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(PART-II)First Aid
and Emergency
Care
Professor Dr Anil Ohri
Learning Objectives
 Chocking
 Fainting
 Heart
attack.
 Haemorrhage.
 Shock.
 Fractures
CHOCKING-I




Foreign object lodged in the throat or windpipe, blocking the flow
of air. In adults piece o fFood. Young children -swallow small
objects.
Effects: cuts off oxygen to the brain
First Aid: Quick.
Sign:Hands clutched to the throat
Inability to talk
Difficulty breathing or noisy breathing
Inability to cough forcefully
Skin, lips and nails turning blue or dusky
Loss of consciousness
CHOCKING Contd:

Red Cross recommends a "five-andfive“ :
Give 5 back blows. First, deliver five back blows
between the person's shoulder blades with the heel of
your hand.


Give 5 abdominal thrusts. Perform five abdominal
thrusts (also known as the Heimlich maneuver).
Alternate between 5 blows and 5 thrusts until the
blockage is dislodged.
CHOCKING –For Unconscoius
Person

Lower the person on his or her back onto the floor.

Clear the airway. Be careful not to push the food or
object deeper into the airway, which can happen
easily in young children.

Begin cardiopulmonary resuscitation (CPR) object
remains lodged and the person doesn't respond after.
The chest compressions used in CPR may dislodge the
object. Remember to recheck the mouth periodically.
CHOCKING-Child Less Than One
Year

Assume a seated position and hold the infant
facedown on your forearm, which is resting on your thigh.

Thump the infant gently but firmly five times on the middle of
the back using the heel of your hand. The combination of gravity and the
back blows should release the blocking object.

Hold the infant faceup on your forearm with the head lower
than the trunk if the above doesn't work. Using two fingers placed at the
center of the infant's breastbone, give five quick chest compressions.

Repeat the back blows and chest thrusts if breathing
doesn't resume. Call for emergency medical help.

Begin infant CPR if one of these techniques opens the airway but
the infant doesn't resume breathing.
FAINTINGFainting -Blood supply to the brain is
momentarily inadequate, causing you to
lose consciousness(Brief),
 No medical significance.
 But Investigate to rule out Any
 An emergency.

FAINTING-Contd

Lie down or sit down.
Place your head between your knees
If someone else faints

Position the person on his or her back. person is


breathing, raising the person's legs above heart level — about 12
inches (30 centimeters) Loosen belts, collars or other constrictive
clothing


Check the person's airway to be sure it's clear. Watch for
vomiting.
Check for signs of circulation (breathing, coughing
or movement).
If absent, begin CPR.
Cardiac Emergency - Heart Attack
Clinical Manifestations
Clinical Manifestations
Chest pain my have
radiation of pain to
back, jaw, or left arm.
 Palpitation.
 Dyspnea.
 Diaphoresis.
 Dizziness.


Weakness.
 Elevated BP and HR.
later, BP may drop.
 Nausea and vomiting
 cool and clammy skin
(cold sweats).
 Fever.
Cardiac Emergency - Heart Attack
Rapid Assessment
1. Is the patient’s airway patent?
a. The airway is patent when speech is clear and no
noise is associated with breathing.
b. If the airway is not patent, consider cleaning the
mouth and placing an airway.
2. Is the patient's breathing effective?
a. Breathing effective.....the skin color normal,
capillary refill is < 2 second.
b. If breathing is not effective, consider O2
administration.
Cardiac Emergency - Heart Attack
Rapid Assessment Cont.
1.



