• Jason Roosevelt • Certified for 14 years – Adjunct Faculty at Phoenix College • Teaching for 8 years – ASHI/AHA CPR instructor trainer • Teaching for 8 years • Fire Communications Lead – 8 Years If you are the first on the scene of accident that results in an injury or serious illness, you may be the only link between a victim and emergency medical care. Your role is to take action, whether by providing first aid, seeking medical help or calling 911. Your actions may improve the victims chance of recovery. The following slides will provide specific information from The American Safety & Health Institute (ASHI) on basic first aid procedures. • The important of this training is for the first person on the scene of an accident or emergency illness to know the steps to keep the patient alive: • HELP UNTIL QUALIFIED HELP ARRIVES! • At work, injuries, and illnesses kill more than two million people in the world each year. • 1 death every fifteen seconds. • 6000 people a day. • By focusing on safe practices and making healthy choices we can prevent this horrible tally of injury, illness, disease, and death. • Once injury or sudden illness has occurred, providing effective first aid can make the difference between life and death, rapid vs. prolonged recovery, and temporary vs. permanent disability. • This program focuses on what you must know and do in order to maintain your composure and provide confident, effective first aid care. • METHOD: Physical skill demonstration by student in classroom and assessed by ASHI authorized instructor • Demonstrate Proper Removal of Contaminated Gloves • Perform the Emergency Action Steps for an Unresponsive and Responsive Victim • Place a Victim in a Recovery Position • Control Severe Bleeding and Manage Shock • Manually Stabilize an Injured Limb • Manually Stabilize a Suspected Spinal Injury • Infectious Illnesses – There have been no documented cases where use of training manikins has been responsible for transmission of bacterial, fungal, or viral diseases. – ASHI authorized instructors routinely and thoroughly clean and disinfect training manikins. – To prevent spread of infectious illnesses, both instructors and students should clean their hands often, using alcohol-based hand sanitizers or soap and water. • Infectious Illnesses Please do not participate if: – Your hands, mouth, or lips have skin lesions. – You are ill. • To prevent injury during skill practices: – Avoid awkward or extreme postures of the body. – Do not practice moving simulated victims if you have a history of back problems. – Practice of these moves may aggravate previous back injuries. • Reason for Learning – Common legal issues are an important element of care and a frequent concern of First Aid Providers. • Always identify yourself prior to requesting permission to treat them. - By treating the patient to the best of your ability, treating within your level of your training, are neither reckless or negligent and are acting in good faith, reduces the chance you will be sued. – This does not protect you from gross negligence. – “Act as any prudent person would.” Good Samaritan Principle and Laws • • • • Legal principle/law based on Biblical story. Prevents a rescuer who has voluntarily helped a stranger in need from being sued for 'wrongdoing.' Designed to encourage people to help in emergencies. Generally protect you from liability as long as you: • Are reasonably careful • Act in “good faith” (not for reward) • Do not provide care beyond your skill level • Good Samaritan Laws and Principles – Different from state to state, province to province, and country to country. – You should be familiar with Good Samaritan laws in the state where you live and in other states or countries where you work or travel. • Obtain Consent • Consent means permission – A responsive adult must agree to receive first aid care. – Expressed Consent means responsive victim gives his or her permission to receive care. – Implied Consent means that permission to perform first aid care on an unresponsive victim is assumed. • Special Consent Situations – Children • Consent must be obtained from a parent or guardian prior to administering any care. – DO NOT delay treatment if a parent or guardian can not be located. – Mentally Challenged • Attempt to obtain verbal consent. If not able to communicate effectively, follow implied consent rules. – Intoxicated or Under the Influence • If a person has an altered level of consciousness, or is too intoxicated to make rational decisions, implied consent applies. When Caring for Older Persons • An elderly person suffering from a disturbance in normal mental functioning, like Alzheimer's disease, may not understand your request for consent. • Expressed consent must be gained from a family member or legal guardian. • When life-threatening situations exist and a family member or legal guardian is not available for consent, care should be given based on implied consent. Prevention • No evidence of a single successful lawsuit in the United States against a person providing first aid in good faith. • Still, it’s necessary to use common sense. – Never attempt skills that exceed your training. – Don't move a victim unless their life is in danger. – Call for an ambulance immediately, even if you decide not to give first aid. – Always ask a responsive victim for permission before giving care. – Once you have started first aid don't stop until qualified help arrives. • Refusing Treatment – A conscious, mentally competent adult has the right to refuse treatment. – Try to persuade the patient to accept treatment. • Confidentiality - Keep all patient information confidential. • Abandonment – DO NOT leave your patient prior to transfer of care to another trained person. A 5-year-old child suddenly turns blue and stops speaking while eating. No parent or legal guardian is present. 1.Do you need permission to care for the child? 2.Why or why not? 3.What is the legal term for this? A 37-year-old trips and falls. His right forearm is painful, swollen, and looks broken. 1.Do you need permission to care for the victim? 2.Why or why not? 3.What is the legal term for this? • Your safety must be your first priority. – You can’t help anyone if you become injured. • Make sure the scene of the accident or illness is safe before you enter. • If the scene is not safe then wait for trained help with the proper equipment and/or personnel to safe make it safe. • NOTE: First Aiders must be aware of the risks associated with emergency medical care. • Diseases can be air borne or blood borne. • Any body fluid can carry diseases. Reasons for Learning • Bloodborne pathogens are viruses or bacteria that are carried in blood and can cause disease in people. • Risk of getting disease while giving first aid is extremely low. • Observing universal precautions for victims of all ages will make it lower. • The best prevention of transmitting any disease is the use of “Protective Barriers”. • The use of gloves, face masks and eye protection is recommended. • These items should be part of any First Aid Kit. • After treating any patient you should always wash your hands. • One of the most effective ways of preventing transmission of a disease is to wash your hands after restroom. • Cover all cuts, scrapes, hangnails, rashes, etc. • Minimize splashing of body fluids • Handle sharp objects with caution • Not handle food, cigarettes, make-up, etc. when around bodily fluids • Use bleach 1:10 solution to clean up any spills or bodily fluids – 1oz bleach to each 10oz of hot water • Universal Precautions is a way to limit the spread of disease by preventing contact with blood and body fluids. – To “observe universal precautions” means that whether or not you think the victim’s blood or body fluid is infected, you act as if it is. – Observe universal precautions for victims of all ages. Personal protective equipment – A barrier between you and victim’s blood or body fluid. – Wear disposable, protective gloves when performing first aid. If a glove is damaged, don't use it! – Goggles or safety glasses with side protection should be used to help protect your eyes. – If you find yourself in a first aid situation without standard personal protective equipment, improvise. • Use an alcohol-based hand rub to clean your hands and other exposed skin after providing first aid. – If an alcohol-based hand rub is not available, wash with soap and water. – Decontaminate all surfaces, equipment and other contaminated objects as soon as possible • Workers designated by employers to give first aid must be provided appropriate personal protective equipment and receive additional training on how to eliminate or reduce exposure and what to do if exposed to blood or other potentially infectious materials (OSHA Standard 1910.1030). You are called to attend to a 45-year-old coworker who is bleeding profusely from the neck after being struck with a pry bar thrown from the intake chute of a rock crusher. The victim is slumped in a corner of the lower platform of the machine with the pry bar in his lap. 1. Should you “observe universal precautions”? Why or why not? 2. What protective equipment should you wear/use? Responding to Emergencies • Experience has led to the development of 3 simple steps – Assess – Whenever you recognize an emergency, you should: • Assess the emergency scene for safety. Is it safe to approach the victims? If not safe, alert EMS for help. Look for additional bystanders for assistance and make them aware of any safety concerns • If you can approach, assess the victim(s) for life-threatening conditions. Assess victims for breathing, circulation or hemorrhaging (severe bleeding) • Experience has led to the development of 3 simple steps – Alert – • EMS for medical assistance if necessary – Attend – Complete a “head to toe” exam and provide necessary care until advanced medical help arrives and takes over. • Emergency rescue is a procedure for moving a victim from a dangerous location to a place of safety • In most cases, a First Aid Provider should not move an injured person. – Emergency services personnel are the best trained and equipped to do this, and you should use them. – However, in a life-threatening emergency or catastrophic disaster, there may not be time to wait for professional help. – In these cases, it may be necessary to perform an emergency move. • Fire or danger of explosion • Danger of asphyxia due to lack of Oxygen or presence of gas • Serious traffic hazard • Risk of drowning • Exposure to cold / heat • Possibility of injury from collapsing walls or building • Electrical injury or potential injury • Pinning by machinery • • • • • • Avoid unnecessary disturbances Ensure open airway