Respiratory

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lecture 4
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• Respiratory
• Circulatory
• Emergencies

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1. Choking
2. Drowning
3. Suffocation
4. Shock

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• B- Drowning
• When person is submerged in liquid (water) making
  breathing difficult and causing death.
• Drowning is death from suffocation (asphyxia)
  caused by a liquid entering the lungs and
  preventing the absorption of oxygen leading to
  cerebral hypoxia and cardiac arrest.
• Kids are especially at risk because they're
  curious and attracted to water but are not yet
  able to understand how dangerous it is. 
• If your child is the victim of a near-drowning,
  this fast-action rescue plan can prevent a
  tragedy.

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• Drowning Hazards
• A small child can drown in as little as one to
  two inches of water
• Bathtubs Never leave a child under 4 alone in
  the tub or near a running bath.
• Buckets and containers A curious toddler can
  fall headfirst into a water-filled bucket and be
  unable to get out.
• Baby bath seats or rings Never leave your child
  unattended in a bath seat. He could slip down
  into the water and get trapped underneath.

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• In an Emergency case
• Your first priority is to get a drowning child
  out of the water as soon as possible.
• If he isn't breathing, place him on his back on a
  firm surface.
• Immediately begin rescue breathing and have
  someone call for help.
• Don't assume it's too late to save a child's
  life - even if he's unresponsive, continue
  performing CPR and do not stop until medical
  professionals take over.

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• Symptoms
• Difficulty or lack of breathing.
• Coughing.
• Lethargy.
• Cyanosis or bluish skin.
• Abdominal swelling.
• Vomiting.
• Unconsciousness.
• Confusion.

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Aims of Management

• To get the casualty on to dry land with minimum
  danger to yourself.
• To restore adequate breathing.
• To treat him for drowning hypothermia if
  necessary (keep him warm).
• To arrange removal to hospital.

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• First Aid Management
• Get the drowning person out of the water using a
  flotation device. (Reach Throw, Dont get into
  the water)
• Check for ABCs, start CPR, if essential.
• Contact EMS.
• Treat him from hypothermia (remove wet clothing
  protect from cold)
• If person vomits during CPR, turn him on his side
  (recovery position).

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• First aid for a near-drowning victim
• The focus of the first aid for a near-drowning
  victim in the water is to get oxygen into the
  lungs without aggravating any suspected neck
  injury.
• If the victim's breathing has stopped, begin
  mouth-to-mouth rescue breathing as soon as you
  safely can.
• Continue to breathe for the person every 5
  seconds while moving the victim to the shore.
• If the airway is obstructed making breathing
  impossible, perform the Heimlich maneuver until
  the airway is cleared.

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• Chest compressions in the water are difficult to
  do without a flat surface.
• Once on shore, reassess the victim's breathing
  and circulation (heartbeat and pulse(.
• If there is breathing and circulation without
  suspected spine injury, place the person in
  recovery position to keep the airway clear and to
  allow the swallowed water to drain.

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• If there is no breathing, begin CPR. Continue CPR
  (mouth-to-mouth breathing and chest compressions)
  until help arrives or the person revives.
• If resuscitating, be aware that water in the
  lungs the effects of cold can increase
  resistance to artificial ventilation chest
  compression, so you may have to do both at slower
  rate than normal.

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• Keep the person warm by removing wet clothing and
  covering with warm blankets to prevent
  hypothermia.
• Remain with the recovering person until emergency
  medical personnel have arrived. (V(

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• C - Suffocation (Asphyxia)
• Asphyxia is a condition of severely deficient
  supply of oxygen to the body that arises from
  being unable to breathe normally.
• An example of asphyxia is choking and drowning.
  Asphyxia causes generalized hypoxia, which
  primarily affects the tissues and organs.
• If this continues for some minutes breathing
  stops and death occurs.

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• Suffocation occurs when life is threatened
  because the breath is deficient in O2.
• It can result not only from airway obstruction,
  but also from contamination of the air
  interfering with the ability of the blood to
  carry O2.

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• Asphyxia is a condition of severely deficient
  supply of oxygen to the body that arises from
  being unable to breathe normally.
• Lungs dont get sufficient oxygen supply for
  breathing.
• If this continues for some minutes breathing
  stops and death occurs.
• The depletion of oxygen in the body is known as
  hypoxia. Tissues begin to deteriorate rapidly.
  Brain cells will start to die if oxygen supply is
  interrupted for as little as 3 min.

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• Causes
• Obstruction of air passage by food (choking),
  water (drowning) or irritant gas (smoke).
• Swelling of tissues of the throat and as a result
  of scalding (boiling water) or injury, burns and
  corrosives.
• Compression e.g. hanging, covering face with
  plastic bag, pillow, unconscious person lying
  face downwards on a pillow etc.
• Sleep apnea (in infants)
• Drug overdose e.g. morphine, barbiturates, etc.
• Lack of oxygen at high altitudes with low
  atmospheric pressure.

