Cuándo detener la RCP básica

When to Stop Basic CPR

• CPR should be maintained until specialized teams arrive, except in certain situations
• The patient recovers spontaneous circulation. Monitor vital functions periodically.
• There is documented evidence of the affected person's prior wish not to receive CPR.
• There is unambiguous documentation that the cardiac arrest occurred as a result of the terminal and irreversible progression of an incurable disease.
• Despite initiating CPR, it is unmistakably confirmed that these maneuvers began more than 10 minutes after the initiation of cardiac arrest, except in situations of drowning, accidental hypothermia, or intoxication with barbiturates.
• After a reasonable period, never less than 30 minutes, there is still an absence of any electrical cardiac activity, except in situations of hypothermia or drowning, and there is evidence of generalized hypoxia, lividity, mydriasis, etc.
• The rescuer is exhausted, possibly when a single rescuer performs prolonged CPR.

Initial Assessment of the Victim

• Scene and victim assessment should follow a consistent pattern: Protect (prevent new accidents), Alert (call 112 or emergency services), and Assist (in order of vital emergency priority).
• Determine the level of consciousness of the victim by talking to them or applying small painful stimuli.
• Immediately apply the "A, B, C, D" protocol for victim assessment: Airway (A), Breathing (B), Circulation (C), and Disability (Neurologic status) (D).
• Assess airway patency, placing the patient in the recovery position.
• Open the airway using the head tilt-chin lift maneuver in non-traumatic patients.
• Check for foreign objects or fluids in the mouth. If unconscious, insert a Guedel cannula. Immobilize the cervical spine with a collar.

Breathing Assessment

• Check for spontaneous breathing: observe chest movement, listen for air entry/exit, and feel for humidity and warmth of exhaled air.
• If not breathing, begin resuscitation maneuvers.
• If breathing, assess respiratory rate (normal is 10-20 breaths per minute), depth, regularity, symmetry, sounds, and effort.

Circulation Assessment

• Check for a carotid pulse in adults. If absent, begin resuscitation maneuvers.
• If a pulse is present, assess heart rate (normal is 60-120 bpm), rhythm, strength, presence of hemorrhages, capillary refill time (<2 seconds), skin temperature, and color (cyanosis).

Neurologic Status Assessment

• Assess consciousness and presence of neurological deficits using the AVPU scale: Alert (A), Responds to Verbal stimuli (V), Responds to Painful stimuli (P), Unresponsive (U).

Asphyxia and Respiratory Alterations

• Asphyxia is the suspension or difficulty in breathing due to a decrease or lack of oxygen in the air breathed, resulting in hypoxia.
• Causes: inadequate ventilation (obstruction of upper airways, foreign bodies, suffocation, inert gases, electrocution, toxins, strangulation), decreased oxygen in inspired air (rarefied air, immersion), and inadequate oxygen transport (carbon monoxide, toxins).
• Classification: livid/blue (lack of O2, slow circulation) and pale/white (glottis spasm, weak pulse, abolished reflexes).
• Action protocol: Rescue or remove the victim, open the airway and perform mouth-to-mouth, and transport urgently while applying oxygen.

Asphyxia Due to Carbon Monoxide

• Carbon monoxide (CO) is a colorless, odorless, and tasteless gas that is difficult to detect, produced by incomplete combustion.
• Symptoms: headaches, nausea, vomiting, blurred vision, lack of coordination, pallor, tachycardia, dizziness, confusion, coma, and death.
• Action protocol: Remove the victim and air the room, perform mouth-to-mouth, and transport urgently for treatment.

Circulatory Alterations: Lipothymia

• Lipothymia is a sudden loss of consciousness due to a temporary reduction in blood supply to the brain.
• Causes: stagnation of blood in the lower extremities (peripheral vascular alteration), excessive heat, crowds, or prolonged fasting.
• Symptoms: dizziness, sweating, pallor, nausea, weakness, hypotension, slow and irregular pulse, loss of consciousness, pale, cold, and clammy skin.
• Action protocol: Seat the victim with their head between their knees or lay them down with their feet elevated, place them in a cool place, turn their head to the side to prevent aspiration, and give small sips of water if conscious.

Syncope

• Syncope is a sudden decrease in blood supply to the brain, triggered by cardiac arrest or arrhythmia.
• Symptoms: sudden loss of consciousness, pallor, sweating, weak and rapid pulse (thready), or cardiorespiratory arrest.
• Action protocol: lay victim down with feet elevated, turn head to the side to prevent aspiration, cover to prevent heat loss, perform CPR if needed, transport urgently.

Myocardial Infarction

• Myocardial infarction is necrotic damage to the cardiac muscle due to acute ischemia (coronary thrombosis).
• Symptoms: intense chest pain radiating to the left arm, neck, or back, pallor, cyanosis, shallow breathing, irregular pulse, and sometimes cardiac arrest. Urgent medical assistance is needed.
• Action protocol: initiate CPR if there is no carotid pulse, place in the recovery position if unconscious, loosen clothing, do not elevate lower extremities, seat conscious victim at a 45-degree angle, and monitor pulse, breathing, and level of consciousness.

