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Materials to prepare for classes students

June 10, 2024

Materials to prepare for classes students.

Lesson 1. Premedical aid, principles of, consistency and legal aspects. Cardiopulmonary resuscitation, algorithms (protocols) of CPR. Terminal states.
Restoring airway affected in different situations.

The main purpose of emergency and urgent care in the premedical phase is save, save lives and support of vital functions and patients with impaired respiration and circulation, as well as victims of injuries and poisonings. Moreover, premedical aid provides a relatively inexpensive aid to the injured, which is relatively hope for their survival.
According to the Law of Ukraine “On emergency medical assistance” from 05.07.2012 № 5081-VI, which defines organizational and legal basis for citizens of Ukraine and other persons who are within its territory, emergency medical care, including during emergencies and response, and principles for the creation, operation and development of emergency medical care.
In this Act, the following terms have the following meanings:

1) brigade emergency (emergency) medical care – a structural unit of the station emergency (emergency) medical center or emergency medical care and emergency medicine, whose task is to provide emergency medical assistance to a person in emergency conditions directly at the scene and during transportation of such person to health institution under this Act;

2) emergency medical care – urgent message about the human condition and place of events and / or address the need for emergency medical care by a single telephone call emergency medical assistance or 103 for a single telephone number of emergency population 112;

3) emergency department (emergency) medical care – a unit of a multi-hospital, in which the clock is provided for emergency medical care;

4) premedical help – Urgent action and organizational measures to save and preserve life in emergency conditions and minimize the effects of this state of her health, carried out at the scene by persons who have no medical training, but their service responsibilities should have basic practical skills of rescuing and preserving human life, which is in urgent condition, and according to the law are required to undertake such activities and events;

5) emergency medical care – medical care, which is the employee of emergency medical care in accordance with this Law urgent organizational, diagnostic and therapeutic measures aimed at saving and preserving life in emergency conditions and minimize the effects of this situation on her health ‘ I;

6) scene – the area office or any other location of the person in emergency conditions at the time of emergency medical care;

7) immediate human condition – a sudden deterioration in physical or mental health, which poses a direct and imminent threat to life and to human health or the surrounding people and is caused by disease, injury, poisoning or other internal or external causes;

8) point permanent base brigade emergency (emergency) medical care – location brigade emergency (emergency) medical care and specialized sanitary transport, adapted and equipped for its work around the clock;

9)Temporary deployment brigade emergency (emergency) medical care – a place of temporary stay brigade emergency (emergency) care to ensure timely provision of emergency medical care, including during events and activities involving persons on which the public health ;

10) system of emergency medical care – a set defined by this Law healthcare institutions and their structural units that provide the organization and provision of emergency medical care, including during emergency situations and liquidation of their consequences;

11) specialized ambulances – equipped with special light and sound signaling devices vehicle designed to transport people in emergency conditions and equipped to provide emergency medical care in accordance with national standards for this type of transport.
In the materials to prepare for classes can meet the terms “pre-medical”, “emergency”, “first aid “ which in this instance is analogous term “premedical aid».

GENERAL PRINCIPLES:
Emergency aid
Prehospital
Often emergency aid to victims accounted provide in extreme situations, when there are additional factors that threateot only the victims but also their rescuers. In such cases, medical personnel should observe the following principles:
– Inspect the scene.
– Conduct initial review of victim and give him emergency medical care for a condition that threatens his life.
– Conduct a secondary survey of the victim and, if necessary, to assist him in identifying other problems.
Overview scene
Once you’ve determined what happened and prepared to act, make sure that no danger to you, your employees and others.
When you spend viewing the scene, pay attention to everything that can threaten your safety. If necessary, seek appropriate professional rescue service or police.
Try to determine the details that you might suggest events and causes injury. These details are especially important if the victim is unconscious or witnesses are not available.
Must have to determine whether at the scene of other victims.

