Source: Close, A. "Emergency Care", 2001.
Shock is "the loss of effective (blood) circulation." Effective circulation, or perfusion, is achieved when blood that is carrying sufficient oxygen is supplied to all cells throughout the body. Insufficient oxygen supply to the cells is called hypoxia. The causes of shock fit three main categories: Absolute, Relative and Cardiac. Although they have different causes, they all result in lack of sufficient oxygen to meet the body's needs.
Absolute Fluid Loss
Also known as hypovolaemic shock, absolute fluid loss can be caused by either bleeding, or dehydration from sweating. If not controlled it will result in inadequate oxygen supply to the tissues (shock). Blood loss can be external or internal.
Relative Fluid Loss
The blood volume remains the same but the size of the blood vessels in the system increases )similar to 1 litre of milk in a 2 litre carton). The effect of increasing the size of the blood vessels but not increasing blood volume may be a rapid and life-threateding drop in blood pressure. This may be caused by:
- Nervous control: the size of blood vessels are affected by pain, spinal injury, etc
- Chemicals and drugs: such as alcohol causing enlargement of blood vessels
- Severe Infections: (septic shock) toxins cause the size of blood vessels to increase
- Anaphylaxis: severe allergic reactions cause blood vessels to enlarge, the heart to beat too rapidly, and extreme difficulty in breathing as well as other detrimental effects on the body.
Heart Failure
This is also known as cardiac failure, or in severe cases cardiogenic shock. It is the failure of the heart to pump effectively due to injury or disease. If the heart's blood supply is intterupted by a coronary artery becoming narrowed or blocked (such as occurs in a heart attack) it's pumping ability may be reduced. If the damaged heart fails and cannot pump enough blood, the cells of the body will not be adequately perfused (oxygenated) causing shock.
Signs of shock appear when blood loss excedes 15%, or 750 mls (120 mls for infants). When the body suffers shock, the brain stem compensates with a combination of responses:
- Increasing heart and breathing (respiratory) rates to maximise blood oxygenation
- Constriction of the blood vessels to maintain blood pressure. This diverts blood away from teh skin, muscles, stomach and intestines to the vital organs such as heart, kidneys, and brain.
Signs and Symptoms of Shock
- Breathing rate and depth increase to supply more oxygen to the body
- Pulse rate increases and becomes more rapid and weak as shock progresses
- Pale, cool and moist (clammy) skin
- The skin will become blue (cyanosed) as oxygen supply decreases
- Blood pressure drops, heart and breathing rates try to increase
- Nausea and or vomiting
- Patient complains of excessive thirst
- Muscle weakness, due to poor flow of blood to the muscles
- Anxiety, restlessness and fainting due to the lack of oxygen to the brain
- Decreasing consciousness ending in unconsciousness
- Breathing failure due to hypoxia of the control center and muscles of respiration
- Heart failure due to a slowing, irregular and or chaotic pulse
- Loss of pulse and respiratory failure results in death
Normal Patient:
- Pulse: 60-80
- Skin Colour: Pale
- Skin Temperature: Warm
- Conscious state: Conscious, alert, responding
- Respiration: 12-14 Quiet Shallow
Early Shock
- Pulse: >100 increasing
- Skin Colour: Normal/Pink
- Skin Temperature: Cool, Moist
- Conscious State: Conscious, alert, responding
- Respiration: Increasing in rate (>20) and depth
Late Shock
- Pulse: Rapid >120 and weak (or no pulse)
- Skin Colour: Pale, cyanosed
- Skin temperature: Cold
- Conscious state: Unconscious
- Respiration: Increase in rate >30 or <6-8 breaths/minute or no breathing.
Treatment of Shock
In emergency, the only cause of shock that can be effectively treated by the First Aider is external bleeding and the patient who has simply fainted. While waiting for assistance, the First Aider can minimise the factors that contribute to, or accelerate, the shock process such as anxiety and pain. Fire Aid assists in reducing the pain and physical effects of shock.
- Carry out DRABC
- Control bleeding immediately
- Arrange urgent medical/ambulance assistance
- Reassure the patient
- Rest the patient by laying or sitting them down, if possible in position of least pain.
- Perform the secondary survey and establish history
- Dress any wounds and treat burns
- Manage fractures, to reduce pain and internal bleeding
- Place the patient in the shock position by elevating the legs if not fractured
- Keep the patient comfortable and maintain body temperature but don't overheat.
- Loosed any tight clothing
- Provide oxygen therapy if it is available and you have been trained to administer it
- Monitor and record pulse, breathing, skin and conscious level at regular intervals
- Inform emergency services of all information about the incident and patient(s)
Showing posts with label First Aid. Show all posts
Showing posts with label First Aid. Show all posts
1/3/07
Haemorrhage Control
Source: Close, A. "Emergency Care", 2001.
