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The 2 categories of chest injuries
In _____ the chest wall is penetrated by some object. And in _____ the skin is not broken.
- Open chest injuries
- Closed chest injuries
All chest victims should have their ______, _______, ________ checked and rechecked.
- Circulation (ABC's)
How should chest victims be positioned? if the injury is on a side?
- sit up
- be placed with the injured side down
PLACE VICTIM ON THE INJURED SIDE BC IT KEEPS THE BLOOD ON THAT SIDE!!
2 kinds of closed chest injuries
- 1. Rib fractures
- 2. Flail chest
The upper four ribs are rarely fractured, and the lower two are difficult bc they have freedom to move so they give with impact which is why they are called FLOATING RIBS.
RIBS 3-10 is where most fractured ribs occur.
BREATH NORMALLY AND TAKE DEEP BREATHS with a rib fracture.
**SIGNS OF RIB FRACTURE**
- *Sharp pain, especially when the victim takes a deep breath, coughs, or moves
- *Shallow breathing
- *Victim holds the injured area, trying to reduce the pain
**CARE FOR RIB FRACTURES**
- 1. Help the victim find a comfortable position
- 2. Stabilize the ribs by having the victim hold a pillow or other similar soft object against the injured area or use bandages to hold the pillow in place. You can also tie an arm over the injured are. Do not apply tight bandages around the chest bc they will restrict breathing (increasing chances of pneumonia).
- 3. Give pain meds.
- 4. Seek medical care.
A serious injury that involves several ribs in the same area broken in more than one place.
When only one side of the chest rises, seen in flail chest victims
The are over the injury may move in a direction opposite to that of the rest of the chest wall during breathing known as ______
**SIGNS AND SYMPTOMS OF FLAIL CHEST**
- *Paradoxical chest motion takes place. The area over the injury may move in a direction opposite to that of the rest of the chest wall during breathing.
- *Breathing is very painful and difficult.
- *Bruising of the skin over the injury occurs.
**CARE FOR FLAIL CHEST**
- 1. Support the chest by one of several methods:
- -Apply hand pressure. This is useful for a short time.
- -Place the victim on the injured side with a blanket or clothing underneath.
- 2. Monitor breathing.
- 3. Seek medical care.
IMPALED OBJECT IN CHEST
*If an object penetrates the chest wall, air and blood escape into the space btw the lungs and the chest wall. The air and blood cause the long to collapse. LUNG COLLAPSE can lead to shock and death.
**CARE FOR IMPALED OBJECT IN CHEST**
- 1. Stabilize the object in place with bulky dressings or cloths. Do not try to remove an impaled object. Doing so can result in bleeding and air in the chest cavity.
- 2. Call 9-1-1
Results when a chest wound allows air to pass into and out of the chest with each breath. Bubbles may be seen and a sucking sound heard during inhalations.
Sucking chest wound
**SIGNS OF A SUCKING CHEST WOUND**
- *Blood bubbling out of a chest wound during exhalation.
- *Sucking sound heard during inhalations.
**CARE FOR A SUCKING CHEST WOUND**
- 1. Seal the wound with anything available to stop air from entering the chest cavity. Plastic wrap or a plastic bag works well. Tape it in place, but leave one side untaped to create a flutter valve to prevent air from being trapped in the chest cavity. If plastic wrap is not available, you can use your gloved hand.
- 2. If the victim has trouble breathing or seems to be getting worse, remove the plastic cover to let air escape, then reapply.
- 3. Call 9-1-1
Occur when the internal abdominal tissues are damaged but the skin is unbroken. (blunt injuries)
Closed abdominal injury
RECOGNIZING A CLOSED ABDOMINAL INJURY
- Examine the abdomen by gently pressing all four quadrants of the abdomen with the fingertips. A normal abdomen is soft and not tender when pressed. SIGNS:
- *Bruises or other marks
- *Pain, tenderness, muscle tightness, or rigidity
- **Expect VOMITING.
