106 First Aid and Field Sanitation

Question 1

9 General First Aid Rules

Answer 1

TUMER RANA

Take a moment to get organized

Unless contraindicated, make your prelim exam in the position and place you find the victim

Multi victim - limit prelim survey to observing for ABC’s

Examine for fractures (esp. skull, neck, spine, rib)

Remove enough clothing to see the full extent of injury, respect PT modesty, don’t let them get cold

Reassure victim and make them comfortable

Avoid touching wounds and burns with fingers or unsterile objects

Never give an unconscious PT anything by mouth. Position unconscious or semiconscious on side or back with head turned to the side to prevent choking or breathing vomit.

Always carry a litter PT feet first

Question 2

Define Triage (which is french for “to sort’’)

Answer 2

quickly assessing multiple casualties in an incidence and assigning a PT priority or classification based on the severity of injuries

Question 3

Class I Sorting for Tactical Treatment

Answer 3

MINOR

require MINOR treatment that can be done outpatient or ambulatory.

can be returned to duty in a short period of time

Question 4

Class II Sorting for Tactical Treatment

Answer 4

IMMEDIATE

require IMMEDIATE life sustaining measures or are of a moderate nature.

require minimum amount of time, personnel, and supplies

Question 5

Class III Sorting for Tactical Treatment

Answer 5

DELAYED

definitive treatment can be delayed without jeopardizing life or loss of limb

Question 6

Class IV Sorting for Tactical Treatment

Answer 6

EXPECTANT

wound or injuries require extensive treatment beyond immediate medical capabilities

treatment of these casualties would be detrimental to others

Question 7

Priority I Sorting for Non Tactical Treatment

Answer 7

IMMEDIATE

Immediate correctable life threatening injuries or injuries like

respiratory arrest or obstruction
open chest or abdomen wounds
femur fractures
critical burns

Question 8

Priority II Sorting for Non Tactical Treatment

Answer 8

DELAYED

Delayed serious but non life threatening injuries like

moderate blood loss
open or multiple fractures
eye injuries

Question 9

Priority III Sorting for Non Tactical Treatment

Answer 9

MINIMAL

Minor injuries like

soft tissue injury
simple fracture
minor to moderate burns

Question 10

Priority IV Sorting for Non Tactical Treatment

Answer 10

EXPECTANT

dead of fatally injured PTs

exposed brain matter
decapitation
incineration

Question 11

Primary survey

Answer 11

rapid initial assessment to detect and treat life-threatening conditions that require IMMEDIATE care

*followed by a status decision about PT stability and priority for transport to MTF

Question 12

A = Airway

Answer 12

obstructed airway can lead to respiratory arrest and death

assess responsiveness. open if necessary

Question 13

B = Breathing

Answer 13

Respiratory arrest leads to cardiac arrest.

assess breathing. provide rescue breathing if needed

look for and treat conditions that compromise breathing like penetrating chest trauma

Question 14

C = Circulation

Answer 14

if heart is stopped. no blood to brain

• irreversible changes to brain in 4-6 min.
• cell death in 10 min.

Assess circulation and do CPR if necessary.

Check for profuse bleeding that can be controlled.

Assess and begin treatment for severe shock or the potential for severe shock.

Question 15

D = Disability

Answer 15

Serious CNS injuries can result in death.

Assess PT level of consciousness

If head or neck injury suspected, apply rigid neck collar

Observe the neck before covering up

Do quick assessment of extremity mobility

Question 16

E = Expose

Answer 16

You can’t treat injuries you can’t see.

Remove clothing to check for life threatening injuries.

Protect PT privacy and keep PT warm w/ blanket if necessary.

Question 17

What do you do after ABCDE is completed?

Answer 17

Make a status decision of the PT’s condition.

The ABCDE and status/transport decision should take 10 minutes to complete from arrival on scene.

Question 18

The essence of shock control and prevention?

Answer 18

To recognize onset of condition and start treatment before the symptoms fully develop

Question 19

Signs and symptoms of Shock

Answer 19

PT’s B-E-S-T Puls and BP

PT status: Restlessness and apprehension followed by apathy(lack of interest/concern)

Breathing: rabid or labored –shallow/irreg in late stage

Eyes: Glassy and dull; pupils may dilate

Skin: cool and clammy sweat

Temp: continuous fall

Pulse: rapid weak and thready.
NEUROGENIC=60bpm HEMORRHAGIC=140bpm

Blood Pressure: severely lowered

• surface veins may collapse
• systolic blood pressure falls below 80 for long periods
• kidneys may shut down
• person may faint from inadequate venous blood return to the heart..may be from standing up to quickly

Question 20

What are the ways to control hemorrhage?

