BLS Flashcards
Casualty Responds to AVPU
ALERT,
VOICE,
PAIN
UNRESPONSIVE
Patient needs to give consent unless
Under 18 or Unresponsive
Heart Rhythm - VF
Ventricular Fibrillation - Lower Chambersof heart contract in Unsyncronised Fluttering type action - little or not blood pumped
Heart Rhythm - Pulseless VT
Ventricular Tachycardia - lower chambers of heart beat in an abnormally fast rate
I M I S T A M B O
Identification
Mechanism of Injury
Injury
Signs and Symptoms
Treatment
Allergies
Medications
Background History
Other information
D rsabcde
Danger - Don’t do first aid in the Hot Zone
d R sabcde
Response - AVPU- ALERT, VOICE (COWS - Can you hear me, Open your eyes, Whats your name, Squeeze my hand), PAIN (Press pen on nails), Unresponsive
dr S abcde
Send for help - Phone, Radio - if asking someone else to do it get them to come back and tell you when its been done.
drs A bcde
Airway - Head Tilt, Jaw Thrust, Chin lift
Be conscious of Cervical Spine issue also but airway takes precedence.
drsa B cde
Breathing - Look, Listen, Feel
(Normal 12-20 breaths per min)
Abnormal is outside this range
drsan C de
Compressions 30:2, 100-120 per min
Circulation when considering Trauma - How well perfused is the patient, their pulse, capillary refill
drsabc D e
Defibrillator
“Disability” when considering Trauma - Consider how orientated your patient is and what can/can’t they move or feel.
Immediate Care Priority
C A B C
Check for Danger First
1) Catastrophic Haemorrhage
2) Airway
3) Breathing
4) Circulation
drsabcd E
Exposure - Expose the patient to ensure you identify all life threatening injuries
In the Pre Hospital setting conduct a _ _ _ _ survey. Which is what?
Check for Danger First
O xygenation
O n a stretcher
O ptions
O ut of there
What is Oxygenation?
The process of getting oxygenated blood to the tissues. A, B and most of C in primary survey.
Kens Law?
Air goes in and out,
Blood goes round and round.
Any variation of this is Bad.
On a Stretcher. Things to consider
FACILITATE the casualty moving, themselves.
Improve access if can’t get on stretcher.
Don’t delay transport for non-life threatening Interventions.
What OPTIONS are available for the casualty to improve their situation? 5 Items
Cooling of Burns
Splints
Reassurance
Wound Dressing
Protection from elements
Out of there
This is a treatment in its own right.
What are the key sites of Potential Major blood loss. PLACES
P - Pelvis - Use Binders or stabilise
L - Long Bones
A - Abdomenm - Can loose 4-6L of blood into Abdomen
C - Chest
E - External
S - Scalp
If bleeding from Abdomen or chest best thing to do is get them to a hospital.
How do you address External Haemorrhage?
- Direct Pressure
- Indirect Pressure (pressure points)
- Elevation
- Tourniquet
What are signs that the patient has a problem with their circulation?
- Blood
- Loss of Consciousness
- Pulse
- Skin Colour
- Capillary Refill
- Heart rate
Note: Blood in water looks like there is a lot of blood and also car seats absorb a lot of blood.
Details of Direct Pressure?
Apply Direct Pressure (with a Pad) to the direct point of blood loss. Roll up a dressing so there is “Point” load over the wound to apply direct pressure.
When placing the bandage as it passes over the wound area twist the bandage 180Deg over the dressing to apply greater direct pressure to the wound.
Describe Indirect pressure to stop external haemorrhage
For Femoral (leg) use your knee. Put knee in groin with a slight twist. Apply direct pressure while applying Tourniquet.
Will Tourniquet’s work on lower limbs
No - The veins and arteries run through the two bones, so tightening will only push against the bones.
Tourniquets are applied…
- If you can see the wound then 4 fingers above the wound. This is with the FRNSW issued Torniquets.
- IF you can’t see the wound then High, Wide and Tight
- Veins and arteries can spring back so put Tornos high to ensure cutting off blood.
- Also they are the last option to be used if direct pressure is not working. They are very painful and get worse as time goes on.
- Remove clothing from the limb and apply directly to the skin.
- Do not remove the Tourniquet. If not working add another Torno Higher up or tighten.
- Tighten until bleeding stops then do extra half turn on the “WIndless” then lock in.
Can a Triangular bandage be used as a Tourniquet?
Yes. Needs to be at least 5cm wide.
