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 AJUTOR
Scop:
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 Recovery
Face 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 evidenta
Systems 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 recomandari
In guidelines and other publications, recommendation for a clinical service is
classified by the balance of risk versus benefit of the service and the
level of evidence on which this information is based. The U.S. Preventive
Services Task Force uses:
Level A: Good scientific evidence suggests that the benefits of the clinical
service substantially outweighs the potential risks. Clinicians should discuss
the service with eligible patients.
Level B: At least fair scientific evidence suggests that the benefits of the
clinical service outweighs the potential risks. Clinicians should discuss the
service with eligible patients.
Level C: At least fair scientific evidence suggests that there are benefits
provided by the clinical service, but the balance between benefits and risks
are too close for making general recommendations. Clinicians need not
offer it unless there are individual considerations.
Level D: At least fair scientific evidence suggests that the risks of the
clinical service outweighs potential benefits. Clinicians should not routinely
offer the service to asymptomatic patients.
Level I: Scientific evidence is lacking, of poor quality, or conflicting, such
that the risk versus benefit balance cannot be assessed. Clinicians should
help patients understand the uncertainty surrounding the clinical service.
Ghiduri
Un ghid medical (denumit si ghid clinic,
protocol clinic, ghid de practica
medicala) este un document destinat
orientarii deciziilor si criteriilor de:
diagnostic
conduita
tratament intr-un domeniu specific medical
De ce ghiduri?
PRIM AJUTOR- Obiective

A. Airway: Mentinerea permeabilitatii

cailor aeriene
B. Breathing: Mentinerea respiratiilor
C. Circulation: Mentinerea circulatiei

+
Oprirea hemoragiilor
Prevenirea/ reducerea socului
PRIM AJUTOR
Evaluare 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 AJUTOR
Se vor evalua:
1. SIGURANTA proprie si a pacientului
2. MECANISMUL DE PRODUCERE A LEZIUNII
Constient
Inconstient

3. INFORMATII TRANSMISE PE CAI

SPECIALE
- Medalion, bratara cu simboluri
- card cu informatii
PRIM AJUTOR
4. NUMARUL VICTIMELOR
Cand sunt mai multe- evaluarea
A,B,sangerare si C
5. 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-legale
Secventalogica:
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
BAZA
1. 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 coloana
2. Nu mobilizati pacientul mai mult decat necesar.
Indepartati hainele cu efect restrictiv, asigurati
comfortul termic
PRIM AJUTOR-REGULI DE
BAZA
3. Asigurati confort psihic pacientului
4. Nu atingeti rani, arsuri decat daca e absolut
necesar. Folositi obiecte sterile. Folositi bariere.
Spalati maini!
5. Nu oferiti apa sau alimente din primul moment
6. 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
epidemiologice
Transmitere de boli infectioase
HIV
Virusul hepatitei B, C
Tuberculoza
Masuri de protectie universala- orice pacient trebuie
considerat potential purtator de agenti cu transmitere
sanguina
Purtati manusi sau folositi alta bariera
Spalati-va mainile cu apa calda si sapun:
La venire/plecare
Inainte/dupa examinare, procedura
Dupa scoaterea manusii, mastii
Dupa folosirea batistei, toaletei, trecere prin par, activitati
administrative/gospodaresti
Bariera pentru respiratii artificiale, protectie oculara
NOTIUNI ELEMENTARE DE
ANATOMIE SI FIZIOLOGIE
Notiuni elementare
OXIGEN PLAMANI SANGE

GLUCIDE
CELULE
LIPIDE
PROTEINE
Ce se intampla daca
Se opreste respiratia.
Se opresc bataile cardiace?
Sudden Cardiac Arrest

300,000 victims of out-of-hospital cardiac arrest

each year in the U.S.
Less than 8% of people who suffer cardiac
arrest outside the hospital survive.
Sudden cardiac arrest can happen to anyone at
any time. Many victims appear healthy with no
known heart disease or other risk factors.
Sudden cardiac arrest a heart attack.
Sudden cardiac arrest: electrical impulses in
the heart become rapid or chaotic, which causes
the heart to suddenly stop beating.
A heart attack: when the blood supply to part of
the heart muscle is blocked. A heart attack may
cause cardiac arrest
SUDDEN CARDIAC
ARREST
Approximativ 700,000 stopuri cardiace pe an in
Europa

