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Rol: de a pregtii studenii pentru a putea interaciona medical cu pacienii absena achiziiei abilitii pericliteaz d.p.d.v. medical pacientul absena achiziiei abilitii pericliteaz reputaia de halat alb Msurarea tensiunii arteriale Determinarea glicemiei utiliznd glucotestul Efectuarea electrocardiogramei Injecia intramuscular fesierul ventral absena achiziiei abilitii limiteaz major posibilitatea studentului de a activa la nivel clinic

Splarea medical a minilor (ap i spun; soluii alcoolice)


Masajul cardiac extern

Injecia intramuscular deltoid


Injecia subcutanat Plasarea pacientului n poziie
lateral, decubit dorsal, ventral, Fowler, Sims n pat.

Manevra Heimlich
Poziia lateral de siguran

Asistarea pacientului pentru a sta la marginea patului Asistarea pacientului in locomoie un asistent.
Intervenia n cazul dezechilibrrii pacientului.

Administrarea oxigenoterapiei

Recoltarea unei probe de snge venos. Injecia intravenoas


Efectuarea peackflowmetriei. Administrarea medicaiei inhalatorii

Administrarea medicaiei orale

i m p o r t a n egal

Rol: de a pregtii studenii pentru a putea interaciona medical cu pacienii absena achiziiei abilitii pericliteaz d.p.d.v. medical pacientul absena achiziiei abilitii pericliteaz reputaia de halat alb Msurarea tensiunii arteriale Determinarea glicemiei utiliznd glucotestul Efectuarea electrocardiogramei Injecia intramuscular fesierul ventral absena achiziiei abilitii limiteaz major posibilitatea studentului de a activa la nivel clinic

Splarea medical a minilor (ap i spun; soluii alcoolice)


Masajul cardiac extern

Injecia intramuscular deltoid


Injecia subcutanat Plasarea pacientului n poziie
lateral, decubit dorsal, ventral, Fowler, Sims n pat.

Manevra Heimlich
Poziia lateral de siguran

Asistarea pacientului pentru a sta la marginea patului Asistarea pacientului in locomoie un asistent.
Intervenia n cazul dezechilibrrii pacientului.

Administrarea oxigenoterapiei

Recoltarea unei probe de snge venos. Injecia intravenoas


Efectuarea peackflowmetriei. Administrarea medicaiei inhalatorii

Administrarea medicaiei orale

post splare medical a minilor


Necesar dotare: chiuvet cu alimentare ap cald i sisteme de scurgere distribuitor erveele hrtie distribuitor spun lichid acionat prin celul fotoelectric distribuitor soluii hidratante piele acionat fotoelectric distribuitor prosoape hrtie acionat prin celul fotoelectric co gunoi pentru deeuri infecioase distribuitor soluii alcoolice de splare mini Necesar consumabile: erveele hrtie - necesar per manevr: 5; per semestru: 30 cutii a cte 200 spun lichid - necesar per manevr: 10 ml; per semestru: 3 recipiente a cte 5 l soluie hidratant - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5
l

post electrocardiografie

prosoape hrtie - necesar per manevr: 4; per semestru: 80 pachete a cte 330
buc.

saci gunoi pentru deeuri infecioase - necesar per semestru: 70 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

40 50 m2
(6 m x 7,5 m)
seturi

Necesar dotare: sistem electrocardiografie canapea consultaie distribuitor erveele hrtie co gunoi pentru deeuri nepericuloase distribuitor soluii alcoolice de splare mini

Necesar consumabile: erveele hrtie - necesar per manevr: 12; per semestru: 48 cutii a cte 200 caiet registru ecg - necesar per semestru: 1 hrtie ecg - necesar per semestru: 10 pachete erveele soluie degresant - necesar per manevr: 6; necesar per semestru: 48 saci gunoi pentru deeuri nepericuloase - necesar per semestru: 70 soluie alcoolic splare - necesar per manevr: 10ml; per semestru: 4 recipiente de 5 l

post determinare tensiune arterial post peackflowmetrie, medicaie inhalatorie

Necesar dotare: sistem peackflowmetrie i medicaie inhalatorie canapea consultaie distribuitor erveele hrtie co gunoi pentru deeuri nepericuloase distribuitor soluii alcoolice de splare mini

