Course of First Aid for 1st year
Medical Students
(1 lecture)
Introducton to first aid. First aid management. Asphyxia
and artificial respiration.
The most critical and visible health problems
are the sudden death and disability caused
by catastrophic accidents and illnesses
Aleksander Sipria
Clinic of Anaesthesiology and Intensive Care
Tartu University (http://www.kliinikum.ee/aikliinik)
Each year in the US
Most Cases of Out-of-Hospital Death
• Heart disease
• Accident injury
• Poisoning (alcohol and drug overdose)
• About 500 000-700 000 sudden cardiac arrest
victims
• Over 150 000 people die from trauma and
400 000 receive permanent injuries
• More than 100 000 people die because of the
lack of adequate and available emergency
medical services
Each year in Europe
• About 700 000 sudden cardiac arrest victims
(50-60% of them die on prehospital level)
• During last 30 years survival after out-of-hospital
sudden cardiac arrest did not significantly
changed
Major Causes of Mortality in Estonia
• Over 3000 people die each year from sudden
cardiac arrest of cardiac origin
• About 2300 people die from trauma
• About 300 people die from alcohol poisoning
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Time-Intervals of Management
of Out-of-Hospital Cardiac Arrest
EM System in Estonia
• Pre-hospital emergency care
- 90 ambulances (84 ACLS units and 6 MICU-s),
medical teams only, about 26% of them have a
physician, as rule three team members
- 2 MICU in Tartu and 2 MICU in Tallinn operate as a
first or secondary responding units
- 4 emergency dispatch centres (joint alarm call
number 112 for fire-rescue and ambulance services
since 1999)
EM System in Estonia
• EM is an Independent medical specialty
since 2000 (residency for EM since 1998)
• In-hospital emergency care
- Most hospitals providing emergency care reorganized
reception wards on ED in which EM residents or
physicians work with other medical specialists
- No designated trauma centres
Time 0.00 Collapse/Recognition
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Call to Dispatch Center
3
2
Call-Response Interval
Vehicle stops
First Defibrillation / ACLS
The Most Important Out-of-Hospital Care
Problems in Estonia
• The weakest part in the chain of survival in Estonian
EMS system is long collapse-to-call interval. Insufficient
quality of first aid.
• The likelihood of survival after call-response interval
more than 10 minutes is very low (main reason of bad
results in rural areas)
• Further improvement of public education, early access to
the EMS system, quality of medical dispatch, early
defibrillation and early ACLS country-wide are needed
The Purposes of First Aid
What is first aid?
First aid is the immediate or
emergency assistance given on the
scene to sick or injured person before
professional medical care
• to save life
• to provide reassurance and comfort to the ill or
injured
• to prevent further injury or illness becoming
worse (cause no harm)
• to minimize or prevent infection
and promote rapid recovery
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Three Primary Objectives
of First Aid
First aid measures are not meant to
replace proper medical diagnosis and
treatment
• to maintain an open airway
• to maintain breathing
• to maintain circulation
• During this process you will also control
bleeding and reduce or prevent shock
Initial Assessment
• Safety (vehicle accidents, electrical accidents, gas,
smoke and poisonous fumes, fires and collapsing
buildings)
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Mechanism of injury
Medical information devices
Number of casualties
Bystanders
Introduce yourself
Priority Action Approach
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Take charge of the situation
Call to attract the attention of bystanders to assist you
Assess the hazards at the scene
Make the area safe for yourself and others
Identify yourself to the casualties as First Aider and offer
to help
Safety of the First Aider
• The energy source or factor that caused the
original injury
• The hazards from secondary or external factors
• The hazards of rescue or first aid procedures
Priority Action Approach
• Quickly assess the victims for life-threatening
conditions
• Give first aid for life-threatening conditions
• Send someone to call for help- ambulance,
police etc.
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Calling Emergency Services
(in Estonia 112)
• Address or location of the incident, giving cross-streets if
applicable
• Telephone number from which the call is being placed (if
needed)
• What`s happened? (Circumstances of the incident:
trauma, illness?) Who is calling? Number of casualties
involved?
• Is victim conscious?
• Is victim breathing?
