eee eR WOH FA EY FA Hy 3 sFst print June 2004 Fepited January 2008 Reprinted October 2006 pinta Jy 2007 eprint January 2008 epited Ape 2008 Fe published July 2008 Reprinted May 2010 Foprnted December 2010 eprint May 2011 printed March 2012 ISBN 1-900109.068 PTR em Ete) u AATAATAAAA AAO MOO OO a This manual provides advice for Both he Basic and intermediate Awards ‘aie witout marked borders ‘Stor Gane & ‘ntermadite re ang ara VENTLATON SUPPORT RAG YALVEMASK ‘er ore tena toma cg)& & & © & Introduction Ivroduetion ‘Sutden ness oF inuy may secur witout waning at any tne. Serius ‘Seequeres yan aod and even ate avd by aoa ‘simple away menoew for exampe, may sav all. The vison behind he Frat Person on Scene swans Haws fms ‘Simo tings save Ives — is should be pao ores ‘The ist Person on Sone awards am 6 provide the essen underpin -ncwfoge anal wih 2 emphasis an understanding to why ae wl a The waning srogramme hasbeen ceatd tough »panerstip between HCD (Gat ot Edexcel andthe Faculty af Pre Hospia Core o he Roya Cotene o ‘Suigeons of Ednburgh. This brags together wo of he hey eaveabons ase ‘iotdatdstodesn Pre Hospi emeigency care ICD roi awarcng body service or NHS Ambulance saad as prt ot Edescel has consrstle expertise hv the cea of swat neseoareet rocertes and quily assurance of ring proven, ‘The Facity was founded in 1906, sad on experince nthe Pre-Hospital okt ewstoped lhe Roja! Cotege of Surgeons of Ean fom O88 Edexcel Acknowledgements sexe! would wth to acknowedge the contsbuons mae by the fling to ‘© Toe models wo appar Try roombal:Visce Cooper Dave Lavender Binds Faulner: Hap Green, Rashard Niche. George Thurgood ad ‘Gioe Fences (wn indy agreodto be hac), License Fre & Reseos {© zaham Brown and Gary Buchanan for esistance in ating sctons of is Imawat ie very mach Sopris 1 Solutions Trang & Advisor inte ah dated ho advice on best practn ‘rth moving and naning patents neecton N12 1 2 Ywome Onen, Medes Bieter of he Linnie Integrated Vlunary Eneroncy Services (UVES). who. drafed the sien on exseaion ‘luton and arway managenienUh aceTe esse) ‘A spacial mane sraserved fre contrition made by Andy Thurgood bring 1 ontibseo he mana manapng the pots ost and posaeny he fe IhusvatoneEdeseal hank Any fra and aemoeege Ne wllagnes ogo ‘he era mile when equree Faculty of Preshospital Care Acknowledgements ‘Te Foeuty woud wish a scknonedge Or Faint es Fener Dr Stoo rset Mr AThurgocs| ‘About the manca! Fer consistency with and flowing the recommendation fom the Pin English Caml, he has been used tvougout De Wanual'o dnote eter Neosho ‘Those secions bordered by chequr markings prove infomton over and ‘owe the auaiicaton requrament and te prone enhance uncerstandng, ATT PPP PPO www Hage ee ww uw Introductio ICD FIRST PERSON ON SCENE AWARDSCONTENTS 414 The Pre-Hospital Environment the rl f Fat Person on Scene = Slane satel = postinegeneproosures aw ww 412 First Person on Scene and the Ambul = FOS sctvaton = Sting Singer fo FPOS ana untoward indians inl pr ome Fandover othe ambusnce ere 13 Patient Assessment (enhanced) = commuricaing wih patents = fetpen and conn = Bhaminaton and assessment 44 Airway and Breathing = Sheng and menting @ dear seway = pte ond san er es = fecognton of espiatry protons Gi respay probiems cee & & & e e e e e e e 5 5 5 5 5 5 5 5 s s s 8 ® 51.5 Basic Lite Support = he patent who sconsous, treating and has pulse =e patent wo is uneaacou bat rethng patent who nol beating sass obo in crc eres Sonal saree on base He support echlenes then stp resussaton tke of uct the recovery poston 116 Automated External Defibilation (enhanced) ~ rermatstnonmal hee syns = Safety conaderatone = ing an Automated teal Deft (AED or casinc rest = post tesustaton sare 117 Circulation and Shock = sszossment of creation = sigs of bod es = canto of exert beeing ina management ofl bleeding 18 Medical Emergencies argaheat tack = anaphfanieterge reacton 19 Airway Management (enhanced) tse of rophanmes ways engen hen the een ey vento sun a & & & e E e e e E 5 E E Ee 5 5 ® 5 5 5 5 © 5 Ww a 8 3 s a = = = wow we 1.40 Trauma Related Emergencies ~ recogaten and intl eae of nus to tone ‘wud essing ard sett! mebitaaton = ‘cognition and nl eae of ne and sealds : = eoanion an ina are fear vaunted iris = patent handover re 0 asue 1.41 Assisting the Paramedic ~ capabies of Paramedk = sagen) cae canner = patent sty 1 Ambulance Technicians 112 Moving and Handling Patients = general pines of moving and hang = lssesing he need omove he patent Batentpostoring per onaton| fre fang ae fan patent = mong’ paler im exerns 1143 Extrication of the Trapped Patient {ores inched nines ‘ene sey ‘mechan jury Tyla! Naty patos of entrapped patents !arapomet ol he entapped patent rage sever of nun sated fo sped and method of extcaton Immobtsng the entapoed pate removing the enrapped patent fatent nsx eaupmet Felootr ste patent handover [© HCO. No pat ofthe manus may be repos ‘whout tb pro witan pasion othe pbk er pulsed a ary formatPm eeS oe Aen ioe Ae to fe 10 9801) 0209 0a w ue paveuss Bypeot 2 9 Bus rau ve 0, meso paced Sng bu Bian ae vo ene a9 arabes s2ous yoavoy mepén roe eeees 3 UTE lcm ere ee Rae CRC | 1 eS | F & “This section covers ie “| k EE Be Re ea shemeeemnete™ fe ithaeaen Ef Gee ie Fa he 2 ea ig le ie eS eee a if a (3 que Rove oF Finsr PERSON ON SCENE z ft le EE lee E | Imari Penn on Sere POR ners tm cern oh 9 z_[ RUBE NEE] | Li (Recs Se irene meron Can @ iif fe be | | le ee crn ee ay rants bre pte mays a Pelee || ile £3 Rrgeemsrisnmmcnbonmoveas ge Oe | | Re EE seieleesn gue HUE luge [2 Ter sane ra arpenettenttan ele wears nc ng Sal: E eaves if foes +5 eproveris ty hove to dal th a sion proto the alo fe al see ¢ gf Erle 2 BER i eo ae onthe tare aoe, er elf a cals [seen f elle ea Selon mor be prod ws ts ht ry eae ae eee pi Sede Sa? ab © [5 weary pte nr, es epee nae Bale gSeecle lszatle 2 cicle ! patent survival ae ote simp and focussed on ves Key seas: elu et ee ee BE =o 2 aroy semen od saan feck rs ee a a EBS Sy amano oe set a els jaceretamre mange teenters tent ances é se gelgig sig sie e\gie ela eg cane ot es care ean ee. | The L Clay tmenecimmtoay eta ngnn woe enn L LE Lk {COS Set cet ese 3 pm Teva weeny le [ 5] 1 Stacia nea er to sya er ts1.1 The Pre-Hospital Environment The Pre-Hospital Environment 1]. [As pat of the FPOS teaching proaramme, the prove wit lo be taught © Look Spprecate sme fhe as and mpm fear ovaries evening ee esc ‘endo, inca hea stack. ac and ss of coaceurness. oer ‘Unnecessary ceahe fom cardiac arest may te reduced ty a sedes of Intrventorskrown a fhe “Chon of Sura In lato to cre at hae ‘sr fori nthe ea 1 any emergency serie aonss basic fe suppor 1 for hazards sch a ct erent 4 at ie intent to en what hes happened «atime mechani of jy: his wil enabie yout conser that cen ihurec maybe resent for evar ithe part ha aon fom helt 4 othe poston patents ae i, a6 tay wapped or ying awh? 410 see how many casuals Bere are {0 oetrie which are the most serous «© oatydottaton any advanced fe support ‘The et ime spent Betwean each ink, he geste the chances f sural The waned FPOS provider i walt he calvry ofthe fest three ofthese Components By making ® mary aesesement and flowing he ade Vee «for dangers to youre and he patent for example, vate + 10 winesses or bstandars cling what happened plo fo your avg + 10 you caleagues, members of oer emergency sens SCENE SAFETY “Think about (ond conser that its safle to do so. Consider: ‘ at yeu nave seen oer — {sete tons 1 wat canbe done hp each paint “he et fe oman allowing an eden may be very confusing ard even eee eee angers. sal et you evaute he scene aa at wa he kal cause of any nies ston Remember take ite time 4 do this ~ do not rsh in = et Pe ‘he rel sna DT AATE OTe| 1 Maal im ae ‘The violent or aggressive pationt itis er any hatyou wi knowing be sent a pat or stun thought to Inveve velene or appetson However, some medial cortons aflect how Pater bona fa potent ora relatve becomes aggresive of contotatoal, do rat Lider any crcumstances rect or become confontanal yousat ~ tft station becomes dangerous, you shold withdraw tom he Inedent Do nt return elect equprment and he eariest aie on handover desctoed NEXT STEPS Having mace an ial patent assessment and detained eaten pros, ‘he provider shoul alow te adie oferedin te ter scone is mance Pa 10 201 Pin nat = e a e i e E F & e & e & E 5 5 5 5 © © © 5 © rs Pou’ 5 Section Review 1. Name one ofthe mar factors aflectng the ably of he paint fo Uetraand wat you me sayn fo Fim sno me Misa understood 2. Name fou pats fhe commuicaton e725? 4: List ve actons yu cn ake to heb you communicate beter wit patos tah speak or uterstan ie Engen {4 Wat should you avo whan sping your communication wih patents \Wrohave ately uncrstandg you? 5, Wha ate te components ofa pat ison”? 6, Naa ne four components of pimary sey? 7 Name two checks tobe made whon assessing patents alway? What i the rte of traahs par mila alow whin you commence What do the nies AVPU mean inspect of assessing a pale eel of ‘orccousess? 10. How often shoud you check the cnsious lel fs patent? 11. What can oan mask exter beeing inpatient? 12 What does ne word tga mean? © Dream unten see tare 14. The gels at pontsing ABC ae revered in ape ston, Wo tae stent e201 retNOC R Cun) ‘This section covers a “6 the tacked say ‘6 suspected nek and spinal cont Spenng and mantaing a dear” inutes 1s Song ' recogtion of respon «¢ Samo breating probes ee Introduction ‘The sues ofthe tod require oxygen one Bul soe are moce save Te Biggon tan oes The bran may suflr meverble damage dented aren or even oo tie a2 3 minnes. Heart muse may sue a ite 2 Sr eeeh te succes of sefoilaton ae caracarest decreases raphy wit fine rune mines bing te ecal ie nats. “To provide an adequate oxygen sizoly othe tissues there needs ob: ve llc oxygen eroded (8. th akosphere, trou etal air Feavactoson by augmenting thea Supp wih onygen FOM inde = ae away = adequate respatry elo = an tet sina ord “Amosphere onjgen is extent o alow absorption trough the lungs in he trout pation An aca estyplanybesies between 12 and 20 mes er IN rales teow this or the absence of adequstorespaloy fot he ‘apaaten needs supooring win an onygen cntaning atmosphere ‘Nemal ai canans 21% ong: he bey ely uses around of his, Eahsad Br Conain 16 ony, whch adequs f support the patents rexpraton then peter moutio moh resoue bean ee woe eew eee ewneeenw we ed Bestrg Poet s21.4 Airway and Breathing and ood may be dict a clear, andthe use of sucton device ary (eo seeton 15) Inept te sy er: ~ food debris trig bey ‘ter checking th mau, he sound sl yo lt pen he sways the chin itor ow trust meade wihout xcoshe mover fe Pac ar ay soca ot ono comoge oe spa ue on Head tit, chin ure nha ont, sn sun one ple eet ae ead genty gain ok sen and fel rss of boating fr 10 eacond If you a8 not able to ope the sway using chin ead! he jw thst ‘movie canbe uae (a below) BG Figue 14.2. Head (inontrumate cases) owe 43. Chin ave wy es Bc v A vw Airway and Breathing 4.42 SUSPECTED NECK AND SPINAL CORD INJURIES hy someone who uncinscious aii — parla hey have seed uma sve the earbores, the ska Injury te the spine nthe neck must {hny be considered Typical inns fhe sot scrum ~ road te ctisons = fale down stars = ng inte shatow water = and sporting nis such a runby and equesbian acts. nena ot found inthe reta (sua) positon shouldbe moves gory Ino amine poston ese igure 144 