10th HKG 港島第十旅

By: Lee Yat Sing (SI)

WARNING – THIS IS CRAZY
THIS IS A 85-MINUTE
LECTURE, EVERY THING IS
IMPORTANT, BUT DO NOT
EXPECT TO GET IT ALL!
 Learning Objectives
• Understand the DRABCDEF of site control
• Understand the Patient Assessment Model
and perform a body survey
• Understand and perform a recovery position
(復原卧式)
• Know basic diagnostic skills
 3 Basic Principles

1 •保存生命

2 •防止情況（傷勢）惡化

3 •促進復原
- Scene
- Patients
- Priority
- Help
 Common approach to cases
D • Danger – RSE, MOI
R • Response – MOI, LOC (AVPU)
A • Airway
B • Breathing CPR?
C • Circulation
D • Damage
E • Examination – Rapid Body Survey, MOI
F • Follow-up – treatment, secondary survey (PQRST)
D Rescue Scene Evaluation (RSE)
拯救現場評估
R - DO NOT focus on details, observe first
→ Get a concept of the Scene, Danger, MOI
A Scene 環境:
- Search for important clues (number, severity, incident)
B - Search for route of evacuation e.g. exit
- Search for any other people in need
C - Search for any witnesses or relatives
Danger 危險:
D
- Be aware of any dangers/ potential dangers, e.g.
sharp objects, things that may trip you
E
Mechanism of Injury (MOI) 患者至患過程:
F - Guess: What exactly happened?
→ Clues to other injuries, treatments
Before touching your patients,
WEAR GLOVES!!!
WEAR GLOVES!!!
WEAR GLOVES!!!
WEAR GLOVES!!!
WEAR GLOVES!!!
WEAR GLOVES!!!
WEAR GLOVES!!!
D Level Of Consciousness (LOC)
清醒程度
R - Approach patient DIRECT with a SMILE
A - INTRODUCE yourself
- Develop CONTACT
B
- Ask about MOI
C - LOC: Levels AVPU
A Alert (清醒)
D
V Verbal (言語)
E
P Pain (痛楚)
F U Unresponsive (昏迷)
D

R Airway (氣道)
- Check airway for ALL patients
A - Alert patients: if patient can speak clearly
→ airway good and clear
B
- Non-alert patients: Check!
C
1. Clear obstructions (if necessary)
2. Perform ‘Head tilt chin lift’
D 按額托頭法 →
- If there is suspected spinal fracture
E → use jaw thrust (創建推顎法)

F
D

R Breathing (呼吸)
- See, hear and touch (視聽觸) for 10s
A - if able to speak clearly → deep and easy
breath
B - Other descriptions:
- Deep/ Shallow (深/淺)
C
- Rapid/ Slow (快/慢)
D - Easy/ Hard (容易/努力)

F
D Circulation (血液循環)
- Check radial pulse(橈側脈膊) for 10s:
R -present → at least 80mmHg systolic (上壓)
-Absent → check carotid pulse (頸動脈)
A
→ at least 60mmHg (下壓)
- Descriptions:
B
- Strong/ weak (強/弱)
- Rapid/ Slow (快/慢)
C - Regular/ irregular (有規律/亂)
D
- Look for signs of circulation around body
E

F
D

C
D

E Radial pulse Carotid pulse

F
D

R
Damage (創傷)
A -Deal with immediate wounds,
e.g. control bleeding (止血)
B

D
E

F
D Rapid body survey(RBS)
快速身體檢查
R - Tell your patient that you are going to do a RBS
- Pay special attention to bleeds, deformities,
A swellings, disabilities (出血、變形、腫脹、殘缺)
-Within 30s:
B
- Touch through body (see next slide)
C - Note for hospital wristband (醫療手帶)
- Expose & handle any wound (展露及處理傷處),
D especially heavy bleeds
- Note skin colour, with back of hand check
E warmth and moisture (以手背探皮膚溫度及濕度)
→ Pale/ red/ purple? warm/ cold? Dry/ wet?
F ＊Note sign of shock休克(pale, cool, wet)
D Rapid Body Survey (RBS)
R
Note:
A - Bleeds
- Deformities
B - Swellings
- Disabilities
C - Hospital wristband
- Skin
D

E
F
D

R Follow-up (跟進及處理)
- Diagnosis (診斷)
A - Call for help (尋找支援)
- Patient’s ICE (Idea-Concern-Expectation)
B - Treatments for conditions
- Suspected abnormalities from MOI
C
- Secondary Survey (進一步檢查)
D

