6. abc and maternal resusctation rev_19.5.10
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  • 1. IN PARTNERSHIP WITHLiverpool School of Tropical MedicineLiverpool Associates in Tropical HealthAirway, Breathing andAirway, Breathing andCirculationCirculation
  • 2. AimsAimsTo understand the ABC and D approachTo understand the ABC and D approachTo develop and practise the skills ofTo develop and practise the skills ofcardiopulmonary resuscitation using the ABCcardiopulmonary resuscitation using the ABCapproachapproachTo achieve competence in those skillsTo achieve competence in those skills
  • 3. Airway, Breathing and CirculationAirway, Breathing and Circulation Assessment of any sick patient begins with ABCAssessment of any sick patient begins with ABC Done in this order because airway and/orDone in this order because airway and/orbreathing problem will kill before a circulationbreathing problem will kill before a circulationproblemproblem You assess airway and breathing,You assess airway and breathing, and treatand treat,,and then assess circulationand then assess circulation and treatand treat
  • 4. Airway and BreathingAirway and Breathing‘‘Hello how are you MrsHello how are you MrsTilt?’Tilt?’If no response:If no response: Assess if patient isAssess if patient isbreathing or notbreathing or not
  • 5. Airway and BreathingAirway and Breathing LookLook for breathing byfor breathing bylooking for movementlooking for movementof the chestof the chest ListenListen for breathingfor breathingor noisy breathingor noisy breathing FeelFeel for breathingfor breathing
  • 6. Airway and BreathingAirway and BreathingIf not breathing orIf not breathing ordifficult breathing:difficult breathing: Open airway byOpen airway byhead tilthead tilt andand chinchinliftlift
  • 7. Airway and BreathingAirway and Breathing Open airway byOpen airway byjaw thrustjaw thrust
  • 8. Airway and BreathingAirway and Breathing Gentle suctionGentle suction if necessary under direct visionif necessary under direct vision
  • 9. Airway and BreathingAirway and Breathing If still not breathing:If still not breathing: place oropharyngeal airwayplace oropharyngeal airway
  • 10. Airway and BreathingAirway and BreathingIf still not breathing:If still not breathing: give rescue breathsgive rescue breaths
  • 11. Airway and BreathingAirway and BreathingIf breathing:If breathing: givegive oxygenoxygen(if available)(if available) Sit patient upSit patient up (if alert)(if alert)or place inor place in recoveryrecoverypositionposition
  • 12. CirculationCirculationHow do we assess circulation?How do we assess circulation?
  • 13. CirculationCirculation Colour-Colour-?pale ?greyish?pale ?greyish Skin-Skin-?cold, ?hot ?sweaty?cold, ?hot ?sweaty Mental State-Mental State- ? confused ?aggressive ?not alert? confused ?aggressive ?not alert Urine output-Urine output-?reduced?reduced Heart rateHeart rate- ? High ? low- ? High ? low Blood pressureBlood pressure-low-low Fetal heart RateFetal heart Rate - ? High ? low- ? High ? low
  • 14. CirculationCirculation Pregnant uterus compresses vena cavaPregnant uterus compresses vena cavacausing BP to dropcausing BP to drop ‘‘Hello Mrs Tilt’……..Hello Mrs Tilt’……..
  • 15. CirculationCirculation Place iv lines, take bloods, start iv fluidsPlace iv lines, take bloods, start iv fluids Why is there a circulation problem?Why is there a circulation problem? Stop bleedingStop bleeding Treat infectionTreat infection
  • 16. Cardiopulmonary resuscitationCardiopulmonary resuscitation(CPR)(CPR) This is the approach to an apparentlyThis is the approach to an apparentlylifeless patientlifeless patient It is a rapid assessment ofIt is a rapid assessment of AAirway andirway and BBreathing andreathing and CCirculationirculation starting treatment quicklystarting treatment quickly
  • 17.  Ensure you are not putting yourself atEnsure you are not putting yourself atrisk!risk! Is it safe to approach?Is it safe to approach?
  • 18. Shake and shoutShake and shout Hello how are you?Hello how are you? If no response, callIf no response, callor send for helpor send for help Tilt to left lateralTilt to left lateralposition if greaterposition if greaterthan 20 weeksthan 20 weekspregnantpregnant
  • 19. Open the AirwayOpen the Airway Turn onto back andTurn onto back andopen airwayopen airway Head tilt or chin lift orHead tilt or chin lift orjaw thrustjaw thrust Assess breathing andAssess breathing andfeel for a pulse for 10feel for a pulse for 10secondsseconds Look, listen, feel Palpate carotid pulsefor 10 seconds
  • 20. No breathing, No pulseNo breathing, No pulse Start chestStart chestcompressionscompressions
  • 21. Chest compressionsChest compressions place heel of firstplace heel of firsthand on lower part ofhand on lower part ofsternumsternum place heel of secondplace heel of secondhand on top of firsthand on top of first interlock fingersinterlock fingers
  • 22. Chest compressionsChest compressions Keep arms straightKeep arms straightand depress sternumand depress sternum4-5 cm at a rate of4-5 cm at a rate of100 compressions per100 compressions perminuteminute Change the personChange the persondelivering thedelivering thecompressions tocompressions toavoid getting tiredavoid getting tired
  • 23. Give 30 compressions:2 breathsGive 30 compressions:2 breaths Give 2 slow breathsGive 2 slow breathseach lasting about 1each lasting about 1secondsecond Watch for chest riseWatch for chest rise Give oxygen ifGive oxygen ifavailableavailable
  • 24. If breathingIf breathingTurn into recovery positionTurn into recovery positionCheck pulse, BP and FHCheck pulse, BP and FHRegularly reassessRegularly reassessAssessAssess DD, DISABILITY (level of consciousness), DISABILITY (level of consciousness)AA-Alert,-Alert, VV-respond to voice,-respond to voice, PP-respond to pain,-respond to pain,UU - Unresponsive- Unresponsive
  • 25. Think of Reversible CausesThink of Reversible Causes• 4 H’s, 4 T’s4 H’s, 4 T’sHypovoleamiaHypovoleamiaHypothermiaHypothermiaHypo/HyperkalaemiaHypo/HyperkalaemiaHypoxiaHypoxiaTension PneumothoraxTension PneumothoraxTamponadeTamponadeThromboembolismThromboembolismToxinsToxins
  • 26. ??
  • 27. AAirway beforeirway before BBreathing beforereathing before CCirculationirculationOpenOpen AAirway and maintain, give oxygenirway and maintain, give oxygen Check forCheck for BBreathing, assist if necessaryreathing, assist if necessaryAssessAssess C and don’t forget left lateral tiltC and don’t forget left lateral tiltTreatTreat CC problemproblemRECAP-1RECAP-1
  • 28. IN PARTNERSHIP WITHLiverpool School of Tropical MedicineLiverpool Associates in Tropical HealthRECAP-2RECAP-2The approach to an apparently lifelesspatientRemember: CALL FOR HELP!ABC approachCPR 30:2Left lateral tiltThink about causes - 4 H’s, 4 T’s4 H’s, 4 T’s