Supravietuirea la externare de aprox 5-10%

CPR efectuat de martori: interventie vitala

inaintea sosirii echipajelor de urgenta dubleaza
sau tripleaza supravietuirea dupa SCR

Resuscitarea precoce si defibrilarea prompta (in

decurs de 1-2 minute) poate duce la supravietuiri
de >60%.
CPR: Ghiduri
The International Liaison Committee on
Resuscitation (ILCOR)
American Heart Association (AHA)
International Guidelines 2000 for
Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care
International Consensus Conference on
Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science With Treatment
Recommendations (2005 Consensus Conference).
CPR
Cardiopulmonary resuscitation (CPR) is an emergency
medical procedure for a victim of cardiac arrest or, in some
circumstances, respiratory arrest. CPR is performed in
hospitals, or in the community by laypersons or by
emergency response professionals.
CPR involves physical interventions to create artificial
circulation through rhythmic pressing on the patient's chest
to manually pump blood through the heart, called chest
compressions, and usually also involves the rescuer
exhaling into the patient (or using a device to simulate this)
to inflate the lungs and pass oxygen in to the blood, called
artificial respiration,
CPR is unlikely to restart the heart; its main purpose is to
maintain a flow of oxygenated blood to the brain and the
heart, thereby delaying tissue death and extending the
brief window of opportunity for a successful resuscitation
without permanent brain damage
 Istoric
1740 The Paris Academy of Sciences officially recommended mouth-to-mouth
resuscitation for drowning victims.
1767 The Society for the Recovery of Drowned Persons became the first organized effort
to deal with sudden and unexpected death.
1891 Dr. Friedrich Maass performed the first equivocally documented chest compression
in humans.
1903 Dr. George Crile reported the first successful use of external chest compressions in
human resuscitation.
1904 The first American case of closed-chest cardiac massage was performed by Dr.
George Crile.
1954 James Elam was the first to prove that expired air was sufficient to maintain
adequate oxygenation.
1956 Peter Safar and James Elam invented mouth-to-mouth resuscitation.
1957 The United States military adopted the mouth-to-mouth resuscitation method to
revive unresponsive victims.
1960 Cardiopulmonary resuscitation (CPR) was developed. The American Heart
Association started a program to acquaint physicians with close-chest cardiac resuscitation
and became the forerunner of CPR training for the general public.
1963 Cardiologist Leonard Scherlis started the American Heart Association's CPR
Committee, and the same year, the American Heart Association formally endorsed CPR.
1966 The National Research Council of the National Academy of Sciences convened an
ad hoc conference on cardiopulmonary resuscitation. The conference was the direct result
of requests from the American National Red Cross and other agencies to establish
standardized training and performance standards for CPR.
1972 Leonard Cobb held the world's first mass citizen training in CPR in Seattle,
Washington called Medic 2. He helped train over 100,000 people the first two years of the
programs.
1981 A program to provide telephone instructions in CPR began in King County,
Washington. The program used emergency dispatchers to give instant directions while the
fire department and EMT personnel were en route to the scene. Dispatcher-assisted CPR
is now standard care for dispatcher centers throughout the United States.
SCA
40% din victimele SCA: FV
Deteriorare in asistolie-
sanse reduse de
resuscitare
Tratament optim pentru
SCR cu FV este:
CPR de catre martori+
defibrilare

Tratamentul optim pentru

SCR cauzat de asfixie
(inec, trauma, droguri,
copii):
rescue breaths vitale
Lantul supravietuirii
CHAIN OF SURVIVAL
LANTUL SUPRAVIETUIRII
Recunoastera precoce si activarea
sistemului de urgenta: poate preveni SCR
Early CPR:dubleaza/tripleaza
supravietuirea din fv
Fiecare minut fara CPR scade supravietuirea cu
7-10%
Defibrilarea precoce:CPR + defib in 3-5
min: supravietuire de 49-75%
Fiecare minut intarziere- reduce sansele de
externare cu 10-15%
 BASIC LIFE SUPPORT
secventa de proceduri efectuate pentru a
restabili circulatia sangelui oxigenat dupa
un SC/R
Compresii sternale si ventilatie pulmonara
efectuate de oricine care stie cum sa o
faca, oriunde, imediat, fara alt
echipament.
 Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
 APPROACH SAFELY!

