First Aid - introduction
Preparation material
1. Slide handouts
2. G.D. Perkins et al. European Resuscitation Council
Guidelines for Resuscitation 2015: Section 2. Adult basic life
support and automated external defibrillation.
Resuscitation, October 2015, Pages 81 - 99
3. D.A. Zideman et al. European Resuscitation Council
Guidelines for Resuscitation 2015 Section 9. First aid.
Resuscitation, October 2015, Pages 264 - 277
Evaluation
• During the classes – BLS practical test
• At the end – written exam
• Pass/fail mark only
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Aim of the lecture
• Define the term „First Aid”
• Cardiac arrest and clinical death
• Chain of survival
First Aid Definition
• helping behaviours and initial care provided
for an acute illness or injury
First Aid provider is the person who knows how to :
recognise, assess and prioritise the need for first aid
provide care using appropriate competencies
recognise limitations and seek additional care when needed
First Aid Goals
• Preserve life
• Alleviate suffering
• Prevent further illness or injury
• Promote recovery
• Primum non nocere!
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Cardiovascular diseases (mortality in
Europe)
• Cardiovascular diseases are responsible for
40% of deaths in persons younger than 75 in
Europe
• 1/3 of all persons developing acute myocardial
infarction dies before reaching the hospital
• EKG rhythm in most of those cases –
VF/pulseless VT
• In-hospital cardiac arrest – non shockable
rhythms are more frequent
How long can humans survive without
basic energy sources?
• Without food - weeks
• Without water - days
• Without oxygen - minutes
The course of dying - agony
• Usually there is an arrest of a single vital
function which gradually leads to an arrest of
the second vital function (cardiac and
respiratory)
• Isolated single vital function arrest is more
often seen in hospitals
• Out of the hospital, by the time the EMS gets
to the patient, patients are in both cardiac and
respiratory arrest
Replacing vital functions and brain
function
Function Artificial replacement of Max. duration of Possibility of
vital function replacement transplantation
Respiratory Rescue breaths / No limits +
mechanical ventilation
Cardiac Chest compressions Couple of +
E-CPR hours/days
Brain None avaliable -
The course of dying with primary
circulatory colapse
Signs Time of appearance
Absent carotid pulse Instantaneously
Loss of conciousness 10-20 s
Agonal breathing/respiratory 15-30 s
arrest
Dilated, areflecting pupils 60-90 s
Taken from: Safar P. Cardiopulmonary cerebral resuscitation. 2nd ed. Philadelphia, WB Saunders Co; 1988:83.
The course of dying with primary
respiratory colapse
Signs Time of appearance
Asphyxia (hypoxemia and hypercarbia) lead to In 5 to 10 minutes
apnea and cardiac arrest
Taken from: Safar P. Cardiopulmonary cerebral resuscitation. 2nd ed. Philadelphia, WB Saunders Co; 1988:21.
Cardiac arrest
• Cardiac arrest is defined as absent cardiac mechanical
activity confirmed by absence of pulse on carotid or
femoral artery, absent reaction to a stimulus and
absence of breathing (including agonal breaths)
• Confirmed cardiac arrest in which we consider giving
CPR is the one where the patient doesn’t respond to a
stimulus, doesn’t breathe, doesn’t have a pulse and we
have called an EMS team which then once again
confirmes the absence of pulse
Taken from: Joint Task Force. Uniform Reporting of Data From Out-of-Hospital Cardiac Arrest: The Utstein Style.
Circulation 1991;84(2):960-975.
Clinical death
• Clinical death is a potentially reversible vital function
arrest characterized by apnea, cardiac arrest and a stop
in brain function. This is an early stage of death in
which high quality CPR can lead to return of all vital
functions includin normal brain activity.
Taken from: Safar P. Cardiopulmonary cerebral resuscitation. 2nd ed. Philadelphia, WB Saunders Co; 1988:161.
CP(C)R – Cardiopulmonary (Cerebral)
Resuscitation
• CP(C)R is a set of diagnostic and therapeutic
actions meant to reestablish vital functions with
the main goal not only to survive but to achieve a
good quality of life and social integration present
prior to cardiac arrest
Taken from: Safar P. Cardiopulmonary cerebral resuscitation. 2nd ed. Philadelphia, WB Saunders Co; 1981.
The Chain of Survival
Sudden cardiac death - prognosis
• Chances of survival depend on early
bystander CPR and early defibrillation
(shock that goes through the heart in order
to restore a normal cardiac rhythm)
The meaning of early CPR, early
defibrillation and advanced life
support
CPR start (min) ACLS start (min) Survival(%)
0-4 minutes 0-8 minutes 43%
0-4 minutes 16+ minutes 10
8-12 minutes 8-16 minutes 6
8-12 minutes >16 minutes 0
JAMA .1979,241.1905-1907
Do you have any questions?
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Conclusion
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Thank you for your attention!
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