Initial review (ABC)
The primary survey is identifying conditions that threaten the life of the patient for emergency surgery to restore vital body functions.
Initial review begins with the definition of victim consciousness and includes the following elements:
A (Airway) – airways, including immobilization of the cervical spine.
B (Breathing) – Breathing.
C (Circulation) – Circulation.
A. airway
Evaluation and, if necessary, support airway conscious damaged cervical spine is made very carefully and with caution.
1. Ensure airway:
– Clean finger or suction mouth;
– Let down your head and lift the chin;
– Extend and anchor your tongue.
2. Maintain airway:
a) orofarenhal intubation;
b) nazofarenhal intubation.
Indications for intubation:
– Apnea;
– Risk of aspiration;
– Threat or presence of respiratory failure (damage to the respiratory tract, maxillo – facial injury);
– Closed head injury;
– Hypoxemia, despite carrying oxygen therapy;
– Respiratory rate less than 7 or more than 40 for 1 minute (adults);
– The threat of respiratory and cardiac activity (sepsis, severe burns).
Violation of consciousness, no obvious signs of damage to the cervical spine, mouth, pharynx held orofarenheal intubation. Adults input tube of large diameter (7.0 – 8.0 mm).
If the damage of the cervical spine, trauma of the mouth, pharynx and preserved consciousness to spend nazofarenheal intubation.
3. Creating artificial airway:
– Prehospital for creating auxiliary respiratory tract mainly used krykotireoideotomiyu (konykotomiya).
Krykotireoideotomiya – krikotireoidnoyi cut ties (approximately 2 cm), the introduction and fixation of the cannula tube. Progress in adults (after age 12) in the following cases:
– Big facial injury that does not allow laryngoscopy;
– Obstruction of the upper airway as a result of swelling, bleeding, or foreign body;
– Failed endotracheal intubation.
Koniyotomiya
Can be used as an alternative krykotireoideotomiyi. But it is a temporary measure that can provide adequate ventilation only for 30 minutes. Children younger than 12 must mainly before krikotireoideotomiyeyu.
Performed by puncture krikotireoidnoyi ties 5 ml syringe with anhiokateterom 12 – 14 caliber and joining the cannula catheter adapter 3 mm pediatric endotracheal tube. With the Y-shaped adapter can be given oxygen through a tube and adapter with speed of 15 l / min.
4. Control of the cervical spine:
considered one of the main activities in providing airway.
If no means for immobilization must perform manual extraction and fixation.
The patient must be conducted as a victim of whiplash injury (to X-ray examination) if:
– On physical examination revealed changes in the vertebrae or the patient feels pain in his back.
– The patient received blunt trauma above the clavicles, has damaged several organs, or impaired consciousness as a result of trauma or acute poisoning.
– There maxillo – facial trauma.

B. Breathing and ventilation:
Assessment of the lung, chest and diaphragm:
1. Tense pneumothorax – decompression by puncture needle to the catheter, followed by thoracostomy.
2. Pathological chest mobility – fractures of several adjacent ribs. The risk associated with lung injury.
3. Massive hemothorax – puncture or drainage of the pleural cavity.
4. Open pneumothorax – occlusive dressing, puncture or drainage of the pleural cavity.
5. Dynamic control – monitoring of respiratory rate, oxygen therapy.

C. Circulation
Assessment of central and peripheral hemodynamics.
The most common complication is a shock:
– Bleeding (most often);
– Kardiohenyy: tamponade, myocardial injury;
– Neyrohenyy: spinal cord injury;
– Septic (rare in acute injuries);
It may also be associated with intense pnevmatoraks by reducing venous return to the heart.
By the classification of hemorrhagic shock can be:
Class I – Weight <15% of blood volume (CBV). Symptoms of blood loss is not pronounced or absent.
Class II – loss of 15% -30% BCC. There tachycardia, anxiety.
Class III – loss of 30-40% of BCC. Tachycardia, pallor skin, lethargy, lowering blood pressure.
Class IV – loss> 40% of BCC. Severe cardiovascular collapse, consciousness disorders. Treatment of central and peripheral circulation in accordance with the relevant protocols.
Advanced primary examination (ABC + DE)
D. Neurological Disorders (Disability)
Short neurological examination.
1. Assessment of consciousness.
Based on the patient’s ability to respond to health worker:
– Patient accessible to contact;
– Reacts to loud noises;
– Responds to pain;
– Does not respond to any stimul.
A more in-depth assessment of consciousness held during secondary inspection. Assessment of the patient is determined by Glasgow (Appendix 2).
2. The cause neurological disorders may be:
– Closed head injury;
– Hypoxemia;
– Shock;
– Acute poisoning;
– Meningitis, encephalitis.
E. Additional survey (Exposure)
Related to three things:
– Examination of the patient after stripping;
– Monitoring and instrumental examination;
– Medical history.
1. Undress the patient:
– Completely remove clothing, jewelry, etc.;
– Note the presence of additional violations that may lead to a deterioration of the patient (bleeding, fractures, etc.).
2. Monytoryng and instrumental examinations:
– Ventilation and oxygenation;
– Definition of pulse, blood pressure measurement, ECG monitoryng.
3. Collecting history:
– Allergic reactions;
– Medication;
– Carried diseases;
– Last meals
– Immunization against tetanus;
– Use of alcohol;
– In the circumstances there was an accident.
Secondary Review
Secondary assessment of the patient is a survey “from head to toe,” conducted after the implementation of urgent measures to restore vital body functions.
Examination of the head and neck starting from the back of the neck of the 7th vertebra with the transition to the surface of the head, face and front of the neck with a test of the collarbone and shoulder blades. The attention to any deviations from normal: lumps, bumps, open sores, depression, skin color, its temperature, humidity, the presence of bleeding and spinal fluid discharge from the ear canal and nasal passages. If marked neck pain on palpation or neck movements must apply a Immobilizing collar.
A survey carried out by methods of chest palpation and auscultation. Particular attention is paid to the symmetry of the respiratory movements, signs of blunt or penetrating trauma. An examination of the abdomen spend his palpation and auscultation, excluding the presence of penetrating wounds and intraabdominal bleeding. Examination of the musculoskeletal system of the lower limbs begin and finish the survey back. Inspect all limbs. Often you caot pay attention to the individual fractures, especially when combined injuries. Sometimes remain unrecognized fractures of the pelvis until the patient when trying to move will not feel pain. Particular attention should be paid to the presence of even a suspected spinal injury. Such patients are necessarily fixed on a long conveyor board.

