Exam for First Aid & CPR

Coronary heart disease (CHD):

A disease in which cholesterol and plaque build up on the inner walls of the arteries that supply blood to the heart; also called coronary artery disease (CAD).

Cholesterol:

A fatty substance made by the liver and found in foods containing animal or animal products; diets high in cholesterol contribute to the risk of heart disease.

Diabetic Ketoacidosis (DKA)

A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available.

Unusual Odors

A foul or unusually strong chemical odor The smell of smoke The smell of gas An unrecognizable odor An inappropriate odor (e.g., a sickly sweet odor on a person's breath)

Genitourinary system:

A group of organs and other structures that eliminate waste and enable reproduction.

Endocrine system:

A group of organs and other structures that regulate and coordinate the activities of other systems by producing chemicals (hormones) that influence tissue activity.

Ventricular fibrillation (V-fib):

A life-threatening heart rhythm in which the heart is in a state of totally disorganized electrical activity, and does not pump blood effectively.

Ventricular tachycardia (V-tach):

A life-threatening heart rhythm in which there is very rapid contraction of the ventricles (the lower chambers of the heart), causing the heart to pump blood ineffectively or not at all.

Cardiopulmonary resuscitation (CPR):

A technique that combines chest compressions and rescue breaths to circulate blood containing oxygen to the brain and other vital organs for a person whose heart and normal breathing have stopped.

recumbent position

lying down in any position

prone

lying face down

supine

lying on the back

Partial seizures

may be simple or complex. They usually involve only a very small area of one hemisphere of the brain. Partial seizures are the most common type of seizure experienced by people with epilepsy (see the related section on Epilepsy in this chapter). Partial seizures can spread and become a generalized seizure.

Red blood cells account for

most of the solid components of the blood.

Proximal/distal:

nearer the trunk or attached end/farther from the trunk or point of attachment

first thing done for AED

turn it on

BP is described using

two measures, the systolic pressure (when the left ventricle contracts) and the diastolic pressure (when the left ventricle is at rest). Oxygen and nutrients are delivered to cells throughout the body, and carbon dioxide and other wastes are taken away, all through the delivery of blood. This continuous process is called perfusion.

Aed's should be placed in

upper right and lower left

Anatomic splints

use the person's own body as a splint (Figure 12-3). For example, an arm can be splinted to the chest; an injured leg can be splinted to the uninjured leg.

Complex partial seizures

usually last for 1 to 2 minutes, though they may last longer, and awareness is either impaired or lost while the person remains responsive. Complex partial seizures often begin with a blank stare followed by random movements such as smacking the lips or chewing. The person appears dazed, the movements are clumsy and the person's activities lack direction. They may be unable to follow directions or answer questions. The person cannot remember what happened after the seizure is over, and may be confused. This is called the post-ictal phase.

The venous system includes

veins andvenules.

Getting Info If the person has impaired vision:

{ Speak in a normal voice. It is not necessary to shout. { As you give care, describe what you are doing.

aneurysm

—a weak area in the wall of an artery that balloons out and can rupture

Coronary arteries:

Blood vessels that supply the heart muscle with oxygen-rich blood.

Cyanotic:

Bluish discoloration of the skin around the mouth or the fingertips resulting from a lack of oxygen in the blood.

Hyperventilation:

Breathing that is faster than normal.

how bruise forms

Bruises result when the body is subjected to a blunt force, such as when you bump your leg on a table or chair. This bump or blow results in damage to soft tissue layers and vessels beneath the skin, causing internal bleeding. When blood and other fluids seep into the surrounding tissues, the area discolors and swells.

Mechanical airway obstruction:

Complete or partial blockage of the airway by a foreign object such as a piece of food or a small toy, or by fluids such as vomit or blood.

Anatomical airway obstruction:

Complete or partial blockage of the airway by the tongue or swollen tissues of the mouth, throat or other airway structures.

Airway obstruction:

Complete or partial blockage of the airway, which prevents air from reaching a person's lungs; a common cause of respiratory emergencies.

The emergency medical services (EMS) system

is a network of professionals linked together to give the best care for people in all types of emergencies.

A sudden illness

is a physical condition that requires immediate medical attention. Examples of sudden illness include a heart attack and a severe allergic reaction.

The soft tissues include the

layers of skin, fat and muscle that protect the underlying body structures.

Closed fractures

leave the skin unbroken and are more common than open fractures

Asystole:

A condition in which the heart has stopped generating electrical activity.

systolic pressure

Blood pressure in the arteries during contraction of the ventricles.

whenever breaths don't go in second time...

if object is visible, do a finger sweep

subcutaneous layer

(also called the hypodermis), located beneath the epidermis and dermis, contains adipose (fat), blood vessels and connective tissues

Fainting

(also known as syncope or "passing out") is a temporary loss of consciousness caused by a temporary reduction of blood flow to the brain, such as when blood pools in the legs and lower body. When the brain is suddenly deprived of its normal blood flow, it momentarily shuts down and the person faints. Fainting usually is not harmful. The person typically recovers quickly with no lasting effects. However, what appears to be a simple case of fainting actually may be a sign of a more serious condition.

Type 1 diabetes

, formerly called juvenile diabetes, affects about 1 million Americans. This type of diabetes, which usually begins in childhood, occurs when the body produces little or no insulin.

Heart attack:

A sudden illness involving the death of heart muscle tissue when it does not receive oxygen-rich blood; also known as myocardial infarction.

osteoporosis

A condition in which the body's bones become weak and break easily.

signs and symptoms of heart attack

-chest discomfort or pain that is severe , lasts longer than 3-5 minutes and goes away and comes back even when resting -discomfort, pain or pressure that is persistent and ranges from a discomfort to an unbearable crushing sensation in the center of the chest and possibly spreading to the shoulder, arm, neck, jaw, stomach, or back and is not relieved by medication or rest -pain that comes and goes -difficulty breathing -pale or ashen skin, especially around the face -sweating -dizziness or light headedness -nausea or vomiting -fatigue or light headedness

How long should each rescue breath last

1 seconds

Emergency Action Steps

1. CHECK- the scene and the person. 2. CALL 9-1-1 or the designated emergency number. 3. CARE for the person.

Cardiac arrest:

A condition in which the heart has stopped beating or beats too irregularly or weakly to pump blood effectively.

steps to check a person

1. obtain consent 2. SAMPLE 3. Head to toe check 4. care/ determine to call 911 if needed

compressions per minute for CPR

100-120 compressions

infant cpr could possibly have

15 compressions

how much sugar should be given to a diabetic requiring it

15-20

Infant CPR

30 chest compressions (1.5 inches deep) followed by 2 ventilations. one hand on forehead and other 3-2 fingers in middle of chest.

Respiratory distress:

A condition in which a person is having trouble breathing or requires extra effort to breathe.

Frostbite:

A condition in which body tissues freeze; most commonly occurs in the fingers, toes, ears and nose.

Respiratory arrest:

A condition in which breathing has stopped but the heart is still beating.

Atherosclerosis:

A condition in which deposits of plaque, including cholesterol (a fatty substance made by the liver and found in foods containing animal or animal products) build up on the inner walls of the arteries, causing them to harden and narrow, reducing the amount of blood that can flow through; develops gradually and can go undetected for many years.

diabetic coma

A loss of consciousness due to uncontrolled diabetes and the buildup of ketones in the blood.

Finger sweep

A method of clearing the mouth of foreign material that presents a risk of blocking the airway or being aspirated into the lungs.

adhesive compress

A small pad of nonstick gauze on a strip of adhesive tape, applied directly to small injuries.

The three basic causes of musculoskeletal injury are

A, direct force, B, indirect force C, twisting force.

ADULT CPR

After determining when a person is not breathing and unresponsive and the scene is safe, assume cardiac arrest and direct someone to obtain the AED, first aid kit, and call the designated emergency # Make sure the person is on hard/flat ground kneel beside the person with your gloves on and protective barrier nearby Place hand on center of chest (heel of hand), fingers are interlaced and off chest Arms are straight and your body weight is on top of your hands and wrists 30 compression to the beat of "staying alive" or rate of 100-120 compressions/minute and at least 2 inches in depth on the chest Place breathing barrier and open airway, make sure entire mask is pushed down on face, tilt head backwards with one finger on forehead and two on bony part of chin past neutral position, deliver 2 rescue breaths, pinch nose Repeat this process 5 times and recheck for breathing Continue until medical help arrives

CHILD CPR

After determining when a person is not breathing and unresponsive and the scene is safe, assume cardiac arrest direct someone to obtain the AED, first aid kit, and call the designated emergency # Make sure the person is on hard/flat ground kneel beside the person with your gloves on and protective barrier nearby Place hand on center of chest (heel of hand), fingers are interlaced and off chest Arms are straight and your body weight is on top of your hands and wrists 30 compression to the beat of "staying alive" and 2 inches in depth on the chest Place breathing barrier and open airway, make sure entire mask is pushed down on face, tilt head backwards with one finger on forehead and two on bony part of chin slightly past neutral position, pinch nose deliver 2 rescue breaths Repeat this process 5 times and recheck for breathing Continue until medical help arrives

Defibrillation:

An electric shock that disrupts the electrical activity of the heart long enough to allow the heart to spontaneously develop an effective rhythm on its own.

Exertional heat exhaustion (EHA):

An inability to cope with heat and characterized by fatigue, nausea and/or vomiting, loss of appetite, dehydration, exercise-associated muscle cramps, dizziness with possible fainting, elevated heart and respiratory rate, and skin that is pale, cool and clammy or slightly flushed; if a core body temperature can be obtained, it is typically higher than 104° F (40° C). The person may be weak and unable to stand but has normal mental status; often results from strenuous work or wearing too much clothing in a hot, humid environment, and may or may not occur with dehydration and electrolyte imbalance.

embedded object

An object that remains in the open wound is called an embedded object (Figure 10-8). An object may also pass completely through a body part, creating two open wounds—one at the entry point and one at the exit point.

Before you act, consider the following limitations to moving one or more persons quickly and safely:

Any dangerous conditions at the scene The size of the person The distance the person must be moved Your physical ability Whether others (bystanders) can help you The person's condition Any aids or equipment to facilitate moving the person at the scene

If the person has an open wound to the scalp, control the bleeding with direct pressure:

Apply several dressings and hold them in place with your gloved hand. If gloves are not available, use a protective barrier. Be sure to press gently at first because the skull may be fractured. If you feel a depression, spongy areaor bone fragments, do not put direct pressure on the wound. Attempt to control bleeding with pressure on the area around the wound (Figure 13-6). Secure the dressings with a roller bandage or triangular bandage.

signs of shock

Apprehension, anxiety, restlessness or irritability. ■ Altered level of consciousness. Nausea or vomiting. Pale, ashen or grayish, cool, moist skin. Rapid breathing. Rapid, weak heartbeat. Excessive thirst.

