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Midterm Revision , Spring 2014١

First Aid Course

Midterm Revision

(Spring 2014)

Presented By:

Dr. Shaimaa Nasr Amin

@yahoo.com599shaimaaEmail; ١ 3/21/2014

Topics included in midterm exam,

Spring 2014:

1-Basic life support

2-Wounds

3-Bleeding

4-Shock

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General rule : Assessing the Scene

• Look out for danger to you and the injured

person

• Look for people who can help you and look for

telephones

• Who’s injured?

• Where are they?

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Basic life support

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Midterm Revision , Spring 2014٢

Basic life support -It is an essential knowledge and skills needed to

treat patients in cardiac arrest for short time

before the arrival of the resuscitation team &

transport of patient to the hospital .

*Cardiac arrest is the sudden stoppage of the

normal circulation of the blood due to heart

failure .

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Causes of cardiac arrest

cardiac

extracardiac

Primary lesion of cardiac muscle leading to the progressive decline of contractility, conductivity

disorders, mechanical factors

all cases accompanied with hypoxia

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Causes of circulation arrestCardiac• Ischemic heart disease

(myocardial infarction, stenocardia)

• Arrhythmias of different origin and character

• Electrolytic disorders

Extracardiac

• airway obstruction

• acute respiratory failure

• shock

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Basic life support

Signs of cardiac arrest :

- No pulse

- No respiration

- Loss of response to any external stimuli

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Midterm Revision , Spring 2014٣

Basic life support

Cardiopulmonary Resuscitation (CPR )

It is an emergency procedure which is

performed by the first aider to support &

maintain breathing and circulation in case of

cardiopulmonary arrest .

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Basic life supportAims of CPR:

- Restoring of breathing & circulation via

providing of oxygen & blood flow to vital

organs like brain in a short time until the

transport of the victim to the hospital.

Time of CPR:

It must be performed within 4—6 min.١٠ 3/21/2014

Basic life support

Steps of CPR:

1- Air way supporting :

via placing of the person on his back on a hard

surface. Head- tilt & chin is raised up in case of

healthy spinal and cervical vertebrae .

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• In case of suspected spinal injury :

Don’t lift the chin to open an airway. Instead, you

should gently pull the jaw forward.

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Midterm Revision , Spring 2014٤

Basic life supportSteps of CPR:

2- Mouth to mouth breathing :

- By pinching of the person's nose & give him a

full breaths by the rate of 12 cycle / min . Look the

movement of the chest wall during the artificial

respiration .

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Basic life support

Steps of CPR:

3- Circulation supporting : It occurs via chest

compression by rate 100/min.& 4.5cm. Depth. This

procedure leads to squeezing of the heart between

the chest wall , so the blood can be pushed to all

blood vessels .

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Midterm Revision , Spring 2014٥

Guidelines of American Heart Association

changed the sequence from A-B-C to C-A-B for

adults and children .

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An automated external defibrillator (AED)

• If you start CPR

then, AED may be

used within a few

minutes, as it

provides the best

chance of saving a

life.

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Wounds

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Midterm Revision , Spring 2014٦

Wounds

-They are disruption of the continuity of the tissues due to traumatic conditions .

Types of wounds:1- Closed wounds

2- Open wounds

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1- Closed wounds-characterized by intact skin & damaged sub. Cut. Tissues .

- caused by strong trauma with blunt object resulting in rupture of sub. Cut. Vessels .

2- Open wounds- they are associated with frank cutting of the skin with bleeding.

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Types of wounds

a- Contusion & abrasions :It is due to friction of the skin with rough surface in the street. it bleeds & may be infected.

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Types of wounds

b- Cut wound :It occurs by cutting with a sharp instrument like knife or glass. Bleeding is massive & its edge is irregular or regular depending on the cutting instrument.

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Midterm Revision , Spring 2014٧

Types of wounds

c- Contused wound :It results from exposure to strong trauma or falling from height . It is may be associated with fracture or rupture of internal organs that must be excluded.

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Types of wounds

d- Avulsion wounds : It occurs by exposure to a machine injury, animal bites or explosives. There is a removal of the skin or fingers. It can be retransplanted again if it keeps in cold saline .

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Types of wounds

e- Stab wound :By knife or nails. It causes deep injury resulting in int. or ext. bleeding .

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General signs &

symptoms :

1- Bleeding (systemic

manifestations according to

the degree of bleeding).

2-signs and symptoms of

infection if the wound is

contaminated

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Midterm Revision , Spring 2014٨

General Treatment of wounds:

1- Cleaning the wound & cover it by sterile

dressing in case of open wound.

2- Cold compressors to decrease the blood

loss via V.C of the bleeding vessels .&

minimize edema & pain in case of closed

wound.