Approach safely
Scene
Check response
Rescuer Shout for help
Open airway
Victim
Check breathing
Bystanders 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
CHECK RESPONSE

Shake shoulders gently

Ask Are you all right?
If he responds
Leave as you find him.
Find out what is wrong.
Reassess regularly.
SHOUT FOR HELP

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
OPEN AIRWAY

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
OPEN AIRWAY

Head tilt and chin lift

- lay rescuers
- non-healthcare rescuers

No need for finger sweep

unless solid material can be seen
in the airway
OPEN AIRWAY

Head tilt, chin lift + jaw thrust

- healthcare professionals
AIRWAY OPENING BY
NECK EXTENSION

Campbell
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 cardiac

Erroneous 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 OBSTRUCIE SEVERA

MODERATA
Te ineci? Da Incapabil sa vorbeasca,
poate incuviinta

Alte semne Poate tusi, respira, Nu poate respira/

vorbeste respiratie cu
Wheezing/silentiu/ince
arca sa tuseasca/
inconstienta
ADULT FBAO TREATMENT
ABDOMINAL THRUSTS
30 CHEST
COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
CHEST COMPRESSIONS

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
 The most effective rate for chest
compressions is 100 compressions per
minute the same rhythm as the beat of
the BeeGees song, Stayin Alive.

http://www.dailymotion.com/video/x1afd7
_bee-gees-staying-alive_music
RESCUE 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 victims chest rise

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

30 2
Video Demons tration of CPR for Adults .flv
Hands-only CPR
DEFIBRILLATION
 Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
Attach AED
Follow voice prompts
AUTOMATED EXTERNAL
DEFIBRILLATOR (AED)

Some AEDs will

automatically switch
themselves on when
the lid is opened
ATTACH PADS TO
CASUALTYS BARE
CHEST
ANALYSING RHYTHM
DO NOT TOUCH VICTIM
SHOCK
INDICATED

Stand clear
Deliver shock
 SHOCK DELIVERED
FOLLOW AED
INSTRUCTIONS

30 2
 NO SHOCK ADVISED
FOLLOW AED
INSTRUCTIONS

30 2
http://
www.youtube.com/watch?v
=O9T25SMyz3A
IF VICTIM STARTS TO
BREATHE NORMALLY
PLACE IN RECOVERY
POSITION
 Approach safely Approach safely
Check response Check response
Shout for help Shout for help
Open airway Open airway
Check breathing Check breathing
Call 112 Call 112
30 chest compressions Attach AED
2 rescue breaths Follow voice prompts
 CONTINUE RESUSCITATION
UNTIL
Qualified help arrives and takes over

The victim starts breathing normally

Rescuer becomes exhausted

CHEST COMPRESSIONS
- infant, lone rescuer
Lone
rescuer:
compress
the
sternum
with the
tips of two
fingers
CHEST COMPRESSIONS-
children over 1 year
Pediatric FBAO
Pediatric FBAO
No abdominal thrusts for choking infants
Risk because of the horizontal position of
the ribs- upper abdominal viscera more
exposed to trauma
Pediatric AED
Automated external defibrillators (AEDs) are safe
and successful when used in children older than 1
year of age.
Purpose made paediatric pads or software
attenuate the output of the machine to 5075 J
and these are recommended for children aged 18
years.
If an attenuated shock or a manually adjustable
machine is not available, an unmodified adult AED
may be used in children older than 1 year.
There are case reports of successful use of AEDs
in children aged less than 1 year;
in the rare case of a shockable rhythm occurring
in a child less than 1 year, it is reasonable to use
an AED (preferably with dose attenuator).
Special circumstances
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 victims 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
primary
respiratory impairment from
submersion/ immersion in a
liquid medium.
a liquid/air interface is present
at the entrance of the victims
airway: the victim does not
breathe air.
Immersion=to be covered in
water or other 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: treatment
1. aquatic rescue
2. basic life support
3. advanced life support
4. post-resuscitation care
Initial rescue: bystanders, trained lifeguards
BLS: initial responders
Number of victims-
 Drowning: treatment
1. 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: treatment
2.BLS
Rescue 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: 1015 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: treatment
2.BLS
Chest 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 victims chest, attach
the AED pads and turn the AED on.
deliver shocks according to the AED prompts
Drowning: treatment
Regurgitation 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 41F),
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
3234 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 during

