masuri de prim ajutor 2011

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MASURI DE PRIM AJUTOR2011

PLANDefinitie, Obiective, Principii EVIDENCE BASED MEDICINE-medicina bazata pe dovezi Aspecte etico-medico-legale si epidemiologice ale CPR si primului ajutor Notiuni elementare de anatomie si fiziologie CPR: definitie Lantul supravietuirii BLS la adult

INTRODUCEREProceduri de ingrijire medicala simple, de urgenta aplicabile de catre neprofesionisti pana la sosirea personalului medical de specialitate. Se face referinta atat la laici, cat si la personalul de pe ambulante sau alti first responders. NU INLOCUIESTE UN TRATAMENT MEDICAL COMPETENT

PRIM AJUTORMasuri de ingrijire si tratament de urgenta aplicate unui bolnav sau unei persoane traumatizate INAINTEA sosirii/defeririii catre servicii medicale. MASURILE DE PRIM AJUTOR NU SUNT APLICATE CU SCOPUL DE A INLOCUI DIAGNOSTICAREA SI TERAPIA CORECTA MEDICALA ofera asistenta temporara pana la sosirea personalului medical calificat

PRIM AJUTORScop: Salvarea vietii Prevenirea producerii in continuare a leziunilor Reducerea la minimum/prevenirea infectiilor Cei trei P P - Preserve Life. P - Prevent the condition worsening. P - Promote Recovery Face diferenta dintre: Leziune temporara/permanenta Vindecare rapida/ infirmitate permanenta Viata/moarte

Medicina bazata pe dovezi (EBM)

EBM are ca scop utilizarea celor mai bune dovezi disponibile provenite din metode stiintifice pentru a conduce la decizii medicale urmareste sa stabileasca calitatea dovezilor ce stabilesc riscurile si beneficiile tratamentelor (inclusiv absenta acestora). EBM recunoaste ca multe aspecte ale medicinii depind de factori individuali cum ar fi calitatea si rationament al valorii vietii ce sunt doar partial supuse cercetarilor stiintifice. sa aplice aceste metode in practica medicala cu scopul de a asigura cea mai buna predictie asupra prognosticului ad vitam, chiar daca persista inca controversele legate de tipul prognosticului de urmarit.

Masuratori statistice

Evidence-based medicine incearca sa exprime beneficiile clinice ale testelor si tratamentelor utilizand metode statistice

EBM- stadializarea nivelurilor de evidenta

Evidence-based medicine categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research. The strongest evidence for therapeutic interventions is provided by systematic review of randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition. Little value as proof: patient testimonials, case reports, and even expert opinion

the placebo effect, the biases inherent in observation and reporting of cases, difficulties in ascertaining who is an expert, etc.

Nivel de evidentaSystems to stratify evidence by quality have been developed, such as this one by the U.S. Preventive Services Task Force for ranking evidence about the effectiveness of treatments or screening: Level I: Evidence obtained from at least one properly designed randomized controlled trial. Level II-1: Evidence obtained from well-designed controlled trials without randomization. Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

Categorii de recomandariIn guidelines and other publications, recommendation for a clinical service is classified by the balance of risk versus benefit of the service and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses: Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweighs the potential risks. Clinicians should discuss the service with eligible patients. Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients. Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations. Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients. Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.

GhiduriUn ghid medical (denumit si ghid clinic, protocol clinic, ghid de practica medicala) este un document destinat orientarii deciziilor si criteriilor de: diagnostic conduita tratament intr-un domeniu specific medical

De ce ghiduri?

PRIM AJUTOR- ObiectiveA. Airway: Mentinerea permeabilitatii cailor aeriene B. Breathing: Mentinerea respiratiilor C. Circulation: Mentinerea circulatiei

+Oprirea hemoragiilor Prevenirea/ reducerea socului

PRIM AJUTOREvaluare initiala Inspectia rapida a zonei

Pericole (curent electric, foc, apa, haz mats, obiecte instabile, ascutite, animale) Trafic Violenta Conditii de relief si clima Situatii speciale

Preluarea controlului

calm, rapid si eficient

PRIM AJUTORSe vor evalua: 1. SIGURANTA proprie si a pacientului 2. MECANISMUL DE PRODUCERE A LEZIUNII Constient Inconstient 3. INFORMATII TRANSMISE PE CAI SPECIALE - Medalion, bratara cu simboluri - card cu informatii

PRIM AJUTOR4. NUMARUL VICTIMELOR Cand sunt mai multe- evaluarea A,B,sangerare si C 5. MARTORI Pot furniza informatii, ajutor chiar daca sunt nepregatiti prin: apel de urgenta, suport moral victimei, impiedicarea imixtiunii altor persoane 6. PREZENTATI-VA ca persoane calificate in prim ajutor; consimtamant cerut celor constienti, prezumat pentru cei inconstienti

Aspecte etico-legale

Datoria de a interveni(desemnata, serviciu sau responsabilitate preexistaenta fata de victima) Standard: cat si pentru ce aveti calificare Consimtamant= acord, permisiune

Confidentialitatea Legea Bunului Samaritean (urgenta, cu bune intentii, fara compensatii, fara a produce daune/leziuni) Abandon Neglijenta (datorie, nerespectarea datoriei sau substandard, producere de leziun/daune, nerespectarea limitelor)

Pacient constient/inconstient Minor/major Bolnavi cu afectiuni psihiatrice Exprimat/prezumat

Aspecte etico-legaleSecventalogica: Obtineti consimtamantul victimei INAINTE de A O ATINGE Urmati ghidurile si protocoalele pentru care ati fost instruiti, fara a va depasi nivelul de competenta Explicati victimei fiecare lucru pe care urmeaza sa-l faceti Odata ce ati demarat asistarea victimei, nu o parasiti pana nu o deferiti unei persoane cel putin la fel de calificata ca dumneavoastra!

Aspecte etice

OUT OF HOSPITAL SETTINGS

To initiate resuscitation Not to initiate resuscitation To terminate resuscitationTo initiate resuscitation Not to initiate resuscitation To terminate resuscitation To withdraw life support

IN HOSPITAL RESUSCITATION

PRIM AJUTOR-REGULI DE BAZA1. Mentineti pacientul in decubit dorsal, capul la acelasi nivel cu corpul, pana la evaluarea gravitatii situatiei. Identificati exceptiile la aceasta regula: Varsaturi sau hemoragii in zona cavitatii bucalepozitie laterala de siguranta ! la leziunile suspectate de coloana cervico-dorsala (2% explozii, 6% traumatism facial sau GCS60%.

CPR: Ghiduri

The International Liaison Committee on Resuscitation (ILCOR) American Heart Association (AHA) International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (2005 Consensus Conference).

CPR

Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed in hospitals, or in the community by laypersons or by emergency response professionals. CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient's chest to manually pump blood through the heart, called chest compressions, and usually also involves the rescuer exhaling into the patient (or using a device to simulate this) to inflate the lungs and pass oxygen in to the blood, called artificial respiration, CPR is unlikely to restart the heart; its main purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage

Istoric

1740 The Paris Academy of Sciences officially recommended mouth-to-mouth resuscitation for drowning victims. 1767 The Society for the Recovery of Drowned Persons became the first organized effort to deal with sudden and unexpected death. 1891 Dr. Friedrich Maass performed the first equivocally documented chest compression in humans. 1903 Dr. George Crile reported the first successful use of external chest compressions in human resuscitation. 1904 The first American case of closed-chest cardiac massage was performed by Dr. George Crile. 1954 James Elam was the first to prove that expired air was sufficient to maintain adequate o