below) However, fressance elo ‘cay eneouriered shoul be let te pation found, are te procedure Spies aesociely. You wl nat be cea fhe patent has 2 sna irr othe nak, butte ‘uth sry shouldbe opened using he ow bust manoeuie Movemantat ‘he neckinpatents who are suspected of hang neck nur must bo sooo ‘reduce te tk of rhe nary the spinal Crd ana ssaquent prays The conscious patient whos sures type ofr may compl ain eck and pa snd tnging nhe arms ad hands = they shoul be Kept {il'and not sl up, Hower nthe on resting patent sacunng he sey ‘the rnoat important factor and must the pony, te fecha fa Wn Howe 14.4 Simple amen’ of head and nck 0 2 noua poston1.4 Airway and Breathing Jaw thrust manoeuvre ‘Tis can be done without extending (bonding backwar) the neck Use te ts of the index and mile Koger of tot hands paces behing he Sng ofthe ju on bth sides, and ppl pessure to move te Jon forwar ‘Adina Mt canbe gen by ung counter pressure aganst tho pavers {reokbones Th ache canbe used wi the ptr ing on is back orn ‘ting poston, making pancully usta fore unconssisue patent who ‘ting Up, ors in eb ley, he proder should be bein he pan ‘These ray ranoeues ovate he jon, fing me tongue muses away fom Figure 148. The ow trast manoouie False teeth ante wha have lose fing daniues may experince problems wih any ‘managements hey may dodge casing Boston, Therefore poor ng ‘omres should ta removes. However, cere tata wel ing shoul be Iain ise, as they may hap to mania the shape of he mouth enabing ‘eter fal around the ips dung vesoue beans NNN mann Peewee Terme em ee ere) ‘oropharyngeal airways ‘ese ae devices dese to preven the tongue fllng ont he ack fe teat assur aedncaranconaineRonsimernwe es ‘CHOKING Choking occurs whan 8 “oreign tod” (rst onan apace off dgesin he EretSPise eto uper sway, locang he away. The inc may have uty breting ond peaing and often rloe his hand to Ns hoa the Ederson ot eared, he pation wl fst boome yerose (a Bush th fo ‘Srtoce end ips) and eventnty bow consabusness, before sling @ carne urinal actn ito veassur th pat! wo si conscious and encouroge ‘Si'utert ws cough wih ive eeeng however, te nda nab stand tothe sie ad sight behind the patent Figure 146. Stand to one so of he pationt 2, mopent he chest with one hand: ean the pallor forwards 0 the lodged ‘jz Scope. wl not go frner down he windpe Dl be sete way reg Pot7 ea Fenton nent mm to mut maton Tenet eS forced oan ‘lungs and may clear the foreign body. In order to do this, the > Fy cana nond patent pce bot mm ru he pes of Be Eg dometatnnecpetnendandpa arty ees od parts is, FS ees eye tgs gs ae ES =ss es Figure 14.7 Leon the patent fonwacs e ' = 3. give up to five firm blows with the heel of the hand between the shoulder es iss e/3 = | 2 5 | a e | a = a 5 ! a ela Pee 148 tego = = ee ee ee ra1.4 Airway and Breathing Airway and Breathin: a aE choking in a Chita Intempo ear an obsiucion sou oly be made ifthe eis Urabe to trea ere are wo bai princes for dealing witha choking chi Tercouragg the cds terps fo dlear he oegn body fr himself by 7 cote + caing sobs to rete a sudden merase of prossure wii he chest and a ore the objet out nine ace fered blow 3 ids aged up 8 yeas, nti aged uo Ss ‘dwn the srw and tear the sf ss 1] BE pomot- use sbomina trusts in an infant (this may damage Intra er sions a Figure 1491 Plt shor inwards mm ge Actors shes POSITION Loss of consciousness. Infant poston the nad down (such a long an arm) I deste hese sctons, he casualty becomes unconscious, ten he ston ‘os insure wtnananctne mae ne et andy The provi shoul = ppt the patent othe ground = begn CPR Pa 0 Moy 2011 ewe and sing oa a a TTT MO OO HTH ONS a an forward or poston te ead down (such as over a knee) encourage the chi tees ner te ockage by costing ie tts fe ghve up 0 5 sharp and quick back ows wth the hel ofthe hand between fhe souier les Weiss ‘sv up © 5 sharp and auc chest compressions ove he owes hal of Fs tess fron na te fa of te hand fro eis. exereng Sere seecrs to dpress he sioram fom one tir 0 one hal of he (opin othe eres «chuck me mouth fo any dsladped abjets and open the sway 1 rept the sequence of back blows and chest compressions unconscious commence CPR ray eg Pao st£1.4 Airway and Breathing RECOGNITION OF RESPIRATORY PROBLEMS Normal breathing focvebrothing allows enough at ante the ung enabing oxy o be olvered othe sol sacs win he lugs. This en tanstered the ood {oe austed othe heevs to support cell acy Carbon dons, # waste ‘rodul produce by calar sty, en pases nf hear be exala, frashing nas two components, rate and volume, To breathe efectvey, the pation must Reve a good fate and an adequate volume ‘Remember: adequate breathing depends on rate and volume Lock of oxygen inthe bond (hypoxia) can be Me teatening td hears he ‘Sao ofthe patos breathing is pron. I the pate! le ot beating sequal, 1, poor vume o not at tn the rode may need Yo hap Fim (se tection 15), ‘The normal healthy adult rate at rest breathes between 12 and 20 nes per mint; btw 1 par minute you nwa 1 ap Signs of Breathing Problems ‘ound ot resin n contrast stor ocsaring when he port creates, ‘he sound aecca wim ashna eat a wncee Socring hese pat reine ot Inastha, a wala te sdorl sound, here may be xtra muse use a lp vith beating, ad Pere may be ever sraing” to musdes nthe eck In someone who i receiving instant oxygen atthe ress ofan away oF ‘resting pola, tere may bes bis ge oe shin prs 10 te lips eyes. ‘Sigs of breathing protiers ince: aoe 2 ve rd Bey weaa ew TOTP ARAVA eo oo a i i aa — uve of acceesoy” muses between the ribs and ine neck = cyanosis = a whnaze or sider = she positon of he pasen — pretering fst up and lean fora, often ‘Popping rel on dt or suppor. prover shou ensue the pin hassle xygon by cesng ‘td suppotig the testy by rescue beading. (Aeaonal Ealing [ime prowior to use a bopvalvelosk combination and scons! oxygen). Te genera princes of cag for 2 patent wih beating aticutes nude: ~ remaining cam yourett ~ encourage the ant ores oF tin he polio hey fd mos ‘Somorabie ~ osening ght cating = re-aesuing he pation and lives — montnng the patent eaeuty and tira prepared to respond hey ‘atari ef hs testing rte ale Blow 10 per minute (eee Seaton 13) ‘common breathing problems that he prover may be involved with nce: 4 scthma (ee Section 1.8) 1 series (208 Section 1.8) 4 ryperetian 608 below) nw and erg Pa| | PT CAC Le} Hyperventitation Hyperentton cis when he patents breathing a much ghee han (ost ant ond pani ta common eaves of ths typervenston fay ‘hited by verencming emotona! smut tthe red fr eral, er. “The oflect ofthe hgh rate of resting i 1 reduce the cncerraon of carton ‘Gouge in he ood wach icalyproducos 3 muscle spasm and tgingin te ‘nde and'n some pant eling of tahnersn he hes ‘The management of sf best achieved by “aking down” the satent and reosragig hen tobeahe oral a of 12-20 treats amine, Th may ‘sure to patencs but shou evortualy achieve he dese eect. Hyperion i recognised by sonra rte eal sharp breaths patent complaining af ging a fgers an around Hos ands going ito spasm fatet showing signs of pak ad anty pid breathing sania othe hyperventilation can also be caused by oer ‘rede potens ana the prod shuld ake hs ro aecaut when asses=ng the patent ‘Treatment sac te patient ‘remove he cause of any stimu possble) talk tthe patent and reassure hn = encourage the patent ost down ~ loosen clting as apprenite the patent o focus on slow deliberate beats Poe wt and aig wn annem ooh —nmm Peeves a EU LCC] COMMON BREATHING PROBLEMS = chest incon ~ chronic eat coe (9.9, conic Hench an emphysema) — ities to he chest (eg, rates ts) (CHEST INFECTIONS - ae carman ata ages but pata nto ely fare moy be a sony of # cough, shared of bey ecg url nd rossaiy a ngh temperature PATIENTS WITH CHRONIC CHEST OISEASE (or examsie, erphysems, rons) neve song hitey ot chest protlams: cough shrtess beat ISeefas thet face Tey may wel have thr ow sellenedcaton sh as ‘haters snd onygon rowers should erosurape and ast patents wh sal amiston a apres In hese caves, ving esablahed clear sways, providers shouls ge re ‘Sesuence and sncaurgement ana wate fartar moe! asitance INJURIES TO THE CHEST - te cananest chectiny is bring othe chest “tl andor facie oh se the par may Yes the pati’ breatng. The “vir shoul encourage he patert to spor fe ured pa win Ns hand Eco adoot he ost comfoabe poston or breaing way rng Paes21.4 Airway and Breathing Section Review 1. How many ies does an adut rest beste por mine? 2. What pecontage of xygens normaly gresent inthe strespher? 3. Wal sercentage of onsen does te body normaly use when beating in? 4. Wat percentage of oxygen do you breath ou? 5, Rese breathing common is also known a8? 6. Whats hemos common cause ofan abut say? 7 Name te ater eases ofan obstte ay? 8, Whats ais? 8. When checking for breshing, Mow do you fel rte movement ofa? 10. What the hea icin it manosue used fr? 1 nase of suspects ap or nck jy, wl eg sed open 12. Inthe coking patent, whet sne et metho be wed eae sway? 18, tts al, what ter tchigue shal you parton? 1. st he signs assoited win treating prelems? 15 Hyperventatng ie when he patente beating. ..? f Poo 8 marr WOU TTT aera mm CES ee Stns ‘This section covers 1 te patent who has no sgn fe Th patom who's consccus, & adkonal adie on base Ho «general approseh Suppor eaiquce | brosting ang has 3 pus ‘¢ heptlon whe i unconscious when to stop esustaten tho recovery poston \* Se Bese sa a The guidence in his sseon is based on that publened by the UKRC (Ret ‘eres 1g.) The 2010 Gudenes place emghass Bate supper oh Ianianing etc tough chest compressions an lass hme Ot Tsou treating INTRODUCTION as ie suppor i designed to keep ongoratad bled culating tote vis Sycwes na los upon single measures wat te need for Shy ‘eomplosta eqpmen. For efcive bas He suppor is recessry 0 have «+ supprted eating oatow oxigen enter the lings — rescue Breathing + supertedceiaon a cary the oxygensie lod owl organs chest ‘However, fallre to lear and open an airway i ely o rebut ‘reversible bran damage within 3 to 4minte. "Treating has stopped, hen cetaon wl alo stop. This krown 9 aie ‘nex Thapar heeds ba cst compressor an tescve beats known 3 ‘fra pulmonary rsusctaton (CPR) fc te agerGENERAL APPROACH | ivee speach ried fo patents anh follows national quienes fromsied By he Resusctaten Cour (UK) ‘Chace tent and see i he responds by get shaking his shoulders and ‘Shing loudly "re you al gh Do this coset the pit ear, snes he may nt have good heating. “provider may be presentod th four eslagores of patent who other equ, ‘THE PATIENT WHO IS CONSCIOUS, BREATHING AND HAS A PULSE reassure te patint ‘ slae in inthe positon wien he fn most confor fo trmerdorger continue to check the patent's ‘Sway, beating and Geaton «ae he aia fhe 999 crew ot (rode meres ‘THE PATIENT WHO IS, UNCONSCIOUS BUT Airway «open ne away: hea ei it ‘open he mouth and remove ay iste ‘bewuston inudng loose cetires, fet loare al ting Seren ace. ‘gure 155 Open mou nT ener ee OH THT Vee recess, tr the patent onto hissde oun fad to the owe 182. rain ary ui fom mouth Pace your hand on is freneas nd geny atthe. "head bac ping your bum ‘ard. index ger tee to cose te ose if ‘ieee beating fread Fie 159. Gent tit head bck im your gers under ne pt (fa patents enn tthe cn 0 ‘ponte anu voi head i rau pe cnr ro Foure 1546 Uitte chin oe ‘ese sgnaS Breathing 1 keeping te away open, oo, stn, and el for norm betting (more ‘han an occasional esp or weak aempts a breathing) Basic Life Support ‘gue 155. Look for host movement Fore 156 Fel or ion your chook 1 10k sen, an fal or no more han 10 seconds to determine he 1 Fe patents beating normaly move it the recovery poston see ou) © reassess regula fr continu testing Pace My 201 ace Ue Suppor TRAM AA ATT HMM TM MOTT ow vw wa oww aa w Basic Life Suppo ‘THE PATIENT WHO HAS NO SIGNS OF LIFE ‘The heart may have some sc for some time awa, however, not Stic fst ‘The patent whos not eating hereto sued io be in care are ‘chest compressions 11 hepato ot breathing normaly ent besthing ot a, stat chest Cmpresions nthe sone he shea shown iis important to matin hand poston on he ck of te chest. 