Emergency Procedures Final Exam notes

Chapter 13 Chest, Abdominal, and Pelvic Injuries

Chest Injuries:
- Open or closed chest injuries
o Closed- skin is not broken
o Open- skin has been broken and the chest wall is penetrated
- All victims with suspected chest injuries should have their airway, breathing,
and circulation checked FREQUENTLY!
- Responsive victim should sit up or placed with injured side down
Rib fractures:
- broken ribs usually occur along the side of the chest
- upper four ribs are protected by collarbone and shoulder blades
- lower two ribs are floating ribs- freedom to move
- gently press inward on both sides of the chest at the same time to assess for
a rib fracture
- usually associated with sharp pain with deep breath, coughing, or moving;
tender to touch, shallow breathing
- Care victim by helping them find a comfortable position, stabilize the ribs with
a pillow, seek medical care
Flail Chest
- involves several ribs in the same area broken in more than one place
- paradoxical movement- the fractured segment moves in a direction opposite
to that of the rest of the chest wall during breathing
- breathing is very painful and difficult, rapid and large bruising may occur
- care for victim by supporting the chest, apply hand pressure, place them on
injured side with blanket underneath, monitor breathing, seek medical care
Impaled object in the chest
- an impaled object penetrates the chest wall, causes air and blood to escape
into the space between lungs and chest wall
- lung collapses, can lead to shock and death
- care by stabilizing the object in place with bulky dressings
- DO NOT try to remove object, call 911
Sucking chest wound
- a sucking chest wound results when an open chest wound allows air to pass
into and out of the chest with each breath
- blood bubbling out of chest wound during exhalation, suckling sound during
inhalation
- care by sealing the wound, lean or lay victim on injured side
- remove seal/plastic if victim has trouble breathing, call 911
Abdominal injuries
- Open or closed, can involve hollow and/or solid organs
- Hollow organ- injury may spill contents of organ into abdomen (bladder,
intestines)
- Solid organ- injury results in extensive internal bleeding (liver, spleen)
- Closed- internal abdominal tissues are damaged but skin is unbroken
o AKA blunt injuries, because they are easily missed!
o Care by gently pressing all four quadrants of the abdomen
o Notice bruises or marks, pain, tenderness, or rigidity, distention
(swelling)
o If victim is UNRESPONSIVE- place on left side in comfortable position
with legs bent (fetal position), call 911
o If victim is RESPONSIVE- place victim on one side in comfortable
position with legs slightly bent, call 911

Open- skin has been broken

o AKA penetrating injuries, always serious, usually causes internal organ
damage
o Care for penetrating would: stabilize the penetrating object, place
bulky dressings around object, do not try to remove object, call 911
Protruding organs AKA Evisceration
- severe injury in which internal organs escape or protrude from wound
- care by calling 911 first, allow victim to stay in comfortable position, legs
pulled toward abdomen, cover protruding organs, treat for shock
Pelvic Injuries
- pelvic fractures are usually caused by falling or a motor vehicle crash
- pain in hip, groin, or back increases with movement
- inability to stand or walk
- signs of shock
- check pelvis by gently pressing inward and downward on tops of hips
- care by treating victim for shock, place padding between victims thighs,
secure victims knees and ankles together, keep victim on a firm surface, call
911
Chapter 14 Bone, Joint, and Muscle Injuries
Bone injuries
- Closed- the skin is intact
- Open- the skin has been broken
Types of fractures:
- Greenstick- incomplete fracture (seen in kids)
- Transverse- crosses the bone at right angles
- Oblique- cross the bone in a slanting direction
- Comminuted- bone is fragmented into more than two pieces
- Impacted- bone ends are jammed together
- Spiral- usually result from a twisted injury
DOTS
- Deformity, Open wounds, Tenderness, Swelling
Signs and symptoms:
- loss of use, guarding, crepitus (a grating sensation), history-mechanism of
injury
Care for fractures:
- check for life threatening conditions first, gently remove clothing covering the
injured area, examine area by looking and feeling for DOTS, check blood flow
and nerves using the mnemonic CSM
CSM:
- CIRCULATION
o Arm injury- feel for radial pulse
o Leg injury- feel for posterior tibial pulse
o May also check capillary refill
- SENSATION
o Lightly touch or squeeze one of the victims toes or fingers
- MOVEMENT
o Have the victim wiggle his or her toes and fingers
- Stabilize/ splint the injured part in the position found!
- Apply ice pack, seek medical care
- For an open fracture, DO NOT push on protruding bones, control bleeding (use
ring pad if necessary), cover wound with dressing without applying pressure
Dislocations
- occurs when a joint separates

