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CHAPTER 7

CHAPTER 7. Scene Size-Up. Overall Assessment Scheme. Scene Size-Up. Initial Assessment. Trauma. Medical. Physical Exam. SAMPLE History. Vital Signs & SAMPLE History. Physical Exam & Vital Signs. HOSP. Detailed Physical Exam. Ongoing Assessment. K ey Term. Scene Size-Up.

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CHAPTER 7

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  1. CHAPTER 7 SceneSize-Up

  2. Overall Assessment Scheme Scene Size-Up Initial Assessment Trauma Medical Physical Exam SAMPLE History Vital Signs & SAMPLE History Physical Exam & Vital Signs HOSP Detailed Physical Exam Ongoing Assessment

  3. Key Term Scene Size-Up Determining any threats to your own safety or to the safety of your patients or bystanders, to determine the nature of the call, and to decide if you will need additional help

  4. Scene Safety

  5. Key Term Scene Safety An assessment to assure the well-being of the EMT–Basic

  6. Scene Safety Protect bystanders (prevent them from becoming patients). Never enter an unsafe scene. Make scene safe or call for someone who can.

  7. Danger Zone Minimum 50’ around scene, further if: • Fuel spill • Fire • Hazardous materials • Downed power lines

  8. Crash or Rescue Scenes

  9. Toxic Substances or Hazmat

  10. Unstable Surfaces: Slopes, Ice, Water

  11. Scene Violence Use scene clues: Fighting Loud voices Alcohol/drug use Unusual silence Prior experience

  12. Crime Scenes and Violence

  13. Body SubstanceIsolation

  14. Body Substance Isolation Anticipate the need for BSI. Always have BSI equipment available. Use appropriate equipment to prevent exposure.

  15. BSI Review: Gloves

  16. BSI Review: Mask and Eye Protection

  17. BSI Review: Gown

  18. Mechanism of Injury/ Nature of Illness

  19. Key Term Mechanism of Injury The physical event that caused an injury (fall, motor vehicle accident, etc.)

  20. Mechanism of Injury Determined from: Patient Family Bystander Observation of the scene

  21. Mechanism of Injury: Motor Vehicle Collision–Head On

  22. Mechanism of Injury: Motor Vehicle Collision–Rear Impact

  23. Mechanism of Injury: Motor Vehicle Collision–Side Impact

  24. Mechanism of Injury: Motor Vehicle Collision–Rollover

  25. Mechanism of Injury: Motor Vehicle Collision–Rotational Rotational May have multiple impacts

  26. Mechanism of Injury: Motor Vehicle Collision Ejection Deformed windshield, steering wheel, etc. Amount of vehicle deformity Seat belt use

  27. Mechanism of Injury: Motor Vehicle Collision–Vehicle Interior

  28. Mechanism of Injury: Motor Vehicle Collision–Motorized Vehicle Motorcycles All-terrain vehicles Snowmobiles Jet-Ski

  29. Mechanism of Injury:Falls

  30. Mechanism of Injury: Falls Distance patient fell Part of body that struck surface Type of surface landed on Did anything break the fall?

  31. Mechanism of Injury: Penetrating Trauma • Velocity • Low velocity–knife • Medium velocity–handgun, shotgun • High velocity–rifle • Body region penetrated • Exit wounds

  32. Mechanism of Injury:Penetrating Trauma

  33. Mechanism of Injury:Blunt Force Trauma

  34. Nature of Illness: Medical Patient Sources of Information Scene Patient Family and bystanders

  35. Adequacy ofResources

  36. Adequacy of Resources Number of patients? Hazardous materials? Fire or rescue? Unusual situations?

  37. Adequacy of Resources Call for assistance before beginning care. Use triage procedures if necessary.

  38. Review Questions 1. Why must BSI be considered during the size-up? 2. List several factors which may make a scene unsafe. 3. Describe ways to determine information about the nature of medical emergencies.

  39. Review Questions • For each of the following mechanisms of injury, list several things to look for or consider: • Falls • Motor vehicle accidents • Penetrating trauma

  40. STREET SCENES • What other scene size-up issues are still left to consider? • Is the scene now safe, or do other precautions need to be taken? • What BSI precautions should be considered?

  41. STREET SCENES • When the second ambulance arrives, where should it be located in relation to the collision scene?

  42. STREET SCENES • What precautions should you take to protect the patient from any further harm while they are being extricated from the vehicle?

  43. STREET SCENES • How should you plan to make sure that you can safely get the patient from the scene to the ambulance?

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