Medical first aid knowledge 3. Cardiopulmonary resuscitation (CPR)
The life chain is considered the most effective on-site first aid method by modern rescue.
The "chain of life" refers to a "chain" consisting of a series of behaviors from the first witness discovering the injured to the arrival of professional first aid personnel at the scene for rescue. It is a chain of four interrelated links. link. Including ① early access (call for help); ② early cardiopulmonary resuscitation; ③ early cardiac defibrillation; ④ early advanced life support.
On-site cardiopulmonary resuscitation refers to the rescue process in which the first witness performs basic life support (BLS) on the injured person at the scene of the accident when the heart and respiratory arrest occur. Its main purpose is to use artificial respiration and external chest cardiac compressions to deliver oxygenated blood to the brain and heart to sustain life.
(1) Cardiopulmonary resuscitation indications
Cardiopulmonary resuscitation is suitable for patients with cardiac and respiratory arrest caused by various reasons. Such as acute myocardial infarction, severe trauma, electric shock injury, crush injury, trampling injury, drowning, poisoning, etc.
(2) Cardiopulmonary resuscitation procedures
1. Judgment of awareness
Gently tap the patient’s shoulder and shout loudly; “Hey, what’s wrong with you?” !?, babies can tap the soles of their feet, etc.
2. Call for help
? Someone, come quickly! Come and help! I am an ambulance, please dial the emergency number ?120?. The content of the call for help is:
(1) Name and phone number of the reporter;
(2) Detailed address of the injured or injured person;
(3) The number of injured and injured and their main injuries;
(4) Hang up the phone after getting a reply from the emergency center;
(5) Wait and lead the way on the 120 route. .
3. Place the patient in an appropriate position
Quickly place the injured person on the ground or floor in a supine position. The ground requirements are: flat, hard, insulated, and ventilated.
4. Clear the respiratory airway
Check the airway, including the mouth. If there are loose teeth, food or vomit, you can use your fingers to dig them out.
To open the airway: You can use the head-up and chin-lift method, head-up-neck support method, and jaw support method.
The degree of head tilt when opening the airway (even if the angle between the patient's mandibular angle and the earlobe is as perpendicular to the ground as possible): 90 degrees for adults, 60 degrees for children, and 30 degrees for infants.
5. Judgment of breathing and heartbeat
(1) Judgment of breathing: Use the methods of first sight, second listening and third feeling. That is, look to see if the patient's chest and upper abdomen are breathing up and down; listen to see if the patient is breathing out; feel if the rescuer's cheek is close to the patient's mouth and nose to feel if there is any air blowing.
(2) Judgment of heartbeat: Adults and children can touch the carotid artery to see whether there is a pulsation when judging the heartbeat; babies can feel whether the brachial artery is pulsating when judging the heartbeat.
6. Percussion on the chest area
Percussion on the chest area is a method used by rescuers to detect ventricular fibrillation at the scene without an automatic external defibrillator (AED). Implement defibrillation rescue measures for the injured.
Positioning: Same as the external chest heart compression site (i.e., the middle and lower 1/2 of the sternum)
Method: Hold a hollow fist with one hand, and place the other hand on the percussion site, the distance between the hollow fist and the hand 25-30 cm from the back of the other hand, tap twice with medium force.
7. Artificial respiration
When the injured person has respiratory arrest, mouth-to-mouth artificial respiration can be used for adults or children, and mouth-to-mouth artificial respiration can be used for infants.
Method: The rescuer will pinch the patient's nose with the thumb and index finger of the hand placed on the forehead of the injured person, take a deep breath, wrap the lips of the injured person with his lips, and slowly Blow in the gas slowly (the blowing time is 1 second), and the blowing volume is 500-800 ml. It is appropriate to raise the chest; the blowing frequency is 10-12 times/minute. Then release, exhale, and then blow again according to the above method, that is, blow twice each time.
8. External chest heart compression
(1) Location: middle and lower 1/2 of the sternum.