Tie around limb, Put knot in it. Put an improvised windless (piece of bar, screwdriver, torch, Trauma shears) in knot area then rotate. Tie Windless off then put another triangular bandage around the whole thing.
How do you address internal Haemorrhage?
- Direct and indirect pressure.
- Get them to a hospital ASAP.
- Where bones are involved get the two ends back together.
- If the Femur, splinting can help stop/reduce the blood flow.
What are the signs of a Pelvis Fracture?
Feet splay out. “Open book” pelvis fracture.
Do not roll the casualty if this has occurred. If have to roll do not lift the knee, but rather have 3 people with alternating hands.
Put Pelvic binder on.
What is the procedure for putting on an improvised pelvic binder?
1) Bring feet together and tie together with a bandage..
2) Put sheet folded up under the arch of back.
3) Slide the sheet down under the pelvis.
4) Pull around and tie a knot with the sheet. Add a windless (bar etc) and tighten like a torno.
5) Tie the windless off so it does not loosen.
Putting in a Gadel for an adult, what is the current approach. Also child?
Don’t rotate. Go in straight down, can start just to the side of the tongue.
For a child go in the way it will end up.
When clearing out a casualty’s mouth what do we use
- casualty’s fingers
- Gadels
- Something that is not going to break.
- Do not use your own fingers
When opening someone’s mouth to create an airway what technique is used?
Jaw Thrust
- If doing from the top of the head (casualty on back) brace your thumbs on their cheeks.
- if from in front place thumbs on chin and fingers around jaw and pull forward.
What’s the volume output of a BVM? What’s the volume range of lungs?
- BVM holds 1500mls
- Lungs 400-600ml
Do breaths slowly when using a BVM and squeeze until you see the chest rise. - place the mask on the chin first, then place on nose. Try to do a jaw thrust with other fingers.
- Can use an adult mask on a child. Reverse the mask so the narrow part is on the chin. Be mindful of the amount of air being administered.
What are the colours used in a Triage system
Red - Immediate attention required
Yellow - Urgent
Green - Delayed
Black or white - Unsalvageable (does not mean dead yet) (maintain dignity of body)
What’s the overall objective in a Mass casualty situation
Greatest good for the greatest number.
What’s the Triage order model
1) Walks -> Yes - DELAYED (if you can walk come to me)
->No
2) Do they obey commands
2YES) do they have a Radial pulse. (above wrist with two fingers. PUSH down really hard then half release). If YES then - URGENT, IF no then IMMEDIATE attention req.
2NO) Do they breath with an open airway. IF YES then IMMEDIATE attention req. If NO then UNSALVAGEABLE
Note: Greens can become yellows or reds
Note: Ambos in NSW carry SMART mass casualty kits.
What is Crush injury?
A direct injury resulting from a crush. eg vehicle accidents, building collapses, or unconscious casualties.
What is Release Syndrome
Systemic manifestation of muscle cell damage resulting from pressure or crushing of large muscle masses. (thighs, abdomen, pelvis etc)
- Usually requires crush to exist for greater than 60 mins.
- Three killers are
1) Hypovolemia (blood pooling in wrong place)
2) Sudden Cardiac arrest (Due to potassium release)
3) Kidney Failure (Due to high lactic acid levels after 3 days)
What’s a method to minimise release syndrome
Can put a tourniquet on.
Note: can get release syndrome when hanging in a harness for too long.
Apply basic first aid principles including Haemorrhage control and splinting.
What are some considerations with Hypothermic Patients?
- Handle very gently. simple moving a patient that is hypothermic can send them into Cardiac Arrest. <32degC can easily fibrillate
Psychological first Aid - 5 elements of
- Promotion of Safety
- Promotion of Calming
- Promotion of sense of Self-efficacy
- Promotion of connectedness
- Instilling hope.
Dont tell them what to do. Give them some suggestions. “Have you thought of any alternatives, or another way to approach it?”
I’m here to support you
Look - Safety, Needs and Concerns, Distress responses
Listen - avoid suggesting you know what they need and how they feel
Link - Help address basic needs and services, give information , connection people with loved ones and social support
Recovery Centres should be hubs where people can access all sorts of support.
Help people use their own coping resources and strategies.
show compassion
What’s the TASC model in relation to suicide
- Tune-in
- Ask about whether they are thinking about suicide
- State the seriousness of suicidal thoughts
- Connect to helping resources, lifeline, beyond blue, suicide callback service.
