Compromised airway can result from three issues, namely obstruction, constriction, or trauma.
Obstruction can happen through tongue positioning, foreign body, vomiting, or aspiration
Constriction a.k.a. swelling can happen in the mouth, by the tongue, or due to airway structures
Trauma can be either maxillo-facial (trauma to the jaw and face) or mandibular (trauma to the lower jaw)
Assessment for Compromised Airway
1. look
Watch out for accessory muscle use, tracheal tug, or paradoxical (see-saw) chest-abdo movements…
2. Listen
Can you hear any gurgling, stridor, snoring or hoarseness coming out of the casualty’s mouth?
3. feel
Can you feel air moving in and out of the casualty’s mouth or nose?
First Aid for Compromised Airway by Foreign Bodies
If a person coughs excessively whilst eating, keep a hands-off approach and encourage the person to cough. Coughing signifies that air is still going in and out of the lungs, thus, encourage to deep breathe and cough as hard as possible to cough out the obstructed foreign body.
If the person is not coughing, or coughing is ineffective, follow the 3 first aid maneuvers for compromised airway by foreign body listed below:
Back Blows
give up to 5 back slaps – hit back from low direction upwards (least effective, least damaging)
Abdominal Thrusts
perform up to 5 abdominal thrusts (moderately effective, moderately damaging – may cause organ rupture)
Chest Thrusts
perform up to 5 chest thrusts (most affective, most damaging – casualty needs to be taken to hospital following chest thrusts to have internal organs checked due to possible damage)
NOTE: If obstruction doesn’t get cleared out, the casualty eventually collapses. At this point perform CPR and before giving mouth-to-mouth check inside the mouth to see if object has dislodged with compressions.
Paediatric Compromised Airway
Babies usually deal with choking on their own, without needing first aid
DO NOT perform abdominal thrusts on infants, since doing so may cause liver rupture. Instead, perform chest thrusts and back blows
Narcan (Naloxone)
Narcan (Naloxone) is a medication used to block the effects of opioids. It is commonly used in the case of decreased breathing triggered by opioid overdose such as in heroin overdose.
Naxolone may be combined with an opioid to decrease the risk of opioid misuse.
Retrieved from https://www.princeedwardisland.ca/en/information/health-and-wellness/preventing-opioid-related-overdoses on 27th September 2022
Retrieved from https://rightpathaddictioncenters.com/opiate-withdrawal/ on 27th September 2022
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Self love is a common word which various things are categorised within. Self love is a term used to support the idea of doing something good for yourself. One might find soothing a simple task such as a walk in the park, while for someone else means partying all night. The idea behind it is to fuel up yourself with positive energy to be able to cope with the stressful life we most live in.
However, lately our society has tagged many self love things as a justification of selfishness. Prioritizing your needs and what you deserve is vital, however, not when it comes at the cost of causing discomfort to others. Especially if you can help it not to happen.
Self love doesn’t justify being selfish or mean. You cannot justify something which leaves others astray or which brings negativity into someone else’s life as self love. We do have responsibility toward other people and we can’t disregard that by doing things for our own gain, without giving explanations or answers of our behaviour. Doing what you want rather than what you have responsibility to do isn’t practicing self love. Do not use this powerful word to excuse selfish behaviour. You are simply choosing to do what you want without worrying about how much hurt it will cause. Especially if you know what the consequences of your actions will be.
Giving priority to yourself is important and healthy. Taking decisions which let you live a happy life are important too, thus this means you do so in a reasonable way.
If you need to cut off a relationship, be clear about it, keep up with your decisions and give answers for your actions. Even if your answers may cause anger to the other person, it is still better than letting someone waiting for a conclusive answer. If you feel that certain things are bothering you, talk about it, state what your actions will be if nothing is improved, but ghosting others or simple show up not being your true self is not acceptable.
When asked why you are acting in a certain way, be truthful, no matter what the outcome will be. The other end deserves the truth and you deserve the peace of mind that you are offering a transparent connection without lies or half truths.
Self love is such an important and amazing thing, a person who practices the real self love will surely not be able to act selfishly towards others.
Wounds are skin breakages caused by injury. Complications in relation to wounds include bleedingand infection.
