Transcript In Flight Emergencies - CPR at Your Location

In Flight Emergencies
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CPR – AED
Chain of Command
First Aid Review
OSHA
Bloodborne Pathogens
Hazardous Materials
Emergency Procedures
Communicable Disease
Next Slide
Chain of Survival
Notify Capt.
Access
AED
Early
CPR
Early
Early
Defibrillation Advanced
Care
Notify Pilot
Early
Recognition
Initial
Life Support
ABCS CARE
The Plan
CPR and Med Kit
Timely
Definitive
Care
Continued
Life Support
ABCS CARE
Rapid
Defibrillation
Extent of the Problem
• 1.1 million heart attacks Annually
• 480,000 deaths due to
coronary heart disease
• 250,000 prehospital
cardiac arrests annually
• Landing time to closest airport
• Other problems
• Lack of Training
• Unfamiliar with CPR or AED
Recognize Emergency
• Airway obstruction
– Universal distress signal, blue skin
Perform Abdominal Thrusts
• Respiratory arrest
– Not breathing - Agonal Breaths
• Cardiac arrest
– Not breathing and no signs of life or
pulse present – Blue is Bad
– Start CPR – Open Airway – Give 2
breaths – Check for signs of life
Open Airway
• Head Tilt/Chin Lift
• Empty the mouth?
Check Breathing
• Look
• Listen
• Feel
Breathing
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- Quantity - Quality
– Open Airway
Tilt Head back
Lift Chin up
B – Check Breathing
No Breathing
Use mask or Shield
Give 2 easy Breaths
that make chest rise
Signs of Cardiac Arrest
• Unresponsive
• Not breathing
• No signs of circulation
or pulse
• START Chest
Compressions
• 30:2 – 5 Cycles
• Press Hard
• Press Fast
100/Min 2 inches
Begin CPR – 5 cycles
2
Breaths
30
Compressions
AEDs and
Ventricular Fibrillation
• VF is the most frequent initial rhythm in sudden
cardiac arrest
• VF is a useless quivering of the heart that results in no
blood flow
• Defibrillation is the only
effective treatment for VF
• Successful electrical
defibrillation diminishes
rapidly over time
Time and AEDs
• Approximately 50% survival after 5 minutes
• Survival reduced by 7% to 10% each minute
• Rapid defibrillation
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100
key
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• CPR helps extend
survival
60
time
40
Survival
20
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1
3
6
10
minutes
Heartsaver AED
for the Lay Rescuer and
First Responder
A – Airway
B – Breathing
C – Circulation
D – Defibrillation
Special Considerations
• Is victim lying in water?
• Is victim less than
8 years old?
• Is victim wearing a
transdermal medication
patch on his or her chest?
• Does victim have a
pacemaker or implanted
defibrillator?
Cardiac Pacemakers
• Small device implanted under the skin
(commonly inferior to either clavicle).
– Device provides electrical stimuli for the heart
should the internal pacemaker site fail to operate
properly.
– You can easily see and palpate this device when
your patient has had one surgically placed.
– You can still use the AED; just do not apply an
electrode directly over the pacemaker site.
Precautions & Concerns
Avoid Placing the Electrode Directly Over
Implanted Heart Devices
R
Pacemaker
AEDs and Personnel
• One rescuer
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Unresponsiveness
Notify - Get the AED
Position Patient - Assess Breathing / Signs of Life / Pulse
Attach and use AED
• Two rescuers
– #1 – Notify /Perform CPR
– #2 – Attach and use AED
• More than two rescuers
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#1 – Notify
#2 – Evaluate and use AED
#3 – Perform CPR
#4 – Med Kit / Med Com
Operation of AED
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POWER ON the AED
ATTACH pads
ANALYZE rhythm
SHOCK (if advised)
Witnessed – Use AED
Un-witnessed – Perform 2
Minutes CPR then use AED
Electrode Pad Placement
• Right electrode pad
– To the right of the
breastbone
– Below the collarbone
above the right nipple
• Left electrode pad
– Outside the left nipple,
upper edge of the pad
several inches below the
left armpit
Effective Adherence of Pads
• Sweaty chest
– Dry with a towel
– Do not use alcohol
• Hairy chest
– Shaving may be
needed
AED Safety
• No patient contact during
analysis and shock
• Warn bystanders:
– “I’m clear”
– “You’re clear”
– “Everybody’s clear”
• Perform a visual inspection
• Press to shock
AED Summary
• Use AED as indicated
• Perform CPR as needed
• Do Not remove AED until
EMS arrival.
