응급조치요령

요즈음 응급구호 자원봉사를 위해 응급처치법을 배우느라 정신이 없습니다. 더우기 재무나 세무와는 달리 뼈나 혈관 등의 명칭은 한국어로 바꾸기도 쉽지 않은 라틴어가 많아 그냥 외우고 있습니다. 아직 저도 완전히 숙달된 것은 아니지만 공유하고자 올립니다.   간단히 말하자면 어떤 이유이던지 산소가 인체에 공급되지 않으면 뇌, 폐, 심장은 4분, 주요장기는 45분, 피부와 근육은 3시간이 지나면서 죽기시작합니다. 그래서 가장 중요한 것이 호흡과 혈액순환이라는 것을 염두에 두시고 읽어보시기를 바랍니다.   감사합니다.   Medical First Responder Student Manual                                                                                                             2011.5.28 1.   Assessment Protocol for Emergency Scene Management A.    Scene survey: Your safety must come first, were gloves! B.      Primary                         i.         Level of Consciousness(AVPU) 1.      Alert: Talk opening eyes 2.      Verbal: Reply to questions 3.      Pain: Response to pinch 4.      Unresponsive                       ii.         ABC 1.      Airway A.      Conscious Patient: If they speak B.      Unconscious Patient                                                    i.         Open: Head tilt, chin lift                                                  ii.         Inspect: Remove foreign from mouth within 15 sec                                                iii.         Clean: If required                                                 iv.         Secure: Insert OPA or NPA or recovery position 2.      Breath: Feel for air movement 3.      Circulation A.      Conscious: Check pulse presence only at wrist B.      Unconscious: Check in the neck                      iii.         Defibrillation: AED and CPR by 2-30/15/15 for 5/4/3 thousand                       iv.         Rapid Body Survey: For bleeding or fracture in 30 sec.                        v.         Oxygen within 30 min or humidification C.    Secondary                         i.         SAMPLE: symptoms, allergies, medication, past history, last oral intake, events leading to the injury                       ii.         Vitals 1.      Respiratory Status: 12-20 breaths/min 2.      Heart Rate: 60-100 beats/min (five times) 3.      Skin condition: Pink, Dry, and Warm 4.      Pupils: Constricted for drug, Dilated for lack of Oxygen 5.      Blood Pressure: 6-90/14-150                      iii.         Head to Toe D.    Handover   2.   The First Responder A.      Roles and responsibilities B.    Legal and ethical issues                         i.         Age definitions: infant-1-child-2ndary sex char.-adult                       ii.         Breach of duty 1.      Failure to obtain consent 2.      Failure to provide care up to the level of training received 3.      Providing care beyond the level of training received 4.      Inappropriat3 termination of care                      iii.         Reporting criminal acts: abuses, assault and suicide C.     Infection control D.     Critical Incident Stress E.    Anatomical terminology                         i.         Topographical terms Ante/post/sup/inferior proximal/distal flexion/extension                       ii.         Systems of body 1.      Respiratory/digestive/urinary/Cardiovascular 2.      musculoskeletal/nervous/integumantary 3.      reproductive/endocrine   3.   Airway and Breathing Management A.    Opening and maintaining the airway                         i.         The recovery position 1.      Place the closer arm straight out and the other at neck 2.      Bend the farer leg at the knee 3.      Place your hand at the neck and support throughout the roll 4.      Roll the patient toward you by pulling the bent knee                       ii.         The Haines position: 1, 2, reach behind the patient’s shoulder, 4 B.    Clearing the airway                         i.         Begin ESM for choking                       ii.         Let the patient cough up the object for a few minutes                      iii.         Use abdominal thrust(or chest for larger/pregnant) 1.      Stand behind the patient ready to support 2.      Press your fist against abdominal not ribs by forearms                       iv.         When the patient become unconscious 1.      Send someone for 911 and AED 2.      Open, inspect and clean 3.      Assess for normal breathing for 10 sec. 4.      Breathe into the patient’s mouth 5.      Reposition and check your seal and try one more 6.      Begin chest compressions 7.      Ventilate twice and give chest compressions 8.      When the patient breathe, check for a pulse 9.      If no pulse, begin CPR 10.    If breathing is abnormal, provide AR C.     Artificial ventilation (AR) D.     Oxygen administration   4.   Circulatory Management A.      Cardiopulmonary resuscitation B.      Automated external defibrillation (AED) C.    Severe bleeding                         i.         Begin ESM                       ii.         Perform primary assessment and administer 100% oxygen                      iii.         Apply direct pressure and indirectly together when needed 1.      Lower arm: brachial, inside of the upper arm 2.      Leg: femoral, groin area 3.      Head to toe: head(superficial temporal, external maxillary), neck-carotid, wrist(radial, ulnar), leg-popliteal, foot(dorsalis pedis, posterior tibial) 4.      Never use indirect pressure for fracture to the limb                       iv.         Check pulse, movement and sensation before and after bandage 1.      Add another dressing when blood soaks 2.      Never remove an object embedded in a wound 3.      