I- INTRODUCTION :
first aid actions, such as’they are taught for the rescuer must make it possible to stabilize the’state of the person, c’that is to say to allow l’waiting for help in conditions that will degrade as little as possible the’victim's state of health.
II- GOALS :
- Recognize the cardiovascular and ventilatory stop distresses vital medical origin.
- Alert the rapidly specialized relief and appropriate manner.
- Act pending the specialized reinforcement and the defibrillator before a stop cardioventilatoire.
- Fit into a cardiopulmonary resuscitation team with advanced equipment.
- Rate vital distress of medical origin and know the treatment priorities.
- Undertake basic gestures while waiting for reinforcements.
- basic first aid concept (traumatology, burn, malaise, haemorrhage).
- emergency obvious
- Victim conscious choking
- critical emergencies recorded in the balance sheet
- unconscious breathing victim
- The victim is not breathing
- Situations that may progress to a life-threatening emergency
- Assaults and violent behavior
- physical trauma
- Achievement of bones and joints (chute, choc, Wrong move)
- Bru trick
- non-urgent actions
1- EMERGENCY OBVIOUS :
a- L’HEMORRAGIE :
- L’bleeding may go unnoticed at first, for example, it is hidden by clothing.
- This shows the’importance of properly questioning the victim about the circumstances, and monitor her during the’waiting for help.
b- VICTIM CONSCIOUS THAT STALLS :
- The person brings his hands to his throat ;
- No sound, she can not speak; or cough
- She made efforts to breathe, guard mouth open, but’air does not pass
c- VICTIM NOT BREATHING :
- If the victim is not breathing but has a pulse, it needs to ventilate: 15 insufflations d’air per minute (mouth to mouth)
- If the victim n’has no pulse, it has to be massaged: external cardiac massage at a rate of 100 / min. It is an AED (DSA or DEA) are at proximity, immediately go get him and l’install on the victim.
SITUATIONS THAT CAN GROW IN EMERGENCY VITALE
- A malaise is an 'evil to the’comfortable ", a painful sensation felt by the victim (aware), and which reflects a malfunction of the’organization ; it can be temporary or permanent, occur suddenly or gradually.
- Unlike trauma and injuries, we can not determine the cause.
→ put the person at rest, in a secure place and reassuring, ensuring the protection from the cold, wind or d’too much heat, and if possible not exposed directly instead of the’accident (especially s’there is some’other victims) ; raise human complaints (sensations, pain) and identify abnormal signs ;
→ ask the person (or if it can not speak his entourage) in his usual state of health, its history, current drug treatments ;
→ call medical emergencies, even if the victim s’y oppose, and retransmit the information collected ; answer questions from the doctor and follow his advice.
→ stay put (as long as it does not place the rescuer himself in danger vital) and monitor the person for the duration of their discomfort or until’to’arrival of help, it may have a more serious later malaise, and then experience a vital distress.
1- GOALS :
- Knowing cardiopulmonary resuscitation bases gestures
- Knowing the medical management of cardiopulmonary arrest
- Know the etiology and treatment.
2- DEFINITION :
The SCA (ACR) is a life-threatening emergency.
It is a sudden interruption of blood flow in the body. It is accompanied by a ventilation stop loss of consciousness and lead to patient death.
The establishment of early resuscitation can sometimes, avert death.
3- SIGNS :
- Loss of consciousness (lack of verbal response, motor and opening of voluntary eye)
- respiratory failure
- Abolition of carotid pulse
4- etiologies :
- cardiovascular (rhythm disorder, conduction disorder, myocardial infarction, aortic dissection, haemorrhage )
- traumatic (Public road accident, chute, injuries weapons, burns )
- neurological (cerebrovascular accident, )
- Intoxications (carbon monoxide, drug, ethyl, )
- respiratory (" wrong way ", drowning, )
- Other (metabolic disorders, electrical injuries, )
5- THE BEHAVIOUR TO HAVE :
Alert : Get the best possible answer to your needs in the shortest time, it must include the following elements :
- Names and qualifications
- Phone number where we can reach you
- Place right where you are (or service + floors + family + room number or the street or lane and direction + house number + city)
- Circumstances of the occurrence of the problem
- Number of victims and the vital balance of each of them
- conservatory acts undertaken
Only outside the hospital
- Always start with protection (electrical hazard ? risk of falling objects?…) and protect the victim and onlookers (ex : on a busy road evacuate everyone).
- The presence of hemorrhage : (stop it if necessary).
- See unconsciousness.
- Releasing the upper airways.
- See stop on ventilatory 10 seconds.
- Achieve 2 insufflations (if ventilatory arrest proved).
- See cardiac arrest on 10 seconds.