1 nan oat me am shoul be ogre down approximately 5-6 centimetres Sn poly ough pressure aove tah beer oes Nae han Foto achive adoguate depth 1 reas al he pressure wihout losing contac tetaeen te ha and $temsr he repeat ta rao of 00 100-120 times minute Tray be Pips cout sua ' compossion shold take at east ha of heme. Compression ae release Shoubot be neo movements 1 ata timos he pressure shuld be fn, contol and ape vera. Erratic wolot acon ls dangerous 1 ster 30 compressions he head ft he en. and give 2 farther ' combina chest congressions and rescue beating 1 one rescue breath stoulé be dovred ove 1 second an the two beatns Soul rat ike more han 8 seconds overt « etim your nande out diy othe cot poston on he cee ofthe fhest ard ge 30 further compressions crtmang compressions sh treat oo of 3.2 ‘sop compressns to recheck the pant onl Hy sat show Sans of ‘egening conscousness, suc a coughing, ee oping. spkng, 6 ‘mown purposely ANG solo eae normaly Oterwes ot Incr retusa ness dfoiaton aking lace. omember: the CPR cycle — 30 compressions to 2 rescue breathe soe le sip ay 201 Paes1.5 Basic Life Support F Basic Life Support 1,5: = — ER“ Nlncodteecinioy eel erponton wnca) sen hc a eae 2 epeneori ese at nae a na cS ea ea Figure 1.5.7 Lower nib edge es ea ‘Docc tee Pace te hee! of one ES Sivonen ote smn and Ea oeacurees ea nore Eg Pan TS pn ea Figure 1.5.8 Interlocking fingors an ea ‘Open patents mow 3 ie, but ove te Jett eto = ‘with your arms straight, and ea SP ae Shee cer a - & i a ee ee oer oe tle an wn ee =~ Figure 1.512 Pacing a pockst mask 1 ster placing the mas, ensure the mouths open in I) «if the patent isnt beating, rs ony making eacasoral gasps or weak ‘stomp at beabieg, san resce bresthng 1 take a deep traatn ol your ung wih a, and ace you ps sound he Socket mass, shed or he patent's mou, ming sure tat You have a (ood sal btwaon the mas and he pats face + ge arn mrt, mcr en een of eh aes + take your head sna bebon breast vod re-reating te patient's ‘ryaerdeieted ar ad wat the ces «ony smal amount of ressance to testing shoul be fl durng rescue ‘reaming «i pct ny eough ow ne het say, aon ‘he pe but il ba force in the stamach Ths wl cause voriing and ‘Mhecuut smy costucton Oven cn ores cd arage {ote ngs tom tomach cries end reduced tons fow the heat ‘you cannot perform rescue beats, ero chet eomeression oly + ha cmos oy re prcmes, nse stb ata Pao 208 me Ue Sept TARA T TMT TMT OOOO MO MOOT Seu eee Basic Life Support +s 1 29 and recheck he pater ony if thay stato show ss of regaining ‘Soscusness such ge coushing, ve opnng, sealing, moana purposofly AND ste reatne normaly, oferise Go not erp Figure 15.14. Blow stoi ora sige scant es ene ce an ‘anos aoc Le Sgn us 208 ross1.5 Basic Life Support [Airway obstructed 1 ithe iia rescue ean of ach sequance oes nt mae he chest ae ‘Sm noma bresng, then Before your nxt teat 2 yc pert moun and ramove ry vl obstruction (erdnck tere adequate Poa nd hin thet compressions — reo sampled tess shoud not ake more than 5 seconds 1 vnsuccwefu, move ont chest compressions {he pant stats to besthe normaly on his own bu emalns tnconecous ta henna Tecovey postion «bs waty ota the pat ono Ns back ad estan rescue resin he ope erating [ADDITIONAL ADVICE ON BASIC LIFE SUPPORT TECHNIQUES Witnessed Cardiac Arrest It you are caring fr a patent wth chest pains who colapses, and tough ‘Ekesomonyouonlin snr ames is inpotant to tach he AED 2s Ifyou are by yoursel,atsching the AED takes prot over CPR. Sno ateches he AED. " : Rescue breathing ‘he oume of io be sched is abut 700-1000 nan ad our aly requted fo produce chest expenson i an “The rescue train shouldbe delivered overt second ang the wo beats shoud ‘alike mote tan 8 saconds, sowing he hes fo fa between breath, The exacting of expation srt eta he chest oud be alowed fall Tere anoiner breaths gen TATA TAHT TO TT HTS Vueyouveveeeeeennnvonoe Basic Life Support Mouth-to-nose ventilation ‘his may bo used as an erative when he casas mouth sue, mouth ‘incu! seals ict scheve, or even when the bua bang supported 1 Sescac tm war As wit mouth io-antieathig, ep the dy open ‘yuan the head and win the easusys mou closes. Form 2 gh sal Sounds rose and bow, Although is aay Bow ts ss easy or the iS ome out and te mouth shou be alowed t open 38a comes out Mouth to tracheostomy ventilation “There ore a sal buingartan rou of patents who trethe tough openings (Gomes) in their neck Sore’ patents, boat entry bvough ths tae fanpeciomy) ters beste paral (racoostry) The stoma can be low down an the neck and covered wth cing such 35 Tr or eesens, so cast examina equ © oni such patients, “Te pncl of sway management and CPR Ie bascaty he same atboush {13sdonel cores ned ensure al he tomas aro ny mucis an tha [nefecve sea cesta when pesooing rscue breig. ‘inen performing resco breathing on paril neck breathers (racheostomy Fuseng) smart csck hat he Si oes hat cap fo he mou oF Fase "Ths ean be Sone by cbsenng fhe chat wa ts tose when owing — ‘may ao be heard to scape om fe aut nose, ‘Best preter pati neck reathereis to ace wo fingers on ene side othe fovea te tar ungemeath fe into dove he mou when towing Te ‘gos shoss be teedseo tener wl ema iret ola vt athe test ve Chest compressions: ‘The recarmended rie of chest compression is 100-120 tmes print. is ‘Mciereu necks of 30, win ar oe or two reatuorsprowes Ths means uw pertorm about ne groups of 20 compressions tw ese rears Ove WHEN TO STOP RESUSCITATION Cnty Sep chest compressions when 1 the scene becomes dangerous 1 the ptt shows igs of ecavery noe Ue Suton uo 208 PetEPS e MCR Teas — Basic Life Suppot EH es < setetmrsmnorssnjenatgmascmssen Rey ee ee eS es Sa «a 30% of the normal, soit fs essential to pertorm them wel es _ eS 1 tet ee ep to ir eo . ecause hey con Gran ee) fom te mouth es Elm npr one aaecens ? ej ea to "tae te ne pen besitos ce aii e ela ory sla ea Figure 1.5.17 Knee! beside the patient and pull a a a iy | SS at sssBa LORI oad He wn CEO ee toi 3 es ee 3 Preparation of the patent before movement ‘Crane pant nar you ons ee MO Sele rues reese eS = Seetiornpnes BT ERTS Mey ay chetacton FE 3 pacing the patent inthe recovery postion : Eres arch me nny osomiente ea pressure sores Ait priest he [3 fmm cite nay sme mee eas ant hepa ene whantamperstve tues ge Chak ep eos rt ener em crn 120 rent, ras th acm | ar provise dticut nursing problems and edversely affect the engin of hosp cel MURS Gece herons omer ste i By Poe patert etuay rims the conecauarc by triag ela Sti naan ann e i a USE OF SUCTION roe pe ! aaese rane nny tm nan a scion den, wih nl Mteate Nea = i a Temoving blood of vor from the back ofthe throat. The prmary scion rowers Kno at ela Eos Netnng sen ero ao creek ep te Cae shou always be taken as even inthe unconscious pant the ouch of the ‘head tited and facing = I a ‘End of the suction device into the back ofthe throat may induce gagging oF even, ign wasn =o ‘Pith chon orice SO er cpa ue don ey. heck he treating bi) a me ae corse Serres an 0 mecan> ey Ss tion ic ae conrad See e i a sla Foe 15.20. Adige nd poston 4 Page 14 =a aa a 5S ! a1.5 Section review 1, Wma se process of basi fe suport desigod todo? 2 Haye erred ta he scene i sl, what 6 your fat aton when performing basic Me support? all “The cmbinton of chest comeresions and eso breathing is known a8? Wnen ging rescue breaths, what Ie the main danger fom Blowing too ‘ey? " " 5. vat zone et chat ten ren che EEO Re tins ‘that the commande a fr chest conpressont pet min when raring CPR ono as? permet es 1. whan peroming ces compression, he comeresson and lease phates ‘outlbesmost and epvar True Talse? ae 8, Chest compressions shou be petoxmed In leks of how many? 9. Under what creumstances cou atlamets a resuscitation be slapped? 10. When placing patent ith recover polio, what isthe purpose of removing objects om Dat pockets eI? PCRS CCM LL od = 6 sing on Automat Extra Detar Cae aest (AED or cae rest, ‘Sip carmideratone © post resuscaton care [This section covers | “e heart yes and Introduction rte “chain of sui" il ks ar: ¢ fret "erly access” (io the emergency care syem) second ~ ety ase e suppor (BLS) 1 ti ey destin ‘noo pumps rhythmical, he muse bxing canoe by lctical moles ‘Aiineet Puttin ine fear omebmes the Mythm bears dsomanses Seo, ogee esling i ho broad calepaes of arSac ore sa sockate tim ~dsorgariad lotic actu wih 2 quivering Neon ‘muse but o out 1 on-shecabl - antl (n eletcal att in he heat) or TSB Rea acumy sti chet procont but {fare eno ood being pumped oud ne body, osm severe Hood os fo amp) nen the hoa in vrtfvlar Rian, rama actly may be restored by (en ee ic shock wh aise proces ated deton ‘Avomoted eta defilrs (AEDS), are sophisticated devices that 6 carat, Smo to opal, When staciostos patents chest AEDs asi ‘Fame myn snd ears ne operator rough vole poms ote acton 1 TE Stah pricy the AED wi ndicate when hem stackable ‘Te sooner dean is delivered, the mae ofectve i, The chances ot Tus scene Stemaon decne st aa of =10% wih each minute of iy BEERS Stace Te chance of sucoess wih an AED is mgroved erin? Siepuamonor esusctaton hasbeen powdes. CPR stone's uy TeSNee venscusrfomaton to 8 nornal mytim but does mena some toned Exe etn Pave1G Automated External Defibrillation {reuatng oxygen. which brachial pls point or arm losing (abe Figure 1.73) > femoral puise pont for eg Heed (ste Figure 1.74) Ce ww ww w eee ewww ewe we ww u v Circulation and Shock 41,7 = make a note ofthe tra of appiaton ‘CONTROL OF MAJOR EXTERNAL BLEEDING Gloves should be worn at al times to void direct contact with bodily ‘he piri of controling enteral beeing se Section 14 Away and Brsthing) *+ spy direct pressure to the wound ty lacing a sessing over te Ueecng Ste an presung as fy as naceaeay (ae Figure 1.73) + corot emove any penetrating obec but pad round thm wih dressing ounaite dessin pecs teaies1.7 Circulation and Shock Figure 17'5 Oreo presse ona wound and elevation of he nb 1 drect poss, elevation of the mb and indtet pressive ver apse pont {alto contol etomal less ~ spy cure! ove ledig pot ndotenu Bera ~ ‘doaty mark no patents forehead wih 2 T = make sure hat whoaver you hand overs made aretha! he easly Fas a ovis! appted [ASSESSMENT OF CIRCULATION ‘pulse may be fet whore a major arr pases vera bone. When checking ‘ue, ou shoul aeanae Sn rer he © presence or absence 1 rte (eas per mute) ‘volume (fem weak stoma) TTT TTT Poo retin aa sh Veo eee Circulation and Shock 41.7 somple of puses and ta relevance lo you ae rad! ple fol at me ws estabishadequat cevsing pressure corte pul: en the neck estab casa ast bea! pulse el in he uppers for insect cote f teeing fom he «femora use: fen the gon or ince ono of leding Kam te ag Ina pom est