PhD Medical Surgical Nursing

1. First Aid
Dr. Walaa El- Leithey
PhD Medical Surgical Nursing
Alexandria University

2. Check the scene for anything that may threaten the
safety of you, the injured persons and bystanders.
‫المتفرجين‬ ‫او‬ ‫المصاب‬ ،‫امانك‬ ‫تهدد‬ ‫اخطار‬ ‫الى‬ ‫الحادث‬ ‫مسرح‬ ‫مراجعة‬

3. in special situations

4. ‫النزيف‬
Bleeding
escaped blood from the blood vessels. ‫االوعية‬ ‫من‬ ‫الدم‬ ‫خروج‬
‫الدموية‬
Hemorrhage – large amount of bleeding in a short
time
External bleeding –seen blood coming from an open
wound –outside the body ‫خارجى‬ ‫نزيف‬
- often overestimated
Internal bleeding – inside the body ‫داخلى‬ ‫نزيف‬
- often underestimated

5. bleeding type according to the type of vessel
damaged. ‫المتضررة‬ ‫الدموية‬ ‫لالوعية‬ ‫طبقا‬ ‫النزيف‬ ‫انواع‬
1.Arterial ‫الشريانى‬
•bright red colour ‫فاتح‬ ‫احمر‬
•under pressure, comes out in spurts ‫متدفق‬
•the most serious ‫االخطر‬
•fast rate ‫االسرع‬
•large blood loss ‫اكثر‬ ‫المفقود‬ ‫الدم‬ ‫كمية‬
•less likely to clot (clot only when blood flow is slow)
• ‫النزف‬ ‫سريان‬ ‫توقف‬ ‫اذا‬ ‫اال‬ ‫تجلط‬ ‫يحدث‬ ‫ال‬
•dangerous : it must be controlled

6. bleeding type according to the type of vessel
damaged. ‫المتضررة‬ ‫الدموية‬ ‫لالوعية‬ ‫طبقا‬ ‫النزيف‬ ‫انواع‬
2. Venous ‫وريدى‬
•dark red colour ‫غامق‬ ‫احمر‬
•low pressure ‫اقل‬ ‫ضغط‬ ‫تحت‬
•blood flow steadily ‫ثابت‬ ‫النزيف‬ ‫سريان‬
•it is easier to control ‫علية‬ ‫السيطرة‬ ‫سهل‬
•most veins collaps when cut
but
•bleeding from deep veins can be as massive as
arterial bleeding !!!

7. bleeding type according to the type of vessel
damaged.
‫المتضررة‬ ‫الدموية‬ ‫لالوعية‬ ‫طبقا‬ ‫النزيف‬ ‫انواع‬
3.Capillary bleeding
• oozing out, leaking ‫ترشح‬
• most common ‫انتشارا‬ ‫االكثر‬
• blood oozes
• usually not serious ‫خطيرا‬ ‫ليس‬
• easily controlled ‫علية‬ ‫السيطرة‬ ‫سهل‬
• often it clots and stops itself
‫نفسة‬ ‫من‬ ‫ويتوقف‬ ‫يتجلط‬ ‫االغلب‬ ‫فى‬
4. Mixed bleeding

8. Bleeding - clinical symptoms
 Depend on - the quantity of the blood loss
- the rapidity of the blood loss
!!! Sudden loss of a large quantity of blood results in
shock:
- skin - cold, pale
- pulse - weak, fast
- mental disorders, fear, unconscioussness

9. Bleeding
What to do?
 the first aid is the same reagardless of the type
of bleeding
 most important = to controll bleeding
 ‫النزف‬ ‫على‬ ‫السيطرة‬

10. ‫الخارجى‬ ‫النزيف‬
External bleeding
Management:
1. Protect yourself (exam gloves )
2. Manual control of external
haemorrhage. ‫قفازات‬ ‫ارتدى‬
3. Expose the wound (remove or cut
clothing) to find the source
4. Place sterile pad or clean cloth and
apply direct pressure (fingers,
palm, hand) = pressure over the
wound. ‫النزيف‬ ‫على‬ ‫مباشرة‬ ‫اضغط‬
5. If bleeding from arm or leg –
elevate extremity above the heart
level + pressure over the wound
6. ‫اضغط‬ ‫الذراع‬ ‫او‬ ‫القدم‬ ‫من‬ ‫النزيف‬ ‫حالة‬ ‫فى‬
‫القلب‬ ‫مستوى‬ ‫فوق‬ ‫رفعة‬ ‫مع‬ ‫المكان‬ ‫على‬

