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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
Secventa”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 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 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
CONTINUE CPR

30 2
Video Demonstration 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
CASUALTY’S 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=O9
T25SMyz3A
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 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).
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 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
primary
respiratory 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: 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: 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: 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 victim’s 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 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 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%
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 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 (35–32 ◦C),
 moderate (32–28 ◦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 stages≥II 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 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 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!
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 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: Principii de tratament
Generala: A,B,C + stabilizarea Imobilizare:
coloanei cervicale + controlul  Inainte de mutarea
hemoragiei pacientului
A membrului afectat: se compara  Reduce durerea
membrul lezat cu cel sanatos  Previne riscul de leziuni
 Se indeparteaza hainele ulterioare
 Se examineaza de la  Reduce riscul sangerarii si a
articulatiile superioare spre leziuniloe nervoase
inferioare Tehnica imobilizarii
 Pacientul trebuie intrebat ce  Se indeparteaza hainele
simte (durere, parestezii,  Se examineaza complet (puls,
nimic) sensibilitate, motricitate)
 Se evalueaza:  Se panseaza plagile
 circulatia: pulsul (in aval de  Se imobilizeaza articulatia de
leziune), recolorarea capilara deasupra si dedesuptul
 sensibilitatea leziunii
 miscarea  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  ABC
1. Semnele traumatismelor  Indepartati cu grija hainele
inchise  Pozitia cea mai
2. Plagi intepate sau comfortabila-pe spate, cu
contuze, hematemeza picioarele ridicate usor/
3. Dureri lombare 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 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
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 appearance
hot objects, or  Deep tissue
electricity. 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