students skill lab manual book emergency...

STUDENTS SKILL LAB MANUAL BOOKEMERGENCY AND TRAUMATOLOGY SYSTEM

EMERGENCY AND TRAUMATOLOGY SYSTEMMEDICAL FACULTY

HASANUDDIN UNIVERSITYMAKASSAR

2011

AIRWAY MANAGEMENT

Definition: Freeing the airway to ensure the air exchanges normally both by manual or tools.Learning Goals: after learning this manual the students are expected to have the ability to:

1. Identify the airway’s disturbance2. Free or open airway without any tools3. Free airway by using tools4. Clean the airway5. Deal with the obstruction of the airway for both partial and total obstruction

Media and the learning tools:1. Student’s skill lab manual book emergency and traumatology system2. Video and slide of the Airway Management Methods3. Children and adult mannequin dolls4. Oropharyng tubes in all size5. Nasopharyng tubes in all size6. Gloves7. Dry Gauge8. Suction9. Stiff and flexible Suction tubes

Indication1. It is done to the unconscious patients in any cause2. It is done to the patients with partial or total airway obstruction

Learning MethodProcedures demonstration that is performed based on the manual

Airway Management Activities Description

Activity Time Description

1. Introduction 5 minutes 1. Introduction, manage the students sitting position2. Brief explanation of the work procedures, students role,and time allocation

2. Short demonstration of theairway managementtechnique by the instructor

10minutes 1. All students watch the airway management technique bythe instructor at the model2. Brief discussion if there are problems that are lessunderstood

3. Practicing Airway

management technique

10minutes 1. One student as the assistant help to prepare all tools. Onestudent practices the airway management technique. Otherstudents observe attentively and correct if there are anymistakes.2. Instructor watches and guides the students if there anymistakes in the practice.3. Instructor goes around among the students and supervisesusing the checklist.

4. Discussion 10minutes 1. Discussion of the students’ impression toward the airwaymanagement practice: what is easy, what is hard?2. The students give advice or correction on the practice thatday. The instructor listens and gives answers.3. The Instructor explains the general assessment on thepractice: whether it runs nicely, or whether some studentsneed more practice. If possible, announce each of thestudents mark.

Total time 35minutes

LEARNING MANUAL

AIRWAY MANAGEMENT SKILLS

Steps/Activity Information

Early Preparation

Check all tools

Diagnosis on airway disturbance1. Look Look at the breathing movement/ chest inflation and retraction

between the ribs2. Listen Listen to the breathing sound3. Feel Feel the airflow of breathing

Instructor explains anddemonstrates the techniquesof how to assess the signs ofairway disturbance

Opening the airway without tools

Head-tilt

Technique:Put one hand on the patient’s forehead and push it so the head will beupward and the tongue support will be raised to the frontChin lift

Technique:Use the middle and the point fingers to hold the patient’s chin bone,then lift and push the bone to the frontJaw thrust

Technique:Push the angle of the left and right jaws to the front until all theinferior teeth are in line with the superior teeth. Or enter the motherfinger in to the patient’s mouth and along with the other fingers pullthe chin to the front.

This technique is used to thepatient with airwayobstruction because of theback fall of the tongue

Airway management with toolsA. Oropharynx tube

Installation technique:1. Wear the gloves2. Open the mannequin/patient’s mouth with chin lift technique

or use the mother and point fingers3. Prepare the oropharynx tube which has the right size4. Clean and moist the tube to make the tube is easy to be

entered5. Direct the curve facing the palatal6. Enter half of the tube, turn the curve facing under the tongue7. Push the tube slowly to the right position8. Make sure the tongue is supported by the tube by looking at

the breathing pattern, feel and listen to the sound of breathingafter the installation.

B. Nasopharynx tube

1. Wear gloves 2. Evaluate the size of the nostrils with the tube that is going to be

entered.

3. Evaluate the abnormality in the nasal cave. 4. Smear the tube and the nostril that is going to be entered with

gel. If it’s needed, give vasoconstrictor inside the nose. 5. Hold the tube with the position where the edge facing the ear. 6. Push the tube slowly until all of the tube enter the nose and

then evaluate the airflow in the tube. 7. Fix the tube with tape/plaster.

Clearing the airway1. Finger swab

Techniques :

a. Wear glovesb. Open the patients mouth with jaw thrust technique and

push the chin downwardc. Use two fingers (the pointer and middle fingers) which

are clean or folded by gloves or gauge to clean andpick all the foreign things inside the mouth.

2. With suction

Being done if there is any

foreign things inside the

mouth

Airway management in obstruction case by solid foreignobjectA. CHOKING

BACK BLOW / BACK SLAPSAdult and conscious casualties

1. If the patient is totter, hold the patient from behind

2. One arm holding the body, the other arm does the BACK- BLOW/ BACK SLAPS. Hold the patient and preventfrom falling

3. Give five hard blows/ slaps with your fist at the imaginary crosslines of the vertebra and the scapula. If it fails, lay the patient slowlyin up position. Do the abdominal thrust.

ABDOMINAL THRUSTStanding/conscious adult patient

1. Hold the totter patient with your two arms from behind2. Do the thrust, five times by pulling your two arms footing on

your two fists right at thrust point on the middle of theumbilicus and the processus xyphoideus of the patient.If it fails, lay the patient in up position slowly. Do theabdominal thrust again.

ABDOMINAL THRUST

Lying/unconscious adult patient1. If the patient is unconscious, lie the patient in up position.2. The helper takes the position like riding horse on top of the

patient’s body or beside the patient’s hip.3. Do pushing thrust five times by using your two arms footing

on the thrust point (epigastria area).

Make sure the foreign object has moved or out by:- Look inside the patient’s mouth, if it’s visible, take it- If it’s not visible, blow air mouth to mouth while watch if

the air enters the lung. If the chest inflates, it means thatthe airway has opened

- In the contrary, if the air doesn’t enter it means that theairway is still obstructed, do ABDOMINAL THRUSTAGAIN, and so on

If it fails, think to prepare cricothyroidotomy followed bytracheotomy.

CricothyroidotomyDefinition

Performing puncture at cricothyroid membrane with large needle as a short cut for oxygenationand ventilation on the breathing failure patient because of upper respiratory tract obstruction.Learning Goals:

After this learning the students are expected to have the ability to:1. Conduct puncture at the cricothyroid membrane2. Prepare the equipments that are needed in cricothyroidotomy3. Conduct the emergency airway management after the puncture of cricothyroid membrane

Learning media and tools:1. Student’s skill lab manual book emergency and traumatology system2. Video and slide of cricothyroidotomy3. Mannequin dolls4. Table or the place for instruments5. Gloves6. Disinfectant liquid (alcohol, povidon iodine) and cotton7. Two Syringes of 12 cc8. Lidocain 2 %9. Jet insufflations equipment : Y form tube, where one of the wholes is connected to the

oxygen and the aqualung10. Two IV polyurethane protective catheter sized 12 to 1411. Sterile Gauge or sterile bandage12. Antibiotic cream13. Plaster or fabric tape14. Washbasin for hand washing and antiseptic soap

Indications1. If there is a significant upper airway obstruction2. If the attempt to give ventilation with bag-valve-mask has failed

Learning Method

Procedures demonstration that is performed based on the manual

Cricothyroidotomy Activities Description


1. Introduction 5minutes 1. Introduction, arrange the students sitting position2. Brief explanation of working procedures, the studentsrole, and time allocation