Types of Wounds
incision – a cut, such as one made with a knife
laceration – pulled off skin
abrasion – wound caused by friction
contusion – a.k.a. bruising
puncture wound – wound caused by a pointy object eg. nail
Retrieved from https://emedicodiary.com/que/437/wound on 20th September 2022
First Aid for Traumatic Wounds
There are 3 concepts required in providing immediate care for traumatic wounds:
control the bleeding
clean the wound
protect the wound
1. Control the Bleeding
Step 1: wear gloves to protect self from casualty’s blood
Step 2: control the bleeding
Step 3: assess for shock & if suspected, provide first aid for shock
Step 4: call 112 for assistance
2. Clean The Wound
Step 5: once the bleeding is under control, irrigate the wound with running water
Step 6: remove gross debris
3. Protect The Wound
Step 7: cover wound with a clean cloth or sterile dressing if available
Step 8: seek medical advice as required
NOTE: DO NOT remove any foreign objects embedded in wounds! Such objects need to be removed in a hospital setting, with adequate pain relief. If foreign object is embedded, apply bandaging to hold it in place until casualty arrives at the hospital.
First Aid for Particular Types of Wounds
Fracture site wounds
If there is a visible fracture at the injury site, or a fracture is suspected, do not apply a lot of pressure to stop the bleeding since this would cause a lot of pain, as well as create further problems with the fracture. In such case you can still irrigate the wound by running water.
Thoracic Wounds
When dealing with thoracic wounds, do not apply too much pressure to stop the bleeding. Additionally, leave the chest wound uncovered. You may clean the area surrounding the wound, but there is no need to irrigate the wound with running water.
Abdominal Wounds
If an injury to the abdomen causes the intestines to be pushed out of the abdomen, do not attempt to push them back inside the casualty, as this may cause serious damage. Instead, use a moist sterile cloth and cover the intestines, or else leave the intestines uncovered and wait for the ambulance to arrive.
Burns
Burns occur when the body is exposed to thermal, chemical, or electrical energy which leads to skin loss and damage to the underlying tissue. Complications arising from burns include tissue damage, fluid loss, heat loss, and infection.
Types of Burns
thermal burns – flames, hot objects, flash burns, radiation, hot liquids, and steam burns
chemical/corrosive burns
electrical burns – caused by electric conduction which usually causes 2 wounds: a small entry wound and a larger wound at the earthing area; electrical burns can easily cause a cardiac arrest!
The severity of an injury caused by a burn depends on factors such as the site of injury, the depth and extent of injury, the cause, as well as the casualty’s age, prior health status and additional injuries.
Burn Depth
1. Superficial Burn
In a superficial burn, the burn affects only the epidermis of the skin. Signs of a superficial burn include:
pain
redness
blanches with pressure
absent oedema
2. Partial Burn
In a partial burn, the burn affects both the epidermis and the dermis. In such burns, blisters may appear, which are fluid-filled located between the epidermis and the dermis. NEVER burst a blister unless in a hospital setting! Signs of a partial burn include:
pain
blisters
moisture
3. Full Burn
In a full burn, the burn uncovers the structure of the affected area – structures such as muscles and bones. Nerves are usually burned in these types of burns, which causes the casualty to experience no pain sensation. Signs of a full burn include:
uncovered structures
discolouration
dryness
absent pain
Retrieved from https://suprathelu.com/row/ on 20th September 2022
Measuring the Extent of a Burn
Method #1: The Palmar Method
Method #2: The Rule of 9’s
Retrieved from https://twitter.com/hp_ems/status/1421585002073149445 on 20th September 2022
Managing Burn Injuries
In burn injuries the main aims are to:
reduce pain
reduce the burning process
protect the injury
cool burn down with running water
remove ALL burnt clothing
cover burned area with a moist dressing and keep it wet so it doesn’t stick to the burnt area
if a moist dressing is not available, cover the area with plastic film
seek medical attention
DO NOT use any creams to treat burns.
DO NOT use ice to calm down the burning sensation as ice can cause a burn too.
DO NOT remove any clothing that is seemingly stuck to the burnt area.
First Aid for Other Types of Burns
Electrocution burn
Whilst an electrocuted casualty may not experience a cardiac arrest immediately, it is still possible after some time. Thus, if the casualty complains of chest pain and dyspnoea, get ready to resuscitate as a cardiac arrest may become quite possible.
Liquid chemical burn
If a casualty experiences a liquid chemical burn, flood burned area with water.
Dry Powder Chemical Burn
In the case of dry powder chemical burns, brush dry powder off, making sure it is still safe for you, and then flood with water.
NOTE: Inhaling hot or chemical fumes causes burns within the airway and the lungs. Thus, a casualty experiencing inhalation in such cases should go to the hospital for treatment as soon as possible.
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A decrease in blood pressure and SPO2 indicate circulatory failure – the brain is slowly dying due to lack of oxygen, and so, it triggers a defense mechanism: SHOCK.
