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HN to HM3 Emergency Medicine

Corpsman Advancement Study Emergency Medicine Chapters 20, 21, 22
STUDY
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Dressing
Sterile pad or compress (usually made of gauze or cotton wrapped in gauze)
Battle Dressing
Combination compress and bandage
Roller Bandage
Long strip of material (gauze, muslin, or elastic)
Initial turn on extremity should be applied securely, and, when possible around the part of the limb that has the smallest circumference.
Wet Bandage
HM must allow for shrinkage
Roller Bandage for Elbow
Spica or Figure-eight type
Roller Bandage for Hand/Wrist
Bandage diagonally upward and around the wrist and back over the palm. 2 or 3 inch bandages
Roller Bandage for Ankle
Figure-eight
Roller Bandage for Hand and Heel
3 inch bandage
Four-Tailed Bandage
Good for bandaging any protruding part of the body. i.e.: Nose, Chin
Barton Bandage
Lower Jaw fractures and retain compresses to the chin
Triangular Bandage
Usually made of muslin. Can be used for Head, Shoulder, Chest, Hip/Buttock, Side of the Chest, and Foot/Hand.
Tringular Bandage for Head
Retain compresses on the forehead or scalp. tie in a SQUARE KNOT.
Cravat Bandage
Triangular bandage can be folded into a strip for easy application during emergency. Can be used for Head, Eye, Temple/Cheek/Ear, Elbow/Knee, Arm/Leg and Axilla.
Modified Barton
Carvat Bandage for Temple, Cheek, Ear.
CAT (trademark)
Combat Application Tourniquet
Asherman Chest Seal
ACS (Trademark) is 5.5" diameter, includes gauze pad (4"x4")
Monitoring Devices
Automated External Defibrillator (AED).
Pulse Oximeter
Measures O2 saturation of patients blood and changes in blood volume in the skin. Acceptable normal ranges are from 95% to 100%. Although values down to 90% are common.
Intravenous Fluids
Two types:
Crystalloids: Aqueous solutions of mineral salts or other water-soluble molecules.
Colloids: Larger insoluble molecules
Normal Saline
(NS) 0.91% w/v of NaCl. Rapid infusion can cause Metabolic Acidosis. 1.5 and 3 liters a day for an adult.
Lactated Ringers Solution
(LR) Often usef for fluid resuscitation after blood loss due to trauma, surgery, and/or burn injury. Rate of administration: 20 to 30 ml/kg
Hetastarch
Synthetic plasma expander. It is used to prevent shock following severe blood loss caused by trauma. Dosage for plasma volume expansion: Adults: 500-1000 mL (up to 1500 mL/day) or 20 mL/kg/day (up to 1500 mL/day)
Infusion Equipment
Intravenous Infusion Set
Intraosseous Device: Pyng Fast-1 (trademark)
Infusion pump
Use of O2
HM in emergency cases will have D or E cylinder of O2 available
O2 Cylinder
Color coded green, silver or chrome
Big-Valve Mask
(BVM) Ventilator: When using external cardiac compressions, cardiac compressions, the cardiac output is cut to 25 to 30% of normal capacity, and artificial ventilation does not supply enough 02 through the circulatory system to maintain. 5 liters per min. 50% concentration. 15 liters per min. 90% concentration.
Pocket Face Mask
Mouth-to-Mouth ventilation
Hypoxia
Characterized by tachycardia, nervousness, irritability, and finally cyanosis.
Artificial Airways
Oropharyngeal
Nasopharyngeal
Keep the tongue from occluding (closing) the airway
Oropharyngeal
Only on unconscious casualties because a conscious person will gag on it. Extend from corner of the patient's mouth to the tip of the earlobe
Nasopharyngeal
May be used on conscious casualties. Extends from the patient's nasal opening to the tip of the earlobe on the same side of the patient's face.
O2 Breathing Apparatus
Oxygen Breathign Apparatus
SCBA
20 to 45 minutes life span of the oxygen canister
Lifeline
Standard Navy lifeline: steel-wire cable 50 feet long. Rescue personnel must wear gloves
Phase of Rescue Operation
4 phases
1. Remove lightly pinned casualties
2. Remove those casualties who are trapped in more difficult circumstances
3. Removes casulaties where extractions is extremely difficult and time consuming
4. Removal of dead bodies
Stages of Extrication
5 stages
1. Gain access
2. Give lifesaving emergency care
3. Disentanglement
4. Preparing casualties for removal
5. Removing casulaties from trapped areas and transporting to an ambulance or sickbay
Providing Care while Receiving Combat Fire
HM may be essential obtaining tactical fire superiority, Return fire!
Stroker Stretcher
Wire basket supported by iron rods, can also be used with flotation devices to rescue injured survivors from the water. Should be padded with 3 blankets: 2 placed lengthwise; under each leg of patient. 1 folded in half and placed in the upper part to protect shoulders/head.
