What to do if a person is unconscious, BUT breathing?
In this case, it is necessary to ensure the prevention of possible complications (for example, in a victim lying on his back the root of the tongue may sink, which can lead to respiratory arrest; also, if vomiting begins, then the vomit may enter the respiratory tract). To avoid such complications, place an unconscious (or confused) person in a recovery position:
restorative position- This is a position on the side in a stable posture. In this position, the airways are open.
In this position, you can easily put a person of any build and weight, if you know how to do it correctly. So, you need:
1. Remove from the victim and put away everything hanging on his belt: mobile phones, waist bags, knives, etc. It is advisable to do this in front of witnesses so that later you cannot be accused of stealing.
2. Remove and set aside glasses (if the victim is wearing glasses).
3. Remove your mobile phone, glasses, and anything else from your pants pockets that could be crushed or hurt when turned over to the side position. It is advisable to do this in front of witnesses.
4. Sit on your knees on the side of the victim. Place one of your hands under the victim's knee (with outside), bend his leg at the knee as much as possible. With the other hand, take the hand of the victim (farthest from you): 
Place the palm of the victim's hand behind his cheek (when you turn the victim to the side position, his cheek will lie in the palm of your hand).
Next, you simply use bent knee the victim and the elbow wound on the cheek of the hand like a lever, turning the person over: 
Here is a video of how this happens (a video from the same first aid school that I went to):
Despite the fact that for some reason this was not taken into account in the video, in the classroom we were told that we needed make sure that:
- lower hand straightened and lies with the palm on the ground;
- the cheek lies on the second hand;
- the nose and mouth are not closed by anything;
- elbow upper hand lies on the ground;
- should not be "foot on foot".
That is, a person should lie as on picture below and not like in the video (I don’t even know why there are such discrepancies in the same first aid school):
IMPORTANT: every 20 minutes you need to turn the victim, changing the side on which he lies.
First aid is a set of urgent simple measures to save a person's life. Its purpose is to eliminate life-threatening phenomena, as well as to prevent further damage and possible complications.
On the basis of Federal Law No. 267 of November 23, 2009 “On Amendments to the Fundamentals of Legislation Russian Federation on the Protection of the Health of Citizens” Article 19.1 First aid is provided to citizens of the Russian Federation and other persons located on its territory, until medical care in case of accidents, injuries, poisoning and other conditions and diseases that threaten their life and health, by persons obliged to provide it by law or by a special rule and having appropriate training (employees of the state fire service, rescuers of emergency rescue teams and emergency rescue services, drivers Vehicle, and others).
First aid rule
1. Take charge and provide first aid to the victims before the arrival of professional help: EMS, rescuers. Invite witnesses to the incident to help. Give requests and instructions to assistants clear and specific. Provide assistance to the victim only in medical gloves
2. Immediately call an ambulance. Answer the questions of the EMS dispatcher clearly and calmly. Excessive emotionality will only make it difficult for the EMS dispatcher to understand your answers.
3. Start helping with life-saving activities. Do the most necessary things first. Pay attention to the children, without visible injuries, indifferently looking at what is happening.
5. Handle casualties with care.
6. Maintain visual, verbal and tactile contact with the casualty at all times.
7. Do not leave the scene until professional help arrives.
8. Transfer the injured to the ambulance crew, rescuers "from hand to hand".
Priority life-saving measures:
1. Stop severe external bleeding in any way possible;
2. Restore and maintain airway patency, giving the victim a stable lateral position;
3. Perform the simplest anti-shock measures (put the victim in a transport position appropriate for the injury, cold to the injury site, anesthesia);
4. Begin cardiopulmonary resuscitation (CPR) to the victim without signs of life;
5. Observe the victim until the arrival of the ambulance crew. Transfer the victim to the ambulance crew "from hand to hand".
6. Transport the victim independently in the appropriate transport position only in exceptional cases (significant distance from the settlement and medical institution, the time of arrival of the ambulance crew is more than an hour, and the victim needs emergency medical care for health reasons).
Rules for calling an ambulance to the scene
Basic "rescue questions", which must be answered when calling an ambulance at the scene of the incident, their sequence:
Where? an incident happened(exact or approximate address with landmarks of the scene).
What? It happened(reason for calling the EMS, information available at a glance).
Who? injured in an accident(the number of victims, including children, pregnant women, the presence of squeezed, crushed victims, the presence of dead).
You must specify:
the exact address of the scene of the incident and indicate the reason for the call:
accident, fall from a height, traffic accident, etc.
Full name of the caller, phone number.
It is necessary to organize a meeting of the ambulance brigade (if possible).
First aid for prolonged compression syndrome
Compression syndrome or traumatic toxicosis is a disease that occurs as a result of prolonged and sometimes short-term extensive compression of one or more large segments of the limbs with a pronounced mass (shin, thigh, gluteal region).
Compression of the extremities occurs in a peaceful and military environment during landslides, car accidents, train wrecks, earthquakes, building collapses. Due to prolonged compression, there is a violation of blood circulation in the tissues, delivery to them nutrients and oxygen. As a result, tissue necrosis occurs with the release of toxic products of their vital activity (autotoxins) into the body. Immediately after the release of the limb from compression, a significant amount of toxins can enter the bloodstream. At the same time, the condition of the victims noticeably worsens, up to a violation of cardiac activity and respiration. Especially detrimental effect of toxic products on nervous system, kidneys and liver. Due to impaired renal function, urine output decreases sharply and then stops. In severe cases, death can occur in the next 2-4 days from a violation of the function of the kidneys, liver, and cardiovascular system.
What is going on? Firstly, the victim experiences severe, unbearable pain, which leads to spasm of the kidney vessels. This spasm, in turn, leads to acute renal failure.
Secondly, under the influence of gravity in the tissues of the victim's limbs, blood circulation stops - venous, arterial, not to mention capillary. And this means that the nutrition of the tissues stops and the tissues begin to die. Necrosis develops and there is an accumulation of under-oxidized metabolic products, decay and destruction of tissues. That is, a kind of time bomb is formed, because these accumulated products are extremely toxic to the body. As soon as the pressure stops and blood circulation is restored, these toxins rush into the bloodstream, damaging the kidneys, liver and heart.
Thirdly, it is the loss of blood and plasma. The permeability of the walls of the vessels for fluid in the compressed tissues increases sharply, and when the pressure is removed, the blood plasma (up to 30% of the circulating blood) rushes from the vessels into the muscles, forming limb edema. Right before our eyes, the limb sharply increases in volume, the contours of the muscles are lost, the edema acquires such a degree of density that the leg becomes like a wooden one both in hardness and in the sound emitted by light tapping.
But this is one side of the coin. On the other hand, the amount of circulating blood in the vascular system decreases sharply, causing not only dehydration and a sharp decrease in blood pressure, but also an overconcentration of toxins. And this is what causes death in the first minutes after removing the victim from under the rubble.
After the release of the victim from under the rubble, the severity, danger and outcome depend on the duration of the compression of the limb:
Up to 4 hours - mild severity;
Up to 6 hours - average;
Up to 8 hours or more - extremely heavy.
First aid sequence
1. Before releasing the limb from compression, a tourniquet is applied above the compression site.
2. An anesthetic is administered.
3. After release from compression, without removing the tourniquet, bandage the limb from the base of the fingers to the tourniquet, then remove the tourniquet for 30 minutes, alternately pinching the limb with a tourniquet or finger pressing the femoral artery for 1-2 minutes.
4. Immobilization (immobilization) of the limb with splints is performed, the limb is covered with ice.
5. Give a plentiful alkaline drink (preferably mineral water or 1 tablespoon of soda per 1 liter of water).
6. Provide warming of the victim (wrap in a blanket, give a warm drink).
7. Urgently evacuate the victim to a medical institution (on a stretcher).
Bleeding
Bleeding- the outflow of blood from a damaged vessel.
Acute blood loss the first danger that threatens a person in case of injury. With blood loss, the volume of blood circulating through the vessels of the body decreases, which is normally equal to 4.5-5.5 liters, the return of blood to the heart gradually decreases, which leads to a deterioration in the blood supply to the organs.
The true cause of shock in trauma is not due to the pain experienced by the victim. , and by reducing the volume of blood circulating through the vessels of the body.
Rice. Mechanism of traumatic shock.
Types of bleeding:
I. By type of vascular damage:
Arterial bleeding, characterized by a scarlet stream of blood, a pulsating "fountain" beating from the wound;
Venous bleeding - the blood is dark, cherry-colored, does not pulsate in the wound, but flows from its edges;
Capillary (the rate and volume of blood loss is minimal) bleeding from the smallest vessels of the skin, dangerous blood loss is rare;
Parenchymal (injuries to parenchymal organs) bleeding (from organs such as the liver, kidneys, and spleen) and can lead to dangerous blood loss.
Mixed (most common).
II. Depending on where the blood is poured:
External blood flows from wounds or natural orifices of the human body;
Internal: in physiological cavities, in soft tissues(hematoma), under the skin (bruise), blood accumulates in tissues and body cavities.
For example, pulmonary bleeding, when the victim coughs up frothy, bright scarlet blood, or stomach bleeding - vomiting blood or contents that resemble "coffee grounds".
Bleeding leads to blood loss.
blood loss(dangerous, large, acute) - the loss of a large amount of blood in a short period of time, aggravating the severity of the victim's condition.
