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Being a HELIX means you are the medical units of the MPF. If you don't know your shit, people are going to die. This is a very thorough guide, and you DO NOT NEED TO KNOW THIS WORD FOR WORD! This is just so that new players (specifically new HELIX units), and even I myself, can come to this guide during RP, and look up a few things. This is very wordy, and confusing. I suggest reading the bottom and top first if you do not understand a few words. I tried to make it as simple step by step as possible, I apologize for being very complicated, suck it up.
Being a HELIX unit, means you need to have patience (but not too much, don't worry) and the ability to passive RP medical injuries. Also, other units and people, if you get shot, don't walk it off, come RP, we HELIX units don't get much medical RP, we love it.
There is a very helpful glossary to those new to medical terms at the bottom.
DISCLAIMER!!!--- THIS GUIDE CAN NOT BE USED IN REAL LIFE DUE TO IT BEING A SUMMED UP GUIDE SO PEOPLE WON'T SPEND HOURS RPING THE MEDICAL-NESS. Do not blame me, if you try this and real life, and people die, its not all good for real life, specific muscles, arteries, etc. MUST be treated by a trained proffesional.
Note: Important stuff colored/bolded. You don't need to really read past the list of treatments, although the bottom is very helpful for specific things and would be good to graze over. The most important stuff is higher up.
What you'll find in a common Medical Kit:
Anti-Septic Cream (in a small tear-able packet)
Hydrogen Peroxide (small 100ml bottle)
Bandages
Suturing Kit
Green Medi-Gel (see below)
Burn Cream
QuiKClot (Calcium Zeolite artificial coagulant)
Steri-Strips (band-aids)
Powder-Free Latex Gloves
Scalpel and Tweezers
You are encouraged to make your own medkit. My DvL carries a dufflebag with this stuff and a few things such as plyers in place of tweezers.
HL2RP Specific Medical Items:
Green Medi-Gel - Used as a plaster, in a sense. It has the consistency of grape jelly (viscous but will easy come apart). After the container is opened, you can not re-close it. There would only be one of these in a medkit, or you can carry them separately. You would plaster this gel onto open wounds while holding the wound shut, and it will solidify, effectively creating an artificial seal. It takes about 10 seconds to harden once spread thin enough (too thin and it'll break easily). To remove, after dry, it peels off after some work at it. This isn't a comfortable experience but it's better than an open wound. This does not heal the wound in any way, and it won't allow for the blood to naturally clot. But this closes the wound to allow transport of a patient or to quickly stop bleeding of a large wound, and can be removed later to help the patient in a safer location. It will fall off itself after about eight to twelve hours.
On scene!
There are things that must be checked on scene, the first is DR-ABCs. DR-ABCs is an abreviation for "Danger, Response, Airway, Breathing, Circulation". Danger, is it safe? If there are opposing forces in the area or you are at risk, LEAVE the patient and get to safety. You are doing more harm than help if you get injured trying to assist those while out on the field. Response, does he respond to your voice? Your knuckles dragging across his sternum? A pinch at his ear? If he does, you can skip this part unless he is clearly having difficulties. To check circulation place two fingers at the cartoid artery. If the casualty has lost alot of blood, his HR will be high. For airways and breathing, perform the jaw-pull maneuver. Place an ear to his mouth and have a hand at his chest, feel and listen for breathing. There can be no breathing and a pulse but not the other way around.
If he is unconscious, check these. Also be sure to check for trauma. Usually you should assume trauma until you've made sure it isn't. This means checking for pupil dilation and using the jaw-pull maneuver when checking airways and breathing. If the eyes are not dilating or are blown open, it means he is more than likely concuss. I will explain what to do later.
Always work as a team, you are not a one man show. If there are multiple casualties, then you can split up and work but single cases it's best if you work together.
Don't be discouraged if someone dies while you're working on them. If they were in a extremely bad condition when you arrived and were a little past the point of no return, it was only a matter of chance if you saved him or not.
Common procedures
Bullet wound
1 Check DR-ABCs
2 Check for internal bleeding with a Stethoscope. It will sound like a waterfall, if there is. Check to make sure there isn't Artery bleeding at the torso. There is alot of them, so if the artery is struck, more than likely they will require a Specialist at the O.R. or they'll be dead on scene.
3 Apply the powdered QuiKclot Calcium Zeolite
4 Withdraw and apply 3cc of Morphine in the form of an IM to the Cubital Vein.
5 If you suspect your patient had been like this for awhile or was in a bad condition, use a tourniquet to promote the cubital vein, take an IV of Lactated Ringer's Solution D50NS 500cc. Place the IV needle in, withdraw it in the place of the Cathera and use Saline to check the flow.This will help with what blood has been lost. You can hang it from your own gun to anything that's at a higher elevation.
6 Cover the open wound with a sterile gauze pad and bandage roll, transfer the casualty onto a gurney. Take them to a safe and sterile area, usually the med bay.
7 Call for someone of expertise. If none are available, continue with the following.
8 Place them onto an ECG, eight pad set to the bare torso. This will monitor the HR and BP.
9 Give them 10cc of Methohexital if they're conscious as it is a General Anaesthetic, which numbs and puts them to sleep. If they're unconscious, use 5cc of Lidocane which is a local anaesthetic, numbing.
10 Make an incision with a scalpel, use clamps to hold it open. If you're with a partner, have them use a bovie pen to cauterize the blood vessels.
11 If there was internal bleeding, use acetaminophen in the form of an IM to
remove the clottage Calcium Zeolite created, before cauterizing the blood vessels.
12 Remove the bullet with a pair of forceps. Have your partner finish up on the cauterizing. If they're not present, do so yourself. Read more to find out about organ damage, if it occurs.
13 Suture the incision
14 If they need a transplant, place them onto an IV packet of O - blood until you get their blood type. Otherwise, give them NSAIDs and antibiotics. For example, Daptomycin and Ibuprofen.
Normal lacerations.
Sterilize it, give them a Local Anaesthetic and suture it.
Artery bleeding
1 Check DR-ABCs.
2 90 percent of Artery bleeding is usually when the skin isn't present. The other 10 percent is where it's swollen, hot to touch and has the whole web of capillaries clear to be seen.
3 There is different approaches, usually the area differs. For example, the arm most you just treat as usual bleeding. However, from the Brachial V(Near top of the arm) to the Radial Collateral A(Just about at the elbow) you use a Tourniquet instead of applying a powdered QuiKclot. For the leg, it's the Iliac(top of the leg) to the Femoral artery (just about at the kneecap) that requires a tourniquent.
If it is not in need of a tourniquent, handle it like normal bleeding.
4 If the casualty has received a hit to the torso that caused artery bleeding(there is a shit ton of them in the human torso, it is a grain of salt chance they'll go unharmed), the casualty is usually more than likely dead. Bullet wounds you usually want to claim the Kevlar took most of the impact.
Extreme lacerations and/or gashes
1 Check DR-ABCs
2 Check for internal bleeding with a Stethoscope. It will sound like a waterfall, if there is.
3 Apply the powdered QuiKclot Calcium Zeolite
4 Withdraw and apply 3cc of Morphine in the form of an IM to the Cubital Vein.
5 If you suspect your patient had been like this for awhile or was in a bad condition, use a tourniquet to promote the cubital vein, take an IV of Lactated Ringer's Solution D50NS 500cc. This will help with what blood has been lost. You can hang it from your own gun to anything that's at a higher elevation.
6 Cover the open wound with a sterile gauze pad and bandage roll, transfer the casualty onto a gurney. Take them to a safe and sterile area, usually the med bay.
7 Call for someone of expertise. If none are available, continue with the following.
8 Place them onto an ECG, eight pad set to the bare torso. This will monitor the HR and BP.
9 Give them 10cc of Methohexital if they're conscious and if you suspect organ damage or anything of the sort as it is a General Anaesthetic, which numbs and puts them to sleep. If they're unconscious, use 5cc of Lidocane which is a local anaesthetic, numbing.
10 Check for organ damage, if none then just cauterize the blood vessels and suture it. Prescribe NSAIDs and Antibiotics, example being Daptomycin and Ibuprofen.
11 If there is organ damage, continue reading.
Burns
1 Check DR-ABCs
2 Apply a cloth or gauze pad coated in petrollium jelly. If you don't and just apply it by itself, it will hurt upon removing. You can also use cold water.
