Lecture two. CPR (Cardio-Pulmonary-Resuscitation): If the victim is not breathing and has no signs of circulation, then begin CPR. In Infants: Place two.

Lecture two

CPR (Cardio-Pulmonary-Resuscitation):

If the victim is not breathing and has no signs of circulation, then begin CPR.

In Infants: Place two of your fingers on the

breastbone just below the nipple line.

Your other hand on the infant's forehead to keep the head tilted back and the airway open .

Using your two fingers, give 30 chest compressions, compressing the chest about 5-1 inch each time. [V]

With the infant's head tilted back, cover the infant's mouth and nose with your mouth and give two gentle breaths.

Repeat these Steps about four more times, which should take about 2 minutes.

Recheck for signs of circulation and breathing. If infant does not have signs of circulation and does not begin breathing, continue CPR until medical help arrives.

In Child or Adult: . Place your hand on the breastbone

midway between the nipples. Use the heel of just one hand for a

child, and place other hand on child's forehead. [V]

For adult, place other hand on top of hand that is positioned on breastbone.

Align your shoulder(s) above your hand(s) and straighten your elbow(s), using the weight of your upper body to do chest compression

Perform 30 compressions. Count aloud at a steady and fast pace to achieve this rate.

With victim's head tilted back, pinch victim's nose, place your mouth over victim's mouth, and give 2 breaths for an adult or child.

Repeat Steps 4-5 five times. This should take about 2 minutes.

Recheck for signs of circulation and breathing.

If victim does not have signs of circulation and does not begin breathing, continue CPR until the victim's signs of circulation and breathing return or until medical help arrives

Measuring Vital SignsA- Breathing:- Examination of breathing: Look to see if the chest is rising Listen for any sounds of breathing Feel for any air movement on your

cheek. - Taking no more than 5–10 secondsNormal respiratory rate: Adults:12-20/min Children and infants: 30-

40/min. First aid provider must check:- Depth and regularity of respiration - Presence of any strange odour

(alcohol, acetone, etc.) or Sound.

B- Circulation Make sure that circulation is

maintained by checking pulse.

Figure 5

Carotid artery Figure 6

Radial artery

Figure 7

Brachial artery [V[

C- Temperature:• Temperature can give an indication of

the patient's condition. • Normal temperature ranges between

36.6ºC-37.2ºC. • Temperature can be recorded by putting

thermometers under the tongue, in the rectum (higher by ½ degree) or under the armpit (lower by ½ degree).

Never use mouth thermometers in cases of unconsciousness, injured nose, inflamed mouth or in young children.

The Recovery Position

The recovery position or more technically known as the lateral recumbent position.

A first aid technique

recommended for assisting people who are unconscious (or nearly so) but are still breathing.

When an unconscious person is laying face upwards, there are risk factors which can lead to suffocation:

1- Fluids (blood or vomitus) can collect in the back of the throat, causing respiratory obstruction.

2- Fluids may flow down into the lungs causing a condition known as aspiration pneumonia.

3- The oesophagus tilts down associated with loss of muscular control, can lead to the stomach contents flowing into the throat leading to airway obstruction

To a limited extent, it is possible to protect against airway obstruction by Head-Tilt-Chin-Lift method.

However, an unconscious person will not remain in this position unless held constantly.

If the person is placed in the Recovery Position, the action of gravity will allow any fluids to drain.

The recovery position is suitable for any unconscious person who does not need CPR (can breathe) but never do it if spinal injury is suspected.

How can you put a victim in the recovery position? [V]

1- Check the mouth of the causality to make sure there is no foreign matter in the mouth.

2- Place near arm of the causality close to his body (inserting the hand under the nearside leg or put it 90 degree to the body)

3- Cross the far arm over the chest towards you and Lift up the patient's furthest knee.

4- Protect and support the head with one hand. With the other hand use the patient's knee as a lever and pull it onto your knees. 5- Bend the victim's uppermost arm into a convenient position to support the upper body and his uppermost leg at the knee to bring the thigh well forward to support the lower body.6- Carefully pull the other arm out from under the victim and place it parallel to the patient to prevent the victim from rolling on to the back. [V]

Medical Emergency

A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life.

Response to an emergency medical situation depend on:

Situation PatientAvailability of resources to help them.

I- Unconsciousness

It is a mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli.

When a person is sleeping he awakes when you call, touch or shake him but when he fails to respond he is considered unconscious.

Causes:- Head injury or concussion.- Hypoglycemia or Hyperglycemia as in

diabetics.- Anemia or excessive bleeding. - Heat stroke or heat exhaustion. - Hypoxia.- Poisoning.- A sudden change in body position like

standing up too fast (postural hypotension).

