Students Manual for Emergency 2011

7/30/2019 Students Manual for Emergency 2011

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STUDENTS SKILL LAB MANUAL BOOK

EMERGENCY AND TRAUMATOLOGY SYSTEM

EMERGENCY AND TRAUMATOLOGY SYSTEM

MEDICAL FACULTY

HASANUDDIN UNIVERSITY

MAKASSAR

2011



AIRWAY MANAGEMENT

Definition: Freeing the airway to ensure the air exchanges normally both by manual or tools.

Learning Goals: after learning this manual the students are expected to have the ability to:1. Identify the airway’s disturbance

2. Free or open airway without any tools3. Free airway by using tools

4. Clean the airway5. Deal with the obstruction of the airway for both partial and total obstruction

Media and the learning tools:1. Student’s skill lab manual book emergency and traumatology system

2. Video and slide of the Airway Management Methods3. Children and adult mannequin dolls

4. Oropharyng tubes in all size5. Nasopharyng tubes in all size

6. Gloves

7. Dry Gauge8. Suction9. Stiff and flexible Suction tubes

Indication1. It is done to the unconscious patients in any cause

2. It is done to the patients with partial or total airway obstruction

Learning MethodProcedures demonstration that is performed based on the manual

Airway Management Activities Description

Activity Time Description

1. Introduction 5 minutes 1. Introduction, manage the students sitting position

2. Brief explanation of the work procedures, students role,and time allocation

2. Short demonstration of theairway management

technique by the instructor

10minutes 1. All students watch the airway management technique bythe instructor at the model

2. Brief discussion if there are problems that are lessunderstood

3. Practicing Airway

management technique

10minutes 1. One student as the assistant help to prepare all tools. Onestudent practices the airway management technique. Other students observe attentively and correct if there are any

mistakes.2. Instructor watches and guides the students if there any

mistakes in the practice.3. Instructor goes around among the students and supervises

using the checklist.

4. Discussion 10minutes 1. Discussion of the students’ impression toward the airwaymanagement practice: what is easy, what is hard?

2. The students give advice or correction on the practice that

day. The instructor listens and gives answers.3. The Instructor explains the general assessment on the practice: whether it runs nicely, or whether some students

need more practice. If possible, announce each of thestudents mark.

Total time 35minutes



LEARNING MANUAL

AIRWAY MANAGEMENT SKILLS

Steps/Activity InformationEarly Preparation

Check all tools

Diagnosis on airway disturbance

1. Look

Look at the breathing movement/ chest inflation and retraction between the ribs

2. ListenListen to the breathing sound

3. FeelFeel the airflow of breathing

Instructor explains and demonstrates the techniques

of how to assess the signs of airway disturbance

Opening the airway without tools

Head-tilt

Technique:

Put one hand on the patient’s forehead and push it so the head will beupward and the tongue support will be raised to the front

Chin lift

Technique:

Use the middle and the point fingers to hold the patient’s chin bone,then lift and push the bone to the front

Jaw thrust

Technique:Push the angle of the left and right jaws to the front until all the

inferior teeth are in line with the superior teeth. Or enter the mother finger in to the patient’s mouth and along with the other fingers pull

the chin to the front.

This technique is used to the patient with airway

obstruction because of the back fall of the tongue

Airway management with tools

A. Oropharynx tube

Installation technique:

1. Wear the gloves2. Open the mannequin/patient’s mouth with chin lift technique

or use the mother and point fingers3. Prepare the oropharynx tube which has the right size

4. Clean and moist the tube to make the tube is easy to beentered

5. Direct the curve facing the palatal6. Enter half of the tube, turn the curve facing under the tongue

7. Push the tube slowly to the right position8. Make sure the tongue is supported by the tube by looking at

the breathing pattern, feel and listen to the sound of breathingafter the installation.

B. Nasopharynx tube

1. Wear gloves

2. Evaluate the size of the nostrils with the tube that is going to beentered.



3. Evaluate the abnormality in the nasal cave.4. Smear the tube and the nostril that is going to be entered with

gel. If it’s needed, give vasoconstrictor inside the nose.5. Hold the tube with the position where the edge facing the ear.

6. Push the tube slowly until all of the tube enter the nose and

then evaluate the airflow in the tube.7. Fix the tube with tape/plaster.

Clearing the airway

1. Finger swab

Techniques :

a. Wear gloves b. Open the patients mouth with jaw thrust technique and

push the chin downward

c. Use two fingers (the pointer and middle fingers) whichare clean or folded by gloves or gauge to clean and pick all the foreign things inside the mouth.

2. With suction

Being done if there is any

foreign things inside the

mouth

Airway management in obstruction case by solid foreign

objectA. CHOKING

BACK BLOW / BACK SLAPS

Adult and conscious casualties

1. If the patient is totter, hold the patient from behind

2. One arm holding the body, the other arm does the

BACK- BLOW/ BACK SLAPS. Hold the patient and preventfrom falling

3. Give five hard blows/ slaps with your fist at the imaginary cross

lines of the vertebra and the scapula. If it fails, lay the patient slowlyin up position. Do the abdominal thrust.

ABDOMINAL THRUSTStanding/conscious adult patient

1. Hold the totter patient with your two arms from behind 2. Do the thrust, five times by pulling your two arms footing on

your two fists right at thrust point on the middle of theumbilicus and the processus xyphoideus of the patient.

If it fails, lay the patient in up position slowly. Do theabdominal thrust again.

ABDOMINAL THRUST

Lying/unconscious adult patient

1. If the patient is unconscious, lie the patient in up position.2. The helper takes the position like riding horse on top of the

patient’s body or beside the patient’s hip.3. Do pushing thrust five times by using your two arms footing

on the thrust point (epigastria area).



Make sure the foreign object has moved or out by:- Look inside the patient’s mouth, if it’s visible, take it

- If it’s not visible, blow air mouth to mouth while watch if the air enters the lung. If the chest inflates, it means that

the airway has opened

- In the contrary, if the air doesn’t enter it means that theairway is still obstructed, do ABDOMINAL THRUSTAGAIN, and so on

If it fails, think to prepare cricothyroidotomy followed by

tracheotomy.

Cricothyroidotomy

Definition

Performing puncture at cricothyroid membrane with large needle as a short cut for oxygenation

and ventilation on the breathing failure patient because of upper respiratory tract obstruction.

Learning Goals:

After this learning the students are expected to have the ability to:1. Conduct puncture at the cricothyroid membrane

2. Prepare the equipments that are needed in cricothyroidotomy3. Conduct the emergency airway management after the puncture of cricothyroid membrane

Learning media and tools:1. Student’s skill lab manual book emergency and traumatology system

2. Video and slide of cricothyroidotomy3. Mannequin dolls

4. Table or the place for instruments5. Gloves

6. Disinfectant liquid (alcohol, povidon iodine) and cotton7. Two Syringes of 12 cc

8. Lidocain 2 %9. Jet insufflations equipment : Y form tube, where one of the wholes is connected to the

oxygen and the aqualung10. Two IV polyurethane protective catheter sized 12 to 14

11. Sterile Gauge or sterile bandage

12. Antibiotic cream13. Plaster or fabric tape14. Washbasin for hand washing and antiseptic soap

Indications1. If there is a significant upper airway obstruction

2. If the attempt to give ventilation with bag-valve-mask has failed

Learning Method

Procedures demonstration that is performed based on the manual



Cricothyroidotomy Activities Description


1. Introduction 5minutes 1. Introduction, arrange the students sitting posit ion2. Brief explanation of working procedures, the students

role, and time allocation2. Short demonstration of

cricothyroidotomy by theinstructor

5minutes 1. All students watch the demonstration of

cricothyroidotomy by the instructor on the model2. Short discussion if there is something that is less

understood

3. CricothyroidotomyPractice

10minutes 1. One student as the assistant help preparing thecricothyroidotomy practice.