3 Remove the skin around the area of the burn.
4 Sterilize it with Vaseline.
5 Prescribe Solarcane(Topical, just spray it on.) and Daptomycin(antibiotic).
3rd/4th degree burn
1 -Check ABCs
2 -Do not apply burn gel. Apply cold water.
3 -Place them on an IV of L.R. Solution D50NS 500cc infused with penicillin or administer via IM into IV line. Keep them hydrated
.
4 -4th degree burn to the chest, neck or head is death. If the arm is too badly burned, use the Femoral artery at the leg. Or any blood vessels that can handle the
strain of an IV. If you cannot get access to the leg, use the CVA. IV to the jugular.
5 -Cover with sterile bandage rolls and gauze pads ASAP.
6- No sterilizing will be needed on scene, the heat it self is a pretty good disinfectant. If you sterilize it with Hydrogen peroxide on scene, it will be the equivalent of lighting his arm on fire. Don't use that.
7 - Transfer in, change bandages oftenly, prescribe Solarcane and Daptomycin.
8 - Three or four weeks into the healing process, the patient is then going to be in need of skin graphing.
9 - Call in a someone specialized with Plastic Surgery or a Dermatologist procedures.
Organ damage
Most people would be screwed on the dot, as I don't believe we have organs for organ transplants. However, if one were to come to this, you can follow this procedure. (I have no clue if the ACP has spare organs, if so, go ahead!)
Some organs cannot be replaced, some organs can. The intestines for example cannot be removed, however they can be shortened. Clamp off the ends surrounding the damaged part of the intestine, remove it with a scalpel, remove the clamps, bring them together, cauterize the blood vessels and secure it with staples. The patient however, will die from Sepsis in weeks or months. We have no current antibiotic that can stop Sepsis, nor stop it from sterilizing it thoroughly.
Usually when replacing an organ, you do the following.
1 Clamp off the ends of the organ which is being removed.
2 Remove it with a scalpel.
3 Take the replacement, place it in. Cauterize the blood vessels, secure it with staples.
4 Use an over-head laser for the nerves. This will take hours, RP wise. It is a major pain in the ass to do.
5 Check for signs of organ rejection. Can't just toss any ol' Organ in there.
Punctured LUNG
1 Check DR-ABCs
2 Check for internal bleeding with a Stethoscope. It will sound like a waterfall, if there is.
3 Apply the powdered QuiKclot Calcium Zeolite
4 Withdraw and apply 3cc of Morphine in the form of an IM to the Cubital Vein.
5 If you suspect your patient had been like this for awhile or was in a bad condition, use a tourniquet to promote the cubital vein, take an IV of Lactated Ringer's Solution D50NS 500cc. This will help with what blood has been lost. You can hang it from your own gun to anything that's at a higher elevation.
6 Place them onto an ambu-bag. Manuel pump instrument. You pump it, they recieve oxygen from the mask. Simple.
7 Cover the open wound with a sterile gauze pad and bandage roll, transfer the casualty onto a gurney. Take them to a safe and sterile area, usually the med bay.
8 Call for someone of expertise. If none are available, continue with the following.
9 Place them onto an ECG, eight pad set to the bare torso. This will monitor the HR and BP.
9 in a half (fuck the zo-lice.) Place the patient onto the M.A.B (Mechanically assisted breathing)
10 Give them 10cc of Methohexital if they're conscious as it is a General Anaesthetic, which numbs and puts them to sleep. If they're unconscious, use 5cc of Lidocane which is a local anaesthetic, numbing.
11 Make an incision with a scalpel, use clamps to hold it open. If you're with a partner, have them use a bovie pen to cauterize the blood vessels.
12 If there was internal bleeding, use acetaminophen in the form of an IM to remove the clottage Calcium Zeolite created, before cauterizing the blood vessels.
13 Remove the rib puncturing the lung. If it's still attached, remove it with a bonesaw, reposition it and secure it with screws. If it is a bullet, remove the bullet. Chances are it would've passed through however. You remove them with a pair of Forceps.
14 Drain the lungs of blood with a vacuum tube. Cauterize the blood vessels and secure the puncture with staples.
15 Cauterize the blood vessels (I know I say this alot but it's usually what needs to be done) and remove the clamps. Suture the incision.
16 If they need a blood transplant, place them onto an IV of O - blood
17 Prescribe NSAIDs and antibiotics. In this case, clarithromycin and Ibuprofen.
Broken limbs.
1 Check DR-ABCs.
2 Use a Stethoscope to check for internal bleeding. It will sound like a waterfall, if there is any.
3 Secure the limb with a splint.
4 Transfer the patient onto the stretcher. If there was internal bleeding, apply a QuiKclot in the form of a IM.
5 Once at the bay or area that is sterile and secure for operating.
6 Remove the splint, apply molding solution. Wait for it to harden.
7 Apply casting wrap.
8 If there was internal bleeding, place them under a G.A. if they were conscious, place them under a L.A. if unconscious. Make an incision, apply acetaminophen in the form of an IM to remove the clottage the QuiKclot created. Use a bovie pen to cauterize the blood vessels, then perform the suturing once removing the clamps holding the incision open. Pay no mind to the two statements above, instead use them after this step.
9 Give them NSAIDs. Ibuprofen. Daptomycin for antibiotics if you had to make an incision, just to be sure that if an infection occured, they're already backed.
Compound fracture
1 Check DR-ABCs
2 Check for internal bleeding with a Stethoscope. It will sound like a waterfall, if there is.
3 Apply the powdered QuiKclot Calcium Zeolite
4 Withdraw and apply 3cc of Morphine in the form of an IM to the Cubital Vein.
5 If you suspect your patient had been like this for awhile or was in a bad condition, use a tourniquet to promote the cubital vein, take an IV of Lactated Ringer's Solution D50NS 500cc. This will help with what blood has been lost. You can hang it from your own gun to anything that's at a higher elevation.
6 Cover the open wound with a sterile gauze pad and bandage roll once it is in a splint, transfer the casualty onto a gurney. Take them to a safe and sterile area, usually the med bay.
7 Call for someone of expertise. If none are available, continue with the following.
8 Place them onto an ECG, eight pad set to the bare torso. This will monitor the HR and BP.
9 Give them 10cc of Methohexital if they're conscious as it is a General Anaesthetic, which numbs and puts them to sleep. If they're unconscious, use 5cc of Lidocane which is a local anaesthetic, numbing.
10 Make an incision to expose it entirely, use clamps to hold it open.
11 Remove the bone with a bone saw, re-allign it and secure it with screws.
12 Cauterize the blood vessels and suture the incision.
13 Apply molding solution and casting wrap.
14 Prescribe NSAIDs and antibiotics, example being Ibuprofen and Daptomycin.
If it's a broken rib, nothing can be done unless it's compromising the lungs. They will be stuck in bed for a long while because of this though. They cannot move.
Concussed patients
1 Check DR-ABCs.
2 Check for pupil dilation. If there is none or if its blown open, it means the patient is concussed.
3 Not much can be done aside from drawing blood from their head with a sterile empty syringe and placing an icepack on them. Bring them in for a CAT scan. If it checks out, the patient will be fine. If there is brain damage then they're more than likely boned. If the brain has shifted out of place, he is dead.
ANAPHYLAXIS
The anaphylaxis is a severe allergic reaction which can produce shock and circulatory collapse. In sensitive people, anaphylaxis can occur within minutes, but may also occur up to several hours after exposure to a specific allergy-causing substance. If a patient got an allergic reaction:
- Check for special medications that the person might be carrying to treat an allergic attack, such as an auto-injector of epinephrine
- Look for a medical emergency ID bracelet or necklace.
- Have the person lie still on his or her back with feet higher than the head.
- Loosen tight clothing and cover the person with a blanket.
- If there's vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.
- If there are no signs of circulation (breathing, coughing or movement), begin CPR.
Poisoned Patients
1 Check DR-ABCs
2 Apply Naloxone. Flushes the body, helps coagulate the blood too. Might want to place them onto a "piss pot", turn their head sideways to prevent choking when they vomit. They will vomit, urinate, crap and possibly cry.
3 Place onto an IV of NaCl Saline.
List of other information that's handy.(Copy pasta from old EMT .txt from LS-RP, could come in handy here!)