Is the patient’s circulation effective?
a. Circulation is effective when the radial pulse is
present and the skin is warm and dry.
b. If circulation is not effective, consider:Placing the patient in the recumbent position.
Establish IV access.
Giving a 2oo ml fluid bolus.
Cardiac Emergency - Heart Attack
Initial assessment and intervention
1.
Ask the patient to undress, remove all jewellery, put on
gown.
1.
Get vital signs include pulse oximetry, or test capillary
refill.
a. Institute continuous heart monitoring, and non
invasive blood pressure monitoring.
b. Document the initial heart monitor strip and
document changes of rhythm.
Cardiac Emergency - Heart Attack
Initial assessment and intervention Cont.
3. Place on oxygen at 4 litres by nasal cannula.
4. Assure the patient that he is safe.
5. Perform a focused physical examination
a. Auscultate the lung.
b. Listen to heart sound.
c. Inspect for peripheral oedema.
6. Evaluate the level of consciousness to use as a baseline.
Cardiac Emergency - Heart Attack
Initial assessment and intervention Cont.
6. Establish intravenous access, hang normal saline and
draw laboratory blood specimens.
7. Initiate any medications covered under nurse or
paramedic initiated hospital protocol.
8. Initiate any diagnostic test e.g., ECG, laboratory studies,
chest x- ray.
9. Instruct the patient not to eat or drink .
Cardiac Emergency - Heart Attack
Initial assessment and intervention Cont.
10. Elevate the side rails and place the stretcher in the
lowest position.
11. Inform the patient, family, and caregivers of the usual
plan of care .
12. Ask the patient to call for help before getting of the
stretcher.
Cardiac Emergency - Heart Attack
Ongoing evaluation and intervention
10. Monitor vital signs an effective breathing.
11. Monitor therapy closely for the patient's therapeutic
response ( effect within 20 – 30 minutes).
12. Monitor closely for the development of adverse
reaction to therapy.
13. Monitor the patient's laboratory and x-ray results and
notify the physician.
Cardiopulmonary resuscitation
(CPR)



Cardiopulmonary resuscitation (CPR) is
a lifesaving technique useful in many
emergencies,
Situations:Heart attack or Near drowning,
Done When: someone's breathing or heartbeat has stopped.
AHA- recommends that everyone — untrained bystanders and
medical personnel alike — begin CPR with chest compressions.

Better to do something than nothing Remember, the
difference between your doing something and doing nothing
could be someone's life.
Cardiopulmonary resuscitation
If an AED is immediately available, deliver
one shock if instructed by the device, then
begin CPR.
 Remember to spell C-A-B
 The AHA uses the acronym of CAB —
compressions, airway, breathing — to

help people remember the order to perform the steps of CPR.
Cardiopulmonary resuscitation
CPR
Before starting CPR, check:

Is the person conscious or unconscious?

If the person appears unconscious, tap or shake his
or her shoulder and ask loudly, "Are you OK?"
NO response and two people are available, one call
the local emergency number and one should begin
CPR.
Alone and have access to phone, call before


beginning CPR — unless you think the person has become
unresponsive because of suffocation (such as from drowning). In
this special case, begin CPR for one minute and then call local
emergency number.
Cardiopulmonary resuscitation
(CPR)

Advice By AHA:
Untrained. Provide hands-only CPR. i.e uninterrupted chest
compressions of about 100 a minute until paramedics arrive
(described in more detail below). You don't need to try rescue
breathing.

Trained and ready to go. 30 chest compressions before
checking the airway and giving rescue breaths.

Trained but rusty. If you've previously received CPR training
but you're not confident in your abilities, then just do chest
compressions at a rate of about 100 a minute. (Details described
below.)
IMPORTANCE OF LEARNING CPR
Advice applies to adults, children and
infants needing CPR, but not newborns.
 CPR can keep oxygenated blood flowing to the brain and other

vital organs until more definitive medical treatment can restore a
normal heart rhythm.

When the heart stops, the lack of
oxygenated blood can cause brain
damage in only a few minutes. A person
may die within eight to 10 minutes.
CPR-HOW TO LEARN
Take an accredited first-aid training
course, CPR and to use an automated
external defibrillator (AED).
 Before you begin
 Remember to spell C-A-B
 The American Heart Association uses the
acronym of CAB — compressions,
airway, breathing — to help people
remember the order to perform the steps
of CPR.

Cardiopulmonary resuscitation
(CPR) Contd-I

Compressions: Restore blood circulation

Put the person on a firm surface.



