Professional Documents
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Basic Emergency Care
Basic Emergency Care
20091st Edition
DR.Mohammmad A.Ghany
5/5/2009
Basic Emergency Care
(Cardiopulmonary Resuscitation and
First Aid)
Edited by:
May, 2009
Preface
The Editor:
Dr∕Mohammad A.Ghany
سةْ نَفسْي كَما
علّمني أنْ أدَا ِ
"يا َربْ عَلمّنْي أنْ أدةّ النَاسْ كَما أدةّ نَفسْي وَ َ
علّمنْي أنْ التسَامخ هَوأكْثَر مَراتة القوّج وَأنّ دةّ االنتقام هَو أولْ
سةْ النَاسْ وَ َ أدَا ِ
مَظاهِر الضعْفَ .يا َربْ ال تدعني أصَاب تِالغرور إذا نَجَذْت وَال تاليأس إذا فْشلت تَل
ذكّرني دائِـماً أن الفَشَل هَو التجَارب التي تسْـثِق النّجَاح"
Table of Contents
Introduction to Emergency Medical Care……………………1
– Respiratory system…………………………………..…..5
– Cardiovascular system………………………………...11
– Pulse………………………………………………………......36
– Respiration……………………………………………..…. 37
– Blood pressure……………………………………...……38
– Chain of survival……………………………..…………..40
– Introduction to CPR……………………………………..42
– CPR, know what to do? .................................43
– Infant CPR……………………………………………………49
– Child CPR…………………………………………………….50
Chapter 6: Choking……………………………………………51
Chapter 2: Trauma……………………………………………..66
– Shock …………………………………………………………81
– Bleeding……………………………………………………..86
– Epistaxis……………………………………………….…….87
– Internal bleeding………………………………………..88
– Contusion, Haematoma………………….…….…….91
– Abrasion……………………………………………….……92
– Laceration, Puncture, Avulsion……………..……93
– Amputation……………………………………………….94
– Evisceration, Neck wound, chest wound…….95
– Fracture………………………………………………….….97
– Dislocation, Sprains, Strains………………………100
Chapter 6: Burns………………………………………………103
– Scalp laceration………………………………..……….117
– Skull fracture……………………………………….……118
– Brain concussion……………………………………....118
– Cerebral contusion……………………………………119
– Epidural haematoma………………………………...119
– Subdural haematoma…………..……………………120
– Cerebral laceration…………………………………….120
– Assessment of head injury…………………………121
– Management of head injury………………………122
Introduction
Prehospital Care
Emergency Departments
Specialty facilities
– Cardiac center
– Stroke center
– Trauma centers
-1-
Introduction
– Burn centers
– Pediatric centers
– Others
– Personal safety
– Safety of crew, patient, and bystanders
– Patient assessment
– Patient care
– Lifting and moving patients safely
– Transport/transfer of care
– Record-keeping/ data collection
Basic emergency care includes:
Basic Life Support:
- Airway management & CPR
- Automated External Defibrillation
- Emergency Oxygen
Basic First Aid: Care for Injuries and Sudden Illness
-2-
Part One
Cardiopulmonary
Resuscitation
Chapter 1
Cardiovascular
and Respiratory
Anatomy
&Physiology
Respiratory System CPR
Fig.(1-2)Larynx
A leaf-shaped structure called the epiglottis closes the larynx to
prevent foods and foreign objects from entering the trachea during
swallowing. The larynx contains the vocal cords. The cricoid
cartilage is a ring-shaped structure that forms the lower portion of the
larynx.
The trachea
Is the tube that carries inhaled air from the larynx down toward
the lungs, It is formed of 15-20 C shaped cartilages, incomplete
posteriorly At the level of the lungs, the trachea splits (bifurcates)
into two branches called the bronchi. One to each lung. Inside each
lung, the bronchi continue to branch and split and the air passages get
smaller and smaller. Eventually, each branch ends at a group of alve-
oli. The alveoli are the small sacs within the lungs where gas ex-
change takes place with the bloodstream.
The lung
Are two large spongy organs, occupying the thoracic cavity.
They are cone-shaped having apex, base and two surfaces:
– Surfaces:
The diaphragm
Is the muscular structure that divides the chest cavity from the
abdominal cavity. The intercostal muscles fill the intercostal spaces.
During normal respiration, the diaphragm and intercosals work
together to allow the body to inhale and exhale.
Pleura
Two layers
Air moves into the lungs through the series of airpassages (the
airway). During inhalation, air is moved into the alveoli. These small
sacs in the lungs are where gas exchange with the blood takes place.
The alveoli are very small. The blood vessels around the alveoli are
capillaries.