2. Short demonstration ofcricothyroidotomy by theinstructor

5minutes 1. All students watch the demonstration ofcricothyroidotomy by the instructor on the model2. Short discussion if there is something that is lessunderstood

3. CricothyroidotomyPractice

10minutes 1. One student as the assistant help preparing thecricothyroidotomy practice.One student performs the cricothyroidotomy practice.The other students observe attentively and correct if thepractice is not perfect2. The instructor watches and guides the students in thepractice3. The instructor goes around the students and superviseusing the checklist

4. Discussion 10minutes 1. Discussion of the students’ impression toward thecricothyroidotomy practice: what is easy and what ishard2. The students give advice or correction toward thepractice on that day. The instructor listens and givesanswers3. The instructor gives general explanation of thecricothyroidotomy practice: is generally the practiceruns well, are there some students still need morepractice. If it is necessary announce the mark for eachstudents

Total time 30minutes

LEARNING MANUAL

CRICOTHYROIDOTOMY SKILL

Steps/Activities Annotation

Early preparation before installation

1. Check all the equipments Connect oxygen hose with one of the Y tube whole and make

sure the oxygen flows properly through the hose2. Place the IV catheter sized 14 to the 12 cc syringe

Cricothyroidotomy Procedures

3. Disinfect neck area with antiseptic

4. Palpate cricoids membrane, at the anterior between thyroid andcricoids cartilage. Hold the trachea with your thumbs andpointer finger so the trachea won’t move to the lateral in theprocedure

5. With the other hand (right hand) puncture the skin at themidline on top of cricoids membrane with big needle sized 12-14which has been placed on a syringe. To easy the needlepenetration, you can make small incision at the puncture pointwith knife sized 11

6. Direct the needle 45 degrees to the caudal, then carefullypenetrate the needle while sucking the syringe. If the air isaspirated or there is bubble in the syringe which is filled withaquadest it means that the needle has entered the trachea lumen7. Release the syringe from the IV catheter, than pull the mandrinand push the catheter gently downward8. Connect the end of the catheter with one of the end of theoxygen hose with Y form9. Scheduled ventilation can be done by closing one end of theopened Y hose with your thumb for one second and open it for 4seconds. This procedure can last from 30 to 45 minutes

GIVING THE BREATHING AID

Definition: Giving the breathing aid with or without ant equipment to the breathing failurepatient in any cause.

Learning Goals: after this study the students are expected to have the ability to:1. Prepare the equipments that are needed to give the breathing aid2. Give the breathing aid to the breathing failure patient without any equipments3. Give the breathing aid to the breathing failure patient with equipments

Learning Media and tools :1. Skills lab students’ manual book of emergency and traumatology system2. Video and slide of airway management3. Mannequin dolls of adult and children intubation4. Oropharyng tubes in any size5. Orothracheal tubes in any size6. Nasotracheal tube in any size7. Bag-valve-mask8. Oxygen hose and oxygen tank9. Laryngoscope handle and battery10. Laryngoscope leaves in any size and extra lamp11. Plaster12. Stethoscope13. Endotracheal tube gel14. Local anesthetic spray for nasal15. Semi rigid cervical collar16. Magill forceps17. Stylet (introducer) endotracheal tube that is flexible18. Tongue spatula19. Hand gloves20. Dry Gauge21. Suction22. Rigid and flexible suction tubes

Indication

It is done to the breathing failure patients

Learning Method


Activities descriptions of airway management


1. Introduction 5 minutes 1. Introduction, arrange the students sitting position2. Brief explanation of working procedures, the studentsrole, and time allocation

2. Short demonstrationof the procedure ofgiving the breathing aidby the instructor

10 minutes 1. All students watch the demonstration of theprocedure of giving the breathing aid by the instructor onthe model2. Short discussion if there is something that is less

understood3. Practice theprocedure of giving thebreathing aid by theinstructor

10 minutes 1. One student as the assistant helps preparing theequipments.One student performs the procedure of giving thebreathing aid. The other students observe attentively andcorrect if the practice is not perfect2. The instructor watches and guides the students in thepractice3. The instructor goes around the students and superviseusing the checklist

4. Discussion 10 minutes 1. Discussion of the students’ impression toward thegiving the breathing aid practice: what is easy and what ishard2. The students give advice or correction toward thepractice on that day. The instructor listens and givesanswers3. The instructor gives general explanation of the givingthe breathing aid practice: is generally the practice runswell, are there some students still need more practice. If itis necessary announce the mark for each students

Total time 35 minutes

LEARNING MANUALGIVING THE BREATHING AID SKILL

Steps/Activities Ket

Early Preparation

Check all the equipments

Bag-valve-mask Ventilation1. Choose the mask size that is fit to the patient’s face2. Connect the oxygen hose to the bag-valve-mask and set the oxygen flow up to

12 L/minutes3. Make sure the patients airway is free and maintain it with the technique that has

been explain in the previous chapter4. Install the oropharynx tube5. The left hand hold the mask in the position where the mask tight to the face and

make sure there is no air that flow out from the mask when the bag is pumped.The right hand holds the bag and pumps it until the patient’s (doll) chest looksinflated.

6. For two helper : one helper hold the mask with two hands and the other helperhold the bag and pump it with two hands

7. The ventilation adequacy is evaluated by watching the movement of thepatient’s (doll) chest

8. Ventilation is given in every 5 seconds

Orotracheal Intubation1. Make sure that the airway is free and the oxygenation still goes on2. If the patient is still given the breathing aid with bag-valve-mask, give enough

preoxygenation before performing the intubation3. Pump up the endotracheal tube to make sure that the balloon is not leaked. If it is

not leaked, deflate the balloon4. Connect the laryngoscope leave to the handle and check the lamp light5. Hold the laryngoscope with the left hand6. If the oropharynx tube is installed, put it of right away7. Enter the laryngoscope at the right side of the patient’s mouth and push the

tongue to the left8. Visually identify the epiglottis and then the vocal chord9. Carefully enter the endotracheal tube in to the trachea without pressing the teeth

or the other tissue in the mouth10. Pump up the balloon with the air from the syringe until there is no air is heard

from the interspaces of endotracheal tube and the trachea11. Connect the endotracheal tube with the bag-valve and then pump it while

watching the chest inflation12. Auscultate the left-right chest to check if the breathing sound is similar. The

abdominal auscultation to make sure the tube is correctly installed13. Install the orotracheal tube and fixate the endotracheal tube to the mouth with

plaster

NEEDLE THORACOCENTHESIS

DefinitionPerforming puncture toward the chest wall at the second intercostals in order to expel the air inthe pleura in the tension pneumothorax cases

Learning Goals:After this study the students are expected to have the ability to:

1. Perform the puncture at second intercostals2. Prepare the equipments that are needed in performing the needle thoracocenthesis

Learning media and tools:1. Skills lab students’ manual book of emergency and traumatology system2. Video and slide of needle thoracocenthesis3. Mannequin dolls4. Table or the place for instruments5. Gloves6. Disinfectant liquid (alcohol, povidon iodine) and cotton7. Two Syringes of 12 cc8. Lidocain 2 %9. Two IV polyurethane protective catheter sized 12 to 1410. Sterile Gauge or sterile bandage11. NaCl 0,9%12. Washbasin for hand washing and antiseptic soap

IndicationIn tension pneumothorax cases


Activities Description of Needle Thoracocenthesis

Activity Time Description1. Introduction 5 minutes 1. Introduction, arrange the students sitting position

