Acute Medical Emergencies: Choking and Basic Life Support

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Questions and Answers

In a scenario of acute airway obstruction due to a foreign body in an adult, when initial attempts to relieve the obstruction are unsuccessful, and the patient becomes unconscious, what is the MOST critical next step, assuming you are alone?

  • Immediately perform a finger sweep to manually dislodge the obstruction, followed by rescue breaths.
  • Administer abdominal thrusts until the obstruction is relieved, even if it compromises your safety.
  • Initiate chest compressions before calling for help to quickly address potential cardiac arrest from hypoxia.
  • Call for HELP, then position the victim supine, and initiate chest compressions, omitting initial attempts at ventilation. (correct)

Following the 2021 Resuscitation Council UK guidelines, in what specific clinical context should chest thrusts be prioritized over abdominal thrusts when managing a choking patient?

  • If the patient has a body mass index (BMI) over 40, chest thrusts are preferred to avoid injury.
  • Chest thrusts are specifically indicated for choking infants and pregnant women, ensuring the maneuver does not compress the abdomen. (correct)
  • Abdominal thrusts should never be performed, with chest thrusts being the single appropriate response regardless of patient characteristics.
  • If initial abdominal thrusts fail to dislodge the obstruction after three attempts, switch to chest thrusts to vary the pressure.

Which of the following statements BEST encapsulates the underlying principle behind prioritizing early defibrillation in the 'Chain of Survival'?

  • Early defibrillation minimizes the risk of neurological sequelae following prolonged cardiac arrest.
  • Early defibrillation eliminates the need for subsequent advanced cardiac life support (ACLS) interventions.
  • Early defibrillation guarantees the restoration of spontaneous circulation (ROSC) in all patients experiencing cardiac arrest.
  • Early defibrillation decreases morbidity, providing more opportunities to restore quality of life. (correct)

During the primary survey of an unresponsive adult, after establishing that the scene is safe and shouting for help, which procedural step takes precedence according to current resuscitation guidelines?

<p>Opening the airway using a head-tilt/chin-lift maneuver to assess and ensure airway patency. (D)</p> Signup and view all the answers

While performing chest compressions during CPR, what nuanced adjustment should be implemented to optimize the effectiveness of each compression, reflecting the most current understanding of cardiac physiology?

<p>Minimize interruption, with full chest recoil after each compression, switching rescuers every 5 minutes to maintain efficacy. (A)</p> Signup and view all the answers

In administering rescue breaths during adult CPR, what specific parameter should dictate both the volume and rate of each breath to optimally balance oxygenation and minimize complications?

<p>Give breaths over approximately 1 second, aiming for visible chest rise, while avoiding excessive volume or pressure. (A)</p> Signup and view all the answers

When utilizing a pocket mask for providing rescue breaths, what crucial step optimizes seal efficacy and thereby mitigates the risk of air leakage during ventilation?

<p>Employing the 'C-E' technique to ensure a tight seal, using both hands to secure the mask while another provider delivers breaths. (A)</p> Signup and view all the answers

In the context of pediatric resuscitation, what is the MOST critical modification to the adult basic life support (BLS) sequence when managing an infant found unresponsive and not breathing?

<p>Deliver five initial rescue breaths before commencing chest compressions to address likely respiratory etiology. (B)</p> Signup and view all the answers

During cardiopulmonary resuscitation (CPR) on a child, what anatomical landmark guides proper hand placement to ensure effective chest compressions?

<p>Using the heel of one hand on the lower third of the sternum, avoiding the xiphoid process. (C)</p> Signup and view all the answers

In managing anaphylactic shock, what is the principal physiological rationale for administering intramuscular adrenaline (epinephrine) as the first-line treatment?

<p>Adrenaline non-selectively agonizes adrenergic receptors to reverse vasodilation, mitigate increased vascular permeability, and relieve bronchospasm. (D)</p> Signup and view all the answers

Based on current best practices, what decisive action should a healthcare provider take immediately upon recognizing signs and symptoms indicative of anaphylaxis in a patient?

<p>Administer intramuscular adrenaline, call for help, and prepare to manage airway, breathing, and circulation. (C)</p> Signup and view all the answers

A 6-year-old child presents with severe respiratory distress, widespread urticaria, and angioedema shortly after being stung by a bee. Anaphylaxis is suspected. According to the guidelines, what is the appropriate dose of intramuscular adrenaline (1 mg/mL concentration) to administer?

