Day 3 Flashcards
Steps before supplying OTC drugs to employee
OFA attendant must:
be familiar with its use, side effects, any drowsiness
Adhere expiry date
Get history of events that led up to worker taking medication
Find out if worker is taking medication
Inform worker of side effects, reasons they shouldn’t take it
Make entry in first aid record
Be familiar with route of administration
When is first aid record completed
Whenever OFA person sees a patient (initial, subsequent visits,), redressing, reassessment
T or F; info in records can be viewed by other employees
F; its confidential
what does first aid record do?
- gives history of injury when OFA attendent must re address the injury
- info for injury and patient followup about injuries that have occured on previous shifts or when other OFAs were on duty
- gives picture of employees improvement or deterioration (infection?)
what does first aid record do for employer?
- gives info about their health and safety program
- sees trends in type, severity of injuries or illnesses, so action can be taken
- any areas or practices that are causing injuries
- info for comparison to claims statistics when assessing affectiveness of companies first aid and health and safety programs
- written record of incident in case of compensation claim
what goes on first aid record
- full name and ocupation
- date, time of injury
- date, time injury was reported to employer
- witnesses names
- description of how injury happened, the nature, the treatment,
- OFA signature
how much blood can you comfortably lose over 15-20 min
500ml
any more, could go into shock
when should brisk hemorrhage be identified and controlled?
primary survey
how can bleeding be helped?
pressure on wound
T or F; internal bleeding causes shock
T
aterial bleeding
spurts, pulses out
bright red
very brisk if its a large vessel
venous bleeding
steady flow
darker colour
can be very brisk
capillary bleeding
continuous, steady ooze
bodys natural response to bleeding
retraction of blood vessels (elastic fibres in walls of vessels pull them back into tissue, reduced bleeding)
clotting (seals injured portion of vessel and stops bleeding)
T or F; internal bleeding doesnt occur with fractures of femur or pelvis
F; it does occur
is internal bleeding RTC?
yes
signs, symptoms of internal bleeding
skin is cool, cold, pale, clammy
pulse is weak, rapid
air hunger, dyspnea
fainting, dizzy
thirtsy, anxious, restless
nauseaous, vomit
3 Ps of hemorrhage control
pressure
patient position at rest (lying down). reduce anxiety
prevent movement (unneeded movement). do not elevate limb if it causes pain
what should you use to apply pressure
almost anything soft, clean, absorbent (towel, cloth)
sterile pressure dressing or gauze pad are preffered
support injured limb while applying
what does bandage do?
coveres entire sterile dressing above and below wound
tightly secured
if dressing becomes blood soaked…
applying additonal dressings over initial dressing, continue applying pressure
if bleeding continues, apply pressure with gloved hand for 5 mins
may need tourniquette
T or F; tourniquets are rarely needed
T
precautions for tourniquets
do not use unless other forms of control are ineffective
dont use belts, rope or wire
you need sufficient pressure,
dont cover with bandages
never release
mark patient as having one (tag to limb)
what does immobolization do
helps to maintain hemorrhage control
bleeding in neck. problems?
immediate, continued direct pressure until medical aid
RTC
avulsion
full thickness of skin is pulled away, exposes deeper tissues
loss of blood, infection, delayed healing
amputation
loss of body part
bleeding, shock, infection, disability
what are dressings used for?
they should be…
initial covering of open wounds to prevent contamination
can be used to soak up blood
larger than wound
sterile
thick, soft, compressible, to permit evenly distributed pressure over entire area of wound
lint free surface
bandages used for…
secure dressings covering wounds
hold dressings in place
apply, maintain pressure
secure splints to body or limbs
general principles of treating major wounds
control bleeding
prevent infection
immobilize affected part
keep patient at rest
once bleeding is controlled…
wound cleaning (can be quite limited, like brushing stuff off)
no chemicals
just saline
general management of amputation
find the part
clean it off briefly
dress it in sterile gauze, clean sheets
moisten with saline
put in waterproff bag
place in container with ice
transport with patient
what is crush syndrome
signs?
