EMERGENCY

ERMIE V.VILLANUEVA, RN, MAN

Problems Requiring

Emergency Care

AIRWAY OBSTRUCTION

HEART ATTACK

HAT REQUIRE

EMERGENCY CARE

Objectives: AIRWAY OBSTRUCTION

1. Identify four signals of respiratory

distress.

2. Describe first aid care for a victim of

respiratory distress.

3. Demonstrate rescue breathing for an

adult.

4. Demonstrate first-aid for a conscious

victim with an obstructed airway.

5. Demonstrate first aid for an unconscious

victim with an obstructed airway.

HEART ATTACK

1. Identify four signals of heart attack

2. Describe how to care for a heart attack

victim.

3. Identify the primary signal of a cardiac

arrest.

4. Describe the purpose of CPR.

5. Demonstrate CPR.

AIRWAY OBSTRUCTIONPathophysiology

A. Partially occluded B. completely occluded

1. hypoxia 1. permanent brain injury

2. hypercarbia or death will occur

within 3- 5 mins

3. respiratory cardiac arrest

absence of air movement

O2 sat of the Blood ↓

O2 deficit occurs in the brain Unconsciousness

Death

Upper Airway Causes:

1. aspiration of foreign bodies.

2. Trauma

3. Anaphylaxis

4. inhalation / Chemical burns

3. Viral or bacterial infection

Clnical Manifestation

A.Typically, a person cannot speak, breath,

or cough. The patient may clutch the neck

with fingers (universal distress signal).**

B. Choking, apprehensive appearance,

stridor, labored breathing, suprasternal &

intercostal retractions, flaring nostrils,

restlessness, & confusion. Cyanosis &

unconsciousness.

EARLY WARNING SIGNS OFRESPIRATORY FAILURE

unable to speak,

breath or cough

clutches neck

(universal

distress signal)

bluish color of

skin and lips

ASSESSMENT & DIAGNOSTIC FINDINGS

• Simply asking the person whether he or she is

choking.

• If the person is unconscious, inspection of the

oropharynx may reveal the offending object.

• x-rays

• Laryngoscopy, or bronchoscopy

SUDDEN CARDIAC

ARREST

Sudden Cardiac Arrest – A Health Burden

• Approximately 50% of deaths from

cardiovascular disease occur as SUDDEN

CARDIAC ARREST.

Sudden Cardiac Arrest is the most

common mode of death in patients with

coronary artery disease.

Blood Supply

Health Burden of Sudden Cardiac Arrest

• Almost 80 percent of out-of-hospital cardiac

arrests occur at home and are witnessed by

a family member.

• Only 4-6 % of sudden cardiac arrest victims

survive because majority of those witnessing

the arrest do not know how to perform CPR .

Sudden Cardiac Arrest

• Unpredictable and can happen to anyone, anywhere, at anytime

• Risk increases with age

• Pre-existing heart disease is a common cause

• May strike people with no history of cardiac disease or cardiac symptoms

EARLY WARNING SIGNS OF HEART ATTACK

prolonged compressing pain or unusual discomfort in the center of the chest

may radiate to shoulder, arm, neck or jaw, usually on the left side

may be accompanied by sweating, nausea, vomiting and shortness of breath

The NEW Chain of Survival

• Early access: immediate recognition and activation

•Early CPR

•Early defibrillation

•Early advanced care

•Integrated post-

cardiac arrest care

A well-informed lay person

- key in the early access

link.

Recognition of signs of

heart attack and

respiratory failure

Call for help immediately if

needed

Activate the Emergency

Medical System

The First Link- Early Access

EARLY WARNING SIGNS OF HEART ATTACK

prolonged compressing pain or unusual discomfort in the center of the chest

may radiate to shoulder, arm, neck or jaw, usually on the left side

may be accompanied by sweating, nausea, vomiting and shortness of breath

MANAGEMENT

Airway Obstruction

MANAGEMENT

• If the patient can not breath & cough

spontaneously, a partial obstruction should be

suspected.