11. External bleeding
Management ‫االجراءات‬
6. If bleeding continues – continue +
apply pressure against the bone at
pressure points ( brachial or
femoral points) ‫على‬ ‫الضغط‬ ‫واصل‬
7. ‫الطرفية‬ ‫الشرايين‬ ‫اماكن‬
7. Use pressure bandage – you have
free hands for help to other
victims ‫ضاغط‬ ‫رباط‬ ‫استخدم‬
8. For application of direct pressure –
use ring pad
9. Tourniquets – rarely on the
extremities – it can damage nerves
and vessels !!! ‫لمدة‬ ‫فقط‬ ‫تورنيكية‬ ‫استخدم‬
15
‫دقيقة‬
10.When you need it – use wide, flat
materials and write the time of
application !!! Only 15 minutes

12. External bleeding
‫االجراءات‬
Management
‫النزف‬ ‫استمر‬ ‫اذا‬
:

‫اخر‬ ‫غيار‬ ‫اضافة‬ ‫مع‬ ‫الضغط‬ ‫فى‬ ‫استمر‬

‫التامة‬ ‫بالراحة‬ ‫المصاب‬ ‫نصيحة‬ ‫مع‬ ‫ينزف‬ ‫الذى‬ ‫الجزء‬ ‫رفع‬

‫باالسعاف‬ ‫االتصال‬

‫الحيوية‬ ‫العالمات‬ ‫متابعة‬
‫الشديد‬ ‫النزف‬ ‫حالة‬ ‫فى‬
:

‫ن‬ ‫على‬ ‫الضغط‬ ‫واضافة‬ ‫النزف‬ ‫نقطة‬ ‫وتحديد‬ ‫الغيارات‬ ‫جميع‬ ‫ازالة‬
‫قطة‬
‫النزف‬

‫الصدمة‬ ‫معالجة‬
(
‫حدوثها‬ ‫حالة‬ ‫فى‬
)

13. ‫ال‬
‫مك‬ ‫يسد‬ ‫النه‬ ،‫المضمن‬ ‫الجسم‬ ‫تزيل‬ ‫ال‬
‫ان‬
‫النزف‬
‫المضمن‬ ‫الجسم‬ ‫حول‬ ‫غيار‬ ‫ضع‬
‫المكان‬ ‫حول‬ ‫مستمر‬ ‫ضغط‬ ‫ضع‬
‫المضمن‬ ‫الجسم‬ ‫على‬ ‫تغط‬ ‫ال‬
‫المصاب‬ ‫المكان‬ ‫ورفع‬ ‫تحريك‬ ‫عدم‬ ‫مع‬
‫مستريح‬ ‫وابقائة‬ ‫بالمصاب‬ ‫العناية‬
‫وهادئ‬

14. Internal bleeding
•
‫فى‬ ‫داخلى‬ ‫نزيف‬ ‫حالة‬ ‫فى‬ ‫الشك‬
‫حاالت‬
:
•
‫قرحة‬ ،‫اعلى‬ ‫من‬ ‫السقوط‬ ،‫الحوادث‬
،‫الرحم‬ ‫خارج‬ ‫حمل‬ ،‫سابقة‬ ‫معدية‬
‫نافذ‬ ‫جرح‬
•
‫يكو‬ ‫ان‬ ‫الممكن‬ ‫من‬ ‫الداخلى‬ ‫النزيف‬
‫ن‬
‫مخفى‬ ‫او‬ ‫ظاهر‬
•
‫النصف‬ ‫وضع‬ ‫فى‬ ‫المصاب‬ ‫ضع‬
‫جالس‬

15. Internal bleeding
 skin is not broken ‫سليم‬ ‫الجلد‬
 blood is not seen ‫مرئى‬ ‫غير‬ ‫الدم‬
 difficult to detect ‫اكتشافها‬ ‫فى‬ ‫صعوبة‬
 can be life threatening ‫الحياة‬ ‫تهدد‬
 traumatic and nontraumatic origin
‫جرح‬ ‫بسبب‬
‫بدون‬ ‫او‬
What to look for?
 “Swelling“ on extremities in case of trauma
 Contussion of the skin
 Painful, rigid, tender abdomen
 Vomiting or coughing up blood
 Black stools or stool with bright red blood

