Primeros auxilios: Evaluación inicial

• First aid refers to the measures taken in response to a health emergency, which is a situation that requires immediate action due to a sudden injury, illness, or the worsening of a condition that could endanger someone's life.

Assessing the Situation

• First, you must make an initial assessment of the environment and the injured person.
• Assess the surroundings: make sure the danger that caused the emergency cannot worsen the patient's condition or injure those helping. Common hazards include electricity, fire, uneven ground etc.
• A safe space should be established to attend to the victim, away from the source of the emergency or any other element which could compromise safety, like traffic.
• Assess the patient: it is important to determine their condition to take appropriate actions and establish priorities. This can help determine which patient requires the most urgent assistance.

Evaluating Patient Severity

• The recommended order to assess the severity of the patient and the measures to be taken is as follows:
  • Level of consciousness
  • Respiratory status
  • Cardiocirculatory status
  • Presence of hemorrhages
  • Presence of fractures
• With the first three steps, you can assess the vital urgency by observing consciousness and vital signs.
• Then, assess possible injuries, paying special attention to external hemorrhages, exteriorized hemorrhages, and fractures.
• The level of consciousness is the first parameter to assess in an emergency. It gives a clue about the action to be followed and indicates the seriousness of the patient, as in traumatic brain injuries.

Assessing Consciousness

• To assess the consciousness of an injured person in an emergency, call the patient loudly, asking how they feel, and shake them gently to avoid aggravating any potential injuries.
• The Glasgow scale is used to monitor the level of consciousness. There are three parameters used (eye opening, verbal response, and motor response). Each parameter is assigned a score based on its results.
• By repeating the scale at certain intervals, the level of consciousness and its evolution can be determined.

Glasgow Scale

• Spontaneous eye opening: 4 points
• Eye opening to verbal stimulus: 3 points
• Eye opening to pain stimulus: 2 points
• No eye opening response: 1 point
• Oriented verbal response: 5 points
• Confused verbal response: 4 points
• Inappropriate words verbal response: 3 points
• Incomprehensible sounds verbal response: 2 points
• No verbal response: 1 point
• Obeys verbal commands motor response: 6 points
• Localizes pain stimulus motor response: 5 points
• Withdraws from pain motor response: 4 points
• Flexion response (decorticate posture) motor response: 3 points
• Extension response (decerebrate posture) motor response: 2 points
• No motor response: 1 point

Interpreting Glasgow Scores

• After the assessment, the scores of the three parameters are added up to get a Glasgow scale score.
• 15 points (maximum value): normal level of consciousness
• 9 to 13 points: moderate decrease in the level of consciousness
• 8 or less points: severe decrease in the level of consciousness (requires intubation)
• 3 points (minimum value): deep coma

Quantitative Disorders of Consciousness

• Quantitative disorders of consciousness are those in which the alertness function is affected, they would fall into the field of psychiatry and among the quantitative disorders we can highlight:
  • Lipothymia: transitory dizziness without loss of consciousness is caused by a decrease in cerebral blood flow due to a decrease in blood pressure, emotions, exposure to heat sources, etc. It is a transient loss of consciousness.
  • Syncope: sudden, brief, and reversible loss of consciousness. The cause is a decrease in cerebral blood flow, more intense or prolonged than in lipothymia.
  • Obnubilation: the subject remains drowsy and comes out of it in the presence of strong stimuli of a sound or luminous type. Responds correctly to complex commands, but with slowness or difficulty in concentration.
  • Stupor: a more advanced degree and can manifest itself from a state in which the person reacts to stimuli such as noises, strong light, shaking, etc., to one in which it only reacts to painful stimuli, for example pinches or squeezes.
  • Coma: the most serious of the problems of consciousness. It is accompanied by abolition of sensitivity and voluntary motility, and there is no response even to painful stimuli.
• In cases of loss of consciousness in any of its degrees, especially if it has been caused by a traumatic brain injury, in addition to the Glasgow scale, an inspection of the pupils is carried out, which provides information about the cerebral state.
• Reactive pupils contract when a light source shines on them. Non-reactive pupils do not contract when an intense light source is shined on them.
• Miosis: pupils smaller than normal for the light intensity where the study is performed.
• Mydriasis: pupils larger than normal for the light intensity where the study is performed.
• Isocoric: both pupils are the same size (normal)
• Anisocoric: one pupil is larger than the other (abnormal).

Basic Life Support (BLS)

• The European Resuscitation Council (ERC) is the European organization in which the Spanish National Cardiopulmonary Resuscitation (RCP) plan is integrated.
• The ERC is responsible for dictating the rules and protocols of action in matters of cardiopulmonary resuscitation. These rules are established by the group of experts of the European countries that form it.
• In 2017 these rules and protocols have been updated, and it has been verified that in pediatrics survival increases if CPR is performed with compressions and rescue ventilations.