the vulnerable period

myocardial ischaemia because of coronary artery
spasm.
asystole may be primary, or secondary

to 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%
 Ensure that any power source is
switched off and do not approach the casualty
until it is safe.
Electrocution: Rescue
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 womans 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 is
unknown. Aim for between 15 and 30. Even a small amount of
tilt may be better than no tilt. The angle of tilt used needs to allow
good quality chest compressions and if needed allow Caesarean
delivery 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 (3532 C),
moderate (3228 C) or
severe (less than 28 C)
The Swiss staging system based on clinical signs
can 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 hypothermia
Diagnosis
Normal 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 young
Other 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 rewarming
Decision 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 hypothermia
Resuscitation
the same ventilation and chest compression rates
as for a normothermic patient
stiffness of the chest wall, making ventilation and
chest compressions more difficult
Rewarming
removal from the cold environment,
prevention of further heat loss and
rapid transfer to hospital.
Swiss stagesII should be immobilized and
handled carefully
the whole body dried and insulated( Wet clothes
should be cut off)
Accidental hypothermia
Rewarming
Conscious victims can mobilise as exercise rewarms a
person more rapidly than shivering
Somnolent or comatose victims should be immobilized and
kept horizontal
Passive 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 trunk

Hypothermic 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 survive

when 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
Hyperthermia
Definition
when the bodys 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 exercise
in high environmental temperatures and/or high humidity
usually affects healthy young adults
Mortality from heat stroke ranges between 10 and 50%
Hyperthermia
Management
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
 Hyperthermia
Modifications to cardiopulmonary
resuscitation
There are no specific studies on cardiac
arrest in hyperthermia.
the prognosis is poor compared with
normothermic cardiac arrest
SOCUL, HEMORAGIILE,
LEZIUNILE TESUTURILOR
MOI
Socul
Hemoragii
Plagi
Fracturi
Traumatisme craniene
Traumatisme toracice
Traumatisme abdominale
 Pompa
Presarcina
1. SOCUL Postsarcina
1. SOCUL
Pompa: inima tetracamerala
Atrii/ ventriculi
Miocard contractil
Contractilitate/inotropism
Sistemul circulator:
Artere
Vene
capilare
Fluidul circulant
Elemente celulare (hematii, leucocite, trombocite)
Plasma
Pulsul
1. SOCUL
1.SOCUL
Reprezinta incapacitatea cordului si a
sistemului circulator de a mentine perfuzia
catre organele vitale prin aport de de
sange cu continut de oxigen.
Situatie amenintatoare de viata
Recunoasterea semnelor si simptomelor-
nu toate concomitent, nu imediat
1. SOCUL- semne si
simptome
1. Anxietate, agitatie,
confuzie
2. Tegumente palide, reci,
umede, lipicioase
3. Tahipnee, respiratii
neregulate
4. Tahicardie/puls slab
batut/ nepalpabil periferic
5. Greturi, varsaturi
6. Sete
7. Privire goala, mohorata,
pupile dilatate
1. SOCUL
I.
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 cardiaca

III.
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. HEMORAGII
HEMORAGIILE EXTERNE:
control
1. 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 aplicat
2. Ridicarea extremitatii
lezate deasupra nivelului
cordului- impreuna cu
compresia directa.
2. HEMORAGII
3. 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. HEMORAGII
4. 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.HEMORAGII
HEMORAGII 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.HEMORAGII
Epistaxisul
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
Conduita in epistaxis :
spate,eliberati de haine

Pozitie sezanda, nu capul

pe spate,eliberati de haine

stranse
stranse in jurul in
strangeti aripile
jurul gatului
gatului

strangeti
apasati; gheata sauaripile
nazale(exceptie fracturi) si
comprese reci la baza

nazale(exceptie
nasului 5-10 min
Presiune la niveleul buzei fracturi) si
superioare sub nas
apasati; gheata sau comprese
Incurajati sa scuipe
Nu freaca sau sufla nasul

reci la baza nasului 5-10 min
timp de min 1 ora
Pozitie laterala de
Presiune la niveleul buzei
siguranta daca devine
inconstient
Corp strain- copii: nu
superioare
impingenti! Sunati 112!
sub nas
3.TRAUMATISMELE
TESUTURILOR MOI
Plagi= 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
PLAGI
Generalitati- principii de tratament
Plagi recente:
controlul hemoragiilor si prevenirea socului
prevenirea infectiei
Stabilizarea partii lezate
Stabilizarea corpurilor penetrante
Plagi vechi si infectate: ridicarea zonei afectate, pansament
umed caldut
Plagi 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
Localizare