One student performs the cricothyroidotomy practice.The other students observe attentively and correct if the

practice is not perfect2. The instructor watches and guides the students in the

practice3. The instructor goes around the students and supervise

using the checklist

4. Discussion 10minutes 1. Discussion of the students’ impression toward the

cricothyroidotomy practice: what is easy and what ishard

2. The students give advice or correction toward the practice on that day. The instructor listens and gives

answers3. The instructor gives general explanation of the

cricothyroidotomy practice: is generally the practice

runs well, are there some students still need more practice. If it is necessary announce the mark for eachstudents


LEARNING MANUAL

CRICOTHYROIDOTOMY SKILL

Steps/Activities Annotation

Early preparation before installation

1. Check all the equipmentsConnect oxygen hose with one of the Y tube whole and make

sure the oxygen flows properly through the hose

2. Place the IV catheter sized 14 to the 12 cc syringe

Cricothyroidotomy Procedures

3. Disinfect neck area with antiseptic

4. Palpate cricoids membrane, at the anterior between thyroid and

cricoids cartilage. Hold the trachea with your thumbs and pointer finger so the trachea won’t move to the lateral in the

procedure

5. With the other hand (right hand) puncture the skin at themidline on top of cricoids membrane with big needle sized 12-14

which has been placed on a syringe. To easy the needle penetration, you can make small incision at the puncture point

with knife sized 11



6. Direct the needle 45 degrees to the caudal, then carefully penetrate the needle while sucking the syringe. If the air is

aspirated or there is bubble in the syringe which is filled withaquadest it means that the needle has entered the trachea lumen

7. Release the syringe from the IV catheter, than pull the mandrin

and push the catheter gently downward 8. Connect the end of the catheter with one of the end of the

oxygen hose with Y form

9. Scheduled ventilation can be done by closing one end of the

opened Y hose with your thumb for one second and open it for 4seconds. This procedure can last from 30 to 45 minutes

GIVING THE BREATHING AID

Definition: Giving the breathing aid with or without ant equipment to the breathing failure

patient in any cause.

Learning Goals: after this study the students are expected to have the ability to:1. Prepare the equipments that are needed to give the breathing aid

2. Give the breathing aid to the breathing failure patient without any equipments3. Give the breathing aid to the breathing failure patient with equipments

Learning Media and tools :

1. Skills lab students’ manual book of emergency and traumatology system2. Video and slide of airway management

3. Mannequin dolls of adult and children intubation4. Oropharyng tubes in any size

5. Orothracheal tubes in any size6. Nasotracheal tube in any size

7. Bag-valve-mask 8. Oxygen hose and oxygen tank

9. Laryngoscope handle and battery10. Laryngoscope leaves in any size and extra lamp

11. Plaster 12. Stethoscope

13. Endotracheal tube gel14. Local anesthetic spray for nasal

15. Semi rigid cervical collar 16. Magill forceps

17. Stylet (introducer) endotracheal tube that is flexible18. Tongue spatula

19. Hand gloves20. Dry Gauge

21. Suction22. Rigid and flexible suction tubes

Indication

It is done to the breathing failure patients

Learning Method




Activities descriptions of airway management


1. Introduction 5 minutes 1. Introduction, arrange the students sitting posit ion

2. Brief explanation of working procedures, the students

role, and time allocation2. Short demonstrationof the procedure of

giving the breathing aid by the instructor

10 minutes 1. All students watch the demonstration of the procedure of giving the breathing aid by the instructor on

the model2. Short discussion if there is something that is less

understood

3. Practice the

procedure of giving the breathing aid by the

instructor

10 minutes 1. One student as the assistant helps preparing the

equipments.One student performs the procedure of giving the

breathing aid. The other students observe attentively and correct if the practice is not perfect

2. The instructor watches and guides the students in the practice

3. The instructor goes around the students and superviseusing the checklist

4. Discussion 10 minutes 1. Discussion of the students’ impression toward thegiving the breathing aid practice: what is easy and what is

hard 2. The students give advice or correction toward the

practice on that day. The instructor listens and givesanswers

3. The instructor gives general explanation of the giving

the breathing aid practice: is generally the practice runswell, are there some students still need more practice. If itis necessary announce the mark for each students

Total time 35 minutes

LEARNING MANUAL

GIVING THE BREATHING AID SKILL

Steps/Activities Ket

Early PreparationCheck all the equipments

Bag-valve-mask Ventilation

1. Choose the mask size that is fit to the patient’s face2. Connect the oxygen hose to the bag-valve-mask and set the oxygen flow up to

12 L/minutes3. Make sure the patients airway is free and maintain it with the technique that has

been explain in the previous chapter 4. Install the oropharynx tube

5. The left hand hold the mask in the position where the mask tight to the face and

make sure there is no air that flow out from the mask when the bag is pumped.The right hand holds the bag and pumps it until the patient’s (doll) chest looksinflated.

6. For two helper : one helper hold the mask with two hands and the other helper hold the bag and pump it with two hands

7. The ventilation adequacy is evaluated by watching the movement of the patient’s (doll) chest

8. Ventilation is given in every 5 seconds



Orotracheal Intubation1. Make sure that the airway is free and the oxygenation still goes on

2. If the patient is still given the breathing aid with bag-valve-mask, give enough preoxygenation before performing the intubation

3. Pump up the endotracheal tube to make sure that the balloon is not leaked. If it is

not leaked, deflate the balloon4. Connect the laryngoscope leave to the handle and check the lamp light5. Hold the laryngoscope with the left hand

6. If the oropharynx tube is installed, put it of right away7. Enter the laryngoscope at the right side of the patient’s mouth and push the

tongue to the left8. Visually identify the epiglottis and then the vocal chord

9. Carefully enter the endotracheal tube in to the trachea without pressing the teethor the other tissue in the mouth

10. Pump up the balloon with the air from the syringe until there is no air is heard from the interspaces of endotracheal tube and the trachea

11. Connect the endotracheal tube with the bag-valve and then pump it whilewatching the chest inflation

12. Auscultate the left-right chest to check if the breathing sound is similar. Theabdominal auscultation to make sure the tube is correctly installed

13. Install the orotracheal tube and fixate the endotracheal tube to the mouth with plaster

NEEDLE THORACOCENTHESIS

Definition

Performing puncture toward the chest wall at the second intercostals in order to expel the air inthe pleura in the tension pneumothorax cases

Learning Goals:

After this study the students are expected to have the ability to:1. Perform the puncture at second intercostals

2. Prepare the equipments that are needed in performing the needle thoracocenthesis

Learning media and tools:

1. Skills lab students’ manual book of emergency and traumatology system2. Video and slide of needle thoracocenthesis

3. Mannequin dolls4. Table or the place for instruments

5. Gloves6. Disinfectant liquid (alcohol, povidon iodine) and cotton

7. Two Syringes of 12 cc8. Lidocain 2 %

9. Two IV polyurethane protective catheter sized 12 to 1410. Sterile Gauge or sterile bandage

11. NaCl 0,9%12. Washbasin for hand washing and antiseptic soap

Indication

In tension pneumothorax cases




Activities Description of Needle Thoracocenthesis


1. Introduction 5 minutes 1. Introduction, arrange the students sitting position2. Brief explanation of working procedures, the

students role, and time allocation

2. Short demonstrationof the needlethoracocenthesis

procedure by theinstructor

5 minutes 1. All students watch the demonstration of the procedure of needle thoracocenthesis by the instructor on the model

2. Short discussion if there is something that is lessunderstood

3. Practice the needlethoracocenthesis

procedure by theinstructor

10 minutes 1. One student as the assistant helps preparing theequipments for needle thoracocenthesis.