Damage to any circulatory vessels (arteries, veins, capillaries) result in haemorrhage (bleeding). Bleeding can be of two types:
1) Internal Bleeding: Normally concealed inside the body and hard to detect, clues indicating internal bleeding may be the signs and symptoms of shock, pain, swelling, and tenderness. If suspected, patient needs treatment and hospitalisation.
2) External Bleeding: Easily found and can, in most circumstances, be controlled by the First Aider.
Types of Wounds
- Abrasions: shallow wound where bleeding presents as ooze due to capillary blood vessel damage. Abrasions are caused by sliding on rough surfaces that are contaminated by things such as gravel, dirt and sand.
- Laceration: an opening or cut in the body caused by blunt or sharp objects, such as a knife or chainsaw. Results in jagged uneven edges.
- Incision: similar to lacerations, but are the result of a sharp edged object cutting the skin. Results in a straight and clean wound.
- Penetrating Wound: wounds which have small openings through the skin and very little external bleeding. They may be misleading, however, as even though the wound is slight, it may be very deep. Puncture wounds are often the result of stabbings or shootings, but also include things such as nail guns, or flying fragments from explosions. Prompt medical attention is needed because of the high risk of surgical amputation due to infection and tissue damage.
- Amputation: where a part of the body is completely torn or cut away. If tissue still connects the stump to the amputated part, this is called partial amputation. The amputated part must be found and taken with the patient for reattachment.
- Avulsion: is where a flap of skin is torn or cut loose from the surrounding and underlying tissue. A common injury is caused by blunt trauma to the skull causing the scalp to be torn away in a large flap.
Control of Bleeding
- Ensure area is safe
- Protect yourself from blood with latex gloves
- Rest and reassure patient by lying or sitting them down
- Elevate and support the wound site above the height of the heart
- Sit the patient up slightly if they have a wound on the head
- Expose the wound: quickly, find the main bleeding point(s) and any foreign bodies
- Apply direct pressure to the site of the bleeding
- The patient can assist with this pressure by squeezing the wound edges together
- Apply sterile or clean dressing pad(s) and bandage firmly over the bleeding site, tight enough to stop the flow of blood and allow clotting, but not enough to restrict circulation
- Check the circulation below the wound site
If the bleeding is not controlled by the first pressure dressing:
- Increase the elevation and apply additional pad(s) and bandage(s) over the bleeding site.
If the initial pressure dressings are not stopping the bleeding they may need repositioning.
- Maintain elevation then reapply direct and indirect pressure whilst the bandage is removed
- Inspect the wound and reposition the bandage to provide the best pressure on the bleeding site
- Reapply the crepe bandage and support in an elevated position
- Check the circulation below the wound site
Control of Severe Bleeding
If bleeding is severe and still not controlled then consider the following:
- Apply indirect pressure to the artery supplying the site to reduce blood flow
- Elevate the wound site whilst applying initial or extra dressing pads and bandages
- Check the circulation beyong the wound site
- In extreme, uncontrollable bleeding such as shark bite, a tourniquet may be necessary
Control of Bleeding - Foreign Bodies
- Do not remove embedded objects from a wound. Removing the object may cause further tissue damage, dislodge blood clots and unseal blood vessels causing bleeding to increase
- Do not apply direct pressure over or to the object
- Foreign bodies if they are small and sitting on the surface may be brushed off with a sterile pad
- Pressure should be applied to the sides of the wound, holding the wound together
- Pad around the object to hold pressure on the wound edges and secure wiht a diagonal bandage
Control of Bleeding - Indirect Pressure
If the bleeding is not controlled by direct pressure, elevation and dressings, then pressure on the artery that supplies the bleeding area can be used, thus stopping blood flow at wound sites and allowing more time for more dressings and pressure.
Checking Circulation after Bandaging
The circulation check ensures that the pressure bandage has not stopped the blood flow to the area beyong the wound site. Checking distal pulses will indicate it. Other indicators are warmth, color of skin, numbness or tingling. Another test is "capillary refill" - squeeze the nail bed on the injured side and look for the speed of return of normal colour, then compare to the uninjured site. If blood flow has stopped at the wound site, the bandage will need to be loosened.
Amputations
Amputee patients will often loose a lot of blood and therefore present in shock - rapid pulse, pale clammy skin, rapid breathing and altered conscious state. When dealing with amputated body parts, handle them gently, place them in sealed airtight plastic bags and then in a container of iced water (the amputated part must not come in contact with the ice).
