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Monday, 27 December, 1999, 13:34 GMT
Minutes matter
Basic resuscitation techniques are vital
The blur of activity around a stricken patient is a familiar scene from hospital dramas - but what are they actually doing?

Accident and Emergency
Both at the scene of an horrific accident, and in the resuscitation area of an accident and emergency department, every second can count when it comes to saving life.

It's no use having a nice neat drip inserted into a corpse's arm

Dr Peter Holden, BASICS
Doing the right things in the right order can make all the difference.

Just like schoolchildren, emergency doctors and paramedics have their ABC - except, in their case, the letters stand for Airway, Breathing and Circulation.

If the human brain is starved of oxygen because something is filling the mouth and blocking the throat of the casualty, fatal brain damage can occur within four minutes.

That is why checking and clearing the airway comes first when medical help reaches a seriously injured person.

Dr Peter Holden, a GP member of the British Association for Immediate Care (BASICS), explains the principle.

"Essentially, we deal with things in the order in which they will kill people.

"It's no use having a nice neat drip inserted into a corpse's arm. If the airway is blocked, then the patient will die - no argument.

"Very often someone who is in a car that has crashed into a ditch will have a mouthful of leaves and debris.

"In other cases, they may well have inhaled vomit which is blocking their throat."

Breath of life

The next step is breathing - the airway might be clear, but can the patient breathe unassisted?

Speed is the key to saving lives
If not, vital tissues will still be starved of oxygen, and death will be the result.

There are a variety of reasons why someone might not be breathing, ranging from spinal damage, to being trapped underneath something heavy which is stopping the chest rising.

They may even have received a severe facial injury or taken a drugs overdose.

In many cases, the first aider can use mouth to mouth resuscitation techniques to keep the air passing in and out of the lungs.

Later, the a tube can be passed down the throat or nasal passages so that air can be mechanically forced in by a bag or a ventilator.

If necessary, they can be given extra oxygen. through the tube or via a mask.

However, even if the oxygen is reaching the right spot, if the heart is not working, it cannot circulate around the body.

If the heart cannot be re-started with electric shocks, then resuscitation techniques - pushing on the chest - are used to simulate the action of the heart and push the blood around the body.

Once the ABC has been safeguarded, the priority now is to get the patient to hospital as quickly as possible.

If there is any hint that the patient may have a spinal injury, it is vital that the neck cannot move around and possibly cause further permanent, or even fatal damage.

The higher the spinal damage, the more potentially serious the consequences.

Even low fractures could mean life in a wheelchair if the spinal cord is damaged.

So the patient's back and neck are immobilised by strapping them to a specially-designed board.

Although the term "golden hour" is not strictly accurate, in general terms, the speed at which treatments and surgery can be received play a big part in determining outcome.

Looking at the figures

Once hospital is reached, the A&E doctor has a battery of monitoring instruments which can give clues as to the extent of injuries.

As well as the heart rate monitor, the amount of oxygen in the blood can be measured - dropping oxygen saturations could mean that the patient is not getting enough air.

Falling blood pressure might be a sign of serious internal bleeding.

The job of the casualty doctor is a continual balancing act - treating one symptom might mean neglecting another, more important problem.

Virtually every action they take could produce problems elsewhere in a failing body, be it worsening a brain injury or reducing blood pressure.

Any fan of "Casualty" or "ER" knows how skilful these doctors are - but their expertise has only recently been fully recognised in the pecking order of the medical profession itself.

See also:

14 Sep 99 | Health
First aid for schools
08 Jul 99 | Health
Major onslaught on accidents
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