First Aid Course PDF

1: Basic Life Support (BLS) Basic Life Support includes all resuscitation elements performed without equipment by a person or persons providing first aid to a victim in cardiac arrest. These elements include: initial assessment, ensuring a clear airway, artificial ventilation with expired air, and...

1: Basic Life Support (BLS) Basic Life Support includes all resuscitation elements performed without equipment by a person or persons providing first aid to a victim in cardiac arrest. These elements include: initial assessment, ensuring a clear airway, artificial ventilation with expired air, and external cardiac massage. The goal of BLS is to maintain adequate circulation and ventilation until the arrival of qualified medical personnel. In other words, basic cardiopulmonary resuscitation is a set of maneuvers that attempt to maintain perfusion and oxygenation of vital organs (brain, heart). Sometimes this operation may require a long time, depending on the cause of the cardiac arrest. Any delay reduces the victim's chance of recovery. Therefore, it is necessary to act quickly and according to the protocol. Level of consciousness: The victim's condition is assessed: is he conscious or unconscious? Gently shake his shoulder and ask loudly: 'What happened? Are you okay?' or try to get him to respond to commands such as: 'Open your eyes. ABC of Resuscitation Airway - Clearing the airway. By keeping the airways open and clear, air circulation between the body and the environment is allowed. Breathing - Respiration - The process by which air enters the lungs and carbon dioxide is released into the atmosphere. Circulation - Circulation - The circulation of blood through the body. Airway - Clearing the airway Clear the airways by lifting the chin and hyperextending the head by pressing on the forehead. Place one hand on the patient's forehead (so that the thumb and index finger are free to pinch the victim's nose when performing mouth-to-mouth resuscitation). At the same time, with two fingers of the other hand, lift the victim's chin. In the case of an unconscious victim, the tongue may fall back towards the posterior pharynx, thus blocking the upper airways. By hyperextending the head and lifting the chin, the tongue rises and clears the airways. Section B: Breathing Keeping the airways clear, listen, feel, and observe if the victim is breathing normally. Lean over the victim with your face towards their chest and listen at the level of the victim's oral cavity for breathing sounds, feel if there is an exchange of air by bringing your cheek close to the victim's nose and mouth, observe the chest movements. To determine the presence or absence of breathing, LISTEN, FEEL, and WATCH for a minimum of 5-10 seconds. Section C: Circulation Circulation is performed by the heart. Its evaluation is done by checking the pulse. The pulse can be felt best on the carotid artery which is located in the groove formed by one of the neck muscles and the Adam's apple. The index and middle fingers locate the Adam's apple and will slide laterally on the neck until the beat is felt at their tips. The pulse can be palpated on both sides of the neck but never at the same time. This step can be performed simultaneously with checking breathing, also for 5-10 seconds. Section: Recognizing Cardiopulmonary Arrest Palpating the carotid pulse (or at any other level) is an inaccurate method for confirming the presence or absence of blood circulation, both for laypeople and for those with medical training. Both medically trained and lay people have difficulty assessing the presence or absence of effective or normal breathing in unconscious persons. This may be due to inadequate opening of the airway or the presence of gasps (agonal breathing), which occur in the first few minutes after the onset of cardiac arrest in up to 40% of cases. Laypeople should be taught to start resuscitation when the victim is unconscious (unresponsive) and not breathing normally. During training, emphasis should be placed on the fact that agonal breathing should not be confused with normal breathing and that it represents an indication to immediately start CPR Section: Basic First Aid Protocols The victim is not breathing and has no pulse: The first step in this situation is to call 112 and request the help of a qualified medical team with appropriate equipment, then start cardiopulmonary resuscitation. If the victim is not breathing, has no pulse, and you are sure that qualified professional help will arrive, start artificial ventilation and chest compressions. They are performed successively. The ratio of cardiac massage to ventilation should be 30:2, and this is repeated for one minute. Perform 10 cycles after which the patient is reassessed. Each cycle begins with cardiac massage and ends with 2 ventilations, according to the 2010 Resuscitation Guidelines. Section: Positioning the Victim Raise the knee (opposite to the rescuer), pulling it up and keeping the foot on the ground. With one hand, grasp the shoulder opposite to the rescuer, and with the other hand, grasp the patient's knee. Turn the patient laterally towards the rescuer; ensure they are supported on their knee and elbow, rearrange the head into hyperextension, and open the mouth. Monitor the patient until the medical team arrives. Section: Artificial Ventilation Kneel beside the patient. With the victim's head in hyperextension, keep the mouth slightly open with one hand, while with the other hand, support the forehead and pinch the nose. Take a deep breath, place your mouth tightly over the victim's mouth, and blow air in for 1-2 seconds. At the same time, check if the chest rises when you blow. Each breath should be strong enough to raise the chest. Keep the head in hyperextension with the chin lifted, remove your mouth from the victim's mouth, and allow the patient's chest to return. The volume of air you blow is more important than the rate at which you administer it. The rescuer should administer each ventilation in approximately 1 second, with enough volume of air to cause the victim's chest to expand, but avoiding rapid or abrupt ventilations. Section: Chest Compressions With the victim lying on their back on a hard surface, locate the compression point located in the lower part of the sternum. The ring finger goes along the costal margin until the xiphoid process (the meeting point of the ribs). At this level, next to this finger, place two other fingers, the middle finger and the index finger, then place the palm of the other hand, tangent to the two fingers placed on the chest, this is the place where chest compressions should be performed. Section: Combined Chest Compressions and Ventilations The rescuer will send someone for help, and if they are alone, they will leave the victim and go for help; upon returning, they will start chest compressions. Section: Chest Compressions The rescuer kneels next to the victim, positions themselves vertically over the victim's chest, and with straight arms, compresses the sternum by 4-5 cm. After each compression, the chest should return to normal without losing contact of the hands with the sternum; compressions and decompressions should be continued at a rate of 100/minute (a little less than 2 compressions/second). Compressions and decompressions should be equal in time intervals Section: Chest Compressions and Ventilations After 