Equiptment:
ECG (Electrocardiogram) - Records the electrical activity of the heart over time. It uses electrodes to attach to the chest and body to read the activity.
AED (Automated External Defibrillator) - A portable electronic device that automatically diagnoses the potentially life threatening cardiac arhythmias* of Ventricular Fibrillation and Ventricular Tachycardia in a patient.
ET Tube (Endotracheal Tube) - The tube used when intubating.
Forceps - Handheld, hinged instrument used for grasping and holding objects. Used when the obect is slippery or small. (Tweezers, tongs, pliers, clips and clamps basically.)
Laryngoscope - An instrument used to obtain a view of the vocal folds and glottis (Space between the cords).
Mcgill Forceps - Long angled forceps, useful for retreiving objects out of the upper airway. They are slightly curved so they are useful for working in or near the airway. They have rubber grippings on the end.
Scalpel (10 blade) - An extremely sharp knife used for surgery.
Sphygmomanometer - Used to measure blood pressure. It consists of an inflatable cuff and a meter. It is used with a stethoscope. Inflated until no noise can be heard, slowly deflate it while listening with your stethoscope below the sphymomanometer. You will hear a whooshing or pounding sound, this is the Systolic pressure of the BP. Keep releasing pressure, once there is no noise, that is the Diastolic BP.
Stethoscope - Used for Auscultation (Listening) to the internal sounds of a body. Often used to listen to heart sounds. Also used to listen to internal organs and the lungs. A stethoscope is one of your best friends in making a diagnosis.
Trauma Kit - A trauma kit is a kit onboard of the ambulance. It carries a variety of equiptment and objects used in the field.
Basic Emergency Response:
Grab your Trauma kit and triage. Tag the dead for the Morgue.
Triage - The process of prioritizing patients based on the severity of their condition.
During a large casualty call, prioritize by the following simple triage guideline
1. The deceased - Black
2. The injured who can be helped by immediate transportation - red
3. The injured whose transport can be delayed - yellow
4. Those with minor injuries, who need help less urgently - green
Start your examination by communicating to the patient.
Vocal stimuli - Is he responding to vocalization?
Painful Stimuli - Is he responding to a pinched ear or knuckles on the sternum?
If he is responding you can skip the ABC's, otherwise.. ABC's:
A - Airway
B - Breathing
C - Circulation
A:
Check if the patient is breathing. Use a simple maneuver such as pulling their chin forward (Jaw thrust). If their tongue is blocking their airway, move it, keep it out of the way. After that, check:
- Do you feel air coming out?
- Do you hear breathing?
- Do you see the chest going up and down?
Any of the previous and you know your patient is breathing.
If there is no breathing, begin diagnosing why.
Check the upper airway, make sure nothing is blocking it such as blood or their tongue. If their tongue is blocking the airway, insert an OPA or NPA.
An OPA is an Oropharyngeal airway, NPA is Nasopharyngeal airway.
OPA a medical device, used to maintain a patents airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the patient from breathing.
NPA is Nasopharyngeal airway. Same thing, except in the nose. Popular because there is no gagging. DO NOT USE ON HEAD TRAUMA.
If the upper airway is blocked, you need to remove it or preform a crichothyrotomy. Covered in intermediate level skills. IF liquid, suction. Blood or spit.
B:
Check if the lungs are working. If you cleared the airway you should now see him breathing by himself. If they aren't breathing by themselves, begin ventilating the patient. If you begin ventilating the patient and the chest moves up and down, move to C. Otherwise:
Check for a pulse. If there is a pulse but no breathing, perform a Heimlich maneuver before the patient dies.
C:
Check their pulse.
If there's no palpable pulse, attach to ECG and check for a shockable rhythm.
ECG will show one of three things.
Asystole - Flatline. Begin CPR, do 5 cycles and check for a shockable rhythm.
Normal rhythm - Not shockable. If no pulse, begin CPR.
fribulated rhythm - Shockable. Pumps to fast to load blood into the ventricles.
CPR (Cardio Pulmonary Recessitation):
CPR consists of 30 compressions (Or external heart massages) and two ventilations in cycles of 5. Use the palm of your hand on the chest push down with your weight.
Two ventilations, 30 compressions, two ventilations, 30 compressions, 2 vents, 30 comp, 2 vent, 30 comp, 2 vent, 30 comp and then check for an available rhythm or shockable rhythm.
Infants are 15:2, use two fingers instead of a palm.
Before transport, DO NOT MOVE. Spinal board and c-collar until the spine is cleared by a doctor. Always give oxygen, calming factor. Saline - Fluid replenishing salt water - Lactated Ringer's solution D50NS.
ALLERGIES
Methylprednisolone – Anti inflammatory drug, used in asthma and anaphylaxis. Routes: IV, IM, IV Infusion, Oral.
Diphenhydramine/Benadryl – Used for allergic reactions. reduction of smooth muscle contraction, making diphenhydramine a popular choice for treatment of the symptoms of allergic rhinitis, hives, motion sickness, and insect bites and stings. Routes: Oral, IM, topical, suppository.
Epinephrine (also referred to as adrenaline) – Used in Anaphilaxis (Severe allergic reaction) Increases speed and strength of heart contractions and raises blood pressure. Routes: IV, IM, endotracheal.
Pain Relief
Morphine - Pain control. Different from others because it acts directly on the central nervous system. It’s highly addictive when compared to other substances. Routes: Inhalled, Insufflated, Oral, SC, IM.
The Barbiturate phenobarbital - It's preferred by Terrorists and Bank Robbers alike. Increases your pain tolerance to the extreme. Northern Hollywood shootout for an example, one of the robbers took a 12 gauge shot to the back, turned around, sprayed the Officer up and walked off like nothing happened. Drawbacks is that the chance of having a heart attack goes through the roof.
While it is not preferred in your practices, if the situation is either a final stand or you /need/ to move or you will die, it would appropriate to use it. Not issued by default, might want to talk to your superior for obtaining it.
ADMINISTRATION ROUTES
Intranasal - Nasal sprays, used for the nasal delivery of a drug or drugs, generally to alleviate cold or allergy symptoms such as nasal congestion.
Intravenous(IV) - is the giving of liquid substances directly into a vein(neck, wrist or arm). It can be intermittent or continuous; continuous administration is called an intravenous drip. It’s used with an IV line needle. EMT BLSes are not allowed to access these routes.
Intramuscular(IM) – is the kind of injection of a substance directly into a muscle.
Insufflation - is the practice of inhaling substances into a body cavity, but is common with many respiratory drugs used to treat conditions in the lungs (asthma or emphysema) and paranasal sinus (allergy).
Topical – It’s applied to body surfaces such as the skin or mucous membranes, for example the vagina, anus, throat, eyes and ears. Some hydrophobic chemicals such as steroid hormones can be absorbed into the body after being applied to the skin in the form of a cream, gel or lotion.
Oral – Its when you give pills, drink, like cough syrup. Simply through the mouth or in other words, enternaly.
Rectal – Its when its injected into the main rectal vein or artery, which are near the rectum. For the diagnosis of certain ailments, a rectal exam may be done. Also called Enternally. EMT BLSes are not allowed to access these routes.
Endotracheal – Also called Endotracheal tube, ET tube or just ETT. Used in general anaesthesia, intensive care and emergency medicine for airway management and mechanical ventilation. The tube is inserted into a patient's trachea in order to ensure that the airway is not closed off and that air is able to reach the lungs. The endotracheal tube is regarded as the most reliable available method for protecting a patient's airway.EMT BLSes are not allowed to access these routes.
Injection – Simple liquid injection through a syringe. EMT BLSes are not allowed to access these routes.
Suppository - a drug delivery system that is inserted either into the rectum (rectal suppository), vagina (vaginal suppository) or urethra (urethral suppository) where it dissolves. EMT BLSes are not allowed to access these routes.
ET Tube (Endotracheal Tube) - The tube used when intubating.
: A tube that is put through the mouth and goes down to the entrance of the lungs. It clears their way and you can attach an ambu bag (hand pump) or in the hospital a ventilator which breaths for them automatically
/me takes the ET tube from his kit
/me opens the patients mouth and inserts the tube
/me attaches an Ambu bag and starts hand pumping to make them breath
Head Trauma:
Vocal Stimuli? Painful stimuli?
