Emergency.vnmu.edu.ua



First aid in special circumstances.FaintingUnconsciousness. Coma of unknown origin.Seizures Heart conditions: angina pectoris, heart attack1Stroke &TIAAcute abdomenPoisoningBites: insect bites, animal bites (dogs), snake bites.DrowningElectrocution. Lightning strike.FaintingOne common signal of sudden illness is a loss of consciousness, such as when a person faints. Fainting is a temporary loss of consciousness. When someone suddenly loses consciousness and then reawakens, he or she may simply have fainted.Fainting occurs when there is an insufficient supply of blood to the brain for a short period of time. This condition results from a widening of the blood vessels in the body. This causes blood to drain away from the brain to the rest of the body.Fainting usually is not harmful. The person usually recovers quickly with no lasting effects. However, what appears to be a simple case of fainting actually may be a signal of a more serious condition.Signs and symptomsA person who is about to faint often becomes pale, begins to sweat and then loses consciousness and collapses. A person who feels weak or dizzy may prevent a fainting spell by lying down or sitting with his or her head level with the knees.When to call EMSCall the local emergency number when in doubt about the condition of a person who has fainted. It is always appropriate to seek medical care for fainting.First aidLower the person to the ground or other flat surface and position him or her on his or her back, lying flat. Loosen any tight clothing, such as a tie or collar. Check that the person is breathing. Do not give the person anything to eat or drink. If the person vomits, roll him or her onto one side.Unconsciousness. Coma of unknown origin.Unconsciousness is when a person is unable to respond to people and activities.?It is often called a coma or being in a comatose a - from the Greek κ?μα koma, meaning "deep sleep" - is a state of unconsciousness lasting more than six hours, in which a person: cannot be awakened;fails to respond normally to painful stimuli, light, or sound;lacks a normal sleep-wake cycle; does not initiate voluntary actionsComa is caused by dysfunction of either or both the reticular activating system and cerebral cortex. Other changes in awareness can occur without becoming unconscious. These are called altered mental status or changed mental status. They include sudden confusion, disorientation, or stupor.0173990Unconsciousness or any other sudden change in mental status must be treated as a medical emergency.CausesUnconsciousness can be caused by nearly any major illness or injury. It can also be caused by?substance (drug)?and alcohol use. Choking on an object can result in unconsciousness as well. Brief unconsciousness (or fainting) is often a result from dehydration, low blood sugar, or temporary low blood pressure. It can also be caused by serious heart or nervous system problems. Other causes of fainting include straining during a bowel movement (vasovagal syncope), coughing very hard, or breathing very fast (hyperventilating).So, what can cause coma:Brain cancerConcussionDiabetesDrug abuseEncephalitisKidney failureMeningitisPre-eclampsiaRabiesReyes syndromeStrokeVasovagal syncopePostural hypotensionHyperventilationCardiac arrhythmiaHypoxiaHypoglycaemiaEpilepsyThe most common cause of coma are toxic\ metabolic de-arrangement, which are potentially treatable and reversible. Signs and symptoms.The signs of coma commonly include: Closed eyesDepressed reflexes, such as pupils not responding to lightNo responses of limbs, except for reflex movementsNo response to painful stimuli, except for reflex movementsIrregular breathingSymptoms of a coma include the following: No response to outside stimuli, such as: PainSoundTouchSightSpontaneous body movements, such as: JerkingShakingTremblingEyes opening and closingIrregular breathingThe following symptoms may occur after a person has been unconscious:Amnesia for events before, during, and even after the period of unconsciousnessConfusionDrowsinessHeadacheInability to speak or move parts of his or her body (see stroke symptoms)LightheadednessLoss of bowel or bladder control (incontinence)Rapid heartbeat (palpitations)Stupor (profound confusion and weakness)Being asleep is not the same as being unconscious. A sleeping person will respond to loud noises or gentle shaking. An unconscious person will not.First AidIf someone is awake but less alert than usual, ask a few simple questions, such as:What is your name? What is the date? How old are you? Wrong answers or not being able to answer the question suggest a change in mental status.If a person is unconscious or has a change in mental status, follow the first aid steps:Call or tell someone to call the local emergency number.Check the person's airway, breathing, and pulse frequently. If necessary, begin CPR.Evaluate person’s state with AVPU scale.If the person is breathing and lying on their back, and you do not think there is a spinal injury, carefully put the person in a recovery position. Gently tilt their head back to keep the airway open. If breathing or pulse stops at any time, roll the person onto?their back and begin CPR.If you think there is a spinal injury, leave the person where you found them (as long as breathing continues). If the person vomits, roll the entire body at one time to their side. Support their neck and back to keep the head and body in the same position while you roll.Keep the person warm until ambulance arrives.If you see a person fainting, try to prevent a fall. Lay the person flat on the floor and raise their feet about 30 cm.If fainting is likely due to low blood sugar, give the person something sweet to eat or drink when they become conscious.SeizuresWhen the normal functions of the brain are disrupted by injury, disease, fever, infection, metabolic disturbances or conditions causing a decreased oxygen level, a seizure may occur. The seizure is a result of abnormal electrical activity in the brain and causes temporary, involuntary changes in body movement, function, sensation, awareness or behavior.Risk factors for seizures:? Head trauma? Infections of the brain or spinal cord? Epilepsy? Stroke? Drug use or withdrawal? Hypoglycemia (Low Blood Sugar)? Heat Stroke? Fever in infantsEpilepsy is a chronic seizure condition. The seizures that occur with epilepsy usually can be controlled with medication. Still, some people with epilepsy who take seizure medication occasionally have seizures. Others who go a long time without a seizure may think that the condition has gone away and stop taking their medication, thus putting themselves at risk for another seizure.Febrile Seizures: Young children and infants may be at risk for febrile seizures, which are seizures brought on by a rapid increase in body temperature. They are most common in children younger than 5years.Febrile seizures often are caused by infections of the ear, throat or digestive system and are most likely to occur when a child or an infant experiences a rapid rise in temperature. A child or an infant experiencing a febrile seizure may experience some or all of the signals listed below.Signs and symptoms of epileptic seizure include:A blank stare.A period of distorted sensation during which the person is unable to respond .Uncontrolled muscular contractions, called convulsions, which last several minutes.A person with epilepsy may experience something called an aura before the seizure occurs. An aura is an unusual sensation or feeling, such as a visual hallucination; strange sound, taste or smell; or an urgent need to get to safety. If the person recognizes the aura, he or she may have time to tell bystanders and sit down before the seizure occurs.Febrile seizures may have some or all of the following signals:Sudden risein body temperatureChange in consciousn essRhythmic