Basic Life Support

Transcript: Types of Fractures

The Human Skeletal System The skeletal system is made up of 206 bones and provides support, allows for movement, and protects the internal organs of the body.

What Is a Fracture? Sometimes, too much pressure is applied to a bone that results in what is known as a fracture. Fractures are commonly caused by a fall, strike from an object, or by twisting or bending of the bone.

What Is an Incomplete Fracture? When the bone is only cracked or partially broken, doctors refer to it as an incomplete fracture.

What Is a Hairline Fracture? A hairline fracture is an incomplete fracture, like a crack that does not break all the way through the bone. It usually is the result of a relatively minor injury.

What Is a Greenstick Fracture? A greenstick fracture is an incomplete fracture that is similar to the break of a young tree branch. Only one side of the bone breaks causing the bone to bend. Both hairline and greenstick fractures are usually treated by immobilization with a cast to allow it to mend.

What Is a Complete Fracture? When the bone is broken into pieces, doctors refer to it as a complete fracture.

What Is a Simple Fracture? A simple fracture is a complete fracture where the bone is broken into two fragments. This break can be transverse (which means straight across the bone), oblique (which means at an angle)....and spiral (which means an angle that is twisted).

What is a Comminuted Fracture?

A comminuted (or multifragmentary) fracture is a complete fracture where the bone is broken into several fragments. This type of fracture is usually a result of a severe injury. Both simple and comminuted fractures are usually treated with immobilization with a cast or sometimes with pins, screws, and plates.

If You Fracture a Bone All fractures must be taken seriously. If you think that a bone has been fractured, you should seek im

American Heart Association, San Diego County Outline For Basic Life Support

I. BASIC INFORMATION 1. Why CPR? Nearly 50% of all deaths are due to cardiovascular disease (978,000),

60%-70% before hospitalization, often within 2 hours...."The communty has the potential for being the ultimate coronary care unit." 2. Basic Life Support: The basic life saving first aid technique-recognition & prevention of heart disease, management of heart and lung cessation, application of the ABCs of cardiopulmonary resuscitation (CPR) until help arrives. 3. Anatomic/Physiologic basis for sudden death and CPR. o o

brain's need for continuous oxygen and how that need is satisfied biological and clinical death.

1. Call For Help, who responds, information required, what response to expect. 2. Emergency Phone Numbers, the 911 system, paramedics, local numbers.

II. HEART ATTACKS-RECOGNITION AND PREVENTION 1. Early Warning Signs and Symptoms Of Heart Attack: o o o o

Denial is common, causing delay, leading to death, often within 2 hours! Pain: crushing, oppressive, mid chest, often prolonged, perhaps radiating. Shortness of breath, sweating, nausea, Apprehension and feeling of doom.

1. Actions To Take if Suspected: o o

If patient has angina, and carries nitroglycerin, advise victim to take medication. it no angina history, or nitro doesn't relieve, suspect heart attack-get helpactivate EMS or transfer to nearest hospital emergency room & check it out!

1. May Progress To Cardiac Arrest: No pulse, No breathing. Some have a good

prognosis, others poor. CPR is not 100% successful, but is the only alternative. 2. Cardiac Risk Factors: o o

o

Uncontrollable factors: Heredity, Gender, Race, Age. Controllable factors; Cigarette smoking, High blood pressure, Serum cholesterol, lack of exercise, (High Risk: Diabetes, Prior M.I., Premature Cardiovascular Disease). Contributing Factors: Stress, Obesity, Stroke.

1. Prudent Heart Living: "prevention" of heart attacks.

III. STARTING AND STOPPING CPR 1. CPR Is Rarely Not lndicated: the following are not contraindications, flail chest,

broken ribs, open chest wounds, pacemakers, neck injuries, mouth or throat wounds-the alternative is death. 2. If Obviously Dead: (Beyond doubt; decapitation, rigor mortis, etc.) if unsure, always begin CPR 3. CPR Should Be Stopped By Non-physician Only If: o o o o

P: Physician (MD, DO, and Coroner) pronounces victim dead and assumes responsibility. E: Exhaustion, rescuer unable to continue without collapsing and no other help is near. A: Assistance arrives (relieved by paramedics or other personnel qualified to continue efforts at a more advanced level). R: Recovery: (breathing and heartbeat successfully restored).

