1st_aid.ppt for medical responder on the site

FIRST AID

1. First AidFirst Aid
Eduard Kasal,
MUDr., Ph.D., Assoc. Prof.
Department of Anaesthesiology and Intensive Care
Medicine
2014

2. First aidFirst aid
• It is better to know first aid and not to need it
than
to need it and not to know it.
• A delay… can mean the difference between
life and death.
However
• most injuries do not require life-saving efforts

3. First aidFirst aid
Definition:
… is the immediate care given to an injured
or suddenly ill person.
… also includes the things that people can
do for themselves.
…is one of those things you need to know –
but never want to use…

4. First aidFirst aid
…most people do not know first aid.
… even if they know it, they may
panic in an emergency.

5. First aidFirst aid
Legal considerations

• before giving first aid, a first aid provider should
have the victim´s consent (permission)
• expressed consent – conscious mentally
competent person of legal age
• implied consent – an unresponsive victim in a
life-threatening condition – “implied“ consent

6. First aidFirst aid
Legal considerations
Bystander = a vital link between the emergency
medical services and the victim.
Decision to help
Czech Republic: everybody is obligated to provide
first aid adequate to his knowledge and
possibilities…
Refusal to provide first aid
• extra-legal
• a new testimony legalized – driving away from the place of
traffic accident = crime

7. First aidFirst aid
Legal considerations
Foreigners
• are obligated to abide with laws of the country

8. Basic Life Basic Life
SupportSupport
First AidFirst Aid

9. BackgroundBackground
Approximately 700,000 cardiac arrests per Approximately 700,000 cardiac arrests per
year in Europeyear in Europe
Outcome:Outcome:
Survival to hospital discharge presently Survival to hospital discharge presently
approximately 5-10approximately 5-10 - 14 - 14%%
Bystander CPR Bystander CPR = = vital intervention before vital intervention before
arrival of emergency servicesarrival of emergency services
Early resuscitation and prompt defibrillation Early resuscitation and prompt defibrillation
(within 1-2 minutes) can result in >60% (within 1-2 minutes) can result in >60%
survivalsurvival

10. Chain of survivalChain of survival

11. CCardioardioPPulmonary ulmonary
RResuscitationesuscitation
DefinitionDefinition::
CPR is an emergency first-aid procedure CPR is an emergency first-aid procedure
that is used to maintain respiration and that is used to maintain respiration and
blood circulation in a person, whose blood circulation in a person, whose
breathing and heartbeats have suddenly breathing and heartbeats have suddenly
stopped, stopped,
((one or more vital functions failedone or more vital functions failed ). ).

12. CCardioardioPPulmonary ulmonary
RResuscitationesuscitation
Three Three basic vital functions:basic vital functions:

Breathing Breathing

Circulation Circulation

ConsciousnessConsciousness

13. CCardioardioPPulmonary ulmonary
RResuscitationesuscitation
HistoryHistory
1.1.Peter SafarPeter Safar - - Professor of Pittsburgh Professor of Pittsburgh
University presented in 1968 small book University presented in 1968 small book
“Cardiopulmonary Resuscitation”“Cardiopulmonary Resuscitation” ….….
2.2.Guidelines 2000Guidelines 2000
3.3.Guidelines 2005Guidelines 2005
Many changes of almost all algorithms Many changes of almost all algorithms
used for several tens of years…used for several tens of years…
Publication of new guidelines does not mean, that CPR Publication of new guidelines does not mean, that CPR
provided in accordance with previous guidelines is not provided in accordance with previous guidelines is not
effective and not correct, but we should follow them as effective and not correct, but we should follow them as
possible…possible…

14. www.erc.edu
Basic life support

15. CCardioardioPPulmonary ulmonary RResuscitationesuscitation
““TThoracic pump theory“ horacic pump theory“ - -
the chest compression propels blood the chest compression propels blood
out of the thorax by increasing out of the thorax by increasing
intrathoracic pressureintrathoracic pressure … …

the time of the chest compression and the time of the chest compression and
decompression should be equaldecompression should be equal

Pressure should be completaly releasedPressure should be completaly released

Hands should remain in the contact with Hands should remain in the contact with
the chestthe chest

16. CardioPulmonary ResuscitationCardioPulmonary Resuscitation
Theoretical backgroundTheoretical background
Oxygene contentOxygene content
In atmospheric air - 21%In atmospheric air - 21%
In alveoli - 14,5% In alveoli - 14,5%
Expired air Expired air – diluted by air from the airways – diluted by air from the airways
(dead space) (dead space)
- 16 – 18 % O2 - 16 – 18 % O2
Provided that there is an adequate amount of expired Provided that there is an adequate amount of expired
air reaching the victim's lungs, oxygen delivery will be air reaching the victim's lungs, oxygen delivery will be
sufficient to ensure that the victim's haemoglobin will sufficient to ensure that the victim's haemoglobin will
be over 80% saturated with oxygen.be over 80% saturated with oxygen.

17. Theoretical backgroundTheoretical background
Cardiac arrestCardiac arrest
1.1.AsystoleAsystole
2.2.Ventricular fibrillationVentricular fibrillation
Most cardiac arrest victims have an electrical Most cardiac arrest victims have an electrical
malfunction of the heart malfunction of the heart  heart´s pumping heart´s pumping
function abruptly ceasesfunction abruptly ceases
3. 3. Pulseless ventricular tachycardiaPulseless ventricular tachycardia = =
Fast ventricular contractions without Fast ventricular contractions without
haemodynamc effect haemodynamc effect Signs of the both = Signs of the both =
identical!!!identical!!!
Differential dg: only ECGDifferential dg: only ECG

18. Theoretical backgroundTheoretical background
At bestAt best
chest compressions chest compressions provide onlyprovide only 30% of 30% of
normal perfusionnormal perfusion  brain + heart brain + heart
Time! Time! Time! Time! Time! Time! Time! Time!Time! Time! Time! Time! Time! Time! Time! Time!
Failure of the circulation Failure of the circulation 3 - 53 - 5 minutes minutes 
irreversible cerebral damageirreversible cerebral damage..

Chances of successful CPR - restoration of Chances of successful CPR - restoration of
spontaneous circulation (ROSC) decreases by spontaneous circulation (ROSC) decreases by
10% with each minute following sudden 10% with each minute following sudden
cardiac arrest…cardiac arrest…

19. Cause of cardiac arrest and Cause of cardiac arrest and
emergency system activationemergency system activation
AdultsAdults
•Ischemic heart disease - Ischemic heart disease - AMI- with/or AMI- with/or
ventricular fibrillationventricular fibrillation ( (>> 80%) 80%)
CChildrenhildren
•SSuffocation or choking with hypoxemia or uffocation or choking with hypoxemia or
asphyxia. asphyxia.
Ventricular fibrillation is rare in children (only Ventricular fibrillation is rare in children (only
5-8%)5-8%)
Trauma Trauma

20. Cause of cardiac arrest and emergency system
activation

different approach to the emergency system activation.
Adults
electric defibrillator is necessary as soon as possible;
therefore, if telephone is available and you are alone:
1. call for help, then
2. start with CPR
Children
1. start CPR immediately for 1 minute to provide some
tissue oxygenation
2. then call for help

21. Emergency telephone number
155, 112
in the Czech Republic

22. Indication of CPRIndication of CPR

to victims with unexpected cardiac arrest to victims with unexpected cardiac arrest
in otherwise healthy individualsin otherwise healthy individuals ……

= = to those, who can be described as to those, who can be described as
having ”heart too good to die”having ”heart too good to die”

23. • malignant arrhythmia
• acute myocardial infarction (AMI)
• pulmonary embolism
• intoxication
• electrocution
• drowning
• acute suffocation
• severe trauma
• stroke and alike
Indication of CPR

24. CPR is not indicatedCPR is not indicated

signs of signs of definitive definitive biological deathbiological death

witnessed information, that cardiac arrest had happened 15 witnessed information, that cardiac arrest had happened 15
or more minutes before the rescuer arrived or more minutes before the rescuer arrived ((time time
assessment in the assessment in the stressing situation is notstressing situation is not preciseprecise))

terminal stage of incurable disease (generalised malignant terminal stage of incurable disease (generalised malignant
disease…)disease…)

aann evident trauma without chance to survive (catastrophic evident trauma without chance to survive (catastrophic
head injuryhead injury) )

““living will” living will” - - only in countries when constitution accepts itonly in countries when constitution accepts it

DNR -DNR - “Do not attempt resuscitation” has been written in “Do not attempt resuscitation” has been written in
the file (incurable disease after all available therapy the file (incurable disease after all available therapy
failed)failed)

executionexecution
Age of the patient is not restriction of CPRAge of the patient is not restriction of CPR

25. Ventricullar fibrilation – better than asystole
- in case of immediate CPR
Special emphasis

Soon defibrilation
 1 minute - survival - 90%,
 5 minutes - survival - 50%,
 7 minutes - survival - 30%
 10 - 12 minutes - survival - 2 – 5%.
Outcome after CPR

26. •In first 4 minutes – brain damage is unlikely, if
CPR started
•4 – 6 minutes – brain damage possible
•6 – 10 minutes– brain damage probable
•> 10 minutes – severe brain damage certain
Cells of the brain cortex
•Most sensitive for the stop of pefusion and
oxygenation
Without perfusion and oxygenation
 irreversibly damaged after 3-5 minutes
CPR outcome

27. Signs of cardiac arrestSigns of cardiac arrest
(Guidelines 2000)(Guidelines 2000)
1.1.    UnconsciousnessUnconsciousness in several secondsin several seconds
2.
   
2.
   
Respiratory arrestRespiratory arrest ( apnea) ( apnea) oror the last the last
gasps gasps ((1-3 minutes after cardiac arrest1-3 minutes after cardiac arrest))
3.
   
3.
   
Pulse-less on large ( major) arteriesPulse-less on large ( major) arteries
(carotid or femoral artery)(carotid or femoral artery)
4.
   
4.
   