Any issue affecting the heart, the blood vessels, or the blood volume, may lead to a decrease in the body’s blood circulation, leading to a reduction in blood pressure and volume, which in return cause a decrease in tissue perfusion.
Cardiogenic Shock – this may happen due to a heart defect or disorder (cardiogenic = issue originating from the heart itself) eg. Congestive Heart Failure (CHF) or Ischaemic Heart Disease (IHD);
Obstructive Shock – this may happen due to cardiac compression in cases such as in cardiac tamponade (bleeding within the pericardial space) and tension pneumothorax (air accumulation in the pleural space which compresses the lungs and decreases venous return to the heart).
2. Blood Vessel Dilation
Following vasodilation, which refers to the dilation of the blood vessels, a casualty can suffer a distributive shock:
Neurogenic Shock – happens following a spinal injury, head injury, or opiate overdose;
Septic Shock – happens following a severe infection which causes the casualty’s blood pressure to drop to a dangerously low level;
Anaphylactic Shock – happens following a severe allergic reaction
NOTE: due to a biochemical process in the body, chemicals released cause vasodilation, which then causes either a septic shock or an anaphylactic shock.
3. Blood or Fluid Loss
Severe bleeding or severe dehydration can lead to a hypovolaemic shock. This happens due to the drop in blood volume.
Progressive Shock Clinical Indicators
initial weak rapid pulse that eventually becomes thready or absent (body increases heart rate to compensate due to lack of blood; eventually, drop in cardiac output = drop in stroke volume = weak heartbeat)
initial rapid irregular breathing that eventually becomes laboured and dyspnoeic
initial pale skin that eventually becomes cold, clammy and mottled (happens since the body compensates lack of oxygen circulation by sending it in the most important areas rather than in the extremities)
cyanosis – signifies established hypoxia
weakness and fatigue – signifies cerebral hypoxia (lack of oxygen in the brain)
confusion and disorientation
altered level of response leading to unresponsiveness…casualty is now at risk of cardiac arrest!
Shock First Aid
identify cause of shock
control cause of shock
assist casualty in shock position – elevate legs by about 30cm to increase venous return; if casualty is conscious but dyspnoeic, a semi-sitting position helps provide better breathing
maintain casualty’s body temperature – this helps in avoiding hypothermia, which would disrupt an open wound’s clotting process, leading to longer bleeding time
administer high-concentrated oxygen if available
increase ventilation by opening windows if inside
call 112 for assistance
monitor casualty for deterioration – if casualty is in recovery position, attempt to maintain shock position i.e. elevated legs, if possible
provide reassurance at all times
Retrieved from https://persysmedical.com/blog/hypothermia-prevention/trauma-triad-of-death/ on 18th September 2022
NOTE: The term vasoconstriction refers to constriction of the blood vessels. It can be clinically indicated in blood pressure results that show a difference of about 20 only between the systolic and diastolic readings. In such case, the pulse is weak or not palpable.
Bleeding
Bleeding amount depends on what it is originating from:
ARTERIES – spurting blood, pulsating flow, bright red colour
VEINS – steady, slow blood flow, dark red colour
CAPILLARIES – slow and even flow
Bleeding severity depends on the injury body site, blood loss volume, time frame of blood loss volume, casualty’s age (worse in children and the elderly), and casualty’s health status prior to the injury.
Catastrophic bleeding refers to bleeding in which 30% of blood volume is lost. Such bleeding takes priority over Airway and Circulation in the DR ABC acronym.
The major consequence of blood loss is a hypovolaemic shock (explained further up). During this type of shock, the heart becomes unable to pump enough blood throughout the body due to severe blood or fluid loss. This leads to organs shutting down.
External Bleeding First Aid
wear gloves to protect self
control bleeding through direct pressure or using a pressure dressing
monitor and provide first aid for shock
Notes:
In bleeding circumstances without signs of shock, elevation is not recommended anymore.
Indirect pressure (pressing on arteries eg. on femoral or brachial artery) is not a recommended bleeding control technique anymore.
If direct pressure method fails, you may use an emergency bandage, tourniquet, or haemostatic agents, all of which require prior specific training.
In catastrophic bleeding first aid, one may pack the wound with a towel. Worrying about an infection is not a primary concern at this point, since catastrophic bleeding may lead to loss of life.
Haemostatic Agents can be poured on wounds to stop catastrophic bleeding. Only materials specifically prepared for bleeding purposes may be used
A tourniquetis a device that helps apply pressure to a limb or extremity to limit the flow of blood. It may be used in emergency situations, during surgery, or in the post-operative rehabilitation period.
