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First Aid

Eduard Kasal,
MUDr., Ph.D., Assoc. Prof.
Department of Anaesthesiology and Intensive Care
First aid

It is better to know first aid and not to need it

to need it and not to know it.

A delay can mean the difference between

life and death.

most injuries do not require life-saving efforts
First aid
is the immediate care given to an injured
or suddenly ill person.

also includes the things that people can

do for themselves.

is one of those things you need to know

but never want to use
First aid

most people do not know first aid.

even if they know it, they may

panic in an emergency.
First aid
Legal considerations

before giving first aid, a first aid provider should

have the victims consent (permission)

expressed consent conscious mentally

competent person of legal age

implied consent an unresponsive victim in a

life-threatening condition implied consent
First aid
Legal considerations
Bystander = a vital link between the emergency
medical services and the victim.
Decision to help
Czech Republic: everybody is obligated to provide
first aid adequate to his knowledge and
Refusal to provide first aid
a new testimony legalized driving away from the place of
traffic accident = crime
First aid
Legal considerations

are obligated to abide with laws of the country

Basic Life
First Aid
Approximately 700,000 cardiac arrests per year
in Europe
Survival to hospital discharge presently
approximately 5-10 - 14%
Bystander CPR = vital intervention before
arrival of emergency services
Early resuscitation and prompt defibrillation
(within 1-2 minutes) can result in >60% survival
Chain of survival
CPR is an emergency first-aid procedure
that is used to maintain respiration and
blood circulation in a person, whose
breathing and heartbeats have suddenly
(one or more vital functions failed ).
Three basic vital functions:

1. Peter Safar - Professor of Pittsburgh
University presented in 1968 small book
Cardiopulmonary Resuscitation .
2. Guidelines 2000

3. Guidelines 2005
Many changes of almost all algorithms
used for several tens of years
Publication of new guidelines does not mean, that CPR
provided in accordance with previous guidelines is not
effective and not correct, but we should follow them as

Basic life support

CardioPulmonary Resuscitation

Thoracic pump theory -

the chest compression propels blood
out of the thorax by increasing
intrathoracic pressure
the time of the chest compression and
decompression should be equal
Pressure should be completaly released
Hands should remain in the contact with
the chest
CardioPulmonary Resuscitation
Theoretical background
Oxygene content
In atmospheric air - 21%
In alveoli - 14,5%
Expired air diluted by air from the airways
(dead space)
- 16 18 % O2

Provided that there is an adequate amount of expired

air reaching the victim's lungs, oxygen delivery will be
sufficient to ensure that the victim's haemoglobin will
Theoretical background

Cardiac arrest
1. Asystole
2. Ventricular fibrillation
Most cardiac arrest victims have an electrical
malfunction of the heart hearts pumping
function abruptly ceases
3. Pulseless ventricular tachycardia =
Fast ventricular contractions without
haemodynamc effect Signs of the both =
Differential dg: only ECG
Theoretical background
At best
chest compressions provide only 30% of
normal perfusion brain + heart

Time! Time! Time! Time! Time! Time! Time! Time!

Failure of the circulation 3 - 5 minutes
irreversible cerebral damage.

Chances of successful CPR - restoration of

spontaneous circulation (ROSC) decreases
by 10% with each minute following sudden
cardiac arrest
Cause of cardiac arrest and
emergency system activation
Ischemic heart disease - AMI- with/or
ventricular fibrillation (> 80%)
Suffocation or choking with hypoxemia or
Ventricular fibrillation is rare in children (only
Cause of cardiac arrest and emergency
system activation
different approach to the emergency system activation.

electric defibrillator is necessary as soon as possible;
therefore, if telephone is available and you are alone:
1. call for help, then
2. start with CPR

1. start CPR immediately for 1 minute to provide some
tissue oxygenation
2. then call for help
Emergency telephone number

155, 112
in the Czech Republic
Indication of CPR

to victims with unexpected cardiac

arrest in otherwise healthy individuals

= to those, who can be described as

having heart too good to die
Indication of CPR

malignant arrhythmia
acute myocardial infarction (AMI)
pulmonary embolism
acute suffocation
severe trauma
stroke and alike

CPR is not indicated
signs of definitive biological death
witnessed information, that cardiac arrest had happened 15
or more minutes before the rescuer arrived (time
assessment in the stressing situation is not precise)
terminal stage of incurable disease (generalised malignant
an evident trauma without chance to survive (catastrophic
head injury)
living will - only in countries when constitution accepts it
DNR - Do not attempt resuscitation has been written in
the file (incurable disease after all available therapy

Age of the patient is not restriction of CPR

Outcome after CPR
Ventricullar fibrilation better than asystole
- in case of immediate CPR

Special emphasis

Soon defibrilation
1 minute - survival - 90%,
5 minutes - survival - 50%,
7 minutes - survival - 30%
10 - 12 minutes - survival - 2 5%.
CPR outcome
In first 4 minutes brain damage is unlikely, if
CPR started
4 6 minutes brain damage possible
6 10 minutes brain damage probable
> 10 minutes severe brain damage certain

Cells of the brain cortex

Most sensitive for the stop of pefusion and
Without perfusion and oxygenation
irreversibly damaged after 3-5 minutes
Signs of cardiac arrest
(Guidelines 2000)
1. Unconsciousness in several seconds
2. Respiratory arrest ( apnea) or the last
gasps (1-3 minutes after cardiac arrest )
3. Pulse-less on large ( major) arteries
(carotid or femoral artery)
4. Changed general appearance
(colour changes, face changes)
5. Pupils dilation (mydriasis) not reliable
Signs of cardiac arrest
(Guidelines 2005)
1. Unconsciousness
2. No reactivity
3. Absence of normal breathing
Basic conditions for CPR
1. Rescuers safety = the first priority
2. To assess the risk of trauma, intoxication,
3. a victim position: supine on to his/her
4. on the firm flat surface to make
effective chest compressions
5. victims position in relation to rescuers
6. CPR during transfer ???
Rescuers safety
The rescuer should never place him/herself or
others at more risk than the victim

before starting resuscitation assess the risks of

ongoing traffic, falling masonry, electrocution, toxic
fumes and poisons
risk of infections transmission
bloodborne infections (hepatitis B and C, HIV)
- can be transmitted by blood and other body
solutions, excretes
airborne infections (TBC and several infectious
diseases - herpetic, meningococcal etc.
- can be transmitted by mouth-to-mouth breathing
Rescuers safety

