medical flowcharts booklet

ABDOMINALINJURIES

F L O W C H A R T

Check ABCDs and treat accordingly.

Penetrating wound?

Impaled object?

Do not remove object.

Stabilize object.

Do not reinsert organs.

Do not touch organs.

Cover with moist, cleandressing.

Protruding organs?

Seek medical attention.

Roll victim on one sidein case of vomiting.

No liquids.

No Yes

No Yes

No Yes

Blow to abdomen?Yes

EMERGENCY CARDIAC CARE PENDING ARRIVAL

OF EMERGENCY MEDICAL PERSONNEL

Memory aid for “no shock indicated”:• Check pulse• If pulse: check breathing• If inadequate breathing: start rescue breathing

(1 breath every 5 seconds)• If adequate breathing: place in the recovery position• If no pulse, analyze rhythm: repeat “shock indicated”

or “no shock indicated” sequences

• If breathing adequate: place in the recovery position• If breathing inadequate: start rescue breathing

(1 breath every 5 seconds)• Monitor pulse (every 30 to 60 seconds)

• Give 2 slow breaths (11⁄2 to 2 seconds per breath)

• Circulation: Check for a pulse

• Start rescue breathing (1 breath every 5 seconds)• Monitor pulse (every 30 to 60 seconds) Do CPR (until AED arrives and is ready to attach):

• Start chest compressions (80 to 100 per minute)• Start rescue breathing (10 to 12 breaths per minute)• Ratio of 15 compressions to 2 breaths

• Defibrillate (AED on scene):• POWER ON the AED first!• ATTACH AED electrode pads (stop chest compres-

sions for pad placement)• ANALYZE (“Clear!”)• SHOCK (“Clear!”) up to 3 times if advised

Unresponsive — 911 — AED:• Check if unresponsive• Call 911• Get AED

Start the ABCDs:• Airway: Open airway• Breathing: Check breathing

(look, listen, and feel)

After 3 shocks or after any “no shock indicated”:• Check pulse• If no pulse: perform CPR for 1 minute

Check pulse: if absent:• Press ANALYZE• Defibrillate• Repeat 3 times

Unresponsive

Not Breathing

No Pulse

Yes, Breathing

Yes, Pulse

HEARTSAVERAED RESCUERTREATMENTALGORITHM

F L O W C H A R T

AMPUTATION

F L O W C H A R T

Control bleeding.

Find severed part?

Request others to locateand take to hospital.

Care for severed part:1. Wrap part in dry sterile gauze

or clean cloth.2. Put wrapped part in waterproof

container (plastic bag, cup, etc).3. Place wapped part and container

on bed of ice; do not submerge in ice or cold water.


No Yes

ANAPHYLAXIS

F L O W C H A R T

Check ABCs and treat accordingly.

Is victim’s epinephrinekit available?

Inject epinephrine accordingto kit’s directions.

Monitor ABCs andtreat accordingly.

Keep checking victim; secondinjection may be needed.

Seek immediate medical attention.

No Yes

Try asthma inhaleror antihistamines.

A N I M A LB I T E S

F L O W C H A R T

Skin broken by bite?

Wash wound with soap and water.

Try notifying animal’sowner or, if animal is wild,the proper authorities.

Apply direct pressure tocontrol bleeding.

Wild animal?

Do not try to capture.

Do not kill; if you must kill, donot hit or shoot in brain.

Preserve brain for medical exam.

Contact local government healthofficer for advice.


Notify animal control or police.

Animal will be observed for possible rabies.

No Yes

No Yes

Apply cold pack.

A N K L EI N J U R I E S

F L O W C H A R T

Is the victim unable to bearweight enough to take foursteps immediately after injury,and is ankle knob tender?

Suspect ankle fracture.


Suspect ankle sprain.

No Yes

Use RICE procedures.Use RICE procedures.

Immobilize ankle/footwith splint (eg, pillow).

Do not use heat until 48 to 72hours after injury.

If swelling and pain do notdecrease within 48 hours,seek medical attention.