deformity is the main sign, severe pain, swelling, inability of the victim to
move injured joint, shock
- care by checking CSM
- Use a splint to stabilize the joint in the position found, do not try to reduce the
joint, seek immediate medical care
Sprains
- injury to LIGAMENTS
- causes severe pain, pain may prevent the victim from moving or using the
joint, swelling, skin around the joint may be discolored
- when in doubt, treat as a fracture, follow the RICE protocol
o Apply ice pack for 20 minutes
o Apply compression for 3-4 hours,
o Repeat the cycle
o Raise the injured part
- Use cold promptly
Strains
- injury to a muscle or tendon when it is stretched beyond its normal range of
motion
- inflammation begins immediately after an injury, can take 24-72 hrs for pain
and stiffness to begin
- sudden, sharp pain in affected muscle, extreme tenderness when touched,
swelling, weakness and inability to use injured part, stiffness and pain when
victim moves the muscle
- Care by following the RICE protocol (see above)
Chapter 15 Extremity Injuries
Assessment
- look for signs and symptoms of fractures and dislocations
- Examine the extremities using DOTS (Deformity, Open wounds, Tenderness,
Swelling)
- Compare one extremity with the other
- Consider mechanism of injury
- Evaluate CSM (Circulation, sensation, movement)
Types of extremity injuries
- Contusions- occurs when tissue is bruised
- Strains- occur when muscles or tendons are stretched or torn
- Sprains- involve tearing or stretching of joints, causing damage to the
ligaments and joint capsules
- Tendinitis- inflammation of a tendon caused by overuse
- Dislocation- occurs when bones are displaced from their normal joint
alignment, out of their sockets, or out of their normal positions
- Fractures- breaks in bones that may or may not be accompanied by open
wounds
- RICE procedure- REST, ICE, COMPRESSION, ELEVATION
o Do NOT elevate a suspected fracture until it has been stabilized
o Recommended immediate treatment for bone, joint, and muscle
injuries
o If performed consistently during the first 48-72 hrs after an injury, can
significantly relieve pain and speed healing
Shoulder dislocation
- when shoulder bones come apart from a blow or a particular movement
- care: do not force, twist, or pull back in place; place folded or rolled blanket or
pillow between upper arm and chest, apply an arm sling and swathe, ice pack
for 20 min, seek medical care

Clavicle fracture
- common, usually result of falling with arm and hand outstretched, most occur
in the middle third of the bone
- recognize from deformity, dropped or drooped shoulder, fell on outstretched
arm or direct blow to clavicle or shoulder, severe pain over injured area,
holding injured arm against chest, no movement because of pain, swelling/
bruising
- care by applying arm sling and swathe, ice for 20 min, seek medical care
Humerus fracture
- direct blow to area
- Assess and treat for shock, ice for 20 min, stabilize and splint arm, seek
immediate medical care
Elbow fractures and dislocations
- serious, treat with extreme care, immediate swelling, pain, deformity, painful
restricted motion, numbness or coldness of the hand and fingers below the
elbow
- Do not move the elbow, treat for shock, splint the elbow in position found, ice
pack for 20 min, seek medical care
Radius and Ulna fractures
- when one bone is broken, the other acts as a splint, and there may be little or
no deformity
- when both are broken, the arm usually appears deformed
- causes pain in forearm or wrist, deformity, severe pain radiating up and down
arm, inability to move the wrist or painful when moved
- assess and treat for shock if indicated, apply ice for 20 min, apply two rigid
splints on both sides of arm, seek medical care
Wrist fracture
- usually breaks when victim falls with arm and hand outstretched
- snapping or popping sensation
- pain aggravated by movement
- tenderness, swelling, unable or unwilling to move wrist, lump-like deformity
- care using RICE protocol, stabilize the wrist with a splint, seek medical care
Finger fracture
- do not try to realign, ice pack, splint finger using buddy tape method, seek
medical care
Nail Avulsion
- when nail is partly or completely torn loose
- apply antibiotic ointment, secure with bandage, do not trim away loose nail,
consult physician
Hip dislocation
- assess and treat for shock, stabilize injury, check for ankle pulse, seek medical
care
- severe pain in groin area, inability to lift injured leg, may appear shortened
and rotated with the toes pointing abnormally
- treat for shock, stabilize injured leg, monitor ankle pulse, seek immediate
medical care
Femur fracture
- often include open wounds
- external and internal bleeding may be severe
- severe pain at injury, deformity, swelling, severe pop or snap
- assess and treat for shock, cover with sterile dressing, stabilize injured leg
(may require TRACTION SPLINT), monitor ankle pulse, seek medical care
Knee injuries
- most serious joint injuries, deformity will be grotesque (ugly)
- medical care is required if the injury is from being hit or twisted

