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We have a person here who looks like he took a fall down the stairs. There were no bystanders around to give us an eye witness account of what happened exactly. We don't know if he hit his head, we don't know how many stairs he fell down, what we do know is he is lying at the base of a set of stairs, a flight of stairs and he appears to be in pain. So, what we are going to do is try to minimize the movement of the patient as we begin to inquire more about what may have happened and what's going on. Remember the whole point of doing it to figure out if we need to call 911 and get help on the way or whether this person is well enough to be able to get back into regular life and just kinda walk it out. May be that could happen, we know that real things have happened, and we mysteriously can escape without injury or harm, we don't know how but it happens, and then other times we have true injuries. So, this is kind of how it's going to look. I am not going to touch the patient, and I am immediately going to say, sir, I am Roy and I can help, I have been trained. I would like you not to nod your head, just answer me with yes or no or descriptions and then try not to move any part of your body, just in case you have broken bones or an injury, okay? Speaker 2: Okay. Speaker 1: Alright, I am looking over your head, I don't see any bleeding. I may now check in his ears and look for any blood coming out of either ear. I am looking in the mouth. Can you smile at me a little bit? There is no broken teeth that I can see, there is no blood coming from the nose. As I look into the pupils they seemed to be equal and responsive to light. You can also do that by putting your hand over and then bring it back and seeing if pupils react. If they don't this could indicate that they have a concussion, some swelling in the brain and that would be an immediate 911 call. Now, next he is able to talk to me which means he is breathing and awake and has a heart beat. So, we know that there are none of those three reasons to call 911 immediately. So, I am going to ask him a couple of questions. Sir, do you remember what just happened? Speaker 2: I was carrying some boxes down the stairs and I fell. Speaker 1: Okay, do you know if you hit your head? Speaker 2: I don't remember, I don't think so. Speaker 1: Do you know what day is today? Speaker 2: It's Tuesday. Speaker 1: Okay, and it's actually Friday, and do you know like what year it is? Speaker 2: 2001. Speaker 1: And he is incorrect and those two incorrect questions might lead me to think that he did hit his head, he may have lost or may not have lost consciousness, it really doesn't matter but that he may be suffering some altered mental status as a result of this fall. That's enough for me to say, you in the plaid shirt go call 911 and come back. I might need your help and bring an AED if you can find one. Now at the same time I am going to continue with open-ended questions. Now, what does that mean, it means I am not leading him to give me the answer I am looking for. So, I am just going to generally say, can you tell me what hurts right now? Speaker 2: My neck and my back really hurt. Speaker 1: Okay, so bad that you feel you can't move? Speaker 2: I can't move. Speaker 1: Okay, are you able to move your arms or you just trying to just help your back? Speaker 2: I can move them a little. Speaker 1: Can you wriggle your fingers then? Can you wriggle your toes? So, we are not seeing any paralysis per se which would be another thing that might lead to a spinal shock which will then get us thinking as a responder they could get pale, cool, sweaty, go unresponsive and we might need to do CPR because spinal cord injury. So, if we do see any signs of shock, we are going to cover him with a sheet, coat or blanket, and we are going to continue to re-assess the patient for airway, breathing or circulation problems. If at any time they begin to show problems with unresponsiveness, they are not breathing normally, or they are going to fore cardiac arrest, we are going to treat accordingly and wait for EMS to arrive. As a healthcare professional having to deliver CPR, a major complication can be when we suspect a neck injury with an unstable cervical spine. Now a modification of what we might do is use the modified jaw thrust which is the point of this training video. It needs to be used when we have a second rescuer so that we can apply both hands as we actually use the rescue mask with the one-way valve to seal the mouth and draw the jaw open which we will show you in just a minute. The scene would unfold like this, the scene is safe, gloves on hand, my rescue mask with a one-way mask is available. I call out to the patient, they do not respond. So, I place one hand on the forehead to remind me not to move their head and neck. I tap on the collar bone, they still do not respond. I go ahead and access EMS by calling 911. Hey you in the plaid shirt, go call 911 and come back, bringing AED with you when you come if you can find one. Now, I am going to assess for normal breathing and a carotid pulse. No more than ten seconds, there is no pulse and there is no breathing. I gonna begin CPR and call my healthcare professional partner with me. I now position myself at the head of the patient, if they are wearing glasses I am going to remove them. Speaker 3: One, two, three, four, five, six, seven, eight, nine... thirty. Speaker 1: And now for the important part of how we actually apply the mask with the modified jaw thrust. We are going to place the apex of the mask over the bridge of the nose and see all the bell part of the mask just below their bottom lip and above their chin. Now look, we are going to use both thumbs to actually push down on the mask and use our four fingers to actually grab the mandible or the jaw and pull the jaw up into the mask. The jawline or mandible actually comes down and then hooks at the back of the jaw and gives the actual leverage points that we are going to be using to pull that jaw up into the mask. Remember the goal is not to do a head-tilt chin-lift, we may have to do that if you are a lone rescuer but now we have two rescuers, so we are going to do it this way. As we pull the jaw up into the mask, we go ahead and give our rescue breath. First breath goes in, we get chest rise and fall. Second breath goes in, we get chest rise and fall, and we continue with CPR. We are going to continue this CPR using the modified jaw thrust and minimize cervical spine movement until help arrives and AED arrives or until the patient revives.
