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53 Cards in this Set

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In Singapore, heart disease is the _____ commonest cause of death; _____% of total mortality.

Second commonest cause



24% of total mortality

Not the first but?



Close to one quarter.

Total survival rate (pre-hospital collapses) is _____%

2.6%

One, ______, button my shoe + 0.6%

Best Treatment Approach for Cardiac Arrest Victims (Chain of Survival).



What are the 4 links?

Early Recognition & Access


Early CPR


Early Defibrillation


Early Advanced Care

Early...



R_____


C_____


D_____


A_____

Examples of early warning signs of heart attack are...

Sweatiness


Shortness of Breath


Nausea or vomiting


Chest pain

Head


Nose


Mouth


Chest

Chain of Survival: First Link


Early Recognition & Access



How is this facilitated?

Rapid call for first response team


Allow road priority for ambulances


Allow fast access by paramedics e.g. lifts

Phone


Road


Lift

Chain of Survival: Second Link


Early CPR



CPR can always restart the heart. True or False?

False.


CPR cannot always restart the heart.

Buy time to keep vital organs alive till help arrives

Chain of Survival: Third Link


Early Defibrillation



After collapse, survival rate deceases _____% to _____% for every 1 minute delay in delivering defibrillation.

7%-10%

Its a name of a 24 hours convenient store but minus one.

Chain of Survival: Fourth Link


Early Advanced Care



What does this link consist of?

Advanced Airway Management


Administration of Medication

A.M.

Which arteries are blood vessels that send oxygen-rich blood to the muscles of the heart?

Coronary

Sounds like the person who checks on cause of death.

Coronary artery disease is the end result of the gradual buildup of fatty deposits aka _____ and blood cells in the inner lining of the coronary arterial wall, a process that is called _____.

Fatty deposits aka cholesterol plaques



Atherosclerosis

Sounds like the bad thing that accumulates on tooth.



At hero + ....

In a heart attack, chest discomfort or pain usually lasts longer than 20 minutes. True or false?

True

It can't be less than 20 minutes right?

If someone has symptoms of heart attack, to call the ambulance at 9 9 9. True or false?

False



9 9 5

999 is police.

List 3 major risk factor for heart attack that cannot be changed.

Heredity


Male gender


Increasing Age

What do we not have control on?

List 4 major risk factors of heart attack that can be changed.

Cigarette smoking


High BP


High blood cholesterol levels


Diabetes mellitus

Too much smoke


Too much stress


Too much fatty food


Too much sugar

List 3 other risk factors of heart attack that can be changed.

Physical inactivity


Obesity


Stress

O + P + S

The most sensitive organ is _____ and if circulation to here is not restarted within _____ to _____ minutes, there may permanent and irreversible damage. Hence CPR is crucial.

Brain



4-6 minutes.

Pinky and the _____



_____ + _____ = 10

There is 21% oxygen in the air at sea level. When breathed in, only 16% of oxygen is utilised with 5% exhaled. True or false?

False.



Only 5% is utilised and 16% exhaled.

Exhaled > Used

Chest compression squeezes the heart between breastbone and spine and helps circulate blood and oxygen to vital organs especially _____, _____ and _____.

Brain, heart and kidney

Must bring our mind to HK. (BHK)

What are the steps for adult one man CPR?

D - Check for Danger


R - Check for Responsiveness


S - Shout for help


A - Open Airway


B - Check for Normal Breathing


C - Perform 30 Chest Compressions

Here comes "Doctors ABC"

For chest compression (adult one man CPR), we need to compress to depth of at least 5cm and at rate of at least 100/minute. True or false?

True

For adult one man CPR, we need to give 2 breaths; _____ second/breath with tidal Vol of _____ to _____ml.

1 second/breath


400-600ml tidal vol

Adult One Man CPR



Why does the casualty not respond?

Obstructed airway e.g. by food, secretion of tongue that fallen backwards.



Breathing stopped.



Heart stopped beating.

When calling 9 9 5, what information should we provide?

Location (Where)


Telephone Number (What)


What happened? (Why)


Number of casualties (How many)



Tell - Immediate ambulance needed


Listen - Instructions and instructions to hang up


3Ws & 1H.


Tell and listen

For CPR to be effective, the casualty must lie sideways. True or False?

False.



