Methodical development of number 2
THE PRACTICAL LESSON FOR STUDENTS
MEDICAL FACULTY of discipline “emergency and emergency care”
Department of urgent and emergency care
Lesson № 2 (practical-6 hrs)
Theme Modern means of providing the airway patency and artificial lung ventilation for adults. Circulation and respiration arrest. Technology for EMC provision for adults.
Objective: To acquaint students with the causes, diagnosis and treatment of airway obstruction in adults. To improve the theoretical knowledge and practical skills to secure the airway by various methods, including trauma of the cervical spine. Learn the techniques of revision and reorganization of the mouth and hand hardware. Bring to the students the basic screenings and technicians perform tracheal intubation, the use of alternative methods of airway management, symptoms of partial and complete airway obstruction with a foreign body, methods of restoration, to master the method of taking Heymliha, fashion and technology сoniсopunkture, conicotomy.
To acquaint students with the concept of terminal patients, clinical death, her symptoms. Sudden death diagnosis, classification and evaluation of cardiac rhythm in cardiac arrest, methods of cardiopulmonary resuscitation according to current protocols of the European Resuscitation Council. Learn to diagnose the underlying causes of cardiac arrest, which can be removed in the intensive care unit: four “D” and four “T. To master the technique of rapid ECG during resuscitation., Manual defibrillation defibrillator . Bring to the attention of students by administration of medicines, basic pharmacotherapy used in cardiac arrest. Master of technology and its duration in the presence of an automatic defibrillator, the signs that indicate the effectiveness of CPR and the possibility of termination, Postresuscitation support. Familiar with basic errors and complications arising during cardiopulmonary resuscitation., Legal and ethical aspects of CPR.
Professional orientation of students: Statistics show steady increase in mortality and severe disability (injured), the lion’s share (over 70%) are in the pre-hospital period. That knowledge of the basic principles of emergency medical care at this point, with a clear implementation guidelines AVSDE, qualitative statement of absolute and relative signs of clinical death and execution of appropriate clinical protocols can significantly reduce mortality rates, prevent the development of serious complications. An important element in this is the assimilation of knowledge from a variety of modern methods and techniques to ensure the carrying out and supporting and mechanical ventilation, development of equipment, instruments and medicines that are involved during cardiopulmonary resuscitation.
Program Individual Students
1. Causes, diagnosis and emergency medical care for incomplete and complete airway obstruction in adults.
2. Stages and recovery methods airway.
3. The concept of taking Heymliha, the method of its application at various stages of emergency medical care
4. Modern principles of airway management at all levels of emergency medical care.
5. Revision and rehabilitation of oral manual and hardware.
6. Specifications and methods of use of modern instruments, apparatus for supporting and mechanical ventilation.
7. Indications and technique of intubation is required in this toolkit
8. Technique сoniсopunkture, conicotomy.
9. Terminal patients, their clinical manifestations.
10. The concept of clinical death, her symptoms. Absolute and relative signs of clinical death, cause inefficient blood circulation.
11. Sudden cardiac arrest. Classification and measurement of heart rate during cardiac arrest.
12. Indications and contraindications for CPR.
13. Methods of cardiopulmonary resuscitation during ventricular fibrillation, ventricular tachycardia, without pulse electrical activity, asystole in adults according to the protocols of the European Resuscitation Council, 2010.
14. Diagnosis reasons CFT, which can be removed in the intensive care unit – four “D” and four “T”.
15. Express check-ECG during resuscitation. Pharmacotherapy, used in cardiac arrest.
16. The technology of cardiopulmonary resuscitation in the presence of manual and automatic defibrillator.
17. Timeframe perform cardiopulmonary resuscitation, signs that indicate its effectiveness and the possibility of termination. Early and late signs of biological death.
