limmer et al., emergency care, 10 th edition © 2005 by pearson education, inc. upper saddle river,...
TRANSCRIPT
![Page 1: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/1.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
CHAPTER 7
SceneSize-Up
![Page 2: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/2.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Overall Assessment SchemeScene Size-UpScene Size-Up
Initial AssessmentInitial Assessment
TraumaTrauma MedicalMedical
Physical ExamPhysical Exam
Vital Signs &Vital Signs &SAMPLE HistorySAMPLE History
SAMPLE HistorySAMPLE History
Physical ExamPhysical Exam& Vital Signs& Vital Signs
DetailedDetailedPhysical ExamPhysical Exam
OngoingOngoingAssessmentAssessment
HOSPHOSP
![Page 3: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/3.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Scene Size-Up
Key Term
Determining any threats to your own safety or to the safety of your patients or bystanders, to determine the nature of the call, and to decide if you will need additional help
![Page 4: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/4.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Scene SafetyScene Safety
![Page 5: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/5.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Scene Safety
An assessment to assure the well-being of the EMT–Basic
Key Term
![Page 6: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/6.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Scene Safety
Protect bystanders (prevent them from becoming patients).
Never enter an unsafe scene.
Make scene safe or call for someone who can.
![Page 7: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/7.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Minimum 50’ around scene, further if:
Fuel spill
Fire
Hazardous materials
Downed power lines
Danger Zone
![Page 8: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/8.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Crash or Rescue ScenesCrash or Rescue Scenes
![Page 9: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/9.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Toxic Substances or HazmatToxic Substances or Hazmat
![Page 10: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/10.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Unstable Surfaces: Unstable Surfaces: Slopes, Ice, Water
![Page 11: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/11.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Use scene clues:
Fighting
Loud voices
Alcohol/drug use
Unusual silence
Prior experience
Scene Violence
![Page 12: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/12.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Crime Scenes and ViolenceCrime Scenes and Violence
![Page 13: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/13.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
BodyBodySubstanceSubstanceIsolationIsolation
![Page 14: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/14.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Body Substance Isolation
Anticipate the need for BSI.
Always have BSI equipment available.
Use appropriate equipment to prevent exposure.
![Page 15: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/15.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
BSI Review: GlovesBSI Review: Gloves
![Page 16: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/16.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
BSI Review: Mask and Eye ProtectionBSI Review: Mask and Eye Protection
![Page 17: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/17.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
BSI Review: GownBSI Review: Gown
![Page 18: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/18.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury/Mechanism of Injury/Nature of IllnessNature of Illness
![Page 19: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/19.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury
The physical event that caused an injury (fall, motor vehicle accident, etc.)
Key Term
![Page 20: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/20.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury
Determined from:
Patient
Family
Bystander
Observation of the scene
![Page 21: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/21.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury: Motor Vehicle Collision–Head On
![Page 22: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/22.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury: Motor Vehicle Collision–Rear Impact
![Page 23: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/23.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury: Motor Vehicle Collision–Side Impact
![Page 24: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/24.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury: Motor Vehicle Collision–Rollover
![Page 25: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/25.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Rotational
May have multiple impacts
Mechanism of Injury: Motor Vehicle Collision–Rotational
![Page 26: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/26.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Ejection
Deformed windshield, steering wheel, etc.
Amount of vehicle deformity
Seat belt use
Mechanism of Injury: Motor Vehicle Collision
![Page 27: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/27.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury: Motor Vehicle Collision–Vehicle Interior
![Page 28: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/28.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Motorcycles
All-terrain vehicles
Snowmobiles
Jet-Ski
Mechanism of Injury: Motor Vehicle Collision–Motorized Vehicle
![Page 29: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/29.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Mechanism of Injury:Injury: Falls
![Page 30: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/30.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Distance patient fell
Part of body that struck surface
Type of surface landed on
Did anything break the fall?
Mechanism of Injury: Falls
![Page 31: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/31.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Velocity
Low velocity–knife
Medium velocity–handgun, shotgun
High velocity–rifle
Body region penetrated
Exit wounds
Mechanism of Injury: Penetrating Trauma
![Page 32: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/32.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury:Mechanism of Injury: Penetrating Trauma
![Page 33: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/33.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury:Mechanism of Injury: Blunt Force Trauma
![Page 34: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/34.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Nature of Illness: Medical Patient
Sources of Information
Scene
Patient
Family and bystanders
![Page 35: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/35.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Adequacy ofAdequacy ofResourcesResources
![Page 36: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/36.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Adequacy of Resources
Number of patients?
Hazardous materials?
Fire or rescue?
Unusual situations?
![Page 37: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/37.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Adequacy of Resources
Call for assistance before beginning care.
Use triage procedures if necessary.
![Page 38: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/38.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
1. Why must BSI be considered 1. Why must BSI be considered during the size-up?during the size-up?
2. List several factors which may 2. List several factors which may make a scene unsafe.make a scene unsafe.
3. Describe ways to determine 3. Describe ways to determine information about the nature of information about the nature of medical emergencies.medical emergencies.
Review Questions
![Page 39: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/39.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
4. For each of the following mechanisms of injury, list several things to look for or consider:
Falls
Motor vehicle accidents
Penetrating trauma
Review Questions
![Page 40: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/40.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
What other scene size-up issues are still left to consider?
Is the scene now safe, or do other precautions need to be taken?
What BSI precautions should be considered?
STREET SCENESSTREET SCENES
![Page 41: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/41.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
When the second ambulance arrives, where should it be located in relation to the collision scene?
STREET SCENESSTREET SCENES
![Page 42: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/42.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
What precautions should you take to protect the patient from any further harm while they are being extricated from the vehicle?
STREET SCENESSTREET SCENES
![Page 43: Limmer et al., Emergency Care, 10 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 7 Scene Size-Up](https://reader033.vdocument.in/reader033/viewer/2022061305/55141568550346e7488b5265/html5/thumbnails/43.jpg)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
How should you plan to make sure that you can safely get the patient from the scene to the ambulance?
STREET SCENESSTREET SCENES