 Basic Extrication

Soft Tissue Injuries

BLS
 Intro to BLS
 Respiratory Arrest & Rescue Breathing
 Cardiac Arrest & CPR
 Foreign Body Airway Obstruction
 Basic Extrication
Extrication Objectives
Describe and demonstrate the following basic
techniques:
Making Purchase Points
Door Removal
Roof Removal
Dash Displacement
 Soft Tissue Injuries
A soft tissue injury (STI) is the damage of muscles, ligaments and tendons throughout the body. Common soft tissue injuries
usually occur from a sprain, strain, a one off blow resulting in a contusion or overuse of a particular part of the body. Soft
tissue injuries can result in pain, swelling, bruising and loss of function.

Signs and symptoms:

Sprains
A sprain is a type of acute injury which results from the stretching or tearing of a ligament. Depending on the severity of the
sprain, the movement on the joint can be compromised since ligaments aid in the stability and support of joints. Sprains are
commonly seen in vulnerable areas such as the wrists, knees and ankles. They can occur from movements such as falling on
an outstretched hand or a twisting of the ankle or foot.
• The severity of a sprain can be classified:
• Grade 1: Only some of the fibers in the ligament are torn, and the injured site is moderately painful and swollen.
Function in the joint will be unaffected for the most part.
• Grade 2: Many of the ligament fibers are torn, and pain and swelling is moderate. The functionality of the joint is
compromised.
• Grade 3: The soft tissue is completely torn, and functionality and strength on the joint is completely compromised. In
most cases, surgery is needed to repair the damage.

Strains
A strain is a type of acute injury that occurs to the muscle or tendon. Similar to sprains, it can vary in severity, from a
stretching of the muscle or tendon to a complete tear of the tendon from the muscle. Some of the most common places
that strains occur are in the foot, back of the leg (hamstring), or back.
Bruising (contusion)
• A contusion is the discoloration of the skin, which results from underlying muscle fibers and connective tissue being
crushed.This can happen in a variety of ways such as a direct blow to the skin, or a fall taken against a hard surface. The
discoloration in the skin is present when blood begins to pool around the injury.
Tendinitis
Tendinitis is a type of overuse injury to the tendons, which demonstrates signs of inflammation of tendons around a joint. Tendinitis
is the most common cause of shoulder pain. Tendinitis occurs when there is repetitive stress on the subacromial bursa, which causes
the bones to make contact with the tendons and irritate them.

Diagnosis:
Acute injuries
Any type of injury that occurs to the body through sudden trauma, such as a fall, twist or blow to the body. A few examples of this
type of injury would be sprains, strains and contusions.
Overuse injuries
An overuse injury occurs when a certain activity is repeated frequently and the body does not have enough time to recover between
occurrences. Examples include bursitis and tendinitis.
Commonly injured tissues
• Ligaments
Anterior cruciate ligament (knee), medial collateral ligament (knee), ulnar collateral ligaments (wrist/hand), interspinous ligaments
(vertebrae)
• Muscles
Biceps brachii (upper arm), rectus femoris (thigh), transverse abdominis (abdominals)
• Tendons
Patellar tendon (knee), calacaneal/Achilles tendon (foot/lower leg), biceps tendon (shoulder/elbow)
• Nerves
Brachial plexus (shoulder), ulnar nerve (elbow/hand), peroneal nerve (ankle/foot), cranial nerves I-XII(head)
• Bones
Femur (leg), humerus (arm), ribs (torso), metatarsals I-VI (foot), metacarpals I-VI (hand)
• Cartilage
Menisci (knee), intervertebral discs (spine), acetabulum (hip)
 BLS
• Basic life support (BLS) is a level of medical
care which is used for victims of life-
threatening illnesses or injuries until they can
be given full medical care at a hospital. It can
be provided by trained medical personnel,
including emergency medical
technicians, paramedics, and by qualified
bystanders.
 Intro to BLS
Many countries have guidelines on how to provide basic life support (BLS) which are formulated by professional medical bodies
in those countries. The guidelines outline algorithms for the management of a number of conditions, such as cardiac arrest,
choking and drowning. BLS does not include the use of drugs or invasive skills, and can be contrasted with the provision of
Advanced Life Support (ALS). Firefighters, lifeguards, and police officers are often required to be BLS certified. BLS skills are also
appropriate for many other professions, such as daycare providers, teachers and security personnel and social workers
especially working in the hospitals and ambulance drivers.

