First Aid
Eduard Kasal,
MUDr., Ph.D., Assoc. Prof.
Department of Anaesthesiology and Intensive Care
Medicine
2014
First aid
• It is better to know first aid and not to need it
than
to need it and not to know it.
• A delay… can mean the difference between
life and death.
However
• most injuries do not require life-saving efforts
First aid
Definition:
… is the immediate care given to an injured
or suddenly ill person.
… also includes the things that people can
do for themselves.
…is one of those things you need to know –
but never want to use…
First aid
…most people do not know first aid.
… even if they know it, they may
panic in an emergency.
First aid
Legal considerations
• before giving first aid, a first aid provider should
have the victim´s consent (permission)
• expressed consent – conscious mentally
competent person of legal age
• implied consent – an unresponsive victim in a
life-threatening condition – “implied“ consent
First aid
Legal considerations
Bystander = a vital link between the emergency
medical services and the victim.
Decision to help
Czech Republic: everybody is obligated to provide
first aid adequate to his knowledge and
possibilities…
Refusal to provide first aid
• extra-legal
• a new testimony legalized – driving away from the place of
traffic accident = crime
First aid
Legal considerations
Foreigners
• are obligated to abide with laws of the country
Basic Life
Support
First Aid
Background
 Approximately
700,000 cardiac arrests per
year in Europe
Outcome:
 Survival
to hospital discharge presently
approximately 5-10 - 14%
 Bystander
CPR = vital intervention before
arrival of emergency services
 Early
resuscitation and prompt
defibrillation (within 1-2 minutes) can result
in >60% survival
Chain of survival
CardioPulmonary
Resuscitation
Definition:
CPR is an emergency first-aid procedure
that is used to maintain respiration and
blood circulation in a person, whose
breathing and heartbeats have suddenly
stopped,
(one or more vital functions failed ).
CardioPulmonary
Resuscitation
Three basic vital functions:
Breathing
 Circulation
 Consciousness

CardioPulmonary
Resuscitation
History
1. Peter Safar - Professor of Pittsburgh
University presented in 1968 small book
“Cardiopulmonary Resuscitation” ….
2. Guidelines 2000
3.
Guidelines 2005
Many changes of almost all algorithms
used for several tens of years…
Publication of new guidelines does not mean, that CPR
provided in accordance with previous guidelines is not
effective and not correct, but we should follow them as
possible…
www.erc.edu
Basic life support
CardioPulmonary Resuscitation
“Thoracic pump theory“ the chest compression propels blood
out of the thorax by increasing
intrathoracic pressure …
the time of the chest compression and
decompression should be equal
Pressure should be completaly released
Hands should remain in the contact with
the chest
CardioPulmonary Resuscitation
Theoretical background
Oxygene content
In atmospheric air - 21%
In alveoli - 14,5%
Expired air – diluted by air from the airways
(dead space)
- 16 – 18 % O2
Provided that there is an adequate amount of expired
air reaching the victim's lungs, oxygen delivery will be
sufficient to ensure that the victim's haemoglobin will
be over 80% saturated with oxygen.
Theoretical background
Cardiac arrest
1. Asystole
2. Ventricular fibrillation
Most cardiac arrest victims have an electrical
malfunction of the heart  heart´s pumping
function abruptly ceases
3. Pulseless ventricular tachycardia =
Fast ventricular contractions without
haemodynamc effect Signs of the both =
identical!!!
Differential dg: only ECG
Theoretical background
At best
chest compressions provide only 30% of
normal perfusion  brain + heart
Time! Time! Time! Time! Time! Time! Time! Time!
Failure of the circulation 3 - 5 minutes 
irreversible cerebral damage.
Chances of successful CPR - restoration of
spontaneous circulation (ROSC) decreases by
10% with each minute following sudden
cardiac arrest…
Cause of cardiac arrest and
emergency system activation
Adults
•
Ischemic heart disease - AMI- with/or
ventricular fibrillation (> 80%)
Children
•
Suffocation or choking with hypoxemia or
asphyxia.
Ventricular fibrillation is rare in children (only
5-8%)
Cause of cardiac arrest and emergency
system activation
different approach to the emergency system activation.
Adults
electric defibrillator is necessary as soon as possible;
therefore, if telephone is available and you are alone:
1. call for help, then
2. start with CPR
Children
1. start CPR immediately for 1 minute to provide some
tissue oxygenation
2. then call for help
Emergency telephone number
155, 112
in the Czech Republic
Indication of CPR
to victims with unexpected cardiac arrest
in otherwise healthy individuals …
 = to those, who can be described as
having ”heart too good to die”

Indication of CPR
•
•
•
•
•
•
•
•
•
malignant arrhythmia
acute myocardial infarction (AMI)
pulmonary embolism
intoxication
electrocution
drowning
acute suffocation
severe trauma
stroke and alike
CPR is not indicated
signs of definitive biological death
 witnessed information, that cardiac arrest had happened 15
or more minutes before the rescuer arrived (time
assessment in the stressing situation is not precise)
 terminal stage of incurable disease (generalised malignant
disease…)
 an evident trauma without chance to survive (catastrophic
head injury)
 “living will” - only in countries when constitution accepts it
 DNR - “Do not attempt resuscitation” has been written in
the file (incurable disease after all available therapy
failed)
execution

Age of the patient is not restriction of CPR
Outcome after CPR
Ventricullar fibrilation – better than asystole
- in case of immediate CPR
Special emphasis

Soon defibrilation




1 minute
5 minutes
7 minutes
10 - 12 minutes
- survival - 90%,
- survival - 50%,
- survival - 30%
- survival - 2 – 5%.
CPR outcome
• In first 4 minutes – brain damage is unlikely, if
CPR started
• 4 – 6 minutes
– brain damage possible
• 6 – 10 minutes – brain damage probable
• > 10 minutes
– severe brain damage certain
Cells of the brain cortex
• Most sensitive for the stop of pefusion and
oxygenation
Without perfusion and oxygenation
 irreversibly damaged after 3-5 minutes
Signs of cardiac arrest
(Guidelines 2000)
1. Unconsciousness in several seconds
2. Respiratory arrest ( apnea) or the last
gasps (1-3 minutes after cardiac arrest)
3. Pulse-less on large ( major) arteries
(carotid or femoral artery)
4. Changed general appearance
(colour changes, face changes…)
5. Pupils dilation (mydriasis) – not reliable
Signs of cardiac arrest
(Guidelines 2005)
1.
2.
3.
Unconsciousness
No reactivity
Absence of normal breathing
Basic conditions for CPR
1.
2.
3.
4.
5.
6.
Rescuer’s safety = the first priority
To assess the risk of trauma, intoxication,
infection …
a victim position: supine on to his/her
back
on the firm flat surface to make
effective chest compressions
victim´s position in relation to rescuer´s
position
CPR during transfer ???
Rescuer’s safety
The rescuer should never place him/herself or
others at more risk than the victim
•
•
before starting resuscitation – assess the risks of
ongoing traffic, falling masonry, electrocution, toxic
fumes and poisons
risk of infections transmission
• bloodborne infections (hepatitis B and C, HIV)
- can be transmitted by blood and other body
solutions, excretes
• airborne infections (TBC and several infectious
diseases - herpetic, meningococcal etc.
- can be transmitted by mouth-to-mouth breathing
Rescuer’s safety
•
Always: protect yourself !!!
• personal protective equipment (gloves)
• barrier protective devices
• Moth – to - barrier protective devices
breathing
Personal Protective
Equipment
Can control the risk of exposure to
bloodborne pathogens –prevents an
organism from entering the body (medical
exam gloves, eye protection, mask)
 All human blood and body fluids should be
considered infectious
Mouth-to-mouth barrier devices
 Can prevent air-borne pathogens
transmission