Answer 20

3

Pressure dressing
Pressure Points
Tourniquet

Question 21

Pressure dressing

Answer 21

Best way to control EXTERNAL bleeding

Apply compress to wound and exert direct pressure to the wound

Can use Pressure Point if pressure dressing doesn’t stop the bleeding

Elevating extremity and splints can help

Question 22

Pressure Point

Answer 22

A spot where the main artery to an injured part lies near the skin surface over the bone

Apply pressure to this point with fingers or heel of hand

Object is to compress the artery against the bone, thus shutting off blood flow of blood from the heart to the wound.

11 points on each side of the body. Hard to maintain for more than 15 min.

Question 23

Tourniquets

Answer 23

Constricting band that cuts of blood supply to an injured limb

Last Resort

Always applied above the wound and as close to the wound as practical

Question 24

Head Wounds

Answer 24

Never give any medications

Keep victim laying flat w/head at body level
Do not raise the feet if face is flushed

If victim is having trouble breathing, elevate head slightly

If wound is at the back of the head, turn victim on his side

Watch for vomiting-position head to avoid aspiration of vomit or saliva

No direct pressure if the skull is depressed or fractured

Question 25

Facial wounds

Answer 25

MAINTAIN airway Cover both eyes for eye injury to prevent sympathetic movement Only pull out embedded object if obstructing airway

Question 26

Chest wounds

Answer 26

Victims showing signs of difficulty breathing without signs of airway obstruction should be inspected for CHEST injuries Sucking Chest wound is the most serious chest injury. (Penetrating chest wound that produces hole in chest cavity). - seal the wound with hand or airtight material (eg ID CArd) - tape the material in place and secure with pressure dressing - give oxygen if available - place victim in Fowlers position (lazy boy) - watch for shock - do not give drinks - transport to mtf immediately

Question 27

Abdominal Wound

Answer 27

Take to MTF immediately (time is crucial) Only basic first aid should be given DO NOT push intestines back in *If intestines are exposed, taco them in a moistened sterile dressing. Lay that on the PT and secure with a bandage. DO NOT give drinks (moisten mouth with a little water) Put PT in supine position with knees up (place pillow or bulky item to maintain position) Watch for shock If intestines are exposed, use sterile dressing moistened with sterile water and "taco" the intestines into the dressing-then lay it on PT-hold in place with bandage apply JUST sterile dressing if unexposed

Question 28

Closed fracture

Answer 28

injury is entirely internal broke bone - no break in skin

Question 29

Open fracture

Answer 29

open wound in the tissues and skin near broken bone site

Question 30

Forearm fracture

Answer 30

2 long bones in the forearm: radius/ulna When both are broken arm looks deformed When 1 is broken the other acts like a splint and the arm retains somewhat natural appearance - Stop bleeding ASAP - Carefully straighten arm - Apply pneumatic splint(inflatable) or two well padded splints from elbow to wrist - bandage splint to hold in place - forearm should be across chest with palm turned in and thumb pointed up. - use a wide sling to support the arm in position - hand will be 4 INCHES above elbow level * treat for shock/evac ASAP

Question 31

Upper Arm fracture

Answer 31

Signs of fracture include pain, tenderness, swelling, and wobbly motion -if fracture is on the upper arm near shoulder, place folded towel in the armpit, bandage the arm to the body, and support with narrow sling - if fracture is in the middle part of arm, use a well padded split on the outside of arm(shoulder to elbow) - Fasten arm to body and support forearm with NARROW sling - if no distal pulse, apply traction and THEN splint - Treat for shock

Question 32

Thigh fracture

Answer 32

Carefully straighten leg 2 splints: 1 on outside of leg/1 on inside - outside splint should reach from armpit to foot - inside splint should reach from crotch to foot Splint is fastened in 5 places: - around the ankle - over the knee - just below the hip - around the pelvis - just below the armpit - DO NOT MOVE VICTIM until leg is immobilized *Hare or Thomas splint are best- but can improvise

Question 33

Lower leg fracture

Answer 33

Carefully straighten leg Apply pneumatic splint if available If not; apply 3 splints-1 on each side and 1 underneath Make sure splints are padded under the knee and at the bones on each side of the ankle This can be done by putting a pillow under the leg and bringing the sides of the pillow around the front of the leg. -splint each side of the leg(over the pillow) and fasten in place with bandage or adhesive tape. - treat for shock * Hare or Thomas splints can be used

Question 34

Clavicle Fracture

Answer 34

When the victim stands, the injured shoulder is LOWER than the uninjured one. Victim cannot usually raise arm above shoulder May attempt to hold elbow of injured shoulder to side If OPEN fracture: stop bloodflow and treat wound first Apply sling and swathe splint(outside arm on injured side to between inside arm/side of chest on uninjured side) Arm should be bent across chest, palm turned in with thumb pointed up. Hand raised 4 inches above elbow * Figure 8 bandage may also be used - treat for shock and evac ASAP

