MASURI DE PRIM AJUTOR

2011

PLAN Definitie, Obiective, Principii EVIDENCE BASED MEDICINE-medicina

bazata pe dovezi Aspecte etico-medico-legale si

epidemiologice ale CPR si primului ajutor Notiuni elementare de anatomie si

fiziologie CPR: definitie Lantul supravietuirii BLS la adult

INTRODUCERE Proceduri de ingrijire medicala simple, de

urgenta aplicabile de catre neprofesionisti pana la sosirea personalului medical de specialitate.

Se face referinta atat la “laici”, cat si la personalul de pe ambulante sau alti “first responders”.

NU INLOCUIESTE UN TRATAMENT MEDICAL COMPETENT

PRIM AJUTOR Masuri de ingrijire si tratament de urgenta

aplicate unui bolnav sau unei persoane traumatizate INAINTEA sosirii/defeririii catre servicii medicale.

MASURILE DE PRIM AJUTOR NU SUNT APLICATE CU SCOPUL DE A INLOCUI DIAGNOSTICAREA SI TERAPIA CORECTA MEDICALA

ofera asistenta temporara pana la sosirea personalului medical calificat

PRIM AJUTORScop: Salvarea vietii Prevenirea producerii in continuare a leziunilor Reducerea la minimum/prevenirea infectiilor Cei trei “P” P - Preserve Life.

P - Prevent the condition worsening.

P - Promote RecoveryFace diferenta dintre: Leziune temporara/permanenta Vindecare rapida/ infirmitate permanenta Viata/moarte

Medicina bazata pe dovezi (EBM) EBM are ca scop utilizarea celor mai bune dovezi

disponibile provenite din metode stiintifice pentru a conduce la decizii medicale

urmareste sa stabileasca calitatea dovezilor ce stabilesc riscurile si beneficiile tratamentelor (inclusiv absenta acestora).

EBM recunoaste ca multe aspecte ale medicinii depind de factori individuali cum ar fi calitatea si “rationament al valorii vietii” ce sunt doar partial supuse cercetarilor stiintifice.

sa aplice aceste metode in practica medicala cu scopul de a asigura cea mai buna predictie asupra prognosticului ad vitam, chiar daca persista inca controversele legate de tipul prognosticului de urmarit.

Masuratori statistice “Evidence-based medicine” incearca sa

exprime beneficiile clinice ale testelor si tratamentelor utilizand metode statistice

EBM- stadializarea nivelurilor de evidenta Evidence-based medicine categorizes different

types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research.

The strongest evidence for therapeutic interventions is provided by systematic review of randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition.

Little value as proof: patient testimonials, case reports, and even expert opinion – the placebo effect, the biases inherent in observation and reporting of

cases, difficulties in ascertaining who is an expert, etc.

Nivel de evidentaSystems to stratify evidence by quality have been developed,

such as this one by the U.S. Preventive Services Task Force for ranking evidence about the effectiveness of treatments or screening:

Level I: Evidence obtained from at least one properly designed randomized controlled trial.

Level II-1: Evidence obtained from well-designed controlled trials without randomization.

Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

Categorii de recomandariIn guidelines and other publications, recommendation for a clinical service is

classified by the balance of risk versus benefit of the service and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses:

Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweighs the potential risks. Clinicians should discuss the service with eligible patients.

Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients.

Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations.

Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients.

Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.

Ghiduri Un ghid medical (denumit si ghid clinic,

protocol clinic, ghid de practica medicala) este un document destinat orientarii deciziilor si criteriilor de:

diagnostic conduita tratament intr-un domeniu specific

medical

De ce ghiduri?

PRIM AJUTOR- Obiective

A. – Airway: Mentinerea permeabilitatii cailor aeriene

B. – Breathing: Mentinerea respiratiilor C. – Circulation: Mentinerea circulatiei

+ Oprirea hemoragiilor Prevenirea/ reducerea socului

PRIM AJUTOREvaluare initiala Inspectia rapida a zonei

Pericole (curent electric, foc, apa, “haz mats”, obiecte instabile, ascutite, animale)

Trafic Violenta Conditii de relief si clima Situatii speciale

Preluarea controlului calm, rapid si eficient

PRIM AJUTORSe vor evalua:1. SIGURANTA proprie si a pacientului2. MECANISMUL DE PRODUCERE A LEZIUNII Constient Inconstient3. INFORMATII TRANSMISE PE CAI SPECIALE- Medalion, bratara cu simboluri - card cu informatii

PRIM AJUTOR4. NUMARUL VICTIMELOR Cand sunt mai multe- evaluarea

A,B,sangerare si C5. MARTORI Pot furniza informatii, ajutor chiar daca

sunt nepregatiti prin: apel de urgenta, suport moral victimei, impiedicarea imixtiunii altor persoane

6. PREZENTATI-VA ca persoane calificate in prim ajutor; consimtamant cerut celor constienti, prezumat pentru cei inconstienti

Aspecte etico-legale Datoria de a interveni(desemnata, serviciu sau

responsabilitate preexistaenta fata de victima) Standard: cat si pentru ce aveti calificare Consimtamant= acord, permisiune

Pacient constient/inconstient Minor/major Bolnavi cu afectiuni psihiatrice Exprimat/prezumat

Confidentialitatea Legea Bunului Samaritean (urgenta, cu bune intentii, fara

compensatii, fara a produce daune/leziuni) Abandon Neglijenta (datorie, nerespectarea datoriei sau

substandard, producere de leziun/daune, nerespectarea limitelor)

Aspecte etico-legaleSecventa”logica”: Obtineti consimtamantul victimei INAINTE de A O

ATINGE Urmati ghidurile si protocoalele pentru care ati

fost instruiti, fara a va depasi nivelul de competenta

Explicati victimei fiecare lucru pe care urmeaza sa-l faceti

Odata ce ati demarat asistarea victimei, nu o parasiti pana nu o deferiti unei persoane cel putin la fel de calificata ca dumneavoastra!

Aspecte etice OUT OF HOSPITAL SETTINGS

To initiate resuscitation Not to initiate resuscitation To terminate resuscitation

IN HOSPITAL RESUSCITATION To initiate resuscitation Not to initiate resuscitation To terminate resuscitation To withdraw life support

PRIM AJUTOR-REGULI DE BAZA1. Mentineti pacientul in decubit dorsal, capul la

acelasi nivel cu corpul, pana la evaluarea gravitatii situatiei.

Identificati exceptiile la aceasta regula: Varsaturi sau hemoragii in zona cavitatii bucale-

pozitie laterala de siguranta ! la leziunile suspectate de coloana cervico-dorsala (2% explozii, 6% traumatism facial sau GCS<8)

Dispnee- pozitie sezanda sau semi Socul- membrele superioare ridicate (!?) doar

daca nu se suspecteaza leziuni de coloana2. Nu mobilizati pacientul mai mult decat necesar.

Indepartati hainele cu efect restrictiv, asigurati comfortul termic

PRIM AJUTOR-REGULI DE BAZA3. Asigurati confort psihic pacientului4. Nu atingeti rani, arsuri decat daca e absolut

necesar. Folositi obiecte sterile. Folositi bariere. Spalati maini!

5. Nu oferiti apa sau alimente din primul moment6. Imobilizati orice zona suspectata a fi fracturata.

Nu incercati sa reduceti fractura. Nu mobilizati decat daca e strict necesar

7. Mentineti temperatura normala a corpului

PRIM AJUTOR-aspecte epidemiologiceTransmitere de boli infectioase HIV Virusul hepatitei B, C TuberculozaMasuri de protectie universala- orice pacient trebuie

considerat potential purtator de agenti cu transmitere sanguina

Purtati manusi sau folositi alta bariera Spalati-va mainile cu apa calda si sapun:

La venire/plecare Inainte/dupa examinare, procedura Dupa scoaterea manusii, mastii Dupa folosirea batistei, toaletei, trecere prin par, activitati

administrative/gospodaresti Bariera pentru respiratii artificiale, protectie oculara

NOTIUNI ELEMENTARE DE ANATOMIE SI FIZIOLOGIE

Notiuni elementare

OXIGEN PLAMANI SANGE

CELULEGLUCIDE

LIPIDE

PROTEINE

Ce se intampla daca… Se opreste respiratia…. Se opresc bataile cardiace?