Not documented case of disease transmission
But…should be used whenever possible
CardioPulmonary Resuscitation
Barrier devices





S – tube
Face shields (resuscitation veil )
Pocket face mask + one-way valve
Handkerchief
Towel
Stop CPR if
 Victim
starts to breathe normally
 Medical
assistance arrives and instructs
you to stop CPR
 You
are physically exhausted
Stop CPR if:
When CPR has been performed for 20 minutes
without restoration of the spontaneous
circulation
It can be stopped earlier, when:

rescuer is physically exhausted

when signs of biological death develop (postmortal rigidity, post-mortal cooling and
gravity-dependent livid stains) ???
CardioPulmonary Resuscitation
Safar´s algorithm of CPR
stressing conditions  an inadequate situation assessment
Airways
Breathing
Circulation
Drugs
ECG
BLS
?
ALS
New resuscitation
alphabet – in adults
Algorithm of CPR
EKG
Circulation
Airways
Breathing
Drugs
BLS
ALS
BLS sequence
Kneel by the side of
the victim
BLS sequence
Shake shoulders
Ask “Are you all right?”
BLS sequence
If he responds
• Leave as you find him
• Find out what is wrong
• Reassess regularly
BLS sequence
Unresponsive
Shout for help
BLS sequence
Unresponsive
Shout for help
Open airway
BLS sequence
Unresponsive
Shout for help
Open airway
Check breathing
BLS sequence

Look, listen and feel for
NORMAL breathing
 No breathing – apnea
 Gasps (agonal breathing)
Agonal breathing
 Occurs
shortly after heart stops in up to
40% of cardiac arrests
 Described
as barely, heavy, noisy or
gasping breathing
 Recognise
as a sign of cardiac arrest
 Do not confuse agonal breathing with
NORMAL breathing
BLS sequence
Unresponsive
Shout for help
Open airway
Check breathing
Call 155 (112)
BLS sequence
Unresponsive
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
Chest compression

Place the heel of one hand in
the centre of the chest

Place other hand on top

Interlock the fingers

Compress the chest


Rate 100 min-1

Depth 4-5 cm

Equal compression : relaxation
When possible (2 or more
rescuers) change CPR
operator every 2 min. to
prevent fatigue
Chest compression

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 (2 or more
rescuers) change CPR
operator every 2 min. to
prevent fatigue
Chest compression

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 (2 or more
rescuers) change CPR
operator every 2 min. to
prevent fatigue
Chest compression
Unresponsive
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
2 rescue breaths






Pinch nose
Place and seal your lips
over the victim´s mouth
Blow until the chest rises
Takes about 1 second
Allow chest to fall
Repeat (10 – 12 times
per minute)
B) Breathing

expired air resuscitation - several
techniques:
- Mouth-to-mouth breathing
- Mouth-to-nose breathing
- Mouth-to-mouth + nose breathing ( small
children)
- Mouth-to the barrier device ( to protect the rescuer)
- Mouth to tracheostomy
Self-inflating bag
CardioPulmonary Resuscitation
Artificial breath during expired air
resuscitation




Volum = normal breathing volum
Volum = 6-7 ml/ kg bw = 500 ml
Breath duration in adults = 1 second
Expiration – passive
Check the chest rise during rescue breath
Self-infalting bag
Capacity 1500 ml
1 way valve
Volume controlled by compression
Breathing by atmospheric air
Oxygene source - conection
Oxygene reservoir – 100% O2
Continue CPR
CPR
Continue
30
:
2
Ratio 30 : 2
One uniform ratio
• always in adults
• in children in the prehospital CPR
• in children when the rescuer is alone
Defibrillation
Defibrillation
Automated External
Defibrilators (AEDs)
A new generation of “smart“ defibrilators
 Advanced computer technologies
 Ability to interprete heart (ECG) rhythm
 Ability to determine whether
defibrilation is required
 Delivery of electric shock
 Guides the operator through every
action
 Provides voice and message prompts

Legal aspects
AEDs
Easier than CPR
 Readily available on places with haevy
people concentration, where can be
probably used once during 2 years
 Extendes beyon healthcare prefessional
personnel to trained citizens
Switch on AED
 AEDs
will
automatically switch
themselves on when
the lid is opened
Attach pads to casualty’s bare chest
Analyse rhythm – do not touch victim
Shock indicated – stand clear
Rescuer giving defibrilation shock
• is responsible for his safety
• is responsible for the safety of other
people surronding the victim
Immediately resume CPR
Need new
picture
30
:
2
Give CPR every moment, when AED is
not available, always if AED is not
available within 5 minutes
Need new
picture
30
:
2
If victim starts to breathe normally
place him in recovery position
Need new
picture
CPR should not usually be
abandoned after 20 minutes:


in case of the victim´s hypothermia
in case of persistent ventricular
fibrillation = AED indicates
defibrilation shock
Responsibility during CPR
Precordial chest thumps
Indication:
 wittnessed cardiac arrest (patient´s
collapse)
 adults only
 within 20 sec.
Only experienced rescuers
Contraindications:



uknown time of cardiac arrest
chest injury
children
A. Airway management
A)
Head tilted backward
Chin lift
Triple manouvre ???
„A“
• head titlted
backward
• chin lift
Jaw thrust
• suspected cervical spine injury
• experienced rescuer ( anaesthesiologist)
Lower jaw pulled forward
A. Airway management
1. Unconscious patient – tongue
tilt the head backward + lift the chin
2. Conscious patient - foreign body airway
obstruction  choking - partial
airway blockade


encourage the victim to cough
add several hits to his/her back
Cough is much more effective than any
other manoeuvre.
A. Airway management
1.
Foreign body airways obstruction
2.
Potentially treatable
Mostly during eating
Commonly witnessed event
Oportunity for early intervention
Can cause mild (partial) or severe (comlete) airway
obstruction
3.
4.
5.
6.
Heimlich manoeuvre (several thrusts (5))
pregnant ladies, children
A. Airway management
Signs of mild (partial) large airways
obstruction





Suffocation
Difficult intensive inspiration
Neck and thorax soft tissues retraction
Hoarse (croupy) sounds accompanying
inspiration (noisy breathing)
Barking cough
A. Airway management
Signs of severe or complete large
airways obstruction