Are those in which the skin has been broken (known as penetrating injuries-can cause internal organ damage)
Open abdominal injuries
**DO NOT REINSERT PROTRUDING ORGANS.**
**DO NOT COVER THE ORGANS TIGHTLY.**
**DO NOT COVER THE ORGANS WITH ANY MATERIAL THAT CLINGS OR DISINTEGRATES WHEN WET.**
**DO NOT GIVE ANYTHING BY MOUTH.**
Refers to a severe injury to the abdomen in which internal organs escape or protrude from the wound
Protruding organ injury
**CARE FOR PROTRUDING ORGANS**
- 1. Call 9-1-1
- 2. Allow the victim to stay in a comfortable position with the legs pulled up toward the abdomen.
- 3. Cover the protruding organs with a MOIST sterile dressing or clean cloth. Keep organs stable.
- 4. Treat for shock.
_____ are usually caused by falling or a motor vehicle crash.
**SIGNS OF A PELVIC INJURY**
- *Pain in the hip, groin, or back that increases with movement.
- *Inability to stand or walk.
- *Signs of shock.
**CARE FOR PELVIC INJURIES**
- 1. Treat the victim for shock.
- 2. Place padding between the victim's thighs, and then tie the victim's knees and ankles together. If the knees are bent, place padding under them for support.
- 3. Keep the victim on a firm surface.
- 4. Call 9-1-1
*Most vehicle crashes, being struck by a motor vehicle, falls, and bicycle and motorcycle crashes are common causes of pelvic injury.
**It is important to suspect pelvic injuries bc they can result in massive blood loss.
***Do not move the victim.
Same as a broken bone: a break or crack in a bone
The skin is intact, and no wound exists anywhere near the fracture site
The skin over the fracture has been broken. The wound may result from the bone protruding through the skin or from a direct blow that cut the skin at the time of the fracture. The bone may not always be visible.
Fractures that commonly occur in children
How do you assess for an injury such as a fracture?
- Open wound
- Swelling (all around the joint)
**SIGNS AND SYMPTOMS OF FRACTURE**
- * DOTS
- * Loss of use may or may not occur
- * A grating sensation called crepitus can be felt and sometimes even heard when the ends of the broken bone rub together
- * The history of the injury
**CARING FOR FRACTURES**
- 1. Perform an initial check for life threatening conditions.
- 2. Gently remove clothing covering the injured area. Cut clothing at the seams if necessary.
- 3. Examine the area by looking and feeling for DOTS.
- 4. Check blood flow and nerves. CSM
- -CIRCULATION -SENSATION -MOVEMENT
- 5. Stabilize by splinting. Prevent movement.
- 6. If the injury is an open fracture, do not push on any protruding bones. Cover the wound and exposed bones with a dressing. Place rolls of gauze around the bone and bandage the injury without applying pressure on the bone.
- 7. Apply an ice pack if possible.
- 8. Seek medical care.
Where two or more bones come together.
Occurs when a joint comes apart and stays apart with the bone ends no longer in contact.
**SIGNS AND SYMPTOMS OF DISLOCATION**
- *Deformity (main sign)
- *Severe pain
- *Inability of the victim to move the injured joint
**CARE FOR DISLOCATIONS**
- 1. Check the CSM (check for pulse)
- 2. Use the RICE procedures
- 3. Use a splint to stabilize the joint in the position in which it was found.
- 4. Do not try to reduce the joint (don't try to put the joint back in place) bc the nerve and blood vessel damage could result.
- 5. Seek medical care to reduce the dislocation.
Occurs when a joint is twisted or stretched beyond its normal range of motion.
**SIGNS AND SYMPTOMS OF A SPRAIN**
- *Severe pain
- *Pain prevents the victim from moving or using the joint.
- *Skin around the joint may be discolored bc of bleeding from torn blood vessels.
**CARE FOR SPRAINS**
- 1. Follow the RICE procedures.
- -Apply an ice pack for 20 mins, apply compression w/ an elastic bandage for 3-4 hours; repeat. Elevate.
- 2. Swelling can cause stiffness. Promptly use cold and elevate.
