Authors: Rednenko V.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

  • Patient Care Simulator

Clinical situation:

  • You see a person lying on the room floor with his eyes closed without signs of bleeding

Order of the skill performance:

Preparatory stage:

1. Check the scene

a)  Check for hazards (Is the scene safe to enter?)

Possible hazards:

  • Traffic
  • Fire and smoke
  • Unstable position of a vehicle or part of a building
  • Downed electrical wires
  • Pouring flammable or chemically hazardous substances
  • Violence possibility
  • Infection 
  • etc.

b)  Take note of anything that might tell you the cause of the emergency (What happened? What is your initial impression about the nature of the person’s illness or injury?)

Possible types of emergencies:

  • Sudden illness
    • Loss of consciousness for no apparent reason
    • Convulsions
  • Road accident
  • Fall on slippery walkways and roads
  • Falling objects
  • Overheating or hypothermia
  • Fire
  • Use of weapons
  • etc.

c)   Determine the number of victims (How many people are involved?)

Pay attention to persons:

  • who is moving or making noise
  • who has very visible injuries
  • who is silent and not moving
  • who obscured by debris or wreckage

d) Take note of persons who can be of assistance (Is anyone else available to help?)

  • Bystanders
  • Participants in the incident who did not receive damage

Main stage: 

Check of the person to reveal other life-threatening conditions

  • unresponsiveness
  • trouble breathing
  • severe bleeding (see Stop bleeding skills)

2. Check the person's consciousness (check the victim for a response)

  • shout to get the person’s attention, using the person’s name if you know it or ask loudly "Are you all right?".
  • If there is no response, tap or gently shake the person’s shoulder (if the person is an adult or child) or the bottom of the person’s foot (if the person is an infant) and repeat "Are you all right?"
  • try to find out what is wrong with him and get help if needed; reassure him regulary

3.  Call to bystanders for help

Send someone to (if necessary):

  • bring an AED and a first aid kit
  • eliminate a possible threat
  • control traffic
  • restrict a crowd
  • shine a lantern
  • move a casualty
  • call Rescue Services
  • etc.

4. Turn the person onto his or her back

5. Open the airway

  • place your hand on his forehead and gently tilt his head back
  • with your fingertips under the point of the victim's chin, lift the chin to open airway

6. Check breathing

Keeping the airway open, look, listen and feel for normal breathing (an occasional gasp, slow, laboured or noisy breathing is not normal):

  • Look for chest movement
  • Listen at the victim's mouth for breath sounds
  • Feel for air on your cheek

Look, listen and feel for no more than 10 s to determine if the victim is breathing normally

7. Check for signs of a circulation

Check the carotid puls:

  • Locate the carotid artery medial to the sternomastoid muscle (between the muscle and the trachea at the level of the cricoid cartilage, which is in the middle third of the neck).
  • With the pads of your three fingers, gently palpate the carotid artery, one at a time.
  • Avoid palpating the upper third of the neck, because this is where the carotid sinus area is located. You want to avoid pressure on the carotid sinus area because this can lead to vagal stimulation, which can slow the heart rate, particularly in older adults.

It may be difficult to be certain that there is no pulse.

Only those experienced in ALS should try to assess the carotidpulse whilst simultaneously looking for signs of life. This rapidassessment should take no more than 10 s.

8. Alert emergency services

If possible, ask someone else to make the call 103 so that you can begin giving care.  

The person making the call should be prepared to give the dispatcher the following information:

  • The location of the emergency (the address, or nearby intersections or landmarks if the address is not known)
  • The nature of the emergency (e.g., whether police, fire or medical assistance is needed)
  • The telephone number of the phone being used
  • A description of what happened
  • The number of injured or ill people
  • What help, if any, has been given so far, and by whom

If you are alone and there is no one to send to call the designated emergency number, you may need to decide whether to call first or give care first. Most of the time, you will call first and then give care.

CALL First for:

  • Any person about 12 years or older who is unresponsive.
  • A child or an infant whom you witnessed suddenly collapse.
  • An unresponsive child or infant known to have heart problems.
  • A cardiac arrest. In cardiac arrest, the priority is getting help on the scene as soon as possible because early access to EMS personnel and an AED increases the person's chances for survival.

CARE First (give immediate care, then call 103 or the designated emergency number) for:

  • An unresponsive infant or child younger than about 12 years whom you did not see collapse.
  • A person who is choking.
  • A person who is experiencing a severe allergic reaction (anaphylaxis) and has an epinephrine auto injector.
  • A person who has severe, life-threatening bleeding.

If the patient has no signs of life (consciousness, purposeful movement, normal breathing, or coughing), or if there is doubt, start CPR immediately until more experienced help arrives orthe patient shows signs of life

Final stage

9. Give care according to the conditions that you find

  • if the patien is responsive and awake, you may start secondary examination
    • introduce yourself
    • obtain consent to help
      • State the type and level of training that you have (such as training in first aid or CPR).
      • Explain what you think is wrong.
      • Explain what you plan to do.
      • Ask if you may help.
    • interview the person
      • S = Signs and symptoms. Take note of signs (which you can observe for yourself, using your senses) and ask the person about symptoms (feelings that only the person can describe to you, such as pain, shortness of breath or nausea).
      • A = Allergies. Ask the person about allergies, noting causes of allergic reactions in the past and whether the allergic reaction was severe or life threatening.
      • M = Medications. Ask the person about over-the-counter and prescription medications that he or she is taking. Ask about the name of the medication and when the person last took it.
      • P = Pertinent medical history. Ask the person whether he or she has any medical conditions.
      • L = Last food or drink. Ask the person when he or she last had something to eat or drink, what the person ate or drank, and how much.
      • E = Events leading up to the incident. Ask the person what was happening and what he or she was doing just prior to when he or she began to feel ill or was injured.
    • check the person from head to toe
      • Head and neck. Check the scalp, face, ears, eyes, nose, mouth and neck for signs of injury.
      • Shoulders. Check the shoulders for signs of injury.
      • Chest and abdomen. Check the chest and abdomen for signs of injury. Ask the person to take a deep breath and blow the air out. Look for trouble breathing or changes in breathing. Ask the person if he or she is experiencing pain during breathing.
      • Hips. Check the hips for signs of injury. Ask the person if he or she is experiencing hip pain.
      • Legs and feet. Check each leg and foot, one at a time, for signs of injury. Ask the person to wiggle his or her toes and feet.
      • Arms and hands. Check each arm and hand, one at a time, for signs of injury. Ask the person to wiggle his or her fingers and hands.
    • reassure the person by telling him or her that you will help and that EMS personnel have been called (if appropriate).
    • provide care for any conditions found
    • help the person rest in a comfortable position
    • continue to watch for changes in the person's condition until arrival of the ambulance 
  • if the patient is unresponsive and has signs of life or is responsive but not awake
    • interview bistanders
    • check the person from head to toe
    • provide care for any conditions found
    • roll the person onto his or her side into the recovery position

  • if the patient is unresponsive and has no signs of life
    • start CPR
    • do not interrupt resuscitation until:
      • a health professional tells you to stop
      • the victim is definitely waking up, moving, opening eyes and breathing normally
      • you become exhausted
  • if there is no breathing, but there is a pulse (respiratory arrest)
    • ventilate the patient’s lungs
    • check for a circulation every 10 breaths.
    • start CPR if there is any doubt about the presence or absence of a pulse
    • do not interrupt resuscitation until:
      • a health professional tells you to stop
      • the victim is definitely waking up, moving, opening eyes and breathing normally
      • you become exhausted

Последнее изменение: понедельник, 17 февраля 2020, 15:01