Check reflexes. Open the eyelid and shine your penlight in it. If there is dialation and they are concious and aware, they are fine.
If the pupils do not dialate, you assume the patient is concussed.
If one pupil is 'blown', you assume there is a serious head injury. More than a concussion.
In either case, give IV fluids, transport to hospital asap.
Bleeding:
Vocal Stimuli? Painful Stimuli?
Apply pressure to the wound. Sterile Gauze to prevent infection.
If the wound is on an extremity, apply a tourniquet above the wound to prevent the artery from pumping more blood to the wound.
Bandage the count
Once bleeding is controlled, give them IV fluids. Transport to the nearest hospital.
Burns:
Vocal Stimuli? Painful stimuli?
Immediately make attempts to sooth the burn. Cold water or burn gel. Cover the wound in petroleum jelly coated plain gauze, otherwise it will stick and cause pain on removal.
Administer IV Saline. Check for signs of shock.
Do not disinfect, it will make it worse.
Breaks and dislocations:
Vocal Stimuli? Painful stimuli?
If the fracture is compound immediately treat bleeding.
Put the fracture in a traction splint
Administer pain medications
Gunshot wounds:
Vocal Stimuli? Painful stimuli?
Treat same as bleeding, take into account exit wounds.
Check for signs of internal bleeding with your stethoscope. Auscultate.
- Intermediate level examination and procedures:
More detailed examination. Examine area's related to injury. Palpate and auscultate.
Transcutaneous pacing - Temporary means of pacing the patients heart during a medical emergency. Mostly used for a slow heart to speed the pace up to acceptable levels.
Pads placed on patients chest. Attached to monitor/defribrillator, heart rate is selected and a current is increased until electrical capture. You can then speed up the heart.
IV - IntraVenous:
The method of giving fluids or medication through a vein. It is a quick method, valued by emergency medicine for giving quick medication to a patient.
Steps -
Tourniquet arm. Wait for the blood returning in the veins to bulge the medial cubital vein. Take and IV needle and insert it into the vein, feed it through the vein slowly. Push a catheder* into the vein and pull back the needle. Tape down the catheder. Flush the catheder with saline to make sure it has flow.
Emergency Needle Decompression for tension pneumothorax:
Insert a large bore cannula or needle in to the second intercostal space. Field decompression is allowed, but it's better in a sanitary enviroment. Only perform a needle decompression if it's causing discomfort for the patient.
LR (Lactated ringers solution):
is a compound that is isotonic with blood and intended for intravenous administration.
IV administration
- Advanced Level examination and procedures:
Crichothyrotomy:
An emergency incision through the skin and cricothyroid membrane to secure a patient's airway during certain emergency situations, such as an airway obstructed by a foreign object or swelling, a patient who is not able to breathe adequately on their own, or in cases of major facial trauma which prevent the insertion of an airway through the mouth.
Mechanical ventilators:
method to mechanically assist or replace breathing.
Ventilation can be delivered from:
Hand controlled devices such as a BVM
Mechanical ventilators:
Field transport ventilators, ran off battery sources.
ICU ventilators, in the hospital. Ran from hospital power
Central venous access:
If it isn't possible to find a vein on the arm, attempt CVA.
A Central venous catheter is inserted into the large vein in the neck(Jugular line), chest(Subclavian) or groin(Femoral cutdown).
Vasoconstrictors:
The narrowing of blood vessels resulting from contraction of the muscular wall of the vessels. When blood vessels constrict the flow of blood is restricted or decreased, thus, retaining body heat and increasing BP. Skin turns paler as less blood reaches surface. Some drugs cause this such as cocaine and LSD.
It can be beneficial to you, if your patient as lost a lot of blood and his BP is low.
Pseudoephedrine is a vasoconstrictor carried by paramedics. It is given via IV.
Blood Transfusion:
0 negative type blood via IV given to replenish blood loss until a type specific blood is identified.
Synchronized Cardioversion:
Method to slow an abnormally fast heart rate by delivering a therapeutic dose of electrical current to the heart at a specific moment in the cardiac cycle.
Attach two pads, one on the front of the chest, one on the back. Turn the cardioversion machine on and allow it to deliver the shocks.
Rectal tube:
A tube inserted rectally to deliver medication when no other way is possible. Be sure to lube it.
Suturing:
Used to hold skin, internal organs, blood vessels and all other tissues of the human body together after they have been severed by injury, incision or surgery
Sutures are absorbable, no need to come back for removal.
Horizontal Matress suturation - Common suturing technique. Used on area's that don't revert from movement, such as the chest and head. Less chance of scarring.
Vertical Matress suturation - Used on area that invert, such as the fat on the neck. More chance of scaring.
Steri-strips:
Used on simple cuts. hold it shut and keep foreign debris from getting in. Can be changed at home.
Surgical staples:
Can be used instead of sutures. Used on organs or on certain simple wounds. They need to come back, to have them removed.
- Illnesses:
Cough: No cure. Surpress with cough syrup. Xyzal pills, 250cc
Cold: Bit worse than cough, no real cure. Cold medication and quit crying.
Flu: Another uncurable illness. Surpress it with meds and sleep. Antibiotics such Clarithromicine, 250-500cc
Bronchitis: Respiratory illness. Cough and phlegm. inflamed airway, shortness of breath, wheezing. Antibiotics such as Clarithromicine again, plus broncho-dilators, such as Aliflus 500cc.
Appendicitis: Inflammation of the appendix. Surgically removed inflammed appendix.
Hemi-paresis: Weakning of one side of the body. Pain. No cure, you're fucked. Stupid illness for LSRP.
- Vital organs and vessels:
Organs -
The Heart - Muscular Organ responsible for pumping blood through the blood vessels by repeated rhythmic contractions. Left side to body, Right side to lungs.
Lungs - Respiration organ. All complex life forms have lungs of some kind. Located in the chest, either side of the heart. Transport oxygen from the atmosphere into the blood stream. Release carbon dioxide from the bloodstream into the atmosphere.
Once air progresses through the mouth or nose, it travels through the oropharynx, larynx and trachea. Reaches alveoli where gas exchange takes place.
Liver - Frankenstein organ. You can lose 33% of it and live. Responsible for a lot of functions. A few are detoxification, protein synthesis and production of biochemicals necessary for digestion. Necessary for survival, no way to compensate for absense of liver function. Some can be emulated by liver dialysis, such as large ammounts of detoxification.
Brain - Central nervous system in all vertbrae and most invertebrae animals. One of the most confusion and mysterious parts of the human body. LOCATED IN YOUR HEAD, JUST INCASE YOU DIDNT KNOW.
Spleen - Located in the abdomen of the body. It destroys old red blood cells and holds a resevoir of blood.
Kidney - Break down waste in the blood stream. Extra water. The wastes become urine which flows to the bladder. Releases important hormoans including Renin which regulars BP.
Stomach - between the throat and small intestine. It kills parasites and bacteria ingested. Breaks down food into smaller particles. Temporarely hold food and release it at a steady constant rate to the intestine.
Reproductive - Anatomical parts of the body which are involved in sexual reproduction, which I believe you know pretty well. I bet you had thousands of lessons on youporn, right? Right.
Senses - Hearing, visuals, smelling, feeling and taste.
Blood vessels:
Vein - To heart
Artery - away from heart
Aorta - Largest artery, carries blood out of the heart.
Aorta Branches in to several large arteries:
Carotid artery - Supplies the neck and the head with oxygenated blood
Subclavian artery- Major artery of upper thorax, mainly supplies blood to the head and arms. Located below the clavical bone.
Superior Mesenteric Artery - front of the aorta, supplies the intestine, colon and pancreas as well as lower thorax.
Rental Artery - Off the side of the abdominal aorta, supply the kidneys with blood.
Iliac artery - lower thorax and pelvic artery
Artery connects to Arteriole.
Arteriole connects to capillaries and capillary bed.
Capillaries connect to Venule.
Venule connects to vein.
Triage - The process of prioritizing patients based on the severity of their condition.
