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    © All Rights Reserved
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    10 views6 pages

    European Council Guidelines 2021 (Summarize)

    Uploaded by

    sebastian luna

    Copyright:

    © All Rights Reserved
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    ELSEVIER ‘Available online at www sciencedirect.com Resuscitation journs! homepage: www.elsevier.com/locate/resuscitetion EUROPEAN, (gy) \resuscraion Jcounci. European Resuscitation Council Guidelines 2021: First aid ® a David A. Zideman*’*, Eunice M. Singletary”, Vere Borra®’, Pascal Cassan®, Carmen D. Cimpoesu’, Emmy De Buck", Therese Djarv', Anthony J. Handley”, Barry Klaassen'’/, Daniel Meyran“, Emily Oliver’, Kurtis Poole* “Thames Valley Air Ambulance, Stokenchurch, UK ® Dopartment of Emergency Medicine, University of Virgina, USA ° Centre fr Evidence-based Practice, Belgian Red Cross, Machelen, Belgium *Cachrane First Aid, Mechelen, Belgium * Intorational Federation of Red Cross and Red Crescent, France "University of Medicine and Pharmacy “Gigore T. Popa’ as, Emergency Department and Prehospital EMS SMURD lasi Emergency County Hospital "St. Spirdon" Iasi, Romania 5 Department of Pubic Heath and Primary Care, Facully of Medione, KU Leuven, Leuven, Belgium "cambridge, UK “Emergency Medicine, Ninewells Mospital and Medical Schoo! Dundee, UK “Briisn led Cross, UK “Franch Red Crass, Batailon do Marins Pompors do Marseio, Franco "Department of Medicine Solna, Karolinska Instituto and Division of Acuto and Reparative Medicine, Karolinska University Hospital, Sweden Introduction and scope 1h 2016 the European Resuscitation Counc! pushed its intial Fist ‘Aid guidelines’ based on the Intemational Lisson Commitee on Resuscitation (ILCOR) Consensus on First Ald Science with “Treatment Recommendations published in the same year.*? In 2015 ILCOR modified ts consensus on science review process roma ‘ive-yoar cycle 1 a continuous evidence evaluation process. This Corresponding author. E-mal address: av zdeman@ gmail com (OA, Zioman). psi’ orto 1076) resuscitation 2021 02.013, teftected in the 2020 ILCOA Consersus on Science wth Treatment Flocommendations (CoSTRs)."* In 2016 the ILCOR First Aid Task Force assessed al the topics reviewed by me American Hoar Assocation ane American Red Gross In the 2010 evidence review” and the 13 medical Population, Intervention, Comparison, Outcome (PICO) questions, ten trauma PICO questions and one education PICO examined in the ILCOR 2018 CoSTR review."* Thirty-eight PICO topies were selected for scoring and ranking by the task force members. Scoring was ‘0300 9572/6 2021 Eurepean Resuscitation Coun. Pubished by Elsevier 8.V. Al rights reserved an cofientated as to whether here was any published new evidence that ‘would modly the 2015 CoSTRs. The top wenty ranked topes were: selected and submited by the ILCOR Continuous Evidence Evaluaton (CEE) group, the constituent ILCOR councls for raifca tion and then opened for publocomment, The First Aid task orce then ‘evaluated each selactod topic. The taskforce selected topics where ‘hey beloved there was new published evidence (since 2015) and submited these for systematic review. For some topics the PICO. ‘quostion was changed to address gaps identified by previous reviews and these ware also submited for systematic review. The control of life-threatening bleeding topics were combined into a mege-PICO for an integrated systematic review. Where the task force was uncertain that there was sufficient now published ‘evidence to suppor a systematic review, the PICO was submitted to a scoping review process. Scoping reviews are based on a broader search strategy, Including grey Iterature, and provide a narrative report of their ndings rater than the rical appraisal ofa systematic review, The resuting manuscripts for both the system- alc reviews and scoping reviews wore subject to pubic comment and published on the ILCOR CoSTA website and in the 2020, CCoSTA summary." A numberof the systematic reviews have been leecly published inclusing ‘Immediate interventions for presyn- cope',’ “Management of hyoogiyenemia’.” “Early versus late administration of aspirin for nor-traumatic chest pain." ‘Cooling techniques for heat stioke and exerional hyperthermia’, "> ‘Com- pression Wrapping for Acute Closed Extromity Joint injuries’ ‘Dental avulsion” and “Stoke Recagniton for Fitet Ald Providers° ‘Tho European Resuscitation Councl Fst Ald witing group has used the pub shed systomatic reviews and scoping