We have a person here who looks like he took a fall down the stairs. There were no bystanders
around to give us an eye witness account of what happened exactly. We don't know if he
hit his head, we don't know how many stairs he fell down, what we do know is he is lying
at the base of a set of stairs, a flight of stairs and he appears to be in pain. So, what
we are going to do is try to minimize the movement of the patient as we begin to inquire
more about what may have happened and what's going on. Remember the whole point of doing
it to figure out if we need to call 911 and get help on the way or whether this person
is well enough to be able to get back into regular life and just kinda walk it out. May
be that could happen, we know that real things have happened, and we mysteriously can escape
without injury or harm, we don't know how but it happens, and then other times we have
true injuries. So, this is kind of how it's going to look. I am not going to touch the
patient, and I am immediately going to say, sir I am Roy and I can help, I have been trained.
I would like you not to nod your head, just answer me with yes or no or descriptions and
then try not to move any part of your body, just in case you have broken bones or an injury,
okay? Speaker 2: Okay. Speaker 1: Alright, I am looking over your head, I don't see any
bleeding. I may now check in his ears and look for any blood coming out of either ear.
I am looking in the mouth. Can you smile at me a little bit? There is no broken teeth
that I can see, there is no blood coming from the nose. As I look into the pupils they seemed
to be equal and responsive to light. You can also do that by putting your hand over and
then bring it back and seeing if pupils react. If they don't this could indicate that they
have a concussions, some swelling in the brain and that would be an immediate 911 call. Now,
next he is able to talk to me which means he is breathing and awake and has a heart
beat. So, we know that there are none of those three reasons to call 911 immediately. So,
I am going to ask him a couple of questions. Sir, do you remember what just happened? Speaker
2: I was carrying some boxes down the stairs and I fell. Speaker 1: Okay, do you know if
you hit your head? Speaker 2: I don't remember, I don't think so. Speaker 1: Do you know what
day is today? Speaker 2: It's Tuesday. Speaker 1: Okay, and it's actually Friday, and do
you know like what year it is? Speaker 2: 2001. Speaker 1: And he is incorrect and those
two incorrect questions might lead me to think that he did hit his head, he may have lost
or may not have lost consciousness, it really doesn't matter but that he may be suffering
some altered mental status as a result of this fall. That's enough for me to say, you
in the plaid shirt go call 911 and come back. I might need your help and bring an AED if
you can find one. Now at the same time I am going to continue with open ended questions.
Now, what does that mean, it means I am not leading him to give me the answer I am looking
for. So, I am just going to generally say, can you tell me what hurts right now? Speaker
2: My neck and my back really hurt. Speaker 1: Okay, so bad that you feel you can't move?
Speaker 2: I can't move. Speaker 1: Okay, are you able to move your arms or you just
trying to just help your back? Speaker 2: I can move them a little. Speaker 1: Can you
wriggle your fingers then? Can you wriggle your toes? So, we are not seeing any paralysis
per se which would be another thing that might lead to a spinal shock which will then get
us thinking as a res ponder they could get pale, cool, sweaty, go unresponsive and we
might need to do CPR because spinal chord injury. So, if we do see any signs of shock,
we are going to cover him with a sheet, coat or blanket, and we are going to continue to
re-assess the patient for airway, breathing or circulation problems. If at any time they
begin to show problems with unresponsiveness, they are not breathing normally, or they are
going to fore cardiac arrest, we are going to treat accordingly and wait for EMS to arrive.
As a healthcare professional having to deliver CPR, a major complication can be when we suspect
a neck injury with an unstable cervical spine. Now a modification of what we might do is
use the modified jaw thrust which is the point of this training video. It needs to be used
when we have a second rescuer so that we can apply both hands as we actually use the rescue
mask with the one way valve to seal the mouth and draw the jaw open which we will show you
in just a minute. The scene would unfold like this, the scene is safe, gloves on hand, my
rescue mask with a one way mask is available. I call out to the patient, they do not respond.
So, I place one hand on the forehead to remind me not to move their head and neck. I tap
on the collar bone, they still do not respond. I go ahead and access EMS by calling 911.
Hey you in the plaid shirt, go call 911 and come back, bringing AED with you when you
come if you can find one. Now, I am going to assess for a normal breathing in a carotid
pulse. No more than ten seconds, there is no pulse and there is no breathing. I gonna
begin CPR and call my healthcare professional partner with me. I now position myself at
the head of the patient, if they are wearing glasses I am going to remove them. Speaker
3: One, two, three, four, five, six, seven, eight, nine... thirty. Speaker 1: And now
for the important part of how we actually apply the mask with the modified jaw thrust.
We are going to place the apex of the mask over the bridge of the nose and see all the
bell part of the mask just below their bottom lip and above their chin. Now look, we are
going to use both thumbs to actually push down on the mask and use our four fingers
to actually grab the mandible or the jaw and pull the jaw up into the mask. The jawline
or mandible actually comes down and then hooks at the back of the jaw and gives the actual
leverage points that we are going to be using to pull that jaw up into the mask. Remember
the goal is not to do a head or chin lift, we may have to do that if you are a lone rescuer
but now we have two rescuers, so we are going to do this way. As we pull the jaw up into
the mask, we go ahead and give our rescue breath. First breath goes in, we get chest
rise and fall. Second breath goes in, we get chest rise and fall, and we continue with
CPR. We are going to continue this CPR using the modified jaw thrust and minimize cervical
spine movement until help arrives and AED arrives or until the patient revives.