Transcript Pregnant woman resuscitation Near drowning Electrocution

Pregnant woman resuscitation
Near drowning
Electrocution
MUDr.M.Grochová PhD
I.KAIM, LF UPJŠ a UNLP, Košice
Pregnant woman resuscitation
Causes of cardiac arest
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Cardiac disease
trombembolism
Fetal water embolism
Pregnancy related
hypertension
• Extra-uterine
gravidity
• Bleeding
• Sepsis
ERC, 2005
Pregnant woman resuscitation
•Left lateral position
(15 degrees left )
•Hands position upper than in the middle
of sternum
•Adhesive pads more useful
•OTI with the pressure on the cricoideal cartilage
Pregnant woman resuscitation
• Gestational age < 20 weeks : no C.S.
• Gestational age 20 - 23 weeks : urgent
C.S. fore mother sake
• Gestational age > = 24 - 25 weeks :
urgent C.S. for mother and newborn sake
Pregnant woman resuscitation
• Delivery can by helpfull for
improving prognose of succesfull
resuscitation
• Start hysterotomy 4 min. after cardiac arrest
Near drowning
• Asfyxia – airways occlusion after drowning
• Conected with aspiration, submersion,
bacterial contamination of airways
• Wet drowning - aspiration
• Dry drowning – without aspiration
(laryngospasm)
Near drowning
BLS - breathing
• Lift a victim from the water into a bout or towards
waterside
• Personal safety
• Initial arteficial breaths important - 1 min
• Trained professionals in the water
• Others - shallow water, waterside, firm base
• Non breathing
– If > 5 min towards the waterside – + 1 min then stop
artef. breaths and transfer towards the waterside
If < 5 min towards the waterside – transfer synchronized
with arteficial breaths
– No effort to empty airways
– Regurgitation by 86% of pac. – breathing and chest
compressions
Near drowning
• Aspired water removement from
lungs capillars impossible- don´t try
to remove water!
• Secundary near drowning – lungs
insuficiency
72 hours after near drowning
Near drowning
• Near drowning sequalae – hypoxia
• Ice –cold water
hypoxia tolerance
• By submersion start CPR even
after 20-60 min.of cardiac arrest
Near drowning
BLS – chest compressions, AED
• C spine injury
• In the water - uneffective chest
compressions, start immediatly after lifting on
the waterside
• Dry skin befor AED
• If TT< 30°C – maxim. 3 shocks, next after
warming
C spine injury suspected
• Fix neck in the neutral position, turn into
supine position before lifting from the water
• If changing position on the waterside – turn
dead, neck and the rest of body as one
complex
• By rescue breaths head is neutral position with
jaw thrust or chin lifting
Near drowning
Every victim even consious
after CPR (even minimal) must
be transported to the hospital
and hospitalized
Electrocution
potentially devastating
multisystem injury
adults - in the workplace
high voltage
children primarily at
home, the voltage is
lower (220V,110)
lightning strikes - rare,
1000 deaths each year
electric shock injuries - direct
effects of current on cell
membranes and vascular
smooth muscle
respiratory arrest - paralysis
of the central respiratory
control system, respiratory
muscles after high voltage,
may persist for several hours
Cardiac damage after electrocution
VF the commonest initial
arrhythmia after
highvoltage AC shock if
cerrent traverses
the myocardium during
the vulnerable period
myocardial ischaemiacoronary arteryspasm
• asystole – after DC
shock
• primary or
secondary to asphyxia
following respiratory
arrest
• use standard protocols
for this and other
arrhythmias
Lightning strikes
• survivors of the initial
shock - extensive
catecholamine release
or autonomic stimulation
may occur-hypertension,
tachycardia, nonspecific
ECG changes (including
prolongation of the QT
interval, transient Twave
inversion)
• myocardial necrosis
• 300 kV over a
few milliseconds
• mortality from
lightning injuries is
as high as 30%,
with up to 70% of
survivors sustaining
significant morbidity
Electrocution - CPR
• Ensure that any power
source is switched off
and do not approach
the casualty until it is
safe
• Start standard basic
support without
delay
• Remove smouldering
clothing and shoes to
prevent further thermal
injury
• Airway management difficult
if there are electrical burns
around the face and neck
• Early tracheal intubation
is needed, as extensive
softtissue oedema may
develop causing airway
obstruction
• Head and spine trauma can
occur after electrocution
Immobilize the spine until
evaluation can be
performed.