inter first-aid skills - body survey
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By: Lee Yat Sing (SI)
Intermediate First-aid Skills- body survey
10th HKG 港島第十旅
Learning Objectives
• Know the basic anatomy of a human being• Understand the Patient Assessment Model
and be able to perform a body survey
3 Basic Principles
•保存生命1
•防止情況(傷勢)惡化2
•促進復原3
Common approach to cases
D
•Danger – RSE, MOI
R
•Response – MOI, LOC (AVPU)
A
•Airway
B
•Breathing
C
•Circulation
D
•Damage
E
•Examination – Rapid Body Survey, MOI
F
•Follow-up – treatment, secondary survey (PQRST)
﹜CPR?
DR
A
B
C
D
E
FRescue Scene Evaluation (RSE) 拯救現場評估- DO NOT focus on details, observe first → Get a concept of the Scene, Danger, MOIScene 環境 :- Search for important clues (number, severity, incident)- Search for route of evacuation e.g. exit- Search for any other people in need- Search for any witnesses or relatives
Danger 危險 :- Be aware of any dangers/ potential dangers, e.g. sharp objects, things that may trip you
Mechanism of Injury (MOI) 患者至患過程 :- Guess: What exactly happened?→ Clues to other injuries, treatments
Before touching your patients,
WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!
D
RA
B
C
D
E
FLevel Of Consciousness (LOC)清醒程度- Approach patient DIRECT with a SMILE- INTRODUCE yourself- Develop CONTACT- Ask about MOI- LOC: Levels AVPU
A Alert ( 清醒 )V Verbal ( 言語 )P Pain ( 痛楚 )U Unresponsive ( 昏迷 )
D
R
AB
C
D
E
F
Airway (氣道 )- Check airway for ALL patients- Alert patients: if patient can speak clearly
→ airway good and clear- Non-alert patients: Check!
1. Clear obstructions (if necessary)2. Perform ‘Head tilt chin lift’ 按額托頭法 →
- If there is suspected spinal fracture → use jaw thrust ( 創建推顎法 )
D
R
A
BC
D
E
F
Breathing (呼吸 )- See, hear and touch ( 視聽觸 ) for 10s- if able to speak clearly → deep and easy breath- Other descriptions:- Deep/ Shallow ( 深 / 淺 )- Rapid/ Slow ( 快 / 慢 )- Easy/ Hard ( 容易 / 努力 )
D
R
A
B
CD
E
FCirculation (血液循環 )- Check radial pulse( 橈側脈膊 ) for 10s:- present → at least 80mmHg systolic ( 上壓 )- Absent → check carotid pulse ( 頸動脈 )
→ at least 60mmHg ( 下壓 )- Descriptions:
- Strong/ weak ( 強 / 弱 )- Rapid/ Slow ( 快 / 慢 )- Regular/ irregular ( 有規律 / 亂 )
- Look for signs of circulation around body
Radial pulse Carotid pulse
D
R
A
B
CD
E
F
D
R
A
B
C
DE
F
Damage (創傷 ) -Deal with immediate wounds, e.g. control bleeding ( 止血 )
D
R
A
B
C
D
EF
Rapid body survey(RBS) 快速身體檢查- Tell your patient that you are going to do a RBS- Pay special attention to bleeds, deformities, swellings, disabilities (出血、變形、腫脹、殘缺 )-Within 30s:- Touch through body (see next slide)- Note for hospital wristband (醫療手帶 )- Expose & handle any wound (展露及處理傷處 ), especially heavy bleeds
- Note skin colour, with back of hand check warmth and moisture (以手背探皮膚溫度及濕度 ) → Pale/ red/ purple? warm/ cold? Dry/ wet?* Note sign of shock休克 (pale, cool, wet)
Rapid Body Survey (RBS)1234 56
7
8
Note:- Bleeds- Deformities- Swellings- Disabilities- Hospital wristband- Skin
D
R
A
B
C
D
EF
D
R
A
B
C
D
E
FFollow-up (跟進及處理 )- Diagnosis (診斷 )- Call for help (尋找支援 )- Patient’s ICE (Idea-Concern-Expectation)- Treatments for conditions- Suspected abnormalities from MOI- Secondary Survey (進一步檢查 )
10 on 5 off
Call for help ( 尋找支援 )
報警十大•地點•事故•傷者數目•性別•年齡
•傷勢•支援物資•急救者資料•聯絡資料•重複
F
Note: in real cases, you can ask any pedestrian to call 999 for you, but make sure you have told him/her all the information listed above
• Patient history ( 病歷 )– Major discomfort ( 主要不適 )• “ 邊到最唔舒服?”
– History of major discomfort → before, during, after
*PQRST – for pain ONLY• Position • Quality• Radiation/ Relief• Severity• Timing
F Secondary Survey ( 進一步檢查 )
Secondary Survey ( 進一步檢查 )
• Patient history ( 病歷 ) – cont’d– Medical history e.g. heart disease, seizure, allergy– Medicine (usually patients bring them along)– Patients’ particulars e.g. name, age– Vital signs ( 維生指數 )
• LOC (清醒程度 )
• Pulse (脈膊 )
• Ventilation (呼吸 )
• Skin (皮膚 )
• Body temperature (體溫 )
– Body survey (詳細檢查 )
F
Body Survey ( 詳細檢查 )
• Ask and explain to patient for body survey• Finish within 5 minutes• Compare left and right side• Do not touch wounded regions• Use your eyes and hands– Eyes: look for bruising ( 瘀傷 ), bleeding( 出血 ),
deformities( 變形 ), swellings( 腫脹 ), wounds( 傷口 ), excretions( 排泄 )
– Hands: Check for pain at fracture( 骨折 ), deformities( 變形 ), sinks( 下陷 ), swellings( 腫痛 ), tenderness( 觸痛 ), firmness( 堅實 )
F
Lungs
Heart
Liver
Stomach
Intestines
Body Survey ( 詳細檢查 )-1FH
ead - Scalp ( 頭皮 )
- Face & forehead- Ears and nose- Eyes- Lips and mouth- Teeth (esp fake)- Tongue
Nec
k - Spine- Swelling- Voice- Loosen collar- Remove necklace
Ches
t - Clavicle ( 鎖骨 )- Ribcage mov’t- Ribs- Deep breath
Body Survey ( 詳細檢查 )-2FAb
dom
en - Internal organs(swelling, pain)- Loosen belt
Back - Spine
- Do not move
Pelv
ic R
egio
n - Pelvis ( 盆骨 )- Groin ( 陰部 ) (bleed, pain)
Body Survey ( 詳細檢查 )-3FLo
wer
lim
bs - Thigh and calf- Knee- Pedal pulse- Nails: cap refill (Press 5s, read 2s)- Sensation- StrengthU
pper
lim
bs - Shoulders- Arms- Radial pulse- Nails: cap refill- Force- Remove accessories
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