hsu 100-1 choking and other conditions.lecture 4

8/11/2019 HSU 100-1 Choking and Other Conditions.lecture 4

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BLS.


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Choking in an Adult.

Recognitionrecognition of choking (airway obstruction by aforeign body) is the key to successful outcome.It is important not to confuse this emergencywith fainting, heart attack, seizure, or otherconditions that may cause sudden respiratory

distress, cyanosis, or loss of consciousness.Foreign bodies may cause either mild orsevere airway obstruction.


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General signs of choking Attack occurs while eatingVictim may clutch his neck


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Signs of mild airwayobstruction

Response to question Are you choking? Victim speaks and answers yesOther signsVictim is able to speak, cough, and breathe

Attempts to cough and breath Attempts to grasp throatWheezing/difficult breathing


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Signs of severe airwayobstruction

Response to question Are you choking? Victim unable to speakVictim may respond by nodding

Other signsVictim unable to breatheBreathing sounds wheezy

Attempts at coughing are silentVictim may be unconsciousUnable to speak, cough or breathClutches the neck with thumb and fingers.


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Sequence for the treatment ofadult choking.

(This sequence is also suitable for use inchildren over the age of 1 year)

1. If the victim shows signs of mild airwayobstruction:Encourage him to continue coughing, but donothing else.

Continue to check for deterioration toineffective cough or until obstruction relieved.


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2. If the victim shows signs of severe airwayobstruction and is conscious:Give up to five back blows.Stand to the side and slightly behind thevictim.Support the chest with one hand and lean the

victim well forwards so that when theobstructing object is dislodged it comes out ofthe mouth rather than goes further down theairway.


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Give up to five sharp blows between theshoulder blades with the heel of your otherhand.

Check to see if each back blow has relievedthe airway obstruction. The aim is to relieve

the obstruction with each blow rather thannecessarily to give all five.


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If five back blows fail to relieve the airwayobstruction give up to five abdominal thrusts.Stand behind the victim and put both armsround the upper part of his abdomen.Lean the victim forwards.Clench your fist and place it between theumbilicus (navel) and the bottom end of thesternum (breastbone).Grasp this hand with your other hand and pullsharply inwards and upwards.

Repeat up to five times.


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3. If the victim becomes unconscious:

Support the victim carefully to the ground.

Call an ambulance immediately.

Begin CPR (from 5B of the adult BLSsequence). Healthcare providers, trained andexperienced in feeling for a carotid pulse,should initiate chest compressions even if apulse is present in the unconscious chokingvictim.


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Cont.

NB: A strong cough often expels the objectfrom the airway. A person with a strong coughshould be allowed to continue coughing.


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Heimlich maneuver

These are distinct and sustained abdominalthrusts in standard individuals or chest thrustsin obese or pregnant women.(5 in number).

This produces increased pressure in theabdomen and chest, which expels the object.

Repeat abdominal/chest thrusts until effectiveor victim becomes unconscious.


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If the obstruction is still not relieved, continuealternating five back blows with five abdominalthrusts.


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PAEDIATRIC CHOKING

Recognition of chokingWhen a foreign body enters the airway thechild reacts immediately by coughing in anattempt to expel it.

A spontaneous cough is likely to be moreeffective and safer than any manoeuvre a

rescuer might performHowever, if coughing is absent or ineffective,and the object completely obstructs the airway,the child will become asphyxiated rapidly.


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Active interventions to relieve choking aretherefore required only when coughingbecomes ineffective.

The majority of choking events in childrenoccur during play or whilst eating, when acarer is usually present.

Interventions are usually initiated when thechild is conscious.Choking is characterized by the sudden onsetof respiratory distress associated withcoughing, gagging, or stridor.


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Similar signs and symptoms may also beassociated with other causes of airwayobstruction, such as laryngitis or epiglottitis,

which require different management.


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Suspect choking caused by a foreign body if:the onset was very sudden;

there are no other signs of illness;

there are clues to alert the rescuer, forexample a history of eating or playing withsmall items immediately prior to the onset ofsymptoms.


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General signs of choking

Witnessed episode

Coughing or choking

Sudden onset

Recent history of playing with or eating smallobjects


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Unable to vocalize

Quiet or silent coughUnable to breathe

CyanosisDecreasing level ofconsciousness

Crying or verbal

response toquestionsLoud cough

Able to take abreath beforecoughingFully responsive

Ineffective coughing Effective cough


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Conscious child with choking

If the child is still conscious but has absent orineffective coughing, give back blows.

If back blows do not relieve choking, givechest thrusts to infants or abdominal thrusts tochildren. These manoeuvres create an

artificial cough to increase intrathoracicpressure and dislodge the foreign body.