Occurs when a muscle is stretched beyond its normal range of motion and tears the muscle
Muscle STRAIN; also known as a muscle pull
**SIGNS AND SYMPTOMS OF A MUSCLE STRAIN**
- *Sudden, sharp pain in the affected muscle
- *Extreme tenderness when the area is touched
- *Weakness and inability to use the injured part
- *Stiffness and pain when the victim moves the muscle
- *After a few days, the skin around the injury may be discolored bc of bleeding from torn blood vessels.
To care for STRAINS, simply follow the RICE procedures.
Occurs when a muscle goes into an uncontrolled spasm and contraction
2 categories of muscle cramps
- 1. Night cramps
- 2. Heat cramps
What causes heat cramps?
Dehydration and electrolyte imbalance (lack of potassium and sodium)
- *Sudden, severe pain, usually in the legs.
- *A knotting of the muscle may be felt and sometimes seen.
- *Restricts movement
**CARE FOR CRAMPS**
- 1. Stretch the muscle.
- 2. Relax the muscle by pressing and massaging it.
- 3. Apply an ice pack
- 4. Pinch the upper lip hard to reduce calf-muscle cramping
- 5. Drink lightly salted cool water or a sports drink.
Results form a blow to the muscle
Muscle contusion or bruise
- *Pain and tenderness
- *After a few days, the skin in the area may become discolored due to bleeding from torn blood vessels.
To care for muscle contusions, follow the RICE procedures.
2 mnemonics used in assessment
Use these guidelines to assess injuries to the extremities:
- -Look for signs and symptoms of fractures and dislocations
- -Examine the extremities using DOTS.
- -Compare one extremity with the other to determine size and shape differences.
- -Use the "rule of thirds" for extremity injuries.
- -Consider the cause of injury (COI) when evaluating the possibility of a fracture and its location.
- -Use CSM
Where do you check for a pulse?
below the break
Bruising of the tissue
Muscles are stretched or torn
Involve the tearing or stretching of the joints, causing mild to severe damage to the ligaments and joint capsules
Inflammation of a tendon due to overuse (cord that attaches muscle to bone)
Bones are displaced from their normal joint alignment, out of their sockets, or out of their normal positions
Breaks in bones that may or may not be accompanied by open wounds
**CARE FOR EXTREMITY INJURIES**
- 1. Use the RICE procedures
- 2. Apply a splint
Does not use or move the injured part
For 20-30 mins every 2-3 hours during the first 24-48 hours.
The four stages the skin passes when cold:
- 1. Cold
- 2. Burning
- 3. Aching
- 4. Numbness
**RECOGNIZING SHOULDER DISLOCATION**
- *In about 95% of shoulder dislocations, the victim holds the upper arm away from the body, supported by the uninjured arm.
- *The dislocated arm cannot be brought across the chest wall to touch the opposite shoulder.
- *Extreme pain in the shoulder area
- *In a dislocation, the shoulder looks squared off, rather than rounded.
- *An injury to the shoulder resulting in complete loss of function is more apt to be a dislocation than a fracture.
- * The victim may describe a history of previous dislocations.
- *Numbness or paralysis in the arm from pressure, pinching blood vessels or nerves.
**CARE FOR A SHOULDER DISLOCATION**
- 1. Do not try to force, twist, or pull the shoulder back in place bc it may cause bone, nerve or blood vessel injury.
- 2. Place folded or rolled blanket or a pillow between the upper arm and the chest to support the arm.
- 3. Apply an arm sling and swathe (binder). Use the arm sling which has one end tucked between the arm and body and ties in the back. This keeps pressure off of the area.
- 4.Apply an ice pack for 20 min.
- 5. Seek immediate medical care.
**RECOGNIZING FOOT AND ANKLE INJURIES**
- 1. Press on the bones.
- 2. Ask the victim, "Have you tried standing on it?" If a sprain they should be able to take 4 steps or more. If broken cant take more than 4.
- 3. If the victim hops on the good foot
- 4. Swelling
Almost anything can be used as a splint
Reasons for splinting
- * Reduce pain
- * Prevent damage to muscles, nerves, and blood vessels.
- * Prevent a closed fracture from becoming an open fracture.
