Masuri de Prim Ajutor 2011
Transcript of Masuri de Prim Ajutor 2011
PLAN Definitie, Obiective, Principii EVIDENCE BASED MEDICINE-medicina
bazata pe dovezi Aspecte etico-medico-legale si
epidemiologice ale CPR si primului ajutor Notiuni elementare de anatomie si
fiziologie CPR: definitie Lantul supravietuirii BLS la adult
INTRODUCERE Proceduri de ingrijire medicala simple, de
urgenta aplicabile de catre neprofesionisti pana la sosirea personalului medical de specialitate.
Se face referinta atat la “laici”, cat si la personalul de pe ambulante sau alti “first responders”.
NU INLOCUIESTE UN TRATAMENT MEDICAL COMPETENT
PRIM AJUTOR Masuri de ingrijire si tratament de urgenta
aplicate unui bolnav sau unei persoane traumatizate INAINTEA sosirii/defeririii catre servicii medicale.
MASURILE DE PRIM AJUTOR NU SUNT APLICATE CU SCOPUL DE A INLOCUI DIAGNOSTICAREA SI TERAPIA CORECTA MEDICALA
ofera asistenta temporara pana la sosirea personalului medical calificat
PRIM AJUTORScop: Salvarea vietii Prevenirea producerii in continuare a leziunilor Reducerea la minimum/prevenirea infectiilor Cei trei “P” P - Preserve Life.
P - Prevent the condition worsening.
P - Promote RecoveryFace diferenta dintre: Leziune temporara/permanenta Vindecare rapida/ infirmitate permanenta Viata/moarte
Medicina bazata pe dovezi (EBM) EBM are ca scop utilizarea celor mai bune dovezi
disponibile provenite din metode stiintifice pentru a conduce la decizii medicale
urmareste sa stabileasca calitatea dovezilor ce stabilesc riscurile si beneficiile tratamentelor (inclusiv absenta acestora).
EBM recunoaste ca multe aspecte ale medicinii depind de factori individuali cum ar fi calitatea si “rationament al valorii vietii” ce sunt doar partial supuse cercetarilor stiintifice.
sa aplice aceste metode in practica medicala cu scopul de a asigura cea mai buna predictie asupra prognosticului ad vitam, chiar daca persista inca controversele legate de tipul prognosticului de urmarit.
Masuratori statistice “Evidence-based medicine” incearca sa
exprime beneficiile clinice ale testelor si tratamentelor utilizand metode statistice
EBM- stadializarea nivelurilor de evidenta Evidence-based medicine categorizes different
types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research.
The strongest evidence for therapeutic interventions is provided by systematic review of randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition.
Little value as proof: patient testimonials, case reports, and even expert opinion – the placebo effect, the biases inherent in observation and reporting of
cases, difficulties in ascertaining who is an expert, etc.
Nivel de evidentaSystems to stratify evidence by quality have been developed,
such as this one by the U.S. Preventive Services Task Force for ranking evidence about the effectiveness of treatments or screening:
Level I: Evidence obtained from at least one properly designed randomized controlled trial.
Level II-1: Evidence obtained from well-designed controlled trials without randomization.
Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
Categorii de recomandariIn guidelines and other publications, recommendation for a clinical service is
classified by the balance of risk versus benefit of the service and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses:
Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweighs the potential risks. Clinicians should discuss the service with eligible patients.
Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients.
Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations.
Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients.
Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.
Ghiduri Un ghid medical (denumit si ghid clinic,
protocol clinic, ghid de practica medicala) este un document destinat orientarii deciziilor si criteriilor de:
diagnostic conduita tratament intr-un domeniu specific
medical
PRIM AJUTOR- Obiective
A. – Airway: Mentinerea permeabilitatii cailor aeriene
B. – Breathing: Mentinerea respiratiilor C. – Circulation: Mentinerea circulatiei
+ Oprirea hemoragiilor Prevenirea/ reducerea socului
PRIM AJUTOREvaluare initiala Inspectia rapida a zonei
Pericole (curent electric, foc, apa, “haz mats”, obiecte instabile, ascutite, animale)
Trafic Violenta Conditii de relief si clima Situatii speciale
Preluarea controlului calm, rapid si eficient
PRIM AJUTORSe vor evalua:1. SIGURANTA proprie si a pacientului2. MECANISMUL DE PRODUCERE A LEZIUNII Constient Inconstient3. INFORMATII TRANSMISE PE CAI SPECIALE- Medalion, bratara cu simboluri - card cu informatii
PRIM AJUTOR4. NUMARUL VICTIMELOR Cand sunt mai multe- evaluarea
A,B,sangerare si C5. MARTORI Pot furniza informatii, ajutor chiar daca
sunt nepregatiti prin: apel de urgenta, suport moral victimei, impiedicarea imixtiunii altor persoane
6. PREZENTATI-VA ca persoane calificate in prim ajutor; consimtamant cerut celor constienti, prezumat pentru cei inconstienti
Aspecte etico-legale Datoria de a interveni(desemnata, serviciu sau
responsabilitate preexistaenta fata de victima) Standard: cat si pentru ce aveti calificare Consimtamant= acord, permisiune
Pacient constient/inconstient Minor/major Bolnavi cu afectiuni psihiatrice Exprimat/prezumat
Confidentialitatea Legea Bunului Samaritean (urgenta, cu bune intentii, fara
compensatii, fara a produce daune/leziuni) Abandon Neglijenta (datorie, nerespectarea datoriei sau
substandard, producere de leziun/daune, nerespectarea limitelor)
Aspecte etico-legaleSecventa”logica”: Obtineti consimtamantul victimei INAINTE de A O
ATINGE Urmati ghidurile si protocoalele pentru care ati
fost instruiti, fara a va depasi nivelul de competenta
Explicati victimei fiecare lucru pe care urmeaza sa-l faceti
Odata ce ati demarat asistarea victimei, nu o parasiti pana nu o deferiti unei persoane cel putin la fel de calificata ca dumneavoastra!
Aspecte etice OUT OF HOSPITAL SETTINGS
To initiate resuscitation Not to initiate resuscitation To terminate resuscitation
IN HOSPITAL RESUSCITATION To initiate resuscitation Not to initiate resuscitation To terminate resuscitation To withdraw life support
PRIM AJUTOR-REGULI DE BAZA1. Mentineti pacientul in decubit dorsal, capul la
acelasi nivel cu corpul, pana la evaluarea gravitatii situatiei.
Identificati exceptiile la aceasta regula: Varsaturi sau hemoragii in zona cavitatii bucale-
pozitie laterala de siguranta ! la leziunile suspectate de coloana cervico-dorsala (2% explozii, 6% traumatism facial sau GCS<8)
Dispnee- pozitie sezanda sau semi Socul- membrele superioare ridicate (!?) doar
daca nu se suspecteaza leziuni de coloana2. Nu mobilizati pacientul mai mult decat necesar.
Indepartati hainele cu efect restrictiv, asigurati comfortul termic
PRIM AJUTOR-REGULI DE BAZA3. Asigurati confort psihic pacientului4. Nu atingeti rani, arsuri decat daca e absolut
necesar. Folositi obiecte sterile. Folositi bariere. Spalati maini!
