Hagau Medical First Aid

Natalia Hagău
Medical First Aid
Course for 1st year

Medicine and Dental Students
Contributors:
Constantin Bodolea
Dan Dîrzu
Cristina Indrei
Sebastian Trancă
EDITURA MEDICALĂ UNIVERSITARĂ „IULIU HAłIEGANU” CLUJ-NAPOCA
Natalia Hagău, Constantin Bodolea, Dan Dîrzu, Cristina Indrei, Sebastian Trancă
Medical First Aid
Descrierea CIP a Bibliotecii NaŃionale a României

Medical first aid / Hagău Natalia, Bodolea Constantin, Indrei
Cristina, ... - Cluj-Napoca : Editura Medicală Universitară
"Iuliu HaŃieganu", 2010
Bibliogr.
ISBN 978-973-693-355-4
I. Hagău, Natalia
II. Bodolea, Constantin
III. Indrei, Cristina
616-083.98
Toate drepturile acestei ediŃii sunt rezervate Editurii Medicale Universitare “Iuliu
HaŃieganu”. Tipărit în România. Nici o parte din această lucrare nu poate fi reprodusă sub
nici o formă, prin nici un mijloc mecanic sau electronic, sau stocată într-o bază de date fără
acordul prealabil, în scris, al editurii.
Copyright  2010
EDITURA MEDICALĂ UNIVERSITARĂ „IULIU HAłIEGANU”
CLUJ-NAPOCA
Editura Medicală Universitară „Iuliu HaŃeganu” CLUJ-NAPOCA

Universitatea de Medicină şi Farmacie „Iuliu HaŃieganu” Cluj-Napoca
400023 Cluj-Napoca, str. Emil Isac 13
Tel.+40-0264-597256 Fax: +40-0264-596585
Director Editură: Ioana Robu
Tehnoredactare: Gabriela Jeler
Tiparul executat la Tipografia UniversităŃii de Medicină şi Farmacie

„Iuliu HaŃieganu” Cluj-Napoca
400001 Cluj-Napoca, str. MoŃilor 33
Tel: +40-0264-596089
PRINTED IN ROMANIA
Preface
The course is a useful, concise textbook addressed primarily to medicine,

dental, pharmacy, biology, physical education students, and also to all those who are
willing to acquire first aid notions.
It comprises emergency basic notions and rescue medical techniques which
are structured in five chapters: basic life support, first aid in environmental
emergencies, in intoxications and in trauma, and the first aid kit.
The learners are recommended to practice the emergency treatment of
patients simulating: the cardio-pulmonary resuscitation and the basic life support, the
patient airway patency maintenance, the adequate haemostasis, the correct joint and
bone immobilization, the intramuscular and subcutaneous injection and the
emergency treatment of patients using the first aid kit.
The course provides the student with good medical judgment in emergency
situations, clinical and decision-making skills during realistic patient care scenarios,
the practice of teamwork, leadership and communication skills, to become fastest,
efficient and professional life-savers.
Correct first aid measures according to international protocols, and an
improved capacity of intervention in emergency situations increase the citizen safety
in the modern society.
The authors Cluj-Napoca, Romania

February 2010
Contents
Basic life support 1
First aid in environmental emergencies 7
First aid in trauma 19
Acute Intoxication 33
First Aid Kit 43
Bibliography 47
Medical First Aid University of Medicine Cluj-Napoca
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1 year course Anaesthesia and Intensive Care
Basic life support
Cardiac arrest is an abrupt cessation of cardiac pump function which may be

reversible by a prompt intervention but will lead to death in its absence.
Clinical death is a nonspecific term used for cardiac and respiratory arrest, but
biologic death is irreversible cessation of all biologic function. Neurological lesions
appear after 3-5 minutes after cardiac arrest and are the first cellular lesions.
Cardio respiratory resuscitation refers to thoracic compressions pulmonary
ventilation made to maintain blood flow to vital organs and to prevent cellular lesions.
Basic life support refers to maintaining airway patency and supporting
breathing and the circulation, without the use of equipment other than protective
device.
Advanced life support is the treatment of cardiac arrest and refers to
advanced manoeuvres made by trained medical personnel, final purpose being
mechanical activity of the heart.
There is no efficiency in resuscitation if is initiated after 15 minutes of cardiac
arrest because after this period permanent brain damage is present. In case of
hypothermia metabolic requirements are reduced and the brain is protected, so in
hypothermic patient we only call death if we warmed him first.
Basic life support (BLS) alone will have little recovery, with serious
complications. Basic life support should be seen as method to preserve human body
until defibrillation and advanced life support is available. Only 5-10 % of those who
receive basic life support alone survived.
Basic life support protocol Follow these steps in out
HELP! of hospital basic life
support
Open airway
NOT BREATHING!
CALL 112
30 thoracic compresions
2 ventilations
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University of Medicine Cluj-Napoca Medical First Aid
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Anaesthesia and Intensive Care 1 year course
First aid always starts with saviour making sure that the victim, any bystanders
and he is safe. Next step is to check victim for a response. For this, gently shake his
shoulders and ask loudly: „are you all right?”
If he responds:
• leave him in the position in which you find him provided there is no further
danger;
• try to find out what is wrong with him and get help if needed;
• reassess him regularly.
If he does not respond
• shout for help;
• turn the victim onto his back and then open the airway using head tilt and
chin lift (see below);
• keeping the airway open, look, listen and feel for normal breathing.
If he is breathing normally:
• put him in the recovery position;
• send or go for help, or call for ambulance;
• check for continuous breathing.
If he is not breathing normally:
• ask someone to call for an ambulance or, if you are on your own, do
this yourself. Do not forget the emergency number 112;
• start chest compressions;
• combine 30 chest compressions with rescue breathes;
• if you are not able or are unwilling to give rescue breaths give chest
compressions only at a rate of 100 per minute;
• continue resuscitation until qualified help arrives and take over, the
victim starts breathing normally or you become exhausted.
There are several variations of the recovery position, each with its own
advantages. This position should be stable, near a true lateral position with head
dependent, and with no pressure on the chest to impair breathing. The sequence of
actions to place a victim in the recovery position:
• remove the victim’s spectacles;
• kneel beside the victim and make sure that both his legs are straight;
• place the arm nearest to you out at right angles to his body, elbow bent with
the hand palm uppermost (Fig.1);
• bring the far arm across the chest, and hold the back of the hand against the
victim’s cheek nearest to you (Fig.2);
• with your other hand, grasp the far leg just above the knee and pull it up,
keeping the foot on the ground (Fig.3);
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• keeping his hand pressed against his cheek, pull on the far leg to roll the
victim towards you onto his side (Fig.4);
• adjust the upper leg so that the hip and knee are bent at right angles;
• tilt the head back to make sure the airway remains open.
Fig.1 Arm in right angle Fig.2 Far arm under cheek
Fig.3 Knee up Fig.4 Victim is rolled
Head tilt chin lift is used to lift soft tissue of the anterior neck which in comatose
patient closes the airway. To do this you have to:
• place your hand on his forehead and gently tilt his head back;
• with your fingertips under the points of the victim’s chin, lift the chin to open
the airway (Fig.5).
Fig.5 Head tilt chin lift. Keeping the airway

open, look for chest movement, listen for breath sounds and fell for air on your cheek.
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For chest compressions (Fig.6):

• kneel down by the side of the victim;
• place the palm of one hand in the center of the victim’s chest;
• place the palm of your other hand on the top of the firs hand;
• interlock the fingers of your hands and ensure that the pressure is not
applied over the victim’s ribs, do not apply any pressure over the upper
abdomen or the bottom end of the sternum;
• position yourself vertically above the victim’s chest and with your arms
straight pres down sternum 4-5 cm;
• after each compression, release all the pressure on the chest without losing
contact between your hands and sternum. Repeat at a rate of 10 times per
second;
• compress and release should take an equal amount of time.
Fig.6 Chest compression – correct position