30 compressions, reopen the airways by tilting the head and lifting the jaw. Pinch the soft parts of the nose using the thumbs and index fingers of the hand on the forehead. The rescuer inhales normally, places their lips around the victim's mouth ensuring a good seal, and exhales steadily into the victim's mouth; during exhalation, the rescuer will watch the rise of the anterior chest wall and will ensure that it remains elevated for 1 second, as in a normal breath; this represents an effective ventilation. Section: Chest Compressions Only Resuscitation Can be performed as follows: If the rescuer cannot or does not want to administer mouth-to-mouth ventilations, they will perform only chest compressions. In this case, chest compressions should be performed continuously at a rate of 100/minute. Resuscitation will be stopped for reassessment only if the victim starts to breathe normally; otherwise, resuscitation should not be interrupted. Section: Upper Airway Obstruction Obstruction of the airways means the blockage of the upper airways with a piece of food or a foreign body. The victim will suffocate. The obstruction can be incomplete or complete. If the victim is conscious, they will indicate this by grabbing their throat with one or two hands. In case of incomplete obstruction, breathing is noisy, the patient is leaning forward, and encouraged to cough. If this does not work, you should try another maneuver called the Heimlich maneuver; it is applied when the obstruction becomes complete. Approach the victim from behind, hold them under the arms, spread their legs, place one hand in the middle of the distance between the navel and the xiphoid process, with the other hand grab the clenched hand and make sudden movements inwards and upwards. These movements will compress the diaphragm which in turn will compress the lungs and the pressure created in the bronchi will throw the foreign body into the oral cavity. Make these movements until you clear the airways. Section: Heimlich Maneuver Continued Place your other hand on top of this one (as in cardiac massage) and perform compressions with abrupt movements deep and upwards. Repeat these movements 4-5 times, then, turning the victim's head to one side, check their oral cavity to remove the food bolus or foreign body. If it is not visible, try to ventilate again, observing if air enters or not. In case of failure, repeat the Heimlich maneuver until the airways are clear. Section: Pediatric Resuscitation 80% of cardiac arrests in children occur due to respiratory failure. The prognosis is significantly improved if the child is resuscitated early by resolving the respiratory problem. Section: Terminology The term newborn refers to a newborn immediately after birth up to the age of 4 weeks. An infant is a child under the age of one year, and the term child refers to children between 1 year and the onset of puberty. From the onset of puberty, children are called adolescents, for whom the regulations in force for adults apply. In addition, it is necessary to differentiate between children under one year and other children, as there are some important differences regarding diagnosis and interventional techniques between the two groups. Section: Chest Compressions for Children Over One Year The compression-to-ventilation ratio used for children is the same regardless of whether there are one or more rescuers. Thus, lay rescuers who usually learn only single-rescuer techniques should be trained to use a ratio of 30 compressions to 2 ventilations, which is the same as in adult protocols, allowing any person trained in BLS to resuscitate children. Professional rescuers should learn and use a ventilation-compression ratio of 15:2, as validated in animal and mannequin studies. Section: Mouth-to-Mouth and Nose Resuscitation for Newborns Keep the airways open. The amount of air from the rescuer's mouth is sufficient to ventilate the newborn (puff). The rescuer places their mouth tightly over the mouth and nose of the newborn. Perform the inflation (puff) for 1-1.5 seconds, a volume of air sufficient to raise the chest. Allow the chest to return (expiration). Then perform the following inflations using the same technique. Section: Chest Compressions for Newborns Use two fingers placed in the lower third of the sternum. If there are two or more rescuers, the technique can be used where the rescuer encircles the newborn's chest with their hands so that both thumbs are positioned on the sternum. Initiate if the heart rate is less than 60/minute after 30 seconds of ventilation. Rate: 90/minute, with a ratio of 3:1. Section: Infant Resuscitation Support the infant in a prone position with their head down to allow gravity to help remove the foreign body. A seated or kneeling rescuer should be able to support the child in their lap. Support the child's head by placing the thumbs of one hand at the angle of the mandible and one or two fingers of the same hand at the same point but on the other side of the mandible. Do not compress the soft tissue under the child's mandible as this will worsen the airway obstruction. Administer up to 5 strong blows with the heel of the hand on the midline of the back in the interscapular space. The goal is for each blow to be able to remove the foreign body, and not to give all five blows. Turn the child into a supine position with their head down. This position can be safely obtained by placing the free upper limb along the back of the infant and supporting the occipital area with the hand. Support the infant on your forearm which should be placed in your lap along or perpendicular to your thigh. Identify the landmark for chest compressions (in the lower half of the sternum, about one finger's width above the xiphoid process). Perform five chest compressions; these are similar to compressions in CPR but are deeper and are administered at a slower rate. Section: First Aid for Children Over 1 Year Back blows are more effective if the child is positioned with their head down. A young child can be placed in the rescuer's lap like an infant. If this is not possible, support the child in a forward-leaning position and administer blows to the interscapular space while standing behind the victim. If back blows fail to dislodge the foreign body, and the child is still conscious, use chest compressions for infants and abdominal thrusts for young children. Do not use abdominal thrusts (Heimlich maneuver) for infants Section: Primary Emergency Care for Traumatized Patients In the case of traumatized patients, it is very important to know exactly what to do and what not to do. Any mistake made can worsen the patient's condition, putting their life at risk. The main objective in the case of traumatized patients is to ensure early and correct treatment because this can significantly improve the patient's rehabilitation later. So the fundamental principle that should guide our behavior during an emergency is: DO NOT WORSEN THE VICTIM'S CONDITION! Evaluation of the area and rescuer safety remain our focus. Ensure the safety of the accident site: signaling, parking of vehicles. Remove the injured person from imminent danger or the cause of the accident, avoiding risks and/or aggravating the situation. Section: Additional Considerations for Traumatized Patients If artificial ventilation cannot be performed, chest compressions can be performed with a ratio of 