Sudden Cardiac Arrest

• 300,000 victims of out-of-hospital cardiac arrest each year in the U.S.• Less than 8% of people who suffer cardiac arrest outside the hospital survive.• Sudden cardiac arrest can happen to anyone at any time. Many victims appear healthy with no known heart disease or other risk factors.• Sudden cardiac arrest ≠a heart attack.

Sudden cardiac arrest: electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating.

A heart attack: when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest

SUDDEN CARDIAC ARREST

Approximativ 700,000 stopuri cardiace pe an in Europa

Supravietuirea la externare de aprox 5-10%

CPR efectuat de martori: interventie vitala inaintea sosirii echipajelor de urgenta – dubleaza sau tripleaza supravietuirea dupa SCR

Resuscitarea precoce si defibrilarea prompta (in decurs de 1-2 minute) poate duce la supravietuiri de >60%.

CPR: Ghiduri The International Liaison Committee on

Resuscitation (ILCOR) American Heart Association (AHA) International Guidelines 2000 for

Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (2005 Consensus Conference).

CPR Cardiopulmonary resuscitation (CPR) is an emergency

medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed in hospitals, or in the community by laypersons or by emergency response professionals.

CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient's chest to manually pump blood through the heart, called chest compressions, and usually also involves the rescuer exhaling into the patient (or using a device to simulate this) to inflate the lungs and pass oxygen in to the blood, called artificial respiration,

CPR is unlikely to restart the heart; its main purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage

Istoric 1740   The Paris Academy of Sciences officially recommended mouth-to-mouth

resuscitation for drowning victims. 1767   The Society for the Recovery of Drowned Persons became the first organized effort to deal with sudden and unexpected death. 1891   Dr. Friedrich Maass performed the first equivocally documented chest compression in humans. 1903   Dr. George Crile reported the first successful use of external chest compressions in human resuscitation. 1904   The first American case of closed-chest cardiac massage was performed by Dr. George Crile. 1954   James Elam was the first to prove that expired air was sufficient to maintain adequate oxygenation. 1956   Peter Safar and James Elam invented mouth-to-mouth resuscitation. 1957   The United States military adopted the mouth-to-mouth resuscitation method  to revive unresponsive victims. 1960   Cardiopulmonary resuscitation (CPR) was developed. The American Heart Association started a program to acquaint physicians with close-chest cardiac resuscitation and became the forerunner of CPR training for the general public. 1963   Cardiologist Leonard Scherlis started the American Heart Association's CPR Committee, and the same year, the American Heart Association formally endorsed CPR. 1966   The National Research Council of the National Academy of Sciences convened an ad hoc conference on cardiopulmonary resuscitation.  The conference was the direct result of requests from the American National Red Cross and other agencies to establish standardized training and performance standards for CPR. 1972   Leonard Cobb held the world's first mass citizen training in CPR in Seattle, Washington called Medic 2.  He helped train over 100,000 people the first two years of the programs. 1981   A program to provide telephone instructions in CPR began in King County, Washington.  The program used emergency dispatchers to give instant directions while the fire department and EMT personnel were en route to the scene.  Dispatcher-assisted CPR  is now standard care for dispatcher centers throughout the United States.

SCA 40% din victimele SCA: FV Deteriorare in asistolie-

sanse reduse de resuscitare

Tratament optim pentru SCR cu FV este: CPR de catre martori+

defibrilare

Tratamentul optim pentru SCR cauzat de asfixie (inec, trauma, droguri, copii): rescue breaths vitale

Lantul supravietuirii

CHAIN OF SURVIVAL

LANTUL SUPRAVIETUIRII Recunoastera precoce si activarea

sistemului de urgenta: poate preveni SCR Early CPR:dubleaza/tripleaza

supravietuirea din fv Fiecare minut fara CPR scade supravietuirea cu

7-10% Defibrilarea precoce:CPR + defib in 3-5

min: supravietuire de 49-75% Fiecare minut intarziere- reduce sansele de

externare cu 10-15%

BASIC LIFE SUPPORT secventa de proceduri efectuate pentru a

restabili circulatia sangelui oxigenat dupa un SC/R

Compresii sternale si ventilatie pulmonara efectuate de oricine care stie cum sa o faca, oriunde, imediat, fara alt echipament.

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

APPROACH SAFELY!

Scene

Rescuer

Victim

Bystanders

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

Factori de risc legati de scena actiunii Mediu

Trafic cladiri Electricitate Apa, foc Toxice

Victima Boli infectioase Intoxicatii

Tehnici Defibrilatoare Instrumente taioase sau ascutite

Training- manechin

Risk factors Infection tramsmissions Accidents with needles Rescuers having wound on their mouth, hands Case reports of tuberculosis, SARS, but no case

report of HIV transmission Mannequins: of the estimated 40 mil. in the USA

and perhaps 150 mil worldwide that have been taught mouth to mouth rescue breathing on mannequins in the last 25 years, there has never been a documented case of transmission of bacterial, fungal or viral disease by a CPR training mannequin

CHECK RESPONSE

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

Shake shoulders gently

Ask “Are you all right?”

If he responds

• Leave as you find him.

• Find out what is wrong.

• Reassess regularly.

CHECK RESPONSE

SHOUT FOR HELP

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

OPEN AIRWAY

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

OPEN AIRWAY

Head tilt and chin lift- lay rescuers- non-healthcare rescuers

No need for finger sweep unless solid material can be

seen in the airway

OPEN AIRWAY

Head tilt, chin lift + jaw thrust- healthcare professionals

AIRWAY OPENING BY NECK EXTENSION

Cam

pbel

l

CHECK BREATHING

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

CHECK BREATHING

Look, listen and feel for NORMAL breathing

Do not confuse agonal breathing with NORMAL breathing

Respiratii agonice

Apar la scurt timp dupa oprirea cordului in aproximativ 40% din stopurile cardiace

Descrise ca respiratii “grele”, dificile. Zgomotoase, “gasping”

Recunoscute ca semn de stop cardiacErroneous information can result in withholding CPR from cardiac arrest victim

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

Obstructia cailor aeriene cu corp starin (FBAO)

Approximativ 16 000 adulti si copii sunt tratati annual in UK pentru obstruictie de cai aeriene cu corpi straini

SEMNE OBSTRUCIE MODERATA

OBSTRUCIE SEVERA

“Te ineci?” “Da” Incapabil sa vorbeasca, poate incuviinta

Alte semne Poate tusi, respira, vorbeste

Nu poate respira/ respiratie cu Wheezing/silentiu/incearca sa tuseasca/ inconstienta

ADULT FBAO TREATMENT

ABDOMINAL THRUSTS

30 CHEST COMPRESSIONS

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

Place the heel of one hand in the centre of the chest

Place other hand on top Interlock fingers Compress the chest

Rate 100 min-1

Depth 4-5 cm Equal compression : relaxation

When possible change CPR operator every 2 min

CHEST COMPRESSIONS

• The most effective rate for chest compressions is 100 compressions per minute – the same rhythm as the beat of the BeeGee’s song, “Stayin’ Alive.”