(2) Method: The rescuer overlaps the roots of his hands and presses against the pressing area, interlocks the fingers, lifts the palms, leans the upper body forward, straightens the arms, and presses vertically downwards firmly and rhythmically for 30 seconds. times, the compression and relaxation time are equal (i.e. 1:1); compression depth: 4-5 cm for adults, 2-3 cm for children, 1-2 cm for infants; compression frequency 100 times/minute.
The ratio of chest compressions to artificial respiration is 30:2 (one cycle).
Five cycles constitute one cycle, and each cycle determines one breath and heartbeat.
9. Observation effect
(1) Effective indicators of cardiopulmonary resuscitation:
① Pupils: from large to small;
② Complexion (Lip): From pale and blue to rosy;
③ Carotid artery pulsation: The carotid artery resumes pulsation;
④ Consciousness: The patient's eyeballs can move and the light reflex has recovered. Twitching of hands and feet, moaning;
⑤ Spontaneous breathing: Appears.
(2) Criteria for termination of cardiopulmonary resuscitation:
① The patient breathes spontaneously and the pulse recovers;
② After cardiopulmonary resuscitation is performed for half an hour, the patient breathes spontaneously and the pulse has not recovered;
③Others or professional first aid personnel arrived at the scene to take over;
④A doctor arrived at the scene and confirmed that the injured person was dead.
Medical first aid knowledge 4. Trauma on-site first aid technology
Trauma refers to the damage and dysfunction of human tissue caused by various injury factors. Due to the many factors that cause injuries, the types of injuries are diverse and the degree of injury varies. In mild cases, it causes surface damage, pain or bleeding, and in severe cases, it causes functional impairment, disability, and even death. Trauma care includes four techniques: hemostasis, bandaging, fixation, and transportation.
(1) Hemostasis
After the human body is injured, bleeding often occurs first. It is usually calculated based on the total blood volume of an adult accounting for 8% of the body weight. For example, a person weighing 50 kg has a total blood volume of approximately 4000 ml. When the blood loss reaches more than 20% of the total blood volume, symptoms such as dizziness, rapid pulse, decreased blood pressure, cold sweats, pale skin, and decreased urine output will occur. When the blood loss exceeds 40% of the total blood volume, life will be in danger. Implementing rapid, accurate and effective hemostasis is of great significance to saving the lives of the injured.
1. Types and judgment of bleeding
(1) Arterial bleeding: Bright red blood pulsates out from the wound in a jet-like shape.
(2) Venous bleeding: Dark red blood continues to overflow from the wound.
(3) Capillary bleeding: bright red blood oozes from the wound.
2. Hemostasis methods
Hemostasis methods include: finger pressure to stop bleeding, tightening to stop bleeding, flexion and padding, tourniquet to stop bleeding, etc.
(1) Acupressure hemostasis method
It is suitable for bleeding in certain parts of the head and limbs. It is a temporary hemostasis method. Mainly use your fingers to compress the upper (proximal) artery of the blood vessel bleeding from the wound, pressing the artery toward the deep bone to block blood flow.
①Hemostasis method of finger pressure on the arteries of the head and face:
A. finger pressure on the superficial temporal artery: suitable for large traumatic bleeding on one side of the head, forehead, and temporal region. In front of the injured ear, align the thumb of one hand with the mandibular joint to compress the superficial temporal artery, and fix the head with the other hand.
B. Acupressure on the facial artery: suitable for severe bleeding due to facial trauma. Use the thumb and index finger or thumb and middle finger of one hand to press the depression about 1 cm in front of the bilateral mandibular angles to block the facial artery blood flow. Because the facial artery has many branches that anastomose with each other on the face, both sides must be compressed.
②Acupressure on the arteries of the limbs to stop bleeding:
Acupressure on the arteries of the fingers (toes): suitable for heavy bleeding in the fingers (toes). Use your thumb and index finger to compress the digital arteries on both sides of the base of your fingers (toes) to block blood flow.
(2) Tightening to stop bleeding
Suitable for stopping bleeding in limbs.