Providing premedical aid in case of accidents.
Premedical help – a collection of simple, appropriate action to preserve the health of the victim. In providing assistance premedical must be guided by the following principles: accuracy and appropriateness, speed, thoughtfulness, determination. peace.
Those who provide first aid should know: the main signs of the vital functions of the human body, the general principles of first aid and its methods to the nature victim received injuries.
A person who provides first aid should be able to:
assess the condition of the victim and determine the kind of help in the first place, he needs;
provide artificial respiration “mouth to mouth” or “mouth-to-nose” external cardiac massage and assess their effectiveness;
temporarily stop the bleeding overlay harness, thick headbands, finger pressing the blood vessels;
apply a bandage in case of damage (injury, burns, frostbite, shock) to imobilizate damaged body part fractures, severe impact, thermal impression;
to assist in heat and sunstroke, drowning, nausea, loss of consciousness;
use handy tools for carrying, loading and transportation of the victim, to determine the need for removal of the victim ambulance or passing traffic, use the first aid kit.

Sequence First Aid: eliminate impact on the factors that threaten the health and life of the victim (release of the electric current, to make from the contaminated zone, extinguish burning clothing, remove from the water), to assess the condition of the victim;
determine the nature and severity of injuries are the biggest threat to the life of the victim and the sequence of steps to his rescue;
perform necessary measures to save the victim in order of urgency (to free the airway, make artificial respiration, external cardiac massage, stop bleeding,to immobilizate location of the fracture, apply a bandage, etc..)
maintain basic life functions of the victim before the arrival of the medical officer;
summon an ambulance or a doctor or take measures to transport the victim to the nearest medical facility.
Reanimation consists of two main procedures: restore breathing (artificial respiration) and heart activity (external cardiac massage).
The purpose premedical assistance are:
– Save the life of the victim;
– The elimination or reduction of damaging factors (factors);
shock, wound infection, secondary damage of soft tissue, nerves, blood vessels, bone fragments, etc. Activities that temporarily inhibit further development of complications that threaten the lives of victims of such serious consequences lesions as bleeding, asphyxia.
On how quickly will the bleeding stopped, removed or asphyxia introduced antidote (remedy for poison) in lesions of toxic substances depends on the future life of the wounded (affected).

By premedical aid include the following measures:
1. Pulling wounded (damaged) with automotive and other equipment from the rubble and other various places of residence, including pulling out of the water.
2. Extinguishing burning clothes (skin care) and incendiary mixtures, burning the body.
3. Putting a gas mask and protective skin on the infected areas and toxic substances entering antidote (antidote).
4. Removal of asphyxia (clearing upper airways from foreign matter, broken teeth, mucus, blood, pouring water, keeping the tongue with a napkin in his retraction, etc.).
5. Exemption from parts of compressive garments.
6. Artificial respiration and closed cardiac massage in the absence of cardiac activity and respiration.
7. Overlay occlusive dressings (one that seals) on the chest with an open pneumothorax (penetrating chest trauma) using polyethylene film or rubberized shell from package dressings individual.
8. Stop bleeding by different methods.
9. Overlay aseptic dressings on a wound or burn the surface.
10. Introduction intra-muscular analgesic substances pre-filled syringes or syringe.
11. Immobilization of limbs and other parts of the body that have been damaged (fractures, wounds and burns), using improvised and otherwise (unless you personally need to transport the victim to a medical facility).
12. Providing the body affected physiologically advantageous position.
13. Warming affected, watering it with water or alkaline-saline.
14. Direct contact with the victims, his belief in the success of the rescue.
Along with providing premedical aid should immediately call “ambulance”: independently in providing premedical aid or ask it to perform other witnesses an accident that you help.
15. Transporting the victim to medical facility if you can not call or visit “ambulance”.

1. PRINCIPLES FOR ASSISTANCE PREMEDICAL
The main principles are as follows:
1. Inspect the scene and find out:
• whether it is safe you
• what happened (will anticipate what were traumatic factors which are likely to damage the victims and their severity)
• how many victims
• is able to help you around.
The main rule is – provide assistance only in a safe environment for you. If you are in danger and you are not able to provide a safe environment – no nearer to a victim! Instantly call “ambulance” (phone 103) and rescue service (call 101), if possible, maintain contact with victims, give tips for self care. Your actions should not increase the number of victims of the accident.
2. Conduct initial review of victim and give him at MIT condition that is life threatening.
3. Call the “ambulance”.
4. Conduct a secondary survey of the victim and, if necessary, to assist in identifying other injuries. Should continuously monitor the victims, maintain contact with him and soothe the arrival

“First”.
5. If the arrival of “ambulance”, or other services that are required to participate in the organization of aid in case of accidents, accidents or disasters is unlikely – to ensure the conditions for transporting the victim to a medical institution.

