BLS

Question 1

Casualty Responds to AVPU

Answer 1

ALERT,
VOICE,
PAIN
UNRESPONSIVE

Question 2

Patient needs to give consent unless

Answer 2

Under 18 or Unresponsive

Question 3

Heart Rhythm - VF

Answer 3

Ventricular Fibrillation - Lower Chambersof heart contract in Unsyncronised Fluttering type action - little or not blood pumped

Question 4

Heart Rhythm - Pulseless VT

Answer 4

Ventricular Tachycardia - lower chambers of heart beat in an abnormally fast rate

Question 5

I M I S T A M B O

Answer 5

Identification
Mechanism of Injury
Injury
Signs and Symptoms
Treatment
Allergies
Medications
Background History
Other information

Question 6

D rsabcde

Answer 6

Danger - Don’t do first aid in the Hot Zone

Question 7

d R sabcde

Answer 7

Response - AVPU- ALERT, VOICE (COWS - Can you hear me, Open your eyes, Whats your name, Squeeze my hand), PAIN (Press pen on nails), Unresponsive

Question 8

dr S abcde

Answer 8

Send for help - Phone, Radio - if asking someone else to do it get them to come back and tell you when its been done.

Question 9

drs A bcde

Answer 9

Airway - Head Tilt, Jaw Thrust, Chin lift
Be conscious of Cervical Spine issue also but airway takes precedence.

Question 10

drsa B cde

Answer 10

Breathing - Look, Listen, Feel
(Normal 12-20 breaths per min)
Abnormal is outside this range

Question 11

drsan C de

Answer 11

Compressions 30:2, 100-120 per min
Circulation when considering Trauma - How well perfused is the patient, their pulse, capillary refill

Question 12

drsabc D e

Answer 12

Defibrillator
“Disability” when considering Trauma - Consider how orientated your patient is and what can/can’t they move or feel.

Question 13

Immediate Care Priority
C A B C

Answer 13

Check for Danger First

1) Catastrophic Haemorrhage
2) Airway
3) Breathing
4) Circulation

Question 14

drsabcd E

Answer 14

Exposure - Expose the patient to ensure you identify all life threatening injuries

Question 15

In the Pre Hospital setting conduct a _ _ _ _ survey. Which is what?

Answer 15

Check for Danger First

O xygenation
O n a stretcher
O ptions
O ut of there

Question 16

What is Oxygenation?

Answer 16

The process of getting oxygenated blood to the tissues. A, B and most of C in primary survey.

Question 17

Kens Law?

Answer 17

Air goes in and out,
Blood goes round and round.
Any variation of this is Bad.

Question 18

On a Stretcher. Things to consider

Answer 18

FACILITATE the casualty moving, themselves.
Improve access if can’t get on stretcher.
Don’t delay transport for non-life threatening Interventions.

Question 19

What OPTIONS are available for the casualty to improve their situation? 5 Items

Answer 19

Cooling of Burns
Splints
Reassurance
Wound Dressing
Protection from elements

Question 20

Out of there

Answer 20

This is a treatment in its own right.

Question 21

What are the key sites of Potential Major blood loss. PLACES

Answer 21

P - Pelvis - Use Binders or stabilise
L - Long Bones
A - Abdomenm - Can loose 4-6L of blood into Abdomen
C - Chest
E - External
S - Scalp

If bleeding from Abdomen or chest best thing to do is get them to a hospital.

Question 22

How do you address External Haemorrhage?

Answer 22

• Direct Pressure
• Indirect Pressure (pressure points)
• Elevation
• Tourniquet

Question 23

What are signs that the patient has a problem with their circulation?

Answer 23

• Blood
• Loss of Consciousness
• Pulse
• Skin Colour
• Capillary Refill
• Heart rate

Note: Blood in water looks like there is a lot of blood and also car seats absorb a lot of blood.

Question 24

Details of Direct Pressure?

Answer 24

Apply Direct Pressure (with a Pad) to the direct point of blood loss. Roll up a dressing so there is “Point” load over the wound to apply direct pressure.
When placing the bandage as it passes over the wound area twist the bandage 180Deg over the dressing to apply greater direct pressure to the wound.