Difficult intensive inspiratory effort
Powerful breathing movements
Neck and thorax soft tissues retraction
No breathing phenomena hearable
Patients non-cooperation, restlessness,
convulsions, coma, blue skin color
Equipment for airway
management
C: Circulation
Diagnosis:
•
Signs of functional circulation
(breathing, coughing, movement, skin condition,
responsiveness, pulse)
•
Pulse-less on large ( major) arteries –
only experienced rescuers
Compression-only CPR
“Top-less”





Reluctance of rescuers to perform mouthto-mouth breathing on strangers
Unwilling person to breathe…
Unability to perform …(vomiting,
bleeding, trauma, unskilled rescuer…)
Chest compressions only
Better some resuscitation than no
resuscitation
Compression-only CPR
New recommendation of AHA
Witnessed collapse of the patient
First 10 minutes
Contraindications:






Children
Sudden cardiac arrest due to choking
CPR in children
Who is an infant?
0 – 1 year
Landmark between child and adult: puberta
Who is a child?
1 - puberta
CPR in children
Differencies:






Cause of cardiac arrest –choking, trauma
Activation of emergency system
Hypoxia developes faster – high metabolic rate
Ventricular fibrillation – rare
Primary cardiac arrest uncommon,
Precordial thump is contraindicated
Length of CPR = identical
Chain:
Choking- hypoxia – hypercapnia – apnoea – bradycardia –
cardiac arrest

Trauma
CPR in children
A)
The most often cause of vital
functions failure = choking


Foreign body airway obstruction
Infectious diseases afecting throat by
swelling ( epiglotitis, acute suffocating
LTB, croup)
Trauma

CPR in children
Sequence of action
 Rescuers with no knowledge of pediatric
resuscitation may use the adult sequence
with the exception that they should
 start with 5 initial breaths followed by
 30 compressions
 30 : 2 for 1 minute
 than call 155 (112)
but
 Generally prefered ratio in children
= 15:2 (in-hospital CPR, 2 rescuers)
CPR in children
“A“



Identical with adults
More often inflamation throat diseases
with swelling and suffocation
Foreign bodies!!! Small toys and toys
that can be dismantled for small
parts!!!
CPR in children
“B“






Look, listen and feel no more than 10 s
Volum 6-7 ml /kg bw
Blow steadily over 1 – 1.5 sec.
To make the chest visibly rise
Start with 5 breaths
Paediatric size of self-inflating bag

Adult self-inflating bag???
Start with 5 breaths in adults with choking
as well !!!!
CPR in children
“C“





Look for signs of circulation (movements,
coughing, skin colour, breathing…)
Check the pulse (if you are an experienced
health provider) no more than 10 s
Lower third of the sternum (1 finger above
xiphoid process)
One third of the depth of the chest
100 compressions per min.
CPR in children
C)





Technique of chest compressions
Rate of chest compressions
Algorithm of CPR: 2:15
1 rescuer: 2:30
Infants: 1:3
CPR in children
2 : 15
2 : 30
CPR in children
Chest compressions in infants
CPR in children
Chest compressions in
children
BLS in children
FBAO
• back blows
• chest thrusts
• abdominal compression
All manouevres   intrathoracic pressure

expulsion of FB out from the airways
50% of cases – more than 1 manouevre is
necessary
Complications during CPR

Gastric distension –often in children
Prevention: avoid overinflating the lungs
appropriate volum making the chest rise

Rib fractures
Prevention:
correct hand´s position
do not remove hands from the chest wall
prevent “dancing on the chest“)

Gastric content (or other fluids) aspiration
Prevention:
prevent gastric distension
recovery position in unconscious victims
Children suffocation disease
 Croup: laryngotracheobronchitis

age 1-3 years, viral origin

accompanbies influenza, children infection diseases, winter or early
spring season

barking cough

not sore throat

no special position

swalloving problems

intercostal retractions

not so fast progression of suffocation

Dysfonia, afonia
Children suffocation disease
 Epiglottitis

age 3-7 years, bacterial origin

air hunger

anxiety

sitting position, hyperextended head

severe sore throat

swallowing problems, salivation

Severe inspiratory dyspnea with stridor

Mortality 10% !!! underestimated
Children suffocation disease
Both situations
Transfere to the hospital, where
anaesthesiologist or intensivist is
available
as soon as possible !!!!
Not to a general practicioner
www.erc.edu
First aid
in special situations
Bleeding
= escaped blood from the blood vessels
Hemorrhage – large amount of bleeding in a
short time
External bleeding –seen blood coming from an
open wound –outside the body
- often overestimated
Internal bleeding – inside the body
- often underestimated
Bleeding
3 kinds according to its source:
1. Arterial
•
•
•
•
•
•
•
bright red colour
under pressure, comes out in spurts
the most serious
fast rate
large blood loss
less likely to clot (clot only when blood flow is slow)
dangerous : it must be controlled
Bleeding
3 kinds according to its source:
2. Venous
• dark red colour
• low pressure
• blood flow steadily
• it is easier to control
• most veins collaps when cut
but
• bleeding from deep veins can be as massive
as arterial bleeding !!!
Bleeding
3 kinds according to its source:
3. Capillary bleeding
•
•
•
•
•
•
oozing out, leaking
most common
blood oozes
usually not serious
easily controlled
often it clots and stops itself
4. Mixed bleeding
Bleeding - clinical symptoms
 Depend on - the quantity of the blood loss
- the rapidity of the blood loss
!!! Sudden loss of a large quantity of blood results in
shock:
- skin - cold, pale
- pulse - weak, fast
- mental disorders, fear, unconscioussness
Bleeding
 What to do?
 the first aid is the same reagardless of the type of
bleeding
 most important = to controll bleeding
External bleeding
Steps:
1. Protect yourself (exam gloves or improvizations)
2. Manual control of external haemorrhage
3. Expose the wound (remove or cut clothing) to find
the source
4. Place sterile pad or clean cloth and apply direct
pressure (fingers, palm, hand) = pressure over the
wound
5. If bleeding from arm or leg – elevate extremity
above the heart level + pressure over the wound
External bleeding
Steps:
6. If bleeding continues – continue + apply pressure
against the bone at pressure points ( brachial or
femoral points ???)
7. Use pressure bandage – you have free hands for
help to other victims
8. For application of direct pressure – use ring pad
9. Tourniquets – rarely on the extremities – it can
damage nerves and vessels !!!
10.When you need it – use wide, flat materials and
write the time of application !!!
Internal bleeding





skin is not broken
blood is not seen
difficult to detect
can be life threatening
traumatic and nontraumatic origin
What to look for?





“Swelling“ on extremities in case of trauma
Contussion of the skin
Painful, rigid, tender abdomen
Vomiting or coughing up blood
Black stools or stool with bright red blood
Internal bleeding
What to do?

