First Aid: Respiratory Emergencies and CPR - PDF

chapter - Two Respiratory Emergencies and Artificial respiration, Cause of Respiratory failure 1  Learning Objectives After studying the material in this chapter, the student will be able to:- Applying basic rule of "DRSABCDE  Define respi...

chapter - Two Respiratory Emergencies and Artificial respiration, Cause of Respiratory failure 1  Learning Objectives After studying the material in this chapter, the student will be able to:- Applying basic rule of "DRSABCDE  Define respiratory emergencies and artificial respiration.  Identify causes of respiratory failure  Prevent respiratory accident, give artificial respiration and manage respiratory accident 2  Basic ABCDE rules The mnemonic “ABCDE” stands for Airway, Breathing, Circulation, Disability, and Exposure The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is applicable in all clinical emergencies for immediate assessment and treatment  In case of respiratory failure the vital steps to carry out is applying basic rule of "DRSABCDE"  Danger (D):-Check the surrounding area and sure it’s safe for you , the injured person and others in the area  Response(R):- Check the patient’s responses by gently shake and shout at the casualty You may say : can you hear me, what is your name and open your eye  basic rule of "DRSABCDE“ con’t… If the patient responds they are conscious, breathing and have pulse:- Make them comfortable and check them for any injuries , call for help if required and Continue to monitor them for at least 10-15 minutes before letting them move. basic rule of "DRSABCDE“ con’t… A person who does not respond is unconscious and this is potentially life-threatening as they are at risk of choking their breathing may stop or uncontrolled bleeding may result in death.  basic rule of "DRSABCDE“ con’t……  Send for help(S):- call and seek for an ambulance or medical assistance as soon as possible.  basic rule of "DRSABCDE“ con’t…  Airway (A): Open airway to allow air to reach the lungs. Check that the individual’s airway is clear so that their breathing is not obstructed. To check their airway use the head tilt/chin lift technique as this helps lift the tongue from the back of the throat. One hand is placed on the casualty’s forehead to tilt the head back while the fingers of the other hand are positioned on the bony part of the chin to lift it up and outward. basic rule of "DRSABCDE“ con’t… The mouth should then be gently opened by pulling down on the jaw to check for any obstruction. If there is any foreign material present you should move the casualty into the recovery position and allow gravity to aid in draining material from the mouth. Ensuring and providing an open airway always takes precedence over the possibility of a spinal injury. basic rule of "DRSABCDE“ con’t…  Breathing (B): While keeping the airways open *look for chest movement * listen for sounds for breathing *feel for breathing on your check  If no breathing give artificial respiration.  basic rule of "DRSABCDE“ con’t… Circulation(C): Determine if there is adequate perfusion and Check for life-threatening bleeding. Look for signs of poor perfusion, Cool, moist extremities, Delayed capillary refill, Low blood pressure, Tachypnea and Absent pulses If no pulse , then start CPR basic rule of "DRSABCDE“ con’t…  Disability(D): Assess and protect brain and spinal functions. Assess level of consciousness (AVPU or GCS) in trauma Look for abnormal repetitive movements or shaking and Seizures/convulsions basic rule of "DRSABCDE“ con’t…  Exposure (E): Examine the entire body for hidden injuries Other lesions Rashes, such as hives, can indicate an allergic reaction Other rashes can indicate infection  Definition Respiratory emergency is one in which normal breathing stops or in which breathing is reduced so that oxygen intake is insufficient to support life. Artificial respiration is a procedure for making air to flow into and out of a person’s lungs when his natural breathing is inadequate or ceases. 14  Overview of cardiac and respiratory system 15  RESPIRATORY SYSTEM General Function A primary requirement for all body cell activities and growth is oxygen, which is needed to obtain energy from food. The fundamental purpose of the respiratory system is to supply oxygen to the individual tissue cells and to remove their gaseous waste product, carbon dioxide. Breathing , or ventilation, refers to the inhalation and exhalation of air. Functions of the Respiratory System The four basic functions:  Provides oxygen to the bloodstream and removes carbon dioxide  Sound production or vocalization  Assists in abdominal compression during defecation (passing of feces), and parturition (childbirth).  Protective and reflexive: coughing and sneezing passageways clean.  