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Initial assessment (for soccorista)

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Street Medic Wikia (beta), the online resource for street medics that anyone can edit


This article needs work:

Specifically, it may contain irrelevant information, or may not be entirely appropriate to the medical realities of the soccoristas who will use it as a learning supplement.

Feel free to edit as you translate.


La evaluación inicial es una manera organizada de reconocer y responder a emergencias que amenazan la vida en una crisis. Puede tomar desde unos cuantos segundos hasta un minuto, y despues usted se quedará con el herido o lesionado hasta que llegue ayuda avanzada, o hasta que la persona y usted decidan que está bien que usted se vaya.

Respire hondo Edit

Imagine que uno de sus amigos se lesiona o se enferma de repente. O quizá usted es el primero en encontrar a una persona desmayada en una manifestación. ¿Qué hará? ¡Bueno, no tenga miedo! Respire hondo y piense.

Inspección de la escena Edit

Antes de acercarse, inspeccione la escena:

  • ¿Es segura?
  • ¿Cuanta gente necesita ayuda?
  • ¿Es peligroso? observe cosas como:
    • Fuego
    • Escombros cayendo
    • Estructura inestable
    • Policía avanzando
    • Multitud fuera de control
    • Trafico
  • ¿Cómo se acercará y cómo permanecerá seguro?

Elimine o preparese para daños potenciales para el enfermo o lesionado, para usted y para los testigos. ¡Trate de que lo que sea que le haya pasado a su amigo o camarada no le pase a usted también!

Precauciones universales / ASC (Aislamiento a Sustancias Corporales)

  • Mientras de cuidado de emergencia para otros, es importante que usted se proteja de enfermedades transmisibles por la sangre como VIH y hepatitis B o C. Use guantes de latex o de plástico si usted tiene que tocar sangre. Lo mejor es ponerselos siempre que tenga que dar cuidado de emergencia.
  • ¿No tiene guantes? una bolsa de plástico funcionará para un apuro. Dese cuenta que algunas personas son alérgicas al latex; es por eso que más y más proveedores están usando guantes de plastico (Nitrilo).
  • Recuerde, las enfermedades se pueden pasar mediante las respiraciones de rescate (resucitación boca-a-boca).

Use a la multitud para mover obstáculos, dirigir el tráfico, ir por ayuda, y tener un espacio seguro alrededor de la gente lastimada. Trate de hablar en una voz calmada para ayudar a que los demás estén calmados. Recuerde, la gran mayoría de la gente quiere ayudar.

Preséntese Edit

  • "Hola, soy fulano-de-tal. Sé algo de primeros auxilios.

Determine si la persona está alerta Edit

  • "¿Está usted bien?"
  • "¿Cuál es su nombre?"
  • "¿Sabe usted donde está? /¿Qué día es? /¿Qué pasó?"

Si la persona no responde a la conversación normal, grítele y de golpecitos en el hombro-- pero no agite a la persona, esto podría empeorar una lesión espinal o de cuello.

Si la persona no responde a la conversación, al grito o a los golpecitos:

  • Lleve a la persona a un hospital o centro de salud.
  • Si hay otra gente presente, mande cuanta gente pueda por ayuda. Dígales que regresen con ayuda, un coche, a que le digan a usted cuando va a llegar la ayuda. Si esa gente no llega rápido, mande más gente.
  • Mantenga la vía aérea de la persona abierta poniendo a la persona en posición lateral de seguridad (PLS).

Consiga el consentimiento Edit

Descubra si la persona va a aceptar su cuidado. Si ellos no quieren hablar o ser tocados por usted, o lo que sea, haga un esfuerzo para saber por qué y consiga alguna ayuda que ellos acepten.

Consentimiento

  • Siempre diga que va a hacer antes de tocar a la persona-- si es una emergencia, seguramente estarán asustados y depositan su confianza en usted. Es el cuerpo de la persona, y es correcto que la persona diga no a lo que sea.
  • But if you think their life is in danger, you have a responsibility to explain potential consequences, and to help them get care even if not directly from you.