For CPR to be effective, the casualty must lie on firm and flat surface.

2Fs

Adult One Man CPR



To open the airway, do the _____ manoeuvre. By moving the lower jaw forward, the tongue which has fallen back will be lifted away from the back of the throat.

Head tilt-chin tilt manoeuvre.



To perform the manoeuvre:


1. Place one hand on casualty's forehead and fingers of other hand under bony part of lower jaw to lift the jaw forward.


2. Apply firm backwards pressure on forehead while lifting jaw.



Do not perform blind finger sweep as it may push foreign bodies back into airway.


Perform jaw thrust or gentle chin lift of head or neck injury is suspected.

Adult One Man CPR: Check for Normal breathing



Do these for 10 seconds. What do you need to do?

Look for chest rise and fall


Listen for air escaping during exhalation


Feel for flow of air from mouth/nose moving past your cheeks


CPR immediately if gasping

Adult One Man CPR: Assess Pulse



1. With index and middle finger locate _____


2. Slide finger down into groove at side of neck near you; _____ pulse


3. Apply gentle pressure and feel for pulse as you check breathing.


4. Check not more than 10 seconds.


5. If no pulse, commence chest compression. If unsure, assume cardiac arrest and commence chest compressions.


Adam's Apple / centre of throat



Carotid Pulse

Chest Compression = serial, rhythmic pressure over _____ half of sternum to create blood flow to vital organs by increasing _____ pressure.

Lower



Intrathoracic

Hand position for chest compression: run middle finger from lower margin of rib cage till you reach the _____ _____.



And then place index finger next to middle finger, followed by heel of other hand next to index finger on lower half of sternum.

Xiphoid process

Adult One Man CPR: Chest Compressions.


1. Interlace fingers of both hands and lift fingers off chest wall.


2. Straighten both elbows and lock them in position.


3. Position shoulder directly over casualty's chest.


4. Use body weight to compress at least 5cm, counting loudly:



1 and 2 and 3 and 4 and 5 and


1 and 2 and 3 and 4 and 10 and


1 and 2 and 3 and 4 and 15


1 and 2 and 3 and 4 and 20


1 and 2 and 3 and 4 and 25


1 and 2 and 3 and 4 and 30



The ratios:


_____ compressions: 2 breaths


_____ cycles of 30 compressions and 2 breaths for approximately _____ minutes



30 compressions: 2 breaths


5 cycles of 30 compressions and 2 breaths for approximately 2 minutes

Adult One Man CPR: Mouth to Mouth Breathing



1. Maintain head tilt-chin tilt.


2. Pinch nose with thumb and index finger.


3. Seal lips around casualty's mouth and give 2 breaths


4. Release nostril after each breath



Duration of each breath = _____ second

1

Adult One Man CPR: Mouth to Mouth Breathing



To much air can cause air to enter stomach and result in _____ ______

Gastric Distension

Dissatisfied and with tension.

Adult One Man CPR: Reassess



1. Assess for pulse and breathing after every _____ cycles of CPR _____:_____


2. If pulse absent or unsure, continue CPR 30:2


3. If both pulse and breathing present, position casualty in _____ _____


4. Continue to monitor at least once in _____ minutes.

1. Assess for pulse and breathing after every 5 cycles of CPR 30:2



.....



3. If both pulse and breathing present, position casualty in recovery position.



4. Continue to monitor at least once in 5 minutes.

FBAO stands for?

Foreign Body Airway Obstruction (FBAO)

FBAO can be cause by:



Intrinsic (tongue and epiglottis) causes such as: Name 3



or



Extrinsic (Foreign Body) causes such as: Name 2



Contributing factors include:


1. Large, poorly chewed food pieces


2. Elevated blood alcohol levels


3. Dentures


4. Playing, crying, laughing and talking with food in mouth.

Intrinsic (Tongue and Epiglottis)


1. Tongue fall backwards into pharynx in an unconscious casualty


2. Blood from head or facial injuries flow into airway


3. Regurgitated stomach contents enter airway



Extrinsic (Foreign Body)


1. Food


2. Dentures

FBAO Symptoms



Partial Airway Obstruction:


Name 2 symptoms



Complete Airway Obstruction:


Name 5 symptoms

Partial:


1. Coughing


2. Wheezing



Complete:


1. Can't speak


2. Can't breathe


3. Can't cough


4. Become Cyanotic


5. Clutch neck with thumb and fingers.

Heimlich Manoeuvre (or sub diaphragmatic abdominal thrusts), which elevates diaphragm and increase airway pressure is used on:



Children (1-8yo) and responsive adults (>8yo)



Or



Pregnant and obese casualties?

