First Aid 2010 Lukáš Dadák, M.D. Dept. of Anesthesia &ICU FN USA 15740@mail.muni.cz How to survive? •Do not kill the patient. •Reason of lectures - to pass the exam - to know important information for life How to survive •D •R •A •B •C Danger > Danger •to you •to other •to the casualty •make sure that no one elso gets hurt. You will not be able to help if you are also a casualty •only proceed if it is safe to do so. > Danger •look & listen & feel –vehicle on the street –gas in the house –fire –poison, infection –electricity •Position the patient on their back. Basic Vital signs: •RESPOND = consciousness •A+B breathing •C circulation Primary Survey = 20s Resposiveness lShout ‚Are You O.K.?‘, Can you hear me?' , 'What is your name? lShake Shoulder lopening eyes lmovement lwords lunconsciousness Airway + B •open it and keep it open •Tilt the head back Clear airway if necessary •with the casualty supported on the side, tilt the head backwards and slightly down. •Open the mouth and clear any foreign object. Only remove dentures if loose or broken. Breathing ? •Normal = look & listen & feel – movement of chest wall [reg., 10-20/ min] –air flow •abnormal breathing - "agonal respiration" and is the result of the brain's breathing center sending out signals even though circulation has ceased. The key point - sound like grunting, gasping or snoring. It disappears in 2-3 minutes. •No breathing Circulation ? Signs: •normal consciousness •normal breathing •movement •coughing •{PULSATIONS a.carotis} •Any doubt = NO circulation No consciousness No breathing No sign of circulation Cardio Pulmonary Resuscitation lStart Basic Life Support 30:2 ABC and what next? •managing life-threatening problems - ABC, bleeding •(turn the casualty to a stable side position) •look for –bleeding –burns –fractures. Note any tenderness, swelling, wounds or deformity … Secondary Survey Examine the casualty l in the following order: -head and neck -chest (including shoulders) -abdomen (including hip bone) -upper limbs -lower limbs - back lcall medical aid as soon as possible … Secondary Survey Adult basic life support Chest compressions •Place the heel of one hand on the breastbone -- right between the nipples. •In the centre of the chest •Place the heel of your other hand on top of the first hand. •Position your body directly over your hands. Your shoulders should be in line with your hands. DO NOT lean back or forward. •Give 30 chest compressions. 100/minute •Press down on the sternum 4 -5 cm EAR expired air resuscitation (mouth-to-mouth ventilation) = O2 1. Knee beside the head of casualty. 2. Keep the casualty's head tilted back. 3. Pinch the casualty's nostrils with your fingers 4. Lift the jaw forward with your other hand. 5. Take a normal breath and open your mouth wide. 6. Place your mouth firmly over the casualty's mouth making an airtight seal. 7. Breathe into the casualty's mouth. 8. Remove your mouth and turn your head to observe the chest fall and listen or feel for exhaled air. 9. If the chest does not rise and fall, check head tilt position first, then check for and clear foreign objects in the airway. 10. Give 2 breaths, then go back to 30 compressions Mouth to nose •the victim’s mouth is seriously injured •cannot be opened, •the rescuer is assisting a victim in the water, •a mouth-to-mouth seal is difficult to achieve. There is no published evidence on the safety, effectiveness or feasibility of mouth to-tracheostomy ventilation, but it may be used for a victim with a tracheostomy tube or tracheal stoma 3 thinks are the most important: lCompressions lCompressions lCompressions BLS When to start BLS: -always when victim is unconsciousness, no breath, no circulation When not to start: -end stage disease, no prognosis -trauma with no hope for life (decapitation) -signs (indication) of death (patch) -time factor (15 – 30 minutes from stop of circulation) When ... When stop CPR: -restoring vital functions (normal breathing, movement) -ER takes care of victim -no power to continue with CPR -new danger Risk to the rescuer The safety of both rescuer and victim are paramount during a resuscitation attempt. There have been few incidents : ltuberculosis lsevere acute respiratory distress syndrome (SARS) Transmission of HIV has never been reported. Barrier devices with one-way valves, prevent oral bacterial transmission from the victim to the rescuer during mouth-to-mouth ventilation. The safety of both rescuer and victim are paramount during a resuscitation attempt. There have been few incidents of rescuers suffering adverse effects from undertaking CPR, with only isolated reports of infections such as tuberculosis (TB) and severe acute respiratory distress syndrome (SARS) Transmission of HIV during CPR has never been reported. There have been no human studies to address the effectiveness of barrier devices during CPR; however, laboratory studies have shown that certain filters, or barrier devices with one-way valves, prevent oral bacterial transmission from the victim to the rescuer during mouth-to-mouth ventilation.35,36 Rescuers should take appropriate safety precautions where feasible, especially if the victim is known to have a serious infection, such as TB or SARS. Top-less Chest-compression-only CPR may be used as follows: • If you are not able or are unwilling to give rescue breaths, give chest compressions only continuous, at a rate of 100 min−1 • Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation. Precordial thump Not part of BLS reserved : lwitnessed cardiac arrest when no defibrillator is immediately available lif done in first 20s 25% regain cardiac function Defibrilation in Czech provided by ER lcontinue with CPR Attach AED Follow voice prompts Start of AED lSome AEDs will automatically switch themselves on when the lid is opened ATTACH PADS TO CASUALTY’S BARE CHEST ANALYSING RHYTHM DO NOT TOUCH VICTIM SHOCK INDICATED lStand clear lDeliver shock SHOCK DELIVERED FOLLOW AED INSTRUCTIONS 30 : 2 NO SHOCK ADVISED FOLLOW AED INSTRUCTIONS 30 : 2