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Chapter II - Grade 1 emergencies, casualties in a state of coma or shock

DETERMINING EMERGENCIES AT THE SCENE OF THE ACCIDENT

Following an accident several persons may be injured and removing them from the motor vehicle must be done as quickly as possible and carried out as correctly as possible.

This will be done by lifting and not by pulling or pushing, so that the head, neck and trunk of the victim are kept as much as possible in the same plane. Thus avoiding the aggravation of existing injuries or the occurrence of others.

The determination of emergencies is done by identifying the symptoms characteristic of each state of the injured person.

Grade I emergencies (casualties in a state of coma or shock):

• A. casualties with respiratory arrest;
• B. casualties with cardiac arrest;
• C. casualties who present burns on the surface of the body.

A. Cardio-respiratory arrest

Breathing is a basic vital function. The number of breaths in an adult is 14-16 times per minute.

Cardio-respiratory arrest is represented by the cessation of cardiac and respiratory function. If this dysfunction, either cardiac or respiratory, is not remedied quickly, it may lead to the death of the victim.

Supporting breathing or restarting circulation is achieved by cardio-respiratory resuscitation maneuvers.

Respiratory arrest is represented by the sudden stopping of pulmonary activity, it is also known as asphyxiation.

Recognition signs:

• decrease of respiratory movements or their stopping;
• cyanosis of the skin, especially of the face;
• rapid pulse;
• loss of consciousness.

To check the breathing of a victim a sheet of paper can be used, which is placed above the nostrils and if the casualty breathes it will move, or a mirror which fogs up if the victim is breathing.

Breathing resuscitation can be performed by:

• mouth-to-mouth breathing:
• the victim is placed on the back with raised shoulders (for this a soft, rolled material can be used which will be placed under the shoulder blades);
• the victim’s head is bent backwards and the chin is kept raised;
• with one hand you squeeze the victim’s nostrils between the thumb and forefinger and with the other hand you keep the chin raised and open the mouth;
• you inhale normally, you lean forward and with your mouth you cover the victim’s mouth completely;
• you exhale air uniformly into the victim’s mouth and at the same time check if the rib cage rises. One breath must last about one second;
• the victim’s head is kept bent and the chin raised. Check if the chest goes down after you have introduced the air;
• you inhale again and perform a second mouth-to-mouth breath;
• you reposition your hands accordingly and continue with another 30 chest compressions.
• Mouth-to-nose breathing method: this method is used when the victim’s mouth cannot be opened. The insufflations will be made through the victim’s nostrils, the mouth remaining closed.

B. Cardiac arrest

It appears when the heart stops beating. The blood is no longer pumped into the organs of the body, so there is no pulse and the person loses consciousness and no longer breathes.

For the victim to recover and resume vital functions, the intervention must be done quickly so that the heart starts beating again, the blood circulates and breathing ensures the need for oxygen.

Recognition signs:

• the pulse is weak or absent;
• loss of reflexes;
• the pupils are dilated;
• difficulty in breathing;
• cold sweats;
• loss of consciousness.

In the case of cardiac arrest, resuscitation will be done by external cardiac massage.

Checking cardiac activity is done by palpating the pulse at the neck or by listening to the heartbeat by bringing the ear close to the victim’s chest.

First aid in case of cardiac arrest:

The victim will be positioned on the back, on a hard and straight surface.

The victim’s head will be positioned so that the airways are free (the chin will be raised and the head will be tilted backwards).

Circulation of the blood in the body will be ensured through the pumping effect of the heart.

This is performed with the help of the palms of both hands placed one over the other, the left hand will be positioned with the fingers towards the direction of the head and the right will be placed transversely over the left, having the arms extended vertically to transmit the weight of the rescuer’s body.

The compressions will be short and regular and are between 80 and 100 per minute in the adult and the child and 120 for the infant.

Cardiac massage continues until the heartbeat resumes.

C. Burns

They are accidents caused by heat in various forms, by chemical agents, electricity or radiation.

They can cause various conditions which are determined directly by the size of the burned surface, depth and the evolution of the local injury.

Classification of burns:

a) Depending on the size of the burn on the surface of the body they can be:

• under 15% of the surface of the body;
• between 15-30% of the surface of the body;
• between 30-40% of the surface of the body;
• over 40-50% of the surface of the body.

b) According to the depth of the burn they can be:

• first-degree burns: those burns which affect the epidermis (the superficial layer of the skin) and manifest as redness. Usually these burns heal faster, generally in two - three weeks;
• second-degree burns: those burns which affect the epidermis (the superficial layer of the skin) and part of the dermis (the middle layer of the skin). Blisters with liquid content appear. These burns require disinfection and the application of a sterile dressing;
• third-degree burns: those burns which destroy the epidermis, the dermis and the hypodermis (the deep layer of the skin). In the case of these burns hospitalization in a specialized center is required and recovery will take a longer period of time.

First aid in case of burns:

• the flames will be extinguished by covering the victim with a blanket;
• the burned areas will be covered with sterile dressings;
• in the case of chemical burns, the burn will be washed with plenty of water;
• no disinfectants, ointments or powders will be applied over the wound;
• during transport to the hospital, for the victim to maintain a comfortable temperature, he will be covered with a coat or a blanket.