emergency first aid dr iskasymar ismail emergency...
TRANSCRIPT
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Emergency First AidDR ISKASYMAR ISMAIL
Emergency Physician/ Medical Lecturer
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Content
•ABCDE APPROACH
•ANAPHYLAXIS
•BLS
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Loss of Airway will kill you before
Cessation of Breathing will kill you before
Interruption to Circulation will kill you before
Neurological Disability will kill you before
a few other things that you won’t find unless you
get good Exposure
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• LOOK
• LISTEN
• FEEL
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ABCDE Approach
• To improve the clinical outlook of the unwell patient, with or without a definitive diagnosis.
• The clinical signs of life threatening acute illness may be readily identified, even though the underlying disease may not be
• Assessment and treatment are concurrent
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The principles
• Perform primary survey ABCDE (5-10 min)
• Instigate treatment for life threatening conditions as you find them
• Reassess when any treatment is completed
• Perform more detail secondary ABCDE survey including investigations
• If condition deteriorates repeat primary survey
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The Primary Survey
• Looking for immediately life threatening conditions
• Rapid intervention usually includes max O2, IV access, Fluid challenge +/-specific treatment
• Can be repeated as many times as necessary
• Get experienced help as soon as you need it
• If you have a team delegate jobs
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The secondary survey
• Performed when patient more stable
• Get a brief relevant HPC & Hx
• More detailed examination of patient
• Order investigations to aid diagnosis
• IF PATIENT DETERIORATES RETURN TO PRIMARY SURVEY
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Initial Steps• Safety…. Apron, gloves
• Look at patient in general…. Unwell?
• Greet
• If awake…. “how are you?”
• If unconscious, collapsed…. Shake him and ask “are u alright?”
• Normal response…. Patent airway, breathing and has brain perfusion
• Talk in sentence… breathing problem?
• Unresponsive… critically ill
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• Rapid Look, Listen n Feel….. Around 30s
• Critically ill? call for HELP early
• Unconscious, unresponsive, no/ abnormal breathing CPR
• Monitor the vital signs early
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AIRWAY
• Airway Patency
• OSTRUCTION? complete or partial
• RISK OF ASPIRATION?
• Safe
• Talking coherently
• No added noises
• Unsafe
• Depressed level of consciousness
• Paradoxical chest movement
• Abnormal sounds; Grunting, Snoring, Stridor
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AIRWAY
ASSESSMENT
• Is the airway patent and maintained?
• Can the patient speak?
• Are there added noises?
• Is there see sawing movement of the chest and abdomen
MANAGEMENT
• Ensure airway patent and maintained
• Simple airway manoeuvres
• Suction
• Consider using airway adjuncts and position patient
• O2 via HFM
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BREATHING
• GOOD OXYGENATION AND VENTILATION?
• RESPIRATORY FAILURE?
• Respiratory distress?
• Increase work of breathing?
• Safe features
• Talking comfortably
• RR 12-20
• SpO2> 96% (RA)
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BREATHING
ASSESSMENT
• Observe rate and pattern
• Depth of respiration
• Symmetry of chest movement
• Use of accessory muscle
• Colour of patient
• SpO2
MANAGEMENT
• Position of patient
• Oxygen via HFM
• Bag valve mask
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CIRCULATIONS
• SHOCK? Hypovolaemic?!
• Safe features Unsafe Features
• CRT < 2 sec Cold peripheries , mottled skin
• HR 51-90 HR <40 or >130
• sBP 120-140 sBP <90 or more >220
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CIRCULATION
ASSESSMENT
• Manual pulse and BP
• CRT
• Urine output/ Fluid balance
• Temperature
• Ensure patent IV access
MANAGEMENT
• Cannulate
• Take appropriate bloods
• Fluid (Normal Saline/ Harttmann) bolus-administer- titre
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DISABILITY
• Hypoxia, Hypercapnia, Hypovoalemia excluded/ treated?!
• ABC optimised?
• Drugs/Toxins/Poison causing low GCS? Intracranial causes?
• SAFE
• Normal consciousness, orientated
• UNSAFE
• Depressed level of consciousness, localising neurological signs, meningism
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DISABILITY
ASSESSMENT
• Conscious level
• Blood glucose
• Pupil size and reaction
• Observe for seizures
• Pain assessment
Management
• Consider recovery position
• Correct blood glucose
• Control seizures
• Control Pain
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Anaphylaxis
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If unconscious + not responding + No/ abnormal breathing!!!
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ADULT CHAIN OF SURVIVAL
Immediate recognition of cardiac arrest and activation of the emergency
response system
Early CPR with an emphasis on chest compression
Rapid defibrillation
Effective advance life support
Integrated post-cardiac arrest care
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Monica E. Kleinman et al. Circulation. 2015;132:S414-S435
Copyright © American Heart Association, Inc. All rights reserved.
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Open airway (A-Airway) – non-invasive technique
Head tilt-chin lift
Jaw Thrust (if suspected trauma)
Breathing (B )
Almost simultaneously when opening the airway
Not more then 10 seconds
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Check Pulse
Carotid Pulse, within 10 seconds
CPR (C-Circulation)
Lone rescuer, 30 compressions to 2 breaths (30:2)
5 cycles or 2 minutes
Chest compression Correct victim position and correct hand placement
100/min-120/min
at least 2 inches (5cm), avoiding excessive chest compression depths (greater than 2.4 inches or 6 cm)
Allow the chest to recoil completely after each compressions
Minimize interruptions in compression (less than 10 seconds)
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Ventilations
Open airway (+/- adjuncts)
Technique
Mouth to Mouth Ventilation
Mouth to Mask Ventilation
Bag-Valve-Mask Ventilations
Each Breath given over 1 second to ensure visible chest rise
Avoid excessive ventilations
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Automated External Defibrillator (AED)/ Defibrillator (D-defibrillator)
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1st rescuer
Performed chest compression
Count compression aloud
2nd rescuer
Maintain open airway
Provide ventilations
Encourage 1st rescuer to perform good chest compressions
Switch duties every 5 cycles or about 2 minutes, taking <5 seconds to switch