adi at et, he rc use canbe fl ata rat of 60-90, {hats ar mint (an extreme ors may havea ower puse ate around Steal parmiteevong volume) Painandsbessmayinceas he pulse ae Location of the radial pulse Th rac pul a alton the pi sid ofthe wa he base of he than. ‘ace to gre inthe postion shown Figure 1.76 below = ess ty 0 foo te pe ‘fea for en secondo determine Is presence, ae and wheter ts weak or ‘rong (lone) ithe racial use cannot be fe. move your fgessghy ond reduce the pressure 1 coun he rata for 10 seconds an tly by 6 6 got torte por minute Fue 1.76 Locaton of ada puise resto rd Sick Paes. $41.7 Circulation and Shock Circulation and Shock 1.7 S10NS OF BL.000 LOSS AND SHOCK Star oa a ter ea ro ae eae Speer { nceaeecbrating re 620 per minute) is welt toramarber hat ples may be har ose in casuals wah dank ‘Sin itean be halp a ook nis the tatom ipl se itis ik noma) oF pale (atnorma). Flowing tne assesment forthe presnce ofan asequst Coat, he next proven assess nd management othe casa Se an tp ‘yoda teed, Yee eee eee ‘CONTROL OF INTERNAL BLEEDING Sometimes eens cannot be seen because Is happening ise the body, ‘sis cad tema losing ond may occ i the Pique 17.70 8 Location of the cart pulse ae Location ofthe carotid pulse ‘ pows - “The caro ple maybe ft in the neck a folows: 410g bone actices (emus) ensure me ay is open ar clear 1 fel fore “acams apple nthe mil of he oat 1 side 2 or gor sideways away For yo othe groove a the Si of ‘te "naam apie” a8 shown Figure 12.7 pre ity to hack for caro ple 1 ou canat el pus, ty moving your fagers up towards the jaw 1 fe! for 10 seconds whist checking for one sano ie > We pate reat nal? 18 Me patent mowing” > 18 te patent swatowing? ‘Buti, for aaa uti from rad tac calion of om ate. ‘ay cause nema teeang, ema esting may be conser an rest ‘oreofehockinthe patent Hownve, even f conser to belie bvestonng, {oes nt ike grocedonse over any management ‘teas conser now an inuyooced nd Hieral Besding | Poss. see TTT em Pao Crodtin nd Stace n£4.7 Circulation and Shock Patents who are Bleeding intra require urgent ander hosp! where Gatnivesugery oan te ony means of sloping te ood toss ‘Sins of lasing inl he ins of dovlping sock: © rapid pulse f wo0k puso «confusion andor estossness 1 pal, seat skin 1 snreased (orneeasng) breaig rato 1 sasping reas ‘Adena signs may be: 1 Pass and tenderness round he seo ry Brisng and neeasng swing Inti management of internal beeding iis not posse to contl eal leeingwiout surgery but pening anser to hoop he prone hou «manage te ay and beating 1 series angen rine 1 0) ‘eck tr enteral berg snd cont as described stove ‘pinay and petower ri ractae are nt suspected Ths wi rot sop he lasing but il el 9 mantan culation the brain at etl opens nea seated they must fealn seas, lowered, te Hoos {iret the ower Imbe and he los that wil have bee Fost by the ‘imued bleeding, overal ee wl be less ood cing 4 encourage he patente st 4 losen tt ting rune he neck {6 cover he pti wth warm Banka rete him fom he envionment continue to check ane ocr beating a pl aes the patons breathing stops then CPR shouldbe commenced (eee Section {13 Baste ite Suppor). Pane Lena & um umn ee ee ammm 4 Core Mo LiCeLg ‘section review 1. Bod ss to fon a6... 2 Whee can the caro pl be fet? 2, Haw long shoud you teal rhe presence ofa pute? 4. Pole sin is 2 in of lod loss, Where can ths be checked for ona patent ‘sth dor shin? 5 ed comes tough a desing, what acon should yu take? 6 What cton can you tke ec pressure on a wound fas to sto eedng?| 8 Medical Emergencies * palor Homaver in some patents, partousry the elderly and dabetes, myocaral Inarton may our ito pain the scaled “alert Management of anginalheart attack ‘The se and symptoms of angina and heart stack ae Seay, and be ponder ‘Shout oy to ferent betes tho to bu ange un gooeaway wih ‘ea the pa as lorger hans mues he casero key tbe 3 haart ‘ack. Any pelt ho presents wh chest pln shous be eated = 3 ‘emergency, gen earcrarc, sath fe ree comforts positon (oen hal ‘feng up) AB00m arpen shoudbe given an oxygen groves (rare ao fo) none the avant hs been adise oad Sep [Aplin work by making pss (fd lod el) ess sky so they ao less {St ump tgeer oom or ian 2c = not en ai ha pin, ‘The poet shou be asad to chew o seth sap ns mau rather than awatow woo, sit ges ine Be bo Tater rat way Howoveri'a patent Seeing sek or hes every ry uth hs might be aut The sutton oven of nse caial chat pain a ghining sapere the pase andvenssurane aay Thi Yeasirance wil edsce he cance of "paler covloning abnor Mohs due to ceased aarenaine ovl, Produced bythe bosy dings Meat atack The power must b prepared © Sette the patont and provi CPR I the patent progresses t cardac rest, whteavoring De ertlonce to arve. ‘Onygen is of considerable benefit to patent wth ether angina or ‘myocardial infareton but should ony be used by those providers who TTT mmm mm me UO eee Ur Tet Ca ‘THE DIABETIC PATIENT ‘abet patos fal ino two main catego. ‘+ hypogiyesemic- wheter sow agar in he 008 «4 hyperatyeaemle— nae there it rgh sigs lve te Boo Most colpses alate to dlobetes ae caused by hypoglycsemia ‘ute oten, patents wth @ known risery of hypatycaemia have avable Srepes to fevers the ete, these icose Ques gel yp") oF {ecogon frnecon aon gre bya lave), owevermany abet pairs know when hey ae gong ype” and may sek Fr tfoe beconsg unconacau,ntaue tases te response may hp he fate! ae gary as or wets o cunt an atackSomebmes Sovlonng Frocgsema mince the elects of seo inowesion ana the paint (eomes rte appessne. in such crcumtanens, protect yours Url te ‘Those patlonts wth ypogycaemia may ato have the ow Hoos sugar coected ly he neavennusadrintaton of cose o the tenuscuareamnaaton ‘f gucago thay are unconacovs| he wilbe undertaken by amlanes crews ‘ect professional Faterte who are ther typo oF nyperpheaemc, wil tenet from the ‘mins of oxygen thes ante ‘te sgarnvls However my be be fat presentation parca the ‘doesy it monested by conuson and servation por to loss otA Beene ad Recognition and initial management of diabetic patients HypoctycaeMA tow ood sup) HYPERGLYCAEMA = seorenion = ey have 8 medical art reat ‘Sons and symptoms of Fypoalvesemi are guck o present ‘restment Wonacous nat ata ABCs = Recovery postion ‘Sthorifomaton on meccaton Palen thes for abet pans on 12099 team) Clues — kngun abt? Heesion® beat re Seca ray breath Growsines ena Signs and symptoms of hyporgjeoema sr sow to present Sa may devsep oer day or = Rcovry potion Pees cute THE STROKE PATIENT ‘The tr stoke ape to ha sudenlokageor tuo Hood vessel in he bran, Wit 9 constant ood sappy bran cls san be damaged or sesroye Soke is @ medic! enerpency regung eBfy treatment ard an accurate dlagesis hor inst he bron ocur at rest of trauma, bare ik of eer rising the brain tesve onasscn or tw dovcopment ofc ees tain or scuna te bran. Cancusson may produ ost of consciousness oe Simpy site af enkon bt eno nave be Weed iy ana he pent ‘Shays rte fr rtarmvensgabon, usual in hos a spre Signs and symptoms Presentation: stroke clasiall present wih he sudden onset of one or more of te folowen, 1 kero weakness cr numiness of arms rage «+ weakness of he fue on oe side 1 acy wt spooch or understanding speech Stoke is mare common in ler age groups, an parton tose wh raised For supoced stoke, use the FAST test Fac: Ask the patent seo show toh, Look for NEW lack syramty ‘Aan Weaknoss Ask the patent her sms ogee an al. Does one ‘am do a down? § Spooch Problems: If he patent tems Seuraneo of speach Tne teal marpeney hele ‘enversaton, Look for NEWa ear os Initial teatment © ces Ary. Beating, Create Day eas Sct 1 ina management snd oxygen tery re hgh pitas to avait ‘econsry’ any (Pains she be by mouth '¢Somaone who wanessed ne onsat of symptoms tou be encouraged to secompany be patent ‘¢ At mesicaon should be brought wih the patent “ne paint hau be ranstered to hospital as. an emergency response to he ‘Ambulance Serce wh seer The patent shou be tatored i cone with prowsin for epecii stoke cae Transient ischaemic attack ‘An schoo stoke overt wh complete covey win 24 nous scaled @ ‘rain cinomieAtach or MAA TA ors when hee enperany Most IA nas short tne an presen th he symptoms of stroke, Those ‘lth TA Rave a gear kof aeveoping stoke win 24 hous of one! of Sota, than does «prc wih ches gan sto go onto have ae stack ‘ny pater wih 8 suspected TIA routes em spel meal ssestment ‘cen fa tbe symploms seem fo have gone ‘Do ot ely he patent na symploms of ugpected stoke or TA they rece ‘a emerpety sponse tom he Anbuance Soe. Pane Mes Eee mmm nee am ammmm mm nm SOUS U UO n ere u uric) ‘THE FITTING PATIENT (EPILEPSY) Epilepy(conusios) the res of tara leccal acy nthe ran hat Fosse ts Sometimes the pant has a kon nisin ols eplepy) Sr REST Moscacrt:bacll ora maieatonsanfrming te Gognoss “ee istometines uncertsnly when soraone colepses 3s © whee thoy Tee had a Yat’ or aft However the epiode was winessod and {cena rovermete were seen, tere i postibaty of pep. shou ‘tome tnmind atin fe gabe who farsa hen sles s degree oF aay {eucon, tag may flow ‘spent may ster 2 for varus reasons. Young chon wih tgh fevers hha he i, but do algo ont dvalp acl pepe Signs and symptoms, on ‘aura (unusual snsatons, sls ots) + muscle atehing «+ conmlsonafeting movements of bs 1 muscle ty fockuig jw cenching) Initial management of @ seizure 00 NOT RESTRAN THE PATIENT '» DO NOT FORCIBLY OPEN THE MOUTH = when the connisions have stoppe, manage th away an beating ant pine he patent the eeovery Postion ‘The prey is © malian the away. and athough with on epleptc tae is ‘ial recovry aring etalon ta lows te ing ped may be nacssar to gve sway support by means of ein or aw Bust Un ven ith he recognises elec patent. ecovery may be low, tt he usualy tocomgs avers ois croumstnces std curowndings ards able 0 ep NSA Mercury Management ‘Tye management that he prover can ge is ited. However, the Ina management 1 feassu ho patint freatng ‘encourage he patito us sown mediation ‘ssi the patont to use a nebutcerspacer dev, they have one | sive constant estaurnee and encouragement ‘Severe apa ie Meneatning condton and must be teat a sch, th {gent edison fo Resp Be prpare to carmance CPR vequred. Increased ofort may be requires to vel he patent ANAPHYLAXIS AND ALLERGIC REACTION ‘Mor argle reactors ee common, but anaphanis is an exaggerated erat wien may develop imo siden and paound alone of Be Srcuaton The can occu win seconds of exporue lo the aubslance Common causes Se = gs (ste by sno ete) ~ pani or xa «insect stogs~ wasp and bees In partcuar «cana foods ~rotcebly mss “This expceure produces ld lak rom the relaon nto the tatu, esuligin ‘Jeting te happens the veo te way ae Tne pent may to ‘este ence ad ly ah Thre mayb close oo Foray, anaphians a rare even. Eflectve treatment is achieves by ‘Smnstetna eoephine (ao srown as agers), bu peng tas you rust ‘ncure ade’ away and efecave verblaton Inimay cases, ere i istry of pres sens reacton and patents who ‘ave been susessed ee havng ‘angpnyacsereacions may ohen wear a MedcAlet™ bret end’ cary Ns oun’ epieghnne.