Post Professional-DPT

1. Post Professional-DPT Course: Emergency Procedure and Patient Care-Lec-2

2. Physical Examination of the Critically Injured person • physical examination • Scene assessment and safety • Body substance isolation precautions • Primary survey • Secondary survey • Vital signs

3. Physical Examination • Four components: • Inspection • Palpation • Percussion • Auscultation

4. Inspection • Inspection involves a close examination of the injured area looking for; • Deformity • Contusions • Abrasions • Swelling • Bleeding.

5. Palpation • Palpation involves touching the injured area to note abnormal findings such as; • Deformity • Crepitus.

6. Percussion • Percussion consists of tapping the injured area to elicit tympanic sounds. • Percussion is used for thoracic and abdominal injuries

7. Auscultation • Auscultation refers to listening to lung sounds with a stethoscope and, although difficult in a noisy environment.

8. Scene assessment and safety • Tunnel vision should be avoided; When approaching a person who is down, get a global picture of the scene. • Make sure the scene is safe for you to be there. • How many persons are injured? • Are there hazards in the area such as electrical cords, water, or blood? • Do you have sufficient resources and equipment to manage the injured person? • If the person is an assault victim, • where are the assailant and the weapon? • Failure to see the big picture is often called tunnel vision and can lead to significant dangers being missed

9. Body Substance Isolation Precautions • Protection against the transmission of infectious diseases such as Hepatitis B or HIV. • The degree of protection depends on the procedure performed and the body fluids you might come in contact with. • Hand washing is the single most effective way to prevent the transmission of diseases. • Use warm water if possible. • Rinse completely with a strong stream of water and dry completely. • Waterless alcohol based soap can be used in absence of soap and water. • Repeated use of these waterless soaps is not recommended.

10. Human Immunodeficiency Virus (HIV) • The human immunodeficiency virus (HIV) attacks the cells of our immune system, causing AIDS. • Ways of transmission: • Through blood • Sexual contact • From a pregnant mother to her unborn child. • Although there is not yet a cure for AIDS but the disease could be controlled through precaution.

11. Hepatitis B • Hepatitis B is 100-times more transmissible than HIV or hepatitis C because of the high volume of hepatitis B viruses in the blood of infected people, compared to the lower viral load in people infected with HIV or hepatitis C. A safe and effective vaccine does exist that prevents HBV infection, but unfortunately, not all patients have been immunized. (http://www.hbvadvocate.org/hepatitis/hepB/HBV)

12. Level of Protection for Various Procedures • Procedure : Gloves Mask Gown Eye Protection • Control minor bleeding ; Yes No No No • Control major bleeding ; Yes Yes Yes Yes • Vital signs; No No No No

13. Primary Survey • The primary survey is a rapid head-to-toe assessment designed to identify and immediately correct life- and limb threatening injuries. • Within the first minute, you must determine if the person is critically injured and activate the emergency action plan (EAP). • The primary survey consists of five parts, a common mnemonic used to help remember these parts of the primary survey is simply the first five letters of the alphabet (ABCDE)

14. Parts of The Primary survey A: Stabilize cervical spine and check the airway. B: Check for breathing. C: Check for circulation. D: Check for neurological disability (or apply defibrillator). E: Check level of exposure.

15. Stabilize cervical spine and check the airway • Injury to the cervical spine is most common in accidents, so it should be find out first. • Stabilize the head and keep it in a neutral position with reference to the neck. • Now evaluate the airway and determine responsiveness. • It the person speaks in a clear and normal voice, you are assured the airway is patent. • If the person is unconscious, look and listen for signs of airway compromise such as snoring. • Either lifting the chin or using a modified jaw thrust maneuver with the cervical spine neutral, can relieve an airway obstruction. • Abnormal airway sounds such as gurgling or stridor indicate the presence of a possible foreign body that must be removed.

16. Stabilize cervical spine and check the airway The jaw thrust maneuver is used to open the airway when a cervical spine injury is suspected. The head tilt–chin lift method is used to open the airway occluded by the tongue.

17. Check for Breathing. • Look and feel for the chest to rise. • Look to see that the chest rises in a symmetrical fashion. Asymmetry may indicate significant chest trauma. • Evaluate the rate and quality of breathing. • A respiratory rate less than 8 or greater than 30 is significant and cause for concern. • The color of the oral mucosa and nail beds should be checked for cyanosis, which is a bluish color indicating hypoxia. • Breathing must be adequate to ensure oxygenation of tissues (ventilation).

18. Check for Circulation • Quickly feel the radial pulse and note if it is fast or slow, regular or irregular, and strong or weak. • If the radial pulse is absent, check the carotid pulse. • A weak or absent radial pulse is a strong indication that the person is in critical condition and mortality and morbidity are increased. • Capillary refill. Press on the nailed of any finger and quickly release, noting how quickly color returns. Color should return within 3 seconds or as quickly as you can say the words “capillary refill.” • If capillary refill is delayed, the person’s circulation is not sufficient to perfuse the vital organs.

19. Check for Neurological Disability (or apply defibrillator) • Disability refers to a brief neurological examination. • It is time consuming to perform a focused neurological examination, and merely asking the person to move his or her arms and legs is sufficient for a primary survey. • If the person is in cardiac arrest, the automatic external defibrillator should be used immediately.

20. Check Level of Exposure • Clothing or equipment may need to be removed to examine the injured person. • Modesty or environmental concerns should be taken into account but should never inhibit the examination.

21. Secondary Survey Examination • Starting at the head use a look, listen, and palpate approach. • Look for contusions, abrasions, lacerations, and deformity. • Listen to breath sounds in the chest. Palpate body parts for crepitus, pain, and rigidity or masses. • Listen for abnormal sounds while palpating.

22. Points to Be Remember • A physical examination has four components: inspection, palpation, percussion, and auscultation. • The primary survey is a rapid head-to-toe assessment designed to identify and immediately correct life- and limb-threatening injuries. • The primary survey includes five parts: stabilize cervical spine and check the airway, check for breathing, check for circulation, check for neurological disability (or apply defibrillator), and check level of exposure. • The secondary survey consists of a complete head-to-toe examination to rule out other injuries that may not be apparent on the primary examination.