http://www.dailymotion.com/video/x1afd7_bee-gees-staying-alive_music

RESCUE BREATHS

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

RESCUE BREATHS

Pinch the nose Take a normal breath Place lips over mouth Blow until the chest

rises Take about 1 second Allow chest to fall Repeat

RESCUE BREATHS

RECOMMENDATIONS:- Tidal volume 500 – 600 ml

- Respiratory rate give each breaths over about 1s with enough volume to make the victim’s chest rise

- Chest-compression-only

continuously at a rate of 100 min

CONTINUE CPR

30 2

Video Demonstration of CPR for Adults.flv

Hands-only CPR

DEFIBRILLATION

Call 112

Approach safely

Check response

Shout for help

Open airway

Check breathing

Attach AED

Follow voice prompts

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

Some AEDs will automatically switch themselves on when the lid is opened

ATTACH PADS TO CASUALTY’S BARE CHEST

ANALYSING RHYTHM DO NOT TOUCH VICTIM

SHOCK INDICATED

Stand clear Deliver shock

SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS

30 2

NO SHOCK ADVISEDFOLLOW AED INSTRUCTIONS

30 2

http://www.youtube.com/watch?v=O9T25SMyz3A

IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

Attach AED

Follow voice prompts

CONTINUE RESUSCITATION UNTIL

Qualified help arrives and takes over

The victim starts breathing normally

Rescuer becomes exhausted

CHEST COMPRESSIONS- infant, lone rescuer

Lone rescuer: compress the sternum with the tips of two fingers

CHEST COMPRESSIONS- children over 1 year

Pediatric FBAO

Pediatric FBAO No abdominal thrusts for choking infants Risk because of the horizontal position of

the ribs- upper abdominal viscera more exposed to trauma

Pediatric AED Automated external defibrillators (AEDs) are safe

and successful when used in children older than 1 year of age.

Purpose made paediatric pads or software attenuate the output of the machine to 50–75 J and these are recommended for children aged 1–8 years.

If an attenuated shock or a manually adjustable machine is not available, an unmodified adult AED may be used in children older than 1 year.

There are case reports of successful use of AEDs in children aged less than 1 year;

in the rare case of a shockable rhythm occurring in a child less than 1 year, it is reasonable to use an AED (preferably with dose attenuator).

Special circumstances

Drowning WHO: worldwide,drowning accounts for

approximately 450,000 deaths each year A common cause of accidental death in

Europe the duration of hypoxia is the most critical

factor in determining the victim’s outcome oxygenation, ventilation and perfusion

should be restored as rapidly as possible CPR by a bystander and immediate

activation of the EMS system.

Drowning- epidemiology 97% of deaths from drowning occur in low-

and middle-income countries more common in young males is the leading cause of accidental death in

Europe in young males suicide, traffic accidents, alcohol and drug

abuse varies between countries

Drowning: definition ILCOR: “a process resulting in

primaryrespiratory impairment from submersion/ immersion in a liquid medium.

a liquid/air interface is present at the entrance of the victim’s airway: the victim does not breathe air.

Immersion=to be covered in water or other fluid

Drowning: at least the face and airway must be immersed.

Submersion = that the entire body, including the airway, is under the water or other fluid

Drowning: pathophysiology cardiac arrest occurs as a consequence of

hypoxia the victim initially breath holds before

developing laryngospasm. this time the victim frequently swallows large

quantities of water. breath holding/laryngospasm continues,

hypoxia and hypercapnia develops victim aspirates water into their lungs

leading to worsening hypoxaemia

Drowning: treatment1. aquatic rescue2. basic life support3. advanced life support4. post-resuscitation careInitial rescue: bystanders, trained lifeguardsBLS: initial respondersNumber of victims-

Drowning: treatment1. Aquatic rescue and recovery from the water. personal safety and minimize the danger to yourself and the

victim at all times attempt to save the drowning victim without entry into the

water. talking to the victim rescue aid throwing a rope

use a boat or other water vehicle If entry into the water is essential, take a flotation device. safer to enter the water with two rescuers Never dive head first in the water (loose visual contact with the

victim, risk of spinal injury) incidence of cervical spine injury in drowning victims is very low(approximately 0.5%)

Drowning: treatment2.BLSRescue breathing: prompt initiation of rescue breathing or

positive pressure ventilation increases survival Give five initial ventilations/rescue breaths Rescue breathing can be initiated whilst the victim is still in

shallow water provided the safety of the rescuer is not compromised

mouth-to nose ventilation may be used as an alternative to mouth-to-mouth ventilation

In-water resuscitation: 10–15 rescue breaths over approx. 1min . normal breathing does not start spontaneously, and the victim is

<5 min of from land, continue rescue breaths while towing. If more than an estimated 5min from land, give further rescue

breaths over 1min, then bring the victim to land as quickly as possible without further attempts at ventilation.

Drowning: treatment2.BLSChest compression on a firm surface before starting chest compressions

as compressions are ineffective in the water Confirm the victim is unresponsive and not breathing

normally and then give 30 chest compressions, tan 30:2

Compression-only CPR: to be avoided.Automated external defibrillation if an AED is available, dry the victim’s chest, attach

the AED pads and turn the AED on. deliver shocks according to the AED prompts

Drowning: treatmentRegurgitation during resuscitation. Rescue breathing: need for very high inflation

pressures Regurgitation of stomach contents and

swallowed/inhaled water is common during resuscitation from drowning

turn the victim on their side and remove the regurgitated material using directed suction if possible

Abdominal thrusts can cause regurgitation of gastric contents and other life-threatening injuries and should not be used.

Care should be taken if spinal injury is suspected

Drowning Discontinuing resuscitation efforts Salt versus fresh water. Hypothermia after drowning. Victims of submersion: primary or secondary

hypothermia Submersion occurred in icy water (<5 ◦C or 41◦F),

hypothermia may develop rapidly and provide some protection against hypoxia

a secondary complication of the submersion and subsequent heat loss through evaporation during attempted resuscitation

consider rewarming until a core temperature of 32–34 ◦C is achieved

Electrocution 0.54 deaths per 100,000 people/year Electrical injuries

in adults: in the workplace and are associated with high voltage, children are at risk primarily at home, where the voltage

is lower (220V in Europe, Australia and Asia; 110V in the USA and Canada)

Lightning strikes is rare, but worldwide it causes 1000 deaths each year

Electric shock injuries: the direct effects of current on cell membranes and vascular smooth muscle

The thermal energy associated with high-voltage electrocution: burns

Electrocution Factors influencing the severity of electrical injury

current: alternating (AC) or direct (DC) voltage, magnitude of energy delivered, resistance to current flow, pathway of current through the patient, the area duration of contact

Contact with AC may cause tetanic contraction of skeletal muscle, which may prevent release from the source of electricity.

Myocardial or respiratory failure may cause immediate death

Electrocution paralysis of the central respiratory control system or the respiratory muscles: respiratory arrest VF if it traverses the myocardium duringthe vulnerable period myocardial ischaemia because of coronary artery

spasm. asystole may be primary, or secondaryto asphyxia following respiratory arrest current that traverses the myocardium is more

likely to be fatal transthoracic (hand-to-hand)>a vertical (hand-to-

foot)/straddle (foot-to-foot)

Lightning strike 300 kV over a few milliseconds. the current from a lightning strike passes over the surface

of the body in a process called ‘external flashover Industrial shocks and lightning strikes: deep burns at the

point of contact. Industrial shocks: the points of contact are usually on the

upper limbs, hands and wrists Lightning: mostly on the head, neck and shoulders. Lightning can also cause:

central and peripheral nerve damage; brain haemorrhage and oedema, Peripheral nerve injury

Mortality from lightning injuries is 30%-70%

Electrocution: Rescue

Ensure that any power source is switched off and do not approach the casualty until it is safe.

High-voltage electricity can arc and conduct through the ground for up to a few meters around the casualty.