• Complete incident report
• Re-stock AED
• Critique incident
• Review guidelines
First Aid Quick Review
CPR
Stroke
Bleeding
AED
Heart
Attack
Seizures
Head
Injuries
Burns
Allergic
Reaction
Choking
Fractures
Shock
Diabetes
Choking
• Adult – perform up to 5 abdominal thrusts.repeat if necessaryunable to reach around abdoman – perform a chest thrust Unconscious – check mouth and perform steps of CPR.
• Child – perform up to 5 abdominal thrusts kneeling behind. Repeat
if necessary – Unconscious – perform steps of CPR – do not perform
blind finger sweeps.
• Infant – perform 5 back slaps / 5 chest thrusts – Unconscious –
perform steps of CPR – do not perform blind finger sweeps
The steps of CPR
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Establish Unresponsiveness
Open Airway – Give 2 Breaths
Check for signs of Life – If Absent
Start Chest Compressions / Breaths
Perform 5 Cycles – Press Hard – Press Fast – 100 / Min
Adult – 30:2 – 2 Hands – center of chest between nipples
Child – 30:2 – 1 or 2 Hands - depending on size.
Infant – 30:2 – 2 Fingers - between nipples
• Pediatric compression depth is ½ to 1/3 the depth of their chest
Automatic External Defibrillator
Turn on AED
• Remove all clothing from
patients chest including bra.
• Attach AED Pads
• Follow Icons / Voice Prompts
• Clear to Analyze
• Clear to Shock
• Follow Directions
• Do Not Disconnect AED
• Turn over Patient to EMS
• Restock AED
• Review Incident
Special Considerations
• Pediatric size AED pads
• Implantable device
• Transdermal Med Patch
• Hairy Chest
• AED use in wet conditions
• AED battery life
• AED self testing
• AED Laws
• Local EMS
Decreased Level Of Consciousness
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Evaluate Level Of Consciousness
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Abnormally Sleepy
Alcohol
Drugs
Stroke
Diabetes –glucometer
Blood sugar 90-120
Low < 80 w symptoms
Give sugar
High > 200
Contact medical direction
Difficulty Breathing
• Asthma – Inhaler
• Anxiety – Psychological FA
• Allergic – Use Epi pen
• Call MD - Benedryl
• Call EMS – breathing treatment
• Fluid in Lungs – sound = rales
Sign of Congestive Heart
Failure - Blue is Bad
• Chronic Obstructed Pulmonary
Disease / Emphysemia
• Pink Puffers – Next Slide
Conditions that Cause Breathing Difficulty
Obstructive Lung Disease:
Emphysema Findings
• Thin, barrel chest appearance
• Generally unproductive cough
• Prolonged exhalation through
pursed lips
• Diminished breath sounds
• Possible wheezing or ronchi
• Dyspnea on exertion
• Pink completion (pink
puffers)
• Tachypneic and tachycardic
• Tripod positioning, and
commonly
on oxygen at home
Sudden Difficulty Breathing
– Pulmonary Embolism
• Sudden Onset
• Common findings
• Caused by long periods
of inactivity
• Blood clotting
Thermal Burns
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First & Second
Apply cool
water to burn
area
Third
Use burn sheet
Treat for Shock
Contact
Medical
Direction
Bleeding
• Artery – Direct Pressure
• Vein – Apply dressing
• Capillary – Band Aid
• Use Sterile
dressing
• Use Sterile
bandage
• Change daily
• Keep it dry
• AAA Ointment
• Tetanus
• Infection
Wound Care
• Direct pressure
• Pressure bandage
SHOCK
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Check ABC’s
Check for and Treat Injuries
Elevate Legs
Stop if there is pain upon
movement
• Cover with blanket
• Conserve Body heat
• Nothing to eat or drink
• Signs – pale – sweaty
• Symptoms – nausea - dizzy
Fractures
• Splint arm or leg with pillow
blanket or splint
• Do not wrap to tight
• Check circulation
• Leave fingers and toes exposed
• Apply Ice – not directly on skin
• Maintain position of comfort
• Do not move if angulated
• Treat for Shock
• Seek Medical direction
Stroke – Seizure – Head Injuries
• Stroke
– Head ache, facial droop,slurred speech,loss of movement
Contact medical direction to locate the closest stroke center hospital
• Seizure – Protect passenger from further injury – determine if
traumatic, epilepsy or febrile in nature.