16. Internal bleeding
•
‫مخفى‬
:
،‫الكبد‬ ‫من‬ ‫نزيف‬ ‫حالة‬ ‫فى‬
‫المخ‬ ،‫الطحال‬
(
‫نزيف‬ ‫يظهر‬ ‫ال‬
)
•
‫ظاهر‬
:
‫من‬ ‫نزف‬ ‫حالة‬ ‫فى‬
:
•
‫الرئة‬
:
‫برغوة‬ ‫احمر‬ ‫بصاق‬ ‫مع‬ ‫كحة‬
•
‫المعدة‬
:
‫احمر‬ ‫او‬ ‫بنى‬ ‫قئ‬
•
‫المثانة‬ ‫او‬ ‫الكلية‬
:
‫محمر‬ ‫بول‬
•
‫االمعاء‬
:
‫الشرج‬ ‫من‬ ‫نزيف‬
(
‫احمر‬
‫فاتح‬ ‫او‬ ‫غامق‬
)
•
‫الرحم‬
:
‫مهبلى‬ ‫نزيف‬

17. Internal bleeding
What to do?
 Steps:
1. Check ABCs
2. Expect vomiting – keep the victim on his/her left
side
3. Treat for shock:
 Elevate legs
 Cover the victim to keep him/her warm
 Do not give a victim anything to eat and drink
(prevention of lung aspiration, can cause
complications during surgery)
 Splinting extremities
 bleeding
  pain
 prevents nerve and vessels injury

18. Internal bleeding
Loss of blood - long bones fractures:
• Pelvis 2 – 5 L
• Femur (thigh) 1 – 2,5 L
• Shin (tibia) bones 1 – 1,5 L
• Arm ( humerus) 0,5 – 1 L
• Forearm – 0,5 L

19. ‫صدمة‬
Shock
Definition:
the circulatory system fails to deliver enough
oxygen-rich blood to the body’s tissues and
vital organs. The body’s organs, such as the
brain, heart and lungs, do not function properly
without this blood supply.
Three components:
1. Heart pump  failure
2. Network of (vessels)  enlargement
3. Adequate volume of circulated fluids
 fluid loss
- blood
- plasma
- extracellullar fluids
(vomit, diarrhoea, sweatting, urine…)
Damage of any of these
components can produce
conditions known as shock.

20. ‫صدمة‬
Shock
•
‫اسبابها‬
•
‫الدم‬ ‫كمية‬ ‫فى‬ ‫فقد‬
(
‫نزيف‬
-
‫ف‬
‫قد‬
‫سوائل‬
)
–
‫داخلى‬ ‫نزيف‬
/
‫خارجى‬
•
‫كبيرة‬ ‫او‬ ‫متنوعة‬ ‫كسور‬
•
‫خطيرة‬ ‫حروق‬
•
‫شديد‬ ‫واسهال‬ ‫قئ‬
•
‫الدم‬ ‫ضغط‬ ‫فى‬ ‫فقد‬
(
‫قدرة‬ ‫عدم‬
‫الدم‬ ‫ضخ‬ ‫على‬ ‫القلب‬
)
‫حاالت‬
‫القلبية‬ ‫واالزمة‬ ‫الحرارة‬ ‫ضربة‬
•
‫االوعية‬ ‫فى‬ ‫اتساع‬ ‫او‬
‫االص‬ ،‫الشديدة‬ ‫الدمويةالحساسية‬
‫ابة‬
(
‫المخ‬ ‫او‬ ‫الفقرى‬ ‫بالعمود‬
)

21. Shock
• Altered mental status, restlessness or irritability.
• ،‫الوعى‬ ‫حالة‬ ‫تغير‬
(
‫ضجر‬
/
‫هياج‬
)
• 2. Pale, cold, clammy skin, livid lips ،‫وتعرقة‬ ‫الجلد‬ ‫برودة‬ ، ‫برودة‬ ،‫شحوب‬
‫الشفاة‬ ‫شحوب‬
• 3. Limited perfussion of peripheral parts of the body
• ‫الجسم‬ ‫الجزاء‬ ‫قليلة‬ ‫بحدود‬ ‫الدم‬ ‫وصول‬
• 4. Capilary refil phenomenon – nail beds
• 5. Nausea and vomiting ‫وقئ‬ ‫دوخة‬
• 6. Rapid breathing ‫سريع‬ ‫تنفس‬
• 7. Rapid weak pulse or pulseless on peripheral arteries
• ‫االطراف‬ ‫فى‬ ‫النبض‬ ‫احساس‬ ‫عدم‬ ‫او‬ ‫ضعفها‬ ‫مع‬ ‫القلب‬ ‫ضربات‬ ‫زيادة‬
• 8. Unresponsiveness, when shock is severe ‫االستجابة‬ ‫عدم‬
The signals that indicate a
person may be going into
shock include: ‫عالماتها‬