Nose Bleed (Epistaxis)
- Place the patient in a comfortable position, sitting down with head slightly forward
- Pinch the soft part of the nose together for 10 minutes
- Tell the patient to avoid blowing their nose
- Encourage the patient to spit the blood out. Swallowing it can cause vomiting.
- An ice pack may be used on the nose to assist in stopping the flow of blood.
Summary of Bleeding Control
To control bleeding the First Aider must act:
- Promptly, to prevent loss of blood and to minimise shock
- To stop blood flow at the injury site enabling clotting to take place (direct pressure, elevation and dressing)
- Carefully, to protect against contamination to the wound or the First Aider
- To consider other implications of the injury, for example, a fractured skull.
Damage to any circulatory vessels (arteries, veins, capillaries) result in haemorrhage (bleeding). Bleeding can be of two types:
1) Internal Bleeding: Normally concealed inside the body and hard to detect, clues indicating internal bleeding may be the signs and symptoms of shock, pain, swelling, and tenderness. If suspected, patient needs treatment and hospitalisation.
2) External Bleeding: Easily found and can, in most circumstances, be controlled by the First Aider.
Types of Wounds
- Abrasions: shallow wound where bleeding presents as ooze due to capillary blood vessel damage. Abrasions are caused by sliding on rough surfaces that are contaminated by things such as gravel, dirt and sand.
- Laceration: an opening or cut in the body caused by blunt or sharp objects, such as a knife or chainsaw. Results in jagged uneven edges.
- Incision: similar to lacerations, but are the result of a sharp edged object cutting the skin. Results in a straight and clean wound.
- Penetrating Wound: wounds which have small openings through the skin and very little external bleeding. They may be misleading, however, as even though the wound is slight, it may be very deep. Puncture wounds are often the result of stabbings or shootings, but also include things such as nail guns, or flying fragments from explosions. Prompt medical attention is needed because of the high risk of surgical amputation due to infection and tissue damage.
- Amputation: where a part of the body is completely torn or cut away. If tissue still connects the stump to the amputated part, this is called partial amputation. The amputated part must be found and taken with the patient for reattachment.
- Avulsion: is where a flap of skin is torn or cut loose from the surrounding and underlying tissue. A common injury is caused by blunt trauma to the skull causing the scalp to be torn away in a large flap.
Control of Bleeding
- Ensure area is safe
- Protect yourself from blood with latex gloves
- Rest and reassure patient by lying or sitting them down
- Elevate and support the wound site above the height of the heart
- Sit the patient up slightly if they have a wound on the head
- Expose the wound: quickly, find the main bleeding point(s) and any foreign bodies
- Apply direct pressure to the site of the bleeding
- The patient can assist with this pressure by squeezing the wound edges together
- Apply sterile or clean dressing pad(s) and bandage firmly over the bleeding site, tight enough to stop the flow of blood and allow clotting, but not enough to restrict circulation
- Check the circulation below the wound site
If the bleeding is not controlled by the first pressure dressing:
- Increase the elevation and apply additional pad(s) and bandage(s) over the bleeding site.
If the initial pressure dressings are not stopping the bleeding they may need repositioning.
- Maintain elevation then reapply direct and indirect pressure whilst the bandage is removed
- Inspect the wound and reposition the bandage to provide the best pressure on the bleeding site
- Reapply the crepe bandage and support in an elevated position
- Check the circulation below the wound site
Control of Severe Bleeding
If bleeding is severe and still not controlled then consider the following:
- Apply indirect pressure to the artery supplying the site to reduce blood flow
- Elevate the wound site whilst applying initial or extra dressing pads and bandages
- Check the circulation beyong the wound site
- In extreme, uncontrollable bleeding such as shark bite, a tourniquet may be necessary
Control of Bleeding - Foreign Bodies
- Do not remove embedded objects from a wound. Removing the object may cause further tissue damage, dislodge blood clots and unseal blood vessels causing bleeding to increase
- Do not apply direct pressure over or to the object
- Foreign bodies if they are small and sitting on the surface may be brushed off with a sterile pad
- Pressure should be applied to the sides of the wound, holding the wound together
- Pad around the object to hold pressure on the wound edges and secure wiht a diagonal bandage
Control of Bleeding - Indirect Pressure
If the bleeding is not controlled by direct pressure, elevation and dressings, then pressure on the artery that supplies the bleeding area can be used, thus stopping blood flow at wound sites and allowing more time for more dressings and pressure.