IV. BASIC LIFE SUPPORT AND CARDIOPULMONARY' RESUSCITATION (ABC'S) 1. Check For Unresponsiveness: gently shake and shout 2. Call For Help: Dial 911, Return and start CPR 3. Establish An Airway: o o o

Head-Tilt Chin-lift (lifting tongue and epiglottis of back of throat). Fingers on bony part of chin, not soft tissues. If there is concern over neck fracture trauma, use Jaw-Thrust method, NO HEAD TILT! (see VI-3 below).

1. Check For Breathing: 3-5 seconds o o

Look, Listen. and Feel, rise and fall of chest, air movement on ear. If breathing, maintain an airway and monitor until EMS response arrives.

1. Initiate VentiIations: Rescue Breathing o o o

Mouth-to-Mouth, Mouth-to-Nose, Mouth-to-Stoma, (Infant; Mouth-toMouth & Nose). Maintain airway, pinch nostrils with 2 fingers, deliver 2 slow breaths Observe rise and fall of chest; if obstructed (use steps outlined in V-5 below).

1. Check Circulation and Activate EMS: Carotid or Brachial pulse for 5-1O seconds on adult; Peds, Quick check. o o

o

Adult & Child - "neck groove" on closer side with 2 fingers, never use thumb; lnfant - 2 fingers on inside of upper arm. if pulse is present, continue ventilations only: In adult, every five seconds (1012 x per minute); child, every 3 seconds (20 x per minute); infant, every 3 seconds (20 x per minute). If no pulse, start full CPR (external chest compressions and ventilations).

1. Administering External Chest Compressions o o

o o o o

Patient must be flat on a firm surface (not bed, in water etc.) Hand position is important. Heel of bottom hand on lower half of sternum, above xiphoid; keep fingers off chest wall; maintain skin-to-skin contact at all times. Sternum must be depressed 1-1/2 to 2"; in average adult for adequate flow. Artificial circulation is only 20 - 30% of normal). Possible complications: fractured sternum or ribs, liver laceration. After one minute, check pulse and breathing for 5 seconds, if no pulse, give 2 slow breaths and continue CPR. CPR should not be interrupted for more than 7 seconds; except in certain circumstances.

1. One Rescuer CPR: o o

30:2 compression to ventilation cycle, at least 100 compressions/minute. Useful acronym is 1 and-2-and-3-and 4 and...breathe;, any will do.

1. lnfant and Child Variations: infant 0-1 year, child ages one to puberty. o o o o o

30:2 compression/ventilation cycle: infants 100/minute; child 100/minute. 2 fingers for infant compressions; 1 OR 2 hands for child; hand position is one finger below nipple line for infant, and on the lower sternum for child. Sternum depressed half the depth of chest. Use brachial pulse between shoulder and elbow of infants (not carotid). Avoid over inflation (gastric distention), watch for rise and fall of chest.

V.OBSTRUCTED AIRWAY 1. International Distress Signal For Choking: throat grasped between thumb

and forefinger. 2. Airway Anatomy - Susceptibility To Choking: the leading cause of accidental

death. 3. "Cafe Coronary"actually airway problem - drinking, inattention, poor

dentures/teeth. 4. If victim Is Conscious: o Inquire: (Are you choking??)-assess good or poor air exchange? o o If good: do not interfere unless it becomes total, or condition worsens to poor air exchange (turns blue, weak cough, whistling)-encourage coughing. o o If poor air exchange or total obstructions send for help and begin Heimlich Maneuver. o

1. If Victim Is Unconscious: o Victim flat on back-open airway by head tilt: tongue is the #1 airway obstructor! o o Do not waste time looking for obstruction, unless very obvious-immediately attempt to ventilate. o o If unsuccessful, reposition head and try again. o o Open mouth and finger sweep the throat attempting to hook object and pull out. o o Open airway (head-tilt, chin-lift) and attempt to breathe. o o If unsuccessful. continue alternation of steps until EMS response arrives. o

1. Infant and Child Modification: 90% of deaths in this group are caused by

airway obstruction. No blind finger sweeps, in infants and children, (visualize and grasp): Infants only-5 back slaps and 5 chest thrusts, o

o

SPECIAL SITUATlONS 1. Near Drowning: cold water (hypothermia), salt/fresh water differences, don't

compress in water, possible neck injury.