Control Bleeding Check for Injury Immobilize injured parts before moving Transport • • • • • • • Pulling the Victim Lifting the Victim Supporting the Victim Chair Carry Two Man Carry Blanket Lift Three Man Hammock Carry Drags • Drag victim in the direction of the long axis of the body to protect spine as best as possible. • Never pull victim sideways or pull head away from neck and shoulders. Sparks from a grinding operation has caused an explosion and fire, knocking a nearby coworker off a suspended scaffold. The 12-foot fall has knocked the worker unconscious. The scene is not safe. and there is no time to wait for professional help. 1. Should you perform an emergency move? 2. If no, why? 3. If yes, how? • Call 9-1-1 or your number local emergency when you suspect any type of serious injury or illness. • When in doubt, CALL 911 !!! • Know your location, phone number and what the exact emergency is. Paramedics and Emergency Medical Technicians are trained to prioritize their patients and make the transportation decision based on the patient s injuries. Triage • If there is more than one victim at the scene of an emergency, the first aid providers should prioritize or classify the injured victims. This process is called triage. It is the best way to help and provide care that would benefit the greatest number of victims. The first aid provider(s) should classify the victim’s priority status into one of four groups: Triage • Life-threatening injuries or illnesses that may be corrected or treated successfully. – – – – – – – – – Respiratory arrest or obstruction Suspected heart attack severe bleeding unconscious or unresponsive severe head injuries open chest wound suspected spinal injury abdominal wounds severe burns or severe shock • Assessment Time is critical. The first aid provider should assess victims in a rapid manner. – Less than 1 minute Triage • Not life-threatening injuries. – Example: (moderate blood loss, moderate burns, fractures, eye injuries or other illnesses or injuries in which the victim appears to be stable. Triage – • Victims who appear to be stable or are able to move to a specified site for classification. • This group should be identified by announcing “ anyone able to walk, please move to (a specified area) or a safe location” Triage – • Victims who have exposed brain matter, have been decapitated, have severed trunk or have been incinerated. • This also includes victims who have been in cardiac arrest for over 20 minutes – With exception to those that are in cardiac arrest due to severe hypothermia or cold water drowning Reasons for Learning • The Emergency Action Steps are intended to help the First Aid Provider spot and care for life-threatening problems in a responsive or unresponsive victim. • A First Aid Provider should perform these steps quickly - in a minute or less. • Assess Scene – If scene is unsafe or at anytime becomes unsafe, GET OUT! • Assess Victim – Not moving? No response? • Alert – If no response, alert EMS (Call 9-1-1) or activate Emergency Action Plan. • Attend to the ABCs • A – Airway – Patent? – Obstructions • B – Breathing – Rate, Rhythm and Quality • C – Circulation – Rate, Rhythm and Quality – Skin Condition • Color, Temperature or Condition • D – Defibrillation – For those trained in CPR with AED • Airway should be open and free of obstructions (patent) • Use Head Tilt-Chin Lift or Jaw Thrust to open airway • Only remove obstructions you can see – NO BLIND FINGERSWEEPS – A=AIRWAY. Open Airway • Tilt head, lift chin. • Respiration should be free of any wheezing, snoring or gurgling – Open Airway to assist • If choking, perform appropriate intervention • Normal adult breathing should be 12-20 times per minute. (Once every 3-5 seconds) • Normal child/infant breathing should be 20 times per minute • Perform rescue breathing if necessary • B=BREATHING. Check Breathing – Look, listen, and feel for at least 5 seconds, but no more than 10. – If victim is not breathing normally or you are unsure, perform CPR. – If breathing normally… • Circulation includes pulse and skin condition • Normal adult pulse should be 60-100 • Normal child/infant pulse should be 100 • Pulseless, START CPR • Pulse rate below 30, START CPR • Observe skin conditions, treat for shock or environmental problems as necessary. • C=CIRCULATION – Look for blood pumping or pouring out of a wound. – Control it with direct pressure. – Look for normal tissue color. Use your exposed wrist to feel for body temperature. • Only way to reverse the fibrillation of the heart. • Part of CPR • Life Saving • Continue to Attend to the ABCDs – – – – – Keep airway open. Assure normal breathing. Control bleeding. Monitor tissue color and temperature. Help maintain normal body temperature. If it’s available and you are properly trained, give emergency oxygen. • When Caring for Children – – Caring for children is very stressful. You must remain calm. In the child daycare setting, see your Facility Emergency Action Plan for details regarding alerting EMS, notifying parents, and supervising other children during a medical emergency. • When Caring for Older Persons – – – – – Remain alert for special hazards due to chronic illness in older persons. In home-care or assisted living settings, look around carefully. Victim may be contaminated with infectious body fluids such as urine, feces, vomit, or weeping wounds. Furniture, wheelchairs, walkers, and medical devices may also be contaminated. Observe Universal Precautions. Use Personal Protective Equipment! • You are called to help a sick woman in the front office. The woman is lying on the floor and appears lifeless. Her lips are bluish. You squeeze her shoulder and say “Are you okay?” There is no response. 1. 2. • What should you do first? Then what? You are called to help a sick child on the playground. The child’s lips are blue, he is short of breath and cannot stop coughing. 1. 2. What should you do first? Then what? • Reason for Learning – Recovery positions prevent an unconscious victim’s tongue and secretions from blocking the airway and causing death. • First used in hospitals to protect unconscious patient’s airway from being blocked by tongue or secretions as the individual “recovered” following surgery. – Has since become an important technique in first aid. • • Place an unresponsive, uninjured victim who is breathing normally on his or her side. Especially if victim is having difficulty with secretions, is vomiting or if you must leave victim alone to get help. • • • • Make sure body position is stable so the victim does not roll onto the face or back. Make sure there is no pressure on chest that could make it harder to breathe. Because blood flow in the lower arm may be impaired, turn victim to opposite side if he or she is in recovery position for more than 30 minutes. Check breathing regularly. • As a rule, you should not move an injured victim. However, there are times you may have to; – – – When victim is lying flat on his or her back and has debris, blood, or secretions in the mouth that might block airway. When you must leave victim alone to get help. When victim is lying on a very hot or very cold surface, and you need to get a blanket under them to maintain a normal body temperature. • Use HAINES position for injured victim – – – – HAINES stands for “High Arm IN Endangered Spine” and is a modified recovery position. When using HAINES position, there is less neck movement and less risk of spinal cord damage. Roll victim to side so that head rests on extended arm. Bend both legs at knees to stabilize victim. • HAINES Position • Prevention – – – Choking on vomit is a cause of severe brain damage and death for victims of accidental alcohol and drug overdose. These problems may be prevented when victim is placed on his or her side, because fluid can drain easily from mouth. Never leave an unresponsive person, including one “passed out” from excessive alcohol or drug use, alone while lying flat on his or her back. • You are attending to an unresponsive victim who fell 17 feet through a roof opening onto a concrete floor. The victim is lying face up on his back. You see blood pouring from his mouth and hear gurgling. EMS has been alerted. The scene is safe. Bystanders tell you not to move the victim. – What should you do? Why? – Signs and Symptoms – Level of Consciousness – Primary Complaint – Check Vital Signs • ABC’s • Respiration • Pulse • Skin Condition • Eyes – Allergies – Allergies to foods, medications, insects or other things – Look for medical alert bracelets – Ask victim if they may have been exposed to an allergen – Medications – Is the victim taking any medications – Under the influence ? – Pre-existing Medical History – Look for medical alert bracelets, necklace etc. – Ask victim about any medical conditions that may relate to their current problems – Last Meal – Ask victim when they ate last, and when did they eat? – Events – What events led up to the illness or injury – What were they doing when the problem started • Normal: 98.6 F ( 37 C) ) • Over 100 F is abnormal – Heat Stress – Heat Stroke – Febrile Seizure • Under 97 F is dangerous – Hypothermia – Frostbite • Temperature – Hot – Warm – Cool • Color – Pink – Red • Heat, Burn or Carbon Monoxide – Pale • Shock – Ashion • Lack of Oxygen/Shock – Cyanotic • Lack of Oxygen • Condition – Dry – Clammy • Moist – Diaphoretic • Sweaty • Capillary Refill – Normal is less than 2 seconds – Press the fingernail and count until pink returns. • More than 2 seconds is a sign of shock • For dark pigmented patients, you can check the fingernail beds, mouth inside the mouth, and/or eyelids for change. • “PERL” is normal – – – – P - Pupils are: E – Equal and R – Reactive to L – Light – Unequal size – possible head injury – Un-reactive – • Constricted – Drugs or other disease • Dilated – Drugs, possible head injury – Unconscious ? • Normal Adult Blood Pressure range for an adult is 100/60 to 140/100 • ???