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Slide 1 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Scene Size-up Chapter 8
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Slide 2 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Case History You are dispatched to a report of a male shot in the chest. The area is a well-known drug location. You immediately respond to the scene. You are dispatched to a report of a male shot in the chest. The area is a well-known drug location. You immediately respond to the scene.
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Slide 3 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Overview of Patient Assessment Scene size-up Initial assessment Focused history and physical Medical Trauma Detailed physical exam Ongoing assessment
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Slide 4 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Scene Size-up Components Don appropriate PPE. Determine if scene/situation is safe. Determine mechanism of injury/nature of illness. Determine number of patients. Request additional help if necessary. Begin triage. Consider stabilization of the spine as appropriate.
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Slide 5 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Standard Precautions Blood Body fluid Secretions and excretions (except sweat) Nonintact skin Mucous membranes
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Slide 6 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Standard Precautions Routine use on calls Gloves When blood or body fluid splash is possible (e.g., arterial bleed, childbirth, consider eye protection, gown, mask HEPA respirator When exposed to airborne or droplet infectious agents
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Slide 7 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Scene Safety Definition: An assessment for potential danger to you, other rescuers, bystanders, and the patient. An assessment for potential danger to you, other rescuers, bystanders, and the patient.
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Slide 8 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. High-Risk Scenes Crash and rescue scenes Toxic substances Crime scenes Environmental conditions Examples Ice Ice Water Water Unstable surfaces Unstable surfaces
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Slide 9 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Motor Vehicle Crash Hazards Oncoming traffic Gasoline spills Fire Unstable vehicles Glass and sharp metal Slippery or unstable surfaces Downed power lines
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Slide 10 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Resources Advanced life support Law enforcement Fire Rescue Hazardous materials experts Other specialized rescue Examples High-angle rescue High-angle rescue Cave Cave Water Water Utility companies
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Slide 11 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Traffic Delineation Devices Reflectors Better at night Flares Clearly visible at night Less benefit in the daytime If gasoline has spilled at the scene, flares represent a fire hazard. Traffic cones Make noise to wake up sleeping drivers Battery-operated lights
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Slide 12 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Traffic Delineation Devices Place devices at least 3 times the distance (in feet) of the posted speed limit (e.g., 30 miles per hour = 90 feet) 90 Feet Speed Limit 30
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Slide 13 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Environmental Hazards Protect yourself. Do not enter situations that you are not trained to manage (e.g., water rescue). Protect patient from additional injury. Protect bystanders from becoming victims.
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Slide 14 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mechanism of Injury Helps determine probable severity of injuries Speed of crash Height of fall Velocity of weapon Helps locate specific injuries associated with the mechanism
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Slide 15 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Force Kinetic energy increases with force, resulting in more serious injuries.
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Slide 16 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Force Falls onto the feet can result in injuries along the long axis of the body.
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Slide 17 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Force Compression forces from a front-end collision can result in significant injuries to the chest wall and internal organs.
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Slide 18 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mechanisms and Examples of Associated Injuries Head-on collisions Rear-end collisions Side collision Head, spinal, chest abdomen, extremities (knee, hip), protection injury to arm Head, spinal (whiplash) Head, spinal, chest abdomen, shoulder, clavicle, upper extremities, hip
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Slide 19 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mechanisms and Examples of Associated Injuries Fall onto feet Fall onto outstretched arm Feet, heel, knee, hip, spine Wrist, elbow, humerus, shoulder
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Slide 20 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mechanisms and Associated Injuries Penetrating trauma Specific to entrance and exit wounds Severity related to location and velocity of gunshot wounds
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Slide 21 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Hidden Injuries Seat belts and airbags can prevent death/injury. Patients who use safety devices may still have serious injuries. Shearing forces may have damaged internal organs. Shoulder belt worn without lap belt can cause neck injury. Lap belt can ride up the abdomen, causing abdominal and spinal injury.
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Slide 22 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Hidden Injuries Airbags may not be effective without use of a seat belt. Lift airbag and look at the steering wheel for deformity.
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Slide 23 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Infants and Children Significant injuries Bicycle injuries Fall from lower heights Struck by vehicles Infants at greater risk for falls Children 6-12 at high risk for vehicle-related injuries Bicycles Pedestrians Auto passengers
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Slide 24 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nature of Illness Medical Patients Nature of illness Why was EMS activated? Determine from the patient, family, or bystanders Look for clues on the scene. Medication bottles Medication bottles Exposure to allergens Exposure to allergens Blood Blood
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Slide 25 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Multiple Patients Determine the total number of patients. More patients than the responding unit can effectively handle? Initiate a mass casualty plan. Consider spinal precautions and continue care. Call for additional help before contact with patients. Law enforcement, fire, rescue, ALS, utilities EMT is less likely to call for help if involved in patient care Begin triage.
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Slide 26 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Summary Scene size-up is first step of patient assessment. Critical to making scene safe, identifying cause of the problem, identifying number of patients, and calling for additional resources. Includes several components Don appropriate PPE. Determine if the scene/situation is safe. Determine the mechanism of injury/nature of illness. Determine the number of patients. Request additional help, if necessary. Request additional help, if necessary. Begin triage. Begin triage. Consider stabilization of the spine, as appropriate.
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