The stages of most generalized seizures are as follows:

Auraphase:personmaysensesomethingunusual(notallpersonswillexperienceanaura) Tonicphase:unresponsivenessthenmusclerigidity Clonicphase:uncontrollablemuscularcontractions(convulsions) Post-ictalphase:diminishedresponsivenesswithgradualrecoveryandconfusion(personmayfeel confused and want to sleep)

Artery bleeding

Because arterial blood is under more pressure, it often spurts from the wound, making it difficult for clots to form. As a result, arterial bleeding is harder to stop. The high concentration of oxygen gives arterial blood a bright red color.

aura

Before a generalized seizure occurs, the person may experience an unusual sensation or feeling called an aura. An aura can include a strange sound, taste or smell, or an urgent need to get to safety. If the person recognizes the aura, there may be time to warn bystanders and to sit or lie down before the seizure occurs.

when to call for bleeding

Call 9-1-1 or the designated emergency number immediately if: A person complains of severe pain or cannot move a body part without pain. You think the force that caused the injury was great enough to cause serious damage. An injured extremity is blue or extremely pale. ■ The person's abdomen is tender and distended. ■ The person is vomiting blood or coughing up blood. ■ The person shows signs and symptoms of shock or becomes confused, drowsy or unresponsive.

If you think that someone might be having a heart attack, you should:

Call 9-1-1 or the designated emergency number immediately. Never try to drive a person who is experiencing signs and symptoms of a heart attack to the hospital yourself. EMS personnel can transport the person to the hospital safely while initiating care. Have the person stop what they are doing and rest in a comfortable position to reduce the heart's need for oxygen. Many people experiencing a heart attack find it easier to breathe while sitting (Figure 6-3). Loosen any tight or uncomfortable clothing. Reassure the person. Anxiety increases the person's discomfort. If the person has a history of heart disease and takes a prescribed medication to relieve chest pain (e.g., nitroglycerin), offer to locate the medication and help the person to take it. If the person is responsive, able to chew and swallow, and allowed to have aspirin, you may offer two low-dose (81-mg) aspirin tablets or one 5-grain (325-mg) regular-strength aspirin tablet (Box 6-1). Closely monitor the person's condition until EMS personnel arrive and take over. Notice any changes in the person's appearance or behavior. If you are trained in giving CPR and using an automated external defibrillator (AED), be prepared to give CPR and use an AED if the person becomes unresponsive.

capillary bleeding

Capillary bleeding, the most common type of bleeding, is usually slower because the vessels are small and the blood is under low pressure (Figure 8-2, C). It is often described as oozing from the wound. Clotting occurs easily with capillary bleeding.

There are many possible reasons for shock to occur. These include:

Cardiogenic shock, resulting from failure of the heart to pump enough oxygenated blood. If the heart rate is too slow, the rate of new oxygenated blood cells reaching each part of the body will not be enoughto keep up with body's demand. Likewise, when the heart beats too rapidly (ventricular tachycardia or supraventricular tachycardia [SVT]), the heart is not an effective pump, and oxygenated blood is not sent throughout the body as it should be. Damage to the heart can lead to weak and ineffective contractions; this can be related to trauma, disease (e.g., diabetes or cardiovascular disease), poisoning or respiratory distress. Distributive shock, resulting from abnormal dilation of the blood vessels. If the blood vessels are not able to adequately constrict or become abnormally dilated, even though the blood volume is adequate and the heart is beating well, the vessels are not filled completely with blood. Since oxygen is absorbed into the body through the walls of the blood vessels, this condition leads to less oxygen being delivered to the body. There are several types of distributive shock based on the cause. Abnormal dilation of the blood vessels can be caused by spinal cord or brain trauma (neurogenic/vasogenic shock), by infection (septic shock) or anaphylaxis (anaphylactic shock). Hypovolemic shock, resulting from severe bleeding or loss of fluid from the body. Insufficient blood volume can lead to shock. Also, if the levels of some components of the blood, such as plasma or fluids, become too low, blood flow will be impaired and shock can result. Hemorrhagic shock is the most common type of hypovolemic shock. It results from blood loss, either through external or internal bleeding. Other causes include severe vomiting, diarrhea and burns.

When a person becomes suddenly ill, they usually look and feel sick. Common signs and symptoms include:

Changes in level of consciousness such as drowsiness, confusion or unresponsiveness. Numbness, tingling, light-headedness, dizziness or giddiness. Breathing problems (i.e., trouble breathing or no breathing). Signs and symptoms of a possible heart attack, including persistent chest pain, discomfort or pressure lasting more than a few minutes that goes away and comes back or that spreads to the shoulder, arm, neck, jaw, stomach or back. Refer to Chapter 6 for more about heart attack. Signs or symptoms of a stroke, including sudden weakness on one side of the face (facial droop); sudden weakness, often on one side of the body; sudden slurred speech or trouble forming words; or a sudden, severe headache. Loss of vision or blurred vision. Signs of shock, including rapid breathing, changes in skin appearance and cool, pale or ashen (grayish) skin. Refer to Chapter 9 for more about shock. Sweating.Persistent abdominal pain or pressure. Nausea or vomiting.Diarrhea and abdominal cramping. Seizures.

You may also find certain signs and symptoms that indicate a serious injury. These signs and symptoms include:

Changes in the level of consciousness. Severe pain or pressure in the head, neck or spine. Tingling or loss of sensation in the extremities. Partial or complete loss of movement of any body part. Observable, unusual bumps or depressions on the head or neck. Sudden loss of memory. Blood or other fluids in the ears or nose. ■ Profuse external bleeding of the head, neck or back. ■ Seizures in a person who does not have a seizure disorder. ■ Impaired breathing or impaired vision as a result of injury. ■ Nausea or vomiting. ■ Persistent headache. ■ Loss of balance. ■ Bruising of the head, especially around the eyes or behind the ears

Follow these basic steps when caring for a heat burn:

Check the scene for safety by performing a scene size-up and only approach if it is safe to do so. Stop the burning process by removing the person from the source of the burn. Check for life-threatening conditions. As soon as possible, cool the burn withlarge amounts of cold running water for atleast 10 minutes or until pain is relieved(Figure 10-23, A). Be careful to not cause hypothermia when cooling large burns or burns on small children, who are more prone to hypothermia than adults due to their greater skin surface area. If possible, have the injured person removeall rings, bracelets or watches from a burned extremity. Once the extremity swells, this will be much more difficult to do. Cover the burn loosely with a dry, sterile dressing (Figure 10-23, B). Take steps to minimize shock. Have the person lie down flat on their back and prevent them from getting chilled or overheated. Comfort and reassure the person.

AED WITH ONE RESPONDER

Check to make sure scene is safe Begin CPR until AED is brought Turn on AED, remove all clothing on the chest Place one pad on the upper right and lower left side of chest Plug cables into machine Make sure no one is near your or the person Announce clear in a loud, commanding voice If a shock is needed, make sure you and everyone around is not touching the person and announce clear in a loud, commanding voice again Push shock button to deliver shock Begin CPR with compressions and follow AED instructions as continued until medical help arrives

Signs and symptoms of both types of bronchitis include: .

Chest discomfort. Cough that produces mucus. Fatigue. Additional signs of chronic bronchitis include: Ankle, feet and leg swelling. Blue lips. Fever (usually low). Shortness of breath that worsens with activity. Wheezing. Frequent respiratory infections, such as colds or the flu

Signs of a heart attack

Chest pain, which can range from mild to unbearable. The person may complain of pressure, squeezing, tightness, aching or heaviness in the chest. The pain or discomfort is persistent, lasting longer than3 to 5 minutes, or going away and then coming back. It is not relieved by resting, changing position or taking medication. It may be difficult to distinguish the pain of a heart attack from the pain of indigestion, heartburn or a muscle spasm. Discomfort or pain that spreads to one or both arms, the back, the shoulder, the neck, the jaw or the upper part of the stomach Dizziness or light-headedness Trouble breathing, including noisy breathing, shortness of breath or breathing that is faster than normal Nausea or vomiting Pale, ashen (gray) or slightly bluish skin, especially around the face and fingers Sweating A feeling of anxiety or impending doom Extreme fatigue (tiredness) Unresponsiveness

ligaments

Connect bone to bone

infection

Contamination or invasion of body tissue by pathogenic organisms

The signs and symptoms of exertional heat exhaustion include:

Cool, pale, clammy or slightly flushed skin. ■ Fatigue. ■ Nausea and/or vomiting. ■ Loss of appetite. ■ Dehydration.Dizziness with possible fainting. Elevated heart and respiratory rate. Muscle cramps.

Common signs and symptoms of COPD include:

Coughing up a large volume of mucus. Tendency to tire easily. Loss of appetite. Bent posture with shoulders raised and lips pursed to make breathing easier. A fast heartbeat. Round, barrel-shaped chest. Confusion (caused by lack of oxygen to the brain).

If you detect signs or symptoms of injury or illness:

Determine whether to call 9-1-1 or the designated emergency number (see Chapter 2, Box 2-2). Help the person rest in a comfortable position. Reassure the person by telling them that you will help and that EMS personnel have been called (if appropriate). Give care according to the conditions that you find and your level of knowledge and training. Be alert to signs that the person's condition is worsening, such as changes in level of consciousness, changes in breathing, changes in skin color or restlessness. These could be signs of shock, a life- threatening condition.

signs of concussion

Difficulty thinking clearly Difficulty remembering events that occurred just prior tothe incident and just after the incident Difficulty remembering new information Difficulty concentrating Feeling mentally "foggy" Difficulty processing information Headache Blurry vision Nausea or vomiting Dizziness Sensitivity to noise or light Balance problems Feeling sluggish (lack of energy) Irritability Sadness Heightened emotions Nervousness or anxiety Changes in sleeping habits (sleeping more or less than usual, difficulty falling asleep) Changes in playing and eating habits (in children)

Once you complete the head-to-toe check, give care for any specific injuries you find. To give care for the person until EMS personnel arrive, follow these general guidelines:

Do no further harm. Monitor the person's level of consciousness and breathing. A change in the person's condition may be a sign of a more serious injury or illness. A condition that may not appear serious at first may become serious over time. Help the person rest in the most comfortable position. Keep the person from getting chilled or overheated. Comfort and reassure the person, but do not provide false hope. Give any specific care as needed.