2. REVIEW AND SEQUENCE Victim Assistance
With immediate treatment and resuscitation in many cases can be prevented and eliminated pathological changes developing in the body in terminal patients, and to save the patient (victim).
For resuscitation of the patient, in a state of clinical death, above all measures should be aimed at combating hypoxia and functional recovery of pulmonary and cardiovascular systems. Science of quickening the body, prevention and treatment of terminal states called resuscitation. There are two levels of resuscitation: basic and specialized. Basic resuscitation is the first step in providing assistance, the main elements of which are formulated in the 60 years of the last century P. Safar (Professor, University of Pittsburgh):
A – airway (airways) – providing airway.
B – breathing (breathing) – artificial ventilation.
C – circulation (blood flow) – indirect heart massage.

Approach to the affected
When approaching the victim talk to random witnesses, rescue or police what happened, or the scene is safe as there are victims.
If the scene, you feel connected with criminal activities, then immediately call the police if required intervention of rescuers – please rescue service. In all cases, if there was a crime, or used violence, law enforcement agencies must first ensure the safety for medical rescuers.
If there is no information, act independently, especially paying attention to anything that might threaten your security: the place should fully explore. If there is the slightest threat (containers marked with special signs, spilled liquid, smoke, fog, fire, and other natural gas, electric power wires, explosive objects, objects that may fall from the top, etc.) think about whether you can it yourself without personal risk to eliminate, if not, stop traffic to the victim, call rescuers. In this situation it is necessary to maintain verbal contact with the victims to find out his concern and give him advice on self-and mutual aid.
If you decide to approach the victim, along find out for yourself what happened to predict the mechanism of injury and tune the technology of care.
Pay attention to all the details of the scene, constantly monitors the scene because in the end may be additional risks that cause you to save not only the life of the victim, but also their own. The priority remains his own life, then the patient’s life, then – for all others.

Find out if you need further assistance or additional tools?
When you approached the victim and it is conscious, try to calm him down and first tell me, who are you, explain that you know how to provide premedical aid and offer their services. If you will permit the victim, explain what you want to do. If the victim is unconscious, consider that you have the right to give it a premedical aid.
Remember that the victim may refuse your service! However, if his condition is serious, but the reason for the refusal, in your opinion – mental disorders, premedical aid should provide.
When the victim is a child, you must ask permission from people who accompany it (parents, relatives, and others.). If the child is unaccompanied proceed to provide premedical aid.
If the victim refused your service – maintain contact with him, calling “ambulance”.
Help victims should be provided quickly and efficiently, but deliberately and consistently. The sequence depends on the correct assessment of the victim, identify the main lesion, which is most threatened in this time of his life, which immediately conduct initial review by the ABC method of no more than 40-60 seconds. Initial examination
Come to the victim when possible because of the head. First visually assess the patient’s condition in general (age, sex, body morphology, language, color of skin, posture, presence movements (chest, extremities), facial expressions, eye condition, visible lesions traumatic factor), make initial conclusion about its severity and algorithm further assistance.
Find out the state of consciousness algorithm AVPU:
A – Alert (awake, gives adequate answers to questions can perform conscious actions – at the request of the medical rescue);
V – Responds to Verbal stimuli – responds to voice, or rather the loud sound of the ear;
P-Responds to Pain – responds to pain (pinch under the skin in the area of the left pectoral muscle with the rotation of about 360);
U – Unresponsive – unconscious.
If you suspect a simulation fainting expand 2 and 5 fingers forever. The patient, who is conscious, must strain the muscles of eyelids and they resist with stress.

If victim conscious, ask him: “Do you need help?” If the answer is no – check your reaction to pain – squeeze trapecy muscle (Fig. 1).

Fig.1. Test pain reaction of the victim (compression trapecy muscle).

No response may be indicative of fainting (swoon, coma) or biological death. If a person has fainted, painful irritation often return her to consciousness. Coma indicates profound central nervous system. Timely resuscitation can save lives so affected. Coma should be immediately distinguished from biological death, if any further rescue actions are not carried out.
The signs of biological death is corneal drying, which marked a symptom of “cat” eye (Figure 2), rigor (property of the body), the appearance of dead men’s spots on the skin (due to the flow of blood in these areas were slain – bluish-purple color).

Fig. 2. Symptom “cat” eye in the body due to corneal drying (A – a living human cornea, B – dry cornea in the body, B – Liners cornea while pressing on the eyeball in the body).

2. If you have more data because the human coma continue to review and follow steps A (Airway) – Ensure patency of the upper airway. A priori, we assume that brain injury occurs when motor accidents, sports injuries, falls from heights, injuries on the water, as well as injuries of children.

Fix the hands cervical spine in the position in which you found the victim
If the situation is not conducive to providing breathing, gently turn the victim on his back, or in a position that is close to a stable (on the side) Begin initial review by the method A, B, C (optimal deadline – 10 s), and assess whether to conduct an audit mouth. At current discharge (blood, vomit, foreign objects (depending on the mechanism of damage) should reveal the oral cavity (between the molar teeth should put struts to prevent accidental squeezing fingers), remove foreign bodies holder with suction pad or provide toilet mouth and pharynx, release them from the discharge (if there are multiple affected then the priority is their location by terrain head down), let down your head and lift the chin, with a suspected head injury head throw forbidden, should raise the chin.
• Rate of respiration and heart rate (less than 10 seconds)
In the presence of extraneous fluids (blood, water) head and torso turning to the right or left side, the index finger is pulled down the corner of his mouth, which facilitates self draining mouth. For the partial closure of the upper airway tongue that fuse, or a foreign body is typical noisy breathing crescendo during inspiration when every attempt to inhale involved neck muscles, intercostal space and the abdominal wall. respiratory sounds but not listening and not feel air movement.