fracture generally occurs as a result of a fall or a direct blow

may look like a dislocation, deformity, tenderness, swelling
if no deformity, feel for pulse in ankle, if pulse is felt, split leg with the knee
straight
- if significant deformity, feel for pulse in ankle, if pulse is felt, splint the knee in
the position found
- if pulse is absent, seek medical care immediately
Patella dislocation
- must be treated immediately
- most commonly occurs in teenagers and young adults who are engaged in
athletic activities
- a blow or twisting causes kneecap to move outside the knee joint, swelling,
pain, deformity, inability to bend or straighten knee
- follow RICE protocol, do NOT relocate, splint knee in position found, seek
medical care
Lower leg injuries (Tibia and Fibula fractures)
- deformity when bone is broken
- causes severe pain, swelling, deformity, tenderness
- stabilize leg, apply ice, seek medical care
Ankle and foot injuries
- frequently injured by twisting
- stretches or tears ligaments
- most ankle injuries are sprains that involve the outside ligaments
- two part test to determine whether an X-ray is needed:
o Press along the bones- pain and tenderness may indicate a broken
bone
o Have victim try to stand on it- ability to take 4+ steps is most likely a
sprain
o Inability to walk on it may indicate a break
o If injured ankle cannot tolerate hopping on opposite foot, suspect a
fracture
o Swelling on one side indicates a sprain, swelling on both sides
indicates a fracture
- Use RICE procedure for care after taking shoes off
o Repeat for 24-48 hrs
o Use a contrast bath if swelling persists
o Begin range of motion exercises once initial swelling has decreased
o Begin gentle exercises
o Within 7-14 days, if pain and swelling have stopped begin to stretch
and strengthen the calf and ankle, brace or tape healed ankle, NSAIDs
(nonsteroidal anti-inflammatory drugs)
Toe Injuries
- includes torn off nails, hematoma formation under the nails, dislocations,
fractures
- pain and swelling, deformity
- treat the same as a finger injury
Chapter 16 Splinting Extremities
-

injured extremities should be stabilized by splinting in the position it was

found
stabilizing means to minimize further injury by protecting the body part to
prevent movement
all fractures should be stabilized before victim is moved

splinting reduces pain, prevents damage to muscles, nerves, and blood

vessels, prevents a closed fracture from becoming an open fracture, reduce
bleeding and swelling, prevents fractured bone from moving into soft tissues
Types of splints
- RIGID SPLINT: inflexible device used to maintain stability, long enough to be
secured above and below fracture site
- SOFT SPLINT: pillow, used for lower leg, forearm
- SELF-SPLINT/ ANOTOMIC SPLINT: uses the body, injured extremity tied to an
uninjured part
- TRACTION SPLINT: used to stabilize femur fractures
- First cover open wounds with sterile dressing, check CSM
- If there is no pulse, gently line up a fracture or dislocation, do not force
anything into position, warn the victim
Applying a splint- use the rule of thirds
- Injury located in upper or lower third of bone- extend the splint above and
below the joint
- Injury located in middle third- stabilize joints above and below the fracture,
place injured arm in a sling and swathe
- Use extra padding with rigid splints, place splint materials on both sides of the
injured part
- Apply splints firmly, but do not restrict blood flow- check CSM before and after
splinting
- Use RICE (Rest, Ice, Compression, Elevation)
- Do not apply ice packs if pulse is absent
- Seek immediate medical care for no pulse, open fracture, dislocation, injury
with moderate or severe swelling, deformity, tenderness, or swelling over the
bone, victim is unable to walk or bear weight, snaps, crackles, or pops, hot,
tender, swollen, or painful injured areas, especially a joint, lack of rapid
movement, and uncertainty whether bone was broken
Slings
- an open triangular bandage can be used as a sling
- a folded triangular bandage, known as a cravat, can be used as a swathe in
conjunction with a sling
- when applying sling to upper arm, hold victims arm slightly away from chest
with wrist and hand slightly higher than tip of elbow
- place triangular bandage between forearm and chest, pull upper end of
bandage over uninjured shoulder
- bring lower end of the bandage over the forearm, around neck to uninjured
side, tie the ends at the hollow above the clavicle, secure point of the
bandage at the elbow
- place swathe around the upper arm and body, thumb-up position
- place padding underneath both knots, adjust sling, only fingers should be
exposed
Chapter 17 Sudden Illnesses
Causes of chest pain
- muscle or rib pain from exercise or injury
- respiratory infection
- indigestion
- angina pectoris
- heart attack (myocardial infarction)
Cardiac compromise- occurs when blood flow to the heart is reduced or cut off