The respiratory system may be divided into:  Upper respiratory tract  Lower respiratory tract The upper respiratory tract consists:  Nose or nostrils  Nasal cavities  Pharynx(throat)  Larynx (voice box) The lower respiratory tract(found within the chest cavity):  Trachea (Windpipe)  Lung  Bronchi  Bronchioles  Alveoli  GAS EXCHANGE NOSE AND NASAL CAVITIES Functions:  Filter dust from the inhaled air.  Warming and humidifying the inhaled air.  Olfaction (Smell)  Lightening the head (Sinuses)  Resonance (vibration) during sound production (Sinuses).  Epiglottis: “Guardian of the airways”  It is the ninth cartilage which is flexible.  Has spoon-shape.  Composed of elastic cartilage.  It is almost entirely covered by a taste bud- containing mucosa.  It keeps food out of the lower respiratory passages  TRACHEA  It is a tube connecting the larynx to the primary bronchi.  12 cm long and 2.5 cm wide.  Lies ventral to the esophagus and is held open by C- shaped cartilaginous rings.  The cilia that project from the epithelium keep the lungs clean by sweeping mucus and debris toward the pharynx:  A series of 16 to 20 C-shaped hyaline cartilages form the supporting walls of the trachea. These tracheal cartilages ensure that the airway will always remain open. The open part of each of these cartilages faces the esophagus and permits the esophagus to expand slightly into the trachea during swallowing.  BRONCHIALTREE The trachea divides into a right primary and a left primary bronchus at the fifth thoracic vertebra. The point where the trachea divides is called the carina. The right primary bronchus is:  more vertical  Shorter, and wider  As a result, an aspirated object is more likely to enter and lodge in the right primary bronchus than the left.  On entering the lungs, the primary bronchi divide to form smaller bronchi called (lobar) bronchi, one for each lobe of the lung. The right lung has three lobes; the left lung has two.  The secondary bronchi continue to branch forming smaller bronchi called bronchi that divide into bronchioles.  Bronchioles branch repeatedly into smallest tubes called terminal bronchioles. Organs of the Respiratory System 26  Anatomic location of the heart In the thoracic cavity b/n vertebra and sternum Superior to diaphragm Anterior to the vertebral column, posterior to the sternum Located in the mediastinum between two lungs. Located in the mediastinum between two lungs.  Heart Wall  Pericardium – a double-walled sac around the heart. It protects and anchors the heart.  Epicardium – visceral layer of the serous pericardium.  Myocardium – cardiac muscle layer forming the bulk of the heart bulk of the heart.  Endocardium – endothelial layer of the inner myocardial surface  Four Chambers On either side of the heart are two chambers, one a receiving chamber (atrium) and the other a pumping chamber (ventricle): The right atrium:- is a thin-walled chamber that receives the blood returning from the body tissues. This blood ,which is low in oxygen,is carried in the veins, the blood vessels leading to the heart from the body tissues.  The right ventricle:- pumps the venous blood receved from the right atrium and sends it to the lungs. The left atrium:- receives blood high in oxygen content as it returns from the lungs. The left ventricle:- which has the thickest walls of all pumps oxygenated blood to all parts of the body. This blood goes through the arteries, the vessels that take blood from the heart to the tissues.  Pathway of Blood Through the Heart and Lungs  Right atrium tricuspid valve  Right ventricle  pulmonary semilunar valve  pulmonary arteries Lungs  pulmonary veins  left atrium  bicuspid valve  left ventricle aortic semilunar valve Aorta  systemic circulation  Heart valves 1. Atrio-ventricular valves A. Tricuspid valve : found between Right auricle and right ventricle B. Mitral valve : found between left auricle and left ventricle 2. Semilunar valves: A. Pulmonary valve: between right ventricle and pulmonary artery B. aortic valve: between left ventricle and aorta  Pathway of the blood Superior Vena Cava Right Atrium Tricuspid Valve Right Ventricle Pulmonary Semilunar Valve Lungs Pulmonary Vein Bicuspid Valve Left Ventricle Aortic Semilunar Valve Aorta To the bodies organs & cells 33  Causes of Respiratory Failure A, Anatomical Obstruction  The most common cause of respiratory emergency is interference with breathing caused by the drooping of the tongue back and obstructing the throat.  