Kurban Gather 1430H in Qatar

Lebaran Idul Adha telah berlalu, tetapi setiap perayaannya selalu membekas apalagi dengan makna pengorbanannya.

Tidak seperti kebiasaan masyarakat di Indonesia merayakan hari raya Idul Adha ini dengan segala persiapan penyambutannya mulai dari menu lontong, ketupatnya sampai ke bingkisan-bingkisan kue yang tertata rapih dimeja tamu. Begitu pun dengan persiapan hewan kurbannya seperti kambing, domba atau sapi yang sudah dibeli jauh-jauh hari atau pun serentak pembeliannya sehari sebelum perayaan Idul Adha.

Berbeda dengan kondisi di Qatar ini, suasana lebaran tidak begitu terlihat keistimewaaanya seperti halnya perasaan sumringah tersebut di atas, hanya dirasakan perbedaanya sangat ramai di tempat-tempat perbelanjaan saja, tidak ada gemuruh, suara bedug ataupun pawai-pawai gema takbir lainnya yang terdengar ataupun terlihat. Mungkin karena budaya yang membedakannya.Budaya kental kita ini dalam penyambutan hari raya yang dianggap tepat sebagai momen silatutrahim, sudah mulai dikobarkan sejak beberapa tahun yang lalu.

Kedutaan RI yang merupakan pusat berkumpul dan hala-bihalalnya masyarakat Indonesia tetap menjadi primadona sebagai tempat berjibaku dan memadu rindu semua masayarakat Indonesia se-Qatar. Apalagi dengan diselenggarakannya bazar bermacam aroma makanan khas Indonesia menjadikannya 'rasa' ini seolah berada di kampung halaman sendiri.Tak ketinggalan masyarakat medical yang tergabung dalam ikatan Indomediqa dan INNA-Q meleburkan suasana haru ini kedalam berbagai kegiatan.

Persiapan acara pun digelontorkan paling tidak satu minggu sebelumnya mulai dari tempat, pembagian menu dan agendanya. Yang lebih dari ikatan kita ini adalah adanya persamaan kewajiban dan kebutuhan yang telah membalut rasa kebersamaan sesama anggotanya sehingga segala kebutuhan di setiap acaranya dapat terkoordinir dengan sempurna.Bahagia, senang, dan rasa rindu tumpah ruah ketika kami dari berbagai wilayah Qatar bertemu dan berkumpul di tempat yang telah ditentukan. Cornich yang bagi kami adalah perumpamaan sebagai rumah karuhun yang mudah dijangkau oleh semuanya telah menjadi saksi bisu makna persaudaraan ditunjang dengan suasana pantai dan berbukitan yang disertai udara winter yang segar, apalagi didukung dengan keberadaan tempat bermain anak-anak yang setidaknya dapat meredam rengekan dan teriakannya.

Ternyata perayaan ini tidak hanya sampai disitu saja, malam harinya sebahagian diantara kami ada yang melanjutkannya dengan pertandingan persahabatan badminton dengan komunitas masyarakat Indonesia lainnya, menyaksikan live show anak-anak di City Centre atau sekedar berkunjung saja.Tidak sempurna rasanya kalau lebaran dan liburan kali ini tidak disertai dengan hidangan ikan bakarnya, membiarkan anak-anak bermandikan lumpur atau merendam tubuh ini dengan asinnya air laut. Maka kami pun memutuskan untuk berlibur di Sealine pada hari kedua lebaran walau hanya dihadiri oleh beberapa keluarga saja berhubung kesibukan dan tugas dari rekan-rekan lainnya. Suasana pantai yang suhu udaranya hampir sama dengan suhu udara di Indonesia telah menyelimuti kedekatan diantara kami, ditambah dengan permainan bola pasir dan berombak ria membuat suasana pada hari itu serasa bersama dengan keluarga sendiri.

kul'am waantum bikhoir ....

Back in Service

Assalamu'alikum wr.wb.

