contract and push blood into the ventricles below. The SA node

also passes a further impulse to the next node called the Atrioventricular (AV) Node

which causes the ventricles to contract, pumping blood oxygenated blood to the cells

of the body and de-oxygenated blood to the lungs.

If this electrical system is disrupted either by illness or injury, this can cause the

electrical signals to become very random and disorganised or stop all together,

therefore stopping the heart from pumping, this is a cardiac arrest.

Blood Circulation of the Heart Electrical Conduction of the Heart

June 2015

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How to use an AED

• Check that the patient is unconscious and not breathing using D.R.A.B.

• Ensure that the chest is prepared and all safety aspects considered

• Switch the AED on

• Attach the electrodes (pads) to the patient’s chest

• The AED will automatically analyse the patient’s heart rhythm

• Listen and follow the voice prompts

June 2015

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AED Pad Placement and Preparation

AED Pad Positioning

Pad Position

Patient Preparation

�� Remove clothing to expose the bare

chest (cutting the clothing off if

necessary)

�� Chest must be dry – remove any fluids

on the chest

�� Chest may need shaving in areas of

pads

�� Keep pads away from pacemakers

�� Remove any jewellery from chest area

�� Remove any GTN / Medication

patches

�� On female patients, the left pad should

be placed under the left breast and not

directly onto the breast tissue

AED Safety Considerations

�� Water

�� Direct Contact (yourself and

others)

�� Indirect contact (yourself and

others)

�� Avoid any potential

conducting surfaces

�� Ensure any oxygen supply is

moved to one side prior to

defibrillation (at least 1 metre)

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Adult BLS with an AED

June 2015

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AED Handover

The following information should be given to the ambulance crew on handover

where possible:

• Current situation on arrival of crew

• How long since patient collapse

• Number of shocks delivered

• Any public/bystander CPR?

• Relevant History

Cardiac Science G3 Laerdal FR2

Zoll AED Plus

June 2015

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Paediatric Basic Life Support

June 2015

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Paediatric Basic Life Support

The Facts

Whilst arguably one of the most difficult incidents that any emergency care provider

can experience, mercifully paediatric cardiac arrests are a very rare event.

Recent studies have found that many children do not receive resuscitation because

potential rescuers fear causing them harm. It is important to understand that it’s far

better to perform “adult style” resuscitation on a child (who is unresponsive and not

breathing) than to do nothing at all.

Approximately only 7-15% of cases require a defibrillator as cardiac arrest is usually

secondary to another cause such as Hypoxia. Unfortunately the majority of

paediatric cardiac arrests have a poor prognosis with survival rates estimated

somewhere between 3-17%.

Causes

• 60% are due to progressive respiratory problems (e.g. croup, bronchiolitis,

asthma, pneumonia, FB’s)

• Respiratory depression caused by prolonged convulsions, raised I.C.P. (head

injury), neuromuscular disease or drug overdose

• Sepsis (major infection)

• Dehydration

• Hypovolaemia

• Electrocution

• Congenital heart defect

June 2015

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Paediatric Basic Life Support (continued)

Providing CPR to a child in cardiac arrest

Supporting the child

Always ensure that all children are held in a safe and secure manner:

� For babies, this will necessitate cradling in your arms

� For older children this will normally require either lying them across your lap or

onto a suitable surface

If possible, for ease and security, it is advisable to get all paediatric cardiac arrest

patients lying flat onto a firm surface such as a table or the floor.

Maintaining the airway

There are subtle anatomical differences between a child’s and an adult’s airway.

Whilst many of the structures are smaller, the tongue is actually much larger than an

adult (in relative terms) which means that the airway is easily obstructed by the

tongue.

Dependant upon the child’s size, the technique used to open the airway will need to

be varied:

� For babies/small infants, the head should always remain in neutral alignment

� For toddlers/children, a small application of head tilt/chin lift should be applied

to achieve a position known as ‘sniffing the morning air’

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Paediatric Basic Life Support (continued)

Baby/Infant (up to 1 year)

Children over 1 year

Adjust CPR technique according to the size of the child

Ventilations

(you may use a pocket mask)

Compressions

(1/3 depth of the patient’s chest

June 2015

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Paediatric AED Use

Approximately only 10% of paediatric cardiac arrests require defibrillation due to

Hypoxia being the primary cause of cardiac arrest within children.

Therefore, whilst an AED may be used on a paediatric patient in cardiac arrest, this

is no substitute for highly effective BLS and the use of an AED should in no way

unnecessarily impact or disrupt BLS efforts.

By their very design, AED’s are extremely simple to use and this is no different with

children, with only the following minor notes

• Specific pads, smaller in physical size, automatically adjusts the AED’s charge

delivery and in some cases the algorithm followed

• Paediatric pads may be used on any cardiac arrest patient up to 8 years of age

• Commence CPR with 5 rescue breaths and then 30:2 for 1 minute prior to using

the AED

• Do not delay CPR unnecessarily to use the AED

• If you use an AED, follow the voice prompts as normal

AED Pad Positioning for Paediatric Patients

In the majority of cases, due to the size of the patient’s chest you will need to use

paediatric pads in the Anterior/Posterior position, however if size dictates, then you

may also use them in the normal adult AED pad positions (as pictured)

Alternative Positioning

(Apex/Sternum)

Normal Paediatric AED Pad Position

(Anterior/Posterior)

June 2015

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Do Not Attempt CPR Instruction (DNACPR)

When some people reach a point in their illness whereby it is considered that any

resuscitation attempt may be deemed futile or not conducive to them maintaining

their life to the same level pre-arrest, they may have a Do Not Attempt CPR

instruction applied to them.