(Epepen') Yor sl ‘mnerahon| Pato Tema MMe Sour Medical Emergencies ‘Signs associated with severe anaphylaxisiaergic reaction « swaing of te faco or neck 1 treating ct rom sling around the upper away, ce and neck 1 shoes of beth and wheeze + geneadecress 6 esos oe rash (smi etl ash) 1 case ofthe reuaton an even care ares! Management of anaphylaxsiallergi reaction =u anapyace shock s 9 Meshresonng concen and reques ppl ‘Mitel overoone the sraay and caovascuar protien sci sway © msi ow oe if ines to oso) 4 lett ptt en 8 popped pene poston o ee trea 1 He patent has tis oun Eien, enenurage hint se scone rather thane 1 be prepare io commence CPR Tan Egupan sued and he pln shows sigs of recovery, mel atnton aneRsPe ght act rtuncoramon fhe ul wo presents th ‘remus have 9 wtsequnt apse wie low PoueM e sue ‘Section roview 1. What causes angina? 2m myocar infarction, what happens to cera cal of te heat? 3. Usttree ote symptoms commonly Seen pallets suing an arin or heer stack? nn “ 4 Ar the sympoms of hypoayeaemi slow or ack 1 presen? 5. Uist wo of he sgn associated wth ypercseia? 6. List tae symptoms ascoatad wth stoke, 7. Whats your pony when managing a pation who has sures stra? 1. Lat nee causes of unconsiusnees. 9. What are thee clegones of sta? 10. What is you Inte management ofa patintseng an eagle sedan? . laine TAFT UU EA eR ene ue) H 1s vse of sucon oxygen meray ‘removal of crash namets —_& wah anyoencalety 2 srstoe steno vento Spat bop vabemsay [ This section covers: USE OF SUCTION The Responders assessment ané etment approach © the patent should ‘lw tne ecogrsed sequence | any = rearing = Greist During te ital pase of satantmanagemert (Away) maybe necessary 19 oar ana open tho away. remembering an away can be contmnaed wh ‘hi snr aotd mater Rowevor stanton so fo he retave gue ng 'eknaras sl he commonest cause 9 abswetion and come! Poaonng Examples of sold ae = enti 2 tore fsa id = Seertons Solid Obstructions Cae requ when using suclon squpment to remove sls aie ay to te locked wh sold matron wil qn become eflecve there aso ‘kal he objets wil be pushed furor Sock the twos Use ust enough ‘cton old ne so eject on to nao etude and ony apy sucbon hen, vay eager (tc) aWwithroning, not advancing, the sucker. See also Section 1 for the management tbe cheting ict, rte away to species spl ‘Alboush most of the fuid may be cain using these simple manual manceuwes & may sl be neceseary oso suchon We coe he ee Fluid obstruction in the breathing patient de scton nich igh ger voring ace the conscious pation renee se Shine) Leaving the fut in th ray lo inreases the of poten Me-teaten shea arptzators example ng daage and tc Te ee {ult Rid being ean ihe urge: thse paca sole sacs ak when conta a anda tat ote eal ee mr Bung sound maybe baa ina bresting patient who | Fluid obstruction in the non-breathing patient A paint may have sloped breathing and hve fuid inthe away. n is tun tere leno nae tom hin Fuld sutton Car's ed ns ronreating sant by lose Wel apecon (ti dar use a smal oreo doh) ~ Stoning othe away wen veriaong wits pocket mask eg vate ‘mask (you may bear bubting or guging ts you vers ay ~ By aptecing te nature of ny fc Mts he ray hae” here may be 008 oF vor aig no he sway fhe on nc tac OY : amas aaa Pace ‘way Manaponet rare) ’ Let) 1 9 Airway Management (En Principles of suction ~ sy ue sco afore rae att ost) ha eon Stenptd ly use suston once active vering hes ceonee ~ nly pny Suction under ret sualeaton ey suck ol what you can coe) yy Sha at esis of is mouth, moving owl, unde dec ison towards {o-ack (ris ecru wt avid string th pa ei ul omy apBY Scion when hector boing minds ~ ae soul be taken wen sbetonng a he Back of tongue a this may inaicevoriing or gg reflex ~ Sito at too vigorous may over sort he pant and make hin ‘can mie fet era pase ose = ont psy acon whl you oe withoung the sucker = ‘sucton devices are be used ony upto 10 seconde at tine, ‘Once sucton has been apie to the mau a re-assossment of te pationt's way shuld be cated ato cetarmne th etecivenes oe nevenon iis woh nating hat whist he sways bing suctoned, sand hus oxygen) is tleo bing removed fom he patent's areay, ith hs ta, scoring shou bo rested les than W0 seconde a ne, Types of suction device fucion dn cn bead pe, ge ae. tty or anspor The major of sucton devies aed te penospi sary re ater ok ‘Grape moot at soup’ Searcy ees hes 2oweteeene and fncionng of te suchon device faut ct @ suction dove Sin be ctastoph or th pent ‘ewe nape (tered) Poe2 —[ 7 eo PICU ue = sau) Ac & it s Sa Fw OW cst setnser ior memes Sucion devea cant single we pons or nlp ve, wich wl ou | eae ae ae ee we oe ‘aarp ster we, Be sees eet eee at eee Cane tr er cn exdorrtibe ny alanis A tay Ay Sec oer ogi Safe pase ae : "mses ie rm entre om, * Shay ser eens nme oh Stary cnispcuentimarman a vas of ay ible containing water rs ‘etc ev fr roe une Sb or '© use @ disinfectant soluton to clean the equipment Ea ‘n situation (2), i is advisable to leave te helmet in place whilst nai 4 ° tw te epee a Schacter eee «© excrete acumen is compet dry blorereassenbng E [| ormomie one aay rox Temes (© whist re-assembling, check thatthe equipment isin good working order a i 3 1 situation (3), it recommended that the helmet be removed inne with the It is Important to remember the princig iversal ns Y Serahe paiowr: ton wing season Sqr eee of aves dps 3 be E58 reremovaotproacn ees staube carid utty n peo ayo eset cla REMOVAL OF CRASH HELMETS ea ‘Taco cen vena pate genes van avy pasos A La Tere pce tetera ee ay tir ae Herc ine oan, a semanocrrmerenss WL q re a : en Es Procedure for helmet removal by two people [ Remember: airway ie always the ft priory ] Have scissors to hand when removing a heimst as you may need to cut the recente ne eee cla "ons 1 tego ttcs e puna a at an 8 arog 0 eee ene +1) the patient is conscious and abie to talk freely e 2 2 open reece eas a ey j '3) the patient is unconscious and the sirway is blocked (partial or complete) 5 | = ca 5 | a sis ———= 5 pePAC RGORE cGy + 5 CUOMO) es [ RESCUER 1 ia RESCUER 1 RESCUER 2 oes Ea ta ele £ 3 Ewa E a ca toa : a E iad ole a a hi 1 a wvme Wu cUs ac) Airway Management (Enhanced) | _Q 2 es eS meee somes © SR Sec cecmacsn ii erage Sag eat Sereicrecartese | Seaairecomres | MES A oetnN aia smennmnny Sha Receewanas | = © 3 neni: vot mu nv tay temas 'o wy men gr Troha a en be ela etceare ey pate tn TW in te snconscous adult, tho tongue is the moot conmon causes of alway an check te signer fhe cn, | tockage A «patent's lave of eanscausness drop, fer reflexes and muse een ae E+ UA love at netp to mamiain te tongue's positon, are reduced, ana fals to the © [Uh sve mone nents rnc ts mare ela My Selec Sid tetera E aa Fy aesziemmeetay iar device nts orque oy fom ne ack othe a es Siaacce etii a a n ee ove Bh ef By Seis cena: eres Snenana ss els ela a & i s aid s|s BW rue 197 els igure 1.9.89 & Figure 1.9.62 8 0 sls = mortoemcienned gly amamenme wscod 1.9 Airway Management (Enhanced) Airway Management (Enhanced) “ s es Recognition of airway obstruction by the tongue F/R wrung ene unten oe ond ‘Away obstcton bythe tongue charactries by ele 2 sotrg sound (paral oberon) liq Contrninceation for OP Airway Use * taste Seatteed oy hha ple beng en | ‘Tre cepharyoea sway shou ro be ued fe owing tuaons Stour eres ne canoe epee beoe iva | EBL Bg eons ate rs Fela fo me weomcius potent wih a nat gf Remember: afte aay sway sabliston ls pat ofthe providers I he pte uflerng irs (cnehed jee) 0 ot ce open he Fe inmedite cre pony é rn E ‘Remember: OP airway devices are nota subtle for bale away “Types of Oro-pharyngeal Airway eonnaues | Th O syn in tn ater ty mee BE | ee cone rg ste hard so pak te eto fe mut The Siseitbcede arses eimsrbonetesebergns AE 1m terion fn orphans say “Thor fange i) on he OP sway ais use he moto prevent it | oe ae Sousa Segeeiehen manana EY NY Sessa teat snares) tetteon he tango of he OP sway ar tele of te pa E {Pibe ange of ee Pe 9.8) Indications for the use of an OF Alrway es ix imran veezaie he pte noe uate oman own say i Fin. ‘cots hepolottaossietconecnisnes iow porucheAWeU ME | see) i oneve, or avins ae note subi orbs aay teu: simle EF somata = Remember: basic away techniques mun always be used prior the i Inaorton ofan OF airway a —P — roves 1986 199 “The oo pharyngeal ay cn be uedin te fotowng stuns e: Cinecmnanmave pein vii hearey anemone ng AY gl Mi alos 8 an gO lw we ina ernest \ ihe cor an oninat (ee Pe 189 2. Openthe atts nth nd again ensue sla ot ud and debi wg «fet aan an open say utr assed verltion ee bow) ® Sting and sucon fone to do) Reve any pee - emer whch maybe astodgea when he OF sways incre. Pee way et en) ent Manager rane) Pane 1Cu Gu ‘mou dng te longue aga be Noro he mou. (eee Fuge 1.10) 4 ren inserting the OP airway in an upside down position can ‘commended method of insertion fo the paediatric patent sto inset ee vee w wv irway Management (Enhanced) Gon sie he sway along the rot of he mouth othe sot plate ton ‘tate 180 degre fo poston i ove the ang wih the lange resting Sehind he tpe ara aga the ety sue Figure 18.12) eS z Stoning tor mproved ara ra © (Roker anon away conot(ae Figures 19888) , &,1.9 Airway Management (Enhanced) ‘Remember: an OP airway i aways supported with a manual airway ‘mancauvte except when the patient requires defriation, Once seid, the aay shoul bo ef npn unless ‘the pat eects the OP ainay tb sting or puling out RS tar ne a or cecum os a 95 fe ‘the ora ast ls wth vom, 008, mucus sala i the cue remove the sway, auton the mou and eins nw ‘ean OP away te rt has Boon soled Potential Complications Good ecigue and care handing ae essen Rlp prover he ftowing 1 iway blockage — hs ca occur ater he fig of an inc szes {he OF away can fa the ora avy — Too Large: An OP army at stooge cn fold down the egos {eb epenng ofeach easing compte alway cstacton, the OP array on insrion can overeat no he roo of De torgue, thus bocong the away ‘= namage o sft tesue-raueh handing may ea the mucous membranes Inne uh casing Beading ond ptenbly asang io arwey Probons tings - poor nserton ecnques may Desk 1 Damage to teeth or det fn Be paced ro tho upper and ones {ecm ar dena tage wn srways causing a bocage ‘stimulation of the gag refex~i he patent gans dung OP sway iRoeton remove teeta as over soruiton of be back fo toot ‘may nducevonsing or pean ot the ly “he oo ghanngeal away 2 ure away management anc bu ke any foce of nada equpmen, care assesment segura before deiding oF AE vac and once hae been ute, the patent must be constant reassess, "tie important thatthe provider maintains competency In arway =k ‘hugh regular relesherwalnng ent Mapes (and) Pao Foe smal: An OP airway thats fo smal an push the orgue back or ee irway Management (Enhanced) OXYGEN THERAPY (REVISED) Breathing and Oxygen rg i ore, whut the as wil hat we ean in ur ungs contains oxygon ta concen of 21%, hs nygon gare abeored abu lunge and fansprted aout he od Stoo by ro eed cela, These fed cols fan dover tne onygan ta the ‘sues around ne body nature he oxygen to bu ucseto cea energy fer fet cl strana eton done reproduced as westa products wien ae fren anspor fhe ood away tom he ody To te ngs where ney se Drie a 8 gue ‘abn xe fs harmo he ogy it bul up in the lod. ‘The fed col havea specie colour when fly bade wth oxygen. This cour onay canbe celeced by a acting sated a paseoxmeter rch asa probe ‘atatines ight tvough he skn The pulse oxmetr can calc now much te ro clear slug wth oxygen ss they fw by to pete. a he red (sare aurea in onygen then the puse oumeter wil ge an Oxygen ‘Stuatoneaang of 100% Holy 0%! he ed col aesauated win oxygen ante reaang woul be 80% the romal range of oxygen saturation i 4% 9 98%. S20, Is used a a shor vand for onygen saturation Four 1.9.14 Pua oximeter