Lo que usted descubra en la primera parte de la evaluación inicial afecta sus acciones en la segunda parte. Cuando usted haya inspeccionado la escena haya determinado que la persona está alerta, usted probablemente se dará una idea del mecanismo de lesión o enfermedad (MDL), que es una palabra rimbombante para denominar a la causa del problema. ¿Cree que la persona cayó? ¿la persona estaba en una riña? ¿la persona está borracha? preste atención.

Lo más importante que usted se debe preguntar antes de continuar es:

Basado en el MDL, ¿sospecha usted una lesión espinal? Edit

Sospechando lesión espinal

Si alguna parte de la columna vertebral está fracturada la médula espinal está en riesgo de ser pellizcada, aplastada, o cortada. La parte más crítica de la columna vertebral está localizada en la vertebra cervical (cuello). Actue como si la vertebra cervical está lastimada si la lesión involucra:

  • Cualquier lesión que deje a la persona inconsciente
  • Paradas repentinas con mucha fuerza (como un accidente de coche)
  • Caídas de altura
  • Lesiones resultado de zambullidas de altura
  • Trauma contuso al cuello

Si usted sospecha una lesión espinal, lleve a la persona a un centro de salud mientras sujeta la cabeza para mantenerla inmovil, y siga las precauciones espinales incluidas en el resto de esta información mientras usted completa su evaluación inicial.

Lleve a cabo el CAB Edit

Esto es una manera de checa las amenazas a la vida potenciales antes de actuar sobre un problema especifico. Desde el 2010, la Asociación Americana del Corazón (AHA, por sus siglas en inglés) hace enfasis en las compresiones toracicas, y ha cambiado el protocolo ABC, por CAB. Siempre evalue y trate los sistemas en su orden de prioridad. C está antes de A...

  • Compresiones (Circulación)
  • vía Aérea
  • Buena respiración
  • Discapacidad
  • Ambiente

C-- Circulación ¿Es necesario dar compresiones? Edit

Si la persona le hablo a usted de manera normal, la vía aerea está . Si la persona no habla y parece no respirar, de 30 compresiones presionando fuerte y rápido en el centro del pecho de la víctima.

Interventions to open the airway:

  • Manually open it with the head tilt/ chin lift (or with the jaw thrust if you suspect spinal injury)
  • Manually expel material with the Heimlich maneuver (if you know how)
  • If they are having an asthma attack, help them use their own inhaler and press the ping ch'uan points on their back
  • If they are having an allergic reaction, they may need an epinephrine (Adrenalin) injection immediately. A double dose of diphenhydramine (Benadryl)-- usually 4 capsules-- orally may buy time
  • Get the person to a health center at once
  • Keep their airway open by rolling them into recovery position

B-- is the person Breathing? Edit

If they can talk normally to you, they are breathing, right?If they didn't talk, and there seems to be no airway obstruction, but no breath is coming out or in, the problem might be with their breathing system.

Interventions to start breathing:

  • If they are in respiratory arrest (like from an overdose), try to keep them awake and breathing on their own by pinching their shoulder or earlobe
  • If you can't keep them breathing on their own, start rescue breathing if you know how. Remember BSI
  • get the person to a health center at once
  • Keep their airway open by rolling them into recovery position

C-- is their Circulation compromised? Edit

The circulatory system is contained within the heart and blood vessels. If the person is breathing, their heart is beating. Don't waste time taking their pulse unless you know how.

  • Look for bleeding. Remember that bulky clothing, sand, or rocks might disguise blood loss. Blood loss may also be internal. Even if you find one bleeding injury, keep looking-- there may be other hidden injuries that are more severe.
  • If they are pale, cool, and clammy, and if they are becoming less alert, consider that they may be entering shock.