Kendrik Extrication Device
KED. Semi-regid used to immobilize casualties with minor neck and back injuries.
Miller Board
Full Body. Fits within a Stokes (basket) stretcher and will float a 250 lbs person.
Spineboard
2 sizes: Short: (18"x32") and long (18"x72")
One-rescuer techniques
Fireman's Carry
Pack-strap Carry
Arm Carry
Blanket Drag
Tied-Hands Crawl
Two-Rescuer Techniques
Chair Carry: NEVER BE USED TO MOVE A PERSON WHO HAS AN INJURED NECK BACK OR PELVIS
Arm Carry
Aircrafta
UH-1: 2 pilots, 1 chief, 1 medic. 3 litters, 4 ambulatory.
Max: 6 litters, 9 ambulatory. Red Crosses (4) one one the nose belly and each cargo door
UH-60A: Same crew as UH-1. 4litters and 1 ambulatory
Max: 6 litters, 1 ambulatory or 7 ambulatory. 5 crosses nose, belly, each cargo door and on top.
CH-47: 2 pilots, 2 chiefs, 1 medic 6 litters. 12 litters and 16 ambulatory
Max: 31 ambulatory or 1 ambulatory and 24 litters. No red cross markings. (Casualty Evac)
Toxicity Levels
NFPA 704 Labeling System.
Red: Flammability
Hazmat Classification
Yellow: Reactivity
White: Special Hazards
Blue: Health Hazard
Protection Levels
A,B,C, and D.
A: Fully encapsulating
B. Chemical Resistant Clothing
C. Full-Face piece, air-purifying canister-equiped respirator
D: Coveralls, safety boots, glasses, and hard hat.
Hot Zone
Exclusion Zone: Contamination has occured
Contamination-Reduction Zone
Warm Zone: Transition are between the contaminated area and clean area.
Rescue from Hot Zone
Never Enter the Area Unless Properly Trained to Do So.
Decontamination
Dilution
Absorption
Chemical Washes
Disposal and Isolation
Law of Armed Conflict
Emcompasses all international law regulating the conduct of nations and individuals engaged in armed conflict.
Non Tactical Triage for Treatment
Priority I,II,III,IV,V
I. Immediate
II. Delayed
III. Minor
IV. Expectant
V. Dead
S.T.A.R.T
Simple Triage and Rapid Transport
Surgical Cricothyroidotomy
Casualties with total upper away obstruction, inhalation burns, massive maxillofacial trauma and cannot be ventilated by other means
Needle Chest Decompression
Between the second and third rib, large bored 3.25 inch, 14 gauge needle and catheter unit
NRB Mask
10-15 liters/minute up to 90% O2
Nasal Cannula
1-4 LPM to deliver 24-44% O2
Hypovolemic
Shock loss of intravascular volume
Blood lose is 5-6 liters. Normal loss of approx. 1 liter or 25-40% of person's total blood volume
Massive hemorrahage maybe fatal within 60-120 seconds
Distribute
Shock: Vasogenic; blood vessles dilate
Neurogenic
Shock caused by failure of nerveous system
Septic Shock
Caused by the presence of severe infection
5-7 days to develop
Psychogenic
Vasovagol shock mediated through para-sympathetic system (fainting)
Cardiogenic
Shock caused by heart failure
Stages of Shock
Compensated (non-progressive): Blood pressure is maintained; however, there is narrowing of the pulse pressure
Decompensated (progressive): Blood pressure is falling because blood volume has dropped to 15-25%
Irreversible: Shock has progressed to terminal stage
Destributive Shock
Septic, Neurogenic, and Psychogenic
Most common cause of shock
Uncontrolled hemorrhage
Cerebrovascular Accident
Stroke or Apoplexy interruption of blood supply to a portion of the brain. 1st sign includes weakness or paralysis of the side of the body opposite side of the brain that has been injured.
Convulsions
Seizures; uncontrolled muscle spasms or muscle regidity 1 or 2% population
Epilepsy
Seizure/Fits: Controlled often with medictions, during a conscious states. Multifactorial
Grand Mal Seizure
Serious type of epilepsy. Aura
Petit Mal
Short Duration. Altered State of awarness or partial loss of consciousness
Suicide Attemps
Ranges from verbal threats, gestures to a successful suicide.
Ingestion
In case of ingestion of substances do not induce vomiting in a patient who is not awake or alert
TEN (Scalded Skin Syndrome)
Toxic Epidermal Necrolysis
Toxic Epidermal Necrolysis
Condition charaterized by sudden onset, excessive skin irritation, painful erythema, bullae, and exfoliation of the skin in sheets.
