First aid refresher for the practice team: CPR and AED, infant CPR, choking, adrenaline devices, asthma, bandaging and bites

Instructor

Unnamed first aid instructor (name not given in the transcript). He mentioned a background in rescue work and scuba diving, and that he supplies compression bandages.

Participants

Unnamed practice GPs and staff. GPs added comments on asthma inhalers and adrenaline devices; these are labelled as practice comments below.

Session context

Otter title First Aid Training Workshop · id StSxj0JLF1RMXO_thfaC8O36NLQ · 1 h 57 min. Otter split the audio across about 30 speaker labels. Small talk, the instructor's family stories, a reception phone call and lunch plans have been left out.

At a glance

Calling for help and finding your location

The instructor said location is "the most annoying thing" when you call: on a street, beach or in a restaurant you may not know the address. His tips:

• Ask a bystander for the address, use landmarks, or open a maps app.
• Emergency+ app (free; orange icon with a cross). It shows your address, latitude and longitude, and a what3words code that pins a 3 m by 3 m square. He said emergency services still use it.
• On most phones, repeatedly pressing the power button starts an emergency call without unlocking the phone. Useful if your own phone is broken and you grab someone else's. Cancel it if triggered by mistake.
• Fill in your phone's medical ID and emergency contacts. Rescuers can see these from the emergency call screen without unlocking.
• Newer iPhones can detect a car crash, call 000 and text your emergency contacts with your location. He also warned that a smartwatch may call 000 during vigorous CPR practice.

Airway and breathing checks

• Check A and B only when it is not obvious. If someone is clearly talking or moving, you do not need to open their mouth.
• Open and look: control the jaw (a "pistol grip"), other hand on the forehead, open the mouth and look without leaning too close.
• If something is in the mouth, roll the person onto their side, away from you, and "scoop the goop". His order of preference: use the casualty's own hand, then a bystander's, then your own. Gloves are often not on yet at this stage.
• Then head tilt: full tilt in adults, half tilt in children, neutral (flat) in infants. Tilting lifts the jaw and tongue off the airway.
• Breathing check: cheek close to the mouth and nose, watch the chest, for 5 to 10 seconds. People breathe on average every 4 seconds, so this gives at least one or two chances to see a breath.
• If breathing: recovery position, which he taught as the left side, mainly to protect the airway from vomit, blood, teeth, dentures or food.
• No pulse check. Cardiac arrest for first aid purposes is "unresponsive, not moving and not breathing effectively". Most people are poor at finding a pulse.

Adult CPR

• Where: centre of the chest on the sternum. Draw a line in from the armpit, or find the bottom of the sternum and go two fingers above it. Avoid the xiphoid.
• How: heel of one hand in the groove, the other hand on top, arms straight, lean over and use your body weight.
• Full recoil. After 5 to 10 minutes it is easy to stay low because you are tired. Come all the way back up.
• Depth and rate: one third of that person's chest depth; 100 to 120 per minute. A song with a strong beat helps keep pace.
• 30 compressions, 2 breaths. Head tilt, seal, give a breath and watch the chest rise. Mouth to mouth, mouth to nose, mouth to stoma, and mouth to mouth and nose for babies are all options. He recommends a mask with a one-way valve.
• Breaths are a choice. If you choose not to give breaths, do continuous compressions.
• When to stop: the ambulance or another rescuer takes over, the person recovers, the scene becomes dangerous, or you are physically unable to continue.

Using an AED

1. Keep CPR going while someone else prepares the chest. Work around the person doing compressions.
2. Prepare the skin using the AED kit: cut the shirt from the side (not down the middle where the hands are), shave where the pads go, and dry off water, blood or oil.
3. Jewellery: remove loose items, but leave piercings in.
4. Pacemaker or other implanted device? Still use the AED. If the person is in cardiac arrest, the pacemaker is not doing the job.
5. Pads as pictured: one below the right collarbone, one on the lower left side of the chest.
6. "Stand clear" when it analyses and shocks. The person in charge says "clear" and checks no one is touching. Some units are fully automatic and shock without a button, so step back when told.
7. After a shock, restart CPR straight away and follow the AED's metronome beat. It re-analyses every 2 minutes.
8. If the person starts breathing: recovery position, leave the pads on and the AED switched on.

He explained why an AED may say "no shock": it only shocks ventricular fibrillation or ventricular tachycardia, not a normal rhythm and not asystole. A rhythm may become shockable later, so do not give up after a "no shock" message.

