Chapter 7:

Special Resuscitation Situations

 

Lesson Objectives

After completing this lesson, participants should be able to:

•   Identify emergency situations that may present special challenges for the health care provider.

•   Describe how to approach and manage a patient with a possible head or neck injury.

•   Describe how to manage a near-drowning victim.

•   Describe how to recognize and properly care for a patient with hypothermia.

•   Identify the precautions the health care provider should take when approaching and caring for a patient who has been electrocuted.

Approximate Time: 10 minutes

Skill Practice: Yes

DVD Covers Points in Lesson: Yes

PowerPoint™ Presentation Supports Points in Lesson: Yes

 

Teaching Points

•   Trauma is the leading cause of death for persons ages 5 to 44. To have the best chance of survival, trauma patients must be transported to the nearest trauma center.

•   Whenever you encounter an unresponsive person, you must consider the possibility that he or she may have a head, neck, or spinal injury.

•   Care begins with the ABCs. Keep the patient’s head in line with the body. Use the jaw-thrust maneuver to open an unresponsive patient’s airway and prevent any movement of the head. However, if the jaw thrust does not adequately open the patient’s airway, carefully perform the head tilt-chin lift maneuver.

•   If you must move the patient quickly, use the emergency clothes drag.

•   Near drowning refers to survival for more than 24 hours following submersion.

•   If a patient is still in the water when you arrive, attempt to rescue him or her if you have the proper training, equipment, and personnel.

•   There are four ways to reach a victim in the water:

   Reach the victim with an object such as a pole and hook. Make sure you have the proper footing and have someone grasp your belt or pants.

   Throw the victim something that floats if he or she is out of reach. Be sure to attach a line.

   Row, or use a motorized boat, to reach a victim who is out of throwing range. Wear a personal safety device. When practical, pull the victim into the boat.

   Go to the victim if the water is shallow and there is no danger to you. You must have appropriate equipment and support personnel if the water is deep of swift-moving.

•   A submerged victim should be removed from the water as soon as possible. Rescue breathing can be done in water, but CPR and defibrillation cannot.

•   Resuscitation should be attempted unless obvious signs of death are present. Assess a patient pulled from water as you would any other patient. If the patient is not breathing and does not have a pulse, begin CPR (starting with chest compressions) until a defibrillator is available. If the patient is not breathing, but has a pulse, provide rescue breathing. If the chest does not visibly rise, reposition the head and reattempt to ventilate. If visible chest rise is still absent, begin airway obstruction removal techniques.

•   Hypothermia occurs when the body’s core body temperature falls below 95°F (35°C). It does not need to be very cold for hypothermia to occur.

•   It is important to attempt resuscitation even in extreme cases.

•   If you suspect hypothermia, move the patient to a warmer area, remove wet clothing, and cover the patient with layered blankets, paying particular attention to covering the head. When positioning the hypothermic patient, do not raise the feet. Assess breathing and pulse for 30 to 45 seconds before beginning CPR.

•   Arrhythmias may develop in the heart, so handle the patient gently. Begin CPR until a defibrillator is available. If the AED advises you to deliver a shock, deliver one shock and then immediately resume CPR. Further defibrillation attempts should be deferred until the patient has been adequately warmed.

•   Safety is the most important consideration when treating the victim of an electric shock. When you arrive at a scene involving electric hazards, make sure the scene is safe before you approach the patient.

•   Your main concern for a victim of electric shock is the possibility of respiratory or cardiac arrest. Electrical injuries may cause fractures to the spinal column, so open the unresponsive patient’s airway using the jaw-thrust maneuver. If the patient is in respiratory arrest, provide rescue breathing. If the patient is in cardiac arrest, begin CPR until a defibrillator is available. Unless bleeding is major, care for burn wounds associated with electric shock is of low priority for a patient in cardiac arrest.

 

Application

•   Participants should discuss how to properly provide care for:

   Trauma patients

   Drowning victims

   Patients suffering from hypothermia

   Electrocution victims

•   Participants should complete the “Check Your Knowledge” questions at the end of Chapter 7 in the textbook.

 

 

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