CPR provided in the field increases the time available for higher medical responders to arrive and provide ALS care. An
important advance in providing BLS is the availability of the automated external defibrillator or AED. This improves survival
outcomes in cardiac arrest cases. Basic life support promotes adequate blood circulation in addition to breathing through a
clear airway:

• Circulation: providing an adequate blood supply to tissue, especially critical organs, so as to deliver oxygen to all cells and
remove metabolic waste, via the perfusion of blood throughout the body.
• Airway: the protection and maintenance of a clear passageway for gases (principally oxygen and carbon dioxide) to pass
between the lungs and the atmosphere.
• Breathing: inflation and deflation of the lungs (respiration) via the airway

These goals are codified in mnemonics such as ABC and CAB. The American Heart Association (AHA) endorses CAB in order to
emphasize the primary importance of chest compressions in cardiopulmonary resuscitation.

Healthy people maintain the CABs by themselves. In an emergency situation, due to illness (medical emergency) or trauma, BLS
helps the patient ensure his or her own CABs, or assists in maintaining for the patient who is unable to do so. For airways, this
will include manually opening the patients airway (Head tilt/Chin lift or jaw thrust) or possible insertion of oral (Oropharyngeal
airway) or nasal (Nasopharyngeal airway) adjuncts, to keep the airway unblocked (patent). For breathing, this may
include artificial respiration, often assisted by emergency oxygen. For circulation, this may include bleeding control or
cardiopulmonary resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action.
 Respiratory Arrest & Rescue Breathing
What is respiratory arrest?
Respiratory arrest is a condition that exists at any point a patient stops breathing or is ineffectively breathing. It often
occurs at the same time as cardiac arrest, but not always. In the context of advanced cardiovascular life support, however,
respiratory arrest is a state in which a patient stops breathing but maintains a pulse. Importantly, respiratory arrest can
exist when breathing is ineffective, such as agonal gasping.

What causes respiratory arrest?

We often think of cardiac arrest leading to respiratory arrest, but the respiratory system may shut down without the
heart’s involvement. If the nerves and/or muscles are not capable of supporting respiration, a patient may enter
respiratory arrest. One example of this is in the disease amyotrophic lateral sclerosis (Lou Gehrig’s disease). If the area of
the brain that controls respiration becomes depressed, as might occur in an opioid overdose, the brain does not drive
respiration. Another example is a state in which the chest might not be able to physically support respiration. This might
occur externally (e.g., with a crush injury to the chest) or internally (e.g., in acute respiratory distress syndrome or tension
pneumothorax). It is important to keep these possible causes of respiratory arrest in mind during resuscitation.

Respiratory arrest management

The response to respiratory arrest follows the same process as any other emerging resuscitation, namely BLS and ACLS
sequences.
The BLS survey
1. Check responsiveness
2. Activate EMS
3. Check circulation
4. Defibrillate

For the purposes of respiratory arrest, the patient will have circulation and thus there is no need to defibrillate. Indeed,
there is no need for chest compressions or formal CPR for that matter. Respiratory arrest management, at least initially,
centers on successful ventilation.
 Respiratory Arrest & Rescue Breathing
• The ACLS survey
1. Airway
2. Breathing
3. Circulation
4. Differential diagnosis

The first goal is to establish an open airway in the patient. The rescuer should use the tools available to them according to a
given situation and as appropriate. For instance, if the patient is found in respiratory arrest in a non-hospital setting, the
rescuer may only be able to use basic airway techniques such as head tilt/chin left or jaw thrust maneuver. Incidentally, the
head tilt/chin left is used when cervical spine injury is not an issue and the jaw thrust maneuver is used when an injury to
the cervical spine is suspected or feared. If an oropharyngeal or nasopharyngeal airway device is available, consider using
these means to assist in airway maintenance (see A Review of Airways).

When you are administering artificial respiration, you are breathing for the patient. Avoid excessive ventilation and make
sure that you see the chest rise and fall with breaths. Are you providing sufficient oxygenation? If you have access to
supplemental oxygen, use it. You may use 100% oxygen initially, but it is best to titrate the level of supplemental oxygen
necessary to achieve blood oxygen levels of 94% or higher (based on pulse oximetry). Likewise, if you have access
to quantitative waveform capnography, you can use it to monitor end tidal carbon dioxide.

