Primeros Auxilios: Evaluación Inicial

• First aid encompasses actions taken in a health emergency
• A health emergency requires immediate action due to sudden injury or illness, or worsening of an existing condition, that endangers the person's life

Assessing the Situation

• Initial assessment involves evaluating the environment and the patient
• Environmental assessment means checking that the cause of the emergency does not pose a further threat to the patient of individuals providing aid (e.g., electricity, fire, unstable terrain)
• Ensuring a safe space to attend to the victim, away from the cause of the emergency or any factor that could compromise safety, such as traffic
• Patient assessment is determining the patient's condition to prioritize actions; also determining which patient needs the most urgent assistance

Assessing the Victim

• A recommended order for assessing a patient's severity includes evaluating: Consciousness, breathing, circulation, hemorrhages, and fractures

Consciousness

• Assessing level of consciousness is the first step, that guides subsequent actions and indicates severity, especially in head trauma
• Level of consciousness is evaluated by calling the patient loudly and asking how they feel, then gently shaking them to avoid aggravating potential injuries
• The Glasgow Coma Scale (GCS) is widely used
• The GCS analyzes three parameters: eye-opening, verbal response, and motor response, assigning points based on observed responses
• The GCS can be repeated to monitor the level of consciousness over time

Glasgow Coma Scale

• Eye-opening: Spontaneous (4 points), to verbal stimulus (3 points), to pain (2 points), no response (1 point)
• Verbal response: Oriented (5 points), confused (4 points), inappropriate words (3 points), incomprehensible sounds (2 points), no response (1 point)
• Motor response: Obeys commands (6 points), localizes pain (5 points), withdraws from pain (4 points), abnormal flexion (decorticate) (3 points), abnormal extension (decerebrate) (2 points), no response (1 point)
• GCS score interpretation: 15 points (normal consciousness), 9-13 points (moderate level of consciousness), 8 or less - severe (requires intubation), 3 points (deep coma)

Quantitative Consciousness Disorders

• Quantitative consciousness disorders involve the function of alertness
• They can be categorized as:
  • Lipothymia: transient dizziness without loss of consciousness as a result of decreased cerebral blood flow.
  • Syncope: sudden, brief, and reversible loss of consciousness.
  • Obnubilation: subject is drowsy, responds to strong stimuli, and can follow complex commands but displays slowness or difficulty in concentration.
  • Stupor: more advanced, reacting only to strong stimuli (loud noises, bright lights, or pain).
  • Coma: most severe. Includes loss of sensitivity and voluntary movement, with no response to stimuli, even pain.

Pupil Inspection

• Pupil inspection gives information about cerebral state and is performed especially after head trauma, alongside using the Glasgow scale
• Pupil abnormalities: reactivity, size, symmetry
  • Reactivity: pupils' reaction to light source
    • Reactive: pupils constrict when a light is shined on them (normal)
    • Non-reactive: pupils do not constrict when exposed to light (abnormal)
  • Size
    • Miosis: pupils smaller than normal for light conditions (abnormal)
    • Mydriasis: pupils larger than normal for light conditions (abnormal)
  • Symmetry
    • Isocoric: pupils are the same size (normal)
    • Anisocoric: pupils are different sizes (abnormal)

Basic Life Support

• European Resuscitation Council (ERC) dictates guidelines for cardiopulmonary resuscitation (CPR)

ERC Guidelines

• Early recognition of the emergency and call for help to activate emergency services
• Early Basic Life Support (BLS) or CPR
• Early defibrillation and early advanced life support and post-resuscitation care
• Interruptions in chest compressions should be minimized

Adult Basic Life Support (BLS)

• Think of the safety of yourself, the others and the victim
• Check for the victim's response, gently shake shoulders and ask
• If the victim responds
  • Leave them in position if not in danger.
  • Try to see what their condition is, and what happened
  • Reassess the situation regularly
• If the victim does not respond
  • Shout for help
  • Put victim on their back and open the airway by head tilt/chin life
  • Place one hand on head and gently tilt back, keeping index and thumb finger free to close the nostrils for rescue breathing
  • With fingers of the opposite hand, under the victim's head, elevate the mandible to open the airways

Assessing for Breathing

• Look for chest movement
• Listen at the mouth of the victim for sounds of respiration
• Feel for expired air on the face
• Do not confuse occasional, insufficient breaths (gasping), for normal respiration
• Look for 10 seconds to determine if the victim is breathing normally
• If breathing normally, place into the recovery position
• Send someone for help, and regularly check for breathing
• If not breathing, send someone to alert ambulance, return and being chest compressions
• Kneel by the victim
• Place the root of one hand at the center of the chest
• Place the second hand atop the first hand, interlocking fingers
• Compress the chest 5-6cm vertically, using back strength
• After each compression, decompress the chest to allow blood to fill
• Perform at a rate of 100-120 compressions/minute (2 compressions/second)

Rescue Breath

• After 30 compressions, perform rescue breaths, ensure the wind-pipe is cleared
• Pinch the victims the nose
• Allow for the victims mouth to open, but ensuring their chin is up
• Make a normalized breath, and position mouth ensuring a strong seal
• Watch chest elevate, then maintain head tilt/chin lift, remove mouth and look for chest to deflate
• Redo until the victim is breathing without assistance

Continue with Reanimation

• Perform 30 compressions, and 2 rescue-breaths, and do not stop until help or victim is reanimated
• Initial rescue may fail to inflate as normal, revise mouth and remove obstruction, ensure proper head is tilted, and do not try more than 2 times

Using Two People for Lifesaving

• If two people, swap every two minutes to prevent fatigue, ensure minimal delay

Lifesaving with No Available Assistance

• If no rescue breaths were given, and continue chest compressions at 100/min
• Only re-evaluate the victim if starting to breathe normally

Airway Obstruction - Choking

• Common cause of choking is food, for children it is usually food and toys
• Mild airway obstruction victim is able to cough
• If there is poor airway exchange/victim is conscious, perform five back blows
• Slightly behind the victim, support the chest with the hand while putting the other hand and leaning victim forward

Back Blows

• Sharp blows must be in the middle of the omoplates with the palms of the hand checking is worked after
• If the back blows fail, administer five blows following
• When not working on adults, do five abdominal thrusts, and alternate five back blows
• With the arm secure the top part of the patients abdomen, perform thrusts and put it from the end of the sternum
• If the victim is unconscious, activate help immediately and administer CPR without stopping in the meantime

Hemorrhages Classification

• Hemorrhages occurs when blood comes out of blood vessels due to a wound or previous sickness
• It could depend on the speed, loss of blood, age, and status
• Depending on the broken blood vessels:
  • Capillary: It happens in the capillary grid.
  • Venous: the blood exits form one or various injured veins.
  • Arterial: it shows in a broken veins.
  • Depending on where does the blood exits, there is two classification
    • Internal: it never exits the boundary of the body.
    • Externalized: Comes from the inside, but goes to the outside thought the boundary