• The victim is encouraged to cough forcefully

and to persist with spontaneous coughing and

breathing efforts as long as good air exchange

exist.

• If the patient demonstrates a weak, ineffective

cough, high-pitched noise while inhaling,

increased respiratory difficulty, or cyanosis, the

patient should be managed as if there were

complete airway obstruction.

ESTABLISHING AIRWAY

Establishing an airway may be as simple as

repositioning the patient’s head to prevent the

tongue from obstructing the pharynx.

Maneuvers:

1. Abdominal thrusts

2. head-tilt-chin-lift

3. jaw- thrust

4. insertion of specialized equipment

- Oropharyngeal Airway - Combitube

- Endotraheal intubation - Cricothyroidotomy

MANAGING A FOREIGN BODY AIRWAY

OBSTRUCTIONAsses for indication of Airway

Obstruction

person may clutch the neck between thumb & fingers**

Weak, ineffective cough; high-pitched noises on inspiration

↑ respiratory distress

inability to speak, breath, or cough

collapse

Heimlich Maneuver (subdiaphragmatic

abdominal thrust)

For standing or sitting conscious patient:

stand behind the patient, wrap your arms around

the patient’s waist, & proceed as follows:

1. Make a fist with one hand, placing the thumb side

of the fist against the patient’s abdomen, in the

midline slightly above the umbilicus and well below

the xiphoid process. Grasp the fist with the other

hand.

2. Press your fist into the patient’s abdomen with a

quick inward and upward thrust. Each new

thrust should be a separate & distinct

maneuver.

Heimlich Maneuver (subdiaphragmatic

abdominal thrust)

For patient lying down (unconcious)

1. Position patient on the

back.

2. Kneel astride the patient’s

thighs, facing the head.

3. Place the heel of one

hand against the patient’s

abdomen, in the midline

slightly above the umbilicus

and well below the tip of

the xiphoid; place the

second hand directly on

the top of the first.

4. press into the abdomen

with a quick upward thrust.

FINGER SWEEP

1. Open the adult patient’s mouth

by grasping both the tongue

and lower jaw between the

thumb & fingers and lifting the

mandible.

2. Insert the index finger of the

other hand down along the

inside of the cheek & scrape

across the back of the throat.

3. use a hooking action to

dislodge the foreign body &

maneuver it out of the mouth

for removal. Care is used to

avoid forcing the object deeper

into the throat.

HEAD-TILT-CHIN-LIFT MANEUVER

Place one hand on the victim’s forehead

Place fingers of other hand under the bony part of lower jaw near chin

Tilt head and lift jaw--avoid closing victim’s mouth

Head Tilt Chin Lift Maneuver

This maneuver prevents airway

obstruction by the epiglottis.**

L;

Effective CPR

done

immediately

after cardiac

arrest can

double a

victim’s chance

of survival.

What is C P R ?

• CPR = Cardio-Pulmonary Resuscitation

The NEW Chain of Survival

• Early access: immediate recognition and activation

•Early CPR•Early

defibrillation•Early

advanced

care

•Integrated

post-cardiac

A well-informed

lay person - key

in the early

access link.

Recognition of

signs of heart

attack and

respiratory

failure

The First Link- Early Access

EARLY WARNING SIGNS OFRESPIRATORY FAILURE

unable to speak,

breath or cough

clutches neck

(universal

distress signal)

bluish color of

skin and lips

Life saving

technique for

cardiac &

respiratory

arrest

Chest

compressions

+/- Rescue

Second Link - Early CPR

Why is early CPR important?

CPR is the best treatment for cardiac

arrest until the arrival of ACLS care.

prevents VF from deteriorating to

asystole

may increase the chance of

defibrillation

It significantly improves survival.

Brain

(Cerebral)

Heart

(Cardiac)Lungs

(Pulmonary)

How does CPR work?

All the living cells of our

body need a steady

supply of oxygen to

keep us alive.

During CPR, you can breathe air into the victim’s lungs to provide oxygen into the blood.

