MASURI DE PRIM AJUTOR2011

PLANDefinitie, Obiective, PrincipiiEVIDENCE BASED MEDICINE-medicina bazata pe doveziAspecte etico-medico-legale si epidemiologice ale CPR si primului ajutorNotiuni elementare de anatomie si fiziologieCPR: definitieLantul supravietuiriiBLS la adult

INTRODUCEREProceduri 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 AJUTORMasuri 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 vietiiPrevenirea producerii in continuare a leziunilorReducerea la minimum/prevenirea infectiilorCei trei P P - Preserve Life. P - Prevent the condition worsening. P - Promote RecoveryFace diferenta dintre:Leziune temporara/permanentaVindecare rapida/ infirmitate permanentaViata/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 statisticeEvidence-based medicine incearca sa exprime beneficiile clinice ale testelor si tratamentelor utilizand metode statistice

EBM- stadializarea nivelurilor de evidentaEvidence-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.

GhiduriUn 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 aerieneB. Breathing: Mentinerea respiratiilorC. Circulation: Mentinerea circulatiei+Oprirea hemoragiilorPrevenirea/ reducerea socului

PRIM AJUTOREvaluare initialaInspectia rapida a zoneiPericole (curent electric, foc, apa, haz mats, obiecte instabile, ascutite, animale)TraficViolentaConditii de relief si climaSituatii specialePreluarea controlului calm, rapid si eficient

PRIM AJUTORSe vor evalua:1. SIGURANTA proprie si a pacientului2. MECANISMUL DE PRODUCERE A LEZIUNIIConstientInconstient3. INFORMATII TRANSMISE PE CAI SPECIALEMedalion, bratara cu simboluri card cu informatii

PRIM AJUTOR4. NUMARUL VICTIMELORCand sunt mai multe- evaluarea A,B,sangerare si C5. MARTORIPot furniza informatii, ajutor chiar daca sunt nepregatiti prin: apel de urgenta, suport moral victimei, impiedicarea imixtiunii altor persoane6. PREZENTATI-VA ca persoane calificate in prim ajutor; consimtamant cerut celor constienti, prezumat pentru cei inconstienti

Aspecte etico-legaleDatoria de a interveni(desemnata, serviciu sau responsabilitate preexistaenta fata de victima)Standard: cat si pentru ce aveti calificareConsimtamant= acord, permisiunePacient constient/inconstientMinor/majorBolnavi cu afectiuni psihiatriceExprimat/prezumatConfidentialitateaLegea Bunului Samaritean (urgenta, cu bune intentii, fara compensatii, fara a produce daune/leziuni)AbandonNeglijenta (datorie, nerespectarea datoriei sau substandard, producere de leziun/daune, nerespectarea limitelor)

Aspecte etico-legaleSecventalogica:Obtineti consimtamantul victimei INAINTE de A O ATINGEUrmati ghidurile si protocoalele pentru care ati fost instruiti, fara a va depasi nivelul de competentaExplicati victimei fiecare lucru pe care urmeaza sa-l facetiOdata 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 SETTINGSTo initiate resuscitationNot to initiate resuscitationTo terminate resuscitationIN HOSPITAL RESUSCITATIONTo initiate resuscitationNot to initiate resuscitationTo terminate resuscitationTo 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

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 necesar7. Mentineti temperatura normala a corpului

PRIM AJUTOR-aspecte epidemiologiceTransmitere de boli infectioaseHIVVirusul hepatitei B, CTuberculozaMasuri de protectie universala- orice pacient trebuie considerat potential purtator de agenti cu transmitere sanguinaPurtati manusi sau folositi alta barieraSpalati-va mainile cu apa calda si sapun:La venire/plecareInainte/dupa examinare, proceduraDupa scoaterea manusii, mastiiDupa folosirea batistei, toaletei, trecere prin par, activitati administrative/gospodarestiBariera pentru respiratii artificiale, protectie oculara

NOTIUNI ELEMENTARE DE ANATOMIE SI FIZIOLOGIE

Notiuni elementareOXIGEN PLAMANI SANGE

CELULEGLUCIDELIPIDEPROTEINE

Ce se intampla dacaSe 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 ARRESTApproximativ 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: GhiduriThe 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).

CPRCardiopulmonary 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

Istoric1740 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.

SCA40% din victimele SCA: FVDeteriorare in asistolie- sanse reduse de resuscitareTratament 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 SUPRAVIETUIRIIRecunoastera precoce si activarea sistemului de urgenta: poate preveni SCREarly CPR:dubleaza/tripleaza supravietuirea din fvFiecare 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 SUPPORTsecventa de proceduri efectuate pentru a restabili circulatia sangelui oxigenat dupa un SC/RCompresii sternale si ventilatie pulmonara efectuate de oricine care stie cum sa o faca, oriunde, imediat, fara alt echipament.

Approach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

APPROACH SAFELY!

