By: Lee Yat Sing (SI)

Intermediate First-aid Skills- body survey

10th HKG 港島第十旅

Learning Objectives

• Know the basic anatomy of a human being• Understand the Patient Assessment Model

and be able to perform a body survey

3 Basic Principles

•保存生命1

•防止情況（傷勢）惡化2

•促進復原3

Common approach to cases

D

•Danger – RSE, MOI

R

•Response – MOI, LOC (AVPU)

A

•Airway

B

•Breathing

C

•Circulation

D

•Damage

E

•Examination – Rapid Body Survey, MOI

F

•Follow-up – treatment, secondary survey (PQRST)

﹜CPR?

DR

A

B

C

D

E

FRescue Scene Evaluation (RSE) 拯救現場評估- DO NOT focus on details, observe first → Get a concept of the Scene, Danger, MOIScene 環境 :- Search for important clues (number, severity, incident)- Search for route of evacuation e.g. exit- Search for any other people in need- Search for any witnesses or relatives

Danger 危險 :- Be aware of any dangers/ potential dangers, e.g. sharp objects, things that may trip you

Mechanism of Injury (MOI) 患者至患過程 :- Guess: What exactly happened?→ Clues to other injuries, treatments

Before touching your patients,

WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!WEAR GLOVES!!!

D

RA

B

C

D

E

FLevel Of Consciousness (LOC)清醒程度- Approach patient DIRECT with a SMILE- INTRODUCE yourself- Develop CONTACT- Ask about MOI- LOC: Levels AVPU

A Alert ( 清醒 )V Verbal ( 言語 )P Pain ( 痛楚 )U Unresponsive ( 昏迷 )

D

R

AB

C

D

E

F

Airway (氣道 )- Check airway for ALL patients- Alert patients: if patient can speak clearly

→ airway good and clear- Non-alert patients: Check!

1. Clear obstructions (if necessary)2. Perform ‘Head tilt chin lift’ 按額托頭法　 →

- If there is suspected spinal fracture → use jaw thrust ( 創建推顎法 )

D

R

A

BC

D

E

F

Breathing (呼吸 )- See, hear and touch ( 視聽觸 ) for 10s- if able to speak clearly → deep and easy breath- Other descriptions:- Deep/ Shallow ( 深 / 淺 )- Rapid/ Slow ( 快 / 慢 )- Easy/ Hard ( 容易 / 努力 )

D

R

A

B

CD

E

FCirculation (血液循環 )- Check radial pulse( 橈側脈膊 ) for 10s:- present → at least 80mmHg systolic ( 上壓 )- Absent → check carotid pulse ( 頸動脈 )

→ at least 60mmHg ( 下壓 )- Descriptions:

- Strong/ weak ( 強 / 弱 )- Rapid/ Slow ( 快 / 慢 )- Regular/ irregular ( 有規律 / 亂 )

- Look for signs of circulation around body

Radial pulse Carotid pulse

D

R

A

B

CD

E

F

D

R

A

B

C

DE

F

Damage (創傷 ) -Deal with immediate wounds, e.g. control bleeding ( 止血 )

D

R

A

B

C

D

EF

Rapid body survey(RBS) 快速身體檢查- Tell your patient that you are going to do a RBS- Pay special attention to bleeds, deformities, swellings, disabilities (出血、變形、腫脹、殘缺 )-Within 30s:- Touch through body (see next slide)- Note for hospital wristband (醫療手帶 )- Expose & handle any wound (展露及處理傷處 ), especially heavy bleeds

- Note skin colour, with back of hand check warmth and moisture (以手背探皮膚溫度及濕度 ) → Pale/ red/ purple? warm/ cold? Dry/ wet?＊ Note sign of shock休克 (pale, cool, wet)

Rapid Body Survey (RBS)1234 56

7

8

Note:- Bleeds- Deformities- Swellings- Disabilities- Hospital wristband- Skin

D

R

A

B

C

D

EF

D

R

A

B

C

D

E

FFollow-up (跟進及處理 )- Diagnosis (診斷 )- Call for help (尋找支援 )- Patient’s ICE (Idea-Concern-Expectation)- Treatments for conditions- Suspected abnormalities from MOI- Secondary Survey (進一步檢查 )

10 on 5 off

Call for help ( 尋找支援 )

報警十大•地點•事故•傷者數目•性別•年齡

•傷勢•支援物資•急救者資料•聯絡資料•重複

F

Note: in real cases, you can ask any pedestrian to call 999 for you, but make sure you have told him/her all the information listed above

• Patient history ( 病歷 )– Major discomfort ( 主要不適 )• “ 邊到最唔舒服？”

– History of major discomfort → before, during, after

*PQRST – for pain ONLY• Position • Quality• Radiation/ Relief• Severity• Timing

F Secondary Survey ( 進一步檢查 )

Secondary Survey ( 進一步檢查 )

• Patient history ( 病歷 ) – cont’d– Medical history e.g. heart disease, seizure, allergy– Medicine (usually patients bring them along)– Patients’ particulars e.g. name, age– Vital signs ( 維生指數 )

• LOC (清醒程度 )

• Pulse (脈膊 )

• Ventilation (呼吸 )

• Skin (皮膚 )

• Body temperature (體溫 )

– Body survey (詳細檢查 )

F

Body Survey ( 詳細檢查 )

• Ask and explain to patient for body survey• Finish within 5 minutes• Compare left and right side• Do not touch wounded regions• Use your eyes and hands– Eyes: look for bruising ( 瘀傷 ), bleeding( 出血 ),

deformities( 變形 ), swellings( 腫脹 ), wounds( 傷口 ), excretions( 排泄 )

– Hands: Check for pain at fracture( 骨折 ), deformities( 變形 ), sinks( 下陷 ), swellings( 腫痛 ), tenderness( 觸痛 ), firmness( 堅實 )

F

Lungs

Heart

Liver

Stomach

Intestines

Body Survey ( 詳細檢查 )-1FH

ead - Scalp ( 頭皮 )

- Face & forehead- Ears and nose- Eyes- Lips and mouth- Teeth (esp fake)- Tongue

Nec

k - Spine- Swelling- Voice- Loosen collar- Remove necklace

Ches

t - Clavicle ( 鎖骨 )- Ribcage mov’t- Ribs- Deep breath

Body Survey ( 詳細檢查 )-2FAb

dom

en - Internal organs(swelling, pain)- Loosen belt

Back - Spine

- Do not move

Pelv

ic R

egio

n - Pelvis ( 盆骨 )- Groin ( 陰部 ) (bleed, pain)

Body Survey ( 詳細檢查 )-3FLo

wer

lim

bs - Thigh and calf- Knee- Pedal pulse- Nails: cap refill (Press 5s, read 2s)- Sensation- StrengthU

pper

lim

bs - Shoulders- Arms- Radial pulse- Nails: cap refill- Force- Remove accessories