1.
2.
3.
Steps:
Check ABCs
Expect vomiting – keep the victim on his/her left side
Treat for shock:
 Elevate legs
 Cover the victim to keep him/her warm
 Do not give a victim anything to eat and drink
(prevention of lung aspiration, can cause
complications during surgery)
 Splinting extremities
 bleeding
  pain
 prevents nerve and vessels injury
Internal bleeding
Loss of blood - long bones fractures:
• Pelvis 2 – 5 L
• Femur (tigh) 1 – 2,5 L
• Shin bones 1 – 1,5 L
• Arm ( humerus) 0,5 – 1 L
• Forearm – 0,5 L
Shock
Definition:
Circulatory system failure when insufficient amounts of
blood is provided for different parts of body (insuficient
perfussion)
Three components:
1. Heart pump  failure
2. Network of pipes (vessels)  enlargement
3. Adequate volume of circulated fluids  fluid loss
- blood
- plasma
- extracellullar fluids (vomit, diarrhoea, sweatting, urine…)
Damage of any of these components can
produce conditions known as shock.
Shock
What to look for?
1.
2.
3.
4.
5.
6.
7.
8.
Altered mental status, restlessness
Pale, cold, clammy skin, livid lips
Limited perfussion of peripheral parts of the body
Capilary refil phenomenon – nail beds
Nausea and vomiting
Rapid breathing
Rapid weak pulse or pulseless on peripheral arteries
Unresponsiveness, when shock is severe
BP < 60 mm Hg
Shock
What to do?
1.
Treat life-threatening injuries
2.
Lay the victim on his/her back
3.
Raise the victim´s legs ( if no evident injury) – drain of
blood from legs to the heart
4.
Prevent body heat loss (blankets)
5.
Splintig of long bones fractures
6.
Seek immediate medical attention
Shock
What to do?
6. ABC
7. In case of severe shock - prevent peroral intake

nausea + vomiting

inhaling foreign material into the lungs

complications during surgery
8. Oxygene …
Bruises (suffusions) = a form of internal bleeding, but not life
threatening
Allergy, anaphylaxis
Definition: A powerful reaction to substances (eaten, injected,
contacted…) Reaction antigene + antibody.
Anaphylaxis = severe allergic reaction
Characteristics:



Occurs within minutes or seconds
Fast progression
Can cause death if not treated immediatelly
Common cause:
Medications, food + food additives, insect stings, plant and
flowers pollen, parfumes…
Allergy, anaphylaxis
What to look for ?
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Fast development
Sneezing, coughing, wheezing
Shortness of breath
Suffocation (swelling in the throat, tongue, mouth, neck =
Quincke oedema…)
Tightness in the chest
Increased pulse rate
Dizzines
Nausea + vomiting
Diarrhoea
Anaphylactic shock
Urtica with skin itching (pruritus), blisters, quickly spreading
exanthema
Allergy, anaphylaxis
What to do?
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Immediatelly interrupt the contact with allergene
Check ABCs
Seek immediate medical attention
Help the victim to use epinephrine, if he/she is
provided with
Strangulation
Removing the body from the noose - prevention of body fall and other injuries
Suspected injury of
- the brain
- cervical spine, larynx, cervical vessels
(thrombosis of the carotid artery, of the jugular vein)
What to look for?
- Status of vital functions
What to do?
 ABC
 stabilize head against movement
 seek medical attention
 admission to the hospital ICU
Seizures (convulsions)
Seizure (convulsions, crumps)
- is a burst of electrical activity from the brain that results in involuntary
movements, loss of consciousness (LOC), or both.
Basic classification
 generalised - always LOC -
convulsive - tonic or combination of tonic with
- clonic convulsions (seizures) urinary incontinence or
tongue biting may occur
nonconvulsive - absence, myoclonic
 partial - no LOC
Seizures (convulsions)
Risk factors:
 Serum electrolyte disturbances - Na <120 or >160 mmol/l,
Ca<1mmol/l, Mg<0,5mmol/l
 Drugs - amphetamine, cocaine, ethanol, TCAs
 CNS infection - meningitis, encephalitis
 Miscellaneous - CNS tumour
- hypertensive encephalopathy
- severe hypoxemia
- Head injury
Seizures (convulsions)
Clinical signs:
 Seizures have abrupt onset and last 1-5 minutes
 the period of altered mental status can last up to 30
minutes
 Status epilepticus - defined as seizures lasting
>30 minutes or two or more seizures without
lucid interval in between.
Seizures (convulsions)
What to do?
 Restrain the victim as necessary to protect from self-
injury and from secondary injury - cars and traffic on
the road, sharp objects in the proximity of the patient
 Bring the patient gently into recovery position to prevent
aspiration in the case of vomiting - rough treatment
could provoke other paroxysm
 ABC as soon as the seizures stop
 Call for help and arrange transport to the hospital
Near drowning
 Drowning is death from asphyxia secondary to submersion in a
liquid (usually water) or within 24 hours of submersion.
 Near drowning is survival of suffocation secondary to submersion
in a liquid.
 Mechanisms of near drowning
with aspiration - aspiration of water and vomitus
 in fresh water  loss of surfactant – fast absorbtion to the
circulation
 in see water  flooding of alveoli  hypoxemia (80-90%)
no aspiration – laryngospasm  spastic closure of glottis (vocal cords)
 hypoxemia (in 10-20%) = dry drowning.
Near drowning
What to do?
 Extrication of the victim from the water - very dangerous
- protect yourself !!!
 ABCs - the earliest as possible - Airways + oxygenation
+ ventilation
 The airway should be checked for foreign material and
vomitus
 Prevent additional hypothermia
 Seek for medical attention
Heat stroke
 Heat stroke - defined as a heat injury + altered mental
status in consequence of failure of the body
temperature control.
 Rectal (core) body temperature is above 40°C -
usually there is a history of exposure to exercise
or increased temperature and humidity.
Causes:
 high ambient or environmental temperature
 increased endogenous heat production
 decreased ability to dissipate heat
Heat stroke
Risk factors - extremes of age (infants and the elderly)
dehydration
alcoholism, medication (atropine)
Mortality is high because of the risk of multi-organ failure
Clinical signs:
 hyperpyrexia
 altered mental status
 lack of or minimal sweating
 ataxia
 neurological deficit – paralysis (hemiplegia, Babinsky reflex)
Heat stroke
What to do?
 ABC
 Reduction of core temperature – water should be
- sprayed on undressed patient with breeze from fans or
- wrap the patient in wet packsheet till the temperature
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falls to 38,5°C, then stop the cooling
Continuation of cooling could cause the uncontrolled
drop of body temperature.
 Cold water immersion or air-cooling
 Seek medical attention
Heat cramps
Heat cramps - are painful, involuntary contractions of skeletal
muscles that mostly involve the calves, thighs, and shoulders.
Causes - the same as those for heat stroke
The main risk factor - is the replacement of sweating losses
with plain (hypotonic) water. The hypo-osmolality can
lead to the brain edema with the cramps.
What to do?
 Give to the patient the glass with salt water one half of the glass
every 15 min.
 Massage the muscles to relieve the spasm
 Seek medical attention
Cold injury - hypothermia
Shivering
 Besides goose pimples - as a part of “cold
stress reaction“  protective reaction
 = an early response to cold stress
 Shivering is able to increase the basal
metabolism rate two-to five fold
 Heart oxygene and energetic consumption is
increased by 500%
 It is operative between 30-37°C
Cold injury - hypothermia
Clinical signs:
 gradually deteriorating mental status
incoordination  confusion  lethargy  coma
 body is cold to touch, dysarthria
 Tachycardia  bradycardia - ventricular fibrillation occurs at
temperatures 28°C
 Hypertension  hypotension
 Tachypnea (↑rate of breathing)  bradypnea (↓ rate of breathing)
 Hyperreflexia  areflexia – fixed and dilated pupils with
coma at temperature below 22°C
 Asystole - at 22º C
Cold injury - hypothermia
Cause - is the exposure of the person to the low
environmental temperature.
Hypothermia is supported by the wind and high humidity.
Classification
 mild hypothermia core temperature - 32-35°C
 moderate hypothermia - 28-32°C
 severe hypothermia < 28°C
Risk factors :
 extremes of age (infants and elderly)
 accompanying diseases and bad status of health
 alcohol intoxication and drug overdose
Cold injury - hypothermia
What to do?
In mild hypothermia:
 Transport patient to the warm environment and give him
warm fluids (but no alcohol)
In severe hypothermia:
 ABC
 Transport the patient to the warm environment, undresse
him and remove the rings and all thing, that can
constrict lower and upper extremities and limit the
perfusion
 Avoid movements with the patient´s body parts
 Seek medical attention
Cold injury - frostbite
Frostbite - a cold-related contact injury
characterised by freezing of tissues
Most often affected parts of body =
peripheral - face, ears, nose, hands, feet,
penis and scrotum
Most cases - in soldiers, winter outdoor
enthusiasts, e.g. mountain climbers
Cold injury - frostbite
Pathophysiology - cold exposure leads to
 ice crystal formation
 cellular dehydration
 protein denaturation
 inhibition of DNA synthesis
 abnormal cell wall permeability
 damage to capillaries
 pH changes
Cold injury - frostbite
Degree of injury
 1st-degree injury - erythema, oedema, waxy
appearance, hard white plaques, and sensory
deficit
 2nd-degree injury - erythema, edema, and
formation of clear blisters
 3rd-degree injury - presence of blood-filled blisters
 4th-degree injury - full-thickness damage affecting
muscles, tendons, and bones
Cold injury - frostbite
What to do?
 Examine vital functions, start ABC when necessary
 Replace wet clothing with dry, soft clothing to minimise
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further heat loss. Remove constricting clothing.
Initiate rewarming of affected area as soon as possible.
Avoid rubbing affected area with warm hands or snow, as
this can cause further injury.
Transport patient to the warm environment and give him
warm fluids.
Active re-warming of the frost-bitten part via immersion in
circulating clear water at 40-41°C
Dry sterile dressing of the frostbite
Seek medical attention
Open wounds - types
 Abrasion - the top level of skin is removed = painful -
(nerve endings)
 Laceration - skin is cut with jagged, irregular edge
 Incision - smooth edges (surgery) - bleeding depends on
the depth, the location and the size of the wound
 Punctures - deep narrow wounds (nail, knife), the object
may remain impaled in the wound
 Amputation , avulsion - the cutting or tearing off of a
body part – finger, toe, hand, foot, arm or leg
Open wounds - what to do
 Protect yourself - use medical gloves if possible or
several layers of gauze or clean cloth and apply
pressure on the wound (your bare hand should
be used only as a last resort)
 Expose the wound - to see where the blood is coming
from
 Control the bleeding
 Do not clean large extremely dirty or life threatening
wounds. Let hospital emergency department
personnel to do the cleaning
 Do not scrub a wound
Open wounds - wound care
 Shallow wounds should be cleaned to prevent infection -
risk of restarting of bleeding by disturbing the clot
 For severe bleeding, leave the pressure bandage in
place until medical attention.
 To clean a shallow wound
- wash inside the wound with soap and water
- irrigate the wound with water from a faucet (tap)
- for a wound with a high risk for infection (animal
bite, very dirty or ragged wound or a
puncture) seek medical attention for wound
cleaning
 Cover the area with a sterile dressing
Open wounds - amputation
 Control the bleeding
 Treat the victims shock
 Recover the amputated part, take it with the victim -
- it does not need to be cleaned
- wrap it with a dry sterile gauze or clean cloth
and put it in the plastic bag
- keep it cool, but do not freeze
 Seek medical attention immediately - 18 hours is the
maximum time allowable for a part that has been
cooled properly.
Muscles without blood lose viability within six
hours.
Open wounds - impaled objects
What to do
 Expose the area - remove or cut away clothing
surrounding the injury
 Do not remove or move an impaled object - movement of
any kind could produce additional
bleeding and tissue damage
 Control any bleeding with pressure around the impaled