Scene

Rescuer

Victim

BystandersApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

Factori de risc legati de scena actiuniiMediuTraficcladiriElectricitateApa, focToxiceVictimaBoli infectioaseIntoxicatiiTehniciDefibrilatoareInstrumente taioase sau ascutite

Training- manechin

Risk factorsInfection tramsmissionsAccidents with needles Rescuers having wound on their mouth, handsCase reports of tuberculosis, SARS, but no case report of HIV transmissionMannequins: 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 RESPONSEApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

CHECK RESPONSEShake shoulders gentlyAsk Are you all right?If he responds Leave as you find him. Find out what is wrong. Reassess regularly.

SHOUT FOR HELPApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

OPEN AIRWAYApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 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 AIRWAYHead tilt, chin lift + jaw thrust- healthcare professionals

AIRWAY OPENING BY NECK EXTENSION

CHECK BREATHINGApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

CHECK BREATHINGLook, listen and feel for NORMAL breathing

Do not confuse agonal breathing with NORMAL breathing

Respiratii agoniceApar 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 safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 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

ADULT FBAO TREATMENT

ABDOMINAL THRUSTS

30 CHEST COMPRESSIONSApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

CHEST COMPRESSIONSPlace the heel of one hand in the centre of the chestPlace other hand on top Interlock fingersCompress the chestRate 100 min-1Depth 4-5 cmEqual compression : relaxationWhen possible change CPR operator every 2 min

The most effective rate for chest compressions is 100 compressions per minute the same rhythm as the beat of the BeeGees song, Stayin Alive. http://www.dailymotion.com/video/x1afd7_bee-gees-staying-alive_music

RESCUE BREATHSApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

RESCUE BREATHSPinch the noseTake a normal breathPlace lips over mouthBlow until the chest risesTake about 1 secondAllow chest to fallRepeat

RESCUE BREATHSRECOMMENDATIONS:- Tidal volume 500 600 ml

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

- Chest-compression-only continuously at a rate of 100 min

CONTINUE CPR

302

Hands-only CPR

DEFIBRILLATION

Call 112Approach safelyCheck responseShout for helpOpen airwayCheck breathingAttach AEDFollow voice prompts

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)Some AEDs will automatically switch themselves on when the lid is opened

ATTACH PADS TO CASUALTYS BARE CHEST

ANALYSING RHYTHM DO NOT TOUCH VICTIM

SHOCK INDICATEDStand clearDeliver 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 safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breathsApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 112Attach AEDFollow voice prompts

CONTINUE RESUSCITATION UNTIL Qualified help arrives and takes over

The victim starts breathing normally

Rescuer becomes exhausted

CHEST COMPRESSIONS- infant, lone rescuerLone rescuer: compress the sternum with the tips of two fingers

CHEST COMPRESSIONS- children over 1 year

Pediatric FBAO

Pediatric FBAONo abdominal thrusts for choking infantsRisk because of the horizontal position of the ribs- upper abdominal viscera more exposed to trauma

Pediatric AEDAutomated 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 5075 J and these are recommended for children aged 18 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

DrowningWHO: worldwide,drowning accounts for approximately 450,000 deaths each yearA common cause of accidental death in Europethe duration of hypoxia is the most critical factor in determining the victims outcomeoxygenation, ventilation and perfusion should be restored as rapidly as possibleCPR by a bystander and immediate activation of the EMS system.

Drowning- epidemiology97% of deaths from drowning occur in low- and middle-income countriesmore common in young malesis the leading cause of accidental death in Europe in young malessuicide, traffic accidents, alcohol and drugabuse varies between countries

Drowning: definitionILCOR: a process resulting in primaryrespiratory impairment from submersion/ immersion in a liquid medium.a liquid/air interface is present at the entrance of the victims airway: the victim does not breathe air.Immersion=to be covered in water or other fluidDrowning: 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: pathophysiologycardiac arrest occurs as a consequence of hypoxiathe victim initially breath holds before developing laryngospasm.this time the victim frequently swallows large quantities of water.breath holding/laryngospasm continues, hypoxia and hypercapnia developsvictim aspirates water into their lungs leading to worsening hypoxaemia

Drowning: treatmentaquatic rescuebasic life supportadvanced life supportpost-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 timesattempt to save the drowning victim without entry into the water.talking to the victimrescue aidthrowing a ropeuse a boat or other water vehicleIf entry into the water is essential, take a flotation device.safer to enter the water with two rescuersNever 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 survivalGive five initial ventilations/rescue breathsRescue breathing can be initiated whilst the victim is still in shallow water provided the safety of the rescuer is not compromisedmouth-to nose ventilation may be used as an alternative to mouth-to-mouth ventilationIn-water resuscitation: 1015 rescue breaths over approx. 1min .normal breathing does not start spontaneously, and the victim is

Drowning: treatment2.BLSChest compressionon a firm surface before starting chest compressions as compressions are ineffective in the waterConfirm the victim is unresponsive and not breathing normally and then give 30 chest compressions, tan 30:2Compression-only CPR: to be avoided.Automated external defibrillationif an AED is available, dry the victims 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 pressuresRegurgitation of stomach contents and swallowed/inhaled water is common during resuscitation from drowningturn the victim on their side and remove the regurgitated material using directed suction if possibleAbdominal 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