Be the last to hang up! Be prepared to act according to instructions of
dispatcher
Call first is important for early
defibrillation
• If the victim is an adult, and the cause
unconsciousness is not trauma (injury) or
drowning, the rescuer should assume that the
victim has a heart problem and go for help
immediately when unresponsiveness is
established or after the absence of breathing
First Aid – Follow-up Care
• After immediate first aid is given:
- Call emergency services if someone else has not
already done so
- Monitor the casualties continuously
- Keep the casualty comfortable and warm enough to
maintain normal body temperature
- Do not give the casualty anything to eat or drink because
it may cause vomiting, and because of the possible need
for surgery
- Protect and shelter the casualty while awaiting the arrival
of medical aid
When to Get Help
• It is vital for rescuers to get help as quickly as
possible
• When more than one rescuer is available, one
should start resuscitation while another rescuer
goes for help
• Alone rescuer will have to decide:
Call first or call fast?
Call fast is important for early rescue
breathing
• If the likely cause of unconsciousness is trauma
(injury) or drowning or if the victim is an infant or
child, the rescuer should perform resuscitation
for about one minute before going for help
First Aid Follow-Up Care
- Safeguard the casualty`s personal belongings
- Assist in the evacuation of the casualty by ambulance
- Ensure that casualties who do not require medical aid
are placed in the care of friend or relatives
- Make notes of the names of the casualties and
bystanders and record the first aid given
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Responsibilities of First Aider
and Legal Implications
• Verbal (actual) consent and implied consent
• If help is refused, remain with the person until help
arrives
• If the casualty`s life is not danger and you do not know
what to do, stay with him and send for help
• You use caution in giving first aid so that you do not
aggravate or increase injury
• You give the help you would hope to receive if you were
in similar circumstances
Casualty Assessment
• History of the case
• Signs (objective evidence, vital signs)
• Symptoms (sensations that a person feels and
describes)
Keep the casualty lying down, head
level with the body, until you
determine the extent and seriousness
of the illness or injury.
The Conscious Casualty
• Ask where the injury or pain is located and
examine that area first
• Ask if anything else is wrong and make sure
there are no injuries that are
masked by pain, numbness or drugs
The Unconscious Casualty
• Primary examination
-
Severe external bleeding?
Unconsciousness?
Breathing?
Circulation (pulse)?
Give first aid for life-threatening conditions
in all victims before conducting a secondary
examination
The Unconscious Casualty
Body checks
A full body check should be carried out in the following
order
• Secondary examination
- Look: for bleeding, skin colour and condition, and deformity
- Listen: for patient responses or sounds
- Feel: (very gently) for deformity, texture, swelling, or temperature
- Smell: the patient´s breath and other odours to form an impression
of other problems the patient may have
Inform the casualty of what you are doing and why
Assess vital signes: temperature, pulse and respiration
If you suspect head or neck injuries or are unsure of the casualty`s condition,
keep them lying flat and wait for professional medical assistance
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Priorities in First Aid- Multiple Injuries
Priorities in First Aid –Multiple Injuries
• Next in priority
• The highest priority
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Asphyxia and breathing difficulties
Severe bleeding
Unconsciousness
Shock
Other immediate life-threatening medical emergencies
- Burns
- Fractures
- Back injuries
• The lowest priority
- Minor fractures
- Minor bleeding
- Behavioural problems
Do not attempt to straighten broken or dislocated bones because of the high risk
of causing further injury. Splint them in the position in which they are found.
Asphyxia
Causes of respiratory arrest
(in the circulating blood 02↓, CO2↑)
• Airway obstruction (unconsciousness, FBAO, allergy,
trauma, drowning)
• Reduced oxygen supply (toxic gases)
• Deterioration of lung and heart functions (chest
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Electric shock
Drowning
Suffocation
Inhalation of poisonous
gases
• Head injuries
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Seizures
Airway obstruction
Stroke
Drug overdose
Heart problems
Allergy reactions
trauma, poisonings, diseases)
• Signs of abnormal breathing (irregular or restricted
chest movements, noisy sounds, low or high respiratory
rate, blue coloration of the skin - late sign)
In cases of the sudden primary respiratory arrest circulation (pulse)
can be present during the first 1-2 min before cardiac arrest.
Respiratory arrest is treated initially with artificial ventilation,
together with treatment of the likely cause.