Initial care for a serious injury to the thigh includes the following:

Do not move or straighten the injured area. Control any external bleeding with direct pressure, unless the bleeding is located directly over a suspected fracture. With a fracture, apply pressure around the area. Always wear disposable latex-free gloves or use another protective barrier. Call 9-1-1 or the designated emergency number immediately.Emergency medical services (EMS) personnel are much better prepared to care for and transport a person with a serious thigh injury. While waiting for EMS personnel to arrive: Stabilize the injury in the position found. If the person's leg is supported by the ground, do not move it. Rather, use rolled towels or blankets to support the leg in the position in which you found it. Help the person rest in the most comfortable position. Apply a cold pack. Take steps to minimize shock, remembering that a fractured femur can result in serious internal bleeding and the likelihood of shock is considerable: Keep the person lying down and try to keep them calm. Keep the person from becoming chilled or overheated and make sure to call 9-1-1 or the designated emergency numbe

In general, care for upper arm injuries in the same way as for shoulder injuries:

Do not move or straighten the injured area. Stabilize the injury in the position found. Control any external bleeding with direct pressure, unless the bleeding is located directly over a suspected fracture. With a fracture, apply pressure around the area. Always wear disposable latex-free gloves or use another protective barrier. If you must transport or move the person, and it does not cause more pain, splint an upper arm injury using a padded rigid splint on the outside of the arm. { If the elbow can be comfortably bent, place the upper extremity in a sling and binder to further stabilize the injury. { If the elbow cannot be comfortably bent, or if the rigid splint you are using is longer than the upper arm, keep the arm straight at the person's side and wrap bandages or binders around the arm and chest Apply a cold pack. Take steps to minimize shock. Most people with an injured shoulder or upper arm will prefer to be in a seated or semi-recumbent position and will have difficulty lying down.

Abandonment:

Ending the care of an injured or ill person without obtaining that person's consent or without ensuring that someone with equal or greater training will continue care.

Other specific signs and symptoms of a stroke have a sudden onset, including:

Facial droop or drooling. Weakness or numbness of the face, arm or leg. This usually happens on only one side of the body. Trouble with speech. The person may have trouble talking, getting words out or being understood when speaking, and may have trouble understanding. Loss of vision or disturbed (blurred or dimmed) vision in one or both eyes. The pupils may be of unequal size. ■ Sudden severe headache. The person will not know what caused the headache and may describe it as "the worst headache ever." ■ Dizziness, confusion, agitation, unresponsiveness or other severe altered mental status. ■ Loss of balance or coordination, trouble walking or ringing in the ears. ■ Incontinence.

Exercise-associated muscle cramps:

Formerly known as heat cramps, these muscle spasms can be intense and debilitating and occur typically in the legs, arms and abdomen; painful involuntary muscle spasms occur during or after physical exertion, particularly in high heat and humidity, possibly due to loss of electrolytes and water from perspiration; not associated with an increase in body temperature.

If the diabetic person is awake, can follow simple commands, is able to swallow and advises you that they need sugar:

Give 15 to 20 grams of sugar in the form of 3 to 4 glucose tablets (Figure 15-5), a handful of candies containing sucrose or glucose that can be chewed, 8 ounces of milk, a non-diet soft drink, fruit strips or 4 to 5 teaspoons of table sugar dissolved in a glass of water or juice. Most fruit juices and non-diet soft drinks have enough sugar to be effective. If the problem is hyperglycemia (too much sugar in the body), this amount of sugar will not cause immediate harm. If symptoms persist for more than 10 to 15 minutes, repeat the administration of sugar and call 9-1-1 or the designated emergency number.

If you think that a person is in cardiac arrest:

Have someone call 9-1-1 or the designated emergency number immediately. Begin CPR immediately. Use an AED as soon as possible.

caring for shock

Have the person lie flat on their back. Control any external bleeding. Cover the person with a blanket to prevent loss of body heat (Figure 9-1). Do not give the person anything to eat or drink, even though they may complain of thirst. Eating or drinking increases the person'srisk for vomiting and aspiration (inhalationof foreign matter into the lungs). Aspiration can cause serious complications, suchas pneumonia. Ensure the person's airway is open and clear. Keep a person with signs and symptoms of shock from getting chilled or overheated. Provide reassurance, and help the person rest comfortably. Anxiety and pain can intensify the body's stress and speed up the progression of shock. Continue to monitor the person's condition and watch for changes in level of consciousness.

If you suspect a fractured rib, follow these care steps:

Have the person rest in a position that will make breathing easier. Encourage the person to breathe normally if tolerated. Do not move the person if you suspect a head, neck or spinal injury. Call 9-1-1 or the designated emergency number. Give the person a blanket or pillow to hold against the fractured ribs to support and immobilize the area (Figure 14-5). Use a sling and binder to hold the person's arm and/or blanket or pillow against the injured side of the chest. Monitor breathing. Take steps to minimize shock.

Getting Information When the Injured or Ill Person Is a Child

If the child's parent or guardian is present, remember to get the parent's or guardian's consent to give care. Be aware that children often take emotional cues from the adults around them. If the child sees that adults are upset, the child's anxiety and panic may increase. Stay calm, and encourage the child's parent or guardian to do the same. The child's parent or guardian can bea valuable source of information if thechild is not able to speak for themself. However, if the child is old enough to understand and answer your questions, speak directly to the child using age-appropriate language, rather than addressing your questions to the parent or guardian. If the care you need to give will cause discomfort or pain, describe what thechild can expect to feel in terms the child can understand. Never make promises or statements that you cannot support (e.g., do not say that something will not hurt if it will). Take into consideration the child's developmental stage.

Signs and symptoms of an infected wound may include:

Increased pain, swelling, redness or warmth in the area of the wound. Red streaks extending from the area of the wound. Pus (a thick yellow or green fluid) draining from the wound (Figure 10-18). Fever

Dermis

Inner layer of skin contains the nerves, sweat glands, oil glands and blood vessels

superficial burns (1st degree)

Involve only the top layer of skin (Figure 10-19). Cause skin to become red and dry, are usually painful, and the area may swell. Usually heal within a week without permanent scarring.

Partial-thickness burns/ 2nd degree

Involve the top layers of skin (epidermis and dermis) (Figure 10-20). Cause skin to become red; are usually painful; have blisters that may open and weep clear fluid, making the skin appear wet; may appear mottled; and often swell. Usually heal in 3 to 4 weeks and may scar.

In general, you should consider the possibility of a serious head, neck or spinal injury if the injured person:

Is unresponsive. Was involved in a motor-vehicle crash or subjected to another significant force. Was injured as a result of a fall from greater than the person's standing height. Is wearing a safety helmet that is broken. Complains of neck or back pain. ■ Has tingling or weakness in the extremities. ■ Is not fully alert. ■ Appears to be intoxicated. ■ Appears to be frail. ■ Is older than 65 years. ■ Is a child younger than 3 years with evidence of a head or neck injury.

Chronic obstructive pulmonary disease (COPD)

is a long-term lung disease encompassing both chronic bronchitis and emphysema.

Signs of frostbite

Lack of feeling in the affected area. Swelling. Skin that appears waxy, is cold to the touch and is discolored (flushed, white, yellow or blue) (Figure 19-6). In more serious cases, blisters may form and the affected part may turn black and show signs and symptoms of deep tissue damage.

Good Samaritan laws:

Laws that protect people against claims of negligence when they give emergency care in good faith without accepting anything in return.

The purposes of immobilizing an injury are to:

Lessen pain. Prevent further damage to soft tissues. Reduce the risk for severe bleeding. ■ Reduce the possibility of loss of circulation to the injured part. ■ Prevent closed fractures from becoming open fractures.

asthma

a chronic illness in which certain substances or conditions, called triggers, cause inflammation and narrowing of the airways, making breathing difficult

care for closed wounds

Make a cold pack by filling a sealable plastic bag with a mixture of ice and water, and then apply it to the injured area for about 20 minutes. Place a thin towel as a barrier between the cold pack and the bare skin. If an ice-and-water mixture is notavailable, use a bag of frozen vegetables or a chemical cold pack as an alternative. Do not place ice directly on a wound. Remove the cold pack and wait 20 minutes before reapplying a new cold pack. If the person is not able to tolerate a 20-minute application, limit application to 10 minutes. ■ Elevating the injured part may help toreduce swelling; however, do not elevatethe injured part if doing so causes morepain or you suspect a dislocation or fracture

CHECKING A CONSCIOUS VICTIM:

Make sure the scene is safe. If the person is responsive and awake, get consent to provide care (consent is State your name, 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. If there are no life threatening conditions, get more information by asking questions and perform a head to toe check Use SAMPLE to ask the interview questions. (Symptoms, Allergies, Medications, Past Medical History, Last food or drive, Event that happened) Check the person from head to toe. Before beginning the check, tell the person what you are going to do. Then check the person in a methodical way. Check one part of the body at a time, moving straight down the body from head to toe, and then checking the arms. As you check, take note of any medical identification tags, such as a bracelet or sports band, on the person's wrist or ankle, or a necklace around the person's neck. Look and gently feel for signs of injury, such as bleeding, cuts, burns, bruising, swelling or deformities. If a life threatening condition occurs, call or instruct someone to call 9-1-1 and help the person rest in a comfortable position.

CHECKING AN UNCONSCIOUS VICTIM:

Make sure the scene is safe. Shout "Are you okay?" and tap 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 shout again, while checking for normal breathing. Check for Responsiveness and breathing for no more than 5-10 seconds (Head is tilted on mouth to feel and hear for breathing, eyes on chest to look for movement) IF THE PERSON IS BREATHING Send someone to call 911. Proceed with gathering information from bystanders using the SAMPLE questions Conduct a head-to-toe check. Roll the person onto his or her side into a recovery position if there are no obvious signs of injury. IF THE PERSON IS NOT BREATHING Send someone to call 911 or the designated emergency number and obtain an AED and first aid kit. - Ensure that the person is face-up on a firm, flat surface such as the floor or ground. - Begin CPR (starting with compressions) or use an AED if one is immediately available, if you are trained in giving CPR and using an AED. - Continue administering CPR until the person exhibits signs of life, such as breathing, an AED becomes available, or EMS or trained medical responders arrive on scene.

Full-thickness burns/ 3rd degree

May destroy all layers of skin and some or all of the underlying structures—fat, muscles, bones and nerves. The skin may be brown or black (charred), with the tissue underneath sometimes appearing white, and can either be extremely painful or relatively painless (if the burn destroys nerve endings) (Figure 10-21). Healing requires medical assistance; scarring is likely.