15:2. In cases of severe trauma, such as penetrating chest injuries, external cardiac massage can be performed through a chest wound, avoiding the need for mouth-to-mouth resuscitation. If the victim is bleeding heavily, control the bleeding first, then start resuscitation. In all cases of trauma, consider the possibility of a cervical spine injury. The suspicion of a cervical spine injury arises in any polytrauma patient (patients who have more than two injuries, at least one of which is life-threatening). Section: Moving a Traumatized Patient Moving a traumatized patient. Removing a traumatized patient. At the accident site, this is done only to prevent imminent danger that may occur. The removal of the victim should be done by well-trained personnel, knowing that improper mobilization can greatly worsen the patient's condition. The following situations may require the removal of the patient: The patient is in a room with smoke or fire. The patient is in an unstable vehicle that is about to overturn. The patient is in a vehicle with an imminent risk of explosion. Before removing the victim, check that the patient's feet are not caught in the pedals and unfasten the seat belt. Once removed from the vehicle, placing them on the ground also requires strict adherence to certain rules, namely: the head must be kept in alignment at all times. If the victim is found lying on their stomach, examination cannot be done until they are placed in a supine position (lying on their back). This requires at least three people. One of the rescuers sits at the victim's head, aligns them, and immobilizes them, commanding the entire turning operation. The other rescuers will sit laterally to the victim, as close to them as possible, raising the arm towards the rescuers, next to the victim's head. At the command of the person at the head, all rescuers will turn at the same time, keeping the patient's spine aligned at all times. Section: Immobilization and Fractures Immobilization of the traumatized patient. Fractures. Signs of probability: Spontaneous pain or pain in a fixed point, exacerbated by palpation or mobilization. Functional impairment of the affected limb. Deformity and shortening of the region. Delayed bruising. Swelling, edema, increased local temperature. Signs of certainty (sure signs): Abnormal mobility at the focus. Palpation of bone crepitus. Non-transmission of movements distal to the fracture focus. Obvious interruption (on inspection or palpation) of bone continuity. THE SAFEST METHOD OF DIAGNOSIS IN THE CASE OF SUSPECTED FRACTURE IS PERFORMING AN X-RAY. Temporary immobilization of fractures is done to prevent movement of the fractured bone fragments, to avoid complications that can be caused by the movement of a bone fragment. Hemorrhages: Hemorrhage is the leakage of blood outside the vascular system through one or more solutions of continuity. Depending on the type of vessel injured, it can be: Arterial: in which the blood is bright red, well oxygenated, and spurts rhythmically, synchronously with the heartbeat; Section: Types of Hemorrhages Venous hemorrhage: the blood is dark red, does not spurt, flows continuously; Capillary hemorrhage: the blood is dark red, oozes slowly; Hemorrhage from the respiratory tract: the blood is bright red, foamy; Hemorrhage from the digestive tract: the blood is dark red, in the form of coffee grounds; Hemorrhage from the urinary tract: the blood is bright red or dark red, depending on the location of the bleeding. Section: First Aid for Hemorrhages Emergency assistance in hemorrhages: Direct pressure: apply pressure directly to the wound with a clean cloth or bandage for at least 5 minutes. Indirect pressure: if direct pressure is not possible or does not control bleeding, apply pressure to a pressure point. Elevation: raise the injured limb above the level of the heart to reduce blood flow to the wound. Hemostatic agents: apply hemostatic agents (e.g., gauze with clotting factors) to the wound. Tourniquet: in extreme cases, a tourniquet can be applied to control bleeding from a limb. However, this should only be done as a last resort and by trained personnel, as it can cause tissue damage if left in place for too long. Section: Shock Shock: Shock is a life-threatening condition that occurs when the body is unable to deliver enough blood and oxygen to the tissues. It can be caused by blood loss, among other factors. Signs and symptoms of shock: Rapid, weak pulse. Low blood pressure. Rapid, shallow breathing. Cold, clammy skin. Pale or bluish skin color. Nausea and vomiting. Dizziness or fainting. Confusion or altered mental status. First aid for shock: Lay the victim down flat. Elevate the legs. Loosen tight clothing. Cover the victim with a blanket to maintain body temperature. Monitor the victim's breathing and pulse. Call for emergency medical help immediately. Hemostasis Hemostasis is the process of stopping bleeding. It can occur spontaneously in the case of small hemorrhages, through the intervention of the body's own mechanisms, but more often it requires the intervention of other people to achieve hemostasis. Hemostasis can be temporary or definitive. Temporary hemostasis can be achieved through: digital compression, compressive dressing, tourniquet. The compressive dressing is one of the most effective methods used to achieve temporary hemostasis. Applying a tourniquet is the last resort. The tourniquet, while stopping the bleeding, also stops the blood circulation in the part of the limb below it. For this reason, keeping it on for more than 2 hours can lead to very serious complications. Burns First-degree burn: Affects only the superficial layer of the skin, the epidermis. It manifests as redness of the skin, local edema, pain, and chills. A typical first-degree burn is sunburn, caused by prolonged and irrational exposure to the sun. It lasts 3-4 days, after which the redness decreases and is replaced by a brown pigmentation followed by desquamation. Second-degree burn: Affects the epidermis, detaching it from the dermis, causing the appearance of blisters, vesicles (blisters) filled with a yellowish liquid, which is nothing more than extravasated blood plasma. This type of burn is caused by hot liquids or incandescent metals that have acted on the skin for a short duration. It is the most painful because the nerve endings at this level are affected. Third-degree burn: Affects the entire dermis. The blisters have a bloody content. The pain is no longer as intense, it may even be absent because the nerve endings may be or are completely destroyed. Fourth-degree burn: Affects all layers of the skin, necrosis (cell death) occurs. Characteristics: In case of burns caused by flames: It is important to stop the burning as quickly as possible with a jet of water. This is also true for situations where the flame has already been extinguished, as in this case the burn can continue to spread in depth. Remove the patient's clothing, provided that it is not stuck to the skin and that the undressing maneuver does not cause tissue damage. Once the patient is undressed, ensure their protection from hypothermia. In case of burns caused by chemicals: Washing the burned area with a jet of water in these situations must be of a longer duration, to ensure that any trace of the causative substance is removed. The depth of the burn is directly proportional to the contact time, the concentration of the substance, and the properties of the substance.  