Course of First Aid for 1st year
Medical Students
(1 lecture)
Introducton to first aid. First aid management.
Asphyxia and artificial ventilation.
The most critical and visible health problems
are the sudden death and disability caused
by catastrophic accidents and illnesses
Aleksander Sipria
Clinic of Anaesthesiology and Intensive Care
Tartu University (http://www.kliinikum.ee/aikliinik)
Tel. 7318 405
Each year in the US
Most Causes of Out-of-Hospital Death
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Heart disease
Accident injury
Poisoning (alcohol and drug overdose)
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Time-Intervals of Management
of Out-of-Hospital Cardiac Arrest
Major Causes of Mortality in Estonia
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Time 0.00
Over 3000 people die each year from sudden
cardiac arrest of cardiac origin
About 2300 people die from trauma
About 300 people die from alcohol poisoning
1,5 million heart attack victims (50% die
within two hours)
Over 150 000 people die from trauma
and 400 000 receive permanent injuries
5 million poisonings (90% of them children)
More than 100 000 people die because of the
lack of adequate and available emergency
medical services
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3
Collapse/Recognition
First CPR-Bystanders
Call to Dispatch Center
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Call-Response Interval
Vehicle stops
First Defibrillation / ACLS
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The Most Important Out-of-Hospital Care
Problems in Estonia
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The weakest part in the chain of survival in Estonian
EMS system is long collapse-to-call interval. Insufficient
quality of first aid.
The likelihood of survival after call-response interval
more than 10 minutes is very low
(main reason of bad
results in rural areas)
Further improvement of public education, early access to
the EMS system, quality of medical dispatch and early
defibrillation country-wide are needed
What is first aid?
First aid is the immediate or
emergency assistance given on the
scene to sick or injured person before
professional medical care
The Purposes of First Aid
„ to save life
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provide reassurance and comfort to the ill or
injured
to prevent further injury or illness becoming
worse
to minimize or prevent infection
and promote rapid recovery
First aid measures are not meant to
replace proper medical diagnosis and
treatment
Three Primary Objectives
of First Aid
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to maintain an open airway
to maintain breathing
to maintain circulation
Initial Assessment
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During this process control bleeding
and reduce or prevent shock
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Safety (vehicle accidents, electrical accidents, gas,
smoke and poisonous fumes, fires and collapsing
buildings)
Mechanism of injury
Medical information devices
Number of casualties
Bystanders
Introduce yourself
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Responsibilities of First Aider
and Legal Implications
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Verbal (actual) consent and implied consent
If help is refused, remain with the person until help
arrives
If the casualty`s life is not danger and you do not
know what to do, stay with him and send for help
You use caution in giving first aid so that you do not
aggravate or increase injury
You give the help you would hope to receive if you
were in similar circumstances
Safety of the First Aider
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Priority Action Approach
Priority Action Approach
(sequence of actions)
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Take charge of the situation
Call to attract the attention of bystanders to assist you
Assess the hazards at the scene
Make the area safe for yourself and others
Identify yourself to the casualties
The energy source or factor that caused the original
injury
The hazards from secondary or external factors
The hazards of rescue or first aid procedures
(sequence of actions)
6. Quickly assess the victims for life-threatening
conditions
7. Give first aid for life-threatening conditions
8. Send someone to call for help- ambulance,
police etc.
as First Aider and offer to help
Calling Emergency Services
(in Estonia 112)
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Address or location of the incident, giving cross-streets if
applicable
Telephone number from which the call is being placed
(if needed)
What`s happened? (Circumstances of the incident:
trauma, illness?) Who is calling? Number of casualties
involved?
Is victim conscious?
Is victim breathing?
When to Get Help
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It is vital for rescuers to get help as quickly as
possible
When more than one rescuer is available, one should
start resuscitation while another rescuer goes for
help
Alone rescuer will have to decide:
Call first or call fast ?
Be the last to hang up! Be prepared to act according to instructions of
dispatcher
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Call first is important for early
Call fast is important for early
defibrillation
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If the victim is an adult, and the cause
unconsciousness is not trauma (injury) or
drowning, the rescuer should assume that
the victim has a heart problem and go for
help immediately when unresponsiveness
is established or after the absence of
breathing
rescue breathing
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Casualty Assessment
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History of the case
The Conscious Casualty
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Signs (objective evidence, vital signs: pulse, respiration,
temperature)
Symptoms (sensations that a person feels and
describes)
Keep the casualty lying down, head level with the body,
until you determine the extent and seriousness of the
illness or injury.
The Unconscious Casualty
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Primary examination
Severe external bleeding?
Unconsciousness?
Breathing?
Circulation (pulse)?
Give first aid for life-threatening conditions
in all victims before conducting a secondary examination
If the likely cause of unconsciousness is
trauma (injury) or drowning or if the
victim is an infant or child, the rescuer
should perform resuscitation for about one
minute before going for help
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Ask where the injury or pain is located and
examine that area first
Ask if anything else is wrong and make
sure there are no injuries that are masked
by pain, numbness or drugs
The Unconscious Casualty
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Secondary examination
- Look: for bleeding, respiration, skin colour,
condition, and deformity
- Listen: for patient responses or sounds
- Feel: for pulse, temperature, for deformity
(very gently), texture and swelling
- Smell: the patient´s breath and other odours
to form an impression of other problems the
patient may have
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Body checks
A full body check should be carried out in the following order
Inform the casualty of what you are doing and why
During your examination, move the casualty no more than is necessary.
