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Practical Manual Notes
Life Support
Introduction
Objective of Life Support course:
➔ To provide basic training in acute medicine, with the emphasis on …
1. Fast and correct identification of (life threatening) problems and situations
2. Correct and adequate action
3. Clear communication
➔ To distinguish between help in and outside of the hospital, and between (amateur) First
Aid and professional medical care
Victim → someone with an acute, (non-)life threatening disorder in his physical or mental
health, judged by himself or those around him
ABCDE Approach
• This protocol is used internationally for the structured assessment and care of an acutely
ill or injured patient
• Useful in acute, (non-)life threatening situations which allow for little time to think, few
possibilities to carry out extensive examinations, and opportunity to ask for advice
Three pillars of this course:
1. Anatomy
2. (Patho)physiology
3. Clinical knowledge/skills
Importance of First Aid
• Article 450 of the Criminal Law Code → every Dutch citizen is legally obligated to help,
as far as possible, a fellow human being in need
o Medical students and doctors are expected to perform First Aid in medical
emergencies
Two Basic Principles of First Aid
➔ The ABCDE and SAFE approaches are based on the following principles:
1. Treat first what kills first
2. Do no further harm
o Stressful situations and lack of experience can cause wrong priorities to be set
when treating a victim
o Example → a care responder treats a large, ugly wound on a patient’s leg, while
not noticing that her breathing is increasingly slow and eventually stops
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Why are structured approaches effective?
• Treatment in First Aid is based on principles, not on the individual preferences of the
caregiver
• Stress and inexperience can lead a doctor/care respondent to make incorrect judgements
and choices
• Working with a standard approach (e.g. ABCDE approach) greatly reduces the risk of
this
Learning Objectives
1. Assess the vital functions according to the ABCDE protocol and provide adequate
treatment to disorders of the vital functions
2. Carry out adequate resuscitation according to the Dutch Resuscitation Council
(Nederlandse Reanimatie Raad) guidelines when faced with circulatory arrest
3. Provide adequate First Aid to accident victims (e.g. treatment of wounds and bites,
bandaging, removing splinters)
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Chapter 1: ABCDE
ABCDE Protocol
• The aim of ABCDE protocol is to have systematic care for acute critically ill patients
• It serves as the primary survey or the first care for a patient
• Problems which are most life-threatening are treated first, following the principle “treat
first what kills first”
A Airway (and cervical spine)
B Breathing
C Circulation
D Disabilities
E Exposure / Environment
Who is the protocol for?
The ABCDE protocol needs to be applied on all patients of all ages with suspected
disturbed or threatened vital functions
Primary Survey
• Objective: systematic identification and treatment of direct life-threatening conditions
Assessment of Vital Functions
There is a systematic assessment taking place for each letter
(ABCDE):
1. Look
2. Listen
3. Feel
Going to the next letter is only possible when all necessary
lifesaving procedures are done and the ‘letter’ (e.g. ‘A’ for
airway) is secured
1: Airway and Cervical Spine Injury (CSI)
• Assessing ‘A’ refers to whether the airway is free and if air can pass to and from the
lungs
Assessment
The quickest way to assess the airway is for the victim to talk
1) Look
o Is there a suspected cervical spine injury?
o Is the victim alert and oriented?
o Injury, obstruction, or swelling in the face? → face injury /mouth inspection
o Chest excursions
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2) Listen
o Normal/abnormal breathing sounds:
▪ None → is breathing present?
▪ Snoring → obstruction of the airway by tongue
▪ Gurgling → obstruction of the airway by fluids (blood or vomit)
▪ Squeaking (stridor) → obstruction by an object or by swelling of upper
airways
3) Feel
o Exhaled air
The tongue is a large muscle!
Cervical Spine
• The cervical spine should always be taken into account
during assessment of the ‘A’
• If there is a suspicion of possible cervical injury,
procedures need to be adjusted to this
• In the case of CSI, movement of the neck can be
dangerous and can injure important structures in this
area
Possibilities of Cervical Injury when:
➔ High energy injury (e.g. biker crashing into a car)
➔ Fall from height (1.5 – 2 times patient’s body length)
➔ Injury to the clavicle or above this region is observed
➔ Hyperextension or hyperflexion injury of neck (e.g. car
collision)
➔ Situational awareness
C3, 4, 5 keep the diaphragm alive (phrenic nerve roots are located there)
Interventions
• If there is an abnormal finding after the assessment, it must be
directly treated
• In each unconscious victim, the airway is threatened, because the
tongue will sink into the pharynx → the patient’s airway must be
made and kept free
• It is necessary to check after every procedure if it has the
suspected/desired effect
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Procedures
In case of a threatened airway, always open and maintain an airway by:
Name Purpose
Head-tilt chin-lift Opens the airway from the tongue
Only used when there is no suspected CSI
Jaw thrust Opens the airway from the tongue
Neck is not moved → safe procedure for suspected CSI
Recovery position Opens the airway from the tongue and liquids (= blood and vomit can drain when lying
on one side)
So after checking the airway with a HTCL or jaw thrust, you still have to open the airway!
2: Breathing
• ‘B’ is the second step in the protocol after ‘A’ has been secured
• ‘B’ refers to the quality of breathing, which is determined by the
ability of the lungs to oxygenate and to ventilate (meaning to
blow off carbon dioxide)
Breathing Requirements
• Intact respiratory center → the brain
• Adequate lung function
• Intact and coordinated movement of the diaphragm and thorax
wall
Assessment
1) Look
• Level of consciousness
• Color of the skin: does it look blue (cyanotic)?
o Tongue → central cyanosis
• Does the victim use respiratory aid muscles? Is the victim
short of breath?
o Respiratory labor/distress
• Are there external injuries to the thorax?
• Breathing frequency
• Symmetry of rising thorax (is one side expanding less than the other?)
• Depth of respiration: shallow or deep breathing?
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2) Listen
• Not possible on the street
• Possible elongated exhalation or wheezing (expiratory): obstruction of the lower
airways
3) Feel
• Breathing frequency
• Depth of respiration
• Symmetry of rising thorax
Assess the ‘B’ from top to bottom
1. Cyanosis
2. Use of respiratory aid muscles
3. External injuries to thorax
4. Depth, frequency, and symmetry of the rising thorax by looking and feeling at the same
time, and listening to the presence of wheezing
Mnemonic: C, R, E, DFSW
Interventions
If the victim does not breathe anymore:
o Resuscitation needs to be started
o Professional emergency services need to be contacted
If the victim is breathing, but there are other abnormalities in the ‘B’:
o Needs to be reported to the emergency services
o Abnormalities need to be reassessed constantly
The best thing to do outside the hospital is to provide reassurance to the patient → a
quiet patient can control his/her breath better
If a victim is short of breath:
o Let them sit upright (unless there is a suspected CSI)
o Assess the ABCDE while the patient is in a sitting position
When the victim wants to sit or lie down, do not struggle against the patient’s
preference
o The comfort of the patient is more important than the ease/preference of the first
aid provider!