Fue 1.9140 Paes oximeter reading ‘ew Horapenet arcs) PoeBe PN i cued ae) Pulse oximeter error Fatty lon reacngs may be caused by ow prin othe extremity beng uted {vauay 2 ngeroen due ote pat aig cl nae sens appteaton, hl callowsed sin and movement (uch as shiverha) especaly ie patents Bod pressures ow, al vrs, ol, grease anit may ao not ako he sensor work To toa acy, te ser shou ean 3 sat pte or pulse {sea be nsw ocr te engin dd a) igi smeting er fan anger east ates meno ase {facto rvang may Say th vcngncon of hence fo baad Covent ‘en ses aca a nts dace yn nese a ee wt ‘ot hoer they Sesh ht ores te tn Ps tte eve arm ona maw oneness ta cio ved cet Thamar be ops x on eomacanns ey ‘rate of breathing. a ois iaceaen reagent onan ose by tet ‘morc le aka rom hen nay ay Aas gee {Stroon vali Thais basting sonst aed apy foe ‘rgenioves maybe ow because he ins ate no wong eects ne reese rofteg ston tyes eg rg Tet ie yen sraton a be ama cls cee! ncten evry othe ‘eno sy ot ola ‘Te ong saan nh bay cn be st ty ov supe ge Beep. ower doy of onge W s Sa Sa te bin opt ag ea eo reas ede Eo Foren oi of gatas noni ope eaten ears a havea sre offs so opr res cach ‘ern ote nea oe coe te Pa Pry Haagen (Ener) AFAR Tham TMM eam wre sees eee UCN Cuca cu) Be | seszarch ha ened be patent groups pes wih diferent oxigen therapy the italy 3 pet 6, crac aes, who reques 100% oxygen 2 te serousyW patent whose oxygen sauatenf Below he romal range, (tho gure oxen feapy to marian nomal oxygen sera ees 2. pains sflrng tom cone chest aes rng cn, whose bes {Etcte on ower an rool oygeneraion les, Say, parts who may not be we But whose oxygen stration lvls ae Stun normal rango 94% = 90%) cou be aceret acing fe onaen ‘Shraton lvls ceate above noma by oxeen Meany The lecmmened ats i sebestig mask shown nies 91S. Ih how ate flrthese patent groups is shawn in Figure 1.150 ovat. S00 {i> pt fr descptons of Ws ond oer masks py Examples of ricaly and serous it ptents nce: ~ espa atest = care nest = reaper conpromee rete compromse = cardae ees ain Soke ound eve f consciousness — our = Shitmeaca mazes ‘opened salar = Bee tne {Ty pave in eel congon Figures 1.9150 ‘em Mosport rrirway Management (Enhanced) ‘re ovel of oxygen tary provided oa paint i dependant on = fhe tow at the onyo0n fhe Seo Setueen he doves andthe pat’ face 1.9 Airway Management (Enhanced) Remember the importance of galning patient consent before treatment fegven ‘Type of MaskiDevice “Trae oe several maskelaevoes usd for oxigen dlvery. The most amon {ince uted in he penarpl enronmentare mpc foreasts the Veni” freak anc parlor non retrsting masks. The chee of mask wit be ‘pendant on te oad of he patent Simpl face masks av the most common used mas or oxen therapy. ers toX-B0N onyen copending on he fw rte. When ws ths ask ind parison of r Ye Owen LIVES DATTA TP i re tl iw E Ce é | , - 8 3 e fe 4 ™ Ja ee! i i i l iF | i Ei v i 33 ey Bali: i d 2 fl) ia} lege’ &j re . z i é $555\ 52 2 li a ; BE) melt) mre bE ELS By erroreentsrmnes i HE) cel) Gola fife gc g By Mommmmreatariantignstyae ts taror er mart 5 a f) 2) By e3 i rowed Songer toy a1 tee per mn, OP i ay : i H) Hille) by pe Wl eecmecareray emo 7 | ne ——— |» no1.9 Airway Management (Enhanced) “This device consists of ear paste face mask a resenok bop and wo one wy hater vates one atached oth eo he mack ch et rani re ‘rang of ened ar te recon lo lp evi the reser tag. The reser ag shout ints fly before appleston by Hocking he valve to he rename hte hand (See Fee 151) «= > 19.978 tar “< gure 1.9.57, Band € Non r-reatho mask “The Venturi mask is cesgned lo deliver a predate and precise ongen {Brouraton 8» proce onyge flow ao. Typlea values ae between 20% — 4t onygen This alows cata tne oxygen Gelvor to pats who wou treaty afected by hgh concanraten exygen therapy. 29 patons wi ‘one chest asese ane 20 ws soem) See eee eee Airway Management (Enhanced) any patents witha histor of breathing fale due 190 Nigh concentration ‘ge therapy wi ary an OXYGEN ALERT cord. ads the esc” he ‘ethan most and Now eo be usd, and he fret oxygen saturate, ou @ Pig 1.2180 and Vent ask ‘OXYGEN ALERT CARD en Ton Smith 000:2¢h Til mse prone ‘nimete ie the best indeator fr ‘overall condition ofthe patont Ie away ange Ete Paw 21Q Airway Management (Enhanced) Cautions With protongod us, axypen therapy may cause crying atthe patents mut, oso nd estoy at parm pas ‘Asis an emergency suaon, do not give te gael ayting nk as he may nee an anactbetei's howeverscoade owe te mouths dar ‘este or ct USING OXYGEN SAFELY © o1ygen must never be used na fre hazardous envionment og. ope ie, {care should also be taken when uring nes elect equpment «© stoking must never be permite te vy dung usage 1 when deviating a patent. tu ne oxygen of ‘Special cate should be taken when using @ defile. deft Sechatged an 3 spar geese, ary Gahing or beddeg at app ‘goer may beget bum. is terelore een at ongen sled od arose mesthegvotemaat ie vemoved fom We plant ian Oxygen Cylinders Mecca oxygens stored os compresod gate vuln sel cinders aon {tralumum cys oe netengh beng Usa) cur coded itu OR ob Si et od oe mon onoe rbd Ov we Brated on ho ind, hae ae sever! sce foyer but ose gon Sed nthe prchospi seg ae Es oeeety © 00 26-70 Hes # 0 size ~e0 es 1 F sie — 1360 tres (general ep im arbuance votes) ‘2a flow menace ecmmendaons end achereo mee drectves in reuton a operaton sage and sate use, Some unites pots t remember ar: = igen stout mone tno mosats nen te eae ‘efter, any ober deta eupment sho aso be maaved Paez way anager) mmmmmmmmm me SSRs aaamm Airway Management (Enhanced) cyinders sul be secre 1 prevert amage dung ant ‘Say yds shou be tt spare rm ka cers hese can be ‘Setar apes of rerong ape sss ee seh Keep inde anny fom comeusine materls poston cinders an aca tat proves ecorence wih he deny ~ op ners ana rom debs (or exam, tom road alle aiden) fe snckng ne wonty where ongtn sin ue or sores Shar reaee mst never coment contot win cynde ings, hoses and Saves as the may esinan exoson = yeti et eyes un comple empty, reac ess than a qtr oe ~ Saves shud be closed wan fhe cinders ot mus, een fhe ak tomo te slope dust an cvearnton te vale atom. hen wong wie ender always potion youre fea fe ‘nae Never pace ry gat of your Day ve he env ~ hints sto reve be cropper ht = hyve cana oxygen einer auld be mane wih compressed ‘Remember; make sure you havea ey o open the cylinder valve with Regulators (low valve) ‘region td the onder fvough 9 ohana eystom o 2 nose ‘mscelor Ts contol he posers noun ng delivered To the Palen 1. Pin index (CD & Osi) 2. But noe (F-ze) Te pin index connectors codes andi designed fr us wih an oxy inder {yh proven ts conocten 19 2 oer ga ‘An oxygen oylnder should never be used without safe, propery fing Yeguator vale Both fhe above requir have an "0" rg or Bd ses! help oem a 935 ‘al basen he epuaor andthe ender A odor aa sa ass ing wih 8 I vor ring nsec Trs rnter rng seals the fow requir fo tho One" Cynder ten sree hans ht ay agen (tc) Pa 2824.9 Airway Management (Enhanced) : Powe 1920 “The ow rat regu bya Tow mater, which canbe austed o he deed {tng theaturedn ites per inue Fw meters conta te anount of Orpen ‘Setvered tam ne cyindarto he maiden or examplonighfow rota 10 “Stes per mint ove gure 18.20), iis portant note holon he 2atent has been acing onge sa you tne then the synaria yt nou aa popoe new ane Tati 1¢ trlow rondes 2 natn of now ong an onygen ender wast Sepening ‘onthe Fo ae ‘yin ‘upto 10 liresimin | _ 10-78 lives © Sines BD minates c 25 minutos 1 minutos D 30 mates 2D minus é 2 hous mines Tome 199 a 24 ent aapone nerd) Ss s s s 3 a 3 3 3 3 a 3 = a a = 3 = = ta 2 Airway Management (Enhanced) vines nnrerahing ase flowrate vod nd me Me wea evans te suing neprabon, sl extend te use oe ‘Sender wich mye use # here a prolonged on-scene time ‘Assembling the Equipment ‘way flow the sama saquenee when you assemble oxygen equienent in xSFoance wih ne manufoctrersgucetnes. 1 Remove the manutactrer’squaliysfey se 2. Check for danage tte nde outlet “1 Tum he ener awey for yourself ad lners and careful paral pen Talat leas 9 sal amount aso low aay ary Su 4 Check tha he equator and ender oe tings are compatible su the fom mete nthe of positon ‘Screw onthe reultot nea, making sue tat tis sated rly opis he ESE Shon tor Pn rn) and thee we no pas tak by fstorag fr ‘Sing he he nga fred on Be not everighten. “Turon oxygen Poston youre te sd ofthe cdr, away Hom he under vlve Check the coments gage ‘Check he fow mater = than tum of Remember always follow safety guidelines when operating oxygen aupment ‘Summary of Oxygen therapy 1 ateays explain he procedure fo the patient and wher posse gan ther «place ne onygen eauipeent in sae place © choose the apropae delivery device for ne patents needs 1 open he ender ve tay 1 atach makidvice end ting oe cnr and turn onthe flow mateo «ensure he onyen sowing trough he maskdoice by eng and 1 * fate tr tow ewe Manone (rare) nesE | 9 CALCUL ucla UCU) 6 alow te resent bap ot 1 se mashiseve tthe patents fae: check an ensure a god sel © the poets apprehensive abot fcemasks, reassure therm hati al ‘make ta beating cabanas pat ef to eaten « monitor he patients breathing ~ check that he car mas soap! ‘ising wit each best © crock the oxygen saturation love sing pulse sneer 1 dispose masks and tubing must nly be used once Patents receiing ongen therapy. should be_moniored_contnuoisy ‘Assessment should ice alway, eonaeous lee 'skn colour esprator) ‘at. dep yin ond efor of beating, ‘Remember: continuously monitor therapy receiving oxygen VENTILATION SUPPORT (BAG-VALVE-MASK) (Note: for providers, this is a twoxman technique) Etec ongeraton fhe ed cals by inhlaion ad removal ofearbondoxde Dy entation Te ony achieved trough 2 good rte, tym ana. doph of ‘ressng. 