To ventilate (Fig.7):
• after 30 compressions open the airway again using head tilt chin lift;
• pinch the soft part of the victim’s nose closed, using the index finger and
thumb of your hand on his forehead;
• allow his mouth to open but maintain chin lift;
• take a normal breath and place your lips around his mouth, making sure that
you have a goo seal;
• blow steadily into his mouth whilst watching for his chest to rise, take about
one second to make his chest rise as in a normal breathing;
• maintaining head tilt and chin lift, take your mouth away from the victim and
watch for his chest to fall as air comes out;
• make another ventilation, then return without delay to chest compressions.
Fig.7 Open mouth for ventilation
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If your rescue breaths do not make the chest rise as in normal breathing, then
before next attempt:
• check the victim’s mouth and remove any visible obstruction;
• recheck that there is adequate head tilt and chin lift;
• do not attempt more than two breaths each time before returning to chest
compressions.
If there is more than one rescuer present, another should take over chest
compressions about every 2 minutes to prevent fatigue. Ensure the minimum of delay
during the changeover of rescuers.
The safety of both the rescuer and the victim is the paramount during a
resuscitation attempt. There have been few incidents of rescuers suffering adverse
effects from undertaking resuscitation with only isolated reports of infections such as
tuberculosis and severe acute respiratory distress syndrome (SARS). Transmission
of HIV during resuscitation has never been reported. There have been no human
studies to address the effectiveness of barrier devices during ventilation, but rescuers
should use them to prevent contamination during mouth to mouth ventilation.
In most cases basic life support should start with chest compressions. There
are situations when lack of ventilation is the cause of cardiac arrest. This situation is
seen in drowning, small child, asphyxia. In this patients basic life support should start
with 5 rescue breaths followed by one minutes of 30 compressions to 2 ventilations.
Only after this one minute we stop for phone call to 112. If we are not sure about the
cause of arrest we start with compressions.
Choking
Because recognition of choking (airway obstructions by foreign body) is the key
to successful outcome, it is important to not confuse it with fainting, heart attack,
seizure or any other cause of loose of consciousness. Choking may be seen in
seizure attack for instance making rescuer job even harder.
Foreign bodies may cause either mild – victim speaks, cough, breathe - or
severe airway obstructions when victim is unable to speak, breath, attempt of
coughing are silent and may respond by nodding.
If the victim shows signs of mild airway obstructions first aid is to encourage him
to continue coughing, but do nothing else.
1. If the victim has severe obstruction but is conscious:
• give up to five back blows;
• check to see if each blow has relieved the airway obstructions;
• if five back blow fail to relieve the airway give up to five abdominal thrusts;
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• if the obstruction is still not relieved continue alternating five back blows with
five abdominal thrusts.
2. If the victim becomes unconscious:
• support the victim carefully to the ground;
• call an ambulance;
• begin chest compressions in BLS protocol. Do not stop for pulse checking –
chest compressions should be initiated even if pulse is present in choking
unconscious victim.
To give back blows:
• stand to the side and slightly behind the victim;
• support the chest whit one hand and lean the victim well forward;
• give sharp blows between the shoulders blades with the heel of your other
hand;
• remember that the aim is to relieve obstruction with each blow rather than
necessarily to give all five.
To do abdominal thrust (Fig.8):
• stand behind the victim and pull both arms round the upper part of his
abdomen;
• lean the victim forwards;
• clench your fist and place it between the umbilicus and the bottom of the
sternum;
• grasp this hand with your other hand and pull sharply inwards and upwards;
• repeat up to five times.
Fig.8 Abdominal thrust
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First aid in environmental emergencies
First aid is a series of simple life-saving techniques which can be provided by

trained lay-people in cases of medical and surgical emergencies.
The life of a trauma victim depends on the moment first aid is provided and
on the rescuer’s skills.
Simple devices that are needed in providing first aid are usually kept in a first
aid kit.
Hypothermia
Hypothermia is defined as a core temperature of less than 35˚C.
Hypothermia can occur in healthy people exposed to low temperatures,
especially when there is a combination of high humidity and wind (e.g. cold water
submersion-heat loss is due to water conduction which is 30 times higher than that
of air).
At the extremes of ages (children and old people) hypothermia may occur
even at moderate low temperatures. The risk of hypothermia is high in people with
alcohol and drug addiction, chronic illness, hypoglycaemia or trauma.
The minor grade of hypothermia (32-35˚C) manifests as intense cold
sensation, shivering (this is an involuntary defence reflex that increases heat
production up to 500kcal/h), peripheral vasoconstriction and increase of the basal
metabolic rate. The breathing frequency is also increased. The patient is confused
and tired.
The moderate grade of hypothermia (28-32˚C) is marked by the absence of
shivering, a low metabolic rate (for a core temperature of 28˚C the basal metabolic
rate decreases to 50% of the normal value), low oxygen and glucose consumption.
The heart rate progressively decreases and the patient is at risk for ventricular
arrhythmias.
The most severe grade of hypothermia- the decrease of the core temperature
below 28˚C – is marked by the decrease of brain perfusion and oxygen
consumption, the decrease of the cardiac output, heart frequency (20-30
beats/min) ant arterial pressure. The defence mechanisms against heat loss are
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absent. The patient is in deep coma, with dilated pupils that do not react to light.
Because the brain functions are depressed the victim seems dead.
The core temperature represents the temperature measured with
temperature probes that are placed in the rectum or in the oesophagus.
Should cardiac and respiratory arrest appear, hypothermia may have a
protective effect on the brain, and other organs as well, and full neurologic
recovery is possible.
In a hypothermic victim, the therapy focuses on the cessation of further heat
loss, warming up and rapid transport to the hospital:
• Heat loss prevention: wet clothes have to be taken off; the survival sheath
has to cover the patient (with the silver part inside, close to the body), warm
blankets.
• The conscious victim may drink warm liquids.
• Careful transport to the hospital, avoiding brisk movements that can lead
to cardiac arrest.
• In case of hypothermia external chest compressions are difficult to
perform because of chest rigidity.
Fig.1. The use of the survival sheath with the silver part towards the patient.
Frostbites
Cold injuries can occur when the environment temperature is below 0 ˚C,
functional impairment and anatomical mutilation can be a consequence. The type
of cold injuries is dependent on the degree and duration of exposure.
Frostbites are the most common lesions caused by cold and appear when
body tissues freeze.
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Bearing in mind that human tissues do not contain only water, they do not
freeze until they reach – 3 ˚C. For this it is necessary that ambiental temperature
is below – 6 ˚C. The temperature of the tissues is influenced by environment
temperature and by internal heat production.
The injury is caused by ice crystals in the interstitial space between the cells,
small thrombus formation that causes vascular stasis and capillary injuries.
Fig.2. Severe frostbites of the fingertips
The signs and symptoms of the frostbites are cold sensation, inability of
movement, local pain, burn sensation, erythema, paresthesia, local anaesthesia,
pallor.
First aid:
• rescuer’s and victim’s security;
• call for an ambulance;
• check the victim’s consciousness;
• ABC evaluation;
• cardio-pulmonary resuscitation in cardiac arrest;
• the injured regions must not be touched;
• the victim must be protected against further coldness and the clothes or
shoes that worsen stasis must be taken out. The victim must be dressed
with warm dry clothes.
• the injured regions must be progressively warmed with water 36-40˚C. Be
attentive to the temperature of the water.
• further exposure of the injured regions to cold must be avoided;
• the warming process can lead to local pain and the patient has to be
given proper analgesics (e.g. Paracetamol 500mg);
• quick transport to the hospital with ongoing rewarming;
• application of a sterile drape on the lesions.
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Fig.3. Hand frostbites
After the extremities have been rewarmed, local excruciating pain is

common. It usually resolves within 2 to 4 days, but sometimes may be present for
up to weeks. Local oedema and erythema may also appear. Rarely, black dry
scars may be formed in 2 weeks.
Avalanches
Avalanches are rapid movements of the snow masses in the mountains.
These are one of the most dangerous events in the mountains and are real
threats for the people who live in the mountains all over the world. Tourists,
especially those who practice winter sports, are also at risk.
The avalanches’ appearance is favoured by specific factors: the snow layer
characteristics, the mountain structure and the weather conditions.
Fig.4. Avalanche
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In order to avoid the danger produced by avalanches it is important to know

exactly in which locations they occur. Performing risk maps allow mountain
rescuers to establish efficient measures against crisis situations.
We have to leave behind us all the mountain equipment in the case of an
avalanche. The skis need to be taken off unless we consider that we can rapidly
get out of the avalanche.
When, despite all efforts of prevention, one is caught in an avalanche the
rescue chances depend mainly on his or her attitude.
The snow does not permit sound transmission, but the degree of sound
absorption varies and shouting for help may be beneficial. For this, the shout has
to be short and with a high tonality and whistles can also help.
Some victims may be lost in the snow. For these, the survival chances
depend upon several factors as for instance the depth, the snow quality, the air
availability and rapid exit.
Death supervenes through:
• trauma;
• rapid asphyxia;
• slow asphyxia – this is the most common cause of death in avalanches
and it is due to low oxygen availability and CO2 accumulation;
• hypothermia.
The search for the victims and their rescue must be rapidly organized as the
chances for survival decrease abruptly in time. First it is established how many
persons miss from the groups. If there are more survivals, one or two send SOS
and bring rescuers when there are no more rapid solutions like mobile phone alert.
The victim must not be moved. During transport close monitoring has to be
performed. The transport has to be as quick as possible, by helicopter or by Akija
sleigh, if possible.
Improving rescue devices and searching methods, together with the increase
of the rescue teams’ skills have raised the chances of survival, but this does not
mean that the avalanches are less dangerous.
Sending S.O.S. in the mountains

In the mountains, calling for help is done by sending six signals per minute
(one signal at 10 seconds). The signals may be light, acoustic or visual.
Light signals may be done by turning on the flashlight of a lantern or other
light sources during the night, by covering and uncovering of a fire, the light of a
cooker, a voyage primus and even a candle or by lightening six matches at 10
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seconds interval. During day time the light signals are done with the use of a
mirror that reflects the sunshine, with manual rackets or pistols.
The acoustic signals are shouts, whistles, striking a metallic object at 10
seconds intervals.
Visual signals, other than light ones, consist of raising and waving of clothes,
branches and even the arms above the head.
Very important: the six signals, whatever form they have, are launched at 10
seconds intervals for one minute. Then a pause of one or two minutes is done.
The signals are launched in the direction of mountain paths, mountain shelters,
hotels or close places.
If the victim is already in a mountain shelter and needs help he has to wave
the red stag. This has 2 x2 metres, has to be in any shelter and can be seen from
far.
How should we respond to a rescue signal?
If one sees the rescue signals in the mountains he has to respond to them
immediately.
The confirmation is done through three signals per minute (at 20 seconds
time intervals).
The victim continues to launch signals until the rescuers reach him, in order
to maintain contact with the rescuers.
Very important: the one who sees the rescue signals is obliged to
immediately alert the closest refuge, shelter or hut, and from these the rescue
need is transmitted to the SALVAMONT teams.
Sunstroke and hyperthermia