jerking of the head and limbsLoss of bladder or bowel controlConfusionDrowsinessCrying outBecoming rigidHolding breathUpward rolling of the eyesTypically seizures usually last no more than three minutes. Some common occurrences during a seizure include stopped or irregular breathing, body rigidness or convulsing, defecation, urination, and drooling.When to call EMSCall the local emergency number if:The seizure lasts more than 5 minutes.The person has multiple seizures with no signs of slowing down.The person appears to be injured or fails to regain consciousness after the seizure.The cause of the seizure is unknown .The person is pregnant.The person has diabetes.The person is a young child or an infant and experienced a febrile seizure brought on by a high fever.The seizure takes place in water.The person is elderly and could have suffered a stroke.This is the person's first seizure.If the person is known to have occasional seizures, you may not have to call the local emergency number. He or she usually will recover from a seizure in a few minutes.First aidAlthough it may be frightening to watch, you can easily help to care for a person having a seizure. Remember that he or she cannot control the seizure. Do not try to stop the seizure. General principles of managing a seizure are to prevent injury, protect the person's airway and make sure that the airway is open after the seizure has ended.Do not hold or restrain the person. Do not put anything in the person's mouth or between the teeth. People having seizures rarely bite their tongues or cheeks with enough force to cause significant bleeding; however, some blood may be present.Make sure that the environment is as safe as possible to prevent injury to the person who is having a seizure. Remove any nearby furniture or other objects that may injure the person.Give care to a person who has had a seizure the same way you would for an unconscious person. When the seizure is over, make sure that the person's airway is open. Usually, the person will begin to breathe normally. If there is fluid in the person's mouth, such as saliva, blood or vomit, roll him or her on one side so that the fluid drains from the mouth. If the child or infant has a febrile seizure, it is important to immediately cool the body by giving a sponge bath with lukewarm water.The person may be drowsy and disoriented or unresponsive for a period of time. Check to see if he or she was injured during the seizure. Be comforting and reassuring. If the seizure occurred in public, the person may be embarrassed and self-conscious. Ask bystanders not to crowd around the person .He or she may be tired and want to rest. Stay on the scene with the person until he or she is fully conscious and aware of the surroundings.Heart conditions: angina pectoris, heart attackCardiac emergencies are life threatening. Heart attack and cardiac arrest are major causes of illness and death. Recognizing the signals of a heart attack and cardiac arrest, calling the local emergency number and giving immediate care in a cardiac emergency saves lives. Performing CPR and using an automated external defibrillator (AED) immediately after a person goes into cardiac arrest can greatly increase his or her chance of survival.-11430061595Left VentricleRight Ve ntricle00Left VentricleRight Ve ntricleBackgroundThe heart beats more than 3 billion times in an average lifetime. The heart is about the size of a fist and lies between the lungs in the middle of the chest. It pumps blood throughout the body. The ribs, breastbone and spine protect it from injury. The heart is separated into right and left halves.Blood that contains little or no oxygen enters the right side of the heart and is pumped to the lungs. The blood picks up oxygen in the lungs when you breathe. The oxygen-rich blood then goes to the left side of the heart and is pumped from the heart's blood vessels, called the arteries, to all other parts of the body. The heart and your body's vital organs need this constant supply of oxygen-rich blood.11328405588000Cardiovascular disease is an abnormal condition that affects the heart and blood vessels. The most common conditions caused by cardiovascular disease include coronary heart disease, also known as coronary artery disease, and stroke, also called a brain attack.Coronary heart disease occurs when the arteries that supply blood to the heart muscle harden and narrow. This process is called atherosclerosis. The damage occurs gradually, as cholesterol and fatty deposits called plaque build up on the inner artery walls). As this build-up worsens, the arteries become narrower. This reduces the amount of blood that can flow through them and prevents the heart from getting the blood and oxygen it needs. If the heart does not get blood containing oxygen, it will not work properly. When the heart is working normally, it beats evenly and easily, with a steady rhythm. When damage to the heart causes it to stop working effectively, a person can experience an angina, a heart attack or other damage to the heart muscle. A heart attack can cause the heart to beat in an irregular way. This may prevent blood from circulating effectively.When the heart does not work properly, normal breathing can be disrupted or stopped. A heart attack also can cause the heart to stop beating entirely. This condition is called cardiac arrest. The number one cause of heart attack and cardiac arrest in adults is coronary heart disease. Other significant causes of cardiac arrest are non-heart related (e.g., poisoning or drowning).Heart conditions.When blood flow to the heart muscle is reduced, people experience chest pain. This reduced blood flow usually is caused by coronary heart disease. When the blood and oxygen supply to the heart is reduced, a heart attack may result.Angina (angina pectoris) is a 'miniature heart attack' caused by a short term blockage. Angina almost always occurs after strenuous exercise or periods of high stress for the victim.The key differentiation between a heart attack and angina is that, in line with their typical onset modes, angina should start to relieve very shortly after resting (a 5 minutes), whereas a heart attack will not relieve with rest. Even after the medication intake.Signs and symptoms.A heart attack can be indicated by common signals. Even people who have had a heart attack may not recognize the signals, because each heart attack may not show the same signals.Chest pain, discomfort or pressure. The most common signal is persistent pain, discomfort or pressure in the chest that lasts longer than 3 to 5 minutes or goes away and comes back.Unfortunately, it is not always easy to distinguish heart attack pain from the pain of indigestion, muscle spasms or other conditions. This often causes people to delay getting medical care. Brief, stabbing pain or pain that gets worse when you bend or breathe deeply usually is not caused by a heart problem .The pain associated with a heart attack can range from discomfort to an unbearable crushing sensation in the chest.The person may describe it as pressure, squeezing, tightness, aching or heaviness in the chest.Many heart attacks start slowly as mild pain or discomfort.Often the person feels pain or discomfort in the center of the chest.The pain or discomfort becomes constant. It usually is not relieved by resting, changing position or taking medicine.Some individuals may show no signals at all.Discomfort in other areas of the upper body in addition to the chest. Discomfort, pain or pressure may also be felt in or spread to the shoulder, arm, neck, jaw, stomach or back.Trouble breathing. Another signal of a heart attack is trouble breathing. The person may be breathing faster than normal because the body tries to get the much-needed oxygen to the heart. The person may have noisy breathing or shortness of breath.Other signals. The person's