Other causes of obstruction that constrict the air passages are: Asthma Croup Diphtheria Laryngeal spasm Swelling after burns of the face Swallowing of corrosive poisons Direct injury caused by a blow  Causes of Respiratory Failure con’t… B. Mechanical Obstruction Solid foreign objects lodging in the respiratory passage e.g. choking of food Accumulation of fluids in the back of the throat (mucous ,blood or saliva) Aspiration (Inhalation of any solid or liquid substance) Fig. Obstruction of the air way by foreign body 36  Causes of Respiratory Failure con’t… C. Air Depleted of Oxygen or Containing Toxic Gases Asphyxia – is a condition in which there is a lack of oxygen in the blood and the tissue do not receive an adequate supply of oxygen. It may occur due to decreased oxygen in the air or increased carbon monoxide (CO) or other toxic gases e.g., mining area, sewer etc. Explosion hazard -Combustible gases that accumulate in confined spaces where natural or manufactured gases are free in the air, and are explosive in certain concentrations.  Causes of Respiratory Failure con’t… D. Additional Causes of Respiratory Failure are:- Drowning Circulatory collapse (shock) Heart disease Strangulation Lung disease e.g. pneumonia Poisoning by alcohol, barbiturate, codeine etc. Electrical shock Compression of the chest e.g. accident  First Aid management of air way and breathing problem The following activities are helpful to position the patient for airway and breathing status management: Shout for help (depend on the condition) Determine the consciousness of the causality by taping the victim on the shoulder and asking loudly Are you okay!? Assess and ensure that patient air way is clear Place the patient flat on his back with the head turned to one side  First Aid management of air way and breathing problem con’t… Remove any thing which is preventing the taking in of air (Remove constraints from the neck) Kneel beside the patient’s head place one hand under his neck and the other hand under his lower Jaw extend his head and neck gently back ward. This prevents the tongue from falling back in to the throat. Place your cheek and ear close to the victim’s mouth and Nose. Look at the victim’s chest to see if it rises, falls, and listen and fell for air to be exhaled for about 5 seconds.  First Aid management of air way and breathing problem con’t… If there is no breathing pinch the victim’s nostrils shut with thumb and index finger of your hand that is pressing on the victim’s forehead. This action prevents leakage of air when the lungs are inflated through the mouth. Take very deep breath and hold it. Fit your mouth tightly over the patients open mouth and forcibly in to the lungs While carrying out respiration, check the patient’s pulse every 2 or 3 minutes to ensure the heart has not stopped.  First Aid management of air way and breathing problem con’t… Continue the breathing procedure at the rate 12 to 18 breaths per minute until the chest is seen to rise and the patient is breathing for himself. If a patient is child, our mouth should cover both his nose and mouth. Very gentle breathing should be used and the younger the child, the gentler this should continue at a rate of 25 breaths per minute. Once the patient can breathe by him/herself/ place him/her in what is called the recovery position.  Figure. Mouth to mouth respiration  First Aid management of air way and breathing problem con’t… For infants mouth- to- mouth and -nose resuscitation are administered as described above except that the Backward head tilt should not be as extensive as that of adult. Both the mouth and nose of the infant should be sealed off by your mouth. Blow in to the infant’s mouth and nose once every 3 seconds (about 20 times per minutes) But in the case of children blow once every 4 seconds (about 15 times per minute). The amount of air is determined by the size of the victim.  Figure. Infant mouth to mouth respiration  If mouth to mouth is failed and no pulse cardiopulmonary resuscitation is followed.  Compressions/CPR Cardiopulmonary Resuscitation (CPR) is the name given to the technique of combining rescue breaths with external cardiac compressions. It restore circulation to keep blood circulating and carrying oxygen to the heart, lungs, brain, and body.  What does CPR stand for? C = Cardio (heart) P = Pulmonary (lungs) R = Resuscitation (recover) 47  Circulation can be assessed by looking for signs of collapse or indications of a life- threatening situation such as stopped breathing, no pulse and unconsciousness. If the casualty was found unconscious and not breathing properly, then CPR could be performed.  CPR STEPS When you perform CPR apply the following steps: – Ensure the person is lying on their back, if possible and ideally on a flat, hard surface, and with their head at the same level as their heart. – Kneel beside the person midway between the head and chest for ease of movement between giving breaths and compressions. – Find the correct hand position – this is in the center of the chest. – Apply pressure to the sternum with the heel of your hand, keeping your fingers up.  