- * Reduce bleeding and swelling.
Injured extremities should be _____ by splinting the extremity in the position it was found.
Any devices used to stabilize a fracture or a dislocation. can be improvised.
3 examples of splints
- 1. Pillow splint
- 2. Buddy splint (using body as splint)
- 3. SAM splint
- 1. Cover any open wounds with a sterile dressing before applying a splint.
- 2. Check CSM in the extremity.
- 3. Determine what to splint by using the RULE OF THIRDS.
- 4. If two first aiders are present, one should support the injury site and minimize movement of the extremity until splinting is completed.
- 5. When possible, place splint materials on both sides of the injured part, especially when 2 bones are involved, such as the radius and ulna in the lower arm or the tibia and fibula in the lower leg.
- 6. Apply splints firmly but not so tightly that blood flow into an extremity is affected. Check CSM after splint is applied.
- 7. Use RICE on the injured part.
Occurs when the heart muscle tissue dies bc its blood supply is reduced or stopped (usually by a clot in a coronary artery) and medical name
Heart attack (Miocardial Infarction)
If you suspect a heart attack seek medical attention AT ONCE.
**SIGNS OF A HEART ATTACK**
- * Pressure, squeezing, or pain in the center of the chest that lasts more than a few minutes or that goes away and comes back; some victims have no chest pain (angina pectorus)
- * Pain spreading to the shoulders, neck, or arms
- * Dizziness, sweating, nausea
- * Shortness of breath
**CARE FOR HEART ATTACK VICTIMS**
- 1. Call 9-1-1 or go to the nearest hospital that offers 24 hour emergency cardiac care.
- 2. Monitor breathing. Give CPR if necessary.
- 3. Help the victim to the most comfortable resting position, usually SITTING.
- 4. If the victim is alert, able to swallow, and not allergic to asprin, give one adult aspirin or 2 to four chewable children's aspirin.
- 5. Find out whether the victim is using NITROGLYCERIN (relieve chest pain from angina but not from a heart attack; dilates the coronary arteries which increases blood flow to the heart muscle.) victim should sit or lie down once taken. can repeat a total of 3 doses in 10 min
- 6. If the victim is unresponsive, check breathing and start CPR
Occurs when the heart muscle doesn't get as much blood as it needs, which leads to a lack of oxygen
Brought on by physical exertion, exposure to cold, or emotional stress. Seldom lasts longer than 10 min and almost always is relieved by nitroglycerin.
The drug used most often to dilate the coronary arteries and increase the blood supply to the heart.
**RISK FACTORS YOU CAN'T CHANGE FOR HEART DISEASE**
- * Heredity
- * Sex: Men have a greater risk, although heart attack is still the leading cause of death among women
- * Age: most heart attack victims are 65 yrs. or older
**RISK FACTORS FOR HEART ATTACK YOU CAN CHANGE OR CONTROL**
- * Cigarette smoking: twice the risk of heart attack
- * High blood pressure: adds to the hearts workload
- * Diabetes: affects the bloods cholesterol and triglyceride levels
- * Obesity: influences blood pressure and blood cholesterol, can result in diabetes, adds strain on the heart
- * Physical inactivity: inactive ppl have twice the risk
- * Stress: long term stress
**CARE FOR PPL WITH ANGINA**
- 1. Give nitroglycerin
- 2. If pain does not quickly subside (5-10 min) suspect a heart attack
Causes of chest pain that have nothing to do with the heart
- 1. Muscle or rib pain due to exercise or injury--treat with aspirin or ibuprofen
- 2. Respiratory infections such as pneumonia, bronchitis, pleuritis, or lung injury
- 3. Indigestion--relieved by antacids.
Called a brain attack; occurs when part of the blood flow to the brain is suddenly cut off; this occurs when arteries in the brain rupture or become blocked so part of the brain does not receive the blood flow it needs.