Normal use tourniquets are orange in colour, while the Combat Application Tourniquet (CAT) is usually black.
Internal Bleeding
Internal bleeding may be caused as a disease process eg. due to a stomach ulcer, or trauma.
Common sites of serious internal bleeding include the head, the chest, the abdomen and pelvis.
Internal bleeding is more difficult to diagnose, since it usually doesn’t show. The worst type of internal bleeding happens in the pelvic area, right in the retroperitoneum.
Recognition of internal bleeding may be done through:
History
Signs & Symptoms
Pain & Tenderness
Revealed Internal Bleeding (eg. internal bleeding in the head may produce trickling blood out of orifices such as from the ear)
Types of Internal Bleeding:
Otorrhoea – blood coming out of the ear
Rhinorrhoea – blood coming out of the nose
Haemoptysis – coughed out blood
Haematemesis – vomited blood
Haematuria – bleeding in the urine
Rectal Bleeding – bleeding coming out of the intestines
Bruising
Retrieved from https://psnet.ahrq.gov/web-mm/coming-undone-failure-closure-device on 18th September 2022
NOTE: If there is suspicion of internal bleeding, it NEEDS TO BE ASSUMED! Monitor for ABC compromise and signs of shock, and provide first aid as needed!
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When I embarked on my journey for a Degree in Nursing as a mature student 4 years ago, I must admit I was pretty sure I wouldn’t make it past the interview phase.
I had zero self confidence. I did not believe in myself. Not at all. But there were a few individuals around me who did believe in me. And so, although I couldn’t see a possibility, I tried. I applied. I attended…and I passed the interview phase.
When I was asked to sit for an English Proficiency Test, I walked in, terrified, trembling. My mouth dried up…I could probably use an IV infusion at that time! And when we were asked to start writing, I could hear other students starting to write frantically on their exam papers while I had to close my eyes and calm my heart’s drastically increasing rate through deep breathing. It took me probably about 5 minutes to start writing…but I did it. I finished on time. And I passed.
When I stepped in a lecture room at the University of Malta for the first time at 37 years old after being accepted to take the 5 year long course, I wanted to do my best to sink into the seat I was sitting on, hoping that I would blend in or even better, go unnoticed amongst all the other students, most of who were the same age as my oldest daughter.
But day by day, the course started changing me.
Now, 4 years later, I can affirm I’ve probably been one of the biggest butt-pains my amazing lecturers have experienced so far (some of them know this…I’ve literally told them so because I feel it’s true!!).
Asking questions following deep reflections has become the norm for me. I no longer sink into my seat…I don’t mind speaking up anymore. I don’t mind advocating for others, be it students, patients, or anyone in need of support for a good cause.
A new challenge is now coming up…speaking up on a broader spectrum – speaking up with the aim of breaking health-related taboos that we still are dealing with here in Malta.
I know beyond doubt that this is going to be quite a tough challenge for me, yet I am ready to face it. For even as a registered nurse, in 2 years’ time I want to have enough experience to be a better advocate for my patients, both on an individual level, and if necessary, even on a larger scale. I want to be the voice of those who haven’t yet found theirs…who are still in the same spot I was 4 years ago, just sinking in my seat to avoid being seen.
Never did I imagine I could be where I am today, and for this I can only humbly thank those who believed in me when I didn’t, as well as all the lovely lecturers and academics at UM who were willing to listen and to encourage me from the very beginning to always speak up whenever I deem necessary.
One final piece of advice… It is NEVER TOO LATE to start something new! Believe in yourself and when hurdles pop up, jump. If you fall, get back up, dust yourself off and retry…keep trying until you make it through!
You too can be all you have ever wanted to be. You have all the potential you need to be or have whatever you wish.
Are you ready to turn your dreams into reality?
Acknowledge your power! Believe in yourself! YOU are the sole creator of your life! Start living the Life of your Dreams today!
A sudden cardiac arrest is a sudden cessation of the pumping action of the heart.
A sudden cardiac arrest is NOT the same as a Myocardial Infarction (heart attack), which occurs when the blood flow to the heart (or part of) decreases or stops, causing damage to the cardiac muscle. A Myocardial Infarction usually produces symptoms such as chest pain, or discomfort traveling into the shoulder, arm, back, neck, or jaw.
In Cardiovascular Disease a.k.a. Heart Disease, narrowed or blocked blood vessels may lead to a Myocardial Infarction, angina, or a stroke.