Always: protect yourself !!!

personal protective equipment (gloves)
barrier protective devices
Moth to - barrier protective devices
Personal Protective
Can control the risk of exposure to
bloodborne pathogens prevents an
organism from entering the body (medical
exam gloves, eye protection, mask)
All human blood and body fluids should be
considered infectious
Mouth-to-mouth barrier devices
Can prevent air-borne pathogens
Not documented case of disease transmission
Butshould be used whenever possible
CardioPulmonary Resuscitation
Barrier devices

S tube
Face shields (resuscitation veil )
Pocket face mask + one-way valve
Stop CPR if

Victim starts to breathe normally

Medical assistance arrives and instructs

you to stop CPR

You are physically exhausted

Stop CPR if:
When CPR has been performed for 20 minutes
without restoration of the spontaneous

It can be stopped earlier, when:

rescuer is physically exhausted

when signs of biological death develop

(post-mortal rigidity, post-mortal cooling and
gravity-dependent livid stains) ???
CardioPulmonary Resuscitation
Safars algorithm of CPR
stressing conditions an inadequate situation assessment

Breathing BLS
Circulation ALS
Drugs ?
New resuscitation
alphabet in adults
Algorithm of CPR

Circulation BLS
Airways ALS
BLS sequence
Kneel by the side of
the victim
BLS sequence

Shake shoulders
Ask Are you all right?
BLS sequence
If he responds
Leave as you find him
Find out what is wrong
Reassess regularly
BLS sequence


Shout for help

BLS sequence


Shout for help

Open airway
BLS sequence


Shout for help

Open airway

Check breathing
BLS sequence

Look, listen and feel for

NORMAL breathing
No breathing apnea
Gasps (agonal breathing)
Agonal breathing
Occurs shortly after heart stops in up to
40% of cardiac arrests

Described as barely, heavy, noisy or

gasping breathing

Recognise as a sign of cardiac arrest

Do not confuse
agonal breathing with
NORMAL breathing
BLS sequence


Shout for help

Open airway

Check breathing

Call 155 (112)

BLS sequence


Shout for help

Open airway

Check breathing

Call 112

30 chest compressions
Chest compression
Place the heel of one hand in
the centre of the chest
Place other hand on top
Interlock the fingers
Compress the chest
Rate 100 min-1
Depth 4-5 cm
Equal compression : relaxation
When possible (2 or more
rescuers) change CPR
operator every 2 min. to
prevent fatigue
Chest compression
Place the heel of one hand in
the centre of the chest
Place other hand on top
Interlock fingers
Compress the chest
Rate 100 min-1
Depth 4-5 cm
Equal compression : relaxation
When possible (2 or more
rescuers) change CPR
operator every 2 min. to
prevent fatigue
Chest compression
Place the heel of one hand in
the centre of the chest
Place other hand on top
Interlock fingers
Compress the chest
Rate 100 min-1
Depth 4-5 cm
Equal compression : relaxation
When possible (2 or more
rescuers) change CPR
operator every 2 min. to
prevent fatigue
Chest compression

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths
2 rescue breaths
Pinch nose
Place and seal your lips
over the victims mouth
Blow until the chest rises
Takes about 1 second
Allow chest to fall
Repeat (10 12 times
per minute)
B) Breathing
expired air resuscitation - several
- Mouth-to-mouth breathing
- Mouth-to-nose breathing
- Mouth-to-mouth + nose breathing ( small
- Mouth-to the barrier device ( to protect the rescuer)
- Mouth to tracheostomy

Self-inflating bag
CardioPulmonary Resuscitation
Artificial breath during expired air

Volum = normal breathing volum

Volum = 6-7 ml/ kg bw = 500 ml
Breath duration in adults = 1 second
Expiration passive
Check the chest rise during rescue
Self-infalting bag

Capacity 1500 ml Breathing by atmospheric air

1 way valve Oxygene source - conection
Volume controlled by compression Oxygene reservoir 100% O2
Continue CPR
Continue CPR

30 : 2
Ratio 30 : 2

One uniform ratio

always in adults
in children in the prehospital CPR
in children when the rescuer is alone
Automated External
Defibrilators (AEDs)
A new generation of smart defibrilators
Advanced computer technologies
Ability to interprete heart (ECG) rhythm
Ability to determine whether
defibrilation is required
Delivery of electric shock
Guides the operator through every
Provides voice and message prompts
Legal aspects
Easier than CPR
Readily available on places with haevy
people concentration, where can be
probably used once during 2 years
Extendes beyon healthcare prefessional
personnel to trained citizens
Switch on AED

AEDs will
automatically switch
themselves on when
the lid is opened
Attach pads to casualtys bare chest
Analyse rhythm do not touch victim
Shock indicated stand clear
Rescuer giving defibrilation shock

is responsible for his safety

is responsible for the safety of other
people surronding the victim
Immediately resume CPR

Need new

30 : 2
Give CPR every moment, when AED is
not available, always if AED is not
available within 5 minutes
Need new

30 : 2
If victim starts to breathe normally
place him in recovery position

Need new
CPR should not usually be
abandoned after 20 minutes:

in case of the victims hypothermia

in case of persistent ventricular
fibrillation = AED indicates
defibrilation shock

Responsibility during CPR

Precordial chest thumps
wittnessed cardiac arrest (patients
adults only
within 20 sec.

Only experienced rescuers

uknown time of cardiac arrest
chest injury
A. Airway management

Head tilted backward

Chin lift

Triple manouvre ???

head titlted
chin lift
Jaw thrust
suspected cervical spine injury
experienced rescuer ( anaesthesiologist)
Lower jaw pulled forward
A. Airway management
1. Unconscious patient tongue
tilt the head backward + lift the chin
2. Conscious patient - foreign body airway
obstruction choking - partial
airway blockade
encourage the victim to cough
add several hits to his/her back

Cough is much more effective than any

other manoeuvre.
A. Airway management
1. Foreign body airways obstruction
2. Potentially treatable
3. Mostly during eating
4. Commonly witnessed event
5. Oportunity for early intervention
6. Can cause mild (partial) or severe (comlete) airway

Heimlich manoeuvre (several thrusts (5))

pregnant ladies, children
A. Airway management
Signs of mild (partial) large airways

Difficult intensive inspiration
Neck and thorax soft tissues retraction
Hoarse (croupy) sounds accompanying
inspiration (noisy breathing)
Barking cough
A. Airway management
Signs of severe or complete large
airways obstruction

