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First aid III
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  1. First aid III Štefan Trenkler, MD, PhD 1. klinika anestéziológie a intenzívnej medicíny UPJŠ LF a FNLP Košice 2009

  2. Outlook • Shock/Colapse • Seizures • Diabetes emergencies • Acute intoxications

  3. Shock

  4. Definition • Syndrom- decreased effective blood volume- decreased capilary perfusion- cells and organs dysfunction • Shock is a life-threatening condition due to lack of sufficient blood or oxygen flow to the tissues • Factors: blood volume - heart - vessels

  5. 1. Hypovolemic shock • a) Loss of fluids from the body - bleeding, vomiting, diarhoea • b) Internal losses - gut inflammation, gut obstruction

  6. 2. Cardiogenic shock • heart attack • arrhytmia • other- pneumothorax - heart tamponade - lung embolism

  7. 3. Anaphylactic shock - drugs, foreign proteins, insects

  8. Shock – what happens • Low blood pressure • Low tissue perfusion • Organ damage

  9. Shock - signs • The skin is cool and clammy. It may appear pale or gray. Mucous membranes are dry. • The pulse is weak and rapid. • Breathing may be slow and shallow, or hyperventilation (rapid or deep breathing) may occur. Blood pressure is below normal. • The eyes lack luster and may seem to stare. Sometimes the pupils are dilated. • The person may be conscious or unconscious. If conscious, the person may feel faint or be very weak or confused. Shock sometimes causes a person to become overly excited and anxious.

  10. If you suspect shock, even if the person seems normal after an injury • Dial 112/155 • Have the person lie down on his or her back with feet higher than the head. If raising the legs will cause pain or further injury, keep him or her flat. Keep the person still. • Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR. • Keep the person warm and comfortable. Loosen belt(s) and tight clothing and cover the person with a blanket. Even if the person complains of thirst, give nothing by mouth. • Turn the person on his or her side to prevent choking if the person vomits or bleeds from the mouth. • Seek treatment for injuries, such as bleeding or broken bones.

  11. First aid • Maintain verbal contact - calm the affected person, ensure quiet • Prevent loss of blood • Reduce pain by treatment, but don’t give the affected person pain pills • Keep the affected person warm - danger of growing cold • Don’t give drinks to the affected person - only moisten lips and wipe the face • Lay the affected person in anti-shock or auto-transfusion position (in case of massive bleeding) • Call for medical aid as quickly as possible (112/155)

  12. Shock - position

  13. Trendelenburg position

  14. Fainting, syncope

  15. Fainting (syncope) • Is a sudden loss of consciousness from a lack of blood flow to the brain. • Victims usually wake up quickly after collapsing. • Management is simple, usually requiring little more than letting the victim recover while lying flat. • More important than immediate management is treating the cause of the fainting.

  16. Causes • Dehydratation • Emotions • Health problems • Orthostatic hypotension

  17. Fainting occurs when the blood supply to your brain is momentarily inadequate, causing you to lose consciousness. This loss of consciousness is usually brief. • Fainting can have no medical significance, or the cause can be a serious disorder. • Therefore, treat loss of consciousness as a medical emergency until the signs and symptoms are relieved and the cause is known.

  18. If you feel faint: • Lie down or sit down. • If you sit down, place your head between your knees.

  19. First aid Position the person on his or her back. Elevate the legs above heart level — about 30 centimeters, if possible. Check the person's airway to be sure it's clear. Watch for vomiting. Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR. Call 112/155 Continue CPR until help arrives or the person responds and begins to breathe. Help restore blood flow. If the person is breathing, restore blood flow to the brain by raising the person's legs above the level of the head. Loosen belts, collars or other constrictive clothing. The person should revive quickly. If the person doesn't regain consciousness within one minute, dial 112/155. If the person was injured in a fall associated with a faint, treat any bumps, bruises or cuts appropriately. Control bleeding with direct pressure.

  20. First aid - positions • Unconciousness: recovery position • Shock: horizonal, head down/legs up • Breathing problems: seated position • Backbone trauma: horizontal

  21. Recovery

  22. Trendelenburg

  23. Dyspnoe

  24. Backbone trauma

  25. Seizures

  26. A seizure results from a sudden rush of abnormal electrical signals in the brain. • Symptoms may range from a minor daze to uncontrollable muscle spasms (convulsion). • In some cases, the victim may even lose consciousness. A seizure can be caused by a high fever, head injury, drug reaction, or condition such as epilepsy.