This is to inform you that d-ners is back and ready for service after few month absent due to an acceptable reason, hah ?

During absent, I had had a best journey, best lecture and opportunity. Actualy, I could not left my time here to express my idea but best is the best from best of me and time now to create and explore my best here again to make a memory.

I'm tired, busy and lazy. I hope my stories and ideas here can develope my spirit and propensity even I'm busy or tired but it can demolish my those negative habits. I should be.

D-Ners Weblog: Religious- Ramadhan 1428 H

D-Ners Weblog: Religious- Ramadhan 1428 H

Religious- Ramadhan 1428 H

Munggahan-Ramadhan in Qatar
O you who believe! Observing al-sawm (the fasting) is prescribed for you as it was prescribed for those before you, that you may become al-muttaqoon (the pious). (Qur’an al-Baqarah 2:183).

This is my 4th Ramadhan and 2nd Ramadhan with family in Qatar. Ramadhan is the Islamic fasting month. It is celebrated every day of the month of the Ramadhan on the Islamic Calender. In this year 2007/1428H, this month begins on Thursday September 13 2007. Ramadhan is beleived to be the month in which the first verses of teh Qur'an were revealed by GOD Allah SWT to the prophet Muhammad saw. Fasting during this month teaches us self-dicipline Almost everything changes during the Holy month of Ramadhan - from waking to working hours and daily habits (both physical and moral). Many people become more religiously observant. In Qatar, pre-ramadhan (munggahan) there is no special culture ceremony that I see and feel like in Indonesia, or may be because of our hard profession activity or really I don't know. But if we join with Masjid organization or social forum we'll have other opinion that we always celebrate when Ramadhan is come as our culture.
Some of the many important lessons we learn from Ramadan are:
- Developing Taqwa
Fasting has been legislated in order that we may gain taqwa, as Allah – the Most High – said:
"O you who believe! Fasting is prescribed for you, as it was prescribed upon those before you in order that you may attain taqwa." [Qur’an al-Baqarah 2:183]
The Prophet (peace and blessings be upon him) said: "Fasting is a shield with which the servant protects himself from the Fire." (Hasan: Ahmad, authenticated by al-Albani in Saheeh ut-Targheeb)
So we should ask ourselves, after each day of fasting: Has this fasting made us more fearful and obedient to Allah? Has it aided us in distancing ourselves from sins and disobedience?
- Seeking Nearness to Allah
"Whosoever reaches the month of Ramadan and does not have his sins forgiven, and so enters the fire, then may Allah distance him." (Ahmad and al-Bayhaqee)
- Acquiring Patience
What is meant by the month of Patience is the month of Ramadan …so fasting is called patience because it restrains the soul from eating drinking, conjugal relations and sexual desires." (At-Tamheed of Al Haafidh ibn Abdul Barr)
The Prophet Muhammad (peace and blessings be upon him) said:
"O youths! Whoever amongst you is able to marry, then let him do so; for it restrains the eyes and protects the private parts. But whoever is unable, then let him fast, because it will be a shield for him." (At-Tamheed of Al Haafidh ibn Abdul Barr)
So fasting is a means of learning self-restraint and patience. With patience we are able to strengthen our resolve to worship Allah alone, with sincerity, and also cope with life’s ups and downs. So – for example – with patience we are able to perform our Prayers calmly and correctly, without being hasty, and without merely pecking the ground several times!
With patience we are able to restrain our souls from greed and stinginess and thus give part of our surplus wealth in Zakaah (obligatory charity). With patience we are able to subdue the soul’s ill temperament, and thus endure the ordeal and hardships of Hajj, without losing tempers and behaving badly. Likewise, with patience we are able to stand firm and fight Jihad against the disbelievers, hypocrites and heretics – withstanding their constant onslaught, without wavering and buckling, without despairing or being complacent, and without becoming hasty and impatient at the first sings of hardship. Allah – the Most High – said:
"O Prophet, urge the Believers to fight … So if there are one hundred who are patient, they shall overcome two hundred; and if there be one thousand, they shall overcome two thousand, by the permission of Allah. And Allah is with the patient ones." [Qur’an al-Anfaal 8:65-66].