Heart attack (AKA myocardial infarction)- one or more of the arteries delivering blood
to the heart becomes blocked (infarction) resulting in damage (necrosis) to the heart
muscle (myocardium)
Cardiac arrest- either the heart stops beating or the hearts lower chambers suddenly
develop a rapid irregular rhythm causing the ventricles to quiver rather than contact
(fibrillation)
Dyspnea- shortness of breath
Diaphoresis- breaking out in a cold sweat
Angina- occurs when coronary arteries become narrow and cannot carry sufficient
blood to meet the demands during physical exertion, excitement, emotional upset,
eating of a heavy meal, extreme hot or cold temp exposure, cigarette smoking,
results in hypoxia to heart muscles, relieved by nitroglycerin
Level of responsiveness indicates how well the brain is functioning
STOP mnemonic
S- Sugar, Seizures, Stroke, Shock (blood glucose levels are too low or too high)
T- Temperature (too high or too low)
O- Oxygen (inadequate oxygen)
P- Poisoning, Pressure on brain (drug/alcohol overdose, carbon monoxide
poisoning, head injury)
Stroke- sudden interruption of blood flow to the brain, arteries in brain rupture or
become blocked
Ischemic strokes- blood vessels become narrowed, damaged or clogged with plaque
Hemorrhagic strokes- blood vessels ruptures in or near the brain resulting in bleeding
Recognizing stroke
- weakness, numbness, paralysis of face or one side of body
- blurred or decreased vision
- problems speaking or understanding
- dizziness or loss of balance
- unexplained headache
- deviation of the eyes from PEARL
Asthma- chronic lung disease that inflames and narrows the airways, causes
recurring periods of wheezing, chest tightness, shortness of breath, and coughing
Hyperventilation- fast, deep breathing, common during emotional stress
COPD- applied to emphysema, chronic bronchitis, related to lung diseases, common
factor is cigarette smoking
Fainting- AKA syncope or psychogenic shock, associated with decreased blood flow
causing deficient oxygen (hypoxia) or decrease glucose levels (hypoglycemia)
Seizures- a symptom of epilepsy, epilepsy is the underlying tendency of the brain to
produce sudden bursts of electrical energy that disrupt other brain functions
Convulsive seizures- AKA Grand Mal or Tonic-Clonic Seizures

Non-Convulsive seizures- AKA Petit Mal Seizures

Prolonged seizures- AKA Status Epilepticus
Care for Hypoglycemia (low blood sugar):
- The rule of 15s- EAT 15g of sugar, if condition does not improve in 15 min,
give 15 more grams of sugar
- If no improvement, seek medical care
Care for Hyperglycemia (high blood sugar):
- if uncertain is victim has high or low blood glucose, give responsive victim a
beverage or food containing sugar
- If no improvement in 15 min, seek medical care
Care for abdominal pain
- give victim clear liquids
- give victim an antacid
- place hot water bottle against victims abdomen or soak in a warm bath
- be prepared for vomiting
- keep victim in comfortable position
Chapter 18 Poisoning
Poison
- anything that can cause harm to someone if it is used in the wrong way, used
by the wrong person, or used in the wrong amount
- most common cause of accidental death in children
Types:
1. ingested (swallowed)- via digestive system
2. inhaled
3. injected
4. absorbed
Forms:
1.
2.
3.
4.

solids
liquids
sprays
gases

Poison Help Center- 1-800-222-1222