This section is about providing care for someone who has taken a fall or sustained a physical injury that may appear to include the spine, and how you should proceed in these situations. Before we get into the jaw thrust CPR technique, there are some other things to keep in mind first.
When you encounter a victim who appears to be immobile and in pain, you want to minimize their movement as much as possible, as you inquire more about what happened, how the patient is feeling, and whether or not you need to activate EMS.
If the victim is conscious, let them know who you are and that you're there to help. Instruct the patient to not move and avoid nodding, and to answer your questions verbally, as you continue to assess his or her condition.
Look specifically for head wounds and bleeding – from the head, nose, and ears. Check to see if the person has any broken teeth and if their pupils are responsive to light.
Pro Tip #1: To check for responsiveness to light, simply place one hand over the patient's eyes and then remove it. Do the pupils react? If not, the victim could have a possible concussion and swelling of the brain. If you suspect this to be the case, call 911 immediately.
Otherwise, if the victim is conscious, has a heartbeat, and is breathing normally, you may not have to call 911, at least while you continue to assess the situation. Some questions you should ask include:
Should the victim answer one of those last two questions incorrectly, you may be dealing with someone who may have an altered mental state, likely due to a head injury. Remember, if you suspect a head injury at any point during your evaluation, call 911 immediately.
Warning: If the patient is showing signs of paralysis, this could potentially lead to spinal shock. You may recall learning about the signs of shock in the bleeding control course material – pale, cold, sweaty, etc. If the patient does go into shock, this could lead to the patient becoming unresponsive and requiring CPR.
Pro Tip #2: If you see signs of shock, cover the patient with a blanket or coat. It's important to keep them warm while you continue to reassess for airway or circulation problems.
Should the patient become unresponsive or begin having trouble breathing normally, or go into full cardiac arrest, proceed with CPR using the jaw thrust technique to avoid any potential and/or further spinal injuries.
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me?
If you don't get an initial response, place your hand on the patient's forehead and tap on his or her collarbone, while also reminding yourself not to move the neck or head. If you still do not get a response, proceed with CPR as you normally would.
The purpose of the jaw thrust technique is to minimize cervical spine movement. It requires two responders. One should be positioned at the head of the patient, while the other begins chest compressions as you normally would.
When you get to the point of delivering two breaths into the rescue mask, proceed with the following steps:
Pro Tip #3: The jaw line goes down then hooks at the back of the jaw, providing the leverage points you'll be using to pull the jaw upward, into the mask.
Warning: Remember that you do not want to perform a normal head tilt, chin lift on a patient who you suspect may have a spinal injury. The only scenario when you would use the normal maneuver is if you are the lone responder and you have no choice.
When two responders are available, responder one should size up the scene and make sure it's safe, begin the primary patient assessment, and then begin chest compressions.
Responder two should call for help, get/find an AED, or prepare its readiness if you have one, while responder one continues with 30 chest compressions followed by two rescue breaths.
Continue this way until responder two is ready to jump in and take over or until the AED is ready to use.
When the AED is ready, responder one should move to the patient's head while responder two gets into a hovering position to perform chest compressions. Switch positions when the responder performing chest compressions becomes fatigued.
Pro Tip #4: The best time to switch positions is while the AED is analyzing the patient. Use an agreed upon term like switch, and make sure the responder doing the chest compressions is counting out loud so the other responder can anticipate the switch.