skin may be pale or ashen (gray), especially around the face. Some people suffering from a heart attack may be damp with sweat or may sweat heavily, feel dizzy, become nauseous or vomit. They may become fatigued, lightheaded or lose consciousness. These signals are caused by the stress put on the body when the heart does not work as it should. Some individuals may show no signals at all.Differences in signals between men and women. Both men and women experience the most common signal for a heart attack: chest pain or discomfort. However, it is important to note that women are somewhat more likely to experience some of the other warning signals, particularly shortness of breath, nausea or vomiting, back or jaw pain and unexplained fatigue or malaise. When they do experience chest pain, women may have a greater tendency to have atypical chest pain: sudden, sharp but short-lived pain outside of the breastbone.If you think the person might be having a heart attack call the local emergency number immediately, act quickly.First aid.Any heart attack might lead to cardiac arrest, but prompt action may prevent further damage to the heart. Most people who die of a heart attack die within 2 hours of the first signal. Many people who have heart attacks delay seeking care. Often they do not realize they are having a heart attack. They may say the signals are just muscle soreness, indigestion or heartburn.Early treatment with certain medications-including aspirin-can help minimize damage to the heart after a heart attack. To be most effective, these medications need to be given within 1hour of the start of heart attack signals.If you suspect that someone might be having a heart attack, you should:Call the local emergency number immediately.Have the person stop what he or she is doing and rest comfortably. This will ease the heart's need for oxygen. Many people experiencing a heart attack find it easier to breathe while sitting.Loosen any tight or uncomfortable clothing.Closely watch the person until advanced medical personnel take over. Notice any changes in the person's appearance or behavior. Monitor the person's condition.Be prepared to perform CPR and use an AED, if available, if the person loses consciousness and stops breathing.Ask for a history of heart disease. Some people with heart disease take prescribed medication for chest pain. You can help by getting the medication for the person and assisting him or her with taking the prescribed medication.Offer aspirin, if medically appropriate and local protocols allow, and if the patient can swallow and has no known contraindications (see the following section). Be sure that the person has not been told by his or her health care provider to avoid taking aspirin.Be calm and reassuring. Comforting the person helps to reduce anxiety and eases some of the discomfort.Talk to bystanders and if possible the person to get more information.Do not try to drive the person to the hospital yourself. He or she could quickly get worse on the way.Aspirin – to lessen the heart damage.You may be able to help a conscious person who is showing early signals of a heart attack by offering him or her an appropriate dose of aspirin when the signals first begin. Always call for help as soon as you recognize the signals of a heart attack. Then help the person to be comfortable before you give the aspirin.If the person is able to take medicine by mouth, ask:Are you allergic to aspirin?Do you have a stomach ulcer or stomach disease?Are you taking any blood thinners, such as warfarin?Have you ever been told by a doctor to avoid taking aspirin?If the person answers no to all of these questions, you may offer him or her two chewable (81mg each) baby aspirins, or one 5-grain (325 mg) adult aspirin tablet with a small amount of water. Do not use coated aspirin products or products meant for multiple uses such as for cold, fever and headache. You also may offer these doses of aspirin if the person regains consciousness while you are giving care and is able to take the aspirin by mouth.StrokeThere are two main types of stroke - a CVA (Cardiovascular Attack - sometimes called just a stroke or major stroke) and a TIA (Transient Ischaemic Attack - sometimes called a mini-stroke).A stroke, also called a brain attack, is caused when blood flow to a part of the brain is cut off or when there is bleeding into the brain. Strokes can cause permanent brain damage, but sometimes the damage can be stopped or reversed.A stroke usually is caused by a blockage in the arteries that supply blood to the brain. Once the blood flow is cut off, that part of the brain starts to "suffocate" and die unless the blood flow can be restored. Blockages can be caused by blood clots that travel from other parts of the body, like the heart, or they can be caused by slow damage to the arteries over time from diseases such as high blood pressure and diabetes.In a small percentage of strokes there is bleeding into the brain. This bleeding can be from a broken blood vessel or from a bulging aneurysm that has broken open. There is no way to tell the type of stroke until the person gets to an emergency room and undergoes a thorough medical evaluation.A mini-stroke is when a person has the signals of a stroke, which then completely go away. Most mini-strokes get better within a few minutes, although they can last several hours. Although the signals of a mini-stroke disappear quickly, the person is not out of danger at that point.Those, who has a mini-stroke is at very high risk of having a full stroke within the next 2 days.Risk FactorsThe risk factors for stroke are similar to those for heart disease. Some risk factors are beyond one's control, such as age, gender and family history of stroke or cardiovascular disease. Other risk factors can be controlled through diet, changes in lifestyle or medication. With a history of high blood pressure, previous stroke or mini-stroke, diabetes or heart disease one's chances of a stroke increases.High blood pressure.Uncontrolled high blood pressure is the number one risk factor for stroke. It puts added pressure on arteries and makes them stiffer. The excess pressure also damages organs, including the brain, heart and kidneys. Even mildly elevated blood pressure can increase one's risk of a stroke. High blood pressure is the most important of the controllable risk factors. It has to be checked regularly and if it is high, it must be controlled by losing weight, changing diet, exercising routinely and managing stress. If those measures are not sufficient, proper medication must be prescribed.DiabetesDiabetes is a major risk factor for stroke. If someone has been diagnosed with diabetes, he or she needs to control the level of blood sugar. If uncontrolled, it damage blood vessels throughout the body.Cigarette SmokingCigarette smoking is another major risk factor of stroke. Smoking increases blood pressure, damages blood vessels and makes blood more likely to clot. The damage from smoking actually may be reversible. Approximately 10 years after a person has stopped smoking, their risk of stroke is about the same as the risk for a person who has never smoked. Inhaling smoke from smokers harms your health also. Avoid long-term exposure to cigarette smoke and protect children from this danger as well.DietDiets that are high in saturated fats and cholesterol increases the risk of stroke by causing fatty materials to build up on the walls of blood vessels. Foods high in cholesterol include egg yolks and organ meats, such as liver and kidneys. Saturated fats are found in beef, lamb, veal, pork, ham, whole milk and whole-milk products. Limiting the intake of these foods can help to prevent stroke.Preventing strokeYou can help prevent stroke if you:Control blood pressure.Quit smoking.Eat a healthy diet.Exercise regularly. Regular exercise reduces your chances