Cardiopulmonary Resuscitation
Common Emergencies
First Aid
Basic Health Care; HCE100
General Comments & Definitions
• Medical Emergency = any situation that presents a life threatening situation
if not treated immediately
• First Aid = immediate, temporary care given to a person in distress until
you can get a professional to see victim
• Biological Death = no brain activity
» Window of time = 6 minutes
• Clinical Death = cardiac arrest; i.e. no vital signs
• Cerebral Concussion = head trauma without brain tissue injury
» sudden loss of consciousness------ lasting only a few minutes
» amnesia follows ------- lasts 12 - 24 hours
• Cerebral Contusion = head trauma with brain bruise
» more serious than concussion
» loss of consciousness greater than 24 hours
» frequently associated with skull fracture
» can get hematomas (epidural or subdural)
IN ANY MEDICAL EMERGENCY--------- it’s essential to remain calm-------• First, always do 3 C’s
1. Check Scene & Victim
2. Call 911
3. Care for Victim
4. Calm
• When doing # 1 and Checking Victim, Do ABC’s
A = Airway
B = Breathing
C = Circulation
C = Consciousness --- DO FIRST
Key Circulatory & Respiratory Emergencies
1. Choking
2. Rescue breathing
3. CPR
•
These 3 conditions may be different for:
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Adults
Children ---- age 1 to 8
Infants ------- age birth to 1 year
Choking
• If choking & conscious:
– First see if person can (1)breath (2) cough or (3) talk
• If can encourage more coughing since most effective way of
expelling object from airway
– If person can not do those things, then Heimlich (abdominal thrusts)
• But if infant---- do back blows (5) & chest thrusts (5)
• If unconscious & airway obstruction
– How to determine: 2 slow “test” breaths to see if air goes into lungs
– For unconscious adults & children:
• Do ABDOMINAL THRUSTS
– 5 thrusts ------ finger sweep -------- breaths
– For infants
– Back blows (5) & Chest Thrusts (5)
note: head down
» No finger sweep in infants, just look in mouth
Choking
• Key points
– If adult very obese or very pregnant
• Do Chest Thrusts , not abdominal thrusts
– Hands on sternum & give downward thrusts
– Finger Sweeps
• When doing, keep tongue forward with one hand
Rescue Breathing & CPR
• First do 3 C’s & then ABC’s on first C (check victim)
• First thing to do when checking victim --------------check if unconscious
• This done by “tap & shout”
– If victim can talk, they have pulse & are breathing
• Second: A = airway
• Determine if open or obstructed via 2 “test breaths”
• If obstructed go right to Heimlich, etc.
• Third: B = breathing
• Breathing check = look, listen, & feel
• If none then do rescue breathing
• Fourth: C = circulation
• Check for pulse
• If no pulse, then cardiac massage
Rescue Breathing
• Adult
• Tilt head, lift chin,
• 2 test breaths
• Then 1 breath/ 5sec
pinch nose
• Child
• Same as above, except 1 breath/ 3 seconds
• Infant
• Same as above, except don’t pinch nose
– You cover the mouth & nose with your mouth
CPR
• Adults
• Chest compression = 2 inches ---- use both hands
• Hands on xiphoid
• 15:2 ratio
• Child
• Chest compression = 1½ inch ----use one hand
• Hand on mid sternum
• 5:1 ratio
• Infant
• Chest compression = 1 inch ------ use one hand
• 2 fingers on sternum just below nipple line
• 5:1 ratio
Key changes to CPR (AHA)
•
For all groups --- 30:2
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•
•
Compression to ventilation ratio
Compression rate = 100/ min
Compression landmark
– nipple line
• Infants use 2 fingers
•
CPR done in 2 minute intervals
Specific Medical Emergencies
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FAINTING
also called Syncope
Etiol = decrease blood flow to brain from many causes
Vasovagal Reaction ------ get anxiety & blood pooling
proper victim position
– supine with feet elevated
– after regaining consciousness, keep supine for 10 minutes
– Never elevate legs if head injury
WOUNDS
• Skin Unbroken = hematomas & bruises (contusions)
• Skin Broken = abrasion, avulsion, incision, laceration, & puncture
» Puncture one most frequently gets infected
CHEST PAINS & HEART ATTACK
• All chest pain cases are to be treated as medical emergencies
• Heart attack
– usually refers to acute coronary artery attack
– most common cause of sudden death
– Symptoms
» substernal chest pain = commonest
» also pain down left arm, jaw & neck
» sweating (diaphoresis)
» anxiety (apprehension)
» N&V
» SOB
– Key = differentiate angina from myocardial infarction