Apply direct pressure over wound:• Place sterile dressing or cleanest cloth available over wound.• If possible, use medical exam gloves, extra dressing, or plastic wrap.• Do not remove an impaled object.

Bleeding stopped?

Bleeding stopped?

Locate pressure pointand apply pressure.

Keep pressure overwound.

Treat for shock.

Bleeding stopped?

Apply tourniquetas last resort.

Treat for shock.

Care for wound.

Seek medical attentionif needed.


Bleeding from arm or leg?

No Yes

No Yes

No Yes

No Yes

Locate bleeding source.

Elevate extremity above victim’s heartand continue pressing on wound.

B L E E D I N G

F L O W C H A R T

BLISTERS

F L O W C H A R T

Pain is unbearable?

Break blister by:

1. Washing area with soap and water.

2. Making small holes at blister’s base with sterile needle.

3. Draining fluid.

4. Applying sterile dressing.

5. Leaving blister’s roof on.

6. Watching for signs of infection.Blister has been broken?

Drain fluid.

Apply sterile dressing.

Leave blister’s roof on.

Watch for signs of infection.

No Yes

Yes

Prevent further injury bycovering blister with tape,moleskin, or a doughnut ofgauze, felt, or moleskin.

It’s best to leave blister unbroken.

B O N EI N J U R I E S

F L O W C H A R T

Look and feel for DOTS.

Remove or cut away clothingover injury site.

Bleeding from openfracture?

Control bleeding.

Do not push bone.

Cover wound and bonewith a dressing.

Check circulation,sensation, andmovement (CSM).

Most broken bones areminor and do not needstraightening.

Apply splint.

Recheck CSM periodically.


No Yes

C H E M I C A LB U R N S

F L O W C H A R T

Dry chemical?

Caustic or corrosive(acid, alkali, or organiccompound)?

Brush off before washing with water.

Remove clothing and jewelry.


No Yes

Yes

Do not try to neutralize.

Wash with water for20 minutes.

Wash immediately withwater for 20 minutes.

Remove clothing and jewelry.

Do not try to neutralize.

C H E S TI N J U R I E S

F L O W C H A R T


Penetrating wound?

Impaled object?

Do not remove object.

Stabilize object.

Seal wound to prevent airfrom entering.

Sucking chest wound?


Stabilize ribs and chest.

No Yes

No Yes

No Yes

Rib fracture? Yes

D E N T A LI N J U R I E S

F L O W C H A R T

Toothache?

Broken tooth?

Rinse tooth; do notscrub it.

Gently insert intosocket so top is evenwith adjacent teeth.

Rinse mouth with warm water.

Remove trapped food withdental floss.

Use cold pack on outside ofcheek for swelling.

Do not place aspirin on achingtooth or gum tissue.

Soak cotton with oil of clovesand place on aching tooth.

Preserve tooth.

Do not clean tooth.

Take tooth and victim to dentist.

Rinse mouth with warm water.

Apply an ice pack on outside of cheek.

If dental care is delayed, melt piece ofparaffin or candle mixed with cottonstrands.

As it cools, apply as a temporary cap.

Seek dentist for assistance.

Yes

No Yes

No Yes

Blow to mouth area?No Yes

Yes

Tooth knocked out?

Remote area?

Replant tooth?

Yes

No

DIABETICEMERGENCIES

F L O W C H A R T

Can tell differencebetween diabetic comaand insulin shock?

Victim conscious?

Give victimfood or drink containingsugar.

Victim can often directaction to take.

If not sure, give sugar.

Diabeticcoma

Victim ininsulin shock?


No Yes

No Yes No Yes

Do not give any foodor drink.

Keep airway open.

Be alert for vomiting.

Keep victim on side.

If conscious, givevictim fluids.

ELECTROCUTION

F L O W C H A R T

Victim still in contactwith electricity?

Inside building?

Call power company toturn electricity off orcut wires.

Do not touch or movepower lines or victim.

Keep people away.