CPR steps con’t … – With the other hand either grip the wrist of the hand on the chest, or place it over the top of the first hand. You can interlace your fingers so that the top ones pull the bottom ones off the chest during compressions. – Use two hands for an adult, one for a child and the pads of two fingers for an infant. – Keep your shoulders directly over your hands when making compressions – this will help you to push straight down on the chest giving the best blood flow.  CPR steps con’t … – Keep elbows locked – this applies to the elbow of the hand on the chest if holding the wrist and both if interlacing the fingers. This will help reduce fatigue as you will be able to use the weight of your upper body, rather that the strength of your arms when doing the compressions. – Compress the lower part of the sternum by up to a third of the chest depth – this will vary depending on the size of the person.  CPR steps con’t … – After each compression, allow the chest to return to the normal position as you rise up, but keep contact with it. – Keep the up and downward movements smooth, with a steady rhythm. – After every 30 compressions, give two rescue breaths.  CPR steps con’t … After every 30 compressions you will need to deliver 2 rescue breaths. To do this: Position the head using the head tilt/chin lift method. Take a breath and place your mouth over the person’s mouth. Pinch their nose  CPR steps con’t … Blow into their mouth and then turn your head to see if their chest rises and falls with the breath, indicating an effective breath and that air has reached their lungs. If the chest does not rise and fall, adjust the position of the person’s head, being careful not to lift, twist or turn their neck. Repeat with a second breath.  CPR steps con’t … Remember to give smaller breaths to infants and children as they have smaller lung capacities. Whenever possible use a resuscitation mask. If signs of life return consciousness, normal breathing, moving place the person in the recovery position.  CPR steps con’t … If you are unwilling to give mouth-to-mouth you should at least continue to administer chest compressions.Any resuscitation is better than none. Do not stop until emergency help arrives  Figure. Cardio Pulmonary Resucitation  When to stop CPR Only stop CPR if: The casualty shows signs of life, e.g. moving, coughing or opening the eyes AND starts to breathe normally. Someone more qualified arrives and takes over. You are exhausted and cannot carry on. Recovery Position First Aid procedure to use if the person is unconscious, breathing and have a pulse. It is a safe position to put them in while you are waiting for the EMS to arrive Allows them to breathe easily and prevents them from choking on their tongue or any vomit. 59  Recovery position With the patient on their back, kneel beside the patient and position their arms. Place the patient’s furthest arm directly out from their body. Place the patient’s nearest arm across their chest. Position the patient’s legs. Lift the patient’s nearest leg at the knee and place their foot on the floor so the leg is bent.  Recovery position con’t… Roll the patient away from you onto their side, carefully supporting their head and neck the whole time. Keep the patient’s leg bent with their knee touching the ground to prevent the patient rolling onto their face.  Place the patient’s hand under their chin to stop their head from tilting and to keep their airway open Fig. Recovery Position 62  Injuries Related to CPR  Rib fractures  Laceration related to the tip of the sternum (Liver, lung, spleen) 63  Summery of CPR Infant (1-12 Child Adult months) Pulse check Brachial/femoral Carotid Carotid Comp. Rate 100/min 100/min 100/min Comp. Method 2 fingers Heel of hand Hands interfaced Comprehension Ventil- 30:2 30:2 30:2 ation ratio  The chain of survival: The chain of survival:- refers to the steps that needs to be followed to improve the patient out come for some one who has experienced out of hospital cardiac arrest event. Understanding the links in the chain of survival will improve the probability of survival from a cardiac arrest.  The chain of survival con’t…  Four links in the chain of survival: Early Access:- Recognize the signs of an impending cardiac arrest and call for help Early CPR: - As soon as the first aider observes the victim collapse to the ground, Commence CPR immediately.  The chain of survival con’t… Early Defibrillation:- An AED is an electronic device that is portable , easy to operate , and used when the casualty is having a Sudden Cardiac Arrest(SCA). When the machine detects an abnormal heart rhythm , such as Ventricular Fibrillation(VF) or Ventricular Tachycardia(VT),an electrical shock is sent to the heart ,which can restore normal heart rhythm. People requiring CPR has abnormal heart rhythms  The chain of survival con’t… Early Advanced Care Procedures:- The professional emergency medical personnel/workers can attend the casualty , the better the chance of survival. Seek assistance from paramedics as soon as possible.  Figure. Chain of survival