DrowningDiscontinuing resuscitation effortsSalt versus fresh water.Hypothermia after drowning.Victims of submersion: primary or secondary hypothermiaSubmersion occurred in icy water (

Electrocution0.54 deaths per 100,000 people/yearElectrical 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 yearElectric shock injuries: the direct effects of current on cell membranes and vascular smooth muscleThe thermal energy associated with high-voltage electrocution: burns

ElectrocutionFactors influencing the severity of electrical injurycurrent: alternating (AC) or direct (DC)voltage, magnitude of energy delivered, resistance to current flow, pathway of current through the patient,the areaduration of contactContact 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

Electrocutionparalysis of the central respiratory control system or the respiratory muscles: respiratory arrestVF if it traverses the myocardium duringthe vulnerable periodmyocardial ischaemia because of coronary artery spasm.asystole may be primary, or secondaryto asphyxia following respiratory arrestcurrent that traverses the myocardium is more likely to be fataltransthoracic (hand-to-hand)>a vertical (hand-to-foot)/straddle (foot-to-foot)

Lightning strike300 kV over a few milliseconds.the current from a lightning strike passes over the surface of the body in a process called external flashoverIndustrial 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 wristsLightning: mostly on the head, neck and shoulders.Lightning can also cause:central and peripheral nerve damage; brain haemorrhage and oedema,Peripheral nerve injuryMortality 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: ResuscitationAirway management may be difficult if there are electrical burns around the face and neckextensive soft-tissue edema may develop causing airway obstructionHead and spine trauma can occur after electrocution. Immobilize the spine until evaluation can be performed.Muscular paralysis, especially after high voltage, may persist several hoursRemove smoldering clothing and shoes to prevent further thermal injury.Maintain spinal immobilization if there is a likelihood of head or neck traumaConduct a thorough secondary survey to exclude traumatic injuries caused by tetanic muscular contraction or by the person being thrownElectrocution 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 pregnancyproblems associated with pregnancy are caused by aortocaval compressionafter 20 weeks gestation, the pregnant womans uterus can press down against the inferior vena cava and the aorta, impeding venous return and cardiac outputThe 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. Ensuregood 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 hypothermiawhen the body core temperature unintentionally drops below 35 C.mild (3532 C), moderate (3228 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 thermoregulationduring exposure to cold environments, wet or windy conditionsin people who have been immobilized, orfollowing immersion in cold waterImpaired thermoregulation :in the elderly and very youngOther risk conditions:drug or alcohol ingestion, exhaustion,illness

Accidental hypothermiaThe core temperature measured in the lower third of the oesophagus correlates well with the temperature of the heart.epitympanic (tympanic) measurementthe method of temperature measurement should be the same throughout resuscitation and rewarmingDecision to resuscitatecellular oxygen consumption by 6% per 1 C decrease in core temperatureAt 28 C oxygen consumption is reduced by 50% and at 22 C by 75%.can exert a protective effect on the brain and vital organsIn a hypothermic patient, no signs of life (Swiss hypothermia stage IV) alone is unreliable for declaring deathAt 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 hypothermiaResuscitationthe same ventilation and chest compression rates as for a normothermic patientstiffness of the chest wall, making ventilation and chest compressions more difficultRewarmingremoval from the cold environment,prevention of further heat loss and rapid transfer to hospital.Swiss stagesII should be immobilized and handled carefullythe 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 shiveringSomnolent 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 burialasphyxia, trauma and hypothermiaavalanche 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 12 mmol

HyperthermiaDefinitionwhen the bodys ability to thermoregulatefails and core temperature exceeds the normally maintained by homeostatic mechanismsexogenous, caused by environmental conditionssecondary to endogenous heat production.Forms: heat stressheat exhaustionheat strokefinally multiorgan dysfunction and cardiac arrest Malignant hyperthermia (MH)

HyperthermiaHeat strokesystemic 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 elderlyExertional heat stroke (EHS) occurs during strenuous physical exercisein high environmental temperatures and/or high humidityusually affects healthy young adultsMortality from heat stroke ranges between 10 and 50%

HyperthermiaManagementABCDEs and rapidly cooling the patientStart cooling before the patient reaches hospital. Aim to rapidly reduce the core temperature to approximately 39 C.Cooling techniquesdrinking cool fluids, fanning the completely undressed patientspraying tepid water on the patientIce 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 resuscitationThere are no specific studies on cardiac arrest in hyperthermia.the prognosis is poor compared with normothermic cardiac arrest

Hyperthermia

SOCUL, HEMORAGIILE, LEZIUNILE TESUTURILOR MOISoculHemoragiiPlagiFracturiTraumatisme cranieneTraumatisme toraciceTraumatisme abdominale