Sunstroke and caloric shock can be caused by:
• prolonged exposure to sun during hot weather;
• ambiental high temperatures, combined with high humidity;
• hard physical work in a hot closed space.
Hyperthermia occurs when the body’s normal thermal regulation disappears
and the core temperature is above the normal levels.
Hyperthermia may be external (caused by environment factors) or it may be
due to abnormal internal heat production (e.g. following physical activity in closed
hot spaces).
External hyperthermia is caused by radiation heat intake that overwhelms
body heat loss capacity.
Thermic shock is a systemic inflammatory response of the organism that
appears at a core temperature above 41oC. It is characterised by mental status
alteration and various organ dysfunction. Old people, people suffering chronic
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illness, as well as new borns are at risk. High ambiental temperatures together
with high humidity lead to caloric shock. During hot periods in summer many
persons need medical care.
Signs and symptoms of sunstroke:
• slow appearance;
• headaches;
• nausea;
• vomit;
• muscle aches;
• muscle cramps;
• dehydration;
• irritability;
• fatigue;
• drowsiness;
• tahycardia – over 100 heart beats/ minute.
Sings and symptoms of caloric shock:

• core temperature above 41˚C;
• seizures;
• hallucination;
• behaviour changes;
• confusion;
• coma;
• mydriasis- dilated pupils;
• severe dehydration (approximately 2l of fluids/h are lost);
• tachycardia;
• hypotension;
• hematuria;
• warm and dry skin;
• increased breathing frequency.
First aid:
• rescuer’s and victim’s security;
• check the victim’s consciousness;
• ABC evaluation;
• cardio-pulmonary resuscitation in cardiac arrest;
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• providing oxygen;
• the patient in coma must be placed in the lateral safety position;
• temperature monitoring;
• quick cooling until core temperature falls below 39˚C. The faster the
cooling the higher the survival rate. There are more cooling techniques:
• cold fluids intake for conscious victims;
• the use of ventilators that are directed towards the naked victim;
• ice packs in the axilla and around the neck;
• cold water immersion.
Viper bites
There are 11 species of vipers all over the world. The vipers are the most widely
spread poisonous snakes.
In Romania there are only three species (Vipera ammodytes, Vipera ursinii and
Vipera berus), the first two include two subspecies (Vipera ammodytes ammodytes +
Vipera ammodytes montadoni and Vipera ursini renardi + Vipera ursini rakosiensis,
respectively).
How to recognise the viper: the general characteristics of the viper are
observed and analysed: the dimensions and body shape- the vipers that are found in
Romania do not exceed 90 cm in length, their body is short and thick ; other non-
poisonous snakes have thinner and longer body. The viper’s head is triangular; their
pupils are vertical. They are yellowish brown and ash-coloured. An important
identifying marker is the dorsal zigzag pattern.
How to recognise the viper bite: the typical bite has two marks at 5-15mm,
and the surrounding skin becomes purple and sometimes has vesicles. In some
cases there may be a single bite mark or two parallel scratches produced by the two
retractile teeth.
Most frequent the viper bites occur during summer-time (peak incidence july
and august), then the vipers hibernate. The bites are usually localised on the legs,
around the ankles or on the hands (pay attention to children who may try to touch the
snake).
The vipers do not hear, but they can easily feel the presence of people
through vibrations. The most important thing to do when passing a dangerous
zone is to have a stick in the hand that helps you sweep the surrounding areas so
that the vipers run away. As any other animal the viper does not attack people,
they only try to defend themselves.
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The critical time interval for the victim is the first 12 hours after the bite, but
this can take as log as days in extreme cases. Most of the bites are not followed
by any symptoms or these are mild (70%). Lethal cases are extremely rare.
Signs and symptoms:

• local pain and erythema;
• the general clinical manifestations:
• nausea and vomiting;
• diarrhoea;
• abdominal cramps;
• bladder incontinence;
• sweats;
• bronchospasm;
• tachycardia;
• hypotension;
• acute myocardial infarction;
• angioedema;
• spontaneous bleeding;
• seizures;
• coma.
First aid:
First of all: call for help 112.
The patient must be calmed and he/she must lie in a supine position in order to
avoid unnecessary movements. The bitten extremity should be located below the
level of the heart.
At the level of the bite one should immediately place the vacuum system in
order to aspirate the venom. There are special emergency kits that include such
system.
Proximal to the bite an elastic bandage is put in order to limit the venom spread
in the lymphatic circulation. This bandage is taken out only in the hospital and after
anti- venom has been administered.
No surgical incisions should be made and ice should not be applied on the
lesions. The skin is washed with sterile water and after this a sterile drape is put upon
it. A splint should be used to immobilize the extremity.
Anaphylactoid reactions are managed by adrenaline subcutaneous injections
(Anapen® 0.3 mg epinephrine/vial). Histamine blockers may be useful: loratadine
10mg or clorfeniramine 4mg orally.
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If the snake is caught and killed it is useful to bring it to the hospital for
identification.
The patient is transported and permanent check of vital functions is performed.
The emergency team has to announce the arrival and the clinical status of the patient
at the hospital.
Fig.5. Vipera berus Fig.6. Vipera ammodytes
Insect stings
Almost 4% of the general population is allergic to bees’ and wasps’ venom. In
these people, a single sting only can induce a life threatening condition called
anaphylactic shock. Taking into account that the bees leave their acus in the skin,
we can recognise the bee sting. The persons who are allergic to insect venom
must inform all the members of the family, their colleagues and their friends.
Symptoms:
• local pain and oedema;
• urticaria;
• pruritus;
• anxiety;
• tongue oedema;
• laringospasm;
• bronchospasm;
• chest pain;
• respiratory arrest;
• nausea and vomiting;
• 50 % of deaths are in the first 30 minutes.
We can prevent the stings by several simple measures:
• if a bee or wasp flies around you, you should stay still;
• do not touch or hit these insects; If they feel threatened they sting;
• take care when you put on clothes that were left on the grass, insects
may be there;
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• do not walk without shoes on the grass and in the garden; It is

recommended to wear tight clothes.
• avoid using cosmetics, bees and wasps love them;
• avoid blooming orchards, meadows and any place full of flowers;
• pay attention to all objects you want to catch; Avoid picking up flowers!
• it is useful to have a net on the windows to stop insects from entering the
house;
• pay attention to all the sweets you eat or drink, they must be covered;
• do not drive your car with an open window; If an insect gets in stop the
car and open the window so that it can get out.
First aid:
• the victim’s and rescuer’s safety are the most important;
• is the victim conscious?
• ABC evaluation and resuscitation in case cardiac arrest occurred.
If the acus and the venom pouch are still in the skin they have to be taken out
carefully.
Histamine blockers may be useful, but the treatment of anaphylactic shock is
epinephrine. Allergic persons must have a self injecting pen that can be used until
they are provided medical aid. AnaPen is an epinephrine easy-to-use injector that
may be life-saving.
Lightning
Lightning is caused by an electrical discharge within the atmosphere between
two clouds or between a cloud and the land. Thunderstorm clouds have a negative
charge along their inferior surface and the land has a positive charge.
Protection against negative outcomes of lightning is achieved by using
lightning rods, devices that were invented in the 18th century by Benjamin Franklin.
Less than 1/3 of the victims present burns (most of them being superficial)
because the time contact with the organism is very short. There are 240.000
lightning victims annually, 24.000 of them being dead.
In the case of a thunderstorm, you have to find quickly a shelter (a building
with a metallic structure or provided with a lightning rod). Most of the negative
consequences of lightning are material losses caused by fire. The others are
caused by electrical discharges through metallic pipes (water or gas pipes) or
through electrical and telephone wires. During a thunderstorm, it is recommended
to shut down the TV set and disconnect the antennas. It is not recommended to
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touch metallic objects like windows or fences. Any building is a better place than
the open field. Staying inside a car also offers protection.
Fig.7. Lightning
In the open field, metallic

objects are very dangerous. Having
an umbrella, a working tool or an
angling line may be lethal.
In a place without surrounding
trees the human body is the tallest
object and in the case of lightning,
has the highest probability of
receiving the impact. Moreover, in the open field, people may suffer wounds if they
are close to the place where the lightning falls, as the electrical charge spreads
along the land’s surface and produces great potential differences between close
places, e.g. between the two feet of a victim.
The high probability of electrical discharges upon trees during lightning
makes them an improper refuge during thunderstorms. On uneven lands one
should avoid the highest regions. The valleys, the precipices and the ravines have
proved to be more secure. Cycling, horse riding and swimming are dangerous.
To calculate the distance between us and the thunder center we have to
divide by 3 the time (in seconds) between the lightning and the thunder.
First aid:
• the victim’s and rescuer’s safety are the most important;
• is the victim conscious?
• ABC evaluation and resuscitation in case cardiac arrest occurred, there
are high chances of survival;
• burns’ care;
• permanent evaluation of the victim.
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First aid in trauma
General notions
Trauma is the main cause of death in the population aged between 1 and 45
years. 80% of the cases of death in young people and 60% of those in children are
due to traumatic causes.
The notion of trauma cannot be assimilated to that of accident. According to
DEX, an accident is a fortuitous, unpredictable event, which interrupts the normal
course of things, resulting in damage, injury, mutilation or even death. Most events
that involve traumas do not fit this definition, they can be prevented.
So, the care of the traumatized patient also involves the notion of prevention.
Medicine, along with other institutions, is responsible for the education of the
population regarding the adequate use of safety belts, special car seats for children,
the respect of traffic laws, the promotion and respect of laws on the status of
weapons and ammunition, the promotion of the mediation and non-violent solution of
conflicts.
Doctors should also “practice what they preach” and be an example by the way
in which they protect themselves as well as the others while driving.
Trauma includes injuries ranging from a finger cut to major injuries affecting
several organs and cavities of the body.
The first aid will be initiated according to the extension and the importance of
the injuries. During the first moments after severe traumas, the recognition of injuries
and the reaction of witnesses can be life saving.
The recognition and the opening of the obstructed airway, assisted ventilation,
pressure applied to a wound in order to reduce hemorrhage are procedures that can
be performed by persons with minimal training and can ensure the survival of the
victim. Even the best prepared and equipped medical emergency systems can fail to
ensure the survival of the victims of traumas if witnesses do not recognize the
seriousness of the situation, do not ask for specialized medical help and do not
provide basic assistance until its arrival. This is particularly true for events occurring
in isolated or rural areas.
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The knowledge of basic measures in order to ensure survival after trauma is