of stroke by strengthening the heart and improving blood circulation. Exercise also helps in weight control.Maintain a healthy weight. Being overweight increases the chance of developing high blood pressure, heart disease and fat deposits lining the arteries.Control diabetes.Signs and symptoms.As with other sudden illnesses, looking or feeling ill, or behaving in a strange way, are common, general signals of a stroke or mini-stroke . Other specific signals of stroke have a sudden onset, including:Weakness or numbness of the face, arm or leg. This usually happens on only one side of the body.Facial droop or drooling.Trouble with speech. The person may have trouble talking, getting words out or being understood when speaking and may have trouble understanding.Loss of vision or disturbed (blurred or dimmed) vision in one or both eyes. The pupils may be of unequal size.Sudden severe headache. The person will not know what caused the headache and may describe it as "the worst headache ever."Dizziness, confusion, agitation, loss of consciousness or other severe altered mental status.Loss of balance or coordination, trouble walking or ringing in the ears.Incontinence.Think FAST for a StrokeFor a stroke, think FAST, which stands for the following:Face: Weakness, numbness or drooping on one side of the face. Ask the person to smile. Does one side of the face droop?Arm: Weakness or numbness in one arm. Ask the person to raise both arms. Does one arm drift downward?Speech: Slurred speech or difficulty speaking. Ask the person to repeat a simple sentence (e.g., Ask the person to say something like, "The sky is blue.") Are the words slurred? Can the person repeat the sentence correctly?Time: Try to determine when the signals began. If the person shows any signals of stroke, time is critical. When to call EMSCall the local emergency number immediately if you encounter someone who is having or has had a stroke, if you see signals of a stroke or if the person had a mini-stroke (even if the signals have gone away). Note the time of onset of signals and report it to the call taker or EMS personnel when they arrive.In the past, a stroke usually caused permanent brain damage. Today, new medications and medical procedures can limit or reduce the damage caused by stroke. Many of these new treatments must be given quickly to be the most helpful. It is important for the person to get the best care as quickly as possible.First aidNote the time that the signals started. If the person is unconscious, make sure that he or she has an open airway and care for life-threatening conditions. If fluid or vomit is in the person's mouth, put him or her in the recovery position to allow fluids to drain out of the mouth.Remove any material from the mouth with a finger if the person is unconscious. Stay with the person and monitor breathing and for any changes in the person's condition.If the person is conscious, check for non-life-threatening conditions. A stroke can make the person fearful and anxious. Often, he or she does not understand what has happened. Offer comfort and reassurance. Have the person rest in a comfortable position. Do not give him or her anything to eat or drink.Acute abdomen. Acute abdominal distress or acute abdomen is characterized by the sudden onset of severe abdominal pain and discomfort. Many people associate acute abdominal symptoms to simple indigestion that would resolve and “go away.” Although most cases of acute abdominal distress are temporary, some people may experience pain that does not go away or that becomes so severe. The abdominal cavity houses a number of organs and tissues where the pain may originate. Aside from indigestion, which is the most common cause of abdominal distress, other possible problems include:AppendicitisInflammation of the gallbladder (cholecystitis)Inflammation of the pancreas (pancreatitis)Inflammation of abdominal cavity membranes (peritonitis)Intestinal obstructionKidney stonesPerforated ulcerStrangulated herniaEctopic pregnancyAneurysm or rupture of an abdominal blood vesselAcute abdomen may result in general signs and symptoms that include:Pain (widespread or generalized)Diarrhea or constipationLow blood pressureRapid pulseAbdominal distentionFeverRigid abdomenTendernessGuarding behaviorFearSigns of shock (if there is internal bleeding or a major infection)Possible bleeding from the rectum or blood in the urine.Some individuals may report other symptoms that include weakness, restlessness, pain at movement, and assuming curled position.Signs and symptoms of abdominal distress should not be taken lightly. The initial emergency care you provide can be critical for the condition of the patient. ?In case the symptoms continue to get worse, do not try to diagnose or guess the nature of the problem, instead transport the individual or call for emergency help.? First aid:Maintain an open airway. Prepare for possible vomiting.Monitor for signs of shock and be ready to provide first aid.Assist the individual to his side with knees flexed. Stay alert for vomiting.Provide reassurance.If supplemental oxygen is available, provide oxygen if there are symptoms of difficulty breathing or shallow breathing.Do not give anything by mouth.If possible, get details about the symptoms of the patient such as the time of onset, the nature of pain (sharp, gnawing, stabbing), if it was sudden or gradual, any changes in bowel movement and characteristic of stool (dark, tarry stool), any fever or chills, and if there are signs of bleeding. Find out what was last consumed and when the patient last ate.Try save vomitus for possible laboratory test. However, make sure to avoid contact with ALL discharges and body fluids to prevent contracting communicable diseases.Although most cases of abdominal distress end up as indigestion, they should be thoroughly diagnosed to prevent misdiagnosis. Physical examination and laboratory tests are necessary for the accurate diagnosis of abdominal distress. It is important to take the patient to the nearest medical facility for complete medical evaluation.PoisoningA poison is any substance that causes injury, illness or death if it enters the body. In 2008 in USA over 93 percent of poisonings took place in the home. Fifty percent involved children younger than 6 years. Poisoning deaths in children younger than 6 years represented about 2 percent of the total deaths from poisoning. The 20- to 59-year-old age group represented about 76 percent of all deaths from poisoning.In recent years there has been a decrease in child poisonings. This is due partly to child-resistant packaging for medications. The decrease also is a result of preventive actions by parents and others who care for children. At the same time, there has been an increase in adult poisoning deaths. This increase is linked to an increase in both suicides and drug-related poisonings.Types of PoisoningA person can be poisoned by swallowing poison, breathing it, absorbing it through the skin and by having it injected into the body.Swallowed PoisonsPoisons that can be swallowed include foods, such as certain mushrooms and shellfish; an overdose of drugs, such as sleeping pills, tranquilizers and alcohol; medications, such as a high quantity of aspirin; household items, such as cleaning products and pesticides; and certain plants. Many substances that are not poisonous in small amounts are poisonous in larger ones. Combining certain substances can result in poisoning, although if taken by themselves they might not cause harm.Inhaled PoisonsA person can be poisoned by breathing in (inhaling) toxic fumes. Examples of poisons that can be inhaled include:Gases, such as:Carbon monoxide from an engine or car exhaust.Carbon dioxide from wells and sewers.Chlorine, found in many swimming pools.Fumes from:Household products, such as glues and paints.Drugs, such as crack cocaine.Absorbed