  27. Causes • Epilepsy • Brain tumor • Brain trauma • Intoxications

  28. 1. Protect the Head • Help the victim to the floor if he or she begins losing muscle control. Turn the person on his or her side to prevent choking. • Protect the victim's head from injury by placing something soft, such as folded clothes, beneath it, and by moving objects away from the victim. • DON'T cause injury by restraining the person or by placing anything in his or her mouth.

  29. 2.  Preserve Dignity • Clear away bystanders. • Reassure the victim, who may be confused, drowsy, or hostile when coming out of the seizure. • Cover the person or provide dry clothes if muscle spasms have caused a loss of bladder control.

  30. 3. Check for Injury • Make sure the victim's mental state has returned to normal. One way to do this is to ask the person his or her name, the year, and your location. • Look for any injury to the mouth and head. • Stay with the patients, regulary check

  31. 4. Call 112/255 • If the seizure lasts longer than 3 minutes • If a second seizure occurs • If the victim doesnot regain consciousness • If the victim is pregnant • If the victim has no history of seizures

  32. Diabetes mellitus

  33. The level of sugar (glucose) in our blood is kept within a fairly strict range by a hormone (insulin) produced in the pancreas.  • When the pancreas fails to produce the correct amount of insulin, this condition is called diabetes. • People who live with diabetes are usually expert in managing their blood sugar levels, to the range agreed with them by their doctor of nurse. Occasionally their blood has either too much or too little sugar in it, causing problems.

  34. Pancreas and insulin

  35. The level of sugar (glucose) in our blood is kept within a fairly strict range by a hormone (insulin) produced in the pancreas.  • When the pancreas fails to produce the correct amount of insulin, this condition is called diabetes. • People who live with diabetes are usually expert in managing their blood sugar levels, to the range agreed with them by their doctor of nurse. Occasionally their blood has either too much or too little sugar in it, causing problems.

  36. Hypoglycaemia • When a casualty's blood level falls below a certain level, hypoglycaemia will develop. There are a number of ways that someone's blood sugar levels can drop:- - Missing a meal or snack - Over-exterting themselves, without taking account of their extra sugar needs - Accidental overdose of their medication (designed to lower their blood sugar levels to an acceptable level). 

  37. Recognising low blood sugar • The casualty will probably know if they have diabetes. • Other recognition features • Behaviour: confused, violent. possibly weak, faint, hungry, • Breathing: shallow • Pulse: strong, bounding, palpitations, • Level of response: deteriorating • Muscles may have a slight shaking (tremors). • Skin: cool, clammy, pale, sweaty. • The casualty may have a form of recognition, eg. carry a card, wear a bracelet, wear a necklace, carry diabetes medication, etc.

  38. Care if unconscious • Check your own safety. • Open the casualty's airway and check if they are breathing. • If their airway is clear and they are breathing • An unconscious casualty must be placed in the recovery position. • Dial 112/155 for an ambulance • Every 10 minutes their breathing, pulse and level of response must be measured, recorded. Pass these onto the ambulance crew. 

  39. Care if conscious  • Check your own safety. • Give your casualty something to raise their blood sugar quickly(eg. sugary drink, sugar lumps, chocolate, etc) • If they improve QUICKLY, offer more food and drink • Advise them also to discuss the episode with their doctor • If they DON'T improve quickly • Dial 112/155 for an ambulance • Every 10 minutes their breathing, pulse and level of response must be measured, recorded. Pass these onto the ambulance crew.

  40. Hyperglycaemia • This is relatively uncommon in the field of first aid. If you are unsure whether the casualty, who says they have diabetes, is suffering from low or high blood sugar, the chances are it is low, so think carefully before assuming their blood sugar is high! • When a casualty's blood level gets above a certain level, hyperglycaemia will develop. There are a number of ways that someone with diabetes can have increased blood sugar levels: - Inappropriate types & quantities of food and drink - Under-exterting themselves, without taking account of their reduced sugar needs - Accidental under-dosing of their medication. 

  41. Recognising high blood sugar • The casualty may not know if they have diabetes, as the condition often presents as high blood sugar. • Other recognition features • Breathing: laboured and deep breaths. May have a faint smell of acetone (like pear drop sweets or nail varnish remover). • Pulse: fast. • Level of response: may be deteriorating • Skin: dry. • Increased thirst, which leads to drinking more, which leads to passing water more frequently and in greater amounts. • The casualty may have a form of recognition, eg carry a card, wear a bracelet, wear a necklace, carry diabetes medication, etc. REMEMBER, however, they can always be carrying these for somebody else OR they may be un-diagnosed!