The DNACPR form will be clearly printed on lilac paper. On rare occasions you may

be presented with a white copy or photocopy. These are still valid. A copy of this

form is shown on the next page.

The form is designed to ensure that CPR is not attempted where it clearly will not

work, or that the person’s wishes not to have CPR attempted are understood and

respected. It is an essential part of advanced care planning for people with advanced

and life-limiting illnesses, and will be applicable across all healthcare environments

within South Central SHA.

How does it affect responders?

All responders may discontinue/withhold resuscitation attempts if any of the following

exist:

1. A formal DNACPR order is in place, printed on a lilac DNACPR form (White

copies and photocopies are still valid, but these will be rare). The form will stay

with the person and will be located in the following places:

• Hospitals, Nursing Homes & Hospices: In the front of the person’s

notes

• In the Home: The tear off slip should be completed and placed in the

‘message in the bottle’ in the person’s refrigerator. The location of the

DNACPR form must be clearly stated on this slip. This will usually be in

the front of the persons care notes.

2. An Advanced Decision to Refuse Treatment (ADRT) (Previously called “living

wills” or “advanced directive(s)”) has been made by the person. This should be

attached to the DNACPR and documented on the lilac form. An ADRT enables a

person over 18 years, while they have capacity, to refuse specific medical

treatments, for a time in the future when they may lack the capacity or consent to

refuse that treatment. These documents are legally binding when valid and

applicable.

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Do Not Attempt CPR Instruction (DNACPR)

Important Points

• A DNACPR decision does not include immediately remediable witnessed life threatening clinical emergencies such as choking or anaphylaxis. Appropriate emergency interventions, including CPR should be attempted.

• CPR must not be delayed unnecessarily in an attempt to establish either the existence or location of a DNACPR form.

• If a responder has any doubt as to their actions for a given emergency or the validity of a DNACPR form, then they should commence CPR.

For a DNACPR form to be valid, the following sections must be completed:

• Personal details section at the very top of the form

• Section 1 – Reason for DNACPR decision

• Section 2 – Healthcare professional making this DNACPR decision – This must be completed, dated and signed by the healthcare professional with overall responsibility for the person’s care such as a medical consultant or GP.

Sections 3, 4 and 5 do not need to be completed for the form to be valid These forms do not have an expiry date, unless section 3 (review date) has been completed and signed.

If there are any doubts as to the validity of a DNACPR form,

then resuscitation attempts should be started

and EOC contacted immediately

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Do Not Attempt CPR (DNACPR) Form

June 2015

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Patient Assessment

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Patient Assessment

Primary Assessment – this should be carried out for every

patient

Danger – Scene safety, PPE, Gloves, Goggles

Response – Alert? Voice? Pain? Unresponsive?

Airway – Is it open? If not, open it

Breathing – Check for 10 seconds, is the patient breathing adequately?

2+ breaths = adequate breathing effort � <=1 breath - inadequate breathing effort

History: What has happened (e.g. patient fell over)

Signs: What can you see (e.g. bleeding?)

Symptoms: What the patient tells you (e.g. nausea)

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Patient Questioning

The following questions are a guide as to what to ask a patient during an

assessment:

• What is the main problem?

• What are the symptoms?

• When did it start?

• How bad is the primary symptom?

• Has anything changed?

• Has this happened before?

• Do they take any medication?

• Any known allergies

• Consider the ‘Mechanism of Injury’

Remember that the most effective questioning techniques are always a mixture of

both open and closed questions in conjunction with active listening

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Pain Scoring

A pain score is an extremely important part of the assessment process as it can

guide a clinician as to a possible diagnosis and also the requirement or effectiveness

of any treatment.

Every individual has a different pain threshold and regardless of your own thoughts

or observations, you must always rely upon the patient’s perception of the pain as

opposed to your own.

There have been many differing ways used to assess pain over the years; however

things have now been very much simplified, with the following process used:

• No Pain – Score of 0

• Mild – Score between 1-3

• Moderate – Score between 4-6

• Severe – Score between 7-10

• The pain score should be noted on the patient report form

For children, a visual scoring system is used

Please remember that diabetic patient’s can very often have a much higher pain

threshold than other people due to peripheral neuropathy (nerve damage).

June 2015

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Patient Handover

An effective and succinct handover to the attending ambulance clinician is vital to

ensure a seamless delivery of care for the patient.

By following this simple pneumonic below, you will ensure that only the most relevant

information is provided in an accurate, professional and timely manner.

Age of the patient

Time of incident/Onset of symptoms

Mechanism of injury/Medical complaint

Injuries/Examination findings

Signs – Vital signs/Base line observations

Treatment – details of any treatment provided

June 2015

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CFR Patient Report Form (CAS130)

June 2015

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Pulse Oximetry

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Pulse Oximetry

What is Pulse Oximetry?

Pulse oximetry is a simple non-invasive method of measuring the level of oxygen

saturation in the patient’s arterial blood, by assessing the absorption of infra-red light

within oxygenated and non-oxygenated haemoglobin within the small arteries,

usually in the finger-tip. It then calculates the percentage of haemoglobin that is

oxygenated and displays this as the oxygen saturation level on the screen.