Common signs of blood loss:
The presence of a wound or a closed injury;
Visible bleeding, bruising, abrasions;
The presence of blood on clothes;
Thirst, frequent weak pulse and shallow breathing;
Pale, cool, clammy skin (gradual development of shock).
Common manifestations of blood loss:
Complaints of the victim of dizziness and weakness;
Increasing pronounced pallor of the skin;
The skin is moist, cold to the touch;
increased breathing;
Decreased blood pressure (determined by the pulse);
Dizziness;
Disturbances of consciousness, etc.
Hematoma - limited accumulation of blood in tissues (under the skin, in muscles, mucous membranes, internal organs) with the formation of a cavity containing blood in them when the vessel ruptures as a result of a blow. First aid: applying a pressure bandage and "cold" to the area of injury.
frequent pulse;
How to suspect internal bleeding: severe pallor of the skin, frequent pulse, which is poorly defined in the wrist area, there is an indication of an injury or a disease that can cause bleeding.
Signs of internal blood loss in abdominal trauma:
Pale cool clammy skin;
Frequent, weak pulse;
Rapid, shallow breathing;
Protection of the abdomen by the "position of the embryo" when laying the victim (pulling heat to the stomach);
abdominal pain or discomfort;
nausea or vomiting;
Visible enlargement of the abdomen;
Gradual development of shock.
Traumatic shock, or "shock associated with blood loss", develops when more than 30% of the circulating blood volume (1.5-2.0 liters) is lost. With a blood loss rate of more than 150 ml / min, death from blood loss can occur in 15-20 minutes if the bleeding is not stopped immediately!
Common signs of shock, indicating severe blood loss:
Anxiety.
Paleness or blueness of the skin.
Violation of consciousness up to its absence.
The subcutaneous venous network is not defined (collapsed veins).
Chill, cold extremities, cold sweat.
When pressing on the nail, its color is restored in more than 2 seconds.
Lowering blood pressure.
The pulse is frequent, barely palpable.
Determining the approximate value of blood pressure ( BUT D) by the presence of a pulse:
The pulse is determined in the wrist area - blood pressure is not lower than 100-90 mm Hg. Art.
The pulse is determined only on the brachial artery - blood pressure is not lower than 70-80 mm Hg. Art.
The pulse is determined only on the carotid artery - blood pressure is not lower than 50 mm Hg. Art.
First aid for bleeding.
The main thing in helping with acute blood loss is to stop bleeding as quickly and effectively as possible. In most cases, the life of the victim depends on this. At the stage of first aid, a temporary stop of bleeding is carried out, the final one is possible only in a medical institution. Of the ways to temporarily stop bleeding, the following are used:
Maximum limb flexion;
Finger pressing of the artery;
Direct pressure on the wound;
The position of the service or impromptu tourniquet;
Pressure bandage;
Tight bandaging of the wound.
Receptions that help temporarily stop external bleeding:
Elevated position of the injured limb;
Cooling the site of a wound or area of injury if internal bleeding is suspected.
Maximum limb flexion at the joint
This method is used for bleeding from wounds of the forearm - bending the arm in elbow joint, shins - flexion at the knee joint, hips - flexion at the hip joint. Often this technique is intuitively performed by the victim himself immediately after the injury, in the order of "self-help".
Finger pressure on the arteries
The artery is pressed with a finger or fist against the underlying bone. For example, when squeezing the temporal artery, it is pressed against the temporal bone of the skull (A), the submandibular artery - against the angle of the lower jaw (B), the carotid artery - against the transverse processes of the V cervical vertebra (C), the subclavian artery - against the first rib in the supraclavicular fossa (G ), axillary artery - to the head humerus in the armpit (D), the humerus - to the humerus along the inner edge of the biceps (E), the femoral artery - is strongly compressed by the fist in the inguinal fold (G).
Disadvantages: finger pressure is enough for no more than 10 minutes. With this method of stopping the bleeding of the victim, it is impossible to shift and transfer. With heavy bleeding, excitement makes it difficult to remember previously learned “pressure points”, therefore, at present, a simple method of “direct pressure on the wound” is often recommended.
Direct pressure on the wound
The bleeding vessel is squeezed through a sterile napkin or with a tight gauze tampon directly in the wound or along its upper edge. In exceptional cases, squeezing with a palm or fist is allowed (life is more expensive than sterility).
Flaw: can not be used for open fractures, as there is a broken bone in the depth of the wound!
Tourniquet overlays
Stopping bleeding from wounds of the extremities is most often performed by applying an elastic rubber tourniquet or an improvised tourniquet from improvised means.
The classic Esmarch tourniquet is a flowing rubber band 140 cm long, 2.5 cm wide and at least 2 mm thick.
Indications for applying a hemostatic tourniquet: a hemostatic tourniquet is applied only with severe bleeding (arterial).
The classic places for applying a tourniquet are as follows:
Wounds of the forearm - on the lower third of the shoulder
Rice. Shoulder harness
Shoulder wounds - upper part shoulder, closer to the armpit;
Lower leg wounds - on the middle part of the thigh;
Wounds knee joint- on the middle part of the thigh;
Hip wounds - at the base of the thigh, closer to the groin.
Rice. A tourniquet on the thigh.
A tourniquet is used for severe bleeding from wounds of the extremities.
The tourniquet is applied to the limb just above the wound.
The tourniquet is applied to clothing or underlying fabric (with the exception of the absence of the mentioned clothing or fabric).
The tourniquet is pulled with force in the hands to stop the blood with the first, tightest, turn.
The remaining turns are superimposed closely and with less force, after which the tourniquet is fastened (tied).
The time of application of the tourniquet must be marked on a note tucked under it, or on the tourniquet itself, on the skin above the wound, on the forehead or cheek of the victim.
The tourniquet stays on the limb - no more than one hour in the warm season, 30 minutes in the cold season! During this time, the victim must be provided with medical care, since only a doctor has the right to finally remove the tourniquet.
The limb on which the tourniquet is applied must be warmly covered.
If medical care during these periods is not impossible, gangrene of the limb can be avoided by loosening the tourniquet every hour for 10 minutes to restore blood flow. During these 10 minutes, finger pressure on the artery should be applied. The tourniquet is tightened again by slightly shifting it above the previous place.
Rules for applying a hemostatic tourniquet
1. Stop the bleeding by applying finger pressure to the artery above the wound
2. Determine the indications for applying a hemostatic tourniquet.
3. Determine the place (anatomical region) for applying a hemostatic tourniquet (shoulder, thigh), as close as possible to the wound site. The imposition of a hemostatic tourniquet on the forearm and lower leg, anatomical regions with two bones each, does not make sense, since the bleeding will not stop.
4. Apply a service or impromptu tourniquet, observing the technique of its application
5. The hemostatic tourniquet is tightened on the limbs until the bleeding stops.
6. A hemostatic tourniquet is applied to the fabric or parts of clothing placed under it. tourniquet do not impose on your naked body!
7. Indicate the time of application of the hemostatic tourniquet in the note, the date and name of the first aid provider.
8. Perform immobilization of the limb after applying a hemostatic tourniquet in case of damage to a large vessel.
9. "Coldness" on the area of injury with a hemostatic tourniquet applied do not impose!
10. Give the victim a physiologically favorable (convenient) transport position, determined by the severity of the condition or an anti-shock position.
11. Prevent cooling of the victim with severe bleeding, cover even in the warm season.
12. Call an ambulance.
Imposing an impromptu tourniquet
A tie, belt or strong fabric twisted in the form of a strip 2-3 cm wide can be used as impromptu harnesses.
Do not use too wide strips of fabric - they do not create enough pressure.
It is also impossible to use cords, strings, wire because of the danger of cutting through the skin along with vessels that have not yet been damaged!
Rice. Harness "noose"
Rice. The use of a trouser belt as an impromptu tourniquet
Rice. Twist-twist
Rice. Self-help tourniquet
pressure bandage
A pressure bandage is usually applied to stop venous.
Close the wound with a sterile dressing
Place a tightly rolled tampon over the napkin, made from a bandage or a piece of improvised tissue and corresponding in size to the wound.
Press the swab into the wound with force for 7-10 minutes, making sure that the bleeding stops.
Tightly bandage the tampon to the limb.
Perform immobilization of the wounded limb or give the victim a comfortable position.
Advantages:
Intact arteries continue to function;
Nerves and muscles are not compressed.
Disadvantages:
Packing the wound is painful at the time of its implementation;
The tampon may loosen and become soaked with blood;
The method is not applicable for open fractures.
Tight bandaging
Tight bandaging of the wound is usually used for venous and capillary bleeding, since the pressure in the veins and capillaries is lower than in the arteries, and they are not deep.
Nose bleed
Causes: high blood pressure, trauma, cold, vigorous blowing of the nose, clotting disorder.
Signs:
Complaints about the flow of blood along the back of the pharynx.
Intensive discharge of blood from one or both nostrils.
The presence of dried blood in the nasal passages.
First aid for nosebleeds:
1. Seat the victim, tilting his torso and head forward.
2. Clamp the victim's nostrils.
3. If there is no suspicion of a fracture of the bones of the nose, then the entire lower part of the nose should be compressed, and not just its tip.