Thus, without knowledge and patience, nothing remains, except zeal and uncontrolled emotions, shouts and hollow slogans, speech that does not strengthen, but rather weakness, and actions that do not build, but rather destroy! So in this month, we should strive to develop a firm resolve for doing acts of obedience, and to adorn ourselves with patience – having certainty in the saying of our Messenger sallallahu `alayhi wa sallam: "And know that victory comes with patience, relief with affliction, and ease with hardship." ( Saheeh: Ahmad, at-Tabaraanee in al-Kabeer, authenticated by al-Hilaalee in as-Sabrul Jameel)
- Cultivating Good Manners
Fasting is not merely abstaining from eating and drinking. Rather, it is also abstaining from ignorant and indecent speech. So if anyone abuses or behaves ignorantly with you, then say: I am fasting, I am fasting." (Saheeh: Ibn Khuzaymah and al-Haakim, who authenticated it.
- Sensing Muslim Unity
As Muslims from all around the world commence Ramadan we realise that we are part of a community our hearts and actions united in pursuing Allah’s pleasure. There are many ahadith mentioning the blessings of breaking the fast together and there is also much reward in feeding a fasting person. So let us unite in this month of Mercy.
So Ramadan – it is that light in the souls of the righteous and the truthful, and in the hearts of the devout and sincere it gives happiness; for it is the month of obedience, and in it there are beautiful reflections for us all. Indeed, it grants victory to the soul over the body and flesh and gives us a wonderful opportunity to straighten ourselves up with our Lord.
During this month of Sha’baan we should find out more about the traditions of the prophet Muhammad (peace be upon him) related to Ramadan and make a sincere effort to implement them this year. We should also try to purify our hearts and intentions before the commencement of Ramadan to make this fast successful for our families and ourselves, Insya’Allah.
Ramadan is also an opportunity to renew relationships that may have been broken during the year and we should try and clear up any disputes or bad feelings with other Muslims so we may start this month a fresh.
So we ask Allah to grant us the ability to change ourselves for the better, during this blessed month, and not to be of those who are prevented from His Mercy and Forgiveness. Indeed He is the One who Hears and He is the One to Respond.

Our Menu- Cardiac Arrest Management

Cardiac Arrest Management in Our Experience

Common cause of patient dead in our working area is cause by cardiac arrest, and mostly the common cause of cardiac arrest is unknown. Whatever cause of cardiac arrest, arrest is arrest and safe life action is our commitment.

Learn from case to case of cardiac arrest, what should we do better to improve our action, to safe our patient (possibility). The principles of cardiac arrest management as my experiences are:

Ø Control our self, don’t panic

Ø Organize the team

Ø Learn from experience

Ø Learn from latest theory/guideline

Ø Discussion, and

Ø Follow the procedure, do we have it ? if no follow the latest guideline AJA.

Mostly all of references urges the public to be prepared for cardiac emergencies:
Know the warning signs of cardiac arrest. During cardiac arrest a victim loses consciousness, stops normal breathing and loses pulse and blood pressure.
Call Emergency in your area immediately to access the emergency medical system if you see any cardiac arrest warning signs.
Give cardiopulmonary resuscitation (CPR) to help keep the cardiac arrest victim alive until emergency help arrives. CPR keeps blood and oxygen flowing to the heart and brain until defibrillation can be administered.

How is our cardiac work?

What is cardiac arrest?
Cardiac arrest is the sudden, abrupt loss of heart function. The victim may or may not have diagnosed heart disease. It's also called sudden cardiac arrest or unexpected cardiac arrest. Sudden death (also called sudden cardiac death) occurs within minutes after symptoms appear.
A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole.