2. Brief explanation of working procedures, thestudents role, and time allocation

2. Short demonstrationof the needlethoracocenthesisprocedure by theinstructor

5 minutes 1. All students watch the demonstration of theprocedure of needle thoracocenthesis by the instructoron the model2. Short discussion if there is something that is less

understood3. Practice the needlethoracocenthesisprocedure by theinstructor

10 minutes 1. One student as the assistant helps preparing theequipments for needle thoracocenthesis.One student performs the needle thoracocenthesisprocedure. The other students observe attentively andcorrect if the practice is not perfect2. The instructor watches and guides the students inthe practice3. The instructor goes around the students andsupervise using the checklist

4. Discussion 10 minutes 1. Discussion of the students’ impression toward theneedle thoracocenthesis practice: what is easy andwhat is hard2. The students give advice or correction toward thepractice on that day. The instructor listens and givesanswers3. The instructor gives general explanation of theneedle thoracocenthesis practice: is generally thepractice runs well, are there some students still needmore practice. If it is necessary announce the mark foreach students


LEARNING MANUALNEEDLE THORACOCENTHESIS SKILL

Steps/Activities AnnotationEarly preparation before installation

1. Check all equipments

2. Place IV catheter sized 14 to the 12 cc syringe that is filled with 5ml waterNeedle Thoracocenthesis Procedures

3. Disinfect the thorax area that is going to puncture with antiseptic

4. Identify the second intercostals area at the middle of clavicle. If thepatient is conscious inject the local anesthetic5. Puncture the needle that is connected to the syringe at the upper partof the third Costa until the air is expelled signed by the appearance ofthe bubble at the syringe6. Reevaluate the patient breathing if there is improvement or not

CARDIO PULMONER RESCUCITATION

Definition: Performing external heart massage to manage the condition of breath stop and heartstop

Learning Goals: after this study the students are expected to have the ability to:1. Perform the resuscitation to the breath stop patient2. Perform the external heart massage to the heart stop patient

Learning media and tools:1. Skills lab students’ manual book of emergency and traumatology system2. Video and slide of needle thoracocenthesis3. Adult and children mannequin dolls

IndicationBeing done to the breath stop and/or heart stop patient in any cause


CPR activities descriptionActivity Time Description

1. Introduction 5 minutes 1. Introduction, arrange the students sitting position2. Brief explanation of working procedures, thestudents role, and time allocation

2. Short demonstrationof the CPR procedure bythe instructor

10 minutes 1. All students watch the demonstration of the CPRprocedure by the instructor on the model2. Short discussion if there is something that s less

understood3. Practice the CPRprocedure by theinstructor

10 minutes 1. One student as the assistant helps preparing theequipments for CPR.One student performs the CPR procedure. The otherstudents observe attentively and correct if the practiceis not perfect2. The instructor watches and guides the students inthe practice3. The instructor goes around the students andsupervise using the checklist

4. Discussion 10 minutes 1. Discussion of the students’ impression toward theCPR practice: what is easy and what is hard2. The students give advice or correction toward thepractice on that day. The instructor listens and givesanswers3. The instructor gives general explanation of the CPRpractice: is generally the practice runs well, are theresome students still need more practice. If it isnecessary announce the mark for each students


LEARNING MANUALCARDIOPULMONER RESCUCITATION

Steps/Activities Annotation

Early preparation

Check all equipments

Demonstration by one helper1. Arrange the patient’s position and put the patient on the hard base2. For the unconscious patient, make sure the patient is unconscious by calling, clapping

the patient’s back, shaking, or pinching the patient3. Ask help immediately by shouting without leaving the patient4. Check if the patient is breathing5. If the patient is not breathing, open and free the airway6. Recheck if the patient is breathing after opening the airway7. If there is no breathing or the breathing is difficult, give two breathing aid, slow and

full while watching the chest inflation8. Feel the carotid pulse9. If you can’t feel it, perform external heart massage 30 times at the base point which is

two fingers above the processus xyphoideus. Then continue with giving two blows ofbreathing aid

10. Put one hand at the pressure point, the other hand is on top of the first hand11. Both arms are straight and vertical at the sternum. Both of the helper’s knee is close

to each other, and stick to the patient’s arm12. Press downward 4-5 cm for adults, by dropping the weight to the patient’s sternum.13. Compress rhythmically and regularly 100 times/minute. Evaluate at the breathing,

pulse, consciousness, and pupil reaction every end of the fifth cycle14. If the breathing and the pulse are still can’t be felt continue the CPR until the patient

is recoverDemonstration by two helper

1. Step 1-14 above are still performed by the first helper until the second helper comes2. When the first helper makes the evaluation, the second helper takes the position for

heart massage3. If the pulse is still can’t be felt, the first helper gives two times breathing aid slowly

until the chest is inflated, followed by the second helper giving 30 times of heartmassage

PERIPHERAL VEIN CANULATION

DefinitionPerforming puncture at the superficial vein at the arms, feet, neck, or head using intravenouscatheter as indicationLearning Goals: after this learning the students are expected to have the ability to:

1. Know the indication of canulation intravenous catheter (infuse)2. Explain the objectives of the canulation and the procedure to the patient3. Prepare the equipments which are needed for canulation4. Perform the vein canulation in the right way5. Fixate the vein catheter in the right way

Learning media and tools:1. Skills lab students’ manual book of emergency and traumatology system2. Video and slide of vein canulation3. Mannequin dolls and vein replacement kit and advanced vein puncture and injection

arm4. Tourniquet5. Gloves6. Syringe of 1 cc7. Lidocain 2 %

8. Infuse set or transfuse set9. IV polyurethane protective (in any size for adult and children)10. Sterile Gauge or sterile bandage11. Antibiotic cream12. Plaster13. Washbasin for hand washing and antiseptic soap

Indication

1. For giving fluid2. As access for intravenous drugs3. A part of resuscitation action4. Plan for operation5. Nutrition giving via peripheral parentheral

Learning Method


Peripheral vein canulation’s activities description


1. Introduction 5

minutes

1. Introduction, arrange the students sitting position2. Brief explanation of working procedures, the studentsrole, and time allocation

2. Short demonstration of

the peripheral vein

canulation procedure by the

instructor

5

minutes

1. All students watch the demonstration of the procedureof peripheral vein canulation by the instructor on the model2. Short discussion if there is something that is less

understood

3. Practice the peripheral

vein canulation procedure

by the instructor

15

minutes

1. One student as the assistant helps preparing theequipments for peripheral vein canulation.One student performs the peripheral vein canulationprocedure. The other students observe attentively andcorrect if the practice is not perfect2. The instructor watches and guides the students in thepractice3. The instructor goes around the students and superviseusing the checklist

4. Discussion 10

minutes

1. Discussion of the students’ impression toward theperipheral vein canulation practice: what is easy and whatis hard2. The students give advice or correction toward thepractice on that day. The instructor listens and givesanswers3. The instructor gives general explanation of theperipheral vein canulation practice: is generally the practiceruns well, are there some students still need more practice.If it is necessary announce the mark for each students

Total time 35

minutes

LEARNING MANUAL

PERIFER VEIN CANULATION

ACTIVITIES DESCRIPTION

Preparation

1. Check the patient’s medical record or status card (search for diagnose, allergic histories, bloodabnormalities, etc.)

2. Check all of the equipments Check if the transfusion set is connected to thesolution bagMake sure there is no air bubble in thetransfusion setProvide 3 different catheter size intravenous )that may match to the patient

3. Explain the procedure to the patient and his or her

family

Create a pleasant atmosphere in the room bymaking kind and friendly greetings, or either byshaking hands and give a slight and friendlytouch to your patient if necessary. .

