511 likes | 759 Views
Organization of emergency and urgent medical care.The initial and secondary survey. Cardiopulmonary resuscitation. Doctor. Medical assistant 1. Driver. Medical assistant 2. How to approach the injured person. Primary examination.
E N D
Organization of emergency and urgent medical care.The initial and secondary survey. Cardiopulmonary resuscitation
Doctor Medical assistant 1 Driver Medical assistant 2
Primaryexamination Figure out the condition of consciousness according to the algorithm AVPU: A – Alert (conscious, gives adequate answers to the questions, is able to perform conscious actions when asked by the medical rescuer); V – Responds to Verbal stimuli (to a loud sound near the ear); P– Responds to Pain (responds to pinch in the area of left thoracic muscle at the turn of 180 degrees); U – Unresponsive. If there is a suspicion of simulation of unconsciousness, open patient’s eyelids, using 1st and 2nd fingers. The conscious patient will strain his/her eyelids muscles and they will open with tension.
Primary examination Let’s make a priori assumption that cerebral trauma occurs at transport accidents, sports accidents, falling from high places, traumas in water and children’s traumas.
Primary examination Fix with your hands a neck part of the spine in the position which you found the injured in. (medical assistant 1) If that position does not promote breathing, carefully turn the injured on his/her back or to the position, which is close to a stable (on his/her side) (medical assistant 1 + medical assistant 2). Start initial examination according to the A, B, C technique (optimal term of performance – 10 sec) (doctor) Step A Provide patency of airways support (medical assistant 1).
Provide patency of airways support, find out if there are signs of life …to confirm or oppose the circulatory arrest. • Patient’s response • Provide patency of airways support • Check respiration and pulse (not more than 10 sec)
Patency of airways support Suction units (aspirators)
Patency of airways support Respiratory mask
Patency of airways support Laryngeal mask Laryngeal tube
Patency of airways support laryngeal tubes laryngeal tubes
Patency of airways support Combitube
Patency of airways support Respiratory mask and Ambu bag
Patency of airways support A set for conicopuncture
Portable set of respiratory equipment Oxygen therapy Support of artificial ventilation of lungs
Training equipment for developing skills of patency of airways support
Intubation-10-15 sec. Patency of airways support ,
Primary examination Step B. Make sure if the patient is breathing. Count the frequency of respiration during 10 sec.
Primary examination Step C. At the same time find out if there is pulse in the carotid artery (during 10 sec) (in case the patient is unconscious). (doctor) If there is not – start doing closed chest-cardiac massage (doctor, while medical assistant 2 is preparing cardiomonitor and defibrillator) with frequency of 100 times per minute – 30 pressures on the chest and 2 ventilations (medical assistant 1). Simultaneously, connect electrodes of cardiomonitor, link it up and find out the reason of cardiac arrest (medical assistant 2).
“Quick evaluation”Taking electrodes, classic, self-adhesive electrodes.
A chair for immobilization and transportation Wheelcouch/barrow
Hard shield Soft stretchers Frame stretchers
Neck Collar Pectoral immobilization waistcoat Vacuum splints
Cramer’s Splints Elastic splint type Sam Splint Elastic splint type Sam Splint
Respiratory Ambu-bag with a mask, air-channels/providers, a hose for the serve A portable apparatus of ventilation with balloon of oxygen
A set for conicо puncture Hand suction-fan Laryngoscope with attachmentsof different size Foot suction-fan
Electrosuction-fan Pulsoxymeter, located on the finger of patient Medical bag for transference of medical property and medicines Cardiocomplex
Resuscitation should be viewed as a protest against ungrounded death. A belief in true sense of human longevity and the importance to maintain human life. Scientist V.А. Nehovsky One of the most important tasks of becoming a physician is to acquire the skill of cardio-pulmonary-cerebral resuscitation, which allows to renew vital functions of life.
Resuscitation should be viewed as a protest against ungrounded death. A belief in true sense of human longevity and the importance to maintain human life. Scientist V.А. Nehovsky One of the most important tasks of becoming a physician is to acquire the skill of cardio-pulmonary-cerebral resuscitation, which allows to renew vital functions of life.
Intensive therapy– a complex of temporary methods of artificial maintenance of vital life functions in decompensated stages, which is directed to provision of life support. Resuscitology– study about revival of the organism; prophylaxis and treatment of terminal stages. ( according to V.А. Nehovsky).
Terminal state is divided into several stages: 1. Preagony 2. Terminal pause 3. Agony 4. Clinical death
Main signs of clinical death: Absence of pulsation on magistral arteries (carotidand femoral), Pupils are fixed and dilated, non-reactive to light, Absence of independent breathing. Additional signs : Change in skin colour (grey or cyanotic), Absence of consciousness, Absence of reflexes and loss of muscle tone
First stage of resuscitation - provision of first aid ( basic life support). First step –maintenance of airway patency.
Maintain airway patency Evaluate sings of circulation Confirmed ceasing of blood circulation Call resuscitation team CPR 30:2 Up to the point of hooking up a defibrillator/monitor
Precardiac stroke • Immediate treatment of observed and monitored circulatory arrest in VF/VT • Perform, if defibrillator is unavailable
Chest compressions • 30:2 • depth 4-5 сm • 100 min-1 • “center of chest” • Avoid • Exhaustion • Breaks
“Quick Evaluation”Conduct ECG, classic electrodes, self adhesive electrodes.
Provision of airway patency Determination of signs of life Call resuscitation team CPR 30:2 Until defibrillator/monitor is hooked up Evaluation of rhythm To defibrillation(VF/VT without pulse) Nodefibrillation (PEA/ asystole) During CPR: • Rule out problems that can be corrected • Check placement and function of electrodes • Check: • IV availability • airway patency and oxygen • After airway support conduct chest compressions continuously • Inject adrenalin every 3-5 mins. • Choose: amiodarone, atropine, magnesium 1 Defibrillation 150-360 JBiphasic or 360 JMonophasic Immediately start CPR 30:2 2 min. Immediately start CPR 30:2 2 min.
Rhythms prior to defibrillation (VF/VT)
Evaluate rhythm Prior to defibrillation (VF/VT without pulse) 1 Defibrillation 150 J biphasic First defibrillation • 150 - 200 J biphasic Immediate CPR 30:2 2 min
After performing defibrillation • Continue CPR for the next 2 min • Stop CPR only when patient has signs of circulation • Defibrillation – priority • Adrenalin 1 mg • Аmiodarone 300 mg (post 3)
Rhythm not before defibrillation Asystole/PEA
Asystole/РЕА DuringCPR: • Check for electrode connection • Adrenalin 1 mg i. v. every 3-5 min. • Rule out/ treatable condition
Potentially treatable conditions: • Hypoxia • Hypovolemia • Hypo/hyperkalemia and metabolic disruptions • Hypothermia • Tension pneumothorax • Тamponade (Pericardial) • Тoxins • Тhromboembolism (coronary orpulmonary)
During CPR: • Rule out potentially treatable conditions • Check placement of electrodes • Check: • IV availability • Airway patency and oxygen • After maintenance of airway patency conduct continuous chest compressions • Inject adrenalin every 3-5 mins. • Choose : Amiodarone, atropine, magnesium
Summary • Algorithm ALSstandardizes a way of treatment of circulatory arrest in adults • Allows to increase effectiveness of treatment.
Thank • you for • attention!