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• Symptoms
• Rate of breathing increases then gets shorter.
• Veins of the neck become swollen.
• Face, lips, nails, fingers and toes turn blue.
• Pulse gets faster and feebler (weaker).
• Consciousness is lost totally or partially.
• Froth may appear at the mouth and nostrils.
• Convulsions may occur.

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• Management
• Remove the cause if possible or remove the
  casualty from the area to fresh air (cover your
  own mouth and nose or wear a gas mask if there is
  gases or smoke).
• Loosen casualty clothes at neck and waist and
  give artificial respiration, if asphyxiated.
• Continue CPR until natural breathing is restored
  or emergency medical help arrives.

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D - Shock

• Tissues dont receive adequate blood supply to
  provide necessary O2 nutrients leading to
  cellular death, organ failure and death.

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• The circulatory system distributes blood round
  the body, so that O2 nutrients can pass through
  perfuse tissues.
• When the system fails, circulatory shock will
  develop. If not treated, vital organs (heart
  brain) may fail leading to death.
• If there is risk of shock, reassuring the
  casualty making him comfortable may be
  sufficient to prevent the condition to
  deteriorate (Shock is made worse by fear and
  pain).

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Causes of Shock

• Shock can develop when the heart pump fails to
  work properly, causing a reduction in the
  pressure of the circulating blood. The most
  common cause of this type of shock is a heart
  attack.
• Shock can develop as a result of a reduction in
  the volume of fluid circulating around the body.
  external or internal bleeding, or loss body
  fluids through severe diarrhoea, vomiting, or
  burns. The blood supply is diverted from the
  surface to the core of the body. The main
  symptoms and signs of shock relate to such
  redistribution of the circulation.

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• There are 3 main types of shock hypovolaemic,
  cardiogenic and vasogenic shock.
• In hypovolemic shock, the problem is that there
  is a loss of fluid from the circulation.
• In cardiogenic shock, there is a failure of the
  pump, although the blood volume is not affected.
• While in vasogenic shock, the blood volume is
  again not affected but rather the arterioles and
  capillaries dilate, leading to diminished venous
  return and hence diminished cardiac output
  leading to decreased tissue perfusion i.e. shock.

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Classification of Shock by Cause

• Hypovolaemic
• Hemorrhagic blood loss due to soft tissue
  bleeding, fractures, wounds, etc.
• Burns loss of plasma in burn exudates.
• Dehydration major body fluid loss, e.g. due to
  prolonged vomiting, diarrhea or metabolic
  disorders as diabetic ketoacidosis.

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• Cardiogenic
• Failure of cardiac pump leading to inadequate
  cardiac output e.g. after myocardial infarction.
• Vasogenic
• Septic endotoxins from G-ve bacteria can cause
  massive vasodilatation in certain infective
  conditions.
• Anaphylactic severe allergic reaction, histamine
  release leads to dilatation of capillaries and
  arterioles.
• Neurogenic loss of sympathetic control leading
  to dilatation of venules, capillaries and
  arterioles.

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Symptoms progression

• Release of adrenaline causes
• Rapid pulse, Sweating, small vessels in non vital
  areas ,as the skin, shut down to divert blood
  O2 supply to vital organs (pale, cold blue
  skin).
• As shock develops
• Weakness, Nausea vomiting, Thirst, Rapid,
  Shallow Breath Weak Pulse.
• As the brains O2 supply weakens
• Restlessness, anxiety aggressiveness, Air
  hunger, Undetectable pulse, Unconsciousness
  finally Heart stops

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• Shock occurs when the blood supply to the brain
  is insufficient for its needs.
• Symptoms
• Pale, cool and clammy (moist) skin.
• Hypotension with tachycardia
• Irregular respiration Chest pain.
• Confusion or loss of consciousness (up to coma).
• Pupils may be dilated.
• Renal failure and diminished urine output.
• Diarrhea (large intestine becomes irritated due
  to hypotension).

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Your aims are

• To recognize shock.
• Treat any obvious cause.
• Improve blood supply to the brain, heart lungs.
• Arrange removal to hospital.

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• First Aid Management
• Do not let the casualty move unnecessarily, eat,
  drink, or smoke.
• Do not leave the casualty unattended.
• Treat any cause of shock which can be remedied
  (such as external bleeding).
• Lay the casualty down, keeping the head low.
• Raise and support the casualtys legs (be careful
  if suspecting a fracture).

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• Loosen tight clothing, braces or belts, in order
  to reduce constriction at the neck, chest and
  waist.
• Insulate the casualty from cold, both above and
  below.
• Contact the emergency service.
• Check and record breathing, pulse and level of
  response.
• Be prepared to resuscitate the casualty if
  necessary.

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• Have the person lie down on his back with feet
  higher than the head (head down position).
• This will force blood to go to the thorax,
  increasing venous return to the heart and hence
  increasing cardiac output

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• Further management depends on cause
• Blood transfusion in bleeding.
• IV fluids in dehydration.
• Dopamine in cardiogenic shock.
• Atropine in neurogenic shock.

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