<p>0.3 mL (300 micrograms) (D)</p> Signup and view all the answers

In a scenario where a patient's anaphylactic reaction is refractory to two doses of intramuscular adrenaline, and the patient exhibits persistent, life-threatening breathing and circulatory compromise, what should be the immediate next intervention, according to the guidelines?

<p>Initiate an IV fluid bolus while preparing for advanced interventions as per the refractory anaphylaxis algorithm. (C)</p> Signup and view all the answers

During resuscitation of a pregnant woman in cardiac arrest, which modification to standard basic life support (BLS) is MOST critical to optimize maternal and fetal outcomes?

<p>Manually displace the uterus to the left to relieve aortocaval compression during chest compressions. (C)</p> Signup and view all the answers

An individual with a known history of severe anaphylaxis carries an adrenaline auto-injector. However, they are now unconscious and unable to self-administer the medication. What step should a trained first responder take?

<p>Administer the auto-injector intramuscularly into the deltoid muscle and monitor the patient closely. (C)</p> Signup and view all the answers

Which of the following is the MOST accurate representation of the anatomical location for administering an intramuscular injection of adrenaline using an auto-injector during anaphylaxis management?

<p>The anterolateral aspect of the thigh, specifically the middle third. (C)</p> Signup and view all the answers

What is the underpinning rationale for advising individuals experiencing acute anaphylaxis to lie flat (supine) with or without elevating their legs (modified Trendelenburg position), rather than sitting or standing?

<p>Maintaining a supine position augments venous return, thereby ameliorating hypotension and optimizing cerebral perfusion. (D)</p> Signup and view all the answers

A 2-year-old child in severe respiratory distress presents with audible stridor, a barking cough, and suprasternal retractions. The child is also febrile. What is the MOST likely underlying etiology for these clinical findings?

<p>Laryngotracheobronchitis (croup), typically caused by parainfluenza viruses. (B)</p> Signup and view all the answers

What specific intervention is MOST crucial during the initial management of a five-year-old child presenting with acute, severe asthma exacerbation characterized by marked wheezing, diminished air entry, and an oxygen saturation of 88% on room air?

<p>Titrating supplemental oxygen to maintain oxygen saturation above 94% and administer nebulized bronchodilators. (C)</p> Signup and view all the answers

What constitutes the MOST essential element in differentiating between mild, moderate, and severe choking episodes when assessing an adult patient suspected of foreign body airway obstruction?

<p>The patient's ability to vocalize or produce an effective cough. (B)</p> Signup and view all the answers

When administrating back blows to relieve choking, what specific technique optimizes the force and direction to maximize its effectiveness?

<p>Delivering sharp blows between the shoulder blades with the heel of the hand, directing the force upwards towards the head. (B)</p> Signup and view all the answers

What crucial step minimizes the risk of gastric distension–and subsequent regurgitation–when providing rescue breaths during CPR?

<p>Ensuring a tight mask seal and delivering breaths with just enough air to produce visible chest rise. (C)</p> Signup and view all the answers

When caring for an unresponsive adult, what best describes the rationale for placing the individual in the recovery position?

<p>To prevent aspiration of fluids, such as saliva or vomitus, and maintain a patent airway. (C)</p> Signup and view all the answers

In light of the differences between adult and pediatric CPR, by what means should a trained first responder modify their approach to chest compressions when performing CPR on a 3-month-old infant?

<p>Utilizing the two-finger technique, compressing the sternum to a depth of approximately one-third the anterior-posterior diameter of the chest. (A)</p> Signup and view all the answers

Following the 2021 Resuscitation Council (UK) guidelines, in what scenario during CPR is it acceptable to deviate from the 30:2 compression-to-ventilation ratio in adult basic life support?

<p>Only when advanced airway management (e.g., endotracheal intubation) is in place, allowing for continuous chest compressions without pauses for ventilation. (D)</p> Signup and view all the answers

During the management of a patient in suspected anaphylactic shock, when and how should oxygen be administered to optimize its therapeutic effect?

<p>Administer high-flow oxygen via a non-rebreather mask to achieve and maintain an oxygen saturation of 94% or higher. (D)</p> Signup and view all the answers

When prioritizing interventions in a pediatric patient experiencing severe respiratory distress, what precise clinical sign has the HIGHEST predictive value for impending respiratory failure and the necessity of advanced airway management?