Shock

• Shock is a state of acute peripheral circulatory insufficiency due to a decrease in circulating blood volume.
• Characterized by hypotension, tachycardia, coldness, tachypnea, pallor, restlessness, altered consciousness, weak peripheral pulses, and cold, clammy extremities.
• Causes: hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic.
• Action protocol: lay the victim down with feet elevated with anti-shock position, place in the recovery position if vomiting, cover with a blanket, do not give alcohol, moisten lips, and treat injuries.

Coma

• Coma is a prolonged loss of consciousness with decreased or absent protective reflexes.
• Symptoms: unconsciousness, no response to external stimuli, maintained breathing and carotid pulse.
• Action protocol: place victim in the recovery position unless trauma is suspected, loosen clothing, maintain an open airway, control vital signs, and cover to prevent hypothermia.

Hypoglycemia

• In case of hypoglycemia with altered consciousness, do not give food or liquids by mouth and administer glucagon.
• Hyperglycemia may be caused by too little insulin, increased need for insulin due to concurrent illness, or excessive food intake.
• When blood glucose is higher than 250 mg/dL, administer fluids and facilitate lavatory access.
• Severe decompensation can lead to ketoacidosis, characterized by general malaise, thirst, nausea, vomiting, abdominal pain, and a peculiar odor on the breath.

Convulsive Disorders

• Convulsions are energetic and involuntary contractions of skeletal muscles that generally occur suddenly due to stimulation of nerve centers.
• Types include tonic (sustained contractions without mass movement) and clonic (rhythmic contractions with limb flexion and extension).
• Clonic convulsions may be generalized (affecting the entire body), unilateral (affecting one side), or partial (affecting one area).

Epilepsy

• Epilepsy is a chronic neurological condition due to increased electrical activity of neurons that can cause loss of consciousness.
• The attack is preceded by sensations such as dizziness, odors, or localized muscle contractions.
• Following aura is a cry and fall, loss of consciousness, and convulsive phases of rigidity, generalized clonus, and recovery.
• Action Protocol during the rigidity phase: prevent victim from hitting themselves.
• Action Protocol during the convulsion phase: remove nearby objects.
• Action Protocol during recovery: check for injuries, give non-stimulating drinks, and allow rest.

Hemorrhages

• Hemorrhage is the escape of blood from blood vessels due to accidental or spontaneous rupture.
• Classification by destination of blood: external, internal, and exteriorized.
• Classification by vessel type: arterial, venous, and capillary.
• Arterial: bright red, intermittent flow, due to artery rupture.
• Venous: dark red, continuous flow, due to vein rupture.
• Capillary: small, continuous bleeding points, due to capillary rupture.

Other Hemorrhages

• Epistaxis: nasal hemorrhage
• Melena: intestinal hemorrhage from the anus
• Hemoptysis: lung hemorrhage expelled by cough
• Hematemesis: digestive hemorrhage expelled by vomit
• Hematemesis: blood from digestive tract typically from upper GI, can be red or black

Internal Hemorrhages

• Internal hemorrhages more likely from thoracic or abdominal trauma
• More difficult to detect with symptoms like abdominal distention and tenderness
• Signs and symptoms include blood in stool, urine, or vomit
• Can also cause shock
• Action: Place victim in recovery with feet elevated, cover with warm materials, monitor vitals, and do not administer anything by mouth

External Hemorrhages

• Protocol for external hemorrhages:
• Tumbar patient
• Ponerse guantes
• Retirar ropa cubrir zona
• Dejarla al Descubierto
• Taponar la herida con apósitos
• Colocar más apósitos y vendaje
• Elevar zona afectada
• Presión sobre presión arterial

Tourniquetes

• Place tourniquet when all previous measures fail, very last resort, should be applied if blood cannot be stopped via any other method

Burns

• Burns are injuries to the skin caused by chemical, physical, and electrical factors
• Severity is based on depth, size, and patient
• The factors determining the severity of a burn are: PROFUNDIDAD, EXTENSIÓN, EDAD

Classification of Burns

• Divided base on degree of depth and the percentage of surface area affected
• According to depth: affects to what part of the tissue, how painful, and the time to heal

According to Surface

• Head and neck is 9% or total body surface
• Torax and abdomen is 18% of total
• Back is 18% of total
• Extremeties are divided

URGENT Symptoms and Descriptions

• Asphyxia: lack of oxygen from inadequate ventilation or not enough oxygen in the air; symptoms include turning blue, acting by moving air to an area where the person is safe.
• Lipotimia: is a sudden state when a person loses his breath because there is not enough blood. Symptoms include sweating, paled skin, passing out, and sudden loss of hearing. Person may be in the seat and needs a comfortable area to recuperate as well as water.
• Shock: Symptoms are when the victim becomes pale, but there is enough heart function,. The person will also need to sit at 45 degree angle.