ERC Recommendations for Pulmunary Resuscitation and Airway Obstruction (OVACE)

• The chain of survival is the succession of favorable circumstances which, if they occur, make it more likely that a person will survive a situation of sudden cardiorespiratory arrest. These include:
  • Early recognition of the emergency and call for help. Activating the medical emergency services (SEM) or the local emergency response system, for example calling 112. An early and effective response can prevent cardiac arrest.
  • Early CPR. Immediate CPR can double or triple the survival of patients in ventricular fibrillation (VF) (without immediate adequate treatment, the seriously abnormal cardiac rhythm causes the patient's death).
  • Early defibrillation. CPR with defibrillation (electrical discharge in the area of the heart to get all the heart cells to stop and re-initiate their operation in a coordinated manner).
  • Early advanced life support and post-resuscitation care: the quality of treatment during the post-resuscitation phase affects the outcome.
• The interruptions of chest compressions should be minimized. During the interruptions of these compressions, the coronary flow decreases substantially.

Adult Basic Life Support

• Basic life support (BLS) seeks to maintain the patency of the airway and supply the patient's respiration and circulation without using any equipment other than a protective measure.
• BLS consists of the following sequence of actions:
  • Think about the safety of yourself, the victim, and any other person present.
  • Check if the victim responds. To do this, gently shake their shoulders and ask loudly: "Are you okay?".
  • If the victim responds: leave them in the position we found it with attention to make sure there is no danger. Try to find out what is wrong and get help if necessary, then re-evaluate them regularly.
  • If the victim does not respond. Yell for help, place the victim on their back and open the airway by extending the head and lifting the chin.
  • Maintaining an open airway, look, listen and feel for normal breathing.
  • If the victim is breathing normally: put them in the recovery position. Send someone to get help or call an ambulance, and check that they continue to breathe.
  • If they are not breathing call for help or leave the victim and alert the ambulance service and then return and begin chest compressions as follows: kneel next to the victim, put the heel of one hand in the center of the victim's chest, put the heel of the other hand on top of the first, interlock the fingers of your hands and make sure that pressure is not applied on the ribs or abdomen of the victim.
• Combination of chest compressions with rescue breaths: place hands back in position over the sternum and perform another set of 30 compressions.
• When the victimm starts breathing re-assess them.
• If the initial rescue breath does not make the chest rise, before next attempt revises mouth and remove obstructions.
• If there is more than one rescuer, change every 1 to 2 minutes to prevent fatigue.

Airway Obstruction due to a Foreign Body (Choking)

• The most common cause of choking in adults is airway obstruction by food.
• Half of the episodes of choking in children are caused by food (mainly sweets), and the rest by objects such as coins or toys.
• If the victim shows signs of slight obstruction of the airway: encourage them to cough.
• If the victim shows signs of severe obstruction of the airway and is conscious:
  • Give them up to five back blows: stand to one side and slightly behind the victim, support the chest with one hand and lean the victim forward.
  • If the five back blows fail and do not clear the airway, perform up to five abdominal compressions: stand behind the victim and get both arms around the upper part of their abdomen and lean the victim forward.
  • If the obstruction has not been resolved, continue alternating the five back blows with the five abdominal compressions.
• Put the victim on the floor and activate SEM.
• Start from the 5th point of the SVD sequence.

Hemorrhages, Wounds, Burns, Cauterizations, and Frostbite.

• Hemorrhages can be classified according to the type of blood vessel that is broken:
  • Capillary hemorrhage: the blood comes from the capillary network. It is the most frequent and least serious. The capillaries have little pressure and the blood flows very slowly. It is called sheet hemorrhages
  • Venous hemorrhage: the bleeding comes from one or more injured veins. The blood flows continuously and is dark red in color.
  • Arterial hemorrhage: the bleeding comes from one or more injured arteries. It is the most serious, since due to arterial pressure the blood flow is more intense. The blood is bright red in color and usually comes out intermittently coinciding with the pulse.
• According to the place where the blood is going to stop, they are classified into: internal or external hemorrhages.
• In cases of suspected internal hemorrhage, it is recommended: reassure the injured person, control vital signs and treat the injuries (if possible), loosen anything that compresses the victim to facilitate blood circulation, avoid heat loss and evacuate them as soon as possible.
• External hemorrhage: is one that, from the inside, flows to the outside through natural orifices of the body.
• Depending on the orifice through which they come out, six types can be distinguished.

Acting on External Hemorrhages

• In cases of external wounds from arterial or venous bleeding use three techniques that will be applied successively, depending on the previous failure. 1 Direct compression: is done by applying pressure at the bleeding point with a dressing or a cloth as clean as possible for 10 minutes. 2 Arterial compression: compress the main artery of the arm (humeral or axillary) will depend on the source of the wound or leg (Femoral or Popliteal) to reduce or eliminate circulation to that area. 3 Tourniquet: this method will be used to reduce blood flow only if the above two solutions are ineffective and your patients life is in peril.
• In applying a tourniquet never loosen as the lack of circulation causes the accumulation of toxins that can start the cause the patient's death if let back into the circular system.

