Cuándo detener la RCP básica

When to Stop Basic CPR

• CPR should be maintained until specialized teams arrive, except in specific situations.
• Stop when the patient recovers spontaneous circulation, maintaining alertness and periodically checking vital signs.
• Stop CPR if the affected person has a documented advance directive refusing CPR.
• Stop CPR if the cardiac arrest is confirmed to be the result of a terminal and irreversible illness.
• Stop CPR if CPR was initiated after a delay of more than 10 minutes from the cardiac arrest (excluding drowning, hypothermia, or barbiturate intoxication).
• Stop CPR after a reasonable time (at least 30 minutes) with continuous absence of electrical cardiac activity (excluding hypothermia or drowning), showing signs of generalized hypoxia.
• Stop CPR when the rescuer is exhausted, which can occur with prolonged CPR by a single rescuer.

Initial Assessment of the Victim

• Always follow the P.A.S. (Protect, Alert, Support) steps.
• Protect the scene to prevent new accidents.
• Alert emergency services (112).
• Support the victim prioritizing vital emergencies.
• Determine the level of consciousness by speaking to the victim or applying painful stimuli.
• Apply the "A, B, C, D, E" assessment protocol.
• A: Airway - Ensure the airway is patent (permeable).
• B: Breathing - Assess respiratory status.
• C: Circulation - Assess circulatory status.
• D: Disability - Assess neurological status.
• E: Exposure and prevention of environmental factors.
• Assess airway patency, placing the patient in the dorsal supine position.
• Open the airway with the head-tilt/chin-lift maneuver (unless trauma is suspected.)
• Check for foreign bodies or fluids in the mouth.
• If unconscious, insert a Guedel cannula. Stabilize the cervical spine with a collar if trauma is suspected.

Respiratory Assessment

• Check for spontaneous breathing.
• Look for chest movement.
• Listen for air entry/exit.
• Feel for exhaled air humidity and warmth.
• If not breathing, begin resuscitation.
• If breathing, assess respiratory rate (normal 10-20 rpm), depth, regularity, symmetry, noises, and effort.

Circulatory Assessment

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

Neurological Assessment

• Assess level of consciousness and neurological deficits using the AVPU scale.
• A: Alert
• V: Responds to Verbal Stimuli
• P: Responds to Painful Stimuli
• U: Unresponsive

Asphyxia and Respiratory Alterations

• Asphyxia is the suspension or difficulty in breathing due to decreased oxygen in the air and tissues (hypoxia).
• Causes can include inadequate ventilation, obstruction of upper airways.
• Inadequate ventilation typically results from upper airway obstruction by foreign bodies, suffocation, inert gases, tongue prolapse, electrocution, toxins, hanging, or chest compressions.
• Contributing factors can include decreased oxygen content in inspired air (e.g., smoke, dust, gas), submersion, high altitude.
• An additional contributing factor can be inadequate oxygen transport by red blood cells.
• Hemoglobin can combine with toxic products (e.g., carbon monoxide) or cells blocked by toxins (e.g., cyanide).
• Livid or blue asphyxia indicates low oxygen in the blood causing slow blood circulation; the skin appears blue.
• Pale or white asphyxia is due to glottis spasms causing paleness, weak pulse, bradycardia, and absent reflexes.
• Management includes removing the victim from the toxic environment, opening the airway, providing mouth-to-mouth resuscitation, and transporting the victim to a medical center.

Asphyxia Due to Carbon Monoxide

• Carbon monoxide (CO) is colorless, odorless, and tasteless, making it difficult to detect and is produced by incomplete combustion of carbon-based products.
• Symptoms include headaches, nausea, vomiting, blurred vision, incoordination, paleness, tachycardia, dizziness, confusion, coma, and death.
• Management involves removing the victim from the source of CO.
• It is crucial not to breathe during the rescue; the management strategy can also include airing the room.
• Additional steps can involve removing the source, providing mouth-to-mouth resuscitation and transporting the victim for treatment of complications.

Circulatory Alterations

• Lipothymia is sudden loss of consciousness due to a temporary decrease in blood supply to the brain.
• It results from blood stagnation in lower extremities (peripheral vascular alteration).
• Triggering factors include excessive heat, crowds, or prolonged fasting.
• Symptoms include dizziness, sweating, paleness, nausea, weakness (especially in legs), hypotension, slow or irregular pulse, loss of consciousness, and cold, clammy skin.
• Management includes sitting the victim down with head between knees or lying down with legs elevated.
• Additional steps can include moving to a cool and ventilated place, positioning the head to the side, providing small sips of water if conscious, treating injuries from the fall, and avoiding crowds.
• Syncope is the sudden drop in blood to the brain due to cardiac arrest or excessive heart contractions (fibrillation).
• Symptoms are a sudden loss of consciousness, paleness, sweating, weak and rapid pulse (thready), and possible cardiorespiratory arrest (CRA).
• Management includes lying the victim down with legs elevated
• Additional steps can include positioning the head to the side, covering the victim to maintain warmth, performing CPR if necessary, and transferring to a medical center.

