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MedicYeti

Part 1. Basic assessment.

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Greetings Ladies and Gentlemen. There are frequent questions about first aid and medical issues here so I think I’ll throw in my two cents.

I am a NJ Paramedic and have been involved in Emergency Medical Services (EMS) for over 21 years.

I’m going to gear these discussions toward people with little or no medical training and experience. With this in mind, I’ll be over-simplifying some of the discussion. If you have something to add, please do. If you want to get into the complexities of injuries on a cellular level, pm me.

Terms: Signs – things that you see, like a road sign. Symptoms – Things that a person complains of. Nausea is a symptom, vomiting is a sign.

Mental Status – A person’s ability to interact with their environment, speak and follow commands. This will come up a lot in my posts.

Vital Signs – breathing rate and depth and their pulse rate and pulse location. Blood Pressure and temperature are included but will not be extensively covered. Breathing and pulse are measured per minute.

Shock – inadequate tissue perfusion. There isn’t enough oxygenated blood to supply the body’s systems. This can be a problem with the oxygen, like breathing problems or can be a problem with the blood, like bleeding. There are others but shock really basically boils down to these. I’ll discuss others later.

 

Patient (pt) assessment. Many times it’s easy to find out what is wrong with someone; “I shot my foot off!” makes it easy to figure out what happened and where to look for an injury. Sometimes things aren’t that easy.

When you meet with a patient look at them. A persons skin can tell you quite a bit about their overall condition. Sweating, especially when I’s not hot, will tell you that a persons body is working hard. Skin color can also indicate their condition. Pale, gray, blotted or covered in a rash are things to look at.

 

Mental Status – Is the person conscious or not? If conscious can they answer simple questions; Who are you? Where are you? A general location is acceptable, the exact address isn’t vital. What month is it? Many people don’t know the exact date, how often do you look at your phone or watch to see the date? Don’t expect people to know the exact date. Inability to answer these questions may mean the brain isn’t getting enough oxygen and or blood. A decreased mental status is a sign of shock. Assume the pt is altered due to a medical condition. Don’t blow it off thinking the pt has Alzheimer’s.

 

Airway starts at the openings of the nose and mouth and goes deep into the lungs. It’s everywhere air goes. Picture a large tree, the trunk is big and round then goes up and divides in 2 smaller trunks. Large branches come off the trunk, medium branches come off the large branches, the branches get smaller and smaller till you get little twigs and leaves. This is an upside-down picture of your airway the trunk starts at the back of the throat. Oxygen and carbon monoxide exchange is done at the smallest part of the airway. The big parts are the upper airway and the little parts are lower airway. Upper airway issues are usually when something gets in the way, lower airway issues are generally a result of medical issues.

 

Breathing (Respirations) – look at the way the pt is breathing. Breathe the same way that they are, if you can’t keep it up for long – neither can they. Normal breathing for an adult is roughly 10-30 a minute, count for 30 seconds then double. Look at the pt’s neck and shoulders, if they have exaggerated movement in their neck and shoulders they are in significant distress.

 

Pulse – normal adult pulse is between 60 and 100 a minute. There are a number of different places to check pulses, I’ll discuss 3. Count for 30 seconds and double.

Carotid pulse is the neck arteries that supply blood to the brain. To locate the carotid pulse use 2 fingers on the side of your throat near the jaw line press and feel around. Practice this, it can be difficult especially under stress.

Brachial Pulse is inside the upper arm, near the armpit around the inside of the bicep. This is the best place to check on children.

Radial pulse is inside the wrist, near where the meaty part of the thumb muscles meet the wrist. Use 1 finger to feel for the pulse. Practice.

A radial pulse means the patient has a decent blood pressure, no radial pulse with a carotid pulse means the pt’s blood pressure is dangerously low. No carotid pulse means the pt is dead or darn close.

 

Temperature – check the chest or forehead not the extremities. Does the pt feel excessively hot or cool? Do you have a thermometer to check?

Normal human temperature is 98.6*F. 3 degrees off either way is a big deal.

 

Bleeding can be internal (inside the body) or external (outside the body) External bleeding is the easiest to recognize and manage.

Blood comes from 3 types of blood vessels.

Capillary Bleeding is the most common, it occurs when small vessels get damaged and the blood slowly oozes out. Simple bandages and light pressure will usually control capillary bleeding. Interior capillary bleeding usually stops itself and may cause bruises.

Venus bleeding occurs when a vein suffers injury, this bleeding usually leaks out and requires bandaging and some pressure. Sometimes it can require more aggressive management.

Arterial Bleeding it the most dangerous. Arteries carry oxygenated blood to the body, arteries have thick walls that contract which increases the pressure inside. Arteries are deep in the muscles and require a great deal of force to damage. When arteries get damaged they can “spurt’ blood like a water pistol or the blood pours out of the body. Arterial bleeding will require large bandages, direct pressure and in extreme cases it will require a tourniquet. It arterial bleeding isn’t quickly managed a person can die as a result. Watching a human bleed to death is a horrific experience.

 

Assessment begins with looking at the person before you get close enough to touch them. If you think “This dude is screwed” you are probably correct. Think ABC when you assess, (airway breathing circulation) Modern CPR teaches CAB (circulation, airway breathing) this assumes the pt is unconscious and in in potential need of CPR. Either assessment pneumonic is acceptable, choose one and go with it. Since I’ll be talking very little about CPR and more about medical and trauma I’ll be going with ABC.

Find out if they are conscious and if they can talk. If they can speak they are somewhat able to control their airway, move on to breathing. I they are not conscious look at their mouth and nose. If something is in their airway try to remove it, but don’t stick your fingers in there.

Look at breathing, count for 30 seconds, breathe like the pt. Look at the neck and shoulders and look at the pt’s skin.

Feel for a radial pulse in adults or a brachial pulse in a child. If an adult doesn’t have a radial pulse, feel for a carotid. If the pt is conscious they at least have a carotid pulse.

Look for big bleeding and address the arterial bleed first.

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I'm trying to pull together a first-aid kit that is specifically geared towards trauma (GSW, deep stab wound with aterial damage, etc). Leaving out compound fractures, what would you suggest are necessities for the kit? I'm trying to get a good list together before I decide to pull the trigger and make a purchase. So far I have:

 

1. Suture thread

2. Needle

3. Small forceps

4. Gauzes

5. QuikClot/Celox

6. Superglue

7. Betadine

8. Splint

9. Medical tape

10. Scalpel

11. Medical Scissors

12. Gloves

 

Should there be anything else I should include?

 

Sidenote: The above list was prepared with the assumption that there was still some form on medical/emergency infrastructure still available. In the event that this infrastructure is no longer available, should I be including other things? Also, I was thinking if this is the case, I would probably need to be trained in some sort of trauma first-aid, or at least be proficient in suturing skills beyond closing deep superficial wounds...

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Yes, tourniquets (at least 1 if not 2) and chest seals are a big plus for traumatic injuries. Be wary of the types of Quickclot/Celox you buy, the sponges for example are designed for taking a bad spill, not necessarily plugging a deep hole. I'm definitely a fan of the combat gauze. The sutures are great if you know how to use them (like everything else). GFH offers a basic trauma class and Dave from Alpha and Omega offers a great class with the added bonus of getting to use his stuff so you can see what works best for you. Not all tourniquets work the same for example and some might lead to your death if you need to self administer.

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