Tipuri 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
PLAGI
DESCHISE
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
PLAGI
MUSCATE
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 fractura
Fracturi=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
FRACTURI
SEMNE SI SIMPTOME:
Swelling
Pain.
Loss Of Movement.
Irregularity.
Noise.
Tenderness.
Shock
4. OASE, ARTICULATII SI
MUSCULATURA
Examinare:
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 tratament
Imobilizare:
Inainte de mutarea pacientului
Reduce durerea
Previne riscul de leziuni
ulterioare
Reduce riscul sangerarii si a
leziuniloe nervoase
Tehnica 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 perforeaza
plamanul)
FRACTURI
CONDUITA
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
FRACTURI
Plasarea atelei:
Se mentine tractiunea pana la fixarea atelei
Se infasoara de la baza la varf, nu strans
Se verifica pulsul distal
Daca e absent, se largeste bandajul
Se solicita ajutor medical

Rezumat- ACRONIM :
I (ice)
C (compression)
E (elevation)
FRACTURI
ANTEBRAT
BRAT
FRACTURI
FEMUR
GAMBA
ROTULA
FRACTURI
COLOANA 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 craniene
A. 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 craniene
B. 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 craniene
Plagile la nivel cranian:
Zona bine vascularizata: hemoragii masive
Presiune directa
Comprese fixate cu fasa
Suspiciune de fractura craniana: nu compresie
Obraji: pansament compresiv in gura
Traumatismele 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 violenta
2. 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 afectata
3. Tratati socul- pozitie semisezanda
4. Nimic per os
5. Solicitati asistenta medicala de urgenta
Traumatismele abdominale
Inchise: tegument 1. ABC
intact 2. Plasati pacientul in
1. Durere violenta, pozitia cea mai
varsaturi, contractura confortabila
musculaturii 3. Indepartati cu grija
abdominale hainele pentru a
2. Distensie abdominala, evalua corect
soc 4. Tratati socul
3. Pozitie antalgica 5. Nimic per os
Traumatismele abdominale
Deschise
1. Semnele traumatismelor
inchise
2. Plagi intepate sau
contuze, hematemeza
3. 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
Frostbite
Freezing of tissue or moisture in the skin due to
exposure to temperatures below 0 degrees C

Air temps below 0C

skin freezes at -2oC
Superficial frostbite (mild)
freezing of skin surface
Deep frostbite (severe)
freezing of skin and other soft tissues, may include bone
Hands, fingers, feet, toes, ears, chin, nose, groin
area
Frostbite
Symptoms
initially redness in light skin or grayish in dark
skin
tingling, stinging sensation
turns numb, yellowish, waxy or gray color
feels cold, stiff, woody
blisters may develop
Deep frostbyte
Frostbite
Treatment
remove from cold and prevent further heat loss
remove constricting clothing and jewelry
rewarm affected area evenly with body heat
until pain returns
when skin thaws it hurts!!
do not rewarm a frostbite injury if it could refreeze
during evacuation or if victim must walk for medical
treatment
do not massage affected parts or rub with
snow
evacuate for medical treatment
Trench/Immersion Foot
Results from prolonged exposure of skin to
cold or wet conditions, usually at 10
degrees C or colder. Potentially crippling,
nonfreezing injury (temps from 0oC-10oC)
Prolonged exposure of skin to moisture
(12 or more hours)
High risk during wet weather, in wet areas,
or sweat accumulated in boots or gloves
Trench/Immersion Foot
Symptoms
initially appears wet, soggy, white, shriveled
sensations of pins and needles, tingling,
numbness, and then pain
skin discoloration - red, bluish, or black
becomes cold, swollen, and waxy appearance
may develop blisters, open weeping or
bleeding
in extreme cases, necrosis
Trench/Immersion Foot
Trench/Immersion Foot
Treatment
prevent further exposure
dry carefully
DO NOT break blisters, apply lotions, massage,
expose to heat, or allow to walk on injury
rewarm by exposing to warm air
clean and wrap loosely
elevate feet to reduce swelling
Defer for medical treatment
Snow Blindness
Inflammation and Symptoms
sensitivity of the eyes gritty feeling in eyes
caused by ultraviolet redness and tearing
rays of the sun eye movement will
reflected by the snow cause pain
or ice headache

