First Aid - Airway Obstruction Lecture 2 PDF

First Aid Lecture 2 Airway Obstruction Dr. Noha El Hadary MD, PhD E-mail: [email protected] B5.127  ILOs Define choking Identify signs of choking Ex...

First Aid Lecture 2 Airway Obstruction Dr. Noha El Hadary MD, PhD E-mail: [email protected] B5.127  ILOs Define choking Identify signs of choking Explain how to give first aid to conscious choking in adults and children Demonstrate how to help a choking pregnant woman Explain how to give first aid to a choking infant Explain how to give first aid to unconscious choking person Recall the first aid measures in case of asthmatic attack Recognize the first aid measures in case of heart attack  Anatomy of the Respiratory System The upper respiratory tract: nose pharynx larynx above the vocal cords The lower respiratory tract: larynx below the vocal cords trachea bronchi bronchioles The lungs  Swallowing (Deglutition) In the back of the mouth are two openings:  One is the esophagus, which leads to the stomach food goes down this pathway.  The other is the trachea, which is the opening air must pass through to get to the lungs.  During swallowing occurs, the trachea is covered by a flap called the epiglottis , which prevents food from entering the lungs.  Swallowing (Deglutition)-(Cont.) Soft palate rises to close the nasopharynx and prevents passage of food to the nasal cavity The larynx is closed by the epiglottis and prevents passage of food to the trachea  What is Choking? Choking occurs when a foreign object lodges in the throat or windpipe, blocking the flow of air. Choking cuts off oxygen to the brain, give first aid as quickly as possible. Causes of choking: In adults, choking most often occurs when food is not chewed properly. Talking or laughing while eating may cause a piece of food to "go down the wrong pipe. Can be caused by denture or tongue. In children, choking is often caused by chewing food incompletely, or eating hard candy. Children also put small objects in their mouths  Symptoms and Signs Clutching the throat: The natural response to choking is to grab the throat with one or both hands. This is the universal choking sign and a way of telling people around you that you are choking. Coughing or gagging Hand signals and panic (sometimes pointing to the throat) Sudden inability to talk Wheezing, difficulty to breath Passing out Turning blue: the person becomes cyanosed Loss of consciousness  Signs of Choking The universal sign of choking Management of Conscious Choking Remove any visible body from the mouth or the pharynx If the person is able to cough forcefully, encourage the patient to cough if he is conscious If the person is choking and can't talk, cry or laugh forcefully The American Red Cross recommends a "five-and-five" approach to delivering first aid:  Management of Conscious Choking “Five-and-Five” Approach  Give 5 back blows  Give 5 abdominal thrusts  Management of Conscious Choking “Five-and-Five” Approach (cont.)  Give 5 back blows: Stand to the side and just behind a choking adult. For a child, kneel down behind. Place one arm across the person's chest for support. Bend the person over the waist so that the upper body is parallel with the ground. Deliver five separate back blows between the person's shoulder blades with the heel of your hand.  Give 5 abdominal thrusts: Perform five abdominal thrusts (to push with force) (also known as the Heimlich maneuver). Alternate between 5 blows and 5 thrusts until the blockage is dislodged, or the person starts to breath or cough  How to Do the Heimlich Maneuver? Stand behind the person and wrap your arms around the waist. If a child is choking, kneel down behind the child. Place your clenched fist just above the person’s navel. Grab your fist with your other hand. Press hard into the abdomen with a quick, upward thrust as if trying to lift the person up. Perform a total of 5 abdominal thrusts until blockage is dislodged Thrust is to push suddenly or violently in a specified direction.  Management of Unconscious Choking Lower the person on his or her back onto the floor, arms to the side. Clear the airway. If a blockage is visible at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Don't try a finger sweep if you can't see the object. Be careful not to push the food or object deeper into the airway, which can happen easily in young children. Begin CPR if the object remains lodged and the person doesn't respond after you take the above measures. The chest compressions used in CPR may dislodge the object. Remember to recheck the mouth periodically.  If You're Choking Alone Place a fist slightly above your navel. Grasp your fist with the other hand and bend over a hard surface a countertop or chair will do. Push your fist inward and upward  If the Person is Obese or Pregnant Do high abdominal thrusts For the conscious person sitting or standing, take the following steps: Stand behind the person, place your hands under the victim's armpits. Wrap your arms around the victim's chest. Place the thumb side of your fist on the middle of the breastbone. Grab your fist with your other hand and thrust backward. Quickly pull inward and upward. Repeat until the object is dislodged or until the person becomes unconscious.  Management of a Choking Infant (Below 1 Year of Age) Sit down and put the baby facedown on your forearm so the baby’s head is lower than his or her chest. Support the baby’s head in your palm, against your thigh. Don’t cover the baby’s mouth or twist his or her neck. Give up to 5 sharp back slaps with the heel of 1 hand in the middle of the back between the shoulder blades.  