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General Treatment of wounds:

3- Using tourniquet to stop bleeding

4- Giving of Antibiotic to avoid the spreading

of infection.

5 - Elevation of the injured limb upward to

decrease the rate of the blood loss.

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General Treatment of wounds:

6- Anti-tetatnic vaccine to avoid the effect of

the bacterial toxins on the heart or brain .

7- If associated with fractures , it must be

supported gently.

8 - Rapid transport to hospital for more

medical supervision .

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Bleeding

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HaemorrhageDefinition:

- It means loss of blood from the circulatory system.

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Types of haemorrhage2- According to the source of bleeding :a- Arterial bleeding:

- It is pulsatile & fast .- The rate of gushing is high , so it is more

dangerous .- Its colour is brighter due to high oxygen

concentration.b- Venous bleeding :

- Non pulsatile ,slow rate.- Its colour is dark red.- It stops by elevation of the limb.

c- Capillary bleeding: in the form of patchy spots under the skin. 343/21/2014

Dangerous of haemorrhage:- It depends on the volume & the rate of

blood loss, it includes 4 degrees:a- Degree( I ), if blood loss is about 15% of

the total blood volume, no changes in the vital signs. Emergency is not needed.

b- Degree( II), if blood loss is about 30% Of total blood volume. there is tachycardia & cut. V.C . The patient needs saline I.V .

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c-Degree( III ), if blood loss is about 40% Of total blood volume . The person needs blood transfusion to compensate the large vol. of blood loss.

d- Degree (IV), if blood loss over 40% . It leads to shock , so it needs rapid emergency to prevent cardiovascular collapse

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Causes of bleeding :1- Traumatic injures:a- all types of wounds .b- Crushing injures ( car accidents).c- Compound fractures.d- Bullet & blast injuries.e-Animal bites2- Medical causes:a- Intravascular like blood diseases ( hemophilia ) b- Intramural like ( atherosclerosis ).c- Extravascular like tumors or inflammation.

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Manifestations of bleeding :A- Internal bleeding :1-Cardiovascular , like rapid & weak pulse & hypotension .2- Respiratory , like tachypnea .3- The skin is pale ,cold & moistened . 4- Stimulation of thirst sensation .5- Renal , like oliguria or anuria .B- External bleeding (1-4) in addition to:the site of injury can be seen well , pain and irritability .

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Management of the external bleeding:-Put on disposable gloves. If you suspect that blood might splatter, you may need to wear eye and face protection.- Elevate the injured limb upward .-Apply pressure on the bleeding point by sterile dressing.- Ligation before the site of injury .-Reassurance of the patient .- Transport of the person to hospital for blood replacement & observation according to the severity of the condition . 393/21/2014

Guidelines when applying

a roller bandage:

• Check for feeling, warmth and color of the

area below the injury site, especially fingers

and toes, before and after applying the

bandage.

• Elevate the injured body part only if you do

not suspect that a bone has been broken and

if doing so does not cause more pain.

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Midterm Revision , Spring 2014١١

Guidelines when applying

a roller bandage:

• Secure the end of the bandage in place with a

turn of the bandage. Wrap the bandage

around the body part until the dressing is

completely covered and the bandage extends

several inches beyond the dressing. Tie or

tape the bandage in place.

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Guidelines when applying

a roller bandage:

• Do not cover fingers or toes. By keeping these

parts uncovered, you will be able to see if the

bandage is too tight . If fingers or toes become

cold or begin to turn pale, blue or ashen, the

bandage is too tight and should be loosened

slightly.

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Management of internal bleeding : 1- Placing the person on his back .2- Elevation of the lower half of the body upward to help the blood flow to the brain to avoid brain damage .3- Warm the patient well to enhance the speed of the blood circulation .4- Observation of the vital signs like A B P , temperature & the pulse .5- Rapid transport to the nearest hospital for fluids and blood transfusion to avoid cardiovascular collapse & death

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Shock

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Midterm Revision , Spring 2014١٢

Shock

Definition :

Shock is a clinical syndrome of circulatory failure

characterized by a low cardiac output , hypotension and

inadequate tissue perfusion resulting in tissue hypoxia .

Causes of shock :

Shock occurs as a result of many disorders, they are divided into

four main types , according to their causes :

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-Types & causes of shock :

1- Hypovolaemic shock (cold shock ) :

-It is the common type of shock which occurs as a result of severe

reduction of the blood volume .

-It occurs as a result of :

a - Loss of large volume of blood , as in traumatic or surgical shock

b- Loss of large volume of plasma , as in severe burns .

c- Loss of fluids as in severe vomiting & diarrhea .