Intravenous catheter manual

4. Identify the veins that will be suitable to insert a

catheter

Choose the most distal vein than the proximalones.Better to choose extremities that are notdominantSearch for dorsal manus areaDo not insert the catheter in antecubiti areas

5. Wash hands with antimicrobial soap

6. Use the handgloves

7. Insert the tourniquette If needed, an assistant will be helpful toimmobilize the patient.Force the veins towards the distal direction orset the patient’s arm in a position where the armis lower than the cardiac level. Place thetourniquette in the middle part of the armbetween the wrist and elbow ) or either in thelower part of the leg. Do not place thetourniquette forcely or either too gently.If rubber band is used as a tourniquette, not tieit as a “dead lock”. The tie knot should be ableto be easily untied.If the tourniquiette is already placed but veinsare not to be visible yet, a mild tapping on theveins using your hands or placing a warm towelwould help to dilate the veins.

8. Cleanse the place of nsertiion with desinfektan (alcohol ) and let it dry by itself.

After cleansing, ”no touch ” should be kept inmind.

9. Left arm should hold the area beneath the injectionarea, use the thumb to stabilize the veins and softtissue.

If the injection area is to be the dorsal manusarea, the patient can be asked to hold tight itsarm.

10. Do a local anesthetic injection in the injection areausing a small needle ( 30 gauge needle/1ccdisposable a local anesthetic cream If availabe inadvanced, a local anesthetic cream can be used

(EMLA)11. Place the bevel catheter i.v. in a upward position,

between the point finger and the thumb.12. Hold the catheter in a 45 degree position, just above

the skin towards the vein but not yet penetratingthe vein.

Approaches that can be done in penetrating thevein :

Central : penetrate straight to the vein.This is not a very good approach becausewhenever the penetration is far too deep, itcould harm the tissue beneath the veincausing extravacation.Paraveins : penetrate the vein from its sidepart first, then direct the needle intowardsthe vein. This is the best way to penetrateinto the vein.

13. Place the catheter lower than or just as in one levelwith the skin surface dan move the needle tip topass it althrough the vein.

14. Force the catheter slowly into the vein, make surethere is a venous return flow

If there is a resistant sensation, and followedquickly by a smooth penetration, it means thatthe catheter is already placed inside the vein.

15. Force the catheter with its mandrin about 3-5 mminto the vein to make sure the catheter in placedinside the vein’s lumen.

How far the force goes depends on the size anddepth of the veins and the catheter’s size.

16. Pull the mandrin out, push the catheter till the endof the catheter touches the skin surface.

Do not re-insert the mandrin into the catheterbecause it could tear up the catheter.

17. Dispose the used mandrin using the catheter’swrap/plastic wrap.

Be sure that the mandrin is wraped inside thecatheter plastic bag/wrap until you hear a”click” and dispose it carefully in a safe place

18. Release the tourniquette19. Connect the catheter to the infuse/transfusion set If available, connect it with a three way stop

cock.20. Let the saline fluid / i.v. fluid pass through, clean

any blood residuals and then dry it with a sterilizedgaus so the band aid will attach firmly.

I.V. Catheter Fixation21. Attach one band aid 5mm in width, direct the ends

to form the letter “V” just beneath the catheterorigin so it would close the surface where thecatheter was inserted.

Use two band aids, one for catheter fixationintravenously, and the other to fixate thetransfusion set. The length of the band aid isabout 15-20 cm long, not too wide nor toonarrow. ( width 0.5 mm ). Fixation should formthe letter “V”, in a way where it wouldn’tdetached easily. -

22. Attach one band aid to fixate the infuse or transfuseset by forming the letter “V”

Do not manipulate the transfusion pipe/setbefore fixating it to the skin surface, for it maycause difficulties whenever an injection throughthe transfusion set is needed afterwards.

Post fixation

23. Immobilized the extremities wih ada board if thereis any indication. For example : when inserted ininfants, children and joint areas

Do not use gause or any other material as aband in any insertion areas.

24. Instruction for patients :Avoid any unnecessary movements.Call for the nurse/doctor as soon as possiblewhenever there is a swelling, pain or leakagefrom the insertion.

25. Labelize the gause with date of insertion, size ofcatheter and the inisial of the name who inserted it.

26. Write down in the patient’s medical record about :Date of insertionCatheter sizeInitials of names who inserted the catheterPlace of insertionPatient’s tolerance and respond to thetherapy

PENUNTUN BELAJAR

KETERAMPILAN RESUSITASI PADA BAYI BARU LAHIR

Langkah-langkah/Kegiatan Keterangan

Persiapan awal

Periksa semua kelengkapan alat

Langkah awal1. Letakkan bayi di bawah pemancar panas yang telah dinyalakan

sebelumnya.2. Letakkan bayi dengan kepala sedikit tengadah/sedikit ekstensi.3. Hisap mulut kemudian hidung4. Keringkan tubuh dan kepala dari cairan amnion5. Singkirkan kain basah.6. Perbaiki posisi kepala bayi agar leher agak tengadah.

Buka jalan napas1. Bersihkan mulut dan hidung bayi dengan penghisap.2. Posisikan bayi terlentang, kepala posisi tengadah jangan melakukan

ekstensi yang berlebihan3. Berikan ganjal punggung dengan kain setebal 2.5 cm bila kepala

bayi besar atau occiputnya menonjol.4. Jika pernapasan dangkal atau tersengal-sengal segera hisap lendir

mulai dari mulut kemudian hidung. Pengisapan jangan terlalu lama(6 detik).

5. Evaluasi pernapasan, frekuensi jantung, dan warna kulit.6. Jika ketuban keruh atau bercampur meconium kental bila bayi

menunjukkan usaha napas yang baik, tonus otot yang baik, danfrekuensi jantung lebih dari 100 kali/menit, anda cukupmembersihkan sekret dan mekonium dari mulut dan hidung denganmenggunakan balon penghisap yang biasa digunakan atau kateterpenghisap berukuran 12F atau 14F.

Rangsangan taktilCara rangsang taktil yang aman :

1. Menepuk / menyentil telapak kaki2. Menggosok punggung/perut/dada/ekstremitas

Evaluasi kondisi bayi1. Nilai pernapasan bayi dengan melihat pengembangan dada dan

warna kulit. Dengaran suara napas di seluruh lapangan parudengan stetoskop.

2. Nilai denyut jantung dengan mendengar irama jantung denganstetoskop. Hitung frekwensi denyut jantung

3. Nilai warna kulit apakah kemerahan/sianosis perifer atau sianosissentral.

Pemberian napas bantu1. Jika pernapasan tetap tersengal atau apnu setelah rangsangan

singkat, segera berikan pernapasan buatan atau ventilasi tekananpositif dengan oksigen 100 %.

2. Posisikan kepala bayi sedikit ekstensi atau ganjal bahu3. Bersihkan sekret terlebih dahulu dan pastikan jalan napas bersih.4. Pasang pipa orofaring5. Letakkan sungkup di wajah bayi dengan rapat agar tidak bocor

melalui sisi sungkup6. Berikan tekanan positip melalui bag-valve-mask (ambubag) dengan

lembut sambil melihat pengembangan dada bayi.