During a large casualty call, prioritize by the following simple triage guideline
1. The deceased - Black
2. The injured who can be helped by immediate transportation - Red
3. The injured whose transport can be delayed - Yellow
4. Those with minor injuries, who need help less urgently - Green
THE END
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Being a HELIX means you are the medical units of the MPF. If you don't know your shit, people are going to die. This is a very thorough guide, and you DO NOT NEED TO KNOW THIS WORD FOR WORD! This is just so that new players (specifically new HELIX units), and even I myself, can come to this guide during RP, and look up a few things. This is very wordy, and confusing. I suggest reading the bottom and top first if you do not understand a few words. I tried to make it as simple step by step as possible, I apologize for being very complicated, suck it up.
Being a HELIX unit, means you need to have patience (but not too much, don't worry) and the ability to passive RP medical injuries. Also, other units and people, if you get shot, don't walk it off, come RP, we HELIX units don't get much medical RP, we love it.
There is a very helpful glossary to those new to medical terms at the bottom.
DISCLAIMER!!!--- THIS GUIDE CAN NOT BE USED IN REAL LIFE DUE TO IT BEING A SUMMED UP GUIDE SO PEOPLE WON'T SPEND HOURS RPING THE MEDICAL-NESS. Do not blame me, if you try this and real life, and people die, its not all good for real life, specific muscles, arteries, etc. MUST be treated by a trained proffesional.
Note: Important stuff colored/bolded. You don't need to really read past the list of treatments, although the bottom is very helpful for specific things and would be good to graze over. The most important stuff is higher up.
What you'll find in a common Medical Kit:
Anti-Septic Cream (in a small tear-able packet)
Hydrogen Peroxide (small 100ml bottle)
Bandages
Suturing Kit
Green Medi-Gel (see below)
Burn Cream
QuiKClot (Calcium Zeolite artificial coagulant)
Steri-Strips (band-aids)
Powder-Free Latex Gloves
Scalpel and Tweezers
You are encouraged to make your own medkit. My DvL carries a dufflebag with this stuff and a few things such as plyers in place of tweezers.
HL2RP Specific Medical Items:
Green Medi-Gel - Used as a plaster, in a sense. It has the consistency of grape jelly (viscous but will easy come apart). After the container is opened, you can not re-close it. There would only be one of these in a medkit, or you can carry them separately. You would plaster this gel onto open wounds while holding the wound shut, and it will solidify, effectively creating an artificial seal. It takes about 10 seconds to harden once spread thin enough (too thin and it'll break easily). To remove, after dry, it peels off after some work at it. This isn't a comfortable experience but it's better than an open wound. This does not heal the wound in any way, and it won't allow for the blood to naturally clot. But this closes the wound to allow transport of a patient or to quickly stop bleeding of a large wound, and can be removed later to help the patient in a safer location. It will fall off itself after about eight to twelve hours.
On scene!
There are things that must be checked on scene, the first is DR-ABCs. DR-ABCs is an abreviation for "Danger, Response, Airway, Breathing, Circulation". Danger, is it safe? If there are opposing forces in the area or you are at risk, LEAVE the patient and get to safety. You are doing more harm than help if you get injured trying to assist those while out on the field. Response, does he respond to your voice? Your knuckles dragging across his sternum? A pinch at his ear? If he does, you can skip this part unless he is clearly having difficulties. To check circulation place two fingers at the cartoid artery. If the casualty has lost alot of blood, his HR will be high. For airways and breathing, perform the jaw-pull maneuver. Place an ear to his mouth and have a hand at his chest, feel and listen for breathing. There can be no breathing and a pulse but not the other way around.
If he is unconscious, check these. Also be sure to check for trauma. Usually you should assume trauma until you've made sure it isn't. This means checking for pupil dilation and using the jaw-pull maneuver when checking airways and breathing. If the eyes are not dilating or are blown open, it means he is more than likely concuss. I will explain what to do later.
Always work as a team, you are not a one man show. If there are multiple casualties, then you can split up and work but single cases it's best if you work together.
Don't be discouraged if someone dies while you're working on them. If they were in a extremely bad condition when you arrived and were a little past the point of no return, it was only a matter of chance if you saved him or not.
Common procedures
Bullet wound
1 Check DR-ABCs
2 Check for internal bleeding with a Stethoscope. It will sound like a waterfall, if there is. Check to make sure there isn't Artery bleeding at the torso. There is alot of them, so if the artery is struck, more than likely they will require a Specialist at the O.R. or they'll be dead on scene.
3 Apply the powdered QuiKclot Calcium Zeolite
4 Withdraw and apply 3cc of Morphine in the form of an IM to the Cubital Vein.
5 If you suspect your patient had been like this for awhile or was in a bad condition, use a tourniquet to promote the cubital vein, take an IV of Lactated Ringer's Solution D50NS 500cc. Place the IV needle in, withdraw it in the place of the Cathera and use Saline to check the flow.This will help with what blood has been lost. You can hang it from your own gun to anything that's at a higher elevation.
6 Cover the open wound with a sterile gauze pad and bandage roll, transfer the casualty onto a gurney. Take them to a safe and sterile area, usually the med bay.
7 Call for someone of expertise. If none are available, continue with the following.
8 Place them onto an ECG, eight pad set to the bare torso. This will monitor the HR and BP.
9 Give them 10cc of Methohexital if they're conscious as it is a General Anaesthetic, which numbs and puts them to sleep. If they're unconscious, use 5cc of Lidocane which is a local anaesthetic, numbing.
10 Make an incision with a scalpel, use clamps to hold it open. If you're with a partner, have them use a bovie pen to cauterize the blood vessels.
11 If there was internal bleeding, use acetaminophen in the form of an IM to
remove the clottage Calcium Zeolite created, before cauterizing the blood vessels.
12 Remove the bullet with a pair of forceps. Have your partner finish up on the cauterizing. If they're not present, do so yourself. Read more to find out about organ damage, if it occurs.
13 Suture the incision
14 If they need a transplant, place them onto an IV packet of O - blood until you get their blood type. Otherwise, give them NSAIDs and antibiotics. For example, Daptomycin and Ibuprofen.
Normal lacerations.
Sterilize it, give them a Local Anaesthetic and suture it.
Artery bleeding
1 Check DR-ABCs.
2 90 percent of Artery bleeding is usually when the skin isn't present. The other 10 percent is where it's swollen, hot to touch and has the whole web of capillaries clear to be seen.
3 There is different approaches, usually the area differs. For example, the arm most you just treat as usual bleeding. However, from the Brachial V(Near top of the arm) to the Radial Collateral A(Just about at the elbow) you use a Tourniquet instead of applying a powdered QuiKclot. For the leg, it's the Iliac(top of the leg) to the Femoral artery (just about at the kneecap) that requires a tourniquent.
If it is not in need of a tourniquent, handle it like normal bleeding.
4 If the casualty has received a hit to the torso that caused artery bleeding(there is a shit ton of them in the human torso, it is a grain of salt chance they'll go unharmed), the casualty is usually more than likely dead. Bullet wounds you usually want to claim the Kevlar took most of the impact.
Extreme lacerations and/or gashes
1 Check DR-ABCs
2 Check for internal bleeding with a Stethoscope. It will sound like a waterfall, if there is.
3 Apply the powdered QuiKclot Calcium Zeolite
4 Withdraw and apply 3cc of Morphine in the form of an IM to the Cubital Vein.
5 If you suspect your patient had been like this for awhile or was in a bad condition, use a tourniquet to promote the cubital vein, take an IV of Lactated Ringer's Solution D50NS 500cc. This will help with what blood has been lost. You can hang it from your own gun to anything that's at a higher elevation.
6 Cover the open wound with a sterile gauze pad and bandage roll, transfer the casualty onto a gurney. Take them to a safe and sterile area, usually the med bay.
7 Call for someone of expertise. If none are available, continue with the following.
8 Place them onto an ECG, eight pad set to the bare torso. This will monitor the HR and BP.
9 Give them 10cc of Methohexital if they're conscious and if you suspect organ damage or anything of the sort as it is a General Anaesthetic, which numbs and puts them to sleep. If they're unconscious, use 5cc of Lidocane which is a local anaesthetic, numbing.
10 Check for organ damage, if none then just cauterize the blood vessels and suture it. Prescribe NSAIDs and Antibiotics, example being Daptomycin and Ibuprofen.
11 If there is organ damage, continue reading.
Burns
1 Check DR-ABCs
2 Apply a cloth or gauze pad coated in petrollium jelly. If you don't and just apply it by itself, it will hurt upon removing. You can also use cold water.