crushing injuries cut off circulation, leads to further tissue damage
from several hours of being crushed
leads to swelling, leaking fluid from muscles, compresses blood vessels, leads to hypoxia and local cell death
can see symptoms well after incident, feel numbness
look for patches of reddish skin, loss of sensation, swelling
why are facial injuries life threatening
airway obstruction is possible
most important organs of the face
eyes
your first priority to face injuries?
clear airway from:
- bleeding
- vomiting
- loose teeth, dentures
- fractures of mandible, maxilla which deforms airway
- direct injury to trachea
- brain injury and LOC
T or F: facial lacerations that require suturing are medical emergencies
F; they are not
what is risky about facial fractures?
swelling potentially blocking airway
what can you use for facial fractures?
ice packs
control bleeding with pressure
T or F: throat and neck injuries are life threatening
T
T or F: cervical spine injury is suspected with all injuries to throat or neck
T
what is vitreous humor
clear fluid like jelly in eyeball
3 types of eye injuries
direct blows from sharp or blunt objects(lacerations, contusions, extruded eye)
burns (chemical, thermal, radiation)
foriegn bodies
laceration of eye management
gentle direct pressure
use rigid eye patch
flush to remove dirt
moist gauze dressing
transport patient face up
eye contusion
how to treat
blunt trauma to eye causes hyphema
cover eyes
keep in sitting position
is subconjunctival hemorrhage serious injury?
no
resolves itself in time
what to do with extruded eyeball?
dont push back in place
cover both eyes with sterile dressings, moisten with sterile saline
protect eye using padding, rigid protection
transport supine
alkali chemical damage to eye
sodium hydroxide, lye, drain cleaners, cleaning agents, ammonia, cement, plaster
worst injuries
penetrate into tissue
need to dilute with water right away
acid damage to eyes
battery acid, etc
more visible damage to eye
penetrate less deeply
more easily washed out, reduces serious injury
management of chemical burns to eyes
eyewash! right away
30 mins
tap water or saline
then conduct Primary and seconday survey
remove any remaining particles of chemicals you see
flush while en route to medical aid
management of thermal burns to eyes
PAA
dont examine eyes, you may hurt them more
cover both eyes with moistened sterile dressings
transport to medical aid
no home remedies
management of thermal burns to eyes
PAA
dont examine eyes, you may hurt them more
cover both eyes with moistened sterile dressings
transport to medical aid
no home remedies
management of flash burn of eyes
its from UV
less serious
cold compresses, mild pain meds
may need dark sunglasses for a few days
T or F; administering topical anesthetics can be used more than once
F; they can impede healing. only once
no self medication by patient
foreign bodies in eyes; management
are they penetrating (small, high velocity) or superficial (may be easily removed)?
following PAA. suspect penetrating, until you collect info and determine otherwise. wash hands, position patient, wipe away stuff, flush eye (cup of clean water), manipulate eye lid to remove stuff. if its not gone, then eye exam needed
refer to physician if you cant remove
RTC for penetrating; do not attempt to remove
3 anatomical parts of ear and their purpose
external ear (skin, cartilidge, external auditory meatus). traps sound waves
middle ear: eardrum, cavity, 3 tiny bones. connects external to inner ear
inner ear: cochlea (interprets sound), vestibular apparatus (balance)
T or F; you need cooperation from patient with a foreign body in their ear
T
get rid of objects in ear by…
flushing with water, mineral oil
if bleeding or severe pain, hearing loss — cover with dressing, refer to physician
ear lacerations controlled by
direct pressure
clean wound
dress, bandage wound. use sterile gauze dressing
retrieve any avulsed parts, send with patient to medical
what is hematoma
cauliflower ear; disfigurement
use ice packs
risks with skull fractures
infection to middle, inner ear, brain
restrict handling, cleansing of ear
meningitis
inner ear most commonly damaged by…
loud noises, chronic pressure, blunt trauma
scene assessment of walk ins
ask:
- what energy exerted on body
- where it hit
- location of pain
dont need to ask questions for things that are obvously not there
clues about them (how theyre standing? )
- ask about other hazards, others hurt
modified primary survey for walk ins
- can they sit?