5. Nu oferiti apa sau alimente din primul moment6. Imobilizati orice zona suspectata a fi fracturata.
Nu incercati sa reduceti fractura. Nu mobilizati decat daca e strict necesar
7. Mentineti temperatura normala a corpului
PRIM AJUTOR-aspecte epidemiologiceTransmitere de boli infectioase HIV Virusul hepatitei B, C TuberculozaMasuri de protectie universala- orice pacient trebuie
considerat potential purtator de agenti cu transmitere sanguina
Purtati manusi sau folositi alta bariera Spalati-va mainile cu apa calda si sapun:
La venire/plecare Inainte/dupa examinare, procedura Dupa scoaterea manusii, mastii Dupa folosirea batistei, toaletei, trecere prin par, activitati
administrative/gospodaresti Bariera pentru respiratii artificiale, protectie oculara
Sudden Cardiac Arrest
• 300,000 victims of out-of-hospital cardiac arrest each year in the U.S.• Less than 8% of people who suffer cardiac arrest outside the hospital survive.• Sudden cardiac arrest can happen to anyone at any time. Many victims appear healthy with no known heart disease or other risk factors.• Sudden cardiac arrest ≠a heart attack.
Sudden cardiac arrest: electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating.
A heart attack: when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest
SUDDEN CARDIAC ARREST
Approximativ 700,000 stopuri cardiace pe an in Europa
Supravietuirea la externare de aprox 5-10%
CPR efectuat de martori: interventie vitala inaintea sosirii echipajelor de urgenta – dubleaza sau tripleaza supravietuirea dupa SCR
Resuscitarea precoce si defibrilarea prompta (in decurs de 1-2 minute) poate duce la supravietuiri de >60%.
CPR: Ghiduri The International Liaison Committee on
Resuscitation (ILCOR) American Heart Association (AHA) International Guidelines 2000 for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (2005 Consensus Conference).
CPR Cardiopulmonary resuscitation (CPR) is an emergency
medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed in hospitals, or in the community by laypersons or by emergency response professionals.
CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient's chest to manually pump blood through the heart, called chest compressions, and usually also involves the rescuer exhaling into the patient (or using a device to simulate this) to inflate the lungs and pass oxygen in to the blood, called artificial respiration,
CPR is unlikely to restart the heart; its main purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage
Istoric 1740 The Paris Academy of Sciences officially recommended mouth-to-mouth
resuscitation for drowning victims. 1767 The Society for the Recovery of Drowned Persons became the first organized effort to deal with sudden and unexpected death. 1891 Dr. Friedrich Maass performed the first equivocally documented chest compression in humans. 1903 Dr. George Crile reported the first successful use of external chest compressions in human resuscitation. 1904 The first American case of closed-chest cardiac massage was performed by Dr. George Crile. 1954 James Elam was the first to prove that expired air was sufficient to maintain adequate oxygenation. 1956 Peter Safar and James Elam invented mouth-to-mouth resuscitation. 1957 The United States military adopted the mouth-to-mouth resuscitation method to revive unresponsive victims. 1960 Cardiopulmonary resuscitation (CPR) was developed. The American Heart Association started a program to acquaint physicians with close-chest cardiac resuscitation and became the forerunner of CPR training for the general public. 1963 Cardiologist Leonard Scherlis started the American Heart Association's CPR Committee, and the same year, the American Heart Association formally endorsed CPR. 1966 The National Research Council of the National Academy of Sciences convened an ad hoc conference on cardiopulmonary resuscitation. The conference was the direct result of requests from the American National Red Cross and other agencies to establish standardized training and performance standards for CPR. 1972 Leonard Cobb held the world's first mass citizen training in CPR in Seattle, Washington called Medic 2. He helped train over 100,000 people the first two years of the programs. 1981 A program to provide telephone instructions in CPR began in King County, Washington. The program used emergency dispatchers to give instant directions while the fire department and EMT personnel were en route to the scene. Dispatcher-assisted CPR is now standard care for dispatcher centers throughout the United States.
SCA 40% din victimele SCA: FV Deteriorare in asistolie-
sanse reduse de resuscitare
Tratament optim pentru SCR cu FV este: CPR de catre martori+
defibrilare
Tratamentul optim pentru SCR cauzat de asfixie (inec, trauma, droguri, copii): rescue breaths vitale
LANTUL SUPRAVIETUIRII Recunoastera precoce si activarea
sistemului de urgenta: poate preveni SCR Early CPR:dubleaza/tripleaza
supravietuirea din fv Fiecare minut fara CPR scade supravietuirea cu
7-10% Defibrilarea precoce:CPR + defib in 3-5
min: supravietuire de 49-75% Fiecare minut intarziere- reduce sansele de
externare cu 10-15%
BASIC LIFE SUPPORT secventa de proceduri efectuate pentru a
restabili circulatia sangelui oxigenat dupa un SC/R
Compresii sternale si ventilatie pulmonara efectuate de oricine care stie cum sa o faca, oriunde, imediat, fara alt echipament.
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
APPROACH SAFELY!
Scene
Rescuer
Victim
Bystanders
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Factori de risc legati de scena actiunii Mediu
Trafic cladiri Electricitate Apa, foc Toxice
Victima Boli infectioase Intoxicatii
Tehnici Defibrilatoare Instrumente taioase sau ascutite
Training- manechin
Risk factors Infection tramsmissions Accidents with needles Rescuers having wound on their mouth, hands Case reports of tuberculosis, SARS, but no case
report of HIV transmission Mannequins: of the estimated 40 mil. in the USA
and perhaps 150 mil worldwide that have been taught mouth to mouth rescue breathing on mannequins in the last 25 years, there has never been a documented case of transmission of bacterial, fungal or viral disease by a CPR training mannequin
CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
CHECK RESPONSE
SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
OPEN AIRWAY
Head tilt and chin lift- lay rescuers- non-healthcare rescuers
No need for finger sweep unless solid material can be
seen in the airway
CHECK BREATHING
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
CHECK BREATHING
Look, listen and feel for NORMAL breathing
Do not confuse agonal breathing with NORMAL breathing
Respiratii agonice
Apar la scurt timp dupa oprirea cordului in aproximativ 40% din stopurile cardiace
Descrise ca respiratii “grele”, dificile. Zgomotoase, “gasping”
Recunoscute ca semn de stop cardiacErroneous information can result in withholding CPR from cardiac arrest victim
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Obstructia cailor aeriene cu corp starin (FBAO)
Approximativ 16 000 adulti si copii sunt tratati annual in UK pentru obstruictie de cai aeriene cu corpi straini
SEMNE OBSTRUCIE MODERATA
OBSTRUCIE SEVERA
“Te ineci?” “Da” Incapabil sa vorbeasca, poate incuviinta
Alte semne Poate tusi, respira, vorbeste
Nu poate respira/ respiratie cu Wheezing/silentiu/incearca sa tuseasca/ inconstienta
30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Place the heel of one hand in the centre of the chest
Place other hand on top Interlock fingers Compress the chest
Rate 100 min-1
Depth 4-5 cm Equal compression : relaxation
When possible change CPR operator every 2 min
CHEST COMPRESSIONS
• The most effective rate for chest compressions is 100 compressions per minute – the same rhythm as the beat of the BeeGee’s song, “Stayin’ Alive.”
http://www.dailymotion.com/video/x1afd7_bee-gees-staying-alive_music
RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
RESCUE BREATHS
Pinch the nose Take a normal breath Place lips over mouth Blow until the chest
rises Take about 1 second Allow chest to fall Repeat
RESCUE BREATHS
RECOMMENDATIONS:- Tidal volume 500 – 600 ml
- Respiratory rate give each breaths over about 1s with enough volume to make the victim’s chest rise
- Chest-compression-only
continuously at a rate of 100 min
Call 112
Approach safely
Check response
Shout for help
Open airway
Check breathing
Attach AED
Follow voice prompts
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
Some AEDs will automatically switch themselves on when the lid is opened
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
Attach AED
Follow voice prompts
CONTINUE RESUSCITATION UNTIL
Qualified help arrives and takes over
The victim starts breathing normally
Rescuer becomes exhausted
CHEST COMPRESSIONS- infant, lone rescuer
Lone rescuer: compress the sternum with the tips of two fingers
Pediatric FBAO No abdominal thrusts for choking infants Risk because of the horizontal position of
the ribs- upper abdominal viscera more exposed to trauma
Pediatric AED Automated external defibrillators (AEDs) are safe
and successful when used in children older than 1 year of age.
