NUR1013 L2 Principle of First Aid - Bandaging & CPR PDF

Principle of First Aid: Bandaging and Cardiopulmonary resuscitation (CPR) NUR1013 Winsy WAN  Learning Objectives After the lesson, you should be able to: 1) Understand general principles of first aid 2) Understand the criteria & steps of good quality CPR 3) Unders...

Principle of First Aid: Bandaging and Cardiopulmonary resuscitation (CPR) NUR1013 Winsy WAN  Learning Objectives After the lesson, you should be able to: 1) Understand general principles of first aid 2) Understand the criteria & steps of good quality CPR 3) Understand basic concept of bandaging Principle of First Aid  Definition of First Aid helping behaviors and initial care provided for an acute illness or injury Purpose To To prevent secondary To promote To preserve prevent speedy life complications (i.e. suffering further illness or injury) recovery o To assess situation + call help +give early & appropriate care + pass on a report  Causes of injury Mechanical injury o from a blow, crush, cut, or penetrating force (bullet) Common Thermal injury Situations o exposure to excess heat and excess cold sufficient to cause damage to the ❖ Cardiac arrest skin, and possibly deeper tissue ❖ Choking Electrical injury o exposure to natural lightning or electricity in the home or workplace Injury produced by ionizing radiation First Aid – General management  EMERGENCY ACTION STEPS 1) Check scene safety 2) Check victim: o Responsiveness o Pulse and breathing 3) Call for help / Call 999 Care for victim, +/- relatives or friends Check the victim - Responsiveness Unresponsive or unconscious lying on the ground, silent, not moving may be unconscious ❖ Tap on shoulder and ask (shout at both side of ears) ❖ check for responds ❖ Shout victim’s name if you know ❖ Infant: +/- flicking bottom of infant’s foot to see if any respond 1) If conscious, reassurance 2) If unconscious, check pulse and breathing 3) Brief head to toe assessment to check for severe injury / bleeding …  Conscious → Care for victim I. Monitor for any deterioration until ambulance arrive II. Continue assessment III. Give the necessary care following these general principles: o Do no further harm o Help the victim rest in comfortable and safe position e.g. Recovery position o Avoid the victim from getting chilled or overheated o Reassure the victim +/- relatives & friends o Give any specific care as needed e.g. bandaging PLS DO NOT LEAVE HIM ALONE  Recovery Position ❖ evidence shown recovery position will help increase total airway volume & decrease stridor severity Check Pulse + Breathing Circulation ▪ Adult: Check carotid pulse ▪ Locate Pulse Site. Place index and middle fingers on the casualty's trachea or larynx. Then slide your fingers toward you while gently pressing on the neck until you find the groove running parallel to the airway ▪ Feel for Pulse. (? weak, slow, and/or irregular) ▪ Infant: Check brachial pulse Breathing look for any chest rises and falls Check for Gasping (ineffective breathing) = NO Breathing ✓ Pulse and breathing should be confirmed in 5 to 10 seconds (1) Both breathing and pulse present (+ve) →→→maintain airway and recovery position (2) Pulse +ve but No breathing (or gasping) → → → airway management  Unconsciousness is a life-threatening emergency If the person does not respond, assume that he or she is unconscious Airway management and Rescue Breathing 人工呼吸 Airway management Airway assessment check to see if person has an open airway and Open airway by 2 methods: is breathing 1) Head-tilt/chin-lift Unconscious: lying on technique back, tongue may fall 2) Jaw thrust to back of throat then block the airway  Head-tilt/chin-lift technique push down on his or her forehead while pulling up on the bony part of the chin with two or three fingers of your other hand Jaw thrust Grasp the angles of the lower jaw and lift with both hands, one on each side, moving the jaw forward If the victim’s lips are closed, open the lower lip with your thumb For patient suspected neck injury CLEAR Airway In Hospital Suctioning Tool: Yankauer sucker Procedure: like Oropharyngeal suctioning Commonly available in E-trolley MAINTAIN Airway Oropharyngeal airway (OPA)  Placed in the mouth  OPAs will stimulate gag reflex & induce vomiting  Used in unconscious client  Might cause trauma to teeth or soft tissue in mouth if improperly placed OPA Insertion Step 1: SELECT THE PROPER SIZE Measure the OPA from the victim’s earlobe to the corner of mouth Step 2: OPEN THE VICTIM’S MOUTH Use the cross-finger technique to open the victim’s mouth. Using too small OPA: ineffective, can