1. SOCULPompaPresarcina Postsarcina

1. SOCULPompa: inima tetracameralaAtrii/ ventriculiMiocard contractilContractilitate/inotropismSistemul circulator:ArtereVenecapilareFluidul circulantElemente celulare (hematii, leucocite, trombocite)PlasmaPulsul

1. SOCUL

1.SOCULReprezinta 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 viataRecunoasterea semnelor si simptomelor- nu toate concomitent, nu imediat

1. SOCUL- semne si simptomeAnxietate, agitatie, confuzieTegumente palide, reci, umede, lipicioaseTahipnee, respiratii neregulateTahicardie/puls slab batut/ nepalpabil perifericGreturi, varsaturiSetePrivire goala, mohorata, pupile dilatate

1. SOCULI. Socul hipovolemic- cauzat de pierderea excesiva de sange sau fluide din organismApare in conditii de hemoragii, arsuri, varsaturi si diaree excesiveII.Socul cardiogen- deficit de pompa cardiacaIII. Socul septicSocul anafilactic- substanta cu rol de alergen- medicamente, venin de insecte si animale, praf si polen, alimenteSocul spinal

1. SOCUL: tratamentPozitionati pacientul: pe spate, cu membrele inferioare ridicate usor (20-30 cm). Exceptii: pozitie laterala de sigurantaleziuni de coloana suspectatetraumatisme cranienedispneeA, B, C : Mentineti deschisa calea aerianaIdentificati/ inlaturati cauza daca e posibilControlati 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 acesteiaNU alimentati, NU administrati lichide!112 si transport cu ambulanta cat mai repede la spitalUrmariti si reevaluati constant, monitorizati pulsul, respiratia, constienta la fiecare 5 minute.

2. HEMORAGIIPierdera sangelui la nivel capilar, venos sau arterialHemoragii interne- in interiorul corpuluiHemoragii externe- inafara corpuluiAmbeleHemoragii capilare- sangele baltesteHemoragii venoase- sange inchis la culoare, curgere fluenta, continuaHemoragii arteriale- sange rosu aprins, pulsatil- situatie amenintatoare de viata!

2. HEMORAGIIAdultul- 5-6 litri de sangePoate pierde fara consecinte aprox 0.5lLa peste 1l- soc2-3l- decesGreu de identificat uneori daca e arteriala sau venoasacapilare- 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 masurapansament steril sau tesut curatBandaj compresivInca un pansament sau propriul pumnNu 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 ososCu degetele, podul palmei sau mana!- flux inadecvat catre extremitateNU la nivelul carotidelor!Cele mai des utilizate- brahial, femural

2. HEMORAGII4. Garoul- NU!folosire descurajata!!!!doar ca ultima resursa!!!!doar la nivelul extremitatilorfolosit neadecvat poate duce la compromiterea definitiva a membrului sau agravarea hemoragieiBucata de tesatura, curea, fularNu folositi sarme, cabluri etc- ce ar putea taia pieleaNU ACOPERITI GAROUL!!!!!MARCATI POZITIA SI ORA!!!! NU-L MAI INDEPARTATI!!!!

2.HEMORAGIIHEMORAGII INTERNEDe obicei nu sunt la vederePot conduce la socHemoragii la nivelul gurii,varsaturi hemoragice, la nivelul urechilor, nasului, rectului sau altor orificii sunt considerate severe si indica prezenta hemoragiilor interneContuzii, corpuri contondente, fracturiSemne (inafara de eventiale exteriorizari): anxietate, agitatie. sete,greturi si varsaturi, tegumente reci, palide si umede, tahipnee, tahicardie cu puls slab palpabil

2. HEMORAGIIIn tesuturi moi: echimoze- contuziigheata sau pansament rece nu direct in contact cu pielea, ci prin tesaturi- reduce durerea si edemulHemoragii interne severe:Sunati la numarul de urgenta localMonitorizati ABCTratati socul*Plasati pacientul in pozitia cea mai confortabila*Mentineti confortul termicSustineti moral

2.HEMORAGIIEpistaxisulProdus de traumatism, factori de mediu, HTA, schimbari de altitudine, malformatii vasculare locale.Orice pacient suspectata de HTA cu epistaxis se evalueaza la spitalIn 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.HEMORAGIIConduita 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!

3.TRAUMATISMELE TESUTURILOR MOIPlagi= traumatisme ce produc efractia tegumentului, a tesutului subcutanat si altor mucoase.Inchise/deschisePlagi contuze/Plagi dilacerate/Plagi taiate/ intepate/ muscateRiscurile majore:- hemoragii si infectii

PLAGIGeneralitati- principii de tratamentPlagi recente: controlul hemoragiilor si prevenirea soculuiprevenirea infectieiStabilizarea partii lezateStabilizarea 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. PansamentPlagi mari: nu incercati sa spalati sau sa aplicati antiseptic. Acoperiti cu pansament steril, uscat

PLAGIControlul hemoragiei: compresa uscata, sterila, presiune directa, ridicare, puncte de presiuneNu se curata plagile in prespitalCompresa se fixeaza cu pansament compresivCompresa sa acopere plagaDaca se imbiba se plaseaza alta deasupra, nu se indeparteazaSe fixeaza cu rola sau pansament triunghiular