Treatment
remove from sunlight
blindfold both eyes or cover with
cool, wet bandages
seek medical attention
recovery may take 2-3 days
Thermal burns
Burns
Classified
according to
the depth or
degree of skin
damage
First
Second
Third degree of
burns
First Degree Burn
Cause: Signs of First Degree
Overexposure to sun Burns
Light contact with hot Erythema
objects Mild Swelling & Pain
Scalding by hot water Rapid Healing
or steam
First Aid: First Degree
Burns
Cold Water NOT Ice Water
Burn Lotion or Spray

NO BUTTER OR OINTMENTS
Second Degree Burns
Results from a very Signs of Second Degree
deep sunburn Burns
Contact with hot Erythema
liquids Swelling
Flash burns from Blisters
gasoline etc. 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, Signs of Third Degree
ignited clothing, Burns
immersion in hot White or Charred
water, contact with hot appearance
objects, or electricity. 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
Continut
Urgente medicale
Afectiunile cardiace
Sindroamele coronariene acute
Insuficienta cardiaca
Sincopa
Accidente vasculare cerebrale
Convulsii

Intoxicatiile
Intepaturile de animale
Urgentele 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 Factori de risc
sanguin coronarian este neinfluentabili
intrerupt, conducand la Ereditate
necroza zonei de miocard Sex
din lipsa de oxigen Varsta
Afectiune cardio-vasculara Factori de risc influentabili
Durere retrosternala- a se Fumat
suspecta un sindrom HTA
coronarian acut pana la Colesterol
proba contrarie! Obezitate
Sedentarism
Stress
Diabet netratat
Sindroame coronariene
acute
Semne si simptome:
Dureri retrosternale
Iradiere in mandibual, umeri. brate, gat, spate
Dispnee
Tegumente palide, umede, transpiratii profuze
Anxietate, greturi, varsaturi
Astenie
Daca suspectati:
1. ABC
2. Plasati pacientul in pozitia cea mai confortabila (sezanda sau
semi)
3. Mentineti pacientul linistit si in confort termic
4. Slabiti hainele stranse din jurul gatului, a taliei, a toracelui
5. Pregatiti-va sa efectuati CPR
6. Solicitati asistenta medicala
Sindroame coronariene
acute
Angina pectorala: durere toracica cu
caracter constrictiv sau de apasare (rareori
mai mult de 5 minute)
Nitroglicerina
Conduita:
linistirea pacientului si interzicerea oricarui efort
Oxigen pe masca daca e disponibil
Nitroglicerina s.l.
Monitorizare de functii vitale
Pozitie semisezanda, 112
Sindroame coronariene
acute
Infarctul miocardic acut (atac de cord)
Cauze principale: ateroscleroza si tromboza
Daca suprafata afectata din miocard este mare, inima se
poate opri: stop cardiac
Conduita:
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 medicale
Sincopa- 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 vedere

2.transpiratii, paloare, tahicardie
Sincopa
Sistem nervos
Encefal, maduva spinarii, nervi.
Semnale de la si catre creier
Controleaza si activitatea mm involuntare
Neuroni motori
Neuroni senzitivi

Inconstienta: intreruperea functionarii normale a creiereului.