7. Selanjutnya evaluasi lagi pernapasan dan denyut jantung secarasimultan.

8. Bila ventilasi tekanan positip tidak efektif dapat dilakukan intubasiendotrakeal.

Pijat Jantung (penekanan dada)1. Indikasi pijat jantung bila setelah 30 detik dilakukan VTP dengan

100% O2 , FJ tetap < 60 kali / menit2. Diperlukan 2 orang : 1 orang yang melakukan pijat jantung dan 1

orang yang terus melanjutkan ventilasi. Pelaksana kompresi : menilai dada & menempatkan posisi tangan

dengan benar Pelaksana ventilasi : menempatkan sungkup wajah secara efektif &

memantau gerakan dada.3. Penekanan dada dilakukan pada sepertiga bagian tengah sternum,

dibawah garis imajiner yang menghubungkan papilla mammae.4. Teknik ibu jari :

1.Kedua ibu jari menekan tulang dada2.Kedua tangan melingkari dada dan jari-jari tangan menopang bagian

belakang bayi5. Teknik dua jari :

1.Ujung jari tengah dan jari telunjuk atau jari manis dari satu tangandigunakan untuk menekan tulang dada

2.Tangan yang lain digunakan untuk menopang bagian belakang bayi.6. Lokasi untuk kompresi dada :

• Gerakkan jari sepanjang tepi bawah iga sampai mendapatkan sifoid• Letakkan ibu jari atau jari-jari lain pada tulang dada, tepat diatas

sifoid dan pada garis yang menghubungkan kedua puting susu.7. Tekanan saat kompresi dada :

• Kedalaman + 1/3 diameter antero-posterior dada• Lama penekanan lebih singkat dari pada lama pelepasan• Jangan mengangkat ibu jari atau jari-jari tangan dari dada di antara

penekanan.8. Frekuensi : ”satu-dua-tiga-pompa-...” Satu siklus kegiatan terdiri atas tiga kompresi + satu ventilasi. Rasio 3 :1 1 siklus ( 2detik)

1½ detik : 3 kompresi dada ½ detik : 1 ventilasi 90 kompresi + 30 ventilasi dalam 1 menit

9. Setelah 30 detik kompresi dada dan ventilasi , periksa frekuensijantung. Jika frekuensi jantung :

a. Lebih dari 60 kali/menit, hentikan kompresi dan lanjutkanventilasi dengan kecepatan 40-60 kali pompa/menit.

b. lebih dari 100 kali/menit, hentikan kompresi dada dan hentikanventilasi secara bertahap jika bayi bernapas spontan.

c. kurang dari 60 kali/menit, lakukan intubasi pada bayi jika belumdilakukan, dan berikan epinefrin, lebih disukai dengan cara intravena.Intubasi menyediakan cara yang lebih terpercaya untuk melanjutkanventilasi

RESUSITASI BAYI DAN ANAK

Pengertian : Melakukan resusitasi bayi dan anak akibat gawat napas dan sirkulasi.Tujuan pembelajaran : setelah pembelajaran ini mahasiswa diharapkan :

1. Mampu melakukan penilaian kegawatan napas dan sirkulasi2. Mampu melakukan resusitasi bayi dan anak yang mengalami gangguan pernapasan yang

mengancam jiwa3. Mampu membebaskan dan membersihkan jalan napas pada bayi dan anak.4. Mampu memberikan napas bantu pada bayi dan anak yang tidak bisa bernapas/apnu.5. Mampu melakukan pijatan jantung luar pada bayi dan anak yang mengalami henti

jantung.Media dan alat pembelajaran:

1. Buku panduan peserta skill lab sistim emergensi dan traumatologi2. Boneka manikin bayi dan anak.3. Pipa orofaring ukuran bayi dan anak.

4. Kateter penghisap5. Masker resusitasi6. Balon resusitasi tipe mengembang sendiri7. Balon resusitasi tipe tidak mengembang sendiri8. Pipa lambung (gastric tube)9. Pipa endotrakeal no. 3.0 – 7,0

Indikasi1. Dilakukan pada bayi dan anak yang mengalami sumbatan jalan napas2. Dilakukan pada bayi dan anak yang tidak bernapas/apnu.3. Dilakukan pada bayi dan anak yang mengalami henti jantung.

Metode PembelajaranDemonstrasi kompetensi sesuai dengan penuntun belajar

Deskripsi kegiatan resusitasi bayi dan anak.

Kegiatan Waktu Deskripsi

1. Pengantar 5 menit 1. Perkenalan, mengatur posisi duduk mahasiswa2. Penjelasan singkat tentang prosedur kerja, peran masing-masing mahasiswa dan alokasi waktu.

2. Demonstrasi singkat

tentang cara resusitasi

bayi dan anak oleh

instruktur.

10 menit 1. Seluruh mahasiswa melihat demonstrasi cararesusitasi bayi dan anak oleh Instruktur padamodel

2. Diskusi singkat bila ada yang kurang dimengerti.

3. Praktek cara resusitasi

bayi dan anak.

10 menit 1. Satu orang mahasiswa mempraktekkan cararesusitasi bayi dan anak. Mahasiswa lainnyamenyimak dan mengoreksi bila ada yang kurang.

2. Instruktur memperhatikan dan memberikan bimbingan bila mahasiswa kurang sempurna melakukan praktek.3. Instruktur berkeliling diantara mahasiswa dan melakukan supervisi menggunakan ceklis/daftar tilik.

4. Diskusi 10 menit 1. Diskusi tentang kesan mahasiswa terhadap praktek cara resusitasi bayi dan anak: apa yang dirasa mudah, apa yang sulit.2. Mahasiswa memberikan saran atau koreksi tentang jalannya praktek hari itu. Instruktur mendengar dan memberikan jawaban.3. Instruktur mejelaskan penilaian umum tentang jalannya praktek resusitasi bayi dan anak :

apakah secara umum berjalan baik, apakah ada sebagaian mahasiswa yang masih kurang. Bila perlu mengumumkan hasil masing-masing mahasiswa.

Total waktu 35 menit

PENUNTUN BELAJAR

KETERAMPILAN RESUSITASI PADA BAYI DAN ANAK

Langkah-langkah/Kegiatan KeteranganPersiapan awal

Periksa semua kelengkapan alat

RESUSITASI

Pendekatan ’SAFE’ Shout for help ( minta tolong)

Approach with care (tangani dengan hati-hati)

Free from danger (jauhkan dari bahaya)

Evaluate ABC (nilai jalan nafas, pernafasan, sirkulasi)

Tatacara meminta pertolongan:1. Bila hanya 1 org penolong, lakukan bantuan hidup dasar

dulu, baru kemudian meminta bantuan

2. Bila penolong tidak dapat meminta pertolongan, teruskan

resusitasi sampai tiba penolong lain atau sampai kelelahan.

3. Bila ada 2 penolong, penolong pertama melakukan

resusitasi, penolong kedua mencari bantuan

4. Yang meminta bantuan menyebut lokasi, nomor telpon,

jenis kejadian, jumlah korban, pertolongan yg telah

diberikan dan informasi lain yg dibutuhkan.

Penilaian sistem kardiovaskulerA. Airway = jalan nafas

Instruktur menjelaskan dan

memperagakan bagaimana

menilai tanda-tanda adanya

gangguan sistem kardio

vaskuler.

SAFE approach

Are you alright?