Give the following care while waiting for emergency medical services (EMS) personnel to arrive:

Minimize movement of the head, neck or spine by asking the person to remain still. Do not hold their head or restrict the person's movementas this may make the situation worse. Because excessive movement of the head, neck or spine can damage the spinal cord irreversibly, remind the person to remain as still as possible and provide comfort and reassurance to them until EMS personnel arrive and take over. If the person is wearing a helmet, do not remove it unless you are specifically trained to do so and it is necessary to assess the person's airway. Check for life-threatening conditions. Monitor responsiveness and breathing. Control any external bleeding with direct pressure unless the bleeding is located directly over a suspected fracture. Do not apply direct pressure if there are any signs of an obvious skull fracture. Do not attempt to remove a penetrating object; rather, stabilize it with a bulky dressing. Wear disposable latex-free gloves or use another barrier. Take steps to minimize shock. Keep the person from becoming chilled or overheated. If you need to leave the person, such as to call 9-1-1 or get an AED, carefully place them in the recovery position to protect their airway if they begin to vomit. However, do not place a person with a head, neck or spinal injury in the recovery position if you are able to remain with the person and monitor their condition.

Direct contact transmission:

Mode of transmission of pathogens that occurs through directly touching infected blood or other potentially infectious materials (OPIM), or other agents such as chemicals, drugs or toxins.

Epidermis

Outer layer of skin

Angina pectoris:

Pain in the chest that comes and goes at different times; caused by a lack of oxygen reaching the heart.

Signs and symptoms of a chemical burn include:

Pain. Burning. Numbness. Change in level of consciousness. Respiratory distress. Oral discomfort or swelling. Eye discomfort. Change in vision.

Getting Information When the Injured or Ill Person Is an Older Adult .

Pay attention to how the person introduces themself. If the person gives a last name, consider addressing the person more formally (e.g., "Mr. Johnson" rather than "Bill") as a sign of respect. A family member, caregiver or other person who knows the older adult well can be a valuable source of information if the older adult is not able to speakfor themself. However, if the older adult is able to understand and answer your questions, speak directly to them, rather than addressing your questions to others who might be present. Speak clearly and loudly enough for the person to hear you, but do not shout. If the person does not seem to understand what you are saying, change your words, not the volume of your voice, unless you spoke too softly. When interviewing the person, avoid rushing. Allow the person enough time to process your questions and respond. Be aware that in older people, the signs and symptoms of a medical emergency may be very general and nonspecific, and they may not even be noticeable to someone who does not know the person well. General signs and symptoms that could indicate a medical emergency in an older adult include headache, a change in the person's usual level of activity, a change in mental status (suchas agitation, the new onset of confusion or increased confusion in a person who is already confused), lethargy (extreme drowsiness or sleepiness) and difficulty sleeping. Many older adults have impaired hearing, vision or both. If the person seems confused, make sure the "confusion" is not just the result of being unable to hear you or see you clearly. If the person normally wears a hearing aid, make sure it is in place and turned on. If the person usually wears glasses, make sure they have them on

care for major open wounds

Put on disposable latex-free gloves and other PPE as necessary (for example, if blood is spurting, you may need to wear eye and face protection). Cover the area with a sterile gauze pad or other clean dressing(Box 8-1) and apply direct pressure with your gloved hand until the bleeding stops. This may take as longas 15 minutes. If blood soaks through the first dressing, ask person to hold the first gauze and place another dressing on top of the first and apply additional direct pressure (press harder than you did before, if possible). Repeat with additional dressings as needed, always maintaining direct pressure. Do not remove the blood-soaked dressings because disturbing them may disrupt clot formation and restart the bleeding. When the bleeding stops, check the skin on the side of the injury farthest away from the heart (e.g., the hand or foot) for feeling, warmth and color. Then apply a bandage over the dressing to maintain pressure on the wound and to hold the dressing in place. To apply a roller bandage, hold one end of the roller bandage in place while you wrap the other end around the wound and dressing several times, using overlapping turns. Make sure the dressing is completely covered and allow a margin of several inches on all sides. Tie or tape the bandage to secure it (Figure 8-3, A-F). The bandage should be snug but not too tight. Check for feeling, warmth and color again. If there is a change in feeling, warmth or color from your first check (for example, the skin is cooler or paler than it was before, the area is swollen, or the person complains of a numb or tingly feeling), then the bandage is too tight and needs to be loosened.

There are five general ways in which the body can be cooled:

Radiation: This process involves the transfer of heat from one object to another without physical contact. The body loses heat through radiation, mostly from the head, hands and feet. Convection: This process occurs when air moves over the skin and carries the skin's heat away. The faster the air is moving, the faster the body will be cooled. Convection is what makes warm skin feel cooler in a breeze. Convection also assists in the evaporation process. Conduction: This occurs when the body is in direct contact with a substance that is cooler than the body's temperature. Through conduction, the body's heat is transferred to the cooler substance (e.g., if you are swimming in cold water or sitting on a cool rock in the shade, body heat is transferred to the water or to the rock). Evaporation: This is the process by which a liquid becomes a vapor. When body heat causes one to perspire and the perspiration evaporates, the heat that was absorbed into sweat dissipates into the air, which cools off the skin. ■ Respiration: Heat is also lost through respiration, another term for breathing. Before air is exhaled, it is warmed by the lungs and airway.

To care for a person with an embedded object in the cheek that is not embedded in another location in the mouth:

Remove the object by pulling it out in the same direction it entered. Fold or roll several dressings and place them inside the mouth. Also, apply dressings to the outside of the cheek. Be sure not to obstruct the airway. ■ If there are no suspected head, neck or spinal injuries, place the person in a seated position, leaning slightly forward, so that blood will not drain into the throat. ■ As with any severe bleeding or embedded object, call 9-1-1 or the designated emergency number.

signs of shock

Restlessness or irritability. Altered level of consciousness. Nausea or vomiting. Pale, ashen or grayish, cool, moist skin. Rapid breathing and pulse Excessive thirst.

Always suspect an abdominal injury in a person who has multiple injuries. Signs and symptoms of serious abdominal injury include:

Severe abdominal pain. Bruising. External bleeding. Nausea and vomiting (sometimes vomit containing blood). Pale, or ashen, cool, moist skin. Weakness. ■ Thirst.■ Pain, tenderness or a tight feeling in the abdomen.■ Organs protruding from the abdomen. ■ Rigid abdominal muscles.■ Other signs and symptoms of shock.

Signs and symptoms of pelvic injury are the same as those for an abdominal injury. These signs and symptoms include:

Severe pain. Bruising. External bleeding. Nausea and vomiting (sometimes containing blood). ■ Thirst.■ Pain, tenderness or a tight feeling in the area. ■ Organs protruding from the area.■ Rigid abdominal muscles.■ Other signs and symptoms of shock. ■ Weakness.

Examples of situations where it may be necessary to use a tourniquet include:

Severe, life-threatening bleeding that cannot be controlled using direct pressure. A physical location that makes it impossible to apply direct pressure to control the bleeding (e.g., the injured person or the person's limb is trapped in a confined space). ■ Multiple people with life-threatening injuries who need care. ■ A scene that is or becomes unsafe.

The signs and symptoms of hypothermia include:

Shivering (may be absent in later stages of hypothermia). Numbness. Glassy stare. Apathy or decreasing level of consciousness. ■ Weakness. ■ Impaired judgment. ■ Changes in level of consciousness, unresponsiveness.

Getting Info When the Injured or Ill Person Speaks a Different Language

Speak in a normal voice. It is not necessary to shout. Find out if any bystanders speak the person's language and can assist by translating. Do your best to communicate nonverbally, using gestures and facial expressions. When you call 9-1-1 or the designated emergency number, explain that you are having difficulty communicating with the person, and tell the dispatcher which language you believe the person speaks. The dispatcher may have someone available who can help with communication.

Superficial/deep:

Superficial refers to any part near the surface of the body; deep refers to any part far from the surface.

To splint an injured body part:

Support the injured part in the position in which you find it. If possible, have the person or a bystander help you. Check the body part that is on the other side of the injury for circulation (feeling, warmth and color) before and after splinting to make sure the splint is not too tight. Apply the splint to immobilize the bones or joints both above and below an injured area (Figure 12-4). For example, if a bone in the lower leg is broken, use the splint to immobilize the knee and ankle. Cut off or remove any clothing around the injury site. If the person is wearing a watch or jewelry near the injury, these should be removed as swelling may occur beyond the actual injury site. For example, if an elbow is injured, any bracelets, watches or rings should be removed and given to the injured person for storage. Cover any bleeding or open wounds, including open fractures, with sterile dressings and carefully bandage with minimal pressure before splinting. Do not try to push protruding bones back below the skin. Do not attempt to straighten any angulated fracture; always splint the limb in the position found. Do not allow the person to bear weight on an injured lower extremity. Pad the splints you are using so that they will be more comfortable and conform to the shape of the injured body part. Secure the splint in place with cravats, roller bandages or other wide strips of cloth. Avoid securing the splint directly over an open wound or the injury. Elevate the splinted part if doing so does not cause the person discomfort.

When the body is healthy, three conditions are necessary to maintain adequate blood flow to perfuse all the body cells, tissues and organs:

The heart must be working well. The blood vessels must be intact and able to adjust blood flow. An adequate amount of blood must be circulating in the body.

Exertional heat stroke (EHS):

The most serious form of heat-related illness; life threatening and develops when the body's cooling mechanisms are overwhelmed and body systems begin to fail. People with EHS have exaggerated heat production and an inability to cool themselves.

signs of dehydration

The signs and symptoms of dehydration worsen as the body becomes drier. Initial signs and symptoms include: Fatigue. ■ Weakness. ■ Headache. ■ Irritability. ■ As dehydration worsens, signs and symptoms can include: Disorientation or delirium. ■ Loss of appetite. ■ Severe thirst. Nausea.Dizziness. Excessive thirst. Dry lips and mouth. Dry mucous membranes. Sunken eyes.

You may recognize some of the signs and symptoms of a serious chest injury from previous discussions of respiratory distress, soft tissue injuries and musculoskeletal injuries. They include:

Trouble breathing or no breathing. Severe pain at the site of the injury. Flushed, pale, ashen or bluish skin. Obvious deformity, such as that caused by a fracture. ■ Coughing up blood (may be bright red or dark like coffee grounds). ■ Bruising at the site of a blunt injury, such as that caused by a seat belt. ■ A "sucking" noise or distinct sound when the person breathes.

blood volume

The sum of the formed elements and plasma volumes in the vascular system

The severity of a burn depends on:

The temperature of the source of the burn. The extent of the burn. The length of exposure to the source. The person's age and medical condition. The location of the burn.

