Emergency First AidDR ISKASYMAR ISMAIL

Emergency Physician/ Medical Lecturer

Content

•ABCDE APPROACH

•ANAPHYLAXIS

•BLS

Loss of Airway will kill you before

Cessation of Breathing will kill you before

Interruption to Circulation will kill you before

Neurological Disability will kill you before

a few other things that you won’t find unless you

get good Exposure

• LOOK

• LISTEN

• FEEL

ABCDE Approach

• To improve the clinical outlook of the unwell patient, with or without a definitive diagnosis.

• The clinical signs of life threatening acute illness may be readily identified, even though the underlying disease may not be

• Assessment and treatment are concurrent

The principles

• Perform primary survey ABCDE (5-10 min)

• Instigate treatment for life threatening conditions as you find them

• Reassess when any treatment is completed

• Perform more detail secondary ABCDE survey including investigations

• If condition deteriorates repeat primary survey

The Primary Survey

• Looking for immediately life threatening conditions

• Rapid intervention usually includes max O2, IV access, Fluid challenge +/-specific treatment

• Can be repeated as many times as necessary

• Get experienced help as soon as you need it

• If you have a team delegate jobs

The secondary survey

• Performed when patient more stable

• Get a brief relevant HPC & Hx

• More detailed examination of patient

• Order investigations to aid diagnosis

• IF PATIENT DETERIORATES RETURN TO PRIMARY SURVEY

Initial Steps• Safety…. Apron, gloves

• Look at patient in general…. Unwell?

• Greet

• If awake…. “how are you?”

• If unconscious, collapsed…. Shake him and ask “are u alright?”

• Normal response…. Patent airway, breathing and has brain perfusion

• Talk in sentence… breathing problem?

• Unresponsive… critically ill

• Rapid Look, Listen n Feel….. Around 30s

• Critically ill? call for HELP early

• Unconscious, unresponsive, no/ abnormal breathing CPR

• Monitor the vital signs early

AIRWAY

• Airway Patency

• OSTRUCTION? complete or partial

• RISK OF ASPIRATION?

• Safe

• Talking coherently

• No added noises

• Unsafe

• Depressed level of consciousness

• Paradoxical chest movement

• Abnormal sounds; Grunting, Snoring, Stridor

AIRWAY

ASSESSMENT

• Is the airway patent and maintained?

• Can the patient speak?

• Are there added noises?

• Is there see sawing movement of the chest and abdomen

MANAGEMENT

• Ensure airway patent and maintained

• Simple airway manoeuvres

• Suction

• Consider using airway adjuncts and position patient

• O2 via HFM

BREATHING

• GOOD OXYGENATION AND VENTILATION?

• RESPIRATORY FAILURE?

• Respiratory distress?

• Increase work of breathing?

• Safe features

• Talking comfortably

• RR 12-20

• SpO2> 96% (RA)

BREATHING

ASSESSMENT

• Observe rate and pattern

• Depth of respiration

• Symmetry of chest movement

• Use of accessory muscle

• Colour of patient

• SpO2

MANAGEMENT

• Position of patient

• Oxygen via HFM

• Bag valve mask

CIRCULATIONS

• SHOCK? Hypovolaemic?!

• Safe features Unsafe Features

• CRT < 2 sec Cold peripheries , mottled skin

• HR 51-90 HR <40 or >130

• sBP 120-140 sBP <90 or more >220

CIRCULATION

ASSESSMENT

• Manual pulse and BP

• CRT

• Urine output/ Fluid balance

• Temperature

• Ensure patent IV access

MANAGEMENT

• Cannulate

• Take appropriate bloods

• Fluid (Normal Saline/ Harttmann) bolus-administer- titre

DISABILITY

• Hypoxia, Hypercapnia, Hypovoalemia excluded/ treated?!

• ABC optimised?

• Drugs/Toxins/Poison causing low GCS? Intracranial causes?

• SAFE

• Normal consciousness, orientated

• UNSAFE

• Depressed level of consciousness, localising neurological signs, meningism

DISABILITY

ASSESSMENT

• Conscious level

• Blood glucose

• Pupil size and reaction

• Observe for seizures

• Pain assessment

Management

• Consider recovery position

• Correct blood glucose

• Control seizures

• Control Pain

Anaphylaxis

If unconscious + not responding + No/ abnormal breathing!!!

ADULT CHAIN OF SURVIVAL

Immediate recognition of cardiac arrest and activation of the emergency

response system

Early CPR with an emphasis on chest compression

Rapid defibrillation

Effective advance life support

Integrated post-cardiac arrest care

Monica E. Kleinman et al. Circulation. 2015;132:S414-S435

Copyright © American Heart Association, Inc. All rights reserved.

Open airway (A-Airway) – non-invasive technique

Head tilt-chin lift

Jaw Thrust (if suspected trauma)

Breathing (B )

Almost simultaneously when opening the airway

Not more then 10 seconds

Check Pulse

Carotid Pulse, within 10 seconds

CPR (C-Circulation)

Lone rescuer, 30 compressions to 2 breaths (30:2)

5 cycles or 2 minutes

Chest compression Correct victim position and correct hand placement

100/min-120/min

at least 2 inches (5cm), avoiding excessive chest compression depths (greater than 2.4 inches or 6 cm)

Allow the chest to recoil completely after each compressions

Minimize interruptions in compression (less than 10 seconds)

Ventilations

Open airway (+/- adjuncts)

Technique

Mouth to Mouth Ventilation

Mouth to Mask Ventilation

Bag-Valve-Mask Ventilations

Each Breath given over 1 second to ensure visible chest rise

Avoid excessive ventilations

Automated External Defibrillator (AED)/ Defibrillator (D-defibrillator)

1st rescuer

Performed chest compression

Count compression aloud

2nd rescuer

Maintain open airway

Provide ventilations

Encourage 1st rescuer to perform good chest compressions

Switch duties every 5 cycles or about 2 minutes, taking <5 seconds to switch