The display is an LCD screen, and records the:

1. Pulse Rate

2. SaO2/SpO2 (Oxygen Saturation).

3. Signal strength bar or waveform

Normal Readings

In a normally healthy person, the oxygen saturation within their bloodstream spans a

very narrow normal range between 94% - 98%. However illness or serious injury can

cause these levels to drop very quickly:

• 90 – 93% represents evidence of hypoxia

• 85 - 89% represents serious hypoxia

• 85% or less represents CRITICAL hypoxia

Be aware of COPD patients

These patients suffer with a long term respiratory illness such as Emphysema or

Chronic Bronchitis which drastically affects their normal levels of oxygen. Unlike a

healthy person, due to their illness, their normal oxygen levels can be very low, often

between 88 – 92%

Many COPD patients carry oxygen administration warning cards which clearly

explain the use of oxygen and specific saturation levels particular to their condition,

these must be followed.

Use in Children

ALL children with significant illness and/or injury must receive HIGH levels of

supplementary oxygen if possible, regardless of their SpO2 reading.

June 2015

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Pulse Oximetry

When to use Pulse Oximetry

• Any patient exhibiting respiratory distress symptoms (e.g. SOB, dyspnoea,

asthma).

• Any cardiac patient to ensure hypoxia is not present.

• Any patient with an impaired level of consciousness

• Ensuring a regulated supply of oxygen to prevent respiratory acidosis in chronic

respiratory conditions

• If you intend to administer oxygen then pulse oximetry must be used, except in

cardiac arrest

Known carbon monoxide poisoning will cause the results to be artificially elevated,

therefore SpO2 should not be used

Possible Complications in Use

• Thick or dark nail varnish and/or false nails may cause inaccurate readings

• Shivering may cause failure to pick up a signal

• Bright overhead lighting may cause over-reading

• Carbon monoxide poisoning will cause abnormally optimistic readings

• Irregular cardiac rhythms may cause an inaccurate reading

• Children may be fearful or non-compliant, do not force them

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Oxygen

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Oxygen

• The atmosphere contains approximately 21% oxygen

• Every cell of our body requires oxygen in order to survive and function

• Brain death will start to occur after just 3 minutes without oxygen

• Medical oxygen is manufactured and is an essential tool within pre-hospital care. It is a prescription only medication (POM) with special dispensation for emergency care providers

• It is a colourless, odourless naturally occurring gas

• It is stored in lightweight cylinders

• The cylinder is normally white in colour and marked ‘Oxygen’ (usually in black lettering) and contains approximately 460 litres of compressed medical oxygen

Oxygen Tubing

‘CD’ Oxygen Cylinder

Carry Handle

Spigot (for oxygen tubing)

Face Mask with nose grip

Oxygen Mask

Main On/Off Valve

Flow Control Valve in litres

per minute (LPM)

Reservoir Bag

Nasal Cannula

Oxygen Tubing Nasal Prongs

June 2015

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Oxygen

Potential Indications for Use

Hypoxia

This is where the level of oxygen within the body becomes too low to meet the cell’s

needs and can arise from the deterioration of any medical illness or injury.

It can quickly reach dangerous levels causing severe brain injury and/or be fatal.

Causes (list not exhaustive)

• Severe injury/blood loss

• Head/chest injuries

• Heart disease

• Respiratory illness

• Shock

Left untreated, Hypoxia can be fatal

• Cardiac/Respiratory Arrest

• Respiratory Compromise

(e.g. suffocation)

• Chest Pain

• Acute Medical Illness

• Trauma

• Circulatory Compromise

(e.g. crush injury)

• Stroke

• Prolonged Seizure

• Toxic Syndromes

Signs and Symptoms

• Shortness of breath

• Difficulty Breathing (Dyspnoea)

• Low SpO2 reading

• Skin Pallor

• Cyanosis

• Confusion

• Unconsciousness

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Oxygen

Oxygen Administration

• Oxygen is used to treat Hypoxia only

• SpO2 levels must be measured before and during all oxygen administration

• Can be used on any age of patient

• Delivery via:

� Non re-breather oxygen mask (paediatric and adult) – titrated 12 to15 lpm

� Nasal Cannula (COPD patients) – titrated 2 to 6 lpm

� Bag Valve & Mask device (cardiac arrest only) – 15 lpm

• Oxygen Masks, Nasal Cannula and BVM’s are single patient use only

• Be aware of COPD warning cards and if present follow the instructions printed on

them

Safety

• Do not smoke around oxygen cylinders

• Do not expose oxygen cylinders to naked flames or other heat sources

• Check cylinders have an intact seal upon delivery

• Ensure outlet face is not damaged

• Do not allow oil or grease to come into contact with oxygen cylinders

June 2015

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June 2015

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The Human Body in Illness

June 2015

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Respiratory Emergencies

Respiratory emergencies are arguably one of the most common types of emergency

call received by the ambulance service and attended by responders.

Respiratory emergencies can be life threatening, and the application of timely and

effective treatment can literally mean the difference between life and death.

Common Breathing Problems

• Chest Infection - History of productive cough, shortness of breath (SOB), feeling

generally unwell, possible fever

• Chronic Chest Diseases (COPD) (e.g. Emphysema, Bronchitis) – Known

history, persistent cough, SOB, repeat chest infections, specific medications

• Chest Injuries – Bruising or fractures, penetrating wounds, pain reduces

patient’s breathing effort

General Management of Breathing Problems

• Asses D.R.A.B.