Myocardial Infarction

• Myocardial Infarction is necrotic damage to cardiac muscle due to acute ischemia.
• Symptoms include intense chest pain radiating to the left arm, neck, or back.
• Additional signs include paleness, cyanosis, shallow breathing, irregular pulse, and cardiac arrest.
• Management measures: CPR if not carotid pulse.
• Place unconscious patient in recovery position and loosen constricting clothes.
• Don't raise lower limbs.
• Conscious patient in Fowler position. Monitor pulse, respiration and consciousness level.

Shock

• Shock or state of shock is a condition of acute peripheral circulatory insufficiency, often due to a decrease in circulating blood volume.
• This condition presents with hypotension, tachycardia, coolness, rapid breathing (tachypnea), paleness, restlessness, altered consciousness, a weak pulse and cool, clammy extremities.
• Types categorized include hypovolemic or cardiogenic shock.
• Hypovolemic results from loss of circulating volume.
• Cardiogenic results from inadequate heart pumping.
• Septic is caused by septicemia.
• Anaphylactic is caused by allergic reaction and neurogenic stems from nervous stimulation/grave trauma.
• Initial management action is Trendelenburg (feet up).
• Alternate position would be recovery position (if vomiting).
• Cover them. Keep them still. Loosen clothes.
• If conscious, have small sips of: 1l water: 1/2 tsp bicarb: 1 tsp salt NEVER ALCOHOL.
• If no conscious. Moisten lips. Treat lesions.

Coma

• Coma can be described as a prolonged loss of consciousness, often marked by a reduction or absence of protective reflexes.
• Symptoms that characterize coma: lack of consciousness.
• Possible absence of a radial or pedal pulse.
• Protocol is position in recovery position unless of vertebral origin.
• Lossen clothing.
• Be aware, the comatose patient may or may not respond to external stimuli.
• If minutes pass, and the victim recovers, a doctor is necessary.

Hypoglycemia

• If a patient is experiencing ALOC, is vital to refrain from giving any substance by mouth.
• Administer Glucagon a hormone.
• Hyperglycemia can occur if not enough insulin. If intercurrent disease such as tonsillitis is the reason of the symptoms, it is necessary to administer liquids to improve.

Convulsive Disorders

• Convulsions are defined as involuntary contractions, typically of sudden onset.
• Tonic are often contractures.
• Clonic are extensive that result in flexion and extension.
• General if they affect the whole body
• And unilateral etc.

Epilepsy

• Chronic disease the can lead to LOC.
• Fase of agitation and then the patent cries and falls.
• Tonic- rigidity, then clonic after.
• No stimulating beverage is to be drunk after
• Try and have patient repose.

Hemorrhages

• Escape blood from vessels due to accidental/spontaneal breakage divided on:
• External.
• Internal. Blood retained in vessels.
• Exteriorized. (Blood leaves from orifices such as anus etc).
• Arterial: Red blood jets with each pump.
• Produces by tear in vein. Slower.
• Capilar: multiple points of blood
• Also epistaxis and hematemesis of note.

External Hemorrhages

• Lay patient down.
• Direct pressure.
• Do not take old bandages. Just apply MORE.
• Elevate affected zones.
• Apply pressure to a point that supplies affected zone.
• If nothing works apply compress and tourniquet at arterial site, never nerves.

When External Hemorrhage is controlled

• Locate and pressure arterial bleeding site.
• Fingers must apply pressure to compress blood flow effectively.

Localize Hemorrhagic Sites

• Temporalis
• Caratid
• Axilar
• Humeral.
• Femoral etc.

Compress bleeding zones

• Follow instructions on graphic to maximize control.

Tourniquets and more on bleeds

• Last resort.
• Stop blood coming from certain site to point above as to avoid arterial flow and bleeds.

Internal Hemorrhages

• Blood in abdomen
• Occult, unknown cause, internal
• Or visible through natural holes.
• Ulcer, cancer etc.
• Causes.
• Call MD

Nasal Hemorrhage: "Epistaxis"

• Causes more often with blows, scratching nasal areas etc
• Do not make strong movement
• No coughing
• Apply pressure

Otorrhagia

• Do not stop blood.
• Lateral position.

Hematemeisis, Hemoptisis, and Anales

• Hematemesis is blood in projectile vomit, administer cold compress
• Hemoptisis blood w/ cough.
• Transfer and transport samples.
• Anales if rectorrhagia or anal, tell pt to consult doctors

Burns

• Direct effects cause skin lesions.
• Burns come in four classes:
• 1st- Epidermal layer of skin.
• 2nd Superficial, epidermal, upper dermis. S- 2nd Profound dermis. t- 3rd- Hypodermis

Rules to Burns

• Deep
• Width
• Zones, etc.
• Grave:
  • 15%/10% children.
• Mortal- 50% burns

Congealing

• 3 factors Humidity / Wind / Immovility
• To reduce
• Rescue quick
• Sweet warm beverages quick.
• 1/2 Grade Bathe and massage
• 2* 3* warm and take in evac with med autority