Question 25

Describe Indirect pressure to stop external haemorrhage

Answer 25

``` For Femoral (leg) use your knee. Put knee in groin with a slight twist. Apply direct pressure while applying Tourniquet. ```

Question 26

Will Tourniquet's work on lower limbs

Answer 26

No - The veins and arteries run through the two bones, so tightening will only push against the bones.

Question 27

Tourniquets are applied...

Answer 27

- If you can see the wound then 4 fingers above the wound. This is with the FRNSW issued Torniquets. - IF you can't see the wound then High, Wide and Tight - Veins and arteries can spring back so put Tornos high to ensure cutting off blood. - Also they are the last option to be used if direct pressure is not working. They are very painful and get worse as time goes on. - Remove clothing from the limb and apply directly to the skin. - Do not remove the Tourniquet. If not working add another Torno Higher up or tighten. - Tighten until bleeding stops then do extra half turn on the "WIndless" then lock in.

Question 28

Can a Triangular bandage be used as a Tourniquet?

Answer 28

Yes. Needs to be at least 5cm wide. Tie around limb, Put knot in it. Put an improvised windless (piece of bar, screwdriver, torch, Trauma shears) in knot area then rotate. Tie Windless off then put another triangular bandage around the whole thing.

Question 29

How do you address internal Haemorrhage?

Answer 29

- Direct and indirect pressure. - Get them to a hospital ASAP. - Where bones are involved get the two ends back together. - If the Femur, splinting can help stop/reduce the blood flow.

Question 30

What are the signs of a Pelvis Fracture?

Answer 30

Feet splay out. "Open book" pelvis fracture. Do not roll the casualty if this has occurred. If have to roll do not lift the knee, but rather have 3 people with alternating hands. Put Pelvic binder on.

Question 31

What is the procedure for putting on an improvised pelvic binder?

Answer 31

1) Bring feet together and tie together with a bandage.. 2) Put sheet folded up under the arch of back. 3) Slide the sheet down under the pelvis. 4) Pull around and tie a knot with the sheet. Add a windless (bar etc) and tighten like a torno. 5) Tie the windless off so it does not loosen.

Question 32

Putting in a Gadel for an adult, what is the current approach. Also child?

Answer 32

Don't rotate. Go in straight down, can start just to the side of the tongue. For a child go in the way it will end up.

Question 33

When clearing out a casualty's mouth what do we use

Answer 33

- casualty's fingers (maybe) - Gadels - Something that is not going to break. - Do not use your own fingers!!

Question 34

When opening someone's mouth to create an airway what technique is used?

Answer 34

Jaw Thrust - If doing from the top of the head (casualty on back) brace your thumbs on their cheeks. - if from in front place thumbs on chin and fingers around jaw and pull forward.

Question 35

What's the volume output of a BVM? What's the volume range of lungs?

Answer 35

- BVM holds 1500mls - Lungs 400-600ml Do breaths slowly when using a BVM and squeeze until you see the chest rise. - place the mask on the chin first, then place on nose. Try to do a jaw thrust with other fingers. - Can use an adult mask on a child. Reverse the mask so the narrow part is on the chin. Be mindful of the amount of air being administered.

Question 36

What are the colours used in a Triage system

Answer 36

Red - Immediate attention required Yellow - Urgent Green - Delayed Black or white - Unsalvageable (does not mean dead yet) (maintain dignity of body)

Question 37

What's the overall objective in a Mass casualty situation

Answer 37

Greatest good for the greatest number.

Question 38

What's the Triage order model

Answer 38

1) Walks -\> Yes - DELAYED (if you can walk come to me) -\>No 2) Do they obey commands 2YES) do they have a Radial pulse. (above wrist with two fingers. PUSH down really hard then half release). If YES then - URGENT, IF no then IMMEDIATE attention req. 2NO) Do they breath with an open airway. IF YES then IMMEDIATE attention req. If NO then UNSALVAGEABLE Note: Greens can become yellows or reds Note: Ambos in NSW carry SMART mass casualty kits.

Question 39

What is Crush injury?

Answer 39

A direct injury resulting from a crush. eg vehicle accidents, building collapses, or unconscious casualties.

Question 40

What is Release Syndrome

Answer 40

Systemic manifestation of muscle cell damage resulting from pressure or crushing of large muscle masses. (thighs, abdomen, pelvis etc) - Usually requires crush to exist for greater than 60 mins. - Three killers are 1) Hypovolemia (blood pooling in wrong place) 2) Sudden Cardiac arrest (Due to potassium release) 3) Kidney Failure (Due to high lactic acid levels after 3 days)

Question 41

What's a method to minimise release syndrome

Answer 41

Can put a tourniquet on. Note: can get release syndrome when hanging in a harness for too long. Apply basic first aid principles including Haemorrhage control and splinting.

Question 42

What are some considerations with Hypothermic Patients?

Answer 42

- Handle very gently. simple moving a patient that is hypothermic can send them into Cardiac Arrest. \<32degC can easily fibrillate

Question 43

Psychological first Aid - 5 elements of

Answer 43