» In a MI ----- the pain is not relieved by rest or drugs
CVA ( STROKE )
• Treat as if patient was in shock (i.e. ABC’s)
• if can tell one side is affected, position patient so secretions drain out
» Thus, patient is positioned on affected side
• cause is either (1) hemorrhage or (2) obstruction
• can be classified into Minor or Major stroke
– Minor Stroke
» conscious with confusion
– Major Stroke
» unconscious with paralysis
» loss of bowel & bladder control
SEIZURES
• Key = Prevent Harm to Body
» cushion head ; make scene safe
• generally 2 classifications ----- Petit Mal & Grand Mal
• with any seizure may lose bladder control
• Use “bite block” if available
POISONINGS
• Key to first aid management = Call Poison Control Center (PCC)
• Most common form = by Ingestion
– Usual treatment = Induce Vomiting
1. Induce Vomiting via Ipecac (1 tsp/ child ; 2 tsp/ adult)
2. Activated Charcoal ---- it absorbs residual poison
(note that vomiting only removes half the poison)
– Never induce vomiting :
» if poison corrosive ---- e.g. lye
» petroleum products ----- you’ll get aspiration pneumonia
» semiconscious person ---- they have no gag reflex
» less than 1 year old
• 90% occur at home & majority in children
» Thus, key to treatment = PREVENTION
SHOCK
– Def = condition arising from collapsed or depressed circulation
– Symptoms = 5 P’s
» PALLOR ------- best on lips, fingertips, nailbeds, & earlobes
» PROSTATION
» PERSPIRATION --- moist skin
» PULSE ------------------------------------ at first get increase rate
» PULMONARY DEFICIENCY ------ rapid & shallow resp.
• 6 TYPES
– TRAUMATIC
» get extracellular fluid loss
» exp = extensive burns or bruising
– HEMORRAGIC
– CARDIOGENIC
» from congestive heart failure
– NEUROGENIC
» get loss of peripheral tone & thus vasodilation
» KEY to diagnosis =  BP &  Pulse
[ all other types give  BP &  Pulse ]
– SEPTIC
– ANALPHYLACTIC
» severe allergic reaction
Shock (cont)
• First aid treatment of shock
• Position ----- lie down & elevate legs
– Do not raise legs if head or neck injury
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Warmth
Control obvious bleeding
Keep NPO
Call 911
ASTHMATIC ATTACK
– get SOB with wheezing & much anxiety
– Treatment = epinephrine for the acute emergency
– try to relieve the anxiety
INSECT STINGS
• general treatment
– remove stinger ----- by scraping not squeezing
– Ice to affected area ---- slows absorption,  swelling,  pain
– apply paste of baking soda ------ stops itching
– if Tick ---- don’t tear loose; cover with heavy oil for 30 minutes;
it’s occlusive; if still in use tweezers
BITES
– Human/ Animal
-- Snakes
1. Thorough washing X 5 min
1. Thorough washing X 5 min
2. Copious rinsing
2. Immobilize lower than heart
3. Antibiotic ointment & dressing
3. If no help after 30 min--Suck
4. NO Ice, Cut, nor Tourniquet
DIABETES MELLITUS
– get 2 problems:
» Insulin Reaction = hypoglycemia
» Diabetic Coma = hyperglycemia
SEVERE HEMORRHAGE
• get 3 types of bleeding from open wounds
1. Spurting = arterial
2. Continual Dark Ooze = venous
3. Continual Bright Ooze = capillary
• Don’t Use Tourniquet
• Use Pressure Dressing & Elevation Above Heart
• If that doesn’t work ----- then go to pressure points
» Squeeze artery that supplies area
• Be aware of possible “internal bleeding”
» Shocky, rigid abdomen, coughing or vomiting blood
NOSEBLEEDS
• Also called EPISTAXIS
• Treatment
» Pinch nose for 5-10 minutes
» Ice pack to nose
» Position of patient = sitting, leaning forward
MUSCULOSKELETAL INJURY
• Fractures
– basically 2 types: (1) Simple (2) Compound
– key is Immobilization & Splint the broken part
– Don’t ask patient to move the part
• Dislocations
• Sprains, strains, etc.
» Key to treatment = RICE
» Ice and/or Heat
BURNS
– Know degree of burn & percent of body involved (rule of nines)
– Key to Treatment
– 3 B’s
--- 3 C’s
» Burn ---- Stop It !
* Cool the Area (No Ice)
» Breathing
* Cover the Area
» Body Exam
* Carry
nb: ice causes body heat loss
– Facts:
• Burns will continue to cause deep tissue damage up to 20 minutes
after the acute episode
• If nerves destroyed then burn painless
• If clothing stuck to burn, don’t remove it
• If burn greater than 20% ---- need professional care
• If burn greater than 40% ---- then classified “severe”
• In 2o -- don’t break blisters
• In phosphorus burn no running water, just cool rags
– In cooling burns, best to use cool tap water X 20 minutes
– In 2o & 3o burns best to cover first & then cool