Emergencies

Action at an Emergency

The way you approach a incident and patient can contribute much to their survival. Many things may demand your attention at the same time. If you try to do everything at once, you may make things worse. Here are some steps to consider when approaching a patient:

Assess the Situation

Your approach should be brisk, but calm and controlled, so that you can absorb as much information as possible. Your priorities are to identify any dangers to yourself, to the patient and to bystanders. Then assess the resources available and the kind of help available. Don't forget to state you are a Healer. Often people are panicking and will not notice your shoulder knot.

Make the Area Safe

The conditions that caused the injury to the patient may still present further danger. You -must- put your own safety first. You cannot help if you also become a casualty. If the danger cannot be removed, you have to try and put as much distance between it and your patient as possible. Do try and remove the danger first; if unsuccessful and as a last resort, remove the patient. Often in these situations you will require help.

Emergency Aid

Once safe, assess each patient using the ABC of resuscitation. This will dictate your actions. Quickly establish whether the patient is:
(1) fully conscious
(2) is unconscious but breathing
(3) is not breathing but has a pulse, or
(4) has no pulse.

Get Help

You may be faced with a number of tasks. Use other available Healers or bystanders to make the area safe, fetch other help, fetch supplies, control other onlookers, maintain the patient's privacy, control bleeding or support limbs, and help move your patient. Do not get upset with bystanders who refuse to help, they will often have a good reason. However, giving a bystander a simple task may avert panic or morbid interest, thus helping that person, your patient and yourself.

Multiple Casualties

Sometimes you may be faced with multiple patients whilst you are on your own. The order in which you treat them may be crucial to their survival. Remember the rule-those that are most quiet are usually the most seriously injured; the patient that screams in pain is generally less affected. First attend all unconscious patients and follow by checking the ABC of resuscitation to determine priority cases. It is important to remember you can only do your best.

Making a Diagnosis

Making a diagnosis will often involve suspicion rather than certainty. Your diagnosis will be a conclusion, based upon a high degree of reasonable probability, on which you should be prepared to act.

History

This is the full story of how the incident occurred, how the injury was sustained, or how the illness began. It should include anything you can discover about past illness and injury, and should be obtained directly from the patient. If they are unconscious, then question onlookers.

Symptoms and Signs

Every illness or injury presents itself in a way that may aid your diagnosis. These clues are divided in signs and symptoms. Some are obvious, some less so and may be overlooked unless you examine the patient from top to toe. A conscious patient should be examined in the position they are found in, with any obvious injury supported; if they are unconscious, the airway must be first opened and secured. Use the full range of your senses—look, listen, feel and smell. Be quick and alert but do not skimp or make assumptions. Ask your patient to describe any sensations that your touch produces. Although your touch should be gentle, it should be firm enough to detect swellings and/or irregularities.

Symptoms: Symptoms are what the patient feels or experiences. Apart from pain, other symptoms include nausea, giddiness, cold, heat, weakness and impaired sensations.

Signs: Signs are details discovered by applying your senses. Common signs of injury include bleeding, swelling, tenderness or deformity. Pale or flushed skin, sweating, a raised body temperature and a rapid pulse are other signs to be aware of.

Top to Toe Survey

Top to toe surveys should be conducted if the patient is unconscious or if the patient has been involved in an accident. Start at the head and work down, so you won't forget anything. You may need to move or remove clothing as appropriate, but remember that moving your patient may exacerbate injuries. Use both hands and always compare one side of the body with the other.

Skull and scalp: Run your hands over the scalp and check for bleeding, swelling, any soft area or indentation which may indicate a fracture.

Face: Note the color, temperature and the state of the skin.

Eyes: Examine both eyes together, noting the size of the pupils and whether they are equal in size. Look for any foreign body, wound or bruising in the whites of the eyes.

Nose: Check for signs of blood or clear fluid that might indicate damage within the skull.

Ears: Speak to the patient. Ask if they can hear in both ears. Look for blood or clear fluid coming from either ear which may indicate damage in the skull.

Mouth: Record the rate, depth and nature (easy, difficult, noisy or quiet) of breathing. Note any odour. Look and feel inside the mouth for anything that may endanger breathing. Look for any wound in the mouth or irregularity in the line of teeth. Examine the lips for burns or discoloration, particularly blueness (low blood oxygen).

Neck: Loosen clothing. Take the carotid pulse, noting its rate, rhythm and strength. Run your fingers down the spine from the base of the skull to between the shoulders, checking for irregularity or tenderness. Look for bruising.

Trunk: Ask the patient to breathe deeply and observe whether the chest expands evenly, easily and equally on both sides. Check collar bones and shoulders for deformity, irregularity or tenderness. Feel the ribcage for similar abnormalities and inspect the chest for any wound. Gently feel the soft part of the abdomen to discover any wound, rigidity or tenderness. Feel both sides of the pelvic bone and gently 'rock' the pelvis to discover signs of fracture. Note any incontinence or bleeding from the orifices.

Upper limbs: Check movement and sensation in both arms, Ask the patient to bend and straighten the fingers and elbows. Take the hands—can they feel normally? Note the color of the fingers; look for swelling, bruising or deformity.

Lower limbs: Ask the casualty to raise each leg in turn and to bend and straighten ankles and knees. Look and feel for any wound, swelling, or deformity.

Feet: Check movement and feeling in all the toes. Look at their color—blueness of the skin may indicate a circulatory disorder or cold injury.

Back and spine: If you have noted impaired movement or sensation in the limbs you should not move the casualty to examine the spine. Otherwise, without causing undue disturbance, gently pass your hand under the hollow of the back and feel along the spine checking for swelling and tenderness.

Treatment and Aftercare

Calmly and efficiently, treat each condition found. Pay attention to the patient's remarks and requests. Reassure the patient constantly, but do not pester them with questions. Establish treatment priorities:

(1) Follow the ABC of resuscitation
(2) Control bleeding
(3) Treat large wounds, burns or fractures
(4) Look for and treat other injuries or conditions
(5) Treat for shock.

Help the patient into a comfortable position and don't let people crowd around. Make sure they are not left alone for however long is appropriate.

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