be lost in the oropharynx, possibly causing obstruction Using too large OPA: can press against the epiglottis, obstruct the larynx OPA Insertion Step 3: INSERT THE OPA For an adult: Grasp the victim’s lower jaw and tongue and lift upward. Insert the OPA with the curved end along the roof of the mouth. As the tip approaches the back of the mouth, rotate it one- half turn (180 degrees) Slide the OPA into the back of the throat. Step 4: ENSURE CORRECT PLACEMENT The flange should rest on the victim’s lips MAINTAIN Airway Nasopharyngeal airway (NPA)  inserted into the nose  NO stimulating a gag reflex  For Semi-conscious client  can cause nose bleeding  need to be lubricated  size measured from tip of nose to tip of ear  Beware of diameter of nostril  Airway management: Open + Clear + Maintain Open: head tilt chin lift / jaw thrust Clear: Suctioning Maintain: Oropharyngeal airway or nasopharyngeal airway or advanced airway  ??? Rescue 人工呼吸 Breathing  Ventilation Tool: Bag-valve-mask (BVM) Procedure: o victim in Supine position, the rescuer uses three fingers on one hand to lift the jaw toward the mask, opening the airway o E-C Clamp technique ✓ Placement of these three fingers resembles the shape of a capital E. ✓ Meanwhile, the thumb and index finger hold the mask to the face, forming a capital C shape ✓ tight seal between mask and victim’s face, which is required for effective bag-mask ventilation o Use another hand to squeeze the bag (around 1/3 of the bag) o Give 10-12 breaths per min for adult o Assess for visible chest rise CPR for adults ❖ Cardiopulmonary Resuscitation (CPR) ❖ No pulse & No breathing (Gasping) ❖ CPR = Chest compressions + Rescue breaths ❖ Defibrillation delivered by an AED is needed ❖ Early CPR + Rapid Defibrillation >> BEST ❖ chest compressions on a firm, flat surface or use backboard in the hospital) CPR for adults Chest compression ❖ Position your body correctly by kneeling beside the person’s upper chest, placing your hands in the correct position, ❖ keeping your arms and elbows as straight as possible so that your shoulders are directly over your hands. ❖ Compressing person’s chest straight down will help you reach the necessary depth. CPR for adults Chest compression ❖ Locate correctly hand position by placing the heel of one hand on the person’s lower half of sternum (breastbone) at the center of his or her chest ❖ Place your other hand directly on top of the first hand and try to keep your fingers off of the chest by interlacing them or holding them upward CPR for adult Allowing complete Release Ventilation Use of BVM, pocket mask or barrier device 30:2 compression- ventilation ratio Observe for chest rise Compression ❖ Push hard (5 to 6 cm) and fast (100- 120 /min) ❖ Allow complete chest recoil ❖ Minimize interruptions in compression CPR for ❖ Change compressor every 2 minutes, adults (less than 5second to switch position) or sooner if fatigued - KEY points Ventilation ❖ Avoid excessive ventilation No advanced airway, 30:2 compression-ventilation ratio Why minimize interruption?  LUCAS ▪ Active Compression-Decompression CPR device ▪ Lund University Cardiopulmonary Assist System ▪ Increase ROSC from 21% to 36% https://www.lucas- cpr.com/files/9097353_LUCAS%203%20v3.1%20brochure%20%20US%203336670_C_LR.pdf Basic Life Support (BLS) survey 1) Scene Safety 2) Check responsiveness 3) Call for help and bring back AED 4) Check pulse and breathing If pulse and breathing +ve => lie flat If vomit => recovery position If pulse +ve but breathing –ve => Airway management + Rescue breathing If pulse –ve and breathing –ve => CPR Attach Automated external defibrillator (AED)  （心臟）去顫 Defibrillation Automated External Defibrillator (AED) In Hospital Defibrillator In hospital: use Biphasic defibrillator Energy level (suggested) Metronic: 200J Phillip: 150J Zoll: 120J Unknown: max dose Follow Doctor’s order Alert for the written instruction!!!!  Shockable Rhythms Ventricular Defibrillation fibrillation (VF) Pulseless Ventricular tachycardia (VT)  Ventricular fibrillation (Vfib) Pulseless Ventricular Tachycardia (pVT) Defibrillation (AED) - General precautions Use appropriate pads ✓ Do not use pediatric AED pads on an adult or on a child older than 8 years or weighing > 55 pounds Do not touch the person while AED is analyzing ❖Before shocking and during defibrillation with AED, make sure that no one is touching or is in contact with the person (SHOUT OUT + ACTION) + Temporarily remove oxygen (if necessary) Defibrillation (AED) – General considerations ❖ Dry victim’s chest first if necessary, when using AED ❖ NO alcohol to wipe person’s