First Responder

Ali Haedar

Department of Emergency Medicine

Faculty of Medicine University of Brawijaya
 The Well-Being of
the First Responder
 Emotional Aspects of
Emergency Care

You may have to deal with situations

that produce a high level of stress:
Injury or illness to infants and children
Elderly patients
Death and violence
Mass casualty incidents
 Stress Management
Includes:
Recognition of stress
Prevention of stress
Reduction of stress
 Recognition of Stress
Irritability
Guilt
Inability to focus
Loss of appetite
Abnormal disposition
Loss of sex drive
Difficulty sleeping
Loss of interest
Anxiety
in work
Indecisiveness
Isolation
 Prevention of Stress
Eat a healthy well-balanced diet.
Drink adequate amounts of liquids.
Be merry.
 Reducing Stress
Pre-incident stress education
On-scene peer support
Critical incident stress debriefing
(CISD)
 Scene Safety
Infectious diseases
Body substance isolation (BSI)
Universal precautions
Immunizations
Hazards of the scene
 Key Terms
Pathogen: Disease-causing microorganism.
Body Substance Isolation (BSI): Concept
that treats all bodily fluids as potentially
infectious.
Universal precautions: Procedures for
infection control that assume blood is
potentially infectious.
Common Infectious Diseases
Human immunodeficiency virus (HIV)
Hepatitis B
Tuberculosis
 Universal Precautions
Always wear gloves.
Always wear protective eye wear.
Wash your hands.
Do not recap, cut, or bend used
needles.
Dispose of sharps in a sharps
container.
Use a face shield, pocket mask, or
other airway adjunct for resuscitation.
 Removal of Gloves
Proper removal of gloves is
important to minimize the spread
of pathogens.
 Immunizations
Tetanus prophylaxis
Hepatitis B vaccine
Tuberculin testing
 The Human Body:
Anatomy and Function of
Body Systems
The Respiratory System
Consists of the structures within body
contributing to normal breathing.
Brings oxygen into body and removes
carbon dioxide.
Breathing is controlled by the
diaphragm, a muscle at the bottom of
the chest cavity.
 The Circulatory System (1 of 2)
Consists of a pump, network of pipes,
and fluid (heart, vessels, and blood).
Blood picks up oxygen in lungs and
then is pumped to the body by the
heart.
Waste products from cells are carried
back to lungs.
In lungs, waste products are removed
and more oxygen is picked up.
The Circulatory System (2 of 2)
The Heart
 Blood
Blood has several components:
Red blood cells carry oxygen.
White blood cells are infection fighters.
Platelets start blood clotting process.
 The Skeletal System (1 of 2)
Three functions of skeletal system:
Support body.
Protect vital structures.
Manufacture red blood cells.
The Skeletal System (2 of 2)
 The Muscular System
Skeletal muscles: provide movement,
support
Smooth muscles: carry out automatic
functions
Cardiac muscle: found only in the
heart
 The Nervous System
Consists of brain, spinal cord, and
individual nerves.
The brain controls all bodily functions.
Spinal cord is communication system
between brain and body.
Nerves branch out from spinal cord to
every part of the body.
 The Digestive System (1 of 2)
Digestive tract is about 35 feet long
from mouth to anus.
Digestive tract breaks down food,
then carries it to cells of the body.
Bile and insulin are very important in
digestion of fats and sugars.
The Digestive System (2 of 2)
 The Genitourinary System
Responsible for bodys reproductive
functions and removal of waste
products from bloodstream.
 The Skin
Skin covers entire body and has three
functions:
Protection
Temperature regulation
Receiving information from outside
Airway Care and
Rescue Breathing
 Anatomy and Function of the
Respiratory System
All organisms need oxygen to stay alive.
The brain can only last 4 to 6 minutes
without oxygen.
Once brain cells are destroyed, they
cannot be replaced.
The respiratory system provides oxygen
and removes carbon dioxide from cells.
 Airway
Check for responsiveness.
Correct blocked airway.
Check for fluids, foreign bodies, or
dentures.
Correct airway using finger sweeps or
suction.
Maintain airway.
 Correcting the Blocked Airway
Head tiltchin lift technique
Jaw-thrust
technique
 Finger Sweeps
1.Turn patient on side.
2.Insert your finger into patients
mouth.
3.Curve your finger into a C-shape
and sweep from one side of back
of mouth to other.
 Suctioning
Remove any large pieces with gloved
hand.
Suction only as deep as you can see.
Do not suction longer than:
15 seconds at a time for an adult
10 seconds at a time for a child
5 seconds at a time for an infant
 Maintain the Airway
Maintain patients airway using one of
the following:
Recovery position
Oral airways
Nasal airways
Recovery Position
 Oral Airways
Used to maintain patients airway.
May only be used on patients without a gag
reflex.
Functions as a pathway to suction patient.
It is important to select the proper size
airway.
Skill Drill: Inserting an Oral Airway

