Life Threatening Conditions

       K.S. CHEW (MD, MMED)
  Emergency Medicine Department
    School of Medical Sciences
  ...
Life Threatening Conditions are conditions
           that compromise the

                 AIRWAY
               BREATHIN...
Overview
• Examples of conditions threatening to the:
• Airway
  – Trauma: Facial trauma, facial burns
  – Non-trauma: ana...
Overview
• Examples of conditions threatening to the:
• Airway
• Breathing
  – Trauma: Chest trauma – tension pneumothorax...
Overview
• Examples of conditions threatening to the:
• Circulation
  – Trauma: Cardiac tamponande
  – Non-trauma: acute m...
AIRWAY
Why Airway Management?
• Maintain a patent airway
• Facilitate mechanical ventilation in respiratory
  failure
• Optimize ...
Effects of Hypoxia

               0 – 2 min Cardiac Irritability


                     0 – 4 min Brain damage not likely...
Effects of Head-
  Tilt Chin-Lift




Alignment of oral axis,
pharyngeal axis and
tracheal axis
Importance of Opening the Airway


The most common cause of ventilation difficulty during
resuscitation is an improperly o...
Opening the Airway
• Lay Rescuer – open the airway using head-tilt
  chin lift maneuver for non-trauma victims and
  gentl...
Opening the Airway
• If airway obstruction persists despite jaw
  thrust, attempt head tilt-chin lift even in
  trauma
• T...
Effects of Head-
  Tilt Chin-Lift




Alignment of oral axis,
pharyngeal axis and
tracheal axis
Remember to protect
the cervical spine in
cases of trauma
Use bags or pillows,
etc, to immobilize the
cervical spine
OROPHARYNGEAL AIRWAYS
Oropharyngeal Airways

• OPAs are sized by length in centimeters, and
  are available in sizes for all ages.

• A typical ...
How To Perform?
• In adults – insert ‘upside down’ until tip touch
  hard palate and then rotate 180° before
  inserting f...
Size of OPA can be
estimated from the
edge of ear lobe
(angle of mandible)
to the corner of
mouth (incisor teeth)
Emergency Care When The
    Victim is Choking
Universal Sign of Choking
Performing Heimlich
Maneuver (abdominal thrust)
  only if the upper airway
 obstruction is complete or
    near total comp...
Position to place your fist
between the xiphoid
process and the umbilicus
Use one hand as the fist.
The other hand to grasp
the fist and BE
PURPOSEFUL and
DELIBERATE. Thrust
upwards and inwards.
If, at any time, the victim
collapses, lie him flat and
proceed as you would in
BLS sequence.
Open the airway to see if
foreign body is present; if
no, attempt rescue breaths
(five attempts for two
effective breaths)...
BREATHING
Examples of Life Threatening
 Trauma Conditions to the
        Breathing
Initial Assessment/Management in
              TRAUMA
•   Primary Survey
•   Identifies most life-threatening injuries
•  ...
Life Threatening Conditions In
              Trauma
Primary Survey
• Airway obstruction
• Tension pneumothorax
• Open pneu...
Tension Pneumothorax
Tension Pneumothorax: Etiology
• Parenchymal and/or chest-wall
  injuries
• Air enters pleural space ...
Tension Pneumothorax
Tension Pneumothorax: Signs / Symptoms
• Respiratory distress
• Distended neck veins
• Unilateral in ...
Tension Pneumothorax
         Tension Pneumothorax
         • Immediate
           decompression
         • Clinical diagn...
Asthmatic Attack
Asthmatic Attack

• Asthma sufferers have very sensitive airways,
  and when they are exposed to certain triggers,
  their...
Signs and Symptoms
• pale, cool, clammy skin
• coughing, especially at night
• shortness of breath – using all the chest a...
Signs and Symptoms
• cyanosis around the lips (bluish colour)
• anxiety and distress
• exhaustion
• rapid, weak pulse
• li...
First Responder Care
With spacer
• shake inhaler and insert mouthpiece into
  spacer
• place spacer mouthpiece in casualty...
First Responder Care
Contd…

• give 1 puff at a time
• ask the casualty to breathe in and out
  normally 4 times after eac...
First Responder Care
Without spacer
• shake inhaler
• place mouthpiece in casualty’s mouth.
• Give 1 puff as the person in...
First Responder Care
contd…

• Ask the casualty to hold that breath for 4
  seconds, then take 4 normal breaths
• Repeat u...
CIRCULATION
Heart Attack
The Heart
• The normal human heart is a strong, muscular
  pump a little larger than a fist.
• Each day an average heart “...
In Myocardial Infarction,
time lost is myocardium
           lost!!
Pre-hospital Care of MI                                            Hospital fibrinolysis:
                                ...
Typical Chest Pain
Hollywood Heart Attack
Remember


With heart attack, every minute counts. If
the warning signs are present, do not waste
vital moments wondering ...
First Responder Care to Patient
               with MI