Kneel next to the person's neck and shoulders.
Place the heel of one hand over the center of the person's
chest, between the nipples.
Use your upper body weight the chest at least 2 inches
(approximately 5 centimeters). Push hard at a rate of about 100
.
compressions a minute

If you haven't been trained in CPR, continue chest compressions
until signs of movement or until emergency medical personnel take
over& Go on to checking the airway and rescue breathing.
Cardiopulmonary resuscitation
(CPR) Contd-I

Airway: Clear the airway

A-trained in CPR perform 30 chest compressions,
open the person's airway using the head-tilt, chin-lift
maneuver. Put your palm on the person's forehead
and gently tilt the head back. Then with the other
hand, gently lift the chin forward to open the airway.
Check breathing in five or 10 seconds. Look for chest
motion, listen for normal breath sounds, and feel for the
person's breath on your cheek and ear. Gasping is not

considered to be normal breathing.
Cardiopulmonary resuscitation
(CPR) Contd-II

Trained: No Normal breathing normally and you are
trained in CPR, begin mouth-to-mouth breathing.

Untrained: person is unconscious from a heart attack,
skip mouth-to-mouth breathing and continue chest
compressions.
Breathing: Breathe for the person
Rescue breathing can be mouth-to-mouth breathing or
mouth-to-nose breathing if the mouth is seriously injured
or can't be opened.


Cardiopulmonary resuscitation
(CPR) Contd-III



With the airway open (using the head-tilt, chin-lift
maneuver), pinch the nostrils shut for mouth-to-mouth
breathing and cover the person's mouth with yours,
making a seal.
30:2 considered one cycle.
Resume chest compressions to restore circulation.
Cardiopulmonary resuscitation
(CPR) Contd-Iv

If the person has not begun moving after five cycles
(about two minutes) and an automated external
defibrillator (AED) is available, apply it and follow the
prompts. Administer one shock, then resume CPR —
starting with chest compressions — for two more
minutes before administering a second shock.


Untrained In AED:Other emergency medical operator
may be able to guide you in its use. If an AED isn't
available, go to step 5 below.
Continue CPR until there are signs of movement or
emergency medical personnel take over.
Cardiopulmonary resuscitation
(CPR) Contd-V


To perform CPR on a child
The procedure for giving CPR to a child age 1 through 8
is essentially the same as that for an adult.
Differences are as follows:

If you're alone, perform five cycles of compressions and
breaths on the child — this should take about two
minutes — before calling your local emergency number
or using an AED.

Use only one hand to perform chest compressions.

Breathe more gently.
Cardiopulmonary resuscitation
(CPR) Contd-VI



Use the same compression-breath rate as is used for
adults:One Cycle-30:2
Five cycles (about two minutes) of CPR, if there is no
response and an AED is available, apply it and follow the
prompts. Use pediatric pads if available, for children
ages 1 through 8. If pediatric pads aren't available, use
adult pads. Do not use an AED for children younger
than age 1. Administer one shock, then resume CPR —
starting with chest compressions — for two more
minutes before administering a second shock.
Continue until the child moves or help arrives
Cardiopulmonary resuscitation
(CPR) Contd-VII



To perform CPR on a baby
Cardiac arrests in babies occur from lack of oxygen,
such as from drowning or choking. If you know the baby
has an airway obstruction, perform first aid for choking. If
you don't know why the baby isn't breathing, perform
CPR.
To begin, examine the situation. Stroke the baby and
watch for a response, such as movement, but don't
shake the baby.
Cardiopulmonary resuscitation
(CPR) Contd-VIII



If there's no response, follow the CAB procedures below
and time the call for help as follows:
If you're the only rescuer and CPR is needed, do CPR
for two minutes — about five cycles — before calling
your local emergency number.
If another person is available, have that person call
for help immediately while you attend to the baby.
Cardiopulmonary resuscitation
(CPR) Contd-IX