The cardiovascular system consists of the heart and the blood vessels
through which blood is circulated throughout the body.
The human heart is a muscular organ about the size of your fist; located
in the center of the thoracic cavity.
Right atrium: The superior vena cava and the inferior vena
cava are the two large veins that return blood to the heart.
The right atrium receives this blood and sends it to the right
ventricle.
Left atrium. The left atrium receives the oxygen rich blood
from the lungs. When it contracts, it sends this blood to the
left ventricle.
Fig.(1-4)
Valves and openings: (Fig.1-5)
A. Opening between Atria and ventricles guarded by tricuspid valve
on the right and mitral (Bicuspid) valve on the left side.
* Both valves arc called atrio-ventricular valves (A- V valves).
B. Opening from the right ventricle into pulmonary artery guarded
by pulmonary valve.
C. Opening from the left ventricle into Aorta, guarded by aortic
valve.
*Both pulmonary and Aortic valves are called (semilunar valves).
Function of valves: All valves allow flow of blood in one direction and
prevent its regurge.
The kind of vessel that carries blood away from the heart is
called an artery. Arteries begin with large vessels, like the
aorta, they gradually branch to smaller and smaller vessels.
The smallest branch of an artery is called an arteriole .These
small vessels lead to the capillaries.
Capillaries are tiny blood vessels found throughout the
body. the capillaries are where gases, nutrients, and waste
products are exchanged between the body's cells and the
bloodstream. From the capillaries the blood begins its return to the
heart by entering the smallest veins, small veins are called a
venules.
The kind of vessel that carries the blood from capillaries back to
the heart is called a vein.
• Aorta: The aorta is the largest artery in the body. It begins at its
attachment to the left ventricle, travels superiorly, then arches
inferiorly in front of the spine through the thoracic and abdominal
cavities, then splits into 2 iliac arteries.
The pulmonary artery: The pulmonary artery begins at the
right ventricle. It carries oxygen-poor blood to the lungs, an
exception to the rule (arteries carry oxygen-rich blood, and
veins carry oxygen-poor blood). It does, however, follow the
rule that arteries carry blood away from the heart while veins
carry blood to the heart.
Dorsalis pedis artery The dorsalis pedis artery lies on the top
(dorsal portion) of the foot, lateral to the large tendon of the
big toe.
there are two venae cavae. The superior vena collects blood
that is returned from the head and upper body. The inferior vena
cava collects blood from the part of the body below the heart.
superior and inferior venae cavae return blood to the right atrium.
Basic physiology
The contraction (beating) of the heart is involuntary. The heart has its
own pacemaker and special conducting system(modified cardiac muscles
initiate and propagate impulses). Regulation of the heart beat rate,rhythm
and force is under control of the brain:
a - Cardiac acceleratory center (C.A.C): This center
sends stimulating impulses to the heart causing
(Tachycardia).
b - Cardiac inhibitory center (C.LC): This center
sends inhibitory impulses to the heart causing
(Bradycardia).
Fig.(1-6) Main Arteries and Veins of the body
Chapter 2
Cardiovascular
Emergencies
Cardiovascular Emergencies CPR
Cardiovascular Emergencies
Male sex (gender) — Men have a greater risk of heart attack than
women.
Heredity (including Race) — Children of parents with heart
disease are more likely to develop it themselves. African
Americans have more severe high blood pressure than Caucasians
and a higher risk of heart disease.
What are the major risk factors you can modify, treat or control by
changing your lifestyle or taking medicine?
Drinking too much alcohol can raise blood pressure, cause heart
failure and lead to stroke. It contributes to obesity, alcoholism,
suicide and accidents.
Prevention of Heart Disease
a. Regular exercise
b. Optimal body weight
c. Sound nutrition
d. Nonuse of tobacco and other drugs
e. Nonuse use of alcohol
f. Dealing constructively with stress
a. Periodic medical examinations
Coronary Artery Disease CPR
Atherosclerosis (Fig.2-1)
Fig.(2-1):Atheroma or Plaque
Acute Myocardial Infarction CPR
– Substernal
– Unaffected by:
– Unrelieved by rest/nitroglycerin
2. Shortness of breath
4. Nausea, vomiting
5. Pallor and diaphoresis (heavy sweating)
Important Notes:
b. Patent Airway
c. High concentration O2
h. transport immediately:
Causes
3. AMI
Symptoms of CHF
1. Weakness
2. Dyspnea
3. Dyspnea on exertion
1. Sit patient up
Arrhythmia
Sinus Tachycardia
Physiological
1. Exercise
2. Strong emotion
3. Anxiety states
4. Pain
Pathologic
1. Fever-Infection
2. Hemorrhage-Shock
3. AnemiaCongestive
4. heart failure
Sinus Bradycardia
Physiologic
1. athletes
3. Sleep
Pathologic
1. Systemic disease:
– Obstructive jaundice
Patient
assessment and
early
management
Patient Assessment and Early Management CPR
– Scene Survey
– Initial Assessment
– Ongoing Assessment
– Communication
– Documentation
Scene Size Up
– Location
– Incident
– Injured/Injuries
– Observe
Smoke?