obligatory for any category of medical staff and refers to the observance of the
following principles:
• stop to help;
• ask for help (do not forget the emergency number 112);
• evaluate the safety of the environment, then assess the victim;
• start respiration;
• stop bleeding.
Medico-legal problems
Traumatic events are most frequently accompanied by medico-legal

consequences. Regardless of the medical evolution of a victim, particularly under
litigation conditions, a medico-legal indictment starts with the investigation of the first
moments of the assistance of the victim (first aid).
Therefore, information intended for the guidance of first aid care is considered
to be necessary.
Romanian legislation has few regulations on first aid provided by witnesses to
different types of trauma. Only a couple of laws (Law 139 of 1995 of the Romanian
National Red Cross Society and Law 524 of 2004) stipulate the organization of
compulsory first aid courses for all professional categories at risk. The Road Traffic
Code also stipulates that the obtaining of the driving licence requires the attendance
of a first aid course, with the theoretical examination including questions from the
course. According to the same code, any driver who witnesses a road traffic accident
has the obligation to stop and provide first aid care, but the code does not include
measures against those who do not accomplish this duty.
There are four notions that should be considered in the understanding of the
legal consequences of the provision of first aid: the duty to help, neglect, consent,
and the recording of events.
The duty to help describes the legal duty to act in a certain way with respect to
a certain person. After deciding to provide first aid care, the rescuer has the duty to
use his/her knowledge responsibly and to ensure that the actions to be initiated will
not expose the victim to an additional risk. First aid once initiated will be continued
until:
• the site of the accident becomes dangerous;
• another person capable of providing first aid takes over the victim’s care;
• qualified help arrives;
• the victim recovers;
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• the rescuer becomes physically unable to continue first aid care.

Neglect is expressed by the infringement of some ethical and professional
requirements:
• the person who should have provided first aid care had the legal obligation
to do it;
• the person providing first aid care did not act reasonably;
• a medical care standard was disregarded;
• the victim has injuries as a result of an action or an omission of the person
who provided first aid care.
Consent is necessary before any first aid action. In the case in which the victim
is unconscious or incapable to express his/her consent, the rescuer may assume that
there is a consent and may provide first aid treatment. If the victim is a minor, the
consent of the parents or the person responsible for the minor is required. In the
absence of consent, first aid can be provided. First aid should never be given to a
person who refuses it, or when injuries exceed the knowledge and the
competence of the rescuer.
The recording of events is recommended for any action or event, no matter how
insignificant, and is compulsory for those who have the legal duty to provide first aid
treatment. The recording of events should follow several general rules:
• the use of ink or a pen;
• the correction of data is performed only by crossing out with a horizontal
line, never with other correction fluids;
• the record is signed and dated;
• the record is confidential;
• in accidents at the work place, a copy should be submitted to the person
responsible for audit.
The initial examination of the victims of traumas
The treatment of the victim largely depends on the accuracy and the detailing of
information at the site of the trauma.
When approaching the victim, the presence of any potential danger for the
rescuers or the victim is checked. Fuel leakage, fallen electrical wires, the load of a
trailer if a truck is involved will be looked for. Nothing will be touched unless it is
certain that it cannot be a potential danger.
The number of victims and the type of accident are also assessed. The primary
evaluation is identical to that of the diagnostic protocol of cardiorespiratory arrest,
with the difference that the airways are checked avoiding the useless and dangerous
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mobilization of the cervical spine. After the hyperextension of the head for airway
desobstruction, it is recommended to maintain this position, avoiding flexion and
additional mobilization. If the patient is in cardiorespiratory arrest, basic vital support
is initiated.
When the number of rescuers is insufficient, the basic vital support of the
victim is not initiated if there are other victims who need urgent care.
If the patient is conscious, efforts will be made to calm him/her, assuring
him/her that help is coming. The first questions the patient will be asked will be:
• What happened?
• What hurts most?
• Can you breathe in deeply?
These three questions offer important details on the consciousness of the victim
at the time of the accident, on what injury is the most painful and on potential injuries
affecting breathing. At the same time, signs of external bleeding are searched for and
efforts are made in order to control it.
Do not move the victims of road traffic accidents unless there is a fire, a
high risk of additional collision, or this is required for the control of the
airways, in order to stop severe bleeding or for basic vital support. In any other
situation, the risk of mobilization overcomes the benefits.
When the ambulance arrives, all information obtained during first aid treatment
will be provided.
The triage of patients with traumas
Triage defines the situation by which the victims are classified depending on
severity and therapeutic priorities are established.
Although it is generally applied to multiple victims, triage can be involved any
time there is more than one victim and the number of rescuers is insufficient to
provide first aid simultaneously.
In order to increase efficacy in first aid treatment under conditions of limited
resources, some seriously injured persons must be temporarily ignored, to the
detriment of priority victims, who have lesions considered to be much more severe.
This approach should be objective, informed. When prioritizing those who need to be
treated, the person performing the triage should answer three questions:
• Who needs a life saving intervention?
• Who will really benefit from an intervention and who will not?
• If one person is treated, will there be another one who will suffer from lack of
attention?
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The safety of the victim, the permeability of the airways, the maintenance
of respiration and circulation, the control of severe hemorrhage, shock of any
cause and burns are priorities when first aid is given with limited resources.
Patients in cardiorespiratory arrest will be treated only if there are no other
victims whose lives are threatened. An unconscious patient lying on his back, a
patient with severe hemorrhage, a patient with cranial trauma in shock will be the first
treated. A conscious patient with a leg fracture represents a smaller emergency, and
a conscious patient who walks and shouts as loud as he can that his elbow hurts will
be treated at the end of the list of emergencies.
First aid in external hemorrhage
The human body needs a sufficient volume of blood to supply the organs with
oxygen and nutrients and thus maintain them functional.
The rapid loss of half the circulating blood volume is fatal even in young healthy
organisms, while the loss of 80% of the erythrocyte volume under conditions of
relatively maintained volemia is much better tolerated, without significant
consequences. The blood is circulated through the body with a cardiac effort that
generates a certain pressure. Without this adequate blood flow, the organism will
very rapidly undergo collapse and shock, followed by the sometimes irreversible
failure of various organs and systems.
External bleeding or hemorrhage is usually associated with a wound. Severe
wounds are frequently associated with lesions of the vessels. The lesions of arteries
are accompanied by pulsatile bleeding, with light red blood, and the lesions of veins
are accompanied by bleeding with a darker continuous blood flow, while in the
capillaries the blood is light red, with a slow diffuse flow.
First aid in severe life threatening bleeding consists of:
• asking for help! (call 112);
• wearing protection gloves (if available);
• examination of the wound for foreign bodies;
• application of pressure to the wound with a sterile or an as clean as possible
compress (the victim can initiate or continue self-compression);
• positioning of the victim on the back;
• elevation (if possible) and maintenance of the affected part (scalp, neck,
head, upper limbs) above the heart level;
• application of a sufficiently tight bandage in order to maintain the dressing;
• checking of the circulation in order to make sure that the dressing is not too
tight;
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• reevaluation every 30 minutes, with the assessment of consciousness, pulse

and respiration;
• treatment of shock if needed and if available;
• application of a tourniquet if bleeding cannot be controlled.
The tourniquet can be improvised from any bandage which is not too elastic and
has a minimum width of 5 cm. This is tightened at the base of a limb with bleeding
that cannot be controlled by compression, until bleeding stops. The time of its
placement is noted and it is not covered, in order to be easily seen.
The tourniquet is the last option in the control of hemorrhage, when other
methods have failed and the life of the victim is threatened.
If the wound contains a penetrating object, a dressing is applied around the
object, without extracting, moving or compressing it.
In the case of epistaxis (nasal bleeding), first aid consists of pressure applied to
the soft part of the nose (nose wing), right below the bone, for 10 minutes. The
patient leans slightly forward and breathing through the mouth is recommended.
Under high environmental temperature conditions, in a hypertensive patient or one
who has just performed exertion, a longer time period is needed in order to stop
bleeding. Cold compresses applied to the nose, neck and forehead can also be
useful. The patient will be advised not to blow his nose for several hours. If bleeding
persists for a longer time period, medical assistance is required.
Traumatic amputations will be treated like any bleeding wound. After bleeding
has been controlled, the amputated limb is introduced without being washed or
cleaned in a plastic or a waterproof bag with cold water. The amputated limb should
not come in contact with ice in order to avoid the destruction of tissues. The
amputated limb will reach the hospital at the same time with the victim.
It should be mentioned that when blood penetrates the already applied
compresses, other compresses are placed over these, without removing the initial
ones. The wounds are cleaned by washing with sterile water or physiological serum.
In all cases of injury resulting in a wound, antitetanic prophylaxis should be
administered.
First aid in internal hemorrhage
Internal bleeding or hemorrhage can be visible or hidden. Internal bleeding