• Recognize and Call (MOST IMPORTANT!)
• Rest the casualty in a po...
First Responder Care to Patient
               with MI

• If conscious, give casualty 1/2 an aspirin tablet
  and have the...
Pads Position
Posterior Position
Defibrillation               Cardioversion
                             Synchronised on the R
   Not synchronised
        ...
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students
Upcoming SlideShare
Loading in...5
×

Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students

13,002

Published on

This is the lecture I gave to the paramedics during a course

2 Comments
6 Likes
Statistics
Notes
No Downloads
Views
Total Views
13,002
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
436
Comments
2
Likes
6
Embeds 0
No embeds

No notes for slide

Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction For Paramedics and Medical Students

  1. 1. Life Threatening Conditions K.S. CHEW (MD, MMED) Emergency Medicine Department School of Medical Sciences UniversitiSains Malaysia
  2. 2. Life Threatening Conditions are conditions that compromise the AIRWAY BREATHING CIRCULATION
  3. 3. Overview • Examples of conditions threatening to the: • Airway – Trauma: Facial trauma, facial burns – Non-trauma: anaphylaxis, asthma, foreign bodies airway obstruction • Breathing • Circulation
  4. 4. Overview • Examples of conditions threatening to the: • Airway • Breathing – Trauma: Chest trauma – tension pneumothorax, open pneumothorax, flail chest – Non-trauma: asthma, pulmonary embolism • Circulation
  5. 5. Overview • Examples of conditions threatening to the: • Circulation – Trauma: Cardiac tamponande – Non-trauma: acute myocardial infarction, acute thoracic dissection
  6. 6. AIRWAY
  7. 7. Why Airway Management? • Maintain a patent airway • Facilitate mechanical ventilation in respiratory failure • Optimize pulmonary gas exchange; thus prevent hypoxic damage to the brain and other vital organs • Reduce risk of aspiration • Reduce risk of nosocomial pneumonia and assist in removal of bronchial secretions
  8. 8. Effects of Hypoxia 0 – 2 min Cardiac Irritability 0 – 4 min Brain damage not likely 4 - 6 min - brain damage possible 6 - 10 min - brain damage very likely More than 10 min - irreversible brain damage
  9. 9. Effects of Head- Tilt Chin-Lift Alignment of oral axis, pharyngeal axis and tracheal axis
  10. 10. Importance of Opening the Airway The most common cause of ventilation difficulty during resuscitation is an improperly opened airway (AHA Guidelines 2005)
  11. 11. Opening the Airway • Lay Rescuer – open the airway using head-tilt chin lift maneuver for non-trauma victims and gentle chin lift for trauma. Jaw thrust no longer recommended because it is difficult to learn and perform, often not effective. • Health Care Provider – Head tilt-chin lift if not trauma. If trauma, apply manual in-line stabilization and jaw thrust.
  12. 12. Opening the Airway • If airway obstruction persists despite jaw thrust, attempt head tilt-chin lift even in trauma • This is because maintaining a patent airway and providing adequate ventilation is a priority in CPR (AHA Guidelines 2005) • Furthermore, this complication of damaging the cervical cord has not be documented and the relative risk is unknown (ERC Guidelines 2005)
  13. 13. Effects of Head- Tilt Chin-Lift Alignment of oral axis, pharyngeal axis and tracheal axis
  14. 14. Remember to protect the cervical spine in cases of trauma
  15. 15. Use bags or pillows, etc, to immobilize the cervical spine
  16. 16. OROPHARYNGEAL AIRWAYS
  17. 17. Oropharyngeal Airways • OPAs are sized by length in centimeters, and are available in sizes for all ages. • A typical adult female will take an 8-cm OPA, and an adult male, 9 or 10 cm.
  18. 18. How To Perform? • In adults – insert ‘upside down’ until tip touch hard palate and then rotate 180° before inserting further • Can also insert directly (non-inverted way) with use of tongue depressor • This is preferred in children because of risk of trauma to delicate soft tissue
  19. 19. Size of OPA can be estimated from the edge of ear lobe (angle of mandible) to the corner of mouth (incisor teeth)
  20. 20. Emergency Care When The Victim is Choking
  21. 21. Universal Sign of Choking
  22. 22. Performing Heimlich Maneuver (abdominal thrust) only if the upper airway obstruction is complete or near total complete Observe is victim is whether cyanosed, or if his voice becomes muffled or his cough becomes ineffective
  23. 23. Position to place your fist between the xiphoid process and the umbilicus
  24. 24. Use one hand as the fist. The other hand to grasp the fist and BE PURPOSEFUL and DELIBERATE. Thrust upwards and inwards.
  25. 25. If, at any time, the victim collapses, lie him flat and proceed as you would in BLS sequence.