Checking Circulation after Bandaging
The circulation check ensures that the pressure bandage has not stopped the blood flow to the area beyong the wound site. Checking distal pulses will indicate it. Other indicators are warmth, color of skin, numbness or tingling. Another test is "capillary refill" - squeeze the nail bed on the injured side and look for the speed of return of normal colour, then compare to the uninjured site. If blood flow has stopped at the wound site, the bandage will need to be loosened.
Amputations
Amputee patients will often loose a lot of blood and therefore present in shock - rapid pulse, pale clammy skin, rapid breathing and altered conscious state. When dealing with amputated body parts, handle them gently, place them in sealed airtight plastic bags and then in a container of iced water (the amputated part must not come in contact with the ice).
Nose Bleed (Epistaxis)
- Place the patient in a comfortable position, sitting down with head slightly forward
- Pinch the soft part of the nose together for 10 minutes
- Tell the patient to avoid blowing their nose
- Encourage the patient to spit the blood out. Swallowing it can cause vomiting.
- An ice pack may be used on the nose to assist in stopping the flow of blood.
Summary of Bleeding Control
To control bleeding the First Aider must act:
- Promptly, to prevent loss of blood and to minimise shock
- To stop blood flow at the injury site enabling clotting to take place (direct pressure, elevation and dressing)
- Carefully, to protect against contamination to the wound or the First Aider
- To consider other implications of the injury, for example, a fractured skull.
1/2/07
Cardiac Arrest (ECC & CPR)
Source: Close, A. "Emergency Care", 2001.
Circulation has stopped (cardiac arrest) if:
- The patient is unconscious, not breathing and pulseless
- The skin is very pale or blue (cyanosed)
- The body looks limp and there is no movement
If there is no circulation start Cardio-Pulmonary Resuscitation (CPR).
Find Pulse
The carotid pulse is located in the neck. Place the first and second fingers of one hand on the patient's larynx "Adam's Apple". Slide the fingers gently to either side of the larynx into the notch between the patient's larynx and the large muscle at the side of the throat. Check for presence of the pulse for at least 10 seconds.
The radial pulse is located on the inside of the wrist, near the base of the thumb (do not use your thumb to check the pusle - it has a slight pulse that can be mistaken for the patient's).
In infants, the pulse best felt is the brachial pulse on the inside of the upper arm.
Assess Pulse
Assess rate per minute, normal is 60-18 beats per minute (rest), asess rhythm stability, and assess pulse strength (weak, normal or strong).
External Cardiac Compressions
If the heart is not pumping, its function needs to be replaced by the First Aider. This methodis known as External Cardiac Compression (ECC). The technique compresses the heart between the sternum and the spine as well as causing pressure changes within the chest cavity causing blood to flow through the circulatory system.
Locate Compression Position: Find the sternum (breastbone), and place heel of hand on the lower half of the sternum (closer to feet).
Technique - ECC - Adults:
- Grasp the wrist of the lower hand or link the fingers, one hand on top of the other
- Position your knees, slightly apart beside the patient to give good balance
- Straighten your arms and ensure shoulders are directly above hands
- Perform the first compression carefully to assess hardness or softness of the chest
- Compress the sternum 4 to 5 cm or 1/3 of the chests depth
- Do not lift your hands off the chest between compressions
- Continue compressions using your body weight and arms together by bending at the hops to efficiently perform the required rate and depth for that patient.
Technique - ECC - Infants/Children
- Locate the lower end and center line of the sternum, place two fingers and compress sternum 2 to 3 cm.
Cardio-Pulmonary Resuscitation
A person requires Cardio-Pulmonary Resuscitation (CPR) when they have suffered a cardiac arrest. This is when they are unconscious, not breathing and have no pulse. Some common causes of cardiac arrest are heart attack, electrocution, drug overdose, lack of oxygen, and severe bleeding. In order to provide resuscitation of a patient in cardiac arrest, EAR and ECC are combined to form CPR.
CPR = Expired Air Resuscitation + External Cardiac Compression
*CPR is only approximately 30% as effective as the patient's normal breathing and heartbeat, even when it is performed perfectly.
The Standards for performing CPR is 15:2 (15 chest compressions to 2 breaths). This should be repeated 4 times every minute, ending with 60 compressions and 8 breaths (a minimum for survival).
How To Perform CPR
The First Aider performs both the EAR and ECC after delivering the first 5 breaths:
- Start ECC with 15 compressions (within 10 seconds)
- Provide 2 breaths (within 5 seconds)
- Deliver four cycles of 15:2, then check the ABC's, and repeat again, checking then after 2 minutes of CPR.
*Children: 5:1 (within 3 seconds), 20 times a minute.