Necesar dotare: distribuitor soluii alcoolice de splare mini sfigmomanometru canapea consultaie * msu medical reglabil pe nlime * manete tensiometru diverse mrimi distribuitor erveele dezinfecie stetoscop Littmann 3M 3200 Electronic Bluetooth * computer cu plac de sunet i recepie prin bluetooth *

Necesar consumabile: erveele hrtie - necesar per manevr: 5; per semestru: 30 cutii a cte 200 saci gunoi pentru deeuri infecioase - necesar per semestru: 70 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

Sala I

Necesar consumabile: erveele hrtie - necesar per manevr: 12; per semestru: 48 cutii a cte 200 saci gunoi pentru deeuri nepericuloase - necesar per semestru: 70 soluie alcoolic splare - necesar per manevr: 10ml; per semestru: 4 recipiente de 5 l

post injecia intravenoas


Necesar dotare: manechin didactic - manevr medical msu medical reglabil pe nlime flacon didactic medicaie injectabil co gunoi pentru deeuri infecioase distribuitor soluii alcoolice de splare mini Necesar dotare: pat spital dulap mobil medicaie msu reglabil pe nlime recipient ap flacoane medicaie, scop didactic fi prescripie terapie didactic suport plastic mobil co gunoi pentru deeuri nepericuloase distribuitor soluii alcoolice de splare mini

post administrarea medicaiei orale

Necesar consumabile: bomboane tip pastile necesar per manevr: 1; necesar per semestru: 800 phrele administrare medicaie oral - necesar per manevr: 1; per semestru: 800 pahar administrare lichide- necesar per manevr: 1; per semestru: 800 saci gunoi pentru deeuri nepericuloase - necesar per semestru: 70 soluie alcoolic splare - necesar per manevr: 10ml; per semestru: 4 recipiente de 5 l

Necesar consumabile: seringi - necesar per semestru: 800 ace sering necesar per semestru 800 / 1600 ace extragere soluie din flacon necesar per semestru 800 * comprese sterile tifon 4/2 cm - necesar per manevr: 1; necesar per semestru: 800 soluie alcool sanitar - necesar per semestru: 4 flacoane de 1 litru saci gunoi pentru deeuri infecioase - necesar per semestru: 70 co gunoi deeuri neptoare- necesar per semestru: 10 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

Necesar dotare:

post determinare glicemie prin glucotest

post Injecia intramuscular fesierul ventral

sistem glucotest canapea consultaie msu reglabil pe nlime co gunoi pentru deeuri infecioase distribuitor soluii alcoolice de splare mini

Necesar consumabile: teste glicemie- necesar per manevr: 1; per semestru: 800 lancelete- necesar per manevr: 1 per semestru: 800 erveele soluie antiseptic- necesar per manevr: 2; per semestru: 8 seturi a cte 200
buci

comprese tifon 2/2 cm - necesar per manevr: 1; necesar per semestru: 800 co gunoi deeuri neptoare - necesar per semestru: 10 mnui de unic folosin- necesar per manevr: 1; per semestru: 8 pachete a cte
100buc.

40 50 m2
(6 m x 7,5 m)

Necesar dotare: manechin didactic - manevr medical msu medical reglabil pe nlime flacon didactic medicaie injectabil co gunoi pentru deeuri infecioase distribuitor soluii alcoolice de splare mini

saci gunoi pentru deeuri infecioase - necesar per semestru: 70 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

Necesar consumabile: seringi - necesar per semestru: 800 ace sering necesar per semestru 800 / 1600 ace extragere soluie din flacon necesar per semestru 800 * comprese sterile tifon 4/2 cm - necesar per manevr: 1; necesar per semestru: 800 soluie alcool sanitar - necesar per semestru: 4 flacoane de 1 litru saci gunoi pentru deeuri infecioase - necesar per semestru: 70 co gunoi deeuri neptoare- necesar per semestru: 10 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

post asistarea pacientului in locomoie un asistent. Intervenia n cazul dezechilibrrii pacientului. Asistarea pacientului pentru a sta la marginea patului

post injecia subcutanat

Necesar dotare: distribuitor soluii alcoolice de splare mini canapea consultaie / pat spital reglabil pe nlime centur susinere transfer crucior cu rotile *