"Arrested" blood circulation prevents delivery of oxygen to all parts of the body. Cerebral hypoxia, or lack of oxygen supply to the brain, causes victims to lose consciousness and to stop normal breathing. Brain injury is likely if cardiac arrest is untreated for more than 5 minutes, although new treatments such as induced hypothermia have begun to extend this time.To improve survival and neurological recovery immediate response is paramount.

Cardiac arrest is a medical emergency that, in certain groups of patients, is potentially reversible if treated early enough (See Reversible Causes, below). When unexpected cardiac arrest leads to death this is called sudden cardiac death (SCD).The primary first-aid treatment for cardiac arrest is cardiopulmonary resuscitation (commonly known as CPR) to provide circulatory support until availability of definitive medical treatment, which will vary dependant on the rhythm the heart is exhibiting, but often requires defibrillation.

Cardiac arrest refers to a sudden, profound disturbance in the heart’s rhythm that causes the heart to stop beating completely or slow to the point where the life is unsustainable. Cardiac arrest is not the same as a heart attack. A heart attack, while potentially life threatening, usually offers a short period of time in which treatment can save the person’s life.

What causes cardiac arrest?

The most common underlying reason for patients to die suddenly from cardiac arrest is coronary heart disease. Most cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing of the heart. This is called bradycardia.

Other factors besides heart disease and heart attack can cause cardiac arrest. They include respiratory arrest, electrocution, drowning, choking and trauma. Cardiac arrest can also occur without any known cause.

Cardiac arrest must be treated immediately to avoid sudden cardiac death (death that results from cardiac arrest). Unfortunately, most people (85 percent) who experience cardiac arrest cannot get help fast enough. Those who survive the event are said to have lived through an “aborted” sudden cardiac death.

Cardiac arrest is most often caused by ventricular fibrillation, a condition in which the heart’s lower chambers quiver rather than pump blood. Ventricular fibrillation is usually accompanied by existing heart disease, especially coronary artery disease and previous heart attack. According to the American Heart Association, 90 percent of adults who succumb to cardiac arrest have two or more narrowed coronary arteries. Moreover, heart attack survivors have up to six times the rate of sudden cardiac death compared to the general population. In some rare cases, cardiac arrest can be provoked by recreational drug use or trauma.

Although there is some confusion in terms of recoding deaths due to cardiac arrest, it is estimated that about 330,000 Americans die every year due to cardiac arrest. The overwhelming majority of these are caused by ventricular fibrillation.

Can cardiac arrest be reversed?

Brain death and permanent death start to occur in just 4 to 6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed if it's treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A victim's chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. Few attempts at resuscitation succeed after 10 minutes.

How many people survive cardiac arrest?

No statistics are available for the exact number of cardiac arrests that occur each year. It's estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 30–45 percent.

What can be done to increase the survival rate?

Early CPR and rapid defibrillation combined with early advanced care can result in high long-term survival rates for witnessed cardiac arrest. For instance, in June 1999, automated external defibrillators (AEDs) were mounted 1 minute apart in plain view at Chicago's O'Hare and Midway airports. In the first 10 months, 14 cardiac arrests occurred, with 12 of the 14 victims in ventricular fibrillation. Nine of the 14 victims (64 percent) were revived with an AED and had no brain damage.

If bystander CPR was initiated more consistently, if AEDs were more widely available, and if every community could achieve a 20 percent cardiac arrest survival rate, an estimated 40,000 more lives could be saved each year. Death from sudden cardiac arrest is not inevitable. If more people react quickly by calling emergency team and performing CPR, more lives can be saved.

Remember our last cardiac arrest case happened in our area, patient survive after early CPR and ALS done, and other cardiac arrest case brought to our facility after 20 minutes CPR and ALS done, patient’s pulse was present and VS taken reading in normal range. Fabulous, verrrryyyy rarely case.

What is the prevention?