- Alert the rescue (tel SAMU : 25)
- Search succinctly (ask about) an Automated External Defibrillator (DAE)
- It is an AED (DSA or DA) is readily available, put in place as soon as possible and follow its instructions.
- Perform CPR following the cycle 30 chest compressions followed by 2 insufflations.
- Resume carotid pulse all 2 minutes (is 5 cycles).
- As long as the victim is in CAB, continue alternating chest compressions with assisted ventilation (VA).
- Remain available relief upon arrival
- Protect yourself and the(s) patient(s).
- See stop cardio respiratory.
- Alert a friend (the emergency bell, calling "for help", tel ) and begin resuscitation.
- Alert to alert the doctor or.
- Send for the carriage of emergency.
Gestures basic survival
- Liberation of the upper airways
- external cardiac massage
- Breakdown by mouth to mouth
→ The release of air routes(LVA) intervenes after finding the unconscious patient and takes place in three stages :
- Loosen and / or undo anything that can hinder patient ventilation (shirt collar, tie, belt, skirt, )
- Switch cautiously head back while raising the chin
→ external cardiac massage : 100 per minute
- On the back
- hard Map
- Main chest between 2 nipples the middle of the thorax between the 2 nipples
- Shoulders vertically chest
- arms outstretched
- Body weight on the hands
→ Coupling CPR mouth to mouth
- Can be practiced by one or two people
- 30 cuts to 2 insufflations
Rules for proper conduct of resuscitation
- Only one person should lead the resuscitation.
- Discuss beforehand role in the team to be held by each.
- The material must be known and in good working order,
- Only staff needed rest in the room,
- Evacuate "curious" (the neighboring chamber, the visits, ).
- Knowing basic first aid actions (request training, is to upgrade).
- No family during resuscitation but without abandoning the corridor (if possible leave a caregiver with it).
- Know the service protocols in case of CAB
- In case of defective material, do not attempt to repair during cardiopulmonary resuscitation but replaced immediately. There will be time to repair after
- early defibrillation
- drug therapy
A- The semi-automatic defibrillation :
- Place pads : right subclavian, sub-left axillary
- Do not touch the patient
- Wait analysis
- Listen DSA's instructions
- Depending on the instructions : press the flashing button or make the first gesture
B- resuscitation : contribution of’02 as soon as possible
- Protecting VA
- FIO2 = 1 _Vt= 10 ml _ kg-1 FR = 12
- First relief for adrenaline (x 2)
Filling and saline :
- mandatory filling : AC = hypovolémie -» 500 ml crystalloid
- No glucose as hyperglycemia : risk of brain intracellular acidosis
intravenous epinephrine or …intratrachéale :
Adrenaline : drug vasoconstrictor base :
- Increase l’MCE effectiveness
- Increases coronary flow
- Increases cerebral blood flow
1mg IV every 3 minutes or 3 mg IV every 5 minutes
2IT mg every 3 minutes or 6 IT mg every 5 minutes
C- drug therapy :
♦ Peripheral venous route in first intention → Central route otherwise (more dangerous)
♦ No systematic alkalizing
– No study’showed l’effectiveness of alkalinizers (risk of tissue acidosis)
– Rest 3 indications 1 mmol.kg-1/10 minutes (250 ml bicar 14)
- pre-existing metabolic acidosis
- extended stop
♦ The antiarrhythmics if VF-TV :
– lidocaine 1,5 mg Kg’1 bolus IV/10 min (unproven effectiveness)
– Amiodarone 300 mg IV then 150 mg (demonstrated effectiveness)
♦ various treatments, mostly useless
– Atropine : bolus 1 mg
– Isuprel = 0
– Calcium = 0 (except poisoning CCBs)
– Training Electro-Systolic = 0
monitoring : Sp 02 – AND C02 – TA
capnometry (AND C02) : The appearance of C02 in exhaled air is the best witness
recovery of cardiac activity
Stop cardiopulmonary resuscitation ?
- Asystole more 30 minutes at normal temperature (neurological State – duration – ATCD)
- If hypothermia, same time but after obtaining warming
The Chain of Survival
- call -> RCP -> Def -> Int
- different order to : child < 8 years, flooded, intoxication, trauma, respiratory failure.
6- Prognosis :
Sudden death is an important public health problem
The prognosis depends mainly on the speed of the management and
realization of basic resuscitation by witnesses
The use of an automated external defibrillator by witnesses improves prognosis, and installation in public places is crucial.
Result of Cardiopulmonary Resuscitation (RCP) 5 – 30 % survival dependent: etiology, l & rsquo; age, the duration of the CPR and the quality of CPR
Dr W's course. Djelouat – Faculty of Constantine