Professional Documents
Culture Documents
Eduard Kasal,
MUDr., Ph.D., Assoc. Prof.
Department of Anaesthesiology and Intensive Care
Medicine
2014
First aid
than
to need it and not to know it.
However
• most injuries do not require life-saving efforts
First aid
Definition:
… is the immediate care given to an injured
or suddenly ill person.
Breathing
Circulation
Consciousness
CardioPulmonary
Resuscitation
History
1. Peter Safar - Professor of Pittsburgh
University presented in 1968 small book
“Cardiopulmonary Resuscitation” ….
2. Guidelines 2000
3. Guidelines 2005
Many changes of almost all algorithms
used for several tens of years…
Publication of new guidelines does not mean, that CPR
provided in accordance with previous guidelines is not
effective and not correct, but we should follow them as
possible…
www.erc.edu
Cardiac arrest
1. Asystole
2. Ventricular fibrillation
Most cardiac arrest victims have an electrical
malfunction of the heart heart´s pumping
function abruptly ceases
3. Pulseless ventricular tachycardia =
Fast ventricular contractions without
haemodynamc effect Signs of the both =
identical!!!
Differential dg: only ECG
Theoretical background
At best
chest compressions provide only 30% of
normal perfusion brain + heart
Adults
electric defibrillator is necessary as soon as possible;
therefore, if telephone is available and you are alone:
1. call for help, then
2. start with CPR
Children
1. start CPR immediately for 1 minute to provide some
tissue oxygenation
2. then call for help
Emergency telephone number
155, 112
in the Czech Republic
Indication of CPR
• malignant arrhythmia
• acute myocardial infarction (AMI)
• pulmonary embolism
• intoxication
• electrocution
• drowning
• acute suffocation
• severe trauma
• stroke and alike
CPR is not indicated
signs of definitive biological death
witnessed information, that cardiac arrest had happened 15
or more minutes before the rescuer arrived (time
assessment in the stressing situation is not precise)
terminal stage of incurable disease (generalised malignant
disease…)
an evident trauma without chance to survive (catastrophic
head injury)
“living will” - only in countries when constitution accepts it
DNR - “Do not attempt resuscitation” has been written in
the file (incurable disease after all available therapy
failed)
execution
Special emphasis
Soon defibrilation
1 minute - survival - 90%,
5 minutes - survival - 50%,
7 minutes - survival - 30%
10 - 12 minutes - survival - 2 – 5%.
CPR outcome
• In first 4 minutes – brain damage is unlikely, if
CPR started
• 4 – 6 minutes – brain damage possible
• 6 – 10 minutes – brain damage probable
• > 10 minutes – severe brain damage certain
1. Unconsciousness
2. No reactivity
3. Absence of normal breathing
Basic conditions for CPR
1. Rescuer’s safety = the first priority
2. To assess the risk of trauma, intoxication,
infection …
3. a victim position: supine on to his/her
back
4. on the firm flat surface to make
effective chest compressions
5. victim´s position in relation to rescuer´s
position
6. CPR during transfer ???
Rescuer’s safety
The rescuer should never place him/herself or
others at more risk than the victim
S – tube
Face shields (resuscitation veil )
Pocket face mask + one-way valve
Handkerchief
Towel
Stop CPR if
Airways
Breathing BLS
Circulation ALS
Drugs ?
ECG
New resuscitation
alphabet – in adults
Algorithm of CPR
EKG
Circulation BLS
Airways ALS
Breathing
Drugs
BLS sequence
Kneel by the side of
the victim
BLS sequence
Shake shoulders
Ask “Are you all right?”
BLS sequence
If he responds
• Leave as you find him
• Find out what is wrong
• Reassess regularly
BLS sequence
Unresponsive
Unresponsive
Open airway
BLS sequence
Unresponsive
Open airway
Check breathing
BLS sequence
Unresponsive
Open airway
Check breathing
Unresponsive
Open airway
Check breathing
Call 112
30 chest compressions
Chest compression
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
2 rescue breaths
Pinch nose
Place and seal your lips
over the victim´s mouth
Blow until the chest rises
Takes about 1 second
Allow chest to fall
Repeat (10 – 12 times
per minute)
B) Breathing
expired air resuscitation - several
techniques:
- Mouth-to-mouth breathing
- Mouth-to-nose breathing
- Mouth-to-mouth + nose breathing ( small
children)
- Mouth-to the barrier device ( to protect the rescuer)
- Mouth to tracheostomy
Self-inflating bag
CardioPulmonary Resuscitation
Artificial breath during expired air
resuscitation
30 : 2
Ratio 30 : 2
AEDs will
automatically switch
themselves on when
the lid is opened
Attach pads to casualty’s bare chest
Analyse rhythm – do not touch victim
Shock indicated – stand clear
Rescuer giving defibrilation shock
Need new
picture
30 : 2
Give CPR every moment, when AED is
not available, always if AED is not
available within 5 minutes
Need new
picture
30 : 2
If victim starts to breathe normally
place him in recovery position
Need new
picture
CPR should not usually be
abandoned after 20 minutes:
Contraindications:
uknown time of cardiac arrest
chest injury
children
A. Airway management
A)
Suffocation
Difficult intensive inspiration
Neck and thorax soft tissues retraction
Hoarse (croupy) sounds accompanying
inspiration (noisy breathing)
Barking cough
A. Airway management
Signs of severe or complete large
airways obstruction
Differencies:
Cause of cardiac arrest –choking, trauma
Activation of emergency system
Hypoxia developes faster – high metabolic rate
Ventricular fibrillation – rare
Primary cardiac arrest uncommon,
Precordial thump is contraindicated
Chain:
Choking- hypoxia – hypercapnia – apnoea – bradycardia –
cardiac arrest
Trauma
CPR in children
A) The most often cause of vital
functions failure = choking
Foreign body airway obstruction
Infectious diseases afecting throat by
swelling ( epiglotitis, acute suffocating
LTB, croup)
Trauma
CPR in children
Sequence of action
Rescuers with no knowledge of pediatric
resuscitation may use the adult sequence
with the exception that they should
start with 5 initial breaths followed by
30 compressions
30 : 2 for 1 minute
than call 155 (112)
but
Generally prefered ratio in children
= 15:2 (in-hospital CPR, 2 rescuers)
CPR in children
“A“
Identical with adults
More often inflamation throat diseases
with swelling and suffocation
Foreign bodies!!! Small toys and toys
that can be dismantled for small
parts!!!