PoisonsPoisons that can be absorbed through the skin come from many sources including plants, such as poison ivy, poison oak and poison sumac, and fertilizers and pesticides.Injected PoisonsInjected poisons enter the body through the bites or stings of insects, spiders, ticks, some marine life, snakes and other animals or through drugs or medications injected with a hypodermic needle.Signs and symptoms.How will you know if someone who is ill has been poisoned? Look for clues about what has happened. Try to get information from the person or from by standers. As you check the scene, be aware of unusual odors, flames, smoke, open or spilled containers, an open medicine cabinet or an overturned or a damaged plant. Also, notice if the person is showing any of the following signals of poisoning:Nausea and vomitingDiarrheaChest or abdominal painTrouble breathingSweatingChanges in consciousnessSeizuresHeadacheDizzinessWeaknessIrregular pupil sizeBurning or tearing eyesAbnormal skin colorBurns around the lips, tongue or on the skinYou also may suspect a poisoning based on information from or about the person. If you suspect someone has swallowed a poison, try to find out:The type of poison.The quantity taken.When it was taken.How much the person weighs.This information can help you and others to give the most appropriate care.For life-threatening conditions (such as if a person is unconscious s or is not breathing or if a change in the level of consciousness occurs), CALL local emergency number. If the person is conscious and alert, CALL the National Poison Control Center (PCC) hotline and follow the advice given.First aid.After you have checked the scene and determined that there has been a poisoning, follow the general care guidelines (DR CAB):Remove the person from the source of poison if the scene is dangerous. Do this only if you are able to without endangering yourself.Check the person's level of consciousness and breathing.Care for any life-threatening conditions.If the person is conscious, ask questions to get more information.Look for any containers and take them with you to the telephone.Call the National Poison Control Center Hotline atFollow the directions of the Poison Control Center.If the person becomes violent or threatening, move to safety and wait for help to arrive. Do not give the person anything to eat or drink unless medical professionals tell you to do so. If you do not know what the poison was and the person vomits, save some of the vomit.The hospital may analyze it to identify the poison.Bites: snakebites, animal bites, insect bites.General information.Snakebites, insect bites, or stings can cause intense pain and/or swelling. If not treated promptly and correctly, they can cause serious illness or death. The severity of a snakebite depends upon: whether the snake is poisonous or nonpoisonous, the type of snake, the location of the bite, and the amount of venom injected. Bites from humans and other animals, such as dogs, cats, bats, raccoons, and rats, can cause severe bruises and infection and tears or lacerations of tissue. Awareness of the potential sources of injuries can reduce or prevent them from occurring. Knowledge and prompt application of first-aid measures can lessen the severity of injuries from bites and stings and keep the service member from becoming a serious casualty.Types of Snakes13579288800Nonpoisonous Snakes. They have oval- shaped heads and round eyes. Unlike poisonous snakes, discussed below, nonpoisonous snakes do not have fangs with which to inject venom. Figure depicts the characteristics of a nonpoisonous snake.-9715510160000Poisonous Snakes. Poisonous snakes are found throughout the world, primarily in tropical to moderate climates. Pit Vipers (Poisonous).Figure below depicts a variety of poisonous snakes.55290710403800Rattlesnakes, bushmasters, copperheads, fer-de-lance, Malayan pit vipers, and water moccasins (cottonmouth) are called pit vipers because of the small, deep pits between the nostrils and eyes on each side of the head (Figure). In addition to their long, hollow fangs, these snakes have other identifying features: thick bodies, slit-like pupils of the eyes, and flat, almost triangular-shaped heads. Color markings and other identifying characteristics, such as rattles or a noticeable white interior of the mouth (cottonmouth), also help distinguish these poisonous snakes.Further identification is provided by examining the bite pattern of the wound for signs of fang entry. Occasionally there will be only one fang mark, as in the case of a bite on a finger or toe where there is no room for both fangs, or when the snake has broken off a fang.The casualty’s condition provides the best information about the seriousness of the situation, or how much time has passed since the bite occurred. Pit viper bites are characterized by severe burning pain. Discoloration and swelling around the fang marks usually begins within 5 to 10 minutes after the bite. If only minimal swelling occurs within 30 minutes, the bite will almost certainly have been from a nonpoisonous snake or possibly from a poisonous snake which did not inject venom. The venom destroys blood cells, causing a general discoloration of the skin. Blisters and numbness in the affected area follow this reaction. Other signs, which can occur, are weakness, rapid pulse, nausea, shortness of breath, vomiting, and shock.Corals, Cobras, Kraits, and Mambas. Corals (Figure 6-4), cobras (Figure 6-5), kraits, and mambas all belong to the same group even though they are found in different parts of the world. All four inject their venom through short, grooved fangs, leaving a characteristic bite pattern.52827700Figure 6-4. Coral snake.The small coral snake, found in the Southeastern US, is brightly colored with bands of red, yellow (or almost white), and black completely encircling the body. Other nonpoisonous snakes have the same coloring, but on the coral snake found in the US, the red ring always touches the yellow ring. To know the difference between a harmless snake and the coral snake found in the United States, remember the following:“Red on yellow will kill a fellow, Red on black, venom will lack.”7112012509500Figure 6-5. Cobra snake.209180136702800The venom of corals, cobras, kraits, and mambas produces symptoms different from those of pit vipers. Because there is only minimal pain and swelling, many people believe that the bite is not serious. Delayed reactions in the nervous system normally occur between 1 to 7 hours after the bite. Symptoms include blurred vision, drooping eyelids, slurred speech, drowsiness, and increased salivation and sweating. Nausea, vomiting, shock, respiratory difficulty, paralysis, convulsions, and coma will usually develop if the bite is not treated promptly.Sea Snakes. Sea snakes (Figure) are found in the warm water areas of the Pacific and Indian oceans, along the coasts, and at the mouths of some larger rivers. Their venom is VERY poisonous, but their fangs are only 1/4 inch long. The first aid outlined for land snakes also applies to sea snakes.Sea snake.SnakebitesPoisonous snakes DO NOT always inject venom when they bite or strike a person. However, all snakes may carry tetanus (lockjaw); anyone bitten by a snake, whether poisonous or nonpoisonous, should immediately seek medical attention.Poison is injected from the venom sacs through grooved or hollow fangs. Depending on the species, these fangs are either long or short. Pit vipers have long hollow fangs. These fangs are folded against the roof of the mouth and extend when the snake strikes. This allows them to strike quickly and then withdraw. Cobras, coral snakes, kraits, mambas, and sea snakes have short, grooved fangs. These snakes are less effective in their attempts to bite, since they must chew after striking to inject enough venom (poison) to be effective. Figure 6-7 depicts the characteristics of a poisonous snakebite.In the event you are bitten, attempt to identify and/or kill the snake. Take it to medical personnel for inspection/identification. This provides valuable information to medical personnel who deal with snakebites. TREAT ALL SNAKEBITES AS POISONOUS.