object
 Shorten the object if necessary - stick or trunk of the
tree, wooden or iron bar..
Burns and scalds
Rank among the most serious and painful injuries.
Can be classified  thermal (heat) burns - contact with hot objects,
flammable vapor, steam or liquid
 chemical - acids, alkalis and organic
compounds (petroleum, kerosene…)
 electrical - severity of injury depends on the
type of current, the voltage, the area of
body exposed and the duration of contact
Burns and scalds
 1st-degree burns (superficial): surface (outer layer) of the
skin is affected
characteristics - redness, mild swelling,
tenderness and pain
 2nd-degree burns: affect partial thickness of the skin
characteristics - blistering and swelling, severe pain
 3rd-degree burns: penetrates the entire thickness of the skin
and deeper tissues
characteristics - no pain, skin looks waxy or pearly
grey or charred
Burns and scalds - what to do?
 Stop the burning !
 Check ABCs
 Determine the depth (degree) of the burn
 Determine the extend of the burn - rule of nine - how
much body surface area is affected by burns - head 9%,
complete arm 9%, front torso 18%, back 18%, each leg
18%, victims hand excluding the fingers and the thumb,
represents about 1% of victims body surface
 Determine which parts of the body are burned - burns of the face,
hands, feet and genitals are more severe
 Seek medical attention
Calculation
of the burned
surfice extent
Anterior
and
posteror
part of the
trunk
Burns and scalds - what to do in
case of 1st and small 2nd-degree burns
Aim of the care
- reduce pain
- protect against infection
- prevent evaporation
 Cooling - immerse the burned area in cold water - apply
cold until the part is pain free (10-45 minutes)
 Sterile bandage or clean cloth
 Fluids orally ???
 Analgesia
 Shock treatment
Burns and scalds - what not to do
 Do not remove clothing stuck to the skin - pulling will
further damage the skin
 Do not forget to remove jewellery as soon as possible -
swelling could make jewellery difficult to remove
later
 Do not apply cold to more than 20% of an adult´s body
surface (10% for children) - widespread cooling can
cause hypothermia. Burn victims lose large
amount of heat and water evaporation)
 Do not apply ointment, butter or any other coatings on
a burn except of sterile dressing or clean cloth
 Do not break any blisters - intact blisters serve as
excellent burn dressings
Burns and scalds - what to do in
case of large 2nd and 3rd-degree burns
 Do not apply cold because it may cause hypothermia
 Cover the burn with a dry, nonsticking dressing or a
clean cloth
 Treat the shock by elevating the legs and keeping
victim warm with a clean sheet or blanket
 Seek medical attention
Chemical burns - what to do
 Immediately remove chemical by flushing the area with
water - brush dry powder chemicals from the
skin before flushing (water may activate a dry
chemical) - protect yourself
 Remove contaminated clothing and jewellery while
flushing the water
 Flush for 20 minutes all chemical burns (skin, eyes)
 Cover the burned area with a dry, sterile dressing or
clean pillowcase or sheet
 Seek medical attention immediately for all chemical
burns
Chemical burns - what not to do
 Do not apply water under high pressure - it will drive
the chemical deeper into the skin
 Do not neutralize a chemical even if you know which
chemical is involved - heat may be produced,
resulting in more damage.
Some product labels for neutralizing may be
wrong. Save the container or label for the
chemical´s name.
Electric current injury
Effects of electricity on the body are determined by 7 factors:
 type of current - skin offers greater resistance to direct current
than alternating current
 amount of current
 pathway of current
 duration of contact
 area of contact
 resistance of the body
 voltage -
high voltage accident (>1000 V) is regularly
accompanied with burns, while
low voltage (<1000 V) injury causes electric
damage, most often arrhythmia.
Electric current injury
 Both high and low voltage electric currents can adversely
influence vital functions - unconsciousness, breathing
paralysis and severe cardiac dysrhythmias (mostly
ventricular fibrillation).
 Heating by electrical current is the major mechanism of
tissue damage in electrical trauma.
 In high voltage accidents, the victims usually do not continue to
hold the conductor - they are often thrown away from the
electric circuit and thus acquire traumatic injuries (e.g.
fracture, brain haemorrhage).
 Low voltage = heart injury
 High voltage = thermal injury
Electric current injury - what to do
 Make sure the area is safe - unplug, disconnect or turn
off power, if not possible, call for help
 Check ABCs - remember - ventricular fibrillation !!! - start
CPR
 If the victim fell, check for a spinal injury
 Seek medical attention immediately, victims with cardiac
dysrythmias need in hospital observation for 48 72 hrs
 Electrical injuries with burns (high voltage) - cover them
by sterile dressing, victims usually require burn
centre care
Head injuries
 Mechanism of injury – motor vehicle crashes, falls, hits,
gunshots and stab wounds, mortality rate 30-50%
 The main types of head injury
- scalp wounds
- scull fractures - basilar, linear and comminuted
- intracranial lesions - contusion, subarachnoid haemorrhage,
subdural hematoma, epidural hematoma
- diffuse brain injury – concussion, diffuse axonal injury
 Scull fracture is always associated with the brain injury
 In case of suspicion of the brain injury, the patient has to be
hospitalised, examined and monitored for at least 48 hours.
Diffuse brain injury
 Concusion
 Diffuse axonal injury
Concusion
 Is a brief, temporary interruption of
neurological function folloving head trauma
Concussion – clinical features
 Headache
 Nausea, vomiting
 Tachycardia
 Amnesia for the event
 Unconsciousness – short lasting
Concussion - treatment
 ABCs
 Treatment for scalp wounds, aplication of
pressure dressings to prevent hemorrhage
 Seek medical attention
 Transport to the hospital for diagnostics
 Admision to the hospital for monitoring,
observation (mental status, consciousness
assessment, pupils, …)
Head injuries - what to do
When the patient is unconscious
 ABC - monitor vital functions. By the application of airway
management (head position tulted backward) keep in mind the
possibility of cervical spine injury.
 Examine the head gently and cover the external injuries with sterile
dressings (bandage) - don’t press on the wound,
stabilize the victims neck against movement
 Examine the state of pupils - size, similarity, reaction on the light
 Examine also the thorax, abdomen and extremities
 When the circulation and breathing are stable bring the
patient into recovery (stable -side) position (beware of
cervical spine injury) and monitor vital functions.
 Call for help
Head injuries - what to do
When the patient is conscious:
 Bring the patient into supine position with a little elevated
head if there is no suspicion of cervical spine
injury
 Treat the wounds in the same way as above
 Call for help
 Keep in mind, that even if the patient is conscious, the
status of consciousness can alter due to the brain
injury or intracranial bleeding and therefore all the
time monitor the mental status of the victim.
Eye injuries - penetrating eye injuries
 Result when a sharp object (knife, needle) penetrates the
eye
 Seek immediate medical attention - any penetrating eye
injury should be managed in the hospital
 Stabilize any protruding object with bulky dressings or
clean cloth
 Cover the undamaged eye
 Do not wash out eye with water
 Do not try to remove an object stuck in the eye
 Do not press on an injured eyeball or penetrating object
Eye injuries - chemical burns of the eye
 Chemical burn of the eyes are extremely sight-threatening
 Alkalis cause greater damage than acids - they penetrate
deeper and continue to burn longer
 Damage can happen in 1 to 5 minutes - the chemical must
be removed immediately
What to do
 - use your fingers to keep the eye as wide as possible
 - flush the eye with water immediately - irrigate from the
nose side of the eye towards the outside, to avoid
flushing material into other eye
 - loosely bandage both eyes with cold, wet dressings
 Seek immediate medical attention
Nose injuries - nosebleeds
Two types
- anterior - most common (90%)
- posterior - serious and requires
medical attention
Nose injuries - nosebleeds
What to do
 Place victim in a seated position
 Keep his/her head tilted slightly forward so blood can run
out, not down the back of the throat,
which can cause choking, nausea or vomiting
 Pinch (or have victim pinch) all the soft parts of the nose
together between thumb and two fingers for 5 minutes
 Apply an ice pack over the nose and cheeks
 Seek medical attention - if the bleeding continues or you
suspect a broken nose or posterior nosebleed
Spinal injuries
Spinal injuries are often associated with head
injuries
The head may have been moved suddenly in one
or more directions, damaging the spine
What to look for - painful movement of the arms
or legs
- numbness, tingling, weakness or burning
sensation in the arms or legs
- loss of bowel or bladder control
- paralysis of the arms or legs
Spinal injuries
What to do
 Stabilize the victim against any movement
- to stabilize head against movement - place heavy
objects on each side of the head
 Check ABCs
 Transfere the patient by 3 – 4 pairs of hands
 Transfere patient on the vacuum matrace or on the
board
 Seek medical attention
Chest injuries
All chest injury victims should be rechecked for ABC
Broken ribs - main symptom is pain by breathing,
coughing and movements
What to do
 help the victim find comfortable position
 stabilize the ribs using pillow or other soft object fixed
by bandage over the injured area
 some victims find comfort by lying on the injured side
 seek medical attention
Chest injuries - what to do
Impaled object in chest
 Stabilize the object in place with bulky
(wide) dressing
 Do not try to remove an impaled object -
bleeding and air in the chest cavity can
result
 Seek medical attention
Chest injuries Sucking chest wound - results when a
chest wound allows air to pass into and
out of the chest cavity with each breath
Chest injuries
Pneumothorax