Remember that a person who is in respiratory arrest may enter cardiac arrest at any moment. Therefore, it is important to
check for pulses to assess circulation. If the patient enters cardiac arrest at any moment, you should follow the cardiac
arrest resuscitation algorithm immediately.
 Cardiac Arrest
Cardiac arrest is a sudden loss of blood flow resulting from the failure of the heart to effectively
pump. Symptoms include loss of consciousness and abnormal or absent breathing. Some
individuals may experience chest pain, shortness of breath, or nausea before cardiac arrest. If
not treated within minutes, it typically leads to death.

The most common cause of cardiac arrest is coronary artery disease. Less common causes
include major blood loss, lack of oxygen, very low potassium, heart failure, and intense physical
exercise. A number of inherited disorders may also increase the risk including long QT
syndrome. The initial heart rhythm is most often ventricular fibrillation. The diagnosis is
confirmed by finding no pulse. While a cardiac arrest may be caused by heart attack or heart
failure, these are not the same.

Prevention includes not smoking, physical activity, and maintaining a healthy weight. Treatment
for cardiac arrest includes immediate cardiopulmonary resuscitation (CPR) and, if a shockable
rhythm is present, defibrillation. Among those who survive, targeted temperature
management may improve outcomes. An implantable cardiac defibrillator may be placed to
reduce the chance of death from recurrence.
 Cardiac Arrest
Symptoms & Signs :
Cardiac arrest is preceded by no warning symptoms in approximately 50 percent of people. For those who do experience
symptoms, they will be non-specific, such as new or worsening chest pain, fatigue, blackouts, dizziness, shortness of
breath, weakness and vomiting. When cardiac arrest occurs, the most obvious sign of its occurrence will be the lack of a
palpable pulse in the victim. Also, as a result of loss of cerebral perfusion (blood flow to the brain), the victim will rapidly
lose consciousness and will stop breathing. The main criterion for diagnosing a cardiac arrest, as opposed to respiratory
arrest, which shares many of the same features, is lack of circulation; however, there are a number of ways of determining
this. Near-death experiences are reported by 10 to –20 percent of people who survived cardiac arrest.

Causes :
Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) occur when the heart abruptly begins to beat in an abnormal
or irregular rhythm (arrhythmia). Without organized electrical activity in the heart muscle, there is no consistent
contraction of the ventricles, which results in the heart's inability to generate an adequate cardiac output (forward pumping
of blood from heart to rest of the body)

Diagnosis :
Cardiac arrest is synonymous with clinical death. A cardiac arrest is usually diagnosed clinically by the absence of a pulse. In
many cases lack of carotid pulse is the gold standard for diagnosing cardiac arrest, as lack of a pulse (particularly in the
peripheral pulses) may result from other conditions (e.g. shock), or simply an error on the part of the rescuer. Nonetheless,
studies have shown that rescuers often make a mistake when checking the carotid pulse in an emergency, whether they are
healthcare professionals or lay persons.
 CPR
Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial
ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous
blood circulation and breathing in a person who is in cardiac arrest. It is recommended in those who are unresponsive with
no breathing or abnormal breathing, for example, agonal respirations.

CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120
per minute. The rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or nose
(mouth-to-mouth resuscitation) or using a device that pushes air into the subject's lungs (mechanical ventilation). Current
recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR
method involving chest compressions only is recommended for untrained rescuers. In children, however, only doing
compressions may result in worse outcomes.[Chest compression to breathing ratios is set at 30 to 2 in adults.

CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to
the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful
resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart,
termed defibrillation, is usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is effective
only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather
than asystole or pulseless electrical activity. Early shock when appropriate is recommended. CPR may succeed in inducing a
heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous
circulation (ROSC) or is declared dead.
 CPR
Prone CPR
Standard CPR is performed with the person in supine position. Prone CPR or reverse CPR is CPR performed on a person lying
on their chest, by turning the head to the side and compressing the back. Due to the head being turned, the risk of vomiting
and complications caused by aspiration pneumonia may be reduced

Pregnancy
During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease
venous return.[8] It is therefore recommended that the uterus be pushed to the woman's left; if this is not effective, either
roll the woman 30° or healthcare professionals should consider emergency resuscitative hysterotomy.

