48. Untrained lay rescuers
Lay rescuers trained in
chest compression–
only CPR
Lay rescuers trained in
CPR using chest
compressions and
ventilation (rescue
breaths)
Scene safety
Check for response
Activated EMS 1669, On speaker phone
Call for help or
Resuscitation team
Follow the dispatcher’s
instructions
Check no breathing or
only gasping
Check pulse
Chest compression–only
CPR
Chest compression–only
CPR
CPR + Rescue breaths
Follow and answer the dispatcher’s instructions
Use AED under dispatcher’s instructions
Use AED / Defib. as
indicated
55. Summary: Chest compression
▧ Position: lower half of the sternum
▧ Depth: 5-6 cm
▧ Rate: 100-120
▧ Fully Recoil: do not leaning on chest
▧ Minimizing Interruptions in Chest Compressions
56. Respiratory Rate (No advanced airway)
▧ 30 : 2
▧ Avoid hyperventilation
Class IIa, LOE C-LD
63. Initial assessment
▧ Preparation
▧ Triage
▧ Primary survey (ABCDEs) with immediate resuscitation of patients with
life-threatening injuries
▧ Adjuncts to the primary survey and resuscitation
▧ Consideration of the need for patient transfer
▧ Secondary survey (head-to-toe evaluation and patient history)
▧ Adjuncts to the secondary survey
▧ Continued postresuscitation monitoring and reevaluation
▧ Definitive care
64. Primary survey with simultaneous resuscitation
▧ Airway maintenance with restriction of cervical spine motion
▧ Breathing and ventilation
▧ Circulation with hemorrhage control
▧ Disability(assessment of neurologic status)
▧ Exposure/Environmental control
65. Airway maintenance with restriction of cervical spine
motion
▧ signs of airway obstruction
inspecting for foreign bodies
identifying facial, mandibular, and/or tracheal/laryngeal fractures and
other injuries that can result in airway obstruction
suctioning
severe head injuries
▧ If the patient is able to communicate verbally, the airway is not
likely to be in immediate jeopardy
66. ▧ prevent excessive movement of the
cervical spine
Airway maintenance with
restriction of cervical spine motion
72. Breathing and ventilation
Massive hemothorax
▧ >1500 mL of blood or ≥1/3 of the
patient’s blood volume
▧ continuing blood loss (200 mL/hr for
2-4 hours)
▧ persistent need for blood transfusion
73. Breathing and ventilation
Open pneumothorax
▧ opening in the chest wall is
approximately ≥2/3 the diameter of
the trachea
74. ▧ Use pulse oximeter
Breathing and ventilation
80. Circulation with hemorrhage control
Blood Volume and Cardiac Output
▧ Elements of clinical observation
○ Level of Consciousness
○ Skin Perfusion
○ Pulse
81. Circulation with hemorrhage control
Bleeding : External hemorrhage
▧ Direct manual pressure on the wound
▧ Tourniquets
○ massive exsanguination
○ risk of ischemic injury
○ when direct pressure is not effective and the patient’s life is threatened
▧ Blind clamping : damage to nerves and veins
82. Circulation with hemorrhage control
Bleeding : Internal hemorrhage
▧ Chest, abdomen, retroperitoneum, pelvis, and long bones
▧ Identified by physical examination and imaging
▧ Immediate management
83. Resuscitation
▧ Vascular access : 2 large-bore peripheral venous catheters
(≥18G)
▧ Blood samples for baseline hematologic studies are obtained,
including
○ pregnancy test for all females of childbearing age
○ blood type and cross matching
▧ Assess shock : blood gases and/or lactate
84. ▧ Initiate IV fluid therapy
○ warm
○ crystalloids
○ bolus of 1 L
○ isotonic solution
▧ If a patient is unresponsive to initial
crystalloid therapy, he or she should
receive a blood transfusion.
Resuscitation
89. Adjuncts to the primary survey with resuscitation
▧ continuous ECG, pulse oximetry, CO2 monitoring, and
assessment of ventilatory rate, and ABG measurement
▧ urinary catheters, gastric catheters
▧ blood lactate
▧ x-ray examinations and DPL
90. Urinary and gastric catheters
Urinary Catheters
▧ C/I : urethral injury
○ blood at the urethral meatus or perineal ecchymosis
▧ do not insert a urinary catheter before examining the perineum
and genitalia
Gastric Catheters
▧ C/I: fracture of the cribriform plate
▧ insert the gastric tube orally to prevent intracranial passage
91. X-ray examinations and diagnostic studies
▧ AP chest and AP pelvic films
▧ FAST, eFAST, and DPL
92. Consider need for patient transfer
▧ It is important not to delay transfer to perform an in-depth
diagnostic evaluation.
▧ Only undertake testing that enhances the ability to resuscitate,
stabilize, and ensure the patient’s safe transfer.