Prevention of cardiac arrest and sudden cardiac death is aimed at controlling underlying heart disease. Experts generally recommend that people make lifestyle changes to prevent the conditions that could trigger cardiac arrest, including atherosclerosis, which is the leading cause of coronary artery disease. Lifestyle changes may include losing weight, reducing LDL cholesterol levels, eating a heart-healthy diet and getting adequate exercise. When warranted, experts also recommend medical treatment of any underlying conditions, which may involve taking medications and/or having surgery (e.g., placing an implantable defibrillator into the patient’s

More details find at:
http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58
http://www.nda.ox.ac.uk/wfsa/html/u10/u1006_01.htm

Our Menu- Environmental Emergencies

Environmental Emergencies
Thermoregulatory Emergencies

An increase or decrease in the temperature of the body or body part that results in an injury.

Temperature Regulation in the Body

The body performs a delicate balancing act between the heat generated in the body and the heat lost from it

Types of Heat Loss
- Respiration
- Convection
- Conduction
- Radiation
- Evaporation

Heat loss occurs during respiration - when the body warms and humidifies the air.

Maintenance of Body Temp
Falling body temperature
- Peripheral blood vessels constrict
- Muscles produce heat through shivering
Rising body temperature
- Blood vessels dilate
- Sweat glands produce moisture

The body also produces heat by shivering

Exposure to the Cold (at Tembagapura ?)

Extreme weather conditions can produce a variety of cold emergencies

Hypothermia: A condition in which the core body temperature falls below 35o C (95o F) and the body’s normal functions are impaired.

Caused by prolonged exposure to cold.
The most common cause of generalized hypothermia is exposure to a cold environment such as cold water.

Factors that Contribute to Hypothermia
- Cold environments
- Immersion or submersion in water
- Age (the very young and the elderly)
- Alcohol
- Shock (hypoperfusion)
- Some medications and poisons
- Medical conditions
- Diabetes and hypoglycemia
- Metabolic and infectious processes
- Trauma
- Hypovolemia or shock
- Head injuries
- Spinal cord injuries
- Burns

Alcohol use is a complicating factor in many hypothermic patients

Mental & Motor Function Changes caused by Hypothermia
= Dizziness and poor coordination
= Altered mental status
- Memory disturbances
- Poor judgement
- Mood changes
= Communication and speech difficulties
= Stiffness/rigid posture
= Reduced or absent sense of touch
= Changes in vital signs
= Joint or muscle pain
Focused History
What was the source? If water, what was the temperature? What was the general environmental like? How long was the patient exposed? Did the patient experience a loss of consciousness? Are the effects general or local?
Hypothermia Treatment
- Remove the patient from the cold environment and protect from heat loss - Remove any cold or wet clothing, and cover the patient with blankets - Handle the patient with care, and avoid rough handling - Warm the patient compartment of the ambulance as much as possible - Hypothermia Treatment continued - Apply high-flow oxygen; warmed and humidified if possible - Use no stimulants such as caffeine or alcohol - Do not massage the extremities - Check for a pulse for 30 - 45 seconds before starting CPR

Do not attempt to actively warm hypothermic patients who have a decreased level of consciousness...

Care for Hypothermia with No Signs of Life
- Ensure a patent airway - Ventilate the patient with 100% oxygen - Begin CPR if no pulse for 30 - 45 seconds - Use the AED according to local established protocols, or call medical direction

Local cold injuries result from decreased blood flow to, or freezing of, a body part. These injuries are often called frostbite or frostnip.

Early or Superficial Cold Injury
- Pale skin with delayed capillary refill
- Loss of feeling/sensation in injured area
- Skin still soft
- Tingling sensation when rewarmed
Late or Deep Cold Injury
- White or waxy skin appearance
- Firm or frozen skin presentation
- Swelling and blister formation
- Loss of sensation in injured area
- If thawed, skin may be purple and pale
Care for Local Cold Injuries
- Remove patient from cold environment
- Protect the cold extremity from injury
- Administer oxygen
- Remove wet or restrictive clothing and all jewelry
- Splint if extremity involved, and cover with dry, sterile dressing

Place dressings between those fingers affected by local cold injury.
Never

re-expose the area to cold, break blisters, rub or massage the area, apply heat, or allow the patient to use the affected area.