Third leading cause of death
**RISK FACTORS FOR A STROKE**
- * Age (older than 50)
- * Use of birth control pills and age older than 30 years
- * Overweight
- * Hypertension (high blood pressure)
- * High blood cholesterol levels
- * Diabetes
- * Heart disease
- * Sickle cell disease
- * Substance abuse, particularly crack cocaine
- * Family history of strokes or transient ischemic attacks (TIAs-mini strokes)
The most common type of stroke (about 80%) ...when a clot forms in an artery in the brain or travels from the heart to the brain and plugs the artery
The difference between a TIA and a stroke
The symptoms of a TIA are transient, lasting from several minutes to several hours, with a return to normal neurological function.
**SYMPTOMS OF STROKE**
- *Weakness, numbness, or paralysis of the face, an arm, or a leg on one side of the body
- *Blurred or decreased vision, especially in one eye
- *Problems speaking or understanding
- *Dizziness or loss of balance
- *Sudden, severe, and unexplained headache
- *Deviation of the eyes
**CARE FOR A STROKE VICTIM**
- 1. Call 9-1-1.
- 2. If the victim is unresponsive, open the airway and check breathing. If there is no breathing, give CPR
- 3. If the victim is responsive, lay the victim down with the head and shoulders slightly elevated
- 4. Place a victim who is unresponsive but breathing in the RECOVERY POSITION to keep the the airway open and to permit secretions and vomit to drain from the mouth
Is a chronic, inflammatory lung disease characterized by repeated breathing problems
Ppl with asthma have _____ (some call them attacks or flares) when the air passages in their lungs get narrower and breathing becomes more difficult.
**TRIGGERS OF ASTHMA**
- * Respiratory tract infection
- * Exposure to temperature extremes, especially cold air
- * Strong odors, perfumes, talcum powder, deodorizers, and paint
- *Occupational exposures: dust, fumes, and smoke
- * Certain drugs: aspirin, nonsteroidal anti-inflammatory drugs, yellow dy No. 5, and beta blockers
- * Exercise
- * Emotional stress
- * Allergens: pollen, mold, dust mites, animal danger, and tobacco smoke
- * Air pollution: ozone and sulfur dioxide
**SIGNS OF AN ASTHMA ATTACK**
- * Coughing
- * Cyanosis (bluish skin)
- * Inability to speak in complete sentences without pausing for breath
- * Nostrils flaring with each breath
- * Difficulty breathing, including wheezing
**CARE FOR PPL WITH ASTHMA**
- 1. Place the victim in a comfortable, upright position and leanin slightly forward. (TRIPOD POSITION). sitting up is best
- 2. Monitor breathing
- 3. Ask the victim about any asthma meds; use inhaler
- 4. seek medical attention if meds and inhaler dont work
Fast deep breathing; common during emotional stress
- *Dizziness or lightheadedness
- *Tingling of the hands and feat
- *Shortness of breath
- *Breathing rate faster than 40 breaths per min
**CARE FOR HYPERVENTILATION**
- 1. Calm and reassure the victim
- 2. Encourage the person to breathe slowly, using the ab muscles, inhale through the nose, hold the full inhalation for several secs, then exhale slowly
Life long smokers
Chronic obstructive pulmonary disease (COPD)
Is a broad term aplied to emphysema, chronic bronchitis, and related lung diseases. **cig smokin..
COPD-Chronic obstructive pulmonary disease
Caused by chronic infection, which can be brought on by irritations such as tobacco smoke.
Often occurs with chronic bronchitis; difficult breathing
**SIGNS AND SYMPTOMS**
- *Coughing and shortness of breath;
- * Depend on a constant low level of artificially supplied oxygen to maintain breathing
**CARE FOR COPD**
- 1. They will have their own physician-prescribed meds.
- 2. Place victim in sittin position
- 3. Encourage the victim to cough up any secretions
- 4. Encourage the victim to drink fluids
- 5. For acute breathing distress, obtain immediate medical assistance
A sudden, brief loss of responsiveness not associated with a head injury
Syncope (fainting) or psychogenic shock
Can happen suddenly when blood flow to the brain is interrupted
The decreased blood flow can be caused by low blood sugar____
**SIGNS AND SYMPTOMS OF FAINTING**
- * Dizziness
- * Weakness
- * Seeing spots
- * Visual blurring
- * Nausea
- * Pale skin
- * Sweating
LIE DOWN AND ELEVATE THEIR FEET (FAINTING)
**IF A PERSON APPEARS ABOUT TO FAINT**
- 1. Prevent the person from falling
- 2. Help them lie down and raise the person's legs 6-12 inches
- 3. Loosen tight clothing at the neck and waist
- 4. Stay with the victim until he or she recovers.