reviews togethor ‘withthe ILCOR First ia tasktoree consensus on scence andtreatment recommendations (ILCORICOSTR) as evidence for these fst aid guidelines. The wring group also caretuly consideredne evidence to decision tables, naraive reviews and tak force discussions when \wrng these guidelines. In addon, he Wrting Group considered fe ‘Adaltiona topics, nt included in the 2020 ILCOR process, that hac been previousyincudegin he 2015 COR process, forshortevidence reviows. The Witing Group has added these additonal cinical recommendations as expert consensual opinion anc labelled ther as Good Practice Points to dierentiate them trom guidelines derwed directly rom scintic review. In total hese guidelines include 20 PICO topics, subdivided into leven medical ang nine trauma emergencies. Medical emergencies Recovery postion ‘Optimal positioning or shock vitims Bronchodiator acminstation for asthma Recognition of stroke Early aspirin for chest pain ‘Anaphylaxis: ‘Second dose of adrenaline (epinephrine) in anaphylaxis. Recognition of anaphy/axis by fst aid providers Management of hypoglycaemia (Ora rehydration solutions for treating exertion-elated dehydration Management of heat stoke by cooling ‘Supplemental oxygon in acute stroke Management of presyncope Trauma emergencies Control o life-threatening bleeding Management of open chest wounds Cervical spine motion resto and stabilisation Feecogniton of eoncussion Thermal uns: Cooking of thermal burns Thermal bum dressings Dental avulsion Compression wrap for closed extremity joint injuries Straightening an angulated fracture Eye injury from chemical exposure Det n of first aid Frat aids thei care provided for an act ness or iy. gol of fist adinclude presernglte alevaingeutening, revertng ‘unbernes rijurvandpremtngreeovey Fst acican bo nated by anyonein any stuaton,inccing secre. General characteris ofthe provision of ret a, at any level of waning ede + Recognising assessing and prising the need fo ft ad + Providing car using appropiate competencies and recogising batons Sooking adstonal care when needed, suen as actvatng tho femergancy medial serices (EMS) system or other medial Key principles include: First aid should bo medicaly sound and based on the best avaiable scientific evidence Fistaid edveation shoudbe universal: everyone shouldlearn est ais Helping behaviours shouldbe promoted: everyone should act ‘Tne scope of fst aid and helping behaviours varies and may be Influenced by environmental, resource, taining and regulatory factors These guidelines were drafted and agreedby the First Aid Witing| Group members. The methodology used for uideline developments presented in the Executive summary.‘ The guidelines were posted for puble comment in October 2020, The feedback was reviewed by thewrting group andthe guidelines were updated where eleva. The Guideline was presented to and approved by the ERC General Assembly on 10th December 2020, Koy messages from the guidelines aro prosented in Fi. 1. Con 0 gui Recovery position For aduts and citron witha decreased evel of responsiveness due to medical ness or non-physical trauma, who do NOT meet the crteria for the ination of rescue breathing or chest compressions (CPR), the ERC recommends they be placed int lateral, sde-tyng recovery postion (soe Fig. 2). Overall, there i ite evidence to suggest an optimal recovery positon, but he ERC recommends the following sequence of actions: 272 nesuserral Ge anctucheesatee Dania riee ied CeO On ree eer ern ages od rescue breathing or chest compressions (CPR) When exertional or non-exertional heatstroke is suspected, immediately remove the casualty from the heat source, commence passive cooling and use Pre RnornecineRcccrced Pe ee eee ene ee BS Cea aU DU Re Re eR eee le the burn with a dry, sterile dressing or cling wrap 1. 1 = Infographic summary of key messages + Knee beside the vctm and make sure thal both legs are straight * Adjust he upper lag so that both hip and knee are bent at right + Piacethe armnearesttoyououtatrightanglestothebodywithtne angles hand palm uppermost + Tithe nead back to make sute the away remains open + Bring the far arm across the chest and hold he back ofthe hand» Adjust he hand under the cheek necessary, to keep the head against the victim's cheek nearest to you sited and facing downwards to allow quid material to drain from + With your ther hand, grasp the farleg ust above the knoe and pul the mouth Itup,koeping the foot on the ground + Chock regulary for normal breathing + Keeping the nand pressed agains! the cheek, pullonthe ‘arleg to + Only leave the victim unattended if absolutely necessary, for rol the victim fowards you ont their side ‘example ta attend to other vitims. neevscirarian se: (202s) 270-28 273 + Thore is a relatively low risk of complications, pariculatly anaphyaxis and serous bleeding. Do not administer aspirin to adults with known allergy to asprin or containcications such as severe asthma or known gastrointestinal bleeding ‘Anaphylaxis Iisimporantto stress the importance ofmaintaningaclosecheck (on all unresponsive invidvals unt the EMS arrives fo ensure that ‘hair breathing remains normal. In certain situations, such as resusctationselated agonal respirations or trauma, it may not be appropriate to move the Individual into a recovery postion, ‘Optimal position for shock victim + Place individuals with shock into the supine (ying-on back) position + Where there is no evidence of trauma frst aid, providers might consider tho uso of passive log raising asa tomporising measuro While awalting more advanced emergency macieal car. Bronchodilator administration for asthma + Assist individuals with asthma who are experiencing iticully in breathing wih their bronchodiator aeminstratin, + Fist ald providers must be trained in the various methods of ‘administering a bronchodilator. Recognition of stroke + Uso stroke assessment scale to decrease the tie torecogriion ‘and definitive eatmenttoran individual suspected acute stoke, +The folowing stroke assessment scales are available © Face Arm Speech Time to call FAST) © Melbourne Ambulance Stroke Scale (MASS) Cincinnat Prehospital Stoke Scalo (CPSS) © Los Angelos Prehospital Soke Scale (LAPS) aro the most + The MASS and LAPSS scales can be augmented by blood ‘lucose measurement Early aspirin for chest pain For conscious aduts wih nontraumatc chest pan due to suspected myocardial infarction: + Reeassure the casualty + Sitor ie the casualty in a comtonable postion + Callforhelp «Fist id providers should encourage and assist he casualy inthe ‘selt-adminstration of 150-300™mg chewable aspirin as soon as possibe ater the onset of chest pain + Do not administer aspirin to adults with chest pain of unclear or ‘raumatc aetiology ‘The management of anaphylaxs has been described in the ERC Special Circumstancus Gudelies. + tthe symptomsof anaphylaxis donot resolve atterSminof heist Injecton o adrenaline or, the symptoms begin to rtum ater the first dose, administer a second dose by intramuscular injection Using an autoinjctor. + Call fr halp. + Train fist aid providers regulaly in the recognition and fst aid ‘management of anapaylaxs. Management of hypoglycaemia + Tho signs of typoglyeaomia are sudion impaired consciousness: ranging tom dizziness, antng, sometimes nervousness and deviant behaviour (mood swings, aggression, confusion oss of concentra: tion, sons that lok Ike rurkenness) ofoss of consciousness. + Aporson with mid hyposiyczemia typically has less severe signs lor symptoms and has he preserved ability to swallow and follow commands, It hypoglycaemia is suspoctod in someone who has signs or symptoms of mid hyposlycasmia and is conscious and able to swallow: © Give glucose or dextrose tablets (15-209), by mouth © Hf glucase or dextrose tablets are nat avaliable give other lotary sugars in an equivalent amount to glucose, such 95, ‘Skies, Mentos, sugar cubes, Jollybeans, or halt a can of orange juice Fepsat the administration of sugar Ifthe symptoms are stl present and not improving ater 15min tora glucose isnot available a glucose got (partially holdin the chook, and partially swallowed) can be given Call he emergency services + the casualty ior becomes unconscious + the casuatys condition does not improve Folowng recovery from te symptoms ator takng te ugar,encourage lakingalight snack suchasa sandwich orawatle «+ For children who may be uncooperative with swallowing oral slucose: > Consider acministerng hal a teaspoon of table sugar (259) unde the childs tongue, + Hfpossibl, measure and recor the blood sugar levels before and after treatment ral rehydration solutions for treating exertion-related dehydration “th porson has beon sweating excessively during a spors performance and exhibits signs of denycration such as feeling thirsty, dizzy or light-headed andor having a dry mouth or dark yollow and strong-emeling urine, give hinvher 3-8% carbory Grate-lectrolyte (CE) drinks (ypcal ‘spots rehydration drinks) or skimmed ik 274 + Hf9-8% CE drinks o mik are not availabe or not well tolerated, iterative beverages for rehydration incude 0-3% CE drinks, 8 