Part Three
- Cardiopulmonary resuscitation and nursing assessment
Basic cardiopulmonary resuscitation
No adult injured on the street
Definition :
The process of pumping blood through heart massage while providing the lungs with air artificially for a person who will not breathe, speak or respond so that he does not notice any movement at chest level and does not hear the sound of breathing .
Causes :
Total obstruction of the airways - accidents such as drowning - suffocation - exposure to strong electric shock - some diseases such as asthma - pulmonary dropsy.
The caretaker :
The nursing team .
Tools :
Hands.
Steps: :
1. Preliminary assessment of the environment surrounding the injured and ensure that it is free of any hazardous factors ( electricity – fire – drowning ..... Etc.).
2. In the first 10 seconds from the beginning of the viewing, the injured person is placed lying on his back with an assessment of his degree of consciousness and a loud call to him with a shrug of the shoulders ' are you all right?'؟ '.
* There is no reflex response or abnormal breathing.
3. Dial the emergency medical assistant by calling the local number .
4. Make sure that there is a clear pulse ( in a duration of not less than 5 seconds and not more than 10 seconds ) .
* The pulse in the carotid artery ( on both sides of the larynx for easy identification of the presence of the pulse, since it is the largest arteries in the body ) from the opposite side of the paramedic
1. When you are sure that there is no confirmed pulse within 10 seconds, perform cardiopulmonary resuscitation as follows :
* Never expose the injured chest .
* Place the palm of one hand ( hand kidney ) vertically in the middle of the sternum between the nipples .
* Start doing chest compressions at a rate of 30 compressions in a period of no more than 18 seconds or less if it is one or two paramedics .
To perform cardiopulmonary resuscitation in a correct and effective manner, taking into account the following :
· Place the injured person on a hard surface .
· Start pressing on the injured person's chest within 10 seconds .
* Pressing hard, quickly and to a depth of 5 cm in adults over 18 years
* Make the rib cage take the natural space after each press
* Reduce external influences (to be less than 10 seconds )
* Give the injured the same effect ( by opening the airway by tilting the head back, pulling the chin forward and opening the airway-but in case of injuries to the cervical vertebrae, fix the injured head )
* Give 2 breaths in the presence of one or two paramedics to the injured adult in a period not exceeding three seconds .
· The number of five consecutive cycles of push-ups and breathing ( in a duration of two minutes ) is made with a reassessment of breathing and pulse .
Note: when following these steps, the infection control policies for the administration of treatment are taken into account.
Basic cardiopulmonary resuscitation
For a child injured on the street
Definition :
The process of pumping blood through heart massage while providing the lungs with air artificially for a person who does not breathe, does not speak and does not respond so that he does not notice any movement up the chest level and does not hear the sound of breathing .
Causes :
Total obstruction of the airways - accidents such as drowning - suffocation - exposure to a strong electric shock - some diseases such as asthma - pulmonary dropsy .
The caretaker :
The nursing team .
Tools :
Hands .
Action steps :
* Preliminary assessment of the environment surrounding the injured and ensure that it is free of any hazardous factors ( electricity – fire – drowning ..... Etc.)
· In the first 1.0 seconds from the beginning of watching the injured person, the injured person is placed lying on his back with an assessment of his degree of consciousness and loudly calling to him with shaking legs ' are you all right?'؟ '.
· There is no blowback response or abnormal breathing .
* Call the emergency medical assistant on the local number .
* Make sure that there is a clear pulse ( in a period of not less than 5 seconds and not more than 10 seconds ) .
* Pulse in the brachial artery (the inner side of the arm for easy identification of the presence of the pulse, since it is the largest artery in the body from the opposite side of the paramedic .
.When you are sure that there is no confirmed pulse within 10 seconds, perform cardiopulmonary resuscitation as follows :
* Never expose the injured chest .
* Place the fingers of the hand ( index and middle ) vertically in the middle of the sternum between the nipples if it is one paramedic and ( thumbs ) of the hands if it is two paramedics.
* Start doing chest compressions at a rate of 30 compressions in a period of no more than 18 seconds or less if there is one paramedic and if there are two paramedics, 15 compressions are given .
To perform cardiopulmonary resuscitation in a correct and effective manner, taking into account the following :
· Place the injured person on a hard surface .
· Start pressing on the injured person's chest within 10 seconds .
* Pressing hard, quickly and to a depth of 4 cm in children from one to eight years old .
* Make the rib cage take the natural space after each press
* Reduce external influences (to be less than 10 seconds )
* Give the injured the same effect (by opening the airway by tilting the head back, pulling the chin forward, opening the airway-either in case of injuries to the cervical vertebrae fix the injured head).
