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  1. ´╗┐Critical interventions for Impaled objects?
    • If you are not told about an impaled object during your patient overview it will likely be found during your rapid wet check. Once the object is found:
    • 1. Delegate your partner to immobilize the object using a log cabin type dressing. This needs to be delegated as soon as it is found.
    • 2. The only time it is acceptable to remove the impaled object is if it is causing an away obstruction or if it is interfering with the proper hand placement for performing CPR, Prior to removing the object the EMR should consult with online medical control for direction
    • 3. With a through and through impalement, alternate transportation position may be required (do the best you can).
  2. Critical interventions for Deadly Bleeding?
    • 1. Delegate a partner to control the bleeding with direct pressure as soon as you find cut about the bleed. If there is C-spine considerations delegate C-spine control first, then control the bleeding
    • 2. lf you find any bleeding on your rapid wet check you must expose and examine to find out where or what the bleeding is coming from, When appropriate apply direct pressure first.
    • 3. The order of methods to control the bleeding should be
    • a) Direct pressure
    • b) Pressure point
    • c) Pressure dressing
    • d) Elevation
    • e) And, ONLY IF NOT CONTROLLED BY THE FIRST 4, a tourniquet may be considered (preferably) with online medical direction permission,
    • 4. Once you fix the problem you should change your gloves and finish the rapid wet check. If MOI indicates C-Spine, always call C-Spine!
  3. Spinal motion restriction / C-spine control timing?
    • If the MOI is such that it could have caused a spinal cord injury, for example, significant blunt or penetrating trauma to the head, neck, chest or abdomen C-spine control should be delegated:
    • This MUST be done after the patient overview but before the EMR talks to or touches the patient.
  4. Critical interventions for Fractured and dislocations?
    • As soon as you identify any potential fracture or dislocation in either your patient overview or primary survey you should:
    • 1. Delegate a partner to manual immobilize the area. Do not splint on scene with a critical patient, manual immobilize only. Splint after assessing the area in the secondary (en route to hospital).
    • 2. If no distal circulation on the potentially fractured limb, the EMR should realign to anatomical position in an attempt to restore circulation immediately after confirming the absence of circulation. There is only 1 realigning attempt made in the field.
    • 3. Never attempt to realign any fracture that can include a joint, if it does involve the joint immobilize only, It is cut of scope for EMR'S to reduce dislocations.
    • 4. EMRs do not apply traction to fractures. A traction splint is used for mid-shaft femur fractures, in this case the tractions splint is applying the traction. The end points of a traction splint are:
    • - 10% of the patients body weight
    • - Max of 15 lbs of traction (if you are using a bilateral traction splint the max is still 15 lbs)
  5. Critical interventions for ICP/Cushinq's triad?
    • Cushing's triad is a triad of vital signs that are caused by the development of ICP in either a trauma or medical cause. The triad of vital signs are:
    • 1. Hypertension, a blood pressure that is increasing, often over 180 systolic
    • 2. Bradycardia, a head rate that is decreasing, often 60 BPM or lower
    • 3. Cheyne stakes breathing (deep and irregular breathing pattern)
    • 4. Unequal sized pupils
    • 5. Seizures
    • 6. N/V
    • 7. Unconscious
    • If signs of ICP/Cushings are present (unconscious, irregular breathing, slowing down of the pulse and unequal pupils), the critical intervention is to hyperoxygenate the patient using a BVM with a 02 flow rate of 15 L/min making sure the reservoir bag is never less then 2/3 full, ventilating 1 breath every 3 seconds or 20/min. If on a backboard the head end should be elevated 15-20 degrees, if not on a board, elevate the head end of the stretcher 15-20 degrees
  6. Critical interventions for Flail chest?
    • A flail chest is a situation where 2 or more ribs are broken in 2 or more places. This is usually identified on exam of the chest by visualization of paradoxical chest movement and the palpation of TIC. The critical intervention for this is:
    • 1. Hand stabilize the flail segment
    • 2. Delegate you partner to apply a bulky dressing and tape it towards the head and feet. Never encircle the chest.
  7. Critical interventions for Sucking chest wound?
    • A sucking chest wound is a situation where there is a hole through the chest involving the lungs, allowing air to both enter and escape out of the chest via the chest wound. This is usually found during the rapid wet check of your primary survey. Once you find blood on your gloves and you expose and examine to find out where the blood is originating from, you will most commonly find bloody bubbles as well as hear air going through the chest wound. You should then:
    • 1. Seal the sucking chest wound with your gloved hand
    • 2. Delegate your partner to cover the sucking chest wound with an occlusive dressing taped on 3 sides with the open side down. An occlusive dressing is a dressing the air or fluid can't get through; its primary purpose in this case is to prevent air from entering through the chest wall into the chest cavity during inhalation, but allowing air to escape out during exhalation, preventing pressure from building up in the chest
  8. Critical interventions for Eviscerated organs?
    • Eviscerated organs are commonly found in the abdomen due to lacerations, likely found during the rapid wet check of your primary survey. Once you find blood on your gloves and expose and examine to find cut where the blood is originating from, you should delegate your partner to:
    • 1. Cover the eviscerated organs with a moist sterile dressing
    • 2. Cover the dressing with an occlusive dressing taped on all 4 sides
    • 3. Cover the patient with a blanket
  9. Critical interventions for Fractured Pelvis?
    • 1. Use a scoop stretcher with padding (blankets) on both sides of the pelvis and on top of the pelvis before you strap them to the scoop, shoulder to hip, shoulder to hip, hip to knee, hip to knee, followed by head blocks, taping the patients head down using a star pattern across the forehead and one under the chin.
    • 2. The patient must then be secured by at least 3 straps to a back board, the reason for this is that most medical directors do not consider a scoop stretcher to be spinal motion restriction, The patient is then moved to a wheeled stretcher, secured to the stretcher with the 3 straps.
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EMR trauma
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