Turn off electricity atfuse box, circuit breaker,or outside switch box, orunplug appliance.


When danger to rescuers passes:• Check ABCDs and treat accordingly.• Treat for shock.• Treat burns as thermal burns (two

wounds may be present).

No Yes

No Yes

No Yes

No Yes

Chemical in eye?

Holdinjured eyewide open;flush withwarmwater for20 minutes.

Looselybandageboth eyes.

Blow to eye

1. Do not remove embedded object.

2A. If object is long:• Place padding around object.• Place paper cup or cardboard folded

in a cone over eye.

2B. If object is short:• Place doughnut-shaped pad

around eye.

3. Cover uninjured eye with a dressing.

4. Keep victim flat on back.

Do not applypressure.

Cover botheyes withgauze pads.

Position victimwith head elevated.


Keep victimflat on backwith eyesclosed.

Place ice packfor 15 minutes.

No Yes

No Yes

Object embeddedin eye?

Loose objectin eye?

Cut on eye?

Attempt, in order, each procedure until one is effective.

1. Pull upper eyelid down andover lower lid.

2. Pull lower lid down and look at inner surface whilevictim looks up. If object is seen, remove with wetgauze.

3. Lift upper eyelid over Q-tip.If object is seen, removewith wet gauze.

If successful, medical attentionis usually not needed.

E Y E I N J U R I E S

F L O W C H A R T

F A I N T I N G

F L O W C H A R T

Fainting has occurred?

Person about to faint? Check ABCDs.

Position victim on back withlegs elevated 8″ to 12″.

If vomiting occurs or is anticipated, turn victim on side.

Loosen clothing around victim’s neck.

Wipe victim’s forehead withcool, wet cloth.

If vomiting occurs or is anticipated, turn victim on side.

Loosen clothing around victim’s neck.

Wipe victim’s forehead withcool, wet cloth.

Prevent hard fall, if possible.

Lay victim on back with legselevated 8″ to 12″.

Seek medical attention if victim• has repeated attacks of unresponsiveness• loses consciousness while sitting or lying down• faints for no apparent reason• does not quickly regain consciousness

No Yes

Yes

Remove constricting garments orjewelry from affected part(s).

Remove victim from cold exposure if possible.

Near medical facility?

Transport to medical facility.

Place part(s) next to victim’s orsomeone’s body.


No Yes

Any chance ofrefreezing if thawed?

No Yes

Warm wateravailable?

Yes

Put part(s) in warm water(about 104oF/40oC).

Stop rewarming when part(s)become soft.

Do not rub.

Put dry, clean gauze or clothbetween fingers and toes, andover broken blisters.

No

F L O W C H A R T

F R O S T B I T E

H E A DI N J U R I E S

F L O W C H A R T


Check for possible spinal injury.

Head bleeding?

If fracture suspected, applypressure only to the outeredges of intact bone; otherwiseapply pressure over wound.

Keep victim lying on side ifno spinal injury is suspected.

Do not remove impaled objects.

Immobilize the victim’shead and neck.


No Yes

Raise victim’s head and shouldersif no spinal injury is suspectedand victim is not in shock.

Unconscious?No Yes

Seek medical attention if anyof the signs listed under HeadInjury Follow-Up appear, or ifvictim is unresponsive.

F L O W C H A R T

HEAT-RELATEDEMERGENCIES

Exposed to excessive heat.

Hot skin, high bodytemperature, andaltered mental status?

Heatstroke

Move victim to a cool place.

Raise victim’s legs 8″ to 12″.

Remove excess clothing.

Sponge victim with cool water and fan.

Give cold water or commercial electrolyte drink.

Seek medical attention if no improve-ment within 30 minutes.

Move victim to cool placeand remove excess clothing.

High humidity (>75%)?

Place ice packs onneck, armpits, groin.


Spray water on victim’s skin andvigorously fan victim, or

Cover victim with wet sheet orsimilar cloth, keep it wet, andvigorously fan victim, or

Place ice packs on neck,armpits, groin.

