management of life threatening conditions

Health 4 Notes

Sir Daj

Opening The Airway

Head Tilt Chin Lift Jaw Thrust

Cardiovascular Emergencies

Heart attack is the death of the heart muscle due to deficient blood supply. Usually mistaken for angina pectoris.

What causes heart attack?

What are the symptoms?

First Aid?1. Check ABCs2. Call EMS3. If possible, give nitroglycerine4. If needed, use AED

Chain of Survival

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

determine responsiveness

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

activate EMS

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

open the airway

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

determine breathlessness

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

give chest compressions

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

give rescue breathing

5 cycles in 2 minutes

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

defibrillate if available

Basic Life Support

A term used to describe the first aid procedures necessary to sustain life when the cardiovascular system is compromised.

recovery position

Patient has a valid “Do Not Attempt Resuscitation” (DNAR) order.

Signs of irreversible death: Rigor Mortis, Decapitation.

No physiological benefit can be expected because the vital functions have deteriorated despite maximal therapy.

When not to give CPR

When to S.T.O.P. CPR

SPONTANEOUSSPONTANEOUS signs of circulation are restored.signs of circulation are restored.

TURNEDTURNED over to medical services or properly over to medical services or properly trained and authorized personnel.trained and authorized personnel.

OPERATOROPERATOR is already exhausted and cannot is already exhausted and cannot continue CPR.continue CPR.

PHYSICIANPHYSICIAN assumes responsibility (declares assumes responsibility (declares death, take over, etc.).death, take over, etc.).

Adult Child Infant

Compression area

Lower half of the sternum 2 fingers from the substernal notch

Lower half of the sternum 1 finger from substernal notch

Lower half of the sternum 1 finger width below the imaginary nipple line

Depth Approximately 1½ - 2 inches

Approximately 1 – 1½ inches

Approximately ½ - 1 inch

How to Compress

Heels of 1 hand, other hand on top.

Heel of one hand

2 fingers (middle & ring fingertips)

Rate of Compression

Approximately 100/min

Approximately 100/min

At least 100/min

Automated External Defibrillators are medical devices that deliver a controlled shock through pads or electrodes placed in specific locations on the victim’s chest.

What is a fibrillation?

Special Situations

• if victim is a child . . .

• if victim is near water . . .

• if victim has pacemaker . . .

• if victim has patch over electrode site . . .

• if victim has hairy chest

Using an AED

1.Turn the power ON

2.Attach the electrodes to the victim’s bare chest

Using an AED3. Be sure no one is touching the victim and

press ANALYZE

4. Deliver a SHOCK if indicated

Neurological EmergenciesSpinal Cord Injury

• Trauma to the spinal cord leading to temporary or permanent paralysis

• C1-C4 paralysis from neck

• C5-C7 paralysis from chest

• T1-T9 paralysis of lower extremities

Health Care EffectsAverage cost of care for a person with a cervical injury:

•$572,178 first year

•$102,491 each year after

•Economic Hardship

•High cost of rehab and long term care effects

•90% of discharged SCI patients go home

•10% of dishcarged SCI patients go to nursing home, chronic care facility, group home

Parts of the Vertebral Column

• Cervical• Thoracic• Lumbar• Sacral

Nerve damage can be confirmed through MRI

Complete or Incomplete?

Mechanism of Injury

• Traction

• Compression

• Crush

Can you give examples?

Examples of Injury• Accidents (45%)

– Car, van, coach 16.5%– Motorcycle 20%– Bicycle 5.5%– Pedestrian 1.5% – Helicopter 1.5%

• Domestic / Industrial Accidents (34%)• Sport Injury 15%

– Diving 4% “vertical compressions”– Rugby 1%– Horse Riding 3%– Other 7%

• Assault 6%– Self Harm 5%– Assaulted 1%

Assume SCI if . . .• Severe pain on neck or back

• Person won’t move his neck

• Neck/back is oddly positioned

• Person complains of numbness or paralysis in the limbs

ManagementSteps to Spinal Injury Management

1.Check consciousness (AVPU)

2.Manage airway

3.Perform neurological tests

4.Apply cervical collar

5.Log roll into spine board

Neurologic Tests

• Sensation

• Movement

DefinitionSeizures are altered states of consciousness due to uncontrolled abnormal electrical activity of the brain

Its cause may vary from . . .

1.Epilepsy

2.Febrile

3.Head Injury

4.Metabolic Conditions

5.Drug Overdose

Types of SeizuresPartial versus General

Simple versus Complex

Lose consciousness? Convulsions? Whole body?

Phases of a Grand Mal Seizure• Aura a warning sign perceived by the patient

• Tonic patient becomes unresponsive and exhibits muscle rigidity

• Clonic patient experiences alternating episodes of muscle spasms and relaxation

• Postictal recovery phase and could last up to 30min

Seizures are generally harmless and self-limited but if it lasts more than 5 minutes it can be life threatening . . . Why?!?

Medications

Lorazepam popular brand is Ativana potent sedative that is classified as an anticonvulsant

Diazepam popular brand is Valiumincreases action of inhibitory neurotransmitters

Propofol popular brand is Diprivanprimarily used as an anaesthetic but is also a sedative

What to do during . . .

• Protect the patient / support the head

• Loosen tight clothing

• Roll the victim onto the side

• Do not give anything by mouth

• Do not restrain the patient

• Remove dangerous objects from vicinity

What to do after . . .

• Let the patient lie on the side

• Remove vomit / saliva from mouth

• Check for breathing

• Check for head trauma

• Transport to hospital