Changed general appearanceChanged general appearance
(colour changes(colour changes, face changes…), face changes…)
5. 5. Pupils dilation (mydriasis) – not reliablePupils dilation (mydriasis) – not reliable

28. Signs of cardiac arrestSigns of cardiac arrest
(Guidelines 2005)(Guidelines 2005)

1.1.UnconsciousnessUnconsciousness
2.2.No reactivityNo reactivity
3.3.Absence of normal breathingAbsence of normal breathing

29. Basic conditions for CPRBasic conditions for CPR
1.1.Rescuer’s safety Rescuer’s safety = = the first prioritythe first priority
2.2.To To assess the risk of assess the risk of trauma, intoxication, trauma, intoxication,
infectioninfection ……
3.3.a a victim pvictim position: osition: supine on to his/her supine on to his/her
back back
4.4.on the firm flat surface to make on the firm flat surface to make
effective chest compressionseffective chest compressions
5.5.victim´s position in relation to rescuer´s victim´s position in relation to rescuer´s
positionposition
6.6.CPR during transfer ???CPR during transfer ???

30. The rescuer should never place him/herself or
others at more risk than the victim
• before starting resuscitation – assess the risks of
ongoing traffic, falling masonry, electrocution, toxic
fumes and poisons
• risk of infections transmission
•bloodborne infections (hepatitis B and C, HIV)
- can be transmitted by blood and other body
solutions, excretes
•airborne infections (TBC and several infectious
diseases - herpetic, meningococcal etc.
- can be transmitted by mouth-to-mouth breathing

Rescuer’s safety

31. •
Always: protect yourself !!!
•personal protective equipment (gloves)
•barrier protective devices
•Moth – to - barrier protective devices
breathing
Rescuer’s safety

32. Can control the risk of exposure to Can control the risk of exposure to
bloodborne pathogens –prevents an bloodborne pathogens –prevents an
organism from entering the body (medical organism from entering the body (medical
exam gloves, eye protection, mask)exam gloves, eye protection, mask)
All human blood and body fluids should be All human blood and body fluids should be
considered infectiousconsidered infectious
Mouth-to-mouth barrier devicesMouth-to-mouth barrier devices
Can prevent air-borne pathogens Can prevent air-borne pathogens
transmissiontransmission

Not documented case of disease transmissionNot documented case of disease transmission

But…But…should be used whenever possibleshould be used whenever possible
Personal Protective Personal Protective
EquipmentEquipment

33. BBarrier devicearrier devicess

S – tubeS – tube

Face shields (resuscitation veil )Face shields (resuscitation veil )

Pocket face mask + one-way valvePocket face mask + one-way valve

HandkerchiefHandkerchief

TowelTowel
CCardioardioPPulmonary ulmonary RResuscitationesuscitation

34. Stop CPR ifStop CPR if

Victim starts to breathe normallyVictim starts to breathe normally

Medical assistance arrives and instructs Medical assistance arrives and instructs
you to stop CPRyou to stop CPR

You are pYou are physically exhaustedhysically exhausted

35. WWhen CPR has been performed for hen CPR has been performed for 20 20 minutesminutes
without restoration of the spontaneous without restoration of the spontaneous
circulationcirculation
It can be stopped earlier, whenIt can be stopped earlier, when::

rescuer is rescuer is physicallyphysically exhausted exhausted


when signs of biological death develop (post-when signs of biological death develop (post-
mortal rigidity, post-mortal cooling and mortal rigidity, post-mortal cooling and
gravity-dependent livid stains)gravity-dependent livid stains) ??????

StopStop CPR CPR if: if:

36. CCardioardioPPulmonary ulmonary RResuscitationesuscitation
Safar´s aSafar´s algorithm of lgorithm of CCPRPR
stressing conditionsstressing conditions  an an ininadequate situation assessadequate situation assessmentment
AAirways irways
BBreathing reathing BLSBLS
CCirculation irculation ALS ALS
DDrugsrugs
EECGCG
?

37. New resuscitation New resuscitation
alphabet – in adultsalphabet – in adults
AlgoritAlgorithm of CPRhm of CPR
EEKGKG
CCirculationirculation BLSBLS
AAirwaysirways ALSALS
BBreathingreathing
DDrugsrugs

39. Kneel by the side of
the victim
BLS sequence

40. Shake shoulders
Ask “Are you all right?”
BLS sequence

41. If he responds
• Leave as you find him
• Find out what is wrong
• Reassess regularly
BLS sequence

42. Unresponsive
Shout for help
BLS sequence

43. Unresponsive
Shout for help
Open airway
BLS sequence

44. Unresponsive
Shout for help
Open airway
Check breathing
BLS sequence

45. 
Look, listen and feelLook, listen and feel for for
NORMAL breathingNORMAL breathing

No breathingNo breathing – apnea – apnea

GaspsGasps (agonal breathing) (agonal breathing)
BLS sequence

46. Agonal breathingAgonal breathing
Occurs shortly after heart stops in up to Occurs shortly after heart stops in up to
40% of cardiac arrests40% of cardiac arrests
Described as barely, heavy, noisy or Described as barely, heavy, noisy or
gaspinggasping breathing breathing
Recognise as a sign of cardiac arrestRecognise as a sign of cardiac arrest
Do not confuse agonal breathing with Do not confuse agonal breathing with
NORMAL breathingNORMAL breathing

47. Unresponsive
Shout for help
Open airway
Check breathing
Call 155 (112)
BLS sequence

48. Unresponsive
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
BLS sequence

49. 
Place the heel of one hand in Place the heel of one hand in
the centre of the chestthe centre of the chest

Place other hand on topPlace other hand on top

Interlock the fingersInterlock the fingers

Compress the chestCompress the chest

Rate 100 minRate 100 min
-1-1

Depth 4-5 cmDepth 4-5 cm

Equal compression : relaxationEqual compression : relaxation

When possible When possible (2 or more (2 or more
rescuers) rescuers) change CPR change CPR
operator every 2 minoperator every 2 min. to . to
prevent fatigueprevent fatigue
Chest compression

50. 
Place the heel of one hand in Place the heel of one hand in
the centre of the chestthe centre of the chest

Place other hand on topPlace other hand on top

Interlock fingersInterlock fingers

Compress the chestCompress the chest

Rate 100 minRate 100 min
-1-1

Depth 4-5 cmDepth 4-5 cm

Equal compression : relaxationEqual compression : relaxation

When possible When possible (2 or more (2 or more
rescuers) rescuers) change CPR change CPR
operator every 2 minoperator every 2 min. to . to
prevent fatigueprevent fatigue
Chest compression

51. 
Place the heel of one hand in Place the heel of one hand in
the centre of the chestthe centre of the chest

Place other hand on topPlace other hand on top

Interlock fingersInterlock fingers

Compress the chestCompress the chest

Rate 100 minRate 100 min
-1-1

Depth 4-5 cmDepth 4-5 cm

Equal compression : relaxationEqual compression : relaxation

When possible When possible (2 or more (2 or more
rescuers) rescuers) change CPR change CPR
operator every 2 minoperator every 2 min. to . to
prevent fatigueprevent fatigue
Chest compression

52. Unresponsive
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Chest compression

53. 
Pinch nosePinch nose

Place Place and seal your and seal your lips lips
over over the victim´s the victim´s mouthmouth

Blow until the chest risesBlow until the chest rises

TakeTakess about 1 second about 1 second

Allow chest to fallAllow chest to fall

RepeatRepeat (10 – 12 times (10 – 12 times
per minute)per minute)
2 rescue breaths

54. 
expired air resuscitationexpired air resuscitation - - severalseveral
techniques:techniques:
-- Mouth-to-mouth breathing Mouth-to-mouth breathing
 
 
 
 
-- 
Mouth-to-nose breathing
 
Mouth-to-nose breathing
  - - Mouth-to-mouth + nose breathing ( small Mouth-to-mouth + nose breathing ( small children)children)
 
     
 
     
-- 
Mouth-to
 
Mouth-to
the the barrier device ( to protect the rescuer)barrier device ( to protect the rescuer)
- Mouth to tracheostomy- Mouth to tracheostomy

Self-inflating bagSelf-inflating bag
B) BreathingB) Breathing

55. Artificial breath during expired air Artificial breath during expired air
resuscitationresuscitation

Volum = Volum = normal normal breathing volumbreathing volum

Volum = 6-7 ml/ kg bw = 500 mlVolum = 6-7 ml/ kg bw = 500 ml

Breath duration in adults = 1 second Breath duration in adults = 1 second
Expiration – passiveExpiration – passive

Check the chest rise during rescue breathCheck the chest rise during rescue breath
CCardioardioPPulmonary ulmonary RResuscitationesuscitation

56. Capacity 1500 ml
1 way valve
Volume controlled by compression
Breathing by atmospheric air
Oxygene source - conection
Oxygene reservoir – 100% O2
Self-infalting bag

57. Continue CPRContinue CPR
3030 : : 22
Continue CPR

58. Ratio 30 : 2
One uniform ratio
• always in adults
• in children in the prehospital CPR
• in children when the rescuer is alone

59. DefibrillationDefibrillation
Defibrillation

60. Automated External Automated External
Defibrilators (AEDs)Defibrilators (AEDs)
A new generation of “smart“ defibrilatorsA new generation of “smart“ defibrilators

Advanced computer technologiesAdvanced computer technologies

Ability to interprete heart (ECG) rhythmAbility to interprete heart (ECG) rhythm

Ability to determine whether Ability to determine whether
defibrilation is requireddefibrilation is required

Delivery of electric shockDelivery of electric shock

Guides the operator through every Guides the operator through every
actionaction

Provides voice and message promptsProvides voice and message prompts

Legal aspectsLegal aspects

61. Easier than CPREasier than CPR

Readily available on places with haevy Readily available on places with haevy
people concentration, where can be people concentration, where can be
probably used once during 2 yearsprobably used once during 2 years

Extendes beyon healthcare prefessional Extendes beyon healthcare prefessional
personnel to trained citizenspersonnel to trained citizens

AEDsAEDs

63. 
AEDs will AEDs will
automatically switch automatically switch
themselves on when themselves on when
the lid is openedthe lid is opened
Switch on AED

64. Attach pads to casualty’s bare chestAttach pads to casualty’s bare chest

65. Analyse rhythm – do not touch victimAnalyse rhythm – do not touch victim

66. Shock indicated – stand clearShock indicated – stand clear

67. Rescuer giving defibrilation shock
• is responsible for his safety
• is responsible for the safety of other
people surronding the victim

68. Immediately resume CPRImmediately resume CPR
30 : 2
Need new
picture

69. Give CPR every moment, when AED is Give CPR every moment, when AED is
not available, always if AED is not not available, always if AED is not
available within 5 minutesavailable within 5 minutes
30 : 2
Need new
picture

70. If victim starts to breathe normally If victim starts to breathe normally
place place him him in recovery positionin recovery position
Need new
picture

71.  
      