In case of burns caused by electric current: It is important to remove the patient from the current source (or vice versa). Hypothermia Individuals at risk for hypothermia include: the elderly, young children, those with trauma, alcoholics, drug users, and drowning victims. Body temperature can drop more rapidly in water than in air. Depending on the severity of hypothermia, consciousness may be altered or the person may be in a coma. Symptoms can include: weak, palpable pulse, bradycardia, low or unmeasurable blood pressure. First aid in these cases follows the ABC assessment principles. Specific attention should be paid to moving the hypothermic individual: any abrupt or uncoordinated movement can worsen the situation or lead to cardiac arrest. In the case of patients in cardiac arrest, cardiac massage is more difficult to perform because the hypothermic's chest is more rigid. Known methods used for rewarming are: Passive external rewarming: involves wrapping the patient in blankets and keeping them in a warm environment. This type of rewarming is used for patients with mild or possibly moderate hypothermia with a core temperature above 32 degrees C. Active external rewarming: is performed by completely immersing the patient in a bath of water heated to 40 degrees C or by using heated blankets or hot water bags. This technique is suitable for patients with moderate hypothermia with a core temperature up to 31 degrees C or at most 30 degrees C. Immersion in warm water is used when we want to rewarm the patient quickly, which is applicable to those who have lost temperature rapidly. Active core rewarming: used in hospital settings. Drowning Drowning can be associated with alcohol, hypothermia, suicide attempts, trauma, epileptic seizures, etc. The rescuer's safety is of paramount importance in these situations. The rescuer should avoid any risk if they cannot swim or do not have the appropriate equipment for entering cold water. Any drowning victim is suspected of having a cervical spine injury, the victim is kept in a horizontal position, without starting resuscitation maneuvers before removing the victim from the water. Regardless of the cause of drowning, from a physiological standpoint, respiratory arrest occurs first, followed by cardiac arrest. Electrocution Accidents caused by electric current occur as a result of it passing through the human body or as a result of the production of an electric arc. Depending on the current intensity, the following manifestations may occur:  Sensation of body trembling Generalized muscle contractions Loss of consciousness and even death At the point of contact with the current, the victim presents a burn, the extent, depth, and severity of which are due to the transformation of electrical energy into heat energy on the outside or inside of the body. Voltage burns and intensity kills. Procedure to follow: Rescuer safety: Do not touch the victim before interrupting the electric current. Interrupt the power source. Remove the victim from the power source using a dry object such as a broom handle, dry clothes, being careful to stand on a dry area. ssessing Consciousness and Vital Functions (ABC) The next step, while considering the possibility of a cervical spine injury, is to assess the level of consciousness and vital functions (ABC). If the victim is not breathing and has no pulse, cardiopulmonary resuscitation maneuvers should be started immediately after calling for a qualified medical team. All electrocuted patients should be transported to a hospital. Intoxications Carbon Monoxide Poisoning: Carbon monoxide is a colorless, odorless, tasteless gas released by all incomplete combustions. It is most often a collective and usually accidental intoxication. Symptoms presented by patients include: weakness, headache, dizziness, nausea, vomiting, loss of consciousness, and a cherry-red appearance of the skin. Procedure: Ensure the rescuer's safety. Do not enter an area with gas emissions without protective equipment. In all cases, the patient must be immediately removed from the toxic environment and transported as quickly as possible to a hospital. If possible, administer high concentrations of oxygen as early as possible. Caustic Substance Poisoning The group of caustic substances includes a series of acids (nitric, hydrochloric, sulfuric, etc.) or strong bases (ammonia), or weaker ones (ammonium), which can produce, depending on their nature and degree of toxicity, lesions of the mucous membranes from simple erythema to necrosis. Clinical manifestations (after ingestion): include a burning sensation in the oral mucosa, difficulty swallowing, mucous and then bloody vomiting, abdominal cramps, retrosternal pain. Shock can set in very quickly, even a few hours after ingestion. Procedure: Personal protection is extremely important. Assess the level of consciousness and vital functions (ABC). In case of cardiopulmonary arrest, when performing mouth-to-mouth ventilation, avoid direct contact between the rescuer's mouth and the patient's mouth. A piece of gauze or the rescuer's handkerchief can be used. Inducing vomiting and neutralizing the corrosive substance is prohibited. Example: in case of acid poisoning, do not administer milk or oils. Smoke Inhalation Often integrated into a picture associated with burns and trauma, smoke inhalation is the most frequent cause of mortality and morbidity among fire victims. Clinical manifestations: headache, agitation, altered consciousness, deposits of soot in the nostrils, mouth, and pharynx, cough, dyspnea, hoarse voice. Procedure: Personal protection is extremely important. Assess the level of consciousness and vital functions (ABC) after the victim has been removed from the toxic environment. Transport to the hospital as soon as possible with the administration of oxygen, early, in high concentrations. Unconscious patients should be transported in the recovery position. Soft Tissue Injuries Depending on the skin's condition, injuries can be: Closed: contusions Open: wounds In closed injuries, the skin remains intact, while in open injuries, it is damaged. Contusions: These are injuries resulting from the action of a mechanical injuring agent that produces tissue damage but preserves the integrity of the skin. Depending on the force of the injuring agent, contusions can be superficial, deep, or mixed. An ecchymosis is the simplest form of contusion, which appears due to the rupture of blood vessels in the subcutaneous tissue (it appears as a reddish-bluish area that changes color in a few days, becoming purplish, then yellow-green). A hematoma is a painful swelling of variable volume that appears due to the accumulation of a variable amount of blood between tissues or organs, due to the post-traumatic rupture of larger blood vessels. Wounds: Wounds are lesions produced by various agents - mechanical, physical, chemical - that interrupt the continuity of the skin. In the case of wounds, the interval between their occurrence and the time of applying the first treatment is very important. Thus, a wound is considered recent if it is treated within 6-8 hours of occurrence (uninfected wound); after this interval, wounds are considered to be infected. Clinical signs: Pain of varying intensity Bleeding of varying intensity Traumatic marks Wound treatment aims to