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Prehospital Life Support Manual
Kundan Mittal
CHAPTER 1:
Introduction
CHAPTER 2:
Assessment of Seriously Ill Adults
RECOGNIZING AT RISK
Approach to assess the seriously ill patient
Primary survey using ABCDE approach
Categorization of patients after initial assessment
CHAPTER 3:
Assessment of Seriously Ill Children
SUMMARY (FIG. 3.2)
CHAPTER 4:
Assessment of Seriously Injured
PRIMARY SURVEY
Components of primary survey or initial assessment
Airway and cervical spine immobilization
Breathing (ventilation and oxygenation)
Circulation and external bleeding control
Disability/Neurological
Exposure/Environment
General impression
Transport considerations
Secondary survey (indicated only in not load-and-go situations)
Detailed examination
Tertiary survey and Definitive care
Attention
Indicators of severity of trauma
Death
CHAPTER 5:
Monitoring
TYPES OF MONITORING
Clinical monitoring
Hemodynamic monitoring (invasive and noninvasive)
Monitoring of the patient on ventilator
Transport considerations
CHAPTER 6:
Basic Life Support Skills
REVERSIBLE CAUSES OF CARDIAC ARREST
Procedure
SUMMARY
CHAPTER 7:
Neonatal Resuscitation
INITIAL STEPS OF STABILIZATION AT BIRTH
Continue to evaluate
Positive pressure ventilation
When to stop PPV
If baby is not improving, suspect
Chest compression
Indications
Indications for Endotracheal intubation
Transport considerations
CHAPTER 8:
Airway and Cervical Spine
APPLIED ANATOMY OF AIRWAY
Difference between children and adult airway (Fig. 8.1)
Features of airway obstruction
METHODS OF MAINTAINING AIRWAY PATENT
1. Suctioning
procedure
2. Trauma jaw thrust (Fig. 8.3)
3. Trauma chin lift (Fig. 8.4)
4. Oropharyngeal airways
Indications
Procedure
5. Nasopharyngeal airway (NPA)
6. Manual resuscitator (self and flow inflating bags)
Indications
Equipments required for assisted ventilation with bag
Procedure
7. Laryngeal Mask Airway (LMA)
Equipment for LMA insertion
Preparation
Points to remember
CERVICAL SPINE IMMOBILIZATION
Pointers of cervical spine injury
Techniques of cervical spine immobilization
Manual inline stabilization
Application of Hard cervical collar (Fig. 8.23)
CHAPTER 9:
Oxygen Therapy
OXYGEN DELIVERY DEVICES
Points to remember
Low Flow devices
High flow oxygen delivery devices
Monitoring response to oxygen therapy during transport
CHAPTER 10:
Fluid Therapy
CHAPTER 11:
Management of Injured
MANAGEMENT
Principle of assessment
Resuscitation (Treat life threatening problems whenever identified)
THORACIC INJURIES
Clinical features suggestive of thoracic injuries
A. Tension pneumothorax
Features
Management
B. Open pneumothorax (sucking chest wound)
Features
Management
C. Hemothorax
Features
Management
D. Flail chest
Features
Management
E. Disrupted major airway
Features
Management
F. Cardiac tamponade
Features
Management
G. Pulmonary contusion
Features
Management
H. Myocardial contusion
I. Cervical spine injury
Evaluation of cervical spine injury
Management
Transport considerations
Pediatric considerations
Abdominal injury
Management
Musculoskeletal trauma
Management
Transport considerations
Care of Amputated Limb
Facial injury
Head injury
Transport considerations
Control of bleeding
Pain management in trauma victims
Golden principles of prehospital management (Golden period)
CHAPTER 12:
Cardiac Arrest
IMPORTANT CAUSES OF CARDIAC ARREST IN TRAUMA VICTIMS
Management
Pulseless arrest (Nontraumatic)
Etiology of Arrest
Shockable rhythm: Ventricular Fibrillation or pulseless ventricular tachycardia