• Head Injury – Put on PPE -treat bleeding -maintain in line
immobilization – log roll if turning on side is necessary to clear airway.
Use jaw thrust to open airway if victim unable to maintain airway.
Hazardous Materials
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Who, Why,When,Where,What is it ?
Proper storage & handling
Value Jet Crash – Haz-mat cargo fire
UPS – cargo fire - they walked away
Immediately report unusual cargo
Report suspicious activity
Airliners.Net – slide deployment
Hazardous Materials - Routes of Exposure
• Skin Contact – Ingestion – Inhalation - Injection
• Types of Physical Hazards
Combustible – Compressed gas – Explosive – Flammable
Organic peroxide – Oxidizer - Reactive
• Types of Health Hazards
Toxic – Carcinogen - Corrosive – Irritants
Hazardous Materials
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Proper Handling - Labeling - Storage
Air Bill - Identification – Is it approved?
Material Safety Data Sheet
Ingredients – Physical data - Life Safety – Fire – Explosion
Health Hazard data – Reactivity – Spill & Leak Procedures
Special Protection ( gloves,eyes,respiratory,ventilation)
Special Precautions( grounding,storage,no smoking or eating)
• Emergency Evacuation
EMERGENCY PROCEDURES
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737 Exits
Evacuation Techniques
Floatation Device
Ditching: Survival on Water
LOST is BS
Ups & Downs of Cabin
Pressurization
Exit Drills
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Exit Doors
Exit Drills
Emergency slide
Disarming
PRINCIPLES OF DISEASES
TRANSMISSION
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TERMINOLOGY AND CONCEPTS
• Bacteria - type of living
microorganism that can produce
disease in a suitable host, can
multiply outside of the cells on
surfaces or objects
• Virus - type of microorganism
normally resides within other living
cells and cannot multiply outside
living cells
TERMINOLOGY AND CONCEPTS
• Infection - growth of an organism in a
suitable host with or without detectable
signs of illness
• Infection Control - efforts designed to
protect both the patient and care provider
• Infectious Disease - any illness resulting
from invasion of a host by diseaseproducing organisms such as bacteria,
viruses, fungi or parasites
TERMINOLOGY AND CONCEPTS
• Communicable Disease - a disease which
can be readily passed from person to person
• Bloodborne Disease - disease spread by
contact with blood or other bodily fluids
• Airborne Disease -disease spread by
droplets of an organism expelled into the air
by productive cough or sneeze
TERMINOLOGY AND CONCEPTS
• Foodborne Disease - disease spread
through improperly prepared, uncovered or
improperly refrigerated foods
• Antigen - a substance that the body
recognizes as foreign including pathogens
• Antibodies - product created by the
immune system to fight invading antigens
TERMINOLOGY AND CONCEPTS Cont.
• Seroconversion - a change in the status of
serum testing
• Window Phase - time from exposure to the
disease to positive testing
• Incubation Phase - the period of time
beginning with exposure to the disease until
the first appearance of symptoms
TWO METHODS OF DISEASE
TRANSMISSION
• Direct Transmission - occurs when the
disease passes directly from one person to
another because of contact with infected
blood/other body fluids or airborne route
• Indirect Transmission - occurs without
direct person-to-person contact, such as
through a contaminated object
BODY FLUIDS
WHICH POSE AN INFECTIOUS RISK
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Blood
Cerebral Spinal Fluid
Synovial Fluid
Pericardial Fluid
Amniotic Fluid
Any fluids containing blood
BODY FLUIDS WHICH DO NOT POSE
A RISK
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Sweat
Tears
Saliva
Urine
Feces
Vomitus
Nasal Secretions
NOTE:
Hepatitis A which is
not bloodborne can be
transmitted via feces
COMMON BLOOD/BODILY FLUID BORNE
DISEASES
HIV/AIDS -VIRUS
Hepatitis B -VIRUS
Hepatitis C - VIRUS
Syphilis - BACTERIA
PERSONAL PROTECTIVE MEASURES
COMMON
TUBERCULOSIS
MENINGITIS
MUMPS
MEASLES
RUBELLA
CHICKEN POX
AIRBORNE DISEASES
TUBERCULOSIS
TUBERCULOSIS / HIV SIGNS & SYMPTOMS
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Fever
Night sweats
Weight loss
Fatigue
HIV – Purple skin sores
TB Cough
TB-Hemoptysis - coughing up blood
TUBERCULOSIS PERSONAL PROTECTION
MEASURES
• HEPA type masks for prehospital care providers
– Ability to filter particles 1 micron in size, with a filter
efficiency of equal to or greater than 95% given flow rates