22. Shock
What to do? ‫نفعل؟‬ ‫مادا‬
1. Treat life-threatening injuries
‫للحياة‬ ‫المهددة‬ ‫بالمخاطر‬ ‫االهتمام‬
2. Lay the victim on his/her back
‫الضحية‬ ‫وضع‬
(
‫ظهرة‬ ‫على‬ ‫نائم‬
)
3. Raise the victim´s legs ( if no evident
injury) – drain of blood from legs to the
heart ‫العلى‬ ‫القدم‬ ‫رفع‬
(
‫ضرر‬ ‫وجود‬ ‫عدم‬ ‫فى‬
‫واضح‬
)
4. Prevent body heat loss (blankets)
‫تدفئة‬
5. Splintig of long bones fractures
‫للتجبير‬ ‫خشبية‬ ‫شريحة‬
6. Seek immediate medical attention
‫تدخل‬ ‫عن‬ ‫البحث‬
‫سريع‬ ‫طب‬

23. Shock
What to do?(Cont.’) ‫نفعل؟‬ ‫مادا‬
7. ABC (
‫التنفس‬ ،‫الهواء‬ ‫مجرى‬
,
‫الدموية‬ ‫الدورة‬
)
8. In case of severe shock - prevent peroral
intake

nausea + vomiting

inhaling foreign material into the lungs

complications during surgery
9. Oxygene …‫االكسجين‬
Bruises (suffusions) ‫الكدمات‬ = a form of internal bleeding,
but not life threatening

24. Allergy, anaphylaxis
Definition: A powerful reaction to
substances (eaten, injected,
contacted…)
Reaction antigene + antibody.
There are 2 basic categories of
anaphlaxis: Ige mediated and
Idiopathic.
Ige mediated anaphlaxis: is a result of
the immune system releasing
large quantities of histamine and
other chemicals which causes the
typical signs of anaphlaxis.
Idiopathic anaphlaxis: is not fully
understood, but also causes sever
life threatening reactions.

25. Allergy, anaphylaxis - Cont.’
Anaphylaxis =
severe allergic reaction
Characteristics:
 Occurs within minutes or seconds
 Fast progression
 Can cause death if not treated immediatelly
Common cause:
Medications, food + food additives, insect stings, plant and flowers
pollen, parfumes…

26. Allergy, anaphylaxis - Cont.’
what happen in an anaphlaxis
reaction?
• The first time: an allergen prone person runs across
an allergen(e.g. peanuts), their immune system
produces large amount of peanut Ige antibody.

‫االولى‬ ‫المرة‬ ‫فى‬
:
‫المسس‬ ‫المادة‬ ‫ضد‬ ‫مضادة‬ ‫اجسام‬ ‫الجسم‬ ‫يفرز‬
‫ببة‬
‫للحساسية‬
• The second time: this person comes into contact
with peanuts, the peanuts Ige antibody's triggers
the mast cells to release granules of powerful
chemical mediators, such as histamine and
cytokines into the blood stream

‫الثانية‬ ‫المرة‬ ‫فى‬
:
‫اال‬ ‫تقوم‬ ‫المادة‬ ‫لنفس‬ ‫الشخص‬ ‫تعرض‬ ‫عند‬
‫جسام‬
‫خاليا‬ ‫بتحفيز‬ ‫المضادة‬
) (
‫مثل‬ ‫كيميائية‬ ‫وسائط‬ ‫الفراز‬
:
(
‫السيتوكينيز‬ ،‫الهستامين‬
)
‫مباشرة‬ ‫الدم‬ ‫فى‬

27. Allergy, anaphylaxis - Cont.’
what happen in an anaphlaxis reaction?
‫الحساسية؟‬ ‫وجود‬ ‫عند‬ ‫يحدث‬ ‫ماذا‬
• Theses chemical mediators (histamine etc.) cause:
• Vasodilation ‫الدموية‬ ‫االوعية‬ ‫فى‬ ‫تمدد‬
• Fluid loss into tissue ‫الخاليا‬ ‫مستوى‬ ‫على‬ ‫للسوائل‬ ‫فقد‬
• Smooth muscle contraction ‫الملساء‬ ‫العضالت‬ ‫فى‬ ‫انقباض‬
• Increase mucous secretions ‫االفرازات‬ ‫فى‬ ‫زيادة‬
• This causes the common anaphlaxis S&S
• Redness, rashes and welts ،‫ارتكاريا‬ ،‫احمرار‬
• Swelling, chest tightness and breathing difficulties
• Shock
• Cardiac arrest