· Give 2 breaths in case there is one or two paramedics.
· 6-.The number of five consecutive cycles of push-ups and breathing ( in a duration of two minutes ) is made with a reassessment of breathing and pulse.
Advanced cardiopulmonary resuscitation in the hospital
Definition :
The process of pumping blood through heart massage while providing the lungs with air artificially for a person who does not breathe, does not speak and does not respond so that he does not notice any movement at chest level and does not hear the sound of breathing.
Causes :
Total obstruction of the airways - accidents such as drowning - suffocation - exposure to strong electric shock - some diseases such as asthma - pulmonary dropsy.
The caretaker :
The nursing team.
Tools :
Hands.
Action steps :
Ensure that the surrounding environment is safe for the staff and the patient ( in no more than 10 seconds ).
Adjusting the patient's position.
Check the degree of consciousness of the patient (by gently shaking the shoulders and speaking aloud to the patient 'are you okay' for no more than 10 seconds ).
If the patient answers , this indicates that the heart and lungs are working well, in which case it is assessed whether the patient needs other help or not.
1. If the patient does not respond, we start by doing the following steps:
◾ Opening the patient's airway:
◾ Opening the airway by installing a laryngeal tube - these are the best ways to open the airway, but they are installed only in the hospital due to the lack of capabilities and trained human resources on the street.
◾ assessment of the patient's breathing:
◾ By looking at the patient's chest ( the presence of movement in the patient's chest up and down), the duration of the assessment of breathing is 10 seconds.
◾ Assess the presence of a pulse or not:
◾ By checking the pulse with the carotid artery for no more than 10 seconds and no less than 5 seconds from the corresponding direction of the paramedic.
In the absence of breathing and pulse:-
◾ Pressing on the sternum above the xiphoid protrusion with a distance of 2 fingers in the middle of the line between the nipples.
◾ Interlacing the fingers of the hands and pressing them together.
◾ The hands should be straight, perpendicular to the chest, the back is straight, and the force of the press emanates from the muscles of the pelvis and legs.
◾ Give breathing to the patient through the laryngeal tube or by a tube-mask (mouth-to-mouth breathing is not given).
◾ The rate of pressure on the chest to the rate of giving breathing to the patient varies depending on the presence of a laryngeal tube or not.
◾ In the case of a laryngeal tube:
◾ do 30 chest compressions for 2 breaths, whether it is one paramedic or two paramedics .
In the absence of a laryngeal tube:
◾ Make 100 chest compressions per minute and at the same time 8 - 10 breaths are given per minute.
◾ Doing five cycles of chest compressions and breathing, then a reassessment of breathing and pulse is made.
◾ In case the heart returns to work, the pressure on the chest is stopped and the patient is placed on a ventilator according to his condition.
recovery position
The awake position or the side position for safety is the best position for the injured, both unconscious who are breathing and their hearts are beating, as well as conscious people who complain of an illness, all this while waiting for the ambulance or doctor to arrive.
The benefits of the waking position:
- Keep the airways liberated.
- Avoid turning the tongue back.
- Facilitate the exit of liquids to the outside.
- A stable position to avoid deterioration of the condition of the injured.
- Avoid pressure on the chest.
Steps to put the injured in the waking position:
First of all, it should be noted that no one with fractures or wounds should be placed, as well as if he does not feel comfortable in that position, people who have not lost consciousness or woke up.
First step: make the right hand at an angle of 90 degrees.
The third step: gently pull the man and rotate the injured to lie on the right side.
Reminder: the awake position or the side position for safety is a waiting position for cases of unconsciousness with the presence of breathing and pulse.
Adenomyosis (obstruction of the airways )
Definition of a twig:
A lump occurs when a solid or liquid object or the back of the tongue blocks the airway and the sufferer may stop breathing quickly and lose consciousness. Blockages can be partially or completely, such as (artificial teeth - food scraps –coins-.........). This may affect the breathing of the injured person and may lead to loss of consciousness.If immediate intervention is performed, the blockage can be partial or complete
Causes:-
◾ Trying to swallow large pieces of food without chewing them thoroughly.
◾ May result from a muscle spasm .
◾ Using artificial dentures artificial teeth make it difficult to feel the size of the bite during chewing and swallowing.
◾ Talk excitedly or laugh while eating.
◾ Walking, playing or jogging with objects inside the mouth.
Signs:-
Partial airway obstruction:
◾ When the sufferer suffers from partial airway obstruction, he coughs vigorously in an attempt to dislodge the object blocking the airway and may be able to speak.
◾ Whistling may be heard when breathing .
◾ The injured person may grab his throat with one or both hands.