/xxx Is the systolic pressure – Pressure exerted in the artery when the heart contracts • xxx/??? Is the diastolic pressure – Pressure of the vessels when heart is at rest • “Perfect Pressure” is 120/80 • Low blood pressure can cause shock, dizziness, decreased consciousness • High blood pressure can cause chest pain, stroke or dizziness or decreased consciousness • Breathing Condition – Rate - # of times per minute – Rhythm – Normal or erratic – Quality – Shallow, normal or deep • Agonal ? – Slow, long and gasping respirations » BREATHING EMERGENCY • Snoring or gurgling ? – Use airway maneuvers • Wheezing ? – Asthma or Allergic Reaction » Treat Accordingly • Normal Respiratory Rates – Adult – 12-20 – Child – 15-30 – Infant – 25-50 • “every 3 to 5 seconds” • Any person not breathing at least 10 times per minute, start rescue breathing or CPR as necessary. • Normal Pulse – Adult – 60-100 – Child – 80-120 – Infant – 100-120 • Elevated Pulse is a sign of shock. Treat accordingly • Low Pulse can be from variety of ailments. Treat symptoms. • Pulse Under 30, START CPR. • A normal adult is aware of who they are, where they are, current time, and recent events or what happened. • A patient may be: – – – – ALERT & ORIENTED CONFUSED DISORIENTED or UNCONSCIOUS • Adult/Child (AVPU) – Awake and Alert (Awake) – Responds to Talking (Verbal) – Responds to gently shaking shoulder and shouting (Tactile) – Responds to Pinch inside of upper arm (Painful) – Does not respond (Unresponsive) • Infant (AVPU) – – – – – Awake and Alert (Awake) Responds to Talking (Verbal) Responds to gently flicking bottom off foot Responds to Pinch inside of upper arm (Painful) Does not respond (Unresponsive) MOBILITY AND MOVEMENT • Normal Movement – Pain Free and without restriction – Painful • Possible strain, sprain, dislocation or fracture • Unable to move – Paralysis from injury – Paralysis from stroke REACTION TO STIMULI • Awake • Responds to Verbal Stimuli – Are you OK? • Responds to Tactile Stimuli – Gentle Shaking/Tapping • Responds to Painful Stimuli – Pinch • Unresponsive – Breathing? • Be aware of paralysis and injuries • AMA recommends anyone with a medical condition, such as diabetes, heart problems, allergies, etc. wear or carry medical alert identification. Consists of air passages lungs passages, lungs, muscles, and nerves. • Purpose: – To provide a constant supply of oxygen and release carbon dioxide. • Breathing is centrally controlled by the brain. • Respiration can be: – – – – Absent Slow or Fast Deep or Shallow Gasping, Labored or Choking • Treat as needed • Normal Breathing – Does the patient appear to be breathing normally? – Rate is not important as quality – Skin color and overall appearance should be considered • • • • • • • • Choking Asthma Drowning Poisoning Suffocation Smoke Inhalation Drug Overdose g Electrical shock • A disease in which air passages in lungs become narrower from swelling and extra mucus. • This limits airflow into and out of lungs and causes wheezing and/or shortness of breath. • Asthma attacks (or episodes) can be caused by tobacco smoke, dust mites, furred and feathered animals, certain molds, chemicals, and strong odors. • Signs and Symptoms – – – – – – – – – – – Can be very mild to life-threatening. Constant coughing, especially worse at night and early morning. Anxiety. Sudden onset of wheezing. Chest tightness. Shortness of breath. Extreme difficulty breathing. Bluish color to lips and face. Pounding heart. Sweating. Altered mental status. • • An asthma attack or episode can quickly get worse. If victim is unable to administer prescribed medication without assistance, you should help administer the prescribed dose in the correct manner. • Metered Dose Inhaler – – – – Delivers specific amount of medicine. Remove cap and shake inhaler. Hold inhaler upright. Tilt head back slightly and breathe out. Press down on inhaler to release medicine; start to breathe in slowly for 3 to 5 seconds. • Metered Dose Inhaler (cont) – – – – Hold breath for 10 seconds to allow medicine to go deeply into lungs. Repeat as directed. There are many different types and brands of inhalers that require different techniques (i.e.; spacers, dry powder inhaler, etc.). Assist the victim with his or her medication as prescribed. Nebulizer • • • • Turns liquid medicine into a mist for inhaling. Place air compressor on sturdy surface. Put medicine into nebulizer cup. Assemble nebulizer cup and mouthpiece. • Nebulizer (cont) – – – – Connect tubing to air compressor and nebulizer cup. Turn on air compressor. Take slow, deep breaths. If possible, hold each breath for 2-3 seconds to help medicine get into lungs. Continue until nebulizer cup is empty (about 10 minutes). • Alert EMS if the victim has any of the following: – – – – – – – – – No improvement 15-20 minutes after initial treatment with medication. Constant coughing. Difficulty breathing with chest and neck pulled in. Stooped body posture. Struggling or gasping. Trouble walking or talking. Child stops playing and can’t start activity again. Lips or fingernails are grey or blue. Comfort, calm, and reassure while awaiting EMS. • Anaphylaxis is a sudden, severe allergic reaction that involves the whole body. • Swelling of the lips, eyelids, throat, and tongue can block airway. • It is critical for anyone with a history of anaphylaxis to keep epinephrine autoinjectors on hand at all times. Signs and Symptoms: Rapid onset • Anxiety. • Hives/itching. • Sensation of heart pounding. • Nausea/vomiting. • Abdominal pain/cramping. • Diarrhea. • Epinephrine Auto-Injector – An auto-injector is a drug delivery system that is a pressure-activated injector for use in the rapid administration of epinephrine (adrenaline). – Each auto-injector is designed for a single use and is pre-filled with a precise dose of prescribed medication. Storage – Epinephrine auto-injectors should be stored at room temperature until marked expiration date, at which time unit must be replaced. – Auto-injectors should not be refrigerated as this could cause device to malfunction. • Storage (cont.) – – – – Auto-injectors should not be exposed to extreme heat or direct sunlight. Heat and light shorten the life of the product and can cause the medication to break down. To be effective, solution in the auto-injector should be clear and colorless. If solution is brown, replace unit immediately. First Aid • • • If victim has a history of allergic exposure and carries a lifesaving epinephrine autoinjector prescribed by a physician, help the person use it. If the victim is unable, you should administer it. Waiting for paramedics may significantly increase risk of death. • • • • Beneficial effect is relatively short. Auto-injector is for emergency use only and not a replacement or substitute for medical care. Some allergic reactions can be so severe that a single dose of epinephrine may not reverse the symptoms. Victim may carry an epinephrine autoinjector with 2-doses-in-1 device (Twinject). − Epinephrine Auto-injector* − – – – – – Directions for use: Unscrew yellow or green cap off carrying case and remove autoinjector from storage tube. Grasp unit with black tip pointing downward. Form fist around unit (black tip down). With your other hand, pull off gray safety release. Hold black tip near outer thigh. − Directions for use: (cont) – – – – – Swing and jab firmly into outer thigh until it clicks so that unit is at a 90° angle to thigh. Auto-injector is designed to work through clothing. Hold firmly against thigh for approximately 10 seconds. The injection is now complete. Window on autoinjector will show red. Remove unit from thigh and massage injection area for 10 seconds. − • • • • • Directions for use: (cont) Carefully place used auto-injector (without bending the needle), needle-end first, into storage tube. Screw cap of storage tube back on completely and send it with victim to hospital. Most of liquid (about 90%) stays in autoinjector and cannot be reused. Correct dose of medication has been delivered if red flag appears in window. Comfort, calm, and reassure while awaiting EMS. • • • • DO NOT ever put thumb, fingers, or hand over black tip. DO NOT remove gray safety release until ready to use. DO NOT use if solution is discolored or red flag appears in clear window. DO NOT place patient insert or any other foreign objects in carrier with autoinjector, as this may prevent you from removing auto-injector for use. • While attending a school field trip, an 8-year-old child with a history of asthma and allergy to peanuts complains of an itchy feeling in his mouth after eating ice cream. Ten minutes later, the child can’t stop coughing. His lips and face start swelling, and he develops a rash over his entire body. The child has been prescribed an epinephrine auto-injector, but it is in his backpack on the bus. – What should you do? How to Open the Airway •To open the airway, place one hand on the forehead, two fingers under the chin, and tilt the head back to where the chin points to the sky • DO NOT USE THIS TECHNIQUE IF YOU SUSPECT SPINAL INJURY • For suspected spinal injuries • Place thumbs on cheek bones, index and middle fingers at the angle of the jaw. • Press down on the cheek bones, then press out on the jaw to open the airway. • The anatomy of the infants airway is much smaller and can be occluded by tilting the head back too far. • Position the infants head into a “sniffing position” Foreign Body Airway Obstruction • Refer to Basic Life Support Procedures. • Facts – Atmospheric air contains approximately 21% oxygen – Your body consumes approximately 5% oxygen when you breathe – Air you provide during rescue breathing and CPR contains approximately 16% oxygen – 1 Breath every 3-5 seconds • Follow normal breathing rate guide • • • • • • Heart Arteries Veins Arterioles Venules Capillaries • Pulse Location – Carotid: the neck – Brachial: the upper arm – Radial: the wrist • Pulse Quality – – – – Absent Slow or Fast Weak or Pounding Irregular or Regular • A condition in which the heart is generating any no longer blood flow. • There will be no pulse or respiration. • Brain - 4 - 6 minutes • Heart - 4 - 6 minutes • Kidney - 45 - 90 minutes (Acute Myocardial Infarction) • When an artery in the heart becomes partially or totally blocked, it reduces stops to a portion or blood flow of the heart muscle. • Substernal Pain • Squeezing, Pressure or Heaviness in the Chest • Pain MAY Radiate to Jaw, Left arm or Both arms • Pain NOT relieved by rest • Cool, Clammy Skin • Shortness of Breath • Nausea • Feeling of Impending Doom • THE HEART ATTACK PATIENT MAY DENY ANY AND ALL SYMPTOMS OF A HEART ATTACK (Angina Pectoris) • The signs and symptoms of a Heart Attack usually brought on by stress and/or exercise. • Without heart permanent damage to the heart. • Is usually relieved by rest or nitroglycerin. • • • • • • • Call 911 Oxygen (if available) Position of Comfort (usually sitting) Keep Calm Loosen tight clothing Nothing to eat or drink Nitroglycerin as directed • Be ready to perform CPR on any patient complaining or showing symptoms of cardiac problems ..... • Is a red sticky fluid that carries oxygen to the body and removes waste products. • The normal adult has six liters of blood. • A newborn infant has about 300 ml. • Clotting of blood normal takes six to seven minutes. Types of Bleeding • Arterial – Bright red and spurting – Most serious. – Life threatening • Venous – Dark red and steady flow – Result of deep cut that opens a vein. – Bleeding