1. Select the proper

size airway.
2. Open patients
mouth.
3. Insert airway
upside down
along roof of
mouth.
4. Rotate airway 180
degrees into
position.
 Nasal Airways
Can be used on conscious
or unconscious patients.
Should not be used on
patients with head
injuries.
Select proper size airway
prior to insertion.
Lubricate nasal airway
prior to use.
 Skill Drill:
Inserting a Nasal Airway
1. Coat airway with
water-soluble
lubricant.
2. Select larger
nostril.
3. Insert airway until flange
rests against nose.
Signs of Adequate Breathing vs.
Inadequate Breathing
Adequate: Inadequate:
Rise and fall of Noisy respirations,
chest wheezing, or
Sounds of air gurgling
passing into/out Rapid or gasping
of patients respirations
nose/mouth Pale or bluish skin
Air coming out Respiratory arrest
of nose/mouth
 Correct Breathing
Rescue breathing can be performed via:
Mouth-to-mask rescue breathing
Mouth-to-barrier rescue breathing
Mouth-to-mouth rescue breathing
 Foreign Body Airway
Obstruction
Causes of airway obstruction
Tongue
Foreign body
Types of airway obstruction
Partial obstruction
Complete obstruction
 Removing a Foreign Body
Airway Obstruction
Look for signs of choking.
Locate xiphoid process and navel.
Apply abdominal thrusts.
 Abdominal Thrust on an
Unconscious Patient
Place one hand
above
navel and below
xiphoid process
and
other hand on top
of
your first hand.
Thrust inward and
slightly upward.
 Infants and Children
Do not attempt a blind finger sweep
on an infant or child.
Check the mouth for object first.
For infants, perform 5 back blows and
5 chest thrusts instead of abdominal
thrusts.
Do not tilt infants head back too far.
CPR and Circulation
 Circulatory System
Consists of heart, blood vessels,
blood.
Heart pumps blood to lungs and rest
of body.
Pulse is generated when heart
contracts.
Major pulse points include: carotid,
femoral, brachial, and radial pulse.
Locations for Assessing Patients
Pulse
Neck or carotid pulse
Wrist or radial pulse
Arm or brachial pulse
Groin or femoral pulse
 Cardiac Arrest
May be caused by:
Heart attack or stroke
Untreated respiratory arrest
Medical emergencies (electrical shock,
epilepsy, poisoning, etc.)
Drowning
Suffocation
Trauma or shock from massive blood loss
 When to Start CPR
CPR should be started on any
pulseless patient, except when any of
the following exist:
Decapitation
Rigor mortis
Tissue decomposition
Dependent lividity
 When to Stop CPR
Patients pulse returns.
Care is transferred to another trained
person.
Physician assumes responsibility.
Transfer to EMS personnel occurs.
Obvious death is recognized.
You are too exhausted to continue or
continuing would place you or others in
danger.
 Skill Drill: Steps in Performing Chest
Compressions

1. Locate top and bottom of sternum.

2. Place heel of hand on lower half of sternum.
3. Place other hand on top of first hand.
 Skill Drill:
One-Rescuer Adult CPR
1. Establish
responsiveness.
2. Open airway.
3. Check for breathing.
4. Perform rescue
breathing.
5. Check for circulation.
6. chest compressions.
 Switching Rescuers 1 of 2
Rescuer Two, giving compressions,
calls for switch.
Rescuer One delivers 2 breaths after
30th compression.
Rescuer Two completes 5th set of 30
compressions and moves to head to
maintain the airway and ventilation.
 Switching Rescuers 2 of 2
Rescuer Two checks carotid pulse.
If absent, Rescuer Two ventilates
patient twice.
Rescuer One begins chest
compressions.
 Infant CPR
Position infant on firm surface.
Determine responsiveness.
Open airway.
Check for breathing.
Deliver two slow breaths.
Check brachial artery for pulse.
Begin chest compressions.
 Child CPR

Locate top and bottom of sternum.

