Methodical development № 1
THE PRACTICAL LESSON FOR STUDENTS
MEDICAL FACULTY of discipline “Emergency and emergency care”
Department of urgent and emergency care
Lesson № 1 (practical-6 hrs)
Topic 1. Organization of emergency and urgent care in Ukraine. Initial activities of medical staff in case of the patient’s emergency condition.
Procedure for emergency aid to survivors and patients in the prehospital phase. Primary survey.
“Procedure for emergency aid to survivors and patients in the prehospital phase. The Secondary examination”
Objective: To acquaint students with the levels of care, service and tasks of EMD against the law of a single emergency medical assistance to Ukraine and other regulations, equipment ambulance crews, documentation maintained in their work. To lead to note the relationship and coordination of actions Rescue Services: 101, 102 and 103. To improve the theoretical knowledge and practical skills to provide first aid and emergency medical care to the sick and injured in the most common acute illnesses and injuries involving violation of the vital functions of the body, life-threatening and require emergency treatment. To acquaint students with modern principles of primary and secondary survey of patients (victims), clinical protocols, including the protocols of the European Resuscitation Council. Students master the technique of additional methods of examination, assessment of the level of consciousness on a scale com
Professional motivation: Often various diseases, traumatic injuries, accidents, poisoning, etc. require medical care, the timeliness and quality of which depends on the health and life of the patient. Proper organization of work and logistics services EMC multiplied by the high level of training in emergency medical activities on prehospital stage caot only save the lives of patients (victims), but also will contribute to the successful treatment of illness or injury, thus preventing the development of severe complications . That is why the key points at this stage have a clear knowledge of the protocols of primary and secondary survey of the principles AVPU and AVSDE.
Program Individual Students
Topic №1 practice session.
1. Levels of care. The concept of urgent and emergency medical care in the prehospital and early hospital stages.
2. Customer EMC
3. Provide outpatient family doctor and different hospital departments to provide EMC.
4. The concept of “platinum half an hour”, “golden hour” in the provision of emergency medical care.
5. Ergonomic principles in the visiting team EMC (when working indoors, outdoors).
6. The concept of scale com
Theme № 2 practical classes
1. Basic principles, methods (ABCDE) primary and secondary survey of the patient (victim).
2. Making decisions about medical care during the initial examination.
3. Criteria for definition of patients’ Download and gall.
4. Tools for proved drug administration, indications and technique application.
5. The concept of alternative routes of administration of medicines at the stage of CPR.
6. The purpose of the secondary survey.
7. Assessing the level of consciousness on a scale com
8. Additional methods of examination (electrocardiomonitoring, Pulse oximetry, electrocardiography in 12 standard leads, glucometry).
9. Install emergency situation. Definition of medical protocol in medicine emergency conditions.
10.Tehnological of local survey
11. Features collecting history of the patient (victim)
Sample tests and situational tasks:
1. The mother’s brother drunk pushed nephew 6 years, and the bridge height
A. syncope
B. True
C. Asphyxian
D. Mechanical
E. Hydration.
2. The worker was exposed to the action of electric current a few minutes ago. He lost consciousness. There were seizures. The action current was stopped. The patient lies, no breathing, no pulse is determined, cyanotic skin, eyes wide, do not react to light. What kind of help should be given priority?
A. Introduction painkillers;
B. Introduction anticonvulsants;
C. Intravenous reproductive;
D. Closed cardiac massage and artificial ventilation;
E. Intravenous respiratory analeptics.
3. The main condition of possibility of transportation after helping a patient in a state of clinical death?
A. intravenous access
B. Successfully intubation.
C. Last edited independently cardiac
D. The presence of the vehicle
E. Pupillary
4 For the respirator EMC doctor found that throwing the head of the patient is almost impossible due to the stiffness of the cervical spine. What more do I do in these circumstances?
A. Raise the patient’s lower jaw up and open his mouth, with moderate deviation head
B. Return to throw the head of the patient aside and opened his mouth
C. Put a pillow under the head of the patient
D. Put extra effort for maximum casting head of the patient
E. Lay a pillow or folded towel under the patient’s shoulders
Problem 1.
5. The victim, about 45 years old, lying on the ground, and one of the others held him artificial respiration, spreading his hands and squeezing their chest. The victim unconscious. The pupils were dilated, reflexes absent carotid pulse is not detected. Breathing is missing. Skin pale gray.
1. Determine the state of the victim.
2. Specify the measures proper care.
Problem 2.
6. Walking on the
Correct answers to the tests and case studies: Standards of answers: 1 – A; 2 – D; 3 – C; 4 – A. Problem 1.Stan clinical death. Refine your mouth, throw your head back, hold ventilation “mouth to mouth” and closed cardiac massage until the arrival of a specialized team.