 
      
in case of the in case of the victimvictim´s hypothermi´s hypothermiaa
 
      
 
      
in case of persistent ventricular in case of persistent ventricular
fibrillation fibrillation = AED indicates = AED indicates
defibrilation shockdefibrilation shock
Responsibility during CPRResponsibility during CPR
CPR should not usually be CPR should not usually be
abandoned after abandoned after 2020 minutes minutes::

72. Indication:Indication:

wittnessed cardiac arrest (patient´s wittnessed cardiac arrest (patient´s
collapse)collapse)

adults onlyadults only

within 20 sec.within 20 sec.
Only experienced rescuersOnly experienced rescuers
Contraindications:Contraindications:

uknown time of cardiac arrest uknown time of cardiac arrest

chest injurychest injury

childrenchildren
Precordial chest thumpsPrecordial chest thumps

73. A. A. Airway managementAirway management

74. A)
Head tilted backward
Chin lift
Triple manouvre ???

75. „„A“A“
• head titlted
backward
• chin lift

76. Jaw thrust
• suspected cervical spine injury
• experienced rescuer ( anaesthesiologist)

77. Lower jaw pulled forward

79. 1. U1. Unconscious patient nconscious patient –– tongue tongue
tilt the head backwardtilt the head backward + lift the + lift the
chinchin
2. C2. Consciousonscious patient - foreign body airway patient - foreign body airway
obstruction obstruction  ch chokingoking - - partial partial
airway blockadeairway blockade

encourage the encourage the victimvictim to cough to cough

add several hits to his/her backadd several hits to his/her back

Cough is much more effective than any Cough is much more effective than any
other manoeuvreother manoeuvre..
A. A. Airway managementAirway management

80. 1.1.FForeign bodyoreign body airways obstruction airways obstruction
2.2.Potentially treatablePotentially treatable
3.3.Mostly during eatingMostly during eating
4.4.Commonly witnessed eventCommonly witnessed event
5.5.Oportunity for early interventionOportunity for early intervention
6.6.Can cause Can cause mild (partial)mild (partial) or or severe (comlete)severe (comlete) airway airway
obstructionobstruction

Heimlich manoeuvreHeimlich manoeuvre ((several thrusts (5)several thrusts (5)))
pregnant ladies, childrenpregnant ladies, children

A. A. Airway managementAirway management

81. Signs of Signs of mildmild (partial) (partial) large airways large airways
obstructionobstruction
SuffocationSuffocation
Difficult intensive inspirationDifficult intensive inspiration
Neck and thorax soft tissues retractionNeck and thorax soft tissues retraction
Hoarse (croupy) soundsHoarse (croupy) sounds accompanying accompanying
inspiration (inspiration (noisy breathingnoisy breathing))
Barking coughBarking cough
A. A. Airway managementAirway management

82. Signs of Signs of severe or completesevere or complete large large
airways obstructionairways obstruction

Difficult intensive inspiratory effortDifficult intensive inspiratory effort

Powerful breathing movementsPowerful breathing movements

Neck and thorax soft tissues retractionNeck and thorax soft tissues retraction

No breathing phenomena hearableNo breathing phenomena hearable

Patients non-cooperation, restlessness, Patients non-cooperation, restlessness,
convulsions, coma, blue skin colorconvulsions, coma, blue skin color
A. A. Airway managementAirway management

83. Equipment for airway
management

84. Diagnosis: Diagnosis:
•
Signs of functional circulationSigns of functional circulation
(breathing, coughing, movement, skin condition, (breathing, coughing, movement, skin condition,
responsiveness, pulse)responsiveness, pulse)
•
PPulse-less on large ( major) arteriesulse-less on large ( major) arteries – –
only experienced rescuersonly experienced rescuers
C: CirculationC: Circulation

85. Compression-only CPRCompression-only CPR
““Top-lessTop-less””

Reluctance of rescuers to perform mouth-Reluctance of rescuers to perform mouth-
to-mouth breathing on strangersto-mouth breathing on strangers

Unwilling person to breathe…Unwilling person to breathe…

Unability to perform …(vomiting, Unability to perform …(vomiting,
bleeding, trauma, unskilled rescuer…)bleeding, trauma, unskilled rescuer…)

Chest compressions onlChest compressions onlyy

Better some resuscitation than no Better some resuscitation than no
resuscitationresuscitation

86. Compression-only CPRCompression-only CPR

New recommendation of AHANew recommendation of AHA

Witnessed collapse of the patientWitnessed collapse of the patient

First 10 minutesFirst 10 minutes

Contraindications:Contraindications:

ChildrenChildren

Sudden cardiac arrest due to chokingSudden cardiac arrest due to choking

87. CPR in childrenCPR in children
Who is an infant?Who is an infant? 0 – 1 year0 – 1 year
Landmark between child and adult: Landmark between child and adult: pubertapuberta
Who is a child?Who is a child? 1 - puberta1 - puberta

88. CPR in childrenCPR in children
Differencies:Differencies:
Cause of cardiac arrest –choking, traumaCause of cardiac arrest –choking, trauma
Activation of emergency systemActivation of emergency system
Hypoxia developes faster – high metabolic rateHypoxia developes faster – high metabolic rate
Ventricular fibrillation – rareVentricular fibrillation – rare
Primary cardiac arrest uncommon, Primary cardiac arrest uncommon,
Precordial thump is contraindicatedPrecordial thump is contraindicated
Length of CPR = identicalLength of CPR = identical
Chain:Chain:
Choking- hypoxia – hypercapnia – apnoea – bradycardia – Choking- hypoxia – hypercapnia – apnoea – bradycardia –
cardiac arrestcardiac arrest

TraumaTrauma

89. CPR in childrenCPR in children
A)A)The most often cause of vital The most often cause of vital
functions failure = chokingfunctions failure = choking
Foreign body airway obstruction Foreign body airway obstruction
Infectious diseases afecting throat by Infectious diseases afecting throat by
swelling ( epiglotitis, acute suffocating swelling ( epiglotitis, acute suffocating
LTB, croup)LTB, croup)
Trauma Trauma

90. CPR in childrenCPR in children
Sequence of actionSequence of action

Rescuers with no knowledge of pediatric Rescuers with no knowledge of pediatric
resuscitation may use the adult sequence resuscitation may use the adult sequence
with with the exceptionthe exception that they should that they should

start with 5 initial breathsstart with 5 initial breaths followed by followed by

30 compressions30 compressions

30 : 2 for 1 minute30 : 2 for 1 minute

than call 155 (112)than call 155 (112)
butbut

Generally prefered ratio in children Generally prefered ratio in children
= 15:2 (in-hospital CPR, 2 rescuers)= 15:2 (in-hospital CPR, 2 rescuers)

91. CPR in childrenCPR in children
““A“A“

Identical with adultsIdentical with adults

More often inflamation throat diseases More often inflamation throat diseases
with swelling and suffocationwith swelling and suffocation

Foreign bodies!!!Foreign bodies!!! Small toys and toys Small toys and toys
that can be dismantled for small that can be dismantled for small
parts!!!parts!!!

92. CPR in childrenCPR in children
““B“B“

Look, listen and feelLook, listen and feel no more than 10 s no more than 10 s

Volum 6-7 ml /kg bwVolum 6-7 ml /kg bw

Blow steadily over Blow steadily over 1 – 1.5 sec.1 – 1.5 sec.

To make the chest visibly riseTo make the chest visibly rise

Start with 5 breathsStart with 5 breaths

Paediatric size of self-inflating bagPaediatric size of self-inflating bag

Adult self-inflating bag???Adult self-inflating bag???
Start with 5 breaths in adults with choking Start with 5 breaths in adults with choking
as well !!!!as well !!!!

93. CPR in childrenCPR in children
““C“C“

Look for Look for signs of circulationsigns of circulation (movements, (movements,
coughing, skin colour, breathing…)coughing, skin colour, breathing…)

Check the pulseCheck the pulse (if you are an experienced (if you are an experienced
health provider) no more than 10 shealth provider) no more than 10 s

Lower third of the sternumLower third of the sternum (1 finger above (1 finger above
xiphoid process)xiphoid process)

One third of the depthOne third of the depth of the chest of the chest

100 compressions per min.100 compressions per min.