1. Promotion of _Safety_ 2. Promotion of _Calming_ 3. Promotion of sense of _Self-efficacy_ 4. Promotion of _connectedness_ 5. Instilling _hope._ Dont tell them what to do. Give them some suggestions. "Have you thought of any alternatives, or another way to approach it?" I'm here to support you Look - Safety, Needs and Concerns, Distress responses Listen - avoid suggesting you know what they need and how they feel Link - Help address basic needs and services, give information , connection people with loved ones and social support Recovery Centres should be hubs where people can access all sorts of support. Help people use their own coping resources and strategies. show compassion

Question 44

What’s the TASC model in relation to suicide

Answer 44

- Tune-in - Ask about whether they are thinking about suicide - State the seriousness of suicidal thoughts - Connect to helping resources, lifeline, beyond blue, suicide callback service.

Question 45

Difference between medical shock and emotional shock?

Answer 45

Medical shock is due to fluid loss- blood loss, dehydration, burns, anaphylactics. This needs to be addressed. Emotional shock is not as a concern, but still need to be mindful of fainting etc

Question 46

What can a weak pulse be a sign of?

Answer 46

If have a weak pulse could be a sign of medical shock, so be aware.

Question 47

Are you on any medications?

Answer 47

Ask them what the medications are for, rather than what the medications are for..

Question 48

What does increased oxygen do?

Answer 48

It’s a vaso constrictor so giving oxygen can make stroke and heart attack worse. Need to look at perfusion- if they are blue, in shock, bright red, co poisoning will appear red flushed. Also behaviours need to give oxygen..

Question 49

What 02 flow rate for the nasal prongs

Answer 49

2l/m, but also ask them if they take oxygen what flow rate do they use? Use in most cases if think they need oxygen as this delivers a safe amount of oxygen, which shouldn’t make things worse..

Question 50

When will we use a hudsen mask?

Answer 50

Conscious but drowsy casualty. Or if they are a spitter, but don’t plug it in..

Question 51

When does a High concentration mask get used?

Answer 51

Unconscious casualty, or if someone has had carbon monoxide poisoning from inhaling smoke. Need to stress this with paramedics as carbon monoxide poisoning can be missed by them..

Question 52

If unconscious what’s the benefit of putting high concentration mask on?

Answer 52

It can tell you whether they are breathing or not. Don’t plug it in and look for condensation on the mask.. Make this a priority when assessing an unconscious patient!

Question 53

What does an O2 blood sensor miss. Pulse oxsimitor

Answer 53

Carbon monoxide poisoning as this attaches to blood which the oxsimitor does not differentiate.. co is cumulative!! Which lasts 90days. Give blood to remove co blood and promote new blood generation..

Question 54

What do Ambo’s miss if they assess for smoke inhalation?

Answer 54

They can potentially miss carbon monoxide poisoning. Their response protocols for smoke inhalation concentrate around airway issues. Need to flag potential carbon monoxide poisoning as this will then prompt them to assess for carbon monoxide and follow up monoxide protocols 

Question 55

Do you need to move the tongue on an infant when putting in an airway?

Answer 55

Yes, use your little finger to push the tongue out of the way and then put the gadel in..

Question 56

At what interval do we switch over compressions?

Answer 56

Every two minutes. Current procedures with Ambo’s is that they should swap over compressions every two minutes. After two minutes the quality of compressions drops off..

Question 57

When using a defib when do we turn the unit on? What is the age for child setting..

Answer 57

After we have put the pads on, as this will circumvent the start up instructions. The child age is 8 years old.

Question 58

When working on a casualty what side of the casualty do we want to leave open for the Ambos?

Answer 58

The right side of the casualty. The Ambos will want to canulate the right arm as their treatment seat in the ambos is on the right side of the casualty..so do compressions on the left side of the casualty.

Question 59

When inflating the BVM. How many hands do you use?

Answer 59

1 hand. This is now a two person process. 1 person has to have two hands holding the mask on and the other person uses 1 hand on the BVM.

Question 60

Are rescue breaths necessary?

Answer 60

Current studies have indicated that the survival rate is 3 times higher in situations where continuous compressions are given, and first aiders don’t stop to give rescue breaths. Rescue breaths become way more important if drowning is a possibility..

Question 61

If an unconscious patients becomes conscious after shocks, when do you turn the defibrillator off

Answer 61

After you get the details from the defib, such as the amount of shocks and how long the defib has been running.

Question 62

Do all amputations get a tourniquet?

Answer 62

Yes. There may not be bleeding on arrival, but the bleeding could start afterwards.. the tourniquet goes about 5cm above the wound to allow for artery retraction..

Question 63

When should you use a face shield or eye protection?

Answer 63

Generally always when conducting first aid but especially when you are dealing with major bleeds

Question 64

How does the direct pressure get applied with an Israeli bandage?

Answer 64

The label is where the direct pressure gets applied. Place the label on the wound, wrap a couple of times then pull it through then back through the plastic clip, which pulls it over the label and applies pressure to the wound If using haemastatic dressing pack in wound and when covering, put the wrapping in the dressing, so they know it’s been used.