Call 9-1-1 or the designated emergency number for a musculoskeletal injury if:

There is obvious deformity. There is moderate or severe swelling and discoloration. Bones sound or feel like they are rubbing together. A snap or pop was heard or felt at the time of the injury. There is a fracture with an open wound at, or bone piercing through, the injury site. ■ The injured person cannot move or use the affected part normally. ■ The injured area is cold and numb. ■ The injury involves the head, neck or spine. ■ The injured person has trouble breathing. ■ The cause of the injury suggests that the injury may be severe. ■ It is not possible to safely or comfortably move the person to a vehicle for transport to a hospital.

Always suspect a serious musculoskeletal injury when any of the following signs or symptoms are present:

There was a snapping sound. If a bone has fractured, the person may report hearing or feeling the bone snap or break. There is pain. One of the most common symptoms in any muscle, bone or joint injury is pain. The injured area may be very painful to touchor move. There is significant bruising and swelling. The area may be swollen and red or bruised. There is significant deformity. The area may be twisted or strangely bent compared with the uninjured side (Figure 11-12). The injured area has visible abnormal lumps, ridges and hollows (i.e., deformities). The person is unable to use the affected part normally. This may be due to pain or a dislocated joint. There are bone fragments sticking out of a wound. The person feels bones grating. Crepitus, or a grating sound or feeling, occurs when two pieces of bone rub together. The injured area is cold, numb and tingly. The cause of the injury suggests that it may be severe.

femoral arteries

These arteries are one of two branches of the external iliac arteries. They carry blood to the thigh and lower hind limb.

If you discover the person has a medical history of seizures that are medically controlled, there may be no need for medical attention. However, in the following cases, advanced medical care should be provided:

This is the person's first seizure. The seizure lasts more than 5 minutes or the person has repeated seizures with no sign of slowing down (status epilepticus). The person appears to be injured. You are uncertain about the cause of the seizure. The person is pregnant. The person is known to have diabetes. The person is a child or an infant. The seizure takes place in water. The person fails to regain consciousness after the seizure. The person is a young child or an infant who experienced a febrile seizure brought on by a rapid increase in body temperature. The person is older and could have suffered a stroke.

Anatomical position.

This position, where the person stands with body erect and arms down at the sides, palms facing forward, is the basis for all medical terms that refer to the body.

care for minor open wounds

To care for a minor open wound, put on disposable latex-free gloves and other personal protective equipment (PPE) as necessary. Apply direct pressure with a gauze pad to stop the bleeding. It may take several minutes for the bleeding to stop. After the bleeding stops, wash the area with soap and warm water. Rinse under warm running water for about 5 minutes until the wound appears clean and free of debris, and then dry the area. Apply a small amount of antibiotic ointment, cream or gel to the wound if the person has no known allergies or sensitivities to the ingredients. Then cover the area with a sterile gauze pad and a bandage, or apply an adhesive bandage. When you are finished giving care, wash your hands with soap and water, even if you wore gloves.

Emergency medical services (EMS) personnel:

Trained and equipped community-based personnel who give emergency care for injured or ill persons and who are often dispatched through 9-1-1 or a designated emergency number.

Blood has three major functions:

Transporting oxygen, nutrients and wastes Maintaining body temperature by circulating Protecting against disease by producing antibodies and defending against pathogens throughout the body

blanket drag

a method used to move a patient by placing him on a blanket or sheet and pulling it across the floor or ground

To care for a foreign body in the eye:

Try to remove the foreign body by telling the person to blink several times, then try gently flushing the eye with water. If the object remains, the person should receive more advanced medical care. The eye should be flushed continuously until EMS personnel arrive. Flushing the eye with water is also appropriate if the person has any chemical in the eye (Figure 13-9). Flush the eye continuously until advanced medical personnel arrive. If only one eye is affected, make sure you do not let the water run into the unaffected eye.

The signs and symptoms of electrical injury include:

Unresponsiveness. Trouble breathing or no breathing. Dazed, confused behavior. Burns both where the current entered and where it exited the body, often on the hand or foot. Obvious burns on the skin's surface.

vein bleeding

Venous bleeding (bleeding from a vein) is generally easier to control than arterial bleeding (Figure 8-2, B). Veins are damaged more often than arteries because veins are closer to the skin's surface. Venous blood is under less pressure than arterial blood and flows steadily from a wound without spurting. Only damage to veins deep in the body, such as those in the trunk or thigh, produces severe bleeding that is difficult to control. Large wounds with tissue loss may also have severe bleeding that is mostly venous. Because it is oxygen poor, venous blood is dark red or maroon.

Signs and symptoms of an asthma attack include:

Wheezing or coughing. Rapid, shallow breathing (or trouble breathing). Sweating. Being unable to talk without stopping for a breath in between every few words. Feelings of tightness in the chest or being unable to get enough air into the lungs. Anxiety and fear.

Once you begin CPR on an adult, child or infant, do not stop except in one of these situations:

You notice an obvious sign of life, such as normal breathing. An AED becomes available and is ready to use. Another trained responder or EMS personnel arrive and take over. You are too exhausted to continue. The scene becomes unsafe.

pressure bandage

a bandage applied snugly to create pressure on a wound to aid in controlling bleeding

A person who is choking typically has

a panicked, confusedor surprised facial expression. Some people may place oneor both hands on their throat. The person may cough (either forcefully or weakly), or they may not be able to cough at all. You may hear high-pitched squeaking noises as the person tries to breathe, or nothing at all. If the airway is totally blocked, the person will not be able to speak, cry or cough. The person's skin may initially appear flushed (red), but will become pale or bluish in color as the body is deprived of oxygen.

Fowler's position

a semi-sitting position; the head of the bed is raised between 45 and 60 degrees

elastic roller bandage

a type of bandage used for compression on sprains, strains, and contusions; available in various widths

roller bandage

a type of bandage used to wrap or bind various body parts; available in various widths, lengths, and types of material

Superior/inferior:

above/below

Generalized tonic-clonic seizures,

also called grand mal seizures, are the most well-known type of seizure. They involve both hemispheres (halves) of the brain and usually result in loss of consciousness. The seizure activity is known as tonic-clonic, which refers to the initial rigidity (tonic phase) followed by rhythmic muscle contractions (clonic phase), or convulsions.

absence seizure,

also known as a petit mal seizure. These are most common in children. During an absence seizure, there is brief, sudden loss of awareness or conscious activity that may be mistaken for daydreaming. There may be minimal or no movement and the person may appear to have a blank stare. Most often these seizures last only a few seconds. Absence seizures may also be referred to as nonconvulsive seizures, because the body remains relatively still during the episode, though eye fluttering and chewing movements may be seen.

Reye's syndrome

an illness that affects the brain and other internal organs.

Open chest wounds

are due to puncture wounds and range from minor to life threatening. Most injuries to the chest have minor amounts of external bleeding but they can cause more severe, life-threatening internal bleeding. Stab and gunshot wounds are examples of penetrating injuries that may cause an open chest wound.

Capillaries

are microscopic blood vessels linking arterioles and venules (the smallest branches of the veins). Capillaries transfer oxygen and other nutrients from the blood into the surrounding tissue and pick up waste products, such as carbon dioxide, and move them into the venules.

Rib fractures

are usually caused by direct force to the chest. Although painful, a simple rib fracture is rarely life threatening (Figure 14-3). A person with a fractured rib generally remains calm, but their breathing is shallow because normal or deep breathing is painful. The person will usually attempt to ease the pain by supporting the injured area with a hand or arm and leaning toward the side of the fracture (Figure 14-4). When ribs are fractured, suspect the possibility of internal injuries.

diabetes

as the inability of the body to change sugar (glucose) from food into energy. This process is regulated by insulin, a hormone produced in the pancreas. Diabetes can lead to other medical conditions such as blindness, periodontal (gum) disease, nerve disease, kidney disease, heart disease and stroke.

Soft splints

as the name suggests, include soft materials such as folded blankets, towels, pillows ora folded triangular bandage (cravat) (Figure 12-1). A sling is a specific kind of soft splint that uses a triangular bandage to provide stability and support when the shoulder, elbow or upper arm has been injured. A sling may be used in conjunction with a binder (also referred to as a swathe) to immobilize the injury and support the weight of the arm.

If you are with a person who starts to choke, first

ask the person if they are choking, or check to see if an infant is crying or making other noises. If the person can speak or cry and is coughing forcefully, encourage them to keep coughing. A person who is getting enough air to speak, cry or cough forcefully is getting enough air to breathe. But be prepared to act if the person's condition changes. If the person is making high-pitched noises or coughing weakly, or if the person is unable to speak or cry, the airway is blocked and the person will soon become unresponsive unless the airway is cleared. Have someone call 9-1-1 or the designated emergency number immediately while you begin to give first aid for choking.

Tetanus

bacteria

thrombus or embolus

blood clot

The skin is the

body's largest organ. It has three major layers, each consisting of other layers (Figure 4-18). The epidermis, or outer layer, contains the skin's pigmentation, or melanin. The dermis, or second layer, contains the blood vessels that supply the skin, hair, glands and nerves, and is what contributes to the skin's elasticity and strength. The deepest layer, the subcutaneous layer, is made up of fatty tissue and may be of varying thicknesses depending on its positioning on the body.

contusion

bruise, injury

Arteries

carry blood away from the heart, mostly oxygenated blood. The exception is the arteries that carry blood to the lungs for oxygenation, the pulmonary arteries. The aorta is the major artery that leaves the heart. It supplies all other arteries with blood. As arteries travel farther from the heart, they branch into increasingly smaller vessels called arterioles.

Arteries

carry blood away from the heart. Arteries vary in size, with the smallest ones (arterioles) carrying blood to the capillaries

The veins

carry blood back to the heart. The veins also carry waste products from the cells to the kidneys, liver, intestines and lungs, where waste products are processedand eliminated.

transverse plane

horizontal division of the body into upper and lower portions

The brain itself can be further subdivided into the

cerebrum, the largest and outermost structure; the cerebellum, also called "the small brain," which is responsible for coordinating movement; and the brainstem, which joins the rest of the brain with the spinal cord. The brainstem is the control centerfor several vital functions including respiration, cardiac function and vasomotor control (dilation and constriction of the blood vessels), and is the place of origin for most of the cranial nerves

The most frequently injured bone of the shoulder is the

clavicle. Clavicle injuries are more common in children than adults. Typically, the clavicle is fractured or separates from its normal position at either end of the bone as a result of a fall onto the shoulder

Platelets collect at the wound site in an effort to stop blood loss through the process of

clotting

The bones of the upper extremities include the

collarbone (clavicle), shoulder blade (scapula), bone from the shoulder to the elbow (humerus), forearm (radius and ulna), wrist (carpals), hand (metacarpals) .