chest dry. Alcohol is flammable. ❖ Remove body hairs, if necessary, when using AED. ❖ Remove any patches (e.g. nitroglycerin patch) if necessary, when using AED. ❖ Do not defibrillate someone when around flammable or combustible materials, such as gasoline ❖ Avoid using an AED in a moving vehicle ❖ Do not use mobile phone or radio within 6 feet of AED: Radiofrequency (RFI) + electromagnetic interference (EMI) radio signals can disrupt analysis  Defibrillation (AED) – How to USE ① Turn on AED ② Apply AED pads to the person’s bare, dry chest first if needed ③ one pad on upper right chest, other pad on left side of chest ④ Plug the connector into the AED ⑤ Let the AED analyze the heart rhythm. Advise all responders and bystanders to “stand clear” ⑥ If the AED advises that a shock is needed: ① Make sure that no one, including you, is touching the person. ② Say, “EVERYONE, clear” ③ Deliver the shock by pushing the “shock” button, if necessary. ⑦ After delivering the shock, or if no shock is advised Continue CPR  When to STOP CPR ?  an obvious sign of life, such as breathing  An AED is available and ready to analysis rhythm  Another trained responder take over  You are too exhausted to continue  scene becomes unsafe If at any time you notice client is breathing → stop compression + check pulse If Pulse present: Keep his or her airway open continue to monitor breathing + for any changes until trained responder take over Bandaging Why Bandaging?? Bandages are strips, patches or bands of cloth to:  Secure dressings or splints in place  Maintain direct pressure on wounds to control bleeding  Support injured limbs or joints  Prevent movement or further injury of injured parts  Facilitate the transportation of victim Triangular Bandages Triangular bandages can be used as large dressings, as slings to support a limb, or to secure a dressing in place Arm sling support injured upper limbs Elevation Sling Examples: support injured upper injured upper arm, limbs in a raised forearm and wrist position minimise swelling in the forearm or hand How To Make An Arm Sling - First Aid Advice | St John Ambulance (sja.org.uk) https://www.sja.org.uk/get-advice/first-aid-advice/how-to/how-to-make-an-arm-sling/ How To Make An Elevation Sling - First Aid Advice | St John Ambulance (sja.org.uk) https://www.sja.org.uk/get-advice/first-aid-advice/how-to/how-to-make-an-elevation-sling/ How To Make An Elevation Sling - First Aid Advice | St John Ambulance (sja.org.uk) https://www.sja.org.uk/get-advice/first-aid-advice/how-to/how-to-make-an-elevation-sling/ Roller Bandages ① bandages made of open-weave material – these allow ventilation, but do not put pressure on wounds and do not support joints ② elasticated bandages – these mould to a person's body shape, and are used to secure dressings and support soft tissue injuries like sprains ③ crepe bandages – these are used to give firm support to injured joints Roller Bandages ▪ use Right size bandage ▪ Support the injured part adequately ▪ Hold tightly rolled bandage with the ‘head’ of the bandage on top and wrap the ‘tail’ around the body part ▪ Begin by wrapping twice + Finish by wrapping the bandage around once more ▪ Work up limb, winding the bandage in spiral turns ▪ Work from middle of the body or limb in an outwards direction ▪ from narrowest part below dressing & work upwards ▪ Each turn covers 2/3 of the previous turn ▪ Cover totally all dressing and padding used ▪ Secure the bandage with an adhesive tape ▪ Check distal blood circulation ▪ NO too tight nor too loose after completed bandaging  Simple Spiral & Figure of 8 How to bandage a hand - First Aid Advice | St John Ambulance (sja.org.uk) https://www.sja.org.uk/get-advice/first-aid-advice/how-to/how-to-bandage-a-hand/?category=12349  Reference Berman, A. J., Snyder, S. J., & Frandsen, G. (2022). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (11th ed.). Pearson. American Heart Association. (n.d.). CPR and ECC guidelines. Retrieved from https://cpr.heart.org/en/resuscitation- science/cpr-and-ecc-guidelines Lippincott Williams & Wilkins. (2022). Lippincott’s nursing procedures (9th ed.). Wolters Kluwer. American Heart Association. (2020). BLS for healthcare providers. American Heart Association. Kleinman, M. E., Chameides, L., Schexnayder, S. M., Samson, R. A., Hazinski, M. F., Atkins, D. L.,... & American Heart Association. (2010). Part 14: Pediatric advanced life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122(18 Suppl 3), S876-S908.  Thanks! Do you have any questions? Ready for your 1st LAB session? 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