*Pregnancy: remove weight of the baby off the abdominal aorta by "Placing sufficient padding under the right buttock to give an obvious pelvic tilt to the left".
When to Stop CPR
CPR may be discontinued when:
- The patient recovers, OR
- Medical or ambulance assistance arrives, OR
- The patient is pronounced dead by a doctor, OR
- The area where the patient is becomes unsafe, OR
- You are physically or emotionally unable to continue.
Note - Remember attempts to resuscitate a person are not always successful. The important thing is to have a go, and give the patient a chance at survival. Therefore, you should not blame yourself if your resuscitation attempt is unsuccessful.
Circulation has stopped (cardiac arrest) if:
- The patient is unconscious, not breathing and pulseless
- The skin is very pale or blue (cyanosed)
- The body looks limp and there is no movement
If there is no circulation start Cardio-Pulmonary Resuscitation (CPR).
Find Pulse
The carotid pulse is located in the neck. Place the first and second fingers of one hand on the patient's larynx "Adam's Apple". Slide the fingers gently to either side of the larynx into the notch between the patient's larynx and the large muscle at the side of the throat. Check for presence of the pulse for at least 10 seconds.
The radial pulse is located on the inside of the wrist, near the base of the thumb (do not use your thumb to check the pusle - it has a slight pulse that can be mistaken for the patient's).
In infants, the pulse best felt is the brachial pulse on the inside of the upper arm.
Assess Pulse
Assess rate per minute, normal is 60-18 beats per minute (rest), asess rhythm stability, and assess pulse strength (weak, normal or strong).
External Cardiac Compressions
If the heart is not pumping, its function needs to be replaced by the First Aider. This methodis known as External Cardiac Compression (ECC). The technique compresses the heart between the sternum and the spine as well as causing pressure changes within the chest cavity causing blood to flow through the circulatory system.
Locate Compression Position: Find the sternum (breastbone), and place heel of hand on the lower half of the sternum (closer to feet).
Technique - ECC - Adults:
- Grasp the wrist of the lower hand or link the fingers, one hand on top of the other
- Position your knees, slightly apart beside the patient to give good balance
- Straighten your arms and ensure shoulders are directly above hands
- Perform the first compression carefully to assess hardness or softness of the chest
- Compress the sternum 4 to 5 cm or 1/3 of the chests depth
- Do not lift your hands off the chest between compressions
- Continue compressions using your body weight and arms together by bending at the hops to efficiently perform the required rate and depth for that patient.
Technique - ECC - Infants/Children
- Locate the lower end and center line of the sternum, place two fingers and compress sternum 2 to 3 cm.
Cardio-Pulmonary Resuscitation
A person requires Cardio-Pulmonary Resuscitation (CPR) when they have suffered a cardiac arrest. This is when they are unconscious, not breathing and have no pulse. Some common causes of cardiac arrest are heart attack, electrocution, drug overdose, lack of oxygen, and severe bleeding. In order to provide resuscitation of a patient in cardiac arrest, EAR and ECC are combined to form CPR.
CPR = Expired Air Resuscitation + External Cardiac Compression
*CPR is only approximately 30% as effective as the patient's normal breathing and heartbeat, even when it is performed perfectly.
The Standards for performing CPR is 15:2 (15 chest compressions to 2 breaths). This should be repeated 4 times every minute, ending with 60 compressions and 8 breaths (a minimum for survival).
How To Perform CPR
The First Aider performs both the EAR and ECC after delivering the first 5 breaths:
- Start ECC with 15 compressions (within 10 seconds)
- Provide 2 breaths (within 5 seconds)
- Deliver four cycles of 15:2, then check the ABC's, and repeat again, checking then after 2 minutes of CPR.
*Children: 5:1 (within 3 seconds), 20 times a minute.
*Pregnancy: remove weight of the baby off the abdominal aorta by "Placing sufficient padding under the right buttock to give an obvious pelvic tilt to the left".
When to Stop CPR
CPR may be discontinued when:
- The patient recovers, OR
- Medical or ambulance assistance arrives, OR
- The patient is pronounced dead by a doctor, OR
- The area where the patient is becomes unsafe, OR
- You are physically or emotionally unable to continue.
Note - Remember attempts to resuscitate a person are not always successful. The important thing is to have a go, and give the patient a chance at survival. Therefore, you should not blame yourself if your resuscitation attempt is unsuccessful.
Expired Air Resuscitation (EAR)
Source: Close, A. "Emergency Care", 2001.
EAR is used by the First Aider when the patient is either not breathing or not breathing adequately (only 6-8 times per minute, or very shallow - poor volume). The First Aider uses his or her own expired air or breath to provide air to the patient. EAR includes mouth to mouth, mouth to mouth and nose, and mouth to stoma.