To give care for an injury to the female genitals,

control bleeding with pressure using compresses moistened with saline. Use a diaper-like dressing or feminine pad(s) for the wound and stabilize any impaled objects with a bandage. Straddle-type injuries may cause a closed wound with significant swelling, pain or inabilityto urinate. A feminine pad works well as a cushion dressing for these injuries, too. Use cold packs over the dressing to reduce swelling and ease pain. Never place anything in the vagina, including a dressing. Treat the person for shock as required.

Good Samaritan laws, which protect the responder from financial liability, were developed to

encourage people to help others in emergency situations. They assume a responder will do their best to save a life or prevent further injury. Good Samaritan laws require the responder to use common sense and a reasonable level of skill, and to give only the type of emergency care for which the responder is trained. Good Samaritan laws usually protect responders who act the way a "reasonable and prudent person" would act if that person were in the same situation.

anterior/posterior

front and back

Rigid splints

include padded boards, folded magazines or newspapers, and padded metal strips that do not have any sharp edges

Two types of emergencies that require first aid

injury and sudden illness

The adipose layer

insulates the body to help maintain body temperature, mechanical cushion and, most importantly, a source of energy. The amount of adipose varies among the different parts of the body and from person to person.

chronic illness

irreversible illness that causes permanent physical impairment and requires long-term health care

fracture

is a break or disruption in bone tissue. Fractures include bones that are chipped or cracked, as well as bones that are broken all the way through (Figure 11-7). Direct and indirect forces, such as from a fall or a blow, commonly cause fractures. However, if strong enough, twisting forces can also cause a fracture. Some fractures are obvious, but others may not be easy to detect without further assessment. While most isolated fractures are not considered critical or life threatening, if the femur or pelvis is fractured, the person is at serious risk for excessive blood loss, shock and death. Fractures to the spine can also result in damage to the spinal cord.

Epilepsy

is a common neurological disorder, estimated to affect approximately 3 million people in the United States alone. Epilepsy is not a specific disease but a term used to describe a group of disorders in which the individual experiences recurrent seizures as the main symptom. In about one-third of all cases, seizures occur as a result of a brain abnormality or neurological disorder, but in two-thirds of cases there is no known cause.

concussion

is a common type of traumatic brain injury that involves a temporary loss of brain function. Concussions are particularly common sports-related injuries, but they can occur whenever a person experiences a bump, blow or jolt to the head or body that results in rapid movement of the head. A person who has had one concussion is at increased risk for subsequent concussions.

laceration

is a cut, which may have either jagged or smooth edges. Lacerations are commonly caused by sharp-edged objects, such as knives, scissors or broken glass. A laceration can also result when a blunt force disrupts or splits the skin. This splitting often occurs in areas where bone lies directly underneath the skin's surface, such as the chin bone or skull. Deep lacerations can also affect the layers of adipose and muscle, as well as damaging both nerves and blood vessels. Lacerations usuallybleed freely and, depending on the structures involved, can bleed heavily. Lacerations are not always painful because damaged nerves cannot transmit pain signals to the brain. Lacerations can easily become infected if not cared for properly.

A tourniquet

is a device placed around an arm or leg to constrict blood vessels and stop blood flow to a wound.

A dislocation

is a displacement or separation of a bone from its normal position at a joint (Figure 11-9). This movement is usually caused by a violent force tearing the ligaments that hold the bones in place.

occlusive dressing

is a dressing that closes a wound or damaged area of the body and prevents itfrom being exposed to the air or water. By preventing exposure to the air, occlusive dressings help to further prevent infection. Occlusive dressings help keep in medications that are applied to the affected area. They also help keep in heat, body fluids and moisture. Occlusive dressings can be manufactured or improvised. An example of an improvised occlusive dressing is plastic wrap secured with medical tape.

A hemostatic dressing

is a dressing treated with a substance that speeds clot formation.

avulsion

is a serious injury in which a portion of the skin and sometimes other soft tissue is partially or completely torn away. A partially avulsed piece of skin may remain attached but hangs like a flap. Bleeding is usually significant because avulsions often involve deeper soft tissue layers.

bandage compress

is a thick gauze dressing attached to a bandage that is tied in place. Bandage compresses are specially designed to help control severe bleeding and usually come in sterile packages.

Crush syndrome

is also common in people who are trapped in collapsed structures due to, for example, an earthquake or act of terrorism. The injury does not happen at the time that the tissue is crushed, but once the crushed muscle is released from compression and the tissue is reperfused with blood. At that point, multiple adverse processes occur, as the products of muscle breakdown are released into the blood. The person may suffer major shock and renal failure, and death may occur.

A stroke

is caused when there is a disruption of blood flow to part of the brain from an obstruction (a clot) or from bleeding into the brain. A stroke can cause permanent brain damage (if not treated appropriately within several hours), but sometimes the damage can be stopped or reversed.

joint

is formed by the ends of two or more bones coming together at one place

strain

is the excessive stretching and tearing of muscle fibers or tendons (Figure 11-11). A strain is sometimes called a muscle pull or tear. Because tendons are tougher and strongerthan muscles, tears usually occur in the muscle itself or where the muscle attaches to the tendon. Strains often result from overexertion, such aslifting something too heavy or working a muscle too long. They can alsoresult from sudden or uncoordinated movement. Strains commonly involve the muscles in the neck or back, the front or back of the thigh, or the back of the lower leg. Strains of the neck and lower back can be particularly painful and therefore disabling.

abrasion

is the most common type of open wound. It is characterized by skin that has been rubbed or scraped away, such as often occurs when a child falls and scrapes their hands or knees on a rough surface (road) An abrasion is sometimes called a scrape, a road rash or a strawberry. It is usually painful because scraping of the outer skin layers exposes sensitive nerve endings. Bleeding is not severe and is easily controlled, since only the small capillaries are damaged. Dirt and germs frequently have been rubbed into this type of wound, which is why it is important to clean and irrigate an abrasion thoroughly.

Type 2 diabetes

is the most common type, affecting about 90 to 95 percent of people with diabetes. This condition usually occurs in adults but can also occur in children. With type 2 diabetes, the body does not produce enough insulin to meet the body's needs or the body becomes resistant to the insulin it produces. Since type 2 diabetes is a progressive disease, people with this type of diabetes eventually may need to use insulin.

A sprain

is the partial or complete tearing or stretching of ligaments and other tissues at a joint A sprain usually results when the bones that form a joint are forced beyond their normal or usual range of motion. The more ligaments are stretched or torn, the more severe the injury. The sudden, violent forcing of a joint beyond its range of motion can completely rupture ligaments and even dislocate the bones. Severe sprains may also involve a fracture of the bonesthat form the joint. Ligaments maypull bone away from their point ofattachment. Young children are morelikely to have a fracture than a sprainbecause their ligaments are strongerthan their bones.

crush injury

is the result of a body part, usually an extremity, being subjected to a high degree of pressure, in most cases after being compressed between two heavy objects

The upper airway includes the

nose,mouth and teeth, tongue and jaw, pharynx (throat), larynx (voice box) and epiglottis

doing an epi pen

obtain consent hold epi pen in center, not touching either side remove the safety cap put epi pen into thigh for about 10 seconds first click is injected second click is done take time and date when it was administered

If you do not speak the same language as the injured or ill person,

obtaining consent may be challenging. Find out if someone else at the scene can serve as a translator. If a translator is not available, do your best to communicate with the person by using gestures and facial expressions. When you call 9-1-1 or the designated emergency number, explain that you are having difficulty communicating with the person, and tell the dispatcher which language you believe the person speaks.

Open fractures

occur when the skin over the fracture site is broken (Figure 11-8, B). An example of an open fracture is when a limb is severely angulated or bent, causing bone ends to tear the skin and surrounding soft tissues.

If you know the cause of the respiratory distress (for example, an asthma attackor anaphylaxis) and the person carries medication used for the emergency treatment of the condition...

offer to help the person take their medication. Encourage the person to sit down and lean forward. Many people find that this position helps to make breathing easier . Providing reassurance can reduce anxiety, which may also help to make breathing easier. A person who is having trouble breathing may breathe more easily in a sitting position. If the person is responsive, gather additional information by interviewing the person and performing a head-to-toe check. Remember that a person having breathing problems may find it difficult to talk. Try phrasing your questions as "yes" or "no" questions so the person can nod or shake their head in response instead of making the effort to speak. You may also be able to ask bystanders what they know about the person's condition. Be prepared to give CPR and use an AED if the person becomes unresponsive.

transient ischemic attack (TIA),

often referred to as a "mini-stroke," is a temporary episode that, like a stroke, is caused by a disruption in blood flow to a part of the brain.

female heart attack symptom

pain in center of breastbone nausea and vomitting

amputation

partial or complete removal of a limb Although damage to the tissueis severe when a body part is severed, bleeding may not be as bad as you might expect. The blood vessels usually constrict and retract (pull in) at the point of injury, slowing bleeding and making it relatively easy to control with direct pressure. Inthe past, a completely severed body part could not be successfully reattached. With today's medical technology, reattachment is sometimes possible, making it important to carefully handle and send the severed body part to the hospital with the patient.

The lower extremity includes the

pelvic bones, thighbone (femur), kneecap (patella), two bones in the lower leg (tibia and fibula), bones of the ankle (tarsals), foot Fig(mureeta1ta1r-s1a9ls) anOd ptoeersa(tpohr:adlalsng1e0s)-.

The liquid part of the blood is called

plasma

A partial airway obstruction can

quickly become a complete airway obstruction. A person witha completely blocked airway is choking and is unable to cough, speak, cry or breathe, or else can only cough weakly and ineffectively or make high-pitched noises. The person may have a bluish skin color.

acute illness

rapidly occurring illness that runs its course, allowing a person to return to one's previous level of functioning

Scapula fractures are

rare. A fracture of the scapula typically results from a violent force, such as a fall from a height or being hit by acar. Because it takes great force to fracture the scapula, you should look for additional injuriesto the head, neck, spine or chest.

The hypothalamus

receives informationthat triggers physiological responses that adjust the body temperature accordingly.

if a person shows signs of heat exhaustion...

remove the person and put them in a cool place

puncture/penetration wound

results when the skin is pierced with a pointed object, such as a nail, a piece of glass, a splinter or a knife (Figure 10-7). A gunshot wound is also a puncture wound. Because the skin usually closes around the penetrating object, external bleeding is generally not severe. However, internal bleeding can be severe if the penetrating object damages major blood vessels or internal organs.