Airway opening manoeuver

Look, listen, feel

Up to 5 breaths

Check pulse

Start CPR 1 minute

Call emergency services

– Dapat dipertahankan tanpa alat atau memerlukan alat

bantu jalan nafas

B. Breathing = Pernafasan

- Frekwensi

- Gerak nafas (retraksi, merintih, cuping hidung, otot bantu

nafas)

- Aliran udara pernafasan (pengembangan dada, suara nafas,

stridor, wheezing/mengi, gerakan paradoks)

– Warna kulit (ada atau tidaknya sianosis)

C. Circulation = sirkulasi

- Frekwensi jantung, denyut sentral, denyut perifer

tekanan darah.

- Perfusi kulit (capillary refill time, suhu, warna kulit,

kulit berbercak (mottling)

- Perfusi SSP

- Reaksi Kesadaran (AVPU= Alert, Respon to Verbal,

Respon to Pain, Unresponsive) (mengenal org tua,

tonus otot, ukuran pupil, postur

(dekortikasi/deserebrasi)

Penilaian dilakukan tidak lebih dari 30 detik

JALAN NAFAS (AIRWAY)

1. Tentukan derajat kesadaran dan kesulitan nafas

a. Periksa tanda cedera kepala, leher, kesulitan pernafasan &

kesadaran. Bila ada cedera kepala jangan mengguncang

bayi atau anak karena dapat merusak medula spinalis.

b. Bila bayi dan anak tidak sadar tapi bernafas baik,

letakkan pada posisi pulih (recovery position)

c. Bayi dan anak sadar dengan kesulitan bernafas, letakkan

pada posisi senyaman mungkin yg memudahkan

bernafas.

2. Mintalah bantuan

3. Atur posisi korban

a. Letakkan dengan posisi terlentang diatas dasar yg rata

dan keras

b. Bila ada cedera kepala/leher pertahankan posis tubuh-

leher-kepala dalam satu garis. Hindari ekstensi, fleksi dan

rotasi kepala karena dapat mencederai medula spinalis.

c. Memindahkan ke tempat lain, posisi tubuh-leher-kepala,

harus dalam satu garis kesatuan

4. Membuka jalan nafas

- Bila tidak ada cedera kepala dengan cara head tilt atau

chin lift

Head-tilt/chin lift

Cara melakukan:

1. Letakkan satu tangan pada dahi tekan perlahan ke posterior,

sehingga kemiringan kepala menjadi normal atau sedikit

ekstensi (hindari hiperekstensi karena dapat menyumbat

jalan napas).

2. Letakkan jari (bukan ibu jari) tangan yang lain pada tulang

rahang bawah tepat di ujung dagu dan dorong ke luar atas,

sambil mempertahankan cara 1.

- Bila tidak sadar dan ada cedera kepala dengan cara jaw

thrust

Cara melakukannya:

1. Posisi penolong di sisi atau di arah kepala

2. Letakkan 2-3 jari (tangan kiri dan kanan) pada masing-

masing sudut posterior bawah kemudian angkat dan dorong

keluar.

3. Bila posisi penolong diatas kepala. Kedua siku penolong

diletakkan pada lantai atau alas dimana korban diletakkan.

4. Bila upaya ini belum membuka jalan napas, kombinasi

dengan head tilt dan membuka mulut (metode gerak triple)

5. Untuk cedera kepala/ leher lakukan jaw thrust dengan

immobilisasi leher.

PERNAFASAN ( BREATHING)1. Nilai usaha nafas dengan melihat gerak nafas, dengar desah

nafas, dan rasakan aliran udara pernafasan

2. Caranya

a. Pasang sungkup dengan ukuran sesuai umur sehingga

menutup mulut dan hidung, lalu rapatkan

b. Sambil mempertahankan posisi kepala (jalan nafas)

lakukan tiupan nafas buatan dengan mulut atau balon

(bag) resusitasi.

c. Bila dgn mulut, tarik nafas dalam, tiup dan liat

pengembangan dada. Bila tetap tdk mengambang

kemungkinan obstruksi jalan nafas.

3. Frekuensi nafas buatan yg dilakukan:

- Bayi - < 8 thn : 20 kali permenit

- Neonatus : 30 – 60 kali permenit

SIRKULASI DARAH (Circulation)Penilaian sirkulasi : setelah 2-5 kali nafas buatan

Tempat penilaian : bayi baru lahir : arteri umbilikus

bayi : arteri brakhialis

anak : arteri karotis

Indikasi pijat jantung : bradikardia ( <60x/m atau henti jantung )

Lokasi pemijatan : 1/2 bagian bawah tulang dada (sternum)

dengan kedalaman pijatan 1/3 tebal dada.

Cara :

- Bayi: pijatan dilakukan dengan teknik ibu jari atau dua jari

(telunjuk dan jari tengah)

Teknik ibu jari :

1.Kedua ibu jari menekan tulang dada

2.Kedua tangan melingkari dada dan jari-jari tangan

menopang bagian belakang bayi

Teknik dua jari :

1.Ujung jari tengah dan jari telunjuk atau jari manis dari satu

tangan digunakan untuk menekan tulang dada

2.Tangan yang lain digunakan untuk menopang bagian

belakang bayi.

- Anak < 8 tahun : dengan pangkal telapak tangan

- Anak > 8 tahun : pangkal telapak tangan terbuka dan dibantu

dengan tangan yang satu diatasnya.

Frekuensi pemijatan :

- Bayi dan anak : 100 kali permenit

- Neonatus : 120 kali permenit

Koordinasi antara pijat jantung dan nafas buatan:

- Neonatus : 3 : 1

- Anak : Dua penolong : 15 : 2

Satu penolong : 30 : 2

SUMBATAN JALAN NAFASTeknik pukulan dan hentakan

Bayi dan anak kecil

1. Letakkan bayi dengan posisi tertelungkup kepala lebih

rendah. Diatas lengan bawah, topang dagu dan leher dengan

lengan bawah dan lutut penolong.

2. Tangan lainnya melakukan pukulan punggung diantara

kedua tulang belikat secara hati-hati dan cepat sebanyak 5

kali pukulan.

3. Balikkan dan lakukan hentakan pada dada sebagaimana

melakukan pijat jantung luar sebanyak 5 kali.

4. Pada neonatus tidak boleh melakukan cara diatas, hanya

dilakukan dengan alat penghisap (suction)

Pada anak lebih besar :

1. Pukulan punggung dilakukan 5 kali dengan pangkal tangan

diatas tulang belakang diantara kedua tulang belikat. Jika

memungkinkan rendahkan kepala di bawah dada.

2. Hentakan perut (Heimlich maneuver dan abdominal thrust).

Cara: Penolong berdiri di belakang korban, lingkarkan

kedua lengan mengitari pinggang, peganglah satu sama lain

pergelangan atau kepalan tangan (penolong), letakkkan

kedua tangan (penolong) pada perut antara pusat dan

prosessus sifoideus, tekanlah ke arah abdomen atas dengan

hentakan cepat 3-5 kali. Hentakan perut tidak boleh

dilakukan pada neonatus dan bayi.

Teknik ini digunakan pada

penderita sumbatan jalan

napas akibat lidah yang jatuh

ke belakang

Resume Resusitasi AnakManeuver Dewasa dan

anak besar

Anak kecil Bayi Neonatus CPR/Resc

Breathing

> 8 tahun 1-8 tahun < 1 tahun Bayi baru lahir

Airway Head tilt-chin

lift (jika trauma

jaw thrust)

Head tilt-chin

lift (jika trauma

jaw thrust)

Head tilt-chin

lift (jika trauma

jaw thrust)

Head tilt-chin

lift (jika trauma

jaw thrust)

Check responnya

Buka jalan nafas

Breathing

Jumlah nafas

Obstruksi benda

asing

2-5 nafas kira-

kira 1 ½ detik

tiap nafas

± 12 kali/min

Abdominal

thrusts atau

back blows

2-5 nafas kira-

kira 1 ½ detik

tiap nafas

± 20 kali/min

Abdominal

thrusts atau

back blows atau

chest thrust

2-5 nafas kira-

kira 1 ½ detik

tiap nafas

± 20 kali/min

Back blows atau

chest thrust

(jangan

abdominal

thrust)

2-5 nafas kira-

kira 1 detik

tiap nafas

±30–60 kali/min

Suction (jangan

abdominal

thrust atau

back blows)

Cek napas, jika

korban bernafas:

recovery position.

