First Aid (PHMU 702) Lecture 1 PDF

First Aid (PHMU 702) Lecture 1 Cardiopulmonary Resuscitation Dr. Noha.El Hadary MD, PhD E-mail: [email protected]...

First Aid (PHMU 702) Lecture 1 Cardiopulmonary Resuscitation Dr. Noha.El Hadary MD, PhD E-mail: [email protected] B5.127  ILOs a. Knowledge & Understanding a.1.Recognize the principles for basic life support measures a.2.Recognize important and common medical emergencies b. Professional and practical skills b.2. Demonstrate the ability to perform technical procedures of Basic life support for patients who needs CPR b.3. Perform the appropriate first aid measures in case emergency c. Intellectual skills c.1. Demonstrate the rapid and correct assessment of the situation and casualty at the scene of an Incident. c.2. Analyze the common conditions of medical emergencies. d. General and transferable skills d.1. Work effectively in a team d.2. Communicate effectively with emergency care providers d.3. Act in a reliable and responsible manner Cardiopulmonary Resuscitation CPR CPR – or Cardiopulmonary Resuscitation: is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest. NB: Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later. The main purpose of doing CPR is to restore:  Provide oxygenated blood to the brain and vital organs by compression, until hearty rate is restored (compressions help keep blood flowing throughout the body).  Breathing that provides oxygen to the lungs  To provide life support until medical support arrives  Before Giving CPR (Check, Call and Care) Check the scene and make sure the scene is safe - Are bystanders available to help? - Look carefully if there is more than one victim - Check the responsiveness of the victim by tapping the person on the shoulder and shout "Are you OK?" to ensure that the person needs help. - Check for breathing and pulse for no more than 10 seconds Call 123 for assistance and get AED (automated external defibrillator) if available Care Start CPR (C-A-B) if no breathing (only gasping, no pulse)  Check Radial or Carotid Pulse The rescuer should not take more than 10 seconds to check for pulse. If the pulse is not felt within that time period, he should begin CPR   Check for Breathing Look to see if victim’s chest is rising and falling. Listen for breath sound Feel for breathing against the cheek for 10 seconds. CAB Sequences Adult CPR (Cont.)  Adult CPR I- Compression Before performing compression: Check breathing and pulse of the patient Make sure the patient is lying on his back on a firm surface Uncover patients chest from any cloths Kneel next to the person's neck and shoulders  Steps of Compression Adult CPR (Cont.) Place the heel of one hand in the center of the chest (over the breastbone) Place other hand on top of the first one Interlock fingers Position yourself with your shoulders above your hands and keep your elbows straight. Compress the chest - at a rate of 100-120 compression/minute - depth 2 inches (5 cm) - equal compression : relaxation After each compression perform decompression by allowing the chest to return to its original position. When possible change CPR operator every 2 minutes Adult CPR (Cont.) Interlock fingers  Site of Compression Adult CPR (Cont.) For adult and children the lower half of the person's breastbone (the sternum) Adult CPR (Cont.)  Adult CPR (Cont.) Compression & Decompression Decreases intrathoracic pressure Increases intrathoracic pressure Refills the heart and the lungs Ejects blood from the heart & lungs Allows good recoil and creates a Increases forward output and BP negative pressure that allows more refilling of the heart  Adult CPR (Cont.) Precautions in CPR 1. Better compressions lead to better organ perfusion. 2. Decompression (recoil) is just as important as compression. 3. Between each compression, rescuers should avoid leaning on the chest to allow it to return to its starting position. 4. Compression should be fast and hard with no pausing. Rescuer should not be afraid from hurting the victim.  Adult CPR (Cont.) II- Airway: Open the airway Open the person's airway using the: Head-tilt, chin-lift maneuver Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway. This will open the airway & will move the tongue away from the back of the throat. Head-tilt, chin-lift maneuver  Adult CPR (Cont.) III- Breathing: Rescue breath One CPR cycle= 30 chest compressions followed by 2 rescue breaths  Mouth to mouth breathing or  Mouth-to-nose breathing if the mouth is seriously injured or can't be opened.  Mouth to mouth Breathing Adult CPR (Cont.) Steps of mouth to mouth breathing: 1. With the airway open (using the head-tilt, chin-lift maneuver) 2. Pinch the person's nose to close it. 3. Seal your mouth over the patient’s mouth, 4. Blow steadily and firmly into his mouth for about 1 second and watch to see if the chest rises. 5. If the chest rises, give a second breath. 6. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. 7. Resume chest compressions to restore blood flow. 8. Continue CPR 5 cycles are completed 9. If the person has not begun moving, administer one shock using automated external defibrillator (AED) if available, apply it and follow the prompts. 7. Give one shock, then resume chest compressions for two more minutes before giving a second shock.  Adult CPR (Cont.) If there are two people performing CPR, for an adult, conduct 30 compressions followed by two breaths (30:2) Continue CPR until… Do not stop CPR except in one of these situations:  You find an obvious sign of life, such as breathing  An AED is ready to use  Another trained responder or EMS personnel take over  You are too exhausted to continue  The scene becomes unsafe 21  Use of Automated External Defibrillator (AED) Adult CPR (Cont.)  AED is a small, portable computerized device that is simple to operate. It can save the life of someone having sudden cardiac arrest, when the heart suddenly and unexpectedly stops beating.  