3 Remove the skin around the area of the burn.
4 Sterilize it with Vaseline.
5 Prescribe Solarcane(Topical, just spray it on.) and Daptomycin(antibiotic).
3rd/4th degree burn
1 -Check ABCs
2 -Do not apply burn gel. Apply cold water.
3 -Place them on an IV of L.R. Solution D50NS 500cc infused with penicillin or administer via IM into IV line. Keep them hydrated
.
4 -4th degree burn to the chest, neck or head is death. If the arm is too badly burned, use the Femoral artery at the leg. Or any blood vessels that can handle the
strain of an IV. If you cannot get access to the leg, use the CVA. IV to the jugular.
5 -Cover with sterile bandage rolls and gauze pads ASAP.
6- No sterilizing will be needed on scene, the heat it self is a pretty good disinfectant. If you sterilize it with Hydrogen peroxide on scene, it will be the equivalent of lighting his arm on fire. Don't use that.
7 - Transfer in, change bandages oftenly, prescribe Solarcane and Daptomycin.
8 - Three or four weeks into the healing process, the patient is then going to be in need of skin graphing.
9 - Call in a someone specialized with Plastic Surgery or a Dermatologist procedures.
Organ damage
Most people would be screwed on the dot, as I don't believe we have organs for organ transplants. However, if one were to come to this, you can follow this procedure. (I have no clue if the ACP has spare organs, if so, go ahead!)
Some organs cannot be replaced, some organs can. The intestines for example cannot be removed, however they can be shortened. Clamp off the ends surrounding the damaged part of the intestine, remove it with a scalpel, remove the clamps, bring them together, cauterize the blood vessels and secure it with staples. The patient however, will die from Sepsis in weeks or months. We have no current antibiotic that can stop Sepsis, nor stop it from sterilizing it thoroughly.
Usually when replacing an organ, you do the following.
1 Clamp off the ends of the organ which is being removed.
2 Remove it with a scalpel.
3 Take the replacement, place it in. Cauterize the blood vessels, secure it with staples.
4 Use an over-head laser for the nerves. This will take hours, RP wise. It is a major pain in the ass to do.
5 Check for signs of organ rejection. Can't just toss any ol' Organ in there.
Punctured LUNG
1 Check DR-ABCs
2 Check for internal bleeding with a Stethoscope. It will sound like a waterfall, if there is.
3 Apply the powdered QuiKclot Calcium Zeolite
4 Withdraw and apply 3cc of Morphine in the form of an IM to the Cubital Vein.
5 If you suspect your patient had been like this for awhile or was in a bad condition, use a tourniquet to promote the cubital vein, take an IV of Lactated Ringer's Solution D50NS 500cc. This will help with what blood has been lost. You can hang it from your own gun to anything that's at a higher elevation.
6 Place them onto an ambu-bag. Manuel pump instrument. You pump it, they recieve oxygen from the mask. Simple.
7 Cover the open wound with a sterile gauze pad and bandage roll, transfer the casualty onto a gurney. Take them to a safe and sterile area, usually the med bay.
8 Call for someone of expertise. If none are available, continue with the following.
9 Place them onto an ECG, eight pad set to the bare torso. This will monitor the HR and BP.
9 in a half (fuck the zo-lice.) Place the patient onto the M.A.B (Mechanically assisted breathing)
10 Give them 10cc of Methohexital if they're conscious as it is a General Anaesthetic, which numbs and puts them to sleep. If they're unconscious, use 5cc of Lidocane which is a local anaesthetic, numbing.
11 Make an incision with a scalpel, use clamps to hold it open. If you're with a partner, have them use a bovie pen to cauterize the blood vessels.
12 If there was internal bleeding, use acetaminophen in the form of an IM to remove the clottage Calcium Zeolite created, before cauterizing the blood vessels.
13 Remove the rib puncturing the lung. If it's still attached, remove it with a bonesaw, reposition it and secure it with screws. If it is a bullet, remove the bullet. Chances are it would've passed through however. You remove them with a pair of Forceps.
14 Drain the lungs of blood with a vacuum tube. Cauterize the blood vessels and secure the puncture with staples.
15 Cauterize the blood vessels (I know I say this alot but it's usually what needs to be done) and remove the clamps. Suture the incision.
16 If they need a blood transplant, place them onto an IV of O - blood
17 Prescribe NSAIDs and antibiotics. In this case, clarithromycin and Ibuprofen.
Broken limbs.
1 Check DR-ABCs.
2 Use a Stethoscope to check for internal bleeding. It will sound like a waterfall, if there is any.
3 Secure the limb with a splint.
4 Transfer the patient onto the stretcher. If there was internal bleeding, apply a QuiKclot in the form of a IM.
5 Once at the bay or area that is sterile and secure for operating.
6 Remove the splint, apply molding solution. Wait for it to harden.
7 Apply casting wrap.
8 If there was internal bleeding, place them under a G.A. if they were conscious, place them under a L.A. if unconscious. Make an incision, apply acetaminophen in the form of an IM to remove the clottage the QuiKclot created. Use a bovie pen to cauterize the blood vessels, then perform the suturing once removing the clamps holding the incision open. Pay no mind to the two statements above, instead use them after this step.
9 Give them NSAIDs. Ibuprofen. Daptomycin for antibiotics if you had to make an incision, just to be sure that if an infection occured, they're already backed.
Compound fracture
1 Check DR-ABCs
2 Check for internal bleeding with a Stethoscope. It will sound like a waterfall, if there is.
3 Apply the powdered QuiKclot Calcium Zeolite
4 Withdraw and apply 3cc of Morphine in the form of an IM to the Cubital Vein.
5 If you suspect your patient had been like this for awhile or was in a bad condition, use a tourniquet to promote the cubital vein, take an IV of Lactated Ringer's Solution D50NS 500cc. This will help with what blood has been lost. You can hang it from your own gun to anything that's at a higher elevation.
6 Cover the open wound with a sterile gauze pad and bandage roll once it is in a splint, transfer the casualty onto a gurney. Take them to a safe and sterile area, usually the med bay.
7 Call for someone of expertise. If none are available, continue with the following.
8 Place them onto an ECG, eight pad set to the bare torso. This will monitor the HR and BP.
9 Give them 10cc of Methohexital if they're conscious as it is a General Anaesthetic, which numbs and puts them to sleep. If they're unconscious, use 5cc of Lidocane which is a local anaesthetic, numbing.
10 Make an incision to expose it entirely, use clamps to hold it open.
11 Remove the bone with a bone saw, re-allign it and secure it with screws.
12 Cauterize the blood vessels and suture the incision.
13 Apply molding solution and casting wrap.
14 Prescribe NSAIDs and antibiotics, example being Ibuprofen and Daptomycin.
If it's a broken rib, nothing can be done unless it's compromising the lungs. They will be stuck in bed for a long while because of this though. They cannot move.
Concussed patients
1 Check DR-ABCs.
2 Check for pupil dilation. If there is none or if its blown open, it means the patient is concussed.
3 Not much can be done aside from drawing blood from their head with a sterile empty syringe and placing an icepack on them. Bring them in for a CAT scan. If it checks out, the patient will be fine. If there is brain damage then they're more than likely boned. If the brain has shifted out of place, he is dead.
ANAPHYLAXIS
The anaphylaxis is a severe allergic reaction which can produce shock and circulatory collapse. In sensitive people, anaphylaxis can occur within minutes, but may also occur up to several hours after exposure to a specific allergy-causing substance. If a patient got an allergic reaction:
- Check for special medications that the person might be carrying to treat an allergic attack, such as an auto-injector of epinephrine
- Look for a medical emergency ID bracelet or necklace.
- Have the person lie still on his or her back with feet higher than the head.
- Loosen tight clothing and cover the person with a blanket.
- If there's vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.
- If there are no signs of circulation (breathing, coughing or movement), begin CPR.
Poisoned Patients
1 Check DR-ABCs
2 Apply Naloxone. Flushes the body, helps coagulate the blood too. Might want to place them onto a "piss pot", turn their head sideways to prevent choking when they vomit. They will vomit, urinate, crap and possibly cry.
3 Place onto an IV of NaCl Saline.
List of other information that's handy.(Copy pasta from old EMT .txt from LS-RP, could come in handy here!)