12% CE drinks or water + Clean water, in regulated quanttes, san acceptable alternative, atnough it may require a longer time to renyarate, + Avoid the use of alcoholic boverages. + Callthe emergency services if 0 The person is or becomes unconscious © The porson shows signs of a hoat stoke, Management of heat stroke by cooling Recognise the symptoms andsigns otheat stroke inthe prosenceota high ambient temperature + Elevated temperature + Gontusion + Agitation + Disorientation + Seizures + Coma, ‘When exertional or non-exentonal heat siroke i suspected: + Immedately remove the casually trom the heat source and commence passive cooling + Commence adstonal cooing using any technique immediately avaiabie ° ithe core tomperature is above 40°C commence whole body (neck down) cold water (1~26°C) immersion untl the core ‘temperature falls below 39°C © It wator immersion isnot possible uso alternative methods of coating 249. ie sneats, commercial ce packs, fan alone, cold shower, hand cooling devices, cooling vests and jackets or ‘evaporative cooing (ist and fan) ‘+ Where possible measure the casualy’s core temperature (rectal temperature measurement) which may require special traning + Casualties with exertional hyperthermia or nonexortonal heat: stroke wilrequire advancedmedicalcareandadvance assistance should be sought ‘The recognition and management of heat stroke requires special ‘ining (rectal temperature measurement, cold water immersion techniques), However, the recognition of he signs and symptoms ofa raised cove temperature and the use of active cooling techniques is citea in avoiding moricty and martlty Use of supplemental oxygen in acute stroke + Do not routinely administer supplemental oxygen in suspected acute stroke inthe prehospital frst le seting + Oxygen shouldbe adminiserediftne inéviduais showing signet hypoxia, + Training is required for frst aid providers In the provision of supplementary oxygen, Management of presyncope + Prosyncope Is characterised by lightheadednoss, nausea, sweating, black spots infront of the eyes and an impending sense of loss of conscousness, + Ensure the casualty is safe and wil not allo injure themselves they ose consciousness. Use simple physical counterpressure manceuvies to abort bresyncope of vasovagal or orhostatc origin + Lower body physical counterpressure manoewres are. more fective than upper body manoeuvies. Lower body ~ Squating with or without leg crossing © Upper body ~ Hand clenching, neck flexion + Fist provider will nod o be trained in coaching casualties in now to perform physical counterpressute manoeuvres, Controt of life-threatening bleeding Direct pressure, haemostatic dressings, pri cryotherapy for lite-threatening bleeding “+ Apply direct manual pressure forte nial contol of sever, fe threatening exteral bleeding Consider the use of a haemostatic dressing when applying direct manual pressure for severe, ife-hroatening bleeding. Appy the haomostaticdossing direct tothe beoding injury and thon apply lrect manual pressure to the dressing A prossure dressing may be usetul once bleeding is controled to maintain haemostasis but should not be used in lieu of direct manual pressure for uncontrolled bleeding + Use ofpresure points or cold therapy isnot recommended forthe contol of ife-threataning bleeding sure points and ‘Tourniquets for life-threatening bleeding + For ife-nreaterig bleeding from wounds on limbs in a location amenable to the use of a tourniquet (Le. arm or leg wounds, traumatic amputations): © Consider the application ofa manufactured tourniquet as soon as possioe + Place the tourniquet around the traumatised limb 5~7em above the wound but net over a jint Tigaten the touriquet uni the bleeding slows and stops. “This may be extremely painful for the casualty Maintain tho tourriquet pressure Note the time the tourniquet was applied Donot release the tourniquet ~ the touriguel must only be released by a healthcare professional “Take he casuatytohospitalimmediatelyforturhermedical Im some cases, i may require the application of two touriquets in paral! to slow or stop the bleeding + Ifa manufactured tourn ques notimmediately avaiabo, or if bleading is uncontrolid wih the use of a manufactured tourniquet, apply dict manual pressure, with a gloved hand, a gauze dressing, or if available, a haemostatic, dressing Consider the use of an improvised tourvguet only it a manufactured touriquet is not available, direct manual pressure (gloved hand, gauze dressing or haemostatic

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