Figure. 3. Toilet mouth.

Planting pillow under the head of the victim or other items is strictly prohibited (completely covers the trachea).
Cast the head back and lift the chin (Fig. 4), while the tongue stops to close the back of the windpipe, letting air into the lungs. If you suspect a head injury and neck need gentle manipulation of the head and cervical spine, and ensure the airway is possible by giving the lower jaw forward without throwing the head (Fig. 5).

Fig.4. Securing the airway by throwing the head and lifting the chin in case if there is no suspicion of head trauma and neck.

Fig.5. Securing the airway by nominating the mandible forward with suspected head injury and neck (A – side view, B – top view).
Figure 6 illustrates the mechanism of partial airway obstruction in unconscious person lying on the back (A), complete obstruction at planting under the head of different subjects (B, C) and restoration of patency at maximum recording head back and lifting the chin (D, E , E). It is believed that the road accidents, fall from height, injury to water and sports injuries to the victim is a head and neck lesions.

Fig.6. Airway in unconscious at different positions of the head.

Remember, when the victim is unconscious and lying on his back, by relaxing muscles tongue in most cases falls, blocking the air. Man dies from asphyxiation!
3. Take a step in (Breath) – check for breathing (Blood) – severe bleeding. Zoom in closer to your face to the mouth and nose of the victim, hear the noise and feel the air outlet, which is wetter and warmer. This watch lifting and lowering the chest. Do this for a full 10 seconds (Fig. 7).
Do not use a mirror, feather or thread to check for breathing!

Fig.7. Determination of respiration visual, auditory and tactile method for 5 seconds.

In the absence of respiratory movements, as well as frequent and shallow breathing signs of hypoxia (bluish skin and mucous membranes) must perform two full blowing through the mouth, and then – to mechanical ventilation.
Simultaneously, we should pay attention to the presence of excessive bleeding, especially arterial. It should be stopped as soon as possible. Sometimes it is possible internal bleeding. External and internal bleeding can lead to shock, which occurs with the loss of blood, characterized by pallor and chill to the touch skin, lack of pulse at the radial artery and necessitates performance on stage premedical aid antishock measures.
4. Take the last step C (Circulation) – determine the presence pulse, heartbeat and signs of shock. If a person breathes – there is no need to define the pulse. Once you find the point (left or right in the hollow of the neck serving the throat) detects the presence of pulse oscillation for a full 10 seconds. No pulse requires you to perform both mechanical ventilation and closed heart massage – cardio-pulmonary resuscitation. In doubtful cases it is possible listening heart tremors, putting his ear to the chest. Significant speed up and then slow heart rate, content of which is not uniform or gradually weakened, along with frequent and shallow breathing also points to the need for artificial respiration and closed cardiac massage
Signs of life are not determined by changing the position of the body. If the victim no pulse and breathing or difficult to test without changing the position of the body is made turning back, keeping your head so that the head and spine are on the same axis (Fig. 8).

Figure. 8. Technology turning the victim on his back

During the initial examination is injured or in a situation in which you found, or upside down on his back. If found unconscious victim breathes position and no other injuries – the arrival of his “first aid” should not be moved, it is necessary to maintain a state of immobility in the head and neck. If unconscious victim, flipped on his back, marked pulse and respiration, no bleeding – must be converted into a stable side position in which the tongue does not close the airways, vomit, mucus and blood can freely leave mouth (Fig. 9, 10)

A B

Fig.9. Vehicles turning into stable side position unconscious victim with current pulse, breathing and lack of bleeding, shock: put your left hand under the neck of the victim, right opposite leg bent at the knee (A), with one hand supporting the head and neck, and pull the victim over (B ), put it on its side so that the head lying on the outstretched hand and leg was bent at the knee at a right angle. Victim must constantly monitor because provision is to ensure a stable airway, but not sustainable.

Figure. 10. The appearance of the victim in stable position

In the absence of communication and people. How can you help to economically turn the victim on his stomach, respecting property axis of the body, under the forehead and put a bowl of rollers wear (Fig. 11). In this position the unconscious victim may be left temporarily unattended.

Figure. 11. Terms unconscious victim, where it can be left temporarily unattended

Alongside with initial examination and measures first medical aid, should call “ambulance” timely appearance of which significantly affect the amount of assistance that you have done.
Before the arrival of the “fast” should conduct a secondary review – a review that is to identify problems that are not directly pose a threat to life of the victim, but can have serious consequences if left unattended and providing premedical aid.
First you determine the general condition of the victim as satisfactory, moderate or severe.
Criteria for assessment of the affected
Criteria will be affected
mild severity moderately severe
The reaction of the lamination of the eye affected by verbal command in response to painful stimulation inability to self-flattening completely
Language contact speaks fluent with difficulties not speak at all
Consciousness is clearly overshadowed No
Followed to assess the presence of external damage (location, size, presence of wounds and burns, deformities of limbs), and the ability of independent (active) movements in the injured extremity joints and passive – with your help. It tells you on the need for other measures .