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Airway Opening
(P.Safar 1981)
• Triple Airway
Manoeuvre (Esmarch,
Heiberg, Safar)
- Head Tilt, Mouth Open,
Jaw Thrust
(P.Safar 1981)
Keeping the airway open, look, listen and
feel for breathing
Opening the airway
in an unconscious
person (head tilt and
chin lift)
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Look for chest movement
Listen at the victim`s mouth for breath sounds
Feel for air on you cheek
Decide if breathing is normal not normal or absent
Look listen and feel for no more than 10 s to determine
whether the victim is breathing normally
• If he is breathing normally: turn him into the
ERC 2010
recovery position
• Call for help, continue to assess that breathing remains
normal
Recovery position
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Indirect methods (manual techniques)
of artificial respiration (historical overview)
(ERC 2010)
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3
Victim is unconsciousness
and breathing normally
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Artificial ventilation
(expired air resuscitation)
Direct Mouth-to-mouth and
Mouth-to-nose Ventilation
(P.Safar 1981)
Safar P, McMahon M.
JAMA, 1958; 1666:1459
Mouth to mouth artificial ventilation
(ERC 2010)
The most common errors in artificial
ventilation
• Loss of head tilt
- ineffective ventilation and oxygen transport
- distension of the stomach and risk of regurgitation
(silent flow of stomach contents into mouth and nose)
Blow steadily into victim`s mouth
whilst watching for his chest to rise
Take your mouth away from the victim
and watch to his chest to fall as
air comes up
Give each rescue breath over about 1s
The time taken to 2 breath should not exceed 5s
• Hyperventilation (over-inflation)
- increases intrathoracic pressure, decreases
venous return to the heart and reduces cardiac output
- distension of the stomach and risk of regurgitation
Disease transmission and barrier devices
• The risks of diseases transmission during training and
actual CPR performance is extremely low.
• HIV and hepatitis have not been transmitted by
resuscitation to date of publication, although
transmission is theoretically possible. If the victim is
known to have a serious infection (e.g. HIV, tuberculosis,
hepatitis B or SARS) a barrier device is recommended.
ERC 2010
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Mouth-to-mask Ventilation
Mouth-to-mask Ventilation
• Ventilation with
supplementary oxygen
P.Safar 1981
Artificial ventilation
(expired air resuscitation)
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Response assessment
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Breathing assessment
•
Airway opening and breathing
reassessment
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Lung ventilation
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Pulse assessment
• If the victim has a pulse but is not breathing,
rescue breathing may help, but this situation is
difficult for a bystander to evaluate.
• For untrained bystanders chest- compression only CPR is recommended.
Airway Obstruction
( in the circulating blood O2↓ and CO2↑)
• Recognition of airway obstruction (most choking
events are associated with eating, victim may clutch his
neck)
• Partial airway obstruction (noisy breathing, victim
• Survival from cardiac arrest of FBAO
etiology is strictly depending on the time
interval between collapse and ACLS
intervention
can speak, cough and breath)
• Complete airway obstruction (victim unable to
speak, may nod, cannot breathe, wheezy breathing,
silent attempts to cough, unconsciousness)
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Foreign-body airway obstruction
Back blows (A) and abdominal thrusts (B) for
foreign body obstruction in the conscious standing
or sitting victim
P.Safar 1981
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First aid Manoeuvres for Choking
Back blows
Abdominal thrusts (Heimlich manoeuvre)
Finger sweep to remove any solid foreign body
seen in the mouth
- Chest thrusts
- Ventilations
The restoration of breathing takes precedence
over all other measures
Choking emergency device and first aid
Prehospital Emergency Care
and Crisis Intervention
Third Edition by Brent Q. Hafen,
Keith J.Karren Brady Morton Series
1989
ERC 2010 guidelines
not recommended
Manual Cleaning of the Airway
Back Blows and Chest Thrusts - Infants
P.Safar 1981
The most significant difference from the adult algorithm is that abdominal thrusts
should not be used for infants. Chest thrusts are similar to chest compressions
but sharper and delivered at a slower rate
Blind finger sweeps should be avoided and solid material
in the airway removed manually only if it can be seen
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An infant`s airway is more easily
blocked than an adult`s because:
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The head is relatively large
The neck is relatively short
The tongue is large
The trachea (windpipe) is soft and easily
compressed
• The adenoids may be large
ERC 2010
ERC 2010
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