It is safe to approach and handle casualties after lightning strike, although it would be wise to move to a safer environment, particularly if lightning has been seen within 30 min

Electrocution: Resuscitation Airway management may be difficult if there are electrical burns around the face and neck extensive soft-tissue edema may develop causing airway

obstruction Head and spine trauma can occur after electrocution. Immobilize

the spine until evaluation can be performed. Muscular paralysis, especially after high voltage, may persist

several hours Remove smoldering clothing and shoes to prevent further thermal

injury. Maintain spinal immobilization if there is a likelihood of head or

neck trauma Conduct a thorough secondary survey to exclude traumatic

injuries caused by tetanic muscular contraction or by the person being thrown

Electrocution can cause severe, deep soft-tissue injury with relatively minor skin wounds, because current tends to follow neurovascular bundles; look carefully for features of compartment syndrome.

Cardiac arrest associated with pregnancy problems associated with pregnancy are caused by aortocaval

compression after 20 weeks gestation, the pregnant woman’s uterus can press

down against the inferior vena cava and the aorta, impeding venous return and cardiac output

The key steps for BLS in a pregnant patient are: Call for expert help early (including an obstetrician and

neonatologist). Start basic life support according to standard guidelines. Ensure

good quality chest compressions with minimal interruptions. Manually displace the uterus to the left to remove caval

compression. Add left lateral tilt if this is feasible – the optimal angle of tilt isunknown. Aim for between 15◦ and 30◦. Even a small amount oftilt may be better than no tilt. The angle of tilt used needs to allowgood quality chest compressions and if needed allow Caesareandelivery of the fetus. Start preparing for emergency Caesarean section –the fetus will

need to be delivered if initial resuscitation efforts

Accidental hypothermia when the body core temperature unintentionally drops below 35 ◦C.

mild (35–32 ◦C), moderate (32–28 ◦C) or severe (less than 28 ◦C)

The Swiss staging system based on clinical signscan be used at the scene to describe victims:stage I –clearly conscious and shivering; stage II – impaired consciousness without shivering;stage III – unconscious; stage IV – no breathing;stage V – death due to irreversible hypothermia

Accidental hypothermiaDiagnosisNormal thermoregulation during exposure to cold environments, wet or windy conditions in people who have been immobilized, or following immersion in cold water Impaired thermoregulation :in the elderly and

very youngOther risk conditions: drug or alcohol ingestion, exhaustion, illness

Accidental hypothermia The core temperature measured in the lower third

of the oesophagus correlates well with the temperature of the heart.

epitympanic (‘tympanic’) measurement the method of temperature measurement should be the

same throughout resuscitation and rewarmingDecision to resuscitate cellular oxygen consumption by 6% per 1 ◦C decrease in core

temperature At 28 ◦C oxygen consumption is reduced by 50% and at 22

◦C by 75%. can exert a protective effect on the brain and vital organs In a hypothermic patient, no signs of life (Swiss hypothermia

stage IV) alone is unreliable for declaring death At 18 ◦C the brain can tolerate periods of circulatory arrest

for ten times longer than at 37 ◦C. the traditional guiding principle that “no one is dead until

warm and dead” should be considered

Accidental hypothermiaResuscitation the same ventilation and chest compression rates

as for a normothermic patient stiffness of the chest wall, making ventilation and

chest compressions more difficultRewarming removal from the cold environment, prevention of further heat loss and rapid transfer to hospital. Swiss stages≥II should be immobilized and

handled carefully the whole body dried and insulated( Wet clothes

should be cut off)

Accidental hypothermiaRewarming Conscious victims can mobilise as exercise rewarms a

person more rapidly than shivering Somnolent or comatose victims should be immobilized and

kept horizontalPassive rewarming is appropriate in conscious victims with

mild hypothermia who are still able to shiver, by: full body insulation with wool blankets, aluminium foil, cap warm environment. chemical heat packs to the trunkHypothermic victims with an altered consciousness should be

taken to a hospital capable of active external and internal rewarming.

Avalanche burial asphyxia, trauma and hypothermia avalanche victims are not likely to survivewhen they are:• buried >35 min and in cardiac arrest with an

obstructed airway on extrication;• buried initially and in cardiac arrest with an

obstructed airway on extrication, and an initial core temperature of <32◦;

• buried initially and in cardiac arrest on extrication with an initial serum potassium of >12 mmol

HyperthermiaDefinition when the body’s ability to thermoregulate

fails and core temperature exceeds the normally maintained by homeostatic mechanisms

exogenous, caused by environmental conditions secondary to endogenous heat production.Forms:

heat stress heat exhaustion heat stroke finally multiorgan dysfunction and cardiac arrest

Malignant hyperthermia (MH)

Hyperthermia

Heat stroke•systemic inflammatory response a core temperature above 40.6 ◦C, accompanied by mental state change and varying levels of organ dysfunction.•classic non-exertional heat stroke (CHS) occurs during high environmental temperatures and often effects the elderly•Exertional heat stroke (EHS) occurs during strenuous physical exercisein high environmental temperatures and/or high humidityusually affects healthy young adults•Mortality from heat stroke ranges between 10 and 50%

HyperthermiaManagement ABCDEs and rapidly cooling the patient Start cooling before the patient reaches hospital. Aim to rapidly reduce the core temperature to

approximately 39 ◦C.Cooling techniques drinking cool fluids, fanning the completely undressed patient spraying tepid water on the patient Ice packs over areas where there are large superficial blood

vessels (axillae, groins, neck) In cooperative stable patients, immersion in cold water can

be effective

Modifications to cardiopulmonary resuscitation

There are no specific studies on cardiac arrest in hyperthermia.

the prognosis is poor compared with normothermic cardiac arrest

Hyperthermia

SOCUL, HEMORAGIILE, LEZIUNILE TESUTURILOR MOI Socul Hemoragii Plagi Fracturi Traumatisme craniene Traumatisme toracice Traumatisme abdominale

1. SOCUL

Pompa Presarcina Postsarcina

1. SOCUL Pompa: inima tetracamerala

Atrii/ ventriculi Miocard contractil Contractilitate/inotropism

Sistemul circulator: Artere Vene capilare

Fluidul circulant Elemente celulare (hematii, leucocite, trombocite) Plasma

Pulsul

1. SOCUL

1.SOCUL Reprezinta incapacitatea cordului si a

sistemului circulator de a mentine perfuzia catre organele vitale prin aport de de sange cu continut de oxigen.

Situatie amenintatoare de viata Recunoasterea semnelor si simptomelor-

nu toate concomitent, nu imediat

1. SOCUL- semne si simptome1. Anxietate, agitatie,

confuzie2. Tegumente palide, reci,

umede, lipicioase3. Tahipnee, respiratii

neregulate4. Tahicardie/puls slab

batut/ nepalpabil periferic5. Greturi, varsaturi6. Sete7. Privire “goala”,

mohorata, pupile dilatate

1. SOCULI. Socul hipovolemic- cauzat de pierderea excesiva

de sange sau fluide din organism Apare in conditii de hemoragii, arsuri, varsaturi si diaree

excesive

II. Socul cardiogen- deficit de pompa cardiacaIII. Socul septic Socul anafilactic- substanta cu rol de alergen-

medicamente, venin de insecte si animale, praf si polen, alimente

Socul spinal

1. SOCUL: tratament Pozitionati pacientul: pe spate, cu membrele inferioare ridicate

usor (20-30 cm). Exceptii:

pozitie laterala de siguranta leziuni de coloana suspectate traumatisme craniene dispnee

A, B, C : Mentineti deschisa calea aeriana Identificati/ inlaturati cauza daca e posibil Controlati hemoragiile!!!!! Oxigen (daca e disponibil)

Imobilizati eventualele fracturi, nu reduceti! Mentineti temperatura (paturi), inlaturati hainele ude. NU folositi

metode de incalzire activa! Incurajati victima, evitati expunerea zonei ranite vederii acesteia NU alimentati, NU administrati lichide! 112 si transport cu ambulanta cat mai repede la spital Urmariti si reevaluati constant, monitorizati pulsul, respiratia,

constienta la fiecare 5 minute.

