Pregnant woman resuscitation Near drowning Electrocution

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Pregnant woman resuscitationNear
drowningElectrocution

• MUDr.M.Grochová PhD
• I.KAIM, LF UPJŠ a UNLP, Košice

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Pregnant woman resuscitation

• Causes of cardiac arest
• Cardiac disease
• trombembolism
• Fetal water embolism
• Pregnancy related hypertension

• Extra-uterine gravidity
• Bleeding
• Sepsis
• ERC, 2005

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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

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Pregnant woman resuscitation

• Gestational age lt 20 weeks no C.S.
• Gestational age 20 - 23 weeks urgent C.S. fore
  mother sake
• Gestational age gt 24 - 25 weeks urgent C.S.
  for mother and newborn sake

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Pregnant woman resuscitation

• Delivery can by helpfull for improving prognose
  of succesfull resuscitation
• Start hysterotomy 4 min. after cardiac arrest

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Near drowning

• Asfyxia airways occlusion after drowning
• Conected with aspiration, submersion, bacterial
  contamination of airways
• Wet drowning - aspiration
• Dry drowning without aspiration (laryngospasm)

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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 gt 5 min towards the waterside 1 min then
  stop artef. breaths and transfer towards the
  waterside If lt 5 min towards the waterside
  transfer synchronized with arteficial breaths
• No effort to empty airways
• Regurgitation by 86 of pac. breathing and
  chest compressions

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Near drowning

• Aspired water removement from lungs capillars
  impossible- dont try to remove water!
• Secundary near drowning lungs insuficiency
• 72 hours after near drowning

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Near drowning

• Near drowning sequalae hypoxia
• Ice cold water
• hypoxia tolerance
• By submersion start CPR even
• after 20-60 min.of cardiac arrest

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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 TTlt 30C maxim. 3 shocks, next after warming

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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

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Near drowning

• Every victim even consious
• after CPR (even minimal) must
• be transported to the hospital
• and hospitalized

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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

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Cardiac damage after electrocution

• VF the commonest initial
• arrhythmia after
• highvoltage AC shock if
• cerrent traverses
• the myocardium during
• the vulnerable period
• myocardial ischaemia-
• coronary arteryspasm

• asystole after DC shock
• primary or
• secondary to asphyxia following respiratory
  arrest
• use standard protocols for this and other
  arrhythmias

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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

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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.