-1448167600Figure 6-7. Characteristics of poisonous snakebite.The venoms of different snakes cause different effects. Pit viper venom (hemotoxin [blood toxin]) destroys tissue and blood cells. Cobras, adders, and coral snakes inject powerful venom (neurotoxin [nerve toxin]) which affect the central nervous system, causing respiratory paralysis. Water moccasins and sea snakes have venom that is both hemotoxic and neurotoxic.The identification of poisonous snakes is very important since medical treatment will be different for each type of venom. Unless it can be positively identified, the snake should be killed and saved. When this is not possible or when doing so is a serious threat to others, identification may sometimes be difficult since many venomous snakes resemble harmless varieties. When dealing with snakebite problems in foreign countries, seek advice, professional or otherwise, which may help identify species in the particular area of operations.Get the casualty to an medical facility as soon as possible and with minimum movement. Until evacuation or treatment is possible, have the casualty lie quietly and not move any more than necessary. If the casualty has been bitten on an extremity, DO NOT elevate the limb; keep the extremity level with the body. Keep the casualty comfortable and reassure him. If the casualty is alone when bitten, he should go to the medical facility himself rather than wait for someone to find him. Unless the snake has been positively identified, attempt to kill it and send it with the casualty. Be sure that retrieving the snake does not endanger anyone or delay transporting the casualty.If the bite is on an arm or leg, place a constricting band (narrow cravat [swathe], or narrow gauze bandage) one to two fingerbreadths above and below the bite (Figure 6-8). If the bite is on the hand or foot, place a single band above the wrist or ankle. The band should be tight enough to stop the flow of blood near the skin, but not tight enough to interfere with circulation. In other words, it should not have a tourniquet- like affect. If no swelling is seen, place the bands about 1 inch from either side of the bite. If swelling is present, put the bands on the un swollen part at the edge of the swelling. If the swelling extends beyond the band, move the band to the new edge of the swelling. (If possible, leave the old band on, place a new one at the new edge of the swelling, and then remove and save the old one in case the process has to be repeated.)Figure 6-8. Constricting band. CAUTIONDO NOT attempt to cut open the bite nor suck out the venom. If the venom should seep through any damaged or lacerated tissues in your mouth, you could immediately lose consciousness or even die.If the bite is located on an arm or leg, immobilize it at a level below the heart. DO NOT elevate an arm or leg even with or above the level of the heart. CAUTIONWhen a splint is used to immobilize the arm or leg, take EXTREME care to ensure the splinting is done properly and does not bind. Watch it closely and adjust it if any changes in swelling occur.When possible, clean the area of the bite with soap and water. DO NOT use ointments of any kind.NEVER give the casualty food, alcohol, stimulants (coffee or tea), drugs, or tobacco.Remove rings, watches, or other jewelry from theaffected limb.Human or Animal BitesHuman or other land animal bites may cause lacerations or bruises.In addition to damaging tissue, bites always present the possibility of infection.Human Bites. Human bites that break the skin may become seriously infected since the mouth is heavily contaminated with bacteria. Medical personnel MUST treat all human bites.Animal Bites. Land animal bites can result in both infection and disease. Tetanus, rabies, and various types of fevers can follow an untreated animal bite. Because of these possible complications, the animal causing the bite should, if possible, be captured or killed (without damaging its head) so that it can be tested for disease.First Aid.Cleanse the wound thoroughly with soap.Flush it well with water.Cover it with a sterile dressing.Immobilize the injured arm or leg, if appropriate.Transport the casualty immediately to a medical facility.NOTE: If unable to capture or kill the animal, provide medical personnel with any information that will help identify it.Insect (Arthropod) Bites and StingsAn insect bite or sting can cause great pain, allergic reaction, inflammation, and infection. If not treated correctly, some bites/stings may cause serious illness or even death. When an allergic reaction is not involved, first aid is a simple process. In any case, medical personnel should examine the casualty at the earliest possible time. It is important to properly identify the spider, bee, or creature that caused the bite/sting, especially in cases of allergic reaction.Types of Insects. The insects found throughout the world that can produce a bite or sting are too numerous to mention in detail. Commonly encountered stinging or biting insects include brown recluse spiders (Figure 6-9), black widow spiders (Figure 6-10), tarantulas (Figure 6-11), scorpions (Figure 6-12), urticating caterpillars, bees, wasps, centipedes, conenose beetles (kissing bugs), ants, and wheel bugs. Upon being reassigned, especially to overseas areas, take the time to become acquainted with the types of insects to avoid. Figure 6-9. Brown recluse spider. Figure 6-10. Black widow spider. Figure 6-11. Tarantula. Figure 6-12. Scorpion.Signs and Symptoms. Discussed in paragraphs (1) and (2) below are the most common effects of insect bites/stings. They can occur alone or in combination with the others.Less serious. Commonly seen signs/symptoms are pain, irritation, swelling, heat, redness, and itching. Hives or wheals (raised areas of the skin that itch) may occur. These are the least severe of the allergic reactions that commonly occur from insect bites/stings. They are usually dangerous only if they affect the air passages (mouth, throat, nose, and so forth), which could interfere with breathing. The bites/stings of bees, wasps, ants, mosquitoes, fleas, and ticks are usually not serious and normally produce mild and localized symptoms. A tarantula’s bite is usually no worse than that of a bee sting. Scorpions are rare and their stings (except for a specific species found only in the Southwest desert) are painful but usually not dangerous.Serious. Emergency allergic or hypersensitive reactions sometimes result from the stings of bees, wasps, and ants. Many people are allergic to the venom of these particular insects. Bites or stings from these insects may produce more serious reactions, to include generalized itching and hives, weakness, anxiety, headache, breathing difficulties, nausea, vomiting, and diarrhea. Very serious allergic reactions (called anaphylactic shock) can lead to complete collapse, shock, and even death. Spider bites (particularly from the black widow and brown recluse spiders) can also be serious. Venom from the black widow spider affects the nervous system. This venom can cause muscle cramps, a rigid, nontender abdomen, breathing difficulties, sweating, nausea, and vomiting. The brown recluse spider generally produces local rather than system-wide problems; however, local tissue damage around the bite can be severe and can lead to an ulcer and even gangrene.First Aid. There are certain principles that apply regardless of what caused the bite/sting. Some of these are—If there is a stinger present (for example, from a bee), remove the stinger by scraping the