94. CPR in childrenCPR in children
C)C)
Technique of chest compressionsTechnique of chest compressions
Rate of chest compressionsRate of chest compressions
Algorithm of CPR: 2:15Algorithm of CPR: 2:15
1 rescuer: 2:301 rescuer: 2:30
Infants: 1:3Infants: 1:3

95. CPR in childrenCPR in children
2 : 152 : 15
2 : 302 : 30

96. CPR in childrenCPR in children
Chest compressions in infantsChest compressions in infants

97. CPR in childrenCPR in children
Chest compressions in Chest compressions in
childrenchildren

102. • back blows
• chest thrusts
• abdominal compression
All manouevres   intrathoracic pressure

expulsion of FB out from the airways
50% of cases – more than 1 manouevre is
necessary
BLS in childrenBLS in children
FBAOFBAO

103. Complications during CPRComplications during CPR

Gastric distension Gastric distension –often in children–often in children
Prevention:Prevention: avoid overinflating the lungs avoid overinflating the lungs
appropriate volum making the chest riseappropriate volum making the chest rise

Rib fracturesRib fractures
Prevention:Prevention:
correct hand´s positioncorrect hand´s position
do not remove hands from the chest wall do not remove hands from the chest wall
prevent “dancing on the chest“)prevent “dancing on the chest“)

Gastric content (or other fluids) aspirationGastric content (or other fluids) aspiration
Prevention:Prevention:
prevent gastric distensionprevent gastric distension
recovery position in unconscious victimsrecovery position in unconscious victims

104. Children suffocation diseaseChildren suffocation disease

Croup:Croup: laryngotracheobronchitis laryngotracheobronchitis

age 1-3 yearsage 1-3 years, viral origin, viral origin

accompanbies influenza, children infection diseases, winter or early accompanbies influenza, children infection diseases, winter or early
spring seasonspring season

barking coughbarking cough

not sore throatnot sore throat

no special positionno special position

swalloving problemsswalloving problems

intercostal retractionsintercostal retractions

not so fast progression of suffocationnot so fast progression of suffocation

Dysfonia, afoniaDysfonia, afonia

105. Children suffocation diseaseChildren suffocation disease

EpiglottitisEpiglottitis

age 3-7 years, age 3-7 years, bacterial originbacterial origin

air hungerair hunger

aanxietynxiety

sitting position, hyperextended headsitting position, hyperextended head

severe sore throatsevere sore throat

swallowswallowinging problems, salivation problems, salivation

Severe inspiratory dyspnea with stridorSevere inspiratory dyspnea with stridor

Mortality 10% !!! underestimatedMortality 10% !!! underestimated

106. Children suffocation diseaseChildren suffocation disease
Both situationsBoth situations
Transfere to the hospital, where Transfere to the hospital, where
anaesthesiologist or intensivist is anaesthesiologist or intensivist is
available available
as soon as possible !!!!as soon as possible !!!!
Not to a general practicionerNot to a general practicioner

107. www.erc.edu

108. First aid
in special situations

109. BleedingBleeding
= escaped blood from the blood vessels
Hemorrhage – large amount of bleeding in a
short time
External bleeding –seen blood coming from an
open wound –outside the body
- often overestimated
Internal bleeding – inside the body
- often underestimated

110. BleedingBleeding
3 kinds according to its source:
1.Arterial
•bright red colour
•under pressure, comes out in spurts
•the most serious
•fast rate
•large blood loss
•less likely to clot (clot only when blood flow is slow)
•dangerous : it must be controlled

111. BleedingBleeding
3 kinds according to its source:
2. Venous
•dark red colour
•low pressure
•blood flow steadily
•it is easier to control
•most veins collaps when cut
but
•bleeding from deep veins can be as massive
as arterial bleeding !!!

112. BleedingBleeding
3 kinds according to its source:
3.Capillary bleeding
• oozing out, leaking
• most common
• blood oozes
• usually not serious
• easily controlled
• often it clots and stops itself
4. Mixed bleeding

113. Bleeding - clinical symptomsBleeding - clinical symptoms
Depend on - the quantity of the blood loss
- the rapidity of the blood loss
!!! Sudden loss of a large quantity of blood results in shock:!!! Sudden loss of a large quantity of blood results in shock:
- skin - cold, pale
- pulse - weak, fast
- mental disorders, fear, unconscioussness

114. BleedingBleeding
What to do?
the first aid is the same reagardless of the type of
bleeding
most important = to controll bleedingto controll bleeding

115. External bleedingExternal bleeding
Steps:
1.Protect yourself (exam gloves or improvizations)
2.Manual control of external haemorrhage

3.Expose the wound (remove or cut clothing) to find
the source
4.Place sterile pad or clean cloth and apply direct
pressure (fingers, palm, hand) = pressure over the
wound
5. If bleeding from arm or leg – elevate extremity
above the heart level + pressure over the wound

116. External bleedingExternal bleeding
Steps:
6.If bleeding continues – continue + apply pressure
against the bone at pressure points ( brachial or
femoral points ???)
7.Use pressure bandage – you have free hands for
help to other victims
8.For application of direct pressure – use ring pad
9.Tourniquets – rarely on the extremities – it can
damage nerves and vessels !!!
10.When you need it – use wide, flat materials and write
the time of application !!!

117. Internal bleedingInternal bleeding
 skin is not broken
 blood is not seen
 difficult to detect
 can be life threatening
 traumatic and nontraumatic origin
What to look for?
“Swelling“ on extremities in case of trauma
Contussion of the skin
Painful, rigid, tender abdomen
Vomiting or coughing up blood
Black stools or stool with bright red blood

118. Internal bleedingInternal bleeding
What to do?
Steps:
1.Check ABCs
2.Expect vomiting – keep the victim on his/her left side
3.Treat for shock:
Elevate legs
Cover the victim to keep him/her warm
Do not give a victim anything to eat and drink (prevention
of lung aspiration, can cause complications during
surgery)
Splinting extremities

bleeding

 pain

prevents nerve and vessels injury

119. Internal bleedingInternal bleeding
Loss of blood - long bones fractures:
•Pelvis 2 – 5 L
•Femur (tigh) 1 – 2,5 L
•Shin bones 1 – 1,5 L
•Arm ( humerus) 0,5 – 1 L
•Forearm – 0,5 L

120. ShockShock
Definition:
Circulatory system failure when insufficient amounts of
blood is provided for different parts of body (insuficient
perfussion)
Three components:
1.Heart pump  failure
2.Network of pipes (vessels)  enlargement
3.Adequate volume of circulated fluids  fluid loss
- blood
- plasma
- extracellullar fluids (vomit, diarrhoea, sweatting,
urine…)
Damage of any of these components can
produce conditions known as shock.

121. ShockShock
What to look for?
1.Altered mental status, restlessness
2.Pale, cold, clammy skin, livid lips
3.Limited perfussion of peripheral parts of the body
4.Capilary refil phenomenon – nail beds
5.Nausea and vomiting
6.Rapid breathing
7.Rapid weak pulse or pulseless on peripheral arteries
8.Unresponsiveness, when shock is severe
BP < 60 mm Hg

122. ShockShock
What to do?
1.Treat life-threatening injuries
2.Lay the victim on his/her back
3.Raise the victim´s legs ( if no evident injury) – drain
of blood from legs to the heart
4.Prevent body heat loss (blankets)
5.Splintig of long bones fractures
6.Seek immediate medical attention

123. ShockShock
What to do?
6. ABC
7. In case of severe shock - prevent peroral intake

nausea + vomiting

inhaling foreign material into the lungs

complications during surgery
8. Oxygene …
Bruises (suffusions) = a form of internal bleeding, but not life
threatening

124. Allergy, anaphylaxisAllergy, anaphylaxis
Definition: A powerful reaction to substances (eaten, injected,
contacted…) Reaction antigene + antibody.
Anaphylaxis = severe allergic reaction
Characteristics:
Occurs within minutes or seconds
Fast progression
Can cause death if not treated immediatelly
Common cause:
Medications, food + food additives, insect stings, plant and
flowers pollen, parfumes…

125. Allergy, anaphylaxisAllergy, anaphylaxis
What to look for ?
Fast development
Sneezing, coughing, wheezing
Shortness of breath
Suffocation (swelling in the throat, tongue, mouth, neck =
Quincke oedema…)
Tightness in the chest
Increased pulse rate
Dizzines
Nausea + vomiting
Diarrhoea
Anaphylactic shock
Urtica with skin itching (pruritus), blisters, quickly spreading
exanthema

126. Allergy, anaphylaxisAllergy, anaphylaxis
What to do?
Immediatelly interrupt the contact with allergene
Check ABCs
Seek immediate medical attention
Help the victim to use epinephrine, if he/she is
provided with

127. StrangulationStrangulation
Removing the body from the noose - prevention of body fall and other injuries
Suspected injury of
- the brain
- cervical spine, larynx, cervical vessels
(thrombosis of the carotid artery, of the jugular vein)
What to look for?
- Status of vital functions
What to do?
ABC
stabilize head against movement
seek medical attention
admission to the hospital ICU

128. SeizuresSeizures (convulsions) (convulsions)
Seizure (convulsions, crumps)
- is a burst of electrical activity from the brain that results in involuntary
movements, loss of consciousness (LOC), or both.
Basic classification
generalised - always LOC -
convulsive - tonic or combination of tonic with
- clonic convulsions (seizures) - urinary incontinence or
tongue biting may occur
nonconvulsive - absence, myoclonic
partial - no LOC

129. Risk factors:
Serum electrolyte disturbances - Na <120 or >160 mmol/l,
Ca<1mmol/l, Mg<0,5mmol/l
Drugs - amphetamine, cocaine, ethanol, TCAs
CNS infection - meningitis, encephalitis
Miscellaneous - CNS tumour
- hypertensive encephalopathy
- severe hypoxemia
- Head injury
SeizuresSeizures (convulsions) (convulsions)

130. Clinical signs:
Seizures have abrupt onset and last 1-5 minutes
the period of altered mental status can last up to 30
minutes
Status epilepticus - defined as seizures lasting
>30 minutes or two or more seizures without lucid
interval in between.
SeizuresSeizures (convulsions) (convulsions)

131. What to do?
Restrain the victim as necessary to protect from self-
injury and from secondary injury - cars and traffic
on the road, sharp objects in the proximity of the
patient
Bring the patient gently into recovery position to prevent
aspiration in the case of vomiting - rough treatment
could provoke other paroxysm
ABC as soon as the seizures stop
Call for help and arrange transport to the hospital
SeizuresSeizures (convulsions) (convulsions)

132. Near drowningNear drowning
Drowning is death from asphyxia secondary to submersion in a
liquid (usually water) or within 24 hours of submersion.
Near drowning is survival of suffocation secondary to submersion
in a liquid.
Mechanisms of near drowning
with aspiration - aspiration of water and vomitus
 in fresh water  loss of surfactant – fast absorbtion to
the circulation
 in see water  flooding of alveoli  hypoxemia (80-90%)
no aspiration – laryngospasm  spastic closure of glottis (vocal cords)
 hypoxemia (in 10-20%) = dry drowning.