Task 2. Remove the child from the water to clean your mouth with your finger, wrap a piece of cloth, hold ventilation “mouth to mouth” and closed cardiac massage until the machine has not yet come “emergency”
Information generators:
A) basic:
1. American Heart Association in collaboration with the International Liaison Committee on Resuscitation (ILCOR)/ International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. A Consensus on Science // Resuscitation. – 2004. – 46. – P. 103 – 252.
2. European Resuscitation Council. Immediate life support. 1- st Edition. Published by European Resuscitation Council Secretariat VZW, 2006.
3. Lattore F., Nolan J., Robertson C. et al. The ALS working group of the European Resuscitation Council. The European Resuscitation Council Guidelines 2003 for Adult Advanced Life Support Resuscitation. 2000. – 48. – P. 211 – 212.
4. Safar P, Bircher NG. Cardiopulmonary and cerebral resuscitation. 3rd ed.
5. John Campbell. International Trauma Life Support. USA. New Jersey 2008. P. 289.
B) additional:
1. www.erc.edu
5. www.bcs.com
11. www.eusem.org
12. http://zakon2.rada.gov.ua/laws/show/5081-17
13. http://pidruchniki.ws/17540906/bzhd/samodopomoga_vzayemodopomoga_nadzvichaynih_
14. http://www.bibliofond.ru/view.aspx?id=492657.
15. andskp.ucoz.ua/publ/boevaja_podgoto…
16. http://knowledge.allbest.ru/life/2c0a65625a3bc68b4c53a88421316d37_0.html
17. http://5ka.at.ua/load/medicina_ta_zdorov_39_ja/persha_domedichna_dopomoga_v_umovakh_nadzvichajnikh_situacijakh_pri_opikakh_obmorozhenni_udushenni_referat/37-1-0-20950
Methods of practical work (9.00.-12.00)
Work
Studied and applied in the practical implementation of employment equipment on-site team EMC (medical products, medicines, special equipment), including providing outpatient family doctor and different hospital departments to provide EMC and EMC card teams out, the rules of design. Displayed ergonomic principles in the visiting team EMC (when working indoors, outdoors), work as a team. There is a familiarity with the station of EMC further briefing on safety. In this regard, special attention is paid to the employee’s personal security team EMC (health worker) while providing emergency medical care (arrangements, means of personal security), including inspection of the scene. Take into account dangerous situations that are possible at the scene, tactics and priorities for health care workers in case of danger, to determine the number of victims and the need for additional assistance, victim injury mechanism and challenge teams EMC and the timing of its arrival.
Work 2. When considering the topic of practical lessons: “Procedure emergency aid to survivors and patients in the prehospital phase. Primary and secondary survey “students receive case studies where through practical work performed on a mannequin initial examination (ABC), including the technology to implement it in the patient’s conscious and unconscious decision is made regarding a medical aid was provided during the initial examination: cervical collar overlay, supply of oxygen, the removal of life-threatening conditions (obstructive mechanical asphyxia, stop external bleeding, CPR). Determine subsequent tactic on the scene for a category of patients’ Download and gall “; those that require quick examination from head to toe and those ieed of a local survey. Based on these initial assessments should determine the categories of patients “Download and ed. “ We explain role in determining the mechanism of injury severity of the patient. Virtual teams for communication with the primary database, the report on the clinical situation. Implemented in practice to assist and prepare the patient for transport category “Download and gall,” included in this particular transport the sick and injured (laying on the board, stretcher, stretcher-chair, overlapping cervical collar, vest immobilization, the places in the coach cabin EMC) . Worked appliances removal of the affected vehicle and its transfer.
Determine the purpose of the secondary survey and patients subject to rapid examination from head to toe at the scene. On the mannequin playing his technology with the use of additional methods (electrocardiomonitoring, pulse oximetry, electrocardiography in 12 standard leads, glucometry). Active medical history, followed by the definition of emergency conditions. Installed and implemented treatment protocol with emergency medical conditions. Sounded criteria for patients to be a local survey, carried out local surveys technology.
Work
Work 4. The following classes of students receive instruction on safety and health, then go to the challenges within the ambulance crews. In the course of joint action with workers emergency medical students involved in the examination of the patient (victim), help to make diverse manipulation procedures (define AD, conduct intramuscular, intravenous injection, if necessary, removal of ECG imposing change on a limb, cervical collar , Blood tow of defibrillation, resuscitation, etc.). Returning from challenges in training room is their discussion, which examines a reach to patients, validity challenges, the quality of teams EMC, timeliness and accuracy exhibited diagnosis, treatment strategy based on current clinical protocols and possible relationship with the clinic ambulance service , hospital and SES.
Work 5. Performance tests students who have not been tested before the system Moodle.
The student should know:
Topic № 1 practice session:
1. The concept of level of care.
2. The concept of urgent and emergency medical care in the prehospital phase.
3. 2.Organizatsiya service EMC Ukraine. Regulations that govern its activities.