Sala II

Necesar consumabile: erveele soluie antisepticbuci necesar per manevr: 1; per semestru: 4 seturi a cte 200

soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

Necesar dotare: manechin didactic - manevr medical msu medical reglabil pe nlime flacon didactic medicaie injectabil co gunoi pentru deeuri infecioase distribuitor soluii alcoolice de splare mini

Necesar consumabile: seringi - necesar per semestru: 800 ace sering necesar per semestru 800 / 1600 ace extragere soluie din flacon necesar per semestru 800 * comprese sterile tifon 4/2 cm - necesar per manevr: 1; necesar per semestru: 800 soluie alcool sanitar - necesar per semestru: 4 flacoane de 1 litru saci gunoi pentru deeuri infecioase - necesar per semestru: 70 co gunoi deeuri neptoare- necesar per semestru: 10 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

post recoltarea uroculturii metoda caterismului vezical

Necesar dotare: manechin didactic - manevr medical msu medical reglabil pe nlime flacon didactic medicaie injectabil co gunoi pentru deeuri infecioase distribuitor soluii alcoolice de splare mini

post injecia intramuscular deltoid

Necesar consumabile: seringi - necesar per semestru: 800 ace sering necesar per semestru 800 / 1600 ace extragere soluie din flacon necesar per semestru 800 * comprese sterile tifon 4/2 cm - necesar per manevr: 1; necesar per semestru: 800 soluie alcool sanitar - necesar per semestru: 4 flacoane de 1 litru saci gunoi pentru deeuri infecioase - necesar per semestru: 70 co gunoi deeuri neptoare- necesar per semestru: 10 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

Necesar dotare: manechin didactic - manevr medical co gunoi pentru deeuri infecioase distribuitor soluii alcoolice de splare mini

Necesar consumabile: trus cateterism vezical necesar per semestru 800 mnui de unic folosin / sterile - necesar per semestru: 800 perechi saci gunoi pentru deeuri infecioase - necesar per semestru: 70 co gunoi deeuri neptoare- necesar per semestru: 10 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

post efectuarea bii la un pacient adult


Necesar dotare: chiuvet cu alimentare ap cald i sisteme de scurgere pat medical / canapea consultaie manechin medical * prosoape bumbac foarfec co gunoi pentru deeuri nepericuloase co colectare materiale textile refolosibile distribuitor soluii alcoolice de splare mini Necesar consumabile: erveele hrtie - necesar per manevr: 5; per semestru: 30 cutii a cte 200 spun solid - necesar per semestru: 3 soluie hidratant - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5
l

post masaj cardiac extern

role cearceaf unic folosin necesar per semestru: 10 role rol tifon - necesar per semestru: 3 role prosoape hrtie - necesar per manevr: 4; per semestru: 80 pachete a cte 330
buc.

30 40 m2
(6 m x 5,5 m)
Necesar consumabile: Necesar dotare: manechin didactic manevr medical

saci gunoi pentru deeuri infecioase - necesar per semestru: 70 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

post Plasarea pacientului n poziie decubit dorsal, ortopneic, lateral , decubit ventral, Sims, Fowler
Necesar dotare: pat medical reglabil n nlime lenjerie pat medical manechin medical * perne medicale n numr de minim 6 ptur msu medical distribuitor soluii alcoolice de splare mini Necesar consumabile: soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l Necesar dotare: manechin didactic manevr medical

post manevra Heimlich

Sala III

Necesar consumabile: -

post administrarea oxigenoterapiei

post poziia lateral de siguran

Necesar consumabile: manechin didactic manevr medical Necesar dotare: manechin didactic - manevr medical * canapea consultaie medical sistem oxigenoterapie distribuitor soluii alcoolice de splare mini

Necesar dotare: -

Necesar consumabile: sonde nazale ochelar necesar per manevr: 1; necesar per semestru: 800 tub oxigen necesar per semestru: 1 soluie alcoolic splare - necesar per manevr: 5 ml; per semestru: 2 recipiente de 5 l

13 15 9 2 8

1 3 4 7

10

11
5 6 12 14 13 15 9 2 8 1 3 4 7 10 11 5 6 12 14

80% = nota 10; 70 ....... < 80% = nota 9; 65 ....... < 70% = nota 8; 60 ....... < 65% = nota 7; 55 ....... < 60% = nota 6; 50 ....... < 55% = nota 5; < 50% = nota 4;