For every minute that defibrillation is delayed, the chance of survival of a sudden cardiac arrest victim is reduced by about 10%  AED use computers to automatically - analyze the heart rhythm - determine if shock is needed An AED uses an electric shock - deliver a sudden life-saving shock to the heart of the victim in order to help the heart return to its normal rhythm (AED restores normal heart rhythm).  AEDs can be used for adults, as well as for children and infants  AEDs are safe, accurate, and easy to use AED  Placement of AED Pads Adult CPR (Cont.) The pads will then be placed diagonally across the chest. For an adult, one pad will be applied on: - the right side of the chest just below the collarbone. - the other on the left side of the lower ribcage. For a child or a baby one pad will be placed in - the centre of the chest and - the other in the centre of the back.  Steps of Using AED 1. Turn on the AED 2. Prepare the patient's chest area bare and dry 3. Quickly apply the AED pads. 4. Make sure no one is, including the rescuer, is touching the person. 5. Deliver the shock, if advised. 6. Once the shock has been delivered, the AED will prompt you to begin CPR. 7. Begin CPR immediately and continue until the AED tells you to stop. What should you do if you need to use an AED on someone who has been submerged in water? Remove the victim from the water. Firstly, an AED cannot be used if the victim is still in the water Remove wet clothing, AED pads need to be applied to the victim's bare dry chest Ensure the chest is dry  Child CPR Age 1 year to adult CPR involves:  Chest compressions which keep the child's blood circulating  Rescue breathing which provides oxygen to a child's lungs Time is very important when dealing with an unconscious child who is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later.  Before Giving Child CPR (Child CPR Cont.) Check the scene for safety, responsiveness of the casuality. Check for pulse and breathing, listen carefully, for no more than 10 seconds, for sounds of breathing. Call 123 (local emergency line) Care: Open the airway Performing Child CPR (Child CPR Cont.) 1. Put the child on his or her back on a firm surface. 2. Kneel beside the child. 3. Place two hands (or only one hand if the child is very small) on the lower half of the child's breastbone (sternum). 4. Using the heel of one or both hands, press straight down on (compress) the chest about 2 inches (approximately 5 centimeters) but not greater than 2 inches 5. Push hard and fast — 100 to 120 compressions/minute. 6. Continue with cycles of 30 chest compressions followed by 2 rescue breaths until the child begins to recover or emergency help arrives. 7. If there are two people performing CPR, conduct 15 compressions followed by two breaths. (15:2) 8. As soon as an AED is available, apply it.  Infant CPR (C-A-B) An infant is a baby under one year of age Check: Make sure the safety of the scene around the infant. Then check for a response by shouting or gently tapping on the shoulder (or foot for infants). Check for breathing, pulse and signs of life for no more than 10 seconds Call: If there is no response, yell for help to call 123. Care: If not responding and no breathing or signs of life, begin CPR  C- Compression (Infant CPR cont.) 1. Carefully place the baby on his back on a firm, flat surface 2. Place two fingers on the sternum/breastbone just below the nipple line. 3. Push down by 1.5 inches (about 4 cm), apply chest compressions at a rate of 100 to 120 a minute. 4. Give 2 breaths after every 30 chest compressions. Continue CPR until you see signs of life or until the medical personnel arrives.  A- Airway- Infant CPR 1. Open the infant's airway by placing 1 hand on their forehead and gently tilting the head back and lifting the chin. Do not overextend the head and neck. 2. Remove any visible obstructions from the mouth and nose. 3. Place your mouth over the mouth and nose of the infant and blow steadily and firmly into this mouth, checking that his chest rises.  B- Breathing (Infant CPR cont.) 1. After you have compressed the chest 30 times, open the baby's airway for mouth-to-mouth breathing using the head lift-chin lift method 2. Cover both the infant's nose and mouth with your mouth. Give a single breath of air in baby's mouth (deliver a gentle puff of air rather than a deep breath from your lungs).Very little volume or force is required to inflate an infant’s lungs. 3. Blowing too much or too hard will damage the infant’s lungs. 4. Wait one second, watch to see if the baby's chest rises. If it does, give a second rescue breath. 5. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. 6. Continue with 30 chest compressions and two breaths (30:2) 7. Continue CPR until you see signs of life or until medical personnel arrives. 8. If two persons are performing CPR for the child and infant, the ratio will be 15 compressions to 2 breaths (15:2). Infant CPR https://www.nationalcprassociation.com/infant-pediatric-cpr-study-guide/ Check for brachial pulse Two rescuers One rescuer http://phsneb.org/programs/community-training Two rescuers https://www.firstaidforfree.com/how-to-perform-cpr-on-a-baby-or-child/ Head-tilt, chin-lift maneuver Mouth-to-mouth-and-nose 34 Comparison between Compression in Adult, Child & Infant (Infant CPR cont.) Link for CPR for Infants (Newborn to 1 Year) https://www.youtube.com/watch?v=n65HW1iJUuY References https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art- 20056600 https://www.nhs.uk/conditions/first-aid/cpr https://link.springer.com/chapter/10.1007/978-3-319-19464-6_38 https://www.redcross.org/take-a-class/cpr/performing-cpr/child- baby-cpr https://www.nationwidechildrens.org/family-resources- education/health-wellness-and-safety-resources/helping- hands/cardiopulmonary-resesuscitation-cpr-for-infants