Purpose made paediatric pads or software attenuate the output of the machine to 50–75 J and these are recommended for children aged 1–8 years.
If an attenuated shock or a manually adjustable machine is not available, an unmodified adult AED may be used in children older than 1 year.
There are case reports of successful use of AEDs in children aged less than 1 year;
in the rare case of a shockable rhythm occurring in a child less than 1 year, it is reasonable to use an AED (preferably with dose attenuator).
Drowning WHO: worldwide,drowning accounts for
approximately 450,000 deaths each year A common cause of accidental death in
Europe the duration of hypoxia is the most critical
factor in determining the victim’s outcome oxygenation, ventilation and perfusion
should be restored as rapidly as possible CPR by a bystander and immediate
activation of the EMS system.
Drowning- epidemiology 97% of deaths from drowning occur in low-
and middle-income countries more common in young males is the leading cause of accidental death in
Europe in young males suicide, traffic accidents, alcohol and drug
abuse varies between countries
Drowning: definition ILCOR: “a process resulting in
primaryrespiratory impairment from submersion/ immersion in a liquid medium.
a liquid/air interface is present at the entrance of the victim’s airway: the victim does not breathe air.
Immersion=to be covered in water or other fluid
Drowning: at least the face and airway must be immersed.
Submersion = that the entire body, including the airway, is under the water or other fluid
Drowning: pathophysiology cardiac arrest occurs as a consequence of
hypoxia the victim initially breath holds before
developing laryngospasm. this time the victim frequently swallows large
quantities of water. breath holding/laryngospasm continues,
hypoxia and hypercapnia develops victim aspirates water into their lungs
leading to worsening hypoxaemia
Drowning: treatment1. aquatic rescue2. basic life support3. advanced life support4. post-resuscitation careInitial rescue: bystanders, trained lifeguardsBLS: initial respondersNumber of victims-
Drowning: treatment1. Aquatic rescue and recovery from the water. personal safety and minimize the danger to yourself and the
victim at all times attempt to save the drowning victim without entry into the
water. talking to the victim rescue aid throwing a rope
use a boat or other water vehicle If entry into the water is essential, take a flotation device. safer to enter the water with two rescuers Never dive head first in the water (loose visual contact with the
victim, risk of spinal injury) incidence of cervical spine injury in drowning victims is very low(approximately 0.5%)
Drowning: treatment2.BLSRescue breathing: prompt initiation of rescue breathing or
positive pressure ventilation increases survival Give five initial ventilations/rescue breaths Rescue breathing can be initiated whilst the victim is still in
shallow water provided the safety of the rescuer is not compromised
mouth-to nose ventilation may be used as an alternative to mouth-to-mouth ventilation
In-water resuscitation: 10–15 rescue breaths over approx. 1min . normal breathing does not start spontaneously, and the victim is
<5 min of from land, continue rescue breaths while towing. If more than an estimated 5min from land, give further rescue
breaths over 1min, then bring the victim to land as quickly as possible without further attempts at ventilation.
Drowning: treatment2.BLSChest compression on a firm surface before starting chest compressions
as compressions are ineffective in the water Confirm the victim is unresponsive and not breathing
normally and then give 30 chest compressions, tan 30:2
Compression-only CPR: to be avoided.Automated external defibrillation if an AED is available, dry the victim’s chest, attach
the AED pads and turn the AED on. deliver shocks according to the AED prompts
Drowning: treatmentRegurgitation during resuscitation. Rescue breathing: need for very high inflation
pressures Regurgitation of stomach contents and
swallowed/inhaled water is common during resuscitation from drowning
turn the victim on their side and remove the regurgitated material using directed suction if possible
Abdominal thrusts can cause regurgitation of gastric contents and other life-threatening injuries and should not be used.
Care should be taken if spinal injury is suspected
Drowning Discontinuing resuscitation efforts Salt versus fresh water. Hypothermia after drowning. Victims of submersion: primary or secondary
hypothermia Submersion occurred in icy water (<5 ◦C or 41◦F),
hypothermia may develop rapidly and provide some protection against hypoxia
a secondary complication of the submersion and subsequent heat loss through evaporation during attempted resuscitation
consider rewarming until a core temperature of 32–34 ◦C is achieved
Electrocution 0.54 deaths per 100,000 people/year Electrical injuries
in adults: in the workplace and are associated with high voltage, children are at risk primarily at home, where the voltage
is lower (220V in Europe, Australia and Asia; 110V in the USA and Canada)
Lightning strikes is rare, but worldwide it causes 1000 deaths each year
Electric shock injuries: the direct effects of current on cell membranes and vascular smooth muscle
The thermal energy associated with high-voltage electrocution: burns
Electrocution Factors influencing the severity of electrical injury
current: alternating (AC) or direct (DC) voltage, magnitude of energy delivered, resistance to current flow, pathway of current through the patient, the area duration of contact
Contact with AC may cause tetanic contraction of skeletal muscle, which may prevent release from the source of electricity.
Myocardial or respiratory failure may cause immediate death
Electrocution paralysis of the central respiratory control system or the respiratory muscles: respiratory arrest VF if it traverses the myocardium duringthe vulnerable period myocardial ischaemia because of coronary artery
spasm. asystole may be primary, or secondaryto asphyxia following respiratory arrest current that traverses the myocardium is more
likely to be fatal transthoracic (hand-to-hand)>a vertical (hand-to-
foot)/straddle (foot-to-foot)
Lightning strike 300 kV over a few milliseconds. the current from a lightning strike passes over the surface
of the body in a process called ‘external flashover Industrial shocks and lightning strikes: deep burns at the
point of contact. Industrial shocks: the points of contact are usually on the
upper limbs, hands and wrists Lightning: mostly on the head, neck and shoulders. Lightning can also cause:
central and peripheral nerve damage; brain haemorrhage and oedema, Peripheral nerve injury
Mortality from lightning injuries is 30%-70%
Electrocution: Rescue
Ensure that any power source is switched off and do not approach the casualty until it is safe.
High-voltage electricity can arc and conduct through the ground for up to a few meters around the casualty.
It is safe to approach and handle casualties after lightning strike, although it would be wise to move to a safer environment, particularly if lightning has been seen within 30 min
Electrocution: Resuscitation Airway management may be difficult if there are electrical burns around the face and neck extensive soft-tissue edema may develop causing airway
obstruction Head and spine trauma can occur after electrocution. Immobilize
the spine until evaluation can be performed. Muscular paralysis, especially after high voltage, may persist
several hours Remove smoldering clothing and shoes to prevent further thermal
injury. Maintain spinal immobilization if there is a likelihood of head or
neck trauma Conduct a thorough secondary survey to exclude traumatic
injuries caused by tetanic muscular contraction or by the person being thrown
Electrocution can cause severe, deep soft-tissue injury with relatively minor skin wounds, because current tends to follow neurovascular bundles; look carefully for features of compartment syndrome.
