medical emergencies for the common individual

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What happens when you encounter an emergency, someone you love has one, or you yourself are in one and help is not immediately accessible? You improvised and overcome! And I'll show you how!

Submitted: May 04, 2016

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Submitted: May 04, 2016

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Hello and thank you for taking the time to read my small article about some basic but important medical steps that can be done by anyone in case of a medical emergency, and it could even potentially save a life.

First my credentials; I am a Combat Life Saver (CLS) USMC, CPR / AED for the professional rescuer and Tactical Combat Casualty Care (TCCC) certified Medic and within the limits of my medical knowledge and skills spectrum I can treat a broad number of injuries / situations.

Note: This all based on my own personal experiences, knowledge and skills that I have acquired through years in my tactical operational field, this is not meant to make you a medic, but to help you in case you ever have the need to be. If you want to know more the internet has unlimited resources from confirmed sources like North American Rescue, TacMed Solutions, to name a few.

Now to the basics, First Aid

In this section, its something very minor and preventive care is the most important step. Band aids, duct tape, gauze, or any material you have laying around will be your go to material.

  • Headache? Take a pill.

  • Sunburn? Aloe lotion or any sunburn relieving ointment; wear sunscreen next time, smartass.

  • Nauseous, Diarrhea, or Vomiting? Get out of the field, go light on fluids and seek medical attention, not much you can do unless you carry the right meds.

  • Feeling lightheaded, weak and sweating excessively? This is possibly a heat injury, caused by your body basically overheating. Consume fluids, drop kit, remove constricting clothing and move to shade. Continue to consume fluids and stay off the heat, if conditioning perceives or worsens seek medical attention.

  • Hypothermia? Now you're too cold, and this is potentially very dangerous if not addressed. First remove any wet clothing, if applicable. Replace with warm and dry clothing, if exposed to the elements seek shelter. Provide heat by any means necessary until medical personnel arrive. We call it the “Warm and fuzzy”, you're gonna lay there with your buddy, in a blanket in possible and give him your body. If it so happens to be a hot girl, then hey, good on ya! (best way to give body heat is in minimal clothing haha...)

  • Burn? First, remove from source of the burn, then if burn dressing is available, apply it, if not cover the wound to prevent infection. Depending on the type of burn, applying water might actually make it worse, if in doubt don't assume. Depending on the severity and nature of the wound, seek medical attention if needed.

  • Cuts or any injury similar? First clean the wound area, alcohol or any triple antibiotic will do. Then cover the wound to prevent exposure to elements that might cause infection (band aids, gauze, etc...).

  • Injury to limb? You rolled your ankle, fell and broke an arm, or just happen to be extremely unlucky and just broke something. If the bone broke skin and is exposed, DO NOT TRY TO RETRIEVE BACK INTO THE LIMB, I cannot stress this enough and for good reason. By forcing the broken bone back you would actually cause severe damage, so lets do this the smart way and leave it alone for now. What you can do is clean the wound, cover it to prevent exposure, and then splint it in a natural resting place that limits the movement of the limb. Make sure the splint is secure but not so tight it restrains circulation or in case some swelling occurs. And seek medical attention as soon as possible.

  • Eye injury? If possible remove object that caused the trauma, then cover to prevent exposure. Seek medical attention as soon as possible.

Now moving on to CPR / AED

You walk on somebody who seems unconscious and laying on the ground. What do you do?

First, Assess the scene! Make sure that whatever happened to dear old Joe over there doesn't happen to you too, remember its his emergency, not yours.

So you took a good around, realized the mechanism of injury or that there's no immediate threat to you, now look for a response.

  • Yell out to the casualty to assess his condition. A quick, “Hey buddy, are you okay? What happened to you?” Will let you know a few things: is he at all conscious? If he is, what happened to him? Can he move to you or do you have to move to him? Does he actually need help or he's ok?

  • Now assuming you have taken the casualty under your care, first activate EMS, call 911 on your phone and place it on speaker. The operator will ask your basic information and also guide you if you happen to need assistance or are too nervous to remember anything. Also if an AED is available have someone get it.

  • AED procedures are simple: remove clothing and expose chest, place pads on chest, if any metals or jewelry is present, place away from it or remove (they're labeled and easy to understand), and start the AED and follow it's instructions. It will perform an analysis and deliver a shock if necessary, continue your assessment while it analyzes and charges, and follow any instructions it gives. Do not touch the casualty during it's analysis or during the shock sequence!

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  • Now you have to assess the airway; the look, listen and feel approach is best. Look into the casualty's airway, listen for any air flow, and feel for that flow. It's imperative to get up close and personal, otherwise you wont be able to make a solid assessment. If there's anything obstructing the airway, try to remove it. Use your fingers, in sweeping motion while resting the casualty on its side (Use gravity for your benefit!)

  • If hes awake and breathing, hey, good job! Now just keep him awake and alert until EMS arrives. If not, then we move to our chest compressions and rescue breaths.

  • Remember this, CAB, Compressions Airway and Breaths. This is the order you will perform CPR and how you will possible save the casualty. 30 chest compression, 2 rescue breaths. This is your mantra, use it. Now for the technique, its simple. Position your hands in the center of the chest, one hand over the other, and press firmly and deep. Don't be shy, its better to have a few broken ribs than be dead! Now after your 30, tild the head and give two rescue breaths. Congrats that's one cycle, now continue until casualty wakes up or EMS arrives!