prevent complications and achieve the fastest and best quality healing. It consists of local wound cleansing and dressing. Principles of treatment for soft tissue injuries: Mild contusions do not require treatment. Other closed injuries should be treated by applying an ice pack, light compression, and elevating the injured limb. Because an extensive contusion can mask an underlying fracture, in these cases, the injured limb is immobilized (rigid splint). Principles of Wound Treatment: Hemorrhage control: This is the first and most crucial step. Prevention of wound infection: This involves cleaning and dressing the wound. Stabilization of the injured area: This includes immobilizing the area to prevent further damage. Stabilization of any penetrating object: If an object is lodged in the wound, it should be stabilized to prevent further injury. Wound cleansing: Superficial wounds can initially be cleaned with clean water and soap. Deep wounds should only be cleaned with saline solution and should not be explored except by a specialist doctor in a hospital. If there are deep wounds to the chest, abdomen, face, large vessels, if the bleeding is severe, or if the patient has other serious injuries, do not waste time cleaning the wound. Only perform temporary hemostasis and cover with a dressing. Hemorrhage: Hemorrhage is the leakage of blood outside the vascular system through one or more breaks in continuity. Depending on the type of blood vessel injured, the hemorrhage can be: Arterial: The blood is bright red, well-oxygenated, and spurts rhythmically, in sync with the heartbeat. Venous: The blood is dark red (less oxygen, more CO2), it exits with constant but relatively low pressure. Capillary: This is a diffuse hemorrhage, across the entire surface, without a larger vessel being identified as the main source of bleeding. Depending on the site of bleeding, hemorrhage can be: External: The blood leaks out through a break in the skin (wound). Internal: The blood accumulates in one of the body's cavities. Externalized: Characterized by internal bleeding in a hollow organ, followed by the elimination of blood to the outside through natural pathways. Depending on the amount of blood lost, hemorrhage can be: Minor: Loss of up to 500 ml of blood. Moderate: Loss of 500-1000 ml of blood, with signs such as agitation, dizziness when standing. Severe: Loss of 1000-1500 ml of blood, with clinical signs such as pallor, tachycardia, cold sweats, low blood pressure, rapid breathing. Catastrophic: Blood loss of over 1500-2000 ml, unmeasurable blood pressure, unconscious patient. Externalized Hemorrhages: Epistaxis: Nosebleed Hematemesis: Vomiting blood from the digestive tract. In severe bleeding, the blood may be bright red and fresh, or in less severe bleeding, it may appear as coffee grounds (when the blood stagnates in the stomach and is partially digested). Hemoptysis: Coughing up blood from the lungs or respiratory tract. Melena: The passage of black, tarry stools, indicating bleeding in the upper gastrointestinal tract. Hematuria: Blood in the urine. Hemostasis Stopping bleeding is called hemostasis. It can be spontaneous in the case of small hemorrhages, through the body's own mechanisms, but more often it requires the intervention of others. Hemostasis can be: Temporary Definitive Temporary hemostasis can be achieved through: Digital compression Compressive dressing Tourniquet Definitive hemostasis is obtained by permanently obliterating the bleeding vessel, the most common procedure being surgical ligation with sutures. Control of External Hemorrhage: Using sterile gloves and compresses, apply direct pressure to the wound and elevate the area above the level of the heart. If bleeding continues, add more compresses and apply a compressive bandage. Digital compression Correctly applied compression on the injured vessel should be applied above the wound (proximal) in the case of an arterial hemorrhage and below the wound (distal) in the case of a venous hemorrhage, taking into account the direction of blood flow. When bleeding cannot be controlled by compression applied at a distance, direct compression can be used, in which case compression of the bleeding vessel is done with a finger inserted directly into the wound. This method can only be short-term, and another method must be used to supplement and complete it. Compressive dressing This is one of the most effective methods used to achieve temporary hemostasis. In the absence of a sterile dressing, a clean handkerchief or cloth can be used to cover the wound, over which a circular bandage is tightened. Apply the bandage tightly to control bleeding. Be careful, however, as a bandage applied too tightly can block all circulation distal to the application site. Applying a Tourniquet This is the last resort (using a rubber band, belt, tie, scarf, etc.). It should only be used in extreme cases and when bleeding cannot be controlled by other methods (e.g., amputation of a limb). The goal is to stop bleeding without excessively compressing the tissues. Keeping it on for more than 2 hours can lead to very serious complications. When applying a tourniquet, a note should always be attached to the patient, which must obligatorily include the following information: name, first name, exact time of application of the tourniquet. The tourniquet is placed proximal to the wound in arterial hemorrhages and distal in venous ones. Every 30-30 minutes, the tourniquet should be loosened slightly to allow irrigation of the underlying limb segment. The tourniquet should only be removed in a hospital setting and by competent personnel. Dressings These are applied differently depending on the anatomical region. Wounds of the face and scalp: The face and scalp are well-vascularized areas. Due to this good vascularization, a relatively small wound can be accompanied by abundant bleeding. You can control bleeding by applying direct pressure to the wound. If bleeding continues, apply a second compress, without removing the first. After bleeding stops, apply a bandage around the head. On the head, bandages are made using bandages, the typical one for this segment being a cap that starts with 2 circular turns passed over the forehead, above the eyebrows, and earlobes, then passing back and forth (towards the root of the nose and towards the nape), several times, until the entire head is covered. The ends of the bandages are then fixed with a few circular turns. For the nose, chin, eyes, and ears, a so-called 'sling' bandage is made, using a 30-50 cm strip of gauze, split at the ends, with an undivided central part, which is applied to the level of the wound, over the compresses that cover the wound, tying the cut ends crosswise. Wounds of the neck: Apply direct pressure to control bleeding wounds of the neck. After the bleeding has stopped, bandage the neck. Wounds of the chest: Open wounds of the chest should be covered with an airtight material, sealing them hermetically - occlusive dressing. In the case of penetrating (deep) wounds at the level of the chest, we use compresses larger than the wound and fix them with adhesive tape on three sides. The fourth side is left free, unfixed, allowing the dressing to function as a valve. Abdominal wounds: We will use a dressing that we will fix on all four sides. If the wound is complicated by evisceration (protrusion of the abdominal organs), we will