2. HEMORAGII Pierdera sangelui la nivel capilar, venos

sau arterial Hemoragii interne- in interiorul corpului Hemoragii externe- inafara corpului Ambele

Hemoragii capilare- sangele “balteste” Hemoragii venoase- sange inchis la

culoare, curgere fluenta, continua Hemoragii arteriale- sange rosu aprins,

pulsatil- situatie amenintatoare de viata!

2. HEMORAGII Adultul- 5-6 litri de sange Poate pierde fara consecinte aprox 0.5l La peste 1l- soc 2-3l- deces Greu de identificat uneori daca e arteriala

sau venoasa• capilare- usor de controlat pe suprafata

mica • Leziuni profunde cu hemoragii arteriale

sau venoase- Urgenta majora!

2. HEMORAGIIHEMORAGIILE EXTERNE:

control1. Compresie directa- prima si

cea mai eficienta masura pansament steril sau tesut

curat Bandaj compresiv Inca un pansament sau

propriul pumn Nu indepartati sub nici o

forma pansamentul aplicat2. Ridicarea extremitatii

lezate deasupra nivelului cordului- impreuna cu compresia directa.

2. HEMORAGII3. Compresie indirecta

pentru hemoragiile arteriale pe artere sustinute de suport osos

Cu degetele, podul palmei sau mana

!- flux inadecvat catre extremitate

NU la nivelul carotidelor! Cele mai des utilizate-

brahial, femural

2. HEMORAGII4. Garoul- NU! folosire descurajata!!!! doar ca ultima resursa!!!! doar la nivelul

extremitatilor folosit neadecvat poate

duce la compromiterea definitiva a membrului sau agravarea hemoragiei

Bucata de tesatura, curea, fular

Nu folositi sarme, cabluri etc- ce ar putea taia pielea

NU ACOPERITI GAROUL!!!!! MARCATI POZITIA SI

ORA!!!! NU-L MAI INDEPARTATI!!!!

2.HEMORAGIIHEMORAGII INTERNE De obicei nu sunt la vedere Pot conduce la soc Hemoragii la nivelul gurii,varsaturi hemoragice, la

nivelul urechilor, nasului, rectului sau altor orificii sunt considerate severe si indica prezenta hemoragiilor interne

Contuzii, corpuri contondente, fracturi Semne (inafara de eventiale exteriorizari):

anxietate, agitatie. sete, greturi si varsaturi, tegumente reci, palide si umede, tahipnee, tahicardie cu puls slab palpabil

2. HEMORAGII In tesuturi moi: echimoze- contuzii

gheata sau pansament rece nu direct in contact cu pielea, ci prin tesaturi- reduce durerea si edemul

Hemoragii interne severe: Sunati la numarul de urgenta local Monitorizati ABC Tratati socul* Plasati pacientul in pozitia cea mai confortabila* Mentineti confortul termic Sustineti moral

2.HEMORAGIIEpistaxisul Produs de traumatism, factori de mediu,

HTA, schimbari de altitudine, malformatii vasculare locale.

Orice pacient suspectata de HTA cu epistaxis se evalueaza la spital

In caz de fractura de craniu- nu incercati sa opriti hemoragia. Sunati 112!

Conduita in epistaxis :Pozitie sezanda, nu capul pe spate,eliberati de haine stranse in jurul gatului strangeti aripile nazale(exceptie fracturi) si apasati; gheata sau comprese reci la baza nasului 5-10 minPresiune la niveleul buzei superioare sub nasIncurajati sa scuipeNu freaca sau sufla nasul timp de min 1 oraPozitie laterala de siguranta daca devine inconstientCorp strain- copii: nu impingenti! Sunati 112!

2.HEMORAGII Conduita in epistaxis :

Pozitie sezanda, nu capul pe spate,eliberati de haine stranse in jurul gatului

strangeti aripile nazale(exceptie fracturi) si apasati; gheata sau comprese reci la baza nasului 5-10 min

Presiune la niveleul buzei superioare sub nas

Incurajati sa scuipe Nu freaca sau sufla nasul

timp de min 1 ora Pozitie laterala de

siguranta daca devine inconstient

Corp strain- copii: nu impingenti! Sunati 112!

3.TRAUMATISMELE TESUTURILOR MOIPlagi= traumatisme ce produc efractia

tegumentului, a tesutului subcutanat si altor mucoase.

Inchise/deschise Plagi contuze/Plagi dilacerate/Plagi taiate/

intepate/ muscate Riscurile majore:- hemoragii si infectii

PLAGIGeneralitati- principii de tratamentPlagi recente: controlul hemoragiilor si prevenirea socului prevenirea infectiei Stabilizarea partii lezate Stabilizarea corpurilor penetrantePlagi vechi si infectate: ridicarea zonei afectate, pansament

umed caldutPlagi ce contin corpuri straine; pot fi indepartate doar daca

sunt superficiale. ! Nu indepartati niciodata corpurile straine din ochi sau craniu!!!!!!!

OBIECTUL PENETRANT SE LASA PE LOC! ORICE MISCARE A SA POATE PRODUCE LEZIUNI SUPLIMENTARE! NU SE EXTRAGE!!!!!SE STABILIZEAZA CU COMPRESE. SE BANDAJEAZA!

PLAGI

Plagi mici: spalati cu apa si sapun, uscati si aplicati un antiseptic usor, neiritant. Pansament

Plagi mari: nu incercati sa spalati sau sa aplicati antiseptic. Acoperiti cu pansament steril, uscat

PLAGI Controlul hemoragiei:

compresa uscata, sterila, presiune directa, ridicare, puncte de presiune

Nu se curata plagile in prespital

Compresa se fixeaza cu pansament compresiv

Compresa sa acopere plaga

Daca se imbiba se plaseaza alta deasupra, nu se indeparteaza

Se fixeaza cu rola sau pansament triunghiular

PLAGI Dimensiuni LocalizareTipuri de plagi: INCHISE:

ECHIMOZA (contuzie, edem, durere) Semn de fracturi sau leziuni severe subiacente Comprese reci/ gheata nu direct pe tegument!

HEMATOMUL- leziune extinsa a tesuturilor moi cu pierdere de sange in interiorul tesutului- de obicei in zona fracturilor

Compresie manuala, pansamente reci, imobilizare, pozitie elevata

PLAGIDESCHISE Abraziuni (escoriatii) Amputatii traumatice

(complete, partiale) ABC Controlul hemoragiei Pansament Prevenirea/ tratarea socului Solicita asistenta medicala de

urgenta Avulsii- tegumentul este

complet indepartat, smuls din zona respectiva

Hemoragii importante Recuperati tegumentul,

turnati apa, puneti-l in pansament steril, in punga inchisa, puneti cu gheata si trimiteti cu pacientul

PLAGI TAIATE – instrumente ascutite: cutite,

lame, cioburi de sticla Hemoragii importante Cel mai mic risc de infectii

DILACERARI- plagi rupte, smulse INTEPATE

PLAGIMUSCATE Risc de infectie Risc de rabie Minore: apa si sapun Mari: controlul hemoragiei,

comprese,bandaj Obligatoriu medic!IMPUSCATE-orificiu de intrare si iesire Hemoragii interne

4. OASE, ARTICULATII SI MUSCULATURA Fracturi, luxatii, entorse, contuzii Leziuni articulare impreuna cu cele musculare Dificil de diferentiat de fracturi- in caz de

nesiguranta, mai bine tratezi ca fracturaFracturi=intreruperea continuitatii osului prin

trumatism direct sau indirect. Principiu de baza in fracturi: imobilizarea

segmentelor fracturate pentru prevenirea aparitiei in continuare a leziunilor produse de capetele osoase