Difficult intensive inspiratory effort

Powerful breathing movements
Neck and thorax soft tissues retraction
No breathing phenomena hearable
Patients non-cooperation, restlessness,
convulsions, coma, blue skin color
Equipment for airway
C: Circulation
Signs of functional circulation
(breathing, coughing, movement, skin condition,
responsiveness, pulse)
Pulse-less on large ( major) arteries
only experienced rescuers
Compression-only CPR
Reluctance of rescuers to perform mouth-
to-mouth breathing on strangers
Unwilling person to breathe
Unability to perform (vomiting,
bleeding, trauma, unskilled rescuer)
Chest compressions only

Better some resuscitation than no

Compression-only CPR

New recommendation of AHA

Witnessed collapse of the patient
First 10 minutes
Sudden cardiac arrest due to choking
CPR in children
Who is an infant? 0 1 year

Landmark between child and adult: puberta

Who is a child? 1 - puberta

CPR in children
Cause of cardiac arrest choking, trauma
Activation of emergency system
Hypoxia developes faster high metabolic rate
Ventricular fibrillation rare
Primary cardiac arrest uncommon,
Precordial thump is contraindicated

Length of CPR = identical

Choking- hypoxia hypercapnia apnoea bradycardia
cardiac arrest

CPR in children
A) The most often cause of vital
functions failure = choking
Foreign body airway obstruction
Infectious diseases afecting throat by
swelling ( epiglotitis, acute suffocating
LTB, croup)
CPR in children
Sequence of action
Rescuers with no knowledge of pediatric
resuscitation may use the adult sequence
with the exception that they should
start with 5 initial breaths followed by
30 compressions
30 : 2 for 1 minute
than call 155 (112)
Generally prefered ratio in children
= 15:2 (in-hospital CPR, 2 rescuers)
CPR in children
Identical with adults
More often inflamation throat diseases
with swelling and suffocation
Foreign bodies!!! Small toys and toys
that can be dismantled for small
CPR in children
Look, listen and feel no more than 10 s
Volum 6-7 ml /kg bw
Blow steadily over 1 1.5 sec.
To make the chest visibly rise
Start with 5 breaths
Paediatric size of self-inflating bag
Adult self-inflating bag???

Start with 5 breaths in adults with choking

as well !!!!
CPR in children
Look for signs of circulation (movements,
coughing, skin colour, breathing)
Check the pulse (if you are an experienced
health provider) no more than 10 s
Lower third of the sternum (1 finger above
xiphoid process)
One third of the depth of the chest
100 compressions per min.
CPR in children

Technique of chest compressions

Rate of chest compressions
Algorithm of CPR: 2:15
1 rescuer: 2:30
Infants: 1:3
CPR in children
2 : 15

2 : 30
CPR in children
Chest compressions in infants
CPR in children
Chest compressions in
BLS in children
back blows
chest thrusts
abdominal compression

All manouevres intrathoracic pressure

expulsion of FB out from the airways

50% of cases more than 1 manouevre is

Complications during CPR
Gastric distension often in children
Prevention: avoid overinflating the lungs
appropriate volum making the chest rise

Rib fractures
correct hands position
do not remove hands from the chest wall
prevent dancing on the chest)

Gastric content (or other fluids) aspiration

prevent gastric distension
recovery position in unconscious victims
Children suffocation disease
Croup: laryngotracheobronchitis
age 1-3 years, viral origin
accompanbies influenza, children infection diseases, winter or early
spring season
barking cough
not sore throat
no special position
swalloving problems
intercostal retractions
not so fast progression of suffocation
Dysfonia, afonia
Children suffocation disease
age 3-7 years, bacterial origin
air hunger
sitting position, hyperextended head
severe sore throat
swallowing problems, salivation
Severe inspiratory dyspnea with stridor
Mortality 10% !!! underestimated
Children suffocation disease
Both situations
Transfere to the hospital, where
anaesthesiologist or intensivist is
as soon as possible !!!!
Not to a general practicioner
First aid
in special situations
= escaped blood from the blood vessels
Hemorrhage large amount of bleeding in a
short time
External bleeding seen blood coming from an
3 kinds according to its source:

1. Arterial

bright red colour

under pressure, comes out in spurts
the most serious
fast rate
large blood loss
less likely to clot (clot only when blood flow is slow)
dangerous : it must be controlled
3 kinds according to its source:

2. Venous
dark red colour
low pressure
blood flow steadily
it is easier to control
most veins collaps when cut
bleeding from deep veins can be as massive
as arterial bleeding !!!
3 kinds according to its source:

3. Capillary bleeding

oozing out, leaking

most common
blood oozes
usually not serious
easily controlled
often it clots and stops itself

4. Mixed bleeding
Bleeding - clinical symptoms
Depend on - the quantity of the blood loss

- the rapidity of the blood loss

!!! Sudden loss of a large quantity of blood results in shock:

- skin - cold, pale
- pulse - weak, fast
- mental disorders, fear, unconscioussness
What to do?

the first aid is the same reagardless of the type of


most important = to controll bleeding

External bleeding

1. Protect yourself (exam gloves or improvizations)

2. Manual control of external haemorrhage

3. Expose the wound (remove or cut clothing) to find

the source
4. Place sterile pad or clean cloth and apply direct
pressure (fingers, palm, hand) = pressure over the
5. If bleeding from arm or leg elevate extremity
above the heart level + pressure over the wound
External bleeding
6. If bleeding continues continue + apply pressure
against the bone at pressure points ( brachial or
femoral points ???)
7. Use pressure bandage you have free hands for help
to other victims
8. For application of direct pressure use ring pad
9. Tourniquets rarely on the extremities it can
damage nerves and vessels !!!
10.When you need it use wide, flat materials and write
the time of application !!!
Internal bleeding
skin is not broken
blood is not seen
difficult to detect
can be life threatening
traumatic and nontraumatic origin

What to look for?

Swelling on extremities in case of trauma
Contussion of the skin
Painful, rigid, tender abdomen
Vomiting or coughing up blood
Black stools or stool with bright red blood
Internal bleeding
What to do?
1. Check ABCs
2. Expect vomiting keep the victim on his/her left side
3. Treat for shock:
Elevate legs
Cover the victim to keep him/her warm
Do not give a victim anything to eat and drink (prevention
of lung aspiration, can cause complications during surgery)
Splinting extremities
prevents nerve and vessels injury
Internal bleeding
Loss of blood - long bones fractures:
Pelvis 2 5 L

Femur (tigh) 1 2,5 L

Shin bones 1 1,5 L

Arm ( humerus) 0,5 1 L

Forearm 0,5 L
Circulatory system failure when insufficient amounts of
blood is provided for different parts of body (insuficient

Three components:
1. Heart pump failure
2. Network of pipes (vessels) enlargement
3. Adequate volume of circulated fluids fluid loss
- blood
- plasma
- extracellullar fluids (vomit, diarrhoea, sweatting, urine)

Damage of any of these components can

produce conditions known as shock.
What to look for?

