When the head, neck and spine are in the exact, natural alignment. Vital with spinal casualties as any major damage to the spine can result in serious problems, the worst case scenario being paralysis, or even death.
This is why you'll see people holding the head straight, to minimise any movement of the c spine, aka, the cervical spine (the bit of spine in your neck). Damage to this area definitely means trouble, and a properly-fitted collar will help prevent this too.
Monday, 29 June 2009
Log Rolling
An effective technique for transferring a casualty from the floor to a long board.
You need a minimum of five people - 3 for the roll, one for supporting the head, and 1 for sliding the board underneath the casualty.
The roll works thusly - the person maintaining central alignment is in control, and commands when it is time to move the casualty. The people doing the rolling kneel to one side of the casualty, lean over, cross over hands with each other, grab a bit of clothing (perferably) and on the count of the person at the top, roll the casualty towards them. The person with the long board slides it against the back of the casualty, and on the count of the 'head' person again, the casualty is then rolled back onto the board and strapped in securely, ready for transportation.
Its good for spinal casualties, with the aim to keep the spine and neck in exact alignment and minimise any movement which could result in more damage of the spine.
You need a minimum of five people - 3 for the roll, one for supporting the head, and 1 for sliding the board underneath the casualty.
The roll works thusly - the person maintaining central alignment is in control, and commands when it is time to move the casualty. The people doing the rolling kneel to one side of the casualty, lean over, cross over hands with each other, grab a bit of clothing (perferably) and on the count of the person at the top, roll the casualty towards them. The person with the long board slides it against the back of the casualty, and on the count of the 'head' person again, the casualty is then rolled back onto the board and strapped in securely, ready for transportation.
Its good for spinal casualties, with the aim to keep the spine and neck in exact alignment and minimise any movement which could result in more damage of the spine.
Scoop
Resembles a long board or stretcher, but is adjustable at one end so you can measure the scoop to the individual's length. Has clips at the top and bottom so the entire thing can be halved, with each half being placed on either side of the person. Each half is then slid beneath the individual and the scoop is re-clipped, so it is now whole again and fully supportive of the casualty.
It's generally not used for transporting a casualty (with us anyway), but for transferring a casualty from the floor to a long board when log rolling is not appropriate. Scooping is easier anyway really. Unless the clips are gritty.
It's generally not used for transporting a casualty (with us anyway), but for transferring a casualty from the floor to a long board when log rolling is not appropriate. Scooping is easier anyway really. Unless the clips are gritty.
DGH
Dr Grays Hospital:
Elgin's only hospital which has expanded in the past 10 or so years, and is aiming to do so again. But no matter how hard it tries it won't level with Inverness or Aberdeen. Which I imagine is what it's trying to do.
The most confusing hospital to navigate round - ever. I still get lost.
Elgin's only hospital which has expanded in the past 10 or so years, and is aiming to do so again. But no matter how hard it tries it won't level with Inverness or Aberdeen. Which I imagine is what it's trying to do.
The most confusing hospital to navigate round - ever. I still get lost.
ARI
Aberdeen Royal Infirmary:
Aberdeen's main hospital, which has a million and one wards in comparison with Dr Grays and is generally very fancy, modern and high tech in its available treatments and procedures.
Aberdeen's main hospital, which has a million and one wards in comparison with Dr Grays and is generally very fancy, modern and high tech in its available treatments and procedures.
Wednesday, 17 June 2009
GCS
Glasgow Coma Scale -
The second scoring system which we are trained to use, however AVPU is the easier and more favoured one. Well, I think so anyway.
It goes roughly like this:
Best Eye Response. (4)
1. No eye opening.
2. Eye opening to pain.
3. Eye opening to verbal command.
4. Eyes open spontaneously.
Best Verbal Response. (5)
1. No verbal response
2. Incomprehensible sounds.
3. Inappropriate words.
4. Confused
5. Orientated
Best Motor Response. (6)
1. No motor response.
2. Extension to pain.
3. Flexion to pain.
4. Withdrawal from pain.
5. Localising pain.
6. Obeys Commands.
15 is a fully responsive patient and is ideal.
A Coma Score of 13/14 correlates with a mild brain injury. 9 to 12 is a moderate injury and 8 or less a severe brain injury.
However, stating to a colleague that a casualty is GCS 11, for example, is pretty much meaningless. The score needs to be broken down into its seperate components, e.g.
Eye response - 3
Verbal response - 3
Motor response - 5
= GCS 11.
The second scoring system which we are trained to use, however AVPU is the easier and more favoured one. Well, I think so anyway.
It goes roughly like this:
Best Eye Response. (4)
1. No eye opening.
2. Eye opening to pain.
3. Eye opening to verbal command.
4. Eyes open spontaneously.
Best Verbal Response. (5)
1. No verbal response
2. Incomprehensible sounds.
3. Inappropriate words.
4. Confused
5. Orientated
Best Motor Response. (6)
1. No motor response.
2. Extension to pain.
3. Flexion to pain.
4. Withdrawal from pain.
5. Localising pain.
6. Obeys Commands.
15 is a fully responsive patient and is ideal.
A Coma Score of 13/14 correlates with a mild brain injury. 9 to 12 is a moderate injury and 8 or less a severe brain injury.
However, stating to a colleague that a casualty is GCS 11, for example, is pretty much meaningless. The score needs to be broken down into its seperate components, e.g.
Eye response - 3
Verbal response - 3
Motor response - 5
= GCS 11.
AVPU
Just one way of monitoring how responsive a casualty is.
A - Alert
V - Voice
P - Pain
U - unresponsive/unconscious.
Ok, so it seems like double-dutch, but really it's quite simple.
1)If your casualty is alert, they will be fully responsive to anything you do, e.g. they will be able to answer any questions you ask them, and hit you back if you try a pain response.
2)If your casualty is not fully alert, but there is a sign of life when you speak to them, then your casualty is responsive to voice, e.g. if you ask them to open their eyes, they might be able to flutter their eyelashes or something.
3)If your casualty is not fully alert, or doesn't respond to voice, then you get to beat them up. Ok, not like a punch bag, but you can pinch sensitive points on the body, such as the bottom of a fingernail, or the ear lobe, or you can rub their sternum (chest bone), all of which are particularly painful. If your casualty pulls away slightly, or makes a noise, or pulls a face, then they are responsive to pain.
4) Finally, if you've spoken to them, pinched them, generally tried to arouse them, and your casualty still hasn't responded, then they're out cold and unconscious. And that's when you worry.
A - Alert
V - Voice
P - Pain
U - unresponsive/unconscious.
Ok, so it seems like double-dutch, but really it's quite simple.
1)If your casualty is alert, they will be fully responsive to anything you do, e.g. they will be able to answer any questions you ask them, and hit you back if you try a pain response.
2)If your casualty is not fully alert, but there is a sign of life when you speak to them, then your casualty is responsive to voice, e.g. if you ask them to open their eyes, they might be able to flutter their eyelashes or something.
3)If your casualty is not fully alert, or doesn't respond to voice, then you get to beat them up. Ok, not like a punch bag, but you can pinch sensitive points on the body, such as the bottom of a fingernail, or the ear lobe, or you can rub their sternum (chest bone), all of which are particularly painful. If your casualty pulls away slightly, or makes a noise, or pulls a face, then they are responsive to pain.
4) Finally, if you've spoken to them, pinched them, generally tried to arouse them, and your casualty still hasn't responded, then they're out cold and unconscious. And that's when you worry.
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