133. What to do?
Extrication of the victim from the water - very dangerous
- protect yourself !!! rotect yourself !!!
ABCs - the earliest as possible - Airways + oxygenation +
ventilation
The airway should be checked for foreign material and
vomitus
Prevent additional hypothermia
Seek for medical attention
Near drowningNear drowning

134. Heat strokeHeat stroke
Heat stroke - defined as a heat injury + altered mental
status in consequence of failure of the body
temperature control.
Rectal (core) body temperature is above 40°C -
usually there is a history of exposure to exercise
or increased temperature and humidity.
Causes:
high ambient or environmental temperature
increased endogenous heat production
decreased ability to dissipate heat

135. Risk factors - extremes of age (infants and the elderly)
dehydration
alcoholism, medication (atropine)
Mortality is high because of the risk of multi-organ failure
Clinical signs:
hyperpyrexia
altered mental status
lack of or minimal sweating
ataxia
neurological deficit – paralysis (hemiplegia, Babinsky reflex)
Heat strokeHeat stroke

136. What to do?
ABC
Reduction of core temperature – water should be
- sprayed on undressed patient with breeze from fans or
- wrap the patient in wet packsheet till the temperature

falls to 38,5°C, then stop the cooling
Continuation of cooling could cause the uncontrolled
drop of body temperature.
Cold water immersion or air-cooling
Seek medical attention
Heat strokeHeat stroke

137. Heat cramps - are painful, involuntary contractions of skeletal
muscles that mostly involve the calves, thighs, and shoulders.
Causes - the same as those for heat stroke
The main risk factor - is the replacement of sweating losses
with plain (hypotonic) water. The hypo-osmolality can
lead to the brain edema with the cramps.
What to do?
Give to the patient the glass with salt water one half of the glass
every 15 min.
Massage the muscles to relieve the spasm
Seek medical attention
Heat crampsHeat cramps

138. Shivering
Besides goose pimples - as a part of “cold
stress reaction“  protective reaction
= an early response to cold stress
Shivering is able to increase the basal
metabolism rate two-to five fold
Heart oxygene and energetic consumption is
increased by 500%
It is operative between 30-37°C
Cold injuryCold injury - hypothermia - hypothermia

139. Clinical signs:
gradually deteriorating mental status
incoordination  confusion  lethargy 
coma
body is cold to touch, dysarthria
Tachycardia  bradycardia - ventricular fibrillation occurs at
temperatures 28°C
Hypertension  hypotension
Tachypnea (↑rate of breathing)  bradypnea (↓ rate of breathing)
Hyperreflexia  areflexia – fixed and dilated pupils with
coma at temperature below 22°C
Asystole - at 22º C
Cold injuryCold injury - hypothermia - hypothermia

140. Cold injuryCold injury - hypothermia - hypothermia
Cause - is the exposure of the person to the low
environmental temperature.
Hypothermia is supported by the wind and high humidity.
Classification
mild hypothermia core temperature - 32-35°C
moderate hypothermia - 28-32°C
severe hypothermia < 28°C
Risk factors :
extremes of age (infants and elderly)
accompanying diseases and bad status of health
alcohol intoxication and drug overdose

141. What to do?
In mild hypothermia:
Transport patient to the warm environment and give him
warm fluids (but no alcohol)
In severe hypothermia:
ABC
Transport the patient to the warm environment, undresse
him and remove the rings and all thing, that can
constrict lower and upper extremities and limit the
perfusion
Avoid movements with the patient´s body parts
Seek medical attention
Cold injuryCold injury - hypothermia - hypothermia

142. Frostbite - a cold-related contact injury
characterised by freezing of tissues
Most often affected parts of body =
peripheral - face, ears, nose, hands, feet,
penis and scrotum
Most cases - in soldiers, winter outdoor
enthusiasts, e.g. mountain climbers
Cold injuryCold injury - frostbite - frostbite

143. Pathophysiology - cold exposure leads to
ice crystal formation
cellular dehydration
protein denaturation
inhibition of DNA synthesis
abnormal cell wall permeability
damage to capillaries
pH changes
Cold injuryCold injury - frostbite - frostbite

144. Degree of injury
1st-degree injury - erythema, oedema, waxy
appearance, hard white plaques, and sensory
deficit
2nd-degree injury - erythema, edema, and
formation of clear blisters
3rd-degree injury - presence of blood-filled blisters
4th-degree injury - full-thickness damage affecting
muscles, tendons, and bones
Cold injuryCold injury - frostbite - frostbite

145. What to do?
Examine vital functions, start ABC when necessary
Replace wet clothing with dry, soft clothing to minimise
further heat loss. Remove constricting clothing.
Initiate rewarming of affected area as soon as possible.
Avoid rubbing affected area with warm hands or snow, as
this can cause further injury.
Transport patient to the warm environment and give him
warm fluids.
Active re-warming of the frost-bitten part via immersion in
circulating clear water at 40-41°C
Dry sterile dressing of the frostbite
Seek medical attention
Cold injuryCold injury - frostbite - frostbite

146. Open wounds - types
AbrasionAbrasion - the top level of skin is removed - the top level of skin is removed == painful - painful -
(nerve endings)(nerve endings)
LacerationLaceration - skin is cut with jagged, irregular edge- skin is cut with jagged, irregular edge
IncisionIncision - smooth edges (surgery) - - smooth edges (surgery) - bleedingbleeding depends on depends on
the the depthdepth, the , the location location and the and the size size of the woundof the wound
PuncturesPunctures - deep narrow wounds (nail, knife), the object - deep narrow wounds (nail, knife), the object
may remain impaled in the woundmay remain impaled in the wound
AmputationAmputation , avulsion, avulsion -- the cutting or tearing off of a the cutting or tearing off of a
body part – finger, toe, hand, foot, arm or legbody part – finger, toe, hand, foot, arm or leg

147. Protect yourselfProtect yourself - use - use medical glovesmedical gloves if possible or if possible or several several
layers of gauze or clean cloth and apply layers of gauze or clean cloth and apply pressure on pressure on
the wound the wound (your bare hand should (your bare hand should be used only as a be used only as a
last resort)last resort)
Expose the woundExpose the wound - to see where the blood is coming - to see where the blood is coming
fromfrom
Control the bleedingControl the bleeding
Do not clean large extremely dirty or life threatening Do not clean large extremely dirty or life threatening wounds.wounds.
Let hospital emergency department Let hospital emergency department personnel personnel to to do the do the
cleaningcleaning
Do not scrub a woundDo not scrub a wound
Open wounds - what to do

148. Shallow wounds should be cleaned to prevent infectionShallow wounds should be cleaned to prevent infection - -
risk of restarting of bleeding by disturbing the clot risk of restarting of bleeding by disturbing the clot
For For severe bleedingsevere bleeding, , leave the pressure bandage in leave the pressure bandage in
place place until medical attention.until medical attention.
To clean a shallow woundTo clean a shallow wound
- - wash inside the wound with soap and waterwash inside the wound with soap and water
- - irrigate the wound with water from a faucet (tap)irrigate the wound with water from a faucet (tap)
- for a wound with a - for a wound with a high risk for infectionhigh risk for infection (animal (animal bite, bite,
very dirty or ragged wound or a very dirty or ragged wound or a puncture) puncture) seek seek
medical attention medical attention for wound for wound cleaningcleaning
Cover the area with a sterile dressingCover the area with a sterile dressing
Open wounds - wound care

149. Control the bleedingControl the bleeding
Treat the victims shockTreat the victims shock
Recover the amputated part, take it with the victimRecover the amputated part, take it with the victim - -
- it does not need to be cleaned- it does not need to be cleaned- wrap it with a dry - wrap it with a dry
sterile gauze or clean cloth sterile gauze or clean cloth and put it in the plastic bag and put it in the plastic bag
- - keep it cool, but do not freezekeep it cool, but do not freeze
Seek medical attention immediatelySeek medical attention immediately - - 18 hours is the 18 hours is the
maximum time allowable for a part that has been maximum time allowable for a part that has been
cooled properly. cooled properly. Muscles without blood lose Muscles without blood lose
viability within six viability within six hours.hours.
Open wounds - amputation

150. What to doWhat to do
Expose Expose the areathe area - - remove or cut away clothing remove or cut away clothing
surrounding the injurysurrounding the injury
Do not removeDo not remove or move an or move an impaled objectimpaled object -- movement of movement of
any kind could produce additional any kind could produce additional
bleeding and tissue damagebleeding and tissue damage
Control any bleedingControl any bleeding with pressure around the impaled with pressure around the impaled
objectobject
Shorten the objectShorten the object if necessary if necessary - stick or trunk of the - stick or trunk of the
tree, wooden or iron bar..tree, wooden or iron bar..
Open wounds - impaled objects

151. Burns and scalds
Rank among the most serious and painful injuries.Rank among the most serious and painful injuries.
Can be classified - Can be classified -
thermal (heat) burnsthermal (heat) burns - - contact with hot objects, contact with hot objects,
flammable vapor, steam or liquidflammable vapor, steam or liquid
chemicalchemical - - acids, alkalis and organic acids, alkalis and organic
compounds compounds (petroleum, kerosene…)(petroleum, kerosene…)
electricalelectrical - - severity of injury depends on the severity of injury depends on the
type of current, the voltage, the area of type of current, the voltage, the area of
body exposed and the duration of contactbody exposed and the duration of contact

152. 1st-degree burns1st-degree burns (superficial):(superficial): surface (outer layer) of the surface (outer layer) of the
skin is affected skin is affected
characteristicscharacteristics - - redness, mild swelling, redness, mild swelling,
tenderness and tenderness and painpain
2nd-degree burns2nd-degree burns: : affect partial thickness of the skinaffect partial thickness of the skin
characteristicscharacteristics - blistering and swelling, - blistering and swelling, severe painsevere pain
3rd-degree burns3rd-degree burns:: penetrates the entire thickness of the skin penetrates the entire thickness of the skin
and deeper tissues and deeper tissues
characteristicscharacteristics - - no painno pain, skin looks waxy or pearly , skin looks waxy or pearly
grey or charred grey or charred
Burns and scalds

153. Stop the burning !Stop the burning !
Check ABCsCheck ABCs
Determine the Determine the depthdepth (degree) of the burn(degree) of the burn
Determine the Determine the extendextend of the burn - of the burn - rule of ninerule of nine - - how how
much body surface area is affected by burns - head 9%, much body surface area is affected by burns - head 9%,
complete arm 9%, front torso 18%, back 18%, each leg complete arm 9%, front torso 18%, back 18%, each leg 18%, 18%,
victims hand excluding the fingers and the thumb, victims hand excluding the fingers and the thumb,
represents about 1% of victims body surfacerepresents about 1% of victims body surface
Determine Determine whwhichich parts parts of the body are burned - of the body are burned - burns of the burns of the face, face,
hands, feet and genitals are more severe hands, feet and genitals are more severe

SSeek medical attentioneek medical attention
Burns and scalds - what to do?