Sudden Cardiac Arrest ~ Facts
A Myocardial Infarction may lead to a sudden cardiac arrest
Heart disease is the most common cause of a sudden cardiac arrest
Individuals who suddenly fall and die eg. during shopping, swimming, running etc are presumed to have experienced a sudden cardiac arrest
40% of the total amount of deaths of individuals less than 75 years of age are attributed to individuals suffering a sudden cardiac arrest without knowing that they have a cardiovascular disease
What Happens During a Sudden Cardiac Arrest?
the heart stops beating in an effective way
breathing stops
blood flow within the body stops
oxygen supply to the body’s organs stops
the heart and the brain suffer irreparable damage
the individual dies
CPR & AED Use For Sudden Cardiac Arrest
A Sudden Cardiac Arrest is identified right away during the primary assessment:
casualty is unresponsive
casualty is not breathing
DO NOT SPEND MORE THAN 10 SECONDS DOING THE ABOVE…TIME IS CRUCIAL!
4 minutes post start of a Sudden Cardiac Arrest, brain damage starts to take place;
10 minutes post start of a Sudden Cardiac Arrest, brain is dead.
NOTE: Do not confuse agonal breathing with normal breathing. During agonal breathing, the casualty’s chest doesn’t rise and fall. Agonal breathing is not breathing…it is in fact just a reflex.
How To Perform Artificial Ventilations
To perform artificial ventilations on adult casualties:
pinch nose
open airway
take a normal breath
seal your lips around the casualty’s mouth
blow air in until the casualty’s chest rises
allow the casualty’s chest to fall back
repeat
To perform artificial ventilations on children and infants follow the above BUT seal your lips around both the casualty’s mouth AND nose.
The AED: Automated External Defibrillator
Contrary to what is believed by many, an AED’s shock doesn’t restart the heart. About 65% of casualties suffering a sudden cardiac arrest present with an abnormal cardiac rhythm known as ventricular fibrillation, where the heart quivers rather than beats as normal. This rhythm is fatal unless proper treatment is provided in a timely manner. A normal sinus rhythm can be restored following ventricular fibrillation by proper pressure through:
Early CPR
Early AED
Adult Basic Life Support Sequence
If casualty is unresponsive:
open casualty’s airway using the head-tilt chin lift technique
look, listen, & feel for breathing signs
if unresponsive and not breathing call 112 or ask someone to do so & send for an AED
start CPR (30 chest compressions : 2 breaths)
aim for a chest compression rhythm of approximately 2 compressions per second using 2 hands (fingers interlocked) aiming for the middle of the breastbone and a depth of 5-6cm, allowing full chest recoil after each compression
breaths should amount to approximately 1 second each
remember to protect yourself from any vomit/bleeding by using available devices – face sheet & gloves
use an AED if or when available whilst following its verbal instructions (continue CPR unless instructed by AED to not touch the patient)
Stop CPR if help arrives, if the casualty starts breathing again, if the scene becomes dangerous, or if you become too tired and there is no one else who can substitute you.
Infants & Children Basic Life Support Sequence
Paediatric guidelines are as follows…
In the case of individuals responsible for children such as paediatric nurses, educators following special cases, etc. and trained in paediatric basic life support:
open child’s airway using the head-tilt chin lift technique
look, listen, & feel for breathing signs
give 5 rescue breaths
if phone is promptly reachable call 112 immediately while starting CPR
if phone is NOT promptly reachable do 1 min CPR before leaving to fetch a phone
use 1 hand for chest compressions in children up to 8 years of age and 2 hands in largely built children
rate of compressions should be approximately 2 per second (100 – 120 per minute)
depth of compression should be 1/3 of chest but never deeper than 6cm
each breath should be approx 1 sec long providing an effective chest rise
remember to protect yourself from any vomit/bleeding by using available devices – face sheet & gloves
use an AED if or when available whilst following its verbal instructions (continue CPR unless instructed by AED to not touch the patient); IMPORTANT – on a child, one electrode is placed on the front of the chest, and the other is placed on the back, both parallel to each other
NOTE: INFANTS <1 YEAR = 15 chest compressions : 2 breaths (use 2 fingers only on lower half of breastbone); each breath should be approx 1 sec long providing an effective chest rise. IMPORTANT – cover mouth and nose with mouth for an effective breath but do not over-do it!
For those not trained in paediatric BLS or not confident enough, adult basic life support technique should be used, ideally giving 5 rescue breaths before calling for assistance.
Stop CPR if help arrives, if the casualty starts breathing again, if the scene becomes dangerous, or if you become too tired and there is no one else who can substitute you.
