Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's

breathing or heartbeat has stopped. PR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. A person may die within eight to 10 minutes. To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automatic external defibrillator (AED).
Before you begin Before starting CPR, check:

Is the person conscious or unconscious? If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?" If the person doesn't respond and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911 or the local emergency number. If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.

To perform CPR on a child The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:

If you're alone, perform five cycles of compressions and breaths on the child this should take about two minutes before calling 911 or your local emergency number or using an AED. Use only one hand to perform heart compressions. Breathe more gently. Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths. After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available. If pediatric pads aren't available, use adult pads.

Continue until the child moves or help arrives. To perform CPR on a baby Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or choking. If you

know the baby has an airway obstruction, perform first aid for choking. If you don't know why the baby isn't breathing, perform CPR.

To begin, examine the situation. Stroke the baby and watch for a response, such as movement, but don't shake the baby. If there's no response, follow the CAB procedures below and time the call for help as follows:

If you're the only rescuer and CPR is needed, do CPR for two minutes about five cycles before calling 911 or your local emergency number. If another person is available, have that person call for help immediately while you attend to the baby.

Position for reclining abdominal thrust. by straddling the victim at the hips. Place the heels of your hands one on top of the other, along the midline, slightly above the navel, and give four quick upward thrusts into the abdomen, as il- lustrated in figure 4-7. Note that the victim must be lying face up. If unsuccessful, repeat the four abdominal thrusts until the obstruction is dislodged. Chest Thrusts For obese or pregnant victims, the chest thrust methods are recommended for removing airway obstructions since manual pressure in the abdomen area of these people would either be inef- fective or cause internal damage. CHEST THRUST STANDING TECHNI- QUE. Bring your arms under the arms of the victim, and encircle the lower chest, as shown in figure 4-8. Grasp your wrists, keeping the thumbside close to the victims chest. Keep your fist on the middle of the sternum, not the lower part. Press the chest with sharp, backward thrusts. Figure 4-8.Position for standing chest thrust. The Heimlich maneuver is an emergency procedure for removing a foreign objectlodged in the airway that is preventing a person from breathing. The Heimlich maneuver, or abdominal thrusts, is simple enough that it can beperformed immediately by anyone trained in the maneuver. By compressing the abdomen, air is forced out of the lungs, dislodging the obstruction and bringing the foreign material up into the mouth. The maneuver is used mainly when solid material like food, coins, vomit, or small toys are blocking the airway. There has been some controversy about whether it is appropriate to use routinely on near-drowning victims. The AmericanRed Cross and American Heart Association both recommend that the Heimlich maneuver be used only as a last resort, after traditional airway clearance techniques and cardiopulmonary resuscitation (CPR) have been tried repeatedly and failed, or if it is clear that a solid foreign object is blocking theairway.

The Heimlich maneuver can be performed on all people, but modifications are necessary if the choking victim is very obese, pregnant, a child, or an infant. ndications that a person's airway is blocked include:

The person cannot speak or cry out. The face turns blue from lack of oxygen. The person desperately grabs at his or her throat. The person has a weak cough, and labored breathing produces a high-pitched noise. The person does all of the above, then becomes unconscious.\