Equiptment:
ECG (Electrocardiogram) - Records the electrical activity of the heart over time. It uses electrodes to attach to the chest and body to read the activity.
AED (Automated External Defibrillator) - A portable electronic device that automatically diagnoses the potentially life threatening cardiac arhythmias* of Ventricular Fibrillation and Ventricular Tachycardia in a patient.
ET Tube (Endotracheal Tube) - The tube used when intubating.
Forceps - Handheld, hinged instrument used for grasping and holding objects. Used when the obect is slippery or small. (Tweezers, tongs, pliers, clips and clamps basically.)
Laryngoscope - An instrument used to obtain a view of the vocal folds and glottis (Space between the cords).
Mcgill Forceps - Long angled forceps, useful for retreiving objects out of the upper airway. They are slightly curved so they are useful for working in or near the airway. They have rubber grippings on the end.
Scalpel (10 blade) - An extremely sharp knife used for surgery.
Sphygmomanometer - Used to measure blood pressure. It consists of an inflatable cuff and a meter. It is used with a stethoscope. Inflated until no noise can be heard, slowly deflate it while listening with your stethoscope below the sphymomanometer. You will hear a whooshing or pounding sound, this is the Systolic pressure of the BP. Keep releasing pressure, once there is no noise, that is the Diastolic BP.
Stethoscope - Used for Auscultation (Listening) to the internal sounds of a body. Often used to listen to heart sounds. Also used to listen to internal organs and the lungs. A stethoscope is one of your best friends in making a diagnosis.
Trauma Kit - A trauma kit is a kit onboard of the ambulance. It carries a variety of equiptment and objects used in the field.
Basic Emergency Response:
Grab your Trauma kit and triage. Tag the dead for the Morgue.
Triage - The process of prioritizing patients based on the severity of their condition.
During a large casualty call, prioritize by the following simple triage guideline
1. The deceased - Black
2. The injured who can be helped by immediate transportation - red
3. The injured whose transport can be delayed - yellow
4. Those with minor injuries, who need help less urgently - green
Start your examination by communicating to the patient.
Vocal stimuli - Is he responding to vocalization?
Painful Stimuli - Is he responding to a pinched ear or knuckles on the sternum?
If he is responding you can skip the ABC's, otherwise.. ABC's:
A - Airway
B - Breathing
C - Circulation
A:
Check if the patient is breathing. Use a simple maneuver such as pulling their chin forward (Jaw thrust). If their tongue is blocking their airway, move it, keep it out of the way. After that, check:
- Do you feel air coming out?
- Do you hear breathing?
- Do you see the chest going up and down?
Any of the previous and you know your patient is breathing.
If there is no breathing, begin diagnosing why.
Check the upper airway, make sure nothing is blocking it such as blood or their tongue. If their tongue is blocking the airway, insert an OPA or NPA.
An OPA is an Oropharyngeal airway, NPA is Nasopharyngeal airway.
OPA a medical device, used to maintain a patents airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the patient from breathing.
NPA is Nasopharyngeal airway. Same thing, except in the nose. Popular because there is no gagging. DO NOT USE ON HEAD TRAUMA.
If the upper airway is blocked, you need to remove it or preform a crichothyrotomy. Covered in intermediate level skills. IF liquid, suction. Blood or spit.
B:
Check if the lungs are working. If you cleared the airway you should now see him breathing by himself. If they aren't breathing by themselves, begin ventilating the patient. If you begin ventilating the patient and the chest moves up and down, move to C. Otherwise:
Check for a pulse. If there is a pulse but no breathing, perform a Heimlich maneuver before the patient dies.
C:
Check their pulse.
If there's no palpable pulse, attach to ECG and check for a shockable rhythm.
ECG will show one of three things.
Asystole - Flatline. Begin CPR, do 5 cycles and check for a shockable rhythm.
Normal rhythm - Not shockable. If no pulse, begin CPR.
fribulated rhythm - Shockable. Pumps to fast to load blood into the ventricles.
CPR (Cardio Pulmonary Recessitation):
CPR consists of 30 compressions (Or external heart massages) and two ventilations in cycles of 5. Use the palm of your hand on the chest push down with your weight.
Two ventilations, 30 compressions, two ventilations, 30 compressions, 2 vents, 30 comp, 2 vent, 30 comp, 2 vent, 30 comp and then check for an available rhythm or shockable rhythm.
Infants are 15:2, use two fingers instead of a palm.
Before transport, DO NOT MOVE. Spinal board and c-collar until the spine is cleared by a doctor. Always give oxygen, calming factor. Saline - Fluid replenishing salt water - Lactated Ringer's solution D50NS.
ALLERGIES
Methylprednisolone – Anti inflammatory drug, used in asthma and anaphylaxis. Routes: IV, IM, IV Infusion, Oral.
Diphenhydramine/Benadryl – Used for allergic reactions. reduction of smooth muscle contraction, making diphenhydramine a popular choice for treatment of the symptoms of allergic rhinitis, hives, motion sickness, and insect bites and stings. Routes: Oral, IM, topical, suppository.
Epinephrine (also referred to as adrenaline) – Used in Anaphilaxis (Severe allergic reaction) Increases speed and strength of heart contractions and raises blood pressure. Routes: IV, IM, endotracheal.
Pain Relief
Morphine - Pain control. Different from others because it acts directly on the central nervous system. It’s highly addictive when compared to other substances. Routes: Inhalled, Insufflated, Oral, SC, IM.
The Barbiturate phenobarbital - It's preferred by Terrorists and Bank Robbers alike. Increases your pain tolerance to the extreme. Northern Hollywood shootout for an example, one of the robbers took a 12 gauge shot to the back, turned around, sprayed the Officer up and walked off like nothing happened. Drawbacks is that the chance of having a heart attack goes through the roof.
While it is not preferred in your practices, if the situation is either a final stand or you /need/ to move or you will die, it would appropriate to use it. Not issued by default, might want to talk to your superior for obtaining it.
ADMINISTRATION ROUTES
Intranasal - Nasal sprays, used for the nasal delivery of a drug or drugs, generally to alleviate cold or allergy symptoms such as nasal congestion.
Intravenous(IV) - is the giving of liquid substances directly into a vein(neck, wrist or arm). It can be intermittent or continuous; continuous administration is called an intravenous drip. It’s used with an IV line needle. EMT BLSes are not allowed to access these routes.
Intramuscular(IM) – is the kind of injection of a substance directly into a muscle.
Insufflation - is the practice of inhaling substances into a body cavity, but is common with many respiratory drugs used to treat conditions in the lungs (asthma or emphysema) and paranasal sinus (allergy).
Topical – It’s applied to body surfaces such as the skin or mucous membranes, for example the vagina, anus, throat, eyes and ears. Some hydrophobic chemicals such as steroid hormones can be absorbed into the body after being applied to the skin in the form of a cream, gel or lotion.
Oral – Its when you give pills, drink, like cough syrup. Simply through the mouth or in other words, enternaly.
Rectal – Its when its injected into the main rectal vein or artery, which are near the rectum. For the diagnosis of certain ailments, a rectal exam may be done. Also called Enternally. EMT BLSes are not allowed to access these routes.
Endotracheal – Also called Endotracheal tube, ET tube or just ETT. Used in general anaesthesia, intensive care and emergency medicine for airway management and mechanical ventilation. The tube is inserted into a patient's trachea in order to ensure that the airway is not closed off and that air is able to reach the lungs. The endotracheal tube is regarded as the most reliable available method for protecting a patient's airway.EMT BLSes are not allowed to access these routes.
Injection – Simple liquid injection through a syringe. EMT BLSes are not allowed to access these routes.
Suppository - a drug delivery system that is inserted either into the rectum (rectal suppository), vagina (vaginal suppository) or urethra (urethral suppository) where it dissolves. EMT BLSes are not allowed to access these routes.
ET Tube (Endotracheal Tube) - The tube used when intubating.
: A tube that is put through the mouth and goes down to the entrance of the lungs. It clears their way and you can attach an ambu bag (hand pump) or in the hospital a ventilator which breaths for them automatically
/me takes the ET tube from his kit
/me opens the patients mouth and inserts the tube
/me attaches an Ambu bag and starts hand pumping to make them breath
Head Trauma:
Vocal Stimuli? Painful stimuli?
