General Treatment

Tracheotomy Procedure
Opens the trachea to allow external airflow in case of a blockage that cannot be cleared by intubation in time.
STEP ONE: Sterilize neck with Betadine wash.
STEP TWO: Take a scalpel and cut directly below the thyroid cartilage down to the cricoid cartilage. The cut should be deep enough to penetrate the trachea and the circothyroid membrane.
STEP THREE: Spread trachea slightly to expose the airway.
STEP FOUR: Insert the tracheotomy tube guide, followed by the tube itself.
STEP FIVE: Inflate the balloon cuff once inserted.
STEP SIX: If required, enable a ventilator if the patient is unable to do so alone.

Open Pneumothorax
A serious injury involving clear physical trauma in which the lung is punctured with a large enough opening for gasses to pass through the opening rather than the victim's trachea. If untreated, can turn into a tension pneumothorax.
STEP ONE: DR-ABCs
STEP TWO: If the examination shows the patient with a trachea deviating away from the injured side of the body and possibly distended veins with low blood pressure, a tension pneumothorax is evident, proceed to treating that injury.
STEP THREE: If this is not the case, sterilize and clean the wound area.
STEP FOUR: If bleeding persists, use Wilson forceps to clamp bleeders.
STEP FIVE: Tightly seal a hemostatic patch over the wound, use petroleum jelly along the edges if a proper seal fails to form due to the forceps or any other debris.
STEP SIX: Prepare an endobronchial tube and run it down to the injured lung, inflate the cuff within the injured lung's bronchus.
STEP SEVEN: Hand pump air into the EB tube to reinflate the lung to a reasonable degree. Every ten intervals, put an ear over the lung and slowly pump oxygen through. Listen for any sounds. Wheezing indicates air is escaping the lung through the puncture instead of remaining in the alveoli.
STEP EIGHT: If you have wheezing, the patient will need surgery as soon as possible.
STEP NINE: If the trachea and lung have inflated without problem, the general treatment is near complete. Deflate the EB tube cuff and allow pressure to equalize between the trachea and lung.
STEP TEN: Contact surgical teams to begin the second half of treatment, fixing the lung puncture.
STEP ELEVEN: Watch the patient's status closely. If the patient suddenly becomes incapable of breathing, a pleural effusion may be occurring (see pleural effusion). In this case, surgery is urgently needed and is made the priority for HELIX at that moment.

Closed Pneumothorax
A serious injury involving internal physical trauma to the rib(s) in which the lung has been punctured and gas is able to escape into the pleural space or thoracic cavity. Can lead to pleural effusion and tension pneumothorax if untreated or incorrectly treated.
STEP ONE: DR-ABCs
STEP TWO: If the examination shows the patient with a trachea deviating away from the injured side of the body and possibly distended veins with low blood pressure, a tension pneumothorax is evident, proceed to treating that injury.
STEP THREE: Prepare an endobronchial tube and run it down to the injured lung, inflate the cuff within the injured lung's bronchus.
STEP FOUR: General treatment is complete. Prepare the patient for surgery and ensure he has been intubated.
STEP FIVE: In the event, at any time, that a pleural effusion does occur, drop what you're doing and begin treating it.

Pleural Effusion
A serious stage of an injury where a fluid of some sort builds up in the pleural space or thoracic cavity and exerts too much pressure on a lung, causing breathing problems and possibly a tension pneumothorax.
STEP ONE: Listen for which lung is in distress.
STEP TWO: Insert an endobronchial tube into the bronchus of the damaged lung. Use an endotracheal tube if it's both lungs.
STEP THREE: Begin high-flow oxygen ventilation at a slightly elevated pressure to attempt to equalize the pressure in comparison to the effusion.
STEP FOUR: These steps bought you time. Prepare a thoracentesis needle and have the patient sit if possible. Otherwise, begin by inserting the needle through the skin through the ninth intercostal space (flesh between ribs).
STEP FIVE: Connect the needle's line to a cannula that leads to a drainage bag.
STEP SIX: Slowly pull back on the plunger to start the flow of fluid. As this starts, reset the ventilator to a normal pressure.
STEP SEVEN: Wait until the fluid is drained and breathing is possible.
STEP EIGHT: Remove the needle slowly and place a sterile gauze pad over the puncture. Secure the pad in place.

Second Degree Burns
Burns extending to the dermal layer of the skin.
STEP ONE: Sterilize the wound.
STEP TWO: Use clean water to clean the wound off.
STEP THREE: Sterilize once again.
STEP FOUR: Apply polysporin to the edges of the wound and a thin layer over the central part of it.
STEP FIVE: Place a non-stick gauze pad over the wound, secure with gauze bandage.
STEP SIX: Have the officer repeat this process from time to time until the wound has healed. The bandage and padding can be removed after a few days to allow wound respiration, just continue to apply petroleum jelly to the wound in order to keep it hydrated.