Cardiac arrest associated with pregnancy problems associated with pregnancy are caused by aortocaval
compression after 20 weeks gestation, the pregnant woman’s uterus can press
down against the inferior vena cava and the aorta, impeding venous return and cardiac output
The key steps for BLS in a pregnant patient are: Call for expert help early (including an obstetrician and
neonatologist). Start basic life support according to standard guidelines. Ensure
good quality chest compressions with minimal interruptions. Manually displace the uterus to the left to remove caval
compression. Add left lateral tilt if this is feasible – the optimal angle of tilt isunknown. Aim for between 15◦ and 30◦. Even a small amount oftilt may be better than no tilt. The angle of tilt used needs to allowgood quality chest compressions and if needed allow Caesareandelivery of the fetus. Start preparing for emergency Caesarean section –the fetus will
need to be delivered if initial resuscitation efforts
Accidental hypothermia when the body core temperature unintentionally drops below 35 ◦C.
mild (35–32 ◦C), moderate (32–28 ◦C) or severe (less than 28 ◦C)
The Swiss staging system based on clinical signscan be used at the scene to describe victims:stage I –clearly conscious and shivering; stage II – impaired consciousness without shivering;stage III – unconscious; stage IV – no breathing;stage V – death due to irreversible hypothermia
Accidental hypothermiaDiagnosisNormal thermoregulation during exposure to cold environments, wet or windy conditions in people who have been immobilized, or following immersion in cold water Impaired thermoregulation :in the elderly and
very youngOther risk conditions: drug or alcohol ingestion, exhaustion, illness
Accidental hypothermia The core temperature measured in the lower third
of the oesophagus correlates well with the temperature of the heart.
epitympanic (‘tympanic’) measurement the method of temperature measurement should be the
same throughout resuscitation and rewarmingDecision to resuscitate cellular oxygen consumption by 6% per 1 ◦C decrease in core
temperature At 28 ◦C oxygen consumption is reduced by 50% and at 22
◦C by 75%. can exert a protective effect on the brain and vital organs In a hypothermic patient, no signs of life (Swiss hypothermia
stage IV) alone is unreliable for declaring death At 18 ◦C the brain can tolerate periods of circulatory arrest
for ten times longer than at 37 ◦C. the traditional guiding principle that “no one is dead until
warm and dead” should be considered
Accidental hypothermiaResuscitation the same ventilation and chest compression rates
as for a normothermic patient stiffness of the chest wall, making ventilation and
chest compressions more difficultRewarming removal from the cold environment, prevention of further heat loss and rapid transfer to hospital. Swiss stages≥II should be immobilized and
handled carefully the whole body dried and insulated( Wet clothes
should be cut off)
Accidental hypothermiaRewarming Conscious victims can mobilise as exercise rewarms a
person more rapidly than shivering Somnolent or comatose victims should be immobilized and
kept horizontalPassive rewarming is appropriate in conscious victims with
mild hypothermia who are still able to shiver, by: full body insulation with wool blankets, aluminium foil, cap warm environment. chemical heat packs to the trunkHypothermic victims with an altered consciousness should be
taken to a hospital capable of active external and internal rewarming.
Avalanche burial asphyxia, trauma and hypothermia avalanche victims are not likely to survivewhen they are:• buried >35 min and in cardiac arrest with an
obstructed airway on extrication;• buried initially and in cardiac arrest with an
obstructed airway on extrication, and an initial core temperature of <32◦;
• buried initially and in cardiac arrest on extrication with an initial serum potassium of >12 mmol
HyperthermiaDefinition when the body’s ability to thermoregulate
fails and core temperature exceeds the normally maintained by homeostatic mechanisms
exogenous, caused by environmental conditions secondary to endogenous heat production.Forms:
heat stress heat exhaustion heat stroke finally multiorgan dysfunction and cardiac arrest
Malignant hyperthermia (MH)
Hyperthermia
Heat stroke•systemic inflammatory response a core temperature above 40.6 ◦C, accompanied by mental state change and varying levels of organ dysfunction.•classic non-exertional heat stroke (CHS) occurs during high environmental temperatures and often effects the elderly•Exertional heat stroke (EHS) occurs during strenuous physical exercisein high environmental temperatures and/or high humidityusually affects healthy young adults•Mortality from heat stroke ranges between 10 and 50%
HyperthermiaManagement ABCDEs and rapidly cooling the patient Start cooling before the patient reaches hospital. Aim to rapidly reduce the core temperature to
approximately 39 ◦C.Cooling techniques drinking cool fluids, fanning the completely undressed patient spraying tepid water on the patient Ice packs over areas where there are large superficial blood
vessels (axillae, groins, neck) In cooperative stable patients, immersion in cold water can
be effective
Modifications to cardiopulmonary resuscitation
There are no specific studies on cardiac arrest in hyperthermia.
the prognosis is poor compared with normothermic cardiac arrest
Hyperthermia
SOCUL, HEMORAGIILE, LEZIUNILE TESUTURILOR MOI Socul Hemoragii Plagi Fracturi Traumatisme craniene Traumatisme toracice Traumatisme abdominale
1. SOCUL Pompa: inima tetracamerala
Atrii/ ventriculi Miocard contractil Contractilitate/inotropism
Sistemul circulator: Artere Vene capilare
Fluidul circulant Elemente celulare (hematii, leucocite, trombocite) Plasma
Pulsul
1.SOCUL Reprezinta incapacitatea cordului si a
sistemului circulator de a mentine perfuzia catre organele vitale prin aport de de sange cu continut de oxigen.
Situatie amenintatoare de viata Recunoasterea semnelor si simptomelor-
nu toate concomitent, nu imediat
1. SOCUL- semne si simptome1. Anxietate, agitatie,
confuzie2. Tegumente palide, reci,
umede, lipicioase3. Tahipnee, respiratii
neregulate4. Tahicardie/puls slab
batut/ nepalpabil periferic5. Greturi, varsaturi6. Sete7. Privire “goala”,
mohorata, pupile dilatate
1. SOCULI. Socul hipovolemic- cauzat de pierderea excesiva
de sange sau fluide din organism Apare in conditii de hemoragii, arsuri, varsaturi si diaree
excesive
II. Socul cardiogen- deficit de pompa cardiacaIII. Socul septic Socul anafilactic- substanta cu rol de alergen-
medicamente, venin de insecte si animale, praf si polen, alimente
Socul spinal
1. SOCUL: tratament Pozitionati pacientul: pe spate, cu membrele inferioare ridicate
usor (20-30 cm). Exceptii:
pozitie laterala de siguranta leziuni de coloana suspectate traumatisme craniene dispnee
A, B, C : Mentineti deschisa calea aeriana Identificati/ inlaturati cauza daca e posibil Controlati hemoragiile!!!!! Oxigen (daca e disponibil)
Imobilizati eventualele fracturi, nu reduceti! Mentineti temperatura (paturi), inlaturati hainele ude. NU folositi
metode de incalzire activa! Incurajati victima, evitati expunerea zonei ranite vederii acesteia NU alimentati, NU administrati lichide! 112 si transport cu ambulanta cat mai repede la spital Urmariti si reevaluati constant, monitorizati pulsul, respiratia,
constienta la fiecare 5 minute.
2. HEMORAGII Pierdera sangelui la nivel capilar, venos
sau arterial Hemoragii interne- in interiorul corpului Hemoragii externe- inafara corpului Ambele
Hemoragii capilare- sangele “balteste” Hemoragii venoase- sange inchis la
culoare, curgere fluenta, continua Hemoragii arteriale- sange rosu aprins,
pulsatil- situatie amenintatoare de viata!
