First aid fundamentals (28th October 2010) 1st part : education Department of anaesthesiology and inten. medicine, SNP 1 st. 2nd part :education Department of Traumatology, Rastislavova 43 st. Seminary room KAIM 2nd floor, SNP st. 1, we ask students to wait for teacher on the 2nd floor in front of University Department of Anaesthesiology & Intensive Care Exercise date Time Seminary room KAIM Lecture PA 14.00 – 15.30h 3.11.2010 Wednesday 10.00-10.45h DM 4ab 29.10.2010 Friday KAIM 12.00- 12.45h Substitute date 3.12.2010 Friday TEST 14.00- 14.45 h Substitute date is for students, who were not able to arrive for normal date. 3.12.2010 14.00h TEST: 10 MCQ First aid ( Basic life support adults, Pediatric basic life support, Shock, Wounds, Heat Stroke, Burns , Emergency Rescue and Transfer – Removal from Automobile,… Literature: First Aid Manual, Latest Update, St John Ambulance Association, 2005, www.erc.com, Moule P., Albarran J., 2009: Practical resuscitation for healthcare professionals www. books.google.com

Paediatric basic life support KLINIKA ANESTÉZIOLÓGIE a INTENZÍVNEJ MEDICÍNY UPJŠ LF a UNLP KOŠICE Paediatric basic life support Monika Grochová MD, PhD Klinika anestéziológie a intenzívnej medicíny LF UPJŠ a UNLP Košice

www.erc.edu www.resus.org.uk Resuscitation (2005, 2010) 67 Supplement Resuscitation (2005, 2010) 67

Airway – airways opening Breathing – arteficial ventilation Basic life support Airway – airways opening Breathing – arteficial ventilation Circulation – recovery of circulation CBA adults

Paediatric basic life support simplification based on the knowledge that many children receive no resuscitation at all because rescuers fear doing harm Age: - An infant is a child under 1 year of age - a child is between 1 year and puberty 25 kg, 8. years

CPR IN CHILDREN Adult CPR techniques can be used on children Compressions 1/3 of the depth of the chest

30 30

BASIC LIFE SUPPORT (BLS) Approach safely Check response Shout for help Open airway Campbell head tilt and chin lift,

BASIC LIFE SUPPORT (BLS) Approach safely Check response Shout for help Open airway Check breathing Look, listen and feel for NORMAL breathing

Breathing sure you have a good seal • Take a breath and cover the mouth and nasal apertures of the infant with your mouth, making sure you have a good seal • Blow steadily into the infant’s mouth and nose over 1—1.5 s, sufficient to make the chest visibly rise • Take another breath and repeat this sequence five times

Breathing No effective breathing: - the airway may be obstructed • Open the child’s mouth and remove any visible obstruction. • Ensure that there is adequate head tilt and chin lift, try the jaw thrust method • Make up to five attempts to achieve effective breaths; if still unsuccessful, move on to chest compressions

Breathing, circulation • look for signs of a circulation any movement, coughing normal breathing=circulation is present (not agonal gasps, which are infrequent, irregular breaths)

Basic life support Chest compressions To 1. year 2 fingers (2 thumbs circular) Over 1. yer one hand/two hands Low part of sternum Thumb over processus xiphoideus Compression by 1/3 of antero-posterior distance AED Children > 1 year Smaller size of pads for children to 8 years 50 – 75 J (4 J/kg)

Chest compression

Chest compressions to depress the sternum by approximately one third of the depth of the chest and repeat at a rate of about 100 min−1

Chest compressions : breaths 30:2

AED IN CHILDREN Age > 8 years use adult AED Age 1-8 years use paediatric pads / settings if available (otherwise use adult mode) Age < 1 year use only if manufacturer instructions indicate it is safe

AED DEFIBRILLATION

ATTACH PADS TO CASUALTY’S BARE CHEST

ANALYSING RHYTHM - DO NOT TOUCH VICTIM

SHOCK INDICATED Stand clear Deliver shock

SHOCK DELIVERED FOLLOW AED INSTRUCTIONS 30 2

Recovery position

Approach safely Approach safely Check response Check response Shout for help Shout for help Open airway Open airway Check breathing Check breathing Call 112 Call 112 5 rescue breaths Attach AED 30 chest cmpressions Follow voice prompts

Anatomical diferencies of airwais by children

Postresuscitation care Aproppriate tissue perfusion Cooling – if unconsiousness after CPR 32 – 34°C of body core 12 – 24 hours Warming 0,25 – 0,5°C / hour AE- infection, koagulopathy, glykémia, ións, circulation Avoid hyperthermia - antipyretics

ETICS and CPR Start – not start Parents´presens during CPR Decision to stp CPR- team leader, not parents

CPR of newborn

Newborn resuscitation Lungs distension- ambu- bag with face mask, in term newborn f: 30-60/min if bradycardia persists - increase oxygen concentration Mecónium – desuflation by weak newborns Compressions- breathing ratio 3:1 90 compressionsií and 30 breaths Adrenalín, if despite art. Vent.with O2 bradycardia <60/min dose 0,01-0,03 mg/kg i.v., into ETT 5-7 x more Check HR every 30 sekúnd, STOP if HR > 60/min Circulation support evective only by lungs distension Temperature of body core maintenance

Foreign body airway obstruction Combination of methods needed 5 hits back blows 5 chest compressions (till 1year) / abdominal thrusts over 1 year Horisontal rib´s position – abdominal organs damage risk

KLINIKA ANESTÉZIOLÓGIE a INTENZÍVNEJ MEDICÍNY ANY QUESTIONS? KLINIKA ANESTÉZIOLÓGIE a INTENZÍVNEJ MEDICÍNY UPJŠ LF a UNLP KOŠICE