Resusc and CPR
Basic Knowledge and Skills

Resuscitation and CPR
Knowing how to save a life is taught to all first aiders and medical people. We give you some stories and some advice.

Erasmus : Our aim here is to give you basic disaster coping skills. Skills that at a pinch give you some basis for making
sensible decisions in a crisis.

Erasmus :
1.   The first and most essential rule for resuscitation / CPR is: 
You cannot help the injured and dying by "joining" them.
Always - safety first. Look after yourself first.

When you see a crisis, work out what is happening, what is the danger, why is there a crisis developing- and make sure that you are safe first. ONLY do what is safe for you. You are not obliged to risk your life and health. You can catch diseases. You can get injured. You can get hurt. Yes there is a problem / crisis. Make sure you will not be the next addition to the disaster in progress.  

Erasmus : “ME” is always most important: Is it safe to approach scene?
If they are conscious, they obviously can give consent or permission for you to take physical actions to help them. If they appear not to be conscious- assess this before proceeding

Erasmus :

C    Can I help You?
O    Open Your Eyes?
W    What is your Name?
S    Squeeze my hands.    

Erasmus :
Danger
Response
Send For Help                   
Danger:

Lots of things are problems: Look First
Blood is dangerous: always use gloves, care re blood on clothes: 
PPE: Personal Protective Equipment: Gloves, Eye Wear, Masks, Aprons, Spills Kit, 
Airways: Oral Herpes, Pneumonia, CoVid do spread to others quite well. (If you do mouth to mouth on a CoVid patient, you may not be doing yourself a favour. Your own health and welfare may suffer.
People do have nits and lice infesting their hair. Quite contagious.
Quite Unpleasant.

Erasmus : Sending for Help:
You can Delegate : ask someone else to go for help.
Ambulances have 2 beds: or one bed and one seat
Fire, Police, Ambulance, Gas?
What Problem?
Who Needed?
How much?

Erasmus :
2.   Consent: Competent adults can refuse treatment,
Cultural issues re Touching exist,
ASK: Do you need help?

 

Doing CPR

Dr Xxxxx : The Resusc / CPR Protocol:  Assess: 

DR
Danger
Response
We've dealt with this above.

 

A B C D    H F S
Airway
Breathing
Compressions, CPR, Circulation, 
De-fibrillation

Haemorrhage
Fracture
Shock

 

 

Dr Xxxxx : Airway:
Unconscious casualties who are gasping or not breathing normally require resuscitation
Recovery Position: inside stuff in, and outside stuff out

 

Dr Xxxxx : Compressions:
CPR 30:2
30 Compressions to 2 breaths (official 200 compressions in 2 minutes) (My version: almost 2 per second) 
Start Compressions first, not breaths

The newest CPR versions say don't worry about the breaths - just the cardiac comnpressionss. This gets around people's distaste for kissing old people, likely strangers. It simplifies the job. But eventually if you keep up the pumping, you will need fresh Oxygen going into the lungs - probably definitely at the one minute mark.

Consider CPR Hand Positions

Stop CPR if:
*    Physically stuffed
*    Paramedics arrive and take over
*    Danger
*    Patient gets better

Applying a Defibrillator

 

Dr Xxxxx :  Defibrillator: 
Dry skin, No hair, No metal, Bra out of the way
Aim: Early access> Early CPR> Early defib> Early advanced care
Reports are Part of the Routine: 

*    An assigned first aider must provide first aid to any injured /ill person at a workplace.
o    Any resusc is better than no resusc. 
o    Workplace report required: Documents can be discovered through court action

Careful what reports you make
and be aware that other people may not see things as you do.
Others' reports may be quite denigrating of your actions.
People are not always grateful.

 

 

Goo : Crises occur in many places, at many levels of seriousness.

Dr Xxxxx : A friend remembers helping someone who collapsed on a plane. The person would not look at them, talk to them or even acknowledge them after the event. Some people may be grateful. But some may not. Expect to do a competent job within your capabilities, but you cannot expect gratitude or thanks for your actions. It is nice if you get it though.

In Queensland Australia, we have Good Samaritan legislation which allows you to provide help / assistance to the limit of your competency. Do what you can do reasonably and with safety. That’s all you can do.

 

Erasmus : Assessments: 
Sick people - probably are !
If the story sounds bad, probably it is bad.

 

Dr Xxxxx : Symptoms:
*    Chest Pain :  heart attack; but could be infection: pleurisy, pericarditis,
*    Palpitations :  heart problems, anxiety or panic, drugs
*    Breathing Problems : asthma; pneumonia, obstruction
*    Bleeding:  Cut=skin;   
..... from mouth, from nose, from ear, from bum, from vagina

*    Pains : fractures; trauma; Bites : snake or spider; labour
*    Bites :
*    Won’t function/work or weak: fracture; stroke
*    Can’t Talk: Stroke, Breathing problems;
Altered Consciousness: drugs or psych issues;
*    Don’t make sense : panic or psych issues, epilepsy, stroke, drugs

*    Burns : beware electrical issues. Live power is instantly dangerous
*    Can’t pee or poo : “blockage”
*    Sick Kid / Baby: Yes they are sick. Risk to me? You may be a lot less interested in events if you thought you may be catching meningitis next.