One student performs the needle thoracocenthesis procedure. The other students observe attentively and

correct if the practice is not perfect2. The instructor watches and guides the students in

the practice3. The instructor goes around the students and

supervise using the checklist

4. Discussion 10 minutes 1. Discussion of the students’ impression toward the

needle thoracocenthesis practice: what is easy and what is hard

2. The students give advice or correction toward the practice on that day. The instructor listens and gives

answers3. The instructor gives general explanation of the

needle thoracocenthesis practice: is generally the

practice runs well, are there some students still need more practice. If it is necessary announce the mark for each students


LEARNING MANUALNEEDLE THORACOCENTHESIS SKILL


Early preparation before installation

1. Check all equipments

2. Place IV catheter sized 14 to the 12 cc syringe that is filled with 5

ml water

Needle Thoracocenthesis Procedures

3. Disinfect the thorax area that is going to puncture with antiseptic

4. Identify the second intercostals area at the middle of clavicle. If the patient is conscious inject the local anesthetic

5. Puncture the needle that is connected to the syringe at the upper part

of the third Costa until the air is expelled signed by the appearance of the bubble at the syringe

6. Reevaluate the patient breathing if there is improvement or not



CARDIO PULMONER RESCUCITATION

Definition: Performing external heart massage to manage the condition of breath stop and heart

stopLearning Goals: after this study the students are expected to have the ability to:

1. Perform the resuscitation to the breath stop patient2. Perform the external heart massage to the heart stop patient

Learning media and tools:1. Skills lab students’ manual book of emergency and traumatology system

2. Video and slide of needle thoracocenthesis3. Adult and children mannequin dolls

Indication

Being done to the breath stop and/or heart stop patient in any cause


CPR activities description


1. Introduction 5 minutes 1. Introduction, arrange the students sitting position

2. Brief explanation of working procedures, thestudents role, and time allocation

2. Short demonstrationof the CPR procedure by

the instructor

10 minutes 1. All students watch the demonstration of the CPR procedure by the instructor on the model

2. Short discussion if there is something that s lessunderstood

3. Practice the CPR procedure by the

instructor

10 minutes 1. One student as the assistant helps preparing theequipments for CPR.

One student performs the CPR procedure. The other students observe attentively and correct if the practice

is not perfect2. The instructor watches and guides the students in

the practice3. The instructor goes around the students and

supervise using the checklist

4. Discussion 10 minutes 1. Discussion of the students’ impression toward the

CPR practice: what is easy and what is hard

2. The students give advice or correction toward the practice on that day. The instructor listens and givesanswers

3. The instructor gives general explanation of the CPR practice: is generally the practice runs well, are there

some students still need more practice. If it isnecessary announce the mark for each students




LEARNING MANUAL

CARDIOPULMONER RESCUCITATION


Early preparation

Check all equipments

Demonstration by one helper1. Arrange the patient’s position and put the patient on the hard base2. For the unconscious patient, make sure the patient is unconscious by calling, clapping

the patient’s back, shaking, or pinching the patient3. Ask help immediately by shouting without leaving the patient

4. Check if the patient is breathing5. If the patient is not breathing, open and free the airway

6. Recheck if the patient is breathing after opening the airway7. If there is no breathing or the breathing is difficult, give two breathing aid, slow and

full while watching the chest inflation8. Feel the carotid pulse

9. If you can’t feel it, perform external heart massage 30 times at the base point which istwo fingers above the processus xyphoideus. Then continue with giving two blows of

breathing aid 10. Put one hand at the pressure point, the other hand is on top of the first hand

11. Both arms are straight and vertical at the sternum. Both of the helper’s knee is closeto each other, and stick to the patient’s arm

12. Press downward 4-5 cm for adults, by dropping the weight to the patient’s sternum.13. Compress rhythmically and regularly 100 times/minute. Evaluate at the breathing,

pulse, consciousness, and pupil reaction every end of the fifth cycle

14. If the breathing and the pulse are still can’t be felt continue the CPR until the patientis recover

Demonstration by two helper

1. Step 1-14 above are still performed by the first helper until the second helper comes2. When the first helper makes the evaluation, the second helper takes the position for

heart massage3. If the pulse is still can’t be felt, the first helper gives two times breathing aid slowly

until the chest is inflated, followed by the second helper giving 30 times of heartmassage

PERIPHERAL VEIN CANULATION

DefinitionPerforming puncture at the superficial vein at the arms, feet, neck, or head using intravenous

catheter as indicationLearning Goals: after this learning the students are expected to have the ability to:

1. Know the indication of canulation intravenous catheter (infuse)2. Explain the objectives of the canulation and the procedure to the patient

3. Prepare the equipments which are needed for canulation4. Perform the vein canulation in the right way

5. Fixate the vein catheter in the right way

Learning media and tools:

1. Skills lab students’ manual book of emergency and traumatology system2. Video and slide of vein canulation

3. Mannequin dolls and vein replacement kit and advanced vein puncture and injectionarm

4. Tourniquet5. Gloves

6. Syringe of 1 cc7. Lidocain 2 %



8. Infuse set or transfuse set9. IV polyurethane protective (in any size for adult and children)

10. Sterile Gauge or sterile bandage11. Antibiotic cream

12. Plaster

13. Washbasin for hand washing and antiseptic soap

Indication

1. For giving fluid 2. As access for intravenous drugs

3. A part of resuscitation action4. Plan for operation

5. Nutrition giving via peripheral parentheral

Learning Method


Peripheral vein canulation’s activities description


1. Introduction 5

minutes

1. Introduction, arrange the students sitting position

2. Brief explanation of working procedures, the studentsrole, and time allocation

2. Short demonstration of

the peripheral vein

canulation procedure by theinstructor

5

minutes

1. All students watch the demonstration of the procedure

of peripheral vein canulation by the instructor on the model2. Short discussion if there is something that is less

understood

3. Practice the peripheral

vein canulation procedure

by the instructor

15

minutes

1. One student as the assistant helps preparing the

equipments for peripheral vein canulation.One student performs the peripheral vein canulation

procedure. The other students observe attentively and correct if the practice is not perfect

2. The instructor watches and guides the students in the practice

3. The instructor goes around the students and supervise

using the checklist4. Discussion 10

minutes

1. Discussion of the students’ impression toward the peripheral vein canulation practice: what is easy and what

is hard 2. The students give advice or correction toward the

practice on that day. The instructor listens and givesanswers

3. The instructor gives general explanation of the peripheral vein canulation practice: is generally the practice

runs well, are there some students still need more practice.If it is necessary announce the mark for each students




LEARNING MANUAL

PERIFER VEIN CANULATION

ACTIVITIES DESCRIPTION

Preparation

1. Check the patient’s medical record or status card (

search for diagnose, allergic histories, blood abnormalities, etc.)

2. Check all of the equipments Check if the transfusion set is connected to thesolution bag

Make sure there is no air bubble in thetransfusion set

Provide 3 different catheter size intravenous )that may match to the patient

3. Explain the procedure to the patient and his or her

family

Create a pleasant atmosphere in the room bymaking kind and friendly greetings, or either by

shaking hands and give a slight and friendlytouch to your patient if necessary. .