Cricothyroidotomy is usually regarded as an emergency surgical procedure in which a surgeon or other trained person cuts a hole through a membrane in the patient's neck into the windpipe in order to allow air into the lungs. he primary purpose of a cricothyroidotomy is to provide an emergency breathing passage for a patient whose airway is closed by traumatic injury to the neck; by burn inhalation injuries; by closing of the airway due to an allergic reaction to bee or wasp stings; or by unconsciousness. It may also be performed in some seriously ill patients with structural abnormalities in the neck. Some surgeons consider a cricothyroidotomy to be preferable to a standard tracheotomy in treating patients in an intensive care unit . The major
indication for cricothyroidotomy is the inability to establish an airway by orotracheal or nasotracheal intubation. Failure to secure an orotracheal or nasotracheal airway may be due to factors such as difficult patient anatomy; excessive blood in the mouth.
SHORT SPINE BOARD a. Indications for Use. Indications for use are the same as for the Kendrick extrication device. The short spine board is rarely used now due to the presence of superior equipment such as the KED. b. Procedures. Follow this procedure: (1) Apply the cervical collar and immobilize the head manually. (2) Place the short spine board between the patient and the seat. Center the board. (3) Secure the patient's trunk to the spine board with two straps. (4) Place support material around the patient's head and neck. For example, a rolled blanket or clothing can be used as support material. (5) Secure the patient's head to the board with a strap around the patient's forehead. (6) Move the patient onto a long board. (7) Both rescuers position themselves on opposite sides of the patient. Rescuers each place one arm around the back of the board and the other arm under the patient's thighs. The rescuers lock arms. (8) Rescuers may turn and lower the patient onto a long spine board. Or, the rescuers may lift the patient out of his seat and lower him onto a long spine board. LONG SPINE BOARD The goal is to secure the patient to a long spine board as soon as possible so that he can be evacuated without further injury. a. Indications for Use. Indications that a patient should be secured to a long spine board include: (1) Suspected spinal injury

central venous pressure (CVP) provides a direct measurement of the changes in the pressure of blood returning to the heart, since the CVP is the pressure in the large vein just outside the right atrium of the heart. Before this experiment was carried out, it was widely believed that this measurement of CVP would establish the amount of fluids that redistribute or shift to the upper part of the body and how rapidly that shift of fluids occurs. As fluids shift toward the upper body, pressure in the veins close to the heart should increase, and this should lead to increased central pressure. As upper-body fluid flow stabilizes or decreases, then this should be reflected directly by a stabilization or decrease in the CVP value. This section will examine if, in fact, these suppositions were correct. The system for the measurement of CVP provides a means for directly measuring the pressure in the large veins near the heart. Before a mission, a medical doctor inserts a catheter (a thin, soft plastic tube) into an arm vein and advances the tube through the veins to a point just outside of the right atrial chamber of the heart (Figure 18). The position of the catheter in the body is verified by taking an X-ray. The catheter is attached to monitoring systems outside of the body that measure and record the changes in CVP. Let's look a little closer at how the CVP system works.
The Philadelphia Collar

Our Philadelphia Collar with is made with innovative, high quality materials that provided a superior combination of immobilization and comfort. The Philadelphia Collar consists of two pieces, front and back, attached on the sides by Velcro. This collar is typically worn following a cervical fusion, cervical strain or after certain types of fractures that are not considered highly unstable. The collar consists of Plastazote which is non-toxic and also distinguishes itself by its light weight. This collar is soft and not the very hard plastic the most Philadelphia collars are made from. This considerably increases wearer comfort which is also enhanced by the ventilation holes. The Philadelphia Collar is water resistant and easy to clean with lukewarm water and neutral soap. The philadelphia style collar has been shaped for perfect fit at chin, neck and shoulders. Providing stable support with its front (ventral) and back (dorsal) reinforcement, the Philadelphia Collar provides a high stabilizing effect and simultaneously ensures immobilization of the neck. Cervical root irritation, simple and stable fractures, post-operative after luxations/ luxation fractures, after Halo Body Jacket. Specific indications must be determined by the physician. Indications:

Cervical root irritation Simple and stable fractures Post-operative after luxations / luxation fractures After Halo body jacket