4. Put "cold" on the nose area.
5. If the bleeding does not stop, make turundas (flagella) from dressing material. Turunda enter tightly into the nasal passages. This technique with a nose injury cannot be performed!
6. Reassure the victim.
7. Convince to breathe only through the mouth for an hour after the bleeding stops.
8. In case of prolonged bleeding, call an ambulance.
First aid for internal bleeding
1. Call an ambulance.
2. Give the victim an anti-shock position or another position appropriate for the injury. Place the unconscious victim in a stable lateral position.
3. Apply "cold" to the injury site.
4. Cover the victim even in the warm season.
5. Control the state of consciousness, breathing, blood circulation until the arrival of the ambulance team.
6. Do not feed or water the victim.
7. If it is impossible to call the EMS, transport the victim yourself, observing the rules for transporting the victim.
Large blood loss leads to disruption of the vital activity of all organs and systems. With a blood loss of 750-1000 ml or more, traumatic shock develops.
traumatic shock is a severe, life-threatening condition that occurs in response to trauma, in which there are changes in the activity of the vital important organs leading to impaired consciousness, respiration, blood circulation.
Reasons for the development of traumatic shock:
Severe skeletal injury;
Large blood loss;
Severe extensive burns.
The main manifestations of traumatic shock:
Severe pallor of the skin;
The skin is wet, cold;
Breathing speeded up;
The pulse is frequent, poorly defined on the wrist;
Oppression of consciousness.
Tasks of anti-shock measures
Increase the return of venous blood to the heart.
Increase the volume of circulating fluid.
Reduce heat loss.
Avoid secondary trauma when removing the victim from the car or transferring him.
First aid for traumatic shock
1. Perform a temporary stop of external bleeding. Choose the method of stopping taking into account the type of bleeding.
2. Call an ambulance.
3. Perform immobilization of the cervical spine with an impromptu cervical collar.
4. Give the victim an anti-shock position. Give transport position depending on the injury.
5. Perform immobilization of the damaged area - ensure the immobility of the damaged area.
6. Apply "cold" to the area of injury. When a hemostatic tourniquet is applied, “cold” is not applied.
7. Reassure the victim. Maintain constant visual and verbal contact with the victim.
8. Cover the victim even in the warm season.
9. Give the victim sweet tea to drink in the absence of contraindications: suspicion of abdominal trauma, abdominal trauma, pelvic trauma, impaired consciousness.
10. Observe the consciousness, breathing, blood circulation of the victim before the arrival of the ambulance team.
11. Be prepared to perform cardiopulmonary resuscitation.
electrical injury
Electrical injury - damage electric shock varying degrees of severity (from minor pain to tissue charring and death) depending on the strength, voltage and duration of the current.
According to the need for resuscitation, electrical trauma occupies one of the first places. The severity of electric shock depends on the nature of the current and the state of the body.
Among electrical injuries, there are: local electrical injuries; electrical shocks.
Local electrical injuries:
Electric burn - current or arc. The first occurs at low voltages of the electrical network, resulting in the conversion of current into heat. Arc burn is one of the severe ones. It occurs when an electric arc with a thermal energy of more than 3500 ° C is formed between the current conductor and the human body.
Electrical signs are round spots of gray (pale yellow) color. Arise at the point of contact with the current conductor. They do not pose a particular danger.
Metallization of the skin - the smallest particles of metal melted in an electric arc penetrate the skin, eyes, the lesions are painful.
Electrophthalmia - acute inflammation of the membranes of the eyes with ultraviolet rays from an electric arc, severe pain, pain in the eyes, loss of vision (temporary).
Mechanical injuries - due to involuntary convulsive muscle contractions (tears in the skin, arteries, veins, dislocations, torn ligaments, fractures, falling from a height).
Electric shocks: the effect of a sharp excitation of body tissues by an electric current, accompanied by convulsive muscle contraction. Distinguish 4 Art. electric shock:
1 st. Convulsive muscle contraction, consciousness is preserved.
2 tbsp. Convulsive muscle contraction with loss of consciousness, respiration, cardiac activity preserved.
3 art. Convulsive muscle contraction. Loss of consciousness, respiratory and cardiac disorders.
4 tbsp. clinical death.
The final result of the passage of electric current through the human body in each individual case is difficult to predict, the nature and severity of electric shock depend on many factors related to the state of the person and the external environment (air humidity affecting the body's resistance).
The resistance of current tissues to the passage of electric current can be different, it is approximately proportional to the water content in them. Skin, bones high resistance, blood, muscles, nerves are good conductors of electricity. Therefore, the severity of damage in case of electrical injury is largely due to the trajectory of the passage (loop) of the current.
The most dangerous is the passage of current through chest in this case, cardiac arrest and cessation of breathing is maximum.
In the state of the body, the electrical conductivity of the skin is of primary importance. It depends on the thickness, humidity, the number of blood vessels, sebaceous and sweat glands, the presence of abrasions, scratches, wounds. Dangerous areas are the face, palms, perineum, and most dangerous ways the following are considered to pass the current: hand-head, hand-hand, two hands - two legs. Alcohol intoxication, fatigue, exhaustion, chronic diseases, senile and childhood age increase the severity of the lesion. The surface layer of dry, intact skin has a resistance of 40-100 kOhm. At a voltage of 250-500 volts, this layer instantly breaks through, the skin resistance drops to 0.8-1.0 kOhm, and the current increases sharply.
For electrical injury, direct contact with a current source is not necessary, it is possible to be struck by an arc discharge or “step electricity” when a high-voltage wire falls to the ground. The step voltage is stored within a radius of up to 10 meters from the place where the wire fell, and when approaching it, the potential difference in the leg-to-leg loop is the greater, the more more length step.
With an increase in the duration of the current, the resistance of the skin also falls, so you need to quickly stop the contact of the victim with the current-carrying element.
The severity of injury from electric shock can vary, from short-term convulsions without loss of consciousness to circulatory arrest.
Respiratory paralysis and cardiac arrest sometimes does not occur immediately, but over the next 2-3 hours.
First aid
It is forbidden to touch the victim without de-energizing!
1. Stop contact with the power source with the indispensable observance of safety measures for the rescuer:
Approach the victim on a dry surface, in rubber or dry leather shoes or throwing dry boards, a rubber mat under your feet.
Discard the wire from the victim (or the victim from the current source), using non-metallic objects: a stick, a chair, a rope, a dry towel;
In the zone of the fall of the high-voltage wire, move in small, frequent steps, without touching the ground with legs wide apart;
Turn off the current source (switch, plugs, knife switch) or cut the wire with a tool with an insulated handle;
Pull the victim out of the “stepping voltage” zone of action (at least 10 meters), holding him by dry clothes or a belt and not touching open parts of the body or shoes (metal nails).
2. If there are signs of circulatory arrest, perform resuscitation using the standard basic CPR algorithm.
In case of high-voltage (voltage more than 1000 V) electrical injury:
The rescuer must wear rubber shoes, work with rubber gloves;
Operate with an insulating rod or insulating clamps, calculated for the corresponding voltage.
Mechanical asphyxia:
airway obstruction by foreign bodies
Airway obstruction This is the ingress of a foreign body into the respiratory tract, which prevents breathing and can cause death from suffocation - asphyxia.
Airway obstruction by a foreign body is one of the most common domestic accidents. The most common cause of asphyxia in adults is airway obstruction caused by food such as fish, meat, or poultry. In infants and children, half of the cases of asphyxia occur with food (mainly confectionery), the remaining cases of asphyxia occur with non-food items such as coins or toys.
Since most cases of asphyxia occur while eating, they usually have eyewitnesses and first aid can be provided quickly and successfully while the victim is still conscious.
To do this, it is important to quickly recognize the signs of a foreign body entering the airways: partial or complete obstruction.
1. Partial airway obstruction.
The victim can still cough up the foreign body, although his breathing is hoarse or hoarse. It is necessary to encourage the victim on his own and cough strongly. If he has a weak cough with noisy attempts to inhale in the pauses between coughs, pale skin, bluish or grayish lips or nails, then you should act as if you had a complete airway obstruction.
2. Complete airway obstruction.
The victim is unable to speak, breathe or cough. He grabs his neck with his hands, he has a pronounced motor excitation.
First aid for airway obstruction.
Procedure for adults and children older than 1 year:
If the victim is choking, ask if they can breathe. This is the key question for distinguishing complete obstruction from partial obstruction!
1. If the victim shows signs of partial airway obstruction (breathing and can talk), then he still has an open airway.
Encourage him to keep coughing! Do not prevent him from coughing up a foreign body!
2. If the victim has signs of complete airway obstruction and is conscious.
Foresee a series of blows to the back as follows:
Stand to the side and slightly behind the victim;
Support his chest with one hand and tilt the victim forward so that the foreign body can come out of the mouth;
Apply up to 5 sharp blows between the shoulder blades with the base of the palm of the other hand.
See if any of the blows cleared the airway obstruction. The goal is to release the obstruction with each slap, not necessarily all 5 slaps.
If 5 blows to the back fail to relieve the obstruction, give 5 thrusts to the abdomen as follows;
Stand behind the victim and grasp his stomach with both hands;
Tilt the victim forward;
Make a fist with one hand and place it between the navel and sternum;
Grasp your fist with your other hand and pull sharply towards you and up;
Repeat up to 5 times.
If the obstruction still persists, continue alternating 5 back blows with five abdominal thrusts.