Intravenous catheter manual

4. Identify the veins that will be suitable to insert a

catheter

Choose the most distal vein than the proximal

ones.Better to choose extremities that are not

dominantSearch for dorsal manus area

Do not insert the catheter in antecubiti areas

5. Wash hands with antimicrobial soap

6. Use the handgloves

7. Insert the tourniquette If needed, an assistant will be helpful toimmobilize the patient.

Force the veins towards the distal direction or set the patient’s arm in a position where the arm

is lower than the cardiac level. Place thetourniquette in the middle part of the arm

between the wrist and elbow ) or either in thelower part of the leg. Do not place the

tourniquette forcely or either too gently.If rubber band is used as a tourniquette, not tie

it as a “dead lock”. The tie knot should be ableto be easily untied.

If the tourniquiette is already placed but veinsare not to be visible yet, a mild tapping on the

veins using your hands or placing a warm towelwould help to dilate the veins.

8. Cleanse the place of nsertiion with desinfektan (

alcohol ) and let it dry by itself.

After cleansing, ”no touch ” should be kept in

mind.

9. Left arm should hold the area beneath the injectionarea, use the thumb to stabilize the veins and soft

tissue.

If the injection area is to be the dorsal manusarea, the patient can be asked to hold tight its

arm.

10. Do a local anesthetic injection in the injection area

using a small needle ( 30 gauge needle/1ccdisposable a local anesthetic cream If availabe in

advanced, a local anesthetic cream can be used



(EMLA)

11. Place the bevel catheter i.v. in a upward position, between the point finger and the thumb.

12. Hold the catheter in a 45 degree position, just abovethe skin towards the vein but not yet penetrating

the vein.

Approaches that can be done in penetrating thevein :

Central : penetrate straight to the vein.This is not a very good approach becausewhenever the penetration is far too deep, it

could harm the tissue beneath the veincausing extravacation.

Paraveins : penetrate the vein from its side part first, then direct the needle intowards

the vein. This is the best way to penetrateinto the vein.

13. Place the catheter lower than or just as in one levelwith the skin surface dan move the needle tip to

pass it althrough the vein.14. Force the catheter slowly into the vein, make sure

there is a venous return flow

If there is a resistant sensation, and followed

quickly by a smooth penetration, it means thatthe catheter is already placed inside the vein.

15. Force the catheter with its mandrin about 3-5 mminto the vein to make sure the catheter in placed

inside the vein’s lumen.

How far the force goes depends on the size and depth of the veins and the catheter’s size.

16. Pull the mandrin out, push the catheter till the end

of the catheter touches the skin surface.

Do not re-insert the mandrin into the catheter

because it could tear up the catheter.

17. Dispose the used mandrin using the catheter’swrap/plastic wrap.

Be sure that the mandrin is wraped inside thecatheter plastic bag/wrap until you hear a

”click” and dispose it carefully in a safe place18. Release the tourniquette

19. Connect the catheter to the infuse/transfusion set If available, connect it with a three way stopcock.

20. Let the saline fluid / i.v. fluid pass through, cleanany blood residuals and then dry it with a sterilized

gaus so the band aid will attach firmly.

I.V. Catheter Fixation

21. Attach one band aid 5mm in width, direct the endsto form the letter “V” just beneath the catheter

origin so it would close the surface where the

catheter was inserted.

Use two band aids, one for catheter fixationintravenously, and the other to fixate the

transfusion set. The length of the band aid is

about 15-20 cm long, not too wide nor toonarrow. ( width 0.5 mm ). Fixation should formthe letter “V”, in a way where it wouldn’t

detached easily. -

22. Attach one band aid to fixate the infuse or transfuse

set by forming the letter “V”

Do not manipulate the transfusion pipe/set

before fixating it to the skin surface, for it maycause difficulties whenever an injection through

the transfusion set is needed afterwards.

Post fixation

23. Immobilized the extremities wih ada board if there

is any indication. For example : when inserted ininfants, children and joint areas

Do not use gause or any other material as a

band in any insertion areas.

24. Instruction for patients :

Avoid any unnecessary movements.

Call for the nurse/doctor as soon as possible

whenever there is a swelling, pain or leakagefrom the insertion.



25. Labelize the gause with date of insertion, size of catheter and the inisial of the name who inserted it.

26. Write down in the patient’s medical record about :

Date of insertion

Catheter size

Initials of names who inserted the catheter Place of insertion

Patient’s tolerance and respond to thetherapy



PENUNTUN BELAJAR

KETERAMPILAN RESUSITASI PADA BAYI BARU LAHIR

Langkah-langkah/Kegiatan KeteranganPersiapan awal

Periksa semua kelengkapan alat

Langkah awal1. Letakkan bayi di bawah pemancar panas yang telah dinyalakan

sebelumnya.2. Letakkan bayi dengan kepala sedikit tengadah/sedikit ekstensi.

3. Hisap mulut kemudian hidung4. Keringkan tubuh dan kepala dari cairan amnion

5. Singkirkan kain basah.6. Perbaiki posisi kepala bayi agar leher agak tengadah.

Buka jalan napas1. Bersihkan mulut dan hidung bayi dengan penghisap.

2. Posisikan bayi terlentang, kepala posisi tengadah jangan melakukanekstensi yang berlebihan

3. Berikan ganjal punggung dengan kain setebal 2.5 cm bila kepala bayi besar atau occiputnya menonjol.

4. Jika pernapasan dangkal atau tersengal-sengal segera hisap lendir mulai dari mulut kemudian hidung. Pengisapan jangan terlalu lama

(6 detik).5. Evaluasi pernapasan, frekuensi jantung, dan warna kulit.

6. Jika ketuban keruh atau bercampur meconium kental bila bayimenunjukkan usaha napas yang baik, tonus otot yang baik, dan

frekuensi jantung lebih dari 100 kali/menit, anda cukupmembersihkan sekret dan mekonium dari mulut dan hidung dengan

menggunakan balon penghisap yang biasa digunakan atau kateter penghisap berukuran 12F atau 14F.

Rangsangan taktilCara rangsang taktil yang aman :

1. Menepuk / menyentil telapak kaki2. Menggosok punggung/perut/dada/ekstremitas

Evaluasi kondisi bayi1. Nilai pernapasan bayi dengan melihat pengembangan dada dan

warna kulit. Dengaran suara napas di seluruh lapangan parudengan stetoskop.

2. Nilai denyut jantung dengan mendengar irama jantung denganstetoskop. Hitung frekwensi denyut jantung

3. Nilai warna kulit apakah kemerahan/sianosis perifer atau sianosissentral.

Pemberian napas bantu1. Jika pernapasan tetap tersengal atau apnu setelah rangsangan

singkat, segera berikan pernapasan buatan atau ventilasi tekanan positif dengan oksigen 100 %.

2. Posisikan kepala bayi sedikit ekstensi atau ganjal bahu3. Bersihkan sekret terlebih dahulu dan pastikan jalan napas bersih.

4. Pasang pipa orofaring5. Letakkan sungkup di wajah bayi dengan rapat agar tidak bocor

melalui sisi sungkup6. Berikan tekanan positip melalui bag-valve-mask (ambubag) dengan

lembut sambil melihat pengembangan dada bayi.