Loosen the bandage when the circulation is impaired                        v.         Perform secondary assessment D.    Shock                         i.         Time for organs to survive without oxygen 1.      4 min: lungs, heart, brain 2.      45 min: contents of the abdominal cavity 3.      3 hour: skin, muscle cells                       ii.         Cardiovascular system: heart, vessels, 6 liters’ blood 1.      Veins to right atrium, right ventricle, lungs to have oxygen 2.      To left atrium, left ventricle, arteries to give oxygen                      iii.         Symptoms of shock 1.      Compensatory A.      Anxiety: when circulation lacks, the patient becomes B.      Pale: the brain robs it from skin first C.     Shortness of breath: it speeds up the respirations D.     Fast heart rate: it speeds up the heart E.      Weakness: the muscles are being deprived of circulation F.      Nausea: stomach being deprived of circulation also. 2.      Decompensatory A.      Thirst: due to the lack of fluids B.      Confusion: the brain has already tried everything C.     Increased deep respirations: due to the build up of acids D.     Unconsciousness: the brain shuts itself down to conserve E.      Low blood pressure: acids have filled the cells to death                       iv.         Assessment of shock 1.      Perform a primary assessment and administer 100% oxygen 2.      Treat the injury that is causing the shock 3.      Keep the patient warm 4.      Elevate leg by 30 cm   5.   Assessment A.      ESM and primary assessment B.      Secondary assessment   6.   Medical Emergencies A.    Respiratory system                         i.         The airway 1.      Nose/mouth, pharynx 2.      trachea(epiglottis, larynx), left/right bronchi 3.      bronchiole, alveoli                       ii.         Lungs: inner/outer pleura                      iii.         Diaphragm: intercostal muscles B.    Cardiovascular system                         i.         Pulmonary circulation 1.      Right ventricle, pulmonary valve, right/left pulmonary artery, lungs 2.      right/left pulmonary veins, left atrium, mitral valve, left ventricle                       ii.         Systemic circulation 1.      aortic valve, aorta, artery, capillaries 2.      veins, superior/inferior vena cava, right atrium, tricuspid valve C.     Medical conditions (diabetes and seizures) D.     Behavioral emergencies   7.   Environmental Emergencies A.      Heat and cold injuries and illnesses B.      Poisons, bites and stings   8.   Bleeding and Soft Tissue Injuries A.      Wounds and bleeding B.      Chest injures C.    Gastrointestinal and genitourinary injuries                         i.         The digestive system 1.      Mechanical: mouth, pharynx, esophagus 2.      Chemical A.      Stomach, small/large intestines, rectum B.      Liver/gallbladder-bile, pancreas-insulin 3.      Lymphatic system: spleen                       ii.         The urinary system 1.      Urine: Kidneys, ureters, urinary bladder, urethra 2.      Blood: Abdominal aorta, kidney, inferior vena cava D.    Burns                         i.         The rule of nine 1.      Adult: chest9, abdomen9, each arm9*2, upper/lower back9*2, each front/back leg9*2*2, Head/neck9, genital1 2.      Child: chest9, abdomen9, each arm9*2, upper/lower back9*2, each front/back leg7*2*2, Head/neck18, genital1                       ii.         Critical 1.      1st: 70% or more 2.      2nd: 30% of adult or 20% of child 3.      3rd: 10% of adult, 2% of child or any part of the face, hands, feet or genitals                      iii.         Treatment 1.      Never remove clothing which is stuck to the burn nor break blisters 2.      Immerse in cool water 3.      Dress the wounds with a sterile non-adherent dressing 4.      Keep the casualty warm E.      Eye injuries   9.   Musculoskeletal Injuries A.    Head, spine and pelvic injuries                         i.         Central nervous system 1.      bone A.      head: Cranium, face B.      Spine: cervical7, thoracic12, lumber5, sacrum5, coccyx4 2.      Nerve A.      Brain: cerebrum-think, cerebellum-act, medulla-organ B.      Spinal cord: within 33 vertebrae 3.      Function A.      Sensory/motor nerves B.      Autonomic/voluntary nervous systems                       ii.         Peripheral nervous system 1.      Cranial nerves 2.      Spinal nerves B.      Immobilization and packaging C.    Bone and joint injuries                         i.         Axial skeleton 1.      Head: cranium, mandible 2.      Body: sternum/ribs, xyphoid process, spine                       ii.         Appendicular skeleton 1.      Upper extremity A.      Shoulder girdle: scapula, clavicle B.      Arm: humerus, elbow joint C.     Forearm: radius/ulna, wrist joint D.     Hand: carpals8, metacarpels5, phalanges14 2.      The pelvis and lower extremity A.      Pelvis: sacrum, pelvis bones, hip joints B.      Upper leg: femur, patella C.     Lower leg: tibia/fibula, ankle joint D.     Foot: tarsals7, matatarsals5, phalanges14   10.  Emergency Childbirth and Miscarriage A.      Emergency childbirth and miscarriage   11.  Special Conditions and Operations A.      Lifting and carrying B.      Communication with EMS C.     Documentation and record keeping D.     Patient transportation