Management of a Choking Infant (Cont.) If the object does not pop out, support the baby’s head and turn him or her face up on your thigh. Keep the baby’s head lower than his or her body. Place 2 or 3 fingers just below the nipple line on the baby’s breastbone and give 5 quick chest thrusts (same position as chest compressions in CPR for a baby). Keep giving 5 back slaps & 5 chest thrusts until the object comes out or the baby faints. Keep doing CPR until the baby is breathing or until help arrives.  Bronchial Asthma Bronchial asthma is a chronic inflammatory disease of airways characterized by:  attacks of coughing  wheezing  shortness of breath  chest tightness.  Pathophysiology of Asthma The pathophysiology of asthma is complex chronic disorder of the airways that involves a complex interaction of: 1. Intermittent airflow obstruction 2. Bronchial hyperresponsiveness: increased sensitivity and reactivity of the airways (excessive bronchoconstriction) to numerous types of stimuli, both chemical and physical. 3. Underlying inflammation  Bronchial Asthma (Cont.) Pathological Changes Persistent changes in airway structure:  Thickening and fibrosis of the sub-basement membrane  Mucus hypersecretion  Injury to epithelial cells  Smooth muscle hypertrophy  Angiogenesis  Asthmatic Attack Severe wheezing when breathing both in and out Coughing that won't stop Very rapid breathing Chest tightness Tightened neck and chest muscles, called retractions Difficulty talking Subject acquires a tripod position (in this position, a person sits or stands leaning forward and supports the upper body with hands on knees or other surface) Feelings of anxiety or panic Pale, sweaty face Blue lips or fingernails  Management of Asthmatic Attack 1. Sit the person upright comfortably and loosen tight clothing. 2. Ask the person to take slow, long & deep breaths. 3. Encourage him to stay calm. 4. Call local emergency number immediately if the person is struggling to breathe, has blue lips or fingernails, has no medicine. 5. If the person has asthma medication, such as an inhaler, assist in using it. 6- Help the person to use the inhaler: Steps for Using a Spacer 1. Insert the inhaler into spacer and shake well. 2. Breathe out fully for 2 seconds. 3. Hold the inhaler upright, put the spacer mouthpiece into person’s mouth. 4. Press down on the top of the inhaler once to release medication. 5. Breathe in slowly (for 3-5 seconds). 6. Tell the person to hold breath for 10 seconds and breath out slowly. A second dose may be given in 30-60 seconds. Give a total of four puffs, waiting about one minute between each puff. If no improvement after medication call the emergency  If there’s still little or no improvement, give 4 to 8 puffs every 20 minutes until the ambulance arrives for up to 4 hours. Monitor the person and reassure him until help arrives An emergency room doctor will check the severity of the attack and provide treatment, including medications. The person may be discharged home or hospitalized for further care, depending on response to treatment.  The Purpose of Using a Spacer with an Inhaler Spacer devices ensure the person with asthma gets: 1. The maximum benefit from their medication 2. Helps direct the medicine to the airways of the lungs instead of the mouth. 3. Spacers extend the amount of time the inhaler takes to deliver medicine. 4. Makes using an inhaler easier and more effective  Inhaler for asthma Inhaler with spacer  Drugs for Preventing and Treating Asthma Therapy is based on two classes of drugs: Anti-inflammatory drugs suppress the inflammation that narrows the airways. Anti-inflammatory drugs include corticosteroids. Bronchodilators help dilate the airways. Bronchodilators include beta-adrenergic drugs anticholinergics  Heart Attack A heart attack (angina), also called a myocardial infarction, it can be fatal A heart attack occurs when the flow of blood to the heart is suddenly blocked (usually by a clot). Common Heart Attack Symptoms Chest pain that feels like pressure, squeezing or fullness in the center of the chest. Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or occasionally upper abdomen Nausea, or vomiting, heartburn or abdominal pain Shortness of breath Cold sweat Weakness and fatigue Light-headedness, sudden dizziness and fainting  Heart Attack (Cont.) What to do if you see someone who might be having a heart attack? First call for EMS (123) immediately Have the person sit down, rest and keep calm. Help the victim to sit in the best comfortable position on the floor with the head & shoulders supported and the knees bent, place cushions behind them & under their knees. Shew or swallow Aspirin 300 mg if not allergic to it. Encourage the victim to rest While waiting for help monitor the person’s breathing and pulse If the person becomes unresponsive and stops breathing, begin CPR  Heart Attack (Cont.) Medications Used in Heart Attack Shew or swallow Aspirin 300 mg, immediately to reduces blood clotting, thus helping maintain blood flow through a narrowed artery. Nitroglycerin is administered sublingually, it is used to treat chest pain (angina), it can help improve cardiac blood flow by producing coronary vasodilation. Beta blockers: used to block the effects of stress hormones such as adrenaline on the heart (they slow down the heart). They can reduce the risk of future heart attacks  References https://www.emedicinehealth.com/choking/article _em.htm https://www.mayoclinic.org/first-aid/first-aid- choking/basics/art-20056637 https://www.nhs.uk/conditions/pregnancy-and- baby/helping-choking-baby/ https://www.webmd.com/first-aid/asthma- treatment https://www.mayoclinic.org/diseases- conditions/heart-attack/symptoms-causes/syc- 20373106