METHODS revival affected.

EVENTSCardiopulmonary resuscitation
With no signs of breathing and heartbeat of life of the victim can be saved if possible to restore and maintain breathing and circulation.
Replacing the air in the lungs – the result of periodic respiratory movements with a frequency of 25-30 times in 20 seconds. They Occur by reducing, respiratory muscles that raise the ribs to a horizontal position, which expands the chest cavity and provides admission of air into the lungs through the airways. Exhalation occurs passively, ie through, relaxation of respiratory muscles (including the diaphragm) and decreasing chest. In the mechanism of regulation of pulmonary respiration (frequency and depth) are leading special nerve centers that are positioned in the brain. In severe conditions immediately by cessation of breathing usually occurs within minutes cardiac arrest and clinical death occurs. This period, lasting 3-5 minutes. During which a prolonged minimum gas exchange and other metabolic processes and man you can still revive, if a CPR and restore cardiac function (heart massage).
Skin pale or cyanotic sharply, marked lack of muscle tone.*Signs of clinical death: heart is not beating, there is no breathing and consciousness, pupils dilated and unresponsive to light
Step 1. When after securing the airway (head thrown back or push the lower jaw forward and held toilet mouth) states that the victim no breathing – just doing 30 clicks on the breast in the middle third in 20 seconds, after 2 full injection method ” mouth-to-mouth “the lungs of the victim. Thus fingers of one hand close nose victim on the mouth put handkerchief or a piece of bandage, tightly cover the affected lips his lips and perform 2 full injection. After four such cycles evaluates the effectiveness of your actions.
Often there is a psychological barrier between rescuers and victims caused by poor hygiene in this procedure. This is a natural reaction of a person. To overcome it using special tools that isolate body rescuer and victim – protybakteriyni filters, and better – breathing masks. Therefore it is appropriate that the man who took a first aid course at all times wore one of these vehicles. Also according to the recommendations of the European Resuscitation Council priority is to click on the chest rather than blowing air.
Difficulty of injection into the lungs often arise from obstruction of the upper airways. Under these circumstances it is necessary to improve their patency – even harder to throw your head back and push the lower jaw forward and again perform 2 injection. If now you caot breathe – decision to obstruction of the respiratory tract, which can often be caused by the presence of a foreign body.
Removal of foreign body from the upper respiratory tract. Accidental contact with a foreign body in the airways may, for example, the conversation during the meal. If the obstruction is partial, does not prevent a person cough and then the foreign body can get itself. A person who can cough or talk, getting enough air to breathe. If the victim barely breathing, his cough is very weak and he caot talk at all, it is necessary to provide assistance as the complete obstruction of the airways. An important feature of asthma is forced gesture when a person with one or two hands gripped the throat (Fig. 23) In this case, you must be behind on the victim (who may lose consciousness and fall), firmly embrace his hands at under ribs, making them the castle (Fig. 24), give a command “breathes” and at this point squeeze the upper abdomen (Fig. 25). Harsh airflow can push a foreign body, which must be immediately removed from the mouth. The above method is called by the author – receiving Gaymliha.

Fig.23. The appearance of human airways which blocked foreign body

Fig. 24. Placing hands before pressing the upper quadrant of the human airway obstruction

If no effect on the injured your eyes blue and faints. The procedure to remove the foreign body should continue. Unconscious in the same way cover at the chest, making compression (Fig.26) or forward through the thigh, back of a chair or other similar object, hit his hands on the back between the shoulder blades and try to remove the foreign body mouth fingers.

Fig 25. The reception Gaymliha.

Fig. 26. Methods of removing a foreign body fainted at the sight of your victim.

So you can save a person or heart escape entirely accidental death.
If the victim with signs of upper airway obstruction fainted, not breathing, you must sit astride the hip and injured 5 times palms sharply pressing on his stomach in the upper part, making pushing toward the bottom up (Figure 27).

Fig. 27. Admission removal of foreign body in the victim unconscious.

After 5 aftershocks, performed revision oral foreign body is removed and again performed CPR. The cycle is repeated to ensure a patent airway and efficient two breaths.
In children, the technology to assess the presence of breath is the same as in adults. In his absence, carried 5 inspires, with lifeguard covered her lips and mouth and nose of the child victim. When failure – the decision about the presence of a foreign body in the upper airway. They remove the child performed as follows: a) The child is placed on his forearm head down and do 5 hits hand to interscapular region (Fig. 28), b) shift the child.

