Question

You have entered the patients rooms to   and you find the patient lying on the floor

What are the first steps you would take?

You have determined that the patient is not breathing you attempt manual ventilation and do not see the chest rise and fall. What the first three steps you would take under these circumstances.

Answer 1

Essentials of diagnosis: In the given scenario, the patient gotten sudden cardiac arrest, hence has a primary responder check for Concious, respiratory and pulse. Report of most cases of cardio respiratory arrest were successful managed with chest compressions, defibrillation shocks and assisted ventilation.

   Cardiovascular disease is the most common cause of sudden cardiac arrrst, which causes over 60%of adult coronary heart disease deaths.

   Survival from cardiac arrest depends on a sequence of interventions- the - chain of survival- comprising

1. early recognition and call for help,

2. Early cardiopulmonary resuscitation (CPR),

3. Early defibrillation and

4. post resuscitation care.

( note: DNAR - do not attempt resuscitation, at the request of any person with capacity, as part of end of life care for a person with terminal illness, acute severe illness who might die. Some pts made clear statement of their wish not to receive CPR and such decision should be respected. The decision making process must comply with legislation and human rights)

  when coming back into our case discussion, immediately we have to taken three consecutive steps, they are

1. Maintain airway,

2. Breathing and

3. Stabilise the circulation. These three steps we called a term known as "Basic Life Support" ( BLS)

Essentials of Basic Life support : The essential elements of basic life support are chest compressions, establishing a patent airway in the oropharynx and periodic lung inflations,

- the original mnemonic for these elements A,B,C ( Airway,Breathing, circulation), has been rearranged to CAB ( Circulation, Airway, Breathing), reflecting a recent ' shift in emphasis from ventilation to chest compressions in the resuscitation effort'.

success is achieved by doing the Cardiopulmonary resuscitation.

Cardio Pulmonary Resuscitation: The key steps are mainly

- Early recognition of cardiopulmonary arrest,

- help is summoned,

- CPR ( chest compressions and ventilations) is started immediately and if indicated , defibrillation attempted as soon as possible ( ideally within 3 min of collapse).

- the sequence of actions and outcome depends on Location, skills of responders, number of responders, equipment available and response system to cardiac arrest and medical emergencies.

Sequential steps in CPR : 1) Check the patient for a response, if you see a Pt collapse or apparently unconscious,

a. Shout for help,

b. Assess responsiveness ( shake their shoulders) and seek a verbal response.

2) If the patient does not respond

a. agonal breathing ( occasional gasps, slow, laboured or noisy breathing) is common immediately after cardiac arrest/ do not mistake this for a sign of life,

b. Turn the patient on to their back and open the airway,

3) Open airway, check breathing and check for circulation

a. Open the airway using a head tilt chin lift,

b.Look in the mouth and remove any visible foreign body or debris,

c. A pt airway takes priority over concerns about a potential cervical spine injury, but minimise neck movement if cervical spine injury is suspected,

d. Keeping the airway open , look listen and feel ( for upto 10s) to determine if the patient is breathing normally ( an occasional gasps, slow, laboured or noisy breathing is not normal) and simultaneously feel for a carotid pulse.

4) If the patient has no signs of life, no pulse, or if there is any dought, start cpr Immediately.

a. Ensure help is coming,

b. If alone, leave the patient to get help,

c. Give 30 chest compressions ( depth 5 - 6 cm, rate 100 - 120 compressions/ min, allowing complete chest recoil at end of each compression) followed by two ventilations ( compression - ventilation ratio = 30:2),

d. The hand position for chest compression is the middle of the lower half of the sternum,

e. Allow the chest recoil completely after each compression,

f. Take the same amount of time for compression and relaxation,

g. Use whatever equipment is available immediately for airway and ventilation, use a pocket mask, Larygeal mask airway and self inflating bag or bag mask. Attempt tracheal intubation only if trained and competent to do so,

5. If the pt is not breathing and has a pulse ( respiratory arrest)

a. Ventilate the patient lungs and check for a circulation every 10 breaths,

b. If there is any dought about the presence of pulse , start chest compressions.

Factors affect the Basic life support:

1. Time factor,

2. Chest compressions,

3. Ventilation,

4. High quality CPR.

   The above considerations has to take to sustain life.