PLAGIDimensiuniLocalizareTipuri de plagi: INCHISE: ECHIMOZA (contuzie, edem, durere)Semn de fracturi sau leziuni severe subiacenteComprese reci/ gheata nu direct pe tegument!HEMATOMUL- leziune extinsa a tesuturilor moi cu pierdere de sange in interiorul tesutului- de obicei in zona fracturilorCompresie manuala, pansamente reci, imobilizare, pozitie elevata

PLAGIDESCHISEAbraziuni (escoriatii)Amputatii traumatice (complete, partiale)ABCControlul hemoragieiPansamentPrevenirea/ tratarea soculuiSolicita asistenta medicala de urgentaAvulsii- tegumentul este complet indepartat, smuls din zona respectivaHemoragii importanteRecuperati tegumentul, turnati apa, puneti-l in pansament steril, in punga inchisa, puneti cu gheata si trimiteti cu pacientul

PLAGITAIATE instrumente ascutite: cutite, lame, cioburi de sticlaHemoragii importanteCel mai mic risc de infectii

DILACERARI- plagi rupte, smulseINTEPATE

PLAGIMUSCATERisc de infectieRisc de rabieMinore: apa si sapunMari: controlul hemoragiei, comprese,bandajObligatoriu medic!IMPUSCATE-orificiu de intrare si iesireHemoragii interne

4. OASE, ARTICULATII SI MUSCULATURAFracturi, luxatii, entorse, contuziiLeziuni articulare impreuna cu cele musculareDificil 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 MUSCULATURALuxatiile= 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 MUSCULATURASemne si simptome pentru leziunile musculo-scheletale ale extremitatilor:DurerePlagaTumefiereDeformarea extremitatiiImpotenta 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 hemoragieiA membrului afectat: se compara membrul lezat cu cel sanatosSe indeparteaza haineleSe examineaza de la articulatiile superioare spre inferioarePacientul trebuie intrebat ce simte (durere, parestezii, nimic)Se evalueaza:circulatia: pulsul (in aval de leziune), recolorarea capilarasensibilitateamiscarea

Principii de tratamentImobilizare: Inainte de mutarea pacientuluiReduce durereaPrevine riscul de leziuni ulterioareReduce riscul sangerarii si a leziuniloe nervoaseTehnica imobilizariiSe indeparteaza haineleSe examineaza complet (puls, sensibilitate, motricitate)Se panseaza plagileSe imobilizeaza articulatia de deasupra si dedesuptul leziuniiSe reverifica pulsul si sensibilitateaSe 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 adeziveNu se aplica foarte strans, se lasa expuse extremitatile- degete

FRACTURIInchise- osul este fracturat, dar tegumentul ramane intactDeschise- osul este fracturat, tegumentul lezatComplicate- leziuni secundare(coasta ce perforeazaplamanul)

FRACTURICONDUITAControlul hemoragiei- Tratamentul soculuiMonitorizeaza ABCSe indeparteaza bijuterii, haine, usor, pentru a nu produce leziuni suplimentareSe verifica pulsul distal de fractura- absent:miscari lejere pana la palparea saSe acopera plagile cu pansament steril. NU se apasa capetele osoase inapoi in plagaSe plaseaza atela

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

FRACTURIANTEBRATBRAT

FRACTURIFEMURGAMBAROTULA

FRACTURICOLOANA VERTEBRALAMielice durere, soc, paralizieAmielice-Leziune de coloana cervicala se suspecteaza la:Orice politraumatismOrice TCCOrice traumatism toracic superiorDeformari la nivelul gatuluiOrice pacient constient care acuza dureri la nivelul gatuluiOrice pacient traumatizat cu status mental alterat

Conduita:Pozitie decubit dorsal, stabilizarea capului si gatului in pozitia gasitaCai aeriene: subluxatia mandibulei, ABCSe mentine pozitia neutra a capului si gatului- guler improvizat din prosopSe trateaza socul. Nu se ridica picioareleNu permiteti miscari, nu mobilizati, ajutor medical.

Mobilizarea victimelor: principii generaleSa nu provocati mai mult rauSe mobilizeaza pacientul doar daca e necesarCat mai putin posibilSe mobilizeaza corpul ca un totSe folosesc tehnici de ridicare si mutare adecvate sigurantei personaleUn 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 cranianaEpistaxis sau otoragieCefalee severaAlterarea starii de constienta in secundeAspect echimotic in jurul ochilor sau retroauricularApneeConfuziePierderea echilibruluiPareza sau incapacitatea de a mobiliza membreAnizocorieVarsaturi/vorbire dificilaConvulsii

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 necesitateOpriti sangerarile. Presiune directa cu pansament steril sau textil curat. Nu aplicati compresie daca suspectati fractura cranianaMonitorizati schimbarile de dinamica a respiratiei si constienteiIn lipsa circulatiei- CPR

Traumatismele cranienePlagile la nivel cranian:Zona bine vascularizata: hemoragii masivePresiune directaComprese fixate cu fasaSuspiciune de fractura craniana: nu compresieObraji: pansament compresiv in guraTraumatismele oculare:Evaluare medicala obligatoriePozitie declivaSe acopera ochiul cu compresa uscataCorp strain: compresa si pahar de plastic sau hartie, se bandajeaza ambii ochi dupa avertizare prealabila!Nu se introduc substante in scop antiseptic!