2. HEMORAGII Adultul- 5-6 litri de sange Poate pierde fara consecinte aprox 0.5l La peste 1l- soc 2-3l- deces Greu de identificat uneori daca e arteriala
sau venoasa• capilare- usor de controlat pe suprafata
mica • Leziuni profunde cu hemoragii arteriale
sau venoase- Urgenta majora!
2. HEMORAGIIHEMORAGIILE EXTERNE:
control1. Compresie directa- prima si
cea mai eficienta masura pansament steril sau tesut
curat Bandaj compresiv Inca un pansament sau
propriul pumn Nu indepartati sub nici o
forma pansamentul aplicat2. Ridicarea extremitatii
lezate deasupra nivelului cordului- impreuna cu compresia directa.
2. HEMORAGII3. Compresie indirecta
pentru hemoragiile arteriale pe artere sustinute de suport osos
Cu degetele, podul palmei sau mana
!- flux inadecvat catre extremitate
NU la nivelul carotidelor! Cele mai des utilizate-
brahial, femural
2. HEMORAGII4. Garoul- NU! folosire descurajata!!!! doar ca ultima resursa!!!! doar la nivelul
extremitatilor folosit neadecvat poate
duce la compromiterea definitiva a membrului sau agravarea hemoragiei
Bucata de tesatura, curea, fular
Nu folositi sarme, cabluri etc- ce ar putea taia pielea
NU ACOPERITI GAROUL!!!!! MARCATI POZITIA SI
ORA!!!! NU-L MAI INDEPARTATI!!!!
2.HEMORAGIIHEMORAGII INTERNE De obicei nu sunt la vedere Pot conduce la soc Hemoragii la nivelul gurii,varsaturi hemoragice, la
nivelul urechilor, nasului, rectului sau altor orificii sunt considerate severe si indica prezenta hemoragiilor interne
Contuzii, corpuri contondente, fracturi Semne (inafara de eventiale exteriorizari):
anxietate, agitatie. sete, greturi si varsaturi, tegumente reci, palide si umede, tahipnee, tahicardie cu puls slab palpabil
2. HEMORAGII In tesuturi moi: echimoze- contuzii
gheata sau pansament rece nu direct in contact cu pielea, ci prin tesaturi- reduce durerea si edemul
Hemoragii interne severe: Sunati la numarul de urgenta local Monitorizati ABC Tratati socul* Plasati pacientul in pozitia cea mai confortabila* Mentineti confortul termic Sustineti moral
2.HEMORAGIIEpistaxisul Produs de traumatism, factori de mediu,
HTA, schimbari de altitudine, malformatii vasculare locale.
Orice pacient suspectata de HTA cu epistaxis se evalueaza la spital
In caz de fractura de craniu- nu incercati sa opriti hemoragia. Sunati 112!
Conduita in epistaxis :Pozitie sezanda, nu capul pe spate,eliberati de haine stranse in jurul gatului strangeti aripile nazale(exceptie fracturi) si apasati; gheata sau comprese reci la baza nasului 5-10 minPresiune la niveleul buzei superioare sub nasIncurajati sa scuipeNu freaca sau sufla nasul timp de min 1 oraPozitie laterala de siguranta daca devine inconstientCorp strain- copii: nu impingenti! Sunati 112!
2.HEMORAGII Conduita in epistaxis :
Pozitie sezanda, nu capul pe spate,eliberati de haine stranse in jurul gatului
strangeti aripile nazale(exceptie fracturi) si apasati; gheata sau comprese reci la baza nasului 5-10 min
Presiune la niveleul buzei superioare sub nas
Incurajati sa scuipe Nu freaca sau sufla nasul
timp de min 1 ora Pozitie laterala de
siguranta daca devine inconstient
Corp strain- copii: nu impingenti! Sunati 112!
3.TRAUMATISMELE TESUTURILOR MOIPlagi= traumatisme ce produc efractia
tegumentului, a tesutului subcutanat si altor mucoase.
Inchise/deschise Plagi contuze/Plagi dilacerate/Plagi taiate/
intepate/ muscate Riscurile majore:- hemoragii si infectii
PLAGIGeneralitati- principii de tratamentPlagi recente: controlul hemoragiilor si prevenirea socului prevenirea infectiei Stabilizarea partii lezate Stabilizarea corpurilor penetrantePlagi vechi si infectate: ridicarea zonei afectate, pansament
umed caldutPlagi ce contin corpuri straine; pot fi indepartate doar daca
sunt superficiale. ! Nu indepartati niciodata corpurile straine din ochi sau craniu!!!!!!!
OBIECTUL PENETRANT SE LASA PE LOC! ORICE MISCARE A SA POATE PRODUCE LEZIUNI SUPLIMENTARE! NU SE EXTRAGE!!!!!SE STABILIZEAZA CU COMPRESE. SE BANDAJEAZA!
PLAGI
Plagi mici: spalati cu apa si sapun, uscati si aplicati un antiseptic usor, neiritant. Pansament
Plagi mari: nu incercati sa spalati sau sa aplicati antiseptic. Acoperiti cu pansament steril, uscat
PLAGI Controlul hemoragiei:
compresa uscata, sterila, presiune directa, ridicare, puncte de presiune
Nu se curata plagile in prespital
Compresa se fixeaza cu pansament compresiv
Compresa sa acopere plaga
Daca se imbiba se plaseaza alta deasupra, nu se indeparteaza
Se fixeaza cu rola sau pansament triunghiular
PLAGI Dimensiuni LocalizareTipuri de plagi: INCHISE:
ECHIMOZA (contuzie, edem, durere) Semn de fracturi sau leziuni severe subiacente Comprese reci/ gheata nu direct pe tegument!
HEMATOMUL- leziune extinsa a tesuturilor moi cu pierdere de sange in interiorul tesutului- de obicei in zona fracturilor
Compresie manuala, pansamente reci, imobilizare, pozitie elevata
PLAGIDESCHISE Abraziuni (escoriatii) Amputatii traumatice
(complete, partiale) ABC Controlul hemoragiei Pansament Prevenirea/ tratarea socului Solicita asistenta medicala de
urgenta Avulsii- tegumentul este
complet indepartat, smuls din zona respectiva
Hemoragii importante Recuperati tegumentul,
turnati apa, puneti-l in pansament steril, in punga inchisa, puneti cu gheata si trimiteti cu pacientul
PLAGI TAIATE – instrumente ascutite: cutite,
lame, cioburi de sticla Hemoragii importante Cel mai mic risc de infectii
DILACERARI- plagi rupte, smulse INTEPATE
PLAGIMUSCATE Risc de infectie Risc de rabie Minore: apa si sapun Mari: controlul hemoragiei,
comprese,bandaj Obligatoriu medic!IMPUSCATE-orificiu de intrare si iesire Hemoragii interne
4. OASE, ARTICULATII SI MUSCULATURA Fracturi, luxatii, entorse, contuzii Leziuni articulare impreuna cu cele musculare Dificil de diferentiat de fracturi- in caz de
nesiguranta, mai bine tratezi ca fracturaFracturi=intreruperea continuitatii osului prin
trumatism direct sau indirect. Principiu de baza in fracturi: imobilizarea
segmentelor fracturate pentru prevenirea aparitiei in continuare a leziunilor produse de capetele osoase
4. OASE, ARTICULATII SI MUSCULATURA
Luxatiile= modificarea raporturilor anatomice normale ale extremitatilor osoase intr-o articulatie cu ruperea ligamentelor care sustin articulatia
Entorsele= intinderea ligamentelor care sustin articulatia
4. OASE, ARTICULATII SI MUSCULATURA
Semne si simptome pentru leziunile musculo-scheletale ale extremitatilor:
Durere Plaga Tumefiere Deformarea extremitatii Impotenta functionala
4. OASE, ARTICULATII SI MUSCULATURAExaminare:Generala: A,B,C + stabilizarea
coloanei cervicale + controlul hemoragiei
A membrului afectat: se compara membrul lezat cu cel sanatos
Se indeparteaza hainele Se examineaza de la
articulatiile superioare spre inferioare
Pacientul trebuie intrebat ce simte (durere, parestezii, nimic)
Se evalueaza: circulatia: pulsul (in aval de
leziune), recolorarea capilara sensibilitatea miscarea
Principii de tratamentImobilizare: Inainte de mutarea
pacientului Reduce durerea Previne riscul de leziuni
ulterioare Reduce riscul sangerarii si a
leziuniloe nervoaseTehnica imobilizarii Se indeparteaza hainele Se examineaza complet (puls,
sensibilitate, motricitate) Se panseaza plagile Se imobilizeaza articulatia de
deasupra si dedesuptul leziunii
Se reverifica pulsul si sensibilitatea
Se lasa la vedere degetele
FRACTURI ATELE- orice obiect rigid- umbrele, bete,
plansee, perne ziare pliate, membru inferior nefracturat etc.