1. Altered mental status, restlessness

2. Pale, cold, clammy skin, livid lips
3. Limited perfussion of peripheral parts of the body
4. Capilary refil phenomenon nail beds
5. Nausea and vomiting
6. Rapid breathing
7. Rapid weak pulse or pulseless on peripheral arteries
8. Unresponsiveness, when shock is severe

BP < 60 mm Hg
What to do?

1. Treat life-threatening injuries

2. Lay the victim on his/her back

3. Raise the victims legs ( if no evident injury) drain

of blood from legs to the heart

4. Prevent body heat loss (blankets)

5. Splintig of long bones fractures

6. Seek immediate medical attention

What to do?
6. ABC
7. In case of severe shock - prevent peroral intake

nausea + vomiting

inhaling foreign material into the lungs

complications during surgery

8. Oxygene

Bruises (suffusions) = a form of internal bleeding, but not life

Allergy, anaphylaxis
Definition: A powerful reaction to substances (eaten, injected,
contacted) Reaction antigene + antibody.

Anaphylaxis = severe allergic reaction

Occurs within minutes or seconds
Fast progression
Can cause death if not treated immediatelly

Common cause:
Medications, food + food additives, insect stings, plant and
flowers pollen, parfumes
Allergy, anaphylaxis
What to look for ?
Fast development
Sneezing, coughing, wheezing
Shortness of breath
Suffocation (swelling in the throat, tongue, mouth, neck =
Quincke oedema)
Tightness in the chest
Increased pulse rate
Nausea + vomiting
Anaphylactic shock
Urtica with skin itching (pruritus), blisters, quickly spreading
Allergy, anaphylaxis

What to do?

Immediatelly interrupt the contact with allergene

Check ABCs
Seek immediate medical attention
Help the victim to use epinephrine, if he/she is
provided with
Removing the body from the noose - prevention of body fall and other injuries

Suspected injury of
- the brain
- cervical spine, larynx, cervical vessels
(thrombosis of the carotid artery, of the jugular vein)
What to look for?
- Status of vital functions
What to do?
stabilize head against movement
seek medical attention
admission to the hospital ICU
Seizures (convulsions)
Seizure (convulsions, crumps)
- is a burst of electrical activity from the brain that results in involuntary
movements, loss of consciousness (LOC), or both.

Basic classification
generalised - always LOC -

convulsive - tonic or combination of tonic with

- clonic convulsions (seizures) - urinary incontinence or
tongue biting may occur

nonconvulsive - absence, myoclonic

partial - no LOC
Seizures (convulsions)
Risk factors:

Serum electrolyte disturbances - Na <120 or >160 mmol/l,

Ca<1mmol/l, Mg<0,5mmol/l

Drugs - amphetamine, cocaine, ethanol, TCAs

CNS infection - meningitis, encephalitis

Miscellaneous - CNS tumour

- hypertensive encephalopathy

- severe hypoxemia

- Head injury
Seizures (convulsions)
Clinical signs:

Seizures have abrupt onset and last 1-5 minutes

the period of altered mental status can last up to 30


Status epilepticus - defined as seizures lasting

>30 minutes or two or more seizures without

lucid interval in between.
Seizures (convulsions)
What to do?

Restrain the victim as necessary to protect from self-

injury and from secondary injury - cars and traffic on

the road, sharp objects in the proximity of the patient

Bring the patient gently into recovery position to prevent

aspiration in the case of vomiting - rough treatment

could provoke other paroxysm

ABC as soon as the seizures stop

Call for help and arrange transport to the hospital

Near drowning
Drowning is death from asphyxia secondary to submersion in a
liquid (usually water) or within 24 hours of submersion.

Near drowning is survival of suffocation secondary to submersion

in a liquid.

Mechanisms of near drowning

with aspiration - aspiration of water and vomitus

in fresh water loss of surfactant fast absorbtion to the


in see water flooding of alveoli hypoxemia (80-90%)

no aspiration laryngospasm spastic closure of glottis (vocal cords)

hypoxemia (in 10-20%) = dry drowning.

Near drowning
What to do?

Extrication of the victim from the water - very dangerous

- protect yourself !!!

ABCs - the earliest as possible - Airways + oxygenation

+ ventilation

The airway should be checked for foreign material and


Prevent additional hypothermia

Seek for medical attention

Heat stroke
Heat stroke - defined as a heat injury + altered mental
status in consequence of failure of the body
temperature control.
Rectal (core) body temperature is above 40C -
usually there is a history of exposure to exercise
or increased temperature and humidity.

high ambient or environmental temperature

increased endogenous heat production

decreased ability to dissipate heat

Heat stroke
Risk factors - extremes of age (infants and the elderly)

alcoholism, medication (atropine)

Mortality is high because of the risk of multi-organ failure

Clinical signs:
altered mental status
lack of or minimal sweating
neurological deficit paralysis (hemiplegia, Babinsky reflex)
Heat stroke
What to do?

Reduction of core temperature water should be

- sprayed on undressed patient with breeze from fans or

- wrap the patient in wet packsheet till the temperature

falls to 38,5C, then stop the cooling

Continuation of cooling could cause the uncontrolled
drop of body temperature.
Cold water immersion or air-cooling

Seek medical attention

Heat cramps
Heat cramps - are painful, involuntary contractions of skeletal
muscles that mostly involve the calves, thighs, and shoulders.
Causes - the same as those for heat stroke
The main risk factor - is the replacement of sweating losses
with plain (hypotonic) water. The hypo-osmolality can
lead to the brain edema with the cramps.

