First Aid 2011
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.
>

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




Adult basic life support
Medical Emergency
155

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. at least 100/minute (not more than 120/min)
•Press down on the sternum at leats 5 cm, not more than 6cm










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 to stop CPR:
-restoring vital functions
(normal breathing, movement)
-ER takes care of victim
-no power to continue with CPR
-new danger




ABC and what next?
•managing life-threatening problems - CPR, bleeding
•(turn the casualty to a recovery 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