7. Selanjutnya evaluasi lagi pernapasan dan denyut jantung secarasimultan.

8. Bila ventilasi tekanan positip tidak efektif dapat dilakukan intubasiendotrakeal.

Pijat Jantung (penekanan dada)

1. Indikasi pijat jantung bila setelah 30 detik dilakukan VTP dengan100% O2 , FJ tetap < 60 kali / menit

2. Diperlukan 2 orang : 1 orang yang melakukan pijat jantung dan 1orang yang terus melanjutkan ventilasi.

Pelaksana kompresi : menilai dada & menempatkan posisi tangandengan benar

Pelaksana ventilasi : menempatkan sungkup wajah secara efektif &memantau gerakan dada.

3. Penekanan dada dilakukan pada sepertiga bagian tengah sternum,dibawah garis imajiner yang menghubungkan papilla mammae.

4. Teknik ibu jari :

1.Kedua ibu jari menekan tulang dada2.Kedua tangan melingkari dada dan jari-jari tangan menopang bagian belakang bayi

5. Teknik dua jari :

1.Ujung jari tengah dan jari telunjuk atau jari manis dari satu tangandigunakan untuk menekan tulang dada

2.Tangan yang lain digunakan untuk menopang bagian belakang bayi.6. Lokasi untuk kompresi dada :

• Gerakkan jari sepanjang tepi bawah iga sampai mendapatkan sifoid • Letakkan ibu jari atau jari-jari lain pada tulang dada, tepat diatas

sifoid dan pada garis yang menghubungkan kedua puting susu.

7. Tekanan saat kompresi dada :• Kedalaman + 1/3 diameter antero-posterior dada• Lama penekanan lebih singkat dari pada lama pelepasan

• Jangan mengangkat ibu jari atau jari-jari tangan dari dada di antara penekanan.

8. Frekuensi : ”satu-dua-tiga-pompa-...”Satu siklus kegiatan terdiri atas tiga kompresi + satu ventilasi.

Rasio 3 :11 siklus ( 2detik) 1½ detik : 3 kompresi dada

½ detik : 1 ventilasi 90 kompresi + 30 ventilasi dalam 1 menit

9. Setelah 30 detik kompresi dada dan ventilasi , periksa frekuensi jantung. Jika frekuensi jantung :

a. Lebih dari 60 kali/menit, hentikan kompresi dan lanjutkanventilasi dengan kecepatan 40-60 kali pompa/menit.

b. lebih dari 100 kali/menit, hentikan kompresi dada dan hentikanventilasi secara bertahap jika bayi bernapas spontan.

c. kurang dari 60 kali/menit, lakukan intubasi pada bayi jika belumdilakukan, dan berikan epinefrin, lebih disukai dengan cara intravena.

Intubasi menyediakan cara yang lebih terpercaya untuk melanjutkanventilasi



RESUSITASI BAYI DAN ANAK

Pengertian : Melakukan resusitasi bayi dan anak akibat gawat napas dan sirkulasi.

Tujuan pembelajaran : setelah pembelajaran ini mahasiswa diharapkan :1. Mampu melakukan penilaian kegawatan napas dan sirkulasi

2. Mampu melakukan resusitasi bayi dan anak yang mengalami gangguan pernapasan yangmengancam jiwa

3. Mampu membebaskan dan membersihkan jalan napas pada bayi dan anak.

4. Mampu memberikan napas bantu pada bayi dan anak yang tidak bisa bernapas/apnu.5. Mampu melakukan pijatan jantung luar pada bayi dan anak yang mengalami henti

jantung.

Media dan alat pembelajaran:1. Buku panduan peserta skill lab sistim emergensi dan traumatologi

2. Boneka manikin bayi dan anak.3. Pipa orofaring ukuran bayi dan anak.



4. Kateter penghisap5. Masker resusitasi

6. Balon resusitasi tipe mengembang sendiri7. Balon resusitasi tipe tidak mengembang sendiri

8. Pipa lambung (gastric tube)

9. Pipa endotrakeal no. 3.0 – 7,0Indikasi1. Dilakukan pada bayi dan anak yang mengalami sumbatan jalan napas

2. Dilakukan pada bayi dan anak yang tidak bernapas/apnu.3. Dilakukan pada bayi dan anak yang mengalami henti jantung.

Metode Pembelajaran

Demonstrasi kompetensi sesuai dengan penuntun belajar

Deskripsi kegiatan resusitasi bayi dan anak.

Kegiatan Waktu Deskripsi1. Pengantar 5 menit 1. Perkenalan, mengatur posisi duduk

mahasiswa2. Penjelasan singkat tentang prosedur

kerja, peran masing-masing mahasiswadan alokasi waktu.

2. Demonstrasi singkat

tentang cara resusitasi

bayi dan anak oleh

instruktur.

10 menit 1. Seluruh mahasiswa melihat demonstrasi cararesusitasi bayi dan anak oleh Instruktur pada

model2. Diskusi singkat bila ada yang kurang

dimengerti.

3. Praktek cara resusitasi

bayi dan anak.

10 menit 1. Satu orang mahasiswa mempraktekkan cararesusitasi bayi dan anak. Mahasiswa lainnya

menyimak dan mengoreksi bila ada yang kurang.2. Instruktur memperhatikan dan memberikan

bimbingan bila mahasiswa kurang sempurnamelakukan praktek.

3. Instruktur berkeliling diantara mahasiswadan melakukan supervisi menggunakan

ceklis/daftar tilik.

4. Diskusi 10 menit 1. Diskusi tentang kesan mahasiswa terhadap

praktek cara resusitasi bayi dan anak: apayang dirasa mudah, apa yang sulit.

2. Mahasiswa memberikan saran atau koreksitentang jalannya praktek hari itu. Instruktur

mendengar dan memberikan jawaban.3. Instruktur mejelaskan penilaian umum

tentang jalannya praktek resusitasi bayi dan anak :apakah secara umum berjalan baik,

apakah ada sebagaian mahasiswa yangmasih kurang. Bila perlu mengumumkan

hasil masing-masing mahasiswa.

Total waktu 35 menit



PENUNTUN BELAJAR

KETERAMPILAN RESUSITASI PADA BAYI DAN ANAK

Langkah-langkah/Kegiatan Keterangan

Persiapan awal

Periksa semua kelengkapan alat

RESUSITASI

Pendekatan ’SAFE’

Shout for help ( minta tolong)

A pproach with care (tangani dengan hati-hati)

Free from danger (jauhkan dari bahaya)

Evaluate ABC (nilai jalan nafas, pernafasan, sirkulasi)

Tatacara meminta pertolongan:

1. Bila hanya 1 org penolong, lakukan bantuan hidup dasar

dulu, baru kemudian meminta bantuan

2. Bila penolong tidak dapat meminta pertolongan, teruskan

resusitasi sampai tiba penolong lain atau sampai kelelahan.

3. Bila ada 2 penolong, penolong pertama melakukan

resusitasi, penolong kedua mencari bantuan

4. Yang meminta bantuan menyebut lokasi, nomor telpon,

jenis kejadian, jumlah korban, pertolongan yg telah

diberikan dan informasi lain yg dibutuhkan.

Penilaian sistem kardiovaskuler

A. Airway = jalan nafas

Instruktur menjelaskan dan

memperagakan bagaimana

menilai tanda-tanda adanya

gangguan sistem kardio

vaskuler.

SAFE approach

Are you alright?