  26. 26. Open the airway to see if foreign body is present; if no, attempt rescue breaths (five attempts for two effective breaths) and start chest compression if pulse not present or no signs of life.
  27. 27. BREATHING
  28. 28. Examples of Life Threatening Trauma Conditions to the Breathing
  29. 29. Initial Assessment/Management in TRAUMA • Primary Survey • Identifies most life-threatening injuries • Resuscitation • Airway control • Ensure oxygenation / ventilation • Needle / tube thoracostomy
  30. 30. Life Threatening Conditions In Trauma Primary Survey • Airway obstruction • Tension pneumothorax • Open pneumothorax • Flail chest • Massive hemothorax • Cardiac tamponade
  31. 31. Tension Pneumothorax Tension Pneumothorax: Etiology • Parenchymal and/or chest-wall injuries • Air enters pleural space with no exit • Positive pressure ventilation – Collapse of affected lung – Venous return – Ventilation of opposite lung
  32. 32. Tension Pneumothorax Tension Pneumothorax: Signs / Symptoms • Respiratory distress • Distended neck veins • Unilateral in breath sounds • Hyperresonance • Cyanosis, late
  33. 33. Tension Pneumothorax Tension Pneumothorax • Immediate decompression • Clinical diagnosis, not by x-ray
  34. 34. Asthmatic Attack
  35. 35. Asthmatic Attack • Asthma sufferers have very sensitive airways, and when they are exposed to certain triggers, their airways narrow making it difficult for them to breathe. • An asthma attack can take anything from a few minutes to a few days to develop
  36. 36. Signs and Symptoms • pale, cool, clammy skin • coughing, especially at night • shortness of breath – using all the chest and diaphragm muscles to breathe • ‘sucking in’ of the throat and rib muscles • Severe chest tightness • wheezing – a high pitched raspy sound
  37. 37. Signs and Symptoms • cyanosis around the lips (bluish colour) • anxiety and distress • exhaustion • rapid, weak pulse • little or no improvement after using reliever medication (e.g. Bricanyl or Ventolin) • severe asthma attack: collapse – leading to eventual respiratory arrest
  38. 38. First Responder Care With spacer • shake inhaler and insert mouthpiece into spacer • place spacer mouthpiece in casualty’s mouth and give 4 separate puffs of a blue/grey reliever puffer
  39. 39. First Responder Care Contd… • give 1 puff at a time • ask the casualty to breathe in and out normally 4 times after each puff • wait 4 minutes. If there is little or no improvement, repeat the above sequence
  40. 40. First Responder Care Without spacer • shake inhaler • place mouthpiece in casualty’s mouth. • Give 1 puff as the person inhales slowly and steadily
  41. 41. First Responder Care contd… • Ask the casualty to hold that breath for 4 seconds, then take 4 normal breaths • Repeat until up to 4 puffs have been given • Wait 4 minutes. If there is little or no improvement, repeat the above sequence
  42. 42. CIRCULATION
  43. 43. Heart Attack
  44. 44. The Heart • The normal human heart is a strong, muscular pump a little larger than a fist. • Each day an average heart “beats” (expands and contracts) 100,000 times and pumps about 2,000 gallons of blood. • In a 70-year lifetime, an average human heart beats more than 2.5 billion times.
  45. 45. In Myocardial Infarction, time lost is myocardium lost!!
  46. 46. Pre-hospital Care of MI Hospital fibrinolysis: Door-to-Needle within 30 min. Not PCI capable EMS on-scene Inter- Onset of 9-1-1 Hospital • Encourage 12-lead ECGs. symptoms of EMS Transfer • Consider prehospital fibrinolytic if STEMI Dispatch capable and EMS-to-needle within PCI 30 min. capable GOALS 5 8 EMS Transport min. min. Patient EMS Prehospital fibrinolysis EMS transport EMS-to-needle EMS-to-balloon within 90 min. within 30 min. Patient self-transport Hospital door-to-balloon Dispatch within 90 min. 1 min. Golden Hour = first 60 min. Total ischemic time: within 120 min.
  47. 47. Typical Chest Pain
  48. 48. Hollywood Heart Attack
  49. 49. Remember With heart attack, every minute counts. If the warning signs are present, do not waste vital moments wondering whether it is a heart attack or not. Take immediate action!
  50. 50. First Responder Care to Patient with MI • Recognize and Call (MOST IMPORTANT!) • Rest the casualty in a position of comfort, usually sitting • Assist the casualty to take their medication (nitroglycerine tablets)
  51. 51. First Responder Care to Patient with MI • If conscious, give casualty 1/2 an aspirin tablet and have them chew it slowly, unless it is known that the person has been advised not to take aspirin • Reassurance • Stay with the casualty and observe him
  52. 52. Pads Position
  53. 53. Posterior Position
  54. 54. Defibrillation Cardioversion Synchronised on the R Not synchronised wave For For cardiac arrest periarresttachyarrhythmias (unstable) Higher energy joules Lower energy joules No escalating energy for Escalate for next shock next shock (100 - 200 - 300 - 360J)
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×