The method is to fold the triangle scarf into a belt shape, wrap it around the bleeding limb wound, pull the two ends forward tightly, tie a slip knot, insert the twisting stick into the outer ring of the belt, lift the twisting stick and twist it tightly, and tighten the twisting stick. One end of the tight rod is inserted into the small loop of the slipknot and fixed.
(2) Bandaging
When the human body is affected by external forces and causes wounds, such as cuts, stab wounds, contusions, gunshot wounds and other wounds, it can be bandaged by using triangle towels, towels, toilet bags, etc. Equipment, etc. to bandage the wound.
1. Purpose and requirements
Purpose: to protect the wound, reduce infection, compress and stop bleeding, fix dressing, etc., which is conducive to early wound healing.
Requirements: achieve the "Four Essentials", that is, the bandaging must be fast, accurate, light, and firm.
The four don’ts are not to apply medicine to the wound, not to touch the wound, not to remove foreign objects from the wound, and not to return the internal organs that have prolapsed from the body cavity.
2. Bandaging method
Use triangle towel or towel bandaging method according to the bandaging equipment.
(1) Triangle bandaging method
① Mandibular bandaging:
Suitable for wounds in the mandible. Fold the triangle scarf into a three-finger wide band, leaving the top corner and frenulum, one end wraps the lower jaw from the back of the neck, cross and fold the other end on the cheek side, turn under the jaw, wrap it behind the ears and put the string on the top of the head Secure with a knot.
②Single chest bandaging method:
Suitable for trauma to one side of the chest. Place the top corner of the triangle scarf on the shoulder of the injured side so that the bottom edge of the triangle scarf is centered under the injured area. Wrap the two ends of the bottom edge around the chest and tie a knot behind the back. Then pass the top corner of the triangle scarf through the bottom edge of the triangle. Instead of fixing the knot.
③Single shoulder bandaging method:
Suitable for shoulder injuries. Place one bottom corner under the armpit of the healthy side, fix the top corner around the upper 1/3 of the arm, fold the other bottom corner, and tie it with the other corner under the armpit of the healthy side of the back. Key points: Press the back piece against the front piece and cross over the shoulder.
④Abdominal bandaging method:
Suitable for abdominal trauma. Hold the two bottom corners of the triangle scarf with both hands, straighten the bottom edge of the triangle scarf and place it at the junction of the chest and abdomen, place the top corner on the perineum, then wrap the two bottom corners around the waist of the injured person and tie a knot, and finally tie the top corner frenulum through the perineum and the bottom edge Knot fixed.
⑤Single hip bandaging method:
Suitable for injuries to one hip. Place one bottom corner on the healthy side of the waist, the top corner covers the buttocks, wrap the lace around the root of the thigh, fold the other bottom corner upwards, and tie a knot at the two bottom corners of the waist. Key points: Press the back piece against the front piece and cross it at the trousers seam.
⑥ Knee and elbow joint bandaging method:
Suitable for trauma to the knee and elbow joints. Fold the triangle scarf into four finger widths, cover the knee joint, cross it at the knee (elbow) socket, and wrap the two ends around the knee (elbow) joint to tie it in place.
⑦Hand and foot bandaging method:
Triangular bandage hand bandaging: Place the middle section of the band-shaped triangle bandage close to the palm of the hand, cross the band-shaped bandana on the back of the hand, and wrap both ends to the wrist Cross it, and finally tie it with a knot around the wrist.
Triangular bandage foot bandaging: The method is similar to that of the hands.
(2) Towel bandaging method
Notes on towel bandaging: the corners should be pulled tightly; the bandage should be tight; the knot should be tied firmly.
①Head cap-style bandaging method:
Place the towel horizontally in the middle of the head, align the upper edge with the eyebrows, pull the upper two corners to the back of the pillow and tie them, and pull the lower two corners Tie under the jaw.
② Single eye bandaging method:
Fold the towel into a "gun" style to cover the injured eye, tie the two corners of the towel around the forehead and tie it under the pillow, and use a rope to fasten one corner of the towel. Tie the towel under the jaw and on the healthy side of the face.