18. The concept of the complex after intensive care treatment, its interpretation.
19. Mistakes and complications arising during cardiopulmonary resuscitation. Legal and ethical aspects of cardiopulmonary resuscitation
Sample tests and situational tasks:
1. Girl ’12 pulled from the water after 3 minutes after drowning in the river. Resuscitation measures before the arrival of ambulance carried fathers. It was possible to achieve a rare spontaneous heart rate, but breathing is not restored. What should the doctor immediately:
A. “Triple reception” by M. Safar;
B. Tracheal intubation, respiratory rehabilitation, ventilator;
C. Chest;
D. Intravenous epinephrine enter;
E. Intravenous atropine sulfate type.
2. The worker was exposed to the action of electric current a few minutes ago. He lost consciousness. There were seizures. The action current was stopped. The patient lies, no breathing, no pulse is determined, cyanotic skin, eyes wide, do not react to light. What kind of help should be given priority?
A. Introduction painkillers;
B. Introduction anticonvulsants;
C. Intravenous Rheopolyglukin;
D. Closed cardiac massage and artificial ventilation;
E. Intravenous respiratory analeptics.
3. What steps need to be taken in the first place, if the start of ventricular fibrillation was 30 seconds?
A. Urgent to defibrillation
B. Start chest compressions and ventilation
C. Enter adrenaline
D. Put “precardial blow”
E. Establish airway
4. What is the duration of organism in a state of clinical death?
A. 4-5 minutes.
B. 5-7 minutes.
C. 8-9 minutes.
D. 10-12 minutes.
E. 13-15 minutes.
5. Which of these signs are not the major signs of clinical death?
A. lack of blood pressure
B. absence of pulsation of the femoral artery
C. absence of breathing
D. mydriasis, pupils do not react to light
E. absence of pulsation of the carotids
Problem 1.
The victim, about 45 years old, lying on the ground, and one of the others held him artificial respiration, spreading his hands and squeezing their chest. The victim unconscious. The pupils were dilated, reflexes absent carotid pulse is not detected. Breathing is missing. Skin pale gray.
1. Determine the state of the victim.
2. Specify the measures proper care.
Problem 2.
Walking on the
Correct answers to the tests and case studies: Standards of answers: 1 – A; 2 – D; 3 – A; 4 – A; 5 – A..
Problem 1.Stan clinical death. Refine your mouth, throw your head back, hold ventilation “mouth to mouth” and closed cardiac massage until the arrival of a specialized team.
Problem 2. Remove the child from the water to clean your mouth with your finger, wrap a piece of cloth, hold ventilation “mouth to mouth” and closed cardiac massage until the machine has not yet come “emergency.”
Information generators:
A) basic:
1. American Heart Association in collaboration with the International Liaison Committee on Resuscitation (ILCOR)/ International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. A Consensus on Science // Resuscitation. – 2004. – 46. – P. 103 – 252.
2. European Resuscitation Council. Immediate life support. 1- st Edition. Published by European Resuscitation Council Secretariat VZW, 2006.
3. Lattore F., Nolan J., Robertson C. et al. The ALS working group of the European Resuscitation Council. The European Resuscitation Council Guidelines 2003 for Adult Advanced Life Support Resuscitation. 2000. – 48. – P. 211 – 212.
4. Safar P, Bircher NG. Cardiopulmonary and cerebral resuscitation. 3rd ed.
5. John Campbell. International Trauma Life Support. USA. New Jersey 2008. P. 289.
7.
B) additional:
1. www.erc.edu
5. www.bcs.com
11. www.eusem.org
12. http://zakon2.rada.gov.ua/laws/show/5081-17
13. http://pidruchniki.ws/17540906/bzhd/samodopomoga_vzayemodopomoga_nadzvichaynih_
14. http://www.bibliofond.ru/view.aspx?id=492657.