Atele rigide, moi, vacuum (pe ambulante) Sunt fixate de membrul fracturat cu
bandaje, tesaturi, benzi adezive Nu se aplica foarte strans, se lasa expuse
extremitatile- degete
FRACTURI Inchise- osul este fracturat, dar tegumentul ramane intact Deschise- osul este fracturat, tegumentul lezat Complicate- leziuni secundare(coasta ce perforeazaplamanul)
FRACTURICONDUITA Controlul hemoragiei- Tratamentul socului Monitorizeaza ABC Se indeparteaza bijuterii, haine, usor, pentru a nu
produce leziuni suplimentare Se verifica pulsul distal de fractura-
absent:miscari lejere pana la palparea sa Se acopera plagile cu pansament steril. NU se
apasa capetele osoase inapoi in plaga Se plaseaza atela
FRACTURIPlasarea atelei: Se mentine tractiunea pana la fixarea atelei Se infasoara de la baza la varf, nu strans Se verifica pulsul distal Daca e absent, se largeste bandajul Se solicita ajutor medical Rezumat- ACRONIM : I (ice)C (compression) E (elevation)
FRACTURICOLOANA VERTEBRALA Mielice durere, soc, paralizie Amielice-
Leziune de coloana cervicala se suspecteaza la: Orice politraumatism Orice TCC Orice traumatism toracic superior Deformari la nivelul gatului Orice pacient constient care acuza dureri la nivelul
gatului Orice pacient traumatizat cu status mental alterat
Conduita: Pozitie decubit dorsal, stabilizarea capului si
gatului in pozitia gasita Cai aeriene: subluxatia mandibulei, ABC
Se mentine pozitia neutra a capului si gatului- guler improvizat din prosop Se trateaza socul. Nu se ridica picioarele Nu permiteti miscari, nu mobilizati, ajutor
medical.
Mobilizarea victimelor: principii generale Sa nu provocati mai mult rau Se mobilizeaza pacientul doar daca e
necesar Cat mai putin posibil Se mobilizeaza corpul ca un tot Se folosesc tehnici de ridicare si mutare
adecvate sigurantei personale Un salvator da comanda de mobilizare (cel
aflat la capul pacientului)
Traumatismele cranieneA. Traumatisme craniene minore (majoritatea) 112 trebuie anuntat in caz de :
Hemoragie severa faciala sau craniana Epistaxis sau otoragie Cefalee severa Alterarea starii de constienta in secunde Aspect echimotic in jurul ochilor sau retroauricular Apnee Confuzie Pierderea echilibrului Pareza sau incapacitatea de a mobiliza membre Anizocorie Varsaturi/vorbire dificila Convulsii
Traumatismele cranieneB. Traumatism cranian sever: Mentineti pacientul linisit, imobil, in decubit
dorsal, capul si umerii usor ridicati. Evitati miscarile gatului. Mobilizati doar in caz de stricta necesitate
Opriti sangerarile. Presiune directa cu pansament steril sau textil curat. Nu aplicati compresie daca suspectati fractura craniana
Monitorizati schimbarile de dinamica a respiratiei si constientei
In lipsa circulatiei- CPR
Traumatismele cranienePlagile la nivel cranian: Zona bine vascularizata: hemoragii masive Presiune directa Comprese fixate cu fasa Suspiciune de fractura craniana: nu compresie Obraji: pansament compresiv in guraTraumatismele oculare: Evaluare medicala obligatorie Pozitie decliva Se acopera ochiul cu compresa uscata Corp strain: compresa si pahar de plastic sau
hartie, se bandajeaza ambii ochi dupa avertizare prealabila!
Nu se introduc substante in scop antiseptic!
Traumatismele gatului Trahee, esofag, artere si vene mari,
vertebre, maduva spinarii Plagi: presiune directa pe sursa
hemoragiei Nu fesi circulare! Se mentine stabilitatea capului si gatului Se mentine permeabilitatea caii aeriene
Traumatismele toracice Plamani, vase mari,
cord, coloana Dispnee si hemoragii In lipsa semnelor de
obstructie aeriana: orice dispnee de evaluat pentru trauma toracica inchisa sau deschisa
Pneumotorax deschis Urgenta medicala cu
risc vital
Traumatismele toracice Semne si simptome
1. Dispnee si durere toracica violenta2. Cianoza, anxietate
Primul ajutor:1. Etanseizati rana cu mana sau orice obiect=
pansament ocluziv (card de identitate). Pansament fixat pe 3 laturi. In caz de agravare, indepartati imediat!
