Filehost_masuri de Prim Ajutor 3-4 2010

7/27/2019 Filehost_masuri de Prim Ajutor 3-4 2010

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MASURI DEPRIM AJUTOR

CURS 3-4 /2010

Sef lucrari dr.Ioana Ghitescu

UMF Tg.Mures, Disciplina A.T.I.S.C.J.U. Mures, Clinica A.T.I.


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Bibliografie

www.erc.org


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CHEST COMPRESSIONS- infant, lone rescuer

Lonerescuer:compress

thesternumwith thetips of

twofingers


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CHEST COMPRESSIONS-children over 1 year


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Pediatric FBAO


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Pediatric FBAO

No abdominal thrusts for choking infants

Risk because of the horizontal position ofthe ribs- upper abdominal viscera more

exposed to trauma


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Pediatric AED Automated external defibrillators (AEDs) are safe

and successful when used in children older than 1year of age.

Purpose made paediatric pads or softwareattenuate the output of the machine to 5075 J

and these are recommended for children aged 18 years.

If an attenuated shock or a manually adjustablemachine is not available, an unmodified adultAED may be used in children older than 1 year.

There are case reports of successful use of AEDsin children aged less than 1 year;

in the rare case of a shockable rhythm occurringin a child less than 1 year, it is reasonable to usean AED (preferably with dose attenuator).


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Special circumstances


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Drowning WHO: worldwide,drowning accounts for

approximately 450,000 deaths each year A common cause of accidental death in

Europe the duration of hypoxia is the most criticalfactor in determining the victims outcome

oxygenation, ventilation and perfusion

should be restored as rapidly as possible CPR by a bystander and immediate

activation of the EMS system.


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Drowning- epidemiology

97% of deaths from drowning occur inlow- and middle-income countries

more common in young males

is the leading cause of accidental death inEurope in young males

suicide, traffic accidents, alcohol and drug

abuse varies between countries


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Drowning: definition

ILCOR: a process resulting inprimaryrespiratory impairment fromsubmersion/ immersion in aliquid medium.

a liquid/air interface is presentat the entrance of the victims

airway: the victim does notbreathe air. Immersion=to be covered in

water or other fluid Drowning: at least the face and

airway must be immersed. Submersion = that the entire

body, including the airway, isunder the water or other fluid


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Drowning: pathophysiology cardiac arrest occurs as a consequence of

hypoxia the victim initially breath holds before

developing laryngospasm. this time the victim frequently swallows large

quantities of water. breath holding/laryngospasm continues,

hypoxia and hypercapnia develops victim aspirates water into their lungs

leading to worsening hypoxaemia


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Drowning: treatment

1. aquatic rescue

2. basic life support

3. advanced life support

4. post-resuscitation care

Initial rescue: bystanders, trained lifeguards

BLS: initial responders

Number of victims-


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Drowning: treatment1. Aquatic rescue and recovery from the water. personal safety and minimize the danger to yourself and the

victim at all times attempt to save the drowning victim without entry into the

water.

talking to the victim rescue aid throwing a rope

use a boat or other water vehicle If entry into the water is essential, take a flotation device. safer to enter the water with two rescuers Never dive head first in the water (loose visual contact with the

victim, risk of spinal injury) incidence of cervical spine injury in drowning victims is very low

(approximately 0.5%)


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Drowning: treatment

2.BLS

Rescue breathing: prompt initiation of rescue breathing orpositive pressure ventilation increases survival

Give five initial ventilations/rescue breaths

Rescue breathing can be initiated whilst the victim is still inshallow water provided the safety of the rescuer is notcompromised

mouth-to nose ventilation may be used as an alternative tomouth-to-mouth ventilation

In-water resuscitation: 1015 rescue breaths over approx. 1min . normal breathing does not start spontaneously, and the victim is


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Drowning: treatment

2.BLS

Chest compression

on a firm surface before starting chest compressionsas compressions are ineffective in the water

Confirm the victim is unresponsive and notbreathing normally and then give 30 chestcompressions, tan 30:2

Compression-only CPR: to be avoided.