The Philadelphia Collar is not flame-resistant. Keep the product away from open fires or other heating sources where temperatures can exceed 120 C / 248 F. Wash the orthosis with a neutral soap and lukewarm water. Rinse carefully. Do not expose to sun. Do not use oven or radiator heat for drying. The pericardial space usually contains 15-50 ml of fluid, which serves as lubricant between the visceral and parietal layers of the pericardium. Several systemic conditions can cause an increased amount of fluid in this space. Blood can also collect in this space following trauma. Clinical manifestations are highly dependent on the amount and rate of accumulation of this fluid or blood. The worst outcome is ventricular collapse causing a precipitous drop in cardiac output, hypotension and possible cardiac arrest. Using bedside echocardiography allows the emergency physician to rapidly evaluate the pericardium and identify the presence of a pericardial effusion. Identification of a pericardial effusion causing collapse of the right ventricle is diagnostic of pericardial tamponade and mandates immediate pericardiocentesis. Indications: Emergent detection of pericardial effusion and visual guidance during drainage. Two bottle water seal drainage system It involves the addition of a suction source and a suction-control bottle. These are added if gravity is not sufficient to clear the air or fluid from the chest. The suction-control bottle allows the entrance of air which bubbles through the column of water in the glass rod, reducing the amount of negative pressure from the suction source. This is sometimes called a suction-breaking bottle. When the force of suction exceeds that required to displace the water inside the glass rod, from the water level down to the end of the glass rod, room air will be drawn into the system to reduce the negative pressure applied to the chest. Failure of the breaker bottle to bubble means that the desired amount of suction has not been reached. The reasons for this should be investigated. Causes may include a leak within the bottle and tube system, an inadequate suction source, and a serious air leak into the pleura from ruptured bronchus or bronchopleural fistula. The physician may distinguish among them by briefly clamping the chest tube near the chest to determine whether bubbling will resumed. Resumption of bubbling indicates an intact drainage system. The problem then is an air leak into the pleura from a physiological source. The tube must not remain clamp as a tension pneumothorax will develop if the air leak into the pleural space has no egress. Air leaks into the pleural space may be localize by careful examination of the chest. A three-bottle system It involves the addition of a separate collection bottle so that the drainage may be separate collection bottle so that drainage may be measured and inspected as it comes from the chest. Pleur-evac

It is a commercially available product incorporating all the features all ready discussed. It is a single light weight unit which indicates the amount of air bubbling through the suction chamber from the atmosphere. It calibrates the exact amount of negative pressure in the pleural space and has a client leak air flow meter to indicate the amount of air coming from the individual
Care of patients with chest tube a. b. c. Assess patient for respiratory distress and chest pain, breath sounds over affected lung area, and stable vital signs Observe for increase respiratory distress Observe the following: (1) (2) (3) d. Chest tube dressing, ensure tubing is patent Tubing kinks, dependent loops or clots Chest drainage system, which should be upright and below level of tube insertion

Provide two shodded hemostats for each chest tube, attached to top of patients bed with adhesive tape. Chest tubes are only clamped under specific circumstances: (1) (2) (3) (4) (5) To assess air leak To quickly empty or change collection bottle or chamber; performed by soldier medic who has received training in procedure To change disposable systems; have new system ready to be connected before clamping tube so that transfer can be rapid and drainage system reestablished To change a broken water-seal bottle in the event that no sterile solution container is available To assess if patient is ready to have chest tube removed (which is done by physicians order); the solider medic must monitor patient for recreation of pneumothorax

e.

Position the patient to permit optimal drainage (1) (2) Semi-Flowers position to evacuate air (pneumothorax) High Flowers position to drain fluid (hemothorax)

f.

Maintain tube connection between chest and drainage tubes intact and taped (1) Water-seal vent must be without occlusion

(2) g. h.

Suction-control chamber vent must be without occlusion when suction is used

Coil excess tubing on mattress next to patient. Secure with rubber band and safety pin or systems clamp Adjust tubing to hang in straight line from top of mattress to drainage chamber. If chest tube is draining fluid, indicate time (e.g., 0900) that drainage was begun on drainage bottles adhesive tape or on write-on surface of disposable commercial system (1) (2) Strip or milk chest tube only per MD/PA orders only Follow local policy for this procedure