2. Electric Shock: victim may still be electrified so turn off power. Use non-

conductor to remove wires, burns, falls. 3. Neck Injury: don't tilt head, use Jaw-Thrust technique only. 4. Gastric Distention: don't relieve unless ventilations are compromised. 5. Traumatic Injury: direct pressure for serious bleeding, If pinned in vehicle

don't move unless victim is in immediate danger. 6. Vomiting. turn entire victim onto side and turn as a unit. VII. HEALTHCARE PROVIDER SKILLS (PROFESSIONAL RESCUER) 1. Two Rescuer CPR: o Opposite sides of victim is best; at end of 30:2 compression/ventilation cycle, rescuer #1 opens airway and verifies lack of pulse and breathing for 5 seconds if no pulse, give I breath. o o Rescuer #2 may come in at any point. o o 30:2 compression-to-ventilation cycle (100 compressions/minute). o

1. Changing Position: If compressor becomes fatigued, rescuers should

exchange positions as soon as possible. 2. Cricoid Pressure: area of adams apple on throat, two+ rescuers only. 3. Mouth to Mask: Insure tight seal over mouth (and nose). Watch for adequate

ventilation.

Basic Bandaging Techniques Veterinary Specialty Hospital Sean W. Aiken, DVM, MS, DACVS Bandages are applied to cover and treat wounds, to prevent swelling or to stabilize injuries temporarily. Splints are used to temporarily stabilize fractures for transport or for definitive treatment of some fractures or soft tissue injuries. The primary goal of this lecture is to become familiar with bandaging and splinting techniques. A typical bandage has 3 layers: Primary or contact layer Material in contact with a wound Adherent Wet to dry Non-adherent Semi-occlusive/occlusive dressings Secondary or intermediate layer

Cast padding or roll cotton Tertiary or outer layer Roll gauze Tapes Bandage application is an art form. The only way to become proficient is to practice. Loose bandages as well as bandages placed too tight can result in significant patient morbidity. Always wrap bandaging material from distal to proximal. The bandage should stabilize the joint above and the joint below an injury. A limb bandage should always extend to cover the toes. The more padding the tighter the bandage can be made. When applying splints or casts pad around bony prominences instead of over Avoid placing splint material over bony prominences. Bandage Types Robert Jones Bandage Indications: Used for temporary limb stabilization and to control swelling below the elbow and stifle. Allows support without compromising blood flow to soft tissues. Supplies: Adhesive tape, roll cotton or cast padding, roll gauze, elastic or conforming tape Application: Tape stirrups, 4-6 inches of cotton padding overlapping by 50% with each wrap, tighten with roll gauze, cover with elastic or conforming tape.