What to do?
Give to the patient the glass with salt water one half of the glass
every 15 min.
Massage the muscles to relieve the spasm

Seek medical attention

Cold injury - hypothermia
Besides goose pimples - as a part of cold
stress reaction protective reaction
= an early response to cold stress
Shivering is able to increase the basal
metabolism rate two-to five fold
Heart oxygene and energetic consumption is
increased by 500%
It is operative between 30-37C
Cold injury - hypothermia
Clinical signs:
gradually deteriorating mental status
incoordination confusion lethargy coma
body is cold to touch, dysarthria
Tachycardia bradycardia - ventricular fibrillation occurs at
temperatures 28C
Hypertension hypotension
Tachypnea (rate of breathing) bradypnea ( rate of breathing)
Hyperreflexia areflexia fixed and dilated pupils with
coma at temperature below 22C
Asystole - at 22 C
Cold injury - hypothermia
Cause - is the exposure of the person to the low
environmental temperature.
Hypothermia is supported by the wind and high humidity.

mild hypothermia core temperature - 32-35C
moderate hypothermia - 28-32C
severe hypothermia < 28C

Risk factors :
extremes of age (infants and elderly)
accompanying diseases and bad status of health
alcohol intoxication and drug overdose
Cold injury - hypothermia
What to do?

In mild hypothermia:
Transport patient to the warm environment and give him
warm fluids (but no alcohol)

In severe hypothermia:

Transport the patient to the warm environment, undresse

him and remove the rings and all thing, that can
constrict lower and upper extremities and limit the
Avoid movements with the patients body parts

Seek medical attention

Cold injury - frostbite
Frostbite - a cold-related contact injury
characterised by freezing of tissues

Most often affected parts of body =

peripheral - face, ears, nose, hands, feet,
penis and scrotum

Most cases - in soldiers, winter outdoor

enthusiasts, e.g. mountain climbers
Cold injury - frostbite
Pathophysiology - cold exposure leads to
ice crystal formation

cellular dehydration

protein denaturation

inhibition of DNA synthesis

abnormal cell wall permeability

damage to capillaries

pH changes
Cold injury - frostbite
Degree of injury
1st-degree injury - erythema, oedema, waxy
appearance, hard white plaques, and sensory deficit

2nd-degree injury - erythema, edema, and

formation of clear blisters

3rd-degree injury - presence of blood-filled blisters

4th-degree injury - full-thickness damage affecting

muscles, tendons, and bones
Cold injury - frostbite
What to do?
Examine vital functions, start ABC when necessary
Replace wet clothing with dry, soft clothing to minimise
further heat loss. Remove constricting clothing.
Initiate rewarming of affected area as soon as possible.
Avoid rubbing affected area with warm hands or snow, as
this can cause further injury.
Transport patient to the warm environment and give him
warm fluids.
Active re-warming of the frost-bitten part via immersion in
circulating clear water at 40-41C
Dry sterile dressing of the frostbite
Seek medical attention
Open wounds - types
Abrasion - the top level of skin is removed = painful -
(nerve endings)
Laceration - skin is cut with jagged, irregular edge

Incision - smooth edges (surgery) - bleeding depends on

the depth, the location and the size of the wound
Punctures - deep narrow wounds (nail, knife), the object
may remain impaled in the wound
Amputation , avulsion - the cutting or tearing off of a
body part finger, toe, hand, foot, arm or leg
Open wounds - what to do
Protect yourself - use medical gloves if possible or
several layers of gauze or clean cloth and apply
pressure on the wound (your bare hand should be used
only as a last resort)
Expose the wound - to see where the blood is coming
Control the bleeding

Do not clean large extremely dirty or life threatening

wounds. Let hospital emergency department personnel
to do the cleaning
Do not scrub a wound
Open wounds - wound care
Shallow wounds should be cleaned to prevent infection -
risk of restarting of bleeding by disturbing the clot
For severe bleeding, leave the pressure bandage in
place until medical attention.
To clean a shallow wound

- wash inside the wound with soap and water

- irrigate the wound with water from a faucet (tap)
- for a wound with a high risk for infection (animal
bite, very dirty or ragged wound or a
puncture) seek medical attention for
wound cleaning
Cover the area with a sterile dressing
Open wounds - amputation
Control the bleeding

Treat the victims shock

Recover the amputated part, take it with the victim - - it

does not need to be cleaned - wrap it with a dry
sterile gauze or clean cloth and put it in the plastic
- keep it cool, but do not freeze
Seek medical attention immediately - 18 hours is the
maximum time allowable for a part that has been
cooled properly. Muscles without blood lose viability
within six hours.
Open wounds - impaled objects
What to do

Expose the area - remove or cut away clothing

surrounding the injury
Do not remove or move an impaled object - movement of
any kind could produce additional
bleeding and tissue damage
Control any bleeding with pressure around the impaled
Shorten the object if necessary - stick or trunk of the
tree, wooden or iron bar..
Burns and scalds
Rank among the most serious and painful injuries.

Can be classified -
thermal (heat) burns - contact with hot objects,
flammable vapor, steam or liquid
chemical - acids, alkalis and organic
compounds (petroleum, kerosene)
electrical - severity of injury depends on the
type of current, the voltage, the area of
body exposed and the duration of contact
Burns and scalds
1st-degree burns (superficial): surface (outer layer) of the
skin is affected

characteristics - redness, mild swelling,

tenderness and pain

2nd-degree burns: affect partial thickness of the skin

characteristics - blistering and swelling, severe pain

3rd-degree burns: penetrates the entire thickness of the skin

and deeper tissues
characteristics - no pain, skin looks waxy or pearly
grey or charred
Burns and scalds - what to do?
Stop the burning !

Check ABCs

Determine the depth (degree) of the burn

Determine the extend of the burn - rule of nine - how
much body surface area is affected by burns - head 9%,
complete arm 9%, front torso 18%, back 18%, each leg
18%, victims hand excluding the fingers and the thumb,
represents about 1% of victims body surface
Determine which parts of the body are burned - burns of the face,
hands, feet and genitals are more severe
Seek medical attention
of the burned posteror
part of the

surfice extent trunk

Burns and scalds - what to do in
case of 1st and small 2nd-degree burns
Aim of the care - reduce pain
- protect against infection
- prevent evaporation
Cooling - immerse the burned area in cold water - apply
cold until the part is pain free (10-45 minutes)
Sterile bandage or clean cloth

Fluids orally ???