must be controlled • Capillary – Dark red and oozing – Smallest and most numerous vessels in the body – Slow bleeding • Direct Pressure – Clean, dry cloth or bandage material – Add more dressings to control bleeding as needed. Do not remove soaked dressings. – Apply bandage material • Pressure Bandage • Elevation – Raise above the level of the heart • Pressure Points – Locate pressure point and apply pressure • Tourniquet – Last resort – Can cause tissue damage Direct Pressure Elevation Pressure Points • Brachial Artery – Put Thumb on outside of arm, fingers on inside of middle upper arm and Squeeze…. • Femoral Artery – Place heel of hand directly over femoral artery (located between upper leg and pubic area), lean forward keeping arm straight and apply pressure. Pressure Bandage with Pressure Points • USE ONLY AS A LAST RESORT !!!!!!!!! • Apply as close to the wound as possible • Once applied Never loosen • Get Help at Once!! • Can be life threatening • Call 911 if lasts over 30 min • Can be from high blood pressure, trauma or various other reasons • Do not swallow blood – Can cause vomiting • Pinch the nostrils – Between the nares and bridge • Keep patient in sitting position • Lean patient’s head forward • Apply a cold compress to the nose – Also back of neck if possible • The signs and symptoms of shock with no or minimal external bleeding. • May be life threatening. • Needs fast entry into the EMS system and treatment at a hospital. • Several Causes including trauma and disease. – Rectal Bleeding, Blood in urine, vomiting blood, vaginal bleeding (non-menstrual) – Blood from rectum, mouth, vagina or blood in urine – Bruise or contusion – Rapid pulse – Cool and/or moist skin – Painful, tender or hard spot on abdomen • Closed soft tissue injuries can be as little as a bruise or damage to a vital organ. • Minimal care can be given in the field for a closed soft tissue injury, keep the patient calm and have them transported to the hospital for further evaluation. – Bruises, Contusions, Lacerated liver or Fractured spleen • The key steps in treating a closed softtissue injuries are: – Protect the wound from further injury – Avoid rough handling – There may be a closed fracture • Open soft tissue injuries can be life threatening injuries. • Proper initial care is critical. • You must remove the clothing from the injury site for proper bleeding control – Unless clothing is melted to the skin or wound • NEVER REMOVE AN IMPALED OBJECT – Unless occluding the airway – Use bandages and materials to stabilize the object • The key steps in treating an open softtissue injuries are: – Stop the bleeding: • Direct pressure - the most efficient • Elevation - elevate the injured extremity • Pressure point - apply pressure on the appropriate pressure point • Protect the wound from further damage • Bandage the wound – Control bleeding – Do Not scrub body part – Wrap in clean cloth, place in sealed plastic bag and place in bag containing ice – Get help as soon as possible • Expose the wound • Apply direct pressure with dressing – Do not remove soaked dressings • Secure the dressing with a bandage • Check distal pulse Expose the Wound Apply Direct Pressure with Bandage Secure the dressing with a bandage Check the distal pulse • Shock is a condition which causes failure of the circulatory system to provide sufficient perfusion to parts of the body. • • • • • • • • • • • Restlessness and anxiety Weak and rapid pulse Cold and clammy skin Profuse sweating Pale or cyanotic face Breathing is shallow, labored, rapid, possibly irregular, or gasping Eyes dull or lusterless with dilated pupils Marked thirst Nausea or vomiting Falling blood pressure Possible fainting Shock Signs and Symptoms • Early: – • Victim appears uneasy, restless, or worried. Later on: – – – – – – – – Changes in responsiveness. Cool wet skin from heavy sweating. Pale or bluish tissue color. Shivering. Intense thirst. Nausea, vomiting. Shallow or gasping breathing. Below normal body temperature. • • • • • • • • Maintain a clear airway Control bleeding Give oxygen (if available) Elevate lower extremities Keep patient calm Prevent loss of body heat Keep victim lying down Do not give anything by mouth • RNCHAMPS • • • • • • • • Respiratory • Asthma or Obstruction Neurogenic • Spinal Injuries Cardiogenic • Heart Failure Hypovolemic • Loss of blood Anaphylactic • Allergic Reaction Metabolic • Loss of Fluids Psychogenic • Fainting Septic • Infection • Respiratory compromise • Obstruction or other restriction – Asthma, COPD, Emphysema • Wheezing/difficulty exhaling • Increased pulse rate • Coughing • Anxiety • Distended or Bulging neck veins • Shoulders hunched and chest pulled up by breathing effort • Sit Upright • Supportive Care – Inhaler or Nebulizer as directed • Damage to the spinal cord causing dilated blood vessels • Slow heart rate • Low Blood Pressure • Signs of Neck Injury • Keep still, elevate legs only if no trauma • Keep Warm • Treat ABC’s • Inadequate Heart Function • Chest Pain, Shortness of Breath, Nausea & Vomiting • Weak Pulse • Be prepared for CPR • Sitting Upright • Oxygen if available • Nitroglycerin as directed • • • • • Loss of Blood Control Bleeding as soon as possible Life Threatening Treat ABC’s First Cool Clammy Skin, Rapid and Weak Pulse, Change in mental status • Elevate legs, cover to keep warm, provide oxygen • Nothing to eat or drink • • • • • • • • Allergic reactions Reactions to environment Life Threatening Itching, Hives, Narrowed Airway, Vascular dilation, swelling and edema Cyanosis Treat airway problems first Supportive Care Call 911 – Consider Epi Pen if available. • ONLY IF TRAINED • Caused by excessive vomiting or diarrhea • Similar to hypovolemia • Treat signs and symptoms • Caused by temporary vascular dilation • Can be triggered by bad news, emotional problems, or any other sudden “shock” to the system. • May cause fainting or temporary loss of consciousness • Lay flat, elevate legs, remove from situation, keep warm • Normally Psychogenic Shock is self correcting. • Maintain a clear airway. • Assess for any injury that may have occurred as the patient fell. • Caused by infection • Symptoms will include pale skin, low blood pressure, warm skin and elevated heart rate. • Keep warm, elevate legs, provide supportive care • DO NOT MOVE A PATIENT WITH A HEAD INJURY, ALWAYS SUSPECT A SPINAL INJURY. • Head injuries may make a patient unconscious, confused, or violent. • Bleeding from the ears or nose may be relieving internal pressure) cerebrospinal fluid (pressure). • A late pupils sign may be unequal pupils. • Open or Closed Injuries • Signs & Symptoms – – – – – – – – – – Raccoon Eyes Battle Signs Decreased Mental Status Sleepiness Nausea or Vomiting Dizziness Bleeding from Eyes, Ears or Nose Clear fluid from ears Unequal pupils Slow to react Raccoon Eyes Battle Signs • Maintain the A,B,C’s • Control Bleeding: • Avoid excessive pressure on a suspected skull fracture. • Do not try to stop bleeding from the ears nose if you suspect that it’s cerebrospinal fluid. • Patient may vomit • Be ready to manage the airway. • Seizures may be caused by many conditions: – Head injuries, drugs, diabetes, or epilepsy. • A seizure is the involuntary contractions of the skeletal muscles. • Two types of seizures are: – Petite Mal and Grand Mal. – Febrile • DO NOT TRY TO RESTRAIN A PATIENT HAVING A SEIZURE . • Protect the patient from hurting themselves during the seizure. • Do Not Force anything into the patient’s mouth. • Monitor the patient’s breathing. Strokes Cerebral-Vascular Attack Strokes • “Brain Attack” • Blockage or Rupture of a blood vessel in the brain • Life Threatening • Call 911 • Sit Upright • Nothing by mouth Fractures and Dislocations • Bones, joints, and muscles give the body shape, allow movement, and protect vital internal organs. • Strains and sprains are injuries to muscles and joints; dislocations and fractures are injuries to joints and bones. • It is difficult to tell a dislocated bone from a broken (fractured) one. • A fall on level ground can cause a minor fracture, while a high-speed motor vehicle accident can cause severe fractures involving many bones. Fractures and Dislocations • Fractures can cause total disability. In rare cases, they can cut vital organs and/or arteries and cause death. • If an injured extremity is blue or extremely pale, alert EMS or activate your Emergency Action Plan immediately. • Most often, these injuries are non-lifethreatening. Fractures • Basically there are two types of Fractures: – Open - the skin has where been broken – Closed - where the skin has not been broken • Both types of fractures can result in serious blood loss. • DO NOT MOVE a patient until his fracture has been splinted. Moving the patient may cause further soft tissue injuries. Fractures – Closed Injury • Signs and Symptoms: – – – – – – – – – No open wound. Sharp pain. Swelling. Deformity. Tenderness. Bruising. Joint locked into position. Anxious, pale, clammy, weakness/fainting. Nausea/vomiting. Fractures – Open Injury • Signs and Symptoms: – – – – – – – – – Open wound. Bleeding wound may have bone sticking out. Substantial blood loss from open fractures is possible. Gunshot Wound (often causes open fractures). Pain. Swelling. Deformity. Anxious, pale, clammy, weakness/fainting. Nausea/vomiting. Fractures • May hear a bone snap • Pain & tenderness, difficulty moving injured body part • Swelling and discoloring • Grating Sound • Exposed Bone • Report of grating sensation • Shortening of injured leg/arm • Unusual angle or position of body part FRACTURE Dislocations • Dislocations - a deformity at a joint • NEVER TRY TO STRAIGHTEN A DISLOCATION!! • Keep the patient from moving until the joint has been splinted. Dislocations Dislocated Finger Dislocated Knee ICE • Apply ice or a cold pack to decrease pain, bleeding, and swelling. – Limit application to 20 minutes or less. Immobilize • Manually Stabilize Injured Limb – Gently place your hands above and below the injury to limit movement and prevent further injury while awaiting EMS Don’ts • • • • • DO NOT move victim if you think that there may be a head, neck, or back injury. DO NOT attempt to straighten a painful, swollen, or deformed arm or leg. DO NOT attempt to push bone back under skin. DO NOT allow a victim with leg, ankle, or foot injury to bear weight on it. DO NOT remove shoes or boots unless there is severe bleeding from foot. Sprains & Strains Sprains & Strains • Sprains and strains are injures to the muscles and/or ligaments around a joint. • It takes a X-ray to determine if it is a sprain, strain, fracture, or dislocation. • Treat all sprains and strains as if they were fractures. Properly splint the injury. First