Organizare: 30 Septembrie brouri cu jurmntul deschidere D-na Decan discurs D-na Dr. Antohe - ef Disciplin Nursing ce mbrac primul student cea mai mic not de trecere i apoi progresiv se imbrac alturi de o mbriare, pn la cel cu nota cea mai mare care are un discurs de 5 min. max. Discurs conclusiv D-na Decan

responsabilizeaz integreaz n breasl, n universitate (se vd toi, se mbrieaz la preluarea halatului, toi n alb etc.) ierarhizeaz stimulnd competitivitatea contientizeaz stimuleaz o bun performan de studiu i achiziie de abiliti de nursing

Resuscitarea medical n condiii bazale

You can live without water for a few days and without food for a few weeks. Without air, though, you'll suffer brain damage within a few minutes and die after about ten minutes. Breathing, then, would be a pretty good thing about which to become an expert.

CPR is not 100% successful, but it is the only alternative.

Basic life support (BLS) comprises the elements: initial assessment, then airway maintenance, expired air ventilation (rescue breathing), and chest compression. Basic life support implies that no equipment is employed; where a simple airway or facemask for mouth to mouth ventilation is used, this is defined as "basic life support with airway adjunct".
The purpose of BLS is to maintain adequate ventilation and circulation until means can be obtained to reverse the underlying cause of the arrest. It is therefore a "holding operation", although on occasions, particularly when the primary pathology is respiratory failure, it may itself reverse the cause and allow full recovery. Failure of the circulation for three to four minutes (less if the victim is initially hypoxaemic) will lead to irreversible cerebral damage. Delay, even within that time, will lessen the eventual chances of a successful outcome. Emphasis must therefore be placed on rapid institution of basic life support by a rescuer, who nonetheless should follow the recommended sequence of action.

Early Ages - Flagellation Method

Early Ages - Heat Method

the child, and put his mouth upon his mouth, and his eyes upon his eyes, and his hands upon his hands; and he stretched himself upon the child; and the flesh of the child waxed warm."1 This first recorded event has been the gate through which all of us have 1530 - Bellows Method traveled.

800 BC. Elijah's mouth to mouth. "...And he went up, and lay upon

1711 - Fumigation Method

1770 - Inversion Method

1803 - Russian Method

1773 - Barrel Method

1812 - Trotting Horse Method 1950 - Mouth-to-Mouth Resuscitation

1973 - CPR practice for the population

1992 - New reanimation method - the ACD method 1990's - New reanimation method - the VEST reanimation
1990'er - New reanimation method - the abdominal resuscitation 1998 - Early defibrillation

1960 - 1999 Devices for CPR


2000 Optimised CPR Resuscitation Animax

1961

1991

1992

2000

2005

http://www.erc.edu/

1. Ensure safety of rescuer and victim

Martor bunul samaritean

Medic (oricare) Paramedic

Cine efectueaza RCR?

Nurse led defibrillation Familia

Hospital based medical emergency team

contient

diagnostic
comatos

cu funcii vitale prezervate


respiraie = circulaie

n stop cardiorespirator

asistena respiraiei manevre


asistena circulaiei

Timpii mori

Perioade de asisten efectiv


Durat Eficien

Sequence of actions for adult basic life support


For the purposes of these guidelines an adult is considered a person aged 8 years or over. 1. Ensure safety of rescuer and victim 2. Check the victim and see if he responds: Gently shake his shoulders and ask loudly: "Are you all right?" B. If he does not respond: Shout for help Unless you can assess him fully in the position A. If he responds by answering you find him, turn the victim on to his back and or moving: Place your hand on his forehead and Leave him in the position in gently tilt his head back keeping your which you find him (provided thumb and index finger free to close his he is not in further danger) nose if rescue breathing is required Check his condition Remove any visible obstruction from the Get assistance if needed victims mouth, including disloged Reassess him regularly dentures, but leave well fitting dentures in place With your fingertips under the point of the victim's chin, lift the chin to open the
then open the airway:

Keeping the airway open, look, listen and feel for breathing (more than an occasional gasp or weak attempts at breathing):
Look for chest movement Listen at the victim's mouth for breath sounds Feel for air on your cheek

A. If he is breathing normally: Turn him into the recovery position

Keeping the airway open, look, listen and feel for breathing (more than an occasional gasp or weak attempts at breathing):
Look for chest movement Listen at the victim's mouth for breath sounds Feel for air on your cheek