Airway opening manoeuver

Look, listen, feel

Up to 5 breaths

Check pulse

Start CPR 1 minute

Call emergency services



– Dapat dipertahankan tanpa alat atau memerlukan alat

bantu jalan nafas

B. Breathing = Pernafasan

- Frekwensi

- Gerak nafas (retraksi, merintih, cuping hidung, otot bantu

nafas)

- Aliran udara pernafasan (pengembangan dada, suara nafas,

stridor, wheezing/mengi, gerakan paradoks)

– Warna kulit (ada atau tidaknya sianosis)

C. Circulation = sirkulasi

- Frekwensi jantung, denyut sentral, denyut perifer

tekanan darah.

- Perfusi kulit (capillary refill time, suhu, warna kulit,

kulit berbercak (mottling)

- Perfusi SSP

- Reaksi Kesadaran (AVPU= Alert, Respon to Verbal,

Respon to Pain, Unresponsive) (mengenal org tua,

tonus otot, ukuran pupil, postur

(dekortikasi/deserebrasi)

Penilaian dilakukan tidak lebih dari 30 detik

JALAN NAFAS (AIRWAY)

1. Tentukan derajat kesadaran dan kesulitan nafas

a. Periksa tanda cedera kepala, leher, kesulitan pernafasan &

kesadaran. Bila ada cedera kepala jangan mengguncang

bayi atau anak karena dapat merusak medula spinalis.

b. Bila bayi dan anak tidak sadar tapi bernafas baik,

letakkan pada posisi pulih (recovery position)

c. Bayi dan anak sadar dengan kesulitan bernafas, letakkan

pada posisi senyaman mungkin yg memudahkan

bernafas.

2. Mintalah bantuan

3. Atur posisi korban

a. Letakkan dengan posisi terlentang diatas dasar yg rata

dan keras

b. Bila ada cedera kepala/leher pertahankan posis tubuh-

leher-kepala dalam satu garis. Hindari ekstensi, fleksi dan

rotasi kepala karena dapat mencederai medula spinalis.

c. Memindahkan ke tempat lain, posisi tubuh-leher-kepala,



harus dalam satu garis kesatuan

4. Membuka jalan nafas

- Bila tidak ada cedera kepala dengan cara head tilt atau

chin lift

Head-tilt/chin lift

Cara melakukan:

1. Letakkan satu tangan pada dahi tekan perlahan ke posterior,

sehingga kemiringan kepala menjadi normal atau sedikit

ekstensi (hindari hiperekstensi karena dapat menyumbat

jalan napas).

2. Letakkan jari (bukan ibu jari) tangan yang lain pada tulang

rahang bawah tepat di ujung dagu dan dorong ke luar atas,

sambil mempertahankan cara 1.

- Bila tidak sadar dan ada cedera kepala dengan cara jaw

thrust

Cara melakukannya:

1. Posisi penolong di sisi atau di arah kepala

2. Letakkan 2-3 jari (tangan kiri dan kanan) pada masing-

masing sudut posterior bawah kemudian angkat dan dorong

keluar.

3. Bila posisi penolong diatas kepala. Kedua siku penolong

diletakkan pada lantai atau alas dimana korban diletakkan.

4. Bila upaya ini belum membuka jalan napas, kombinasi

dengan head tilt dan membuka mulut (metode gerak triple)

5. Untuk cedera kepala/ leher lakukan jaw thrust dengan

immobilisasi leher.

PERNAFASAN ( BREATHING)

1. Nilai usaha nafas dengan melihat gerak nafas, dengar desah

nafas, dan rasakan aliran udara pernafasan

2. Caranya

a. Pasang sungkup dengan ukuran sesuai umur sehingga

menutup mulut dan hidung, lalu rapatkan

b. Sambil mempertahankan posisi kepala (jalan nafas)

lakukan tiupan nafas buatan dengan mulut atau balon

(bag) resusitasi.

c. Bila dgn mulut, tarik nafas dalam, tiup dan liat

pengembangan dada. Bila tetap tdk mengambang



kemungkinan obstruksi jalan nafas.

3. Frekuensi nafas buatan yg dilakukan:

- Bayi - < 8 thn : 20 kali permenit

- Neonatus : 30 – 60 kali permenit

SIRKULASI DARAH (Circulation)

Penilaian sirkulasi : setelah 2-5 kali nafas buatan

Tempat penilaian : bayi baru lahir : arteri umbilikus

bayi : arteri brakhialis

anak : arteri karotis

Indikasi pijat jantung : bradikardia ( <60x/m atau henti jantung )

Lokasi pemijatan : 1/2 bagian bawah tulang dada (sternum)

dengan kedalaman pijatan 1/3 tebal dada.

Cara :

- Bayi: pijatan dilakukan dengan teknik ibu jari atau dua jari

(telunjuk dan jari tengah)

Teknik ibu jari :

1.Kedua ibu jari menekan tulang dada

2.Kedua tangan melingkari dada dan jari-jari tangan

menopang bagian belakang bayiTeknik dua jari :

1.Ujung jari tengah dan jari telunjuk atau jari manis dari satu

tangan digunakan untuk menekan tulang dada

2.Tangan yang lain digunakan untuk menopang bagian

belakang bayi.

- Anak < 8 tahun : dengan pangkal telapak tangan

- Anak > 8 tahun : pangkal telapak tangan terbuka dan dibantu

dengan tangan yang satu diatasnya.

Frekuensi pemijatan :

- Bayi dan anak : 100 kali permenit

- Neonatus : 120 kali permenit

Koordinasi antara pijat jantung dan nafas buatan:

- Neonatus : 3 : 1

- Anak : Dua penolong : 15 : 2

Satu penolong : 30 : 2



SUMBATAN JALAN NAFAS

Teknik pukulan dan hentakan

Bayi dan anak kecil

1. Letakkan bayi dengan posisi tertelungkup kepala lebih

rendah. Diatas lengan bawah, topang dagu dan leher dengan

lengan bawah dan lutut penolong.

2. Tangan lainnya melakukan pukulan punggung diantara

kedua tulang belikat secara hati-hati dan cepat sebanyak 5

kali pukulan.

3. Balikkan dan lakukan hentakan pada dada sebagaimana

melakukan pijat jantung luar sebanyak 5 kali.

4. Pada neonatus tidak boleh melakukan cara diatas, hanya

dilakukan dengan alat penghisap (suction)

Pada anak lebih besar :

1. Pukulan punggung dilakukan 5 kali dengan pangkal tangan

diatas tulang belakang diantara kedua tulang belikat. Jika

memungkinkan rendahkan kepala di bawah dada.

2. Hentakan perut (Heimlich maneuver dan abdominal thrust).

Cara: Penolong berdiri di belakang korban, lingkarkan

kedua lengan mengitari pinggang, peganglah satu sama lain

pergelangan atau kepalan tangan (penolong), letakkkan

kedua tangan (penolong) pada perut antara pusat dan

prosessus sifoideus, tekanlah ke arah abdomen atas dengan

hentakan cepat 3-5 kali. Hentakan perut tidak bolehdilakukan pada neonatus dan bayi.

Teknik ini digunakan pada

penderita sumbatan jalan

napas akibat lidah yang jatuh

ke belakang



Resume Resusitasi Anak

Maneuver Dewasa dan

anak besar

Anak kecil Bayi Neonatus CPR/Resc

Breathing

> 8 tahun 1-8 tahun < 1 tahun Bayi baru lahir

Airway Head tilt-chin

lift (jika trauma

jaw thrust)

Head tilt-chin

lift (jika trauma

jaw thrust)

Head tilt-chin

lift (jika trauma

jaw thrust)

Head tilt-chin

lift (jika trauma

jaw thrust)

Check responnya

Buka jalan nafas

Breathing

Jumlah nafas

Obstruksi benda

asing

2-5 nafas kira-

kira 1 ½ detik

tiap nafas

± 12 kali/min

Abdominal

thrusts atau

back blows

2-5 nafas kira-

kira 1 ½ detik

tiap nafas

± 20 kali/min

Abdominal

thrusts atau

back blows atau

chest thrust

2-5 nafas kira-

kira 1 ½ detik

tiap nafas

± 20 kali/min

Back blows atau

chest thrust

(jangan

abdominal

thrust)

2-5 nafas kira-

kira 1 detik

tiap nafas

±30–60 kali/min

Suction (jangan

abdominal

thrust atau

back blows)

Cek napas, jika

korban bernafas:

recovery position.