28. •
‫االدرينالين‬ ‫يفعل‬ ‫ماذا‬
•
‫الدمو‬ ‫باالوعية‬ ‫التمدد‬ ‫يعاكس‬
‫ية‬
•
‫التورم‬ ‫يقلل‬
•
‫القلب‬ ‫من‬ ‫الدم‬ ‫اخراج‬ ‫يزيد‬
•
‫التنفس‬ ‫صعوبة‬ ‫يحسن‬
•
‫خروج‬ ‫يمنع‬
(
(Mast cells
‫من‬
‫عن‬ ‫المسئولة‬ ‫المواد‬ ‫اخراج‬
‫الحساسية‬
Allergy, anaphylaxis - Cont.’

29. Allergy, anaphylaxis - Cont.’

30. Allergy, anaphylaxis - Cont.’

31. Allergy, anaphylaxis - Cont.’
What to look for ?
 Fast development
 Sneezing, coughing, wheezing
 Shortness of breath
 Suffocation (swelling in the throat, tongue, mouth,
neck = Quincke oedema…)
 Tightness in the chest
 Increased pulse rate
 Dizzines
 Nausea + vomiting
 Diarrhoea
 Anaphylactic shock
 Urtica with skin itching (pruritus), blisters, quickly
spreading exanthema

32. Allergy, anaphylaxis - Cont.’
What to do?
 Immediatelly interrupt the contact with
allergene
 Check ABCs
 Seek immediate medical attention
 Help the victim to use epinephrine, if he/she
is provided with

33. Strangulation
Removing the body from the noose - prevention of body fall and other
injuries
Suspected injury of
- the brain
- cervical spine, larynx, cervical vessels
(thrombosis of the carotid artery, of the jugular vein)
What to look for?
- Status of vital functions
What to do?
 ABC
 stabilize head against movement
 seek medical attention
 admission to the hospital ICU

34. Seizures (convulsions)
Seizure (convulsions, crumps)
- is a burst of electrical activity from the brain that results in involuntary
movements, loss of consciousness (LOC), or both.
Basic classification
 generalised - always LOC -
convulsive - tonic or combination of tonic with
- clonic convulsions (seizures) - urinary incontinence
or tongue biting may
occur
non-convulsive - absence, myoclonic
 partial - no LOC

35. Seizures (convulsions)
Risk factors:
 Serum electrolyte disturbances - Na <120 or >160 mmol/l,
Ca<1mmol/l, Mg<0,5mmol/l
 Drugs - amphetamine, cocaine, ethanol, TCAs
 CNS infection - meningitis, encephalitis
 Miscellaneous - CNS tumour
- hypertensive encephalopathy
- severe hypoxemia
- Head injury

36. Seizures (convulsions)
Clinical signs:
 Seizures have abrupt onset and last 1-5 minutes
 the period of altered mental status can last up to 30
minutes
 Status epilepticus - defined as seizures lasting >30
minutes or two or more seizures without lucid
interval in between.

37. Seizures (convulsions)
What to do?
 Restrain the victim as necessary to protect from self-
injury and from secondary injury - cars and traffic on
the road, sharp objects in the proximity of the patient
 Bring the patient gently into recovery position to prevent
aspiration in the case of vomiting - rough treatment
could provoke other paroxysm
 ABC as soon as the seizures stop
 Call for help and arrange transport to the hospital

38. Near drowning
 Drowning is death from asphyxia secondary to submersion in a
liquid (usually water) or within 24 hours of submersion.
 Near drowning is survival of suffocation secondary to submersion
in a liquid.
 Mechanisms of near drowning
with aspiration - aspiration of water and vomitus
 in fresh water  loss of surfactant – fast absorbtion to
the circulation
 in see water  flooding of alveoli  hypoxemia (80-90%)
no aspiration – laryngospasm  spastic closure of glottis (vocal
cords)
 hypoxemia (in 10-20%) = dry drowning.