- can use verbal/visual assessment if they can sit
- conditions can get worse though! (breathing, colour, appearance)
watch for anxiety, lightheadedness, dizziness (lay them down)
- if questions are answered, then airway is clear
- look for difficulty breathing
- look at colour for circulatory
- dont need to do a hands on RBS, can just ask
transport decision of walk ins
do they need medical aid?
determine after thorough head to toe
secondary survey of walk ins
you may do history before vitals , but not if theres unusual symptoms (nausea, headache, etc)
- dont need PPQRRST
- Head to toe only is for area of complaint
- still need to do vital signs
history taking: only includes questions related to how injury is affecting patients overall ondition (allergies, medications, how theyre generally feeling)
head to toe of walk in
examine injury area only
continually inform them of whats being done, get feedback
more it quite thorough and specific
compare injured limb to uninjured
inspect visually
circulation, nerve function distal to injury
abrasion
superficial wound
on skins surface
can be a scratch or wide
bleeding is slight but may become infected
laceration
cut with sharp, jagged edges
underlying tissue, muscles, nerves may be affected
hard to tell
blood loss, infection, functional impairment
puncture
they really vary
can pierce organs, blood vessels
can be fatal bleeding
worry when its chest, neck, abdomen, groin
not severe bleeding if its small
hard to clean
principles of bandaging
tight enough to control bleeding, immobolize, but not to stop circulation
pressure be evenly distributed
cover entire dressing
check fingers and toes for ciruclation, function
knots should be accessible
knots shouldnt pressure
rollers do not encircle a limb
management of minor wounds
after secondary survey
application of cold - slow bleeding, swelling. no more than 20 mins, if cirucaltion is ok
refer to medical aid if
refer minor wounds to medical aid IF
longer than 3cm wound through full thickness of skin
its on palm, back of hand, joint, tendon, or through full thickness of skin
if it requires sutures (flap, gape, over joint, facial wound)
dirty wound
bites
embedded foreign stuff
burns (>10% 2nd, >2%3rd)
T or F: remove rings as part of treating minor injury
T
wound cleansing if returning to work
- get rid of hair, within reason, 1cm back
- warm, clean, running water
- dont use fancy disinfectants, they can hurt tissue
- use detergent if its a bite
- cover wound with sterile gauze, hold dressing over wound
- examine for blood clots, foreign stuff, remove gently
- once clean, irrigate with lots fo warm running water or sterile saline
dressing, bandaging open wounds
- use skin closures properly one at a time, from center of wound in both directions. remove wrong ones if you need to
- tincture of benzoin applied to skin, increases stickiness
- strip of adhesive over flaps on each side of wound
- keep closures in place for at least a week
- sterile dressing over wound, bandage entire dressing
- tell them how to care for wound, then do follow up later
follow up of minor wounds immidiately IF… otherwise its how long
if dressings become wet, soiled
increase of pain
tingling, loss of sensation
signs of infection
24 hours
upon follow up, you must
check wound for infection, a little swelling and redness is ok
if infected, remove closures and drain wound
continue treatment until wound heals (2-3 weeks)
T or F: all puncture wounds are RTC
False; only if to head, neck, groin, abdomen, chest. otherwise its probably medical aid
examples of punctures where its return to work
slivers (wooden, glass, metal)
fish hook
pressure injection injury
can be almost any material (oil, water, paint) and be really bad
medical aid is needed
may not look threatening, but it is
mechanical and chemical damange
sign, symptoms of pressure injection injury
mechanism of injury is clue
small puncture wound
pain in affected area, can be delayed
swelling, subcutaneous emphysema
abscess
collection of pus within tissues
usually hair bearing areas
treat by draining or just left alone
use dry dressings, clean with antibactrial detergent
DO NOT SQUEEZE, may need medical aid if its large or on face, neck, groin, buttocks
what do bacteria need to grow
warmth
moisture
oxygen
nutrients
they get through breaks in skin, inhaling, ingested
from dirt, unclean wounds, not bandaged well
recognize infected wounds by
pain, local tenderness
- heat in area, fever
- redness
- pus beneath skin or draining from wound
- swelling
- red streaks
tetanus
prevention?
