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First Aid Eduard Kasal, MUDr., Ph.D., Assoc . Prof.

First Aid Eduard Kasal, MUDr., Ph.D., Assoc . Prof. Department of Anaesthesiology and Intensive Care Medicine 2014. First aid It is better to know first aid and not to need it than to need it and not to know it. A delay… can mean the difference between life and death.

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First Aid Eduard Kasal, MUDr., Ph.D., Assoc . Prof.

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  1. First Aid Eduard Kasal, MUDr., Ph.D., Assoc. Prof. Department ofAnaesthesiologyandIntensive Care Medicine 2014

  2. First aid • It is better to know first aid and not to need it • than • to need it and not to know it. • A delay… can mean the difference between life and death. • However • most injuries do not require life-saving efforts

  3. First aid Definition: … is the immediate care given to an injured or suddenly ill person. … also includes the things that people can do for themselves. …is one of those things you need to know – but never want to use…

  4. First aid …most people do not know first aid. … even if they know it, they may panic in an emergency.

  5. First aid • Legal considerations • before giving first aid, a first aid provider should have the victim´s consent (permission) • expressed consent – conscious mentally competent person of legal age • implied consent – an unresponsive victim in a life-threatening condition – “implied“ consent

  6. First aid • Legal considerations • Bystander = a vital link between the emergency medical services and the victim. • Decision to help • Czech Republic: everybody is obligated to provide first aid adequate to his knowledge and possibilities… • Refusal to provide first aid • extra-legal • a new testimony legalized – driving away from the place of traffic accident = crime

  7. First aid • Legal considerations • Foreigners • are obligated to abide with laws of the country

  8. Basic Life Support First Aid

  9. Background • Approximately 700,000 cardiac arrests per year in Europe Outcome: • Survival to hospital discharge presently approximately 5-10 - 14% • Bystander CPR = vital intervention before arrival of emergency services • Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival

  10. Chain of survival

  11. CardioPulmonary Resuscitation Definition: CPR is an emergency first-aid procedure that is used to maintain respiration and blood circulation in a person, whose breathing and heartbeats have suddenly stopped, (one or more vital functions failed ).

  12. CardioPulmonary Resuscitation Three basic vital functions: Breathing Circulation Consciousness

  13. CardioPulmonary Resuscitation History Peter Safar- Professor of Pittsburgh University presented in 1968 small book “Cardiopulmonary Resuscitation”…. Guidelines 2000 Guidelines 2005 Many changes of almost all algorithms used for several tens of years… Publication of new guidelines does not mean, that CPR provided in accordance with previous guidelines is not effective and not correct, but we should follow them as possible…

  14. www.erc.edu Basic life support

  15. CardioPulmonary Resuscitation “Thoracic pump theory“ - the chest compression propels blood out of the thorax by increasing intrathoracic pressure … the time of the chest compression and decompression should be equal Pressure should be completaly released Hands should remain in the contact with the chest

  16. CardioPulmonary Resuscitation Theoretical background Oxygene content In atmospheric air - 21% In alveoli - 14,5% Expired air – diluted by air from the airways (dead space) - 16 – 18 % O2 Provided that there is an adequate amount of expired air reaching the victim's lungs, oxygen delivery will be sufficient to ensure that the victim's haemoglobin will be over 80% saturated with oxygen.

  17. Theoretical background Cardiac arrest Asystole Ventricular fibrillation Most cardiac arrest victims have an electrical malfunction of the heart  heart´s pumping function abruptly ceases 3. Pulseless ventricular tachycardia = Fast ventricular contractions without haemodynamc effect Signs of the both = identical!!! Differential dg: only ECG

  18. Theoretical background At best chest compressions provide only 30% of normal perfusion brain + heart Time! Time! Time! Time! Time! Time! Time! Time! Failure of the circulation 3 - 5 minutes  irreversible cerebral damage. Chances of successful CPR - restoration of spontaneous circulation (ROSC) decreases by 10% with each minute following sudden cardiac arrest…

  19. Cause of cardiac arrest and emergency system activation Adults Ischemic heart disease - AMI- with/or ventricular fibrillation (> 80%) Children Suffocation or choking with hypoxemia or asphyxia. Ventricular fibrillation is rare in children (only 5-8%) Trauma

  20. Cause of cardiac arrest and emergency system activation • different approach to the emergency system activation. Adults electric defibrillator is necessary as soon as possible; therefore, if telephone is available and you are alone: • call for help, then • start with CPR • Children • start CPR immediately for 1 minute to provide some tissue oxygenation • then call for help

  21. Emergency telephone number 155, 112 in the Czech Republic

  22. Indication of CPR to victims with unexpected cardiac arrest in otherwise healthy individuals… = to those, who can be described as having ”heart too good to die”

  23. Indication of CPR • malignant arrhythmia • acute myocardial infarction (AMI) • pulmonary embolism • intoxication • electrocution • drowning • acute suffocation • severe trauma • stroke and alike

  24. CPR is not indicated signs of definitive biological death witnessed information, that cardiac arrest had happened 15 or more minutes before the rescuer arrived (time assessment in the stressing situation is notprecise) terminal stage of incurable disease (generalised malignant disease…) an evident trauma without chance to survive (catastrophic head injury) “living will” - only in countries when constitution accepts it DNR - “Do not attempt resuscitation” has been written in the file (incurable disease after all available therapy failed) execution Age of the patient is not restriction of CPR

  25. Outcome after CPR • Ventricullar fibrilation – better than asystole • - in case of immediate CPR • Special emphasis •  • Soon defibrilation • 1 minute - survival - 90%, •  5 minutes - survival -50%, •  7 minutes - survival -30% •  10 - 12 minutes - survival -2 – 5%.