When you press on the chest, you move oxygen - carrying blood through the body.

When will you do CPR?

AS SOON AS POSSIBLE!

Brain cells begin to die after

4-6 minutes without oxygen.

Who may learn about CPR?

• CPR is an easy and life saving procedure

and can be learned by anyone.

• One does not need to be a doctor to learn

how to do CPR.

THE TECHNIQUE AND STEPS IN CPR

IF YOU WITNESS A

CARDIAC ARREST

CHECK AREA

SAFETY.Survey the

scene.See if the scene is safe to do CPR.

Get an idea of what happened.

CHECK UNRESPONSIVENESS.

Tap or gently shake the victim

Rescuer shouts “Are you OK?”

Quick check for normal breathing

If the victim is unconscious,

rescuer calls for help.

CALL FOR HELP:

Ambulance,

Emergency

Services,

Rescuer ACTIVATES the

EMERGENCY MEDICAL

SERVICES.

Get AED/Defibrillator!

NON-RESPONSIVE,

NO NORMAL BREATHING

PULSE CHECK

Palpate for

Carotid Pulse

within 10

seconds

(at the same

time CHECK

FOR

BREATHING)

Do Mouth to Mouth

Breathing

Give one

breath every

5-6 secs

(about 12

breaths/min)

Recheck pulse

If with definite pulse but no breathing

MOUTH TO MOUTH BREATHING and

PULSE CHECK

• Deemphasized in the new guidelines

• For trained healthcare providers only

• As short and quick as possible

• Pulse check not more than 10 seconds

• If unsure, proceed directly to CHEST

COMPRESSIONS!

C – A – B C. COMPRESSION Do chest

compressions first

A. AIRWAY Does the victim have an

open airway (air passage

that allows the victim to

breathe)?

B. BREATHING Is the victim breathing?

After determining unconsciousness,

After determining unconsciousness

and calling for help,

proceed immediately to do

CHEST

COMPRESSIONS!

C – COMPRESSION

(to assist CIRCULATION)

Chest Compressions

• Kneel facing

victim’s chest

• Place the heel of

your hand on the

center of the victim's

chest. Put your other

hand on top of the

first with your

fingers interlaced.

Place the

heel of one

hand on the

sternum in

the center of

the chest

between the

nipples and

then place

the heel of

the second

hand on top

of the first so

that the

hands are

overlapped

and parallel.

Chest Compressions

Give Chest Compressions at 100 per minute

Compress breastbone at least 2 inches deep

Compress at a rate of 100 per minute or more

Compress 30 times initially

Allow the chest to return to its normal position

Give 30 Compressions Compress breastbone at least 2

inches

(30 compressions should take 15-18 sec)

Count aloud “1, 2, 3, 4,

5,6,7,8,9,10,11,12,13,14,15,16,17,1

8,19,20,21,22,23,24,25,26,27,28,29,

and ONE!”

Minimize interruptions

Allow recoil after each compression

A - AIRWAYOpen the Airway:

Use the head tilt/chin

lift method

Place one hand on the victim’s forehead

Place fingers of other hand under the bony part of lower jaw near chin

Tilt head and lift jaw--avoid closing victim’s mouth

Head Tilt Chin Lift Maneuver

This maneuver prevents

airway obstruction by the

epiglottis.

B - BREATHING Give 2 one-second

breaths

• Maintain airway

• Pinch nose shut

• Open your mouth

wide, take a normal

breath, and make a

tight seal around

outside of victim’s

mouth

• Give 2 full breaths

(1 sec/ breath)

• Observe chest rise &

fall; listen & feel for

escaping air

PULSE CHECK• RECHECK PULSE EVERY 2 MINUTES

(equivalent to 5 cycles CPR)

• Very brief pulse check – should take

less than 10 seconds (at the same time

check for normal breathing)

• In case there is any doubt about the

presence or absence of pulse,

CONTINUE CHEST COMPRESSIONS

• For trained healthcare providers only

UNTIL…

•HELP ARRIVES.(Emergency Services, Ambulance, Doctor, AED)

•PERSON IS REVIVED.