• Ensure patient has a patent airway

• Patient positioning (upright or semi-recumbent)

• Provide oxygen therapy if indicated

• Reassure the patient

• Remove the cause (where possible)

• Coach respirations if appropriate

• Never remove any penetrating object

• Monitor patient and record observations

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Asthma

More than 5.2 million people in the UK are being treated for asthma and about 1.1

million of these are children. Asthma affects approximately one in 12 adults and one

in eight children meaning that there is a person with asthma in one in five

households within the UK. It can affect almost anyone, at any age, anywhere,

although it tends to be worse in children and young adults. It is estimated that 3

people a day die as a direct result of asthma.

Asthma is a condition that affects the small airways and when a person with asthma

comes into contact with a trigger (such as dust, pollen, pollution etc), the muscles

around the walls of the airways tighten and the airways become narrower. The lining

of the airways become red and swollen and often sticky mucus or phlegm is

produced. All these reactions cause the airways to become narrower and irritated -

leading to the symptoms of asthma.

Stages of an Asthma Attack

Moderate (Stage 1)

• Speech normal

• May be a slight expiratory wheeze

• RR < 25 bpm

• HR < 110 bpm

Acute Severe (Stage 2)

• Unable to complete

sentences

• Clearly audible expiratory

wheeze

• RR > 25 bpm

• HR > 110 bpm

Life Threatening (Stage 3)

• Silent chest (no wheeze)

• Cyanosis

• Poor breathing effort

• Slowing heart rate

• Exhaustion

• Loss of consciousness

June 2015

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Asthma (continued)

Management of an Asthma Attack

• Reassure

• Position

• Encourage to use own medication/nebuliser/volumiser


• Reassure and encourage

• Be prepared to resuscitate

Types of Asthma Inhalers

June 2015

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Hyperventilation

Hyperventilation is a state of breathing faster or deeper than normal causing

excessive expulsion of the circulating carbon dioxide within the body matched by an

increasing oxygen level.

There can be many causes of hyperventilation and common triggers include

emotions of stress, anxiety, depression, or anger. Occasionally, hyperventilation

from panic can be related to a specific fear or phobia, such as a fear of heights,

dying, or closed-in spaces (claustrophobia) and often, panic and hyperventilation

become a vicious cycle.

The cause of hyperventilation cannot always be determined with sufficient accuracy

(especially in the early stages) within the pre-hospital environment. Therefore you

should always presume hyperventilation is secondary to hypoxia or another

underlying respiratory disorder until proven otherwise.

Hyperventilation may occur secondary to a life threatening condition

Recognition

• Previous history of panic attacks

• Immediate history of emotional

stimuli

• Fast, shallow rate of breathing

• Chest tightness

• Pins and needles/tingling in the

hands, face and around the lips

• Hands in spasm (claws)

Management

• Assess DRAB

• Remove the stimuli (where

possible)

• Sit the patient upright


June 2015

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Traumatic Chest Injuries

Traumatic chest injuries can be life threatening events, and whilst external injuries

may appear somewhat insignificant there is a high risk of injury to the underlying

organs, with unseen internal damage. Any patient with a traumatic chest injury

should be treated as time critical.

Common causes can include road traffic collisions, stabbings (not just with a knife!),

impaled on foreign bodies , crush injuries

Recognition

• Foreign body still present

• Difficult/laboured breathing

(Dyspnoea)

• Coughing up blood (bright red and

frothy)

• Open wound/bleeding

• Signs of shock

• Panic/anxiety

• Pain (may be worse on inspiration)

• Asymmetrical chest movement

• Flail Chest

Management

• Assess DRAB


• Position patient semi-recumbent leaning to the injured

side

• Cover any wounds, use plastic seal (if required)




• Do not remove any foreign object still in situ

June 2015

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Choking (Adult)

Choking is a serious medical emergency that is very much the epitome of a time

critical incident. A complete airway obstruction will mean that air is unable to enter or

leave the body with brain damage occurring as a result of hypoxia in as little as 3

minutes.

Choking is often caused by the ingestion of an object like food or a foreign body into

the upper airway and may either be a partial or complete obstruction.

Management of a Choking Adult

You first need to ask: “Are you choking?”

Mild Obstruction

• Says ‘yes’

• Speaks

• Coughs

• Breathes

Severe Obstruction

• Unable to speak

• May nod

• Cannot breathe or

wheezing

• Silent cough

• Unconscious

June 2015

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Choking (Paediatric)

A paediatric patient presents greater difficulty in assessing the severity of the

obstruction, therefore the rescuer should look for particular verbal clues as to

whether they have an effective cough reflex.

Effective Cough

• Cries or gives a verbal

response

• Coughs loudly

• Breathes before coughing

• Fully responsive

Ineffective Cough

• Cannot vocalise

• Cough is silent

• Cannot breathe

• Cyanosis

• Decreasing level of response

June 2015

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Cardiac and Circulatory Emergencies

June 2015

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Heart Attack and Angina

Heart Attack and Angina – What is the difference?

Signs and Symptoms

Patients may only present with some of these features and it is clear that it is very

difficult to differentiate, with a true diagnosis only being possible following a full ECG

and blood tests. Regardless of the suspected diagnosis, the treatment remains

exactly the same.