open
- persisting opening to the chest

closed
- no external communication

tension (valve)
- air can enter pleural
cavity during inspiration and cannot
escape during expiration
Chest injuries
Air entered into pleural cavity – results in
Pneumothorax

Collaps of the lung
+
increasing intrapleural pressure

mediastinum shift to the healthy side

stopped venous return to the heart

cardiac arrest
Pneumothorax – clinical features
 Sudden onset chest pain
 Chest wall deformity
 Crepitus
 Agitation
 Air hunger
 Tachycardia
 Hypotension
Pneumothorax - treatment
 ABCs is priority
 Immobilization
 Transport to the hospital
Pneumothorax
What to do
 Cover the wound immediately
 Seal the wound with anything available to
stop air from entering the chest cavity plastic wrap or plastic bag, if not
available, you can use your gloved hand
 Seek medical attention urgently !!!
 Pleural puncture should be done as soon as
possible
Pneumothorax (PNO)
What to do
 Always change the open pneumothorax into the
closed
 Plastic bag – place on the chest wound and fix it by
adhesive tape (plaster) from 3 sides with the
fourth side free (pocket)
Abdominal trauma clinical features
 Nausea
 Vomiting
 Dyspnea
 Heartburn
 Abdominal pain
 Abdominal distension
Abdominal trauma clinical features
 Ecchymoses over the abdomen
 Presence of open penetrating wounds
 Abdominal tenderness
 Hypotension
 tachycardia
Abdominal trauma - treatment
 ABCs is priority
 Immobilization
 Monitoring of vital signs
 Transport to the hospital
Abdominal injuries
Blow to the abdomen - observe for pain, tenderness,
muscle tights, or rigidity
What to do - place the victim in a comfortable position and
expect vomiting
check general condition – shock can develope
do not give any food and drink
seek medical attention
Penetrating wound - expect internal organs to be damaged
What to do
- if the penetrating object is still in place,
stabilize the object and control bleeding,
seek medical attention
do not try to remove the object
Abdominal injuries
Protruding abdominal organs -
what to do
 Position - the victim with the head and shoulders slightly
raised, and knees bent and raised
 Cover protruding organs with the (moist) sterile dressing or
clean cloth
 Place towel lightly over the dressing to help maintain warmth
 Seek medical attention
 Do not try to reinsert protruding organs into the abdomen
- you could introduce infection or damage the intestines
 Do not give anything to eat or drink
Pelvic injuries
 If you suspect broken pelvis, press the sides of the pelvis gently
downward and squeeze them inward at the iliac crests (upper
point of the hips)
- broken pelvis will be painful
What to do
 Treat the victims shock
 Place padding between victims thighs, then tie the knees
and ankles together
 Keep the victim on a firm surface - do not move the victim
 Seek medical attention
Bone, joint and muscle injuries
Fractures
- closed fractures - skin is intact
- open fractures - skin over the fracture is
damaged or broken
What to look for: D-O-T-S
• Deformity – abnormal position
• Open wound
• Tenderness
• Swelling
Bone, joint and muscle injuries
What to do:
 Determine what happened and the location of the injury
 Gently remove clothing covering the injured area
 Examine the area by looking and feeling for D-O-T-S
 Check – C-S-M - circulation, sensation,
movement
 First aid: R-I-C-E procedures
(rest, ice, compression, elevation)
 Use a splint to stabilize the fracture – 1 jount above and
1 joint under broken bone !!!
 Seek medical attention
Bone, joint and muscle injuries
Joint injuries
- the
most frequently affected are shoulders,
elbows, fingers, hips, knees and
ankles
Signs and symptoms
 Deformity (main sign)
 Pain
 Swelling
Bone, joint and muscle injuries
What to do:
• Check – C-S-M - circulation, sensation, movement
• First aid: R-I-C-E procedures
- rest, ice, compression, elevation
• Use a splint to stabilize the joint in the position in
which it was found
• Do not try to put displaced parts into their normal
position - nerve and blood vessel damage could
result
• Seek medical attention
Poisoning
Most often causes –
 ingestion - drugs, alcohol, or both of them, toxic food
(mushrooms) or fluids
 inhalation - narcotics and carbon monoxide or other
toxic gases
 intravenous, transcutaneous or intramuscular
application of drugs in addict people
Clinical sings
- polymorphous
- mostly altered mental status
- altered vital functions
- Convulsions
Poisoning
Evaluation of vital functions –
examine ABCs followed by
 history +
 physical examination.
History is of primary importance, but
at altered mental status may be difficult
Obtain as much information as possible from the
patient, from the family and from anyone else who
was at the scene.
Poisoning
The most important questions
 What poison is involved?
 How much was taken?
 By what route was the poison taken (e.g. by mouth, iv., i.m.,
skin exposure)?
 When was it taken?
 What else was taken with it? (combination of drugs and
ethanol)
Poisoning
Besides vital functions are regularly examined, observe:
 Pupillary size - mydriasis - (atropine, cocaine, ethanol),
- miosis (opiates, organophosphates and
barbiturates)
 Oral examination - the odour of the breath is diagnostic clue
hydration (opiates, atropine vs.
organophosphates, strychnine)
 Examination of the skin - marks of i.v. drugs use,
cyanosis, red skin colour (due to cyanide or carbon
monoxide) dry skin (atropine, anticholinergics drugs)
Poisoning
 Call for help and transport the patient to the hospital
 Monitor vital function during the transport - ABCs
 Bring with the patient to hospital all drugs, empty
blisters and boxes of the drugs that are present at
the scene.
 Provoke vomiting in co-operative person
 Don't give any fluids and do not provoke the
vomiting in people with altered state of
consciousness.
Poisoning - specific antidotes
Specific poisonings antidotes:
 Ethyleneglycol  alcohol
 Methylalcohol  alcohol
 Alkali  juice or vinegar or lemon
 Acid  milk ?
 Be careful !!!
Children suffocation disease
 Croup: laryngotracheobronchitis - age 1-3 years
- barking cough
- intercostal retractions
 Epiglottitis - age 3-7 years, sore throat
- air hunger
- anxiety
- sitting position, hyperextended head
- swallow problems, salivation
Children suffocation disease
Large airways obstruction
 Inspiratory stridor
 Soft tisues af the neck and chest (intercostal)
retractions
 Noisy breathing
 Hoarseness
 “Cock“ voice
Children suffocation disease
What to do
 Very urgent life-threatening disease !!!
 Death from suffocation can develop within tens
of minutes or several hours from normal healthy
status !!!
 Organize transfer to the hospital (emergency,
anaesthesiology, ICU) as soon as possible by
prehospital emergency services !!!
Children suffocation disease
What to do
Before transfer: Could weather can help
 Take the child outside
 Aply cold compress on the neck (Prieznitz)
 Assure inhalation of air with high humidity
Chest pain
 Several causes
 Always think about heart attack first
 Medical care at the onset of a heart attack is vital
to survive