Family presence
Evidence generally supports family being present during CPR. This includes in CPR for children.

Other
• Interposed abdominal compressions may be beneficial in the hospital environment. There is no evidence of benefit pre-
hospital or in children.
• Cooling during CPR is being studied as currently results are unclear whether or not it improves outcomes.
• Internal cardiac massage is manual squeezing of the exposed heart itself carried out through a surgical incision into
the chest cavity, usually when the chest is already open for cardiac surgery.
• Active compression-decompression methods using mechanical decompression of the chest have not been shown to
improve outcome in cardiac arrest.
 Foreign Body Airway Obstruction
Foreign body airway obstruction: a partial or complete blockage of the breathing tubes to the lungs
due to a foreign body (for example, food, a bead, toy, etc.). The onset of respiratory distress may be
sudden with cough.
Treatment of airway obstruction due to a foreign body includes:
• Adults: The Heimlich maneuver.
(Mild Airway Obstruction) Encourage him/her to continue coughing but do nothing else. Victims with
mild airway obstruction should remain under continuous observation until they improve, as severe
airway obstruction may develop.
(Severe Airway Obstruction - Conscious)
Apply up to five back blows as follows:
• Stand to the side and slightly behind the victim.
• Support the chest with one hand and lean the victim well forwards.
• Give up to five sharp blows between the shoulder blades with the heel of your hand.
• Check to see if each back blow has relieved the airway obstruction.
• The aim is to relieve the obstruction with each slap rather than necessarily to give all five.
If five back blows fail to relieve the airway obstruction, give up to five abdominal thrusts as follows:
• Stand behind the victim and put both arms around the upper part of his/her abdomen.
• Lean the victim forwards.
• Clench your fist and place it between the navel and xiphoid (lower part of the sternum).
• Grasp this hand with your other hand and pull sharply inwards and upwards.
• Repeat up to five times.
If the obstruction is not relieved, continue alternating five back blows with five abdominal thrusts.
 Foreign Body Airway Obstruction
• If the victim at any time becomes unconscious
• Support the victim carefully to the ground.
• Immediately activate EMS.
• Begin CPR (start with chest compressions)
• During CPR, each time the airway is opened the victim's mouth should be checked for any foreign body
that has been partially expelled. The incidence of unsuspected choking as a cause of unconsciousness or
cardiac arrest is low, therefore, during CPR routinely checking the mouth for foreign bodies is not
necessary.
• The Finger Sweep
Avoid use of a blind finger sweep and manually remove solid material in the airway only if it
can be seen. Use your baby finger for the sweep.
Children over 1 year of age: A series of five abdominal thrusts (a children's version of the
Heimlich maneuver).
Abdominal thrusts are dangerous on infants (below 1 year) because they may damage the
liver. Infants under 1 year of age: A combination of 5 back blows (with the flat of the hand)
and five abdominal thrusts (with two fingers on the upper abdomen).
• Turn the infant into a head-downwards supine (on the back) position. This is achieved safely by placing the
free arm along the infant's back and encircling the base of the head with the hand.
• Support the infant down your arm., which is placed down (or across) your thigh.
• Identify the position for chest compressions (middle of lower sternum).
• Give five chest thrusts; these are similar to chest compressions but sharper and delivered at a slower rate.
 Foreign Body Airway Obstruction
Foreign bodies may cause either mild or severe airway obstruction. The signs and symptoms
enabling differentiation between mild and severe airway obstruction are summarized in the
picture below.
It is important to ask the conscious victim "Are you choking?"

General signs of FBAO: attack occurs while eating, victim may clutch at neck.
As most choking events are associated with eating, they are commonly witnessed. Thus, there is
often the opportunity for early intervention while the victim is still responsive.
 References
https://www.slideshare.net/falmouthfire/basic-
extrication-training
https://en.wikipedia.org/wiki/Soft_tissue_injury
https://en.wikipedia.org/wiki/Basic_life_support
https://www.aclsmedicaltraining.com/respiratory-arrest/
https://en.wikipedia.org/wiki/Cardiac_arrest
https://en.wikipedia.org/wiki/Cardiopulmonary_resuscita
tion
https://www.medicinenet.com/first_aid/article.htm#first
_aid_kit
http://corkwatersafety.ie/choking/