Shock treatment
Burns and scalds - what not to do
Do not remove clothing stuck to the skin - pulling will
further damage the skin
Do not forget to remove jewellery as soon as possible -
swelling could make jewellery difficult to remove
Do not apply cold to more than 20% of an adults body
surface (10% for children) - widespread cooling can
cause hypothermia. Burn victims lose large amount
of heat and water evaporation)
Do not apply ointment, butter or any other coatings on
a burn except of sterile dressing or clean cloth
Do not break any blisters - intact blisters serve as
excellent burn dressings
Burns and scalds - what to do in
case of large 2nd and 3rd-degree burns

Do not apply cold because it may cause hypothermia

Cover the burn with a dry, nonsticking dressing or a

clean cloth

Treat the shock by elevating the legs and keeping

victim warm with a clean sheet or blanket

Seek medical attention

Chemical burns - what to do
Immediately remove chemical by flushing the area with
water - brush dry powder chemicals from the
skin before flushing (water may activate a dry
chemical) - protect yourself
Remove contaminated clothing and jewellery while
flushing the water
Flush for 20 minutes all chemical burns (skin, eyes)

Cover the burned area with a dry, sterile dressing or

clean pillowcase or sheet
Seek medical attention immediately for all chemical
Chemical burns - what not to do
Do not apply water under high pressure - it will drive

the chemical deeper into the skin

Do not neutralize a chemical even if you know which

chemical is involved - heat may be produced,

resulting in more damage.
Some product labels for neutralizing may be
wrong. Save the container or label for the
chemicals name.
Electric current injury
Effects of electricity on the body are determined by 7 factors:
type of current - skin offers greater resistance to direct current
than alternating current
amount of current

pathway of current

duration of contact

area of contact

resistance of the body

voltage - high voltage accident (>1000 V) is regularly

accompanied with burns, while
low voltage (<1000 V) injury causes electric
damage, most often arrhythmia.
Electric current injury
Both high and low voltage electric currents can adversely
influence vital functions - unconsciousness, breathing
paralysis and severe cardiac dysrhythmias (mostly
ventricular fibrillation).
Heating by electrical current is the major mechanism of
tissue damage in electrical trauma.
In high voltage accidents, the victims usually do not continue to
hold the conductor - they are often thrown away from the
electric circuit and thus acquire traumatic injuries (e.g. fracture,
brain haemorrhage).

Low voltage = heart injury

High voltage = thermal injury

Electric current injury - what to do
Make sure the area is safe - unplug, disconnect or turn off
power, if not possible, call for help

Check ABCs - remember - ventricular fibrillation !!! - start


If the victim fell, check for a spinal injury

Seek medical attention immediately, victims with cardiac

dysrythmias need in hospital observation for 48 -
72 hrs

Electrical injuries with burns (high voltage) - cover them by

sterile dressing, victims usually require burn centre
Head injuries
Mechanism of injury motor vehicle crashes, falls, hits,
gunshots and stab wounds, mortality rate 30-50%
The main types of head injury

- scalp wounds
- scull fractures - basilar, linear and comminuted
- intracranial lesions - contusion, subarachnoid haemorrhage,
subdural hematoma, epidural hematoma
- diffuse brain injury concussion, diffuse axonal injury
Scull fracture is always associated with the brain injury

In case of suspicion of the brain injury, the patient has to be

hospitalised, examined and monitored for at least 48 hours.
Diffuse brain injury

Diffuse axonal injury

Is a brief, temporary interruption of

neurological function folloving head trauma
Concussion clinical features

Nausea, vomiting
Amnesia for the event
Unconsciousness short lasting
Concussion - treatment
Treatment for scalp wounds, aplication of
pressure dressings to prevent hemorrhage
Seek medical attention
Transport to the hospital for diagnostics
Admision to the hospital for monitoring,
observation (mental status, consciousness
assessment, pupils, )
Head injuries - what to do
When the patient is unconscious
ABC - monitor vital functions. By the application of airway
management (head position tulted backward) keep in mind the
possibility of cervical spine injury.
Examine the head gently and cover the external injuries with sterile
dressings (bandage) - dont press on the wound,
stabilize the victims neck against movement
Examine the state of pupils - size, similarity, reaction on the light

Examine also the thorax, abdomen and extremities

When the circulation and breathing are stable bring the

patient into recovery (stable -side) position (beware of cervical
spine injury) and monitor vital functions.
Call for help
Head injuries - what to do
When the patient is conscious:

Bring the patient into supine position with a little elevated

head if there is no suspicion of cervical spine

Treat the wounds in the same way as above

Call for help

Keep in mind, that even if the patient is conscious, the

status of consciousness can alter due to the brain
injury or intracranial bleeding and therefore all the
time monitor the mental status of the victim.
Eye injuries - penetrating eye injuries
Result when a sharp object (knife, needle) penetrates the
Seek immediate medical attention - any penetrating eye
injury should be managed in the hospital
Stabilize any protruding object with bulky dressings or
clean cloth
Cover the undamaged eye

Do not wash out eye with water

Do not try to remove an object stuck in the eye

Do not press on an injured eyeball or penetrating object

Eye injuries - chemical burns of the eye
Chemical burn of the eyes are extremely sight-threatening

Alkalis cause greater damage than acids - they penetrate

deeper and continue to burn longer
Damage can happen in 1 to 5 minutes - the chemical must
be removed immediately
What to do
- use your fingers to keep the eye as wide as possible

- flush the eye with water immediately - irrigate from the

nose side of the eye towards the outside, to avoid
flushing material into other eye
- loosely bandage both eyes with cold, wet dressings

Seek immediate medical attention

Nose injuries - nosebleeds
Two types
- anterior - most common (90%)
- posterior - serious and requires
medical attention
Nose injuries - nosebleeds
What to do
Place victim in a seated position

Keep his/her head tilted slightly forward so blood can run

out, not down the back of the throat,
which can cause choking, nausea or vomiting
Pinch (or have victim pinch) all the soft parts of the nose
together between thumb and two fingers for 5 minutes
Apply an ice pack over the nose and cheeks

Seek medical attention - if the bleeding continues or you

suspect a broken nose or posterior nosebleed
Spinal injuries
Spinal injuries are often associated with head
The head may have been moved suddenly in one
or more directions, damaging the spine
What to look for - painful movement of the arms
or legs
- numbness, tingling, weakness or burning
sensation in the arms or legs
- loss of bowel or bladder control
- paralysis of the arms or legs
Spinal injuries
What to do
Stabilize the victim against any movement
- to stabilize head against movement - place heavy
objects on each side of the head
Check ABCs
Transfere the patient by 3 4 pairs of hands
Transfere patient on the vacuum matrace or on the
Seek medical attention
Chest injuries
All chest injury victims should be rechecked for ABC
Broken ribs - main symptom is pain by breathing,
coughing and movements

