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Chain of Survival

 

Follow the links to success.

For there to be a chance of success in a resuscitation attempt the chain of survival needs to be followed. As with any chain it is only as strong as its weakest link. In this case the recognition that help is needed and needed quickly. There is no point in waiting for help to arrive before attempting resuscitation as the brain will die in 3-4 minutes without an effective supply of oxygen.

Remember if the person is need of resuscitation and you attempt to help you can only improve their chances not make it worse.

 

Early Access

Calling for assistance

Help will be required if a person is injured and needs more than basic first aid; if the incident involves multiple persons; if there is a potential or real hazard to those involved in the incident; or if the environment is hazardous, eg due to chemical spillage, gases or smoke.

Give Clear Details:

    • The exact location of the emergency. Use your street directory location if known.
    • The nature of the emergency.
    • The number of people injured.
    • Your name and the telephone number you are calling from.
    • Be the last to hang up.

Help the emergency service, especially if the location is difficult to find. Have someone available to meet them and guide them to the scene.

Follow their instructions or advice, eg evacuate all people from the immediate scene. Know who to contact:

  • Injury or sudden illness: Ambulance Service 000
  • Fire or toxic environment: Fire Service 000
  • Danger to other workers or the public: Police 000
  • Gas leak: Fire Service 000
  • Electrical hazards: Fire Service 000
    1. Keep a list of the contact numbers handy and add other local emergency contact information.
    2. Some incidents will require more than one emergency service. Contact the most appropriate agency for the incident, inform them of the situation and they will send other services, eg if you call the ambulance service, police or the fire service will be called to assist if required.
    3. In the work place, follow the call out procedures as laid down by your employer.

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Early CPR

Objectives:

    • Understand the basic function and relationship between the respiratory and circulatory systems.
    • Develop skills in recognising the non-breathing and pulseless persons.
    • To ventilate a patient to maintain life.
    • To develop the skills required to perform cardiopulmonary resuscitation.

      The function of respiration and circulation.

      The human body consists of nine separate systems, each performing its own separate function, but working in harmony to maintain life. Respiration and circulation are two vital systems without which the others cannot function. All tissues need oxygen and nutrients to work and must have a means by which waste material can be removed.

      The respiratory system is the means by which oxygen enters the body and carbon dioxide is removed. We breathe air into the lungs by a series of passages called the airway. It extends from the mouth and nose to the tiny air sacs in the lungs. Because there is a common entry for food and air, the airway is protected by a flap (the epiglottis) where the windpipe (the trachea) and the gullet (the oesophagus) begin.

      The circulatory system provides the means by which the oxygen and nutrients are transported and delivered to the cells and waste materials are removed. The heart is a pump, which provides the force for circulation.

      If both of these vital systems stops abruptly, a condition known as cardio-respiratory arrest (often called cardiac arrest) exists and is a critical life threatening event. This may be caused by:

        • Reduced oxygen in the atmosphere, e.g. a smoke filled room.
        • Obstruction of the airway, e.g. tongue blocking the airway.
        • Foreign material or vomitus in the airway; asthma.
        • Injury to the chest wall or lungs.
        • Head injury, poisons or drugs.
        • Disruption of heart function, e.g. electrocution.
        • Heart attack (failure of the heart to continue to pump).
        • Severe blood loss.
        • Severe fluid loss, e.g. dehydration, burns.

      Use the primary survey:

        • Check for dangers (remember personal protection).
        • Check response If no response turn the person in to the stable side position.
        • Check airway. Clear any foreign matter from the mouth using your fingers (remember personal protection).
        • Open the airway with head tilt and jaw support.
        • Check breathing. Look, listen and feel for breathing.

      Expired Air Resuscitation (E.A.R)

      Recognition

      After checking for foreign objects in the patient’s airway, the next step is to check for breathing. This is done in three ways as shown previously:

        • Look
        • Listen
        • Feel

      If you cannot detect any breathing you must breathe for the patient. This is done as follows

        • Maintain jaw lift and head tilt.
        • Seal the nose.
        • Seal the person’s mouth with your mouth.
        • Attempt 5 breaths within 10 seconds (at least two effective breaths). Watch for the chest to rise with each inflation.
        • Confirm pulse (or other signs of life).

      If pulse or other signs of life present then

      • Continue with one breath every four seconds.
      • Recheck of signs of life after the first minute, then every two minutes.
      • If chest fails to rise, then recheck airway and head position and try again.