No Yes

No Yes

Heat exhaustion

Stop cooling when mental status improves.


F L O W C H A R T

HYPOTHERMIA

Move victim into a warmarea.

Handle victim very gently.

Replace wet clothing withdry clothing or coverings.

Insulate victim from cold.

In remote location?

Shivering and core bodytemperature > 90oF/32oC

Wait for EMS.

Severe hypothermia Mild hypothermia

Most victims are able to rewarmthemselves by shivering, whichgenerates heat.

Do not use:• warm water immersion• body–to–body contact• chemical heating pads


Check ABCs.

No Yes

No Yes

I N S E C TS T I N G S

F L O W C H A R T

Honeybee sting?

Stinger embedded?Other types of sting insects:• wasp• hornet• yellow jacket

Scrape stinger off with finger-nail, credit card, or knife blade.

Do not squeeze stinger.

Is victim allergic toinsect stings?

Seek medical attention immediately.

Keep part lower than heart.

If epinephrine kit is available, followdirections before using.

Monitor ABCs and treat accordingly.

Watch for signs of allergic reaction.

Wash site with soap and water.

Apply ice pack for 15 to 20 minutes.

Relieve pain by giving aspirin (adult only) oracetaminophen.

Relieve itching and swelling with topical steroidcream (hydrocortisone).

Keep part lower than heart.

No Yes

No Yes

No Yes

M U S C L EI N J U R I E S

F L O W C H A R T

Drink mildly salted cold water.For affected muscle:• Apply ice pack.• Gently stretch and/or apply

pressure.

Blow to a muscle?

Contusion

No Yes

Uncontrolled musclespasm?

No Yes

Muscle stretchedor torn?

Yes

Strain (pulled muscle)

Cramp

Use RICE procedures.

NOSEBLEEDS

F L O W C H A R T

Sit victim leaning slightly forwardso blood does not run down throat.

If nose was hit, suspect a fracture.

Bleeding stopped?

Bleeding stopped?

Pinch nostrils together for 5 minutes.

Refer to other methodsthat might be attempted.• Apply ice.• Use a decongestant

spray.

Gently blow nose and pinchnostrils again for 5 minutes.

Bleeding stopped?

Seek medical attention. Additional care is usually not needed.

No Yes

No Yes

No Yes

POISON IVY, OAK, AND SUMAC

F L O W C H A R T

No Yes

No Yes

Know about immediatecontact?

Take immediate action:Wash with soap and waterand/or rubbing alcohol.

For itching try:• colloidal oatmeal baths• calamine lotion• baking soda paste

Physician-prescribed topicaland oral medications

No Yes

Yes

Mild signs?

Moderate signs?

Severe signs?

Physician-prescribed ointment, cream, or spray

S E I Z U R E S

F L O W C H A R T

Cushion victim’s head.

Loosen victim’s tight neckwear.

Turn victim onto side.

Look for medical-alert identification tag(bracelet or necklace).

Do not give victim anything to drink or eat.

Do not hold victim down.

Do not put anything between victim’s teeth.

Convulsions

Do any of these apply?• nonepileptic victim• seizure >5 minutes• no medical-alert

identification tag• slow recovery• pregnant victim• injury

Offer your help.

Avoid embarrassing victim.

Most seizures are not medical emergencies, end in 1 to 2 minutes,and do not require medical attention.


No Yes

S H O C K

F L O W C H A R T

Preserve body heat.


Head injury or breathingdifficult?

Unconscious or chanceof vomiting?

Elevate head and shoulders ifno spinal injury suspected.

Elevate legs 8″ to 12″ if nospinal injury suspected.

Turn on left side if nospinal injury suspected.


No Yes

No Yes

Get away from the snake.

Be careful around dead snake; bitereflexes can occur for 20 minutes.

Keep victim calm.

Was snake a pit viper?

Distance toantivenin sourcemore than 1 hour?

Keep arm or leg justbelow heart level.

Clean bite site withsoap and water.

Splint bitten extremityto reduce use and pain.