4. OASE, ARTICULATII SI MUSCULATURA

Luxatiile= modificarea raporturilor anatomice normale ale extremitatilor osoase intr-o articulatie cu ruperea ligamentelor care sustin articulatia

Entorsele= intinderea ligamentelor care sustin articulatia

4. OASE, ARTICULATII SI MUSCULATURA

Semne si simptome pentru leziunile musculo-scheletale ale extremitatilor:

Durere Plaga Tumefiere Deformarea extremitatii Impotenta functionala

FRACTURISEMNE SI SIMPTOME:

SwellingPain.Loss Of Movement.Irregularity.Noise.Tenderness.Shock

4. OASE, ARTICULATII SI MUSCULATURAExaminare:Generala: A,B,C + stabilizarea

coloanei cervicale + controlul hemoragiei

A membrului afectat: se compara membrul lezat cu cel sanatos

Se indeparteaza hainele Se examineaza de la

articulatiile superioare spre inferioare

Pacientul trebuie intrebat ce simte (durere, parestezii, nimic)

Se evalueaza: circulatia: pulsul (in aval de

leziune), recolorarea capilara sensibilitatea miscarea

Principii de tratamentImobilizare: Inainte de mutarea

pacientului Reduce durerea Previne riscul de leziuni

ulterioare Reduce riscul sangerarii si a

leziuniloe nervoaseTehnica imobilizarii Se indeparteaza hainele Se examineaza complet (puls,

sensibilitate, motricitate) Se panseaza plagile Se imobilizeaza articulatia de

deasupra si dedesuptul leziunii

Se reverifica pulsul si sensibilitatea

Se lasa la vedere degetele

FRACTURI ATELE- orice obiect rigid- umbrele, bete,

plansee, perne ziare pliate, membru inferior nefracturat etc.

Atele rigide, moi, vacuum (pe ambulante) Sunt fixate de membrul fracturat cu

bandaje, tesaturi, benzi adezive Nu se aplica foarte strans, se lasa expuse

extremitatile- degete

FRACTURI Inchise- osul este fracturat, dar tegumentul ramane intact Deschise- osul este fracturat, tegumentul lezat Complicate- leziuni secundare(coasta ce perforeazaplamanul)

FRACTURICONDUITA Controlul hemoragiei- Tratamentul socului Monitorizeaza ABC Se indeparteaza bijuterii, haine, usor, pentru a nu

produce leziuni suplimentare Se verifica pulsul distal de fractura-

absent:miscari lejere pana la palparea sa Se acopera plagile cu pansament steril. NU se

apasa capetele osoase inapoi in plaga Se plaseaza atela

FRACTURIPlasarea atelei: Se mentine tractiunea pana la fixarea atelei Se infasoara de la baza la varf, nu strans Se verifica pulsul distal Daca e absent, se largeste bandajul Se solicita ajutor medical Rezumat- ACRONIM : I (ice)C (compression) E (elevation)

FRACTURI ANTEBRAT BRAT

FRACTURI FEMUR GAMBA ROTULA

FRACTURICOLOANA VERTEBRALA Mielice durere, soc, paralizie Amielice-

Leziune de coloana cervicala se suspecteaza la: Orice politraumatism Orice TCC Orice traumatism toracic superior Deformari la nivelul gatului Orice pacient constient care acuza dureri la nivelul

gatului Orice pacient traumatizat cu status mental alterat

Conduita: Pozitie decubit dorsal, stabilizarea capului si

gatului in pozitia gasita Cai aeriene: subluxatia mandibulei, ABC

Se mentine pozitia neutra a capului si gatului- guler improvizat din prosop Se trateaza socul. Nu se ridica picioarele Nu permiteti miscari, nu mobilizati, ajutor

medical.

Mobilizarea victimelor: principii generale Sa nu provocati mai mult rau Se mobilizeaza pacientul doar daca e

necesar Cat mai putin posibil Se mobilizeaza corpul ca un tot Se folosesc tehnici de ridicare si mutare

adecvate sigurantei personale Un salvator da comanda de mobilizare (cel

aflat la capul pacientului)

Traumatismele cranieneA. Traumatisme craniene minore (majoritatea) 112 trebuie anuntat in caz de :

Hemoragie severa faciala sau craniana Epistaxis sau otoragie Cefalee severa Alterarea starii de constienta in secunde Aspect echimotic in jurul ochilor sau retroauricular Apnee Confuzie Pierderea echilibrului Pareza sau incapacitatea de a mobiliza membre Anizocorie Varsaturi/vorbire dificila Convulsii

Traumatismele cranieneB. Traumatism cranian sever: Mentineti pacientul linisit, imobil, in decubit

dorsal, capul si umerii usor ridicati. Evitati miscarile gatului. Mobilizati doar in caz de stricta necesitate

Opriti sangerarile. Presiune directa cu pansament steril sau textil curat. Nu aplicati compresie daca suspectati fractura craniana

Monitorizati schimbarile de dinamica a respiratiei si constientei

In lipsa circulatiei- CPR

Traumatismele cranienePlagile la nivel cranian: Zona bine vascularizata: hemoragii masive Presiune directa Comprese fixate cu fasa Suspiciune de fractura craniana: nu compresie Obraji: pansament compresiv in guraTraumatismele oculare: Evaluare medicala obligatorie Pozitie decliva Se acopera ochiul cu compresa uscata Corp strain: compresa si pahar de plastic sau

hartie, se bandajeaza ambii ochi dupa avertizare prealabila!

Nu se introduc substante in scop antiseptic!

Traumatismele gatului Trahee, esofag, artere si vene mari,

vertebre, maduva spinarii Plagi: presiune directa pe sursa

hemoragiei Nu fesi circulare! Se mentine stabilitatea capului si gatului Se mentine permeabilitatea caii aeriene

Traumatismele toracice Plamani, vase mari,

cord, coloana Dispnee si hemoragii In lipsa semnelor de

obstructie aeriana: orice dispnee de evaluat pentru trauma toracica inchisa sau deschisa

Pneumotorax deschis Urgenta medicala cu

risc vital

Traumatismele toracice Semne si simptome

1. Dispnee si durere toracica violenta2. Cianoza, anxietate

Primul ajutor:1. Etanseizati rana cu mana sau orice obiect=

pansament ocluziv (card de identitate). Pansament fixat pe 3 laturi. In caz de agravare, indepartati imediat!

2. Pozitionati pacientul pe partea afectata3. Tratati socul- pozitie semisezanda4. Nimic per os5. Solicitati asistenta medicala de urgenta

Traumatismele abdominaleInchise: tegument

intact1. Durere violenta,

varsaturi, contractura musculaturii abdominale

2. Distensie abdominala, soc

3. Pozitie antalgica

1. ABC2. Plasati pacientul in

pozitia cea mai confortabila

3. Indepartati cu grija hainele pentru a evalua corect

4. Tratati socul5. Nimic per os

Traumatismele abdominaleDeschise1. Semnele traumatismelor

inchise2. Plagi intepate sau

contuze, hematemeza3. Dureri lombare

ABC Indepartati cu grija hainele Pozitia cea mai

comfortabila-pe spate, cu picioarele ridicate usor/ genunchi indoiti

Tratati socul Opriti hemoragiile. Nu

atingeti si nu incercati sa repozitionati organele eviscerate. Acoperiti cu pansament steril cu ser fiziologic, fixat pe 4 laturi

Mentineti temperatura Nimic per os Solicitati asistenta

medicala de urgenta

FrostbiteFreezing of tissue or moisture in the skin due to exposure to temperatures below 0 degrees C