Children (1-8yo) and responsive adults (>8yo)

Baby is in womb...

Chest thrust is used on:



Children (1-8yo) and responsive adults (>8yo)



Or



Pregnant and obese casualties?

Pregnant and obese casualties

Baby is in womb.

Heimlich Manoeuvre may damage internal organs resulting in rupture or laceration of abdominal or thoracic viscera. True or false?

True

How many abdominal/chest thrust do we administer on conscious casualties?

5

Does the FBAO casualty need to be standing when attempting to relief them?

No.



If casualty is standing, have casualty stand with feet apart and rescuer's foot in between.



If casualty is sitting, kneel down behind casualty.

We need to cater to casualty...

To locate landmark to relief FBAO Adult:



1. Place arms around casualty's abdomen.


2. Locate navel


3. Place _____ fingers breath above navel and well below tip of xiphoid process.


4. Make a fist with one hand, grabbing thumb with 4 fingers.


5. Place thumb side of fist against casualty's abdomen in midline and just above 2 fingers spacing.


5. Lean casualty forward


6. Grasp fist with other hand.


7. Give quick successive inward and upward abdominal thrust.


8. Check if foreign body is expelled after _____ thrusts.


9 Repeat until foreign body is expelled or casualty becomes unconscious.

3. Place 2 fingers breath above navel and well below tip of xiphoid process.



8. Check if foreign body is expelled after 5 thrusts.

Chest Thrust for FBAO Conscious Adult



To do this place arms under/above casualty's armpit, encircling chest?

Under

Chest Thrust for FBAO Conscious Adult



Place thumb side of fist on _____ of the casualty's breastbone.

Middle

Steps for relief of Unconscious FBAO Adult



The manoeuvre to use a hooked index finger to dislodge foreign body and manoeuvre it out the mouth is called...

Finger Sweep

Let the fingers do the *clearing dust from ground*

Infant CPR



Cardiac arrest is usually the primary cause for infant collapse. True or false?

False.



Infants rarely collapse due to primary heart problem. Cardiac arrest is usually secondary to other events e.g. major trauma or respiratory illness.

Infant CPR



If breathing is present when assessing for spontaneous breathing, turn infant onto _____ _____.

Lateral (side) position.

Infant CPR: Assess for Pulse



1. Maintain head tilt, locate _____ _____ (inner aspect of upper arm, between infant's elbow and shoulder) with index and middle finger.


2. Apply gentle pressure to feel for up to _____ seconds.

Brachial Pulse



10 seconds.

Infant CPR: Chest Compressions



1. Maintain head tilt with one hand and draw imaginery line between nipples with index finger of other hand.


2. At sternum, place ____ and ____ fingers next to index finger


3. Move all 3 fingers to centre of sternum.


4. Position finger upright.


5. Lift up only index finger and maintain other fingers.


6. Compress lower sternum by 4cm depth, loudly as with adult CPR.


7. _____ cycles of _____ compressions at rate of _____ per minute. _____ breaths for approximately _____ minutes.


8. _____ short breaths in quick succession (____ ml of air at 1 second per breath)

2. At sternum, place middle (3rd) and ring (4th) fingers next to index finger



...



7. 5 cycles of 30 compressions at rate of 100 per minute. 2 breaths for approximately 2 minutes.8. 2 short breaths in quick succession (30ml of air at 1 second per breath)

FBAO Consious Infant



What 2 techniques to use?


Back Blows


Chest Thrusts

Back and front...

FBAO Conscious Infant



Name the symptoms.

Coughing


Gagging


Stridor (high pitched, noisy sound or wheezing)


Loss of voice


Increased breathing difficulty


Infant's face cyanosed

2 to do with mouth


2 to do with voice


1 on breathing


1 related to Avatar/Smurfs

FBAO Conscious Infant



How many back blows does rescuer deliver before the same number of chest thrusts?

5

Infants should never be given abdominal thrusts. True or false?

True.