Cardiac Pump Theory VS Thoracic Pump Theory
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As mentioned in our introduction to first aid blogpost, the most important first aid principles include preserving life, preventing complications, and promoting recovery. It is as important however to mention that in the case of danger to self, first aid may just be about calling for further assistance. You should avoid ending up a casualty yourself!
Hereunder we are going to cover some of the most common scenarios where first aid principles can be applied…
Unresponsive but Breathing Casualty
A person can become unresponsive when there is an interruption of normal brain activity. This leads to loss of awareness. Common conditions that may cause unresponsiveness include:
ABC compromise that leads to hypoxia
hypoglycaemia which leads to neuroglycopaenia (lack of glucose in the brain)
remove any restrictive clothing whilst maintaining dignity where possible
place in the recovery position
attempt to maintain normal body temperature
attempt a secondary assessment based on what you can see and information you can gather from bystanders or present relatives
call emergency 112
Retrieved from https://www.firstaidforfree.com/what-is-the-recovery-position-in-first-aid/ on 8th September 2022
Casualty Experiencing a Fainting Episode a.k.a. Brief Loss of Consciousness
Fainting a.k.a. syncopal episode or syncope is typically triggered by a sudden loss of blood flow to the brain, leading to loss of consciousness and loss of muscle control. Fainting is characterised by:
pale, cold, clammy skin (signalling lack of blood circulation)
slow pulse
usually regains consciousness again after a couple of seconds
First Aid Principles
Once casualty regains consciousness following a fainting episode:
remove tight clothing
elevate casualty’s legs to ensure better circulation and promote blood flow and oxygen to the brain
ensure that the area is ventilated well
identify possible cause
maintain casualty’s body temperature
provide reassurance
monitor ABCs
call for medical assistance as required
NOTE: following a fainting episode, tell the casualty to stand up very slowly so as to avoid recurrence.
Casualty Experiencing a Seizure
While seizures can result due to a disorder, they can be triggered by issues affecting the brain’s normal activity, such as in cerebral hypoxia (lack of oxygen in the brain), fever, and head trauma. Signs of a seizure include:
face twitching
lip smacking
staring spells
drooling / frothing at the mouth
producing abnormal sounds such as snoring and grunting
spasms that usually affect an individual limb
uncontrollable muscle spasms
convulsions
First Aid Principles
start timing the seizure
protect the casualty’s head by cushioning it
provide protection from any possible danger
remove any restrictive clothing if possible, maintaining patient dignity
DO NOT RESTRAIN CASUALTY
DO NOT ATTEMPT TO PUT ANYTHING IN THE CASUALTY’S MOUTH
note time when seizure stops
provide first aid as mentioned further above in the Unresponsive but Breathing Casualty section after seizure stops
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The European Resuscitation Council has produced updated ERC Guidelines 2021 on adult basic life support with the aim of increasing confidence and encouraging individuals to act immediately when witnessing a cardiac arrest. Unfortunately, to this day, failing to recognise a cardiac arrest earlier on remains a barrier to saving more lives.
The following are excerpts from the ERC Guidelines 2021 which may help save lives. Link to the original document will be provided at the bottom of the article for full document reference.
How to recognise cardiac arrest
– Start CPR in any unresponsive person with absent or abnormal breathing.
- Slow, laboured breathing (agonal breathing) should be considered a sign of cardiac arrest.
– A short period of seizure-like movements can occur at the start of cardiac arrest. Assess the person after the seizure has stopped: if unresponsive and with absent or abnormal breathing, start CPR.
High quality chest compressions
– Start chest compressions as soon as possible.
- Deliver compressions on the lower half of the sternum (‘in the centre of the chest’).
- Compress to a depth of at least 5 cm but not more than 6 cm.
- Compress the chest at a rate of 100-120/min with as few interruptions as possible.
- Allow the chest to recoil completely after each compression; do not lean on the chest.
- Perform chest compressions on a firm surface whenever feasible.
– Continue CPR until an AED (or other defibrillator) arrives on site and is switched on and attached to the victim.
- Do not delay defibrillation to provide additional CPR once the defibrillator is ready.
Rescue breaths
– Alternate between providing 30 compressions and 2 rescue breaths.
- If you are unable to provide ventilations, give continuous chest compressions.
When and How to use an aed
– As soon as the AED arrives, or if one is already available at the site of the cardiac arrest, switch it on.
- Attach the electrode pads to the victim’s bare chest according to the position shown on the AED or on the pads.
- If more than one rescuer is present, continue CPR whilst the pads are being attached.
– Follow the spoken (and/or visual) prompts from the AED.
- Ensure that nobody is touching the victim whilst the AED is analysing the heart rhythm.