Note
Pushing with two hands located between the waist and chest is called abdominal compression or Heimlich's maneuver. Alternative way- chest compression (hands placed in the middle of the sternum), used only in women in late pregnancy, in very obese victims, in young children and in victims with abdominal injuries.
3. If the victim becomes unconscious:
While supporting, carefully lower the victim to the ground;
Call an ambulance immediately;
Begin CPR.
When rescuing a child, hit the back in the “drainage” position - upside down. Measure the force of blows and pushes with the weight of the child's body!
First Aid
Prevention of bloodborne infections
As improvised means, they use: clothes, newspapers, magazines, pieces of plywood or cardboard, boards, branches, and more. Other that can be found near the scene.
Hemostatic agents. A classic hemostatic rubber tourniquet is a smooth rubber band 125 cm long, about 2.5 cm wide, 4 mm thick, has fixtures for fixation.
Improvised means that replace the hemostatic tourniquet:
- "twist", "noose" can be made from medical scarves, a piece of fabric and a piece of clothing;
Trouser belt 2.5-4 cm wide.
Remember! Wire, wire, cord of any thickness, elastic rubber tourniquet (venous tourniquet, used only for intravenous injections), etc. cannot be used as a hemostatic tourniquet!
Stretchers are divided into hard and soft ones. Improvised means that imitate soft stretchers , large pieces of dense fabric, a blanket, a bedspread, etc. can serve.
Improvised means imitating a rigid stretcher can be wide boards, doors, countertops, etc. It is a must to have in practical exercises.
Improvised means for transport immobilization: boards matched to the length of the limb, magazines, thick newspapers, cardboard, etc.
How to deal with the victim during examination and assistance
- Be prepared for any situation.
Your behavior should be confident and calm.
Address the victim by name and "you".
Give the victim your name.
Listen carefully to the complaints of the victim.
Communicate regularly with the victim.
Imagine yourself in the position of the victim and then you will find the right words of sympathy.
Turn your empathy into actual help.
Use the help techniques that you are best at.
Explain your actions and purpose of assistance.
Perform all your manipulations carefully and carefully.
Give tasks to people who interfere with you (bring a car first-aid kit, write down the personal data of the victim, protect the scene, take care of the victim's belongings).
Do not respond to possible aggression and insults, they do not apply to you, this is a way for the victim to get rid of his own fear.
Prevent disputes between your assistants.
Try to time all your first aid activities.
Try to do your best.
Rules and procedure for examining the victim.
Assessment of the condition of the victim.
The procedure and rules for examining the victim
1. Make sure there is no danger for you and the victim at the scene. Protect yourself and the victim. Only after these steps have been taken can the examination of the victim begin.
2. Ask a specific person with a mobile phone to call emergency medical care. If you are alone, do not leave the victim alone. Act according to circumstances.
3. Look for external bleeding in the victim. Pay attention to the clothes of the victim, soaked in blood, near the victim there is a pool of blood. Find the place of bleeding and stop it in any way possible.
4. Check Availability consciousness, breathing, pulse (blood circulation). Violation of consciousness, breathing and pulse indicates the severity of the victim's condition. The purpose of the examination of the victim is to determine the severity of the condition. The severity of the condition will determine the further tactics of providing assistance.
4.1. Identify victims with impaired consciousness. Approaching the victim, call him loudly, ask: “Are you all right?” or "What happened?" If the victim does not respond, gently shake him by the shoulders and repeat the question.
The victim is unconscious does not answer your questions, does not respond to calls and touches.
Confused victim when called and touched, it will open its eyes, but it cannot answer your questions or perform a simple action.
Conscious victim on a call, it opens its eyes, answers your questions and fulfills the requests-commands (raise your arm, bend your leg, turn on your side, etc.). During the examination, maintain constant contact with the victim, try to calm the victim, convince him not to move. Ask: "Where does it hurt?"
An example of a dialogue when there are many victims, few helpers and no additional danger. Say loudly and clearly: “Whoever hears me, answer me, raise your hand! Who can walk - come to me! Whoever is next to the victim who is unconscious or bleeding - raise your hand! The purpose of such a survey is to quickly identify victims who are unconscious and with external bleeding.
4.2. Identify victims with respiratory failure. Check the victim's breathing using the "see" method (the chest rises during breathing), "hear" (putting the ear to the victim's nose), "feel" (the warmth of the breath). If the casualty is unconscious, you cannot see breathing movements, you cannot hear or feel breath sounds, proceed to the CPR steps.
If the victim is unconscious but breathing, place him in a stable lateral position.
If the victim is conscious with frequent and difficult breathing - free his neck, chest from restrictive clothing, give him an elevated position.
4.3. Identify victims with circulatory disorders. If the pulse at the wrist (on the radial artery) is poorly determined or not detected, but the victim remains conscious and breathing, give the victim an anti-shock position.
The purpose of the anti-shock position is to ensure normal blood pressure in the vital organs.
When evaluating general condition injured great importance have two questions: "What happened?" and "Where does it hurt?"
From the answer to the question "what happened?" you can get the following information:
does not answer- there is no consciousness (severe TBI, severe poisoning or clinical death);
does not remember what happened - amnesia (mild head injury, think about poisoning, including alcohol or drugs);
answers correctly, but in monosyllables, slowly - shock (look for a source of bleeding or severe skeletal injury);
answers correctly but in short, staccato phrases, breathing problems (trauma to the chest, possibly with damage to the lungs);
responds excitedly, too detailed - incipient shock (look for the source of bleeding, although this may only be a consequence of emotional stress).
When you have ruled out the danger to the life of the victim, examine and feel him consistently, quickly and carefully to look for or rule out other injuries.
Examination of the head, neck and cervical spine. Examine the head of the victim: is there a change in the shape of the head, pay attention to the symmetry of the face, are there any wounds to the eyelids or eyeballs, foreign bodies, traces of blood, bruising, evaluate the width of the pupils (normal pupil width is the same). Pay attention to the shape of the nose, nose wounds, or pinnae. Whether there is a nosebleed or blood clots in the victim's nostrils. The outflow of blood or clear fluid from the ear canals are symptoms of a fracture of the base of the skull. Can the victim open (close) his mouth. Is there any bleeding or blood clots in the mouth.
Examine the scalp carefully, with light movements.
If you feel a “crunch”, stop examining the head.
After examining the head, neck and cervical spine, be sure to put on a cervical collar.
Examination of the chest. The victim with a chest injury takes a forced position to facilitate breathing, sitting or half-sitting. Pay attention to the presence of injuries in the chest area, to the victim's breathing (shortness of breath). With multiple fractures of the ribs, the so-called "broken chest", spontaneous breathing becomes impossible and artificial respiration may be required. Such victims should be taken to a medical facility as soon as possible.
Stomach. Pay attention to the complaints of the victim, for the presence of bruises, wounds, especially with foreign objects or prolapse of internal organs.
Taz. When examining the pelvic bones, sharp pain on pressure, on movement. The victim assumes a forced position (“frog position”)
Hips, Calves, Feet. Are there any wounds, bleeding, shape change. On examination, severe pain.
Mobility of the joints of the limbs. Can the victim flex (extend) the limb? Are these movements painful?
Shoulders, forearms, hands. Examine them in the same way as your thighs, shins, and feet. Avoid rough manipulation, stop examination if it causes sharp pain in the limb.
Back. To avoid possible secondary damage, examine the damage to the back should be examined only if it is initially accessible for examination (the victim lies on his side or stomach).
Pulse detection
1. In adults:
on the sleepy arteries in the region of the right or left anterolateral surface of the neck, between the laryngeal protrusion and the muscle closest to it. Determine the pulse at the same time sleepy arteries prohibited- the flow of blood to the brain stops;
on the ray arteries in the region of the inner surface of the lower third of the forearm, between the radius and the muscle tendon closest to it;
2. In children under 1 year old pulse is determined by shoulder arteries in the region of the inner surface of the shoulder, between the humerus and biceps.
3. In children older than a year the pulse is determined in the same place as in adults.
To determine the pulse feel for the artery with two or three fingers and press it against the underlying bone.
The purpose of the general examination is to quickly and non-traumatically determine leading damage, which can lead to deterioration or death of the victim, for example: TBI, trauma to the spine, chest, abdomen, musculoskeletal system, two or more body cavities (chest and abdomen, head and abdomen, etc.) multiple injuries without leading damage.
The main transport provisions of the victims used during transportation from the scene to a medical institution
Remember! Transportation of an injured or acutely ill person is carried out by a person who does not have a professional medical education, only in case of emergency!
Rules for the transportation of victims:
Properly selected transport position;
Careful transfer;
Reliable fixation of the chest, pelvis, lower extremities;
Immobilization of the head and cervical spine;
Control: consciousness, respiration, blood circulation (pulse) during transportation;
Protect the victim from cooling, cover even in the warm season.
Transport position: correct laying of the victim during transportation or while waiting for the arrival of the ambulance team, which prevents the complication of the injury or the acute condition of the patient.
Transport provisions depend on:
From the type of injury;
From the site of injury (anatomical region): head, chest, abdomen, pelvis, spine, limbs;
From the severity of the condition of the injured or acutely ill: impaired consciousness, breathing, blood circulation.