CPR in children
“B“
Look, listen and feel no more than 10 s
Volum 6-7 ml /kg bw
Blow steadily over 1 – 1.5 sec.
To make the chest visibly rise
Start with 5 breaths
Paediatric size of self-inflating bag
Adult self-inflating bag???
2 : 30
CPR in children
Chest compressions in infants
CPR in children
Chest compressions in
children
BLS in children
FBAO
• back blows
• chest thrusts
• abdominal compression
expulsion of FB out from the airways
Rib fractures
Prevention:
correct hand´s position
do not remove hands from the chest wall
prevent “dancing on the chest“)
1. Arterial
2. Venous
• dark red colour
• low pressure
• blood flow steadily
• it is easier to control
• most veins collaps when cut
but
• bleeding from deep veins can be as massive
as arterial bleeding !!!
Bleeding
3 kinds according to its source:
3. Capillary bleeding
4. Mixed bleeding
Bleeding - clinical symptoms
Depend on - the quantity of the blood loss
• Forearm – 0,5 L
Shock
Definition:
Circulatory system failure when insufficient amounts of
blood is provided for different parts of body (insuficient
perfussion)
Three components:
1. Heart pump failure
2. Network of pipes (vessels) enlargement
3. Adequate volume of circulated fluids fluid loss
- blood
- plasma
- extracellullar fluids (vomit, diarrhoea, sweatting, urine…)
BP < 60 mm Hg
Shock
What to do?
8. Oxygene …
Characteristics:
Occurs within minutes or seconds
Fast progression
Can cause death if not treated immediatelly
Common cause:
Medications, food + food additives, insect stings, plant and
flowers pollen, parfumes…
Allergy, anaphylaxis
What to look for ?
Fast development
Sneezing, coughing, wheezing
Shortness of breath
Suffocation (swelling in the throat, tongue, mouth, neck =
Quincke oedema…)
Tightness in the chest
Increased pulse rate
Dizzines
Nausea + vomiting
Diarrhoea
Anaphylactic shock
Urtica with skin itching (pruritus), blisters, quickly spreading
exanthema
Allergy, anaphylaxis
What to do?
Suspected injury of
- the brain
Basic classification
generalised - always LOC -
- hypertensive encephalopathy
- severe hypoxemia
- Head injury
Seizures (convulsions)
Clinical signs:
Causes:
high ambient or environmental temperature
Clinical signs:
hyperpyrexia
altered mental status
lack of or minimal sweating
ataxia
neurological deficit – paralysis (hemiplegia, Babinsky reflex)
Heat stroke
What to do?
ABC
What to do?
Give to the patient the glass with salt water one half of the glass
every 15 min.
Massage the muscles to relieve the spasm
Classification
mild hypothermia core temperature - 32-35°C
moderate hypothermia - 28-32°C
severe hypothermia < 28°C
Risk factors :
extremes of age (infants and elderly)
accompanying diseases and bad status of health
alcohol intoxication and drug overdose
Cold injury - hypothermia
What to do?