**IF FAINTING HAS HAPPENED**
- 1. Monitor breathing
- 2. Loosen tight clothing and belts
- 3. If the victim fell, check for injuries
- 4. Raise the victim's legs 6-12 inches
- 5. After recovery, have the victim sit for a while, and when he or she is able to swallow, give cool, sweetened liquids to drink and help the victim to slowly regain an upright posture
- 6. Fresh air and a cold, wet cloth for the face usually aid recovery
Seek medical care if a fainting victim:
- -has had repeated attacks of unresponsiveness
- -does not quickly regain responsiveness
- -loses responsiveness while sittin or lying down
- -faints for no apparent reason
Results from an abnormal stimulation of the brain's cells causing uncontrollable muscle movements.
Medical conditions that can increase the instability or irritability of the brain and can lead to seizures
- * Epilepsy
- * Heatstroke
- * Poisoning
- * Electric shock
- * Hypoglycemia
- *high fever in children
- * Brain injury, tumor, or stroke
- * Alcohol withdrawal, drug abuse, or overdose
Most ppl with seizures have _____
**CARE FOR SEIZURES**
- 1. Cushion the victim's head
- 2. Loosen any tight clothing, especially around the neck
- 3. Roll the victim onto his or her side
- 4. Look for a medical tag
- 5. As the seizure ends, offer your help. Most seizures in ppl with epilepsy are not med emergencies. They end after a minute or two without harm and usually do not require medical attention
- 6. Call 9-1-1 if
- -A seizure occurs in someone who is not known to have epilepsy
- -A seizure lasts more than 5 min
- -The victim is slow to recover, has a second seizure, or has difficulty breathing afterward
- -The victim is pregnant or has another medical condition
- -There are any signs of injury or illness
THE DO NOTS FOR SEIZURES:
- DO NOT give the victim anything to eat or drink.
- DO NOT restrain the victim.
- DO NOT put anything between the victims teeth during the seizure.
- DO NOT splash or pour any liquid on the victims face.
- DO NOT move the victim to another place (unless it is the only way to protect the victim from injury).
Is a condition in which insulin, a hormone produced by the pancrease, is lacking or ineffective
2 type of diabetes
- 1. Type 1-(juvenile-onset or insulin dependent diabetes) require external insulin to allow sugar to pass from the blood into cells.
- 2. Type 2-(adult-onset or non-insulin) tend to be overweight; (lifestyle change can help control and even prevent it)
Too much insulin and not enough sugar leads to low blood sugar and possibly ______
Insulin shock (hypoglycemia)
Too much sugar and not enough insulin leads to high blood sugar, and possibly ______ lack of insulin
Diabetic coma (hyperglycemia)
A low blood sugar level called...too much insulin
**RECOGNIZE LOW BLOOD SUGAR** (hypoglycemia)
- -Sudden onset
- -Staggering, poor condition
- -Anger, bad temper
- -Pale skin
- -Confusion, disorientation
- -Sudden hunger
- -Excessive sweating
- -Eventual unresponsiveness
Can lead to diabetic coma, is the opposite of hypoglycemia. Occurs when the body has too much sugar in the blood; insufficient; Diabetic coma
**RECOGNIZING HIGH BLOOD SUGAR**
- -Gradual onset
- -Extreme thirst
- -Very frequent urination
- -Flushed skin
- -Fruity breath odor
- -Heavy breathing
- -Eventual unresponsiveness
**CARE FOR PPL W/ HIGH BLOOD SUGAR**
- 1. Give the person sugar containing food or drink
- 2. If improvement is not seen in 15 min, take the victim to the hospital