- A side effect of some medications. - Drinking too much alcohol. - Anxiety or sudden emotional stress or

fright. - Extreme pain.

General Management

“The main role of the first aider is to maintain respiration and

circulation”

1- Make sure the casualty is still breathing.

2- Loosen any tight clothing.

3- Never give the person anything to eat or drink, not even water.

4- Check for any key that can help in diagnosis; as a medical alert tag, a drug or anybody who can give you history tips revealing the cause of fainting.

5- Try to wake him by shouting at

him loudly, gently shake him or pinch the lobule of the ear.

6- If he in breathing normally place him in the recovery position.

7- If the casualty is breathing but he is snoring or gurgling, open the air way by putting the tongue forward.

8- If he is not breathing normally, mouth-to-mouth breathing is indicated in addition chest compression CPR, may be done till normal breathing is retained.

1- Brain injury or Concussion

It is due to a blow to the head or the jaw

Falling from heights It occurs during sports as

in football or boxing.

Management:– Check ABC (perform CPR if

necessary) – Rapidly call for medical help.– If there is an injury or wound,

try to treat. – If there is bleeding try to stop

it till medical help arrives.– If the victim is breathing

normally put him in the recovery position. If not begin CPR

2- Epilepsy (Convulsions):The victim shows rigidity,

convulsions, loss of consciousness and some times he produces some sounds (Epileptic Cry).

In most cases the fit takes 5-10 minutes then he regains his consciousness but he remains confused for about 1 hour thereafter.

Management:It should be known that you can not do much during the fit but try to protect him from danger.

- Loosen any tight cloth- Remove any furniture around

him- Try not to hold him or let

anyone interrupt the victim - Don't give him any thing

orally.

When the fit is over, turn him comfortably to the recovery position.

Hospitalize the victim if he did not regain consciousness after the fit ends.

[V[

3- Febrile convulsions (in children):

If a child suffers from fever (Temp = 39-40-C) due to any cause convulsions may occur.

The child seems flushed, sweating, his eyes may roll up and his face may show bluish discoloration.

Convulsions appear as stiffness in the neck with arched body.

Figure 10

[V]

Management: Permit good aeration and uncover the child

Control the fever: remove clothing, apply cool washcloths to the face and neck.

Sponge the rest of the body with cool water (do not immerse a seizing child in the bathtub).

Never give him anything by mouth At the end of the fit but him in the

recovery position and cover him with light cover. [V]

4- Nervous shock:Sudden and temporary loss of

consciousness due to rapid decrease of blood flow or O2 supply to the brain.

Causes: Severe emotions, as stress,

sudden fear or astonishment. Severe pain. Standing for a long time in hot

weather.

Manifestations:– Loss of consciousness with no

response to external stimuli– Weak and rapid pulse– Dilated pupil.

Management:Let the causality lying with the head at lower level than his legs.

Untie any tight clothes.Pour some cold water on his face or smell a stimulant (perfume or ammonium hydroxide).

5- Diabetic coma:

A- Hypoglycemic coma B-

Hyperglycemic coma

A- Hypoglycemic coma:Cause: Insulin overdose can reduce the

level of glucose in the blood to extremely low levels and cause hypoglycemic coma

Resulting in destruction of neurons in the hippocampus and cerebral cortex, which are essential to memory and cognition.

Manifestations:Sweating and wet tongue. Stupor, coma and abnormal breathing. Difficulty speaking and slurred speech

Management:If the patient in conscious you can give

him sugar or juice.If not conscious try to hospitalize him

as soon as possible where he will be given dextrose infusion

B-Hyperglycemic comaCause: In patients who suffers from diabetes

mellitus and ate food which is rich in carbohydrates or sugar without taking their treatment (hypoglycemic agent or insulin).

Manifestations: Dry tongue. Irregular breathing and weak pulse. Acetone odor (fruity odor) of the

breath.

Management:If the patient is conscious and can

speak ask him about the drug he takes and give it to him till medical aid arrives.

If the patient is unconscious, try to ask anyone with him about his medication (injection only) and if not available hospitalize him rapidly.

6- Alcoholism:The drunk becomes comatose

when he drinks heavily. His breath smells alcohol.Management:If the patient is conscious give

him a cup of heavy coffee.if not conscious try to make him

regain his consciousness by putting cold water on his face and shaking him them give him heavy coffee.

II- Effects of Temperature

Exposure to extremes of temperature is harmful for body functions and may be damaging to body tissues.

A- Hypothermia

B- Hyperthermia

A- HypothermiaThe drop of body temperature

below 35-C.CausesExposure to cold weather for a

long period and wearing unsuitable clothes.