Question 35

Rib fracture

Answer 35

Make the victim comfortable and quiet to minimize further damage to lungs, heart, or chest wall by the broken ends of the ribs Ask PT to point out the exact area of the pain. There may or may not be a rib deformity, chest wall contusion(bruising), or laceration. Ordinarily rib fractures are not bound, strapped, or taped if the victim is comfortable, but maybe splinted by use of external support If PT more comfortable with ribs immobilized, use a SWATHE (wide strip bandage) and strap the arm on the injured side to the chest. Palm flat, thumb up, forearm raised 45 degrees. Do not use adhesive plaster directly on skin of chest for immobilization as it limits ability of chest to expand thus interfering with proper breathing. Treat for shock and evac

Question 36

How is the seriousness of a burn injury estimated?

Answer 36

Depth, extent, and location of burn Also age and medical complications

Question 37

Burns and scalds are essentially the same injury, but what is the one thing that makes them different?

Answer 37

``` Burn = dry heat Scald = moist heat ```

Question 38

Describe First Degree Burn

Answer 38

Epidermal layer = irritated, red, tingling Skin is sensitive to touch; blanches(white) with pressure Pain: mild-severe Edema: minimal Healing within a week

Question 39

Describe Second Degree burn

Answer 39

Epidermal blisters, mottled appearance, red base Damage extends into but not through the dermis Recovery 2-3 weeks Body fluids may be drawn into injured tissue causing EDEMA(swelling)

Question 40

Describe Third Degree burn

Answer 40

Full thickness injury penetrating into muscle and fatty tissue..even down to the bone. Tissues and nerves destroyed Shock and blood in urine are likely. Pain is absent in the burn site(nerves destroyed) and the surrounding tissue is painful. Tissue color: white(scalds) to black(char burn). Skin grafting may be needed afterwards to replace skin

Question 41

First aid for Thermal Injuries

Answer 41

Kept to a minimum after removal from thermal source - Maintain open airway - control hemorrhage, treat for shock - remove constricting clothing/jewelry * do not remove clothes adhering to the wound - protect burn from contamination w/clean sheets, dry dressing - for serious burns over 20 percent BSA(body surface area) and when in shock start IV with electrolytes (Lactated Ringers) in an unburned area. Pain Relief mild: aspirin moderate: cool, wet compress. ice water immersion severe: morphine or demerol injections small burns: anesthetic ointment (unbroken skin)

Question 42

Aid Station care for Thermal injuries

Answer 42

- continue to monitor airway, hemorrhage, shock - maintain iv to control shock, replace lost fluids - monitor urine output - shave body hair that's away from the burned area and cleanse area with disinfectant soap/water - apply sterile dressing - place bulky dressing around the burned parts to absorb serous exudate (clear,thin,watery plasma) - Tetanus booster for infection/antibiotics - If evac to a definitive care facility is delayed 2-3 days, start TOPICAL ANTIBIOTIC therapy after PT stabilizes and after DEBRIDEMENT (remove tissue and foreign objects) and wound care. * Use sulfamylon or silvadene every 12 hours * treat minor skin reactions with antihistamines

Question 43

Describe Heat cramps and treatment

Answer 43

Excessive sweating can result in cramps in the the ab, leg, and arm muscles Heat Cramps can also occur when drinking cold drinks too quickly or in too large a qnty after exercise. Heat Cramps = early sign of heat exhaustion Treatment: - move PT to cool place - give victim plenty of cool(not cold) water w/ 1 tsp of salt to a liter of water - apply manual pressure to cramped muscle or massage gently to relieve spasm - take to medical if it gets more serious

Question 44

Describe Heat Exhaustion and treatment

Answer 44

the most common condition caused by working/exercising in hot environments. PT's BEST Pulse and BP PT status: weak, dizzy, headache, nausea; victim may faint but will regain consciousness as head is lowered ``` Breathing: rapid and shallow Eyes: dilated pupils Skin: ashen gray; cool-moist-clammy Temp: below normal Pulse: weak BP: vitals usually normal; treat as if shock ``` Treatment: - loosen clothing and cool wet cloths to head, axilla, groin, and ankles. FAN the victim - do not let the victim become chilled - 1 tsp salt in 1 liter cool water if conscious - NO fluids if vomiting - IV therapy to combat shock

Question 45

Describe Heat stroke and treatment

Answer 45

20 percent mortality rate Body's sweating mechanism is broken and unable to eliminate excessive body heat while exercising Brain(esp), kidneys, and liver become permanently damaged the longer the body is overheated(life/death) ``` PT status: headache, nausea, dizzy, weak Breathing: deep and rapid at first; then shallow and almost abs. Eyes: pin point pupils; constricted Skin: flushed, very dry, very hot Temp: 105 or higher Pulse: fast and strong ``` Treatment: - douse body w/cold water - move victim to cool place, remove as much clothing as possible, placing on back;head/shoulders raised slightly - cold packs: axillary,neck,ankles,groin - cool drinking water if conscious;no stimulants - DISCONTINUE cooling at 102 rectal temp (check every 10 min after for rise) - continue cooling measure en route to MTF - IV may be needed to combat shock