*    Temperature: Yes they are sick.
*    Can’t see: Something wrong with eye : inside or outside head
*    Swelling: allergy, trauma
*    Sick: Vomiting, Respiratory Infection

*    Drugs :

o    uppers (speed, cocaine amphetamine),
o    downers ( narcotics, benzos or sleepers), alcohol
o    hallucinogens:

CPR: the Breathing Technique

Erasmus : You need PPE: 
*    Plastic bags? felt pen,
*    Latex Rubber gloves have their limitations: wicking does occur. (This is when biological fluids seep through micro-cracks in items such as gloves and onto your own skin.)
*    CoVid safety gear: most of the stuff used is decorative and gives you a good feeling for doing the right thing. May not protect you much or keep you from getting sick though.

Erasmus : Assess safety yourself. If it looks unsafe, it probably is.

Remember: Some Basics
•    People are watching, Always: 
if it is going to look bad or be messy: move it.

•    You are hurting him / her!   :  ? get them involved
•    People like to Help

The Left Lateral Resusc Position

Erasmus : Exercises

Kinkajou : *    93yo female, walks in, talks to you, sits on chair then starts to mumble and tilt in chair:

Diagnosis : stroke
#    Falling off chair: really dangerous
#    Slow responses to questions:
(teeth loose and trying to get tissue out of handbag), deaf
#    Still functioning cognition

 

Kinkajou : *    74yo woman says chest hurting badly for last 20 minutes and is breathless : wants appointment to see doctor tomorrow:
I have to go home  because my dog is alone:

Diagnosis : heart attack
o    Consent
o    You’ll feel better if you sit down and I can get you a glass of water: reasonable
o    Other people will help and can have input: people can be convinced: breathe a bit of
oxygen
o    I will ring daughter/neighbour re dog  (car in shop centre) > box chocolates: helpful

 

Kinkajou : *    25 year old young man falling asleep (on the nod) in a chair: 
a drug addict ( chin on chest then chin up and deep breath)

Risk Assessment
o    Could stop breathing
o    Could fall off chair / could fit / could vomit
o    Other illnesses: HCV, HBV, HIV
o    Sharps may be around, drugs can also be breathed in
o    You cannot tell if person has a serious illness by looking at them :
Universal Precautions are essential.

 

 

Kinkajou : *    25 year old dirty, really thin woman whose heart is beating really fast and funny:

Diagnosis : ? Overdose (OD) : amphetamine or antidepressants

o    Heart problems of rhythm can get really bad really fast, Not all heart problems are
”heart” problems
o    Keep CALM & keep them calm: more adrenaline won’t help either of you
o    You don’t know if they are addicts, sick, ill
o    Even addicts can turn their lives around: if they don’t die,
(overdosing on drugs is a really easy mistake to make).
o    Not everyone is an addict: e.g. meningitis

 

 

Kinkajou : *    30 year old woman collapses onto ground (with a bang) in waiting  room , was eating sausage roll ,
makes a noise, twitches and starts going blue:

Diagnosis : Fit (epilepsy) or airway obstruction

o    Clear airways: keep fingers out of mouth
o    Saliva can carry virus /  or worse (Chlamydia, Gonorrhoea)
o    can have blood in mouth : esp. if teeth bad

 

 

 

Kinkajou : *    45 year old man collapses in waiting room, 130 kg, a bit of noisy breathing like snoring
o    Need to be in recovery position
o   Quadruple effective weight: if a dead weight 
o    Snowflakes in hair : ? dandruff, ? nits

 

 

Kinkajou : *    50 year old man  90 kg, with varicose veins has knicked one at home in a work accident, blood everywhere,

o    has a bucket to collect the blood, has a towel to collect the blood
o    Blood : safety first
o    Compression will stop, esp. venous bleeding: tell patient what to do

?    Sitting there covered in blood, vomits on self then collapses / slumps : may not be breathing>> getting complicated

Diagnosis : ? Faint ? Fit ? other : stroke, drugs

 

 

 

Dr Xxxxx : DEBRIEF:
You Did Well.  R  U  OK?

Reports are Part of the Routine: 
all involved are required to report an incident.

The Story is everything: will get you into or out of trouble: 
You can ask others for help with paperwork.

I can only tell you to be honest about your reports. But in messy circumstances , honesty can also get you into a lot of trouble. Careful what you say or write. You can always say you are too upset to talk or think at this time. This gives you time to think and write and consider consequences.

Our Avatars: Erasmus and Kinkajou