154. Calculation
of the burned
surfice extent
Anterior
and
posteror
part of the
trunk

155. Aim of the careAim of the care - - reduce painreduce pain
- protect against infection- protect against infection
- prevent evaporation- prevent evaporation
CoolingCooling - immerse the burned area in cold water - apply - immerse the burned area in cold water - apply
cold until the part is pain free (10-45 cold until the part is pain free (10-45
minutes)minutes)
Sterile bandageSterile bandage or clean clothor clean cloth
Fluids orallyFluids orally ??????
AnalgesiaAnalgesia
Shock treatmentShock treatment
Burns and scalds - what to do in
case of 1st and small 2nd-degree burns

156. Do not remove clothing stuckDo not remove clothing stuck to the skin - to the skin - pulling will pulling will
further damage the skinfurther damage the skin
Do not forget to remove jewelleryDo not forget to remove jewellery as soon as possible - as soon as possible -
swelling could make jewellery difficult to swelling could make jewellery difficult to
remove remove laterlater
Do not apply cold to more than 20% of an adult´s body Do not apply cold to more than 20% of an adult´s body
surfacesurface (10% for children) (10% for children) - widespread cooling - widespread cooling
can can cause cause hypothermiahypothermia. Burn victims lose large . Burn victims lose large
amount of heat and water evaporation)amount of heat and water evaporation)
Do not apply ointmentDo not apply ointment, butter or any other coatings on , butter or any other coatings on
a burn except of a burn except of sterile dressingsterile dressing or clean cloth or clean cloth
Do not break any blistersDo not break any blisters - - intact blisters serve as intact blisters serve as
excellent burn dressingsexcellent burn dressings
Burns and scalds - what not to do

157. Do not apply cold becauseDo not apply cold because it may cause hypothermia it may cause hypothermia
Cover the burnCover the burn with a dry, nonsticking dressing or a with a dry, nonsticking dressing or a
clean clothclean cloth
Treat the shockTreat the shock by elevating the legs and keeping by elevating the legs and keeping
victim warm with a clean sheet or blanketvictim warm with a clean sheet or blanket
Seek Seek medical attentionmedical attention
Burns and scalds - what to do in
case of large 2nd and 3rd-degree burns

158. Chemical burns - what to do
Immediately Immediately remove chemicalremove chemical by flushing the area with by flushing the area with
water - water - brush dry powder chemicals from the brush dry powder chemicals from the
skin before flushing (water may activate a dry skin before flushing (water may activate a dry
chemical) - chemical) - protect yourselfprotect yourself
Remove contaminated clothingRemove contaminated clothing and jewellery while and jewellery while
flushing the waterflushing the water
Flush for Flush for 20 minutes20 minutes all chemical burns (skin, eyes) all chemical burns (skin, eyes)
Cover the burned areaCover the burned area with a dry, sterile dressing or with a dry, sterile dressing or
clean pillowcase or sheetclean pillowcase or sheet
SeekSeek medical attentionmedical attention immediately for all chemical immediately for all chemical
burnsburns

159. Do not apply water under high pressureDo not apply water under high pressure - - it will drive it will drive
the chemical deeper into the skinthe chemical deeper into the skin
Do not neutralize a chemicalDo not neutralize a chemical even if you know which even if you know which
chemical is involved - chemical is involved - heat may be produced, heat may be produced,
resulting in resulting in more damagemore damage..
Some product labels for neutralizing may be Some product labels for neutralizing may be
wrong. Save the container or label for the wrong. Save the container or label for the
chemical´s name.chemical´s name.
Chemical burns - what not to do

160. Electric current injury
EffectsEffects of electricity on the body are of electricity on the body are determined determined by by 7 factors7 factors::
 typetype of current - of current - sskin offers greater resistance to kin offers greater resistance to direct direct
currentcurrent than than alternating currentalternating current
amountamount of currentof current
pathwaypathway of current of current
durationduration of contact of contact
areaarea of contact of contact
resistanceresistance of the body of the body
voltagevoltage - - high voltagehigh voltage accident accident ((>1000 V>1000 V) is regularly ) is regularly
accompanied with accompanied with burnsburns,, while while
low voltagelow voltage ((<<1000 V)1000 V) injury causes injury causes electricelectric
damagedamage, most often , most often arrhythmia.arrhythmia.

161. Both high Both high and and low low voltagevoltage electric currents can adversely electric currents can adversely
influence influence vital functionsvital functions - unconsciousness, breathing - unconsciousness, breathing
paralysis and severe cardiac dysrhythmiaparalysis and severe cardiac dysrhythmiass (mostly (mostly
ventricular fibrillationventricular fibrillation).).
Heating Heating by electrical current is the by electrical current is the major mechanismmajor mechanism of of
tissue damage tissue damage in electrical traumain electrical trauma..
In In high voltage high voltage accidentsaccidents, , the victims usuallythe victims usually do not continue to do not continue to
hold the conductorhold the conductor - - they are oftenthey are often thrown awaythrown away from the from the
electric circuit electric circuit and thus acquireand thus acquire traumatictraumatic injuries injuries (e.g. (e.g.
fracture, brain haemorrhage). fracture, brain haemorrhage).
Low voltageLow voltage == heart injuryheart injury
High voltage High voltage == thermal injurythermal injury
Electric current injury

162. Make sure the area is Make sure the area is safesafe - - unplug, disconnect or turn unplug, disconnect or turn
off power, if not possible, call for helpoff power, if not possible, call for help
Check Check ABABCCss - - rememberremember - - ventricular fibrillation !!! ventricular fibrillation !!! - - start start
CPRCPR
If the victim fell, check for a If the victim fell, check for a spinal injuryspinal injury
Seek Seek medical attentionmedical attention immediately immediately, victims with cardiac, victims with cardiac
dysrythmias need in hospital observation for 48 - dysrythmias need in hospital observation for 48 - 72 hrs72 hrs
Electrical injuries with Electrical injuries with burnsburns (high voltage)(high voltage) - cover them - cover them
by sterile dressing, victims usually require burn by sterile dressing, victims usually require burn centre centre
carecare
Electric current injury - what to do

163. Head injuries
Mechanism Mechanism of injuryof injury – – motor vehicle crashes, falls, hits, motor vehicle crashes, falls, hits,
gunshots and stab wounds, gunshots and stab wounds, mortality rate 30-50%mortality rate 30-50%
The The main types main types of head injuryof head injury
- scalp wounds- scalp wounds
- scull fractures- scull fractures - basilar, linear and comminuted- basilar, linear and comminuted
- - intracranial lesionsintracranial lesions - contusion, - contusion, subarachnoidsubarachnoid haemorrhage, haemorrhage,
subdural hematoma, subdural hematoma, epiduralepidural hematoma hematoma
- - diffuse brain injurydiffuse brain injury – concussion, diffuse axonal injury– concussion, diffuse axonal injury
Scull fractureScull fracture is always associated with the brain injuryis always associated with the brain injury
In case of In case of suspicion of the brain injurysuspicion of the brain injury, the patient has to be , the patient has to be
hospitalisedhospitalised, examined, examined and monitored for at least 48 hours. and monitored for at least 48 hours.

164. Diffuse brain injury
Concusion
Diffuse axonal injury

165. Concusion
Is a brief, temporary interruption of
neurological function folloving head trauma

166. Concussion – clinical features
Headache
Nausea, vomiting
Tachycardia
Amnesia for the event
Unconsciousness – short lasting

167. Concussion - treatment
ABCs
Treatment for scalp wounds, aplication of
pressure dressings to prevent hemorrhage
Seek medical attention
Transport to the hospital for diagnostics
Admision to the hospital for monitoring,
observation (mental status, consciousness
assessment, pupils, …)

168. When the patient is unconsciousWhen the patient is unconscious
ABCABC - - monitor vital functions. By the application of monitor vital functions. By the application of airway airway
management (head position tulted backward)management (head position tulted backward) keep in mind the keep in mind the
possibility of cervical spine injury.possibility of cervical spine injury.
Examine the headExamine the head gently and gently and cover cover the external injuries with sterile the external injuries with sterile
dressingsdressings (bandage) - (bandage) - don’t press on the wounddon’t press on the wound, ,
stabilize the victims neckstabilize the victims neck against movement against movement
Examine the Examine the state of pupilsstate of pupils - - sizesize, , similaritysimilarity, , reaction on the reaction on the llightight
Examine also the Examine also the thoraxthorax, , abdomenabdomen and and extremitiesextremities
When the When the circulation and breathing are circulation and breathing are stablestable bring the bring the
patient into patient into recoveryrecovery (stable -side) (stable -side) positionposition (beware of (beware of
cervical spine injury) and monitor vital functions.cervical spine injury) and monitor vital functions.
Call for helpCall for help
Head injuries - what to do

