EXTRICATION, IMMOBILIZATION, POSITIONING, TRANSPORT MUDr. Ondřej Hrdý MUDr. Petr Suk Extrication • Move the casualty only if absolutely necessary (danger, ABC, severe external bleeding), otherway management in actual position – Activation of Emergency service (Fireman, Police) – Asses ABC regularly in short period – Support the head in casualty with potential neck injury Extrication – traffic incidents • Safety first – Park safely – Set up warning triangle – Make vehicle safe (switch off the ignition, disconnect the battery) – Stabilize vehicle • Assume neck injury in every casualty – Best in more rescuers – Rautek maneuver (picture) – Take off helmet (0:27-1:54) (www.youtube.com/watch?v=mlftftUA7XY) – Manual ln-line stabilization (MILS) EXTRICATION – traffic accident • If not necessary, wait for professionals (link 112) • vyproštění z vozidla - video • vyproštění při poranění páteře -video Extrication - FIRE • Warn people around, activate fire alarm, call 150 • Elements of fire – ignition, source of fuel, oxygen – Remove combustible materials – Cut of a fire´s oxygen (door, window, fire blanket) • Leave the place • Clothing on fire (stop the casualty, drop to the ground, roll along the groun (use blanket)) • Smoke and fumes – Stay (or move) low (clearest air), minimise smoke (block gaps under the door), open the window Extrication – electrical incidents • Your safety first !!! – Do not touch the casualty in contact with the electrical current – Turn off the source of electricity (switch off the current, remove the plugwrench the cable…) – Alternatively, move the source away (strand on some dry insulating material, push the casualty limb away (broom, plastic tube) – Pull casualty away (loop a rope around ankles or under arms) – High-voltage current – may jump up to 18m – power must be cut off before anyone approach Extrication – water incidents • Safety first – Concious casualty – stay on dry land, hold out a stick (rope) for him to grab and help him from water – unconcious – if you´re trained and it is safe (low temperature, strong water flow…) swim to the casualty and ashore – If you cannot do this, call help and wait! • Out of water - ABC – Shield him from the wind, prevent hypotermia (replace any wet clothing with dry one) • Arrange transport to hospital anytime – Water intoxication, infection, hypotermia IMMOBILIZATION • WHY? • Prevention of futher damage • analgesia • Minimalization of blood losses • BE AWARE OF • Nerve and vessel damage (check pulsation and sensetion disatl from injury) • Skin damage FRACTURES • Definition: break or crack in a bone • Division: – closed – without skin damage – open - ANY skin damage in the area of fracture (from abrasion to devastation injury) – Many other divisions (stable x unstable, with or withou deviation…) • Causes: considerable force, exceeding bone elasticity – Pathological fracture: lower resistance due to pathological process ( osteoporosis, tumors) FRACTURES • Recognition: – Pain (deteriorating with move), tenderness – Malfunction – i.e. inability to walk in femoral fracture – Shortening, bending, or twisting – Pathological move at the site of fracture – Swelling, haematoma – Coarse grating (crepitus) of the bone ends • Risk: – Blood losses (femur 2L, pelvis 5L) – Nerve damage (typically n. radialis in humeral fr.) – Fatty embolism (long bone fracture) – Infection • FIRST AID: – Immobilization – enough long splint, supporting the joints on both sides of the fracture – Open fr. – cover the wound with clean dressing – Stop severe bleeding After primary treatement: – Do not allow casualty to eat or drink (anaesthesia may be necessary) – Do not move the fractured limb – Arrange transportz to hospital FRACTURES UPPER LIMB FRACTURES Toe fracture • management in sititng position, compare with uninjured limb • remove any rings, keep the hand rised • wrap in soft, non-fluffy padding, place it in elevation sling Wrist and forearm fracture • sitting position • improvised splint across whole forearm and hand • arm sling UPPER LIMB FRACTURES • ZNEHYBNĚNÍ ZÁPĚSTÍ - video UPPER LIMB FRACTURE Humeral fracture • Usually management in sittig position • Suspect nerve and vessel damage • Arm sling and broad-fold bandage around the chest and over the sling • Call emergency UPPER LIM FRACTURE • ZNEHYBNĚNÍ PAŽE - video UPPER LIMB FRACTURE Collar bone fracture • injured limb is usually lower than uninjured • Sitting position • Elevation sling with direction of hand to uninjured shoulder LOWER LIMB