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Back blows: In an infant:

Support the infant in a head-downwards,prone position, to enable gravity to assistremoval of the foreign body.

A seated or kneeling rescuer should be able tosupport the infant safely across his lap.Support the infant s head by placing the thumb

of one hand at the angle of the lower jaw, andone or two fingers from the same hand at thesame point on the other side of the jaw.


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Do not compress the soft tissues under theinfant s jaw, as this will exacerbate the airwayobstruction.

Deliver up to 5 sharp back blows with the heelof one hand in the middle of the back between

the shoulder blades.

The aim is to relieve the obstruction with eachblow rather than to give all 5.


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Back blows: In a child over1year:

Back blows are more effective if the child ispositioned head down.

A small child may be placed across therescuer s lap as with an infant.

If this is not possible, support the child in aforward-leaning position and deliver the backblows from behind.


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NOTE:If back blows fail to dislodge the object, andthe child is still conscious, use chest thrusts for

infants or abdominal thrusts for children.

Do not use abdominal thrusts (Heimlich

manoeuvre) for infants.


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Deliver up to 5 chest thrusts using 2 fingers.These are similar to chest compressions, butsharper in nature and delivered at a slower

rate.

The aim is to relieve the obstruction with each

thrust rather than to give all 5.


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bd l h f


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Abdominal thrusts forchildren over 1 year:

Stand or kneel behind the child. Place yourarms under the child s arms and encircle historso.

Clench your fist and place it between theumbilicus and xiphisternum.

Grasp this hand with your other hand and pullsharply inwards and upwards.


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Ensure that pressure is not applied to thexiphoid process or the lower rib cage as thismay cause abdominal trauma.

The aim is to relieve the obstruction with eachthrust rather than to give all 5.


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Abdominal thrust on a child


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Following chest or abdominal thrusts,reassess the child:If the object has not been expelled and the

victim is still conscious, continue the sequenceof back blows and chest (for infant) orabdominal (for children) thrusts.

Call out, or send, for help if it is still notavailable.Do not leave the child at this stage.


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If the object is expelled successfully, assessthe child s clinical condition.

Possibility of part of the object remaining in therespiratory tract and cause complications:seek medical assistance.

U i hild i h


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Unconscious child withchoking

If the choking child is, or becomes,unconscious place him on a firm, flat surface.Call out, or send, for help if it is still not

available.Do not leave the child at this stage.

Airway opening:

Open the mouth and look for any obviousobject.If one is seen, make an attempt to remove it

with a single finger sweep.


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Do not attempt blind or repeated fingersweeps these can impact the object moredeeply into the pharynx and cause injury.


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Rescue breaths:

Open the airway and attempt 5 rescuebreaths.

Assess the effectiveness of each breath: if abreath does not make the chest rise, repositionthe head before making the next attempt.


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Chest compression and CPR:

Attempt 5 rescue breaths and if there is noresponse, proceed immediately to chestcompression regardless of whether the

breaths are successful.

Follow the sequence for single rescuer CPR

(step 7B above) for approximately 1 minbefore summoning the EMS (if this has notalready been done by someone else).


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When the airway is opened for attempteddelivery of rescue breaths, look to see if theforeign body can be seen in the mouth.

If an object is seen, attempt to remove it with asingle finger sweep.If it appears that the obstruction has been

relieved, open and check the airway as above.Deliver rescue breaths if the child is notbreathing and then assess for signs of life. Ifthere are none, commence chest

compressions and perform CPR (step 7B


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If the child regains consciousness and isbreathing effectively, monitor breathing andconscious level whilst awaiting the arrival of

the EMS.

P di t i Ch ki g T t t


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Paediatric Choking TreatmentAlgorithm

Assess severity

Effective coughIneffective cough

EncouragecoughContinue to checkfor deterioration toineffective coughor until obstructionrelieved

Conscious

5 back blows5 thrusts(chest for infant)(abdominal forchild > 1 year)

UnconsciousOpen airway5 breathsStart CPR


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NEAR DROWNING

NEAR DROWNING


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NEAR DROWNING.

A severe oxygen deprivation (suffocation) caused bysubmersion in water but not resulting in death; whendeath occurs, the event is called drowning.Water entry causes spasms of trachea: prevents water

entry into lungs. Only


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Rescuing a drowning victim

If conscious throw a buoyant aid e.g. surfboard or drug from water using a ropeIf unconscious remove him from waterDon't attempt to rescue a victim beyondyour swimming abilityRescue breathing in water requires atrained person with a floating aidChest compressions are dangerous inwater


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First aid

Call helpIf possible, roll casualty into recovery positionfor assessment of airway and breathing

(casualty likely to regurgitate/vomit)CPR if necessaryTreat hypothermia

Don t try to extract water from trachea Don t bother about abdominal distention


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POISONING


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POISONING

Poison: any substance which if taken in to thebody in sufficient quantity can causetemporary or permanent damage.