The jaw-thrust maneuver, which is taught as part of basic life support and anesthesiology, improves the patency of the upper airway. It consists of grasping and lifting the angles of the lower jaw with both hands, one on each side, while displacing the mandible forward, and is typically performed by a clinician facing the patient's head or standing near the top of the bed. If the lips close, the lower lip may be retracted with the thumbs. The jaw-thrust maneuver allows for the lifting of the epiglottis and enlargement of the laryngeal inlet and the pharynx, indicated by an increased glottic opening and resulting in improved ventilation. Moreover, this maneuver allows for better conditions for intubation when fiberoptic bronchoscopy is used. This effect can be seen on fiberoptic bronchoscopy (inset and video) in a patient undergoing elective oral and maxillofacial surgery during general anesthesia before placement of an orotracheal tube.
Jaw Thrust Method. (1) Kneel at the top of the casualty's head. (2) Rest your elbows on the surface where casualty is lying (ground, etc.). (3) Place one hand on each side of the casualty's lower jaw at the angle of the jaw, below the ears. (4) Stabilize the casualty's head with your forearms. (5) Use the index fingers to push the angles of the patient's lower jaw forward. (6) Use the thumb to retract the patient's lower lip to keep the casualty's mouth open, if necessary. See figure 3-2. CAUTION: Do not tilt or rotate the casualty's head. CAUTION: Do not allow the casualty's mouth to close. The mouth must remain open so the casualty can breath air in and out. CHECKING THE CASUALTY FOR BREATHING While maintaining the open airway position (head-tilt/neck-lift or jaw thrust), place your ear over the casualty's mouth and nose and look toward the chest and stomach a. Look to see if the casualty's chest rises and falls. b. Listen for air escaping during exhalation. c. Feel for the flow of air on the side of your face.

Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score

between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale). GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS, and doctors as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care. Escharotomy -indications

Circulation to distal limb is in danger due to swelling.Circulation to distal limb is in danger due to swelling. Progressive loss of sensation / motion in hand /Progressive loss of sensation / motion in hand /foot.foot. Progressive loss of pulses in the distal extremityProgressive loss of pulses in the distal extremity by palpation. by palpation. In circumferential chest burn, patient might not be ableIn circumferential chest burn, patient might not be ableto expand his chest enough to ventilate,to expand his chest enough to ventilate,and might need escharotomy of the skin of the chest.and might need escharotomy of the skin of the chest.

Indications for the use of epinephrine. (a) Relieve bronchospasm. Epinephrine is used to relieve bronchiospasm as is seen with patients who have asthma. It opens the breathing pathways and allows for easier breathing. (b) Prolong the action of local anesthetics. Epinephrine is sometimes combined with a local anesthetic (that is, lidocaine). Because epinephrine is a vasoconstrictor, it prolongs the effects of the local anesthetic by increasing the time the local anesthetic is in contact with the affected tissue (reduces blood flow to and from the area). (c) Restore cardiac rhythm in cardiac arrest. Because of its effects upon the heart, epinephrine is administered to increase cardiac output and rate in persons who experience cardiac arrest. (d) Stop bleeding on topical surfaces. Because it is a vasoconstrictor, epinephrine is sometimes applied to topical surfaces to reduce or stop bleeding. (e) Treat allergic reactions. Epinephrine is the drug of choice for the treatment of anaphylactic shock. It overcomes the physiological effects of histamine (substance which causes the anaphylactoid reaction). It should be noted that epinephrine is not an antihistamine. One, epinephrine reverses the drop in blood pressure caused by the vasodilatation effect of histamine because epinephrine produces vasoconstriction. Two, the epinephrine reverses the bronchoconstriction produced by the anaphylaxis. (3)Cautions and warnings associated with the use of epinephrine. (a) Epinephrine can cause anxiety, tenseness, headache, and an awareness of a forceful, rapid heart beat. (b) Epinephrine should be used cautiously in-patients who have

hypertension (high blood pressure), hyperthyroidism, and heart disease (that is, angina)

Dopamine
INDICATIONS to increase cardiac output and improve renal blood flow in shock due to myocardial infarction, sepsis, trauma, acute renal failure, open heart surgery and chronic congestive heart failure control of cerebral perfusion pressure