becomes visible as a result of externalization through natural orifices (vomiting or
stool with blood, urine with blood, etc.) and can be easily recognized.
In contrast, hidden internal bleeding (in various cavities such as the peritoneal,
pleural, retroperitoneal cavity) can be suggested by the knowledge of the forces and
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mechanisms that have played a role in the accident and by the observation of the
victim.
Signs suggestive of internal bleeding include:
• pale, wet and cold skin;
• thirst;
• rapid and weak pulse (tachycardia);
• rapid and superficial breathing (polypnea);
• pain, discomfort;
• nausea, vomiting;
• progression to shock (agitation, confusion, coma, seizures caused by
ischemic brain damage).
The required measures are:
• asking for help (call 112);
• the conscious victim is positioned on the back with the legs raised;
• the unconscious victim – lateral safety position and raised legs;
• reevaluation at short time intervals;
• treatment of the other lesions;
• Nothing is administered by oral route!!!!
The rescuer should always assume that internal bleeding is present and that
he/she can do nothing to control it. The patient’s life depends on the time elapsed
until qualified medical assistance is provided.
First aid in the shock of the traumatized patient
Shock is a life threatening condition. The treatment of shock should only be

delayed in order to ensure the safety of the victim and of the rescuer, airway
desobstruction and breathing, basic vital support or the control of severe
hemorrhage. The state of a patient in shock in the absence of deshocking measures
will rapidly deteriorate, the recovery without medical intervention being impossible.
Traumatic shock may have multiple causes:
• bleeding;
• high spinal lesions accompanied by medullary cord lesions;
• crush injuries.
The signs of shock are:
• pale, wet and cold or cyanotic skin (in the absence of hemorrhage);
• thirst;
• rapid and weak pulse;
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• rapid and superficial breathing;

• pain, discomfort (or their absence under conditions of massive trauma or
severe neurological disorder);
• collapse (collapsing blood pressure);
• altered sensorium, agitation, apathy or unconsciousness;
• gradual arrest of vital functions.
A rescuer who evaluates a traumatized victim should anticipate the risk of
traumatic shock and ask himself/herself several questions:
• Is the injury severe?
• Is the victim in shock?
• In the absence of intervention, does the victim have a high risk of developing
shock?
If the answer to all these questions is “yes”, the patient should be treated for
shock.
The required measures are the same as for the patient with internal
hemorrhage. In addition, efforts should be made in order to maintain the normal
temperature of the victim, without overheating him/her.
First aid in the crush syndrome
Crushing is the injury in which a part of the body is exposed to high pressure,
being compressed between two objects or large heavy surfaces. The resulting
injuries may include lacerations (soft part lesions), fractures, bleeding, crush
syndrome.
The crush syndrome occurs when a part of the organism that has been
compressed is released. Compressing results in the arrest of circulation in the
concerned segment, with severe ischemic phenomena. At the same time, cell lesions
occur, with the release of large amounts of electrolytes (particularly potassium) and
toxic compounds (myoglobin) for organs such as the kidneys and the heart. The
conditions required for the appearance of the crush syndrome are:
• implication of a large muscle mass;
• prolonged compression;
• compromised blood circulation.
The signs of the crush syndrome are:
• absence of the pulse in the distal part of the limb;
• absence of pain in the affected area;
• progression to shock.
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The first aid consists of the emergency call, deshocking and transportation of
the victim to the hospital. If the removal of the mass that compresses the victim is
possible, the rescuer has to make sure that this can be done safely.
First aid in burns
Burns are lesions of tissues caused by a flame, hot objects or fluids, chemical
substances, radiation or a combination of these. Electrical burns, although less
common, are usually more severe and deeper than they seem to be, being
sometimes accompanied by cardiac arrhythmias.
Diagnosis is based on the reports of the victim or witnesses and on the
presence of signs of burns: redness, blisters (vesicles), dark skin, pain.
First aid consists of:
• protection of the rescuer and the victim against the burn inducing agent;
• personal protection (wearing of gloves);
• cooling of the burned extremities with clean water (up to 20 minutes for a
flame, at least 20 minutes for chemical burns, at least 30 minutes for
bitumen). phosphorus is continuously maintained wet and phosphorus
particles are removed only with the tweezers;
• bandaging by covering with a dressing;
• removal of clothes and objects that are fixed tightly to the extremities (rings,
jewels);
• the following will be avoided: vesicles will not be broken; bitumen will
not be removed from the eyes or skin; no creams or other lotions will
be used; the burned area and the victim will not be excessively cooled
in order to avoid shiver.
Medical examination is compulsory if:
• the burn is larger than the size of the palm of the victim;
• the victim has inhaled smoke, hot air (explosions in closed spaces);
• the victim is a child;
• the burn involves the palm, the face or the genital organs;
• the burn is caused by laser radiation, microwaves, infrared, ultraviolet or
other radiation.
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First aid in electrocution
The victim will never be touched before making sure that the electrical source
has been disconnected. The rescuer will check the presence of water or electrical
conductor materials that are still in contact with the victim.
In the case of electrocution from household electricity (220 volts), the victim
should be urgently disconnected from the power source by the interruption of power
or by moving the victim using non-conducting materials – wood, blankets. In the case
of higher voltage electrocution, if the victim is in the distribution network area, the
contact with the victim is forbidden until authorities certify the absence of danger. The
rescuer has the duty to protect himself and the others and will not expose himself to
the additional risk of electrocution.
The electrocuted patient may be in cardiorespiratory arrest, can have an
irregular pulse and usually a burn at the site of contact.
• asking for help (call 112), with the mention of the type of electric power;
• protection of the rescuer and the victim against electrocution;
• personal protection (wearing of gloves);
• application of vital support measures if indicated;
• application of the first aid protocol in the case of the presence of burns.
First aid in cranial trauma
Cranial trauma is always a serious problem, generating a high complication and

mortality rate.
A victim apparently unaffected by an accident can frequently develop some time
after the trauma life-threatening neurological complications. This happens because
cranial trauma may not initially have visible signs. The victims of accidents should be
asked if their memory is unaffected, whether they had a blow to the head. The state
of consciousness will always be evaluated, and if this is affected, further neurological
examination is required.
Sometimes cranial trauma is accompanied by visible head injuries.
Cerebrospinal fluid may flow from the ears and the nose, its presence indicating a
skull base fracture.
Contusion is a closed cranial trauma. Due to the initial absence of
symptomatology, it is frequently inadequately treated and the patient may enter a
coma later. Special attention should be given when this trauma appears during
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contact sports or activities involving children, when indifference and neglect may be
disastrous.
Facial injuries that may occur in cranial trauma are dangerous as they can
compromise the permeability of the airways.
The presence of the following manifestations suggests the coexistence of
cranial trauma:
• a head wound;
• cranial deformation;
• altered consciousness;
• flowing of cerebrospinal fluid from the ears or the nose;
• uneven pupils;
• headache;
• neurological manifestations such as: agitation, irritability, speech disorders.
First aid measures:
• immobilization of the cervical area by the placement of a cervical collar (if
this is available and the rescuer knows the technique of its application!!!);
• treatment of wounds;
• adoption of the lateral safety position for unconscious victims;
• the cerebrospinal fluid is allowed to flow freely – if the lateral position is
necessary, the wounded part is placed in a downward position;
• the victims with a contusion are not allowed to “jump about”.
First aid in spinal trauma
The injuries of the spine are dangerous because the concomitant injury of the
spinal cord may cause a number of severe complications such as: tetraplegia
(complete limb paralysis), paraplegia (lower limb paralysis), loss of cutaneous
sensitivity, loss of urinary control, sphincter control, chronic pain, etc.
Any conscious or unconscious patient with a cranial trauma is considered
to have an associated spinal injury until the contrary is demonstrated.
The signs suggestive of spinal trauma include:
• trauma occurring at a high speed, in contact sports, falls from a height;
• unnatural position of the neck, spine;
• pale, cold, perspiring skin;
• tingling sensation and absence of sensitivity in the limbs;
• absence of pain in the limbs in spite of the present lesions;
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• inability to move the limbs;

• signs of shock.
• immobilization of the cervical spine by the placement of a cervical collar; this
will be removed only if it prevents airway desobstruction;
• maintenance of the head aligned with the spine, without moving it in any
direction;
• treatment of shock;
• maintenance of the body temperature;
• mobilization is performed by rolling the victim using two or three assistants,
with the maintenance of the axis of the spine aligned with the axis of the
head (fig.1).
Fig.1. Rolling of the victim with a cervical spinal trauma
Spinal shock is a consequence of spinal trauma, in which a severe decrease in

