Primeros auxilios: Evaluación inicial

• First aid refers to the immediate actions taken in a health emergency, which is a situation requiring immediate action due to a sudden injury, illness, or worsening condition that could endanger a person's life.

Assessment of the environment and the injured person

• The initial assessment involves evaluating the surroundings and the patient to determine if an emergency exists.

Environment assessment

• Ensure the agent causing the emergency can't worsen the patient's condition or injure those helping.
• Secure a safe space to attend to the victim, away from the cause of the emergency and other hazards.

Patient assessment

• Determine the patient's condition to take appropriate measures, prioritize actions, and identify which patient needs urgent assistance if there are multiple victims.
• The recommended order to assess the severity of the patient's condition:
• Level of consciousness
• Respiratory status
• Cardiovascular status
• Presence of hemorrhages
• Presence of fractures
• Assessing consciousness and vital signs during the first three steps helps evaluate vital urgency.
• Afterwards, the possible lesions are evaluated paying special attention to external hemorrhages, externalized hemorrhages, and fractures.

Level of consciousness

• It is the first parameter to be assessed in an emergency, guiding action and indicating patient severity.
• Assess consciousness by speaking loudly to the patient and gently shaking them.

Glasgow scale

• It is widely used to assess the level of consciousness.
• It analyzes three parameters (eye opening, verbal response, and motor response).
• Assigns a score based on the results.
• Repeating the scale periodically can track the level of consciousness.
• Glasgow scale analyzes eye opening, verbal response and motor response.
• Eye opening analyzes spontaneous response (4 points), response to verbal stimulus (3 points), response to painful stimulus (2 points) and no response (1 point).
• Verbal response analyzes oriented (5 points), confused (4 points), inappropriate words (3 points), incomprehensible sounds (2 points) and no response (1 point).
• Motor response analyzes fulfills verbal orders (6 points), locates painful stimulus (5 points), withdraws in response to painful stimulus (4 points), flexion response (decortication posture) (3 points), extension response (decerebration posture) (2 points) and no response (1 point).

Glasgow coma scale score interpretations

• 15 points (maximum value) means normal consciousness
• 9 to 13 points means moderate decrease in the level of consciousness
• 8 or less points means severe decrease in the level of consciousness (requires intubation)
• 3 points (minimum value) means deep coma

Quantitative disorders of consciousness

• They affect the level of alertness and fall into the field of psychiatry.
• Examples include:

Transient

• Lipothymia: temporary dizziness without loss of consciousness due to decreased cerebral blood flow.
• Symptoms include weakness, nausea, blurred vision, pallor and cold sweat.
• Recommend lying the patient down, elevating the legs and loosing their clothes.
• Syncope: sudden, brief, reversible loss of consciousness.
• Causes include cardiovascular, metabolic, neurological or psychological factors.
• Symptoms include fainting and loss of sphincter control .
• Recommendations include checking breathing, elevating feet, loosening tight clothing and calling emergency services.

Prolonged loss of consciousness

• Obnubilation: the person is drowsy but awakens with strong stimuli and responds correctly but slowly.
• Stupor: response only to intense stimuli like pain.
• Coma: complete loss of consciousness, sensitivity, and voluntary movement, with no response to stimuli.

Pupils inspection

• Perform an inspection of the pupils, especially after a traumatic brain injury.
• It provides information about the brain's condition.
• Possible alterations include:
• Reaction to light: reactive (normal) or non-reactive (abnormal).
• Size: miosis (smaller than normal) or mydriasis (larger than normal).
• Symmetry: isocoric (equal size, normal) or anisocoric (unequal size, abnormal).

Basic life support (BLS)

• The European Resuscitation Council (ERC) issues guidelines for cardiopulmonary resuscitation (CPR).
• The ERC updates these guidelines periodically, including updates in 2017.
• CPR with chest compressions and rescue breaths increases survival in children.

ERC recommendations for cardiopulmonary resuscitation and airway obstruction (OVACE)

• The chain of survival includes:
• Early recognition of the emergency and call for help
• Early CPR by the bystander can double or triple the survival rate of patients in ventricular fibrillation
• Early defibrillation between 3 to 5 minutes after the collapse results in high survival rates.
• Early advanced life support and post-resuscitation care.

