Medical aid plan: Introduction

The injured in extreme situations are given the following kinds of the medical help:
3. The first aid.
It is a complex of the simplest medical measures given at the place of getting the injury mainly as self- and mutual aid, and also by participants of rescue works, with use of listed and improvised means.
The basic purpose of the first medical help is the elimination of the causes threatening the life of the victim at the given moment, and to prevent the development of severe complications. The shortest term of rendering the first medical aid is up to 30 minutes after injury. In respiratory arrest this time is reduced to 5-10 minutes.
The main methods and ways of reanimation.
The condition of clinical death, which goes on not more than 3-5 minutes, allows to restore heart activity and respiration by using urgent measures. Due to wide educational work among the population, and teaching the reanimation methods of all medical staff, we may count on conducting artificial ventilation of the lungs (AVL) and close massage of heart in any surroundings, especially in conditions of mass injury. The fulfillment of these measures allows to save the life of casualties, who may have cardiac and respiratory arrest due to a trauma, exposure to electric current, poisoning, sharp bleeding, obstructive disturbances of respiratory tract or other causes.
Attributes of clinical death are:

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  Absence of consciousness;
  
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  Absence of pulse in the carotid or femoral arteries;
  
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  Apnoe (absence of respiratory movements);
  
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  Wide pupils and the absence of their reaction on light (comes in 1 minute after cardiac arrest).
  

In this case it is necessary to start cardio-pulmonary reanimation immediately. It consists of the following stages:
1. - to establish an adequate airway;
2. - AVL by active inhalation of air (oxygen);
3. - artificial circulation with the help of close cardiac massage;
4. - introduction of medicines, ECG, defibrillation;
5. - intensive therapy in the postresuscitation period directed on maintenance and stabilization of vital functions of the organism.
The first three stages can be carried out by way of mutual aid and by participants of rescue works.
For restoration of passableness of respiratory ways it is necessary: to place the injured into the spinal position on a some firm surface, to throw back his head back, to pull forward the lower jaw and to open his mouth. If jaws of the injured are tightly squeezed, they should be opened by any flat subject or mouth dilator and a gause padding is put between the teeth. After that examine the oral cavity with the finger, which has been wrapped in a handkerchief or gauze, and remove vomiting masses, mucus, blood, etc. Pressing your mouth to the mouth of an inured tightly and keeping his nostrils closed exhale sharply into his mouth. If you can’t open the mouth, the air is exhaled into the nose. The mouth and the nose off the injured may be closed with a handkerchief or gauze.12 exhalations per 1 minute are done in adults and 15-18 – in children.
If there are S-shaped airways, manual respiration apparatus, Ambou breathing bag, you may use them, and automatic devices of AVL are used at the in-patient department.
To maintain circulation, we use the closed cardiac massage by pressing the heart between the sternum and the spine in pushing movements (1 time per one second). Two straight arms are placed on each other by hands. Fingers should not touch the chest. Hands are put on the lower third of the sternum. Press the sternum 3-5 cm in the direction of the spine and keep it in this position about 0,5 sec, then relax your hands without taking them away from the sternum. In correct massage the blood flow is kept at 20-40% of the normal, therefore the massage can be stopped only for a few seconds. The chest should be pressed by using the weight of the body. To children till 10-12 years the massage is done by one hand, and to newborns-by tips of two fingers. The number of pushing movements in them is 70-80 and 100-200 correspondingly. The too energetic push can cause rib fracture. Pulse in the carotid arteries in every pushing and narrowing of pupils indicate the effectiveness of the massage.
Frequently it is necessary to combine AVL with cardiac massage. If it is done by one man, two exhalations should be alternated by the following 10-15 pushes. While doing by two persons, one exhalation is combined by 5 pushes. At the moment of breathing in we don’t do pushes. To determine the moment of restoration of the circulation massage is stopped for a few seconds every 2-3 minutes. If the pulsation appears in the carotid arteries, massage is stopped, but AVL continues until the restoration of one’s own ventilation is achieved.
During the reanimation the introduction of medicines is done intravenously, intraarterially and intracardially.

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  Temporary stop of external bleeding by all available means: application of arresting bleeding tourniquet(standard and improvised),a pressure bandage, finger compression of blood vessels;
  
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  Elimination of asphyxia by removing mucus, blood, soil and possible alien bodies from the upper respiratory tract, definite position of the body (in tongue retraction, vomiting, profuse nasal bleeding) and artificial ventilation off the lungs (mouth-to-mouth, mouth-to-nose breathing, S-shaped tube, etc.);
  
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  The closed massage of heart;
  
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  Introduction of pain-killers with the help of a syringe - tube;
  
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  Application of aseptic bandage to the wound and burn surface, application of occlusive bandage in penetrating wounds of the chest by using rubberized coating of the first aid pack;
  
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  Immobilization of the injured area of a body in the simplest ways by using listed and improvised objects;
  
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  Putting on a gas mask while being in the contaminated area;
  
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  Introduction of antidotes to the affected by toxic agents;
  
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