Heart Attack

• Also referred to as a Myocardial Infarction (MI)

• Caused by a complete blockage of a coronary

artery

Angina

• May be stable or unstable

• Caused by a partial obstruction of the

coronary artery

Heart Attack

• Crushing central chest pain

• Pain in the left arm, face or jaw


• Symptoms may start whilst at

rest

• Ashen/cyanosed, sweating

• Nausea/vomiting

• May not have any previous

cardiac history

Angina

• Central chest pain

• Pain in the left arm, face or

jaw


• Feeling weak

• Pale, cold, clammy

• Nausea/vomiting

• May have a previous

cardiac history

June 2015

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Heart Attack and Angina (continued)

Management of a suspected Heart Attack or Angina

As can be seen, both a heart attack and angina share virtually identical signs and

symptoms and as a result the management for either is exactly the same.

The aim of any treatment is to help reduce anxiety, reduce the workload of the heart

and also treat the clot that is causing the problem.

The following treatment steps should be followed:

• Assess D.R.A.B.


• Administer aspirin if indicated

• Place the patient in the semi-recumbent position and loosen any tight clothing

(neck/chest)

• Assist the patient to take any appropriate cardiac medication they may have

(i.e., GTN spray)


• Minimise the amount of movement of the patient



June 2015

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Aspirin

June 2015

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Aspirin

The Facts

• Aspirin is also known as Acetylsalicylic Acid and was originally derived from

the bark of the willow tree

• It helps to reduce the chances of clot formation and also acts as an analgesic

and anti-pyretic

• In emergency care, it is used as a 300mg single dose in tablet form

• Many patients regularly take a therapeutic dose of 75mg daily, this does not

affect any emergency dose administered

Why is it so important?

• Large scale clinical trials have proven a definitive link between aspirin and a

positive prognosis following an MI and are applicable to all groups of adult

patients with a suspected MI

• Aspirin decreases the chances of further clot formation by reducing the

‘stickiness’ of platelets

• Early administration ensures that the risk of clot obstruction will be reduced

within the affected artery, therefore helping to minimise damage to the

myocardium

Within healthcare, the safe administration of any drug is governed by a list of

indications (when it should be administered) and contra-indications (when it

absolutely should not be given).

To prevent any risk to the patient and to ensure that only safe and specific treatment

is provided, the indications, contra-indications and cautions should always be

checked prior to the administration of any drug.

June 2015

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Aspirin Administration

Cautions!

(If the patient confirms YES to ANY of these, contact the clinical support desk for

advice)

℡℡℡℡ Asthma ℡℡℡℡ Pregnancy ℡℡℡℡ Kidney or liver failure ℡℡℡℡ Gastric or duodenal ulcer ℡℡℡℡ Current treatment with anticoagulants

Indication for Use

Aspirin may be administered

to:

�� Patients over 16 years of age

presenting with cardiac

sounding chest pain that is

not exacerbated or eased by

inspiration or expiration and

who are not contra-indicated

Contra-Indications

Aspirin must not be administered to:

�� Any patient under 16 years of age (may

lead to Reye’s syndrome which,

although rare, has a 50% mortality rate)

�� Any known allergy or hypersensitivity to

aspirin

�� Patients diagnosed with haemophilia or

other blood clotting disorders

�� Known active gastric/peptic ulcer

�� If patient has received any other dose

of aspirin from either a F.A.W. or upon

advice from the EOC. (not including

normal daily dose of 75mg)

June 2015

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Side Effects

Although rare, aspirin may increase the chances of wheezing in asthmatics or gastric

bleeding (particularly within the elderly).

Administration Notes

• In the interests of accountability, traceability within the supply chain and

adherence to Trust clinical policy, only aspirin supplied by SCAS is to be used

• All aspirin stock must be securely stored within the main responder bag and not

in any outside pockets to aid child safety

• 1x 300mg tablet to be given and the patient advised to chew the tablet or dissolve

it under the tongue if possible (it will taste foul!). If carried, dispersible aspirin may

be given in a small amount of water.

• The attending ambulance crew should be advised of:

�� Time given �� Dose �� Batch Number �� Expiry Date

June 2015

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Nervous System Emergencies

June 2015

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Stroke

A stroke can be defined as damage caused to the brain by either a blocked or

bleeding artery which may be caused by a variety of reasons such as medical

conditions (high blood pressure, raised inter-cranial pressure etc) or significant

trauma.

A stroke’s effects may be either permanent, called a Cerebral Vascular Incident

(CVI) or temporary which is called a Transient Ischaemic Attack (TIA).

Face – Arms – Speech - Test

Bleed (20%) Blockage (70% of cases)

Signs and Symptoms

• Undertake a F.A.S.T. test

• Altered level of consciousness

• Confusion, abnormal emotional state

• Facial paralysis on one side (palsy)

• Limb weakness on one side

(hemiplegia)

• Difficulty speaking (slurred speech),

swallowing or breathing

• Incontinence

• Unequal pupils

• Relevant history (e.g. visual

disturbances, high blood pressure,

unexplained falls or

unconsciousness)

Management

• Assess DRAB

• Position patient with head

slightly raised

• Provide oxygen therapy if

indicated

• Provide reassurance

• Maintain patient dignity

• Monitor patient and record

observations


June 2015

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Seizures

What is a Seizure?

A seizure can be defined as an episode of disturbed brain activity that cause

changes in attention or behaviour. Symptoms vary from person to person with some

exhibiting simple staring spells, whilst others have violent shaking and loss of

alertness. The type of seizure depends upon the part of the brain affected.