- If a shock is indicated, ensure that nobody is touching the victim.
– Push the shock button as prompted. Immediately restart CPR with 30 compressions.
- If no shock is indicated, immediately restart CPR with 30 compressions.
- In either case, continue with CPR as prompted by the AED. There will be a period of CPR (commonly 2 min) before the AED prompts for a further pause in CPR for rhythm analysis.
Foreign Body Airway Obstruction
– Suspect choking if someone is suddenly unable to speak or talk, particularly if eating.
- Encourage the victim to cough.
- If the cough becomes ineffective, give up to 5 back blows:
1. Lean the victim forwards.
2. Apply blows between the shoulder blades using the heel of one hand
- If back blows are ineffective, give up to 5 abdominal thrusts:
1. Stand behind the victim and put both your arms around the upper part of the victim’s abdomen.
2. Lean the victim forwards.
3. Clench your fist and place it between the umbilicus (navel) and the ribcage.
4. Grasp your fist with the other hand and pull sharply inwards and upwards.
– If choking has not been relieved after 5 abdominal thrusts, continue alternating 5 back blows with 5 abdominal thrusts until it is relieved, or the victim becomes unconscious.
- If the victim becomes unconscious, start CPR.
References
European Resuscitation Council Guidelines 2021: Basic Life Support (2021). Retrieved from https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-Guidelines-2021-Ba.pdf on 6th September 2022
European Resuscitation Council Guidelines 2021: Executive summary (2021). Retrieved from https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-Guidelines-2021-Ex.pdf on 6th September 2022
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Emergency nursing practice requires the nurse to provide immediate emergency care and interventions to preserve the life of individuals experiencing acute illness or injury.
Emergency nursing practice aims to:
Preserve Life through identification and management of life-threatening conditions
Prevent Complications to avoid deterioration of patient’s condition (eg. choking, cardiac arrest, & bleeding)
Promote Recovery by providing reassurance and comfort to the patient, seeing that the patient gets medical attention, as well as managing pain through interventions such as immobilising a fractured limb
What is the 1st thing you should do in Emergency Nursing Practice?
Retrieved from https://www.bereadylexington.com/exercise-message-lexington-emergency-opertion-center-activated/ on 3rd September 2022
Assess the situation from a distance and look out for any possible danger
Determine what the emergency is and the extent of the emergency eg. number of apparent casualties.
Then use the S.A.F.E. approach…
Retrieved from https://www.alsg.org/fileadmin/temp/Specific/Ch04_BLS.pdf on 3rd September 2022
Safety Tips for Emergency Nursing Practice
BLEEDING – protect yourself from blood and other body fluids by using non-sterile gloves, or use non-touch technique eg. by holding the patient’s own hand onto the bleeding wound
HAZARDS – careful about things such as being in a busy road, being close to hazardous substances, or harmful situations; avoid becoming a casualty yourself!
CROWDS – be careful not to get pinned in!
AGGRESSIVE BEHAVIOUR – aggressiveness could be the result of non-organic problems such as due to current emergency
Hazardous Substances – Retrieved from https://www.principalpeople.co.uk/blog/2015/08/working-with-substances-that-are-hazardous-to-health on 3rd September 2022
Emergency Situations Requiring Special Attention…
CAR CRASH EMERGENCY – extra precautions include switching off the vehicle, pulling up the handbrake, removing the keys from ignition, and looking out for other vehicles
FIRE EMERGENCY – if fire has spreaded drastically, do not attempt to go in…call for assistance if it looks too dangerous
ELECTRIC SHOCKEMERGENCY – prior to attempting any first aid procedures, switch off the main and use a non-conductor to remove the electrical object in contact with the patient
DROWNING EMERGENCY – you are NOT expected to jump into the water to save a patient if not confident enough
Calling for an Ambulance
You should call an ambulance:
if you are dealing with a serious situation eg. car crash, fire emergency, and/or multiple casualties
if you are dealing with a situation where a life or a limb may be lost eg. difficulty breathing, severe chest pain, choking, and/or unconsciousness
if you are in doubt
If you are calling for an ambulance (Malta & Gozo):
dial 112
ask for an ambulance
stay calm
mention what happened, where it happened, and who you are
answer any questions in detail
DO NOT BE THE FIRST TO HANG UP!
The Vital Functions of the Human Body
The human body’s primary vital systems are the Respiratory (lungs), Circulatory (heart) and the Brain (oxygenated).
