Clinic2: First Aid Flashcards
What tool should be used to assess if a patient has suffered trauma on arrival to an incident?
C- catastrophic haemorrhage
A - airway, with spinal immobilisation
B - breathing
C- circulation
D- disability
E- environment and exposure
During all stages of initial assessment what anatomical part is important to protect.
The cervical spine
Should avoid moving the remainder of the spin
What are the signs of a potential spinal injury?
Suffered an abnormal force to their neck or back
Complaining of changes in sensation
Difficulty moving
Difficulty breathing
Loss of bladder control
How should the C-spine be protected?
By C-spine immobilisation
Manually or with a collar and a cuff
How should you move a patient with a suspected spine injury?
Log roll
How do you manually immobilise a C-spine?
Kneel behind the persons head - in line with the long axis of the body
Support your elbows on your knees, use your hands to hold either side of the head in the neutral position, (ensure your fingers are on either side of the ears but are not covering the ears)
Roll up towels/clothes to place on either side of the head/neck to add additional support.
Hold position until help arrives and gives further instructions
How to perform a log roll onto a long board?
Requires 3 people
1 manually stabilises C spine
collar is placed on patient and long board brough next to them
2 + 3 kneel on same side of patient, 2 in line with chest, places on hand below shoulder and other below hip, 3 places one hand below chest and one below femur
1 gives command all log roll patient towards them
2+3 position long board so bottom end is mid way between ankle and knee, hold up against the back of the patient
1 - gives instruction so patient and board are placed back down
2 - hand either side of axilla, 3 either side of hips, one instruction from 1 patient is centred and moved up the long board.
What are the common causes of catastrophic heamorrhage?
Amputations
Significant damage to major blood vessels
Lacerations
Complicated fractures where broken bone damages a blood vessel
What are the different ways that a catastrophic haemorrhage can be managed?
Tourniquet
Haemostatic agents
Splints
Shock and movement minisation
What is a tourniquet used for?
used for extremities (below axilla or groin), use the widest size tourniquet as possible
What are homeostatic agents used for?
in absense of tounriquet, applt pressure to wound and dehydrate blood, cause a chemical reaction to clot it and conform to wound.
What are splints used for?
Prevent broken bones from lacterating tissue and causing bleeding.
Immobilises fracture
Done with a vacuum or traction splint.
How do you manage an internal haemorrhage?
Obtain IV access and commenct resusitation with blood products or Crystalloid fluid if available
Keep patient warm with blankets or a bair hugger
This prevents shock.
What should be done to prevent blood loss from a wound?
- wear protective first aid gloves to help prevent spread of infection
- Use a sterile dressing or clean non-fluffy cloth apply pressure around the wound, do not remove any objects from the wound instead apply pressure on either side to push together. May help to elevate the wound if possible
- Call 999 with details of lcoation and severity of bleeding
- Apply a bandage tight enough to maintain pressure but not too tight to restrict circulation
- check circulation posterior to bandage (CRT)
- Take action to prevent shock and keep checking circulation post the injury
What are some St Johns tips to help prevent shock in a patient?
- Elevate legs above level of heart
- lie or sit down
- Loosen any tight clothing around neck, chest and waist
- Cover with a blanket to keep warm
What are the three different types of burns?
Thermal
Electrical
Chemical
How do you treat a thermal burn?
Cool in tepid water for 20-30 minutes
Cling film wrapp applied in layers
How do you manage electrical burns?
remove power source
Require A&E management
How do you manage chemical burns?
Irrigation
Soiled clothing removed
What is classified as a severe burn?
Face, airway, hands, feat, large area of whole limb or chemical/electrical
What might you want to consider in the history taking of a burn patient?
Timing and cause of injury
PMH - that may impair wound healing such as cardiovascular disease, diabetes mellitus, pregnancy, immunocompromised or nutritional status
Predispoing factors to injury - e,g faint, alcohol use
Immunisation status e.g tetnus vaccine
Allergies e.g latex
What is wallaces Rule of NInes for burns?
Used to estimate the Body surface area affected byt the burn
Size of palm and fingers - 1% of BSA
Head and neck - 9%
Each lower extremity - 9%
Each upper extremite - 9%
Anterior and posterior torso - 18% each
What are the different layers of the skin?
Epidermis
Dermis
Hypodermis (subcutaneous fat)
What specalised features are found in the dermis?
Pilosebacoues unit - hair follicle, sebaceous gland and arrector pili muscle
May also have an apocrine sweat gland - hormone driven (axilla and groin)
What features can be found in the hypodermis?
Artery and vein of the skin - project capillaries with go to base of epidermis
Origin of sensory nerve endings with travel until the base of the epidermis
What are the different layers of the epidermis?
Stratum Corneum - dead keratinocytes
Stratum lucidum - only in thick skin, eosinophilis keratinocytes dead
Stratum granulosum - proliferating keratonicytes
Stratum Spinolusm - thick layer, contains melanocytes and lagerhan cells (DCs)
Stratum Basale - cuboidal, contains merkel cells (sensation)
What are main cells/features in the dermis?
Fibroblasts - large amounts of collagen
Mast cells - role in allergy and inflammation
Sensory nerve fibres
Sensation receptors
Capillaries
What are the functions of the skin?