Traumatismele gatuluiTrahee, esofag, artere si vene mari, vertebre, maduva spinariiPlagi: presiune directa pe sursa hemoragieiNu fesi circulare!Se mentine stabilitatea capului si gatuluiSe mentine permeabilitatea caii aeriene

Traumatismele toracicePlamani, vase mari, cord, coloana Dispnee si hemoragiiIn lipsa semnelor de obstructie aeriana: orice dispnee de evaluat pentru trauma toracica inchisa sau deschisaPneumotorax deschisUrgenta medicala cu risc vital

Traumatismele toraciceSemne si simptomeDispnee si durere toracica violentaCianoza, anxietatePrimul ajutor:Etanseizati rana cu mana sau orice obiect= pansament ocluziv (card de identitate). Pansament fixat pe 3 laturi. In caz de agravare, indepartati imediat!Pozitionati pacientul pe partea afectataTratati socul- pozitie semisezandaNimic per osSolicitati asistenta medicala de urgenta

Traumatismele abdominaleInchise: tegument intactDurere violenta, varsaturi, contractura musculaturii abdominaleDistensie abdominala, socPozitie antalgicaABCPlasati pacientul in pozitia cea mai confortabilaIndepartati cu grija hainele pentru a evalua corectTratati soculNimic per os

Traumatismele abdominaleDeschiseSemnele traumatismelor inchisePlagi intepate sau contuze, hematemezaDureri lombare

ABCIndepartati cu grija hainelePozitia cea mai comfortabila-pe spate, cu picioarele ridicate usor/ genunchi indoitiTratati soculOpriti hemoragiile. Nu atingeti si nu incercati sa repozitionati organele eviscerate. Acoperiti cu pansament steril cu ser fiziologic, fixat pe 4 laturiMentineti temperaturaNimic per osSolicitati asistenta medicala de urgenta

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

Air temps below 0Cskin freezes at -2oCSuperficial frostbite (mild)freezing of skin surfaceDeep frostbite (severe)freezing of skin and other soft tissues, may include boneHands, fingers, feet, toes, ears, chin, nose, groin area

FrostbiteSymptomsinitially redness in light skin or grayish in dark skintingling, stinging sensationturns numb, yellowish, waxy or gray colorfeels cold, stiff, woodyblisters may develop

Deep frostbyte

FrostbiteTreatmentremove from cold and prevent further heat lossremove constricting clothing and jewelryrewarm affected area evenly with body heat until pain returnswhen skin thaws it hurts!!do not rewarm a frostbite injury if it could refreeze during evacuation or if victim must walk for medical treatmentdo not massage affected parts or rub with snowevacuate 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 FootSymptomsinitially appears wet, soggy, white, shriveledsensations of pins and needles, tingling, numbness, and then painskin discoloration - red, bluish, or blackbecomes cold, swollen, and waxy appearancemay develop blisters, open weeping or bleeding in extreme cases, necrosis

Trench/Immersion Foot

Trench/Immersion FootTreatmentprevent further exposuredry carefully DO NOT break blisters, apply lotions, massage, expose to heat, or allow to walk on injuryrewarm by exposing to warm airclean and wrap looselyelevate feet to reduce swellingDefer for medical treatment

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

Symptomsgritty feeling in eyesredness and tearingeye movement will cause painheadache

Treatmentremove from sunlightblindfold both eyes or cover with cool, wet bandagesseek medical attentionrecovery may take 2-3 days

Thermal burns

BurnsClassified according to the depth or degree of skin damageFirstSecondThird degree of burns

First Degree BurnCause:Overexposure to sunLight contact with hot objectsScalding by hot water or steam

Signs of First Degree BurnsErythemaMild Swelling & PainRapid Healing

First Aid: First Degree BurnsCold Water NOT Ice WaterBurn Lotion or Spray

NO BUTTER OR OINTMENTS

Second Degree BurnsResults from a very deep sunburnContact with hot liquidsFlash burns from gasoline etc.

Signs of Second Degree BurnsErythemaSwellingBlistersPainOpen WoundsWet appearance due to loss of plasma through damaged skin layers.

First Aid: Second Degree BurnsImmerse in cold water NOT ice waterApply cool compressesBlot dry & apply sterile gauze or clean cloth for protectionDO NOT break blisters or remove tissueDO 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 BurnsCaused by flame, ignited clothing, immersion in hot water, contact with hot objects, or electricity.