AED says no shock is needed

resume CPR

signs of internal bleeding

signs and symptoms of severe internal bleeding include: Skin that feels cool or moist and looks pale or bluish An altered level of consciousness A rapid, weak heartbeat Excessive thirst Tender, swollen or rigid areas of the body, such as the abdomen. Bruising over the injured area. Rapid breathing. Vomiting blood or coughing up blood. An injured extremity that is blue or extremely pale, swollen and rigid.

A person with a partial airway obstruction can

still move airto and from the lungs. In the case of choking, this air allows the person to cough, in an attempt to dislodge the object. The person may also be able to move air past the vocal cords to speak. The person may clutch at their throat with one or both hands as a natural reaction to choking. This action is the universal sign for choking

retroperitoneal space

the area posterior to the peritoneum, between the peritoneum and the back

The nervous system can be divided into two main anatomical systems:

the central nervous system and the peripheral nervous system (Figure 4-16). The central nervous system consists of the brain and spinal cord. Both are encased in bone (the brain within the cranium and the spinal cord within the spinal column), are covered in several protective layers called meninges and are surrounded by cerebrospinal fluid.

simple partial seizures,

the person usually remains aware. There may be involuntary, muscular contractions in one area of the body, such as the arm, leg or face. Some people cannot speak or move during a simple partial seizure, although they may remember everything that occurred. Simple partial seizures may produce a feeling of fear or a sense that something bad is about to happen. Simple partial seizures can also produce odd sensations such as strange smells or hearing voices. Rarely, feelings of anger and rage or joy and happiness can be brought on by the seizure. Auras are a form of simple partial seizure.

insulin shock

the result of too much insulin which causes a dangerous drop in blood glucose.

open wound

the skin's surface is broken, and blood may come through the break in the skin.

Medial/lateral:

toward the midline/away from the midline

You usually can identify a breathing problem by

watching and listening to the person's breathing and by asking the person how they feel. If a person is having trouble breathing, do not wait to see if the person's condition improves. Call 9-1-1 or the designated emergencynumber and give appropriate first aid care until help arrives:

febrile seizures,

which are seizures brought on by a rapid increase or spike in body temperature. They are most common in children under the age of 5 and typically last from a few minutes to no more than 15 minutes. Febrile seizures are often caused by ear, throat or digestive system infections and are most likely to occur when a child or an infant runs a rectal temperature of over 103° F

Blunt trauma

which is caused by impact with a flat objector surface, is a common cause of internal bleeding. Mechanisms of injury that can lead to blunt trauma and internal bleeding include falls, being struck by a vehicle or a piece of heavy equipment, being struck by a blunt object (such as a bat) or being thrown into a blunt object (such as a steering wheel). Crushing forces (for example, when a person's body is squeezed between two hard surfaces) can also cause blunt trauma, leading to internal bleeding.

compartment syndrome

which is swelling andan increase in pressure within a limited space that presses on and compromises blood vessels, nerves and tendons that run through that space.

Penetrating trauma

which occurs when the body is pierced by a sharp, narrow object (such as a knife or bullet) or impaled on a sharp object (such as a branch or piece of metal), can also lead to internal bleeding.

Getting Info If the person has impaired hearing:

{ Approach the person from the front. { Position yourself so that the person can see your mouth and facial expressions. Hearing-impaired people who know how to read lips rely on watching your mouth move. Pronounce your words slowly and clearly, and speak in short sentences. { If the person does not seem to understand what you are saying, change your words, not the volume of your voice, unless you spoke too softly. Shouting sometimes causes the person more distress, and they still may not understand what you are trying to say. { Use gestures or written messages as necessary to make your meaning clear.

signs of heat stroke

■ Changes in level of consciousness, ■ including confusion, agitation, disorientation Flushed or red skin that can be either dry or moist. or unresponsiveness. Trouble seeing. Seizures. Extremely high body temperature (above 104° F, or 40° C). Rapid, shallow breathing. Throbbing headache. Dizziness, nausea or vomiting.

Although hyperglycemia and hypoglycemia are different conditions, their major signs and symptoms are similar. These include:

■ Changes in level of consciousness. ■ Changes in mood.■ Irregular breathing.■ Feeling and looking ill. ■ Abnormal skin appearance. ■ Dizziness and headache.■ Confusion.

To care for shoulder injuries:

■ Do not move or straighten the injured area. Stabilize the injury in the position found. If an injured person is holding the forearm securely against the chest, do not change the position. Holding the arm against the chest is an effective method of immobilization. Allow the person to continue to support the upper extremity in the position in which they are holding it, usually the most comfortable position. Control any external bleeding with direct pressure, unless the bleeding is located directly over a suspected fracture. With a fracture, apply pressure around the area. Always wear disposable latex-free gloves or use another protective barrier. If the person is holding the upper extremity away from the body, use a pillow, rolled blanket or similar object to fill the gap between the upper extremity and chest to provide support for the injured area. If you must transport or move the person, and it does not cause more pain, splint the upper extremity in place using the guidelines described earlier in the chapter. P Place the upper extremity in a sling and, if possible and tolerable for the person, bind it to the chest with cravats (sling and binder) to further stabilize the injury (Figure 12-7). For a suspected shoulder dislocation, you may need to use pillows under the arm between the chest and shoulder to support the area.

Splint the injured part only if the injured person must be moved or transported by non-professional emergency personnel to a medical facility for treatment. When using a splint, follow these four basic principles:

■ Splint only if you have to move the injured person and can do so without causing more pain and Splint the injured area and the joints or bones above and below the injury site. discomfort to the person. ■ Splint an injury in the position in which you find it. Do not move, straighten or bend angulated bones or joints. ■ Check for proper circulation (feeling, warmth and color) before and after splinting. If circulation has changed with splinting, loosen the splint slightly and reassess circulation.

As a trained lay responder, your primary role in an emergency includes:

- Recognizing that an emergency exists. -Being willing to act. -Activating the EMS system by calling 9-1-1 or the designated emergency number. -Giving care until EMS arrives and takes over or the situation resolves itself.

Two-person seat carry

1. Need 2 responders 2. Conscious & not seriously injured 3. One arm behind thighs, one behind back 4. Interlock arms, make sure weight on shoulders 5. Not for head, neck, spinal injury

If a blood spill occurs:

Clean up the spill immediately or as soon as possible after the spill occurs. Use disposable latex-free gloves and other PPE when cleaning up spills. Wipe up the spill with paper towels or other absorbent materials (Figure 3-4). { If the spill is mixed with sharp objects, such as broken glass or needles, do not pick these up with your hands. Use tongs, a broom and dustpan or two pieces of cardboard to scoop up the sharp objects. After the area has been wiped up, flood the area with an appropriate disinfectant, such as a fresh solution of approximately 11⁄2 cups of liquid chlorine bleach to 1 gallon of fresh water (1 part bleach per 9 parts water). Let stand for at least 10 minutes. Dispose of the contaminated material used to clean up the spill in a labeled biohazard container. Contact your worksite safety representative or your local health department regarding the proper disposal of potentially infectious materials.

Personal protective equipment (PPE):

The equipment and supplies that help prevent the responder from directly contacting infected materials; includes gloves, gowns, masks, shields and protective eyewear.

In an unresponsive adult, you may detect an irregular or gasping breath. This is known as

agonal breathing. Do not confuse this for normal breathing. Care for the person as if there is no breathing at all. If the person you are checking is breathing normally, their heart is beating and is circulating blood containing oxygen. In this case, continue to look for other life-threatening conditions. If an unresponsive person is not breathing, or has irregular or gasping breaths (agonal breathing), assume cardiac arrest. Immediately begin CPR, starting with chest compressions.

Capillaries

are the tiny blood vessels that connect the systems of arteries and veins. Capillary walls allow for the exchange of gases, nutrients and waste products between the two systems. In the lungs, there is exchange of carbon dioxide and oxygen in the pulmonary capillaries. Throughout the body, there is exchange of gases and nutrients and waste at the cellular level.

An injury

is damage to the body from an external force, such as a broken bone from a fall.

The circulatory system consists of

the heart, blood and blood vessels. It is responsible for delivering oxygen, nutrients andother essential chemical elements to the body's tissue cells, and removing carbon dioxide and other waste products via the bloodstream

Circulatory system:

A group of organs and other structures that carry blood and other nutrients throughout the body and remove waste.

Integumentary system:

A group of organs and other structures that protect the body, retain fluids and help to prevent infection.

Lay responder:

A layperson who is not trained to provide first aid, but who recognizes an emergency and decides to act.

Trained lay responder:

A layperson who is trained in basic emergency care (i.e., trained to give first aid), but who does not have special or advanced medical training, and is willing to act in an emergency.

Emergency medical services (EMS) system:

A network of professionals linked together to give the best care for people in all types of emergencies.

For any disease to be spread, including bloodborne disease, all four of the following conditions must be met:

A pathogen is present. There is sufficient quantity of the pathogen present to cause disease. The pathogen passes through the correct entry site (i.e., eyes, mouth and other mucous membranes or skin pierced or broken by cuts, abrasions, bites and sharp objects). A person is susceptible to the pathogen.

Emergency medical responder (EMR):

A person trained in emergency care who may be called on to give such care as a routine part of their job until more advanced emergency medical services (EMS) personnel take over. EMRs often are the first trained professionals to respond to emergencies; also called "first responders."

Emergency medical technician (EMT):

A person who gives basic emergency medical care and transportation for critical and emergent patients who access the EMS system. EMTs are typically authorized to function after completing local and state certification requirements; formerly referred to as EMT-Basic.

Unusual Sights

A stopped vehicle on the roadside or a car that has run off the road Downed electrical wires Sparks, smoke or fire A person who collapses or is lying motionless Signs or symptoms of injury or illness, such as profuse sweating for no apparent reason or an uncharacteristic skin color Spilled medication or an empty medication container An overturned pot in the kitchen

emergency medical dispatchers (EMDs)

A telecommunicator who has received special training to respond to a request for emergency medical services via 9-1-1 or a designated emergency number and to allocate appropriate resources to the scene of an emergency. Some EMDs are trained to provide prearrival medical instructions to a responder before emergency medical services (EMS) personnel arrive.

Paramedic:

An allied health professional whose primary focus is to give advanced emergency medical care for critical and emergency patients who access the EMS system. Paramedics may also give nonemergency, community-based care based on state and local community paramedicine or mobile integrated healthcare programs.