What to do
help the victim find comfortable position

stabilize the ribs using pillow or other soft object fixed

by bandage over the injured area
some victims find comfort by lying on the injured side

seek medical attention

Chest injuries - what to do
Impaled object in chest
Stabilize the object in place with bulky
(wide) dressing
Do not try to remove an impaled object -
bleeding and air in the chest cavity can
Seek medical attention
Chest injuries -
Sucking chest wound - results when a
chest wound allows air to pass into and
out of the chest cavity with each breath
Chest injuries
open - persisting opening to the chest
closed - no external communication
tension (valve) - air can enter pleural
cavity during inspiration and cannot
escape during expiration
Chest injuries
Air entered into pleural cavity results in

Collaps of the lung + increasing intrapleural pressure

mediastinum shift to the healthy side

stopped venous return to the heart

cardiac arrest
Pneumothorax clinical features
Sudden onset chest pain
Chest wall deformity
Air hunger
Pneumothorax - treatment
ABCs is priority
Transport to the hospital
What to do
Cover the wound immediately

Seal the wound with anything available to

stop air from entering the chest cavity -
plastic wrap or plastic bag, if not
available, you can use your gloved hand
Seek medical attention urgently !!!
Pleural puncture should be done as soon as
Pneumothorax (PNO)
What to do
Always change the open pneumothorax into the

Plastic bag place on the chest wound and fix it by

adhesive tape (plaster) from 3 sides with the
fourth side free (pocket)
Abdominal trauma clinical features
Abdominal pain
Abdominal distension
Abdominal trauma clinical features
Ecchymoses over the abdomen
Presence of open penetrating wounds
Abdominal tenderness
Abdominal trauma - treatment
ABCs is priority
Monitoring of vital signs
Transport to the hospital
Abdominal injuries
Blow to the abdomen - observe for pain, tenderness,
muscle tights, or rigidity
What to do - place the victim in a comfortable position and
expect vomiting
check general condition shock can develope
do not give any food and drink
seek medical attention

Penetrating wound - expect internal organs to be damaged

What to do - if the penetrating object is still in place,

stabilize the object and control bleeding,

seek medical attention
do not try to remove the object
Abdominal injuries
Protruding abdominal organs - what to do
Position - the victim with the head and shoulders slightly
raised, and knees bent and raised
Cover protruding organs with the (moist) sterile dressing or
clean cloth
Place towel lightly over the dressing to help maintain warmth

Seek medical attention

Do not try to reinsert protruding organs into the abdomen

- you could introduce infection or damage the intestines
Do not give anything to eat or drink
Pelvic injuries
If you suspect broken pelvis, press the sides of the pelvis gently
downward and squeeze them inward at the iliac crests (upper
point of the hips)

- broken pelvis will be painful

What to do
Treat the victims shock

Place padding between victims thighs, then tie the knees

and ankles together
Keep the victim on a firm surface - do not move the victim

Seek medical attention

Bone, joint and muscle injuries

- closed fractures - skin is intact
- open fractures - skin over the fracture is
damaged or broken

What to look for: D-O-T-S

Deformity abnormal position
Open wound
Bone, joint and muscle injuries
What to do:
Determine what happened and the location of the injury
Gently remove clothing covering the injured area
Examine the area by looking and feeling for D-O-T-S
Check C-S-M - circulation, sensation,
First aid: R-I-C-E procedures
(rest, ice, compression, elevation)
Use a splint to stabilize the fracture 1 jount above and
1 joint under broken bone !!!
Seek medical attention
Bone, joint and muscle injuries
Joint injuries
- the most frequently affected are shoulders,
elbows, fingers, hips, knees and

Signs and symptoms

Deformity (main sign)


Bone, joint and muscle injuries
What to do:
Check C-S-M - circulation, sensation, movement

First aid: R-I-C-E procedures

- rest, ice, compression, elevation

Use a splint to stabilize the joint in the position in
which it was found
Do not try to put displaced parts into their normal
position - nerve and blood vessel damage could
Seek medical attention
Most often causes
ingestion - drugs, alcohol, or both of them, toxic food
(mushrooms) or fluids
inhalation - narcotics and carbon monoxide or other
toxic gases
intravenous, transcutaneous or intramuscular
application of drugs in addict people
Clinical sings
- polymorphous
- mostly altered mental status
- altered vital functions
- Convulsions
Evaluation of vital functions
examine ABCs followed by
history +
physical examination.

History is of primary importance, but

at altered mental status may be difficult
Obtain as much information as possible from the
patient, from the family and from anyone else who
was at the scene.
The most important questions

What poison is involved?

How much was taken?

By what route was the poison taken (e.g. by mouth, iv., i.m.,
skin exposure)?
When was it taken?

What else was taken with it? (combination of drugs and

Besides vital functions are regularly examined, observe:
Pupillary size - mydriasis - (atropine, cocaine, ethanol),
- miosis (opiates, organophosphates and
Oral examination - the odour of the breath is diagnostic clue
hydration (opiates, atropine vs.
organophosphates, strychnine)
Examination of the skin - marks of i.v. drugs use,

cyanosis, red skin colour (due to cyanide or carbon

monoxide) dry skin (atropine, anticholinergics drugs)
Call for help and transport the patient to the hospital

Monitor vital function during the transport - ABCs

Bring with the patient to hospital all drugs, empty

blisters and boxes of the drugs that are present at
the scene.

Provoke vomiting in co-operative person

Don't give any fluids and do not provoke the

vomiting in people with altered state of
Poisoning - specific antidotes
Specific poisonings antidotes:

Ethyleneglycol alcohol
Methylalcohol alcohol
Alkali juice or vinegar or lemon
Acid milk ?
Be careful !!!
Children suffocation disease
Croup: laryngotracheobronchitis - age 1-3 years

- barking cough
- intercostal retractions

Epiglottitis - age 3-7 years, sore throat

- air hunger
- anxiety
- sitting position, hyperextended head
- swallow problems, salivation
Children suffocation disease

Large airways obstruction

Inspiratory stridor

Soft tisues af the neck and chest (intercostal)

Noisy breathing

Cock voice
Children suffocation disease
What to do
Very urgent life-threatening disease !!!