39. Near drowning
What to do?
 Extrication of the victim from the water - very dangerous
- protect yourself !!!
 ABCs - the earliest as possible - Airways + oxygenation
+ ventilation
 The airway should be checked for foreign material and vomitus
 Prevent additional hypothermia
 Seek for medical attention

40. Heat stroke
 Heat stroke - defined as a heat injury + altered mental
status in consequence of failure of the body
temperature control.
 Rectal (core) body temperature is above 40°C -
usually there is a history of exposure to
exercise or increased temperature and humidity.
Causes:
 high ambient or environmental temperature
 increased endogenous heat production
 decreased ability to dissipate heat

41. Heat stroke
Risk factors - extremes of age (infants and the elderly)
dehydration
alcoholism, medication (atropine)
Mortality is high because of the risk of multi-organ failure
Clinical signs:
 hyperpyrexia
 altered mental status
 lack of or minimal sweating
 ataxia
 neurological deficit – paralysis (hemiplegia, Babinsky
reflex)

42. Heat stroke
What to do?
 ABC
 Reduction of core temperature – water should be
- sprayed on undressed patient with breeze from fans or
- wrap the patient in wet packsheet till the temperature

falls to 38,5°C, then stop the cooling
Continuation of cooling could cause the uncontrolled
drop of body temperature.
 Cold water immersion or air-cooling
 Seek medical attention

43. Heat cramps
Heat cramps - are painful, involuntary contractions of skeletal
muscles that mostly involve the calves, thighs, and shoulders.
Causes - the same as those for heat stroke
The main risk factor - is the replacement of sweating losses
with plain (hypotonic) water. The hypo-osmolality can lead
to the brain edema with the cramps.
What to do?
 Give to the patient the glass with salt water one half of the glass
every 15 min.
 Massage the muscles to relieve the spasm
 Seek medical attention

44. Cold injury - hypothermia
Cause - is the exposure of the person to the low
environmental temperature.
Hypothermia is supported by the wind and high humidity.
Classification
 mild hypothermia core temperature - 32-35°C
 moderate hypothermia - 28-32°C
 severe hypothermia < 28°C
Risk factors :
 extremes of age (infants and elderly)
 accompanying diseases and bad status of health
 alcohol intoxication and drug overdose

45. Cold injury - hypothermia
Shivering
 Besides goose pimples - as a part of “cold
stress reaction“  protective reaction
 = an early response to cold stress
 Shivering is able to increase the basal
metabolism rate two-to five fold
 Heart oxygene and energetic consumption is
increased by 500%
 It is operative between 30-37°C

46. Cold injury - hypothermia
Clinical signs:
 gradually deteriorating mental status
incoordination  confusion  lethargy 
coma
 body is cold to touch, dysarthria
 Tachycardia  bradycardia - ventricular fibrillation occurs
at temperatures 28°C
 Hypertension  hypotension
 Tachypnea (↑rate of breathing)  bradypnea (↓ rate of breathing)
 Hyperreflexia  areflexia – fixed and dilated pupils with
coma at temperature below 22°C
 Asystole - at 22º C

47. Cold injury - frostbite
Frostbite - a cold-related contact injury
characterised by freezing of tissues
Most often affected parts of body =
peripheral - face, ears, nose, hands, feet,
penis and scrotum
Most cases - in soldiers, winter outdoor
enthusiasts, e.g. mountain climbers

48. Cold injury - frostbite
Pathophysiology - cold exposure leads to
 ice crystal formation
 cellular dehydration
 protein denaturation
 inhibition of DNA synthesis
 abnormal cell wall permeability
 damage to capillaries
 pH changes

49. Cold injury - frostbite
Degree of injury
 1st-degree injury - erythema, oedema, waxy
appearance, hard white plaques, and sensory
deficit
 2nd-degree injury - erythema, edema, and
formation of clear blisters
 3rd-degree injury - presence of blood-filled blisters
 4th-degree injury - full-thickness damage affecting
muscles, tendons, and bones

50. Cold injury - frostbite
What to do?
 Examine vital functions, start ABC when necessary
 Replace wet clothing with dry, soft clothing to minimise
further heat loss. Remove constricting clothing.
 Initiate rewarming of affected area as soon as possible.
 Avoid rubbing affected area with warm hands or snow,
as this can cause further injury.
 Transport patient to the warm environment and give
him warm fluids.
 Active re-warming of the frost-bitten part via immersion
in circulating clear water at 40-41°C
 Dry sterile dressing of the frostbite
 Seek medical attention

51. Open wounds - types
 Abrasion - the top level of skin is removed = painful -
(nerve endings)
 Laceration - skin is cut with jagged, irregular edge
 Incision - smooth edges (surgery) - bleeding depends on
the depth, the location and the size of the wound
 Punctures - deep narrow wounds (nail, knife), the object
may remain impaled in the wound
 Amputation , avulsion - the cutting or tearing off of a
body part – finger, toe, hand, foot, arm or leg