Compressions: Restore blood circulation
Place the baby on his or her back on a firm, flat surface,
such as a table. The floor or ground also will do.
Imagine a horizontal line drawn between the baby's
nipples. Place two fingers of one hand just below this
line, in the center of the chest.
Gently compress the chest about 1.5 inches (about 4
centimeters).
Count aloud as you pump in a fairly rapid rhythm. You
should pump at a rate of 100 compressions a minute.
Cardiopulmonary resuscitation
(CPR) Contd-X



Airway: Clear the airway
After 30 compressions, gently tip the head back by lifting
the chin with one hand and pushing down on the
forehead with the other hand.
In no more than 10 seconds, put your ear near the
baby's mouth and check for breathing: Look for chest
motion, listen for breath sounds, and feel for breath on
your cheek and ear.
Cardiopulmonary resuscitation
(CPR) Contd-X



Breathing: Breathe for the baby
Cover the baby's mouth and nose with your mouth.
Prepare to give two rescue breaths. Use the strength of
your cheeks to deliver gentle puffs of air (instead of deep
breaths from your lungs) to slowly breathe into the
baby's mouth one time, taking one second for the breath.
Watch to see if the baby's chest rises. If it does, give a
second rescue breath. If the chest does not rise, repeat
the head-tilt, chin-lift maneuver and then give the second
breath.
Cardiopulmonary resuscitation
(CPR) Contd-XI




If the baby's chest still doesn't rise, examine the mouth
to make sure no foreign material is inside. If an object is
seen, sweep it out with your finger. If the airway seems
blocked, perform first aid for a choking baby.
Give30:2.
Perform CPR for about two minutes before calling for
help unless someone else can make the call while you
attend to the baby.
Continue CPR until you see signs of life or until
medical personnel arrive.
Respiratory Emergency – Pulmonary Embolus
Definition
Is an embolus that causes obstruction of arterial
pulmonary blood flow to the distal lung.
Causes
 Trauma to the lower extremities or pelvis, long
term fractures
 Immobility but is seen occasionally with obesity.
 Decreased peripheral circulation.
 Congestive heart failure & MI.
Respiratory Emergency – Pulmonary Embolus
How to assess pulmonary embolus
It can be assessed through the signs and symptoms:
signs and symptoms
Shortness of breath
Tachypnea
Tachycardia
Sudden- onset pleuritic
chest pain increase
with respirations.
Cough, haemoptysis
signs and symptoms
Diaphoresis, syncope,
fever.
If the embolus occludes a
large vessel symptoms :
Anxiety, hypotension, and
signs of right ventricular
failure.
Respiratory Emergency – Pulmonary Embolus
Diagnostic Test
 Arterial blood gas value and lung scan.
 Computed tomography angiography.
 Decreased O2 pressure and decreased pCO2.
 Chest radiography.
 ECG
Respiratory Emergency – Pulmonary Embolus
Management
 O2 administration, from low- flow oxygen by
nasal cannula to intubation.
 Analgesic IV if the pt. Extremely uncomfortable.
 IV fluids and vasopressors to maintain pressure.
 IV anticoagulants to prevent farther clot
formation.
 Fibrinolytic therapy should be started
immediately in the unstable pt.
Respiratory Emergency – Pulmonary Oedema
Description
 Acute pulmonary oedema is a result of an acute
event.

Cardiogenic PE is caused by inadequate pumping
of the left ventricle.

Noncardiogenic PE or adult respiratory distress
syndrome is a result of damage to the alveolar –
capillary membrane.
Respiratory Emergency – Pulmonary Oedema
Assessment
 Assess signs and symptoms
Cardiovascular symptoms
Respiratory symptoms
Lower extremity pitting
oedema.
Weight gain.
Rapid, bounding pulse.
Skin is cool, moist and may
appear cyanotic.
Blood pressure initially
increases.
Dyspnea, respiratory rate
increases in an effort.
Productive cough with frothy,
white sputum. or a pink ting.
Cyanosis
Oxygen saturation decreases as
hypoxia increased.
Wheezing.
Respiratory Emergency – Pulmonary Oedema
Diagnosis
 Chest x- ray.
Management
 Administration of high- flow oxygen.
 Bronchodilators inhalation .
 Digoxin IV to increase contractility
( heart rate increased lead to decreased filling and
contractility).
 Diuretic therapy
Respiratory Emergency – Pulmonary Oedema
Management Cont.