Figure. 28. Removal of foreign body from the upper airways in children under 1 year.

hip little face upwards to a 30 press the breasts (depth 2 cm) in area 1 cm below mizhsoskovoyi line c) carefully remove extraneous articles of airway d) perform 2 injection.
Step 2. If there is no pulse start cardiopulmonary resuscitation (CPR and indirect heart massage).
Measures of cardiopulmonary resuscitation should begin without delay, immediately at the scene, and the sooner they start, the more chances for further successful treatment. At a delay resuscitation is often possible to restore the function of the respiratory and circulatory system, but as a result of oxygen starvation of the brain cells following their death – decortication.
Artificial lung ventilation. Frequent and shallow breathing until the absence of respiratory movements of the chest at least 2 and up to 8 for 10 s), along with common respiratory symptoms (bluish skin and mucous membranes, speeding up, and later infrequent, irregular filling pulse, convulsions, loss of consciousness) is indicated for the secondary or mechanical ventilation, before stopping breathing and cardiac activity and the onset of collapse (sudden drop in blood pressure).
kneels at the head of the victim, with one hand holding it in the most abandoned back position, thumb second hand pulls the lower jaw (Fig. 29)., ,Anyone who assists Then it makes a deep breath, either directly or through cheesecloth tightly covering the patient’s mouth his lips and makes a complete exhalation (part vid1 children up to 8 years, easy for children under 1 year), while watching the expansion of the chest. To prevent release of air through the nose clamp affected his fingers, which is located near the forehead to hold the head in a ghost position. Output air is passively by spontaneous decay and reduce the volume of the chest of the patient.

Fig. 29. Methods of mechanical ventilation by “mouth-to-mouth” (A – injection with simultaneous control of lifting the chest, B – passive exhalation).

Little baby breathe air at once, his mouth and nose, holding them with his lips.
Important in carrying out artificial respiration rhythm is blowing performance: adults – 4 second cycles – rescuer breathes air into itself, for 5 – blown into the victim (for 1.5 s), children under 8 years – 2sekund bars – rescuer breathes air a, 3 – blown into the victim (for 1.5 s).
When the victim appear open or closed injuries of the lower and upper jaws used method of mechanical ventilation “from mouth to nose.” Chairman alleged victim as possible and held with one hand, which lies at its crown, the second hand to slightly raise the lower jaw and close the mouth (Fig. 30). Anyone who assists, makes a deep breath and his lips tightly covering nose victim – is blowing air. If chest fall from enough mouth affected during exhalation air slightly open.

Figure 30. Methods of mechanical ventilation by “mouth-to-nose.”

The most common mistake during artificial respiration by these methods is the lack of throwing heads, thus not restored airway and air is blown, into the stomach of the victim.
From frequent respiratory movements whoever assists may experience dizziness and weakness, then it is advisable to replace. Injection of air should be long and hard. Performance indicators ventilation is seen expanding the chest with air injection, redness of the skin and restoring independent breathing (chest victim rises in time with the breath).
In general, the technological features of mechanical ventilation can be submitted the following table.

Closed cardiac massage.

When you stop or a very sharp weakening of cardiac blood flow through the vessels stopped. The main features of cardiac arrest: swoon (loss of consciousness), the lack of pulse, including the carotid and femoral arteries, respiratory arrest, pallor or cyanosis of the skin and mucous membranes (lips), dilated pupils, convulsions, which may appear at the time of loss of consciousness and be the first visible sign to others cardiac arrest. The essence of closed cardiac massage is rhythmic compression between his sternum and spine. When pressing on the breast of blood ejected from the cavities of the heart: from the left ventricle into the aorta, and then – in the artery from the right ventricle – the pulmonary artery. After the cessation of pressure on the chest cavity of the heart filled with blood again.
The victim put her back on a firm footing. Anyone who assists, becoming the side and palms of hands without bending them (Fig. 31 A) (bases of palms, not fingers!), Superimposed on each other (Fig. 31 B), click in the middle of the sternum (Fig. 31 B) whole body body at 30 taps per 20 seconds. This hand is not detached from the surface of the chest . The amplitude of the chest in an adult is about 4-5 cm (Fig. 31 D).

Figure 31. Technique of closed cardiac massage

Children 1.8 years closed cardiac massage should be done with one hand (Fig. 32) at 30 clicks for 20 s, and infants – the tips of the thumb, at 30 taps per 20 s (Fig. 33). Point fingers applying for children under 1 year – on one finger width below the nipple line between. Caution should be carried out heart massage in the elderly, because the rough performed massage can be rib fractures.

Fig. 32. Technique of closed massage child 1.8 years.

Fig. 33. Technique of closed massage baby up to 1 year.

Рис. 34.Cardiopulmonary resuscitation one lifeguard.

Рис. 35. Cardiopulmonary resuscitation by two rescuers.

The indicators of effectiveness of cardiac massage is appearance rate in large arteries (carotid, femoral) pupillary constriction the appearance of weak respiratory movements.
Remember that even the right of external cardiac massage may lead to fracture of the ribs in the area of cartilage that is not considered serious complication. Much more serious may be fractured sternum when you click on the upper part or ruptured liver – the bottom. Lateral displacement hands can damage the lungs.
If after 30-40 minutes from start cardiac massage and ventilation cardiac activity is not restored, the pupils are wide, there corpse spots on the skin and corneal opacity, a sign of the onset of biological (real) death, resuscitation can be stopped.
Signs of effective resuscitation: pupillary constriction, normalization of skin color, sensation under the fingers of arterial pulsations synchronous with massage, sometimes even determined blood pressure. In some cases, it may restore cardiac activity.
This stage resuscitation should be performed continuously, until the arrival of a specialized medical team.