Jika tidak ada

pengembangan

dada : reposisi dan

ulangi sampai 5

kali

Cek nadi

Titik kompressi

Metode

Kompressi

Kedalaman

kompressi

Frekuensi

kompressi

Rasio Kompressi

ventilation

Carotis

1/2 bgn bawah

sternum

Pangkal telapak

tangan dan tgn

satu diatasnya

± 1/3 tebal dada

± 100/min

15 : 2 (2rescuer)

30:2 ( 1 rescuer)

Carotis

1/2 bgn bawah

sternum

1 pangkal

telapak tangan

± 1/3 tebal dada

± 100/min

15 : 2 (2rescuer)

30:2 ( 1 rescuer)

Brachial

1 jari dibawah

garis inter-

mammary

2 atau 3 jari

± 1/3 tebal dada

± 100/min

15 : 2 (2rescuer)

30:2 ( 1 rescuer)

Umbilical

1 jari dibawah

garis inter-

mammary

2 jari atau

teknik ibu jari

± 1/3 tebal dada

± 120/min

3 : 1

Nilai tanda

kehidupan, jika

ada nadi tp napas

tidak ada: lakukan

tindakan bantu

napas, jika nadi <

50x/mnt dan

perfusi jelek :

kompresssi dada



Definition : To do first aid and secondary survey on patients with head and neck trauma

Aim :

After this study, each student are expected to :1.1 Remove patient’s helmet in head and neck trauma cases, in a safe way and know how to

place a servical collar 1.2 Do physical examination on head and neckMenghitung Glasgow Coma Scale (GCS)

1.3. Identify normal head scan1.1 Manage primary survey in a brief time

1.2 Count and estimate the GCS on the patient1.3 Do secondary survey

1.4 Identify epidural hematoma on CT scan

1.1 Estimate and count the derivation of GCS1.2 Manage severe head trauma

1.3 Demonstrate secondary survey on head and neck 1.4 Identify the possibility to consult to a neurosurgeon

Learning media and tools :

1. Skill guide books of emergency and traumatology system2. “Mr. Hurt” manequin doll

3. Helmet4. Cervical collar

5. Print out, of normal head scan, epidural, subdural dan contusion and intracranialhematoma

Learning method:

Scenario by instructor, demonstrated by students


1. Introduction 5 minute 1. Scenario

2. Brief explanation about the scenario,student’s role and time allocation

2. Remove helme dan put

on the collar

10 minute 1. One student stands as the patient,

others as rescuers2. Estimate GCS

3. Managemet of severehead trauma

5 minute 1. Estimate GCS2. Identify signs of high intracranial

pressure

4. Management of head trauma that seems

worsening

10 minute 1. Re-do primary survey2. Estimate GCS

Differentiate the management

between severe head trauma and worsening head trama

5. “Mr. Hurt: 10 minute 1. Do secondary survey head and neck

6. CT scan 5 minute 1. Explanation about CT scan

HEAD AND NECK TRAUMAExamination and Management



GLASGOW COMA SCALE

Variabel Nilai

Eye (E) response Spontaneous

To voicesTo pain

None

4

32

1Motoric (M) response Do as told

Localize the pain Normal flexion (pull away from pain )

Abnormal flexion (decortification)Abnormal extension

None

6

54

32

1

Verbal (V) response Oriented

Confused speakingUnarranged words

Unclear voice

None

5

43

2

1Count GCS = (M + M + V ), Best score = 15, worse score = 3

LEARNING GUIDE

HEAD AND NECK TRAUMA

STEPS / Activities Description

Early preparation

Check for all toolsI. PRIMARY SURVEY

A. ABCDEB. Immobilization and stabilized cervical

C. Brief neurological examination1. Pupil light reflex

2. AVPU or GCS score

II. Secondary survey and ManagementA. Inspect the head carefully, include face

1. Lacertion

2. Any CSS liquid from nose and ear B. Palpate head thoroughly, include the face

1. Fractures

2. Lacerations and fracturesC. Inspeect all laserations on head skin

1. Brain tissure2. Skull depressed fracture

3. Dirt / corpus alienum4. CSS leakage

D. Minineurologis examination and scoring GCS1. Eye response

2. Motoric response3. Verbal response

4. Pupil light reflexE. Cervical vertebrae examination

1. Palpate any pain and place on the semirigid collar if necessary2. Examine cervical vertebrae X-rays on lateral projection if

necessary



F. Judge the width of wound Re-examine continously and observe any deteriorate signs :

1. Frequency2. Parameters

3. Re-do ABCD

III. HOW TO REMOVE HELMETPatient who use helmet and needs breathing aid management has to be

sured that its head and neck are in neutral positions.2 helpers are needed toremove helmet.

One student lie down as the patient with the helmet on. Other students actas helpers doing as follows :

1. One person stabilize the head and neck’s patient, with putting his hand on the helmet, its fingers on the patinet’s mandibula while examining

and make sure that the airway is still open. This position prevent thehelmet to slip away

2. Second helper cuts the helmet’s belt on release it from the D-ring3. Second helper stands on the right or the left side of patient with one

hand on the mandibule angulus, mother finger in one side and other fingers on the other side. While the other hand makes a pressure under

the head on occipital regio. This way 2 helpers are immobilizing thehead and neck

4. First helper push the helmet to the lateral side to release both ears fromhelmet and then remove the helmet slowy. If helmet has face mask,

this mask should be removed first. If the helmet has a very completemask, the nose could be wedged in and complicate the helmet removal.

To set free the nose, helmetshould be hold back and upward across thenose

5. As this happens, second helper should maintain imobilizing position to prevent the patients neck from moving

6. After the helmet is removed, straight immobilization mannual startsfrom top, head and neck are saved from moving during the procedure

7. If by removing the helmet causes pain and parestesia, then it should beremoved by gips scissors.If there is any signs of cervical trauma on

Xrays, helmet should be removed by gips scissors. During the procedure, head and neck are maintained immobilized and stabilized,

while the helmet is cut from the coronal passing through both ears.External layer of the helmet can be easily remove, the internal layer

which made of spyrofoam can be cutted and removed from front. Head and neck in neutral position

8. After the removal, immeadiately place the cervical collar followed by primary surveySetelah helm dapat dilepaskan segera pasang cervical

collar .

