doctor

Organization of emergency and urgent medical care.The initial and secondary survey.

Cardiopulmonary resuscitation

Doctor

Medical assistant 1

Medical assistant 2

Driver

How to approach the injured person

Primary examination

Figure out the condition of consciousness according to the algorithm AVPU:A – Alert (conscious, gives adequate answers to the questions, is able to

perform conscious actions when asked by the medical rescuer);V – Responds to Verbal stimuli (to a loud sound near the ear);

P– Responds to Pain (responds to pinch in the area of left thoracic muscle at the turn of 180 degrees); U – Unresponsive.If there is a suspicion of simulation of unconsciousness, open patient’s eyelids, using 1st and 2nd fingers. The conscious patient will strain his/her eyelids muscles and they will open with tension.

Let’s make a priori assumption that cerebral trauma occurs at transport accidents, sports accidents, falling from high places, traumas in water and children’s traumas.

Primary examination

Primary examinationFix with your hands a neck part of the spine in the

position which you found the injured in. (medical assistant 1)

If that position does not promote breathing, carefully turn the injured on his/her back or to the position, which is close to a stable (on his/her side) (medical assistant 1 + medical assistant 2).

Start initial examination according to the A, B, C technique (optimal term of performance – 10 sec) (doctor)

Step AProvide patency of airways support (medical assistant

1).

…to confirm or oppose the circulatory arrest.

• Patient’s response• Provide patency of

airways support• Check respiration and

pulse (not more than 10 sec)

Provide patency of airways support, find out if there are signs of life

Stage 1. Organization of the emergency team.Stage 1. Organization of the emergency team.

Patency of airways supportPatency of airways support

Suction units (aspirators)

Patency of airways supportPatency of airways support

Respiratory mask

Patency of airways supportPatency of airways support

Laryngeal mask

Laryngeal tube

Patency of airways supportPatency of airways support

laryngeal tubes

laryngeal tubes

Patency of airways supportPatency of airways support

Combitube

Patency of airways supportPatency of airways support

Respiratory mask and Ambu bag

Patency of airways supportPatency of airways support

A set for conicopuncture

Portable set of respiratory equipmentPortable set of respiratory equipment

Support of artificial ventilation of lungs

Oxygen therapy

Training equipment for developing skills of patency of airways support

,

Intubation-10-15 sec.

Patency of airways supportPatency of airways support

Primary examination

Step B. Make sure if the patient is breathing. Step B. Make sure if the patient is breathing. Count the frequency of respiration during Count the frequency of respiration during 10 sec.10 sec.

Primary examination

Step C.At the same time find out if there is pulse in the

carotid artery (during 10 sec) (in case the patient is unconscious). (doctor)

If there is not – start doing closed chest-cardiac massage (doctor, while medical assistant 2 is preparing cardiomonitor and defibrillator) with frequency of 100 times per minute – 30 pressures on the chest and 2 ventilations (medical assistant 1). Simultaneously, connect electrodes of cardiomonitor, link it up and find out the reason of cardiac arrest (medical assistant 2).

“Quick evaluation ”Taking electrodes, classic, self-adhesive electrodes.

Algorithm of providing help

and examination for the patient

Category "Load and Go"after primary examination

Wheelcouch/barrow

A chair for immobilization and transportation

Hard shield

Soft stretchers

Frame stretchers

Neck Collar

Pectoral immobilization

waistcoatVacuum splints

Cramer’s Splints

Elastic splint type Sam Splint

Elastic splint type Sam Splint

Respiratory Ambu-bag with a mask,

air-channels/providers, a hose for the serve

A portable apparatus of ventilation with balloon of oxygen

A set for conicо puncture

Laryngoscope with attachments of different size

Hand suction-fan

Foot suction-fan

Electrosuction-fan

Cardiocomplex

Pulsoxymeter, located on the finger of patient

Medical bag for transference of medical property and medicines

Resuscitation should be viewed as a protest against ungrounded death. A belief in true sense of human longevity and the importance to maintain human life.