Seizures may be caused by a variety of reasons such as epilepsy, diabetic

emergencies, head/brain Injury, alcohol withdrawal, poisoning, stroke or

hyper/hypothermia.

Do not restrain the patient and never allow anyone to force

the mouth open or force objects into it

Recognition

• History of seizures/other

relevant history

• Loss of consciousness (may be

transient)

• Reduced level of response

• Muscle twitching/rigidity

• Incontinence

• Breath holding

• ‘Glazed’ appearance

• Abnormal/inappropriate

behaviour

• ‘Aura’ (smell, taste, sensation)

Management

• Assess DRAB

• Make the area safe to reduce

risk of injury


indicated (this may prove

difficult)

• Time the seizure (where

possible)

• Monitor patient and record

observations

• Consider use of recovery

position after seizure

June 2015

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Febrile Seizures

What is a Febrile Seizure?

Febrile seizures are a relatively common childhood condition, referring to a

child having a seizure (fit) when they have a high temperature of 38ºCF (100.4ºF) or

above, usually as a result of an infection.

Most children have what is known as a tonic clonic seizure, during which the child's

body becomes stiff, they lose consciousness and their arms and legs twitch. Some

children may also wet themselves.

The recognition features are the same as adult seizures and the management is the

same.

In addition to the normal management of a seizure, it is also advisable to suggest

that the parents remove child’s clothing, but do not allow the child to become

hypothermic!

Watching a child having a seizure, particularly if they have no previous history of

seizures, can be very frightening and distressing for the parents and many parents

who have witnessed their child having a febrile seizure say they were convinced that

their child was going to die. However, although febrile seizures may be very

frightening, most are harmless and do not pose a threat to a child’s health.

June 2015

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Head Injury

A head injury can occur as a result of either direct or indirect force. The brain is at

risk following a head injury and may affect airway & breathing. In a significant head

injury, an associated neck injury should also be suspected.

Recognition

• Relevant history

• External head injury (bleeding)

• Brief or partial loss of

consciousness

• Dizziness and unsteady balance

• Nausea/vomiting

• Disorientation, confusion and

amnesia

• Slurred and/or incoherent

speech

• Lethargy

• Prolonged headache (mild and

generalised)

• Visual and audio disturbances

Management

• Assess DRAB

• Lay the patient down with

head slightly raised


indicated

• Treat any external

bleeding

• If unconscious, place in

recovery position

• Monitor patient and

record observations

• Record any periods of

unconsciousness

• Be prepared to

resuscitate

June 2015

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Diabetic Emergencies

What is Diabetes?

Diabetes is a common life-long health condition. There are 2.9 million people

diagnosed with diabetes within the UK and an estimated 850,000 people who have

the condition but don’t know it.

Diabetes is a condition where the amount of glucose in your blood is too high

because the body cannot use it properly. This is because your pancreas does not

produce any insulin, or not enough, to help glucose enter your body’s cells – or the

insulin that is produced does not work properly (known as insulin resistance).

Insulin is the hormone produced by the pancreas that allows glucose to enter the

body’s cells, where it is used as fuel for energy so we can work, play and generally

live our lives. It is vital for life.

Glucose comes from digesting carbohydrate and is also produced by the liver.

Carbohydrate comes from many different kinds of foods and drink, including starchy

foods such as bread, potatoes, fruit, some dairy products, sugar and other sweet

foods.

If you have diabetes, your body cannot make proper use of this glucose so it builds

up in the blood and isn’t able to be used as fuel.

Two forms of diabetes exist:

• Type 1 – Treated with diet & insulin combined

• Type 2 – Treated with diet, tablets or insulin

The two most common diabetic emergency presentations are:

• Hypoglycaemia – Low blood sugar level

• Hyperglycaemia – High blood sugar level

June 2015

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Diabetic Emergencies

Signs and Symptoms

Management of a Diabetic Emergency

• Assess DRAB


• If conscious: Encourage the patient to eat/drink something with a high sugar

content if able

• If unconscious: Place in recovery position


• Monitor and record observations


Hypoglycaemia (Low)

• Rapid onset (minutes)

• Rapid, shallow breathing

• Slow, bounding pulse

• Pale and sweaty

• Irritable, confused, aggressive

behaviour

• Inability to concentrate

• Confusion, dizziness &

headache

• Hunger

• Seizure

• Unconsciousness

Hyperglycaemia (High)

• Gradual onset (hours to

days)

• Slow, deep breathing

• Rapid pulse

• Flushed, dry skin

• Tiredness, lethargy,

drowsiness

• Blurred vision

• Excessive thirst, hunger or

urination

• Smell of acetone on breath

• Seizure

• Unconsciousness

June 2015

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Physiological Shock

Shock can be simply defined as a potentially fatal physiological reaction to a variety

of conditions, including illness, injury, haemorrhage or dehydration, usually

characterised by a marked loss of blood pressure, diminished blood circulation, and

inadequate blood flow to the tissues and cells of the body.

The main types of shock are:

• Toxic – poisoning

• Cardiogenic – heart failing

• Neurogenic – disruption of nervous system

• Hypovolaemic – loss of body fluid

Responders will most commonly deal with hypovolaemic shock which is caused by

an insufficient oxygen supply to the cells of the body due to the loss of circulating

blood/fluid volume.