<p>Depressed level of consciousness or altered mental status. (B)</p> Signup and view all the answers

Following the 2021 Resuscitation Council (UK) guidelines, what is the recommended course of action if you suspect a child has a foreign body airway obstruction but is still coughing effectively?

<p>Encourage the child to continue coughing and closely monitor their condition for any deterioration. (D)</p> Signup and view all the answers

Under what specific circumstances is the administration of blind finger sweeps explicitly contraindicated for managing airway obstruction in pediatric patients?

<p>In situations where the foreign body is not visible or readily accessible, as it may push the object further down. (B)</p> Signup and view all the answers

When performing chest compressions on a newborn, where is the MOST accurate placement of the hands to ensure effective cardiac output?

<p>Using the two-thumb encircling hands technique, with thumbs on the midsternum and fingers encircling the thorax. (C)</p> Signup and view all the answers

What is the primary objective of the "D" (Disability) component of the primary survey?

<p>To determine the patient's level of consciousness, applying measures such as the AVPU Scale. (A)</p> Signup and view all the answers

What adjustment to your technique could you implement in order to maximize the likelihood of success when giving rescue breaths and the first attempt does not cause the chest to rise?

<p>Re-tilt the head and ensure there is adequate placement of your mouth around theirs to creat a seal. (B)</p> Signup and view all the answers

When using an AED on a younger child, what adjustments should you take to ensure the AED and pads are used appropriately?

<p>Use child pads if able, and ensure that they are placed properly and not touching. (A)</p> Signup and view all the answers

Besides allergies, which of the following conditions can be mistaken for anaphylactic shock?

<p>Panic attack. (A)</p> Signup and view all the answers

How do you determine if chest compressions are being given adequately?

<p>Ensure that you leave time for the chest to fully recoil after each breathe. (A)</p> Signup and view all the answers

What is the most important consideration when deciding to put someone into recovery position?

<p>You should put the person into the recovery position if they are breathing regularly but are not responding. (A)</p> Signup and view all the answers

In cases where you suspect cardiac arrest and aren't sure whether they are breathing normally or not–what should you do?

<p>Err on the side of caution and start CPR. (C)</p> Signup and view all the answers

According to the presented information–what is one of the first things that should be done to assess an individual to assess if a person is responsive or not?

<p>Shake their shoulders and ask loudly if they are alright. (B)</p> Signup and view all the answers

In the management of a patient experiencing severe anaphylaxis refractory to initial intramuscular epinephrine administration, which of the following advanced interventions demonstrates the MOST nuanced understanding of biphasic anaphylactic reactions and long-term patient stabilization?

<p>Initiating a continuous intravenous infusion of epinephrine, titrated to maintain systolic blood pressure above 90 mmHg, alongside high-dose corticosteroids. (C)</p> Signup and view all the answers

Considering the inherent physiological differences between adults and children, what optimization strategy during manual chest compressions would MOST effectively augment venous return and cardiac output in a 3-month-old infant experiencing cardiac arrest?

<p>Employing two-thumb encircling hands technique, ensuring complete chest recoil, and minimizing interruptions to maintain consistent coronary perfusion pressure. (D)</p> Signup and view all the answers

A patient with a known history of severe peanut allergy inadvertently consumes a product containing peanuts. Despite immediate self-administration of epinephrine via auto-injector, the patient develops progressive laryngeal edema and profound hypotension (systolic BP <70 mmHg). What preemptive intervention should be initiated FIRST?

<p>Performing an immediate cricothyroidotomy to bypass upper airway obstruction, followed by volume resuscitation with crystalloid solutions. (D)</p> Signup and view all the answers

What is the MOST crucial differentiating factor between the adult and pediatric algorithms for managing foreign body airway obstruction in a conscious patient, reflecting the underlying anatomical and physiological variances?

<p>The selective utilization of chest thrusts over abdominal thrusts in pediatric patients, accounting for the heightened risk of abdominal organ injury. (C)</p> Signup and view all the answers

In a pregnant patient (28 weeks gestation) experiencing cardiac arrest secondary to amniotic fluid embolism, what specific modification to standard advanced life support (ALS) demonstrates optimized maternal and fetal resuscitation?

<p>Implementing manual left uterine displacement (LUD) and initiating perimortem cesarean section within 5 minutes of arrest to enhance venous return and fetal viability. (B)</p> Signup and view all the answers

Flashcards

Choking

Obstruction of the airway by a foreign body, preventing normal breathing.