Automated external defibrillation

if an AED is available, dry the victims chest, attachthe AED pads and turn the AED on.

deliver shocks according to the AED prompts


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Drowning: treatmentRegurgitation during resuscitation. Rescue breathing: need for very high inflation

pressures Regurgitation of stomach contents and

swallowed/inhaled water is common duringresuscitation from drowning

turn the victim on their side and remove theregurgitated material using directed suction ifpossible

Abdominal thrusts can cause regurgitation ofgastric contents and other life-threateninginjuries and should not be used.

Care should be taken if spinal injury is suspected


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Drowning Discontinuing resuscitation efforts Salt versus fresh water. Hypothermia after drowning.

Victims of submersion: primary or secondaryhypothermia Submersion occurred in icy water (


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Electrocution 0.54 deaths per 100,000 people/year Electrical injuries

in adults: in the workplace and are associatedwith high voltage, children are at risk primarily at home, where the voltage

is lower (220V in Europe, Australia and Asia; 110V inthe USA and Canada)

Lightning strikes is rare, but worldwide it causes1000 deaths each year

Electric shock injuries: the direct effects of

current on cell membranes and vascular smoothmuscle The thermal energy associated with high-voltage

electrocution: burns


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Electrocution Factors influencing the severity ofelectrical injury

current: alternating (AC) or direct (DC) voltage, magnitude of energy delivered, resistance to current flow, pathway of current through the patient, the area duration of contact

Contact with AC may cause tetanic contraction ofskeletal muscle, which may prevent release fromthe source of electricity.

Myocardial or respiratory failure may causeimmediate death


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Electrocution paralysis of the central

respiratory control system or the

respiratory muscles: respiratory arrest VF if it traverses the myocardium during

the vulnerable period myocardial ischaemia because of coronary artery

spasm. asystole may be primary, or secondary

to asphyxia following respiratory arrest current that traverses the myocardium is more

likely to be fatal transthoracic (hand-to-hand)>a vertical (hand-

to-foot)/straddle (foot-to-foot)


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Lightning strike 300 kV over a few milliseconds. the current from a lightning strike passes over the surface

of the body in a process called external flashover Industrial shocks and lightning strikes: deep burns at the

point of contact.

Industrial shocks: the points of contact are usually on theupper limbs, hands and wrists

Lightning: mostly on the head, neck and shoulders. Lightning can also cause:

central and peripheral nerve damage;

brain haemorrhage and oedema, Peripheral nerve injury

Mortality from lightning injuries is 30%-70%

El t ti R


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Electrocution: Rescue

Ensure that any power source is

switched off and do not approach the casualtyuntil it is safe.

High-voltage electricity can arc and conductthrough the ground for up to a few metersaround the casualty.

It is safe to approach and handle casualties afterlightning strike, although it would be wise to

move to a safer environment, particularly iflightning has been seen within 30 min

Electrocution:


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Electrocution:Resuscitation Airway management may be difficult if there are

electrical burns around the face and neck extensive soft-tissue edema may develop causing airway

obstruction Head and spine trauma can occur after electrocution. Immobilize

the spine until evaluation can be performed.

Muscular paralysis, especially after high voltage, may persistseveral hours Remove smoldering clothing and shoes to prevent further thermal

injury. Maintain spinal immobilization if there is a likelihood of head or

neck trauma Conduct a thorough secondary survey to exclude traumatic

injuries caused by tetanic muscular contraction or by the personbeing thrown

Electrocution can cause severe, deep soft-tissue injury withrelatively minor skin wounds, because current tends to followneurovascular bundles; look carefully for features of compartmentsyndrome.

Cardiac arrest associated


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Cardiac arrest associatedwith pregnancy problems associated with pregnancy are caused by aortocaval

compression after 20 weeks gestation, the pregnant womans uterus can press

down against the inferior vena cava and the aorta, impedingvenous return and cardiac output

The key steps for BLS in a pregnant patient are:

Call for expert help early (including an obstetrician andneonatologist). Start basic life support according to standard guidelines. Ensure

good quality chest compressions with minimal interruptions. Manually displace the uterus to the left to remove caval

compression. Add left lateral tilt if this is feasible the optimal angle of tilt isunknown. Aim for between 15 and 30. Even a small amount oftilt may be better than no tilt. The angle of tilt used needs to allowgood quality chest compressions and if needed allow Caesareandelivery of the fetus. Start preparing for emergency Caesarean section (see below) the

fetus will need to be delivered if initial resuscitation efforts


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Accidental hypothermia when the body core temperature

unintentionally drops below 35 C. mild (3532 C),

moderate (3228 C) or

severe (less than 28 C)

The Swiss staging system based on clinical signs

can be used at the scene to describe victims:

stage I clearly conscious and shivering;

stage II impaired consciousness without shivering;

stage III unconscious;

stage IV no breathing;

stage V death due to irreversible hypothermia


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Accidental hypothermiaDiagnosis

Normal thermoregulation during exposure to cold

environments, wet or windy conditions in people who have been immobilized, or following immersion in cold water Impaired thermoregulation :in the elderly and

very youngOther risk conditions: drug or alcohol ingestion, exhaustion,

illness


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Accidental hypothermia The core temperature measured in the lower third

of the oesophagus correlates well with thetemperature of the heart.

epitympanic (tympanic) measurement the method of temperature measurement should be the

same throughout resuscitation and rewarmingDecision to resuscitate cellular oxygen consumption by 6% per 1 C decrease in core

temperature At 28 C oxygen consumption is reduced by 50% and at 22

C by 75%.

can exert a protective effect on the brain and vital organs In a hypothermic patient, no signs of life (Swiss hypothermia

stage IV) alone is unreliable for declaring death At 18 C the brain can tolerate periods of circulatory arrest

for ten times longer than at 37 C. the traditional guiding principle that no one is dead until

warm and dead should be considered


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Accidental hypothermia

Resuscitation the same ventilation and chest compression rates

as for a normothermic patient stiffness of the chest wall, making ventilation and

chest compressions more difficultRewarming removal from the cold environment, prevention of further heat loss and

rapid transfer to hospital. Swiss stagesII should be immobilized and

handled carefully the whole body dried and insulated( Wet clothes

should be cut off)


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Accidental hypothermiaRewarming Conscious victims can mobilise as exercise rewarms a

person more rapidly than shivering Somnolent or comatose victims should be immobilized and

kept horizontal

Passive rewarming is appropriate in conscious victims withmild hypothermia who are still able to shiver, by:

full body insulation with wool blankets, aluminium foil, cap warm environment. chemical heat packs to the trunk

Hypothermic victims with an altered consciousness should betaken to a hospital capable of active external and internalrewarming.


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Avalanche burial asphyxia, trauma and hypothermia

avalanche victims are not likely to survive

when they are:

buried >35 min and in cardiac arrest with anobstructed airway on extrication;

buried initially and in cardiac arrest with anobstructed airwa yon extrication, and an initialcore temperature of 12 mmol


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Hyperthermia

Definition

when the bodys ability to thermoregulate

fails and core temperature exceeds tha normallymaintained by homeostatic mechanisms

exogenous, caused by environmental conditions

secondary to endogenous heat production.

Forms:

heat stress heat exhaustion

heat stroke

finally multiorgan dysfunction and cardiac arrest

Malignant hyperthermia (MH)


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Hyperthermia

Heat strokesystemic inflammatory response a core temperature above 40.6 C,accompanied by mental state change and varying levels of organdysfunction.classic non-exertional heat stroke (CHS) occurs during highenvironmental temperatures and often effects the elderlyExertional heat stroke (EHS) occurs during strenuous physical exercisein high environmental temperatures and/or high humidity

usually affects healthy young adultsMortality from heat stroke ranges between 10 and 50%


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HyperthermiaManagement ABCDEs and rapidly cooling the patient Start cooling before the patient reaches hospital. Aim to rapidly reduce the core temperature to

approximately 39 C.

Cooling techniques drinking cool fluids, fanning the completely undressed patient spraying tepid water on the patient Ice packs over areas where there are large superficial blood

vessels (axillae, groins, neck) In cooperative stable patients, immersion in cold water can

be effective


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Modifications to cardiopulmonaryresuscitation

There are no specific studies on cardiac

arrest in hyperthermia. the prognosis is poor compared with

normothermic cardiac arrest

Hyperthermia

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