Emergency Situations

An injured or ill person who needs medical attention and cannot be moved Fire or explosion Downed electrical wires Swiftly moving or rapidly rising flood waters Drowning Presence of poisonous gas Serious motor-vehicle collision

Pathogen

An organism that causes disease

In general, you should give appropriate care to an injured or ill person until one or more of the following occurs:

Another trained responder or EMS personnel take over. You are alone and you need to call 9-1-1 or the designated emergency number after giving initial care in a Care First situation You are too exhausted to continue. The scene becomes unsafe. The person you are helping is awake and alert and asks you to stop giving care.

signs and symptoms of incident stress

Anxiousness and inability to sleep. Nightmares. Restlessness and other problems. Confusion. Lower attention span. Poor concentration. Denial. Guilt. Depression. Anger. Nausea. Change in interactions with others. Increased or decreased eating. Uncharacteristic, excessive humor or silence. Unusual behavior Difficulty performing one's job.

diastolic pressure

Blood pressure that remains between heart contractions.

Cardiac.

Cardiac muscles are only found in the walls of the heart and share some of the properties of the other two muscle types: they are smooth (like the involuntary muscles) and striated (string-like, like the voluntary muscles). They are a special type of involuntary muscle that controls the heart. Cardiac muscles have the unique property of being able to generate their own impulse independent of the nervous system.

Rules of providing Care

Do no further harm. Monitor the person's breathing and level of consciousness. Help the person rest in the most comfortable position. Keep the person from getting chilled or overheated. Reassure the person by telling them that you will help and that EMS personnel have been called (if appropriate). Give care consistent with your knowledge and training as needed, and continue to watch for changes in the person's condition.

When giving care, you should also take the following precautions to protect yourself and the person you are helping:

Do not eat, drink or touch your mouth, nose or eyes when giving care or before you wash your hands after care is given. Avoid handling any of your personal items, such as pens or combs, while giving care or before you wash your hands. Ensure that you clean and disinfect anything you may have touched inadvertently with contaminated gloves such as door knobs, phones or other equipment. Do not touch objects that may be soiled with blood or OPIM.

Ankle Drag

EMERGENCY aka foot drag 1. Move person who is too large to carry/move any other way 2. Person's arms crossed on chest 3. Pull person in straight line 4. Don't bump head

To place an adult or child in a recovery position:

Extend the person's arm that is closest to you above the person's head. Roll the person toward yourself onto their side, so that the person's head rests on their extended arm. Bend both of the person's knees to stabilize the body.

Many different fears and concerns can cause a person to hesitate to respond in an emergency. Understanding these fears and concerns can help you to overcome them:

Fear of being sued. Fear of catching a disease. Being uncertain that an emergency actually exists. Being afraid of giving the wrong care or inadvertently causing the person more harm. Assuming that the situation is already under control Squeamishness related to unpleasant sights, sounds or smells..

Before rushing to help an injured or ill person, conduct a scene size-up and form an initial impression. Try to answer these questions:

Is the scene safe to enter? What happened? How many people are involved? What is your initial impression about the nature of the person's injury or illness? Is anyone else available to help?

Implied consent:

Legal concept that assumes a person would consent to receive emergency care if they were able or old enough to do so.

Indirect contact transmission:

Mode of transmission of pathogens that occurs when a person touches objects that have the blood or other potentially infectious materials (OPIM) of an infected person, and that infected blood or OPIM enters the body through a correct entry site.

OPIM:

Other potentially infectious materials such as body fluids (other than blood).

removing latex gloves

Pinch the palm side of one glove near the wrist. Carefully pull the glove off so that it is inside out. Hold the glove in the palm of the remaining gloved hand. Slip two fingers under the glove at the wrist of the remaining gloved hand. Pull the glove until it comes off, inside out, so that the first glove ends up inside the glove just removed. Dispose of gloves in the appropriate biohazard container.

Walking Assist

Place the person's arm around your shoulder or waist (depending on how tall the person is), and hold it in place with one hand. Support the person with your other hand around the person's waist. (Another responder can also support the person in the same way on the other side.)

SAMPLE first aid

S- signs and symtoms A- allergies M- medications P- past medical history L- last food or drink E- Event that happened

Standard precautions:

Safety measures taken to prevent exposure to blood and OPIM when giving care to injured or ill persons; assumes that all body fluids, secretions and excretions (except sweat) are potentially infective.

Unusual Sounds

Screaming, moaning, yelling or calls for help Sudden, loud noises such as breaking glass, crashing metal or screeching tires A change in the sound(s) made by machinery or equipment The sound of an explosion or falling ladder Unusual silence

Skeletal.

Skeletal, or voluntary, muscles are under the control of the brain and nervous system. These muscles help give the body its shape and make it possible to move when we walk, smile, talk or move our eyes.

Smooth.

Smooth muscles, also called involuntary muscles, are made of longer fibers and are found in the walls of tube-like organs, ducts and blood vessels. They also form much of the intestinal wall.

Before giving first aid care, you must obtain consent (permission) from the injured or ill person (or the person's parent or guardian if the person is a minor) (Figure 3-5). To obtain consent:

State your name. 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.

The musculoskeletal system is a combination of two body systems, the muscular and skeletal systems, and consists of the bones, muscles, ligaments and tendons. This system performs the following functions:

Supports the body Protects internal organs Allows movement Stores minerals Produces blood cells Produces heat

glands of the endocrine system

The hypothalamus and pituitary glandsare in the brain. The pituitary gland, also referred to as the "master gland," regulates growth as well as many other glands. The hypothalamus secretes hormones that act on the pituitary gland. The thyroid gland is in the anterior neck and regulates metabolism, growth and development. It also regulates nervous system activity. The adrenal glands are located on the top of the kidneys and secrete several hormones, including epinephrine (adrenalin) and norepinephrine (noradrenaline). The gonads (ovaries and testes) produce hormones that control reproduction and sex characteristics. The pineal gland is a tiny gland in the brain that helps regulate wake/sleep patterns.

Unusual Appearance or Behaviors

Unresponsiveness Confusion, drowsiness or unusual behavior Personality or mood changes (e.g., agitation in a person who is normally calm or irritability in a person who is normally pleasant) Trouble breathing Sudden collapse, slip or fall Clutching the chest or throat A person doubled over in pain Slurred, confused or hesitant speech Sweating for no apparent reason Uncharacteristic skin color Inability to move a body part

After checking the scene by performing a scene size-up, you should then check the person for life-threatening conditions. Life-threatening conditions include:

Unresponsiveness (unconsciousness). Trouble breathing. Absence of breathing. Severe, life-threatening bleeding.

Emergency Conditions

Unresponsiveness or an altered level of consciousness (LOC), such as drowsiness or confusion Breathing problems (trouble breathing or no breathing) Chest pain, discomfort or pressure lasting more than a few minutes that goes away and comes back or that radiates to the shoulder, arm, neck, jaw, stomach or back Persistent abdominal pain or pressure PHOTO: ■ Severe external bleeding (bleeding that spurts or gushes steadily from a wound) ■ Vomiting blood or passing blood ■ Severe (critical) burns ■ Suspected poisoning that appears to be life threatening ■ Seizures ■ Signs or symptoms of a stroke (e.g., drooping of the face on one side; sudden weakness on one side of the body; sudden slurred speech or difficulty speaking; or a sudden, severe headache) ■ Suspected or obvious injuries to the head, neck or spine ■ Suspected or obvious broken bone

he ability to recognize that an emergency has occurred is the first step toward taking appropriate action. You may become aware of an emergency from certain indicators, including:

Unusual sounds. Unusual odors. Unusual sights. Unusual appearance or behaviors.

Clothes Drag

Use on unconscious or conscious person WITH suspected head, neck, or back injuries. keep head, neck, back, stable. grab clothing behind neck, pull to safety while supporting head in your forearms.

To protect yourself and the person, follow these guidelines when moving a person:

Use your legs, not your back, when you bend. Bend at the knees and hips, and avoid twisting your body. Maintain a firm grip on the person. Walk forward when possible, taking small steps and looking where you are going to maintain a firm footing. Avoid twisting or bending anyone with a possible head, neck or spinal injury. Do not move a person who is too large to move comfortably. Use good posture.

Wear disposable latex-free gloves:

When giving care, especially whenever there is a possibility that you will come in contact with a person's blood or OPIM. When there is a break in the skin on your own hands (cover any cuts, scrapes or sores before putting on the gloves). When you must handle items or surfaces soiled with blood or OPIM.

You should move a person only when you can do so safely and only in one of the following three situations:

When you must move the person to protect them from immediate danger (such as fire, flood or poisonous gas). However, you should attempt this only if you can reach the person and remove them from the area without endangering yourself. When you must move the person to reach another person who may have a more serious injury or illness. When you must move the person to give proper care. For example, it may be necessary to move a person who needs CPR onto a hard, flat surface.

Veins

carry deoxygenated bloodback to the heart. The one exception is thepulmonary veins, which carry oxygenatedblood away from the lungs. The superior andinferior vena cavae are the large veins thatcarry the oxygen-depleted blood back intothe heart. Like arteries, veins also branch intosmaller vessels the farther away they are from the heart. Venules are the smallest branches and are connected to capillaries. Unlike arterial blood, which is moved through the arteries by pressure from the pumping of the heart, veins have valves that prevent blood from flowing backward and help move it through the blood vessels.

sagittal plane

divides body into left and right

Frontal (coronal)

divides the body into anterior and posterior parts

emergency

is a situation requiring immediate action. An emergency can happen at any place (on the road, in your home, where you work), to anyone (a friend, relative, stranger) and at any time.

A non-life-threatening emergency

is a situation that does not have an immediate impact on a person's ability to circulate oxygenated blood but still requires medical attention.

A life-threatening emergency

is an injury or illness that impairs a person's ability to circulate oxygenated blood to all parts of the body and will likely cause death if not cared for immediately.

The lower airway consists of the

trachea (windpipe), bronchi, lungs, bronchioles and alveoli

For an infant in recovery position:

■ You can place an infant on their side asyou would an older child, or you can holdthe infant in a recovery position by positioning the infant face-down along your forearm, supporting the infant's head and neckwhile keeping their mouth and nose clear. Keep the head and neck slightly lower than the chest.

However, under the following three conditions, it would be appropriate to move an injured or ill person:

■ You must move the person to protect them from immediate danger (such as fire, flood or poisonous gas). However, you should attempt this only if you can reach the person and remove them from the area without endangering yourself. ■ You must move the person to reach another person who may have a more serious injury or illness. ■ You must move the person to give proper care. For example, it may be necessary to move a person who needs CPR onto a hard, flat surface.