Remember - Shock can kill very quickly

Recognition

• Pale, cold, clammy skin

• Rapid, shallow

breathing/rapid weak

pulse

• Air Hunger

• Weak and dizzy

• Nauseous / vomiting

• Thirsty

Management

• Treat the cause (where possible)

• Administer high flow oxygen

• Lay the patient down and raise their legs

• Keep the patient warm

• Loosen any tight clothing (neck, chest &

waist)


• Do not move the patient unnecessarily

• Do not allow them to eat, drink or smoke

anything

• Do not leave the patient unattended



June 2015

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Anaphylaxis

What is Anaphylaxis?

Anaphylaxis is a severe over-reaction of the body’s normal protective defences

(histamine) in response to a perceived threatening foreign substance which results in

a sudden, massive drop in blood pressure.

It is characterised by a marked and severe generalised swelling to the tissues of the

body (can be a high risk to the airway) in association with widespread itching

(pruritus) and redness/blotching (urticaria).

The majority of people that experience anaphylaxis have had exposure to the

problematic substance beforehand (often more than once) and common causes

include insect stings/bites, food stuffs (nuts, eggs, etc) and drugs.

June 2015

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Anaphylaxis

Signs and Symptoms

• Swelling of the face/neck

• Difficulty breathing

• Shortness of breath and wheezing

• A generalised blotchy rash (urticaria/wheals)

• Profuse itching (pruritus)

• Pale, cold, clammy skin

• Light-headedness

• May lead to respiratory/cardiac arrest

Management of Anaphylaxis

• Assess DRAB

• Ensure an open airway

• Sit the patient up (if conscious)

• Provide oxygen therapy

• Assist the patient with administering their Epi-pen*

• Loosen tight clothing around the neck/chest




* You may actually administer the Epi-pen only if you have received suitable training

June 2015

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Burns and Scalds

Burn and scald injuries can be grouped into two distinct categories:

Burn Classification

Burns (dry)

• Flame

• Electricity

• Friction

• Radiation

Scalds (wet)

• Boiling water

• Boiling steam

• Hot fats

• Chemicals

Partial Thickness Superficial

Full Thickness

June 2015

- 74 -

Burns and Scalds (continued)

Significant Burn Awareness

The following list may be classed as significant burns with particular dangers.

• To children

• To feet, hands, face or genitals

• All burns which extend around a limb

• Any size, full-thickness burn

• Partial thickness > 1% body surface area

• Superficial burns > 5% body surface area

• Chemical burns

Management of Burns

• Assess D.R.A.B.

• Provide high flow oxygen if indicated

• Non Chemical Burns – Cool for a minimum of 10 minutes

• Chemical Burns – Cool for a minimum of 20 minutes and try to identify the

chemical (if possible)

• Remove any contaminated/non-adherent clothing and jewellery from the affected

area

• Once cooled, apply cling film along the burn (not circumferential) through which

you may continue cooling

• DO NOT apply any lotions, creams, oils, etc

• DO NOT apply adhesive dressings

• DO NOT burst any blisters

• Treat for shock

June 2015

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Blood Loss (Haemorrhage)

Blood loss can occur through a variety of reasons, ranging from obvious external

injuries to an internal rupture of an organ or other structure.

Bleeding can occur from:

Arteries – Bright red and spurting

Veins – Dark red and a continuous flow

Capillaries – Oozes for a short while

Major blood loss is usually obvious and can rapidly lead to serious hypovolaemic

shock, however long term minor loss can also be as dangerous, and should never be

underestimated.

Bleeding from certain areas can also present further problems in addition to

hypovolaemic shock:

• Nose – danger to airway, history of assault

• Mouth – danger to airway, limits communication

• Head – bleeds profusely, possible spinal injury

• Ears – perforated ear drum, head or brain injury

• Lungs – may hinder breathing

• Stomach – vomit is brown, like ‘coffee grounds’

• Rectum – haemorrhoids, sexual assault

• Gynaecological – any unusual bleeding?

Internal Bleeding

Internal bleeding can be caused by either a direct or indirect force, with the

recognition features virtually the same as for external bleeding, however, bruising,

swelling, tenderness and rigidity may also be witnessed within the affected area.

A patient who is suffering from shock with no obvious injuries is likely to be suffering

from internal bleeding and therefore an extensive patient and incident history can be

particularly significant in recognition.

June 2015

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Blood Loss (Haemorrhage)

Management of Blood Loss

• Assess D.R.A.B.

• Expose and examine the wound

• Lay the patient down (if possible)

• Apply direct pressure

• Elevate the affected area above the level of the heart (where possible)


• Treat the patient for shock

• Apply a sterile dressing (if necessary)

• Monitor the patient and record observations

• Do NOT remove any embedded object

June 2015

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Skeletal System Emergencies

There are two common types of injuries that can occur to the skeletal system –

Fractures and Dislocations.

Whilst very different types of injury, they also share a lot of similarities in regards to

cause, presentation, recognition and treatment. It can sometimes be hard to tell if a

bone is dislocated or broken, however both are emergency situations and require the

same immediate treatment.

Patella (Kneecap) Dislocation

Closed

Fracture

Open

Fracture

Comminuted

Fracture

Fractures

A fracture is a break within the continuity

of a bone and it may either be partial or

complete.

Common causes can be either from

direct force such as an arm being hit with

an object and fracturing the radius

(forearm bone), or indirect force such as

falling onto an outstretched hand/arm

and fracturing a collar bone.

Very often there are wounds associated

with fracture sites and these can be

classed as closed, open or comminuted.