Infant CPR

• Danger includes the parent, who may be distressed. Ask the parent what happened, whether it has happened before, medicines, choking.
• Response: talk, see if the eyes open and track, put a finger in the palm to see if they grip, tickle the soles, and if needed a small pinch of skin.
• Airway: no head tilt; keep the head neutral. Open the mouth with your thumb. To clear it, hold the jaw with one hand, run your other arm along the body to grasp the near leg, and roll the baby smoothly to drain and scoop.
• Breathing: cheek close, and a hand on the chest and abdomen to feel small movements.
• Compressions: same spot, one third depth, around 120 per minute (two per second), 30:2. Use two fingers, or two thumbs; thumbs are stronger and tire less over a long wait for the ambulance, but do not over-squeeze.
• Breaths: mouth over the baby's mouth and nose, and give two small puffs, which he called "fogs", like fogging up glasses to clean them. Blowing hard can over-stretch and damage the lungs.
• He noted infant and child arrests are usually respiratory, not cardiac, so good breaths and continuous CPR matter.

Choking

• Partial blockage (coughing, wheezy): encourage them to keep coughing, stay calm and stay with them.
• Complete blockage: no sound, mouth open, eyes bulging and watering, face going red, then purple, then blue, hands to the throat.
• Back blows between the shoulder blades with an upward motion, leaning the person forward. These are firm hits, not pats. A small child can go face down over your thigh, head lower, so gravity helps.
• Infants: hold as for the airway check, head down but neutral (a flexed infant neck kinks the trachea), and give back blows; chest thrusts on the back are another option.
• If they collapse, make sure someone is already calling for help. Look in the mouth, scoop out anything visible, then head tilt and check breathing; start CPR if not breathing.
• During CPR, compressions can push the object up. After each 30, look in the mouth before the head tilt; if you can see it, roll and scoop. If it is too far back, do not dig; continue compressions.

He also mentioned suction-style anti-choking devices as a backup once standard steps have failed.

Anaphylaxis and the adrenaline devices

Signs mentioned: swelling of the throat, lips and tongue; flushing; hives or a red rash spreading quickly; vomiting; breathing difficulty. Lay the person down and keep them still, give adrenaline, call 000, stay and reassure. Adrenaline does not always work, so the call to 000 is not optional.

Practice comments: staff noted neffy is easier to carry (cases hold two with car keys), avoids needle phobia, and has a longer shelf life. Editor note: Allergy and Anaphylaxis Australia lists neffy 2 mg as expiring 30 months and neffy 1 mg 24 months after manufacture. Trainer devices can be reset for practice; real devices cannot.

Asthma first aid

• Signs: wheeze, cough, lips turning blue. Seated for asthma (lying down is for anaphylaxis).
• Use a spacer: spraying straight into the mouth wastes more than half the dose.
• You cannot meaningfully overdose a reliever in this setting; shakes and a fast heart rate are expected.
• Follow 000's directions, which may increase the dose.
• No puffer? Call 000, keep them calm, breathe with them, and remove the trigger if you can: out of the air-conditioning, or inside away from bushfire smoke. If anxiety is part of it, distract with random conversation.

Bleeding and bandage tension

• Clean: outside the clinic, flush with water or saline only, because you do not know the person's allergies. In the clinic, antiseptics are fine.
• Slow bleeding with direct pressure, then bandage over it.
• Tension check: you should be able to slide one finger under. Two fingers means too loose; none means too tight.
• Too tight signs: veins standing out, swelling, colour change, and the person saying it is sore, cold, numb, tingly or "feels weird". Check capillary refill; colour should return within a second or two. Ask whether they always have cold hands, so you know their baseline.

Snake bite, pressure bandages and marine stings

• Move away from the snake, then sit or lie the person down and keep them calm. Treat every snake bite as venomous: you cannot identify snakes reliably by colour.
• Do not suck, wash or cut the wound. Venom left on the skin can be tested at hospital to guide antivenom.
• Bandage over the bite, then from the end of the limb upwards, overlapping by about a third and keeping the printed rectangles stretched to squares. Go over clothing; cut away very baggy clothes if you have scissors. Include the thumb when doing a hand. Use a second bandage if you run out.
• The goal is to slow lymphatic spread of venom, so keep the limb still, firm but without cutting off circulation.
• Marine stings, as taught: bluebottle: remove stinging cells and use hot water; stonefish: hot water, but much more serious and may need hospital; box jellyfish and Irukandji (tropical): vinegar (or seawater if no vinegar), then hospital. Do not urinate on stings.

The instructor also said there has not been a recorded redback death in Australia in a long time, but bites are very unpleasant. We have not checked this claim.

Practice takeaways

Transcript caveats

allcpd.drkotha.com · directory