use a wet dressing. If the wound is caused by a blunt object that is still in the wound, it is left there, immobilized in the position found, and the patient is transported urgently to the hospital. Dressings of the limbs: Dressings are made using circular bandages, in a spiral. Genital Wounds The genitals have a significant vascularization in both females and males. Genital trauma is often associated with severe bleeding. Apply direct pressure to the genital wound with a dry, sterile compress. Direct pressure usually stops the bleeding. Gunshot Wounds Some gunshot wounds may be easily overlooked if a thorough and complete examination of the patient is not performed. Most deaths from gunshot wounds occur due to injuries to internal organs or large blood vessels. Because gunshot wounds are serious, prompt and effective treatment is important. Animal and Human Bites Animal or human bites can range from minor to severe. All bites are highly susceptible to infection. Minor bite wounds should be washed with soap and water, if possible. Traumatized Patient - Primary Emergency Care Fractures and Immobilization The primary objective in the case of traumatized patients is to ensure early and correct treatment as this can significantly improve the patient's rehabilitation later. The fundamental principle that should guide our behavior during an emergency is: DO NOT AGGRAVATE THE VICTIM'S CONDITION! Signs and symptoms of extremity injuries: Pain at the site of the injury Open wound Swelling of the extremity Functional impairment Deformity of the extremity Fractures are injuries that occur as a result of the action of a strong trauma on the bone (especially long bones), consisting of the interruption of its continuity. Classification of fractures: Depending on the mode of action of the injuring agent and its intensity, fractures can be of several types: Closed fractures - the skin around the fracture site is intact Open fractures - the fracture site communicates with the exterior through a wound Direct fractures where the traumatizing agent acts directly at the site of the fracture  Indirect fractures - the fracture line appears at a distance from the site of action of the injuring agent Also, the fracture trajectory can have very varied aspects, depending on the mechanism of production: Spiral fractures, etc. Note: To provide a more accurate and comprehensive translation, please provide additional context or specific questions about the text. Fractures and Dislocations Fractures These are injuries that occur as a result of a strong trauma to the bone, consisting of an interruption of its continuity. Types of fractures: Closed fractures: the skin around the fracture site is intact Open fractures: the fracture site communicates with the exterior through a wound Direct fractures: the traumatizing agent acts directly at the site of the fracture Indirect fractures: the fracture line appears at a distance from the site of action of the injuring agent Other types: spiral fractures, compression fractures, etc. Complete fractures: the entire circumference of the bone is affected Incomplete fractures: only a part of the bone is affected Signs and symptoms of fractures: Probable signs: spontaneous pain, especially on palpation or movement; loss of function of the affected limb; deformity and shortening of the region; late bruising; swelling, edema, increased local temperature Certain signs: abnormal mobility at the fracture site; palpable bone crepitus; failure to transmit movement distal to the fracture site; obvious interruption (on inspection or palpation) of bone continuity The most reliable method for diagnosing a suspected fracture is an X-ray. Dislocations These represent a change in the normal anatomical relationships of the bone ends in a joint with the rupture of the ligaments that support the joint, causing the bones to come out of the joint and possible rupture of blood vessels and nerves. Sprains These represent stretching or even rupture of the ligaments that support the joint, but without displacement of the bones from the joint. Temporary immobilization of fractures is done to prevent movement of the fractured bone fragments, to avoid complications that can be caused by the displacement of a bone fragment. Immobilization of closed fractures: Immobilization must necessarily include the joints located above and below the fracture site. Before immobilization, gentle, painless traction of the segment in the axis is performed. Immobilization of open fractures: Immobilize in the position found, after dressing the wound at that level, without attempting to reduce them by traction. Types of splints used: Kramer splints (made of wire) Pneumatic splints (inflatable) Vacuum splints Improvised splints: from boards, tree branches, etc. To perform immobilization, in most situations, at least two people are needed. One person fixes the limb while the other person fixes the splint. Shoulder Injuries The simplest way to immobilize an injured shoulder is by fixing it to the chest. A triangular bandage or a scarf can be used to support the arm. Clavicle Fractures These are more often caused by indirect trauma and less frequently by direct trauma. The middle part of the clavicle is the most common site. The provisional immobilization position should be with the elbow on the affected side pushed back and up. Humerus (arm) Fractures These are more often caused by direct trauma. For immobilization, the chest can be used as a splint, with the fractured segment fixed using a scarf. Forearm Fractures These are more often caused by direct trauma. Immobilization can be done with any type of special splint or using improvised splints. Hand Fractures Immobilized on the palmar side from the elbow to the fingers. Wounds at this level are dressed sterilely, and the injured hand is placed in a "functional" position. One or two rolls of bandage are placed in the palm. Pelvic Injuries Fractures at this level can often be complicated by severe bleeding due to the severing of large blood vessels. Once a fracture is detected at this level, the patient remains immobile, is not moved, and is kept on a hard surface in a supine position. Generally, two types of injuries occur at this level: dislocation and fracture. These injuries occur as a result of strong traumas with high energy, for example, in the case of a car accident when the victim was not fastened in the seatbelt. Femur Fractures A femur fracture is an unstable injury, causing significant deformation of the thigh at the fracture site. A femur fracture can lead to massive bleeding with a risk of hemorrhagic shock. The most effective way to immobilize a femur fracture is to use a traction splint. Knee Injuries An injured knee should always be immobilized in the position in which it was found. If the limb is found in an extended position, any type of splint can be used. If the affected limb is found in a flexed position, the limb will be immobilized using pillows or rolls of blankets placed under the knee, which are fixed with bandages. Additionally, the affected limb is fixed to the healthy one. Then the patient will be placed on a rigid board. Lower Leg Injuries Immobilization of the lower leg is done similarly to the forearm, using various types of rigid, inflatable, or vacuum splints. As with any immobilization, two people are needed. One person fixes the limb above and below the injury, and