Technique - EAR - Adults
- Use a protective mask or face shield if available
- Place the patient on their back
- Apply head tilt and jaw support according to age and size
- Take a breath in and place your mouth over the patient's open mouth
- Seal the patient's nostril with your cheeck or by pinching with your thumb and forefinger
- Give 5 breaths in 10 seconds
- Check for the chest falling and feel air exhale from the mouth between breaths
- Check for a pulse and signs of perfusion (nutritive delivery to arterial blood)
If a pulse is present, then continue to:
- Deliver 15 breaths per minute, this is one breath every 4 seconds
- Watch for the chest rise and fall with each breath
- Check for return of breathing and/or pulse after 1 minute and then 2 minutely intervals after that
- Lift your mouth away to avoid the patient's exhale of stale air
- Breathing too hard into the patient may force air into the stomach, causing it to swell
- Do not apply pressure to the stomach, this will cause regurgitation.
If there is no chest movement, check the airway, head tilt and your EAR technique.
If there is still no air entry, then treat for airway obstruction (chocking).
If an unconscious patient is breathing, check for pulse.
If a pulse is not present, commence Cardio-Pulmonary Resusciation (CPR)
If an unconscious patient stops breathing at any time roll them onto their back and administer 5 full quick breaths, then continue EAR at 15 breaths per minute. If there is no pulse, commence CPR.
If the patient is breathing inadequately: match patient's breath with your breath to improve the volume of air inhaled into the lungs.
*EAR on infants and children must be modified: gentle breaths (puffs) - only enough to make their chest rise. Do not apply head tilt for infants (keep it straight, unless there is any resistance to first puffs). As children grow older and larger, more head tilt may be needed.
EAR RATES:
Adult: Maximum or slight head tilt, jaw support, 5 breaths to start, 1 full breath every 4 seconds, 15 breaths per minute.
Child: Slight head tilt, slight jaw support, 5 small breaths to start, 1 gentle breath each 3 seconds, 20 breaths per minute.
Infant: No head tilt, slight jaw support, 5 puffs to start, 1 puff each 3 seconds, 20 breaths per minute.
EAR is used by the First Aider when the patient is either not breathing or not breathing adequately (only 6-8 times per minute, or very shallow - poor volume). The First Aider uses his or her own expired air or breath to provide air to the patient. EAR includes mouth to mouth, mouth to mouth and nose, and mouth to stoma.
Technique - EAR - Adults
- Use a protective mask or face shield if available
- Place the patient on their back
- Apply head tilt and jaw support according to age and size
- Take a breath in and place your mouth over the patient's open mouth
- Seal the patient's nostril with your cheeck or by pinching with your thumb and forefinger
- Give 5 breaths in 10 seconds
- Check for the chest falling and feel air exhale from the mouth between breaths
- Check for a pulse and signs of perfusion (nutritive delivery to arterial blood)
If a pulse is present, then continue to:
- Deliver 15 breaths per minute, this is one breath every 4 seconds
- Watch for the chest rise and fall with each breath
- Check for return of breathing and/or pulse after 1 minute and then 2 minutely intervals after that
- Lift your mouth away to avoid the patient's exhale of stale air
- Breathing too hard into the patient may force air into the stomach, causing it to swell
- Do not apply pressure to the stomach, this will cause regurgitation.
If there is no chest movement, check the airway, head tilt and your EAR technique.
If there is still no air entry, then treat for airway obstruction (chocking).
If an unconscious patient is breathing, check for pulse.
If a pulse is not present, commence Cardio-Pulmonary Resusciation (CPR)
If an unconscious patient stops breathing at any time roll them onto their back and administer 5 full quick breaths, then continue EAR at 15 breaths per minute. If there is no pulse, commence CPR.
If the patient is breathing inadequately: match patient's breath with your breath to improve the volume of air inhaled into the lungs.
*EAR on infants and children must be modified: gentle breaths (puffs) - only enough to make their chest rise. Do not apply head tilt for infants (keep it straight, unless there is any resistance to first puffs). As children grow older and larger, more head tilt may be needed.
EAR RATES:
Adult: Maximum or slight head tilt, jaw support, 5 breaths to start, 1 full breath every 4 seconds, 15 breaths per minute.
Child: Slight head tilt, slight jaw support, 5 small breaths to start, 1 gentle breath each 3 seconds, 20 breaths per minute.
Infant: No head tilt, slight jaw support, 5 puffs to start, 1 puff each 3 seconds, 20 breaths per minute.
Care for the Unconscious
Source: Close, A. "Emergency Care", 2001.