Grade:
A= alert
V= voce
P= pain (durere)
U= unresponsive (nu raspunde)
Sincopa
Cauze de pierdere a constientei
F - Fainting
I - Infantile Convulsions
S - Shock
H - Heat Imbalance

S - Stroke
H - Heart Attack
A - Asphyxia
P - Poisoning
E - Epilepsy
D - Diabetes
Scorul Glasgow
A Deschiderea ochilor
- Spontan= 4
- La cerere= 3
- La durere= 2
- Nu deschide= 1
B 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= 1
C. Cel mai bun raspuns verbal
-orientat= 5
-confuz= 4
-cuvinte fara sens= 3
-zgomote= 2
-nici un raspuns= 1
Sincopa
1. Evaluare initiala
2. Decubit dorsal, membrele pelvine ridicate
30 cm. nu permiteti pozitia sezanda
3. Monitorizati A,B,C
4. Largiti orice imbracaminte care strange la
nivelul gatului, toracelui, taliei
5. Verificati daca s-au produs leziuni in
timpul caderii
6. 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
cerebrale
Semne si simptome;
1. Debut brusc
2. Cefalee
3. Ameteli, confuzie, salivatie
4. Slabiciune sau pareza/paralizie a unui hemicorp
5. Pierderea expresivitatii faciale si asimetria gurii
6. Vedere dubla
7. Dificultate de vorbire sau/ si intelegere
8. Anizocorie, greturi, varsaturi
9. Inconstienta
10. Convulsii
11. Stop respirator
12. Incontinenta sfincteriana
Accidentele vasculare
cerebrale
Evaluare:
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 olfactiva
2. strigat
3. Pierdere completa sau partiala a constientei si
rigiditate musculara
4. Spasme ale membrelor
5. spume la gura
6. Posibila emisie de urina si fecale
Crize convulsive: conduita
1. Stai calmi- criza inceputa nu poate fi oprita
2. 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 leziunile
4. NU INTRODUCETI NIMIC INTRE DINTI SAU IN GURA PACIENTULUI si nu
imobilizati pacientul in nici un fel
5. Slabiti hainele stranse din jurul gatului, a taliei, a toracelui
6. Nu va panicati dac pacientul nu respira pentru scurt timp in timpul crizei
7. Dupa incetarea crizei : pozitie laterala de siguranta
8. Evaluati si mentineti ABC
9. Nimic per os
10. Solicitati asistenta medicala
11. Monitorizati si evaluati continuu

Stare neuro-psihica specifica post criza: somn, sau anxietate, ostilitate,

violenta
Evaluati eventualele traumatisme produse prin cadere (! La coloana
cervicala)
INTOXICATIILE
Agent 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 piele
Semne si simptome : istoricul (ce?, cum?, cand?, cat?,
recipiente goale), respiratia, sistem digestiv, sistem nervos,
salivatie, sudoratie
INTOXICATIILE
Prin 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!!!!
INTOXICATIILE
Inhalatie
- Monoxidul de carbon
- Fum
- Gaze iritante (amoniac si cloruri)

Conduita:
-Protectia personala!!!!
-scoaterea din mediu
-ABC
-pozitie laterala pt pacientii inconstienti
-112
INTOXICATIILE
Agenti injectati
Muscatura/intepatura de insecta sau sarpe
Semne:
Inflamatie, edem
Coloratie la locul intepaturii
Slabiciune, oboseala
Direre locala
Pririt
Dispnee, wheezing
Puls filiform
Greturi, varsaturi, diaree
Muscatura 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 etanolica
Semne si simptome;
1. Halena alcoolica
2. Dezechilibrare si vorbire ingreunata
3. Greturi, varsaturi si facies vultuos
Semne ce pot fi identice cu ale unor afectiuni altele decat
intoxicatia etanolica
In caz de suspiciune;
1. Decubit dorsal, protejati de leziuni
2. ABC
3. Evaluare initiala
4. Monitorizati atent- pacientul poate deveni inconstient
5. Nu criticati, fiti fermi
6. Nu plecati niciodata de langa el
7. 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, etc
2. Trauma psihica
3. Trauma fizica (TCC)
4. Boli psihiatrice
5. Substante ce afecteaza gandirea
6. Stress situational (traume emotionale)
Etape:
1. anxietate/ soc emotional
2. Negare
3. Furie
4. Remuscare/ durere/ resemnare
Urgente comportamentale
Management:
Siguranta salvatorului
Evaluarea generala a scenei
Evaluarea primara apacientului
Evaluare secundara
Sample
Evaluare continua

Comunicare: parafrazare, redirectionare, empatie, controlul

multimii
Violenta impotriva salvatorilor
Tentativa de suicid
Violul
Moartea
Consiliere dupa un eveniment critic