Nitroglycerin to increase venous distension and
venous pooling, which decrease blood return to
the heart.

Urinary catheter to monitor urine output.

IV morphine.
Haemorrhage
Definition
It refers to a large amount of bleeding in a short
time.
Type of external bleeding
A –Arterial Bleeding
B-Venous Bleeding
C- Capillary Bleeding
D- Melaena
Haemorrhage
Type of external bleeding Cont.
E-Hematemesis
F-Epistaxis
G-Hemoptysis
H-Rectal Bleeding
I- Vaginal bleeding
Haemorrhage
Rapid ABC Assessment
As Cardiac emergency .
Initial Assessment and interventions
 Get vital signs and place on continuous heart and
automatic blood pressure monitoring.


Establish IV access with two large bore cannula.
Draw a variety of tubes ( haematology, chemistry,
coagulation study, PTT
Haemorrhage
Initial Assessment and interventions
 Assure the patient that he is safe.
 Perform a focused physical examination:
 Auscultate the lungs.
 Assess for signs of anaemia by noting the color of
the conjunctiva, nail beds and capillary refill in
the palm of the hand.
Haemorrhage
Initial Assessment and interventions Cont.

Evaluate the level of consciousness by AVPU:A. alert
V. Responds to voice but not fully orient.
P. Responds to pain.
U. Unresponsive.
For pt. With GIT bleeding:
 Inspect the abdomen for injury and scars post surgery.
 Look for Cullen’s sign ( periumbilical bruising) and
distention
Haemorrhage
Initial Assessment and interventions Cont.
 For pt. With GIT bleeding:
 Auscultate abdominal bowel sounds, Percuss, palpate.





For pt. With vaginal bleeding:
Inspect perineum for lacerations.
Estimate vaginal blood flow.
Consider placing drains e.g., nasogastric tube to reduce
risk of vomiting., urinary catheter to monitor urinary
output.
Instruct the patient to be NPO.
Haemorrhage
Control of External bleeding
For haemorrhage of the extremities.

Elevate the extremities as high as possible above
the heart level and compress the area.

With elevation of the extremity maintained , a
compression bandage will control the bleeding.
Haemorrhage
Control of Internal bleeding
 Venous access with two large bore ( 18 to 14)
cannula or a central venous catheter.
 Continuous
monitoring of the heart, blood
pressure, pulse oximetry, and hourly urine output.
 Fluid
resuscitation with isotonic IV solution
( normal saline), albumin, fresh plasma, in
patients with coagulopathy, PRBC to maintain a
hematocrit of 25 to 30.
Haemorrhage
Control of Internal bleeding Cont.

Administer vitamin K 10 mg SC or IM for patient with
coagulopathy.

Administration of drug therapy specific to problem.

Exploratory emergency surgery for uncontrolled or
prolonged bleeding.

For upper GIT bleeding gastric lavage with normal saline
to remove blood clots beside endoscopy for diagnosis.
Haemorrhage
Penetrating wound of the abdomen

Start with initial assessment and intervention.

Testing of urine, stool, and gastric content for blood.

CT for suspicion of solid organ lacerations.

IVP for suspected disruption of the kidney, ureter,
bladder, or urethra.