15. andskp.ucoz.ua/publ/boevaja_podgoto…
16. http://knowledge.allbest.ru/life/2c0a65625a3bc68b4c53a88421316d37_0.html
17. http://5ka.at.ua/load/medicina_ta_zdorov_39_ja/persha_domedichna_dopomoga_v_umovakh_nadzvichajnikh_situacijakh_pri_opikakh_obmorozhenni_udushenni_referat/37-1-0-20950
5. Methods of practical work (9.00.-12.00)
Work №
Work 2. When considering the topic of practical lessons “Stop circulation and respiration. Technology for emergency medical care for adults “know thebasic principles, methods (ABCDE) initial examination of the patient (victim), stage and stages of cardiopulmonary-cerebral resuscitation. In detail mannequin worked algorithm performance ventilation and closed cardiac massage one and two rescuer. We study the proper signs of resuscitation and reviving the victim. At the same time, highlights the general principles, legal, organizational, medical and deontological features emergency and emergency assistance for adaptation to current clinical protocols. Getting case studies from teachers, students worked through the implementation of the protocols of the European Resuscitation Council in various types of cardiac arrest (rhythms to defibrillation and rhythms not to defibrillation) using required equipment and tools diagnosis is major cause of cardiac arrest, which can be removed in the intensive care unit – four “D” and four “T”. We study the classic mistakes and complications arising during cardiopulmonary resuscitation, legal and ethical aspects of cardiopulmonary resuscitation.
Work 3. A Seminar discussion on the subject, where students demonstrate their theoretical training on various literary sources and material covered on the Web-page emergency department and emergency medical care.
Work 4 . The following classes of students traveling to the challenges within the ambulance crews. In the course of joint action with workers Ambulance students involved in the examination of the patient (victim), help to make diverse manipulation procedures (define AD, conduct intramuscular, intravenous injection, if necessary, removal of ECG imposing change on a limb, cervical collar , Blood tow of defibrillation, resuscitation, etc.). Returning from challenges in training room is their discussion, which examines a reach to illness, validity challenges, the quality of teams SMP, timeliness and accuracy exhibited diagnosis, treatment strategy based on current clinical protocols and possible relationship with the clinic ambulance service , hospital and SES.
Work 5. Performance tests students who have not been tested before the system Moodle.
The student should know:
1. The main reasons, diagnosis and emergency medical care for airway obstruction in adults.
2. Basic principles of airway management at all levels of emergency medical care.
3. Explaine of revision and reorganization of the mouth manual and hardware.
4. Structure, basic specifications and methods touse modern instruments, apparatus for supporting and mechanical ventilation.
5. Indications to perform tracheal intubation.
6. Symptoms partial and complete airway obstruction with a foreign body.
7. Stages and recovery methods airway.
8. The concept of taking Heymliha, the method of its application at various stages of emergency medical care
9. Conicopunkture, conicotomy, indications, technique
10. The concept of terminal states and their characterization.
11. Clinical death of her symptoms. Absolute and relative signs of clinical death, cause inefficient blood circulation.
12. Diagnosis of sudden death. Classification and measurement of heart rate during cardiac arrest.
13. Technology of cardiopulmonary resuscitation during ventricular fibrillation, ventricular tachycardia, without pulse electrical activity, asystole in adults according to the protocols of the European Resuscitation Council, 2010.
14. Diagnostic cardiac causes that can be addressed in the intensive care unit – four D: hypoxia, hypovolemia, hyper / hypopotassiumy, hipomagnesis, acidosis, hypothermia, four T: tension (tense) pneumothorax, cardiac tamponade, thromboembolism, toxic overdose.
15. Engineering Express ECG during resuscitation. Drug therapy, used in cardiac arrest.
16. The concept and technology of cardiopulmonary resuscitation in the presence of manual and automatic defibrillator.
17. Duration of cardiopulmonary resuscitation, signs that indicate its effectiveness and the possibility of termination. Early and late signs of biological death.