If the victim is breathing

The unresponsive victim with spontaneous

respirations should be placed in the recovery

position if no cervical trauma is suspected.

Placement in this position consists of rolling the

victim onto his or her side to help protect the

airway.

Maintain open airway &

position the victim

THE RECOVERY POSITION

Maneuvers Adults Children

RECOGNITION UNRESPONSIVE

No breathing,

not breathing normally (eg. only gasping)

No breathing or only gasping

CPR Sequence CAB CAB

Compression Rate At least 100/min

Compression Depth At least 2 inches (5 cm) At least 1/3 AP depth; About 2 inches

Chest wall Recoil Allow complete recoil between compressions

HCPs rotate compressors every 2 minutes

Compression interruptions

Minimize interruptions in chest compressions

Attempt to limit interruptions to less than 10 seconds

Airway Head tilt chin lift (HCP suspected trauma: jaw thrust)

Compression-Ventilation ratio

30 : 2 (one or 2 rescuers) 30:2(single rescuer); 15:2(2 rescuer)

Ventilations: when rescuer untrained or trained and

not proficient

Compressions only Compressions only

Ventilations with advanced airway (HCP)

1 breath every 6-8 seconds (8-10 breaths/min)

Asynchronous with chest compressions

About 1 second per breath

Visible chest rise

DEFIBRILLATION ( AED ) Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock, resume CPR beginning with compressions

immediately after each shock

Summary of Key BLS Components for Adults and Children

• NOT TRAINED

• DO NOT KNOW MOUTH TO MOUTH

VENTILATION

• NOT SURE ABOUT MOUTH TO MOUTH

VENTILATION

• HESITANT TO DO MOUTH TO MOUTH

VENTILATION

• DO NOT WANT TO DO MOUTH TO MOUTH

VENTILATION

Compression-only bystander CPR

Hands Only CPR

Hands Only CPR should only

be used for adult victims who

have suddenly collapsed or

become unresponsive.

Recommendations:

• All victims of cardiac arrest should receive

high-quality chest compressions

• When an adult suddenly collapses, all

bystanders should activate their community

EMS and provide high-quality chest

compressions, minimizing interruptions

(Class I).

Hands Only CPR

Recommendations:

• If not trained in CPR, provide hands-only

CPR (Class IIa) until

– AED arrives

– EMS providers take over care of the victim

• If trained in CPR, provide either

conventional CPR using a 30:2

compression-to-ventilation ratio (Class

IIa) or handsonly CPR (Class IIa)

Hands Only CPR

Key Changes in the New Guidelines

• CAB instead of ABC

• Compress first

• No more Look Listen and Feel

• Harder! At least 2 inches compression (old: 1 ½ to 2

inches)

• Faster! At least 100/min compression (old: up to

100/min)

• Deemphasize pulse checks

– For trained healthcare providers not more than 10 secs

• Check for normal breathing together with check for

unresponsiveness

• Hands only CPR for the untrained lay rescuer

Important Points• There are no mistakes when you perform CPR.

The only harm is to delay responding.

Start chest compressions now viewed as the most

effective procedure

All victims in cardiac arrest need chest compressions.

• Don't stop pushing.

Keep pushing as long as you can. Push until the AED is in

place and ready to analyze the heart. When it is time to do mouth

to mouth, do it quick and get right back on the chest.

• 80-90% of cardiac emergencies occur at home.

• Training is now simpler and more accessible

Reduced number of steps and simplified process

• Being trained to do CPR can save a

loved one.

• Effective CPR done immediately after

cardiac arrest can double a victim’s

chance of survival.

LEARN CPR TODAY!INQUIRE FROM THE PHILIPPINE HEART ASSOCIATION!

www.philheart.org

If you want know more about

Sudden Cardiac Arrest and

CardioPulmonary

Resuscitation, contact the

Philippine Heart Association

Council on CPR

Thank you for listening…End