blood pressure occurs, accompanied by a decrease in the pulse rate (unlike bleeding
shock).
The cervical collar should be placed whenever possible, in any trauma in which
a spinal injury is suspected. Ideally, two persons should fix the collar, one supporting
the victim’s head, the other fixing the collar. If the collar has an adjustable size, the
correct size is measured and it is adjusted according to the manufacturer’s
instructions (Fig.2). The collar will be fixed securely but comfortably, and for any
adjustment, the head of the victim is supported.
Fig.2. Adjustment of the size of the cervical collar
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First aid in thoracic trauma
Thoracic trauma is a serious problem, difficult to solve under first aid conditions,
the victim requiring emergency medical care in the hospital. The main thoracic
injuries are rib fractures, flail chest and penetrating wounds. Any of these injuries can
be complicated by pneumothorax or hemothorax (accumulation of air and blood,
respectively, in the pleural cavity).
Rib fractures represent a problem because they can affect breathing. The victim
has chest pain, particularly during inspiration, rapid and superficial breathing,
accelerated pulse. The victim’s respiration will be monitored until the arrival of the
emergency team.
Flail chest is a multiple rib fracture, occurring in at least 2 places, which
dramatically affects the dynamics of respiratory movements. The flail area of the
chest wall no longer contributes to ventilatory mechanics, having a paradoxical
inward movement during inspiration. Flail chest is frequently accompanied by
pneumothorax, which results in lung collapse. Pneumothorax may be present in the
absence of flail chest. First aid consists of asking for help (call 112) and the frequent
reevaluation of the victim. If conscious, the victim will sit, and if unconscious, the
victim will be placed in lateral safety position, with the affected part downwards in
order to allow the unaffected side to breathe easily.
Penetrating thoracic wounds are extremely severe and should be considered so
regardless of their size and the initial good state of the patient. It is vital that the
penetrating object remains in place. Even if this is too long (pole, tree branch), help
will be asked for urgently, but under no circumstances will the rescuer remove
the object penetrating the chest. If the wound is open, a dressing is applied,
leaving the upper part of the dressing open so that air can come out of the thorax.
Respiration will be monitored until the arrival of the ambulance.
First aid in abdominal trauma
Abdominal trauma can be accompanied by considerable bleeding, whether the

wound is visible or not. If a penetrating trauma is present and the foreign body is in
place, this will not be removed, like in the case of thoracic wounds.
Evisceration is the protrusion of an abdominal viscus (usually intestines or
epiploon) through the wound. If a dressing is applied to such a wound, clean,
preferably wet sterile compresses will be used, which do not adhere to the organ.
The organs will not be reintroduced in the abdomen. Pain may frequently not be
severe, but the victim can also be in shock, with severe hemorrhage and torn
intestines.
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First aid in traumas resulting in fractures
The fracture of a long bone should not be considered just an isolated trauma of
the affected bone. Injuries of muscles, tendons, vessels, nerves adjacent to the
fractured bone may frequently complicate fractures. Fractures are closed if there is
no wound and open when the fracture focus is exposed through the wound. First aid
consists of asking for help (call 112), the immobilization of the bone segment and the
dressing of the wound. Adequate immobilization is frequently difficult to perform.
The rescuer should always take into consideration the fact that the rapid access
of the victim to specialized medical services is more important than repeated
immobilization attempts.
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Acute Intoxication
Definition: ingestion, aspiration or injection of potentially toxic substances.

Acute intoxication may occur either accidentally, iatrogenic, or purposefully, to
commit suicide or murder.
Mushroom poisoning
Mushrooms are widely distributed throughout the world, thousands of species

have been identified and about 100 species of mushrooms are poisonous to humans,
and 15-20 mushroom species are lethal when ingested. In more than 95% of
mushroom toxicity cases, poisoning occurs as a result of misidentification of the
mushroom by an amateur mushroom hunter.
The severity of mushroom poisoning may vary depending on the geographic
location where the mushroom is grown. Boiling, cooking, freezing, or processing may
not alter the mushroom's toxicity. In general, children, older people, and person with
disabilities are at a higher risk of developing serious complications with mushroom
poisoning than are healthy young adults.
Poisoning occurs after the ingestion of toxins synthesized by the mushrooms
themselves.
Mushroom toxins include the following: cyclopeptides, orellanine, muscarine,
psilocybin, muscimol/ibotenic acid, coprine, and gastrointestinal irritants.
Cyclopeptides
These include amatoxins (high toxicity), phallotoxins (medium toxicity) and
virotoxins (no toxicity).
Amatoxins are responsible for more than 95% of mushroom-related fatalities. In
general, mature mushrooms are not difficult to identify.
At least 5 subtypes of amatoxins are known, the 2 most significant being the
alpha-amatoxin and beta-amatoxin. They are rapidly absorbed by the gastrointestinal
tract. Both are excreted in the urine and may be detected in the vomitus and feces.
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Hepatocellular damage is presumably caused by the formation of free radical

intermediates.
Amanita phalloides (Fig.1), Amanita virosa, Amanita verna, and Galerina
autumnalis are the best known and the deadliest amatoxin-containing mushrooms.
Amanita phalloides description
It has a large and imposing fruiting body, usually with a cap from 5 to 15cm
across, initially rounded and hemispherical, but flattening with age. The color of the
cap can be pale-, yellowish-, or olive-green, often paler toward the margins and often
paler after rain. The remains of the partial veil are seen as a skirt like, floppy annulus
usually about 1 to 1.5cm below the cap. The crowded white lamellae (gills) are free.
The stipe is white with a scattering of grayish-olive scales, with a swollen, sac-like
white base. Young specimens first emerge from the ground resembling a white egg
covered by a universal veil.
Fig.1. Amanita phalloides
Amanita poisoning
Poisoning is characterized by a
latent period of 6-12 hours after
ingestion (range 6-48 h), during which
the patient is asymptomatic.
At the end of this latent period, a
sudden abdominal pain, vomiting, and
profuse watery diarrhoea, this may
lead to severe dehydration, electrolyte abnormalities. This phase, which may last as
long as 2-3 days, is followed by an apparent recovery phase.
The third phase of amanita poisoning, i.e., the hepatorenal syndrome, is
characterized by jaundice, hypoglycaemia, coma, and multiorgan and system failure
followed by death in 50-90% of patients. With therapy, mortality may be well below
10%. The course of amatoxin poisoning typically lasts 6-8 days in adults and 4-6
days in children.
Orellanine
Orellanine is a nephrotoxic compound that is synthesized by a number of
species of the Cortinarius mushrooms and is commonly found in Europe and Japan.
Fig.2 Cortinarius Orellanus
Cortinarius Orellanus description

Rusty brown to orange Cap: 3–8.5cm,
concave. Wide gaps between the gills. Common
throughout European forests, rare in the northern
parts of Europe.
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Poisoning begins with a seemingly minor gastrointestinal illness characterized

by mild nausea, vomiting, and, sometimes, diarrhoea lasting 24-48 hours after
ingestion. This phase is followed by a prolonged latent period lasting from 3 days to 3
weeks. An intense thirst and polyuria herald renal failure. The patient also may
experience headaches, myalgias, muscle cramps, loss of consciousness, and
convulsions. Dialysis may be required in as many as 50% of the patients, and death
may occur in 15% of the cases.
Psilocybin
Psilocybin and psilocin are elaborated by a number of mushroom and, when
ingested, cause psychedelic effects similar to those of lysergic acid (LSD).
Fig.3. Psilocybe semilanceata
Psilocybe semilanceata description

Conical head with a small point or nipple on
the tip. They are yellow to brown in colour. The
gills are darker than the outer cap. Their stems
tend to be long and the same colour than the cap.
Psilocybe is a genus of small mushrooms
growing worldwide. Many other species are found in habitats such as mossy, grassy, or
forest humus soils.
Poisoning
The onset of hallucinations is usually rapid, and the effects generally subside
within 2 hours. Poisoning by these mushrooms is rarely fatal in adults and may be
distinguished from ibotenic acid poisoning by the absence of drowsiness or coma.
The most severe cases of psilocybin poisoning occur in small children, in whom large
doses may cause hallucinations accompanied by fever, convulsions, coma, and
death.
Ibotenic acid/muscimol
Amanita muscaria and Amanita pantherina mushrooms synthesize ibotenic acid
and muscimol, which are hallucinogenic.
Fig.4 Amanita muscaria Fig.5 Amanita pantherina
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Amanita description
Amanita muscaria fruiting bodies emerge from the soil looking like a white egg.
As the fungus grows, the red colour appears through the broken veil. The cap
changes from globes to hemispherical, and finally to plate-like and flat in mature
specimens. Fully grown, the bright red cap is usually around 8–20 cm in diameter.
After emerging from the ground, the cap is covered with numerous small white to
yellow pyramid-shaped warts.
Habitat: Amanita muscaria is a cosmopolitan mushroom, native to conifer and
deciduous woodlands throughout the temperate and boreal regions of the Northern
Hemisphere.
Amanita pantherina: Cap: 4 — 11cm wide, Hemispheric at first, then convex to
plano-convex, deep brown to hazel-brown. Gills: free, close to crowded, white
becoming greyish.
Habitat: throughout Europe
Ibotenic acid/muscimol poisoning
Symptoms generally occur within 1-2 hours of mushroom ingestion. In children,
ibotenic-acid effects may predominate (these effects include hyperactivity,
excitability, delirium, and convulsions). In adults, muscimol effect may predominate
and include drowsiness, dysphoria, and vertigo. Periods of drowsiness may alternate
between periods of hyperactivity and periods of delirium. Symptoms generally last for
a few hours (12 hours).
Muscarine
Ingestion of mushrooms with high concentrations of muscarine, such as
Clitocybe dealbata and Inocybe geophylla, results in muscarine poisoning.
Distribution, America and Europe.
Fig.6 Clitocybe dealbata
Clitocybe dealbata description

A small white or white dusted
mushroom, the 2–4cm diameter cap is
flattened to depressed with adnate to
decurrent crowded white gills. The stipe
is 2–3.5cm tall and 0.5–1cm wide. There is no distinctive taste or smell.
36
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It is found in grassy habitats in summer and autumn. Unfortunately, they often

occur in grassy areas where they may be encountered by children or toddlers. This
may increase risk of accidental consumption.
Poisoning
Is characterized by increased salivation, perspiration, and lacrimation within 15-
30 minutes of mushroom ingestion. With large doses, patients may experience
abdominal pain, severe nausea, diarrhoea, blurred vision, and laboured breathing.
Intoxication generally subsides within 2 hours. Death is rare but may result from
cardiac or respiratory failure in severe cases.
Coprine
A few species of mushrooms, including the Coprinus atramentarius mushroom,
produce coprine, an amino acid that is metabolized to 1-aminocyclopropanol in the
human body. This metabolite blocks acetaldehyde dehydrogenase, and, in the
presence of alcohol, acetaldehyde builds up, resulting in a disulfiram reaction.
Frequently urban, but also found in woods; is widely distributed in North America.
Fig.7 Coprinus atramentarius
Coprinus atramentarius description