Air temps below 0ºC skin freezes at -2oC

Superficial frostbite (mild) freezing of skin surface

Deep frostbite (severe) freezing of skin and other soft tissues, may include bone

Hands, fingers, feet, toes, ears, chin, nose, groin area

Frostbite Symptoms

initially redness in light skin or grayish in dark skin

tingling, stinging sensation turns numb, yellowish, waxy or gray color feels cold, stiff, woody blisters may develop

Deep frostbyte

Frostbite Treatment

remove from cold and prevent further heat loss remove constricting clothing and jewelry rewarm affected area evenly with body heat

until pain returns when skin thaws it hurts!! do not rewarm a frostbite injury if it could refreeze

during evacuation or if victim must walk for medical treatment

do not massage affected parts or rub with snow

evacuate for medical treatment

Trench/Immersion FootResults from prolonged exposure of skin to cold or wet conditions, usually at 10 degrees C or colder. Potentially crippling, nonfreezing injury (temps from 0oC-10oC)

Prolonged exposure of skin to moisture (12 or more hours)

High risk during wet weather, in wet areas, or sweat accumulated in boots or gloves

Trench/Immersion Foot Symptoms

initially appears wet, soggy, white, shriveled sensations of pins and needles, tingling,

numbness, and then pain skin discoloration - red, bluish, or black becomes cold, swollen, and waxy appearance may develop blisters, open weeping or

bleeding in extreme cases, necrosis

Trench/Immersion Foot

Trench/Immersion Foot Treatment

prevent further exposure dry carefully DO NOT break blisters, apply lotions, massage,

expose to heat, or allow to walk on injury rewarm by exposing to warm air clean and wrap loosely elevate feet to reduce swelling Defer for medical treatment

Snow BlindnessInflammation and sensitivity of the eyes caused by ultraviolet rays of the sun reflected by the snow or ice

Symptoms gritty feeling in eyes redness and tearing eye movement will

cause pain headache

Treatment•remove from sunlight

•blindfold both eyes or cover with cool, wet bandages•seek medical attention•recovery may take 2-3 days

Thermal burns

BurnsClassified according to the depth or degree of skin damage First Second Third degree of

burns

First Degree Burn Cause:

Overexposure to sun Light contact with hot

objects Scalding by hot water

or steam

Signs of First Degree Burns Erythema Mild Swelling & Pain Rapid Healing

First Aid: First Degree Burns Cold Water NOT Ice Water Burn Lotion or Spray

NO BUTTER OR OINTMENTS

Second Degree Burns Results from a very

deep sunburn Contact with hot

liquids Flash burns from

gasoline etc.

Signs of Second Degree Burns

Erythema Swelling Blisters Pain Open Wounds Wet appearance due

to loss of plasma through damaged skin layers.

First Aid: Second Degree Burns Immerse in cold water NOT ice water Apply cool compresses Blot dry & apply sterile gauze or clean cloth for

protection DO NOT break blisters or remove tissue DO NOT use an antiseptic preparation, ointment,

spray or home remedy on a severe burn.

If arm or legs are affected, keep them elevated.

Third Degree Burns Caused by flame,

ignited clothing, immersion in hot water, contact with hot objects, or electricity.

Signs of Third Degree Burns

White or Charred appearance

Deep tissue destruction

Complete loss of all skin layers

Nerve Damage Pain or No Pain

First Aid: Third Degree Burns DO NOT remove pieces of adhered

particles of charred clothing. Cover burn with thick, sterile or freshly

laundered cloth. If hands or legs involved, elevate DO NOT immerse or apply ice water to

burn area. DO NOT apply ointment, commercial

preparations, grease, or other home remedies.

Chemical Burns of the Skin First Aid:

Remove clothing Flush with water for 15 – 20 minutes Get name / source of Chemical Seek Medical Attention

Burns of the Eyes First Aid:

Flush face, eyelid, & eye for 15 – 20 minutes Avoid rubbing eye Cover eye Seek medical attention

ContinutUrgente medicale Afectiunile cardiace

Sindroamele coronariene acute Insuficienta cardiaca

Sincopa Accidente vasculare cerebrale Convulsii

IntoxicatiileIntepaturile de animaleUrgentele comportamentale

Urgentele medicale: principii Abordarea unui pacient netraumatizat: Verificati zona Stabiliti contactul cu pacientul incercand sa identificati probleam Prezentati-va Evaluare primara:

ABC Identificati cea mai importanta problema a pacientului 112

Incercati sa aflati rapid un istoric al pacientului dupa algoritmul: S: semn, simptom A: alergii M: medicamente P: probleme medicale anterioare L: (lunch) ultima masa- ce, cat si cand E: evenimente asociate

Evaluare secundara: Examen fizic rapid, monitorizare de functii vitale

Sustineti moral pacientul Evaluati continuu

Sindroame coronariene acute Situatie in care fluxul

sanguin coronarian este intrerupt, conducand la necroza zonei de miocard din lipsa de oxigen

Afectiune cardio-vasculara Durere retrosternala- a se

suspecta un sindrom coronarian acut pana la proba contrarie!

Factori de risc neinfluentabili Ereditate Sex Varsta

Factori de risc influentabili Fumat HTA Colesterol Obezitate Sedentarism Stress Diabet netratat

Sindroame coronariene acuteSemne si simptome: Dureri retrosternale Iradiere in mandibual, umeri. brate, gat, spate Dispnee Tegumente palide, umede, transpiratii profuze Anxietate, greturi, varsaturi AstenieDaca suspectati:1. ABC2. Plasati pacientul in pozitia cea mai confortabila (sezanda sau

semi)3. Mentineti pacientul linistit si in confort termic4. Slabiti hainele stranse din jurul gatului, a taliei, a toracelui5. Pregatiti-va sa efectuati CPR6. Solicitati asistenta medicala

Sindroame coronariene acute

Angina pectorala: durere toracica cu caracter constrictiv sau de apasare (rareori mai mult de 5 minute) NitroglicerinaConduita: linistirea pacientului si interzicerea oricarui efort Oxigen pe masca daca e disponibil Nitroglicerina s.l. Monitorizare de functii vitale Pozitie semisezanda, 112

Sindroame coronariene acuteInfarctul miocardic acut (atac de cord)Cauze principale: ateroscleroza si tromboza Daca suprafata afectata din miocard este mare, inima se

poate opri: stop cardiacConduita: 112 Vorbiti si linistiti pacientul Pozitie semisezanda, tineti-l de mana Nu miscati pacientul, nu-l lasati sa efectueze nici un effort,

sau sa se ridice si sa mearga Oxigen pe masca Monitorizare de functii vitale Anuntare din timp si echipaj specializat in vederea

trombolizei sau angioplastiei

Urgente medicaleSincopa- pierdere temporara de constienta Atunci cand fluxul sanguin cerebral este

temporar inadecvat Fie cu semnificatie medicala minima, fie o

cauza grava. Semne si simptome:

1.ameteli,greturi, tulburari de vedere2.transpiratii, paloare, tahicardie

SincopaSistem nervos Encefal, maduva spinarii, nervi. Semnale de la si catre creier Controleaza si activitatea mm involuntare Neuroni motori Neuroni senzitiviInconstienta: intreruperea functionarii normale a creiereului.Grade: A= alert V= voce P= pain (durere) U= unresponsive (nu raspunde)

Sincopa Cauze de pierdere a constientei

F - FaintingI - Infantile ConvulsionsS - ShockH - Heat Imbalance

S - StrokeH - Heart AttackA - AsphyxiaP - PoisoningE - EpilepsyD - Diabetes

Scorul GlasgowA Deschiderea ochilor- Spontan= 4- La cerere= 3- La durere= 2- Nu deschide= 1B Cel mai bun raspuns motor-la ordin= 6-localizeaza stinul dureros= 5-retrage la durere= 4-flexie la durere= 3-extensie la durere= 2-nici un raspuns= 1C. Cel mai bun raspuns verbal-orientat= 5-confuz= 4-cuvinte fara sens= 3-zgomote= 2-nici un raspuns= 1