serious infectious complication of wound
comes from domestic animal gut, in feces
dont need oxygen, so can get deep in wounds. can get in minor wounds too
makes a toxin, affects nervous system, spasms, irritability, headache, fever, cramps, tightness in jaw muscles, lockjaw, very painful, cardiac failure and death
immunization! within 36 hours
what is ASTD?
activity related soft tissue disorders
injury aggravated by workplace activity, or sports or hobbies
can be from chronic overuse, infection, direct trauma
risk factors in ASTD
repetition of duties
frequency
duration of activity
force
posture
static load
unaccustomed activity
contact stresses (physical contact between soft tissues and objects)
impact loading (kickback from tools)
vibration
temperature of environment
signs, symptoms of tendonitis
if theres fever…
pain
swelling
redness
warmth
crepitus (grating, crackling, popping sound over invloved tissues)
tenderness
then its cellulitis
management of tendonitis
its a walk in
apply cold 20 mins
wear wrist brace
reassess daily
if it gets worse, swelling, redness, pain, seek medical aid
physiotherapy and medication may be needed from physican
nerve entrapment syndrome
most common one is carpal tunnel
its a median nerve compression at wrist
numbness, tingling, burning
pain, muscle weakness
happens with repetitive tasks
can be worse and require rest, splints, medication
how to prevent ASTD
automate repetitive tasks
eliminate unneeded work steps
provide appropriate tools, equipment, clothing, so theres less awkward standing, posture, static loading, contact stresses, vibration
use power tools, touch sensitive tools
tools with less bending of wrists
alter working heights and angles to reduce awkward postures
increase varity of roles of workers
train in safe techniques
rest breaks
what is sprain
stretching, partial or complete tearing of ligament at a joint
can vary in severity
if unsure, treat as fracture
swelling, tenderness, pain in movement
best indicator for sprain vs fracture
mechanism of injury
management of simple spinal sprains
not medical emergencies
need medical referral if mechanism is more serious (fall, direct blow, crash, bowel symptoms)
workplace management:
- ask about any previous problems with it (PPQRRST)
- examine area of injury thoroughly (heat, redness?)
- have them move in all directions in standing
- find what causes pain
- ice packs
- OFC medication
- direct them on what to do in daily life activities (rest, but resume mostly normal)
- document mechanism, findings, treatments
dislocations
compound dislocation
displacement of one or more bones, joint surfaces no longer in contact
pain, deformity, near complete inability to function, locked in deformed position
skin is broken, air and bacteria can enter
fracture dislocation
dislocation associated with a fracture
either open or closed
similar to other dislocations BUT with grating sound, discolouration, severe pain
classification of burns is
based on depth
1st, quite minor
2nd, can affect nerves, may require grafting, painful, blisters, loss of fluid into blisers, can cause shock
3rd: dermis and fat, tissue, muscles, bones, may not hurt as nerves so damaged. may be charred, or appear hard, thick, leathery, black,brown, white. major fluid loss, shock may be if greater than 10%
can be combinations
determining extent of burns
rule of 9s (head and neck, each lower extremity, anterior trunk, posterior trunk, perineum and genitia (1%), hand is 1%
burns are RTC if
smoke inhalation
2nd greater than 10%
3rd greater than 2%
its on face
encircling limb
hands, feet, genitals,
eletrical
chemical
T or F; mechanism of injury important for determining treatment of burn
T
PAA for serioes burns
ensure hazard is gone
remove patient from heat
remove burning clothing
smother in blanket if needed
airway! may be affected by swelling
ask them to cough, inspect plegm, look at tongue for swelling
hoarseness?stridor?cough?hard to swallow?
