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CPR one rescuer unwitnessed
- 1. Determine unresponsive-tap & shout
- 2.Call for help-do not leave pt
- 3.Established airway-position pt,open airway
- 4.Check breathing
- 5.Give 2 full breaths
- 6.Check pulse-carotid artery
- 7. Pulseless start chest compression
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What is the best way to establish patient airway
- Head tilt/chin lift (hyperextend)
- Jaw thrust/modified jaw thrust
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Contraindications for head tilt/chin lift
Fractured neck, suspicion of neck fracture
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What method do you use with a patient with suspected neck fracture?
Jaw thrust/modified jaw thrust
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Complications of CPR
- Gastric distention-most common
- Pneumothorax
- Gastric Rupture
- Cross Contamination
- Aspiration
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Complications external cardiac compression
Rib fractures-most common (Dont Stop CPR)
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How do you check effectiveness of cardiopulmonary resuscitation
- Carotid pulse-during compressions
- Dont remove cervical collar during resuscitation check femoral pulse
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CPR Breathing Rate 8yrs to Adult
10-12 breaths/min every 5 sec
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CPR compression ventilation Ratio
30:2 both one & two rescuer
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Pulseless ventricular tach
- Defibrillation 360 joules
- Unsuccessufl, Start CPR & administer epinephrine,amiodarone, lidocaine
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Ventricular Fib
- Treat Defib 360 joules
- Unsuccessful, start CPR & give epinephrine,amiodarone, lidocaine
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Cardioversion
- Low voltage to heart to convert cardiac dysrhythmia to normal sinus rhythm
- Make sure its ON, electric shock delivered on R wave ECG.
- Versed (midazlam)strong, short acting sedative prior cardioversion
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Defibrillation
- Pulsess vent tach
- Ventricualr Fib
- Start 360 joules
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Troubleshooting Equipment
- Bag fills rapidly & collapses on minimal pressure check inlet valve
- Bag becomes hard to compress & pt compliance normal, patient valve stuck open or closed
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Pneumothorax
- Trachea deviated opposite side
- Hyperresonant
- Decreased BS affected side
- Recommend insertion Chest tube
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Hemothorax
- Trachea deviated opposite side
- Dull Percussion note
- Decreased BS on affected side
- Recommned Chest tube
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Advantages of mouth to valve mask ventilation
- Eliminates direct contact with patient
- Provide O2 up 50% w/ flow rate 10L/Min
- One way valve between mask & practitioners mouth elimination exposure to air
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Land/Air Transport
- 0-80 miles: ambulance
- 81-150 miles: helicopter
- >150 miles: fixed wing aircraft (airplane)
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Pulmonary Edema/CHF
- Left ventricular failure & lung reaction
- Excessive fluid accumulates in lungs & affects ventilation & oxygenation
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Treatment Pulmonary Edema / CHF
- Improves gas exchange-give 100% nonrebreather IPPB 100% O2 PEEP or CPAP
- Increase strength heart contraction (inotropy)
- give digitalis
- Decrese venous return-lasix,fowlers
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Pulmonary embolism
- Blood clots in lungs
- Deadspace disease V/Q mismatch
- Risk post op, bedridden history circulation problems (DVT), longer period at rest
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Treatment Pulmonary Embolism
- O2 therapy 100%
- Anticogaulation therapy (heparin & coumadin)
- Thrombolytic drugs/screens/surgery
- X-ray: peripheral wedge shaped infiltrate
- V/Q scan/spiral CT scan
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Pneumothorax treatment
- Air Pleural space affect ventilation
- Give 100% O2, nonrebreathing mask
- Immediate chest tube/thoracentisis to relieve pressure
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Status Asthmaticus
- Unresponsive bronchodilator therapy
- Affect ventilation/oxygentionv
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Treatment status asthmaticus
- 100% O2 nonrebreather mask
- Continuous bronchodilator therapy albulteral,ipratrioum
- Corticosteriods - IV & oral
- Mechanical Vent-sedate, paralyze
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CO poisoning
- Inability HB to bind w/O2 due to CO2 binding.
- 100% non-rebreathing mask, CPAP< mask
- Hyperbaric Oxgyen
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