Scientist V.А. Nehovsky

One of the most important tasks of becoming a physician is to acquire the skill of cardio-pulmonary-cerebral resuscitation, which allows to renew vital functions of life.

Resuscitation should be viewed as a protest against ungrounded death. A belief in true sense of human longevity and the importance to maintain human life.

Scientist V.А. Nehovsky

One of the most important tasks of becoming a physician is to acquire the skill of cardio-pulmonary-cerebral resuscitation, which allows to renew vital functions of life.

Intensive therapy– a complex of temporary methods of artificial maintenance of vital life functions in decompensated stages, which is directed to provision of life support.

Resuscitology – study about revival of the organism; prophylaxis and treatment of terminal stages. ( according to V.А. Nehovsky).

Terminal state is divided into several stages:

1. Preagony 2. Terminal pause 3. Agony 4. Clinical death

Main signs of clinical death:Absence of pulsation on magistral arteries (carotid and femoral),Pupils are fixed and dilated, non-reactive to light,Absence of independent breathing.

Additional signs :Change in skin colour (grey or cyanotic),Absence of consciousness,Absence of reflexes and loss of muscle tone

First stage of resuscitation - provision of first aid ( basic life support).

First step – maintenance of airway patency.

Maintain airway patencyEvaluate sings of circulation

Call resuscitation

team

Confirmed ceasing of blood circulation

CPR 30:2Up to the point of

hooking up a defibrillator/monitor

Precardiac stroke

• Immediate treatment of observed and monitored circulatory arrest in VF/VT

• Perform, if defibrillator is unavailable

Chest compressions• 30:2 • depth 4-5 сm• 100 min-1

• “center of chest”

• Avoid

• Exhaustion

• Breaks

“Quick Evaluation”Conduct ECG , classic electrodes, self adhesive electrodes.

CPR 30:2Until defibrillator/monitor is hooked up

Evaluation of rhythm

To defibrillation(VF/VT without pulse)

No defibrillation (PEA/ asystole)

1 Defibrillation150-360 J Biphasic

or 360 J Monophasic

Provision of airway patency Determination of signs of life

Immediately start CPR 30:2

2 min.

Call resuscitation team

During CPR:•Rule out problems that can be corrected •Check placement and function of electrodes •Check: IV availability airway patency and oxygen •After airway support conduct chest compressions continuously•Inject adrenalin every 3-5 mins.•Choose: amiodarone, atropine, magnesium

Immediately startCPR 30:2

2 min.

Rhythms prior to defibrillation

(VF/VT)

First defibrillation• 150 - 200 J biphasic•

Evaluate rhythm

Prior to defibrillation (VF/VT without

pulse)

1 Defibrillation150 J biphasic

Immediate CPR 30:2

2 min

After performing defibrillation

•Continue CPR for the next 2 min

•Stop CPR only when patient has signs of circulation

•Defibrillation – priority

•Adrenalin 1 mg

•Аmiodarone 300 mg (post 3)

Rhythm not before defibrillation Asystole/PEA

Asystole/РЕА

During CPR:• Check for electrode connection• Adrenalin 1 mg i. v. every 3-5 min.• Rule out/ treatable condition

Potentially treatable conditions:•Hypoxia•Hypovolemia•Hypo/hyperkalemia and metabolic disruptions •Hypothermia•Tension pneumothorax •Тamponade (Pericardial)•Тoxins•Тhromboembolism (coronary or pulmonary)

During CPR:• Rule out potentially treatable

conditions• Check placement of electrodes• Check: IV availability Airway patency and oxygen • After maintenance of airway patency

conduct continuous chest compressions• Inject adrenalin every 3-5 mins.• Choose : Amiodarone, atropine,

magnesium

Summary

• Algorithm ALS standardizes a way of treatment of circulatory arrest in adults

• Allows to increase effectiveness of treatment.

Thank Thank you for you for

attention!attention!