Basic resuscitation with the following sequence:
1. Before providing assistance, make sure that you victim-
enabled and other persons not present danger.
Remember: You need to save lives, but not at the cost of their own!
2. If the place is safe, determine whether in the minds of the victims – Both-
Supervisory shake on the shoulder and ask loudly, “Are you OK? As
You feel? “. In any case, in order to define consciousness, not
exert pressure on the affected eye, not his colitis sharp objects.
3. If the victim responds:
3.1. If the victim is not in danger, leave it in the previous
its position.
3.2. If possible, find out what happened to him and call an ambulance help.
3.3. Do not leave victim unattended periodically evaluate
his condition.
4. If the victim does not respond:
4.1. Call around to help people.
4.2. If necessary, turn the victim on his back, restore pro-
income instruments airways.
5. By keeping the airways open, determine the presence of respiratory
using triple reception: “hear, see, feel” (see ma-
nipulation number 1).
Determine presence should breath for 10 seconds.
During normal breathing during this period you specify at least 2-3 breaths.
Note: For a few minutes after cardiac arrest in victim may persist weak breathing or single breaths loud. No
confuse them with normal breathing. If you have any doubts
normal breathing, consider that it is not.
To determine the vital parameters no need to check
pulse, can be restricted to determining if breathing.
6. If the victim is breathing normally (16-18 breaths per minute):
6.1. Put it in a stable position (see manipulation of number 4).
6.2. Ask yourself or call an ambulance.
6.3. Do not leave victim unattended to visit doctors.
Watch out for health indicators.
7. If breathing is absent or impaired:
7.1. Ask someone to go through, if you caot –
independently, call an ambulance, if required
leave the victim for some time.
7.2. Only after calling ambulance care start-lane
cardiopulmonary resuscitation.
8. Perform 30 pressures on the chest (see manipulation of number 2):
8.1. Get on your knees to one side of the victim.
8.2. Determine where you click and place your hands on the chest.
8.3. Follow the pressing depth of at least 5 (no more than 6 cm), with a par-
the frequency of 100 (max 120) per minute.
Remember: do not tear your hands off the chest when performing presses.
When performing each click Allow chest
cage back to its original position.
9. Perform two breaths:
9.1. Restore the airway.
9.2. Pinch nostrils victim with one hand.
9.3. Reach tight lipped mouth of the victim, to create
tightness.
9.4. Make uniform exhalation (as iormal breathing) in the mouth in
suffered for one second (while watching the movement of his
thorax). Let the chest of the victim bring-
services remain to be the starting position and immediately follow the second breath.
Remember: You can perform CPR only if protective equipment – mask-valve breathing mask and others. In the absence of protective gear CPR may not do – spend just press on the chest.
Performing two breaths should take no longer than 5 seconds.
10. Immediately after two breaths then start pressing the
chest according to the above recommendations (30:2).
Important:
1. If you are performing resuscitatioo one should change every two
minutes to prevent fatigue.
2. Pause between pressing the chest should be minimal.
3. Stop for the assessment of the victim should be undertaken only after
restore breathing.
4. You can stop cardio-pulmonary resuscitation on the following conditions:
– Arrival of physicians;
– Restoration of breath / awareness;
– Your physical exhaustion.

Reanimation consists of two main procedures: restore breathing (artificial respiration) and heart activity (external cardiac massage).
The purpose premedical assistance are:
– Save the life of the victim;
– The elimination or reduction of damaging factors (factors);
shock, wound infection, secondary damage of soft tissue, nerves, blood vessels, bone fragments, etc. Activities that temporarily inhibit further development of complications that threaten the lives of victims of such serious consequences lesions as bleeding, asphyxia.
On how quickly will the bleeding stopped, removed or asphyxia introduced antidote (remedy for poison) in lesions of toxic substances depends on the future life of the wounded (affected).

By premedical aid include the following measures:
1. Pulling wounded (damaged) with automotive and other equipment from the rubble and other various places of residence, including pulling out of the water.
2. Extinguishing burning clothes (skin care) and incendiary mixtures, burning the body.
3. Putting a gas mask and protective skin on the infected areas and toxic substances entering antidote (antidote).
4. Removal of asphyxia (clearing upper airways from foreign matter, broken teeth, mucus, blood, pouring water, keeping the tongue with a napkin in his retraction, etc.).
5. Exemption from parts of compressive garments.
6. Artificial respiration and closed cardiac massage in the absence of cardiac activity and respiration.
7. Overlay occlusive dressings (one that seals) on the chest with an open pneumothorax (penetrating chest trauma) using polyethylene film or rubberized shell from package dressings individual.
8. Stop bleeding by different methods.
9. Overlay aseptic dressings on a wound or burn the surface.
10. Introduction intra-muscular analgesic substances pre-filled syringes or syringe.
11. Immobilization of limbs and other parts of the body that have been damaged (fractures, wounds and burns), using improvised and otherwise (unless you personally need to transport the victim to a medical facility).
12. Providing the body affected physiologically advantageous position.
13. Warming affected, watering it with water or alkaline-saline.
14. Direct contact with the victims, his belief in the success of the rescue.
*Along with providing premedical aid should immediately call “ambulance”: independently in providing premedical aid or ask it to perform other witnesses an accident that you help.
15. Transporting the victim to medical facility if you can not call or visit “ambulance”.