FRACTURWE FOOT and ANKLE - Support the ankle in the most comfortable position, preferably raised - „U“ splint with sling or bandage fixation - Elevation and cooling to minimise pain - Check peripheral circulation - if impaired, loosen the bandage - Arrange transport by ambulance ZLOMENINY DKK • ZNEHYBNĚNÍ NOHY A KOTNÍKU - video LOWER LIMB FRACTURE LOWER LEG FRACTURE • Place padding between the legs (ankle, knee) • Support the uninjured leg by splinting it to th other leg • Knotting on unijured site • Call ambulabnce LOWER LEG FRACTURE FEMORAL FRACTURE • Neck of the femur – especially in the elderly, fracture can ocure after minor injury, smetimes without severe pauin • Diffrerence in leg lenght, inability to walk, rotation • Same immobilization like in lower leg fracture PELVIC FRACTURE • Expect shock state everytime due to high blood loses • Do not move the casualty if not absolutely necessary (pain, further damage, higher blood loses • Help the casualty lie down, keep her legs straight • Place padding between knees and ankles, bandage both legs together • Call for emergency LOWER LEG FRACTURES • ZNEHYBNĚNÍ BÉRCE, STEHNA, PÁNVE - video VERTEBRAL FRACTURE • Car accident, fall • Local pain, deformiry above fractured vertebra • Assess spinal cord function (limb movement and sensitivity) • Do not move the casualty if not necessary, use Rautek maneuver, better in more rescuers to prevent spine movement • In neck fracture – risk of respiratory and circulatory failure • Prevent head movement • Call for emergency CHEST TRAUMA • CLOSED • OPEN (PENETRATING) • RIB FRACTURE • PNEUMOTHORAX – closed – open – tension PNEUMOTHORAX • Sitting position • Cover and seal the wound from three sides (one way valve) ABDOMINAL TRAUMA • CLOSED - expect parenchymal organ damage with internal bleeding • OPEN - PENETRATING – Do not remove any foreign bodies – Never repond protruded organs – Call for emergency POSITIONING • Rautek (recovery) position Rautekova a stabilizovaná poloha Positioning Polohy vleže na zádech • Poloha vleže na zádech s nepodloženou hlavou a nataženými končetinami na tvrdé podložce Používá se při resuscitaci, poranění páteře • Poloha vleže na zádech s podloženou hlavou Používá se u při postižených při vědomí, základní vyetřovací poloha. • Poloha vleže na zádech s nepodloženou hlavou a podložením dolních končetin o 15 až 30 cm Používá se při začínajícím a rozvíjejícím šoku. - PROTIŠOKOVÁ POLOHA • Poloha vleže na zádech bez podložení hlavy a se zvednutím dolních končetin do 90° Používá se při šoku nebo při velkých ztrátách krve. • Autotransfúzní poloha Používá se u postižených při velkých ztrátách krve. Postižený leží na zádech a horní a dolní končetiny jsou zvednuty v 90° úhlu. Poloha na břiše s podložením čela a ramen Používáme při krvácení z úst, obličeje, při popáleninách zad, u úrazů na sakrální krajině u postižených s plným spontánním dýcháním. Poloha vsedě s oporou zad a hlavy Postižený je při vědomí. Používá se při poranění obličeje, hrudníku (otevřeného i zavřeného) a poranění horních končetin. U poranění dolních končetin – hlezno, pata, Achillova šlacha, prsty nohy. Poloha na boku se skrčenými dolními končetinami a mírně podloženou hlavou Úlevová poloha při náhlých příhodách břišních. Postižený si obvykle sám tuto polohu zvolí jako nejlépe snesitelnou. TRANSPORT Improvised x Medical (if any doubt, call ambulance) Primary (from the place of accident to hospital) Secondary (between hospitals) TRANSPORT • transport - video MAJOR INCIDENTS DEFINITION: Presents a serious threat to the safety of a community, or may cause so many casualities that it requires special arrangements from the emergency servis • Declaration is responsibility of the emergency services • Special organisation in the place of accident • Triage – special systém to assess casualities, all casualities undergo primary survey, than they are divided in subgroups with different priority (every casuality after primary survey is equiped with colored mark) Czech republic START protocol– assesing vital function - Ventilation - Circulation (pulse on art. Radialis) - Conciouseness 1. immediate treatement 2. Can „wait“ – spontaneous respiration, palpable pulsation, arrousable 3. Minor trauma 4. Death PRACTICAL SKILLS • POSITIONONG • Rautek position • IMMOBILIZATION • Immobilization of upper limb HK – wrist – Arm sling • Immobilization of lower limb – ankle – „U“ splint – Fixation of both legs (slings) • EXTRICATION • Rautek maneuver + neck fixation • MILS Thank you for attention