2. Pozitionati pacientul pe partea afectata3. Tratati socul- pozitie semisezanda4. Nimic per os5. Solicitati asistenta medicala de urgenta
Traumatismele abdominaleInchise: tegument
intact1. Durere violenta,
varsaturi, contractura musculaturii abdominale
2. Distensie abdominala, soc
3. Pozitie antalgica
1. ABC2. Plasati pacientul in
pozitia cea mai confortabila
3. Indepartati cu grija hainele pentru a evalua corect
4. Tratati socul5. Nimic per os
Traumatismele abdominaleDeschise1. Semnele traumatismelor
inchise2. Plagi intepate sau
contuze, hematemeza3. Dureri lombare
ABC Indepartati cu grija hainele Pozitia cea mai
comfortabila-pe spate, cu picioarele ridicate usor/ genunchi indoiti
Tratati socul Opriti hemoragiile. Nu
atingeti si nu incercati sa repozitionati organele eviscerate. Acoperiti cu pansament steril cu ser fiziologic, fixat pe 4 laturi
Mentineti temperatura Nimic per os Solicitati asistenta
medicala de urgenta
FrostbiteFreezing of tissue or moisture in the skin due to exposure to temperatures below 0 degrees C
Air temps below 0ºC skin freezes at -2oC
Superficial frostbite (mild) freezing of skin surface
Deep frostbite (severe) freezing of skin and other soft tissues, may include bone
Hands, fingers, feet, toes, ears, chin, nose, groin area
Frostbite Symptoms
initially redness in light skin or grayish in dark skin
tingling, stinging sensation turns numb, yellowish, waxy or gray color feels cold, stiff, woody blisters may develop
Frostbite Treatment
remove from cold and prevent further heat loss remove constricting clothing and jewelry rewarm affected area evenly with body heat
until pain returns when skin thaws it hurts!! do not rewarm a frostbite injury if it could refreeze
during evacuation or if victim must walk for medical treatment
do not massage affected parts or rub with snow
evacuate for medical treatment
Trench/Immersion FootResults from prolonged exposure of skin to cold or wet conditions, usually at 10 degrees C or colder. Potentially crippling, nonfreezing injury (temps from 0oC-10oC)
Prolonged exposure of skin to moisture (12 or more hours)
High risk during wet weather, in wet areas, or sweat accumulated in boots or gloves
Trench/Immersion Foot Symptoms
initially appears wet, soggy, white, shriveled sensations of pins and needles, tingling,
numbness, and then pain skin discoloration - red, bluish, or black becomes cold, swollen, and waxy appearance may develop blisters, open weeping or
bleeding in extreme cases, necrosis
Trench/Immersion Foot Treatment
prevent further exposure dry carefully DO NOT break blisters, apply lotions, massage,
expose to heat, or allow to walk on injury rewarm by exposing to warm air clean and wrap loosely elevate feet to reduce swelling Defer for medical treatment
Snow BlindnessInflammation and sensitivity of the eyes caused by ultraviolet rays of the sun reflected by the snow or ice
Symptoms gritty feeling in eyes redness and tearing eye movement will
cause pain headache
Treatment•remove from sunlight
•blindfold both eyes or cover with cool, wet bandages•seek medical attention•recovery may take 2-3 days
First Degree Burn Cause:
Overexposure to sun Light contact with hot
objects Scalding by hot water
or steam
Signs of First Degree Burns Erythema Mild Swelling & Pain Rapid Healing
Second Degree Burns Results from a very
deep sunburn Contact with hot
liquids Flash burns from
gasoline etc.
Signs of Second Degree Burns
Erythema Swelling Blisters Pain Open Wounds Wet appearance due
to loss of plasma through damaged skin layers.
First Aid: Second Degree Burns Immerse in cold water NOT ice water Apply cool compresses Blot dry & apply sterile gauze or clean cloth for
protection DO NOT break blisters or remove tissue DO NOT use an antiseptic preparation, ointment,
spray or home remedy on a severe burn.
If arm or legs are affected, keep them elevated.
Third Degree Burns Caused by flame,
ignited clothing, immersion in hot water, contact with hot objects, or electricity.
Signs of Third Degree Burns
White or Charred appearance
Deep tissue destruction
Complete loss of all skin layers
Nerve Damage Pain or No Pain
First Aid: Third Degree Burns DO NOT remove pieces of adhered
particles of charred clothing. Cover burn with thick, sterile or freshly
laundered cloth. If hands or legs involved, elevate DO NOT immerse or apply ice water to
burn area. DO NOT apply ointment, commercial
preparations, grease, or other home remedies.
Chemical Burns of the Skin First Aid:
Remove clothing Flush with water for 15 – 20 minutes Get name / source of Chemical Seek Medical Attention
Burns of the Eyes First Aid:
Flush face, eyelid, & eye for 15 – 20 minutes Avoid rubbing eye Cover eye Seek medical attention
ContinutUrgente medicale Afectiunile cardiace
Sindroamele coronariene acute Insuficienta cardiaca
Sincopa Accidente vasculare cerebrale Convulsii
IntoxicatiileIntepaturile de animaleUrgentele comportamentale
Urgentele medicale: principii Abordarea unui pacient netraumatizat: Verificati zona Stabiliti contactul cu pacientul incercand sa identificati probleam Prezentati-va Evaluare primara:
ABC Identificati cea mai importanta problema a pacientului 112
Incercati sa aflati rapid un istoric al pacientului dupa algoritmul: S: semn, simptom A: alergii M: medicamente P: probleme medicale anterioare L: (lunch) ultima masa- ce, cat si cand E: evenimente asociate
Evaluare secundara: Examen fizic rapid, monitorizare de functii vitale
Sustineti moral pacientul Evaluati continuu
Sindroame coronariene acute Situatie in care fluxul
sanguin coronarian este intrerupt, conducand la necroza zonei de miocard din lipsa de oxigen
Afectiune cardio-vasculara Durere retrosternala- a se
suspecta un sindrom coronarian acut pana la proba contrarie!
Factori de risc neinfluentabili Ereditate Sex Varsta
Factori de risc influentabili Fumat HTA Colesterol Obezitate Sedentarism Stress Diabet netratat
Sindroame coronariene acuteSemne si simptome: Dureri retrosternale Iradiere in mandibual, umeri. brate, gat, spate Dispnee Tegumente palide, umede, transpiratii profuze Anxietate, greturi, varsaturi AstenieDaca suspectati:1. ABC2. Plasati pacientul in pozitia cea mai confortabila (sezanda sau
semi)3. Mentineti pacientul linistit si in confort termic4. Slabiti hainele stranse din jurul gatului, a taliei, a toracelui5. Pregatiti-va sa efectuati CPR6. Solicitati asistenta medicala
Sindroame coronariene acute
Angina pectorala: durere toracica cu caracter constrictiv sau de apasare (rareori mai mult de 5 minute) NitroglicerinaConduita: linistirea pacientului si interzicerea oricarui efort Oxigen pe masca daca e disponibil Nitroglicerina s.l. Monitorizare de functii vitale Pozitie semisezanda, 112
Sindroame coronariene acuteInfarctul miocardic acut (atac de cord)Cauze principale: ateroscleroza si tromboza Daca suprafata afectata din miocard este mare, inima se
poate opri: stop cardiacConduita: 112 Vorbiti si linistiti pacientul Pozitie semisezanda, tineti-l de mana Nu miscati pacientul, nu-l lasati sa efectueze nici un effort,
sau sa se ridice si sa mearga Oxigen pe masca Monitorizare de functii vitale Anuntare din timp si echipaj specializat in vederea
trombolizei sau angioplastiei
Urgente medicaleSincopa- pierdere temporara de constienta Atunci cand fluxul sanguin cerebral este
temporar inadecvat Fie cu semnificatie medicala minima, fie o
cauza grava. Semne si simptome:
1.ameteli,greturi, tulburari de vedere2.transpiratii, paloare, tahicardie
SincopaSistem nervos Encefal, maduva spinarii, nervi. Semnale de la si catre creier Controleaza si activitatea mm involuntare Neuroni motori Neuroni senzitiviInconstienta: intreruperea functionarii normale a creiereului.Grade: A= alert V= voce P= pain (durere) U= unresponsive (nu raspunde)
Sincopa Cauze de pierdere a constientei
F - FaintingI - Infantile ConvulsionsS - ShockH - Heat Imbalance
S - StrokeH - Heart AttackA - AsphyxiaP - PoisoningE - EpilepsyD - Diabetes
Scorul GlasgowA Deschiderea ochilor- Spontan= 4- La cerere= 3- La durere= 2- Nu deschide= 1B Cel mai bun raspuns motor-la ordin= 6-localizeaza stinul dureros= 5-retrage la durere= 4-flexie la durere= 3-extensie la durere= 2-nici un raspuns= 1C. Cel mai bun raspuns verbal-orientat= 5-confuz= 4-cuvinte fara sens= 3-zgomote= 2-nici un raspuns= 1
Sincopa1. Evaluare initiala2. Decubit dorsal, membrele pelvine ridicate
30 cm. nu permiteti pozitia sezanda3. Monitorizati A,B,C4. Largiti orice imbracaminte care strange la
nivelul gatului, toracelui, taliei5. Verificati daca s-au produs leziuni in
timpul caderii6. Solicitati asistenta medicala
Accidentele vasculare cerebrale Situatie in care unul sau mai multe vase
sanguine cerebrale sunt ocluzionate sau lezate, ceea ce conduce la moartea celulei nervoase prin lipsa de oxigen
Cauze; Trombi Hemoragii Emboli
Accidentele vasculare cerebraleSemne si simptome;1. Debut brusc2. Cefalee3. Ameteli, confuzie, salivatie4. Slabiciune sau pareza/paralizie a unui hemicorp5. Pierderea expresivitatii faciale si asimetria gurii6. Vedere dubla7. Dificultate de vorbire sau/ si intelegere8. Anizocorie, greturi, varsaturi9. Inconstienta10. Convulsii11. Stop respirator12. Incontinenta sfincteriana
Accidentele vasculare cerebraleEvaluare:
fata, membrele superioare, vorbirea
Unul dintre acestea anormal- probabilitate de AVC de aproximativ 70%
Accidentele vasculare cerebrale Decubit dorsal, capul si umerii usor ridicati Evaluati si mentineti ABC Solicitati ajutor Pozitie laterala de siguranta incazul pacientului
inconstient care respira Mentineti pacientul linistit si in confort termic Stabiliti GCS Monitorizare de functii vitale Nu administrati nimic per os
Crize convulsive Convulsii: miscari ale corpului cauzate de
contractii musculare involuntare, cauze; epilepsie, traumatisme craniene, infectii, febra.