Aid for Sprains & Strains R–I–C–E R – Rest, try not to use the affected extremity I - Ice, apply a cold pack. Do not apply ice directly to skin. C - Compress, use an elastic or conforming wrap - not too tight. E - Elevate, above heart level to control internal bleeding. Child Care • When Caring for Children – – – – Fractures in young children are different than those in adults because bones are softer and more able to bend. Instead of breaking completely through when an injury occurs, bone may buckle and crack. This is called a “greenstick fracture” (like breaking a fresh, green branch). First aid treatment is generally the same as for adults. Elder Care • When Caring for Older Persons – – Loss of normal bone density, mass, and strength make the bones of older persons more brittle and more likely to fracture. First aid treatment is generally the same as for adults. Prevention • Prevention (children) – – – Sports and recreation are the leading causes of injury-related visits by children to emergency rooms. Forearm fractures account for 40 to 50 percent of all childhood fractures. Supervision of children, first aid training for coaches, and the use of protective devices may help to prevent serious injury. Prevention • Prevention (older people) – – – Injuries from falls in older people are a major public health problem in modern societies with aging populations. Many states and local areas have education and/or home modification programs to help older people prevent falls. Check with your local government's health department or division of elder affairs to see if there is a program in your area. Wrap Up Scenario • You are attending to a 37-year-old accidental shooting victim with an open fracture of the lower left leg. The victim is responsive and in significant pain. Broken bone ends are visible in the wound, which is bleeding – although not severely. The scene has been secured and there is no threat from the weapon. EMS has not been alerted. – What should you do? Spinal Injuries • Reasons for Learning – Spinal cord injury is a devastating condition that affects young and healthy people around the world. – Males are four times more likely to suffer spinal injury than females. – Proper first aid can prevent further injury as well as major physical and emotional burdens. Spinal Injuries • Spinal injury is often caused by motor vehicle collisions, gun shot wounds, falls, and sports injuries. • Injuries to the spine cause damage to the bones of the spine, the spinal cord, or to tissues and blood vessels surrounding the spinal cord. Spinal Injuries • Injuries to the spine block the brain's ability to communicate with other parts of body • If you suspect a victim could possibly have a spinal injury, assume the individual does! Spinal Injuries • DO NOT TRY TO MOVE A PATIENT WITH A SUSPECTED SPINAL INJURY. • Have patient remain still and wait for trained help to arrive. • Only reposition the head if the patient is not breathing using the Jaw Thrust maneuver. • Maintain a inline position • Monitor the rate of breathing of the patient. Spinal Injuries • Signs and Symptoms: – – – – – – – – – Altered level of consciousness. Spinal pain, pressure, or tenderness. Obvious injury to the neck, head, or back. Multiple injuries, including pain, swollen, deformed limbs. Numbness, tingling, burning, or loss of sensation in the hands, fingers, feet or toes. Weakness or paralysis in any part of the body. Loss of bladder or bowel control. Bullet or stab wound to head, neck or chest. Dove headfirst into shallow water. Spinal Injuries • Assume a spinal injury has occurred when victim: – Has been exposed to physical force and has any of the previous signs and symptoms. – Was in a motor vehicle (car, truck, motorcycle, ATV) or bicycle crash (occupant or pedestrian). – Fell from greater than a standing height – Has been exposed to physical force and appears drunk or older than 65. Spinal Injuries Caution • Pain and loss of function usually accompany a spinal injury but the absence of pain does not mean that the victim has not been significantly injured. Spinal Injuries • Manually Stabilize Suspected Spinal Injury – – – – Tell responsive victim not to move. Place your hands on both sides of victim’s head to stabilize it. Keep head, neck, and spine in line. Comfort, calm, and reassure. Spinal Injuries • Protect Airway – – If victim is or becomes unresponsive and has debris, blood or difficulty breathing from secretions in the mouth or you must leave to get help: Use HAINES position to protect airway. Spinal Injuries • • • • • • DO NOT ask injured victim to move in order to try to find a pain response. DO NOT move injured victim to test for a pain response. DO NOT move injured victim to perform a physical assessment. DO NOT bend, twist, or lift victim’s head or body. DO NOT move injured victim before medical help arrives unless the airway is in danger. DO NOT remove a helmet if a spinal injury is suspected. Spinal Injuries • When Caring for Children – – – Spinal injury in children is rare, but risk is greatest when child has multiple injuries or chest injuries. Distress and discomfort may make it difficult to restrict spinal motion in a child. Do your best to manually restrict child’s head in the position in which it was found. Spinal Injuries • Prevention – – – DO wear seat belts. DO NOT drink and drive. DO NOT dive headfirst into swimming pools, lakes, rivers, or ocean surf, especially when you do not know the depth of water or when water is not clear. Spinal Injuries • You are attending to an 18-year-old coworker who fell backwards approximately 12 feet from the top of a shelving unit onto a concrete floor. The victim is responsive and is complaining of a burning sensation in his hands. He says he is okay and wants to “walk it off”. – What should you do? • The key reasons for splinting: – Reduce the chance of damage to nerves, or blood vessels muscles. – Prevention of a closed fracture from becoming an open fracture. – Reduce pain. – Reduce risk of paralysis from a spinal injury. • Multiple types of materials could be used as splinting material. • Some samples are: – – – – – Cardboard Wood Air splints Pillow Folded newspaper • The key steps in treating a fracture or dislocation are: – Remove the clothing covering the fracture. – Do not try to replace protruding bones. – Splint in position found • Unless no pulses are present in extremity – Note circulation and nerve status. – Use padded splints or pad the splint. – Immobilize the fracture and joints above and below the fracture. – Always splint fractures before moving the patient. – Recheck circulation and nerve status after splinting. • First Degree – Superficial – – – – – Skin becomes reddened Very tender to touch Overexposure to sun Light contact with hot objects Scalding by hot water or steam • Second Degree – Partial Thickness – – – – Blisters and very painful Results from a very deep sunburn Contact with hot liquids Flash burns from gasoline etc. • Third Degree – Full Thickness – Skin is dry, pale, white, or can be black and charred and is painless – Caused by flame, ignited clothing, immersion in hot water, contact with hot objects, or electricity. • Thermal burns are caused by the sun, fire, hot liquids or objects, and hot gases. • Electrical burns are caused by contact with electrical wires, current, or lightning. • Chemical burns are caused by contact with wet or dry chemicals. • Burns on the face, hands, feet, and genitals can be particularly serious. Types of Burns • • If victim is on fire, tell him or her to STOP, DROP, and ROLL. If victim is in contact with electricity, shut off the power. – – – – Do not touch victim or any wires. Do not touch (or allow your clothing to touch) a wire, victim, or vehicle that is possibly energized. Do not approach within eight feet of it. NEVER attempt to handle wires yourself unless you are properly trained and equipped. • The percentage of burns is measured using a rule called the rule of 9’s. • Each body part can be measured with a multiple of 9. • The following are considered Critical Burns: – Burns/smoke around the mouth or nose – Burns involving the face, hands, or feet – Third degree burns covering more than 10% of the body – Second degree burns covering more than 30% of the body Second Degree Burns Third Degree Burns Moderate burns are: – Third degree burns of 2% to 10% of the body – Second degree burns of 15% to 30% of the body – First degree burns of 50% to 75% of the body • STOP THE BURNING PROCESS – Cool with copious amounts of cool water on thermal or liquid chemical burns • No ICE ! • • • • • • • Do not use water The burned areas should be covered with a clean, dry dressing. Do not break blisters Do not apply ice directly to skin Do not apply any home remedies or ointments NEVER USE GREASE (BUTTER) ON A BURN! Watch for symptoms of smoke/heat inhalation • First Aid: Major Burns – – – – – Expose. Cut and gently lift away any clothing covering burned area. If clothing is stuck to burn, do not remove it. If victim’s skin is in contact with a liquid chemical, immediately flush chemical off with large amount of water. Remove jewelry if possible (burns cause swelling). • First Aid: Major Burns – Separate fingers or toes with dry, sterile, non-adhesive dressings. – Leave burn blisters intact. – Lightly cover the burn area with a dry sterile bandage or clean sheet if the burned area is large. – Continue to ATTEND to the ABCs. • First Aid: Minor Burns – – – – Expose the burn. Cool heat burns with cold water as quickly as possible, and continue cooling at least until pain is relieved. After cooling, cover the burn with a dry, sterile bandage or clean dressing. Protect the burn from pressure and friction. • First Aid: Minor Burns – Immediate cooling of minor burns will reduce swelling, infection, and depth of injury. It will allow faster healing with less scarring. – DO NOT pop burn blisters. – DO NOT apply ointment, butter, ice, medications, cream, oil, spray, or any other substance to a burn. • Dry Chemicals must be brushed off before flooding the affected area with running water. • ALL chemicals, wet or dry, in contact with the skin should be washed off (flooded) with large amounts of water. • Contaminated clothing must be removed. (Flood with water as they remove the clothing) • ALL chemicals, wet or dry, in contact with the eyes should be washed off (flooded) with large amounts of water. • At a minimum flush both eyes for 20 minutes and then transport to the hospital for further treatment. • Electrical burns can be more serious than they appear to be. Most damage is hidden under the skin. • Respiratory and cardiac problems are common with electric shock. • DO NOT TOUCH THE PATIENT