Interventions to help the heart and stop bleeding:

  • If their heart is not beating, find someone who knows CPR and call 911
  • If the person says they are having a heart attack, help them take their own Nitro pills and get the person to a health center at once
  • To stop bleeding, Apply firm direct pressure to the injury. Use a sterile gauze pad, a clean cloth, clothing, or even your gloved hand if necessary. If the person is able, they can put pressure on their own injury. Elevate the injured area above the level of the heart
  • Don't lift the gauze or cloth to check if bleeding has stopped. This can dislodge the blood clot and make bleeding start again
  • Get the person to a health center at once for a bleeding emergency if:
    • Bleeding does not stop in about 15 minutes
    • A wound is spurting blood (this usually means an artery has been cut)
  • If they become light-headed, help them lie down and slightly elevate their feet. Keep them warm

D-- have they been Disabled? Edit

Any person who cannot think, move, or take care of themselves as they normally do-- or any person with a potential spinal injury-- is disabled.

  • Stay with them until they recover or help arrives.

Interventions to help:

  • If you suspect spinal injury, they should be kept still with calm words and hands on the head until help arrives. Get the person to a health center at once
  • If you suspect diabetic emergency, get them sugar and keep an eye on them, or if avalible, administer a glucagon injection
  • If they are scared or traumatized, sit with them, listen to them, and help them breathe; but be realistic about the limits of your care. Help them find further care if they want it
  • If they are intoxicated, keep an eye on them
  • Get the person to a health center if:
    • The person has MOI for spinal injury
    • The person does is unresponsive
    • Sugar does not help a diabetic to recover
    • The person presents a danger to self or others
  • Keep an unresponsive person's airway open by rolling them into recovery position

E-- have they suffered / will they suffer Exposure to a dangerous environment? Edit

While the environment in which you provide first aid might feel fine to you, pay attention to its effect on the sick or injured person.

  • Extremes of heat and cold can complicate any first aid, but cold exposure is more dangerous than heat. Any person with serious blood-loss, burns, or any injury that leaves them disabled needs to be kept warm and dry in all but the hottest of weather.

Think of other environments which can seriously hurt an injured or sick person. Remember that the purpose of initial assessment is to discover threats to a person's life, and protect against those first, before providing general first aid.

Interventions to protect a person from a dangerous environment:

  • If you can safely help someone leave a dangerous environment, do it. Negotiate with police, help them walk away, perform clothes-drag if appropriate. Only perform carries or BEAM if you are trained and it is necessary. Don't injure yourself!
  • Be careful not to move someone into another dangerous environment (like where help cannot find you, where you can get boxed in, in front of glass walls in a protest situation)
  • If the person is cold or could get cold, protect them from getting soaked with water. Pad under them and cover over them. Warm their hands and feet with your armpits if they want. Don't let yourself get too cold
  • Learn how to use any crowd or bystanders to provide privacy, safety, or other needed help

Document your care Edit

It is a good idea to keep notes about any problems you encounter in your initial assessment. Some medics put strips of duct tape on their pants and keep basic notes on it with permanent marker. They number their patients to maintain patient confidentiality, and take notes like this:

#1
19yo F w/(L) leg wound
"shot w/tear gas cannister"
A-- ok
B-- ok
C-- ok (minor bleeding (L) lower leg)
HR elevated w/i normal range
D-- difficulty moving w/o assistance
Pain 4 (out of 5) with pressure
E-- cold
Plan-- help her move inside warm bar, elevate leg, first aid, get to health center.

Many medics write their notes after they have completed initial assessment and basic first aid, so that they can give the person all their attention. Documentation is always important, and becomes more important the more assessment skills you know, and the longer the person will be in your care.

Re-assess as needed Edit

Signs for some life-threats take a while to show up. Keep an eye on the person while they are in your care. If they can talk, have a conversation. Not only is it good for their morale, but you can quickly assess changes in their level of alertness.

If the person's condition appears to change, assess again. Also, if you are going to be with the person a long time, assess them every few minutes, 15 minutes, hour, or few hours, depending on how injured or ill they are. Write down any changes for the better or worse.

Notes Edit

It can be hard to tell what's wrong. Breathing problems may be due to asthma or anaphylaxis. Confusion could be due to diabetes, dehydration, psychological stress, or a head injury. Act out of respect for anyone who trusts you with their infirmity, and harm no one.

This material is intended as a learning supplement. Reading this material is no substitute for first aid / medical training with a qualified trainer. We encourage you to pursue ongoing education, reviewing and upgrading your skills-- for the safety of both yourself and anyone you treat.

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