Transport provisions
Anti-shock position for circulatory disorders
Shock due to acute blood loss (wrist pulse not detectable)
Raise your legs 30-45 cm, or
The foot end of the improvised stretcher is raised at an angle of 15 °
Purpose: Improvement of blood supply to vital organs, improvement of blood flow to the heart.
Stable lateral position or "waiting posture"
Position on the side with support on the knee of a half-bent leg.
Target giving the victim a stable lateral position:
Maintaining the patency of the upper respiratory tract in an unconscious victim, preventing inhalation of vomit or blood, saliva.
exalted position
Target giving the victim an elevated position in case of respiratory failure:
Improving lung ventilation by facilitating the movement of the diaphragm.
Target giving the victim an elevated position in case of a head injury (craniocerebral injury):
Do not throw your head back;
Fixation (immobilization) of the head and cervical spine;
Improving the outflow of venous blood from the brain and preventing cerebral edema.
Target giving the victim an elevated position on his side on the side of the injury in case of chest injury:
If possible on the damaged side.
To improve ventilation of the intact lung, immobilize the injured area of the chest and relieve pain.
Transport position for abdominal trauma
Target giving the victim a transport position in case of abdominal trauma (elevated position of the shoulder-head end of the body, a roller under half-bent knees):
Reducing the tension of the muscles of the anterior abdominal wall and reducing pain.
Transport position for pelvic injury
Target giving the victim a transport position in case of a pelvic injury (lying on his back with legs turned and bent at the knees, a roller under the knees, fixed feet):
Position on the back.
The knees are slightly apart.
Roller under the knees.
Prevention of secondary injuries, pain relief due to immobilization of the pelvic bones.
Transport position for spinal injury
Target giving the victim a transport position in case of spinal injury (position on the back on a hard surface):
Fix the neck with an impromptu collar.
Shift with 4-5 assistants.
Lay on a flat surface.
Prevention of further damage to the spine due to the immobilization of the spine along its entire length.
Transport position in case of respiratory and circulatory disorders caused by acute diseases
Target giving the victim a transport position in case of emergency conditions caused by diseases that led to respiratory and circulatory disorders (pain in the heart area), (bubbling breath, cough with foamy sputum (pulmonary edema)),
sitting with legs down:
Reduce blood flow to a weakened heart and improve lung ventilation (make breathing easier).
Cardiopulmonary resuscitation (CPR)
For human life, a constant supply of oxygen through the respiratory tract is necessary. The lungs, drawing in air, take oxygen from it, with the blood flow, oxygen is carried throughout the body, nourishing every cell. The waste product, carbon dioxide, is released back into the atmosphere. If breathing stops, the heart, continuing to work, will eject blood into the main artery - the aorta, less and less enriched with oxygen, and more and more containing carbon dioxide. In a few minutes, the oxygen content in the blood will be so low that the brain will stop contact with the outside world and the heart will stop beating. Death will come.
The heart pumps out 40 to 70 milliliters of oxygenated blood for each beat. The amount of pumped blood per minute reaches 3-5 liters. If the work of the heart stops, then the organs and tissues of the body will not receive oxygen, despite the fact that the lungs are full of this life-giving gas. Death is coming. So closely interconnected are these most important organ systems - the respiratory organs and the circulatory organs.
Conditions associated with the cessation of breathing and cardiac activity are commonly called cardiac arrest.
The first aid that is given immediately after cardiac arrest is called cardiopulmonary resuscitation.
Resuscitation- practical actions aimed at resuscitation (restoration of blood circulation and respiration) of the victim.
Resuscitation is carried out in every case of clinical death!
Sudden cardiac arrest is clinical death.
Sudden circulatory arrest (cardiac arrest) occurs most often as a result of heart disease, electrical injury, drowning, various kinds suffocation, hemorrhages in the brain, massive blood loss in trauma. The cessation of blood circulation leads to the death of the cerebral cortex, which cannot exist without a constant supply of oxygen for more than 5 minutes. This period of time during which a person can still be brought back to life is called clinical death.
Clinical death - a reversible state of the body, when, despite the absence of cardiac activity, respiration and consciousness in the victim, the viability of tissues and organs (brain) is preserved, a return to life is possible.
The duration of clinical death - no more than 5 minutes! After 5 minutes, irreversible changes occur in the cerebral cortex.
During this period of time, the following happens: after a few seconds from the moment the heart stops, the person loses consciousness, after 40-50 seconds characteristic convulsions develop - usually a single contraction skeletal muscle, the pupils expand, reaching a maximum size after 1.5 minutes. Noisy and rapid breathing stops at 2 minutes of clinical death.
After 5 minutes of clinical death, with brain death, biological death occurs - an irreversible condition when the victim can be considered dead.
Signs of sudden circulatory arrest, signs of clinical death:
Lack of consciousness;
Lack of breathing;
Absence of a pulse in the carotid artery.
In addition to the main signs, there may be:
Unusual pallor or cyanosis of the skin;
Maximum pupil dilation.
It is these signs that are usually the reason for the start of resuscitation.
At the scene of the accident and during transportation, the victim must be given an optimal (favorable) position that affects the function of vital organs. This situation depends on the type of injury and the severity of the victim's condition:
In victims who are unconscious due to traumatic brain injury, poisoning, cerebrovascular accident, etc., there is always a danger of tongue retraction, and due to inhibition of cough, swallowing reflexes, blockage of the airways by vomit, saliva, sputum, foreign bodies, blood (especially if the victim is on his back). This inevitably leads to impaired lung function in the form of asphyxia (suffocation). To prevent this, the victim must immediately be placed in a stable lateral (drainage) position (Fig. 9).
Fig.9 Drainage position to prevent asphyxia
- Remove goggles from the victim (if any).
- Kneel on the side of the victim. Make sure his legs are straight and his arms are at his side.
- Take the arm closest to you at a right angle to the body, bend it at the elbow so that the palm is pointing up.
- Place the hand farthest from you obliquely on the chest of the victim; Place the back of the victim's hand on the victim's cheek closest to you.
- With your other hand, grab the victim's leg farthest from you under the knee; turn the victim towards you so that the victim's bent knee and foot rest on the ground.
- Extend the victim's head so that the airway remains clear. If necessary, adjust the position of the palm on which the patient's head rests so that the airway remains clear.
- Control the victim's breathing.
Before turning the body, in order to prevent the risk of displacement of the cervical vertebrae (if they are fractured), it is advisable to fix cervical region spine with a cervical splint (Fig. 10).
Fig. 10 Neck splint
The “frog” position is used for suspected trauma to the pelvis, lower extremities. The victim is laid on his back with divorced and half-bent at the knees and hip joints limbs that rest on a roller in the popliteal region (Fig. 11).
Fig. 11 The position of the "frog" in case of injury of the pelvis and lower extremities
The position on the back with a padded roller is given to the victim with spinal injuries (Fig. 12).
The horizontal position of the body with legs raised by 30 - 40 cm is used for massive blood loss and ongoing internal bleeding (Fig. 14).
There are several options for the optimal position of the patient, each of which has its own advantages. There is no universal provision suitable for all victims. The position should be stable, close to this lateral position with the head down, without pressure on the chest, for free breathing. There is the following sequence of actions to place the victim in a stable lateral position:
Remove goggles from the victim.
Kneel next to the victim and make sure both legs are straight.
Place the patient's arm closest to you at a right angle to the torso, bending the elbow so that the palm is pointing up.
Throw your far arm across your chest, pressing back side his palms to the victim's cheek with your hand.
With your free hand, bend the victim's leg farthest from you, taking it slightly above the knee and keeping his foot on the ground.
Keeping his hand pressed to his cheek, pull the far leg to turn the victim to your side.
Adjust the top leg so that the hip and knee are bent at a right angle.
Tilt your head back to make sure your airway remains open.
If it is necessary to keep your head tilted, rest it with your cheek on the palm of his bent arm.
Check for breath regularly.
If the victim must remain in this position for more than 30 minutes, he is turned to the other side to relieve pressure on the lower arm.
In most cases, the provision of emergency care in the hospital is associated with fainting and falling. In such cases, it is also necessary to first conduct an inspection according to the algorithm described above. Help the patient back to bed if possible. In the patient's card, it is necessary to make a record that the patient fell, under what conditions this happened and what assistance was provided. This information will help your doctor decide on treatment that will prevent or reduce your risk of fainting and falls in the future.
Another common cause requiring emergency care is - respiratory disorders. Their cause may be bronchial asthma, allergic reactions, pulmonary embolism. When examining according to the indicated algorithm, it is necessary to help the patient cope with anxiety, find the right words to calm him down. To facilitate the patient's breathing, raise the head of the bed, use oxygen bags, masks. If the patient is more comfortable breathing while sitting, be close to prevent a possible fall. A patient with respiratory problems should be referred for X-ray, to measure the level of arterial gases in him, to conduct an ECG and calculate the respiratory rate. The patient's medical history and reasons for hospitalization will help determine the causes of respiratory problems.
Anaphylactic shock- a type of allergic reaction. This condition also requires emergency care. Uncontrolled anaphylaxis leads to bronchoconstriction, circulatory collapse, and death. If a patient is transfused with blood or plasma at the time of an attack, it is necessary to immediately stop their supply and replace it with a saline solution. Next, you need to raise the head of the bed and carry out oxygenation. While one person from the medical staff monitors the patient's condition, the other must prepare adrenaline for injection. Corticosteroids and antihistamines can also be used to treat anaphylaxis. A patient suffering from such serious allergic reactions should always carry an ampoule of adrenaline and a bracelet with a warning about possible anaphylaxis or a reminder for the ambulance doctors.