  26. CPR outcome • In first 4 minutes – brain damage is unlikely, if CPR started • 4 – 6 minutes– brain damage possible • 6 – 10 minutes– brain damage probable • > 10 minutes– severe brain damage certain • Cells of the brain cortex • Most sensitive for the stop of pefusion and oxygenation • Without perfusion and oxygenation • irreversibly damaged after 3-5 minutes

  27. Signs of cardiac arrest(Guidelines 2000) 1.Unconsciousnessin several seconds 2.   Respiratory arrest ( apnea) or the last gasps (1-3 minutes after cardiac arrest) 3.   Pulse-less on large ( major) arteries(carotid or femoral artery) 4.   Changed general appearance(colour changes, face changes…) 5. Pupils dilation (mydriasis) – not reliable

  28. Signs of cardiac arrest(Guidelines 2005) Unconsciousness No reactivity Absence of normal breathing

  29. Basic conditions for CPR Rescuer’s safety = the first priority To assess the risk of trauma, intoxication, infection… a victim position: supine on to his/her back on the firm flat surface to make effective chest compressions victim´s position in relation to rescuer´s position CPR during transfer ???

  30. Rescuer’s safety • The rescuer should never place him/herself or others at more risk than the victim • before starting resuscitation – assessthe risksofongoing traffic, falling masonry, electrocution, toxic fumes and poisons • risk of infections transmission • bloodborne infections(hepatitis B and C, HIV) • - can be transmitted by blood and other body • solutions, excretes • airborne infections (TBC and several infectious diseases - herpetic, meningococcal etc. • - can be transmitted by mouth-to-mouth breathing

  31. Rescuer’s safety • Always: protect yourself !!! • personal protective equipment (gloves) • barrier protective devices • Moth–to-barrier protective devices breathing

  32. Personal Protective Equipment Can control the risk of exposure to bloodborne pathogens –prevents an organism from entering the body (medical exam gloves, eye protection, mask) All human blood and body fluids should be considered infectious Mouth-to-mouth barrier devices Can prevent air-borne pathogens transmission Not documented case of disease transmission But…should be used whenever possible

  33. CardioPulmonary Resuscitation Barrier devices S – tube Face shields (resuscitation veil ) Pocket face mask + one-way valve Handkerchief Towel

  34. Stop CPR if • Victim starts to breathe normally • Medical assistance arrives and instructs you to stop CPR • You are physically exhausted

  35. Stop CPR if: When CPR has been performed for 20 minutes without restoration of the spontaneous circulation It can be stopped earlier, when: rescuer is physically exhausted when signs of biological death develop (post-mortal rigidity, post-mortal cooling and gravity-dependent livid stains)???

  36. CardioPulmonary Resuscitation Safar´s algorithm of CPR stressing conditionsan inadequate situation assessment Airways Breathing BLS Circulation ALS Drugs ECG ?

  37. New resuscitation alphabet – in adults Algorithm of CPR EKG Circulation BLS Airways ALS Breathing Drugs

  38. BLS sequence Kneel by the side of the victim

  39. BLS sequence Shake shoulders Ask “Are you all right?”

  40. BLS sequence • If he responds • Leave as you find him • Find out what is wrong • Reassess regularly

  41. BLS sequence

  42. BLS sequence

  43. BLS sequence

  44. Look, listen and feel for NORMAL breathing No breathing – apnea Gasps (agonal breathing) BLS sequence

  45. Agonal breathing • Occurs shortly after heart stops in up to 40% of cardiac arrests • Described as barely, heavy, noisy or gasping breathing • Recognise as a sign of cardiac arrest • Do not confuse agonal breathing with NORMAL breathing

  46. BLS sequence

  47. BLS sequence

  48. Chest compression • Place the heel of one hand in the centre of the chest • Place other hand on top • Interlock the fingers • Compress the chest • Rate 100 min-1 • Depth 4-5 cm • Equal compression : relaxation • When possible (2 or more rescuers) change CPR operator every 2 min. to prevent fatigue

  49. Chest compression • Place the heel of one hand in the centre of the chest • Place other hand on top • Interlock fingers • Compress the chest • Rate 100 min-1 • Depth 4-5 cm • Equal compression : relaxation • When possible (2 or more rescuers) change CPR operator every 2 min. to prevent fatigue

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