Retrieved from https://www.freepik.com/premium-vector/human-anatomy-internal-organ-set-with-brain-lungs-with-heart_13011199.htm on 4th September 2022
The respiratory system includes the Airway and Breathing
Retrieved from https://learn.canvas.net/courses/2171/pages/introduction-to-abcde-assessment on 4th September 2022
Anything affecting the ABCD of the patient can be life-threatening, requiring prompt action so that life is preserved!
Airway Problems
obstruction by patient’s own tongue during unconsciousness period
foreign body obstruction in a choking patient
swelling of the airway due to an allergic reaction (anaphylactic shock) or inhalation of chemicals
facial trauma following a maxillofacial injury
NOTE: The tongue in an unresponsive casualty can easily obstruct the airway. Hypoglycaemia and overdose are the two main causes of airway obstruction by tongue.
Retrieved from https://medcast.com.au/blog/why-you-should-use-an-abcde-approach-to-patient-assessment on 4th September 2022
Assessing the Patient
Initial Patient Assessment
Immediately identify and address life-threatening (ABCD) problems with the aim of preserving life
Is the patient responsive? SHAKE & SHOUT & use AVPU scale
Is the patient unresponsive? Check if his airway is obstructed, perform head-tilt chin-lift maneuver
Is he breathing? Look, Listen & Feel!
Are there evident serious bleeding signs eg. blood on the floor, blood on chest, abdomen, pelvis, thighs? REMEMBER: 50% Blood Loss = Unconscious Patient!
Is the patient exhibiting signs of shock? (pale & cold, clammy skin; fast weak radial pulse, fast shallow breathing, weak & lethargic)
SHAKE & SHOUT – Retrieved from https://slideplayer.com/slide/4331579/ on 4th September 2022AVPU Scale – Retrieved from https://www.ems1.com/ems-training/articles/use-avpu-scale-to-determine-a-patients-level-of-consciousness-FVpjgzNGwSJAGoeQ/ on 4th September 2022
UNRESPONSIVE & NOT BREATHING = START CPR IMMEDIATELY
SERIOUS BLEEDING = PUT PRESSURE ON THE WOUND TO STOP BLEEDING
Emergency Nursing Practice Techniques that help Clear Airway Obstruction
Manual techniques:
No side effects, no equipment required – use the head tilt chin lift technique or the jaw-thrust maneuver.
Simple Adjuncts:
Minimal side effects – use of a hollow tube that holds tongue in place.
ENDOTRACHEAL INTUBATION (eti):
A medical procedure in which a tube is placed in the trachea via the mouth or nose. If performed wrongly, this may kill the casualty.
Airways:
Ventilation of the larynx with a laryngeal tube or mask.
SOMETHING STUCK IN WINDPIPE = HEIMLICH MANEUVER
sECONDARY PATIENT ASSESSMENT
A secondary patient assessment is performed with the aim to identify conditions that can worsen the primary issue – the 4 B’s…
Breathing
Bleeding
Burns
Bones
A secondary patient assessment can be performed in the following order:
Step 1: Complaint – signs & symptoms
Step 2: Perform a head-to-toe assessment using the D.O.T.S. method:
Deformities
Open Wounds
Tenderness
Swelling
Step 3: Vital Signs – include an accurate respiratory rate and pulse rate
Step 4: History – use the acronym S.A.M.P.L.E.
Retrieved from https://www.slideserve.com/carter/baseline-vital-signs-and-sample-history on 4th September 2022
Signs of Breathing Problems
Dyspnoea – check for visual breathing distress and use of accessory muscles
Noisy Breathing
Abnormal Breathing Pattern – notice the patient’s breathing rate and rhythm
Cyanosis – check for bluish discolouration of the patient’s skin due to lack of oxygen circulation in the body
Disorientation and Confusion
Unusual Aggressiveness
Respiratory Arrest a.k.a. respiratory failure – patient may stop breathing
Signs of Circulatory Problems
Pale, Cold, Clammy Skin
Internal / External Bleeding
Rapid Shallow Breathing
Fast OR Very Slow Pulse
Inability to Palpate Radial Pulse (located at the wrist)
Cardiac Arrest (heart stops pumping blood)
Signs of Neurological Problems
Weakness, Paralysis or Loss of Sensation within the Limbs
Altered Level of Response (patient may also be drowsy)
Summary…
Check ABCs
Gather Signs & Symptoms
Head to Toe Assessment (D.O.T.S.)
Measure Vital Signs (RR & PR)
History (S.A.M.P.L.E.)
Retrieved from https://www.alucansa.com/showroom/?ss=5_6_4_26_36&pp=basic+first+aid+training&ii=2293819 on 5th September 2022
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