Quality of CPR

• Interruptions in chest compressions should be minimized as coronary flow decreases.
• Recent evidence suggests that unnecessary interruptions in chest compressions occur frequently both in and out of the hospital.

Basic adult life support

• It involves ensuring an open airway, breathing, and circulation without specialized equipment.
• The steps are:
• Ensure safety for yourself, the victim, and others present.
• Check for a response by gently shaking shoulders and asking, "Are you okay?"
• If the victim responds, leave them in their position and seek help if necessary.
• If the victim doesn't respond, shout for help and position them on their back.
• Open the airway with a head tilt and chin lift by placing one hand on the forehead and gently tilting the head back while lifting the chin with the fingers of the other hand.
• While maintaining an open airway, check for normal breathing for no more than 10 seconds by looking, listening, and feeling for breath.
• If breathing normally, place the victim in the recovery position.
• If not breathing normally, look for a qualified aide and begin chest compressions.

CPR compressions

• Kneel next to the victim
• Place the heel of one hand in the center of the victim's chest and add the other hand on top.
• Ensure no pressure is applied to other areas
• Position yourself vertically over the chest with straight arms and back.
• Press down on the sternum to a depth of 5 to 6cm at a rate of about 100 compressions per minute.
• After each compression, allow the chest to recoil completely without losing contact.

Combining chest compressions and breaths

• After 30 compressions, open the airway again with a head tilt and chin lift.
• Pinch the soft part of the nose with your thumb and index finger.
• Allow the mouth to open and place your lips around the victim's mouth, ensuring a good seal.
• Give a normal breath, watching for chest rise, for one second.
• Maintain head extension and chin lift, remove your mouth and note the chest falling.
• Complete two rescue breaths and restart compressions following the same process.
• Continue chest compressions and rescues breaths with a 30:2 ratio.
• If the victim starts breathing, stop to re-evaluate, if not, continue the resuscitation.
• If the chest does not rise during rescue breaths before the next attempt review mouth and check air passage.
• When more than one aid is provided, take turns to prevent fatigue.
• CPR can also be done exclusively with chest compressions.
• You only need to value the victim if they begin to breath normally.

Obstruction of the airway by a foreign body (OVACE) (choking)

• In adults, choking is commonly caused by food and in children is caused by toys or candy.
• Treatment for choking:

Mild obstruction of the airway

• If the victim indicates a slight obstruction, encourage them to cough.

Severe obstruction of the airway (conscient)

• With the patient conscious administer five blows to the back.
• Put yourself at the side and slightly behind the victim
• Make sure their chest is secure with one hand while bending them forward.
• If the previous steps do not work complete five abdominal compressions.
• Put yourself behind the victim while wrapping your arms around their upper abdomen.

Severe obstruction of the airway (unconscient)

• If the victim is unconscious,
• Place the victim on the ground.
• Activate the emergency medical service (EMS).

Hemorrhages, wounds, burns, caustics and, frostbite

• Hemorrhage refers to the escape of blood from blood vessels due to an injury.
• The severity depends on the speed and volume of blood lost, patient age and, general health.
• Types of hemorrhages:

Type of blood vessel

• Capillary: slow blood flow from capillaries.
• Venous: continuous flow of dark red blood from veins.
• Arterial: the most serious, with bright red blood spurting out intermittently.

Hemorrhage location

• Internal: bleeding inside the body.
• Measures include: reassure the victim, control vital signs, keep them warm and evacuate as soon as possible.
• Exteriorized: internal bleeding that flows through a body opening.

Orifice of exit

• Rectum: from the rectum (rectorrhagia) or digested blood from higher in the digestive tract (melena).
• Mouth: blood vomiting (hematemesis) or coughing (hemoptysis).
• Nose: nosebleed (epistaxis); apply direct pressure, tilting the head forward and cover it instead of transporting it.
• Ear: bleeding from the ear (otorrhagia); facilitate drainage for the ear.
• Vagina: vaginal bleeding (metrorrhagia); maintain rest, and cover with compresses.
• Urethra: blood in the urine (hematuria); go to urgent care.

External hemorrhages

• Application techniques in cases of injury:
• Direct compression: press on wound area with a clean compress.
• Arterial compression: compress the upper leg (femoral or popliteal) or arm (humeral, axillary) to stop blood flow.
• Tourniquet.