 Seek medical atention immediatelly
Heart attack
Signs and symptoms
 Uncomfortable pressure
 Squeezing or pain in the center of the chest lasting
more than a few minutes or going away and coming
back
 Pain spreading to the shoulders, neck or arms
 Chest discomfort, nausea, shortness of breath
 Not always typical signs
Heart attack
What to do
 Call emergency medical servis or get to the nearest hospital
 The least painful position (sittin with legs up and bent at the
knees)
 Give Nitroglycerin tablets or spray (dilates coronary arteries)
– Caution: possible hypotension
 Avoid Nitroglycerin application if patient used VIAGRA
within last 48 hours
 If unresponsive victim – check ABC and start CPR
Stroke (Brain attack)
 Blood vessels rupture – bleeding or
 blood vessels plugged
 Nerve cells dies within minutes
 Transient attack – closely associated with strokes short duration from minutes to several hours (mini-
strokes)
 serious warning sign of a potential stroke
Stroke (Brain attack)
What to look for
 Weakness, paralysis
 Decreased vision
 Speaking or understanding problems
 Dizziness or loss of ballance
 Severe headache
 Differentiate pupils from “Pupils equal and reactive
for light“
Stroke (Brain attack)
What to do
 If victim unresponsive – ABC
 Call emergency medical servis
 If breathing – recovery position
 Supine position with slightly elevated head and
shoulders ( neutral position)
 Do not give anything to drink and eat (restricted
swallowing, throat paralysis, tendency to vomit…)
Diabetic emergencies
Diabetes mellitus (DM)
Definition: condition, in which insulin is either
lacking or inefective.
Insulin = a hormon produced by pancreas.
Role of insulin: helps the body to use energy from
food. It takes sugar from the blood and carries it
into cells to be used.
In Diabetes:
No insulin  sugar remains in the blood  body
cells must rely on fat as fuel.
Blood sugar is a major body fuel.
Diabetic emergencies
If blood sugar cannot be used in cells:
blood sugar level increases
overflows into the urine
increased urine production

Dehydration
Loss of unused important source of fuel

Diabetes mellitus will develop
Diabetic emergencies
2 types of DM
Type I (juvenile-onset) = insulin dependent
External insulin is required to allow sugar to pass from
the blood into cells
Type II. (adult - onset) = insulin-non-dependent
Not dependent on external insulin
If insulin level is low  known problems as discussed
above
Diabetic emergencies
The body is continuously balancing sugar and
insulin.
Much insulin + not enough sugar

low blood sugar (insulin shock)
Much sugar + not enough insulin

high blood sugar (diabetic coma)
Both low and high blood sugar
= life threatening situation ( coma)
Diabetic emergencies
Low blood sugar = hypoglycemia
Causes:
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delayed food
long fasting
exercise
alcohol
combination
Diabetic emergencies
Low blood sugar = hypoglycemia
Signs:
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sudden onset
poor coordination
anger, bad temper
pale colour
confusion, desorientation
sudden hunger
excessive sweating
unconsciousness – hypoglycemic coma
Diabetic emergencies
Low blood sugar = hypoglycemia
What to do:
• give sugar or sweet juice or glucose tablets
if patient is awake
• if no efect, repeat it
• seek immediate medical attention
• provide ABCs
Diabetic emergencies
High blood sugar = hyperglycemia
Causes:
• inactivity
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insuficient insulin
forgotten application of insulin before eating
overeating (inadequate ingurgitation of food)
illness
stress
combination
Diabetic emergencies
High blood sugar = hyperglycemia
Signs
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gradual onset
drowsiness
extreme thirst
frequent urination of high volume
flushed skin
vomiting
fruity breath odor
haevy deep breathing
unconsciousness - coma
Diabetic emergencies
High blood sugar = hyperglycemia
What to do:
• If you are not sure whether victim has high or low
blood sugar, give the person food or drink with
sugar
• If you do not see improvement, seek medical care
Or:
• Check blood sugar by glucometer
• Help the patient to apply insulin in case of high blood
sugar
Emergencies during pregnancy
Try to remain calm and considerate of the
mother during stressful situation
What to look for?
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vaginal bleeding
cramps in lower abdomen
swelling of the face or fingers
severe continuous headache
dizziness or fainting
uncontrolled vomiting
baby
Emergencies during pregnancy
What to do
• keep quiet
• place sanitary napkin or any sterile or clean pad
over the opening of vagina
• replace bload-soaked pads and save them together
with all tisues that are passed
• arrange immediate transfere to a medical facility
• place a woman partly on her left side in case of
discomfort, collaps, dizziness, faint or try to
shift pregnant abdomen gently to the patient´s
left side (release the pressure on the vena cava
inferior-increased venous return to the heart)
Emergencies during pregnancy
What to do during bustling (fast) delivery
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try to be quiet
try to co-operate with delivering lady
protect the baby´s head
if child is delivered, place him between mother´s
thighs and cover him with dry blanket
congratulate to the mother
thank her for her co-operation
wait for the end of funis (umbilical cord) pulsation
close it by tape
seek medical attention
Acute psychic (mental) disorders
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psychiatric disease
alcohol intoxication
opioid intoxication (heroin)
marihuana intoxications – overdose (joints)
intoxications by stimulationg drugs (extasis)
organic diluents (toluen)
cocain overdose (crack)
haluconogens (LSD, crystal joints…)
rarely mental disorders in lactation
but change of behaviour can be caused also by:
•lack of oxygen - hypoxemia
•rescuer’s personality and look
•development of shock state
•head injury
•cervical spine injury
Acute psychic (mental) disorders
What to do
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very difficult situation
risk of auto and heteroagresivity
risk of suicidal attemts
calm, trustful approach needed
patience to listen to the patient
direct isntructions to undergo the therapy …
• use of physical limitations – delicate situation – only
in cases with risk of autoagressivity and risk of
exposure of the patient or his neighbourhood
• seek emergency medical services to secure safe
transfer to the hospital
Animal bites
What to do
• dogs – similar to other injuries – often face,
extremities, risk of bleeding
• snakes – toxins
-neurotoxins
-cardiotoxins
-clotting disorders
-cytotoxic and hydrolytic effect
not all snake bite has toxic risks (rat snake)
First aid:
• calm down the patient
• immobilisation of extremity
• not invasive therapeutic procedures
• shock therapy
• ABC
• immediate transfer to the hospital
Animal bites
What to do
• spiders – danger very rarely – arachnophobia
toxins – neurotoxic
therapy as snakes
• scorpions
– very painful bite
- rarely very high toxicity
- vegetative neurotoxicity
therapy as snakes
• insects – most danger is hornet (yellow jacket)
bee – 100 bites = lethal dosis
pain, swelling, alergic reactions
therapy – cooling, antiallergic therapy
neck bites – swelling, airways obstruction
ABC
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http://www.lfp.cuni.cz
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