In mild hypothermia:
Transport patient to the warm environment and give him
warm fluids (but no alcohol)
In severe hypothermia:
ABC
cellular dehydration
protein denaturation
damage to capillaries
pH changes
Cold injury - frostbite
Degree of injury
1st-degree injury - erythema, oedema, waxy
appearance, hard white plaques, and sensory deficit
Can be classified -
thermal (heat) burns - contact with hot objects,
flammable vapor, steam or liquid
chemical - acids, alkalis and organic
compounds (petroleum, kerosene…)
electrical - severity of injury depends on the
type of current, the voltage, the area of
body exposed and the duration of contact
Burns and scalds
1st-degree burns (superficial): surface (outer layer) of the
skin is affected
Check ABCs
Analgesia
Shock treatment
Burns and scalds - what not to do
Do not remove clothing stuck to the skin - pulling will
further damage the skin
Do not forget to remove jewellery as soon as possible -
swelling could make jewellery difficult to remove
later
Do not apply cold to more than 20% of an adult´s body
surface (10% for children) - widespread cooling can
cause hypothermia. Burn victims lose large amount
of heat and water evaporation)
Do not apply ointment, butter or any other coatings on
a burn except of sterile dressing or clean cloth
Do not break any blisters - intact blisters serve as
excellent burn dressings
Burns and scalds - what to do in
case of large 2nd and 3rd-degree burns
pathway of current
duration of contact
area of contact
- scalp wounds
- scull fractures - basilar, linear and comminuted
- intracranial lesions - contusion, subarachnoid haemorrhage,
subdural hematoma, epidural hematoma
- diffuse brain injury – concussion, diffuse axonal injury
Scull fracture is always associated with the brain injury
Concusion
Diffuse axonal injury
Concusion
Headache
Nausea, vomiting
Tachycardia
Amnesia for the event
Unconsciousness – short lasting
Concussion - treatment
ABCs
Treatment for scalp wounds, aplication of
pressure dressings to prevent hemorrhage
Seek medical attention
Transport to the hospital for diagnostics
Admision to the hospital for monitoring,
observation (mental status, consciousness
assessment, pupils, …)
Head injuries - what to do
When the patient is unconscious
ABC - monitor vital functions. By the application of airway
management (head position tulted backward) keep in mind the
possibility of cervical spine injury.
Examine the head gently and cover the external injuries with sterile
dressings (bandage) - don’t press on the wound,
stabilize the victims neck against movement
Examine the state of pupils - size, similarity, reaction on the light
What to do
help the victim find comfortable position
What to do
Treat the victims shock
Fractures
- closed fractures - skin is intact
- open fractures - skin over the fracture is
damaged or broken
Pain
Swelling
Bone, joint and muscle injuries
What to do:
• Check – C-S-M - circulation, sensation, movement
By what route was the poison taken (e.g. by mouth, iv., i.m.,
skin exposure)?
When was it taken?
Ethyleneglycol alcohol
Methylalcohol alcohol
Alkali juice or vinegar or lemon
Acid milk ?
Be careful !!!
Children suffocation disease
Croup: laryngotracheobronchitis - age 1-3 years
- barking cough
- intercostal retractions
- air hunger
- anxiety
- sitting position, hyperextended head
- swallow problems, salivation
Children suffocation disease
“Cock“ voice
Children suffocation disease
What to do
Very urgent life-threatening disease !!!
The least painful position (sittin with legs up and bent at the
knees)
Give Nitroglycerin tablets or spray (dilates coronary arteries)
– Caution: possible hypotension
Avoid Nitroglycerin application if patient used VIAGRA
within last 48 hours
If unresponsive victim – check ABC and start CPR
Stroke (Brain attack)
Blood vessels rupture – bleeding or
Decreased vision
Severe headache
In Diabetes:
No insulin sugar remains in the blood body
cells must rely on fat as fuel.
2 types of DM
low blood sugar (insulin shock)
Causes:
• delayed food
• long fasting
• exercise
• alcohol
• combination
Diabetic emergencies
Signs:
• sudden onset
• poor coordination
• anger, bad temper
• pale colour
• confusion, desorientation
• sudden hunger
• excessive sweating
• unconsciousness – hypoglycemic coma
Diabetic emergencies
What to do:
Causes:
• inactivity
• insuficient insulin
• forgotten application of insulin before eating
• overeating (inadequate ingurgitation of food)
• illness
• stress
• combination
Diabetic emergencies
Signs
• gradual onset
• drowsiness
• extreme thirst
• frequent urination of high volume
• flushed skin
• vomiting
• fruity breath odor
• haevy deep breathing
• unconsciousness - coma
Diabetic emergencies
Or:
• Check blood sugar by glucometer
• Help the patient to apply insulin in case of high blood
sugar
Emergencies during pregnancy
• vaginal bleeding
• cramps in lower abdomen
• swelling of the face or fingers
• severe continuous headache
• dizziness or fainting
• uncontrolled vomiting
• baby
Emergencies during pregnancy
What to do
• keep quiet
• place sanitary napkin or any sterile or clean pad
over the opening of vagina
• replace bload-soaked pads and save them together
with all tisues that are passed
• arrange immediate transfere to a medical facility
• psychiatric disease
• alcohol intoxication
• opioid intoxication (heroin)
• marihuana intoxications – overdose (joints)
• intoxications by stimulationg drugs (extasis)
• organic diluents (toluen)
• cocain overdose (crack)
• haluconogens (LSD, crystal joints…)
• rarely mental disorders in lactation
What to do
• very difficult situation
• risk of auto and heteroagresivity
• risk of suicidal attemts
• calm, trustful approach needed
• patience to listen to the patient
• direct isntructions to undergo the therapy …