Falling into cold water.Malnutrition.Cardiovascular diseases.Hypothyroidism.Elderly and young children are

more liable to hypothermia.

Manifestations: Cold, pale skin. Shivering, Slurred speech. Abnormally slow breathing. Fatigue, lethargy and confusion. Management:§ Move the person out of the cold. § Protect the person from the wind,

cover his head and insulate his body from the cold ground.

§ Immediately give him rest and remove any wet clothes.

§ Try to warm him by covering him with a blanket, and if he is conscious give him warm (non-alcoholic) drinks.

§ Call emergency and while waiting monitor the person's breathing. If breathing stops or becomes dangerously slow or shallow, begin CPR immediately.

§ Don't apply direct heat. Don't use hot water, a heating pad or a heating lamp to warm the victim.

§ If the victim is unconscious put him in the recovery position.

§ Don't massage or rub the person, handle people with hypothermia gently, because they're at risk of cardiac arrest.

B - Heat StrokeHeatstroke is life-threatening:

as the body loses its normal mechanisms for dealing with heat stress, such as sweating and temperature control.

Young children, elderly and obese people are at high risk.

Causes:Standing, Exercising or Working in hot humid environments combined with inadequate fluid intake.

Dehydration Alcohol use Cardiovascular disease Medications.

Manifestation: The person appears restless,

flushed, dizzy and may faint. He suffers from sever headache. Markedly elevated body

temperature, generally greater than 40 ºC.

Skin may be hot and dry, but if heatstroke is caused by exertion, the skin may be moist.

Rapid heartbeat. Rapid and shallow breathing. Nausea and vomiting.

First Aid Management:

Move the person out of the sun

into a shady or air-conditioned space.

Loosen or remove the person's clothing.

Lay the person down and elevate the legs and feet slightly.

Cool the person by covering him or her with damp sheets or by spraying or sponging him with cool water.

Direct air onto the person with a fan or newspaper.

Monitor body temperature with a thermometer and continue cooling efforts until the body temperature drops to 38 -38.8°C.

Call for medical aid (ambulance).Have the person drink cool water,

if he or she is alert.

Hyperthermia (fever)

Fever is the elevation of body temperature (normal= 37°C).

Temperature is usually controlled by the hypothalamus. It maintains normal temperature through heating mechanisms (shivering and metabolism) and cooling mechanisms (sweating and dilating cutaneous blood vessels).

Fever is one of the body's reactions to infection.

Generally treatment of fever depends on its cause.

Causes: Infections (bacterial, fungal,

viral, etc.). Poisons. Heat exposure. Some medications (thyroxine,

amphetamines, antihistaminics, sedatives, some antidepressants, anticonvulsants, etc.).

Some diseases (cancer, inflammation, endocrine disorders, HIV, autoimmune diseases, etc.).

When to Seek Medical Help?

In babies with rectal temperature>38.0 °C.

In children and adults with fever persists for three days.

If you suspect dehydration especially in children (sunken eyes, dry diapers).

If febrile seizures develop in children.

If any of these signs or symptoms accompanies fever:

Unusual skin rash Mental confusion. Persistent vomiting. Difficulty in breathing or chest

pain. Abdominal pain. Pain when urinating or blood in

stool. Leg swelling. Lack of appetite and difficulty in

sleeping in children

First Aid Measures:A- In Adults:Fever can be reduced with

ibuprofen or acetaminophen. People with stomach ulcers or

kidney disease, pregnant women and those with aspirin allergy should avoid ibuprofen.

Extremely large doses of acetaminophen may cause liver failure and it should not be given to people with liver disease.

Fever can result in dehydration; hence patient should drink lots of fluids.

If the fever is caused by exposure to hot weather or overexertion or if the patient was confused or unconscious, neither acetaminophen nor ibuprofen will be effective.

The person needs to be cooled immediately (remove patient from the hot environment; remove his or her clothes and cool the body with a wet sponge with a fan directed over the person).

B- In Children:Use acetaminophen or ibuprofen

to reduce temperature for at least 24 hours (if conscious).

Dress the child in light cotton clothes and avoid overdressing.

You can give him a warm bath but do not use alcohol in a bath or rub it on the skin.

Try to give the child fluids to help in reducing the temperature as clear fluids such as non-carbonated decaffeinated drinks or juice (not water as it does not contain the necessary electrolytes and glucose).

- Do not give tea or any caffeine-containing product as it promotes water loss through urination.

- If the child is vomiting, an anti-emetic drug may be given by injection or by rectal suppository. After a period of time, oral fluids will be attempted.

Thank you