Jika tidak ada

pengembangan

dada : reposisi dan

ulangi sampai 5

kali

Cek nadi

Titik kompressi

Metode

Kompressi

Kedalaman

kompressi

Frekuensi

kompressi

Rasio Kompressi

ventilation

Carotis

1/2 bgn bawah

sternum

Pangkal telapak

tangan dan tgn

satu diatasnya

± 1/3 tebal dada

± 100/min

15 : 2 (2rescuer)

30:2 ( 1 rescuer)

Carotis

1/2 bgn bawah

sternum

1 pangkal

telapak tangan

± 1/3 tebal dada

± 100/min

15 : 2 (2rescuer)

30:2 ( 1 rescuer)

Brachial

1 jari dibawah

garis inter-

mammary

2 atau 3 jari

± 1/3 tebal dada

± 100/min

15 : 2 (2rescuer)

30:2 ( 1 rescuer)

Umbilical

1 jari dibawah

garis inter-

mammary

2 jari atau

teknik ibu jari

± 1/3 tebal dada

± 120/min

3 : 1

Nilai tanda

kehidupan, jika

ada nadi tp napas

tidak ada: lakukan

tindakan bantu

napas, jika nadi <

50x/mnt dan

perfusi jelek :

kompresssi dada

Definition : To do first aid and secondary survey on patients with head and neck trauma

Aim :After this study, each student are expected to :

1.1 Remove patient’s helmet in head and neck trauma cases, in a safe way and know how toplace a servical collar

1.2 Do physical examination on head and neckMenghitung Glasgow Coma Scale (GCS)1.3. Identify normal head scan1.1 Manage primary survey in a brief time1.2 Count and estimate the GCS on the patient1.3 Do secondary survey1.4 Identify epidural hematoma on CT scan

1.1 Estimate and count the derivation of GCS1.2 Manage severe head trauma1.3 Demonstrate secondary survey on head and neck1.4 Identify the possibility to consult to a neurosurgeon

Learning media and tools :1. Skill guide books of emergency and traumatology system2. “Mr. Hurt” manequin doll3. Helmet4. Cervical collar5. Print out, of normal head scan, epidural, subdural dan contusion and intracranial

hematoma

Learning method:Scenario by instructor, demonstrated by students

Activity Time Description1. Introduction 5 minute 1. Scenario

2. Brief explanation about the scenario,student’s role and time allocation

2. Remove helme dan puton the collar

10 minute 1. One student stands as the patient,others as rescuers

2. Estimate GCS

3. Managemet of severehead trauma

5 minute 1. Estimate GCS2. Identify signs of high intracranial

pressure4. Management of head

trauma that seemsworsening

10 minute 1. Re-do primary survey2. Estimate GCS

Differentiate the managementbetween severe head trauma andworsening head trama

5. “Mr. Hurt: 10 minute 1. Do secondary survey head and neck6. CT scan 5 minute 1. Explanation about CT scan

HEAD AND NECK TRAUMAExamination and Management

GLASGOW COMA SCALEVariabel Nilai

Eye (E) response SpontaneousTo voicesTo painNone

4321

Motoric (M) response Do as toldLocalize the painNormal flexion (pull away from pain )Abnormal flexion (decortification)Abnormal extensionNone

654321

Verbal (V) response OrientedConfused speakingUnarranged wordsUnclear voiceNone

54321

Count GCS = (M + M + V ), Best score = 15, worse score = 3

LEARNING GUIDE

HEAD AND NECK TRAUMA

STEPS / Activities DescriptionEarly preparationCheck for all toolsI. PRIMARY SURVEY

A. ABCDEB. Immobilization and stabilized cervicalC. Brief neurological examination

1. Pupil light reflex2. AVPU or GCS score

II. Secondary survey and ManagementA. Inspect the head carefully, include face

1. Lacertion2. Any CSS liquid from nose and ear

B. Palpate head thoroughly, include the face1. Fractures2. Lacerations and fractures

C. Inspeect all laserations on head skin1. Brain tissure2. Skull depressed fracture3. Dirt / corpus alienum4. CSS leakage

D. Minineurologis examination and scoring GCS1. Eye response2. Motoric response3. Verbal response4. Pupil light reflex

E. Cervical vertebrae examination1. Palpate any pain and place on the semirigid collar if necessary2. Examine cervical vertebrae X-rays on lateral projection if

necessary

F. Judge the width of woundRe-examine continously and observe any deteriorate signs :

1. Frequency2. Parameters3. Re-do ABCD

III. HOW TO REMOVE HELMETPatient who use helmet and needs breathing aid management has to besured that its head and neck are in neutral positions.2 helpers are needed toremove helmet.One student lie down as the patient with the helmet on. Other students actas helpers doing as follows :1. One person stabilize the head and neck’s patient, with putting his hand

on the helmet, its fingers on the patinet’s mandibula while examiningand make sure that the airway is still open. This position prevent thehelmet to slip away

2. Second helper cuts the helmet’s belt on release it from the D-ring3. Second helper stands on the right or the left side of patient with one

hand on the mandibule angulus, mother finger in one side and otherfingers on the other side. While the other hand makes a pressure underthe head on occipital regio. This way 2 helpers are immobilizing thehead and neck

4. First helper push the helmet to the lateral side to release both ears fromhelmet and then remove the helmet slowy. If helmet has face mask,this mask should be removed first. If the helmet has a very completemask, the nose could be wedged in and complicate the helmet removal.To set free the nose, helmetshould be hold back and upward across thenose

5. As this happens, second helper should maintain imobilizing position toprevent the patients neck from moving

6. After the helmet is removed, straight immobilization mannual startsfrom top, head and neck are saved from moving during the procedure

7. If by removing the helmet causes pain and parestesia, then it should beremoved by gips scissors.If there is any signs of cervical trauma onXrays, helmet should be removed by gips scissors. During theprocedure, head and neck are maintained immobilized and stabilized,while the helmet is cut from the coronal passing through both ears.External layer of the helmet can be easily remove, the internal layerwhich made of spyrofoam can be cutted and removed from front. Headand neck in neutral position

8. After the removal, immeadiately place the cervical collar followed byprimary surveySetelah helm dapat dilepaskan segera pasang cervicalcollar.

STABILISATION AND TRANSPORTATIONDefinition : 1. Prepare safe transportation for patients

2. Give first aid and secondary survey on patients with medulla spinalistrauma

Aim:Students are expected to :1. Demonstrate the techniques of examination to check patients with medulla spinalis trauma2. Discuss the principals of immobilization and log roll on patients with neck trauma/medulla

spinalis trauma and indications to remove protections aid.3. Do neurological examination and estimate the level of trauma4. Decide whether transferring to other hospital is needed and how to immobilize patient

correctly when transfering.