If you suspect head or neck injuries or are unsure of the casualty` s condition,
keep them lying flat and wait for professional medical assistance
Priorities in First Aid –Multiple
Injuries
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Priorities in First Aid- Multiple Injuries
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Next in priority
Burns
Fractures
Back injuries
• The lowest priority
Minor fractures
Minor bleeding
Behavioural problems
The highest priority
Asphyxia and breathing difficulties
Severe bleeding
Unconsciousness
Shock
Other immediate life-threatening medical
emergencies
First Aid – Follow-up Care
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After immediate first aid is given:
Call emergency services if someone else has not already done
so
Monitor the casualties continuously
Keep the casualty comfortable and warm enough to maintain
normal body temperature
Do not give the casualty anything to eat or drink because it may
cause vomiting, and because of the possible need for surgery
Protect and shelter the casualty while awaiting the arrival of
medical aid
Safeguard the casualty` s personal belongings
Do not attempt to straighten broken or dislocated bones because of the high risk
of causing further injury. Splint them in the position in which they are found.
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Asphyxia (in the circulating blood 02↓, CO2↑)
First Aid Follow-Up Care
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Assist in the evacuation of the casualty by ambulance
Ensure that casualties who do not require medical aid
are placed in the care of friend or relatives
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Electric shock
Drowning
Suffocation
Inhalation of poisonous
gases
Head injuries
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Reduced oxygen supply (toxic gases)
Deterioration of lung and heart functions
(chest trauma, poisonings and illnesses)
Make notes of the names of the casualties and
bystanders and record the first aid given
Causes of respiratory arrest
Airway obstruction (unconsciousness,
choking, trauma, allergic reaction,
drowning)
Signs of abnormal breathing (irregular or restricted
chest movements, noisy sounds, low or high respiratory
rate, blue coloration of the skin - late sign)
(A) Airway Opening
(P.Safar 1981)
Seizures
Airway obstruction
Stroke
Drug overdose
Heart problems
Allergy reactions
In cases of the sudden primary respiratory arrest circulation (pulse)
can be present during the first 1-2 min before cardiac arrest.
Respiratory arrest is treated initially with artificial ventilation,
together with treatment of the likely cause.
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Triple Airway
Manoeuvre (Esmarch,
Heiberg, Safar)
- Head Tilt, Mouth Open,
Airway opening:
head tilt and chin lift
Jaw Thrust
(P.Safar 1981)
ERC 2010
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If airway is open
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Look for chest movement
Listen at the victim`s mouth for breath sounds
Feel for air on your cheek
Look listen and feel for no more than 10 s to
determine whether the victim is breathing normally
If the breathing is normal
Turn unconsciousness victim into the recovery
position
Send or go for help
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Recovery position
ERC 2010
Indirect methods (manual techniques)
of artificial respiration before 1960`s
Artificial ventilation
(expired air resuscitation)
(historical overview)
Safar P, McMahon M.
JAMA, 1958; 1666:1459
Direct Mouth-to-mouth and
Mouth-to-nose Ventilation (P.Safar 1981)
Mouth to mouth artificial ventilation
(ERC 2010)
Blow steadily into victim`s mouth
whilst watching for his chest to rise
Take your mouth away from the victim
and watch to his chest to fall as
air comes up
Give each rescue breath over about 1s
The time taken to 2 breath should not exceed 5s
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The most common errors in artificial
ventilation
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Loss of head tilt
- ineffective ventilation and oxygenisation
- distension of the stomach and risk of regurgitation
(silent flow of stomach contents into mouth and
nose)
Hyperventilation (over-inflation)
- increases intrathoracic pressure, decreases
venous return to the heart and reduces cardiac
output
- distension of the stomach and risk of regurgitation
Artificial ventilation
(expired air resuscitation)
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Response assessment
(level of consciousness)
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Breathing assessment
Airway opening and breathing
reassessment
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Lung ventilation
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Pulse assessment
Risks during artificial ventilation
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Disease transmission
- tuberculosis
- meningitis
- cold sores (herpes simplex)
Face
Face
shield
shield
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HIV and hepatitis have not been transmitted
by resuscitation to date of publication,
although transmission is theoretically possible
Mouth-to-mask Ventilation
Airway Obstruction
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Recognition of airway obstruction
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Partial airway obstruction (noisy breathing)
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Complete airway obstruction (victim unable to breath,
cough and speak)
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Differentiation between mild and severe
foreign body airway obstruction (FBAO)
Sign
Mild obstruction
“Are you choking?”
“Yes”
Other signs
Can speak, cough, breathe
Severe obstruction
Unable to speak, may nod
Cannot breathe/wheezy
breathing/silent attempts to
cough/unconsciousness
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Survival from cardiac arrest of FBAO
etiology is strictly depending on the
time interval between collapse and
ACLS intervention
General signs of FBAO: attack occurs while eating; victim may clutch his neck.
ERC 2010
Foreign-body airway obstruction
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Back blows (A) and abdominal thrusts (B) for
foreign body obstruction in the conscious standing
or sitting victim (P.Safar 1981)
First aid Manoeuvres for Choking
- Back blows
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Abdominal thrusts (Heimlich manoeuvre)
Finger sweep to remove any solid foreign body
(only if it can be seen in the mouth)
Chest thrusts
Ventilations
The restoration of breathing takes priority over all
other measures
Choking emergency device and first aid
Back Blows and Chest Thrusts – Infants
(P.Safar 1981)
The most significant difference from the adult algorithm is that
abdominal thrusts should not be used for infants. Chest thrusts are
similar to chest compressions but sharper and delivered at a
slower rate
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Prehospital Emergency
Care and Crisis
Intervention
Third Edition by Brent Q.
Hafen, Keith J.Karren Brady
Morton Series 1989
ERC guidelines
2010 not recommended
ERC 2010
An infant `s airway is more easily
blocked than an adult`s because:
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The head is relatively large
The neck is relatively short
The tongue is large
The trachea (windpipe) is soft and easily
compressed
The adenoids may be large
ERC 2010
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