Question 46

Describe Hypothermia and treatment

Answer 46

general cooling of the whole body is caused from continued exposure to low or rapidly falling temperature. First symptom is SHIVERING PT status: lethargic, indifference, drowsy, unconscious Eyes: glassy stare Skin: susceptible to freezing Temp: death results as body core temp approaches 80 Pulse: weak or absent Blood Pressure: slow and shallow Treatment: -observe respiratory effort/heart beat; CPR may be required during the warming process - Rewarm PT ASAP - Replace wet or frozen clothing; remove constricting clothing to keep circulation -Most EFFECTIVE method of warming is immersion in tub of warm (100-105) water. Not hot - observe for REWARMING shock (minimized by rewarming body trunk before the limbs to prevent extremity vasodilation) - if no tub available BUDDY warm on both sides - hot water bottles/electric warming blanket(no bare skin contact) - give warm liquids to drink - dry victim if water used for rewarming - keep warm during transport/watch for respiratory or cardiac arrest

Question 47

Describe Immersion foot and treatment

Answer 47

Can occur in hands * Results from prolonged exposure to wet/cold conditions at above freezing temps to 50 F - Limited motion of extremities; water soaked protective clothing Signs/Symptoms: tingling,numbness,swelling, bluish discoloration of skin, painful blisters, and gangrene. Treatment: - get victim off feet ASAP - remove wet shoes,socks,gloves(improve circulation) - expose affected area to warm air - keep victim warm Unbroken skin=leave exposed Broken=wrap in sterile sheet to protect sensitive tissue Treat as LITTER PT

Question 48

Describe Frostbite

Answer 48

Ice crystals form in the skin on deeper tissues after exposure to temperatures of 32 or lower. Victims generally incur injury without knowing Affected skin reddens and coldness is uncomfortable *As ice crystals form, the frozen extremity appears WHITE, YELLOW-WHITE, or mottled(thick spider vein looking) BLUE-WHITE and is cold-hard-sensitive to touch. Classified as SUPERFICIAL or DEEP

Question 49

What are the two types of frostbite?

Answer 49

Superficial and Deep

Question 50

Describe Superficial frost bite and treatment

Answer 50

The surface of the skin will feel HARD, but underlying tissue will be SOFT allowing it to MOVE OVER BONY RIDGES. -Take victim inside -Place hands under armpits, between legs, against abdomen to rewarm - Rewarm feet by placing them under armpit or against abdomen of buddy. - Gradually rewarm by warm water immersion, skin to skin contact, or hot water bottles - Never rub frostbite area

Question 51

Describe Deep frostbite and Treatment

Answer 51

Freezing temps reach the DEEP TISSUE LAYERS Ice crystals form in the entire thickness of extremity Skin will not move over bony ridges and feels hard and solid. - Monitor pulse/breathing. CPR if necessary - DO NOT thaw the frostbitten area if there exists a possibility of refreezing - TREAT all PT with foot/leg injuries as LITTER PT - Remove gloves, boots,socks for rewarming **Boots and clothing frozen to the body should be thawed BY WARM-WATER IMMERSION in 100-105F water. - Do not pour water directly on injured area, ensure its completely submerged; not resting on side or bottom of tub - Pat dry, soft towel - keep skin dry with sterile dressings. Place cotton balls between toes to prevent them from sticking together - give hot stimulating fluids like tea or coffee. no smoking - transfer and elevate and keep injury warm

Question 52

Purifying water under field conditions. Where should you draw water from?

Answer 52

Upstream from other activites.

Question 53

How do you use Iodine tablets?

Answer 53

One tablet for clean water Two tablets for cloudy water (Double the amount for a 2 quart canteen) Replace cap. Wait 5 MINUTES Shake canteen loosen cap and flip canteen upside down and allow leakage around the threads tighten the cap and wait another 25 minutes.

Question 54

Boiling water

Answer 54

Use this method when no purification compounds exist. Disadvantages: - boiling requires fuel - water takes a long time to boil and then cool - boiled water needs protection against recontamination - water needs to be at a rolling boiling for 15 seconds to be safe to drink

Question 55

How do you construct a cat hole?

Answer 55

Dig a cat hole 1 foot wide by 1 foot deep Completely cover and pack down with dirt after each use Used when on the march

Question 56

How do you construct a straddle trench?

Answer 56

Dig a straddle trench 4 foot long - 2 1/2 feet deep - 1 foot wide Cover with a shovel of dirt after each use Completely cover and pack down with dirt after each bivouac Used for 1-3 day bivouac sites