Modified Robert Jones Bandage Indications: Mainly used to control swelling after trauma or surgery. Provides less support than above unless splint material is added. Supplies: Same as above usually substituting cast padding for roll cotton. Application: Tape stirrups, about 1-2 inches of cotton padding overlapping by 50% with each wrap, tighten with roll gauze, cover with elastic or conforming tape. Lateral Splints and Casts Indications: Used for fracture stabilization below the elbow and stifle. Indicated for inherently stable fractures. Supplies: Adhesive tape, cast padding, roll gauze, elastic or conforming tape, stockinet, premade splints or fiberglass cast tape. Application: Tape stirrups, stockinet, no more than 2 layers of cast padding overlapping by 50% with each wrap, add padding AROUND not over bony prominences, tighten with roll gauze, add splint or cast material (stabilize splint material with conforming gauze), cover with elastic or conforming tape. Spika Splint Indications: Used for temporary stabilization of femoral or humeral fractures. Supplies: Adhesive tape, roll cotton or cast padding, roll gauze, elastic or conforming tape, aluminum rod or fiberglass cast tape. Application: Apply Robert Jones bandage as above but continue the bandage to incorporate the thorax or pelvis. Additional support from casting tape or aluminum rod placed over the thorax or pelvis to the opposite shoulder or hip joint. When finished the limb and thorax or pelvis should move as one. Thoracic/Lumbar Spinal Splint Indications: Used for stabilization of lumbar or thoracic spinal fractures. Used with inherently stable fractures in patients with stable neurologic status. Supplies: Cast padding, roll gauze, elastic or conforming tape, aluminum rod and fiberglass cast tape. Application: Apply cast padding over the spine about 2 layers thick. Tape two to three aluminum rods together and conform them to the shape of the spine. Lay and “pinch” cast padding over the aluminum rod. Bandage this splint to the pelvis and the thorax, cranial to the fracture. Cover with conforming or elastic tape. Ehmer Sling Indications: Prevents weight bearing of the pelvic limb. Helps maintain reduction of dorsolateral coxofemoral luxations. Supplies: Cast padding, elastic tape Application: Wrap a thin layer of cast padding around the metatarsal region. Wrap elastic tape in a figure of eight pattern around the stifle, hock and metatarsal region. The goal is to internally rotate the coxofemoral joint. The tape is then carried over and around the abdomen in order to abduct the limb.

Postoperative Instructions to Owners: BANDAGE CARE: • The bandage should be kept clean and dry at all times. • If it is raining or the ground is wet, place a plastic bag over the bandage during the short time your pet is outdoors. Do not leave the bandage covered while indoors. • At least twice daily check for: Toes for swelling or discoloration Any foul odor or discharge Slippage or a change in position of the bandage Sores at the top or bottom of the bandage Licking or chewing at the bandage Signs of discomfort with the bandage If the bandage is wet or soiled If any of these signs are noted it may indicate a serious problem and you should be seen by a doctor BANDAGING AND SPLINTING CRITERIA TIME ALLOWED FOR SKILLS PERFORMANCE - 10 MINUTES PER COMPONENT PERFORMANCE OBJECTIVES 1. BANDAGING - Given a human “patient” and a description of the "patient's" injuries, the candidate shall, within the allotted station time, apply a dressing and bandage according to the principles of hemorrhage control and aseptic technique. 2. SPLINTING - Given a human “patient” and a description of the "patient's" injuries, the candidate shall, within the allotted station time, apply splinting techniques according to the principles of fracture immobilization. TESTING CONDITIONS 1. Examiner shall insure that station is conducted as a testing station and NOT as a teaching session. 2. The station shall test only the skill of Bandaging and Splinting and shall NOT be conducted as a part of any other skill or scenario. 3. Candidates shall be tested in private and no more than two candidates at a time. If two candidates are to be tested, starting times for each shall be staggered. 4. Bandaging and Splinting may be tested at the same station. 5. A non-candidate or a previously tested candidate MUST be used as the "patient." The Examiner shall NOT be used as the "patient." 6. The patient shall NOT "cue" the candidate being examined but may assist to the extent that an actual patient would be able. The patient shall be cooperative. 7. The determination of whether to remove the patient's shoe and sock before beginning exam in situations involving the foot shall be based on policies established by the training program's medical director, consulting physician, or Course Coordinator. 8. Examiner shall require candidate to take or verbalize body substance isolation precautions before station time begins. STATION EQUIPMENT 1. A human “patient” 2. Clean 4x4 dressings 3. Self-adhering roller bandages 4. A pillow or blanket 5. Board splints, 2 each - 15", 36", and 54" (wire ladder or cardboard splints are optional)

6. Cravats 7. Tape 8. Paper cups (optional) 9. Watch or clock with reading in seconds immediately.