Within 30 minutesof the bite?

Use the ExtractorTM

for suction.

Do not cut.

Use suction for 30minutes.


No Yes

No Yes

No Yes

Coral snake?No Yes

Nonpoisonoussnake?

Yes

Clean bite site.Treat wound.Watch for infection.

Clean bite site withsoap and water.

Don’t cut or suck.

Wrap bite site andentire arm or legwith an elasticbandage.

S N A K EB I T E S

F L O W C H A R T

S P I N A LI N J U R I E S

F L O W C H A R T



Spinal injury is suspected.

Victim in dangerousplace?

Only onerescuer?

Leave in present position.

Stabilize entire body.

Gently drag victim,keeping head, neck,and torso straight.

Trained rescuers?

Stabilize and gentlymove victim.

Rehearse, if possible,how to move victim.

No Yes

No Yes

No Yes

Wait for trained rescuersand special equipment.

S P R A I N S ,S T R A I N S ,C O N T U S I O N S ,D I S L O C AT I O N S

F L O W C H A R T

Injury located in ajoint?

Caused by a blow to amuscle?

Dislocation

Contusion Sprain

Deformedappearance of joint?


Apply cold: crushed ice inplastic bag (20 minutes) every2 to 3 hours.

No Yes

No Yes

No Yes

Check CSM.

Stabilize joint.

Strain

Compress area with elasticbandage (not too tight) whencold is not being applied.

Elevate part above level of heart.

If recuperation seems long,consult a physician.

SWALLOWEDPOISON

F L O W C H A R T

Conscious?

Instructed to inducevomiting?

Give milk or water.

Not available.

Gagging isineffectiveand saltwateris dangerous. After vomiting, give

activated charcoal?

Give 1 tablespoonful forchildren under 5 years and2 tablespoonsful for adults.

Give glass of water.

Not available.

No Yes

No Yes

No Yes

Chemicals or household products?No Yes

Check ABCs andtreat accordingly.

Place on left side.


Identify poison, howmuch and when taken.

Call poison control centeror other medical source.

Check ABCs. Keep on left side to delaystomach emptying into small intestine.

Give activatedcharcoal?

No YesSyrup of ipecac?

No Yes

Premixed liquid form

Premixed liquid form

T H E R M A LB U R N S

F L O W C H A R T

Severe degree of burn(choose more seriouswhen in doubt)?

Large area?

Apply cold until painstops (10 to 40 minutes).

Check ABCs and treataccordingly.

Treat for shock.

Remove clothing and jew-elry from the burned area.If stuck, cut; don’t pull off.

Apply sterile dressing orclean cloth.

Elevate burned arms/legs.


Check burn severity table as a guide aboutseeking medical attention.

No Yes

No

YesApply aloe vera or othermoisturizer.

Apply cold until painstops (10 to 40 minutes).

Cover with nonstick,sterile dressing.

Remove clothing and jewelry fromburned area.

Apply Bacitracin™ olntment.

T I C KR E M O V A L

F L O W C H A R T

Tick embedded in skin.

Effectively pulled outgently with tweezers?

Tweezers are usually effective.Aftercare:1. Cleanse site with soap and water.2. Apply rubbing alcohol.3. Apply ice pack.4. For itching apply calamine lotion.

Other removal methodsare usually ineffectiveand should not beattempted.

Seek medical attentionfor removal.

No Yes

Watch for signs of infection or unexplained symptoms developing3 to 30 days later. If they appear, seek medical attention.

VICTIMASSESSMENT

F L O W C H A R T

Check ABCDs and treat as needed.

Determine responsiveness(AVPU scale)

Injured victim?

SAMPLE history

SAMPLE history (may come frombystanders or family)

Physical exam(head to toe)

No Yes

Responsive victim? NoYes

Significantmechanismof injury?

No Yes

Physical exam (examineonly complaint)

SAMPLE history SAMPLE history

Physical exam(head to toe)

Physical exam (examineonly complaint)

Ill

medical flowcharts booklet

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