Death from suffocation can develop within tens of

minutes or several hours from normal healthy
status !!!
Organize transfer to the hospital (emergency,
anaesthesiology, ICU) as soon as possible by
prehospital emergency services !!!
Children suffocation disease
What to do
Before transfer: Could weather can help
Take the child outside

Aply cold compress on the neck (Prieznitz)

Assure inhalation of air with high humidity

Chest pain
Several causes

Always think about heart attack first

Medical care at the onset of a heart attack is vital

to survive

Seek medical atention immediatelly
Heart attack
Signs and symptoms
Uncomfortable pressure

Squeezing or pain in the center of the chest lasting

more than a few minutes or going away and coming
Pain spreading to the shoulders, neck or arms

Chest discomfort, nausea, shortness of breath

Not always typical signs

Heart attack
What to do
Call emergency medical servis or get to the nearest hospital

The least painful position (sittin with legs up and bent at the
Give Nitroglycerin tablets or spray (dilates coronary arteries)
Caution: possible hypotension
Avoid Nitroglycerin application if patient used VIAGRA
within last 48 hours
If unresponsive victim check ABC and start CPR
Stroke (Brain attack)
Blood vessels rupture bleeding or

blood vessels plugged

Nerve cells dies within minutes

Transient attack closely associated with strokes-

short duration from minutes to several hours (mini-

serious warning sign of a potential stroke
Stroke (Brain attack)
What to look for
Weakness, paralysis

Decreased vision

Speaking or understanding problems

Dizziness or loss of ballance

Severe headache

Differentiate pupils from Pupils equal and reactive

for light
Stroke (Brain attack)
What to do
If victim unresponsive ABC

Call emergency medical servis

If breathing recovery position

Supine position with slightly elevated head and

shoulders ( neutral position)
Do not give anything to drink and eat (restricted
swallowing, throat paralysis, tendency to vomit)
Diabetic emergencies
Diabetes mellitus (DM)

Definition: condition, in which insulin is either

lacking or inefective.

Insulin = a hormon produced by pancreas.

Role of insulin: helps the body to use energy from

food. It takes sugar from the blood and carries it
into cells to be used.

In Diabetes:
No insulin sugar remains in the blood body
cells must rely on fat as fuel.

Blood sugar is a major body fuel.

Diabetic emergencies

If blood sugar cannot be used in cells:

blood sugar level increases

overflows into the urine
increased urine production

Loss of unused important source of fuel

Diabetes mellitus will develop
Diabetic emergencies

2 types of DM

Type I (juvenile-onset) = insulin dependent

External insulin is required to allow sugar to pass from
the blood into cells

Type II. (adult - onset) = insulin-non-dependent

Not dependent on external insulin
If insulin level is low known problems as discussed
Diabetic emergencies

The body is continuously balancing sugar and


Much insulin + not enough sugar

low blood sugar (insulin shock)

Much sugar + not enough insulin

high blood sugar (diabetic coma)

Both low and high blood sugar

= life threatening situation ( coma)
Diabetic emergencies

Low blood sugar = hypoglycemia


delayed food
long fasting
Diabetic emergencies

Low blood sugar = hypoglycemia


sudden onset
poor coordination
anger, bad temper
pale colour
confusion, desorientation
sudden hunger
excessive sweating
unconsciousness hypoglycemic coma
Diabetic emergencies

Low blood sugar = hypoglycemia

What to do:

give sugar or sweet juice or glucose tablets

if patient is awake
if no efect, repeat it
seek immediate medical attention
provide ABCs
Diabetic emergencies

High blood sugar = hyperglycemia


insuficient insulin
forgotten application of insulin before eating
overeating (inadequate ingurgitation of food)
Diabetic emergencies

High blood sugar = hyperglycemia


gradual onset
extreme thirst
frequent urination of high volume
flushed skin
fruity breath odor
haevy deep breathing
unconsciousness - coma
Diabetic emergencies

High blood sugar = hyperglycemia

What to do:

If you are not sure whether victim has high or low

blood sugar, give the person food or drink with sugar
If you do not see improvement, seek medical care

Check blood sugar by glucometer
Help the patient to apply insulin in case of high blood
Emergencies during pregnancy

Try to remain calm and considerate of the

mother during stressful situation

What to look for?

vaginal bleeding
cramps in lower abdomen
swelling of the face or fingers
severe continuous headache
dizziness or fainting
uncontrolled vomiting
Emergencies during pregnancy

What to do
keep quiet
place sanitary napkin or any sterile or clean pad
over the opening of vagina
replace bload-soaked pads and save them together
with all tisues that are passed
arrange immediate transfere to a medical facility

place a woman partly on her left side in case of

discomfort, collaps, dizziness, faint or try to shift
pregnant abdomen gently to the patients left
side (release the pressure on the vena cava
inferior-increased venous return to the heart)
Emergencies during pregnancy

What to do during bustling (fast) delivery

try to be quiet
try to co-operate with delivering lady
protect the babys head
if child is delivered, place him between mothers
thighs and cover him with dry blanket
congratulate to the mother
thank her for her co-operation
wait for the end of funis (umbilical cord) pulsation
close it by tape
seek medical attention
Acute psychic (mental) disorders

psychiatric disease
alcohol intoxication
opioid intoxication (heroin)
marihuana intoxications overdose (joints)
intoxications by stimulationg drugs (extasis)
organic diluents (toluen)
cocain overdose (crack)
haluconogens (LSD, crystal joints)
rarely mental disorders in lactation

but change of behaviour can be caused also by:

lack of oxygen - hypoxemia
rescuers personality and look
development of shock state
head injury
cervical spine injury
Acute psychic (mental) disorders

What to do
very difficult situation
risk of auto and heteroagresivity
risk of suicidal attemts
calm, trustful approach needed
patience to listen to the patient
direct isntructions to undergo the therapy

use of physical limitations delicate situation only

in cases with risk of autoagressivity and risk of
exposure of the patient or his neighbourhood
seek emergency medical services to secure safe
transfer to the hospital
Animal bites
What to do
dogs similar to other injuries often face,
extremities, risk of bleeding
snakes toxins -neurotoxins
-clotting disorders
-cytotoxic and hydrolytic effect
not all snake bite has toxic risks (rat snake)
First aid:
calm down the patient
immobilisation of extremity
not invasive therapeutic procedures
shock therapy
immediate transfer to the hospital
Animal bites
What to do
spiders danger very rarely arachnophobia
toxins neurotoxic
therapy as snakes

scorpions very painful bite

- rarely very high toxicity
- vegetative neurotoxicity
therapy as snakes

insects most danger is hornet (yellow jacket)

bee 100 bites = lethal dosis
pain, swelling, alergic reactions
therapy cooling, antiallergic therapy
neck bites swelling, airways obstruction
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