52. Open wounds - - what to do
 Protect yourself - use medical gloves if possible or several
layers of gauze or clean cloth and apply pressure on the
wound (your bare hand should be used only as a last
resort)
 Expose the wound - to see where the blood is coming from
 Control the bleeding
 Do not clean large extremely dirty or life threatening wounds. Let
hospital emergency department personnel to do the
cleaning
 Do not scrub a wound

53. Open wounds – wound care
 Shallow wounds should be cleaned to prevent infection - risk
of restarting of bleeding by disturbing the clot
 For severe bleeding, leave the pressure bandage in
place until medical attention.
 To clean a shallow wound
- wash inside the wound with soap and water
- irrigate the wound with water from a faucet (tap)
- for a wound with a high risk for infection (animal
bite, very dirty or ragged wound or a
puncture) seek medical attention for wound
cleaning
 Cover the area with a sterile dressing

54. Open wounds - amputation
 Control the bleeding
 Treat the victims shock
 Recover the amputated part, take it with the victim -
- it does not need to be cleaned
- wrap it with a dry sterile gauze or clean cloth
and put it in the plastic bag
- keep it cool, but do not freeze
 Seek medical attention immediately - 18 hours is the
maximum time allowable for a part that has been
cooled properly.
Muscles without blood lose viability within six
hours.

55. What to do
 Expose the area - remove or cut away clothing surrounding the
injury
 Do not remove or move an impaled object - movement of
any kind could produce additional
bleeding and tissue damage
 Control any bleeding with pressure around the impaled
object
 Shorten the object if necessary - stick or trunk of the
tree, wooden or iron bar..
Open wounds - impaled objects

56. ‫الحروق‬
Burns and scalds
Rank among the most serious and painful injuries.
Can be classified -
 thermal (heat) burns - contact with hot objects,
flammable vapor, steam or liquid ‫حرارية‬
 chemical - acids, alkalis and organic compounds
(petroleum, kerosene…) ‫كيميائية‬
 electrical - severity of injury depends on the type of
current, the voltage, the area of body exposed and the
duration of contact ‫كهربائية‬

57. Burns and scalds
 1st-degree burns (superficial): surface (outer layer) of the
skin is affected
characteristics - redness, mild swelling,
tenderness and pain
‫الم‬ ،‫تورم‬ ، ‫احمرار‬
 2nd-degree burns: affect partial thickness of the skin
characteristics - blistering and swelling, severe pain
‫شديد‬ ‫والم‬ ‫تورم‬ ،‫فقاعات‬
 3rd-degree burns: penetrates the entire thickness of the skin
and deeper tissues
characteristics - no pain, skin looks waxy or pearly
grey or charred
‫متشمع‬ ‫او‬ ‫متقشر‬ ‫الجلد‬ ،‫الم‬ ‫وجود‬ ‫عدم‬

58. Burns and scalds – What to do?
 Stop the burning ! ‫الحروق‬ ‫من‬ ‫المزيد‬ ‫ايقاف‬
 Check ABCs ‫الدموية‬ ‫الدورة‬ ،‫التنفس‬ ،‫الهواء‬ ‫مجرى‬ ‫مراجعة‬
 Determine the depth (degree) of the burn ‫العمق‬ ‫تحديد‬
 Determine the extend of the burn - rule of nine -
how much body surface area is affected by burns - head
9%, complete arm 9%, front torso 18%, back 18%, each leg
represents about 1% of victims body surface ‫االمتداد‬ ‫تحديد‬
‫للحرق‬
 Determine 18%, victims hand excluding the fingers and the
thumb, which parts of the body are burned - burns of the
face, hands, feet and genitals are more severe
 Seek medical attention ‫عناية‬ ‫عن‬ ‫البحث‬
‫طبية‬

59. Burns and scalds
calculation of the burned surfice extent

60. Burns and scalds - what to do in case
of 1st and small 2nd-degree burns
Aim for the care - reduce pain
- protect against infection
- prevent evaporation
 Cooling - immerse the burned area in cold water - apply cold until the part is
pain free (10-45 minutes)
 ‫من‬ ‫لمدة‬ ‫بارد‬ ‫ماء‬ ‫تحت‬ ‫الحرق‬ ‫وضع‬
10
-
45
‫دقيقة‬
 Sterile bandage or clean cloth ‫غيار‬
‫معقم‬
 Fluids orally ???
 ‫بالفم‬ ‫سوائل‬
 Analgesia ‫مسكن‬
 Shock treatment
 ‫الصدمة‬ ‫معالجة‬