A. If he is breathing normally: Turn him into the recovery position

B. If he is not breathing or is only making occasional gasps or weak attempts at breathing: Send someone for help or, if you are on your own, leave the victim and go for help; return and start rescue breathing as below
Turn the victim onto his back if he is not already in this position

Send or go for help Check for continued breathing

Give 2 slow, effective rescue breaths, each of which makes the chest rise and fall:
cu excepia victimelor de: intoxicaii; nec; patologie traumatic; copii; Ensure head tilt and chin lift Pinch the soft part of his nose closed with the index finger and thumb of your hand on his forehead Open his mouth a little, but maintain chin lift Take a deep breath to fill your lungs with oxygen, and place your lips around his mouth, making sure that you have a good seal Blow steadily into his mouth whilst watching his chest; take about 2 seconds to make his chest rise as in normal breathing Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out Take another breath and repeat the sequence as above to give 2 effective rescue breaths in all

If you have difficulty achieving an effective breath: Recheck the victim's mouth and remove any obstruction Recheck that there is adequate head tilt and chin lift Make up to 5 attempts in all to achieve 2 effective breaths Even if unsuccessful, move on to assessment of the circulation

4. Assess the victim for signs of a circulation: Look, listen and feel for normal breathing, coughing or movement by the Only if you have been trained to do so, check the carotid pulse victim Take no more than 10 seconds to do this

If there are no signs of a circulation, If you are confident that you have or you are at all unsure, start chest detected signs of a circulation: compressions: Pulse check requires too much time Continue rescue breathing until With your hand that is nearest the the victim starts breathing his victim's feet, locatecheck the lower half of Rescuers are on wrong about a pulse own the sternum (breastbone): 35% of the time About every 10 breaths (or about Using your index and middle every minute) recheck for signs of a fingers, identify the lower rib edge Some victims of cardiac arrest are circulation; take no more than 10 nearest to you. Keeping your fingers missed because rescuers think a pulse seconds each time together, slide them upwards to the is present when it isnt If the victim starts to breathe point where the ribs join the normally on his own but remains With your middle finger on this sternum. Lay rescuers should check for signs of unconscious, turn him into the point, place your index finger on the circulation (normal recovery position. Be ready to turn breathing, sternum itself coughing, him on to his back and re-start or movement after 2breaths) Slide the heel of your other hand rescue breathing if he stops down the sternum until it reaches breathing your index finger; this should be the middle of the lower half of the

Masajul cardiac extern


linia umerilor

unic zon de contact/compresiune

900
centrul toracelui

linia sternului

Push hard

Depresie stern 5-6 cm. Rata de 100/min este esentiala.


Pauzele scad perfuzia miocardica. Dupa 3 min de RCR performantele se reduc semnificativ.

Push fast Dont stop


Change hands

European Resuscitation Council Guidelines for Resuscitation 2005

Some rescuers are reluctant to give mouth-tomouth breaths to strangers Something (chest compressions alone) is better than nothing In some studies of adult cardiac arrest for short periods, compressions only may be effective Compression-only is recommended for dispatcher-assisted CPR or when the rescuer is unable or unwilling to perform rescue breathing

CC compresie cardiaca MMV ventilatie gura-la-gura

In Olanda, unde RCR se practica in secventa CAB (Chest compresion, Airway, Breathing) rata de supravietuire este comparabila cu cea din SUA.
Simoons ML et al. Eur Heart J 1990; 11(suppl): 92.

Hightower D et al. Decay in quality of closed-chest compressions over time. Ann Emerg Med 1995; 26: 300-303.

30 x

2x

Previous guidelines included a complex set of skills to relieve foreign-body airway obstruction (FBAO) in an unresponsive victim The skills were difficult to teach, learn, and remember Inclusion of complex skills in CPR courses reduced retention of all skills The recommendations have been simplified

Lay rescuer is much more likely to treat a victim unresponsive from cardiac arrest than a victim unresponsive from FBAO
Sudden cardiac arrest 250,000 deaths/yr FBAO 3,200 deaths/yr

Chest compressions may relieve FBAO If adult choking victim becomes unresponsive:

Contact EMS Begin steps of CPR Look for (and remove) obstructing object

Manevra Hemlich

conscious victim:
back slapping abdominal thrusts

unconscious victim:
perform chest

compressions