4. The main objectives, structure and logistics teams EMC.
5. Modern principles of interaction Rescue Services Ukraine (101,102,103).
6. The concept of medical sorting of patients (victims) at the stages medical evacuation.
7. Basic principles of providing and furnishing outpatient family doctor and different hospital departments to provide EMC.
8. The concept of “platinum half an hour”, “golden hour” in the provision of emergency medical care.
9. Ergonomic principles in the visiting team EMC (at work at the track of the street)
10. Com 10.Shkalu
11. Basic principles, methods (ABCDE) initial examination of the patient (victim).
12. Making decisions about medical care during the initial examination.
13. Criteria definition of patients’ Download and go. “
14. Tools entering into a vein for drug administration, indications and technique application.
15. The purpose of the secondary survey
16. Additional methods of examination (Electrocardiomonitoring, pulse oximetry, capnometry, electrocardiography in 12 standard leads, glucometry).
17. Install emergency situation. Definition of medical protocol in medicine emergency conditions.
18. Technology of local survey
19. Features collecting history of the patient (victim)
Students should be able:
|
№ |
Skill |
The level of absorption |
|
1. 2. 3.
4. |
Enjoy modern principles approach to victim (patient). To ensure personal safety. Conduct initial medical sorting Perform primary and secondary surveys on a ABCDE. |
3
3
3 3 |
|
5.
|
Make a local survey. |
3
|
|
6.
|
Identify victims of “Upload and drive” |
3
|
|
7.
|
To use the tools and equipment that is used in the EMC team (board, cervical collar, modern transport bus vest immobilization, suction, ECG machine, etc.). |
3
|
|
8.
|
Working with manual breathing apparatus, to carry mechanical ventilation by Ambu bag. |
3 |
|
9.
|
Enjoy portable ventilator. Apply various air vents, perform input technique laryngeal mask, laryngeal tube. |
3 |
|
10.
|
Prepare and apply the defibrillator and EKG machine to work to remove the defibrillation and ECG, including using modern kardiokompleksu Life-Pack. |
3 |
|
11. |
Run tracheal intubation on a mannequin. |
3 |
|
12.
|
To diagnose basic types and provide first aid to patients with major types of acute respiratory failure. |
3 |
|
13. |
Diagnose and provide first aid to patients with major types of vascular and heart failure. |
3 |
Options to control the test questions practice session number 1:
1. What does the medical sorting red bandage?
A. Patients receiving emergency assistance which may be delayed.
B. Patients in a state of biological death.
C. Patients with minor injuries.
D. Patients help that should be given priority.
E. Patients in a state of emotional arousal.
2. Platinum is a half hour?
A. 15 minutes – Directions to the victim, a 5-minute examination at the scene, 10 minutes – Directions to the hospital.
B. 10 minutes – Directions to the victim, 10-minute survey and relief at the scene, 10 minutes – Directions to the hospital.
C. 10 minutes – Directions to the victim; 5 minutes – test at the scene, 15 minutes – Directions to the hospital.
D. 20 minutes – Directions to the victim, a 10-minute examination at the scene.
E. 15 minutes – Directions to the victim, 15 minutes – test at the scene.
3. After removing the victim from the water to the shore to the beginning of resuscitation:
A. Clean mouth;
B. Unbutton are;
C. Turn face down and wait for the outflow of water from the respiratory tract; D. Wrap up warm clothing to avoid hypothermia;
E. Identify the reaction of pupils to light
4. Enter the type of drowning that develops on stage hospital:
A. Primary;
B. asphyxian;
C. ” Cryo-shock “;
D. Secondary;
E. Syncope.
5. Enter the most frequent type of drowning:
A. Primary;
B. asphyxial;
C. ” Cryo-shock “;
D. Secondary;
E. syncope.
A. Meningoencephalitis;
B. Sudden death syndrome;
C. Aspiration of vomit weight;
D. Status epilepticus;
E. Cardiogenic shock.
7. Electrician ’27 received an electric, touching his hand to the exposed electrical wiring. There was a stop of circulation and respiration. Resuscitation measures ensured the restoration of cardiac activity after 5 min. Which of complications as possible to a few hours or even days after an electric shock?
A. Circulatory arrest;
B. Stop breathing;
C. Acute liver failure;
D. Acute renal failure;
E. Pulmonary Edema
8. Female 32 years enjoyed a faulty power tool. Suddenly collapsed, unconscious, had seizures. What are cardiac arrhythmias, are most likely to be observed on the electrocardiogram?
A. Asystole;
B. Paroxysmal tachycardia;
C. Atrioventricular block;
D. Ventricular fibrillation;
E. Mechanical ventricular electrodissociation
9. Medical worker with knowledge of the serious condition of the patient without good reason refused to provide medical care. As a qualified medical professional of that article of the Criminal Code should be applied?