Place one hand on lower half of
sternum, two finger widths above
xiphoid process.
 Signs of Effective CPR
Pulse is felt during chest
compressions.
Patients pupils begin to constrict.
Patients skin color improves.
Patient regains own pulse and
breathing.
Independent heartbeat begins.
 Complications of CPR
Broken bones
Gastric distention
Vomiting
Patient Assessment
 Patient Assessment Sequence
Perform scene size-up.
Perform initial assessment.
Examine patient from head to toe.
Obtain SAMPLE history.
Perform on-going assessment.
 Step I: Scene Size-up
Review dispatch information.
Maintain body substance isolation.
Maintain scene safety.
Determine mechanism of injury or
nature of illness.
Determine need for additional
resources.
 Step II:
Perform Initial Assessment
Form general impression of patient.
Assess responsiveness.
Check airway.
Check breathing.
Check circulation.
 Initial Assessment:
Assess Responsiveness
AVPU Scale
Alert
Verbal
Pain
Unresponsive
 Initial Assessment:
Check Patients Airway
Head tiltchin lift technique
Jaw-thrust technique
Inspect mouth
Insert airway if needed
 Initial Assessment:
Check Patients Breathing
If conscious:
Check rate and quality.
Check for any difficulty.
If unconscious:
Look, listen, and feel for breathing.
Start rescue breathing, if needed.
 Initial Assessment:
Check Patients Circulation
Check carotid or radial pulse.
Check for severe bleeding.
Check skin color and temperature:
Pale - decreased circulation
Flushed - excess circulation
Yellow - liver problems
Step III: Physical Examination
Check patient from head to toe for
non-life-threatening conditions.
Purpose of exam is to locate and
begin initial management of injury or
illness.
 Signs and Symptoms
Sign: A condition you can feel or see.
Symptom: A condition the patient tells
you.
Important signs:
Respirations
Pulse
Capillary refill
Skin condition
Pupil size and reactivity
Level of consciousness
 Physical Exam:
Examine the Patient from Head to Toe
Look and feel for signs of injury:
Deformity
Open injuries
Tenderness
Swelling
Search all areas of body in a clear,
concise, consistent format.
 Examine Patients Head and Eyes

Examine head:
Use both hands.
Do not move patients head.
Remove eyeglasses.
Remove wigs if necessary.
Examine eyes:
Cover one eye for 5 seconds.
Watch for pupil contraction.
 Examine Patients Neck and
Chest
Examine neck:
Examine each side; check for pain.
Check neck veins.
Examine for stoma.
Check for a medical identification tag.
 Examine Patients Chest

Examine chest:
Check for pain on
inhalation/exhalation.
Look for signs of difficult breathing.
Note injuries, bleeding, or abnormal,
unequal, or painful movement.
Check for collarbone or rib fractures.
Examine Patients Abdomen
Look for signs of external bleeding,
penetrating injuries, or protruding
parts.
Check for stomach rigidity or swelling.
Check for soiled clothing.
Check genital area for external
injuries.
 Examine Patients Pelvis

Examine pelvis:
Check for obvious bruising,
bleeding, or swelling.
Check for pain if no pain has been
reported.
Examine back:
Stabilize head and neck.
Check one side of the back at a
time.
 Examine the Extremities
Observe the extremity.
Examine for tenderness.
Check for movement.
Check for sensation.
Assess the circulatory status.
 Step IV: Patients Medical
History
Signs/symptoms
Allergies
Medications
Pertinent, past medical history
Last oral intake
Events associated with or leading to
the injury
Step V: On-going Assessment
Monitor patients vital signs:
Every 5 minutes if unstable.
Every 15 minutes if stable.
Maintain an open airway.
Monitor breathing and pulse.
Monitor skin color and temperature.
 Hand-off Report
Provide age and sex of patient.
Describe incident and chief complaint.
Describe patients level of responsiveness.
Report vital signs and examination results.
Report pertinent medical condition in
SAMPLE format.
Report interventions provided.