Tourniquette application

• The tourniquet can only be used if the other methods do not work.
• When the area has been amputated, control the hemorrhage.
• Apply a wide pressure band to an area.
• Turn the tourniquet until blood flow is stopped.
• Note the time.

Wounds

• It refers to a cut or break in the skin.
• Severity depends on the depth, location, and presence of internal damage or foreign bodies.

Types of wounds

• Incisions: caused by sharp objects
• Punctures: caused by pointed objects.
• Contusions: Bruises caused by blunt trauma.

Treatment

• Mild: superficial wound, not infected nor has debris.
• Serious: Deep wound, infected, or with a foreign object.

Action

• Washing hands: Use material that has been sterilized, with soap and sterile gloves.
• Stop bleeding: Stop hemorrhage with pressure.
• Clean the lesion with soap and water.
• Applying antispetic: Make sure it doesn't impede infection control.
• Visit the doctor for vaccines and other treatments.

Severe wound treatment

• A severe lesion requires aid of an specialist.
• Make sure to evaluate the general state, stop hemorrhage and cover the wounds.

Puncture

• In thoratic wounds, they occur with air leaving the body.
• The steps to take are:
• Seal the opening by dressing the area.
• The bodies shouldn't be extracted.
• The wounds should remain covered.
• There should be nothing given to the injured to eat.
• Constantly evaluate the injured.
• Transport to a medical facility.

Abdomen

• Intestinal discharge and internal hemorrhage.
• Make sure that no bodies are extracted and provide a sterile cover.

Eyes

• Can be aggravated by conscience actions/movements
• Cover the open eye with gauze
• Make sure both eyes are covered.

Lesions in traumatology

• Include a range of conditions: Bruises, sprains, dislocations, and fractures.

Bruises

• It is a trauma to the skin that doesn't break.
• It is categorized in severity:
• Simple: Red skin.
• First degree (ecchymosis): small vessel breakage.
• Second degree (hematoma): Large vessel breakage.
• Third degree (contusion): Tissue is destroyed.

Steps to take

• Inmovilizing the area and keeping the area high.
• Adding an ice pack so that vessels restrict.
• Visiting the facility for a check up.

Sprains

• Strain and break of the joint ligaments from trauma.
• Signs are inflation is apparent and pain.
• It is classified as:
• Degree I: Ligament is strained.
• Degree II: partial ligament break.
• Degree III: Full ligament break.
• If the level is high then a splint or professional should give you guidance.

Dislocations

• The surface of the articulating joint is broken or displaced.
• Due to trauma.
• Movement causes pain ,with a functional impairment.
• Immobilize member.
• Reduce with a professional reduction.
• After reduction,immobilize and rehabilitate.

Fractures

• An internal bone break due to stress to bone.
• Causes pain.
• Prevents use of appendages.
• Can be of many types.

Types of bone fractures

• Classified by external observation.
• If its closed it shows that the bone is broken while the skin stays intact.
• If its open, the bone can be seen via the break.
• Classified by the form the fracture takes.
• Comminuted: The bones are broken into many parts.
• Oblique: Angled at any side.
• Greenstick: Incomplete.
• spiral: Rotating.
• General treatments involve calming the patient and stopping haemorrhaging.
• Make sure to clear the area of jewelry.
• Stop the area using a sling, and monitor so that the patient can breathe.

Fractures can be dangerous

• Injuries to the vertebrae.
• Immobilize patients using spine board with a c-collar or any other form of support.

Transfer of patients

To transfer the patient between gurney, one person directs the other.

Burns, injuries, caustics,, congelations

Burns

• Burns are injuries to the skin that require various treatments.
• They are classified as being three degrees based of depth.
• I degree: erythema and reddening of the skin.
• II degree:Affects the epidermia and dermis and causes blisters.
• III degree: affects various tissues like arteries,dermis, etc. Destroys nerve ending and causes a blackening.
• In addition to those the causes are also factored in, age location etc.
• Treatment includes putting out the fire and putting water and saline solution..

Injuries due to electricity

• Make sure that you stop the flow before treating patient with chords, and also call emergency.
• Similar to burns covering with cloth and saline solution
• For freezing injuries, treatment is also similar with fabrics.
• Do not make heat applications.
• For full on situations, the water should be tepid, if not warm, and be sure to not use material such as alcohol.