the other person applies the splint. Ankle and Foot Injuries  To immobilize the ankle or foot, an inflatable, vacuum, or improvised splint can be used. Cervical Spine Fractures: Suspicion of a cervical spine injury arises: In any polytrauma patient (patients with more than two injuries, at least one of which is life-threatening). In any patient who has suffered a head injury. In any patient who has suffered trauma to the chest near the head. In any conscious patient who complains of neck pain. In any patient who exhibits crepitus or deformities in the neck. In any patient who has an altered mental status (under the influence of alcohol...). Cervical spine immobilization is initially done manually. The head is placed in a neutral position with gentle axial traction. Cervical collars are used to immobilize the cervical spine. Cervical collars can be of various types: Rigid/soft One-piece/two-piece Adjustable/fixed Cervical immobilization at the scene of the accident is CRITICAL in preventing the dangers caused by stable or unstable cervical spine injuries. For a patient found in a sitting position, the anterior part of the collar is fixed first, then the posterior part. Polytrauma - First Aid Definition: A polytrauma patient is a person with multiple injuries, at least one of which determines the vital prognosis. Any injured person with at least two serious traumatic injuries that cause a major disruption of respiratory and/or circulatory function should be considered a polytrauma patient (Trillat and Patel). BASIC STEPS IN THE TREATMENT OF TRAUMA PATIENTS: Rapid primary examination Call 112 Begin resuscitation maneuvers Complete secondary examination Transport to a healthcare facility Mechanism of Injury: Road traffic accident: ○ Collision (impact)  ○ Deceleration (sudden stop) ○ Acceleration (projection) Special Situations in Resuscitation - Burns / Thermal Burns Breakdown and Explanation This section of a medical text focuses on the specific care required for burn victims. It outlines the types of burns, their causes, and initial first aid measures. Key points covered: Causes of burns: The text discusses burns caused by flames, chemicals, and electric current. Classification of burns: Burns are categorized into different degrees based on the depth of tissue damage. First aid: Immediate steps to take for burn victims are described, such as stopping the burning process, removing clothing (carefully), and washing off chemicals. Chemical burns: The text highlights the differences between acid and base burns, noting that base burns tend to penetrate deeper into tissues. Detailed Translation and Explanation Characteristics of Burns Flame burns: The most important thing is to stop the burning as quickly as possible with a water jet. Even after the flame is extinguished, the burn can continue to spread deeper into the tissue. Remove the patient's clothing, provided it is not stuck to the skin, and ensure the removal process doesn't cause further tissue damage. Chemical burns: For chemical burns, flush the burned area with water for an extended period to remove all traces of the causative substance. The depth of the burn is directly proportional to the contact time, concentration of the substance, and its properties. Electric burns: The primary concern is to remove the patient from the source of the current (or vice versa). Classification of Burns First-degree burns: Affect only the superficial layer of the skin (epidermis). Symptoms include redness, local edema, pain, and chills. A typical example is sunburn. Second-degree burns: Involve the epidermis and dermis, causing blisters. These burns are very painful due to exposed nerve endings.  Third-degree burns: The entire dermis is affected. Blisters may contain blood. Pain may be less intense or absent due to nerve damage. Fourth-degree burns: All layers of the skin are affected, and there may be necrosis (tissue death). Chemical Burns Corrosive substances, usually acids or bases, can cause internal or external injuries. Acids cause coagulative necrosis, which is self-limiting in depth. Bases cause liquefactive necrosis, which can spread deeper into tissues. External chemical burns: These are contamination injuries. Contact with corrosive substances can lead to injuries classified similarly to thermal burns. Pre-hospital Care Assess the victim. Call emergency services (112). Protect the rescuers. Decontamination, Chemical Burns, and Thermal Regulation Emergencies Decontamination: Immediate decontamination: Promptly remove all contaminated clothing and thoroughly wash the affected area with water. Phosphorus burns: Wash and keep the affected area moist, as phosphorus spontaneously ignites at 34°C (93.2°F). Internal Chemical Burns (Ingestion): Pre-hospital care: Assess the patient, position in the recovery position, call emergency services (112), monitor the patient, do not administer anything orally, and do not induce vomiting (risk of further damage). Inhaled Chemical Burns: Pulmonary edema: Corrosive gases can cause severe damage to the trachea, bronchi, and lungs. Water-soluble substances (ammonia, hydrochloric acid, formaldehyde) cause immediate symptoms like coughing, tearing, and conjunctivitis. Pulmonary edema is less common. Fat-soluble substances (sulfur dioxide, chlorine gas) may have delayed symptoms, leading to severe pulmonary edema. Pre-hospital care: Remove the patient from the toxic environment. Assess the patient, position them appropriately, and call emergency services. Monitor the patient regularly. Chemical Burns to the Eyes: Pre-hospital care: Stop contact with the irritant, assess the injury, call emergency services, and flush the eye with plenty of water (37°C or 98.6°F). The body's temperature rises to a dangerously high level, overwhelming the body's cooling mechanisms (sweating, dilation of blood vessels). Causes: Strenuous exercise in untrained individuals or hot environments, pregnancy, workers in hot protective gear. Risk factors: Obesity, alcohol consumption, elderly, children. Symptoms: Hot, red skin, high fever, dehydration, fatigue, muscle cramps, neurological disturbances, digestive issues, rapid breathing, high blood pressure. Severity: Extreme ages, heart disease, obesity, dehydration, altered consciousness, seizures. Treatment: Move the person to a cool place, remove clothing, call emergency services, cool the body with wet cloths or ice packs, provide fluids if conscious. Note: Avoid cold water baths, high humidity worsens the condition. Hypothermia is a condition where the body's core temperature drops below 35°C. Causes: Accidental exposure to cold, medical conditions like coma or burns. Types: Moderate hypothermia (35-32°C) with symptoms like cold, pale skin, and shivering. resisting the exposure of the body to a high temperature, at which the compensation mechanisms (sweat, vasodil.peripheral) are overcome. Etiology intense effort on untrained persons or performed in hyperthermal environment high risk: obesity, alcohol consumption, stress, amphetamine adm, elderly, children, pregnant, workers with tight protective equipment Clinically - general signs: warm skin, tomatoes, T>41°C, dehydration (patients with thermal shock do not sweat due to the overcoming of thermolysis mechanisms), fatigue, muscle cramps neurological signs: behavior disorders, psychomotor agitation, fatigue, temporospatial disorientation, pseudo-ebrious