Dislocations

Joints are areas where two or more bones

come together. If a sudden impact injures a

joint, the bones that meet at that joint may

become dislocated (not connected). That

means the bones are no longer in their

normal position. Usually the joint capsule and

ligaments tear when a joint becomes

dislocated, and often the nerves are injured.

June 2015

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Skeletal System Emergencies (continued)

Management of a Fracture/Dislocation

• Assess D.R.A.B.


• Keep the affected area still (encourage the patient to hold it)

• Immobilise the affected area (if necessary)

• Treat any open fracture wounds by gently covering with a dressing



Never attempt to reduce a dislocation back to normal

Signs and Symptoms of a Fracture/Dislocation

• Swelling

• Loss of power

• Irregularity

• Pain

• Deformity

• Unnatural movement

• Crepitus (bone grating)

• Tenderness

• Bruising

June 2015

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Spinal Injuries

Spinal cord injury (SCI) most commonly affects young and fit people and will

continue to affect them to a varying degree for the rest of their lives. In the extreme,

it may prove immediately fatal where the upper cervical cord is damaged, paralysing

the diaphragm and respiratory muscles. Partial cord damage, however, may solely

affect individual sensory or motor nerve tracts producing varying long-term disability.

Management

Asses D.R.A.B.

If required use jaw thrust method to open airway

Do not move the patient unless required to maintain airway, or patient is in a

dangerous position.

Only place unconscious patient in recovery position if airway cannot be maintained

or patient has to be left alone.

Remember that the unconscious patient cannot tell you any history or

symptoms so always suspect a spinal injury

Common Causes

• Falls from height

• Road traffic collisions

• Any significant head injury

• Multiple injuries

• Diving into shallow water

• Fall from horse

• Any injury resulting in neck or

back pain.

Recognition

• Any of the above, or

mechanism of injury you

suspect may result in spinal

injury

• Sensation of burning or electric

shock in trunk or limbs

• Tingling or loss of movement

or sensation in the limbs

• Pain in neck or back

• Loss of bowel or bladder

control

June 2015

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Glossary of Terms

Acute (of disease): Severe, rapidly developing, or of a sudden onset.

Ambulance Technician: Experienced ambulance crew member capable of delivering a

wide range of drugs and treatments to patients.

Angina: Condition of gripping chest pain associated with disease and the narrowing of the

arteries of the heart which can be described as cramping of the heart muscle.

Asphyxia: Suffocation by smothering or any condition that prevents oxygen being taken up

by the blood.

Aspirator: A suction device used in the removal of fluids from the airway and other cavities.

Asthma: Tightening or restriction of the lower small airways accompanied by a sense of

suffocation or tightness of the chest.

Cardiac: Relating to the heart.

Casualty: Any victim of an accident or sudden illness.

Catheter: A tube designed to be passed into a body cavity.

Chronic (of disease): persistent and lasting disease or medical condition, or one that has

developed slowly.

Communication assistance device: A portable device which may provide a

communication-challenged person with a means of communication. (i.e. an enhanced or

artificial voice, script on a monitor screen).

Community Nurse: A nurse who specialises in care for people within their own home or

local health centres.

June 2015

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Glossary of Terms (continued)

Coronary Thrombus: Blockage of one or more of the arteries that supply blood to the

cardiac muscle usually caused by blood clots and/or fatty tissue.

Cyanosis: A dusky bluish tint to the skin due to a lack of oxygen in the blood.

Diabetes Mellitus: Disease caused by either insulin deficiency or uptake problems.

Dyspnoea: Difficult or laboured breathing.

Emergency Care Assistant: Ambulance crew member usually working alongside a more

experienced colleague in the delivery of emergency care.

Emergency Care Practitioner: Senior and highly skilled ambulance crew member capable

of delivering advanced medical skills and treatments above and beyond that of a Paramedic.

Emergency Operations Centre (EOC): Where 999 calls are received and ambulance

resources despatched/managed from.

Emphysema: A chronic and debilitating condition affecting the very small airways within the

lungs, the primary cause being smoking.

Epilepsy: Convulsive seizures caused by a disorder of the normal functioning of the brain.

Fibrillation: Uncoordinated contraction of muscle fibres and cells within the heart.

Hyperglycaemia: High levels of glucose in the blood.

Hypoglycaemia: Low levels of glucose in the blood.

Hypoxia: Low levels of oxygen within the blood and tissues of the body.

Incident: Any accident, occurrence or other unforeseen event requiring an ambulance

response.

June 2015

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Glossary of Terms (continued)

Pacemaker: An apparatus for artificially controlling the rhythm and rate of the heart.

Paramedic: Senior and highly skilled ambulance crew member capable of administering a

large range of drugs and medical skills.

Personal protective equipment (PPE): Specialised equipment provided for your safety

such as hi-visibility jacket, gloves etc

Pleurisy: Inflammation of the covering of the lungs.

Pneumonia: Infection of the lung tissue.

Pulmonary: Relating to the lungs.

Response times: The time lapse between notification of an emergency and the arrival of an

ambulance response.

Tachycardia: A fast heart rate, normally >100 beats per minute.

Vaccination: Immunisation by giving a vaccine.

Vaccine: Substance created from the germs of an infectious disease used to treat that

disease (vaccine may be either active or inactive).

June 2015

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NOTES

June 2015

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NOTES

June 2015

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NOTES

June 2015

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NOTES

June 2015

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community first responder induction training course

Documents