Cap: 2-8 cm diameter, grey to greyish-brown;
oval then campanulate or conical. Gills: free,
initially white, then black Stem: 10-15 cm long, 8-
15 mm thick; equal; silky white to very light brown
Habitat and distribution: grows in fields and gardens, in rich soils or around stumps.
Common in the Northern Hemisphere; has been reported in South Africa.
Poisoning
The digestion of coprine-containing mushrooms generates a metabolite that
inhibits acetaldehyde dehydrogenase. Therefore, these mushrooms cause symptoms
to occur only when alcoholic beverages are consumed within 2 hours of ingestion.
Symptoms include headache, nausea, vomiting, flushing, chest pain, and diaphoresis
typical of the disulfiram syndrome and may last for 2-3 hours.
Gastrointestinal toxins
Hundreds of mushrooms contain toxins that can cause gastrointestinal
symptoms (e.g. nausea, vomiting, diarrhoea, abdominal pain) similar to those
observed with more dangerous mushrooms. They include Boletus Piperatus and
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Agaricus arvensis, among many others. Found naturally in coniferous and oak
woodland in Europe in autumn.
Fig.8 Boletus Piperatus
Fatalities caused by these mushrooms

are rare and are due to dehydration and
electrolyte imbalances caused by diarrhoea
and vomiting; fatalities occur especially in
debilitated, very young, or very old patients.
Diagnosis
The mushroom poisoning is classified into 3 major categories, depending on the
time-to-symptom development. These categories include the following:
• Early symptom category: Symptoms generally appear within the first 6 hours
of mushroom ingestion and include nausea, vomiting and diarrhoea, allergic, and
neurologic syndromes.
• Late symptom category: Signs and symptoms begin to appear between 6
and 24 hours after ingestion and may include hepatotoxic, nephrotoxic syndromes.
• Delayed symptom category: Symptoms appear more than 24 hours after
ingestion and include mostly nephrotoxic syndromes.
Patient history is the most important aspect of the diagnosis.
Every effort should be made to identify the mushroom or mushrooms early. If a
sample mushroom is available, use of telemedicine and the Internet may prove
valuable in identifying the mushroom. If a sample mushroom is not available,
questioning patients and their family about the identity of the mushroom they thought
they were picking may narrow the list of possibilities.
The history also should include: the time of ingestion, time to onset of
symptoms, the amount of mushrooms ingested, whether other people ingested the
same mushrooms, and whether the meal included other mushroom species.
Treatment
In the absence of a definitive identification of the mushroom, all ingestions
should be considered serious and possibly lethal.
First aid
Gastrointestinal decontamination, including whole-bowel irrigation, may be
necessary. Beyond the first postprandial hour, orogastric lavage is not recommended
because of the procedure's questionable efficacy. Activated charcoal plays a much
more important role in limiting absorption of most toxins and is indicated for all
38
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patients with mushroom poisoning, regardless of the timing of presentation. When

amatoxins are suspected, repeated doses of activated charcoal should be
administered for 3-4 days to interrupt enterohepatic circulation of these toxins.
In the hospital, specific therapy depends on the presumed toxin ingested.
Fulminant hepatic failure is a common complication observed with amatoxin and
gyromitrin poisoning, and it should be treated aggressively because it commonly
follows a fatal course. For these patients, liver transplantation may be the only life-
saving therapy.
Renal failure, commonly observed with orellanine poisoning, may require
hemodialysis.
Carbon monoxide poisoning
Carbon monoxide (CO) is a colourless, odourless gas produced by incomplete

combustion of organic compounds.
Most fatalities result from fires, stoves, portable heaters, and automobile
exhaust. These often are associated with malfunctioning or obstructed exhaust
systems and suicide attempts. Cigarette smoke is a significant source of CO.
CO intoxication also occurs by inhalation of methylene chloride vapours, a
volatile liquid found in degreasers, solvents, and paint removers.
Children riding in the back of enclosed pickup trucks or swimming behind a
motorboat seem to be at particularly high risk. Industrial workers at steel foundries,
plants producing formaldehyde and individuals working indoors with combustion
engines or combustible gases are at risk for exposure.
Pathophysiology
Toxicity primarily results from cellular hypoxia caused by impedance of oxygen
delivery. CO reversibly binds haemoglobin because it binds haemoglobin 230-270
times more avidly than oxygen, even small concentrations can result in significant
levels of carboxyhemoglobin (HbCO).
CO binds to cardiac myoglobin with an even greater affinity than to
haemoglobin; the resulting myocardial depression and hypotension exacerbates the
tissue hypoxia.
HbCO levels often do not reflect the clinical picture, yet symptoms typically
begin with headaches at levels around 10%. Levels of 50-70% may result in seizure,
coma, and fatality.
CO is eliminated through the lungs. Half-life of CO at room air temperature is 3-
4 hours. One hundred percent oxygen reduces the half-life to 30-90 minutes;
hyperbaric oxygen at 2.5 atm with 100% oxygen reduces it to 15-23 minutes.
39
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Neonates and the in utero foetus are more vulnerable to CO and individuals
with pulmonary and cardiovascular disease tolerate CO intoxication poorly.
Symptoms
Misdiagnosis commonly occurs because of the broad spectrum of complaints;
symptoms often are attributed to a viral illness. Symptoms may not correlate well with
HbCO levels.
• Acute poisoning
o malaise, flulike symptoms, fatigue;
o dyspnoea on exertion;
o chest pain, palpitations;
o lethargy;
o confusion;
o impulsiveness;
o distractibility;
o hallucination, confabulation;
o agitation;
o nausea, vomiting, diarrhoea;
o abdominal pain;
o headache, drowsiness (Fig.9);
o dizziness, weakness;
o visual disturbance;
o faecal and urinary incontinence;
o memory disturbances;
o bizarre neurologic symptoms, seizures.
Fig.9. CO intoxication
Physical examination
Physical examination is of limited value. Inhalation injury or burns should always
alert the clinician to the possibility of CO exposure.
• vital signs:
o tachycardia;
o hypertension or hypotension;
o hyperthermia;
o marked tachypnea;
• skin: classic cherry red skin is rare, pallor is present more often;
• neurologic and/or neuropsychiatric:
o patients display memory disturbance, emotional lability;
o coma;
• cardiac arrest.
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First aid
If carbon monoxide is suspected follow these steps:
1. Remove the victim from the area immediately. Breathing fresh air stop the
poisoning from getting worse. Do not stay in the room more than 1-3 min.
Risk of self intoxication!
2. Call the emergency number (112)! Treating carbon monoxide poisoning
requires professional assistance and oxygen delivery equipment or
hyperbaric chamber.
3. Follow the basics of first aid until help arrives for comatose patient or basic
life support for cardiac arrest patient.
41
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First Aid Kit
The first aid kit is a selection of different devices that can be

used when providing first aid is necessary. Its content depends on its
purpose, the people who made up the kit and their training in
providing first aid. Other factors that can influence the contents are
location and statute law.
The content of the kits varies widely. In a first aid kit that was made up for a
summer holiday we can include sun-screen lotions. For a holiday in the delta we
might need creams that protect us from mosquitoes’ bites and for a holiday in the
mountains we might need matches to start a fire, a thermos flask to keep liquids
warm, and roller bandages for fracture splinting. If there is a pregnant woman in the
family we might include sterile drapes, scissors to cut the umbilical cord and sterile
clamps.
New notions:
• Oro-pharyngeal airway= device that maintains an open airway
• Rescue bag= device that is used when ventilating a patient
• Haemorrhage= bleeding
• Haemostasis= bleeding stop
First aid kit rules:

1. Every first aid kit should have a user’s manual.
2. People who have access to the kit should be trained to use it when needed.
3. First aid kits are marked with a white cross on a green background (Symbol
established by The International Organisation for Standardisation).
4. Every kit should include the emergency telephone number (e.g. 112).
5. The first aid kit is stored at home or in the car, with no access for children.
Pupils can be taught how to use the first aid kit and how to call for an
ambulance.
6. The first aid kit content should be regularly checked.
7. The kit should be large enough, easy to handle and transport.
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Contents:
The first aid kit -basic level-should contain personal protective equipment,
devices used during resuscitation and instruments that are used when providing first
aid in minor lesions. Some kits may contain medication.
1. The personal protective equipment includes: sterile gloves (two pairs),
procedure gloves (two pairs), facial protection mask and protection glasses.
Sterile gloves are used in any situation in which we perform an invasive
technique or there is a wound. They protect the patient against infections. The gloves
that are not sterile are used when there are no wounds or infection sites and the
patient is not at risk to become infected. In these cases, the gloves protect the
rescuer and do not allow contact with the victim’s biological fluids (blood, urine,
vomit).
2. Devices used during resuscitation are the pocket masks with unidirectional
valves that are used for mouth-to-mouth ventilation.
In case we see an unconscious person (the state of consciousness is assessed
by talking to the victim, by touching him to see if there is a response to touch or to
painful stimuli) the first thing we have to do is to check the victim’s ability to breathe.
We watch for the chest to inflate, we feel the expired flow. If the person is not
breathing, we have to call for help (any other person or we call 112) and we
immediately start chest compressions with a rate of 100/min. These simple steps
form the basic life support. We are not obliged to perform mouth-to-mouth ventilation,
but if we desire we can use a pocket mask with a one-way valve.
3. Instruments used when providing first aid in case of minor lesions (cuts,
bleeding, thermal burns, chemical burns, fractures):
• dressings of various dimensions (4x4, 5x9, 9x9cm) for wound covering and
protection;
• adhesive bandages, elastic roller bandages for dressings or splinting fixing;
• antiseptic wipes and solutions, disinfectants for wound cleaning;
• antibiotic cream (neomicin, bacitracin) for wound infection prevention;
• heating blanket, survival shield for body heat maintenance in case of
hypothermia;
• thermometer to measure the body temperature;
• burn dressing with cooling gel for burn protection;
• scissors to cut bandages;
• tweezers to extract small particles;
• matches, batteries.
Not all foreign bodies must be taken out from the wounds. There are cases in
which a major haemorrhage can appear (e.g. stabbed wounds).
44
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In case someone has a cut wound we have to clean it by flushing with sterile
water or natural saline. We have to check for bleeding and in this situation we have to
compress locally for haemostasis. We have to call for help (112) if there is severe
bleeding (e.g. the cut of a major vessel) or we have to take the patient to the hospital.
In case someone has fallen and has limb pain (with or without abnormal mobility
and local swelling), we have to splint the fractured limb and we have to take the
patient to the hospital.
In case of burns, we have to be certain that the fire was stopped, we have to
take off the victim’s clothes and we have to take out all the objects that might cause
compression (watches, rings), we have to rinse the burned surface with sterile water
or natural saline and cover the skin with sterile drapes. Ice packs should not be used.
In cases of major burns, with severe injured victims, we have to call for an
ambulance. If cardiac or respiratory arrest occurs, the basic life support algorithm
must be performed.
4. To include or not drugs in the first aid kit is a debatable issue as few persons
know the indication of various medicines. In many countries including aspirin is
mandatory as using it for chest pain improves survival for those with cardiac disease
(chest pain, breathlessness, extreme fatigue, confusion, fall in the levels of the blood
pressure).
Other drugs that can be included are:
• cortisone ointment 1%- for the treatment of skin allergy;
• antiallergic drugs (loratiadine, clorfeniramine), including the adrenaline
prefilled pen (AnaPen or EpiPen) for the treatment of major acute
anaphylaxis;
• antiacids;
• nasal drops;
• eye solution;
• drugs to treat diarrhoea;
• laxative;
• pain relievers.
The route of administration for drugs are oral, subcutaneous, intramuscular,
intrarectal, intravenous, endotacheal.
General rules for drug injection:
1. Before doing anything with the syringe or the drug wash your hands
thoroughly. This is one of the most important ways to prevent infection.
2. Remove the syringe and the needle from the sterile plastic cover.
3. Fill the syringe with the medication that is contained in a sterile ampule.
4. Change the needle.
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5. Remove the air bubbles from the syringe and the needle.
6. Select the correct location.
7. Prepare the skin with an alcohol swab.
8. Hold the syringe and the needle like a pencil.
9. Thrust the needle into the skin with a precise, gentle movement, at 45o for
subcutaneous injection or perpendicular to the skin for intramuscular
injection.
10. Pull back on the plunger to check appearance of blood. If so, remove the
needle and do everything once again.
11. Press on the plunger to administer the drug (inject medication in about 5
seconds).
12. Gently remove the needle.
13. Press or perform gentle massage on the injection site.
14. Try to change injection site each time.
The subcutaneous injection represents the administration of drugs in the fatty
tissue under the skin. The sites of injection are the posterior region of the arm, the
anterior region of the thigh or the abdomen.
The intramuscular route of administration represents the injection of the drug
into the muscle. The injection sites are the middle third of the anterior region of the
thigh (vastus lateralis), the gluteal muscle (in the upper outer quadrant of the
buttocks) and the shoulder (deltoid muscle).
The intermediate level first aid kits In the advanced first aid kits (used by medical
may contain: staff) you can find:
• local haemostats for severe 1. special bandages
bleeding 2. betadine
• syringes, needles 3. suture needles
• scalpel blade 4. sterile drapes
• adrenaline 5. intravenous solutions
• atropine 6. suction unit
• oropharyngeal airway devices 7. facial mask and rescue bag
46
Bibliography
1. Consiliul NaŃional Român de Resuscitare. Resuscitarea cardiopulmonară şi

cerebrală la adult. Editura Alpha MDN, Bucureşti 2006: 117-128.
2. Sethi D et al. Advanced trauma life support training for ambulance crews. On
behalf of the WHO Pre-Hospital Trauma Care Steering Committee. The
Cochrane Database of Systematic Reviews 2006, Issue 1. Chichester, UK, John
Wiley & Sons, Ltd., 2006.
3. Reading CJ. Incidence, pathology and treatment of adder (Vipera berus) bites in
man. Journal Accidents Emergency Medicine 1996; 13: 346-351.
4. Zigenfuß T. Medicină de UrgenŃă. Editura Casa CărŃii de ŞtiinŃă, Cluj Napoca
2001: 316-321.
5. www.emedicine.com/emerg/index.shtml
6. Giurcăneanu C. Înfruntând natura dezlănŃuită. Editura Albatros, Bucureşti 1986:
238-246.
7. Matusz P. Primul ajutor în accidentele vacanŃei. Editura Sport-Turism, Bucureşti
1990.
8. Stewart S. Environmental emergencies. Baltimore: Williams& Wilkins 1990.
9. Trancă S, Hagău N. Muşcătura de viperă. Terapia pacientului critic cu reacŃie
toxică severă la veninul de viperă J Rom Anest Terap Int 2009; 16: 134-139.
10. Mock C et al. Guidelines for essential trauma care. Geneva, World Health
Organization, 2004.
11. Prehospital trauma care systems.Geneva, World Health Organization, 2005.
12. Road safety training manual. World Health Organization, 2006.
13. Varghese M, Mohan P. When someone is hurt: a first aid guide for lay persons
and community workers. New Delhi, The Other Media Communications, 1998.
14. www.parasolemt.com.au/manual.php
15. http://emedicine.medscape.com
16. Diaz JH. Syndromic diagnosis and management of confirmed mushroom
poisonings. Crit Care Med 2005; 33(2): 427-36.
17. Berger KJ, Guss DA. Mycotoxins revisited: Part I. J Emerg Med 2005; 28(1): 53-
62.
18. Eckstein M, Maniscalco PM. Focus on smoke inhalation--the most common
cause of acute cyanide poisoning. Prehospital Disaster 2006;21(2 Suppl 2): s49-
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19. Gorman D, Drewry A, Huang YL. The clinical toxicology of carbon monoxide.
Toxicology 2003; 187(1): 25-38.
20. http://en.wikipedia.org/wiki/Mushroom_poisoning
21. First Aid Manual. 8th Edition St John Ambulance, St Andrew s First Aid, British
Red Cross 2002.
22. www.britishredcross.org.uk
47
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Natalia Hagău

Medical First Aid

Course for 1st year

Medical First Aid

Descrierea CIP a Bibliotecii NaŃionale a României

Editura Medicală Universitară „Iuliu HaŃeganu” CLUJ-NAPOCA

Director Editură: Ioana Robu

Tehnoredactare: Gabriela Jeler

Tiparul executat la Tipografia UniversităŃii de Medicină şi Farmacie

The course is a useful, concise textbook addressed primarily to medicine,

The authors Cluj-Napoca, Romania

Basic life support 1

First aid in environmental emergencies 7

First aid in trauma 19

First Aid Kit 43

Basic life support

Cardiac arrest is an abrupt cessation of cardiac pump function which may be

Fig.1 Arm in right angle Fig.2 Far arm under cheek

Fig.3 Knee up Fig.4 Victim is rolled

Fig.5 Head tilt chin lift. Keeping the airway

For chest compressions (Fig.6):

Fig.6 Chest compression – correct position

Fig.7 Open mouth for ventilation

Fig.8 Abdominal thrust

First aid in environmental emergencies

First aid is a series of simple life-saving techniques which can be provided by

Fig.2. Severe frostbites of the fingertips

Fig.3. Hand frostbites

After the extremities have been rewarmed, local excruciating pain is

In order to avoid the danger produced by avalanches it is important to know

Sending S.O.S. in the mountains

Sunstroke and hyperthermia

Sings and symptoms of caloric shock:

Signs and symptoms:

Fig.5. Vipera berus Fig.6. Vipera ammodytes

• do not walk without shoes on the grass and in the garden; It is

In the open field, metallic

First aid in trauma

The knowledge of basic measures in order to ensure survival after trauma is

Traumatic events are most frequently accompanied by medico-legal

• the rescuer becomes physically unable to continue first aid care.

The initial examination of the victims of traumas

The triage of patients with traumas

First aid in external hemorrhage

• reevaluation every 30 minutes, with the assessment of consciousness, pulse

First aid in internal hemorrhage

Internal bleeding or hemorrhage can be visible or hidden. Internal bleeding

First aid in the shock of the traumatized patient

Shock is a life threatening condition. The treatment of shock should only be

• rapid and superficial breathing;

First aid in the crush syndrome

First aid in burns

First aid in electrocution

First aid in cranial trauma

Cranial trauma is always a serious problem, generating a high complication and

First aid in spinal trauma

• inability to move the limbs;

Fig.1. Rolling of the victim with a cervical spinal trauma

Spinal shock is a consequence of spinal trauma, in which a severe decrease in