Coughing

A first response to choking by the body to clear the blockage.

Back Blows

Technique for dislodging objects. Stand to the side and support the chest. Lean patient forward.

Abdominal Thrusts

Technique for dislodging airway obstructions; involves inward and upward thrusts.

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Chain of Survival

Sequential actions to improve survival from cardiac arrest.

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Primary Survey

Systematic assessment to identify and treat life-threatening conditions.

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DANGER

Ensuring the safety of yourself, the patient, and bystanders.

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RESPONSE

Assessment of the victim's level of consciousness and alertness.

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SHOUT FOR HELP

Seeking assistance from others and activating emergency services.

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AIRWAY

Ensuring a clear and unobstructed passage for air to enter the lungs.

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BREATHING

Assessing the victim's breathing effort and effectiveness.

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COMPRESSIONS

Manual chest compressions to circulate blood when the heart stops.

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GIVE RESCUE BREATHS

Providing artificial ventilation to supply oxygen to the lungs.

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Pocket mask

Device delivering controlled ventilations, avoids direct contact.

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AED

Using an automated external defibrillator to deliver an electrical shock.

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RECOVERY POSITION

Position placing unconscious but breathing individuals to keep airway open.

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Paediatric CPR

Actions for treating infants/children, adjusting standard CPR techniques.

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Anaphylactic Shock

The body's extreme, potentially deadly response to an allergen.

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Adrenaline Auto-injectors

Injectable medication used to treat severe allergic reactions.

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Anaphylaxis Triggers

Foods and drugs that can trigger an anaphylactic reaction

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Study Notes

Aims of Session

  • Emphasize the importance of Acute Medical Emergencies.
  • Reinforce the knowledge, skills, and confidence needed to react in these situations.
  • Topics include: Choking, Primary survey, Chain of survival, Basic life support (CPR), Automated defibrillation (AED), and Recovery position.

Choking

  • Be alert to choking, especially if the victim is eating (coughing).
  • Mild choking allows the patient to speak.
  • Severe choking means the patient cannot speak or cough.
  • Signs of choking from a foreign body include coughing, inability to speak, pallor/cyanosis, difficulty breathing, and collapse.

Choking - Relieving Techniques

  • Coughing is the body's first response to choking.
  • It is generally an effective way to clear the blockage.
  • Stay calm and instruct the patient to cough.

Back Blows

  • Stand to the side and support the chest.
  • Lean the patient forward.
  • Administer up to five sharp blows between the shoulder blades with the heel of your hand.

Abdominal Thrusts

  • Stand behind the patient and put both arms around the upper part of the abdomen.
  • Lean the patient forward.
  • Clench your fist and place it between the navel and the ribcage.
  • Grasp this hand with your other hand and pull sharply inwards and upwards.
  • Repeat up to five times, alternating with back blows if not relieved.
  • Do not perform on a paediatric patient; use chest thrusts instead.

Recap - Choking Treatment

  • Encourage the patient to cough.
  • If the obstruction is severe, administer up to 5 back blows.
  • If back blows fail, attempt up to 5 abdominal thrusts.
  • Repeat back blows/abdominal thrusts until the obstruction is removed or the patient becomes unconscious.
  • If the patient becomes unconscious due to choking, start CPR immediately.

The Chain of Survival

  • A 1-minute delay in treatment results in a 10% reduction in survival.
  • The steps are: Early recognition and call for help, Early CPR, Early defibrillation, and Advanced care.

Primary Survey - Adults

  • The steps of the primary survey for adults include: Danger, Response, Shout for help, Airway, Breathing, Compressions/Recovery position, Give rescue breaths, and AED.

Danger

  • Make sure you, the patient, and any bystanders are safe.
  • If there is danger, consider: Emergency services, Moving the patient to safety, and Protection of the scene.

Response

  • Check the victim for a response.
  • Gently shake their shoulders and ask loudly: "Are you all right?"
  • AVPU is used to assess the response: Alert, Voice, Pain, Unresponsive.

Shout for Help

  • Shout for help.
  • Get a second person to call 999.
  • Get someone to get the closest AED.
  • If you are on your own, continue onto the next step and use your own mobile phone to call for help and put it on loudspeaker.