Route of entry :(deliberate/accidental) Mouth-swallowing/ingestion eating or

drinking poisonous substance.

Lungs-inhalation)- breathing in gases or fumesfrom heaters, car exhaust fumes, smoke, glueetc.

Skin(body contact)- being bitten by someanimals, by injection, absorption through the

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Poisons work by:

Stopping respiration/heart beat

Burning the food passages/ blocking functionsof the GIT by irrigating the passageways.

Burning parts of the body which they come to

contact with.

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General signs and symptoms.Oedema of lip and tongue leading torespiratory obstructionViolent vomitingDiarrhoeaBurning sensations on affected part-mouth,throat.

Abdominal pains

Increased heart beatSweatingFrothing/foaming

Pin pointed pupils.

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Information needed.

What poison was taken

When was it taken-time/duration

Route of entry

Any loss of consciousness

Any first aid given.

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General treatment Quickly ask a conscious casualty what

happened. Do not try to make the casualty vomit

If lips show signs of burning, cautiously coolthem by giving water/ milk to sip slowly if youare qualified to do this.

If unconscious: No breathing, No heart beat,DO CPR.

If unconscious and breathing well, put inrecovery position as may vomit.

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Avoid taking medicine in your child s presence.Children love to imitate.Never store food and cleaning products

together.Store medicine and chemicals in originalcontainers and never in food or beveragecontainers.Read the label on all products and heedwarnings and cautions.Label all medicines and chemicals, never usemedicine from an unlabelled or unreadable

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Know what your child can do physically, e.g.crawl, walk, stand.

Keep the phone number of your health officer,poison centre, police department and

emergency medical system within reach .

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GAS POISONING/SMOKE


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GAS POISONING/SMOKEINHALATION

Inhaled poisons include carbon monoxide,methane (sewers, mines), chlorine (poolchemicals, cleaning products), fumes from

paints, glues and industrial chemicals.s/s: Breathing problems, head ache, nausea,

dizzinessFirst aid:

Ensure own & casualty safety (danger ).Move casualty to fresh airPerform CPR if necessary


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INGESTED POISON

Corrosive substances: Burning substancese.g. acids,petroliums, toilet cleanersNon corrosive substances: Non burning e.g.

medicationss/s :

Pain in mouth/abdomen

Burning sensation in lips/mouthNausea/vomitingDifficult in breathing/sweating

unconsciousness


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First aid

DRABCIf rescue breathing required wipe away anycontamination around mouth.

Identify type, quantity and time poison wastakenDo not induce vomiting unless advised by a

specialistDo not give anything by mouthSend vomitus and container to hospital withcasualty


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ABSORBED POISON

Splash of poisonous chemical e.g. insecticideBe careful not to contaminate yourself; useprotective device e.g. gloves if available.

DRABCCasualty to remove all contaminated clothingFlood affected area with running water

Seek medical help


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EPISTAXIS


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NOSE BLEEDS(EPISTAXIS).Have a variety of causes: blowing nose toohard, sneezing, nose punch, nose picking, coldor dry air, drugs that interfere with blood sability to clot e.g aspirin.

Usually comes from front part of the nasalseptum, which contains many bloods vessels.

Blood flow can be heavy and frightening- thereis danger of the person swallowing or breathingin blood.


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First aidSit the person with head slightly forward.Let casualty breath through the mouth whilepinching the soft part of the nose firmly for 10minutes (or longer), until the flow stops.

Apply cold compress to forehead and neck Advise not to swallow any blood.Do not let person lift the head.Do not plug the nose but clean around the mouth

and nose. Avoid blowing the nose for several hours after anose bleed.If nose bleeding recurs/does not stop seek medical

help.


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BURNS AND SCALDS


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Classification of burns

First-degree burns shallow (superficial).They affect only the top layer of the skin(epidermis).

Second-degree burns extend into the middlelayer of skin (dermis). Very painful

Third-degree burns involve all three layers ofskin ( epidermis, dermis, and fat layer), usuallydestroying the sweat glands, hair follicles andnerve endings as well. May not be painful

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ACTION


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ACTION If casualty is on fire:

Lie casualty down and put out flames with water orwrap person tightly in a coat, curtain or heavy materialthat will not catch fire.

If indoors, do not let casualty panic and rush outside-this worsens the flames.

Cool damaged area under cold running water for atleast 10 minutes or flood area with cold water (20minutes or longer)

Carefully remove/cut off any clothing which has beensoaked in boiling fluid.Dont remove clothescontaminated with chemicals over the face.