Fire?
Yourself
Partner
Other rescuers/Bystanders
– Hand washing
• Protective Clothing
• Dress in layers
– Gloves
Initial Assessment
• Purpose
Include:
A. General Impression
– A - Alert
– V - Verbal
– P – Painful
– U - Unresponsive
– Airway
• Open-Clear-Maintain
– Breathing
• Look
• Listen
• Feel
– Circulation
• Major Bleeding
• Capillary Refill
• Skin Color
• Pale
• Ashen
• Cyanotic
• Mottled
• Red
• Skin Temperature
• Hot (warm)
• Cool
• Skin Condition
• Moist
• Dry
– Disability
– Expose
• Head/Neck
• Chest
• Abdomen
Rapid Evacuation
– Uncontrolled bleeding
• Purpose
AVPU
• A - Alert
• V - Verbal
• P - Painful
• U -Unresponsive
• Time sensitive
On-Going Assessment
• Purpose -
• Procedure
– Check Interventions
Chapter 4
Basic
Vital Signs
Vital signs CPR
VITAL SIGNS
Vital signs are an outward clue to what is going on in the patient’s body
Pulse
Dorsal Pedal
Posterior Tibial
– Adult
• 60-90 Beats/minute
– Child
• 80-110 Beats/minute
– Infant
• 120-150 Beats/minute
Rhythm
• Regular or
• Irregular
Quality
• Full
• Weak (Thready)
• Bounding
Respirations
Rate
– Adult
• 12-20 Resp/min
– Child
• 20-28 Resp/min
– Infant
• 30 Resp/min @ 6 months
Rhythm
• Regular or
• Irregular
Quality
• Full
• Deep
• Shallow
• Labored
• Noisy
Blood Pressure
• Adult
– Male
80
– Female
90 + Age (up to 50
80
Chapter 5
Cardiopulmonary
Resuscitation
(CPR)
Chain of Survival CPR
Chain of Survival
The chain has four elements: (1) early access, (2) early CPR, (3)
early defibrillation, and (4) early advanced care.Fig.(5-1)
Advanced care
Early CPR
Early CPR can increase survival significantly the only time it
does not help is when defibrillation reaches the patient within
approximately 2 minutes.
Early Defibrillation
INTRODUCTION to CPR
Fig.(5-2)
A - AIRWAY
• Head-tilt/chin-lift (Fig.5-3)
Open victims' airway by tilting head back with one hand
while lifting up chin with your other hand
1. Victim revives
3. Unsafe scene
1. Delay in starting
u Improper techniques
4. Terminal disease or unmanageable disease (massive heart attack)
Complications of CPR
Vomiting- Aspiration
Rib fractures
CHILD CPR
Important notes
Choking
Choking CPR
Choking
Causes
2. Vomit
4. Turning blue
Management of choking
Conscious Choking
1. Try to support victim with your knees while lowering victim to the
floor
2. Assess
3. Begin CPR
4. Repeat
Fig.(6-2):Choking Infant
Choking: Unconscious infants
2. RAPABC
3. When the first breaths don’t go in, check for object in throat then
try 2 more breaths.