Sincopa1. Evaluare initiala2. Decubit dorsal, membrele pelvine ridicate

30 cm. nu permiteti pozitia sezanda3. Monitorizati A,B,C4. Largiti orice imbracaminte care strange la

nivelul gatului, toracelui, taliei5. Verificati daca s-au produs leziuni in

timpul caderii6. Solicitati asistenta medicala

Accidentele vasculare cerebrale Situatie in care unul sau mai multe vase

sanguine cerebrale sunt ocluzionate sau lezate, ceea ce conduce la moartea celulei nervoase prin lipsa de oxigen

Cauze; Trombi Hemoragii Emboli

Accidentele vasculare cerebraleSemne si simptome;1. Debut brusc2. Cefalee3. Ameteli, confuzie, salivatie4. Slabiciune sau pareza/paralizie a unui hemicorp5. Pierderea expresivitatii faciale si asimetria gurii6. Vedere dubla7. Dificultate de vorbire sau/ si intelegere8. Anizocorie, greturi, varsaturi9. Inconstienta10. Convulsii11. Stop respirator12. Incontinenta sfincteriana

Accidentele vasculare cerebraleEvaluare:

fata, membrele superioare, vorbirea

Unul dintre acestea anormal- probabilitate de AVC de aproximativ 70%

Accidentele vasculare cerebrale Decubit dorsal, capul si umerii usor ridicati Evaluati si mentineti ABC Solicitati ajutor Pozitie laterala de siguranta incazul pacientului

inconstient care respira Mentineti pacientul linistit si in confort termic Stabiliti GCS Monitorizare de functii vitale Nu administrati nimic per os

Crize convulsive Convulsii: miscari ale corpului cauzate de

contractii musculare involuntare, cauze; epilepsie, traumatisme craniene, infectii, febra.

Confuz si dezorientat dupa convulsii Semen si simptome:1. “aura” vizuala, sonora, gustativa sau olfactiva2. ‘”strigat”3. Pierdere completa sau partiala a constientei si

rigiditate musculara4. Spasme ale membrelor5. “spume” la gura6. Posibila emisie de urina si fecale

Crize convulsive: conduita1. Stai calmi- criza inceputa nu poate fi oprita2. Asezati pacientul in decubit dorsal, protejandu-l de alte lovituri, NU

IMOBILIZATI PACIENTUL!3. Indepartati obiectele apropiate ascutite, fierbinti, dure si ochelarii

pacientului pentru a preveni leziunile4. NU INTRODUCETI NIMIC INTRE DINTI SAU IN GURA PACIENTULUI si nu

imobilizati pacientul in nici un fel5. Slabiti hainele stranse din jurul gatului, a taliei, a toracelui6. Nu va panicati dac pacientul nu respira pentru scurt timp in timpul crizei7. Dupa incetarea crizei : pozitie laterala de siguranta8. Evaluati si mentineti ABC9. Nimic per os10. Solicitati asistenta medicala11. Monitorizati si evaluati continuu

Stare neuro-psihica specifica post criza: somn, sau anxietate, ostilitate, violentaEvaluati eventualele traumatisme produse prin cadere (! La coloana cervicala)

INTOXICATIILEAgent toxic= substanta ce cauzeaza stari de rau sau chiar deces atunci cand este mancata, bauta, inhalata, injectata sau absorbita chiar si in cantitati mici

Consideratii generale: Evaluati daca este sigur sa intrati in incapere, atentie la

mirosuri, cautati ambalaje sau alte semne Nu va apropiati daca e nesigur, solicitati ajutor specializat! ancheta minutioasa-ingestie: tub digestiv-inhalare: gura, nas- sistem respirator-injectarea: ac sau intepatura de insecta sau sarpe-absorbtie- prin pieleSemne si simptome : istoricul (ce?, cum?, cand?, cat?,

recipiente goale), respiratia, sistem digestiv, sistem nervos, salivatie, sudoratie

INTOXICATIILEPrin ingestie- cele mai frecvente ABC Se cauta cutii si ambalaje ce vor fi transportate

cu pacientul la spital Pacient constient: se provoaca varsatura Pacient inconstient: pozitie laterala de siguranta Dilutia: cantitati de apa administrate pacientului

constient in cazuri bine determinate Voma: indusa in situatii specifice, nu la pacienti

cardiaci, la cei care au ingerat acizi, substante alcaline sau kerosen

Carbunele activat: numai sub indrumare ! Intoxicatiile cu ciuperci!!!!

INTOXICATIILEInhalatie- Monoxidul de carbon- Fum- Gaze iritante (amoniac si cloruri)Conduita:-Protectia personala!!!!-scoaterea din mediu-ABC-pozitie laterala pt pacientii inconstienti-112

INTOXICATIILEAgenti injectatiMuscatura/intepatura de insecta sau sarpeSemne: Inflamatie, edem Coloratie la locul intepaturii Slabiciune, oboseala Direre locala Pririt Dispnee, wheezing Puls filiform Greturi, varsaturi, diareeMuscatura de sarpe- conduita: Linistiti pacientul, spalati cu apa si sapun Dezinfectia plagii Garou- dar nu strans Membrul afectata procliv Pungi de gheata 112, supraveghere si monitorizare NU INCIZATI!Intoxicatiile prin absorbtie Urme de lichid sau praf pe piele, piele rosie, inflamata, arsuri chimice, urticarie,

prurit, grata, varsaturi, soc Conduita: se indeparteaza substata- scoatere din medieu, scoase hainele, se perie

(NU SE SPALA) substanta de pe corp, apoi se spala cu apa 20 de min, tratamentul socului

Intoxicatia acuta etanolica Etanolul- ingredient principal al vinului, berii etc Clasificat ca si drog- deprima SNC, afectand

activitatile fizice si mentale Confera dependenta Afectare in etape: relaxare si stare de bine,

pierderea gradata a coordonarii. Incapacitate de a efectua activitati si indatoriri uzuale

Depresie a respiratiilor, pierdere de constienta, coma, deces

Sevrajul: delirium tremens

Intoxicatia acuta etanolicaSemne si simptome;1. Halena alcoolica2. Dezechilibrare si vorbire ingreunata3. Greturi, varsaturi si facies vultuos Semne ce pot fi identice cu ale unor afectiuni altele decat

intoxicatia etanolicaIn caz de suspiciune;1. Decubit dorsal, protejati de leziuni2. ABC3. Evaluare initiala4. Monitorizati atent- pacientul poate deveni inconstient5. Nu criticati, fiti fermi6. Nu plecati niciodata de langa el7. Solicitati asistenta medicala

Urgente comportamentale= situatii in care pacientii manifesta un comportament

anormal, inacceptabil, ce nu poate fi tolerat de pacienti, familie, prieteni sau comunitate.

Factori incriminati in schimbari de comportament:1. Conditii medicale: diabet, hipoxie, febra,frig, etc2. Trauma psihica3. Trauma fizica (TCC)4. Boli psihiatrice5. Substante ce afecteaza gandirea6. Stress situational (traume emotionale)Etape:1. anxietate/ soc emotional2. Negare3. Furie4. Remuscare/ durere/ resemnare

Urgente comportamentaleManagement: Siguranta salvatorului Evaluarea generala a scenei Evaluarea primara apacientului Evaluare secundara Sample Evaluare continuaComunicare: parafrazare, redirectionare, empatie, controlul

multimiiViolenta impotriva salvatorilorTentativa de suicidViolulMoarteaConsiliere dupa un eveniment critic