E 10 on 5 off
F
 F Call for help (尋找支援)
報警十大
• 地點 • 傷勢
• 事故 • 支援物資
• 傷者數目 • 急救者資料
• 性別 • 聯絡資料
• 年齡 • 重複
Note: in real cases, you can ask any pedestrian to call 999 for you, but
make sure you have told him/her all the information listed above
 F Secondary Survey (進一步檢查)
• Patient history (病歷)
– Major discomfort (主要不適)
• “邊到最唔舒服？”
– History of major discomfort → before, during, after
*PQRST – for pain ONLY
• Position
• Quality
• Radiation/ Relief
• Severity
• Timing
 F Secondary Survey (進一步檢查)
• Patient history (病歷) – cont’d
– Medical history e.g. heart disease, seizure, allergy
– Medicine (usually patients bring them along)
– Patients’ particulars e.g. name, age
– Vital signs (維生指數)
• LOC (清醒程度)
• Pulse (脈膊)
• Ventilation (呼吸)
• Skin (皮膚)
• Body temperature (體溫)
– Body survey (詳細檢查)
F Body Survey (詳細檢查)
• Ask and explain to patient for body survey
• Finish within 5 minutes
• Compare left and right side
• Do not touch wounded regions
• Use your eyes and hands
– Eyes: look for bruising (瘀傷), bleeding(出血),
deformities(變形), swellings(腫脹), wounds(傷口),
excretions(排泄)
– Hands: Check for pain at fracture(骨折), deformities(變形),
sinks(下陷), swellings(腫痛), tenderness(觸痛),
firmness(堅實)
F Body Survey (詳細檢查)-1

- Scalp (頭皮) - Spine - Clavicle (鎖骨)

Chest
Head

Neck
- Face & forehead - Swelling - Ribcage mov’t
- Ears and nose - Voice - Ribs
- Eyes - Loosen collar - Deep breath
- Lips and mouth - Remove necklace
- Teeth (esp fake)
- Tongue
F Body Survey (詳細檢查)-2

- Internal organs - Spine - Pelvis (盆骨)

Pelvic Region
Abdomen

Back
(swelling, pain) - Do not move - Groin (陰部)
- Loosen belt (bleed, pain)
F Body Survey (詳細檢查)-3

- Thigh and calf - Shoulders

Upper limbs
Lower limbs

- Knee - Arms
- Pedal pulse - Radial pulse
- Nails: cap refill - Nails: cap refill
(Press 5s, read 2s) - Force
- Sensation - Remove accessories
- Strength
 Lungs

Heart

Liver

Stomach

Intestines
 Criteria for successful case
• Command
• Control
• Coordination
• Communication (First Aid-ers and patients)

• Hygiene
• RECORD EVERY THING IMPORTANT
• CARE and EMPATHY
 Basic diagnostic skills
• Identify the differential features of each
disease – which are more specific/ major?
• Risk factors/ causes?
Disease Major symptoms Minor symptoms
Shock (休克) 脈搏速、弱 皮膚蒼白濕冷、暈眩、呵欠

Syncope (昏厥) 脈搏緩慢 面色蒼白、神志不清

Heat Stroke (中暑) 脈搏強而有力、體溫高 皮膚發紅發熱、乾燥、沒汗、

頭痛、頭暈、神志不清
Heat exhaustion (熱衰竭) 脈搏速而弱、體溫略高 皮膚蒼白濕冷、大量出汗、
暈眩、惡心、頭痛、頭暈、
神志不清、抽筋
Hypothermia (體溫過低) 體溫低、脈搏慢而弱 呼吸淺而慢、皮膚麻木、乾
而冰冷、顫抖、
 Practice - 1
A 55 year-old man exercised intensely under
bright sun without drinking any water for 1
hour. You found him lying on the ground,
barely conscious. He feels very dizzy, hot and
thirsty. He has a strong, rapid pulse. His skin is
damp and cold. What do you think has
happened and how would you deal with it?
 Practice - 2
• Distinguish between非複雜性肋骨骨折、複
雜性肋骨骨折、胸陷傷、中風、腦受壓.
What are the major symptoms of each disease?
 Coma
• Causes:
1. Head injury
2. Blood supply to the brain is disrupted
3. Pressure on brain
4. Chemical/ toxins
5. Others e.g. infections, neurological disorders
Recovery position (復原卧式)
• For patients without severe
injuries
• 防止傷病者的舌頭後墜，阻塞
氣道
• 方便口腔內的分泌物或嘔吐物
從口中流出，減低氣道受阻的
機會
• 在轉動傷病者前，先脫下他的
眼鏡及取出身上的物品，例如
錢包、手提電話，並妥善處理
 Return to
original position,
Body check

10 mins