18. Postresuscitation support, including the concept of the complex after intensive care treatment
19. Errors and complications arising during cardiopulmonary resuscitation. Legal and ethical aspects of cardiopulmonary resuscitation
The student should be able to:
|
№. |
Habit |
The level of absorption |
|
1.
|
Rate and ensure patency of the upper airway using a triple receive Safar |
3 |
|
2.
|
Make Heymliha reception. |
3 |
|
3.
|
To master the technique and execution Conicopunkture, conicotomy |
3
|
|
4. |
Master the technique of intravenous, injections Intraosteal |
3 |
|
5. |
Determine the absolute and relative signs of clinical death |
3 |
|
6. |
Master modern techniques of cardiopulmonary resuscitation |
3 |
|
7.
|
To use the tools and equipment that is used in the SMP team (board, cervical collar, modern transport bus vest immobilization, suction, ECG machine, etc.). |
3 |
|
8. |
Working with manual breathing apparatus, to carry mechanical ventilation by Ambu bag. |
3 |
|
9. |
Enjoy portable ventilator. Apply various air vents, perform input technique laryngeal mask, laryngeal tube. |
3 |
|
10. |
Prepare and apply the defibrillator and EKG machine to work to remove the defibrillation and ECG, including using modern kardiokompleksu Life-Pack. |
3 |
Options to control the test questions practice session № 2:
1. For terminal states are: A – before the agony, terminal pause, agony, clinical death, B – agony, clinical and biological death, C – places, agony, clinical death; D – before the agony, agony, clinical, social death, and E – reduced blood pressure to 80 mmHg, coma, clinical death.
2. Which of these signs are not the major signs of clinical death? A – lack of blood pressure in – no pulsation of the femoral artery, C – lack of breath; D – mydriasis, pupils do not react to light, E – no pulsation of the carotid artery.
3. In carrying out artificial respiration “mouth to mouth” to inject air into volumes: A – 1700-2000 ml B – 500-700 ml C – 1200-1600 ml D – 800-1100 ml E – to maximum breaths .
4. Clinical death in normo thermie goes: A – 7-12 minutes B – 1-3 minutes, C – 4-5 minutes; D – 5-7 minutes E – 10 minutes.
5. In a closed cardiac massage adult victims Brush bottom hand should be placed: And – in a chest, toes toward the chin, B – on the lower third of the sternum, fingers parallel edges, C – middle third of the sternum; D-in the 4th between ribs the left of the sternum, and E – on the chest – in the place of projection apex of the heart.
6. A sign of effective artificial ventilation are: A – pupillary B – noise when blowing air when you exhale, C – silent chest excursion; D – epigastric swelling at injection site, E – “dizziness” rescuer.
7. Reliable signs of cardiac arrest: A – ECG contour B – loss of life by, C – pronounced cyanosis of the skin and mucosa; D – pulse of the radial artery do not palpation: E – lack of blood pressure.
8. Which size should be increased tension electric current ¬ tion at each re-defibrillator discharge? A – J 100 B – 50 J, C – 250 J; D – 20 J 1 kg weight body, E – voltage caot be increased.
9. In a resuscitation solution of sodium bicarbonate is injected to: A – correction of metabolic acidosis, B – prevention of respiratory acidosis, C – Elimination of hypoxia; D – treatment of metabolic alkalosis, E – increase survival time in brain hypoxia.
10. Girl ’12 pulled from the water after 3 minutes after drowning in the river. Resuscitation measures before the arrival of ambulance carried fathers. It was possible achieve rare spontaneous heart rate, but breathing is not restored. What should the doctor immediately:
A. “Triple reception” by M. Safar; B. Tracheal intubation, respiratory rehabilitation, ventilator; C. Chest; D. Intravenous epinephrine enter, E. intravenously lidocaine.
11. The worker was exposed to the action of electric current a few minutes ago. He lost consciousness. There were seizures. The action current was stopped. The patient lies, no breathing, no pulse is determined, cyanotic skin, eyes wide, do not react to light. What kind of help should be given priority?
A. Introduction painkillers; B. Introduction anticonvulsants; C. Intravenous Rheopolyglukin; D. Closed cardiac massage and artificial ventilation; E. Intravenous dihalnyh analeptics.