Loss of consciousness
There are many reasons why a person can lose consciousness. The patient's medical history and reasons for hospitalization provide information about the nature of the disorder. Treatment for each is selected strictly individually, based on the causes of loss of consciousness. Some of these reasons are:
taking alcohol or drugs: Do you smell alcohol from the patient? Are there clear signs or symptoms? What is the reaction of the pupils to light? Is it shallow breathing? Does the patient respond to naloxone?
attack(apoplexy, cardiac, epileptic): have there been seizures before? Does the patient experience urinary or intestinal incontinence?
metabolic disorders: Does the patient suffer from renal or hepatic insufficiency? Does he have diabetes? Check your blood glucose levels. If the patient is hypoglycemic, determine if intravenous glucose is required;
traumatic brain injury: The patient has just suffered a traumatic brain injury. Be aware that an elderly patient may develop a subdural hematoma days after a TBI;
stroke: if a stroke is suspected, computed tomography of the brain should be performed;
infection: whether the patient has signs or symptoms of meningitis or sepsis.
Remember that loss of consciousness is always very dangerous for the patient. In this case, it is necessary not only to provide first aid, to carry out further treatment, but also to provide emotional support.
Airway obstruction by a foreign body (suffocation) is a rare but potentially avoidable cause of accidental death.
- Give five blows to the back as follows:
Stand to the side and slightly behind the casualty.
While supporting the chest with one hand, tilt the victim so that the object that has exited the respiratory tract would fall out of the mouth rather than enter the respiratory tract.
Make about five sharp blows between the shoulder blades with the base of the palm of the other hand.
– After each stroke, monitor whether the obstruction has decreased. Pay attention to efficiency, not the number of hits.
- If five blows to the back have no effect, give five abdominal thrusts as follows:
Stand behind the casualty and wrap your arms around him at the top of his abdomen.
Tilt the victim forward.
Squeeze one hand into a fist and place it on the area between the navel and the xiphoid process of the victim.
Grabbing your fist with your free hand, make a sharp push in an upward and inward direction.
Repeat these steps up to five times.
Currently, the development of cardiopulmonary resuscitation technology is carried out through simulation training (simulation - from lat. . simulation -"pretense", a false image of the disease or its individual symptoms) - the creation of an educational process in which the student acts in a simulated environment and knows about it. The most important qualities of simulation training are the completeness and realism of modeling its object. As a rule, the biggest gaps are identified in the field of resuscitation and management of the patient in emergency situations, when the time for making a decision is minimized, and the development of actions comes to the fore.
This approach makes it possible to acquire the necessary practical and theoretical knowledge without harming human health.
Simulation training allows: to teach how to work in accordance with modern algorithms for providing emergency care, to develop team interaction and coordination, to increase the level of performing complex medical procedures, to evaluate the effectiveness of one's own actions. At the same time, the training system is built on the method of obtaining knowledge “from simple to complex”: starting from elementary manipulations, ending with practicing actions in simulated clinical situations.
The simulation training class should be equipped with devices used in emergency situations (breathing equipment, defibrillators, infusion pumps, resuscitation and traumatic placements, etc.) and a simulation system (dummies of various generations: for practicing primary skills, for simulating elementary clinical situations and actions of the prepared group).
In such a system, with the help of a computer, the physiological states of a person are simulated as fully as possible.
All the most difficult stages are repeated by each student at least 4 times:
At a lecture or seminar;
On the mannequin - the teacher shows;
Do it yourself on the simulator;
The student sees from the side of his fellow students, marks the mistakes.
The flexibility of the system allows it to be used for training and simulation of many situations. Thus, the simulation technology of education can be considered an ideal model for teaching care at the prehospital stage and in the hospital.
Medical deontology
It would seem that such words as “doctor”, “paramedic” or, unfortunately, the forgotten phrase “sister of mercy”, on the one hand, and the concept of “deontology”, on the other, should, if not be synonymous, then be in an inseparable logical connections. It would seem ... In reality, everything is not so simple.
In addition to purely medical errors (therapeutic-diagnostic, tactical, etc.), it is customary to note deontological errors as well. They are understood as a violation of the rules of the relationship between a doctor and a patient, as well as between doctors of one or adjacent medical institutions (unfortunately, this happens!), As well as general ethical norms.
The control room is the place where the first meeting, albeit in absentia, between the caller and the ambulance takes place. And it depends on how it happens, whether the challenge will be accepted, if it is accepted, then what order it will receive, what psychological situation the patient will meet with the team. After Professor V.M. Tavrovsky, it turned out that the main thing a person thinks about when calling an ambulance is not to be refused a call. Therefore, to the dispatcher’s question: “What happened?” instead of a specific answer, a lot of unnecessary information “fell out”: about past and present merits, about participation in wars, about attaching to some “prestigious” hospital, etc. It is impossible to interrupt this “turbulent flow”, this will be regarded as disrespect to "merits". And although time was wasted, I had to put up with it. Only after that the dispatcher could proceed to the "extraction" of the necessary information. And in response to the question asked, hear: “What are you interrogating, come soon, you will see for yourself!”. But it is still unknown whether it is necessary to come, especially “quickly”, whether an ambulance is needed. Sometimes the dispatcher was engaged in moralizing, which is generally unacceptable: “Where were you before, why are you only now calling?”
Offering a new system for the control room, V.M. Tavrovsky recommended a completely different dialogue algorithm. The dispatcher must take the initiative "into his own hands", and this can be done by making it clear to the caller that there are no problems with receiving the call. It is clear that when calling to the street or to the apartment, the information about the patient cannot be the same. After the message about accepting the call, a recommendation is given, for example: "Seat (lay down) the patient, give nitroglycerin, if there is no effect, repeat after 3-5 minutes." Now the waiting time will not be so tedious. If the dispatcher is not sure about the need for an ambulance to arrive, he switches the caller to a senior doctor who not only refuses to leave the team, but gives advice on managing the patient and recommends where to go.
So, if the challenge is accepted, the team went to the patient. Upon arrival, the medical worker should in no case start a conversation with dissatisfaction: why didn’t they meet, why did they call, we drove through the whole city, you are not from our district, the 9th floor, and the elevator does not work, etc. All this "verbal garbage" will immediately create a barrier and interfere with the execution main task: to make the correct diagnosis and, in accordance with it, provide adequate assistance.
Particular attention should be paid to the situation when assistance has to be provided on the street, at an enterprise (at the workplace), in other similar points (shop, public transport salon, underground passage) - in a word, wherever a person is, he may need emergency medical care . The best thing that can be advised in this situation is not to pay attention to others and confidently do your job. Do not enter into discussions, do not respond to remarks. It distracts from work, even if the remarks seem offensive. Be above it. It is necessary to bring the patient's condition to transportable as soon as possible, take him into the car and leave this place (if we are talking about the street). After that, all interest in others will disappear.
The issue of hospitalization of a patient from a public place is decided unambiguously - you can’t leave him on the street. But if you don't know where you need to be hospitalized yet, you can drive around the corner, stop, finish the examination if you haven't already done so, and contact the hospitalization bureau.
For the patient and his relatives, hospitalization is, if not a tragedy, then in any case a disaster, especially when it comes to young man who is suspected (or diagnosed) of acute coronary syndrome (ACS). After all, yesterday the patient led active image life, and today he is forced to lie down, reducing his activity to a minimum.
It is necessary to understand the condition of the patient. There is no need for any "horror stories". The effect of them will be opposite to the expected.
Even if the doctor is confident in the diagnosis of ACS and sees that the patient is afraid of this diagnosis as a sentence, you can tell him that there is no heart attack yet, there is only a threat, and in order for it not to develop, you need to do this and that. After such a conversation, you can hope that the patient will follow your recommendations for treatment and the need for transportation on a stretcher. As a rule, the ambulance either does not have its own “workforce”, or it is not enough: the team is mostly women. When deciding on hospitalization, the following dialogue often arises:
- Look for men, we have no one to carry!
We don't have anyone either. You have a driver, we will pay him!
He can't leave the car!
Verbal duel, as a rule, leads to nothing. Try to start the conversation differently: “The patient needs to be carried on a stretcher, you see, we have only women, maybe you can help us find someone, because we don’t know anyone here.”
This is how the conversation should go. No categoricalness, no "stubbornness", a friendly, calm tone. Then you can count on success.
It is important to remember that no reason (narrow corridor, steep stairs, etc.) can justify a violation of the hospitalization procedure, especially when a stretcher is needed. Realizing this, a competent doctor or paramedic will always find a way out: a chair, a blanket, etc.
Here is another situation: when transporting on a stretcher from some floor, relatives (surrounding) may be perplexed why the patient is carried “feet forward”, because he is still alive? In this case, the doctor or any member of the team should calmly, tactfully explain that this is not “feet forward”, but “feet down”. Because if you take it head first, then on the stairs it will be head down, which is not safe for a seriously ill patient. That is why "feet down" and not feet forward.