state, headache, convulsions, coma digestive signs: nausea, vomiting, diarrhea respiratory signs: hyperventilation with the appearance of respiratory alkalosis CV signs: hTA due to dehydration, vasodil.peripheral and tachycardia Conditions of gravity extreme ages cardio-vascular diseases, obesity dehydration, hematemesis, melena disorders of consciousness, seizures the time elapsed until the application of the tegument cooling measures and medical care TREATMENT Presbyteral - placing the victim in a cool place/dressing evaluation of vital functions emergency call 112 - cooling with wet compresses or ice bags on the back of the neck and on the trajectory of vascular packages, but not less than 38°C if conscious, sit in a semi-seated position and administer cold drinks in small and repeated amounts - if he is unconscious, he sits in PLS - periodic re-evaluation To remember: - will not immerse the patient in the cold water bath the degree of increased humidity negatively influences the evolution once installed, the stress thermia evolves even if the triggers have been suppressed B.) HYPOTHERMIA = central temperature drop below 35° C Etiology: - with maximum defense: accidental (mountain, water) - with minimal defense: drug coma, epileptic coma, AVC, extensive burns, endocrine insufficiency - Types 1.) moderate hypothermia 35°-32°C - skin signs: cold, marbled teguments neuromuscular signs:frisone, ROT vii respiratory signs: tachypnoea cardiovascular signs: tachycardia, HTA 2.) severe hypothermia 32°-28C - skin signs:cold, livide, cutaneous anesthesia, +/- frostbite - neuromuscular signs: disappearance of chills, ROT abolished, rigidity, muscle hypertonia, consciousness disorders, loss of consciousness‹31°C, deep coma occurs release of myoglobin in circulation => renal precipitation => IRA; alkalization prevents kidney precipitation the ocular burn is washed long then patted eye amblyze ANAPHYLACTIC SHOCK Anaphylactic shock is the extreme variant of an intolerance reaction to: - medicines: coloid substances, contrast substances Roentgen poisons of animal origin: insect stings, snake bite - products of vegetable origin: spores, pollen - food: nuts, strawberries, peach The triggering role is the uncontrolled release of mediators such as histamine and leukotrienes from immune system cells. Anaphylactoid reaction: serious, immediate, clinically similar reaction to anaphylactic reaction, without specifying the pathogen mechanism. Clinically - occur 2-3 minutes to 2-3 hours after contact with the triggering factor teguments and mucous membranes: erythema, urticaria, edema - gastrointestinal tract: nausea, vomiting respiratory: bronchospasm, irritative cough, glotic edema circulatory system: tachycardia, hypotension, palpitations, peripheral vasodilation "vasoplegia" TREATMENT: TREATMENT: Presbyteral - interruption of exposure to the triggering agent - evaluation of the positioning victim in Trendelenburg emergency call 112 in need resuscitation - periodic re-evaluation !! To remember: adrenaline is the specific treatment, corticosteroids strengthen its effect immediate intervention is essential protection of airways TOXICOLOGICAL EMERGENCIES The introduction into the human body, voluntary or involuntary, by digestive, respiratory or dermal route of toxic substances (solid, liquid, gaseous) causing serious disorders, sometimes fatal, is called acute intoxication Toxic substance = any kind of substance that, introduced into the body, causes disorders functional or organic lesions Depending on the mode and place of production can be: voluntary accidental (involuntary) professional: non-compliance/unknowledgement of the norms of protection of criminal labor: for the purpose of homicide General therapeutic maneuvers: the symptomatology of intoxication is nonspecific, the most frevent symptom being altered state of consciousness, a gravity dependent on toxic actin (predominantly stimulating or predominantly sedative effect) and the amount ingested about 5% from the total of the poisoning reveals characteristic clinical symptoms: characteristic ethanol-smell intoxication, CO-dark intoxication of the skin Suspicion of an intoxication: deposition of intoxicated persons to the extent that they are reactive - testimony of witnesses /owners concrete circumstances: syringes found next to the patient, boxes of medicines, separation letters detection of a state of altered consciousness, with or without compromising the cardio-circulatory system, and which has no other possible explanation case of death not solved TREATMENT Presbyteral removing the victim from the toxic environment /removing the toxic evaluation of vital functions /positioning in PLS emergency call 112 when needed resuscitation (attention to intoxication by inhalation of toxic) periodic reassessment To remember: bilateral reactive mydriasis may be due to the toxic itself and not to cerebral anoxia acute poisoning can be serious even if the patient is not in a coma ALCOHOL INTOXICATION Causes: - Massive and brutal impregnation of the body with ethyl alcohol, exceeding the ability to purify the liver. - Characteristic sign: foetor alcoholicus (exhalation of the smell of alcohol) I Excitation stage 1-2 g%o. - It is characterized by euphoria, disinhibition, speech disorders (dysarthria, logorrhea) disorders of gait, balance, sight (diplopia) I Hypnosis stage 2-2.5 g%o. - It is characterized by: drowsiness, tachycardia, partial analgesia Ill Stage of narcosis 2.5-4 g%o It is characterized by torpor or coma grade -ll, hypotension, hypoglycemia IV Asphyxia stage >4 g%o - It is characterized by grade III-IV coma, respiratory failure, shock, hypothermia Presbyteral - patient assessment in the stages I will move patients to a place that will provide safety until awakening, mandatory positioning in PLS in the Ill and IV stages it is positioned in PLS then emergency call 112 - thermal protection - periodic re-evaluation To remember: alcohol poisoning can mask other concomitant conditions with vital risk, such as hypoglycemia, adjacent drug poisoning, and craniocerebral trauma - during the maneuvers will take into account the associated hypothermia - positioning in PLS lethal blood alcohol level is 2.5-5 g%o - ethanol coma is the only coma to which Glasgow score < 8 can be waived lot INTOXICATION WITH CO intoxication is often collective and usually accidental. CO, colourless, odourless and tasteless gas is released from all incomplete combustion. 200-300 times the affinity of CO over Hb is given to 02, resulting in cell hypoxia. ig: the symptoms: s function of CO concentration: 5% - 30% - impairment of visual function, headache, dizziness, palpitations, disorientation, pseudo-ebrious state, chills 30% - 50% - progressive drowsiness, altered consciousness, coma 50% - 70% - death in 10 min to 1h, classic red-cherry coloration > 70% - death in minutes TREATMENT: TREATMENT: Presbyteral attention to the protection of rescuers - removing the victim from the toxic environment, airing the evaluation of vital functions unconscious persons - positioning in PLS, conscious persons - in semi-seated position emergency call 112 resuscitation to the need - periodic re-evaluation To remember: pulse oximetry falsely indicates casinormal values in CO poisoning inhaling the "city gas" unburnt does not lead to CO poisoning in a patient with severe burns CO poisoning is often difficult to notice