Check reflexes. Open the eyelid and shine your penlight in it. If there is dialation and they are concious and aware, they are fine.
If the pupils do not dialate, you assume the patient is concussed.
If one pupil is 'blown', you assume there is a serious head injury. More than a concussion.
In either case, give IV fluids, transport to hospital asap.
Bleeding:
Vocal Stimuli? Painful Stimuli?
Apply pressure to the wound. Sterile Gauze to prevent infection.
If the wound is on an extremity, apply a tourniquet above the wound to prevent the artery from pumping more blood to the wound.
Bandage the count
Once bleeding is controlled, give them IV fluids. Transport to the nearest hospital.
Burns:
Vocal Stimuli? Painful stimuli?
Immediately make attempts to sooth the burn. Cold water or burn gel. Cover the wound in petroleum jelly coated plain gauze, otherwise it will stick and cause pain on removal.
Administer IV Saline. Check for signs of shock.
Do not disinfect, it will make it worse.
Breaks and dislocations:
Vocal Stimuli? Painful stimuli?
If the fracture is compound immediately treat bleeding.
Put the fracture in a traction splint
Administer pain medications
Gunshot wounds:
Vocal Stimuli? Painful stimuli?
Treat same as bleeding, take into account exit wounds.
Check for signs of internal bleeding with your stethoscope. Auscultate.
- Intermediate level examination and procedures:
More detailed examination. Examine area's related to injury. Palpate and auscultate.
Transcutaneous pacing - Temporary means of pacing the patients heart during a medical emergency. Mostly used for a slow heart to speed the pace up to acceptable levels.
Pads placed on patients chest. Attached to monitor/defribrillator, heart rate is selected and a current is increased until electrical capture. You can then speed up the heart.
IV - IntraVenous:
The method of giving fluids or medication through a vein. It is a quick method, valued by emergency medicine for giving quick medication to a patient.
Steps -
Tourniquet arm. Wait for the blood returning in the veins to bulge the medial cubital vein. Take and IV needle and insert it into the vein, feed it through the vein slowly. Push a catheder* into the vein and pull back the needle. Tape down the catheder. Flush the catheder with saline to make sure it has flow.
Emergency Needle Decompression for tension pneumothorax:
Insert a large bore cannula or needle in to the second intercostal space. Field decompression is allowed, but it's better in a sanitary enviroment. Only perform a needle decompression if it's causing discomfort for the patient.
LR (Lactated ringers solution):
is a compound that is isotonic with blood and intended for intravenous administration.
IV administration
- Advanced Level examination and procedures:
Crichothyrotomy:
An emergency incision through the skin and cricothyroid membrane to secure a patient's airway during certain emergency situations, such as an airway obstructed by a foreign object or swelling, a patient who is not able to breathe adequately on their own, or in cases of major facial trauma which prevent the insertion of an airway through the mouth.
Mechanical ventilators:
method to mechanically assist or replace breathing.
Ventilation can be delivered from:
Hand controlled devices such as a BVM
Mechanical ventilators:
Field transport ventilators, ran off battery sources.
ICU ventilators, in the hospital. Ran from hospital power
Central venous access:
If it isn't possible to find a vein on the arm, attempt CVA.
A Central venous catheter is inserted into the large vein in the neck(Jugular line), chest(Subclavian) or groin(Femoral cutdown).
Vasoconstrictors:
The narrowing of blood vessels resulting from contraction of the muscular wall of the vessels. When blood vessels constrict the flow of blood is restricted or decreased, thus, retaining body heat and increasing BP. Skin turns paler as less blood reaches surface. Some drugs cause this such as cocaine and LSD.
It can be beneficial to you, if your patient as lost a lot of blood and his BP is low.
Pseudoephedrine is a vasoconstrictor carried by paramedics. It is given via IV.
Blood Transfusion:
0 negative type blood via IV given to replenish blood loss until a type specific blood is identified.
Synchronized Cardioversion:
Method to slow an abnormally fast heart rate by delivering a therapeutic dose of electrical current to the heart at a specific moment in the cardiac cycle.
Attach two pads, one on the front of the chest, one on the back. Turn the cardioversion machine on and allow it to deliver the shocks.
Rectal tube:
A tube inserted rectally to deliver medication when no other way is possible. Be sure to lube it.
Suturing:
Used to hold skin, internal organs, blood vessels and all other tissues of the human body together after they have been severed by injury, incision or surgery
Sutures are absorbable, no need to come back for removal.
Horizontal Matress suturation - Common suturing technique. Used on area's that don't revert from movement, such as the chest and head. Less chance of scarring.
Vertical Matress suturation - Used on area that invert, such as the fat on the neck. More chance of scaring.
Steri-strips:
Used on simple cuts. hold it shut and keep foreign debris from getting in. Can be changed at home.
Surgical staples:
Can be used instead of sutures. Used on organs or on certain simple wounds. They need to come back, to have them removed.
- Illnesses:
Cough: No cure. Surpress with cough syrup. Xyzal pills, 250cc
Cold: Bit worse than cough, no real cure. Cold medication and quit crying.
Flu: Another uncurable illness. Surpress it with meds and sleep. Antibiotics such Clarithromicine, 250-500cc
Bronchitis: Respiratory illness. Cough and phlegm. inflamed airway, shortness of breath, wheezing. Antibiotics such as Clarithromicine again, plus broncho-dilators, such as Aliflus 500cc.
Appendicitis: Inflammation of the appendix. Surgically removed inflammed appendix.
Hemi-paresis: Weakning of one side of the body. Pain. No cure, you're fucked. Stupid illness for LSRP.
- Vital organs and vessels:
Organs -
The Heart - Muscular Organ responsible for pumping blood through the blood vessels by repeated rhythmic contractions. Left side to body, Right side to lungs.
Lungs - Respiration organ. All complex life forms have lungs of some kind. Located in the chest, either side of the heart. Transport oxygen from the atmosphere into the blood stream. Release carbon dioxide from the bloodstream into the atmosphere.
Once air progresses through the mouth or nose, it travels through the oropharynx, larynx and trachea. Reaches alveoli where gas exchange takes place.
Liver - Frankenstein organ. You can lose 33% of it and live. Responsible for a lot of functions. A few are detoxification, protein synthesis and production of biochemicals necessary for digestion. Necessary for survival, no way to compensate for absense of liver function. Some can be emulated by liver dialysis, such as large ammounts of detoxification.
Brain - Central nervous system in all vertbrae and most invertebrae animals. One of the most confusion and mysterious parts of the human body. LOCATED IN YOUR HEAD, JUST INCASE YOU DIDNT KNOW.
Spleen - Located in the abdomen of the body. It destroys old red blood cells and holds a resevoir of blood.
Kidney - Break down waste in the blood stream. Extra water. The wastes become urine which flows to the bladder. Releases important hormoans including Renin which regulars BP.
Stomach - between the throat and small intestine. It kills parasites and bacteria ingested. Breaks down food into smaller particles. Temporarely hold food and release it at a steady constant rate to the intestine.
Reproductive - Anatomical parts of the body which are involved in sexual reproduction, which I believe you know pretty well. I bet you had thousands of lessons on youporn, right? Right.
Senses - Hearing, visuals, smelling, feeling and taste.
Blood vessels:
Vein - To heart
Artery - away from heart
Aorta - Largest artery, carries blood out of the heart.
Aorta Branches in to several large arteries:
Carotid artery - Supplies the neck and the head with oxygenated blood
Subclavian artery- Major artery of upper thorax, mainly supplies blood to the head and arms. Located below the clavical bone.
Superior Mesenteric Artery - front of the aorta, supplies the intestine, colon and pancreas as well as lower thorax.
Rental Artery - Off the side of the abdominal aorta, supply the kidneys with blood.
Iliac artery - lower thorax and pelvic artery
Artery connects to Arteriole.
Arteriole connects to capillaries and capillary bed.
Capillaries connect to Venule.
Venule connects to vein.
Triage - The process of prioritizing patients based on the severity of their condition.
During a large casualty call, prioritize by the following simple triage guideline
1. The deceased - Black
2. The injured who can be helped by immediate transportation - Red
3. The injured whose transport can be delayed - Yellow
4. Those with minor injuries, who need help less urgently - Green
THE END
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