5. Begin 30 compressions
7. Give 2 breaths
Chapter 7
External
Defibrillation
Automated External Defibrillation CPR
Definition
Types
Operational Steps
3. Turn on power
4. Attach device
– Water
– Explosive atmosphere
2. Assess patient
– ABCs
3. Confirm arrest
– Unresponsive
– Apneic
– Pulseless
4. Start BLS
5. Attach defibrillator
– ―Clear‖ patient
– Deliver shock
– Immediately reanalyze
Post-Resuscitation Care
2. Supplemental O2
4. Monitor vitals
Integumentary System
Muscular System(Fig.1-1)
�Composed of muscles and tendons
�Provides locomotion and facial expression
�Maintains posture (Fig.1-1)
�Produces heat
�Provides protection and support
Nervous System
�Composed of the brain, spinal column, and nerves
�Is the fast-acting control system of the body
�Responds to stimuli
�Interprets environmental stimuli
Survival Needs
Anatomical Position
Directional Terms
�Superior
�Inferior
�Anterior
�Posterior
�Medial
�Lateral
�proximal Fig.(1-2)
�Distal Anatomic position
�Superficial
�Deep
Body Cavities (Fig.1-3)
Trauma
Introduction to Trauma First Aid
Trauma is
1. Epidural Hematoma
2. Subdural Hematoma
3. Hemo/Pneumothorax
4. Intra-abdominal Bleeding
5. Pelvic Fractures
6. Femur Fractures
1. Sepsis
Falls
l Critical Factors
– Height
• Increased height = Increased injury
• Always note, report
– Surface
• Decreased stopping distance = Increased injury
• Always note, report
Assess body part that impacts first
Fall onto Buttocks (injuries)
l Pelvic fracture
l Coccygeal (tail bone) fracture
Lumbar compression fracture
Fall onto Feet(injuries)
– Bilateral heel fractures
– Compression fractures of vertebrae
– Bilateral Colles’ fractures
Stab Wounds
Facts about:
Damage confined to wound track
o Four-inch object can produce nine-inch track
Gender of attacker
o Males stab up; Females stab down
Evaluate for multiple wounds
o Check back, flanks, buttocks
Chest/abdomen overlap
– Chest below 4th ICS = Abdomen until proven otherwise
– Abdomen above iliac crests = Chest until proven otherwise
l Small wounds do NOT mean small damage
Gunshot Wounds
TRAUMA ASSESSMENT
I-Scene Size-Up
l Ensure Safety of
– Yourself
– Your partner
– Other responders
– Bystanders
– Patient
l Scene survey
– Location?
– Appearance?
– Where is patient?
– What is condition of vehicle?
– Mechanism of Injury? Amount of force?
–
II-Initial Assessment
– A - Alert
– V - Verbal
– P - Painful
– U - Unresponsive
ii. A-B-C-D
» Low O2 tension
B. Breathing
– Is patient breathing?
o Change in O2 saturation
o Possible shock
o Chest pain
o Chest Trauma
o Dyspnea
o Respiratory Distress
o Rate is <12
o Rate is >24
– If breathing is compromised:
o Expose
o Palpate
o Auscultate
C. Circulation
o Rate
o rhythm
o force
o Cool
o Pale
o Moist
– If circulation is compromised:
o Expose
o Palpate
o Auscultate
o CPR
o Transport
D. Disability
1. Expose, Examine
3. Initial Resuscitation:
Immobilize C-spine
Maintain airway
Oxygenate
III-History, Physical Exam
– Include
– SAMPLE history
Organized, systematic
Superior to Inferior
Proximal to Distal
» Pulse
» Capillary refill
1. Pulse
2. Respirations
» Quality :Shallow-Full-Deep-Labored
3. Blood Pressure
» Hypotensive?
» Hypertensive?
4. Pupils
» Dilated?
» Unequal?
» Reaction to light
5. Skin
» Color
» Temperature
» Moisture
» Turgor
» Capillary refill
SAMPLE History
– Signs, Symptoms
– Allergies
– Medications
Shock &
Bleeding
Shock First Aid
SHOCK
Physiology
Cells get energy needed to stay alive by reacting oxygen with fuel
(usually glucose)
No oxygen= no energy
No energy= no life
Cardiovascular System
1. Pump Heart
3. Fluid Blood
1. Pump Failure
2. Pipe Failure
3. Loss of Volume
Types of Shock and Their Causes
– Causes
2) Cardiogenic Shock
– Causes
3) Neurogenic Shock
4) Psychogenic Shock
5) Septic Shock
6) Anaphylactic Shock
» Restlessness, anxiety
» Nausea, vomiting
» Thirst
» Diminished urine output
• Itch
6. Stabilize fractures
Bleeding
Types
– External
– Internal
• Traumatic
• Non-Traumatic
1. Arterial Bleeding
• Bright red-Spurting
2. Venous Bleed
3. Capillary Bleed
• Dark red-Oozing
1. Direct Pressure(Fig.3-1)
• gloved hand
• dressing/bandage
2. Elevation
3. Arterial pressure points