Signs of Third Degree BurnsWhite or Charred appearanceDeep tissue destructionComplete loss of all skin layersNerve DamagePain or No Pain

First Aid: Third Degree BurnsDO NOT remove pieces of adhered particles of charred clothing.Cover burn with thick, sterile or freshly laundered cloth.If hands or legs involved, elevateDO NOT immerse or apply ice water to burn area.DO NOT apply ointment, commercial preparations, grease, or other home remedies.

Chemical Burns of the SkinFirst Aid:Remove clothingFlush with water for 15 20 minutesGet name / source of ChemicalSeek Medical Attention

Burns of the EyesFirst Aid:Flush face, eyelid, & eye for 15 20 minutes Avoid rubbing eyeCover eyeSeek medical attention

ContinutUrgente medicaleAfectiunile cardiaceSindroamele coronariene acuteInsuficienta cardiacaSincopaAccidente vasculare cerebraleConvulsii

IntoxicatiileIntepaturile de animaleUrgentele comportamentale

Urgentele medicale: principii Abordarea unui pacient netraumatizat:Verificati zonaStabiliti contactul cu pacientul incercand sa identificati probleamPrezentati-vaEvaluare primara: ABCIdentificati cea mai importanta problema a pacientului112Incercati sa aflati rapid un istoric al pacientului dupa algoritmul:S: semn, simptomA: alergiiM: medicamenteP: probleme medicale anterioareL: (lunch) ultima masa- ce, cat si candE: evenimente asociateEvaluare secundara: Examen fizic rapid, monitorizare de functii vitaleSustineti moral pacientulEvaluati continuu

Sindroame coronariene acuteSituatie in care fluxul sanguin coronarian este intrerupt, conducand la necroza zonei de miocard din lipsa de oxigenAfectiune cardio-vascularaDurere retrosternala- a se suspecta un sindrom coronarian acut pana la proba contrarie!Factori de risc neinfluentabiliEreditateSexVarstaFactori de risc influentabiliFumatHTAColesterolObezitateSedentarismStressDiabet netratat

Sindroame coronariene acuteSemne si simptome:Dureri retrosternaleIradiere in mandibual, umeri. brate, gat, spateDispneeTegumente palide, umede, transpiratii profuzeAnxietate, greturi, varsaturiAstenieDaca suspectati:ABCPlasati pacientul in pozitia cea mai confortabila (sezanda sau semi)Mentineti pacientul linistit si in confort termicSlabiti hainele stranse din jurul gatului, a taliei, a toraceluiPregatiti-va sa efectuati CPRSolicitati asistenta medicala

Sindroame coronariene acuteAngina pectorala: durere toracica cu caracter constrictiv sau de apasare (rareori mai mult de 5 minute)NitroglicerinaConduita: linistirea pacientului si interzicerea oricarui efortOxigen pe masca daca e disponibilNitroglicerina s.l.Monitorizare de functii vitalePozitie semisezanda, 112

Sindroame coronariene acuteInfarctul miocardic acut (atac de cord)Cauze principale: ateroscleroza si trombozaDaca suprafata afectata din miocard este mare, inima se poate opri: stop cardiacConduita:112Vorbiti si linistiti pacientulPozitie semisezanda, tineti-l de manaNu miscati pacientul, nu-l lasati sa efectueze nici un effort, sau sa se ridice si sa meargaOxigen pe mascaMonitorizare de functii vitaleAnuntare din timp si echipaj specializat in vederea trombolizei sau angioplastiei

Urgente medicaleSincopa- pierdere temporara de constientaAtunci cand fluxul sanguin cerebral este temporar inadecvatFie cu semnificatie medicala minima, fie o cauza grava.Semne si simptome:1.ameteli,greturi, tulburari de vedere2.transpiratii, paloare, tahicardie

SincopaSistem nervosEncefal, maduva spinarii, nervi. Semnale de la si catre creierControleaza si activitatea mm involuntareNeuroni motoriNeuroni senzitiviInconstienta: intreruperea functionarii normale a creiereului.Grade:A= alertV= voceP= pain (durere)U= unresponsive (nu raspunde)

SincopaCauze de pierdere a constienteiF - Fainting I - Infantile Convulsions S - Shock H - Heat Imbalance S - Stroke H - Heart Attack A - Asphyxia P - Poisoning E - Epilepsy D - Diabetes

Scorul GlasgowADeschiderea ochilorSpontan=4La cerere= 3La durere= 2Nu deschide=1BCel 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

SincopaEvaluare initialaDecubit dorsal, membrele pelvine ridicate 30 cm. nu permiteti pozitia sezandaMonitorizati A,B,CLargiti orice imbracaminte care strange la nivelul gatului, toracelui, talieiVerificati daca s-au produs leziuni in timpul caderiiSolicitati asistenta medicala

Accidentele vasculare cerebraleSituatie in care unul sau mai multe vase sanguine cerebrale sunt ocluzionate sau lezate, ceea ce conduce la moartea celulei nervoase prin lipsa de oxigenCauze;TrombiHemoragiiEmboli