Barrier
Wound healing
Vitamin D synthesis
Sensation
Temperature regulation
Secretion
What are the different fascia layers in the skin?
Superficial fascia (hypodermis) - mainly adipose tissue
Deep fascia - connective tissue overlying muscles
What are the four stages of wound healing?
1.Blood clot formation
2. Inflammation - remove injurious stimuli.
3. Proliferative - tissue and ECM, wound contraction and reepithelization, endothelial cells
4. Remodelling - collagen contraction, maturation of scar tissue, granulation tissue resolves. Extent of scarring/normal tissue is variable.
What are the different types of wound dressing?
Foam dressing
Alginate dressing
Gauze
Semi-permeable dressing
What are foam dressing typically used for?
Absorb exudate - transition into a gel like form or absorb into core
Can be adhesive or non-adhesive
Avoids excessive drying and can manage medium to high level of exudate
However, may cause odour when wet and if adhesive can strip skin to fragile skin
What are alginate dressing typically sued for?
Contain alginates that form a gell of contact with exudate
Helps stimulate macrophages, absorb fluid and is haemostatis
However, may dry out wound, odourous and can stick to wound
Typically used for wounds with medium to high levels of exufate
What is gauze used for?
Temporary absorbent dressing
General cleaning, prepping, packing and debriding wounds.
Avoids sticking to the injury
typically used as a secondary dressing
What are simple island dressing used for?
Absorbent pad with adhesive backing
Used for closed wounds with no-small exudate
Helps wounds healing by primary intention
What is non-adherent wound contact layer used for?
Moist dressings with praffin to reduce adherence to wound bed
Protects wound from contact with secondary dressings
Limited absoprtion
Typically used for superficial wounds or burns that are healing be secondary intent
What are films/membranes used for?
Allow passage of water vapour and oxygen to aid healing
Allow visibility of the wound
Limited absorption of exudate
Typically used for superficial epitheliasing wounds with small exudate
What are some different moist dressing and what are they used for?
Hydrocolloid dressing - prevensts loss of moisture, can lead to maceration. Used for wounds with low exudate
Hydrogel dressings - rehydrates tissue to allow break down of necrotic tissue, requiers a secondary dressing
What are absorbent dressings?
Used for wounds with medium to high exudate
Transforms exudate into soft gel or foam
Can be odourous and may stick to edges of skin
Includes hydrofibre dressing, alginate dressings, foam dressings
What is the use of antimicrobial dressings?
Inhibit bacterial growth using honey, iondine or silver
Can reduce odour
Used on wounds with infection
Does have a small risk of an allergic reaction
What is the use of an odour absorbent dressing?
Seels and absorbs odours
However, can stop functioning when wet.
How to make an arm sling?
triangular sling
Ask patient to support arm
One corner should be where the elbow is
Pass sling over arm and onto opposite shoulder
Pass around back of neck
Lift remaining bandage up over the arm on to neck
Tie to other bandage
Twist and tuck the elbow section
Ensure coverage of full arm and pinky finger
What is an arm sling used for?
Holds forearm horizontally or slightly raised
Treat upper arm injuries
Rib injuries
Wrist injuries
Patient ablet o move their elbow
What is an elevation sling used for?
Support arm in elevated position with fingers near shoulders
Can reduce bleeding and swelling
How to create an elevated sling?
Ask casualty to hold arm in elevated position
Lay triangular bandage over the arm, tuck under arm or ask patient to hold
Pass underneath the arm and around the back
Tie and knot
Twist and tie extra at the elbow
What check should be done after applying a sling?
Check circulation using capillary refill time
How to apply a bandage with a dressing attached?
- Wash hands and put on disposable gloves.
- Unfold dressing and lay directly on wound, ensure covers all wound
- Wrap short end of bandage to secure the dressing
- Wrap long end of dressing, cover all part of dressing, leave short end sticking out
- Tie long and short end together over top of pad - to keep pressure on the wound
- Check circulation
- If bleeds through replace dressing and apply pressure to stop bleeding
How to apply a sterile pad or gauze?
1.Wash hands and put on disposable gloves
2. Ensure pad covers beyond the edge of the wound
3. Hold the pad by the edges and place directly on top of wound
4. Secure the pad with adhesive tap or roller bandage (roller bandage recommended if need to maintain pressure to stop bleeding)
What is the difference between a cut and a graze?
A cut - all layers of the skin have been broken
A graze - when only the top layers of skin are scraped off
How to manage a cut/graze?
- Wear gloves if available
- May want to wash wound by running under water or with sterile wipes
- Ask patient to elevate the wound and give a gauze to apply pressure
- Clean around the wound wiping away with running water or sterile wipes
- Dry using a gauze swab
- remove cloth or gauze covering the wound and apply a sterile dressing
What are the features of a superficial burn?
Generally pink and skin still shown
What are the features of partial thickness burns?
May be superficial - blister, blanches and recolours rapidly
Deep - blisters, red, blanches and recolours slowly
What are the features of a full thickness burn?
Dry and white, brown or black in colour
no blistering and non- blanching
Painless
Must be managed surgically