skin’s surface with a fingernail or knife. DO NOT squeeze the sac attached to the stinger because it may inject more venom.Wash the area of the bite/sting with soap and water (alcohol or an antiseptic may also be used) to help reduce the chances of an infection and remove traces of venom. Remove jewelry from bitten extremities because swelling may occur.In most cases of insect bites the reaction will be mild and localized; use ice or cold compresses (if available) on the site of the bite/ sting. This will help reduce swelling, ease the pain, and slow the absorption of venom. Meat tenderizer (to neutralize the venom) or calamine lotion (to reduce itching) may be applied locally. If necessary, seek medical assistance.In more serious reactions (severe and rapid swelling, allergic symptoms, and so forth) treat the bite/sting like you would treat a snakebite; that is, apply constricting bands above and below the site.Be prepared to perform basic life-support measures, such as rescue breathing.Reassure the casualty and keep him calm.In serious reactions, attempt to capture the insect for positive identification; however, be careful not to become a casualty yourself.If the reaction to the bite/sting appears serious, seek medical assistance.WARNINGInsect bites/stings may cause anaphylactic shock (a shock caused by a severe allergic reaction). This is a life-threatening event and a TRUE MEDICAL EMERGENCY. Be prepared to perform the basic life-support measures and to immediately transport the casualty to an MTF.WARNINGInsect bites/stings may cause anaphylactic shock (a shock caused by a severe allergic reaction). This is a life-threatening event and a TRUE MEDICAL EMERGENCY. Be prepared to perform the basic life-support measures and to immediately transport the casualty to an MTF.NOTE: Be aware that some allergic or hypersensitive individuals may carry identification or emergency insect bite treatment kits. If the casualty is having an allergic reaction and has such a kit, administer the medication in the kit according to the instructions which accompany the kit.Table 6-1. First Aid Measures for Bites and StingsTYPESFIRST AID MEASURESSNAKEBITEMove casualty away from the snake.Remove jewelry from the affected area, if applicable.Reassure casualty and keep him quiet.Apply constricting band, 1-2 fingerbreadths from the bite. You should be able to insert a finger between the band and the skin.Arm or leg bite. Place one band above and one band below the bite site.Hand or foot bite. Place one band above the wrist or ankle.Immobilize the affected part in a position below the level of the heart.Kill the snake (if possible, without damaging its head or endangering yourself) and send it with the casualty.Seek medical assistance immediately.BROWN RECLUSE SPIDER ORBLACK WIDOW SPIDER BITEKeep casualty quiet.Remove all jewelry from affected part, if applicable.Wash the area.Apply ice or freeze pack, if available.Seek medical assistance.TARANTULA BITE ORSCORPION STING ORANT BITEWash the area.Remove all jewelry from affected part, if applicable.Apply ice or freeze pack, if available.Apply baking soda, calamine lotion, or meat tenderizer (if available) to bite site to relieve pain and itching.If the site of the bite is on the face, neck (possible airway problems), or genital area, or if local reaction seems severe, or if the sting is by the dangerous type of scorpion found in the southwest united states desert, keep the casualty as quiet as possible. Seek medical assistance.BEE STINGIf the stinger is present, remove by scraping with a knife or fingernail. Do not squeeze venom sac on stinger; more venom may be injected.Remove all jewelry from affected part, if applicable.If the stinger is present, remove by scraping with a knife or fingernail. Do not squeeze venom sac on stinger; more venom may be injected.Remove all jewelry from affected part, if applicable.DrowningDrowning is a common cause of accidental death in Europe. After drowning the duration of hypoxia is the most critical factor in determining the victim’s outcome; therefore, oxygenation, ventilation, and perfusion should be restored as rapidly as possible. Immediate resuscitation at the scene is essential for survival and neurological recovery after a drowning incident. This will require provision of CPR by a bystander and immediate activation of the EMS system. Victims who have spontaneous circulation and breathing when they reach hospital usually recover with good outcomes. Drowning is death through respiratory impairment from submersion/immersion in liquid. It occurs more frequently in males and the young.Immersion means to be covered in water or other ?uid. Submersion implies that the entire body, including the airway, is under the water or other ?uid.Classification Due to the temperature of the water:Warm-water drowning occurs at water temperatures of 20°C or higherCold-water drowning occurs at water temperatures of less than 20°CDue to type of the water: Freshwater drowningSaltwater drowningClassification (no longer used)Wet and dry (acute respiratory distress syndrome that developed in children hours after swimming) drowningActive (people such as non-swimmers and the exhausted or hypothermic at the surface, who are unable to hold their mouth above water and are suffocating due to lack of air. Instinctively, people in such cases perform well known behaviors in the last 20–60 seconds before being submerged, representing the body's last efforts to obtain air) and passive drowning (people who suddenly sink or have sunk due to a change in their circumstances. Examples include people who drown in an accident, or due to sudden loss of consciousness or sudden medical condition)Secondary drowning ("drowning in their own body fluid“ due to pulmonary edema)Drowning and near-drowning (is the survival of a drowning event involving unconsciousness or water inhalation and can lead to serious secondary complications or death, possibly up to 72 hours after the event) The pathophysiology of drowning : in brief, after submersion, the victim initially breath holds before developing laryngospasm. During this time the victim frequently swallows large quantities of water. As breath holding/laryngospasm continues, hypoxia and hypercapnia develops. Eventually these re?exes abate and the victim aspirates water into their lungs leading to worsening hypoxaemia. Without rescue and restoration of ventilation the victim will become bradycardic before sustaining a cardiac arrest. The key feature to note in the pathophysiology of drowning is that cardiac arrest occurs as a consequence of hypoxia and correction of hypoxaemia is critical to obtaining a return of spontaneous circulation.First AidTreatment of a drowning victim involves four distinct but interrelated phases. These comprise (i) aquatic rescue, (ii) basic life support, (iii) advanced life support, and (iv) post-resuscitation care. The initial rescue from the water is usually undertaken either by bystanders or those with a duty to respond such as trained lifeguards or lifeboat operators. Basic life support is often provided by the initial responders before arrival of the emergency medical services. Resuscitation frequently continues into hospital Basic life supportAquatic rescue and recovery from the water. Always be aware of personal safety and minimize the danger to yourself and the victim at all times. Whenever possible, attempt to save the drowning victim without entry into the water. Talking to the victim, reaching with a rescue aid (e.g., stick or clothing), or throwing a rope or buoyant rescue aid may be effective if the victim is close to dry land. Alternatively, use a boat or other water vehicle to assist with the rescue. Avoid entry into the water whenever possible. If entry into the water is essential, take a buoyant rescue aid or ?otation device. It is safer to enter the water