if they cant breathe well, adopt comfortable position, apply oxygen if trained
T or F; all patients with smoke inhalation injury need supplemental oxygen by face mask
T
T or F: burns do not bleed
T
BUT they lose fluid
major burn wound management
cooling - limits depth of burn, soothing, 20 mins 20% of body at a time, no ice
remove wet and burned clothing
remove rings, watches, footwear
elevate burned extremeities
dont break blisteres
no ointments
wet dressings to less than 20% of body, dry dressings to rest
use blankets
monitor ABCs
3 things determine severity of chemical burn
properties of chemical
concentration
length of exposure
management of chemical burns
dilute and remove chemical by lots of flushing
flushing done right away
remove clothing
estimate degree, extent
continue flushing, use saline soaked dressings, reapplied every 30 mins
transport to medical aid
tar burns
it sticks to skin, so cool tar right away
if its more than 20% of body, be careful of cooling
apply gauze dressings
tar will eventually come off
skins functions
protection (loss of fluids, bacteria invasion, alterations in temp)
and
sensory receptors (info about environment to brain)
2 layers of skin
epidermis: outermost, dead, hardened cells, always getting replaced
dermis: below, well supplied with blood vesels, nerves. structures (sweat glands, oil glands, ducts, hair, blood vessels, nerve endings)
sebum
oily substance
keeps skin waterproof and supple
assessment of skin
colour
temp
moisture
subcutaneous tissue
combination of connective tissue and fat
connects skin to the surface muscles
skeletal muscle
gives body movement
voluntary, contract on command
smooth muscle
responsible for constriction
involuntary, under command of autonomic nervous system
digestive tract, blood vessel walls, tubes for urine, walls of bronchial tree
cardiac muscle
responsible for automatic pumping of heart
skeletons function
give shape, strength, rigidity
protects organs
moveable framework
erect posture against pull of gravity
joints
connect bones
consists of ends of 2 or more bones, surrounding connecting and supporting tissues
spinal column
2 purposes
supports head and upper part of body
provides rigid protection for spinal cord
33 individual vertabrae, seperated by pads of cartilidge (intervertebral discs)
what is thorax
thoracic vertebrae, ribs, costal cartilages, sternum
protects heart, thoarcic blood vessels, lungs, spleen, liver, kidneys
are 11, 12th ribs connected at the front?
no
floor of abdominal cavity
pelvis; bony ring made up of sacrum and 2 large wing like pelvic bones
protects bladder, rectum, blood vessels, reproductive stuff
longest bone in body
femur
long bone of thigh
knee
complex ligaments, prone to injury
immobilization
method of holding a body part still and preventing movement
could be just from a pressure bandage
for RTC, only use this on limb fractures. dont need to splint limb if its RTC
reasons for splinting
joint movement near soft issue injury will cause further bleeding
muscles, spasms tend to pull broken bone into tissue, more damage
prevent bone from rotating or further penetration
principles of immobilization
steady, support limb before, during splinting
cover open wounds, bandage
cut away clothing
check circulatory, motor, sensory distal to injury
apply cold is circulation is ok
long bone and joint fracture of upper, lower limbs immobilized in position found
splint should immobilize any joints nearby, up or down
extra padding in natural body hollows and deformities
dont splint over open wound
anchor splint to stable proximal part of body first, then to part distal to injury, then injured site
elevate limb if possible
splinting upper limb
pliable metallic foam splint
strip of lightweight aluminum, closed cell foam on both sides
soft, adaptable
place injured hand in position of function, extension of wrist
maintain position with a pad in palm
use crepe bandages to secure the splint to upper limb, on proximal part of limb
assess circulation
slings
immobilize upper limb
clavicle fracture
symptoms?
direct blow to clavicle or shoulder or a fall
irregularity
patient may hold arm against chest
reluctant to move arm
bilateral clavicle fracture
both clavicles have been fractured
princiles of immobilization, lower limbs
do not splint
hold limb steady with hands, blankets, towels, etc until help arrives
is pelvic fracture BC EHS?
no its RTC
why is pelvic fracture so serioues
large blood vessels adjacent
tearing or rupture of bladder or urethra
femur may be fracture, dislocated
is hip fracture a RTC?
yes
is knee dislocation a RTC?
yes
when to move patient?
either question is a no
can you assess the patient in the position found?
or
if patient is alert and responsive to voice, can critical interventions be provided in the position found?
what is patella
part of knee on top
menisci injuries caused by
compression or grinding action of femur on tibia
bursitis of knee
bursea are in and around knee joint. they lubricate joint, absorb shock, prevent wear from friction
it is from a blow to knee or prolonged pressure
its swelling, increased pain, can be damaging
ankle sprains caused by
inversion or eversion of the foot
how to tell a ankle sprain
can do motion, only some directions will hurt
swelling
cannot bear weight