Unconsciousness
For a patient to be considered "Conscious", and therefore in complete control of their airway, three things need to be present:
- The eyes to open together and their movement controlled
- The ability to speak coherently and know who and where they are in time and place
- The ability to perform a task on command, such as squeezing the First Aider's hand.
Unconsciousness can be caused by many things:
1). Lack of Oxygen, due to:
a). Airway blockage by blood, food, vomit or drowning.
b). Breathing problems such as suffocation, asthma, smoke and gas inhalation
c). Circulation problems such as heart stopped or blood loss
2). Medical, due to diabetes, stroke, seizure, fainting, poisoning, or drug overdose.
3). Trauma, due to head injury, electric shock, snake bite, hyper or hypothermia.
A danger in unconscious patients is the loss of protective mechanisms, such as gagging, coughing, swallowing and moving. Therefore, an unconscious person on the floor may block their airway with their tongue, mucus, blood or food. The generalized loss of muscle control may also result in passive vomiting of the stomach contents (acidic matter). This happens when the stomach relaxes (opening the sphincter). The stomach contents flow the wrong way along the oesophagus (food pipe). The vomit can cover the airway and be drawn into the lungs. This is called aspiration and can cause serious lung damage or death. If the airway is not kept clear the patient will die.
Resuscitation
- The Lateral Recovery Position: is a simple but lifesaving manoeuvre that assists in clearing the airway by causing the jaw and tongue to fall forward. Blood, vomit and other fluid can then drain out, preventing blockage. Basically, you place the patient's arm across his chest to where he will turn, bend the knee on the same side and also push it across. Finally, you tilt the jaw and put the patient's arm beneath it to stabilize. Beware of any injuries that may counter-indicate movement as such.
- Airway Cleaning: to clean the airway (from food or other) use the "finger swipe" approach. Tilt the head back, support the lower jaw, and open the mouth. Look inside, and use finger sweeps (2 fingers) to clear objects from the front of the mouth. Leave dentures in place, unless broken or loose. Becareful the patient doesn't bite you.
- Breathing: Normal breathing occurs between 12 and 20 times per minute whilst at rest. Noisy breathing is a sign that the airway is no longer completely clear. Vomit, blood or other fluid can block the upper airway or can be inhaled (aspirated) into the lung.
Technique to check breathing: Place the palm of your hand on the patient's 'lower chest, upper stomach' area and your face close to the patient's mouth and nose. From this position:
a) Look for the rise and fall of the patient's chest
b) Listen for breathing sounds at the mouth and nose
c) Feel for the rise and fall of the patient's chest (diaphragm) with your hand; as well feel for the air exhaled from the patient's mouth and nose with the side of your face.
If the patient is either not breathing or not breathing adequately (only 6-8 times per minute, or very shallow - poor volume), the First Aider should commence Expired Air Resuscitation (EAR -see following blog)
If the patient's circulation has stopped (patient is unconscious, not breathing, pulseless, with blue skin and cyanosed, and the body looks limp and is not moving) start Cardio-Pulmonary Resuscitation (CPR - see following blog).
Unconsciousness
For a patient to be considered "Conscious", and therefore in complete control of their airway, three things need to be present:
- The eyes to open together and their movement controlled
- The ability to speak coherently and know who and where they are in time and place
- The ability to perform a task on command, such as squeezing the First Aider's hand.
Unconsciousness can be caused by many things:
1). Lack of Oxygen, due to:
a). Airway blockage by blood, food, vomit or drowning.
b). Breathing problems such as suffocation, asthma, smoke and gas inhalation
c). Circulation problems such as heart stopped or blood loss
2). Medical, due to diabetes, stroke, seizure, fainting, poisoning, or drug overdose.
3). Trauma, due to head injury, electric shock, snake bite, hyper or hypothermia.
A danger in unconscious patients is the loss of protective mechanisms, such as gagging, coughing, swallowing and moving. Therefore, an unconscious person on the floor may block their airway with their tongue, mucus, blood or food. The generalized loss of muscle control may also result in passive vomiting of the stomach contents (acidic matter). This happens when the stomach relaxes (opening the sphincter). The stomach contents flow the wrong way along the oesophagus (food pipe). The vomit can cover the airway and be drawn into the lungs. This is called aspiration and can cause serious lung damage or death. If the airway is not kept clear the patient will die.
Resuscitation
- The Lateral Recovery Position: is a simple but lifesaving manoeuvre that assists in clearing the airway by causing the jaw and tongue to fall forward. Blood, vomit and other fluid can then drain out, preventing blockage. Basically, you place the patient's arm across his chest to where he will turn, bend the knee on the same side and also push it across. Finally, you tilt the jaw and put the patient's arm beneath it to stabilize. Beware of any injuries that may counter-indicate movement as such.