UNLESS YOU KNOW THE POWER IS OFF!! • Once the power is off, ASSESS, ALERT, and ATTEND to the ABCs. – – – Victim may need CPR and defibrillation. Burns may be present at points where the current entered and exited the body. All victims of electric shock require medical assessment because the extent of injuries may not be apparent. Electrical Burns • When Caring for Children – Minor burns in children are extremely common. – Severe burns in children can result in prolonged suffering, disability, disfigurement, and impaired physical and mental development. – First aid for burns in children is the same as with adults. • When Caring for Older Persons – Age and chronic disease contribute to a higher frequency of complications and death in older adults who suffer burn injuries. – First aid for burns in older persons is the same as with adults. • Prevention – – – Hot water scalds are twice as common as thermal burns in young children and typically occur when toddlers reach up and pull a pot of hot water off the stove and onto themselves. Turn handles inward. Closely supervise young children. Many fire-related injuries and deaths occur from children under 5 years old playing with matches or lighters and often start in a bedroom. Keep matches and lighters in a secured drawer or cabinet. Extra caution must be exercised when working near energized power lines. Keep a safe distance between power lines and ladders, tools and work materials. • You are attending to a victim burned from a flash fire and explosion while painting the inside of a recently fabricated 1300-gallon steel tank. The fire is out, and the scene is safe. The victim has moderate and major (second and third degree) burns on his thighs, hands, arms, and chest. – What should you do? • Inhaled Poisons Toxic fumes (gases) • Skin Exposures to Poisons - Plants or chemicals • Swallowed - Plants or Poisons chemicals • Swallowed Poisons – – – – – – Drugs (prescription, illegal, over-the-counter). Alcohol. Household cleaning products, make-up. Pesticides, paints, solvents. Contaminated foods. Poisonous plants (plants and plant parts can cause harm). Most Frequently Involved Substances (Children < 6 Years) Cosmetics and personal care products Cleaning substances Analgesics Foreign bodies Topicals Cough and cold preparations Plants Pesticides Vitamins Antimicrobials Antihistamines Arts/crafts/office supplies Gastrointestinal preparations Hormones and hormone antagonists Electrolytes and minerals Most Frequently Involved Substances (Adults > 19 Years) Analgesics Sedatives/hypnotics/antipsychotics Cleaning substances Antidepressants Bites/envenomations Alcohol Cardiovascular drugs Food products, food poisoning Cosmetics and personal care products Pesticides/Chemicals Hydrocarbons Fumes/gases/vapors Anticonvulsants Antihistamines Stimulants and street drugs • Skin Contact – Corrosives (Alkalis, acids, hydrocarbons) – Poisonous plants (poison ivy, oak, sumac) • Be careful not to expose yourself to the Toxic Environment. • Once the patient is removed the from contaminated area: – Verify breathing and circulation – CPR may be necessary – Get trained help • CARBON MONOXIDE CAUSES MORE POISONING DEATHS THAN ANY OTHER SUBSTANCE. IT IS PRODUCED DURING THE INCOMPLETE BURNING OF ORGANIC FUELS. CARBON MONOXIDE IS A COLORLESS, ODORLESS, TASTELESS GAS; WHICH MAKES ITS DETECTION IN THE AIR DIFFICULT AND THUS INCREASE THE HAZARD. USUALLY THE VICTIM DOES NOT REALIZE WHAT IS HAPPENING UNTIL IT IS TOO LATE. • REMOVE THE PATIENT FROM THE EXPOSURE SITE • PROVIDE PATIENT WITH 100% OXYGEN OR EXPOSE HIM TO FRESH AIR • MONITOR THE PATIENT FOR FURTHER RESPIRATORY DISTRESS • RUN ENGINES OUTDOORS OR WITH DOORS/ WINDOWS OPEN • KEEP WINDOWS CRACKED WHERE YOU SLEEP • DO NOT USE ENGINE EXHAUST FOR HEAT • – SENSE OF PRESSURE IN THE HEAD – ROARING/ RINGING SENSATION OF THE EARS – PATIENT IS CONFUSED AND UNABLE TO THINK CLEARLY – DRUNK APPEARANCE – OFTEN VOMITING – INCONTINENT – CONVULSIONS – BOUNDING PULSE – CHERRY RED LIPS – DILATED PUPILS – COMA NOTE: YOU SHOULD CONSIDER CARBON MONOXIDE POISONING WHENEVER CONFRONTED WITH A GROUP OF PEOPLE WITH DIFFERENT SYMPTOMS WHO ARE SHARING ACCOMMODATIONS. • Be careful not to expose yourself to the Toxic Environment. • Poisonous Plants – Poison Ivy – Poison Oak – Poison Sumac • Once the patient is removed the from contaminated area: – – – – Verify breathing and circulation Decontaminate as necessary CPR may be necessary Get trained help • Ingestion or contact with certain plants ma cause symptoms such as: – – – – – – – – Skin Irritation Eye Irritation Mouth Irritation Pain Breathing Problems Allergic Reactions Stomach and Intestinal Problems Death • Save part of plant for comparison • Plants have oils or sap that of absorbed can cause rash, sores or dermatitis. • Poison Ivy and Poison Oak – Wild Vine/Shrub – Red Stemmed – 3 leaves • Leaves of 3 don’t touch me • Poison Sumac – Shrub/Tree – Clear, watery sap that turns black when exposed to air – Grey/Brown Bark • Treatment – – – – – Calamine lotion Cortisone Cream Aveeno or oatmeal bath or compress Cool Compress Diphenhydramine 25-50mg • It is important to try to find exactly what and how much the patient has swallowed. • Verify breathing and circulation • Call 9-1-1 or Poison Control 1-800-222-1212 – – – – – Age Weight Amount Type How long ago ingested • DO NOT INDUCE VOMITING • DO NOT flush toilet or discard vomit • Gather bottles Prevention – – – Store all medicines, household products, and personal care products in locked cabinets that are out of reach of small children. Identify poisonous plants in your house and yard, and place them out of reach of children or remove them. Make sure visitors to your home keep their medicines out of the reach of children. Prevention • Never mix household and chemical products together. A poisonous gas may be created when mixing chemicals. • Do not burn fuels or charcoal or use gasoline-powered engines in confined spaces such as garages, tents, or poorly ventilated rooms. • Place carbon monoxide monitors near the bedrooms in your house. • A 3-year-old girl was found at home playing with a bottle of a children’s cough and cold medicine. One hour later she fell asleep. Approximately 11 hours later, she is found blue and unresponsive. – What should you do? • Bee Stings: Critical if the patient is allergic to bee stings • In the allergic patient this can be life threatening – Epi Pen • If patient is allergic to bees call 9-1-1 • Swelling may not happen for up to 24 hours • Wash with Soap and Water • Remove Stinger with credit card – No tweezers • Ice and Cortisone Cream • Swelling and pain are normal – (may not happen for up to 24 hour • • • • • Wash with Soap and Water Ice Tylenol or Advil Not normally life threatening Contact Poison Control for directions • Normal sign is minor swelling and pain • Flu like symptoms • Very dangerous to the very young and the elderly • Anti-venom is available • Seek Medical Attention • • • • Normal sign is minor swelling and pain Flu like symptoms Ulcerated sore Needs treatment at a hospital Brown Recluse Hobo • Usually from fights • The human mouth is full of germs and bacteria • The wound needs to be properly cleaned and treated • Watch for signs of infection • Most dog bites are to the face • Dog bites bleed heavily due to the facial blood supply and the tearing forces applied to the skin • The bite may be as simple as a few puncture wounds or it may be life threatening bleeding • Make the sure scene is safe • Apply direct pressure to the wound • Patient should be taken to the hospital for further care to prevent infection • Animal control or the police department must be notified so they can the check dog for rabies • • • • 40,000-50,000 bites – annually Over 8,000 are poisonous snake bites Fewer than 10 deaths reported annually Anti-venom is available • Occurs in less than 30% of bites • Minimal in 30 – 40% of bites • Significant in only 30% of bites • Signs & Symptoms – – – – – Swelling Discoloration Labored breathing Progressive general weakness Convulsions • Make sure the scene is safe • Keep the patient calm • Have the patient transported to the hospital for further treatment • DO CUT THEWOUND NOT THE WOUND OPEN!! • Keep wound BELOW the heart • Ice packs to wound • Use tourniquets sparingly • Restrict Movement • Heat Emergencies – – – – Cramps Heat Heat Exhaustion Heat Stroke • Cold Emergencies – Hypothermia – Frostbite • Exposure to hot, humid environment or excessive exercising in heat can overwhelm body's ability to cool itself down. • Two main heat illnesses are heat exhaustion and heat stroke. • These conditions have common characteristics ranging from mild to severe. • With rapid cooling and medical treatment, the survival rate approaches 90%. • Heat Cramps – Painful muscle spasms – Moist Sweaty Skin – Treatment – • Remove from heat • Rest, water or fluids with salts • Heat Exhaustion – Working in a hot environment, patient is weak, dizzy or faints. – Temperature below 104 – Nausea and Vomiting – Pale, cool and sweaty skin – Treatment • Treat for shock and transport to the hospital • Ice packs in arm pits, groin and behind neck • Limit fluids to prevent vomiting • Heat Stroke – – – – – – – Life Threatening The body is overheating from the inside Hot to touch, Bright Red Skin NO SWEATING Change in mental status Vomiting Temperature above 105 – Treatment • Cool as rapidly as possible – Ice Packs to Neck, Armpits and Groin • Call 911 When Caring for Children and Older Persons • Young children and elderly with chronic diseases (or those who cannot get out of the heat) are at great risk for heat stroke and death. • First aid treatment is the same in all heat emergencies - cool the victim down! Prevention • • When working in the heat, take rest periods in a cool environment, and drink plenty of fluids. NEVER leave a child alone in a motor vehicle in the heat, even to run a quick errand. The passenger compartment can quickly turn into a fatal oven! • After a long day working in a 90F (32C) heat wave, you spot your coworker, a 41-year-old welder, collapsed beside his vehicle. You squeeze the victim’s shoulder and ask, “Are you okay?” There is no response. You shout for help and tilt the victim’s head back to open the airway. The victim is breathing fast and shallow. His face is hot, red, and very sweaty. You can see the man’s heartbeat pounding in his neck. His body suddenly begins twitching and jerking. – What should you do? • Hypothermia – General cooling of the body – Body temperature decreased to 95 F (35 C) or less. • • Early Symptoms – Frostbite. – Pale and cold skin. – Weakness and loss of coordination. – Altered Mental Status. – Uncontrollable shivering. Late Symptoms – No shivering. – Slow (or absent) breathing or heartbeat. • Treatment • Get inside and out of wind. • Remove wet or constricting clothes, replace with dry. • Cover with warm blankets. • Cover head and neck to help retain body heat. • Place victim near a heat source and place containers of warm, but not hot, water in contact with the skin. • Comfort, calm, and reassure the victim until EMS arrives. Prevention • • All deaths from exposure to extreme cold are preventable. Early recognition of signs and symptoms of frostbite and hypothermia, along with awareness of key risk factors, can help minimize both injury and death. • Frostnip – patients skin blanches white • Frostbite - freezing of parts of the body – Superficial • skin is white and waxy • underlying skin is soft – Deep • the skin is frozen • Frostnip – local rewarming with warm hands – Do Not Rub! • Superficial Frostbite – local rewarming, may be painful, may need hospital care – Do Not Rub! • Deep Frostbite – – Must be taken to hospital, – Very painful and may lose extremity • • • DO NOT rub or massage the affected area. DO NOT disturb blisters on frostbitten skin. DO NOT give alcoholic beverages. They do not help and may be harmful. • It’s been a long day working outside in the cold and you feel exhausted. It’s so cold, it’s hard for you to stop shivering. Your feet feel numb. On the way to your truck you slip and fall on the ice. When you try to stand, you slip and fall again. You feel drunk, but don’t even drink. Fortunately, your coworker – a trained First Aid Provider -- finds you lying in the parking lot. She recognizes the emergency and alerts 911 on a cell phone. In this rural location, and with the icy roads, EMS may be significantly delayed. – What should she do? • Too much or too little sugar in the body – Symptoms: cool clammy skin, weak dizzy – First Aid: give sugar in form of candy or drink – ONLY IF ABLE TO SWALLOW – NOT IF UNCONSCIOUS • Orange Juice with Sugar • Soda • Glucose Tabs or Paste • Knocked out tooth: – Place in container of whole milk if tooth can be replaced in 30 min. – Rinse tooth in cold water and place back in socket, then go to dentist ASAP: Eye Injuries Eye Injuries • Requires emergency care • Penetrating Object in the Eye – Protect the eye with padding around the object – Place paper cup or cone over object to keep it from being disturbed – Cover undamaged eye also to prevent movement of the injured eye • Chemical in Eye – Flush with warm water • Loose Object – Remove with flushing if possible or wet gauze – Use Caution • Open Chest Wound With Impaled Object – DO NOT remove an impaled object • Bandage and Stabilize • Minimize Movement – Impaled Knife, etc. • Open Chest Wound Without Impaled Object – Cover wound to prevent outside air from entering the wound – Use plastic wrap with tape on 3 sides to prevent air from leaking – GSW or Stabbing • CALL 911 IMMEDIATELY • Closed Chest Wound – Blow to chest area – Bruised or Fractured Ribs • Cover chest with pillow to hold pressure on wound – Stabilized wound – Watch for signs of shock Every home or business should have one • • • • • • • • • • • • • • • • • Gloves Eye protection Pocket mask 2 x 2 sterile gauze pads 4 x 4 sterile gauze pads 8 x 10 sterile gauze pads Roller bandage 4” Triangular bandage Instant ice Pack Antiseptic towelettes Tape 1” Antibiotic Ointment Betadine prep pads Hydrocortisone cream Eye wash Sting kill pads Multiple adhesive bandages (band aids) Questions, Comments, Etc? TEST 1. A responsive adult must agree to receive first aid care. This is known as: a) b) c) d) Refusal Consent Objection Obligation 1. A responsive adult must agree to receive first aid care. This is known as: a) b) c) d) Refusal Consent Objection Obligation 2. To “observe universal precautions” means: A. Whether or not you think the victim’s blood or body fluid is infected, you act as if it is. B. To quickly look for life-threatening conditions. C. To reassure and comfort the victim. D. To obtain Implied Consent. 2. To “observe universal precautions” means: A. Whether or not you think the victim’s blood or body fluid is infected, you act as if it is. B. To quickly look for life-threatening conditions. C. To reassure and comfort the victim. D. To obtain Implied Consent. 3. When dragging a victim in an emergency, DO NOT: A. Use your legs and keep the weight as close to your body as possible. B. Protect the spine as best as possible. C. Know your physical ability and respect your limitations. D. Pull the victim sideways or pull the head away from the neck and shoulders. 3. When dragging a victim in an emergency, DO NOT: A. Use your legs and keep the weight as close to your body as possible. B. Protect the spine as best as possible. C. Know your physical ability and respect your limitations. D. Pull the victim sideways or pull the head away from the neck and shoulders. 4. The Emergency Action Steps for an UNRESPONSIVE victim include all the following EXCEPT: A. Assessing the scene and victim. B. Alerting EMS or activating your emergency action plan. C. Opening the airway. D. Asking if it’s okay to help. 4. The Emergency Action Steps for an UNRESPONSIVE victim include all the following EXCEPT: A. Assessing the scene and victim. B. Alerting EMS or activating your emergency action plan. C. Opening the airway. D. Asking if it’s okay to help. 5. The Emergency Action Steps for a RESPONSIVE victim include all the following EXCEPT: A. Assessing the scene and victim. B. Assuming it is okay to help. C. Alerting EMS or activating your emergency action plan. D. Helping victim maintain normal body temperature. 5. The Emergency Action Steps for a RESPONSIVE victim include all the following EXCEPT: A. Assessing the scene and victim. B. Assuming it is okay to help. C. Alerting EMS or activating your emergency action plan. D. Helping victim maintain normal body temperature. 6. A responsive adult victim has given you permission to provide first aid care. The victim is awake, talking and complains of feeling weak and dizzy. You should: A. Place victim in recovery position using the HAINES method. B. Call 9-1-1 or activate your emergency action plan. C. Give the victim an alcoholic beverage. D. Apply cool, wet cloths to the victim’s skin. 6. A responsive adult victim has given you permission to provide first aid care. The victim is awake, talking and complains of feeling weak and dizzy. You should: A. Place victim in recovery position using the HAINES method. B. Call 9-1-1 or activate your emergency action plan. C. Give the victim an alcoholic beverage. D. Apply cool, wet cloths to the victim’s skin. 7. You are attending to a victim who is unresponsive from an overdose of pain medicine. EMS has been alerted. You have opened the victim’s airway by tilting the head and lifting the chin. Why? A. Without an open airway, the unresponsive victim will die. B. To manually stabilize a suspected spinal injury. C. To reassure and comfort victim. D. To observe Universal Precautions. 7. You are attending to a victim who is unresponsive from an overdose of pain medicine. EMS has been alerted. You have opened the victim’s airway by tilting the head and lifting the chin. Why? A. Without an open airway, the unresponsive victim will die. B. To manually stabilize a suspected spinal injury. C. To reassure and comfort victim. D. To observe Universal Precautions. 8. You are attending to a seriously injured, unresponsive victim who is lying face up on the pavement. You hear gurgling, and the victim vomits. You should: A. Wait for EMS providers to arrive and explain what happened. B. Quickly place the victim in the recovery position using the HAINES method. C. Tell the injured victim not to move. D. Perform a series of abdominal thrusts until the victim’s stomach is empty. 8. You are attending to a seriously injured, unresponsive victim who is lying face up on the pavement. You hear gurgling, and the victim vomits. You should: A. Wait for EMS providers to arrive and explain what happened. B. Quickly place the victim in the recovery position using the HAINES method. C. Tell the injured victim not to move. D. Perform a series of abdominal thrusts until the victim’s stomach is empty. 9. You are attending to a responsive accident victim who has blood gushing out of a large wound in the leg. To control the bleeding you should: A. Wash wound with clean, running tap water for 5 minutes until bleeding stops. B. Apply direct pressure with absorbent pad until bleeding stops. C. Apply triple antibiotic lotion or cream and cover the wound with an adhesive bandage. D. Apply a tourniquet. 9. You are attending to a responsive accident victim who has blood gushing out of a large wound in the leg. To control the bleeding you should: A. Wash wound with clean, running tap water for 5 minutes until bleeding stops. B. Apply direct pressure with absorbent pad until bleeding stops. C. Apply triple antibiotic lotion or cream and cover the wound with an adhesive bandage. D. Apply a tourniquet. 10. An injured victim is shivering and wet from heavy sweating. His tissue color is pale and he is pleading for something to drink. You should: A. Give warm salty water. B. Give cool, clean tap water. C. Give nothing to drink; remove any blood soaked dressings. D. Give nothing to drink; cover him with a blanket to maintain normal temperature. 10. An injured victim is shivering and wet from heavy sweating. His tissue color is pale and he is pleading for something to drink. You should: A. Give warm salty water. B. Give cool, clean tap water. C. Give nothing to drink; remove any blood soaked dressings. D. Give nothing to drink; cover him with a blanket to maintain normal temperature. 11. You are caring for a coworker with a painful, blistered burn on the arm from a hot liquid. You should: A. Cool it with cold water as quickly as possible and continue cooling until pain is relieved. B. Quickly pop each blister, then apply cold butter until the pain is relieved. C. Apply triple antibiotic ointment to the burn and cover it with an adhesive bandage. D. Apply ice directly to the burn and keep it there until pain is relieved. 11. You are caring for a coworker with a painful, blistered burn on the arm from a hot liquid. You should: A. Cool it with cold water as quickly as possible and continue cooling until pain is relieved. B. Quickly pop each blister, then apply cold butter until the pain is relieved. C. Apply triple antibiotic ointment to the burn and cover it with an adhesive bandage. D. Apply ice directly to the burn and keep it there until pain is relieved. 