STABILISATION AND TRANSPORTATION

Definition : 1. Prepare safe transportation for patients2. Give first aid and secondary survey on patients with medulla spinalis

trauma

Aim:Students are expected to :

1. Demonstrate the techniques of examination to check patients with medulla spinalis trauma2. Discuss the principals of immobilization and log roll on patients with neck trauma/medulla

spinalis trauma and indications to remove protections aid.3. Do neurological examination and estimate the level of trauma

4. Decide whether transferring to other hospital is needed and how to immobilize patientcorrectly when transfering.



5. Limitize patients risk to worsen with doing the right mobilizaiton6. Prepare safe transportation for the patient

Learning media and tools :1. Skill guide book of emergency and traumatology system

2. Video and slide

3. Patient models (students may role as patient)4. Semirigid cervical collar 5. Desk or stretcher or bed.

6. Folded towel to support .7. Blanket

8. Bandage9. Scoop stretcher

10. Long spine board.11. Vacuum mattress

12. KED (Kendrick Extrication Device)

Learning method : Scenario by the instructor, demonstrated by students

Activity description :


1. Introduction 5 minue 1. Tools introduction2. Primary and secondary survey

scenario judgement

2. Scenario I 10 minute 1. Give help on spot using long spine

board and cervical collar only2. Log Roll

3. Scenario II 10 minute 1. Help patient on spot, usingcervical collar, scoop stretcher,

and long spine board

4. Scenario III 10 minute 1. Evacuate patient using vacuummatras

5. Scenario IV 10 mintue 1. Extrict patient with KED

LEARNING GUIDE

STABILIZATION AND TRANSPORTATION SKILLS

STEPS/Activity Descriptin

Preparation

Check list all tools

I. PRIMARY SURVEY RESUSCITATION – SPINAL CHORD

TRAUMA JUDGEMENT

II. Airway

Judge the airway while positioning the cervical spine. Open and clean upthe airway, do the jaw thrust, place oropharynx tube, and do intubation if

necessary

A. BreathingJudge and give adequate oxygen, and ventilation if necessary

B. Circulation

a. Judge the circulation by checking pulsations, blood pressureand perifer perfusion. If hypotension occurs, it has to be

differiated by hypovolemic shock ( decreased blood pressure, increased heart rate and cold extremities)

C. Solution to correct hypovolemia



D. Disability- brief neuorological examinationa. Judge the conciousness and pupil.

b. Decide whether to use AVPU or GCS to judge patient’sconciousness

c. Identify paralysis or paresis

d.II. SECONDARY SURVEY – NEUROLOGICAL

JUDGEMENTA. AMPLE History Taking

1. History and mechanism of trauma

2. Medical record B. Identify and write down any medication given to the patient

before, during, and after treatment

C. Re-examine conciousness and

D. Re-examine GCS score

E. Examine spinal chord

1. PalpationPalpate the whole posterior spinal chord by doing log rollcarefully

Examine ::a. Any deformities/ swelling

b. Crepityc. Increasing pain when palpated

d. Contusion and laceration.

2. Pain, paralyze and paresthesia

a. Yes/No b. Location

c. Neurological level

3. SensationPinprick tes to estimate sensation, is performed in all dermatoms

and write down the most caudal dermatom which givessensation

4. Motoric Sensation

III. PRINCIPALS IN IMMOBILIZING THE SPINAL CHORD AND

LOG ROLL

A. Log roll:

1. One person hold the head and neck to maintain theimmobilization in one line.

2. One person stand by on the side to hold the patient’s body (

pelvis and hips )3. Another person hold the pelvis and limb. With the command

from the person on the head, move the patient in an angle position carefully

4. The 4th person check on the spine chord and place the longspine board

B. Placing the ong spine board 1. Maintain the head and neck in one line when the second person holds

the patient on its shoulders and wrists. Third person holds the patient;shand ad hips with one hand, the other hand holds the bandage that

cords patient’s ankles pergelangan kaki.2. With the commandments from the rescuers whose holding the patient’s

head and neck, perfrorm log roll as a unit towards the other persons/rescuer whose beside the patient. It only needs a minimal

rotation to place the spine board underneath the patient. Maintain the



one line principal of the head and neck in this procedure3. Spine board is placed underneath the patient, afterwards perform log

roll towards the spine board .4. Long spine board with its rope/band is inserted to the thoracal regio,

above crista iliaca, thighs and ankles. Band or bandage is used to fixate

the head and neck to attach to the spine board 5. Perform inline immobilisation of the head and neck manualy, then place the semirigid collar

6. Straighten the arms and place it beside the patients body7. Straighten the limbs carefully and place it in one line with the spine

chord.Both ankles are tied together with a bandage8. Place a pillow/support under the patient’s neck to avoid any

overextended movements and to comfort the patient9. Pillow, blanket or any other supports is place on the right and left side

of the patient’s neck, while the head is tied, attached to the long board 10. Place a bandage above the cervical collar to guarantee there is no

movement of the head and neck.C. Scoop Stretcher

1. Prepare scoop stretcher 2. Open the lock to divide in two

3. Arrange the scoop to match patient’s height4. Place scoop under the patient

5.Scoop stretcher is not for immobilizing the patient.6.Scoop stretcher not a transport device, do not lift scoop on the edges

because it could fold on the middle and will lose the straightnes of thevertebrae

Splint/spalk Installation ( Immobilization of the extremities ) and

Musculoskeletal Management.

Definition : To give first aid to musculoskeletal trauma patients

Aim of study : After this study, students are expected to be able :

1. To do quick examination on patients with musculoskeletal trauma

2. To recognise life and limb threatening problems in musculoskeletal trauma3. To install a spalk/splint correctly.


1. Skill guide book 2. Living models ( students can role as patients )

3. Leg traction splint4. Air splint

5. Spalk 6. Gloves

Learning method :Scenario by the instructor, demonstrated by students



LEARNING GUIDE

MUSKULOSKELETAL SKILL

EXTREMITIES IMMOBILISATION PRINCIPLES

Check the ABCDE and treat conditions which are life threatening first.

1. Loose all clothes thoroughly, including on the extremities

2. Loose watches, rings, necklace and all things that might clamp

3. Check neurovasculars before setting the spalk/splint. Check external bleeding

pulsation that has to be stopped, and check also the sensoric and motoric function of

the extremities.

4. If there are wounds, close it with sterilized bandage

5. Choose kinds and sizes of spalk that matches the traumatized extremities6. The spalk setting should also cover joints below and above the traumatized

extremities.

7. Place a pillow bag above the bone protrusion

8. Support the extremities with spalk/splint in a position where there is a distal

pulsation. If there is not any distal pulsation, try to straighten the extremitis. Make a

traction carefully and maintain it until splint is settled.

9. Splint/spalks are settled onto extremities that are straight, if not, try to straighten it.

MASS DISASTER MANAGEMENT

Definition : To carry out triage principles in whenever patients outnumbered rescuers

Aim of study : After this study, students are expected to :

1. Define triage

2. Understood and able to explain principles and factors that effects and includes

in the proses of triage


1. Slides of guidlines to do triage scenario

2. Triage scenario booklet

Learning methods :

Role’s play



Activity description :


1. Introduction 10 minutes 1. Triage scenario slide presentation2. Brief explanation about the scenario,

student’s roles and time allocation

2. Role play (1) 10 minutes 1. All students have put priorities on which

patients they will handle2. Each student give their suggestions on why

they put their priorities on specific patients

Role play (2)

Fire followed byexplosion in settlements

10 minutes 1. All students have put priorit ies on which

patient they will handle2. Each student give their suggestions on why

they put their priorities on specific patients

Role play (3)Car crash

10 minutes 3. All students have put priorit ies on which patient they will handle

1. Each student give their suggestions on whythey put their priorities on specific patients

Role play (4)A football stadium

collapsed

10 minutes 1. All students have to determine which criteriais used to identify patients and what

priorities should be done2. All students propose the clues and signs that

were given by the patient which could helpin the triage procces

3. All students propose what can be done before and after the paramedics and

ambulance arrives.4. All students should propose which victims

has to go first to the hospital and which typeof hospital should the victim goes to.

Students Manual for Emergency 2011

Documents