of up to 50 liters per minute – N95 mask
– Ability to be qualitatively/quantitatively fit tested in a
reliable way to obtain a face-seal leakage of equal to or less
than 10%
– Ability to fit different facial sizes & characteristics of
healthcare workers
– Ability to check face piece fit, in accordance with standards
established by OSHA and good industrial hygiene practice
by health care workers each time they put on their masks
PREVENTION OF INFECTIOUS DISEASE
Interrupt the disease process
by dealing with any one of it’s
four components, remove it
from the cycle and the process
can be stopped
Prevention by Interruption of the Disease Process
Infectious
Agent
Virulence &
Dose
Direct & Indirect
Means of
Transmission
Host Resistance
Protective
Measures
Routes of Exposure
Airborne
Bloodborne
Foodborne
Exposure Reporting
Stop – Wash - Report
• Report all exposures to your Employer
– Stop what you are doing
– Wash the area with soap and water
– Report the exposure – Complete paperwork
• Protect yourself
• Apply a surgical mask to patient during
transport if it will not interfere with treatment
or worsen medical condition
– Assuming pt condition does not
contraindicate use of mask
UNIVERSAL PRECAUTIONS
• Infectious control strategy developed by the
Center for Disease Control which was
originally designed for controlled health
care settings
– Blood and specific bodily fluids of all patients
are considered to have potential infectious
pathogens for human immunodeficiency virus
(HIV), Hepatitis B virus (HBV) and other
bloodborne diseases
BODY SUBSTANCE ISOLATION (BSI)
• PreHospital strategy for infection control
– All body substances have potential infectious pathogens
If it’s wet and it’s not yours
it’s dangerous
TUBERCULOSIS PERSONAL PROTECTION
MEASURES
•HEPA type masks for pre-hospital care providers
–Ability to filter particles 1 micron in size, with a filter
efficiency of equal to or greater than 95% given flow rates
of up to 50 liters per minute – N95 mask
–Ability to be qualitatively/quantitatively fit tested in a
reliable way to obtain a face-seal leakage of equal to or
less than 10%
–Ability to fit different facial sizes & characteristics of
healthcare workers
–Ability to check face piece fit, in accordance with
standards established by OSHA and good industrial
hygiene practice by health care workers each time they put
on their masks
Exposure Reporting
Stop – Wash - Report
•Report all exposures to your Employer
–Stop what you are doing
–Wash the area with soap and water
–Report the exposure
–Complete paperwork
•Protect yourself - Use N95 mask
•Apply a surgical mask to patient during transport if it will not
interfere with treatment or worsen medical condition
•Assuming pt condition does not contraindicate use of mask
PERSONAL PROTECTIVE
EQUIPMENT
Barrier Protection - used to isolate
mucous membranes and skin from
contact with blood or other potentially
infectious materials
PERSONAL PROTECTIVE
EQUIPMENT
•GLOVES
–MEDICAL EXAM
•Latex more tear resistant
•Latex sensitivity (rash) can occur
with misuse
•Vinyl good for simple exams
•Latex & vinyl not appropriate for
cleaning
–HEAVY DUTY LATEX gloves
should be used for cleaning
–LEATHER GLOVES - should be
disposed of if contaminated with
blood - cleaning near impossible
National Institute of
Occupational Safety and
Health (NIOSH)
June 1997 notice
regarding latex glove
sensitivity/allergy.
Less than 0.8% of
population have latex
allergy
ENGINEERING/WORK PRACTICE CONTROLS
SHARPS CONTAINERS
•Puncture and leak proof
•Required markings
•Single use versus multiple use containers
–Selection should be based on what works best from a
situation and personal perspective
•Only sharps should be put in containers
–Cost of containers disposal is generally by weight
•Storage and disposal
–Must meet all OSHA guidelines
CONTAMINATED MATERIALS
•Red Bags
–Required markings
–What does/does not go in red bags
•Non-sharps –
•Blood/body fluid contaminated disposables i.e.. 4x4’s,
kling
–Bag sealing - use proper technique to assure
contamination does not occur
–Storage and disposal
•Must meet all OSHA guidelines
•EMS will dispose of red bags
HANDWASHING
•Areas for hand washing are to be readily
accessible to employees
•When hand washing areas are not feasible,
alternative systems for hand washing shall be
available
–Treated Towelettes
–Water-less hand washing foam/jells
It’s Never the End so Be Safe and Look Good Doing It..!
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