with two rescuers than alone. Never dive head ?rst in the water when attempting a rescue. You may lose visual contact with the victim and run the risk of a spinal injury.Remove all drowning victims from the water by the fastest and safest means available and resuscitate as quickly as possible. The incidence of cervical spine injury in drowning victims is very low (approximately 0.5%). Spinal immobilisation can be dif?cult to perform in the water and can delay removal from the water and adequate resuscitation of the victim. Cervical spine immobilisation is not indicated unless signs of severe injury are apparent or the history is consistent with the possibility of severe injury. These circumstances include a history of diving, water-slide use, signs of trauma or signs of alcohol intoxication. If the victim is pulseless and apnoeic remove them from the water as quickly as possible (even if a back support device is not available), while attempting to limit neck ?exion and extension.Rescue breathing. The ?rst and most important treatment for the drowning victim is alleviation of hypoxaemia. If possible supplement rescue breaths/ventilations with oxygen. Give ?ve initial ventilations/rescue breaths as soon as possible.Rescue breathing can be initiated whilst the victim is still in shallow water provided the safety of the rescuer is not compromised. It is likely to be dif?cult to pinch the victim’s nose, so mouth-to- nose ventilation may be used as an alternative to mouth-to-mouth ventilation.If the victim is in deep water, open their airway and if there is no spontaneous breathing start in-water rescue breathing if trained to do so. In-water resuscitation is possible, but should ideally be performed with the support of a buoyant rescue aid. Give 10–15 rescue breaths over approximately 1 min. If normal breathing does not start spontaneously, and the victim is <5 min of from land, continue rescue breaths while towing. If more than an estimated 5 min from land, give further rescue breaths over 1 min, then bring the victim to land as quickly as possible without further attempts at ventilation. Chest compression. The victim should be placed on a ?rm surface before starting chest compressions as compressions are ineffective in the water. Con?rm the victim is unresponsive and not breathing normally and then give 30 chest compressions. Continue CPR in a ratio of 30:2. Most drowning victims will have sustained cardiac arrest secondary to hypoxia. In these patients, compression-only CPR is likely to be less effective and should be avoided.Automated external de?brillation. Once CPR is in progress, if an AED is available, dry the victim’s chest, attach the AED pads and turn the AED on. Deliver shocks according to the AED prompts.Regurgitation during resuscitation. Although rescue breathing is dif?cult to perform perfectly on a drowning victim because of the need for very high in?ation pressures or the presence of ?uid in the airway, every attempt should be made to continue ventilation until advanced life support providers arrive. Regurgitation of stomach contents and swallowed/inhaled water is common during resuscitation from drowning. If this prevents ventilation completely, turn the victim on their side and remove the regurgitated material using directed suction if possible. Care should be taken if spinal injury is suspected but this should not prevent or delay life-saving interventions such as airway opening, ventilations and chest compressions. Abdominal thrusts can cause regurgitation of gastric contents and other life-threatening injuries and should not be used. Electrocution. Lightning strike.Electric shock injuries are caused by the direct effects of current on cell membranes and vascular smooth muscle. The thermal energy associated with high-voltage electrocution will also cause burns. Factors in?uencing the severity of electrical injury include whether the current is alternating (AC) or direct (DC), voltage, magnitude of energy delivered, resistance to current ?ow, pathway of current through the patient, and the area and duration of contact. Skin resistance is decreased by moisture, which increases the likelihood of injury. Electric current follows the path of least resistance; conductive neurovascular bundles within limbs are particularly prone to damage.Contact with AC may cause tetanic contraction of skeletal muscle, which may prevent release from the source of electricity. Myocardial or respiratory failure may cause immediate death.Lightning strikeLightning strikes deliver as much as 300 kV over a few milliseconds. Most of the current from a lightning strike passes over the surface of the body in a process called ‘external ?ashover’. Both industrial shocks and lightning strikes cause deep burns at the point of contact. For industrial shocks the points of contact are usually on the upper limbs, hands and wrists, whereas for lightning they are mostly on the head, neck and shoulders. Injury may also occur indirectly through ground current or current “splashing” from a tree or other object that is hit by lightning. Explosive force may cause blunt trauma. The pattern and severity of injury from a lightning strike varies considerably, even among affected individuals from a single group. As with industrial and domestic electric shock, death is caused by cardiac or respiratory arrest. Lightning can also cause central and peripheral nerve damage; brain haemorrhage and oedema, and peripheral nerve injury are common. The circumstances surrounding the incident are not always known. Unconscious patients with linear or punctuate burns or feathering should be treated as a victims of lightning strike. RescueEnsure that any power source is switched off and do not approach the casualty until it is safe. High-voltage (above domestic mains) electricity can arc and conduct through the ground for up to a few metres around the casualty. It is safe to approach and handle casualties after lightning strike, although it would be wise to move to a safer environment, particularly if lightning has been seen within 30 min. ResuscitationCall an EMS. Start standard basic life support without delay. Take care of wounds.Airway management may be dif?cult if there are electrical burns around the face and neck. Early tracheal intubation is needed in these cases, as extensive soft-tissue oedema may develop causing airway obstruction. Head and spine trauma can occur after electrocution. Immobilise the spine until evaluation can be performed.Muscular paralysis, especially after high voltage, may persist for several hours; ventilatory support is required during this period.VF is the commonest initial arrhythmia after high-voltage AC shock; treat with prompt attempted de?brillation. Asystole is more common after DC shock; use standard protocols for this and other arrhythmias.Remove smouldering clothing and shoes to prevent further thermal injury.Consider early surgical intervention in patients with severe thermal injuries.Maintain spinal immobilisation if there is a likelihood of head or neck trauma. Electrocution can cause severe, deep soft-tissue injury with relatively minor skin wounds, because current tends to follow neurovascular bundles.Patients struck by lightning are most likely to die if they sustain immediate cardiac or respiratory arrest and are not treated rapidly. When multiple victims are struck simultaneously by lightning, rescuers should give highest priority to patients in respiratory or cardiac arrest. Victims with respiratory arrest may require only ventilation to avoid secondary hypoxic cardiac arrest. Resuscitative attempts may have higher success rates in lightning victims than in patients with cardiac arrest from other causes, and efforts may be effective even when the interval before the resuscitative attempt is prolonged. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download