But here the patient is placed in the car. He may be alone, may be with relatives or colleagues. The patient is experiencing what happened. Agree that any extraneous conversations will rightly be perceived as disrespectful to his condition. Of course, no one requires the members of the brigade to accompany the patient with mournful faces. However, any talk about things that are not related to "this topic" will rightly be interpreted negatively. As a result, the heroic work done on call, at the bedside of the patient by you, by your colleagues, can be leveled. We must learn to empathize!
A sick person, due to his illness, has an altered psyche, he is exhausted by prolonged pains, perhaps by repeated, and even ineffectual, visits to medical offices. "Ambulance" is in a special position. Sometimes they call her without receiving a referral to the hospital from “their” local doctor or without waiting today for a doctor from the clinic ... But you never know what else! Even a conversation with the dispatcher prior to the arrival of the brigade can drive a sick person “out of himself”. And all the accumulated negative emotions will be thrown out on the one who is available, and from whom you can get the most specific and real help.
But here you are “attacked” with a stream of claims to which you have nothing to do. Start immediately "defend" when the patient or relatives are still hot? This energy will involuntarily be transferred to you (mirror effect), you will get involved in a conflict, and it is possible that you will suffer from it. How to be? There is such an approach. Ask the essence of the claim (knowing very well that it is not for you) to state it again, explaining that you did not understand something. (Just don’t interrupt the patient, let him speak. The time spent on this will pay off by preventing a conflict, maybe even a complaint, which will then take much more time to resolve and not one, but several people. Do not forget to reflect this situation in the call card).
You will notice that there will be less emotions. In extreme cases, you can ask to repeat some part of the entire claim again. The conversation will be very calm. You have given the patient the opportunity to "let off steam." This is just one way to avoid conflict. There is a popular wisdom: "Of the two arguing, the one who is smarter is to blame." And since you naturally consider yourself smarter, so try to make sure that the fire does not flare up.
Try to keep the members of your brigade from taking part in this duel. It will be easier for you. Here is the answer to the question: “Is it possible to be offended by a sick person?” Forgive him! He's sick. Leave your ambitions for later.
The provision of emergency medical care at the prehospital stage implies therapeutic measures not only on the spot, but also during the transportation of patients (injured) to the hospital. These features, in contrast to the conditions of a hospital, require additional attention to moral and legal problems. Here are the features.
The extreme nature of the situation requires urgent action, often performed without proper diagnosis (lack of time).
Patients are sometimes in an extremely serious, critical condition requiring immediate resuscitation.
Psychological contact between a medical worker and a patient can be difficult or absent due to the severity of the condition, inadequate consciousness, pain, convulsions, etc. etc.
Assistance is often carried out in the presence of relatives, neighbors or simply curious people.
The conditions for providing assistance can be primitive (room, cramped conditions, insufficient lighting, lack of helpers or their absence at all, etc.).
The nature of the pathology can be very diverse (therapy, trauma, gynecology, pediatrics, etc.).
The listed features of work in emergency medicine create special ethical and legal problems that can be divided into two main groups:
Due to the specifics of the conditions for providing emergency care, as well as due to insufficient familiarity of medical workers with this problem, the rights of patients are often violated.
Errors in the provision of emergency assistance can occur mainly due to the extreme nature of the situation, sometimes due to criminal negligence.
Problems in the relationship between a medical worker and a patient can be built along two lines. One of them is ethical and deontological, when it is simply about the relationship between two people, which are regulated by moral and ethical frameworks, norms. The second line is legal. This is stated in the concept of informed voluntary consent (IDS). The most common causes of violation of the rights of patients in the provision of emergency care: 1) the lack of psychological contact with the patient (injured) and 2) the extreme nature of the situation. Sometimes the first may depend on the second, and more often both factors act simultaneously, which can lead to their mutual reinforcement. Unfortunately, we have to deal with one more factor: 3) ignorance of the patient's rights by the medical worker.
When a wise man was asked from whom he learned good manners, he replied: “From the ill-mannered. I avoided doing what they do." And, finally, the wonderful thought of the French encyclopedist Denis Diderot: “It is not enough to do good, you must do it beautifully.”
APPS
Application No. 1
1. Basic concepts and definitions in emergency medicine
Prehospital stage provision of medical care - the stage of providing medical care outside a hospital type medical institution.
Ambulance Service- public health care institutions, stations (departments) of the "Ambulance" (AMS), providing emergency medical care to the sick and injured at the pre-hospital stage by the mobile teams of the "Ambulance".
Emergency (ambulance) medical care- urgent elimination of all urgent painful conditions that arose unexpectedly, caused by external or internal factors, which, regardless of the severity of the patient's condition, require immediate diagnostic and therapeutic activities.
patient's life-threatening condition- a state of health in which there is an immediate threat to life. Requires a set of urgent measures to restore the vital functions of the body at the site of emergency care and along the way to hospitalization.
condition that threatens the health of the patient- a chronic disease (usually in elderly patients) that does not pose an immediate threat to life, but is fraught with the occurrence of a threatening moment in the near future.
Field brigade "Ambulance"- a doctor or paramedic trained for independent work, having certificates, providing emergency medical care to the sick and injured at the call site and in ambulance transport on the way to the medical institution.
Ambulance Standard- a list of minimally sufficient emergency medical and diagnostic measures corresponding to the level of mobile ambulance teams in typical clinical situations.
2. Regulations on the paramedic
MOBILE BRIGADE
EMERGENCY ASSISTANCE
1.1. A specialist with a secondary medical education in the specialty "General Medicine", who has a diploma and an appropriate certificate, is appointed to the position of paramedic of the ambulance brigade (AMS).
1.2. When performing the duties of providing EMS as part of the paramedic team, the paramedic is the responsible executor of all work, and as part of the medical team acts under the guidance of a doctor.
1.3. The paramedic of the emergency ambulance team is guided in the work by the legislation of the Russian Federation, regulatory and methodological documents of the Ministry of Health of the Russian Federation, the Charter of the ambulance station, orders and orders of the administration of the station (substation, department), this regulation.
1.4. The paramedic of the ambulance mobile brigade is appointed to the position and dismissed in accordance with the procedure established by law.
Duties
The paramedic of the mobile brigade "Ambulance" is obliged:
2.1. Ensure the immediate departure of the brigade after receiving a call and its arrival at the scene within the established time limit in the given territory.
2.2. Provide emergency medical care to the sick and injured at the scene and during transportation to hospitals.
2.3. Administer to the sick and injured medications for medical reasons, to stop bleeding, to carry out resuscitation in accordance with approved industry norms, rules and standards for paramedical personnel in the provision of emergency medical care.
2.4. Be able to use the available medical equipment, master the technique of applying transport splints, dressings and methods of conducting basic cardiopulmonary resuscitation.
2.5. Master the technique of taking electrocardiograms.
2.6. Know the location of medical institutions and the service areas of the station.
2.7. Ensure the transfer of the patient on a stretcher, if necessary, take part in it (in the conditions of the work of the brigade, the transfer of the patient on a stretcher is regarded as a type of medical care in the complex of therapeutic measures).
When transporting the patient, be next to him, providing the necessary medical care.
2.8. If it is necessary to transport a patient in an unconscious state or in a state of alcoholic intoxication, inspect for the detection of documents, valuables, money indicated in the call card, hand them over to the admission department of the hospital with a mark in the direction against the signature of the staff on duty.
2.9. When providing medical assistance in emergency situations, in cases of violent injuries, act in accordance with the procedure established by law.
2.10. Ensure infectious safety (observe the rules of the sanitary-hygienic and anti-epidemic regime). If a quarantine infection is detected in a patient, provide him with the necessary medical care, observing precautionary measures, and inform the senior shift doctor about the patient's clinical, epidemiological and passport data.
2.11. Ensure proper storage, accounting and write-off of medicines.
2.12. At the end of the duty, check the condition of medical equipment, transport tires, replenish those used during work medicines, oxygen, nitrous oxide.
2.13. Inform the administration of the EMS station about all emergencies that occurred during the call.
2.14. At the request of the employees of the Department of Internal Affairs, stop to provide emergency medical care, regardless of the location of the patient (injured).
2.15. Maintain approved accounting and reporting documentation.
2.16. Raise your professional level to improve practical skills.
The rights
The paramedic of the mobile ambulance brigade has the right to:
3.1. Call, if necessary, for help the medical team "Ambulance".
3.2. Make proposals to improve the organization and provision of emergency medical care, improve the working conditions of medical personnel.
3.3. Improve your qualifications in your specialty at least once every five years. Pass certification and re-certification in the prescribed manner.
Responsibility
The paramedic of the ambulance team is responsible in accordance with the procedure established by law:
4.1. For the professional activities carried out in accordance with the approved industry norms, rules and standards for the paramedical personnel of the "Ambulance".
4.2. For illegal actions or omissions that caused damage to the health of the patient or his death.
3. Regulations on the paramedic (nurse) for receiving and transferring calls to the station (substation, department) of the SMP
General provisions
1.1. A specialist with a secondary medical education in the specialty "General Medicine", "Nursing", who has a diploma and an appropriate certificate, is appointed to the position of a paramedic (nurse) for receiving and transmitting calls from the station (substation, department) of the "Ambulance".
1.2. The paramedic on duty (nurse) for receiving and transmitting calls is directly subordinate to the senior shift doctor. He is guided in his work by service instructions, orders and orders of the administration of the station (substation, department) of the SMP, this regulation.