Wounds

• A wound is any section or break in the skin caused by a trauma and that can affect underlying structures such as muscles, tendons, bones, vessels, organs, etc.
• The graveness of the wound depends on the depth, extension, location, affect organ damage is in evidence
• Depending on the cause that produces classifies into incision, puncture or the crush like wound.
• The main differences are In level of wound and treatment.
• In more severe cases, there is recommendation to see qualified medical professional with the minimum delay.

Burns

• A burn is an injury caused by heat in assessing the severity of a burn, several things will need to be taken into account:
• The severity as they are classified into three or more grades of classification.
• The extent: the greater.
• The location the age in the function of each part of the body is calculated as a 1% to 99% as well as the complications of the wounds.
• No apply creams ,lotion, not give any food neither to drink and transfer to the qualified medical personal.

Injuries by Electricity

• Electric shock is lesion to the skin or internal wounds produced by the electric current.
• The protocol is to: -disconnect the current ,isolate the patient an treated the area of skin and evacuate the patient.
• No do local pressure since the area fragile of any affected.

Freezing

• Freezing is a systemic injury or the skin injuries due the cold.
• The sign for these are the gray or whiter skin tones with numbness in the affected areas.
• You must avoid rubbing the affected of the area and use the warm clothing to insulate the area affected. And transfer to the center to get qualified personal attention.

Traumatic Injuries

• Which are known as conditions of sprains, dislocation and fractures.

Contusions

• The contusions are injuries caused from a crush or hit to a section of portion of skin.
• They are classified into severity base simple bruising which is redness on the skin with not many complications.
• First degree or equimosis that produced a rupture a blood clot under the skin surface.
• Second grade or hematoma which is volume which cause is on subcutaneous level.
• Third grade with tissue death destroyed section.

Acting to treat to control the wound damage.

• Immobilizing the area.
• Application of cold on the wound.
• If there is any doubts to see certified personnel.

Spains

• Are known a dislocation pull with ligament damage and is caused for major tear.
• The are graded from one to three base ligament damage and each the are.
• Treated with immobilization rest an a doctor will need look over the affected area.

Dislocation

• Are the separations injuries between articular and cartilage , it comes in light and high .
• It can be is injured is a lot or not the is why be very careful the treatment, will depend of it.
• Treat the area and call to center if need to qualified personal.

Fractures

• Are lack if continuity on the bone.
• Can be caused due of trauma, illness or bad pressure is made on it to.
• The signs are high pain, deformity area get worse when you move.
• The wound is inmobile and inflammation.

Fractures Types

• A fractured can classified base how it show open, close ,minuted and green and spiral.
• If the is not evidence on the skin being expose it called closed.
• As procedure will need evaluate ,control the hemorrhage the it can calm the victim to.

Treat the Fractured area

• Remove any jewelry on the affected the area to not compress the area.
• Used any rigid element to immobilize, a table and newspapers to.
• Keep in mind immobilize the top and bottom joint and watched the area to be sure vascular injuries.
• With the wound cleaned, cure in area from a infection and after call or transfer to cent for specialized attention.

More Complex of Dangerous Fractured

• Some fractured parts have the potential to have more cause a major deal of concern:
• Lesion in head, muscle or have not to prevent lesion a damage.
• A spinal and this is have 3 personal and move like is a table.

Movement by Political and Traumatized patients

• The patients if the is 2 or more peripheral visceral or mixed that contains any risk need treat in an emergency priority.
• A patient has been have a good job and do decrease a manipulación and patient have less pain and no systematic risk for problems will need for patient: Used accessional equipment, support task secured absent compilation.

Support Element to Immobile to Patients Politics

• There can used cervical support to immobilized the column the cervical has for persons the put equipment over head and fixed.
• Bed, aluminum very light to separate the half each time it be to size.
• Colchon to vacuum which is wrap close what has parts what is fixed you put close air and in anatomies what the patient what and move nothing.
• The Kendrick device help in the chaleco modde what help in to a position what not move.
• Some systems to maintain the the line in the limbs what has to fixated can be: Vacuum to push the position with cremallera.

Basic Procedure for Transferred The Patients

• The will need to transferred to with system of base the transferred with help 4 people. This with make the a level what had is under and top in all the area under. You will need the a stretcher or use in a blank top so will be a top area to move easily.
• With these four people need be perfectly the aligned and the will need to put the the blank in there legs after this, get up the easy the patient and slide the table and move put over so easy and blocked in the board.

bandages

The vendaje is the process that consists in applying a bandage on a zone of the body and, in the case to be used of different parts can be, used bandage in each area and the purpose.

• Mainly, use in securing any wound parts.
• Protect and do not let it move parts do for injuries.
• The motion can combine between the different parts with make easy in any bodies.

To keep mind the bandages you to do:

• All time need have the the clean the is why have cotton the do .
• The regional all be aligned and the wound be top.
• The movement will do circulation go well, The bandage do not be over the wound the is why use cotton the do.
• Can the see it to to a neurovascularity with look the color movement in the skin.
• Is all can be ok if the the bandage work so is to need change ,will need ask ,use the bandage and that ok.