      Cardiopulmonary resuscitation (C.P.R)

      C.P.R can be performed by a single operator or with two operators. The two operator is more efficient than the single operator, as it is more like the way the body works. Also the two operators can change roles as needed. Unfortunately you will probably have to commence C.P.R by yourself, as you will be the only one there, or the only one who is able to perform the procedure in the first instance.

        One operator CPR

      • After administering 5 breaths in 10 seconds (at least two effective breaths):
      • Check for signs of life:
      • If on signs of life:
      • Locate the lower half of the sternum (breast bone). Compress the chest 15 times in 10 seconds and maintain 4 -5 cycles a minute. Compress the chest one third the diameter each time. Administer 2 breaths at the completion of set of 15 compressions. After the first minute check pulse and breathing, then check every two minutes.
      • If pulse returns and breathing is still absent, then continue with E.A.R.
      • Once pulse and breathing return place person in the stable side position
      • Monitor A.B.C.
      • Call ambulance: (call ambulance early - 000).

      It is very important that the call for an ambulance is done at the earliest possible time as the success of this procedure is very time dependent. C.P.R alone will not, in most cases revive the person. They require the type of equipment carried in ambulances and found in hospitals. None of this equipment is of any use if you, as the first aider, do nothing in those first vital minutes.

      Locating the lower half of the sternum (breast bone)

      Two operator CPR

      Operator one

        • After administering 5 breaths in 10 seconds (at least two effective breaths):
        • Check for signs of life:
        • If no signs of life, then administer 1 breath at the completion of each 5th compression.
        • Alternatively the same ratios can be used as for one operator, which ever is easier for you to remember.
        • After the first minute check pulse and breathing, then check every two minutes.
        Operator two
        • If pulse absent. Locate the lower half of the sternum (breast bone).
        • Compress the chest 5 times (once every second).
        • Compress the chest one third the diameter each time each time.
        • If pulse returns and breathing is still absent, then continue with E.A.R.
        • Once pulse and breathing return place person into stable side position.
        • Monitor A.B.C
        • Call ambulance: (call ambulance early - 000).

         

        Child C.P.R

        • Location and compressions.

      Is as above:

        • Use only one hand on lower half of sternum
        • Compress the chest one third the diameter each time.
        • Use jaw support, there may be a need for some slight head extension
        • Single operator, 6 cycles per minute
        • Two operator’s, 20 cycles per minute

      Infant C.P.R

      Is as above:

        • Use only two fingers on lower half of sternum
        • Compress the chest one third the diameter each time
        • Use jaw support. There should be no need for any extension
        • Single operator 6 cycles per minute
        • Two operators 20 cycles per minute

      When to stop CPR

        • When the patient recovers.
        • When instructed to do so by a doctor, or the ambulance officers take over from you.
        • When you can physically no longer continue.

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Early Defibrillation

To deliver the energy across the heart two electrodes need to be placed correctly to direct this energy. Blow is a

diagram of this placement. The pads are clearly marked as to there correct position. Also the cables are colour coded gray and white. The white cable goes on the right side so that the conducting surface is below the collar bone and if possible avoiding the right nipple. The second pad with the gray cable goes on the right side just above the last rib with the bottom edge in line with an imaginary line down from the center of the arm pit (auxiler).

SAFETY

This equipment while a life saving tool if used incorrectly can be deadly to the user and those around at the the time of use. The machine should only be opened and switched on after checking that the victim is unconscious, pulesless and non-breathing. This is done in the primary survey

1. Insure that no one is touching the patient.

2. Insure that the patient is not lying on a conductive surface that any body is in contact with (water, metal, etc).

3. The general environment is safe (gas, petrol fumes, etc).

4. A clear command is given to stand clear.

5. Wait for a clear response from partner that it is all clear and make good eye contact with him/her.

6. Place finger on the button look at the patient as a final check and deliver the shock.

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Early Advanced Life Support

Advanced life support are those skills which are used by paramedics, doctors and nurses. These skills include intubation (the passing of a tube down a persons throat to extend the airway to protect it in the unconscious). The administration of drugs. The placement of tube in a chest to prevent the lungs from collapsing after major chest trauma etc.

It is beyond the scope of this program to go into detail of these skill. However, without the application of good basic life support before the arrival of these people all this skill and knowledge is of no value. It has been said that the person who save your life when you collapse is not the doctor, nurse or ambulance officer but the person who is standing beside you when you collapse (author unknown). This is because The brain will die in 3-4 minutes without oxygen and this will be long before the arrival of the emergency crews.

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