Third Degree Burns
haha no this was bad

Treating Shock
STEP ONE: Get the patient into a safe area, if not already. Ensure you keep the patient's back completely stable. Keep it as immobile as possible and only move if TOTALLY necessary.
STEP TWO: Elevate the patient's legs by 15-20 degrees. Using a tough pillow or other item should do this well.
STEP THREE: Ensure that the patient is breathing correctly. If unconscious, ensure bleeding is minimal and check vitals.
STEP FOUR: Treat the patient dependent upon his or her condition evaluated in step three.
STEP FIVE: Once preliminary treatment for shock is complete, hang a 500mg D5W bag on the IV stand and apply it to the antecubital fossa.
STEP SIX: Observe the patient and treat for any other conditions he or she may be experiencing after the treatment.

Cardio-Pulmonary Resuscitation
STEP ONE: Determine that the patient is not breathing and if he or she has no heart beat.
STEP TWO: If the patient is without heart beat, proceed with the procedure.
STEP THREE: Making sure that the patient is supine, place one hand over the chest of the patient over where the left nipple is by the patient's perspective. Place another hand over the first in a sort of overlapping form.
STEP FOUR: Begin pressing on the patient's chest with your palms out and your fingers up to focus the force of each press through your palm.
STEP FIVE: Continue pumping at 100 repetitions per minute for 30 repetitions.
STEP SIX: Check the airway for breathing or see if the patient's chest rises and falls.
STEP SEVEN: If this is not true, perform the head-tilt, chin-lift maneuver to open the airway some. This is done by tilting the head back to a slight degree (if possible) and lifting the jaw up to the ceiling so that the tongue is up and out of the way as well as not pressing against the back of the throat and pressing the epiglottis against the esophageal wall.
STEP EIGHT: Begin intubation or perform a tracheotomy if the airway is totally blocked.​

Surgical Procedure

Surgery Preparation
STEP ONE: Lay patient supine on operating table.
STEP TWO: Prepare 500mL D5W IV bag and insert the catheter into the dorsum of the hand. Use a double-lumen IV catheter for this.
STEP THREE: Administer propofol 1.5mg/kg IV push.
STEP FOUR: Administer fentanyl 1mg/kg IV push.
STEP FIVE: Wait for the anesthesia to begin working and put the patient under. After this begin intubation. Ensure to connect the ET tube to a ventilator and start it.
STEP SIX: Set the anesthesia machine to these values:
First Hour:
Ketamine 0.8 mg/min
Propofol 1mg/kg/min

Fourth Hour:
Ketamine 0.4mg/min
Propofol 0.8mg/kg/min

Fifth Hour+:
Ketamine 0.2 mg/min
Propofol .6mg/kg/min

Be finished by this time or the patient suffers damage.

STEP SEVEN: Run the anesthesia machine's output line to the catheter's secondary port.
STEP EIGHT: Prepare ECG, EEG set to monitor delta waves, and pulse oximeter.
STEP NINE: Run the machines and ensure they correctly display values and that the patient is ready.
STEP TEN: Sterilize the skin over where the incisions will be made and work is planned to be done. Place a surgical drape over the skin surrounding it to prevent blood from getting everywhere.
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Medical Terminology

anatomical direction- terms used to describe location in a body from an anatomical perspective in relation to another structure

transverse plane- an invisible plane of reference running through the body horizontally; cuts the body into top and bottom halves

sagittal plane- an invisible plane of reference running through the body vertically; cuts the body into left and right halves

coronal plane- an invisible plane of reference running through the body vertically; cuts the body into front and back halves

anterior- front, forward

posterior- back, behind, backward

medial- near the midline of the body

lateral- away from the midline of the body

dorsal- along the upper back

ventral- along the lower front

proximal- near something, close to

distal- away from something, distant from

intubate- the process of inserting any sort of endoscopic tubing into or past the trachea to supply direct oxygen flow to a patient incapable of breathing properly

BVM- bag valve mask; mask with a 3 liter bag attached to pump air manually

laryngoscope- a tool with a curved scope and blade that provides images of a patient's airway, assists in guiding intubation and viewing any obstructive breathing problems

endotracheal tube- a tube used to intubate a patient by supplying oxygen into the trachea

endobronchial tube- a tube used to intubate a patient by supplying oxygen directly to the bronchus of a lung

double-lumen...- prefix describing an instrument (generally tubing) with two 'tubes' that can promote diversion of fluids

catheter- any tubing inserted into the body to deliver or remove fluid

IV push- a term meaning to administer through the IV line, the line more often than not is already flowing with a saline solution that pushes the regents along

hemodialysis- the use of a machine to filter a person's blood

plasmapheresis- a treatment that involves separating an individual's plasma from the blood and filtering the plasma, then returning it to the blood and back into the body

scalpel- a surgical 'knife' with a short narrow blade that can make precise incisions

forceps- surgical 'scissors', many different kinds

hemostat- forceps designed to clamp down on open blood vessels and lock down to prevent bleeding

Wilson forceps- hemostat designed with a bend in front of the axis; can clamp vessels and have a handle flat against skin