Rhythm Not Shockable: Asystole or Pulseless electrical activity
SUMMARY
CHAPTER 13:
Medical Emergencies
SHOCK
Types of shock
Common causes of shock
Clinical features
Goals of management
Prehospital management
ACUTE CORONARY SYNDROME
Clinical presentation
Management
STATUS EPILEPTICUS
Management
Pediatric considerations
Transport considerations
ACUTE STROKE
Clinical Features
Management
ACUTE RESPIRATORY FAILURE
Etiology of respiratory failure
Clinical features
Management
RESPIRATORY ARREST
Management
CHAPTER 14:
Pediatric Emergencies
Shock
Classification and Etiology of shock
Physiology
Signs of shock in children
Recognizing different types of shock (Table 14.1)
General management of shock
Targets in shock
CARDIAC ARREST
Types of pediatric cardiac arrest
Management
RESPIRATORY DISTRESS AND FAILURE
Clinical features of hypoxia
Clinical features of hypercarbia (raised carbon Dioxide in blood)
Classification of respiratory problems on the basis of severity
Classification of respiratory illnesses by type
General management
UPPER AIRWAY OBSTRUCTION
Etiology
Clinical features
Management
LOWER AIRWAY OBSTRUCTION
Etiology
Clinical features
A. Acute bronchiolitis
B. Acute bronchial asthma
Clinical features
Treatment
PEDIATRIC AIRWAY MANAGEMENT
Stabilization of airway
Indications
Procedure
CHAPTER 15:
Thermal Injuries
CHAPTER 16:
Hypothermia
PATIENT IS NOT DEAD TILL HE/SHE IS WARM
Degree of hypothermia
Clinical features (primarily depend on degree of hypothermia)
Initial management of patient with hypothermia (no respiration and pulse)
Patient is breathing and having pulse
Transport considerations
CHAPTER 17:
Submersion Injury
CHAPTER 18:
Poisoning
SNAKE BITE
Clinical features (common to all types)
Prehospital measures
CHAPTER 19:
Obstetric Emergencies
CHAPTER 20:
Accident Scene Management
PRINCIPLES OF ACCIDENT SCENE MANAGEMENT
HELMET REMOVAL
Procedure for Helmet Removal
Evacuation of trapped victim in Road Traffic Accidents
Management
CHAPTER 21:
Infection Prevention
GENERAL MEASURES OF INFECTION PREVENTION
Hand wash
PERSONAL PROTECTION EQUIPMENT (PPE)
Environmental
Equipment
Standard precautions for all
Transport considerations
WASTE DISPOSAL IN AMBULANCE
CHAPTER 22:
Procedures
DEFIBRILLATION
PERIPHERAL VENOUS ACCESS
Equipment
Procedure
INTRAOSSEOUS NEEDLE INSERTION
Indication
Various sites for intraosseous Needle insertion
Equipment
Procedure
Complications
Contraindications
NASOGASTRIC TUBE INSERTION
Indications
Selection of size
Equipment
Procedure
GASTRIC LAVAGE
Equipment
Procedure
URINARY BLADDER CATHETERIZATION
Indications
Equipment
Procedure
Points to remember
Complications
DEVICE SELECTION
CHAPTER 23:
Communication Skills in Acute Care
COMMUNICATION TECHNIQUE
CHAPTER 24:
Transport Guidelines
TRANSPORT
Problems encountered during transport
Targets of safe transport
Conditions requiring transport
Adult
Newborn
Children
What can go wrong if transfer is not proper?
Adult
Newborn
Children
Problems related to equipments (common to all)
Miscellaneous
Level of care required during transport
Transport team's responsibility
What is essential before transfer?
Mode of Transport
Transport vehicle
Concerns during air transport
INTRAHOSPITAL TRANSPORT
Conditions requiring Intrahospital transport
SUMMARY OF TRANSPORT (FIG. 24.1)
CHAPTER 25:
Ambulance and Equipments
BASIC (MINIMUM)
ADVANCED
Extrication equipments
Drugs for Ambulance
Additional Drug
POINTS TO REMEMBER
Suggested Reading
INDEX
TOC
Index
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