12. A young girl pulled from the lake 3 minutes after warming. Unconscious. Breathing is missing, mouth stands gray foam. Leather has violet cyanochroic colour. Ripple on the carotid artery is not defined. Specify the order of intensive care.
A. Clear the mouth and throat with your finger, hold ventilation “mouth to mouth” closed cardiac massage; B. Turn victim head down, pressing on the chest to remove water, hold ventilation “mouth to mouth”; C. Immediately take precardialy blow to conduct mechanical ventilation and closed cardiac massage; D. Release airways of water, hold ventilation for Sylvester; E. Immediately get brigade ambulance to its arrival – hold ventilation for Sylvester and closed cardiac massage.
13. Male 30 years old during the meal suddenly grabbed his neck, there was cyanosis, inability to breath, lack of voice, cough. What should be done to the affected first?
A. Tracheotomy; B. Conycotomy; C. Finger revision mouth;
D. Tracheal intubation; E. Admission Heymliha.
14. As a result, the true Drowning in seawater in a patient stated the clinical death. Enter the correct sequence of these events resuscitati ¬:
A. Restoring patency of the upper airway, ventilation, chest compressions; B. Chest compressions, mechanical ventilation, restoration of patency of the upper respiratory tract; C. Mechanical ventilation, chest compressions, restore patency of the upper respiratory tract; D. Chest compressions, mechanical ventilation; E. Electrical defibrillation, cardiac massage, mechanical ventilation.
15. Patient A., 47 years old diagnosed with clinical death, the ECG – asystole. Against the background of the first steps general reanimation medication intermediaries should be:
A. CORDARONE;
B. Lidocaine;
C. Calcium Chloride;
D. Sodium bicarbonate;
E. Adrenaline.
16. For an intensive infusion therapy in patients with acute respiratory failure subclavian vein catheterization performed by Seldinherom. After introducing 600 ml of infusion fluid status of the patient deteriorated, tachypnea increased from 26 to 40 in 1 minute, auscultation of breath right sharply weakened, percussion – stupidity. Your diagnosis?
A. Pulmonary edema; B. Swelling of the brain; C. Hydrothorax; D. Pulmonary embolism; E. Acute heart failure.
17. A patient 30 years after the accident took road-transport complaints sharp shortness of breath. OBJECTIVE: The skin is pale, cyanotic. Subcutaneous emphysema in the chest, abdomen, neck, right. Auscultation: Breath happens, HR – 130/min., AT – 80/60 mm Hg. century., CVP -140 mm of water. century., BH – 30/min., Ht – 0,27, Hb – 90 g / l. Further treatment in the first place should include the following measures:
A. Urgent ventilation; B. Massive infusion therapy crystalloid solutions; C. Dopamine infusion, 2-5 mg / khhhv; D. Puncture of the right pleural cavity; E. oxygenation100% oxygen.
18. Male 30 years old suffered as a result of road accident. Consciousness absent. Carotid pulse is not detected, no breathing. At the level of the waist to the affected skin wide belt. What actions should I begin? A. Immediately start of artificial ventilation and external cardiac massage without wasting time; B. Turn the victim on the right side; C. Do not touch the victim until the arrival of the police employee; D. Lay the victim back on board; E. To carry out artificial respiration and external cardiac massage after prior removal of the belt.
19. The injured 12-year-old pulled out of the cold sea water after 15 minutes. after drowning dead. What steps should I begin?
A. Release airways of water, a drainage position, proceed to hold events cardiopulmonary resuscitation (CPR); B. Do not hold CPR, due to the large amount of time after the drowning; C. Transported the victim to the nearest medical institution for CPR; D. Not wasting any time to remove the water, begin cardiopulmonary resuscitation; E. Run conicotomy.
20. Which possible complications often with a closed heart massages: A. Fractures of the ribs; B. Damage to the stomach; C. Damage to the liver; D. Pneumothorax, heart damage.
Methodical instruction made assistant professor R.M. Liakhovich
Discussed and approved at a meeting of
9 June 2013 Protocol № 10