In a cold emergency, if transport time will be long:
- Immerse the affected part in warm water (102o - 104o F)
- Continuosly stir and add warm water to maintain temperature
- Continue immersion until the area is soft andcolor and sensation return
- Pat gently and dress with dry, sterile dressings
- Protect the injured area from refreezing
- Refer to local protocols for other treatment

Exposure to Heat

baru ini di Doha,

Predisposing Factors for Heat Emergencies
- Hot, humid weather
- Vigorous physical activity
- Age (the very young and the elderly)
- Medical conditions
- Diabetes
- Heart disease
- Fever
- Predisposing Factors for Heat Emergencies continued
- Dehydration
- Obesity
- Fatigue
- Drugs and medications
- Previous history of hyperthermia
Signs and Symptoms of Hyperthermia
- Muscle cramps
- Weakness or exhaustion
- Dizziness or fainting
- Rapid, bounding pulse
- Altered mental status
- Moist, pale, cool, hot or normal skin
- Nausea, vomiting and abdominal cramps
Care for Hyperthermia with Moist, Pale, Cool or Normal Skin (Heat Exhaustion)
- Remove patient from hot environment
- Administer oxygen
- Loosen or remove clothing
- Cool the patient by fanning
- Place responsive patient supine with legs elevated; if vomiting, place on side
- If no nausea, provide cool water to drink
Care for Hyperthermia with Hot, Dry Skin (Heat Stroke)
- Remove patient from hot environment
- Remove clothing and administer oxygen
- Apply cold to neck, groin and armpits
- Moisten patient’s skin with wet towels
- Fan the patient aggressively
- Transport patient immediately

Drowning and Near Drowning
Care of the Near Drowning Patient
- Immobilize spine if trauma is suspected
- Ensure adequate airway, provide oxygen and ventilate if necessary
- Provide CPR if pulseless (use AED if allowed by local protocols)
- Suction as needed
- If no trauma, place patient on left side
- Transport immediately

Bites and Stings
Care of Bites and Stings
- Ensure adequate ABC’s
- Inspect the site for stinger or bite marks
- Wash the area gently
- Remove jewelry from injured area
- If extremity, position just below level of heart
- If snakebite, consult medical direction
- Watch for development of allergic reaction

Source MOSBY

Our Menu- Prehospital Care

Prehospital Care
An ambulance is a vehicle for transporting sick or injured people, to, from or between places of treatment for an illness or injury. The term ambulance is used to describe a vehicle used to bring medical care to patients outside of the hospital and when appropriate, to transport the patient to hospital for follow-up care and further testing. In some jurisdictions there is a modified form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care, but is not used to transport the patient. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder.

The term ambulance comes from the Latin word ambulare, meaning to walk or move about patients were moved by lifting or wheeling. The word is most commonly associated with the land-based, emergency motor vehicles that administer emergency care to those with acute illnesses or injuries, hereafter known as emergency ambulances. These are usually fitted with flashing warning lights and sirens to facilitate their movement through traffic. It is these emergency ambulances that are most likely to display the Star of Life, shown on the right, which represents the six stages of prehospital medical care. which is a reference to early medical care.

There are other types of ambulance, with the most common being the patient transport ambulance. These vehicles are not usually (although there are exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Their purpose is simply to transport patients to, from or between places of treatment. In most countries, these are not equipped with flashing lights or sirens.
Other vehicles used as ambulances include trucks, vans, station wagons, buses, helicopters, fixed-wing aircraft, boats, and even hospital ships (wilkipedia).

So whatever we have, kind of vehicles can build up as an emergency rescue, at least the vehicle is safe and comfort for the crew. Safe a life with a professional services.

