First Aid 2019 Lukáš Dadák, M.D. Dept. of Anesthesia &ICU FN USA 15740@mail.muni.cz Run of semestr Lectures weekly (ex 11.12.2019) Excerc. a 2 weeks (one topic for 2 weeks) https://is.muni.cz/auth/el/1411/podzim2019/aVLPO011c/index.qwarp Test in 3 parts (BLS adult, BLS child, et. al) Oral exam in 2019:  2 topics  1 min of BLS, AED,... Departments: ARK FNUSA 15740@mail.muni.cz KARIM FN Brno Malaska.Jan@fnbrno.cz KDAR FN Brno Stoudek.Roman@fnbrno.cz How to survive? • Do not kill the patient. • Reason of lectures - to pass the exam - to learn important information for life Study materials is.muni.cz www.cprguidelines.org How to survive • • • • • • D R' S A B C How to survive • • • • • • Danger Responce Shout for Help Airways Breathing Circulation Danger Danger • • • • to you to other to the casualty make sure that no one 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: • RESPONSE = consciousness • A+B breathing • C circulation Primary Survey = 20s Resposiveness   Shout ‚Are You O.K.?‘ Shake Shoulder opening eyes movement words unconsciousness     Airway + B • on the back • open it and keep it open - unconscious • Tilt the head back Airway + B • open it and keep it open • Tilt the head back Keep airway open haed tilt, chin lift Esmarch man. Clear airway if necessary • do not loose time when nothing visible! • 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 A+B: Gasping during ACLS Circulation Signs: • normal consciousness • normal breathing • movement • cough • only for living victims {pulsations are checked by two fingers on a.carotis} • Any doubt = NO circulation Puls on neck artery Puls − neck / femoral a. − radial a. Circulation - puls    i/regular frequency (beat per 10s * 6 = signs of shock ... beats/ min) Capilary refill time compress the skin 5s, releave pressure Time needed for refill of blood Finger = perifery / Chest – central   less than 2s usefull in children ABC – stable and what next? managing life-threatening problems bleeding, recovery position • look for – bleeding … Secondary Survey – burns – fractures. Note any tenderness, swelling, wounds or deformity Examine the casualty … Secondary Survey  in the following order: − − − − − − head and neck chest (including shoulders) abdomen (including hip bone) upper limbs lower limbs back  call medical aid as soon as possible Emergency Call Introduce yourself  Where  what  when  how many  severity of injuries  Do not hang up!! 155 (112) No consciousness + No breathing = No circulation Sudden Cardiac Arrest CardioPulmonary Resuscitation  30:2 Basic Life Support  Advanced Cardiac Support (ACLS) Guidelines 2015  www.cprguidelines.eu Sudden Cardiac Arrest • • • • • • • • arrhythmia during Myocardium infarction = no puls, no flow hypoxia – breathing disorder hypovolemia = bleeding hypothermia → arrhythmia ion disorders – internal enviroment intoxication trauma of Thorax / heart (Pneumothorax /Tamponade) pulmonary embolism SCA → survival = 20% • Early Adult basic life support • Medical Emergency Service 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 Do not stop compression ... Stop compressions 2 rescue breath (AED to check the rhytm and to defibrilate) There is no routine „halt“ to check restorations of life. mouth-to-mouth breathing 1. 2. 3. 4. 5. 6. 7. 8. Knee beside the head of casualty. Keep the casualty's head tilted back. Pinch the casualty's nostrils with your fingers Lift the jaw forward with your other hand. Take a normal breath and open your mouth wide. Place your mouth firmly over the casualty's mouth making an airtight seal. Breathe into the casualty's mouth. 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:    Compressions Compressions Compressions BLS When to start BLS: − always when victim is unconsciousness, no breath 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 not to start: − − − − When ... When to stop CPR: − − − − restoring vital functions (normal breathing, movement) → recovery pos. EMS takes care of victim no power to continue with CPR new danger Do not stop BLS compression only / 30:2 … continue … Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation. Risk to the rescuer The safety of both rescuer and victim are paramount during a resuscitation attempt. There have been few incidents :  tuberculosis,  meningitis  severe acute respiratory distress syndrome (SARS) Risk to the rescuer Transmission of HIV nor Hepatitis 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. Barrier Devices Can increase dead space can increase resistance of airways Can protect you can increase will to ventilate „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 Precordial thump Not part of BLS reserved :  witnessed cardiac arrest when no defibrillator is immediately available EMS Brno 2008..2009 First aid before arrival