- Airway Cleaning: to clean the airway (from food or other) use the "finger swipe" approach. Tilt the head back, support the lower jaw, and open the mouth. Look inside, and use finger sweeps (2 fingers) to clear objects from the front of the mouth. Leave dentures in place, unless broken or loose. Becareful the patient doesn't bite you.
- Breathing: Normal breathing occurs between 12 and 20 times per minute whilst at rest. Noisy breathing is a sign that the airway is no longer completely clear. Vomit, blood or other fluid can block the upper airway or can be inhaled (aspirated) into the lung.
Technique to check breathing: Place the palm of your hand on the patient's 'lower chest, upper stomach' area and your face close to the patient's mouth and nose. From this position:
a) Look for the rise and fall of the patient's chest
b) Listen for breathing sounds at the mouth and nose
c) Feel for the rise and fall of the patient's chest (diaphragm) with your hand; as well feel for the air exhaled from the patient's mouth and nose with the side of your face.
If the patient is either not breathing or not breathing adequately (only 6-8 times per minute, or very shallow - poor volume), the First Aider should commence Expired Air Resuscitation (EAR -see following blog)
If the patient's circulation has stopped (patient is unconscious, not breathing, pulseless, with blue skin and cyanosed, and the body looks limp and is not moving) start Cardio-Pulmonary Resuscitation (CPR - see following blog).
Emergency Action Plan
Information taken from Close, A. "Emergency Care", 2001.
The Primary Survey
Dangers Is it safe to proceed or is further assistance needed? (Fire, water, traffic, etc)
Response Is the patient conscious or need to be in the Lateral Recovery Position?
Airway Is the airway clear or does it need clearing (via finger swipe)?
Breathing Is the patient breathing or is Expired Air Resuscitation needed?
Circulation If no pulse or adequate circulation, then start resuscitation
Damage Check the whole body for damage and control severe bleeding
Emergency Assistance Call for help at the earliest time possible in the primary survey
The Secondary Survey
Determines and treats systematically the other significant problems the patient has by:
- Assessing the seriousness of the patient's illness or injury
- Treating significant injuries, all types of shock and other problems
- Reviewing what has been done and revising treatment if needed
- Handover to the emergency service Paramedics, a Doctor or Nurse
Calling For Help (In Australia only)
Emergency Service (Police, Fire, Ambulance) 000
Royal Flying Doctor Service (RFDS) in your region 000
Poisons Information Centre (Australia wide) 13 11 26
Australia and Asia Diving Emergency DES/DAN 1800-088200
International Diving Emergencies DES 61 8 8212 9242
Australian Venom Research Unit 03 9483 8204
Calling 000
"Triple O" or 000 is Australia's equivalent of 911. When you call it, a Telstra operator will answer the phone and ask "Do you require Police, Fire or Ambulance?" The operator may also ask your location, and then connect you to your choice of service located nearest to your position, who will ask a series of questions in attempt to illuminate the situation.
The Primary Survey
Dangers Is it safe to proceed or is further assistance needed? (Fire, water, traffic, etc)
Response Is the patient conscious or need to be in the Lateral Recovery Position?
Airway Is the airway clear or does it need clearing (via finger swipe)?
Breathing Is the patient breathing or is Expired Air Resuscitation needed?
Circulation If no pulse or adequate circulation, then start resuscitation
Damage Check the whole body for damage and control severe bleeding
Emergency Assistance Call for help at the earliest time possible in the primary survey
The Secondary Survey
Determines and treats systematically the other significant problems the patient has by:
- Assessing the seriousness of the patient's illness or injury
- Treating significant injuries, all types of shock and other problems
- Reviewing what has been done and revising treatment if needed
- Handover to the emergency service Paramedics, a Doctor or Nurse
Calling For Help (In Australia only)
Emergency Service (Police, Fire, Ambulance) 000
Royal Flying Doctor Service (RFDS) in your region 000
Poisons Information Centre (Australia wide) 13 11 26
Australia and Asia Diving Emergency DES/DAN 1800-088200
International Diving Emergencies DES 61 8 8212 9242
Australian Venom Research Unit 03 9483 8204
Calling 000
"Triple O" or 000 is Australia's equivalent of 911. When you call it, a Telstra operator will answer the phone and ask "Do you require Police, Fire or Ambulance?" The operator may also ask your location, and then connect you to your choice of service located nearest to your position, who will ask a series of questions in attempt to illuminate the situation.
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