The philosophy of prehospital care can be summarised as "the appropriate intervention at the appropriate time." To this end it aims to bring the benefits of advanced medical care to the roadside or similar arena. However, it also requires careful judgment as to when it would be beneficial to perform an intervention, and when the delay involved would lead to a deterioration in the patient's condition.
The practice of prehospital care is a far cry from treating a patient in a well lit, warm, and spacious resuscitation room. The situations may be uncomfortable--for instance, managing a patient in a upturned car--and frequently environmental conditions are less than ideal, as incidents often occur in bad weather or at night.
The most important in prehospital care are:
1. Ambulance preparation intact with equipments and supplies, should be ready any time for an emergency call.
2. Communication; hand held radio fully charge battery, communication should short, loud and clear.
3. Stress control; knowledge and skill, familiar the location and learn from the previous case.
4. Action; immediate dispatch the Ambulance and crew, consent with an emergency services professional.
The simple guideline for our action systematically during an emergency, explained in diagram below:

Scene Size-Up Body Substance Isolation Precautions Scene Hazards Number of Patients Need for more Help or Equipment Mechanism of Injury

Initial Assessment General Impression of the Patient Level of Consciousness Airway Breathing Circulation

Load –and -Go Situation?

Rapid Trauma Survey

Focused Exam

Load - and – Go Situation

Detailed Exam

Ongoing Exam

Scene Size-Up

Which BSI Precautions do I need to take ?
Do I See , Hear , Smell , or Sense anything dangerous
Are there any other patients ?
Are additional Personnel or Resources needed ?
Do We need Special Equipments ?
What is the Mechanism of Injury here ?
Is it Generalised or Focussed ?
Is it Potentially Life-Threatening ?

Initial Assessment
What is my General Impression of the Patient as I approach ?
Level of Consciousness (AVPU)
Introduce Yourself and say “We are here to help you . Can you tell us What Happened ?”
Airway
Is the Airway Open and Clear ?
Breathing
Is the Patient Breathing ?
What is the Rate and Quality of Respiration ?
Ventilation Instructions
Order Oxygen for any Patient with abnormal Respiration , altered Mental Status, Shock or Major Injuries .
Delegate assisted Ventilation if the Patient is Hypoventilating ( <12>
Or if there is inadequate movement of air .
Hyperventilate only those Head injury Patients who are unresponsive and show signs of Cerebral Herniation.
Circulation
What is the Rate and Quality of Pulse at the Wrist ( and at the neck if not Palpable at the Wrist ) ?
Is major external bleeding present ?
What is the Skin color , condition , and Temperature ?
Decision
Is this a Critical Situation ?
Are there interventions that I must make now ?

Rapid Trauma Survey
Head and Neck
Are there obvious wounds of the Head or Neck ? Are the Neck Veins Distended ? Does the Trachea look and feel midline or deviated ? Is there deformity or tenderness of the Neck ?
Chest
Is the Chest Symetrical ? Is there Paradoxical movement? Is there any Obvious Blunt or penetrating trauma ? Are there any open wounds or Paradoxical movement? Is there TIC of the ribs ? Are the Breath sounds present and equal ? If breath sounds are not equal , is the chest hyperresonant or dull ? Are heart sounds normal or decreased ?
Abdomen
Are there Obvious wounds ? Is the abdomen soft , rigid , or distended ? Is there tenderness ? Pelvis Are there obvious wounds or deformity ? Is there TIC ?
Upper Legs
Are there obvious wounds , swelling , or deformity ? Is there TIC ?
Scan of Lower Legs and Arms
Are there obvious wounds , swelling , or deformity ? Is there TIC ? Can the patient feel / move fingers and toes ?
Exam of Posterior
( done during transfer to the Back Board ) Is there any deformity , contusions , abrasions , penetrations , burns , tenderness , Lacerations , or swelling (DCAP – BTLS ) of the patient’s posterior side ?
Decision
Is there a critical situation ? Are there interventions I must make now ?
History
What is SAMPLE history ? ( may have been obtained during the exam )
Vital Signs
Are the Vitals Signs abnormal ?
Disability
(Perform this exam now if there is altered mental status . Otherwise , Postpone this exam until you perform Detailed Exam. ) Are the Pupils equal and reactive ? What is the Glasgow Coma Score ? Are there signs of Cerebral Herniation (unconsciousness , dilated pupil (s) , Hypertension , bradycardia , posturing ) ? Does the patient have a medical identification device ?