AVPU Scale
Alert, Verbal, Pain, Unresponsive
DCAP-BTLS
Deformities, Contusions, Abrasions, Punctunre-Penetration, Burns, Tenderness, Lacerations, Swelling
SAMPLE
Sign-Symptoms
Allergies
Medications
Past Medical History
Last PO intake
Event leading
Angina Pectoris
Angina, caused by insufficient oxygen being circulated to the heart.
Acute Myocardial Infarction
Heart Attack. Coronary artery is occluded/block
Anaphylatic Emergencies
Anaphylaxis or Anaphylatic Shock; Severe allergic reaction to foreign material
Anaphylatic Shock Treatment
EPI-PEN 0.3cc subcutaneous injection.
Diabetic Ketoacidosis
Forgetting insulin treatment, or too little insulin to maintain a balance condition.
Insulin Shock
Too little sugar in the blood (hyperglycemia)
Hyperglycemia
Most common of all diabetic emergencies
Concussion
Caused by a violent jar or shock
Sucking Chest Wound
Most serious injury that requires immediate first aid treatment
Open Pneumothorax
Air entering pleura space through defect in pleura wall
Fail Chest
2 or more ribs fractured in two or more places or a fracture sternum
Condition in which air enters the chest cavity through a hole in the lung, expanding the space with every breath taken in
Tension Pneumothorax
Placenta must be delivered within how many minutes
10-20 minutes
Breech Delivery
Condition where baby's legs and or buttocks emerge first
Prolapsed Cord
Gently move a sterile gloved hand into the vagina to keep its walls and the baby from compressing the cord
Morphine dose
Adult 10 to 20 mg
Casualty Marking
"M" and hour of injection (Morphine)
Hematemesis
Vomiting bright red blood
Hemoptysis
Coughing up bright red blood
Melena
Tarry black stool
Hematochezia
Excretion of bright red blood from rectum
Methods of Anesthesia Administration
Topical, Local infiltration, and Nerve Block
Suture Removal Time
Face:4-5 days
Body/Scalp: 7 days
Soles/Palms, Back, Joins: 10 days
Hydrophobia
Caused by a virus that is present in the saliva of infected animals
Rabies Treatment Outline
BUMEDINST 6220.8 series, Streptococcal Infection Control Program
Classification of Severity Burns (Thermal)
1st Degree: Epidermal layer
2nd Degree: Blisters, mottled appearance, and a red base.
3rd Degree: Full Thickness injury
Electrica Burns
Entrance and exit wounds may be small, burns large area below the surface
Chemical Burns
Acids, Alkalis, or other chemicals come in contact witht he skin or other body membranes
White Phosphorus Burns
Particles ignite upon contact with air.
Most common condition caused by working or exercising in hot environments
Heat Exhaustion
Less common but far more serious condition than heat exhaustion. 20% mortality rate. Lack of Sweat
Heat Stroke
Chilblain
Mild cold injury caused by prolonged and repeated exposure for several hours to air temp. from above freezing 32F to as high as 60F
May occur in hands, results from prolonged exposure to wet cold at temps
Immersion Foot
Deep Frostbite
The Skin will not move over bony ridges and will feel hard and solid
Big Boxes
Caisson Disease; Decompression sickness (DCS)
Barotrauma
Damage to tissue caused by a change in ambient pressure
POIS
Pulmonary Over Inflation Syndrome. Emphysema
Mediastinal Emphysema
Tearing of the lungs with air leaking out and remaining inside the chest cavity
Subcutaneous Emphysema
Tearing of the lungs with air leaking out of the lung the migrating up and out of the chest cavity and stopping at the base of the neck
AGE
Arterial Gas Embolism; capillaries on the alveolar sacs at the location of a tear in the lung draw gas into the blood stream
Poison
Substance that when introduced into the body, produces a harmful effect on normal body structures or functions
Ingested Poison
Poisons that have been consumed, most common route of exposure
Corrosives
Acids and alkalis (bases) produce actual chemical burning and corrosion of the tissue of the lips, mouth, throat, and stomach
Corrosives (Acid or Base) Ingestion
Never administer a neutralizing solution by mouth. Give H20 only, unless otherwise directed by PCP or medical officer
Scorpion Stings
Centruroides exilicauda "bark scorpion" Mexico and US southwest region may cause severe effects
Black Widow
Red hourglass-shaped spot on belly, Bites causes dull, numbing pain, spreads gradually from bite site to the muscles of the torso
Brown Recluse
Violin-shaped marking. Bite may go unnoticed, after several hours, bleb develops over site and rings or erythema surrounding the bleb.
Snakes; venomous families
5
Viperidae
Elapidae
Hydrophidae
Colubridae
Atractaspididae
NORTH AMERICAN CORAL SNAKES ONLY
Red on Yellow Kill a Fellow, Red on Black Venom Lack
Alcohol
Most widely abused drug today
Cannabis Sativa
Marijuana
Amphetamines
Used in treatment of conditions such as mild depression, obesity, narcolepsy