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Now what if your casualty is choking or having some sort of airway obstruction but still conscious? Then we go to our dear ol' abdominal thrust! You can easily assess someone is choking, we all have seen it. Now what do you do?

  • Easy, assess the situation and approach the casualty. Ask the stupid but necessary question, "Are you choking, do you need help?" you will know for sure if needs help or not.
  • Approach the casualty from the rear and give a few solid palm strikes to its back to loosen the object. Then proceed to wrap your arms around the casualty, make a fist and drive into the abdomen of the victim in a upwards motion. Repeat as needed. Note: On an infant the abdominal thrust will be done using your fingers and pressing firmly, see attached picture for clarification.

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Now to the good stuff! Trauma medicine

Here we discuss any immediate life threatening injuries that would cause loss of life if left without treatment.

Here's your mantra for Trauma, MARCH

Massive Bleeding, Airway, Respiration, Circulation, Head / Heat

If you can assess these steps properly, you will give the casualty a very solid chance of survival. 

Massive Bleeding

  • Apply direct pressure to the wound to help control the bleeding. If injury is on a limb, it's tourniquet time motherfuckers! If you don't have a tourniquet handy, improvise! Your belt, 550 cord, strong elastic bands, a weapon sling, etc...be creative. 
  • The tourniquet should be placed as high as possible on that limb, high in the armpits or the groin area. Tourniquets should and will hurt, trauma medicine is painful and messy, deal with it. 
  • Once your TQ is secured and tight, move on to the wound itself. Its time to use a pressure dressing to help control the blood flow, nothing fancy just gauze packed into the wound (yes I said into the wound) and then covered with a firm steady pressure to secure it, protect it and add pressure.
  • Any wound that can not be TQ, will be packed and covered with a pressure dressing.
  • Now that the initial bleeding is controlled, let's move on to the blood sweep. Fancy word for looking for other wounds, using a sweeping motion to look for blood. Sweep the arms, armpits, neck, legs and groin area. Treat any additional injuries as you find them.

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Proper tourniquet placement

Airway

  • The same fundamental as CPR apply here: look, listen and feel!
  • Assess the casualty's ability to breath, remove any obstructions, and if possible position him in a way that helps him to breathe better on his own. If unconscious I would use a NPA, which is a fancy word for a nose hose that helps you breathe, but I don't expect you to carry one.

Respiration

  • In this section we are looking for any trauma to the torso, front and back.
  • Use a claw like motion to rake the body from neck to groin looking for wounds on both sides.
  • Once you find one, if its inside your chest cavity box, assume it will lead to tension pneumothorax, or the lung collapsing on one side (if outside the box, treat as a normal bleeding wound). Tension P will happen on one side, and its noticeable due to difficulty breathing, uneven rising of the chest, and the mechanism of injury (a hole in your torso is a huge hint!).
  • Clean the wound, and apply a occlusive dressing secured on all four sides. A chest seal would be perfect, but a simple plastic bag, wrapper, Ziploc bag or anything that will form a barrier works. Once you address one wound, check for an exit wound. 
  • If his condition worsens, remove one side of the seal to relieve some pressure, or if you have the kit perform a needle decompression. Fancy word for sticking a needle inside the chest cavity to relieve pressure. Halfway between the collar bone and the nipple, between the second and third rip. See picture for better understanding.

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Circulation

  • Check vitals, check the pulse of the casualty to assess how much blood loss has occurred and how critical it is.
  • First check the wrist area, pulse there means we're good!
  • If no pulse, move to the groin area, on the inside. If pulse there, some loss has happen but we can still work with this.
  • If no pulse, move to the neck, a pulse no where else but here means a very weak blood pressure and severe blood loss, MEDEVAC ASAP. If no pulse here, he's probably already bleed to death.
  • Fluids through IV would be administrated at this step if you had them and had the knowledge to do so.

Head / Heat

  • Check the head for any trauma, treat wounds with simple dressings, do not apply pressure, swelling could occur and should not be constricted.
  • Lets be honest, if you check for trauma and half the skull is missing, or brain matter is splattered everywhere, sorry it's game over for him.
  • Now for heat, hypothermia is a huge killer and has to be taken seriously. No good comes from great trauma medicine, to then leave your casualty to die of lack of body heat in his own pool of blood.
  • Remove from any blood pools, wet or cold surfaces and remove any clothing that's in the same criteria. Move to a good shelter, provide warm and dry clothing, or a blanket if possible. Give body heat if it becomes necessary and place in on its side in the recovery position if beneficial. Remember, "Warm and fuzzy" reassure him that he wil be fine and that you are trying your best to save him, for both your mental states benefit.

Notes:

MEDEVAC Casualty ASAP, once M has been assessed, casualty can be moved for better care or environment. 

Seek help immediately, before any treatment is given call 911, yell for help, radio for help, and tell everyone around you of the situation and to administer any help possible. Task out those individuals helping you, one should call 911, one should inform everyone of the situation and seek higher immediate help (AED, EMT on site, etc), and one to help you with the casualty.

Remember to keep a clear mind and think outside the box, without your aid the casualty is dead, you are there to give him a fighting chance, take your time and make good choices. 

If needed its ok to take a step back, breathe and then reassess, its better to act with a clear mind that with the rush of the emergency.

And the most important of all, if a higher qualified individual is present let him handle the casualty and only provide help with tasks he gives you.

 


© Copyright 2017 Alex Matos. All rights reserved.

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