A. Neglect of their professional duties, Article 144;
B. Criminal failure to provide medical care, Article 124;
C. It’s not my business, I have to time off;
D. Illegal experiments on humans, Article 118;
E. Violation of medical ethics officer, Article 58.
A. Artificial respiration carry out the method of Sylvester;
B. Artificial respiration spend on an Hohera-Nielsen;
C. Do not hold the maximum throwing back the head of the victim;
D. Do not open the victim’s mouth and hold CPR mouth to nose;
E. Do not print the victim’s jaw up and forward.
B. Turn victim head down, pressing on the chest to remove water, hold ventilation “mouth to mouth”;
C. Immediately make precardiac hit, hold ventilation and closed cardiac massage;
D. Release airways of water to conduct ventilation Silvestri;
E. Immediately get brigade ambulance to its arrival – hold ventilation to Sylvester and closed cardiac massage
B. Turn victim head down, pressing on the chest to remove water, hold ventilation “mouth to mouth”;
C. Immediately take precardiac blow to conduct mechanical ventilation and closed cardiac massage;
D. Release airways of water, hold ventilation for Sylvester;
E. Immediately get brigade ambulance to its arrival – hold ventilation for Sylvester and closed cardiac massage.
13. Outside an old man suddenly collapsed. OBJECTIVE: the carotid pulse is absent, there is no visual breathing, dilated pupils not reacting to light. What should I do first?
A. Finger revision patency of the mouth and upper airway, artificial ventilation; B. Beat in precardiac area, check out the reaction of the pupils;
C. Follow whether the respiratory movements of the chest, finger revision patency of the mouth and upper respiratory tract;
D. Make ECG, finger revision patency of the mouth and upper respiratory tract;
E. Beat in precardiac area, finger revision patency of the mouth and upper respiratory tract.
14. On the sidewalk lying unconscious man 30 35 years. Objectively \: the pulse of the peripheral arteries is not defined, the carotid pulse is frequent, poor volume, breathing self – 20/hv. What action will be faithful?
A. Provide patient position on the side face down and call an ambulance;
B. Independently deliver the patient to the nearest hospital;
C. Perform cardiopulmonary resuscitation and call an ambulance;
D. Carry only the chest;
E. Wasting no time to call an ambulance.
15. The main remedy for treatment of the patient, who have carried strangulation asphyxia?
A. Prolonged mechanical ventilation;
B. Hormonal therapy;
C. Dehydratation therapy of;
D. Antishock therapy;
E. Sedative therapy.
16. The main objective of the first qualified (pre-medical) care is an except:
A. Diagnostics of urgent state (damage) of the patient or victim;
B. Immediate termination of the damaging factor (high or low temperature, electric current, bleeding, etc.);
C. Quickly perform medical practices that prevent the development of biological death (closed cardiac massage, ventilation, etc.);
D. The organization of an enabling environment and transport sick or suffering in medical treatment; E. Monitoring of cardiovascular and respiratory system.
17. Patient 27 years suffered from mechanical asphyxia, which developed as a result of compression of the trachea, blood vessels and nerve roots in the neck hanging. Objectively: marked cyanosis of the skin and mucosa, superficial and rapid breathing with auxiliary muscles, heart rate 140/hv., AT-170/110 mmHg What is the primary event emergency?
A. External cardiac massage;
B. Prednisone 60 mg / in jet;
C. Securing the airway;
D. Artificial ventilation;
E. Defibrillation.
18. Primary event in a patient with traumatic brain injury, lost consciousness, cyanosis, absence of pulse in the carotid artery:
A. Call to consult a neurologist;
B. Roentgenogram of skull;
C. ECG monitoring;
D. Cardiopulmonary cerebral resuscitation;
E. EEG.
19. When performing rescue operations in 2 working heating water and sewage services did not rise to the surface to control time. The team found the victims at the internal flow without gas masks in the unconscious. Breathing is an independent, cyanosis, convulsions, pupils constricted. Add appropriate amount of first aid in the car SHD.
A. Endotracheal mechanical ventilation;
B. Inhalation of oxygen by nasal cannula;
C. Ventilation by mask, intravenous corticosteroids;
D. Inhalation of oxygen, stimulation of respiratory medicine;
E. Stimulation of respiration by drugs.
20. While on the beach with 11 to 14 hours under the intense action of solar radiation a person unconscious. What could directly cause a reaction of the body?
A. Photochemical effects of solar radiation;
B. Photodermatitis of skin;
C. Sunstroke;
D. Erythema action of solar radiation;
E. Skin burns.
Methodical instruction made assistant professor RM Liakhovich
Discussed and approved at a meeting of
9 June 2013 Protocol № 10