Remove anything that might constrict the area if itswells e.g. rings, watches, tight clothing, shoes, belt.

Elevate burnt limb if possible

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Cont


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Cont.Cover with a clean non sticky, preferably sterile

dressing.DO NOT:Remove anything sticking to the burn.

Apply any creams, butter, oil, lotion, grease,flour, eggs to the burnt area.Burst any blisters/remove loose skin

Apply adhesive dressings/plasters.

NB: move to hospital immediately if has burns onthe mouth/throat, inhalational burns.

Extensive burns ma cause shock

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CHEMICAL BURNS


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CHEMICAL BURNSSings & Symptoms; skin may be stinging,

stained/reddened skin, blistering & peeling ofskin.

Treatment:Flood area with cold running water for at least10 minutes (let water drain away safely)

Gently and carefully remove any contaminatedclothing as water runs over injury site.

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If eyes injured:


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If eyes injured:Severe scarring and even blindness can occur.

S &S: intense pain, reddened, swollen andwatering, one may want to rub the eye.Treatment:

Let casualty not rub the eye.

Hold person s face gently under running coldwater to wash the eye and drip off the face, ORput side of face in a container of cold water andblink.

Lightly pad the eye with sterile/clean pad or nonstuff material.Move to hospital immediately.

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ELECTRICAL INJURY/BURNS


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ELECTRICAL INJURY/BURNSMost electrical accidents occur in homes.

Burns occur when electricity passes through bodytissues. It might seem small on the surface but isprobably very deep and damage to tissues belowvery severe.

May cause asphyxia and even broken bones.

Ensure house hold appliances are: wired correctly,kept out of reach of children, away from water.

LOW VOLTAGE: in house hold appliances.S &S: range from weakness, fainting, frightened,confusion, frothing at mouth to difficulty in breathing

and unconsciousness.

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Action :switch off current and plug off before touching thecasualty.If not possible, use something dry and wooden to movethe casualty away from the power source.Check casualty s breathing and pulse. Keep warm and reassure by talking calmly.

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NB:


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NB: Never touch the casualty until power source

has been turned off. Never apply water to a burn from an electric

shock while casualty is still attached to theelectricity source.

HIGH VOLTAGE : power lines/overhead cables. Usually fatal Cause severe burns and casualty may be

thrown from point of contact by muscularspasms.

If casualty is within 18 m(20 yards) of a source,

do not approach or try to rescue unless told its

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Cont


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Cont.Electricity may arc and jump considerable

distances. Even insulation materials may notbe of any practical effect.S &S: redness, swelling, scorching or charring at

the place where electricity entered and where itleft, breathing and heart may have stopped.

ACTION:Call police / power officials.

Keep away bystanders. Approach only if safe.Treat like severe burns

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FAINTING

FAINTING/SYNCOPE


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FAINTING/SYNCOPEBrief loss of consciousness caused by

temporarily lack of enough oxygen flow to thebrain.

Common causes

Sudden fright (frightened) or other emotions

Lack of food/hunger.

Standing still for long in a hot, stuffy

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ACTION


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ACTION Lie person down with legs raised.

Loosen tight clothes around neck, chest and waist. Ensure casualty has plenty of fresh air. Check for and manage any cause. Reassure as the casualty comes by. If standing(parade/crowd); advise to tighten and relax leg

muscles and move toes until circulation improves. If one feels unsteady, advise to sit and lean forward, let

person take deep breaths. Monitor closely at 10 minutes interval.

If unconscious, lay down , raise legs and open airway: do ABCs.

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BITES AND STINGS

BITES AND STINGS


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BITES AND STINGS Bites from mosquitoes/stings from wasps and

bees can be extremely painful causing hard,red, swollen lumps which itch intensely.

ACTION:

If sting has been left in the skin, remove withclean tweezers, taking care not to squeeze thepoison sac as this forces the remaining poisoninto the skin.

Can apply cold compression for pain relief. NB: bites/stings can cause anaphylactic

allergic reaction- oedema + breathingproblems: do ABCs

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SNAKE BITES


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SNAKE BITES Some snakes are poisonous e.g. puff adder,

spitting cobra, green mamba etc. Poisonous snakes produce toxins which are

neurotoxin, cardiotoxic, blood toxic. ACTION: Note snake species or kill it, take patient to

hospital with it. Immediately, lay casualty down with wound lower

than the heart. Immobilise the limb Keep casualty calm and still Remove fangs if visible Promptly take to hospital

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DO NOT


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DO NOT:

Apply torniquet

Slash the wound with knife/sharp instrument

Attempt to suck out the venom

Catch the snake unless it is already dead.

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hsu 100-1 choking and other conditions.lecture 4

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