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Organization of emergency and urgent medical care.The initial and secondary survey. Cardiopulmonary resuscitation. Doctor. Medical assistant 1. Driver. Medical assistant 2. How to approach the injured person. Primary examination. - PowerPoint PPT PresentationTRANSCRIPT
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Organization of emergency and urgent medical care.The initial and secondary survey.
Cardiopulmonary resuscitation
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Doctor
Medical assistant 1
Medical assistant 2
Driver
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How to approach the injured person
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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.
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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
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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).
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…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
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Stage 1. Organization of the emergency team.Stage 1. Organization of the emergency team.
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Patency of airways supportPatency of airways support
Suction units (aspirators)
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Patency of airways supportPatency of airways support
Respiratory mask
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Patency of airways supportPatency of airways support
Laryngeal mask
Laryngeal tube
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Patency of airways supportPatency of airways support
laryngeal tubes
laryngeal tubes
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Patency of airways supportPatency of airways support
Combitube
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Patency of airways supportPatency of airways support
Respiratory mask and Ambu bag
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Patency of airways supportPatency of airways support
A set for conicopuncture
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Portable set of respiratory equipmentPortable set of respiratory equipment
Support of artificial ventilation of lungs
Oxygen therapy
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Training equipment for developing skills of patency of airways support
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,
Intubation-10-15 sec.
Patency of airways supportPatency of airways support
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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.
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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).
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“Quick evaluation ”Taking electrodes, classic, self-adhesive electrodes.
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Algorithm of providing help
and examination for the patient
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Category "Load and Go"after primary examination
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Wheelcouch/barrow
A chair for immobilization and transportation
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Hard shield
Soft stretchers
Frame stretchers
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Neck Collar
Pectoral immobilization
waistcoatVacuum splints
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Cramer’s Splints
Elastic splint type Sam Splint
Elastic splint type Sam Splint
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Respiratory Ambu-bag with a mask,
air-channels/providers, a hose for the serve
A portable apparatus of ventilation with balloon of oxygen
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A set for conicо puncture
Laryngoscope with attachments of different size
Hand suction-fan
Foot suction-fan
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Electrosuction-fan
Cardiocomplex
Pulsoxymeter, located on the finger of patient
Medical bag for transference of medical property and medicines
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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.
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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.
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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).
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Terminal state is divided into several stages:
1. Preagony 2. Terminal pause 3. Agony 4. Clinical death
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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
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First stage of resuscitation - provision of first aid ( basic life support).
First step – maintenance of airway patency.
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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
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Precardiac stroke
• Immediate treatment of observed and monitored circulatory arrest in VF/VT
• Perform, if defibrillator is unavailable
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Chest compressions• 30:2 • depth 4-5 сm• 100 min-1
• “center of chest”
• Avoid
• Exhaustion
• Breaks
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“Quick Evaluation”Conduct ECG , classic electrodes, self adhesive electrodes.
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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.
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Rhythms prior to defibrillation
(VF/VT)
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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
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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)
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Rhythm not before defibrillation Asystole/PEA
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Asystole/РЕА
During CPR:• Check for electrode connection• Adrenalin 1 mg i. v. every 3-5 min.• Rule out/ treatable condition
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Potentially treatable conditions:•Hypoxia•Hypovolemia•Hypo/hyperkalemia and metabolic disruptions •Hypothermia•Tension pneumothorax •Тamponade (Pericardial)•Тoxins•Тhromboembolism (coronary or pulmonary)
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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
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Summary
• Algorithm ALS standardizes a way of treatment of circulatory arrest in adults
• Allows to increase effectiveness of treatment.
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Thank Thank you for you for
attention!attention!