Doctor

1. Organization of emergency and urgent medical care.The initial and secondary survey. Cardiopulmonary resuscitation

2. Doctor Medical assistant 1 Driver Medical assistant 2

3. Howto approach the injured person

4. 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.

5. 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.

6. 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).

7. 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)

8. Stage 1. Organization of the emergency team.

9. Patency of airways support Suction units (aspirators)

10. Patency of airways support Respiratory mask

11. Patency of airways support Laryngeal mask Laryngeal tube

12. Patency of airways support laryngeal tubes laryngeal tubes

13. Patency of airways support Combitube

14. Patency of airways support Respiratory mask and Ambu bag

15. Patency of airways support A set for conicopuncture

16. Portable set of respiratory equipment Oxygen therapy Support of artificial ventilation of lungs

17. Training equipment for developing skills of patency of airways support

18. Intubation-10-15 sec. Patency of airways support ,

19. Primary examination Step B. Make sure if the patient is breathing. Count the frequency of respiration during 10 sec.

20. 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).

21. “Quick evaluation”Taking electrodes, classic, self-adhesive electrodes.

22. Algorithm of providing help and examination for the patient

23. Category "Load and Go"after primary examination

24. A chair for immobilization and transportation Wheelcouch/barrow

25. Hard shield Soft stretchers Frame stretchers

26. Neck Collar Pectoral immobilization waistcoat Vacuum splints

27. Cramer’s Splints Elastic splint type Sam Splint Elastic splint type Sam Splint

28. Respiratory Ambu-bag with a mask, air-channels/providers, a hose for the serve A portable apparatus of ventilation with balloon of oxygen

29. A set for conicо puncture Hand suction-fan Laryngoscope with attachmentsof different size Foot suction-fan

30. Electrosuction-fan Pulsoxymeter, located on the finger of patient Medical bag for transference of medical property and medicines Cardiocomplex

31. 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.

32. 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.

33. 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).

34. Terminal state is divided into several stages: 1. Preagony 2. Terminal pause 3. Agony 4. Clinical death

35. 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

36. First stage of resuscitation - provision of first aid ( basic life support). First step –maintenance of airway patency.

37. 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

38. Precardiac stroke • Immediate treatment of observed and monitored circulatory arrest in VF/VT • Perform, if defibrillator is unavailable

39. Chest compressions • 30:2 • depth 4-5 сm • 100 min-1 • “center of chest” • Avoid • Exhaustion • Breaks

40. “Quick Evaluation”Conduct ECG, classic electrodes, self adhesive electrodes.

41. 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.

42. Rhythms prior to defibrillation (VF/VT)‏

43. 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

44. 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)‏

45. Rhythm not before defibrillation Asystole/PEA

46. Asystole/РЕА DuringCPR: • Check for electrode connection • Adrenalin 1 mg i. v. every 3-5 min. • Rule out/ treatable condition

47. Potentially treatable conditions: • Hypoxia • Hypovolemia • Hypo/hyperkalemia and metabolic disruptions • Hypothermia • Tension pneumothorax • Тamponade (Pericardial) • Тoxins • Тhromboembolism (coronary orpulmonary)‏

48. 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

49. Summary • Algorithm ALSstandardizes a way of treatment of circulatory arrest in adults • Allows to increase effectiveness of treatment.

50. Thank • you for • attention!