Detailed Exam
SAMPLE History
(complete if not already done ) What is the Patient’s history ?
Vital Signs:
What are the Vital Signs ?
Neurological Exam
What is the LOC ?
What is the Blood Glucose (if altered mental Status ) ?
Are the pupils equal ? Do they respond to light?
Can the patient move his fingers and toes ?
Can the Patient feel me touch his fingers and toes ?
What is the Glasgow Coma Score (if altered mental status )?
Head
Is there DCAP-BTLS of the face or head ?
Is Battle’s sign or raccoon eyes present ?
Is there blood or fluid draining from the ears or nose ?
Is there pallor , cyanosis or diaphoresis ?
Airway
Is the airway open and clear ?
If there are burns of the face , are there signs of burns in the mouth or nose ?
Breathing
What is the rate and quality of respiration ?
Neck
Is there DCAP-BTLS of the neck ?
Are the neck veins normal , flat , or distended ? ,Is the trachea midline or deviated ?
Circulation
What is the rate and quality of the pulse ?
What is the skin color , condition ,and temperature (capillary refill in children )
Is all external bleeding still controlled ?
Chest
Is there DCAP-BTLS of the chest ?
Are there any open wounds or paradoxical movement ?
Are the breath sounds present and equal ?
If the breath sounds are not equal , is the chest hyperresonant or dull ?
Are heart sounds normal or decreased ?
If the patient is intubated , is the endotracheal tube still in position ?
Abdomen
Is there DCAP-BTLS of the abdomen ? Is the abdomen soft , rigid , or distended ?
Pelvis
( already examined in the initial assessment – no further exam should be done
Lower Extremities
Is there DCAP-BTLS of the legs ? Is there normal PMS ? Is range of motion normal ?
Upper Extremities
Is there DCAP-BTLS of the arms ? Is there normal PMS ? Is range of motion normal ?

Ongoing Exam
Subjective Changes
Are you feeling better or worse now ?
Mental Status
What is the LOC ?
What is puillary size ? Are they equal ? Do they react to light ?
If altered mental status , what is the Glasgow Coma Score now ?
Reassess ABCs
Airway
Is the airway open and clear ?
If there are burns of the face , are there signs of inhalation injury ?
Breathing and Circulation
What is the rate and quality of respiration ?
What is the rate and quality of the pulse ?
What is the blood pressure ?
What is the skin colour , condition , and temperature (capillary refill in children)
Neck
Is the trachea midline or deviated ?
Are the neck veins normal , flat , or distended ?
Is there increased swelling of the neck ?
Chest
Are the breath sounds present and equal ?
If breath sounds are unequal , is the chest hyperresonant or dull ?
Abdomen ( if mechanism suggests possible injury )
Is there any tenderness ?
Is the abdomen soft , rigid , or distended ?
Assessment of Identified Injuries
Have there been any changes in the condition of any of the injuries that I have found?
Check Interventions
As the appropriate question for your patient .
Is the ET still patent and in the correct position ?
Is the Oxygen rate correct ?
Is the Oxygen tubing connected ?
Are the IVs running at the correct rate ?
Is the Open Chest wound still sealed ?
Is the decompression needle still working ?
Are any of the dressings blood soaked ?
Are the splints in good position ?
Is the impaled object still well established ?
Is the pregnant patient tilted to the left ?
Is the Cardiac monitor attached and working ?
Is the Pulse Oximeter attached and working ?

Coordination with partner, other emergency crew and dispatcher as a team will help an emergency system run well, continue education will help the ambulance crew more confident and professional, and the reporting system will support the team to monitor and evaluate the crew and services.
WORK SAFETY and ACT SAFELY.