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2- Distributive shock ( warm shock ) :

- It occurs as a result of widespread V D . This leads to marked decrease

in A B P , resulting in decreased blood flow to a vital organs like heart &

brain .

-Causes of warm shock :

a- Exposure to strong emotions ( neurogenic shock ) , such as fear or

bad news & severe pain .These lead to marked hypotension due to

sympathetic inhibition .

b- Allergic reactions ( anaphylactic shock ) : , it occurs as a result of

exposure to an antigen . It causes antigen- antibody reactions that

causes histamine secretion , which causes marked V D & shock .

c- Exposure to bacterial toxins ( Septic shock ) : Bacterial toxins stim.

The macrophages that secrete V D cytokines ( interleukin- 1 ) . These

substances predispose to shock . 473/21/2014

3- Cardiogenic shock ( congested shock ) :

-This occurs as a result of inadequate pumping action of the heart which

leads to reduction of the cardiac output and arterial B P .

Causes of cardiogenic shock :

A- Myocardial infarction of the left ventricle .

B- Heart failure .

C- Severe ventricular arrhythmia .

D- Acute myocarditis .

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4- Obstructive shock :

- This occurs as a result of obstruction of blood flow in the lungs or heart .

-This leads to reduction in the cardiac filing & hypotension .

-It occurs as a result of :

a- Pneumothorax .

b- Massive pulmonary embolism .

c- Cardiac tamponade ( fluid in the pericardial sac ) .

d- Cardiac tumor .

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Danger of shock :1 - Severe shock without a rapid control , may be fatal . It becomes

irreversible & end by death .

2 - Death occurs as a result of development of multiple positive

feedback cycles .( death cycles ) , which are :

a- Marked hypotension → cerebral ischemia → depression of V

C C → more V D & bradycardia → more hypotension till death occurs .

b- Marked hypotension → myocardial ischemia → low cardiac

output → more hypotension & death .

c- Pulmonary damage due to pulmonary microembolism by

thrombi formed by coagulant agents released from the damaged cells (

acute or adult respiratory distress syndrome (A RD S ) .

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Manifestations of shock ( hypovolemic shock )

1- Cardiovascular effects , in the form of , rapid& weak pulse .2- Respiratory effects , in the form of tachypnea , due to stim. Of ischemic chemoreceptors that stimulate resp. centers.3- Skin effects , in the form of intense coetaneous V C . That lead to pale & cold skin .4- Overstim . Of the sweat glands , resulting in excessive sweating due to sympath. Stimulation.

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Manifestations of shock ( hypovolemic shock )

5- Kidneys effect , in the form of oliguria or anuria due to V C of the renal vessels or P P T of myoglobin resulting from the crushed cells in the renal tubules.6- C N S effects , in the form of anxiety & restlessness by stim . of reticular formation by catecholamines . While drowsiness due to hypoxia , that inhibits nerve center .7- Change in PH value ( acidosis) , due to accumulation of lactic acid as a result of anaerobic glycolysis that occurs 2ndry to hypoxia .

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Management of hypovolemic shock

- Management of shock aims at :a- Restoration of adequate tissue perfusion

b- Treating the causes .

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Management of hypovolemic shock- The steps of management include the following :

1- Keeping the person in the recumbent position & raising the foot of bed to increase V R & improve the cerebral blood flow .2- Warm the person by covering him by many layers of blankets to enhance the blood flow to a vital organs .3- Avoid any oral drinks .

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Management of hypovolemic shock 4- Observation of the vital signs such as , pulse , A B P , temperature & respiration .5- Giving vasopressor drugs to adjust the B P for keeping cerebral blood flow .6- Rapid hospitalization for treating the causes of shock .

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Management of Anaphylaxis

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Midterm Revision , Spring 2014١٥

Management of Anaphylaxis

1. Seek emergency care

Get immediate help if the person has these symptoms :

Difficulty breathing or wheezing ,tightness in the throat

or a feeling that the airways are closing, hoarseness or

trouble speaking ,swollen lips, tongue, or throat, nausea,

abdominal pain, or vomiting ,fast heartbeat or pulse

,skin that itches, tingles, swells, or develops raised red

areas (hives), anxiety or dizziness, Loss of consciousness.

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Management of Anaphylaxis

2. Inject Epinephrine Immediately

� If the person has a history of anaphylaxis, don't wait

for signs of a severe reaction to inject epinephrine.

� Inject epinephrine into outer muscle of the thigh.

Avoid injecting into a vein or buttock muscles.

�Do not inject medicine into hands or feet, which can

cause tissue damage. If this happens, notify the

emergency room staff.

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Management of Anaphylaxis

3. Do CPR if the Person Stops Breathing

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