Morphine INDICATIONS AND USAGE Morphine sulfate extended-release tablets are indicated for the relief of moderate to severe pain. It is intended for use in patients who require repeated dosing with potent opioid analgesics over periods of more than a few days. The morphine sulfate extended-release tablet, 200 mg strength is a high dose, oral morphine formulation indicated for the relief of pain in opioid tolerant patients only. Mannitol
Uses/Indications - Mannitol is used to promote diuresis in acute oliguric renal failure, reduce intraocular and intracerebral pressures, enhance urinary excretion of some toxins (e.g., aspirin, some barbiturates, bromides, ethylene glycol) and, in conjunction with other diuretics to rapidly reduce edema or ascites when appropriate (see Contraindications-/Precautions below). In humans, it is also used as an irrigating solution during transurethral prostatic resections Benadryl Indications of Benadryl 1. Relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis; mild, uncomplicated urticaria and angioedema 2. Amelioration of allergic reactions to blood or plasma 3. Dermatographism 4. Adjunctive therapy in anaphylactic reactions 5. Mild nighttime sedation 6. Prevention of motion sickness 7. Antinauseant 8. Topical anesthetic 9. Treatment of antipsychotic induced extrapyramidal symptoms

Aminophylline

Intravenous theophylline is indicated as an adjunct to inhaled beta-2 selective agonists and systemically administered corticosteroids for the treatment of acute exacerbations of the symptoms and reversible airflow obstruction associated with asthma and other chronic lung diseases, e.g., emphysema and chronic bronchitis.

Lidocaine Indication :Lidocaine is a local anesthethetic used as an antiarrhythmic drug. Physiology :This drug is used in therapy of ventricular arrthymias. Normal Values :1.5-5 g/ml (6.4-21.4 mol/L)
The efficacy profile of lidocaine as a local anesthetic is characterized by a rapid onset of action and intermediate duration of efficacy. Therefore, lidocaine is suitable for infiltration, block and surface anesthesia. Longer-acting substances such as bupivacaine are sometimes given preference for spinal and peridural anesthesias; lidocaine, on the other hand, has the advantage of a rapid onset of action. Adrenaline supplements delay the resorption; the duration of efficacy can thus almost be doubled. For surface anesthesia several formulations are available that can be used e.g. for endoscopies, before intubations etc. Jelly:

USES: This medication is used to prevent and control pain during certain medical procedures such as inserting a tube into the mouth, nose, throat, or urinary tract (e.g., endotracheal intubation, urinary catheterization). Lidocaine jelly is also used to numb and treat inflammation of the urinary tract (urethritis). Lidocaine is a topical anesthetic that numbs mucus membranes. It does not work to numb thicker skin. Injection: USES: Injectable lidocaine is used to numb an area before surgery or before another medical procedure. Steroid steroid pulse therapy is a first-line treatment for relapsing-remitting multiple sclerosis (RR-MS) in the course of the exacerbation, and apheresis therapy is performed in refractory cases. Treatment strategies for chronic progressive MS are not to be established. Steroid pulse therapy has been established as a treatment for MS in the active phase through randomized controlled trials (RCT). Apheresis therapy includes plasmapheresis and cytapheresis, and plasmapheresis includes plasma exchange (PE) and immunoadsorption plasmapheresis (IAPP). PE and IAPP are performed for MS treatment. PE has been established as a useful treatment for active phase MS. The efficacy of IAPP has been frequently reported, but no reports have been based on RCT. We also summarize the indications, methods, and adverse reactions of steroid pulse therapy and apheresis therapy.

Saint Gabriel College

Old Buswang, kalibo, Aklan

In partial fulfillment in of the requirements in NCM106 (emergency intervention, diagnostic test and drugs)

August 09, 2011

Submitted by: Luznhel E. Villas Student

Submitted to: Mr. Elizalde Baldueza Instructor