Question

(a) You found an unconscious casualty on the street. Discuss on how you can assess breathing and circulation of an unconscious casualty.

(b) Explain in details on how to perform resuscitation technique on the casualty.

(c) Based on your knowledge, explain the FIVE (5) possible complications of cardiopulmonary resuscitation.

Answer 1

Cardiopulmonary resuscitation is an emergency life saving procedure consisting of delivering effective chest compressions and effective ventilation to a victim of cardiac arrest.

Cardiac arrest is cessation of normal circulation of the blood due to failure of the heart to contract effectively. Manifested as

Absence of response

Absence of palpable pulse

Absence of breathing

The treatable and reversible causes of cardiac arrest is the mnemonic 5H and 5T.

Hypovolemia

Hypoxia

Hydrogen ions(acidosis)

Hyperkalemia /hypokalemia

Hypothermia

Toxins

Tamponade

Tension pneumothorax

Thrombosis(MI)

Thromboembolism.

I would like to explain about basic life support since the scenario given is in a street and not in the hospital setting.

The sequence of action is circulation, airway and breathing

Ensure the safety of the rescuer and the patient.

Check the patient and see if he responds.

Gently shake his shoulders and ask loudly are you alright.

If he responds by answering or moving, place him in recovery position and reassess periodically.

If he does not respond call for help and start CPR.

CIRCULATION.

Check the carotid pulse. Simultaneously assess for any movement including swallowing, breathing. Take not more than 10 seconds for the pulse check.

If carotid pulse is present. See whether the victim is breathing. If there is breathing, put the patient in recovery position. If there is no breathing, open the airway, clear the airway and give rescue breaths.

If carotid is absent start chest compression. Place the heel of hand on the lower half of the sternum.

Chracteristics of high quality CPR.

Push hard and push fast:compress at the rate of 100 to120 per minute with the depth of at least 5cm

Allow complete chest recil after each compression.

Minimize interruptions less than 19 seconds.

Give effective breaths with visible chest rise.

Avoid excessive ventilation.

AIRWAY.

open the airway using head tilt chin lift method or jaw thrust maneuver (used when spinal injury is suspected).

Clear the airway. Suction secretions if present.

Use McGill forceps to remove any visible foreign body.

Maintain the airway by inserting an oropharngeal airway or Guedels airway.

BREATHING.

GIVE TWO EFFECTIVE RESCUE BREATHS OVER 2 SECONDS USING E AND C TECHNIQUE WITH A BAG VALVE MASK VENTILATION.

In advanced cardiac life support there is defibrillation and intubation.

Indications of defibrillation.

Ventricular fibrillation

Pulseless ventricular tachycardia.

Complications of cardiopulmonary resuscitation.

rib fracture

lung injuries such as pneumothorax and lung contusion

abdominal organ injuries such as hepatic, splenic and gastric injuries

chest or abdominal pain