Confuz si dezorientat dupa convulsii Semen si simptome:1. “aura” vizuala, sonora, gustativa sau olfactiva2. ‘”strigat”3. Pierdere completa sau partiala a constientei si
rigiditate musculara4. Spasme ale membrelor5. “spume” la gura6. Posibila emisie de urina si fecale
Crize convulsive: conduita1. Stai calmi- criza inceputa nu poate fi oprita2. Asezati pacientul in decubit dorsal, protejandu-l de alte lovituri, NU
IMOBILIZATI PACIENTUL!3. Indepartati obiectele apropiate ascutite, fierbinti, dure si ochelarii
pacientului pentru a preveni leziunile4. NU INTRODUCETI NIMIC INTRE DINTI SAU IN GURA PACIENTULUI si nu
imobilizati pacientul in nici un fel5. Slabiti hainele stranse din jurul gatului, a taliei, a toracelui6. Nu va panicati dac pacientul nu respira pentru scurt timp in timpul crizei7. Dupa incetarea crizei : pozitie laterala de siguranta8. Evaluati si mentineti ABC9. Nimic per os10. Solicitati asistenta medicala11. Monitorizati si evaluati continuu
Stare neuro-psihica specifica post criza: somn, sau anxietate, ostilitate, violentaEvaluati eventualele traumatisme produse prin cadere (! La coloana cervicala)
INTOXICATIILEAgent toxic= substanta ce cauzeaza stari de rau sau chiar deces atunci cand este mancata, bauta, inhalata, injectata sau absorbita chiar si in cantitati mici
Consideratii generale: Evaluati daca este sigur sa intrati in incapere, atentie la
mirosuri, cautati ambalaje sau alte semne Nu va apropiati daca e nesigur, solicitati ajutor specializat! ancheta minutioasa-ingestie: tub digestiv-inhalare: gura, nas- sistem respirator-injectarea: ac sau intepatura de insecta sau sarpe-absorbtie- prin pieleSemne si simptome : istoricul (ce?, cum?, cand?, cat?,
recipiente goale), respiratia, sistem digestiv, sistem nervos, salivatie, sudoratie
INTOXICATIILEPrin ingestie- cele mai frecvente ABC Se cauta cutii si ambalaje ce vor fi transportate
cu pacientul la spital Pacient constient: se provoaca varsatura Pacient inconstient: pozitie laterala de siguranta Dilutia: cantitati de apa administrate pacientului
constient in cazuri bine determinate Voma: indusa in situatii specifice, nu la pacienti
cardiaci, la cei care au ingerat acizi, substante alcaline sau kerosen
Carbunele activat: numai sub indrumare ! Intoxicatiile cu ciuperci!!!!
INTOXICATIILEInhalatie- Monoxidul de carbon- Fum- Gaze iritante (amoniac si cloruri)Conduita:-Protectia personala!!!!-scoaterea din mediu-ABC-pozitie laterala pt pacientii inconstienti-112
INTOXICATIILEAgenti injectatiMuscatura/intepatura de insecta sau sarpeSemne: Inflamatie, edem Coloratie la locul intepaturii Slabiciune, oboseala Direre locala Pririt Dispnee, wheezing Puls filiform Greturi, varsaturi, diareeMuscatura de sarpe- conduita: Linistiti pacientul, spalati cu apa si sapun Dezinfectia plagii Garou- dar nu strans Membrul afectata procliv Pungi de gheata 112, supraveghere si monitorizare NU INCIZATI!Intoxicatiile prin absorbtie Urme de lichid sau praf pe piele, piele rosie, inflamata, arsuri chimice, urticarie,
prurit, grata, varsaturi, soc Conduita: se indeparteaza substata- scoatere din medieu, scoase hainele, se perie
(NU SE SPALA) substanta de pe corp, apoi se spala cu apa 20 de min, tratamentul socului
Intoxicatia acuta etanolica Etanolul- ingredient principal al vinului, berii etc Clasificat ca si drog- deprima SNC, afectand
activitatile fizice si mentale Confera dependenta Afectare in etape: relaxare si stare de bine,
pierderea gradata a coordonarii. Incapacitate de a efectua activitati si indatoriri uzuale
Depresie a respiratiilor, pierdere de constienta, coma, deces
Sevrajul: delirium tremens
Intoxicatia acuta etanolicaSemne si simptome;1. Halena alcoolica2. Dezechilibrare si vorbire ingreunata3. Greturi, varsaturi si facies vultuos Semne ce pot fi identice cu ale unor afectiuni altele decat
intoxicatia etanolicaIn caz de suspiciune;1. Decubit dorsal, protejati de leziuni2. ABC3. Evaluare initiala4. Monitorizati atent- pacientul poate deveni inconstient5. Nu criticati, fiti fermi6. Nu plecati niciodata de langa el7. Solicitati asistenta medicala
Urgente comportamentale= situatii in care pacientii manifesta un comportament
anormal, inacceptabil, ce nu poate fi tolerat de pacienti, familie, prieteni sau comunitate.
Factori incriminati in schimbari de comportament:1. Conditii medicale: diabet, hipoxie, febra,frig, etc2. Trauma psihica3. Trauma fizica (TCC)4. Boli psihiatrice5. Substante ce afecteaza gandirea6. Stress situational (traume emotionale)Etape:1. anxietate/ soc emotional2. Negare3. Furie4. Remuscare/ durere/ resemnare
Urgente comportamentaleManagement: Siguranta salvatorului Evaluarea generala a scenei Evaluarea primara apacientului Evaluare secundara Sample Evaluare continuaComunicare: parafrazare, redirectionare, empatie, controlul
multimiiViolenta impotriva salvatorilorTentativa de suicidViolulMoarteaConsiliere dupa un eveniment critic