1.3. The paramedic (nurse) for receiving and transmitting calls of the station (substation, department) of the SMP is appointed to the position and dismissed in the manner prescribed by law.
Duties
The paramedic (nurse) for receiving and transmitting calls to the station (substation, department) of the SMP is obliged to:
2.1. Receiving and timely transmission of calls to the personnel of free mobile teams. It does not have the right to independently refuse to accept a call.
2.2. To carry out operational management of all field teams in accordance with the territorial-zonal principle of service, to know the location of the teams at any time during the shift.
2.3. Control the efficiency of the work of mobile teams: arrival time, call execution time.
2.4 Immediately inform the administration of the institution about all emergencies.
2.5. Communicate with local authorities, the Department of Internal Affairs, the traffic police, fire departments and other operational services. Know what to do in case of emergency.
2.6. To inform the population orally about the whereabouts of patients (victims) who received medical assistance.
2.7. Be able to use modern means of communication and information transfer, as well as a personal computer.
2.8. The paramedic (nurse) for receiving and transmitting calls to the station (substation, department) must know:
– city topography;
– dislocation of substations and healthcare facilities;
– locations of potentially dangerous objects;
– call acceptance algorithm.
The rights
The paramedic (nurse) for receiving and transmitting calls from the station (substation, department) of the "Ambulance" has the right to:
3.1. Make suggestions for improving the work of emergency medical care.
3.2. Refresher qualifications at least once every five years.
3.3. Pass certification (re-certification) for the qualification category in the prescribed manner.
3.4. To take part in the work of medical conferences, meetings, seminars held by the administration of the institution.
Responsibility
The paramedic (nurse) for receiving and transmitting calls from the station (substation, department) of the "Ambulance" is responsible in the manner prescribed by law:
4.1. For professional activities carried out within their competence, independently made decisions.
4.2. For the disclosure of information that is a medical secret.
4. The main types of violations of regulations by the medical staff of the EMS
All types of these violations are divided into three groups.
Group A. Violations of moral and ethical rules.
Group B. Violations of legal norms.
Group B. Violations of a mixed nature (moral and ethical + legal).
Group A includes:
violations of elementary norms of culture and professional behavior;
conflict relations between SMP workers;
mutual confrontation between the doctor (paramedic) of the EMS and the patient, provoked by: the EMS team or the patient, his relatives;
mutual confrontation between employees of the SMP and other medical and preventive institutions (HCF), provoked by: health workers of the SMP, health workers of health facilities;
some types of iatrogenic (therapeutic and psychological).
Group B includes:
a combination of these types of ethical and deontological violations with each other, with defects in the treatment and diagnostic process (LDP) and (or) violations of a legal nature (of varying severity).
When applying for medical care and receiving it, the patient has the right to:
1) respectful and humane attitude on the part of medical and service personnel;
2) the choice of a doctor, including a family doctor (general practitioner) and an attending physician, taking into account his consent, as well as the choice of a medical institution in accordance with the contracts of compulsory and voluntary medical insurance;
3) examination, treatment and maintenance in conditions that meet sanitary and hygienic requirements;
4) holding, at his request, a consultation and consultations of other specialists;
5) relief of pain associated with the disease and (or) medical intervention, accessible ways and means;
6) keeping confidential information about the fact of applying for medical care, about the state of health, diagnosis and
living information obtained during his examination and treatment;
7) informed voluntary consent to medical intervention;
8) refusal of medical intervention;
9) obtaining information about their rights and obligations and the state of health, as well as the choice of persons to whom, in the interests of the patient, information about the state of his health can be transferred;
10) receiving medical and other services within the framework of voluntary medical insurance programs;
11) compensation for damage in case of harm to his health during the provision of medical care;
12) admission to him of a lawyer or other legal representative to protect his rights;
13) admission to him of a clergyman, and in a hospital institution for the provision of conditions for the performance of religious rites, including the provision of a separate room, if this does not violate the internal regulations of the hospital institution.
In addition to rights, the patient has responsibilities:
1) show respect in communication with medical personnel;
2) provide the doctor with all the information necessary for diagnosis and treatment;
3) after giving consent to medical intervention - strictly comply with all instructions;
4) comply with the internal regulations of the health facility;
5) cooperate with the doctor in the provision of medical care;
6) immediately inform the doctor about changes in his health;
7) immediately contact a doctor if you suspect the presence of a disease that poses a danger to mass spread;
8) not to take actions that could violate the rights of other patients.
5. Types of responsibility of medical workers
A.P. Zilber divides responsibility into the following types: “Directly or indirectly, all types of responsibility, except moral, are included in legal responsibility, which can be defined as state coercion to“ fulfill the requirements of law ””.
Administrative liability is a type of legal liability for an administrative offense (offence), which is not regarded as strictly as the Criminal Code does.
Disciplinary responsibility is a form of influence on violators of labor discipline in the form of disciplinary sanctions: remark, reprimand, dismissal on the appropriate grounds.
Civil, or civil law, liability is a type of legal liability in which measures of influence established by law or an agreement are applied to the offender.
Criminal liability- This is a type of liability that is regulated by the Criminal Code (CC).
1. Start BRM according to the algorithm described above. If there is only one rescuer and an AED is already available, start BRM by using an AED.
2. Once the AED has been delivered to the scene:
Turn on the AED and apply electrodes to the victim's chest. If there is a second rescuer, continuous chest compressions should be continued during electrode placement (????????);
Make sure that no one touches the victim during rhythm analysis - this may disrupt the rhythm analysis algorithm;
An automated external defibrillator performs an automated analysis of the victim's rhythm according to a specially developed computer algorithm: VF and pulseless VT are recognized as rhythms requiring defibrillation.
If defibrillation is indicated (VF or VT without a pulse), make sure that no one is touching the victim and press the button (in the case of automatic AED operation, you do not need to press the button); after applying the discharge, continue BRM at a ratio of 30:2 without delay; also follow the voice and visual commands of the AED;
If defibrillation is not indicated, continue BRM at 30:2 without delay, follow the voice and visual commands of the AED.
Lateral stable position:
Exist various options lateral stable position, each of which should ensure the position of the victim’s body on its side, the free outflow of vomit and secrets from the oral cavity, the absence of pressure on the chest:
1. remove glasses from the victim and put them in a safe place;
2. kneel down next to the casualty and make sure both of his legs are straight;
3. Take the hand of the victim closest to the rescuer to the side until right angle to the body and bend at the elbow joint so that her palm is turned up;
4. move the second hand of the victim through the chest, and hold the back surface of the palm of this hand against the victim’s cheek closest to the rescuer;
5. With the other hand, grab the victim’s leg farthest from the rescuer just above the knee and pull it up so that the foot does not come off the surface;
6. holding the victim's hand pressed to the cheek, pull the victim by the leg and turn him to face the rescuer in a position on his side;
7. bend the victim's thigh to a right angle in the knee and hip joints;
9. check for normal breathing every 5 minutes;
10. shift the victim to a lateral stable position on the other side every 30 minutes to avoid positional compression syndrome.
Algorithm of measures for obstruction of the respiratory tract by a foreign body.
Most cases of airway obstruction by a foreign body are associated with food intake and occur in the presence of witnesses. It is essential to timely recognize obstruction and differentiate from other conditions accompanied by acute respiratory failure, cyanosis and loss of consciousness.
The algorithm of assistance depends on the degree of obstruction.
With mild obstruction, a person can answer the question “Did you choke?”, speaks, coughs, breathes. In this case, it is necessary to maintain a productive cough and monitor the victim.
In severe obstruction, the person cannot answer a question, cannot speak, may nod, cannot breathe or breathes hoarsely, makes silent attempts to clear his throat, and loses consciousness. A common feature of all variants of obstruction is that if it occurs during a meal, the person clutches at the throat.
In case of severe obstruction with preserved consciousness, it is necessary to perform 5 blows to the back:
Stand to the side and somewhat behind the victim;
Supporting the victim with one hand on the chest, with the other, tilt him forward so that when the foreign body moves, it would fall out of the mouth, and not sink deeper into the airways;
Apply up to five sharp blows with the base of the palm to the area between the shoulder blades;
After each blow, check if the airways have cleared; aim for each blow to be effective, and try to achieve restoration of airway patency in fewer blows.
If 5 blows to the back turned out to be ineffective, it is necessary to perform 5 pushes to the abdomen (Heimlich maneuver):
Stand behind the victim and grab him at the level of the upper abdomen with both hands;
Tilt his body forward;
Squeeze your hand into a fist and place it between the navel and the xiphoid process of the sternum;
Grasp the fist with the brush of the second hand and make a sharp push inward and upward;
Repeat the manipulation up to five times;
If the obstruction could not be eliminated, alternately repeat blows to the back and pushes to the stomach five times.
If the casualty loses consciousness, gently place them on the ground, call emergency services, and begin chest compressions to help expel the foreign body from the airway. When conducting BRM in this case, each time the airway is opened, the oral cavity should be checked for the presence of a foreign body pushed out of the airway.
If, after the obstruction is resolved, the victim continues to cough, difficulty swallowing, this may mean that parts of the foreign body are still in the airways, and the victim should be sent to a medical facility. All casualties treated with blows to the back and thrusts to the stomach should be hospitalized and examined for injuries.
==================================================================