1. Lecture 1 Organization of urgent medical care in Ukraine. Primary and secondary examination in the activity of the doctor of emergency team. Speaker: R.M. Lyakhovych I.Ya. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY

2. Stage 1. Organization of the emergency team.

3. Doctor Medical assistant 1 Medical assistant 2 Driver

4. Approaching the injured, ask the witnesses, rescue workers or policemen what has happened, whether the accident scene is safe and how many injured people are there. If the accident scene is, in your opinion, connected with criminal activity, immediately call the police. If there is a need of rescue workers, inform the rescue service. In case of crime or violence, law enforcement agencies have to provide safety for the rescue medical workers. How to approach the injured person

5. If you decide to approach the injured, figure out what has happened, to foresee the mechanism of trauma and to find out the way of providing medical help. Ask one medical worker or a driver to inspect all secluded corners of the accident scene in order to find other possible victims. In case they are found, you have to examine them and provide necessary medical help if needed. How to approach the injured person

6. Primary examination Approach the injured, if possible, from the side of his/her head. First of all, visually assess patient’s general condition (age, sex, morphology of the body, language, skin colour, posture, availability of the movements (thorax, limbs), mimicry, eyes condition, visible injury made by traumatizing factor). Make initial resolution of its degree and further algorithm of help. Figure out the condition of consciousness according to the algorithm AVPU: A – Alert (conscious, gives adequate answers to the questions, is able to perform conscious actions when asked by the medical rescuer); V – Responds to Verbal stimuli (to a loud sound near the ear); P– Responds to Pain (responds to pinch in the area of left thoracic muscle at the turn of 180 degrees); U – Unresponsive.

7. Let’s make a priori assumption that cerebral trauma occurs at transport accidents, sports accidents, falling from high places, traumas in water and children’s traumas. Primary examination

8. Fix with your hands a neck part of the spine in the position which you found the injured in. (medical assistant 1) If that position does not promote breathing, carefully turn the injured on his/her back or to the position, which is close to a stable (on his/her side) (medical assistant 1 + medical assistant 2). Start initial examination according to the A, B, C technique (optimal term of performance – 10 sec) (doctor) Step A Provide patency of airways support (medical assistant 1): Evaluate if there is a need to examine oral cavity

9. …to confirm or oppose the circulatory arrest. Patient’s response Provide patency of airways support Check respiration and pulse (not more than 10 sec) Provide patency of airways support, find out if there are signs of life

10. Patency of airways support Suction units (aspirators)

11. Patency of airways support Respiratory mask

12. Patency of airways support Laryngeal mask Laryngeal tube

13. Patency of airways support laryngeal tubes

14. Patency of airways support Combitube

15. Patency of airways support Respiratory mask and Ambu bag

16. Patency of airways support A set for conicopuncture

17. Portable set of respiratory equipment Support of artificial ventilation of lungs Oxygen therapy

18. Training equipment for developing skills of patency of airways support

19. Primary examination Indications for carrying out trachea intubation apnoea; risk of aspiration danger or presence of respiratory disorder (damage of respiratory tracts, maxillary-facial trauma); closed craniocerebral injury; hypoxemia, in spite of carrying out oxygen therapy; frequency of respiration less than 10 or more than 30 per minute (for adults)danger of respiratory standstill (sepsis, major burns) ). Objective criteria is the data of pulsoximetria: saturation <92 % – indication to oxygenotherapy; saturation <90 % – indication to intubation. Step B. Make sure if the patient is breathing. Count the frequency of respiration during 10 sec.

20. Primary examination Simultaneously with making decision concerning necessity of artificial ventilation and providing oxygen, put a neck collar (a doctor, medical assistant or a driver can do it) and continue initial examination. Step C. At the same time find out if there is pulse in the carotid artery (during 10 sec) (in case the patient is unconscious). (doctor)

21. “ Quick evaluation ” Taking electrodes, classic, self-adhesive electrodes.

22. Primary examination Examine if there is any external haemorrhage (doctor). In case of its availability stop the haemorrhage – press the wound with your hand using sterile tissue. If the haemorrhage stops, put the clutch, bandage. If you found a patient with an amputated limb, stop hemorrhage while evaluating the breathing and pulse condition. Pay attention to the skin temperature (using the back of your hand), skin colour, time of colour return after pressure on the nail, skin moisture (doctor). This information will indicate the development of the shock.

23. Primary examination Check if the patient has trinkets, bracelets, or badges – medical markers, which may hold information about patient’s condition, allergy, need for certain medication (for example, when a patient suffers from diabetes, epilepsy, etc), especially, when the patient is unconscious. (medical assistant 2).

24. Algorithm of providing help and examination for the patient

25. Category "Load and Go"after primary examination This category includes patients, who have very serious mechanism of the trauma (fall from the top, severe sports injury, car accident, etc) or negative impression of the patient at initial examination (amputation of the limb, severe defects, etc ).

26. 1. What is depicted at the picture 1? *Wheelcouch/barrow 2. What is depicted at the picture 4? *A chair for immobilization and transportation

27. 3. What is depicted at the picture 20? * Hard shield 4. What is depicted at the picture 21? *Soft stretchers 5. What is depicted at the picture 40? *Frame stretchers

28. 6. What is depicted at the picture 42? * Neck Collar 7. What is depicted at the picture 43? * Pectoral immobilization waistcoat 8. What is depicted at the picture 44? * Vacuum splints

29. 9. What is depicted at the picture 23? * Cramer’s Splints 10.What is depicted at the picture 34? * Elastic splint type Sam Splint 11. What is depicted at the picture 45? * Elastic splint type Sam Splint

30. 12. What is depicted at the picture 65? *Respiratory Ambu-bag with a mask, air-channels/providers, a hose for the serve 13. What is depicted at the picture 66? * A portable apparatus of ventilation with balloon of oxygen

31. 14. What is depicted at the picture 56? * A set for conic puncture 15. What is depicted at the picture 12? * Laryngoscope with attachments of different size 16. What is depicted at the picture 2? * Hand suction-fan 17. What is depicted at the picture 3? * Foot suction-fan

32. 18. What is depicted at the picture 5? * Electrosuction-fan 19. What is depicted at the picture 6? *Cardiocomplex 20. What is depicted at the picture 7? * Pulsoxymeter, located on the finger of patient 21. What is depicted at the picture 8? * Medical bag for transference of medical property and medicines

35. Video files If you want to look this films, copy them on your PC

64. 64 Thank you for attention!