169. When the patient is consciousWhen the patient is conscious::
Bring the patient into Bring the patient into supine positionsupine position with a little elevated with a little elevated
head if there is no suspicion of cervical spine head if there is no suspicion of cervical spine
injuryinjury
Treat the woundsTreat the wounds in the same way as above in the same way as above
Call for helpCall for help
Keep in mind, that Keep in mind, that even if the patient is consciouseven if the patient is conscious, the , the
status of consciousness can alterstatus of consciousness can alter due to the due to the
brain brain injury or intracranial bleeding and injury or intracranial bleeding and
therefore all the therefore all the time time monitor the mental statusmonitor the mental status of of
the victim.the victim.
Head injuries - what to do

170. Eye injuries - penetrating eye injuries
Result when a sharp object Result when a sharp object (knife, needle) penetrates the (knife, needle) penetrates the
eye eye
Seek Seek immediate medical attentionimmediate medical attention - any penetrating eye - any penetrating eye
injury should be managed in the hospitalinjury should be managed in the hospital
Stabilize any protruding objectStabilize any protruding object with bulky dressings or with bulky dressings or
clean cloth clean cloth
Cover the undamaged eyeCover the undamaged eye
Do not wash out eye with waterDo not wash out eye with water
Do not try to remove an object stuck in the eyeDo not try to remove an object stuck in the eye
Do not press on an injured eyeball or penetrating objectDo not press on an injured eyeball or penetrating object

171. Chemical burn of the eyes are extremelyChemical burn of the eyes are extremely sight-threateningsight-threatening
Alkalis cause greater damageAlkalis cause greater damage than acidsthan acids - - they penetrate they penetrate
deeper and continue to burn longerdeeper and continue to burn longer
Damage can happen inDamage can happen in 1 to 5 minutes1 to 5 minutes - the chemical must - the chemical must
be be removed immediatelyremoved immediately
What to doWhat to do
- use your fingers to keep the eye as wide as possible- use your fingers to keep the eye as wide as possible
- flush the eye with water immediately - - flush the eye with water immediately - irrigate from the irrigate from the
nose side of the eye towards the outside, to avoid nose side of the eye towards the outside, to avoid
flushing material into other eye flushing material into other eye
- loosely bandage - loosely bandage both eyesboth eyes with cold, wet dressings with cold, wet dressings
SeekSeek immediate medical attentionimmediate medical attention
Eye injuries - chemical burns of the eye

172. Nose injuries - nosebleeds
Two typesTwo types
- - anterioranterior - - most common (90%)most common (90%)
- - posteriorposterior - - serious and requires serious and requires
medical attentionmedical attention

173. Nose injuries - nosebleeds
What to doWhat to do
Place victim in a Place victim in a seated positionseated position
Keep his/her Keep his/her head tilted slightly forwardhead tilted slightly forward so so blood can run blood can run
out, not down the back of the throat, out, not down the back of the throat,
which can cause choking, nausea or vomitingwhich can cause choking, nausea or vomiting
PinchPinch (or have victim pinch) (or have victim pinch) all the soft parts of the noseall the soft parts of the nose
together between thumb and two fingers for together between thumb and two fingers for 5 minutes5 minutes
Apply an Apply an ice packice pack over the nose and cheeksover the nose and cheeks
Seek Seek medical attentionmedical attention - - if the bleeding continues or you if the bleeding continues or you
suspect a broken nose or posterior nosebleedsuspect a broken nose or posterior nosebleed

174. Spinal injuries
Spinal injuriesSpinal injuries are often associatedare often associated with with head head
injuriesinjuries
TThe head may have been moved suddenly in one he head may have been moved suddenly in one
or more directions, damaging the spineor more directions, damaging the spine
What to look forWhat to look for - - painful movement of the arms painful movement of the arms
or legsor legs
- numbness, tingling, weakness or - numbness, tingling, weakness or
burningburning
sensation in the arms or legssensation in the arms or legs
- loss of bowel or bladder control- loss of bowel or bladder control
- paralysis of the arms or legs- paralysis of the arms or legs

175. Spinal injuries
What to doWhat to do
 Stabilize the victim against any movementStabilize the victim against any movement
- to stabilize head against movement - place heavy - to stabilize head against movement - place heavy
objects objects on each side of the headon each side of the head
Check ABCsCheck ABCs
Transfere the patient by Transfere the patient by 3 – 4 pairs of hands3 – 4 pairs of hands
Transfere patient on the vacuum matrace or on the Transfere patient on the vacuum matrace or on the
boardboard
Seek Seek medical attentionmedical attention

176. Chest injuries
All chest injury victims should be rechecked for ABC
Broken ribs - main symptom is pain by breathing,
coughing and movements
What to doWhat to do
help the victim find comfortable position
stabilize the ribs using pillow or other soft object fixed
by bandage over the injured area
some victims find comfort by lying on the injured side
seek medical attention

177. Impaled object in chest
Stabilize the objectStabilize the object in place with bulky in place with bulky
(wide) (wide) dressingdressing
Do not try to remove an impaled objectDo not try to remove an impaled object - -
bleeding and air in the chest cavity can bleeding and air in the chest cavity can
resultresult
Seek Seek medical attentionmedical attention
Chest injuries - what to do

178. Sucking chest wound - results when a
chest wound allows air to pass into and
out of the chest cavity with each breath
Chest injuries -

179. Pneumothorax
 open - persisting opening to the
chest
 closed - no external communication
 tension (valve)- air can enter pleural
cavity during inspiration and
cannot escape during expiration
Chest injuries

180. Air entered into pleural cavity – results in
Pneumothorax

Collaps of the lung + increasing intrapleural pressure

mediastinum shift to the healthy side

stopped venous return to the heart

cardiac arrest
Chest injuries

181. Pneumothorax – clinical features
Sudden onset chest pain
Chest wall deformity
Crepitus
Agitation
Air hunger
Tachycardia
Hypotension

182. Pneumothorax - treatment
ABCs is priority
Immobilization
Transport to the hospital

183. What to do
Cover the wound immediately
Seal the wound with anything available to
stop air from entering the chest cavity -
plastic wrap or plastic bag, if not
available, you can use your gloved hand
Seek medical attention urgently !!!
Pleural puncture should be done as soon as
possible
Pneumothorax

184. What to do
Always change the open pneumothorax into the
closed
Plastic bag – place on the chest wound and fix it by
adhesive tape (plaster) from 3 sides with the
fourth side free (pocket)
Pneumothorax (PNO)

185. Abdominal trauma clinical features
Nausea
Vomiting
Dyspnea
Heartburn
Abdominal pain
Abdominal distension

186. Abdominal trauma clinical features
Ecchymoses over the abdomen
Presence of open penetrating wounds
Abdominal tenderness
Hypotension
tachycardia

187. Abdominal trauma - treatment
ABCs is priority
Immobilization
Monitoring of vital signs
Transport to the hospital

188. Abdominal injuries
Blow to the abdomen - observe for pain, tenderness,
muscle tights, or rigidity
What to do - place the victim in a comfortable position and
expect vomiting
check general condition – shock can develope
do not give any food and drink
seek medical attention
Penetrating wound - expect internal organs to be damaged
What to do - if the penetrating object is still in place,
stabilize the object and control bleeding,
seek medical attention
do not try to remove the object

189. Protruding abdominal organs - what to do
Position - the victim with the head and shoulders slightly
raised, and knees bent and raised
Cover protruding organs with the (moist) sterile dressing or
clean cloth
Place towel lightly over the dressing to help maintain warmth
Seek medical attention
Do not try to reinsert protruding organs into the abdomen
- you could introduce infection or damage the intestines
Do not give anything to eat or drink
Abdominal injuries

190. Pelvic injuries
If you suspect broken pelvis, press the sides of the pelvis
gently downward and squeeze them inward at the iliac crests
(upper point of the hips)
- broken pelvis will be painful
What to do
Treat the victims shock
Place padding between victims thighs, then tie the knees
and ankles together
Keep the victim on a firm surface - do not move the victim
Seek medical attention

191. Fractures
- closed fractures - skin is intact
- open fractures - skin over the fracture is
damaged or broken
What to look for: D-O-T-S
•Deformity – abnormal position
•Open wound
•Tenderness
•Swelling
Bone, joint and muscle injuries

192. What to do:
Determine what happened and the location of the injury
Gently remove clothing covering the injured area
Examine the area by looking and feeling for D-O-T-S
Check – C-S-M - circulation, sensation,
movement
First aid: R-I-C-E procedures
(rest, ice, compression, elevation)
Use a splint to stabilize the fracture – 1 jount above and
1 joint under broken bone !!!
Seek medical attention
Bone, joint and muscle injuries

193. Bone, joint and muscle injuries
Joint injuries
- the most frequently affected are shoulders,
elbows, fingers, hips, knees and
ankles
Signs and symptoms
Deformity (main sign)
Pain
Swelling

194. Bone, joint and muscle injuries
What to do:
•Check – C-S-M - circulation, sensation, movement
•First aid: R-I-C-E procedures
- rest, ice, compression, elevation
•Use a splint to stabilize the joint in the position in
which it was found
•Do not try to put displaced parts into their normal
position - nerve and blood vessel damage could
result
•Seek medical attention

195. Poisoning
Most often causesMost often causes – –
ingestion -ingestion - drugs, alcohol, or both of them, toxic food drugs, alcohol, or both of them, toxic food
(mushrooms) or fluids(mushrooms) or fluids
inhalation inhalation -- narcotics and carbon monoxide or other narcotics and carbon monoxide or other
toxic gasestoxic gases
intravenous, transcutaneous or intramuscularintravenous, transcutaneous or intramuscular
application of drugs in application of drugs in addictaddict people people
Clinical singsClinical sings
-polymorphous polymorphous
-mostly mostly altered mental statusaltered mental status
-altered altered vital functionsvital functions
-ConvulsionsConvulsions

196. Poisoning
Evaluation of vital functionsEvaluation of vital functions – –
examine examine ABCsABCs followed by followed by
historyhistory ++
physical examinationphysical examination..
HistoryHistory is of is of primary importanceprimary importance, but , but
at altered mental status may be difficultat altered mental status may be difficult
OObtain as much information as possiblebtain as much information as possible from the from the
patient,patient, from from the the familyfamily and and from from anyone elseanyone else who who
was at the scene.was at the scene.