Airway

  • Turn the patient onto their back and open the airway.
  • Place your hand on their forehead and gently tilt their head back.
  • With your fingertips under the point of the victim's chin, lift the chin to open the airway.

Breathing

  • Look, listen, and feel for normal breathing for no more than 10 seconds.
  • The first few minutes after cardiac arrest may include barely breathing or infrequent, slow, and noisy gasps.
  • If you have any doubt whether breathing is normal, act as if they are not breathing normally and start CPR.

Compressions

  • Kneel and place the heel of one hand in the centre of the patient's chest.
  • Place the heel of your other hand on top of the first hand, interlocking your fingers.
  • Keep your arms straight, shoulders vertical, and press down on the sternum to a depth of 5-6 cm.
  • Each compression should release all the pressure on the chest without losing contact with the sternum.
  • Repeat compressions at a rate of 100-120 per minute.

Give Rescue Breaths

  • Compression-only CPR is an option for those unwilling to give rescue breaths.
  • After 30 compressions, open the airway using head tilt and chin lift and give 2 rescue breaths.
  • Pinch the soft part of the nose closed, using the index finger and thumb of your hand on the forehead.
  • Allow the mouth to open, but maintain chin lift.
  • Take a normal breath and place your lips around their mouth, making sure that you have a good seal.
  • Blow steadily into the mouth while watching for the chest to rise, taking about 1 second (Continue 30:2).

Pocket Masks

  • Ventilation with a pocket mask removes the need for direct contact.
  • It improves lung ventilation and can attach to oxygen.

AED

  • Attach the pads on the patient's bare chest (CPR continues whilst pads are attached to the chest if 2 rescuers).
  • Follow direction prompts and ensure no one is touching the patient.
  • Shock if indicated, deliver shock ensuring no one touches the patient.
  • Push the shock button as directed; immediately restart CPR at a ratio of 30:2.
  • Continue as directed by voice/visual prompts.
  • If no shock is indicated, continue CPR.

Continue CPR Until

  • A health professional tells you to stop.
  • You become exhausted.
  • The victim is definitely waking up, moving, opening eyes, and breathing normally.

Recovery Position

Primary Survey - Paediatrics

  • Primary Survey for paeditrics include: Danger, Response, Shout for Help, Airway, Breathing, Give 5 rescue breaths, Compressions/Recovery Position, and AED.

Paediatric CPR

  • Paediatric arrest is usually secondary to other causes.
  • The differences between infants and children when performing CPR are important.
  • A newborn is an infant just after birth, an infant is under the age of 1 year, and a child is 1 year to 18 years of age.
  • Have the patient on a hard surface.
  • Give 5 rescue breaths if not breathing normally.
  • Compress a third of the depth of the chest (4 to 5cm) at a rate of 100 to 120 compressions per minute.
  • Use one hand on the centre of the chest for a child.
  • Use the 2 thumb or 2 fingers technique for an infant.
  • CPR on children is done at 30 compressions to 2 breaths in out-of-hospital basic life support (in hospital will be done at 15:2 by qualified clinicians).

Anaphylactic Shock

  • Anaphylaxis is an extreme and severe allergic reaction affecting the whole body, often within minutes of exposure to the allergen.
  • Histamine release causes vasodilation, increased vessel permeability, hypoxia/bronchospasm, leading to hypotension/tachycardia.

Causes / Triggers of Anaphylactic Shock

  • Common foods include peanuts, tree nuts, sesame, fish, shellfish, dairy products, and eggs.
  • Non-food causes include wasp or bee stings, natural latex (rubber), penicillin, or any other drug or injection.
  • In some people, exercise can trigger a severe reaction, either on its own or in combination with other factors such as food or drugs (e.g., aspirin).

Symptoms of a Severe Allergic Reaction

  • Generalised flushing of the skin.
  • Urticaria - Nettle rash (hives) anywhere on the body.
  • Sense of impending doom
  • Swelling of throat and mouth.
  • Difficulty in swallowing or speaking.
  • Alterations in heart rate.
  • Severe asthma.
  • Abdominal pain, nausea, and vomiting.
  • Sudden feeling of weakness (drop in blood pressure).
  • Collapse and unconsciousness.

Treatment for Anaphylactic Shock

  • Airway, Breathing, Circulation.
  • Adrenaline auto-injectors are prescribed for those believed to be at risk.
  • Monitor and prepare to resuscitate if needed.
  • Seek medical help.

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