Ultrasound visualizes the configuration of organs and
hematoma.
Haemorrhage
Penetrating wound of the abdomen
 Start venous access with two large bore cannula
& IV fluids of normal saline and blood products.
 Give
oxygen via mask.
 Insert
an indwelling urinary catheter ( do not
insert if injury is suspected to the urethra.
 Insert
a nasogastric tube to reduce the risk of
aspiration.
Haemorrhage
Penetrating wound of the abdomen
 Perform dressing of wounds, and stabilization of
impaled objects.
 Keep
the patient NPO.
 Give
prophylactic antibiotics.
 Prepare
the patient for possible surgery and
hospital admission or transfer.
Shock
Shock
is a fatal condition that occurs when cells become
hypoxic as a result of decreased perfusion.
Causes of shock
1.




Hypovolaemic shock
Massive external bleeding.
Hemothorax, fractures, GIT bleeding, burn.
Massive vomiting & diarrhea.
Excessive diuretic use.
Shock
Causes of shock Cont.
2. Cardiogenic shock
 MI, cardiomyopathy, dysrhythmias, heart valve d.
3. Distributive shock
 Sepsis, anaphylaxis, spinal cord injury, overdose.
4. Obstructive shock
 Pneumothorax, pericardial tamponade, aortic
aneurysm, pulmonary embolus, valvular diseases
Shock
Clinical manifestations
1. Respiratory



Elevation of respiratory rate, rhythm, and depth.
Tachypnea, wheezes.
breath sounds may be absent, unequal, or diminished.
2. Circulatory




Weak thready pulses, drop in systolic pressure.
Flattened jugular vein when the patient is supine.
Cardiac dysrhythmias & presence of S3 or S4
Restlessness, anxiety, or confusion, unresponsive patient.
Shock
Clinical manifestations
3. Nonessential Organs

Skin:
Cool skin, pallor, cyanosis and diaphoresis.
Capillary refill take more than two second.

Kidney: Urine output is decreased.
BUN and creatinine increased.

GIT :
Hypoactive or absent bowel sounds.
Shock
Initial Stabilization and Management
Goal:
Manage inadequate tissue perfusion.

Supplemental oxygen at 100% should be provided.

Endotracheal intubation and mechanical ventilation
anticipated.

Peripheral and central venous assess should maintained.
Shock


Administration of IV fluids and blood as
appropriate .
Warmed IV fluids are preferable to avoid
hypothermia.
Acid – Base Balance

Administration of sodium bicarbonate to correct
metabolic acidosis documented by measurement of
ABG.
Shock
Hemodynamic Monitoring
Pulse oximetry and non-invasive blood pressure
monitor.
 Central venous pressure (CVP) to measure
circulating volume ( 4 to 10 cm H2O).
 Arterial pressure may be measured invasively
using an arterial line . Normal
between
70 and 90.
(A pressure less than 70 indicates inadequate
circulating volume)

Fractures
Definition
A fracture consists of a break or crack in the
bone.
Signs and Symptoms







Deformity.
Pain.
Tenderness.
Swelling.
Crepitus.
Bony fragment protrusion
Impaired neurovascular status and may be shock.
Fractures
Management
1. Expose the area
Remove all clothing and jewellery near the suspected
fracture.
2. Perform a physical assessment
 Inspect for color, position and obvious differences as
compared to the uninjured side.
 Look for break in the skin.
 Assess for bleeding and deformity.
 Assess the extremity for pain, pallor, pulses, paresthesia,
and paralysis
Fractures
Management Cont.
3. Immobilize
Splint with the appropriate splint to immobilize the joints
below and above the injury.
4. PRICE
 P....... Protect
 R....... Rest
 I......... Ice
 C........ Compress
 E......... Elevate
Fractures
Management Cont.
Use heated blankets on the rest of the body to maintain
normal body temperature.
5. Medications
 Administer analgesics.
 Open fractures are often treated with prophylactic
intravenous antibiotics.
6. Diagnostic Testing
 X- ray
Fractures
Management Cont.
6. On- going monitors
Frequently reassess the five Ps:





Pain.
Pallor.
Pulses.
Paresthesia.
Paralysis
Fractures
Management Cont.
7. Anticipate
Anticipate definitive stabilization, cast,
traction, internal or external, fixation,
and hospitalization for closed or open
reduction.
Thank You