4. Splinting
• Air splint
5. Tourniquets
Epistaxis
– It is a Common problem
– Causes
1. Fractured skull
2. Facial injuries
4. High BP
5. Clotting disorders
– Management
1. Sit up, lean forward
4. Keep quiet
6. 15 min adequate
Internal Bleeding
– causes:
• Trauma
• Clotting disorders
– Management
• Open airway
• Assist ventilations
• Stabilize fractures
Soft Tissue
Injuries
Soft tissue Injuries First Aid
• Closed
• Open
Closed Injury
• Types
– Contusions
– Hematomas
Contusion
Hematoma
1. Rest
2. Ice
3. Compression
4. Elevate
5. Splint
Open Injury
– Skin broken
1. Abrasions
2. Lacerations
3. Punctures
4. Avulsions
5. Amputations
Abrasion
Laceration (Fig.4-1)
• Types
– Linear
– Stellate
Punctures
Avulsions (Fig.4-2)
Amputations (Fig.4-3)
2. Control bleeding
Special Considerations
Implanted Objects
• Do NOT remove
• Stabilize in place
• Exception
Eviscerations
Neck Wounds
Musculoskeletal
Injuries
Musculoskeletal Injuries, Fracture First Aid
Musculoskeletal System
o Bones
o Muscles
o Cartilages
o Tendons
o Ligaments
See anatomy
Extremity Trauma
Causes
w Direct force
w Indirect force
• Osteoporosis
• Tumors
w Greenstick
Fig.(5-1):Types of Fractures
Fracture Signs
w Deformity
w Tenderness
w Swelling, ecchymosis
w Exposed fragments
w Crepitus
Signs of dislocation
w Deformity
w Pain/tenderness in joint
C-Sprains
Signs
w Tenderness
w Swelling, ecchymosis
w No deformity
D-Strains
w Muscle pull‖
– Pulse
– Skin color
– Capillary refill
– Sensation
– Movement
w Splinting
• Eases pain
Principles of Splinting
7) Minimize movement
11) Dislocations
Burns
Burns First Aid
BURNS
Skin Functions
1. Sensation
2. Protection
3. Temperature regulation
4. Fluid retention
a) Nerve endings
b) Blood vessels
c) Sweat glands
e) Hair follicles
Fig.(6-1)
Types of Burn Injury
Pathophysiology
– Loss of fluids
– Infection
1) Depth
2) Extent
1) First Degree
(Superficial)
• Involves
only
epidermis
• Red
• Painful
• Tender
• Blanches under pressure
• Salmon pink
• Moist, shiny
• Painful
• Heal in ~7 to 21 days
• Thick, dry
• Painless
• Require grafting
For each year over 1 year of age, subtract 1% from head, add equally
to legs
Rule of Palm
Burn Severity
Based on
• Depth
• Extent
• Location
• Cause
• Patient Age
• Associated Factors
Critical Burns
4. Airway/Respiratory Involvement
5. Associated Trauma
7. Electrical Burns
Moderate Burns
Minor Burns
a) Patient Age
b) Burn Location
MANAGEMENT OF BURNS
3 Phases
– Emergent (resuscitative)
– Acute
– Rehabilitative
Pre-hospital Care
A=airway-
B=breathing-
C=circulation-
• Lasts from onset to 5 or more days but usually lasts 24-48 hours
• begins with fluid loss and edema formation and continues until
fluid motorization and diuresis begins
Fluid Therapy
– size/depth of burn
– age of pt.
– individualized considerations.
– Parkland formula
– Brooke formula
– Modified Brooke
– Evans formula
Parkland Formula
Wound Care
Emergency Department
b. Very large.
Splinting
Face:
Eyes:
Surgical procedures
• Escharotomy
• Fasciotomy
• Dressing / hydrotherapy
• Debridement
• grafting
• Splinting
Chapter 7
Head Injuries
Head Injuries,Scalp Laceration First Aid
Head injuries
– Brain(Cerebrum,Cerebellum,Brainstem)
– Spinal Cord
– Motor nerves
– Sensory nerve
• Scalp Lacerations
• Skull Fracture
Scalp Lacerations
• Exceptions
Skull Fractures
• Linear(fissure)
– Most common
– Crack in skull
• Comminuted
• Depressed
Injuries to Brain
Brain Concussion
Cerebral Contusion
– Loss of consciousness
– Unequal pupils
– Vomiting
Epidural Hematoma
– Deterioration of consciousness
– Seizures
Subdural Hematoma
• Usually results from tearing of large veins between dura mater and
arachnoid
• Deterioration of consciousness
• Seizures
Cerebral Laceration
• Can cause:
• AVPU system
• Glasgow scale
AVPU System
• Alert
• Unresponsive
Glasgow Scale
• Eye Opening
– Spontaneous = 4
– To Voice = 3
– To Pain = 2
– None = 1
• Verbal Response
– Oriented = 5
– Confused = 4
– Inappropriate Words = 3
– Incomprehensible Sounds = 1
– None = 1
• Motor Response
– Follows Commands = 6
– Localizes Pain = 5
– Withdraws = 4
– Flexion = 3
– Extension = 2
– None = 1
• Maximum Score = 15
• Minimum Score = 3
References