5. Limitize patients risk to worsen with doing the right mobilizaiton6. Prepare safe transportation for the patientLearning media and tools :1. Skill guide book of emergency and traumatology system2. Video and slide3. Patient models (students may role as patient)4. Semirigid cervical collar5. Desk or stretcher or bed.6. Folded towel to support .7. Blanket8. Bandage9. Scoop stretcher10. Long spine board.11. Vacuum mattress12. KED (Kendrick Extrication Device)

Learning method :Scenario by the instructor, demonstrated by students

Activity description :

Activity Time Description1. Introduction 5 minue 1. Tools introduction

2. Primary and secondary surveyscenario judgement

2. Scenario I 10 minute 1. Give help on spot using long spineboard and cervical collar only

2. Log Roll3. Scenario II 10 minute 1. Help patient on spot, using

cervical collar, scoop stretcher,and long spine board

4. Scenario III 10 minute 1. Evacuate patient using vacuummatras

5. Scenario IV 10 mintue 1. Extrict patient with KED

LEARNING GUIDE

STABILIZATION AND TRANSPORTATION SKILLS

STEPS/Activity DescriptinPreparationCheck list all tools

I. PRIMARY SURVEY RESUSCITATION – SPINAL CHORDTRAUMA JUDGEMENT

II. AirwayJudge the airway while positioning the cervical spine. Open and clean upthe airway, do the jaw thrust, place oropharynx tube, and do intubation ifnecessaryA. Breathing

Judge and give adequate oxygen, and ventilation if necessaryB. Circulation

a. Judge the circulation by checking pulsations, blood pressureand perifer perfusion. If hypotension occurs, it has to bedifferiated by hypovolemic shock ( decreased bloodpressure, increased heart rate and cold extremities)

C. Solution to correct hypovolemia

D. Disability- brief neuorological examinationa. Judge the conciousness and pupil.b. Decide whether to use AVPU or GCS to judge patient’s

conciousnessc. Identify paralysis or paresisd.

II. SECONDARY SURVEY – NEUROLOGICALJUDGEMENT

A. AMPLE History Taking1. History and mechanism of trauma2. Medical record

B. Identify and write down any medication given to the patientbefore, during, and after treatment

C. Re-examine conciousness andD. Re-examine GCS scoreE. Examine spinal chord

1. PalpationPalpate the whole posterior spinal chord by doing log rollcarefullyExamine ::

a. Any deformities/ swellingb. Crepityc. Increasing pain when palpatedd. Contusion and laceration.

2. Pain, paralyze and paresthesiaa. Yes/Nob. Locationc. Neurological level

3. SensationPinprick tes to estimate sensation, is performed in all dermatomsand write down the most caudal dermatom which givessensation

4. Motoric Sensation

III. PRINCIPALS IN IMMOBILIZING THE SPINAL CHORD ANDLOG ROLL

A. Log roll: 1. One person hold the head and neck to maintain the

immobilization in one line.2. One person stand by on the side to hold the patient’s body (

pelvis and hips )3. Another person hold the pelvis and limb. With the command

from the person on the head, move the patient in an angleposition carefully

4. The 4th person check on the spine chord and place the longspine board

B. Placing the ong spine board1. Maintain the head and neck in one line when the second person holds

the patient on its shoulders and wrists. Third person holds the patient;shand ad hips with one hand, the other hand holds the bandage thatcords patient’s ankles pergelangan kaki.

2. With the commandments from the rescuers whose holding the patient’shead and neck, perfrorm log roll as a unit towards the otherpersons/rescuer whose beside the patient. It only needs a minimalrotation to place the spine board underneath the patient. Maintain the

one line principal of the head and neck in this procedure3. Spine board is placed underneath the patient, afterwards perform log

roll towards the spine board.4. Long spine board with its rope/band is inserted to the thoracal regio,

above crista iliaca, thighs and ankles. Band or bandage is used to fixatethe head and neck to attach to the spine board

5. Perform inline immobilisation of the head and neck manualy, thenplace the semirigid collar

6. Straighten the arms and place it beside the patients body7. Straighten the limbs carefully and place it in one line with the spine

chord.Both ankles are tied together with a bandage8. Place a pillow/support under the patient’s neck to avoid any

overextended movements and to comfort the patient9. Pillow, blanket or any other supports is place on the right and left side

of the patient’s neck, while the head is tied, attached to the long board10. Place a bandage above the cervical collar to guarantee there is no

movement of the head and neck.C. Scoop Stretcher

1. Prepare scoop stretcher2. Open the lock to divide in two3. Arrange the scoop to match patient’s height4. Place scoop under the patient5.Scoop stretcher is not for immobilizing the patient.6.Scoop stretcher not a transport device, do not lift scoop on the edges

because it could fold on the middle and will lose the straightnes of thevertebrae

Splint/spalk Installation ( Immobilization of the extremities ) andMusculoskeletal Management.

Definition : To give first aid to musculoskeletal trauma patients

Aim of study : After this study, students are expected to be able :

1. To do quick examination on patients with musculoskeletal trauma2. To recognise life and limb threatening problems in musculoskeletal trauma3. To install a spalk/splint correctly.

Learning media and tools :1. Skill guide book2. Living models ( students can role as patients )3. Leg traction splint4. Air splint5. Spalk6. Gloves

Learning method :Scenario by the instructor, demonstrated by students

LEARNING GUIDE

MUSKULOSKELETAL SKILL

EXTREMITIES IMMOBILISATION PRINCIPLES

Check the ABCDE and treat conditions which are life threatening first.

1. Loose all clothes thoroughly, including on the extremities

2. Loose watches, rings, necklace and all things that might clamp

3. Check neurovasculars before setting the spalk/splint. Check external bleeding

pulsation that has to be stopped, and check also the sensoric and motoric function of

the extremities.

4. If there are wounds, close it with sterilized bandage

5. Choose kinds and sizes of spalk that matches the traumatized extremities

6. The spalk setting should also cover joints below and above the traumatized

extremities.

7. Place a pillow bag above the bone protrusion

8. Support the extremities with spalk/splint in a position where there is a distal

pulsation. If there is not any distal pulsation, try to straighten the extremitis. Make a

traction carefully and maintain it until splint is settled.

9. Splint/spalks are settled onto extremities that are straight, if not, try to straighten it.

MASS DISASTER MANAGEMENT

Definition : To carry out triage principles in whenever patients outnumbered rescuers

Aim of study : After this study, students are expected to :

1. Define triage

2. Understood and able to explain principles and factors that effects and includes

in the proses of triage

Learning media and tools :

1. Slides of guidlines to do triage scenario

2. Triage scenario booklet

Learning methods :

Role’s play

Activity description :

Activity Time Description1. Introduction 10 minutes 1. Triage scenario slide presentation

2. Brief explanation about the scenario,student’s roles and time allocation

2. Role play (1) 10 minutes 1. All students have put priorities on whichpatients they will handle

2. Each student give their suggestions on whythey put their priorities on specific patients

Role play (2)Fire followed byexplosion in settlements

10 minutes 1. All students have put priorities on whichpatient they will handle


Role play (3)Car crash

10 minutes 3. All students have put priorities on whichpatient they will handle


Role play (4)A football stadiumcollapsed

10 minutes 1. All students have to determine which criteriais used to identify patients and whatpriorities should be done

2. All students propose the clues and signs thatwere given by the patient which could helpin the triage procces

3. All students propose what can be donebefore and after the paramedics andambulance arrives.

4. All students should propose which victimshas to go first to the hospital and which typeof hospital should the victim goes to.

students skill lab manual book emergency...

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