Accidentele vasculare cerebraleSemne si simptome;Debut bruscCefaleeAmeteli, confuzie, salivatieSlabiciune sau pareza/paralizie a unui hemicorpPierderea expresivitatii faciale si asimetria guriiVedere dublaDificultate de vorbire sau/ si intelegereAnizocorie, greturi, varsaturiInconstientaConvulsiiStop respiratorIncontinenta sfincteriana

Accidentele vasculare cerebraleEvaluare:fata, membrele superioare, vorbireaUnul dintre acestea anormal- probabilitate de AVC de aproximativ 70%

Accidentele vasculare cerebraleDecubit dorsal, capul si umerii usor ridicatiEvaluati si mentineti ABCSolicitati ajutorPozitie laterala de siguranta incazul pacientului inconstient care respiraMentineti pacientul linistit si in confort termicStabiliti GCSMonitorizare de functii vitaleNu administrati nimic per os

Crize convulsiveConvulsii: miscari ale corpului cauzate de contractii musculare involuntare, cauze; epilepsie, traumatisme craniene, infectii, febra.Confuz si dezorientat dupa convulsiiSemen si simptome:aura vizuala, sonora, gustativa sau olfactivastrigatPierdere completa sau partiala a constientei si rigiditate muscularaSpasme ale membrelorspume la guraPosibila emisie de urina si fecale

Crize convulsive: conduita

Stai calmi- criza inceputa nu poate fi opritaAsezati pacientul in decubit dorsal, protejandu-l de alte lovituri, NU IMOBILIZATI PACIENTUL!Indepartati obiectele apropiate ascutite, fierbinti, dure si ochelarii pacientului pentru a preveni leziunileNU INTRODUCETI NIMIC INTRE DINTI SAU IN GURA PACIENTULUI si nu imobilizati pacientul in nici un felSlabiti hainele stranse din jurul gatului, a taliei, a toraceluiNu va panicati dac pacientul nu respira pentru scurt timp in timpul crizeiDupa incetarea crizei : pozitie laterala de sigurantaEvaluati si mentineti ABCNimic per osSolicitati asistenta medicalaMonitorizati 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 miciConsideratii generale:Evaluati daca este sigur sa intrati in incapere, atentie la mirosuri, cautati ambalaje sau alte semneNu 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 frecventeABCSe cauta cutii si ambalaje ce vor fi transportate cu pacientul la spitalPacient constient: se provoaca varsaturaPacient inconstient: pozitie laterala de sigurantaDilutia: cantitati de apa administrate pacientului constient in cazuri bine determinateVoma: indusa in situatii specifice, nu la pacienti cardiaci, la cei care au ingerat acizi, substante alcaline sau kerosenCarbunele activat: numai sub indrumare! Intoxicatiile cu ciuperci!!!!

INTOXICATIILEInhalatieMonoxidul de carbonFumGaze 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, edemColoratie la locul intepaturiiSlabiciune, obosealaDirere localaPriritDispnee, wheezingPuls filiformGreturi, varsaturi, diareeMuscatura de sarpe- conduita:Linistiti pacientul, spalati cu apa si sapunDezinfectia plagiiGarou- dar nu stransMembrul afectata proclivPungi de gheata112, supraveghere si monitorizareNU INCIZATI!Intoxicatiile prin absorbtieUrme de lichid sau praf pe piele, piele rosie, inflamata, arsuri chimice, urticarie, prurit, grata, varsaturi, socConduita: 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 etanolicaEtanolul- ingredient principal al vinului, berii etcClasificat ca si drog- deprima SNC, afectand activitatile fizice si mentaleConfera dependentaAfectare in etape: relaxare si stare de bine, pierderea gradata a coordonarii. Incapacitate de a efectua activitati si indatoriri uzualeDepresie a respiratiilor, pierdere de constienta, coma, decesSevrajul: delirium tremens

Intoxicatia acuta etanolicaSemne si simptome;Halena alcoolicaDezechilibrare si vorbire ingreunataGreturi, varsaturi si facies vultuosSemne ce pot fi identice cu ale unor afectiuni altele decat intoxicatia etanolicaIn caz de suspiciune;Decubit dorsal, protejati de leziuniABCEvaluare initialaMonitorizati atent- pacientul poate deveni inconstientNu criticati, fiti fermiNu plecati niciodata de langa elSolicitati 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:Conditii medicale: diabet, hipoxie, febra,frig, etcTrauma psihicaTrauma fizica (TCC)Boli psihiatriceSubstante ce afecteaza gandireaStress situational (traume emotionale)Etape:anxietate/ soc emotionalNegareFurieRemuscare/ durere/ resemnare

Urgente comportamentaleManagement:Siguranta salvatoruluiEvaluarea generala a sceneiEvaluarea primara apacientuluiEvaluare secundaraSampleEvaluare continuaComunicare: parafrazare, redirectionare, empatie, controlul multimiiViolenta impotriva salvatorilorTentativa de suicidViolulMoarteaConsiliere dupa un eveniment critic