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MEDICAL DOCTOR
(SOON TO BE)
Natalia.christina@uph.edu
When you are on your way to Medical Faculty, there is a motorcycle
accident happened in front of you
What will you do?
A. Take a U-turn and pretend that you didn’t see anything
B. Scream outloud so anyone could help the victim
C. Since there is no one recognize you as a medical student, then you can just
leave the scene and pray
D. Be confident, take responsibility, do some basic life support pre hospital
and call for an ambulance
You will make a good choice, cause you had
already choose MEDICINE
PRIMARY SURVEY
• Airway with Cervical spine protection
• Breathing and ventilation
• Circulation with hemorrhage control
• Disability: Neurologic status
• Exposure/ Environmental control
SECONDARY SURVEY
The secondary survey does not begin until:
• the primary survey is completed,
• resuscitation efforts are well established,
• the patient is demonstrating normalization of vital functions.
• Head-to-toe evaluation
• Complete history and Physical Examination
You just have to be brave, smart and
have a DOCTOR spirit
But the victim is NOT breathing…. So HOW?
Basic Life Support
First Aid
Background
Causes of cardiac
arrest
17
Cardiac pump during the cardiac massage
Between compressions
thoracic cage is
expanding and heart is
filled with blood
18
Thoracic pump at the cardiac massage
Blood circulation is restored
due to the change in intra
thoracic pressure and jugular
and subclavian vein valves
During the chest compression
blood is directed from the
pulmonary circulation to the
systemic circulation. Cardiac
valves function as in normal
cardiac cycle.
19
Cause of cardiac arrest and emergency system activation
Adults
electric defibrillator is necessary as soon as possible;
therefore, if telephone is available and you are alone:
1. call for help, then
2. start with CPR
Children
1. start CPR immediately for 1 minute to provide some
tissue oxygenation
2. then call for help
CPR is not indicated for..
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 not precise)
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)
• Age of the patient is not restriction of CPR
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
• Airways
• Breathing BLS
• Circulation ALS
• Drugs
• ECG ?
New resuscitation alphabet
– in adults
EKG
Circulation BLS
Airways ALS
Breathing
Drugs
BLS sequence
Kneel by the side of
the victim
BLS sequence
Shake shoulders
Ask “Are you all right?”
BLS sequence
If he responds
• Leave as you find him
• Find out what is wrong
• Reassess regularly
BLS sequence
Unresponsive
Unresponsive
Open airway
BLS sequence
Unresponsive
Open airway
Check
breathing
BLS sequence
Unresponsive
Open airway
Check
breathing
Unresponsive
Open airway
Check
breathing
Call 112
30 chest
compressions
Chest compression
Open airway
Check
breathing
Call 112
30 chest
compressions
2 rescue
breaths
2 rescue breaths
• Pinch nose
• Place and seal your lips over the
victim´s mouth
• Blow until the chest rises
• Takes about 1 second
• Allow chest to fall
• Repeat (10 – 12 times per
minute)
B) Breathing
expired air resuscitation - several
techniques:
- Mouth-to-mouth breathing
Self-inflating bag
CardioPulmonary Resuscitation
Artificial breath during expired air resuscitation
30 : 2
Ratio 30 : 2
30 : 2
If victim starts to breathe normally place him in
recovery position
Need new
picture
A. Airway management
„A“
• head titlted
backward
• chin lift
Jaw thrust
• suspected cervical spine injury
• experienced rescuer ( anaesthesiologist)
Lower jaw pulled forward
A. Airway management
1. Unconscious patient – tongue
tilt the head backward + lift the chin
2. Conscious patient - foreign body airway
obstruction choking - partial airway
blockade
encourage the victim to cough
add several hits to his/her back
Potentially treatable
Mostly during eating
Commonly witnessed event
Oportunity for early intervention
Can cause mild (partial) or severe (complete) airway obstruction
Heimlich manoeuvre (several thrusts (5))
pregnant ladies, children
Signs of mild (partial) large airways obstruction
Suffocation
Difficult intensive inspiration
Neck and thorax soft tissues retraction
Hoarse (croupy) sounds accompanying
inspiration (noisy breathing)
Barking cough
A. Airway management
Signs of severe or complete large
airways obstruction
Difficult intensive inspiratory effort
Powerful breathing movements
Neck and thorax soft tissues retraction
No breathing phenomena hearable
Patients non-cooperation, restlessness, convulsions, coma, blue
skin color
C: Circulation
Diagnosis:
• Signs of functional circulation
(breathing, coughing, movement, skin condition,
responsiveness, pulse)
• Pulse-less on large ( major) arteries –
only experienced rescuers
Compression-only CPR
Differencies:
Cause of cardiac arrest –choking, trauma
Activation of emergency system
Hypoxia developes faster – high metabolic rate
Ventricular fibrillation – rare
Primary cardiac arrest uncommon,
Precordial thump is contraindicated
CPR in children
A) The most often cause of vital
functions failure = choking
“C“
Look for signs of circulation (movements, coughing,
skin colour, breathing…)
Check the pulse (if you are an experienced health
provider) no more than 10 s
Lower third of the sternum (1 finger above xiphoid
process)
One third of the depth of the chest
100 compressions per min.
BLS in children
FBAO
• back blows
• chest thrusts
• abdominal compression
expulsion of FB out from the airways
However
• most injuries do not require life-saving efforts