③How to bandage the eyes:
Fold the towel into a heart shape, with the waist edge consistent with the forehead of the injured person, cover the eyes, tie the two corners of the towel under the pillow, and leave Secure the two corners of the towel behind the pillow.
Tip: Fold the towel into a heart corner, place it on the wounds of both eyes, tie the two ends around the headrest, leaving the two corners knotted next to the ears.
(3) Fracture fixation
Fracture refers to the complete or incomplete breakage of a bone after being struck by an external force. Closed fractures and open fractures are caused by direct violence, indirect violence, muscle traction, bone disease and other reasons.
1. Judgment of fracture
If the injured person appears after a fracture: pain and tenderness, swelling, deformity, dysfunction and other symptoms, it can be judged as a fracture.
2. Purpose of immobilization
① Brake and relieve pain
② Prevent injury from worsening
③ Protect the wound
④Easy to carry.
3. Fixation method:
Temporarily fix the injured person by using standard fracture fixation equipment and toilet equipment.
(1) Fixation method using fixation equipment
①Humeral fracture fixation:
Use two triangle towels and a splint to first fix the injured limb, and then use a dovetail Hang the forearm in the middle of the triangular scarf, wrap the two bottom corners around the neck and tie a knot. Finally, use a belt-shaped triangle scarf to tie the knot under the armpit of the healthy side through the chest and back.
② Fixation of radius and ulna fractures:
Place a suitable splint under the injured limb, use two strip-shaped triangle towels or bandages to fix the injured limb and the splint, and then use a A swallowtail-shaped triangle scarf is used to suspend the injured limb, and finally the two bottom edges of a belt-shaped triangle scarf are wrapped around the chest and back and knotted under the armpit of the healthy side to fix it.
(2) Fixation method of healthy limb
If there is no standard or toilet equipment, a triangle towel or bandage can be used to fix the injured limb to the trunk or the injured limb to the healthy limb. fixed.
① Forearm fracture fixation method
After bandaging the injured area, first use a large triangle sling to hang the injured arm in front of the chest, and then use a triangle towel to fix the injured arm to the chest.
②Clavicle fracture fixation method
Fold two triangle towels into strips five fingers wide, pad the armpits with cotton pads, and then use two triangle towel strips to surround the shoulders and armpits respectively. Make a circle around the waist, tie a knot behind the armpits, and then use another triangle scarf to tighten the two triangle scarves behind the back and tie them, so that the shoulder joints are stretched backwards and the clavicle is fixed. Cross the two forearms in front of the chest and use the triangle scarf to hold them in place.
③ Method of fixing the healthy limb of calf fracture
After bandaging the injured part, fix the injured limb against the healthy limb, add padding between the knee and ankle joints, and then use 5 Fold a triangular scarf into strips to fix the two ends of the fracture, knee joint, ankle joint, thigh, etc. respectively.
(4) Transportation
Transportation is an important part of trauma rescue. It is the process in which rescuers use bare hands or instruments to transfer the injured from the scene of the accident to a transport vehicle or medical institution.
1. Barehand handling method
It can be divided into single-person, double-person, and multiple-person unarmed handling methods. It is suitable for rescue at the scene of the accident and transporting the injured over short distances.
(1) Single-person bare-hand carrying method is completed by the rescuer alone, usually using: supporting method, holding method, carrying method, dragging method, crawling method, etc.
(2) The two-person bare-hand carrying method is completed by two rescuers working together. Usually: four-hand seat lifting method, three-hand seat lifting method, second-hand seat lifting method, front and rear support method, etc. People with spinal injuries should not use this method to carry.
(3) Multi-person bare-hand carrying method: It is completed by the cooperation of 3-4 rescuers. Usually: three-person carrying method or four-person carrying method is suitable for those with serious injuries or those with spinal problems. The injured.
2. Instrument transportation method
The instrument transportation method is to use a standard stretcher or simple homemade equipment to transport the injured. It is suitable for injured people with serious injuries who are not suitable for carrying with bare hands. It is divided into two-person stretcher transportation method and four-person stretcher transportation method.