197. The most important questionsThe most important questions
What poisonWhat poison is involved? is involved?
How muchHow much was taken? was taken?
By By what routewhat route was the poison taken was the poison taken (e.g. by mouth, iv., i.m., (e.g. by mouth, iv., i.m.,
skin exposure)?skin exposure)?
WhenWhen was it taken? was it taken?
What else was taken with it?What else was taken with it? (combination of drugs and (combination of drugs and
ethanol)ethanol)
Poisoning

198. Besides vital functions are regularly examined, observe:
Pupillary size - mydriasis - (atropine, cocaine, ethanol),
- miosis (opiates, organophosphates and
barbiturates)
Oral examination - the odour of the breath is diagnostic clue
hydration (opiates, atropine vs.
organophosphates, strychnine)
Examination of the skin - marks of i.v. drugs use,
cyanosis, red skin colour (due to cyanide or carbon
monoxide) dry skin (atropine, anticholinergics drugs)
Poisoning

199. Call for help and transport the patient to the hospital
Monitor vital function during the transport - ABCs
Bring with the patient to hospital all drugs, empty
blisters and boxes of the drugs that are present at
the scene.
Provoke vomiting in co-operative person
Don't give any fluids and do not provoke the
vomiting in people with altered state of
consciousness.
Poisoning

200. Specific poisonings antidotes:
Ethyleneglycol  alcohol
Methylalcohol  alcohol
Alkali  juice or vinegar or lemon
Acid  milk ?
 Be careful !!!
Poisoning - specific antidotes

201. Children suffocation disease
Croup: laryngotracheobronchitis - age 1-3 years
- barking cough
- intercostal retractions
Epiglottitis - age 3-7 years, sore throat
- air hunger
- anxiety
- sitting position, hyperextended head
- swallow problems, salivation

202. Children suffocation disease
Large airways obstruction
Inspiratory stridor
Soft tisues af the neck and chest (intercostal)
retractions
Noisy breathing
Hoarseness
“Cock“ voice

203. Children suffocation disease
What to do
Very urgent life-threatening disease !!!
Death from suffocation can develop within tens of
minutes or several hours from normal healthy
status !!!
Organize transfer to the hospital (emergency,
anaesthesiology, ICU) as soon as possible by
prehospital emergency services !!!

204. Children suffocation disease
What to do
Before transfer: Could weather can help
Take the child outside
Aply cold compress on the neck (Prieznitz)
Assure inhalation of air with high humidity

205. Chest pain
Several causes
Always think about heart attack first
Medical care at the onset of a heart attack is vital
to survive

Seek medical atention immediatelly

206. Heart attack
Signs and symptoms
Uncomfortable pressure
Squeezing or pain in the center of the chest lasting
more than a few minutes or going away and coming
back
Pain spreading to the shoulders, neck or arms
Chest discomfort, nausea, shortness of breath
Not always typical signs

207. Heart attack
What to do
Call emergency medical servis or get to the nearest hospital
The least painful position (sittin with legs up and bent at the
knees)
Give Nitroglycerin tablets or spray (dilates coronary arteries)
– Caution: possible hypotension
Avoid Nitroglycerin application if patient used VIAGRA
within last 48 hours
If unresponsive victim – check ABC and start CPR

208. Stroke (Brain attack)
Blood vessels rupture – bleeding or
blood vessels plugged
Nerve cells dies within minutes
Transient attack – closely associated with strokes-
short duration from minutes to several hours (mini-
strokes)
serious warning sign of a potential stroke

209. Stroke (Brain attack)
What to look for
Weakness, paralysis
Decreased vision
Speaking or understanding problems
Dizziness or loss of ballance
Severe headache
Differentiate pupils from “Pupils equal and reactive
for light“

210. Stroke (Brain attack)
What to do
If victim unresponsive – ABC
Call emergency medical servis
If breathing – recovery position
Supine position with slightly elevated head and
shoulders ( neutral position)
Do not give anything to drink and eat (restricted
swallowing, throat paralysis, tendency to vomit…)

211. Diabetic emergencies
Diabetes mellitus (DM)
Definition: condition, in which insulin is either
lacking or inefective.
Insulin = a hormon produced by pancreas.
Role of insulin: helps the body to use energy from
food. It takes sugar from the blood and carries it
into cells to be used.
In Diabetes:
No insulin  sugar remains in the blood  body
cells must rely on fat as fuel.
Blood sugar is a major body fuel.

212. Diabetic emergencies
If blood sugar cannot be used in cells:

blood sugar level increases
overflows into the urine
increased urine production

Dehydration
Loss of unused important source of fuel

Diabetes mellitus will develop

213. Diabetic emergencies
2 types of DM
Type I (juvenile-onset) = insulin dependent
External insulin is required to allow sugar to pass from
the blood into cells
Type II. (adult - onset) = insulin-non-dependent
Not dependent on external insulin
If insulin level is low  known problems as discussed
above

214. Diabetic emergencies
The body is continuously balancing sugar and
insulin.
Much insulin + not enough sugar


low blood sugar (insulin shock)
Much sugar + not enough insulin

high blood sugar (diabetic coma)
Both low and high blood sugar
= life threatening situation ( coma)

215. Diabetic emergencies
Low blood sugar = hypoglycemia
Causes:
• delayed food
• long fasting
• exercise
• alcohol
• combination

216. Diabetic emergencies
Low blood sugar = hypoglycemia
Signs:
• sudden onset
• poor coordination
• anger, bad temper
• pale colour
• confusion, desorientation
• sudden hunger
• excessive sweating
• unconsciousness – hypoglycemic coma

217. Diabetic emergencies
Low blood sugar = hypoglycemia
What to do:
• give sugar or sweet juice or glucose tablets
if patient is awake
• if no efect, repeat it
• seek immediate medical attention
• provide ABCs

218. Diabetic emergencies
High blood sugar = hyperglycemia
Causes:
• inactivity
• insuficient insulin
• forgotten application of insulin before eating
• overeating (inadequate ingurgitation of food)
• illness
• stress
• combination

219. Diabetic emergencies
High blood sugar = hyperglycemia
Signs
• gradual onset
• drowsiness
• extreme thirst
• frequent urination of high volume
• flushed skin
• vomiting
• fruity breath odor
• haevy deep breathing
• unconsciousness - coma

220. Diabetic emergencies
High blood sugar = hyperglycemia
What to do:
• If you are not sure whether victim has high or low
blood sugar, give the person food or drink with
sugar
• If you do not see improvement, seek medical care
Or:
• Check blood sugar by glucometer
• Help the patient to apply insulin in case of high blood
sugar

221. Emergencies during pregnancy
Try to remain calm and considerate of the
mother during stressful situation
What to look for?
• vaginal bleeding
• cramps in lower abdomen
• swelling of the face or fingers
• severe continuous headache
• dizziness or fainting
• uncontrolled vomiting
• baby

222. Emergencies during pregnancy
What to do
• keep quiet
• place sanitary napkin or any sterile or clean pad
over the opening of vagina
• replace bload-soaked pads and save them together
with all tisues that are passed
• arrange immediate transfere to a medical facility
• place a woman partly on her left side in case of
discomfort, collaps, dizziness, faint or try to shift
pregnant abdomen gently to the patient´s left
side (release the pressure on the vena cava
inferior-increased venous return to the heart)

223. Emergencies during pregnancy
What to do during bustling (fast) delivery
• try to be quiet
• try to co-operate with delivering lady
• protect the baby´s head
• if child is delivered, place him between mother´s
thighs and cover him with dry blanket
• congratulate to the mother
• thank her for her co-operation
• wait for the end of funis (umbilical cord) pulsation
• close it by tape
• seek medical attention

224. Acute psychic (mental) disorders
• psychiatric disease
• alcohol intoxication
• opioid intoxication (heroin)
• marihuana intoxications – overdose (joints)
• intoxications by stimulationg drugs (extasis)
• organic diluents (toluen)
• cocain overdose (crack)
• haluconogens (LSD, crystal joints…)
• rarely mental disorders in lactation
but change of behaviour can be caused also by:
•lack of oxygen - hypoxemia
•rescuer’s personality and look
•development of shock state
•head injury
•cervical spine injury

225. Acute psychic (mental) disorders

What to do
• very difficult situation
• risk of auto and heteroagresivity
• risk of suicidal attemts
• calm, trustful approach needed
• patience to listen to the patient
• direct isntructions to undergo the therapy …
• use of physical limitations – delicate situation – only
in cases with risk of autoagressivity and risk of
exposure of the patient or his neighbourhood
• seek emergency medical services to secure safe
transfer to the hospital

226. Animal bites
What to do
• dogs – similar to other injuries – often face,
extremities, risk of bleeding
• snakes – toxins -neurotoxins
-cardiotoxins
-clotting disorders
-cytotoxic and hydrolytic effect
not all snake bite has toxic risks (rat snake)
First aid:
• calm down the patient
• immobilisation of extremity
• not invasive therapeutic procedures
• shock therapy
• ABC
• immediate transfer to the hospital

227. Animal bites
What to do
• spiders – danger very rarely – arachnophobia
toxins – neurotoxic
therapy as snakes
• scorpions – very painful bite
- rarely very high toxicity
- vegetative neurotoxicity
therapy as snakes
• insects – most danger is hornet (yellow jacket)
bee – 100 bites = lethal dosis
pain, swelling, alergic reactions
therapy – cooling, antiallergic therapy
neck bites – swelling, airways obstruction
ABC

228. Web-side address:
http://www.lfp.cuni.cz
Study
Actual study information
Study information,
sekce Medical studies in English