IN PARTNERSHIP WITH

Liverpool School of Tropical Medicine

Liverpool Associates in Tropical Health

Airway, Breathing and Airway, Breathing and Circulation Circulation

AimsAims

To understand the ABC and D approachTo understand the ABC and D approach

To develop and practise the skills of To develop and practise the skills of cardiopulmonary resuscitation using the ABC cardiopulmonary resuscitation using the ABC approachapproach

To achieve competence in those skillsTo achieve competence in those skills

Airway, Breathing and CirculationAirway, Breathing and Circulation

Assessment of any sick patient begins with ABCAssessment of any sick patient begins with ABC

Done in this order because airway and/or Done in this order because airway and/or breathing problem will kill before a circulation breathing problem will kill before a circulation problemproblem

You assess airway and breathing, You assess airway and breathing, and treatand treat, , and then assess circulation and then assess circulation and treatand treat

Airway and BreathingAirway and Breathing

‘‘Hello how are you Mrs Hello how are you Mrs Tilt?’Tilt?’

If no response:If no response:

Assess if patient is Assess if patient is breathing or notbreathing or not

Airway and BreathingAirway and Breathing

Look Look for breathing by for breathing by looking for movement looking for movement of the chestof the chest

ListenListen for breathing for breathing or noisy breathingor noisy breathing

Feel Feel for breathingfor breathing

Airway and BreathingAirway and Breathing

If not breathing or If not breathing or difficult breathing: difficult breathing:

Open airway by Open airway by head tilt head tilt and and chin chin liftlift

Airway and BreathingAirway and Breathing

Open airway byOpen airway by

jaw thrustjaw thrust

Airway and BreathingAirway and Breathing

Gentle suctionGentle suction if necessary under direct vision if necessary under direct vision

Airway and BreathingAirway and Breathing

If still not breathing: If still not breathing: place oropharyngeal airwayplace oropharyngeal airway

Airway and BreathingAirway and BreathingIf still not breathing: If still not breathing: give rescue breathsgive rescue breaths

Airway and BreathingAirway and Breathing

If breathing:If breathing:

give give oxygenoxygen

(if available)(if available)

Sit patient upSit patient up (if alert) (if alert) or place in or place in recovery recovery positionposition

CirculationCirculation

How do we assess circulation?How do we assess circulation?

CirculationCirculation Colour-Colour-?pale ?greyish?pale ?greyish

Skin-Skin-?cold, ?hot ?sweaty?cold, ?hot ?sweaty

Mental State- Mental State- ? confused ?aggressive ?not alert? confused ?aggressive ?not alert

Urine output-Urine output-?reduced?reduced

Heart rateHeart rate- ? High ? low- ? High ? low

Blood pressureBlood pressure-low-low

Fetal heart Rate Fetal heart Rate - ? High ? low- ? High ? low

CirculationCirculation

Pregnant uterus compresses vena cava Pregnant uterus compresses vena cava causing BP to dropcausing BP to drop

‘‘Hello Mrs Tilt’……..Hello Mrs Tilt’……..

CirculationCirculation

Place iv lines, take bloods, start iv fluidsPlace iv lines, take bloods, start iv fluids

Why is there a circulation problem?Why is there a circulation problem? Stop bleedingStop bleeding Treat infectionTreat infection

Cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR)(CPR)

This is the approach to an apparently This is the approach to an apparently lifeless patientlifeless patient

It is a rapid assessment of It is a rapid assessment of AAirway and irway and BBreathing and reathing and CCirculationirculation starting treatment quicklystarting treatment quickly

Ensure you are not putting yourself at Ensure you are not putting yourself at risk!risk!

Is it safe to approach?Is it safe to approach?

Shake and shoutShake and shout

Hello how are you?Hello how are you? If no response, call If no response, call

or send for helpor send for help

Tilt to left lateral Tilt to left lateral position if greater position if greater than 20 weeks than 20 weeks pregnantpregnant

Open the AirwayOpen the Airway

Turn onto back and Turn onto back and open airwayopen airway Head tilt or chin lift or Head tilt or chin lift or

jaw thrustjaw thrust

Assess breathing and Assess breathing and feel for a pulse for 10 feel for a pulse for 10 secondsseconds

Look, listen, feel

Palpate carotid pulse for 10 seconds

No breathing, No pulseNo breathing, No pulse

Start chest Start chest compressionscompressions

Chest compressionsChest compressions

place heel of first place heel of first hand on lower part of hand on lower part of sternum sternum

place heel of second place heel of second hand on top of firsthand on top of first

interlock fingersinterlock fingers

Chest compressionsChest compressions Keep arms straight Keep arms straight

and depress sternum and depress sternum 4-5 cm at a rate of 4-5 cm at a rate of 100 compressions per 100 compressions per minuteminute

Change the person Change the person delivering the delivering the compressions to compressions to avoid getting tiredavoid getting tired

Give 30 compressions:2 breathsGive 30 compressions:2 breaths

Give 2 slow breaths Give 2 slow breaths each lasting about 1 each lasting about 1 secondsecond

Watch for chest riseWatch for chest rise Give oxygen if Give oxygen if

availableavailable

If breathingIf breathingTurn into recovery positionTurn into recovery position

Check pulse, BP and FHCheck pulse, BP and FH

Regularly reassessRegularly reassess

Assess Assess DD, DISABILITY (level of consciousness), DISABILITY (level of consciousness) AA-Alert, -Alert, VV-respond to voice, -respond to voice, PP-respond to pain, -respond to pain, U U - Unresponsive- Unresponsive

Think of Reversible CausesThink of Reversible Causes

• 4 H’s, 4 T’s4 H’s, 4 T’s

HypovoleamiaHypovoleamiaHypothermiaHypothermiaHypo/HyperkalaemiaHypo/HyperkalaemiaHypoxiaHypoxia

Tension PneumothoraxTension PneumothoraxTamponadeTamponadeThromboembolismThromboembolismToxinsToxins

??

AAirway before irway before BBreathing before reathing before CCirculationirculation

Open Open AAirway and maintain, give oxygenirway and maintain, give oxygen

Check for Check for BBreathing, assist if necessaryreathing, assist if necessary

Assess Assess C and don’t forget left lateral tiltC and don’t forget left lateral tilt

Treat Treat C C problemproblem

RECAP-1RECAP-1

IN PARTNERSHIP WITH

Liverpool School of Tropical Medicine

Liverpool Associates in Tropical Health

RECAP-2RECAP-2

The approach to an apparently lifeless patientRemember: CALL FOR HELP!

ABC approach

CPR 30:2

Left lateral tilt

Think about causes - 4 H’s, 4 T’s4 H’s, 4 T’s