8 may of rerinaer an saute! broabes between 12nd 20 tes or moat wi utientvelure to maketh chest Im some patients yng on the round, te chest does ra olen move tis he hsomne! muscas that ‘are dong tne work. The adequacy of ths ype of treating noede be urhoraseassed by fang er tow forthe meu, 3s there may be never volume hereby roqurng ventory supeor ‘nan patent al to breath, ori no veiling etectvey (moving ain an Dub ngs), may be necessary tae oer Supp th breathing © mouth mout (se secon 1.5) 1 pocket mak se section 1.8) 6 bagaivernask (VM) ‘The bagisivemesk method of supporting a patent's breabing should be ‘ested Yo he pata or non-breing pate shuld be remembered Mat Uhiese 2 provid has sddiional Yainng” and regulary checked Pio 26 ewe rapenet (ares) ’ wy murn Vee TTT Airway Management (Enhanced) competence, 9 poche mark wih agen provides mor fen verison and ersten than 8 bapialvelmask stom paration of a bag-valve mask “he bgave mask mus et bens por io ser sericabilty. Pons Diootlrare face mack sean fate mast er and roe fom any damage ffee mac ms corecty ono vale = Geer hat ne morbe fer ite) i secure (some Amtuonee ‘Stree nave sgl velsoposable sytem) ae systole and wong a one way eit = Sage sts nt has good rotor normel a once squeezed ond ‘eased {he at ero ag clean an warting Tecmo scotesea io og and hes no hoes ‘Srygen tung ft wo Be nek pte pera sayy sah comes on it ~ oro tng ete pant. he bap vate-mesk rust be pad wh Srjoen. Ts one urge ow eusta on he ee 18 Ghee fe reser sited Ihe bopralve-resk sey ue, Sizing and fitting of a mask Te selec the corect sito facemask oe pales, We Klong pines ‘haul be fotowod «te base of ie mash shou ot poke over he Sa ne cin 1 te pont of he mask sous ft vee ep of he be of he rose Gust ‘Sow the mip of ie eens) “ose e mat. th folowg pels shoul te flowed “8c he corey ied math oer he patent fc8 sing the darks Sceartod Soo lee tgues 1921 1822) " «lace he base ofthe hubs vere dome of he mask the fers shad Eetenses outwards (oe fae 1.923)1.9 Airway Management (Enhanced) vs e e e E E E E E owe 1.9.21 Powe 1922 re e r ® e e 5 © ® ® ® ® Airway Management (Enhanced) cing the ger our to lke ald fhe angle of he ow cee fue 1.3.28) «sing bot sts of fogrs, trust te ow forward S08 Secton 14 for aw {trust manoeuve), Caution: te fngors are to fr forward, owas th ip ofthe cin, ‘omer ane Fue 1924) Difficulties in placing and using a bagwvalve mask In patent wit # bard, he use of any mask ncuing pocket masks ieut fal vr dnt te oa ard makes tbe ack leo postion 2= 8 ides iy ovr te face, These probleme ray bo overcome by using 2 operator iSehiqus ana app & gem bears promte an efecve sea Ventilation of a patient using a bag-valve mask _ sre operator can ute the tagstve-nask but tis test performed a8 a Wo peratortecngue (ee bow), Single operators are advid To Use be Gocket ‘mack wh suplementl onan. ‘amy, The second eporao then squeezes ‘Shure "by using Toca beler away” convo! fs actieved. whilst {Seating good verdant he chet wins high canceaten of Oxaen ‘Single operator ure ofa bagivalve onsidered Bayon {ape of practice fr Fist Person om Seane WX) EP Powe 1923, Fue 1924 NUUU Heian Pace 28 way agent rhc) wt Manno arcs) Pe1 .Q Airway Management (Enhanced) Section review 1. What i the most commen cause a away bstcton in he unconsious patent? 2. Best practice when using suction equpmt is © apy Sucon ery when ‘Srancing the tuchr mo te mou. ue ease? " 3. Ge me examen of ir cscs ane oud he 4+. Yat the rset ako hepa when ving scion women when 5. Bost proctco Is mat suctoning shoud be carted out consanty et al ‘sbsructone and fue Rave buen removed, fun orale? 6. Under what conden iit adit to eave a pabens cash helmet on? 7nd saiaten Inohes te algoment ef whch Gree areomeal landmarks? ‘en 18. The purpose of n OP aay so Keep te anu forward te fee? 8, Describe te term wheal i what i ts gncane? 10. OP airways are conrad in he consus pai, veo flo? 11 Name wo anatomical landmarks used to size an OP aay fora ptt Sate ects yu te mae rs an OF sey i ety 13, Stat the potential complcatons when fing an OP sway "14. nen proving ongen therapy 0 Balen what sr he hee kay factors ‘hatifuence the percentage te patent woe? 18 Sate re cantons wher you woul conte adn om 8 1. Prong naan herapy may eae dying of he patents mut ue or 1, Sat ho precautions te be taken when adnsiring onygen to a pant 1. How isthe tow rate of onyoen excess? 19, wnat ow rate of onypen scsi igh? 20. vnen sang na bar ater aoa sou he pf ‘the mask ft to on the face? 7 P30 ‘ewe anon rence) mma | i i i | i | i | i i i i i | | | i I I TOM AM TOM nm 7 BME R Ec M suc uaa | This section covers | © aguante ‘6 recogion an inl ere of Sms and seas (pores to bones end som sues 1 feconiton end ita ar of (tou cresng ard sella ch hore a Fe nt inreduton uy cre ion tees a waster feery no heb: tis can oc na reat nae rere lan sae wit 8 weapon 8 road at ‘ison The afar he toy led are organs and oes so tssues Sedona whaccan be caraped or boken. The sever ina Steines pine lcs rived and ne pats oft body fected “Tis secon roves iformaton on the assessment and emedate cre of ‘reumave nny RECOGNITION AND INITIAL CARE OF INJURIES TO BONES [AND SOFT TISSUE ‘Signs and symptoms of skeletal and soft tissue injury Slot! injury oon icles breaking of bone tssue (9 face), enor Sacstont he ouplon of bones a jk. acres can be snp OF Srmpcuns te ter sats tat the thn broken et he Face te Simos wih we troten ore potudng slowing neon tetera wound [nd enea bleeding ocr Comeon ypes of actreincie: «simple sometimes hee site of a0 jury sounding tees. These Teed facuree, win sin beak vere Face st 1 compound -assodted damage issue or ans, herby be tone Pe yy bt cased tate Ts ives ry heey of Sih clan nan op ace sometmes wih he ne prowuang "rough ne ahn bese “eure Rate Cranes PeeURIs riecurisy Song and soto asa wth focues ne Stet = resvced movement optus (tora sounds when he ib is moves - YOU SHOULD NEVER TRY TO CREATE THIS NOISE BY NOVING A Li). ‘Traumatic injures oso sues canbe categorised using the meron CLIP.G Contusion- 2 rie {aceration aang of asues Incision ~ a clean eu Puncture ~apaneratng wound which may be deep) ‘Gunshot caused by bl, hot shrapnel Ines to bones andor soft sues ae aways socompani ty blood ss, which may be extemal or congested intemal) and bth cates may be Srscant— sso Section 17 fo sign,symplons and management Initia management of injuries to bones and soft tissues ‘conser sone salty: sft of youl andthe patent cu esi ta Can at wih "Rin rau, rts away wih cers sine conte = (8 breathing, may include anyon erapy 1 celta, indudes cate of onan | semen: Do not everlook catastrophic ie threatening bleeds in your primary survey. + onc CABCS have Been manoges conc scandy suey ie ‘the main presenitng injunes and then: ed ** Gen wounds anton) mooie fasts ase below) © soaton pst appropri, 0 mine decoto and revel Pe ‘aun ato mini wwe we TOT Tem mm TM THT Pe O Rue WOUND DRESSING AND SKELETAL STABILISATION Dressing wounds con edie esd athe ik ofinfcton When selecting 3 Tipe ought ett eover fe ny vr made Poh Sorbent tel ht wi = {Te Sopa sufi pressure contol he eedng Stabieaon of an inured ind can be achieved by Saking te patie ho there i sto, exo, “Hold his Sim dose your chest me most amore poste’ = Splyng acer bande to mince rovers = SEiting heen ung avaatie mato for example, a propretry sli Inger woos pion, red tse! = — Ina uty oes te aruetet eave wal tig soos in lace wes Femovl whip sstss tnd enbie he wound tbe essed “The provider shoud ot ten treohtendearmedibs, 9 this con est {neoken tore ends donagra boo veswes ad neve is ao very po {he stoulsbe ete anaonce row wo wi aaa nave eects pan eet Praia, Wen dressings or apts are apple, you should check tat they are ot ‘eicng credaton by crecng fox e presence ofa pulse kn cout and Shy oleate ta sort teyon he wound or Pace Itmay be necessary ‘Sut he bndogg adi spntng earn (See ka Section 17 Greulaion and Shock or wound mananeret) ‘ana rps PacesUBER Sheena curity Injuries tothe spine ‘Spinal injures are potetalySehvestring, The sie protects te nerves and ‘final cord. and runes can fesut severe Seat. Sgn of spn my pn i the sin roa 22a ekg below the aren of ny oma sansatens, Such sane and needles, buing ole stock = grain one or more ibs = Seto the sine The mechs of icy mays spon a thee & spl nyo ad acelin iat tor a hgh Ging nt show water = Seon ny ny aove the shouders = lone of conscusnass| splines ae ot managed correct, hs may resi in fatar tity Remember ifn doubt, reat the trauma patient as having @ op ie Initial management of injury to the spine er an ny toe spin i suspecte, peat cae mut be taken avoid nn al mover Wharve’ possi. Pe patent shold be len the poston "ch ey ae ungures its necessary tomave Noro eecay manage Ihe CABCS never st he pat uo The spine acts as prec for tw spinal cord, The Mok elt he etl Denes tut Be undaing ard ana the rod nerves whch pass thug te ‘pie. Almovemens ofthe patent must yo keep he spine fas net faa Bigrmen! a pose, However hres hl ask tie CaSCs pote ih 2 sppaenty sbeoma' postion shoud bee poten unt he {you consider necessary fo re-posion the patent to «neutral positon, ‘nen ine stabilcaton ie mandatory. The isthe alghment of thes ‘snatomieatndmarks (nose, strmum and the ante poin at the top ofthe Fue 1.10.1 Aopyng aretpessue to» wound aoe ‘oun Rees meres ‘Tuna Rte tne Paes TATRA M eee em rm w vawwe1.10 trauma Related Emergencies owe 1102 {gs} in ne straight ine This principle lps fo maintain the spina column Iva neural positon thus reducing the risk of further injury 10. te Uindrying spinal cord and verebree. See Figure 10.2, ‘A cereal colar can be used help stabs ne ead and neck, but complete ‘pal sbisaonequres spacial equoment such as along boars acum ‘tress. Url hese are avalob, Me provi shoul encourage him roman {land provide sipport where necessary. You may tea oi ace co racer ey a ae RECOGNITION AND INITIAL CARE OF BURNS AND SCALDS Classifications and characteristics of burns and scald ‘Tere ae fe main pes of bu 1 Inet rel) — fr example, Fam oot suace (nudes salss trom ot water att) 1 feton =e exam rope burs 1 enenical forename, sits, as 1 radon or eagle, sn Pane rue ts Ene = s g s a 5 a a 3 3 a a a a a a a a = a 2 2 2 2 & F F F : ‘ e F e F e e Ee Fe fs 5 © 5 ® ® 5 S 1 peront for the provide avid being inure by the bring cost Farin ehemcels et maya be present nthe ervionmetor Be pat’ ‘es The salty ote provi and bers s paramour you Su hr danger preset yu shoud repro ambulance contol ard awa the Sree ambulance Sew or oer emergency seve ‘The main danger othe patint om tums “sock (used by ose of body uh ‘ecton (esting fom damage =k) ‘arage othe resort Wat flowing inhalation of ot aor ames ums se lsd by caph andthe area of he boy tected is # major factor mastering every. salsing the cause ofthe bun is mot ust Depth Fulitickness bs comely destroy to skin scr and ae nt pl a5 foe none endings are Sesoyes, Suprfiland pata ckness Pum ae uit gst nav ending, whast damaged, ae sl funconng rea It is elite make an accurate assessment ofthe ares burt bu ook out for ey: f= yrna pane ye) and ery {any bum around he mouth ofa (singed naa he nots or sotin the ‘out soul lo you oO possi of away Somage) «6 burs reslg from fie a explosions in a conned space «tne length of tine the patent is exposed tthe source ofthe bun its portant to esablsh how ong th exposure was and when any cong Commorcad (See eo overeat management)1.10 Trauma Related Emergencies Initial management of burns and seaids approach of he responder toa station involng Bue Is shy 1 Safety — fi sae to apron? (sup ~ me bring process 1 CABC — a8 por Primary Survey 1 Cool the bun wound hore fos, emove any bunatmouserng cating (whee Is nt {hein ote oi) Te nal management of bus and seal sal ocos novia Ten b sone ted tn caw ay ims baa Running water rom ap mala els tut od exes fea str 3 thor so more an 10 mite, roe Larger ares an be coved wih wet elo hes bu be are he ak Ei ctesing hypaerma feseton mse boxy tempers) epee sal hen Stars, wn os Boy Yea gat co Continue cooing, necessay, unl he sbulace crew aves. Onc cold toverna boned ara win) an song cg canary eects temporary Sessng ae hens te burt are te ctzered an cing wih Sr can be conned nesenny Howeve, “Cig oss be aed eet nol ed around 9 no whore f mug ipa euasor not ay Es, and do ot us ams crane 25 hy may ‘tirsunsequen hes Ses Burs the Sway, shuld be tested 38 Mah pty and onsen therapy Should be prone. The prov must be ready fo sap fe pats ‘natn ncaa Where safe 0 do 20, retain burnt materia fom the pallet for possble ‘ramnatin by emataice or hop sao te pote ’ HNUN marrme nama mm mm SIEM R Ec Mucus chemical burns ‘reat care should be akan whon managing apart who Nas sere chemical ie ts becorang contains Yur sft paramount nt approach Bester fis sale oo ao, Rernve hen Wom he ere etonment Tere commence your management rere possbl, ty 12 remove any fesidal chemical rom ts skin or Garanates coting Iemost cats water canbe ved, alhough spies aie must be sought {hcl srpuncertay about ne comical ager inlvd. Containers or aes ‘an provide vas norsion RECOGNITION AND INITIAL CARE OF OTHER TRAUMA, RELATED INJURIES Initial management of trauma related injuries HEAD he greatest danger patents wth severe head nui way comeromie ‘es econ damage otha bras cause y Maaequse venation of he thos cavong poo onygenaton a he sss on tuld up of carton Sond, Sreh couse strom sowed Ts chen coors becouse te ureonscousTend TR ses MS tut ins sulla poston and he org as Dax TO 00K Suppo vention whore necessary (ie. wen tar fs absent brething or Sreing tte bolo 10 bests pr minut). ana provide nyo fra head ‘ured pens, who wl have 8 Yeued ow of od fo De tan. Femenbor give oxygen al ead injure patients. | Remember: do not use of creams or ointments on a burn. ] al n Wee e eee nm ‘CHEST, ABDOMEN, PELVIS and FEMUR ‘These are ange caviisno whch great deaf too can be ost without beng Vice. In aaaton, some of hem corn wal organs such 8s he ng, Paar ‘De fuer wnih can eney be damaged wi senous consequences Time Rid Eman Peemannan naam ame Assisting the Paramedic ‘This section covers «¢ capabites of Paramedics ano 1 proving assistance ‘avalon Technics, 1 patent senity ‘Smerponey creeper ae | Introduction Ps 9 responder, you wil come ino contact wih ambulance sta or other ‘cergoncy care specolim most eases, Ps wl be ether an ambulance techn oF parame ‘eel as proving infomation onthe slay and your care ofthe patent. ts ely you wi be ase toast te emarpenty sta atoning Ta assstance tn ary pending on te excumetanoee and the secten proses flv Iomoton on the capebiies of amouance staf andthe nae of ‘Sfoutange inch you are te Yo be aed. some cass, YOU May ot ‘Nankai asa and you ost respect the wes ote emergency Sa ns CAPABILITIES OF PARAMEDICS AND AMBULANCE TECHNICIANS IHS Ambulance stat rove emergency care cover 24 hours a doy, yar ound "hey ae toed fo dos ins range of Cocina ana re se prone a thoraoy suport of hese, ss we a manage range of medial emergent ‘roe are hwo main grades emargency ambiance aM «« arbulnce teenies (or wane paramedics) “ne techn the ety ee for erarpency ambulance sat wh paremedics ‘heen adatonal ann aovance fo sing le. The Waning of ese ‘af covers a ange of eondtion not covered by POS, bl des share he our Iminpreies of presereng ie and promoting recovery, nal * Catastrophe Hoosing fower * Cheuston Ascatrg me Pane a1.111 Assisting the Paramedic “ho mai his areas for Teciins and Paramadisar summarized below Caasohie ‘fr Teton tesa Foameat nt fe Tecan ps tae ston or Teen [eranion seen oe “Aircore ny [ra ery | aso rane ees) | Tn aation we un ie [tesiseses) | —guepon(ascean)” | fetechacae»apnan gues elcabehs) | meg ch um ecb ~2Stet stay | roomate Pros eg ‘baie era rest ferearource snes | 12 eet 1 shaw ding acess 1 any unconscious patent who has undergone eum Cervical spine contro! \Wrenoverhe rescuer suspects spinal in. tom the macharism ony othe patent conan the fet stp iso prone in Ine sabzaton The pate’ head shoulé be femly grasped sing both hands and carly rove io neal rine pout fee Figute 131 below), ‘ha psien should te martes manuoly url the patent's eed, rack ond tear aly steed and scared ea ong spe boar Fee 112.1 Nort sigan’ ‘eto th Tape rt a's; a OEE i Racor Movement of he patents hed ine raul gran e contended in the fotowing stutone ves 2 ncreazed pain wth movement * commencement or incase of numbness, ping or weakness inthe ibs 19 compromises the sway or boating ln these stuns, support he Nea an nck the positon found Fig crv colars sain suport the neck and ing vere. They do fot lone adcoutey sabe the heck and ransasaohzaton shout te ‘hin eseabed no flowing ber: Patients with suspected spinal injury require ful spinal Stabisation which consists of» ria cervlesl cals head blocks and tape, attached to long spinal bomrd Pa Ect the rap att Extrication of the Trapped Patient | 13, REMOVING THE ENTRAPPED PATIENT thie aurea that he decison o remove the ptt hasbeen tke. ‘Gad team work i esentl dung the removal ofan entrapped pln, Each ‘rambo of te team must unetand wna envied nd te pot dangers {Dine pater dung tne process af vemos ‘Long spine boards in extrication Lota pine tars re desis for rescue and renova of patents rom vehicles Srtcine awars spaces, nrost cases ne pata il ioe eeteed Fost secured he bot aaugh tere ' ak of pressure tres afer 3 Ines stablcaton wo id exrcston doves. Thare are tree space methods of exticaton from a vehi: 16 Removal rom the ear of he vehile troughs Nalenosck alt, he ‘Serundom othe Sol lowing rer sot removal. Ths the asst treed of eatin ekng mama pase movement Te Sst ms Be tty ec Yar sxeaton, ral removal - i be set cant be ty etn, he root should be ‘omowes ana th board ines tan ange tend the patent 1 Rapid removal rom the ide ofthe vice — sed on enous Ie reseng stuatlons where raped vorova! of ie patent rogues IRenage te away. breting or selon Manual ssa fe proved file te patents ues so tal hsp faces the open or omoved teor “The boards hen lacs bhi the at and the patentiovered on he board Unt hoon The patent eben advanced on he bard oe desis ve Procedure for use of a long spine board “This requis a minimum of 4 personne na Responders shou be amar wh ali. The gear procles axon na se bad weve Ptarg may be necessary to uly stabs he patentnrelston to the bod Wen te patent is aly seewed he canbe moved othe waltng seen: is sre borane by Resi th oar nace be Oho vesonct te Tapper Pace1.13 Extrication of the Trapped Patient TPT Tm Oh Creuset. | 3 Extrication ofthe Trapped Patient “| 13 bond te patent om the head ‘own roe 1132 i i Ao scary se cri | Rese ae cont ees i See arent i : ae L room 11208at. es z ely GRR le i a. 5 Fiting a cervielcotar IES 4 recta auntie an Drinlonce crow mon pons of secuing a savcal cor are os Sescioed at ET am pecs wi te rnc acre a eaSindstermnntenonstuetancince Ee lay ea eas ea eas rca 4 e:a Figwe 1.13.10 Adjusting colar eva (© Maintain stabilisation of the head and neck. suooorting the patent: 3 ely f° etn cuma Fare 1188 Fae on ptet cla Vege eet ted neck ce ria cla = ! a sla sla te sla Pane 1199 oes ep or peli rove 11011 syringe ct _ tome pls EE ssaeee MC Rac Fire 1.18.12 Prot appying coer 4 te ptt io on os th lash ed our rece 16 The ella shou bn contact wt ne ein end aon op tng owe 1.1212 8¢ Provider sooyng ctr unm mm Anh Thon m amine eee eee nn dl Extrication of the Trapped Patient | 5 | 3 Pee 1.19.19 Securing eater 1 secure the clara per manufacturers instuctons ‘You mst ensue that be patent can opens maul eer sppcaton of Te Page 113.1428 Mataning heed immotiaton «* Hanan ne hood stabeaton ul essiance Is avaabe fo rane tho pation» bystander an Be wed loss wah ve are: Ful ia sabigatn ‘only achieved once the pationt | wresencl te Topped Pate Papasa | i} CURR a ea ‘The cal when ape fo patent, can be uncomonsbie and erste some Zetenal iiss wh the sway Best pace fa fe colony aad unng any movenant pase ep, exticaton or Mandover the eae end Emerpeney Separment The colar can be essened when the part ban “ranapored inthe back of on ambulances head! bicke end saps ae {Sdoquale slabasaton dees sng he anapont ps. PATIENT TRANSFER EQUIPMENT There at orange of devices used when extieatingortansterng patents em tho scene of he redant oan ambulance hep: The manenes used re ‘esebed blow and you shoud be fama wah he devices wed by your best ‘You should at tempt to use thee nies special trinad io do so aug you may be sed 1 asa mtr we The scoop stretcher Tho scoop setter, aco hnown a8 he othopaed aetna) s made fom Tahir ateal (metal or lyme ana a designed to slo to par, ‘uh are hen si unr he pant om ater sone other aces (st Fours 113 150°) gure 1.19188. Scoop sector (apa Figure 112.180 Scoop arethar (aed. . Tah h nm TH r ! | i i | i i i MRR Cee | a | i Five 11218 KED device Wt teing uncomfortable forthe pstert and a potent cause of pressure ‘round (or even a long boar) lo a vacuum mates (where avaiate) or ley. ‘Tho KE (Kendrick Extrication Device) “ho MED i @ short spinal board, which can be used for both exticaton and Ltbisaton There ares rumor of varaons a design and whet the KED i less they to cause pesture areas ar erento, ihe he scoop sch air use(s 35 en exteaton sevice rer han & means of tana stent any detaoe (ese Figure 11316), “The vacuum mattress ‘Awan mats scons te ‘ld andar fo pn abst of ‘nd f necessary canbe let onthe pon ring rarer fo Hostal an cesar: onto he inenave eve unt (ua igure 40 17) stele remembered the vacisim mats fe nating device once ita, {he patent need ob laced on op of along spina ardor scoop seca tne fatert reads to be cat any canceeee MC Cec owe 1.19.7 Yocum matress HELICOPTER SAFETY Helicopter Landing Area Preparation ste approximate 80 x BO (25m x 25m) that is unobstctd {2 whe or ght cowed sheets god fo spoting Ho 800-1000 (250m x tm vt ssid be rroved sn secured annem sua esiatasneg a ine oteapor as own he 08 1 te ste shou be elated fa eos abject, make su a eos cating Istaslerad and kep o enon and animals unde! conto. © report anyobsteces (9 cates, posses et) oho plot if possible 1 never sine ight athe hacpter stand in tea a 9X ateaye woor eye protection ten must be omes ay naan ater vee 2s coud ee Helicopter Landing Area Safety 1 ony approach the nebcopter with te ht crew's prmisson and wat fr the plats hares up Po 28 eon fh apd att nanan nm nm mmm Extrication ofthe Trapped Patient |] 3% th cny outa you soul ake fo he sat is within the cone of 45° angle 1 never approach the heap om an ws ope de not walk nea Be al ar or vents and exaust 1 de not ue tan photography or camer ighls dung ange Fake ots Peas note seen loasng is gerealy othe pc ef) oor conraty om {he par of he arcats ab, alvaye follow the dectons of he ight ce Remember: The danger area should only be entered when escorted by [number ofthe ar erew= even f the rotors te not tuning PATIENT HANDOVER ‘ine handng over the patent © the ambuance saramedis,prosert the ‘nomaton away thet eure clear communcaton and’ accuracy of Inematon, Be logcal ana conc ‘© namo and age of patent 1 2 of ident 1 how much time has ps0 snc impact 1 inues ours during te primary survey ‘rues founding the secondary suey ‘¢veament given and response weatrent '¢watisor was entrapng the patent i i i i i i1.1 3 CRC SRC Section Review 1. What re the to typ65 of entrapped casa? 2. Newio's second law of maton sas thal energy canna be cried or ‘Seuvoyatbutcan ony change nfm, ina are he praca! consequsness tins'orihe snort search erase ino ree a 30 mph? Tho grater te speed th es Kntic nery i nerd, Tre rate? Name tree common ses where sures re thay where sudden ‘Seoderaton i expanenced? Compt ne folowing soquonce, Look, ison Bunt vaua has a geste fect on the body inteal orice? 7 Wats he potent oa patent ian abegdeoys under he cin? 4 Name wo common ny pas See wi ae impact etisons ear impactclisons 9. The parraunt oncom al he ate of vehi cation > 10, wnat s me AVPU systom used to deterine when assessing patents? 1. Ima multiple csuatystusten, the aim of tho responder it ton to the ‘ost Meseatrng yun fs We or fase? 12, Tee rica patents shuld be ested on scanein preference toaster to ows rue or fae? 12, wien is ta refered athod of coin fr enepped casuals, contol corral ease? 14 Gwe two contraincatons for moving @ patent interaural igre? 15. wnat ae the thre mai factors ht determin he metho snd sped af fntzaon of an ontapped pation? 18. & KendckExteaton Deve (KED) Is usd io both exticate and stabi {he patents one, we or faee? hen exer, tueee ee