12. You are attending to a responsive adult who tripped and fell. She has sharp pain, swelling, and deformity in her right leg. EMS has been alerted. You should: A. Tap and shout, “Are you okay?” B. Manually stabilize the injured leg. C. Firmly snap the dislocated bone ends back into place. D. Apply a pressure bandage around the entire length of the extremity. 12. You are attending to a responsive adult who tripped and fell. She has sharp pain, swelling, and deformity in her right leg. EMS has been alerted. You should: A. Tap and shout, “Are you okay?” B. Manually stabilize the injured leg. C. Firmly snap the dislocated bone ends back into place. D. Apply a pressure bandage around the entire length of the extremity. 13. You are caring for a responsive victim that was thrown from a motorcycle. He has given you permission to provide first aid care and complains of a burning sensation in his fingers. He is wearing a helmet and has no severe bleeding. You should: A. Tell him to sit up so you can check for a pain response. B. Place your hands on both sides of the helmet to keep his head, neck and spine in line. C. Remove his helmet and perform a physical assessment. D. Place him in the recovery position. 13. You are caring for a responsive victim that was thrown from a motorcycle. He has given you permission to provide first aid care and complains of a burning sensation in his fingers. He is wearing a helmet and has no severe bleeding. You should: A. Tell him to sit up so you can check for a pain response. B. Place your hands on both sides of the helmet to keep his head, neck and spine in line. C. Remove his helmet and perform a physical assessment. D. Place him in the recovery position. 14. You are assisting a person with asthma in taking his/her prescribed medication. There is no improvement from the medicine after 20 minutes, and the person seems to be struggling to breathe. You should: A. Instruct the person to double the prescribed dose and try again. B. Be patient. Wait for the medication to take effect. C. Perform a physical assessment. D. Alert EMS or activate your emergency action plan. 14. You are assisting a person with asthma in taking his/her prescribed medication. There is no improvement from the medicine after 20 minutes, and the person seems to be struggling to breathe. You should: A. Instruct the person to double the prescribed dose and try again. B. Be patient. Wait for the medication to take effect. C. Perform a physical assessment. D. Alert EMS or activate your emergency action plan. 15. You are caring for a victim who has been stung by a wasp and is severely allergic to them. The victim has an epinephrine auto-injector but is having trouble handling the device due to her constant coughing. Her lips and face appear swollen. You should: A. Help the victim use the device. If she is unable, administer it yourself. B. Comfort, calm, and stay with victim until the swelling goes down. C. Attempt to raise the victim’s blood sugar level as quickly as possible. D. Leave the victim alone to provide privacy and minimize embarrassment. 15. You are caring for a victim who has been stung by a wasp and is severely allergic to them. The victim has an epinephrine auto-injector but is having trouble handling the device due to her constant coughing. Her lips and face appear swollen. You should: A. Help the victim use the device. If she is unable, administer it yourself. B. Comfort, calm, and stay with victim until the swelling goes down. C. Attempt to raise the victim’s blood sugar level as quickly as possible. D. Leave the victim alone to provide privacy and minimize embarrassment. 16. You are attending to a victim of suspected heat exhaustion. All of the following are correct, EXCEPT: A. Have the victim lie down in a shady cool place. B. Loosen or remove excess clothing. C. Give a cool sports drink to replace lost fluid, salts and minerals. D. Cover head and neck to help retain body heat. 16. You are attending to a victim of suspected heat exhaustion. All of the following are correct, EXCEPT: A. Have the victim lie down in a shady cool place. B. Loosen or remove excess clothing. C. Give a cool sports drink to replace lost fluid, salts and minerals. D. Cover head and neck to help retain body heat. 17. You are called to attend to a coworker who collapsed while working in a hot warehouse. The victim is unresponsive. His skin is hot and wet. EMS has been alerted. You should: A. Spray or pour water on the victim and fan him. B. Comfort, calm, and stay with the victim until fully recovered. C. Apply heat packs to the victim’s neck, groin, and armpits. D. Administer the victim’s prescribed medication. 17. You are called to attend to a coworker who collapsed while working in a hot warehouse. The victim is unresponsive. His skin is hot and wet. EMS has been alerted. You should: A. Spray or pour water on the victim and fan him. B. Comfort, calm, and stay with the victim until fully recovered. C. Apply heat packs to the victim’s neck, groin, and armpits. D. Administer the victim’s prescribed medication. 18. You are caring for a coworker who is complaining that his fingers are numb after a long day working outside in the winter cold. His fingers look pale and they feel very cold and hard. There is a medical clinic not too far away. You should: A. Put his fingers in warm 100°F to 105°F (38° to 40°C) water. B. Place a sterile dressing between his fingers and seek medical attention. C. Place hot water near, but not in contact with the skin. D. Instruct the victim to briskly rub the affected area. 18. You are caring for a coworker who is complaining that his fingers are numb after a long day working outside in the winter cold. His fingers look pale and they feel very cold and hard. There is a medical clinic not too far away. You should: A. Put his fingers in warm 100°F to 105°F (38° to 40°C) water. B. Place a sterile dressing between his fingers and seek medical attention. C. Place hot water near, but not in contact with the skin. D. Instruct the victim to briskly rub the affected area. 19. You are attending to a responsive victim of hypothermia. The victim has been moved inside. Wet clothes have been replaced with dry and you have covered the victim with warm blankets. Next, you should: A. Place the victim near a heat source and place containers of warm water in contact with the skin. B. Briskly massage the victim’s arms and legs. C. Give a cool sports drink. D. Give a warm alcohol drink. 19. You are attending to a responsive victim of hypothermia. The victim has been moved inside. Wet clothes have been replaced with dry and you have covered the victim with warm blankets. Next, you should: A. Place the victim near a heat source and place containers of warm water in contact with the skin. B. Briskly massage the victim’s arms and legs. C. Give a cool sports drink. D. Give a warm alcohol drink. 20. You have been called to provide first aid for a coworker who is complaining of a headache and nausea after inhaling a chemical cleaning product. The scene is safe and other than the symptoms described, the victim seems fine. You should: A. Encourage the victim to go back to work. B. Induce vomiting with syrup of ipecac. C. Administer a whole adult aspirin tablet (325 mg.). D. Call the Poison Center. 20. You have been called to provide first aid for a coworker who is complaining of a headache and nausea after inhaling a chemical cleaning product. The scene is safe and other than the symptoms described, the victim seems fine. You should: A. Encourage the victim to go back to work. B. Induce vomiting with syrup of ipecac. C. Administer a whole adult aspirin tablet (325 mg.). D. Call the Poison Center. 21. When life-threatening situations exist and the parent or legal guardian is not available, first aid care for a child should be given based on: A. B. C. D. Refusal Implied Consent Objection Obligation 21. When life-threatening situations exist and the parent or legal guardian is not available, first aid care for a child should be given based on: A. B. C. D. Refusal Implied Consent Objection Obligation 22. You are assisting a child with asthma in taking prescribed medication. Ten minutes later the child is bent over and can’t stop coughing. You should: A. Double the prescribed dose of medication and have the child try again. B. Be patient. Wait for the medication to take effect. C. Perform a physical assessment. D. Alert EMS or activate your emergency action plan. 22. You are assisting a child with asthma in taking prescribed medication. Ten minutes later the child is bent over and can’t stop coughing. You should: A. Double the prescribed dose of medication and have the child try again. B. Be patient. Wait for the medication to take effect. C. Perform a physical assessment. D. Alert EMS or activate your emergency action plan. • 23. You been called to provide first aid for a 3-year old child who was discovered on the floor of the bathroom drinking from an open bottle of skin care lotion. Other than crying loudly when you quickly take the bottle away, the child appears fine. You should: A. Administer sips of lemon juice or vinegar to neutralize the product. B. Administer 25–50 grams of activated charcoal in a glass of water to dilute the product. C. Administer ½ ounce syrup of ipecac to help the child vomit out the product. D. Call the Poison Center. • 23. You been called to provide first aid for a 3-year old child who was discovered on the floor of the bathroom drinking from an open bottle of skin care lotion. Other than crying loudly when you quickly take the bottle away, the child appears fine. You should: A. Administer sips of lemon juice or vinegar to neutralize the product. B. Administer 25–50 grams of activated charcoal in a glass of water to dilute the product. C. Administer ½ ounce syrup of ipecac to help the child vomit out the product. D. Call the Poison Center. 24. The Emergency Action Steps for a RESPONSIVE victim include all the following EXCEPT: A. Assessing the scene and victim. B. Opening the airway. C. Alerting EMS or activating your emergency action plan. D. Helping the victim maintain normal body temperature. 24. The Emergency Action Steps for a RESPONSIVE victim include all the following EXCEPT: A. Assessing the scene and victim. B. Opening the airway. C. Alerting EMS or activating your emergency action plan. D. Helping the victim maintain normal body temperature. • 25. This was the best First Aid Class you have ever had. A. True B. False • 25. This was the best First Aid Class you have ever had. A. True (Of Course) B. False Survey Information • Please be sure to either complete a survey today and return it to your instructor, or you may also visit the ASHI website at http://ashinstitute.org/quality.htm and choose the RATE OUR PROGRAM link. Training Center Name: Mt Lemmon Fire District Class Title: Basic First Aid and CPR/AED for the Lay Person