61. Burns and scalds - what not to do
‫تفعلة‬ ‫ال‬ ‫الذى‬ ‫ما‬
 Do not remove clothing stuck to the skin - pulling will
further damage the skin ‫للجلد‬ ‫المالمسة‬ ‫المالبس‬ ‫بنزع‬ ‫تقوم‬ ‫ال‬
 Do not forget to remove jewellery as soon as possible -
swelling could make jewellery difficult to remove
later ‫ازلة‬ ‫تنسى‬ ‫ال‬
‫المجوهرات‬
 Do not apply cold to more than 20% of an adult´s body
surface (10% for children) - widespread cooling can
cause hypothermia. Burn victims lose large amount of
heat and water evaporation)
 ‫من‬ ‫اكثر‬ ‫بارد‬ ‫ماء‬ ‫تضع‬ ‫ال‬
20
%
‫البالغ‬ ‫الشخص‬ ‫سطح‬ ‫من‬
 Do not apply ointment, butter or any other coatings on a
burn except of sterile dressing or clean cloth ‫مراهم‬ ‫اى‬ ‫تضع‬ ‫ال‬
 Do not break any blisters - intact blisters serve as excellent
burn dressings ‫الفقاعات‬ ‫بقتح‬ ‫تقوم‬ ‫ال‬

62. Burns and scalds - what to do in case
of large 2nd and 3rd-degree burns
 Do not apply cold because it may cause hypothermia
 Cover the burn with a dry, non-sticking dressing or a
clean cloth
 Treat the shock by elevating the legs and keeping
victim warm with a clean sheet or blanket
 Seek medical attention

63. Chemical burns - what to do
 Immediately remove chemical by flushing the area with
water - brush dry powder chemicals from the
skin before flushing (water may activate a dry
chemical) - protect yourself
 Remove contaminated clothing and jewellery while
flushing the water
 Flush for 20 minutes all chemical burns (skin, eyes)
 Cover the burned area with a dry, sterile dressing or
clean pillowcase or sheet
 Seek medical attention immediately for all chemical
burns

64. Chemical burns - what not to do
 Do not apply water under high pressure - it will drive the
chemical deeper into the skin
 Do not neutralize a chemical even if you know which
chemical is involved - heat may be produced,
resulting in more damage.
 Some product labels for neutralizing may be
wrong. Save the container or label for the
chemical´s name

65. Electric current injury
Effects of electricity on the body are determined by 7 factors:
 type of current - skin offers greater resistance to direct
current than alternating current
 amount of current
 pathway of current
 duration of contact
 area of contact
 resistance of the body
 voltage - high voltage accident (>1000 V) is regularly
accompanied with burns, while
low voltage (<1000 V) injury causes electric
damage, most often arrhythmia.

66. Electric current injury
 Both high and low voltage electric currents can adversely
influence vital functions - unconsciousness, breathing
paralysis and severe cardiac dysrhythmias (mostly
ventricular fibrillation).
 Heating by electrical current is the major mechanism of
tissue damage in electrical trauma.
 In high voltage accidents, the victims usually do not continue to
hold the conductor - they are often thrown away from the
electric circuit and thus acquire traumatic injuries (e.g.
fracture, brain haemorrhage).
 Low voltage = heart injury
 High voltage = thermal injury

67. Electric current injury - what to do
 Make sure the area is safe - unplug, disconnect or turn
off power, if not possible, call for help
 Check ABCs - remember - ventricular fibrillation !!! - start
CPR
 If the victim fell, check for a spinal injury
 Seek medical attention immediately, victims with cardiac
dysrhythmias need in hospital observation for 48 -
72 hrs.
 Electrical injuries with burns (high voltage) - cover them
by sterile dressing, victims usually require burn
centre care

68. Head injuries
 Mechanism of injury – motor vehicle crashes, falls, hits,
gunshots and stab wounds, mortality rate 30-50%
 The main types of head injury
- scalp wounds
- skull fractures - basilar, linear and comminuted
- intracranial lesions - contusion, subarachnoid haemorrhage,
subdural hematoma, epidural hematoma
- diffuse brain injury – concussion, diffuse axonal injury
 Scull fracture is always associated with the brain injury
 In case of suspicion of the brain injury, the patient has to be
hospitalised, examined and monitored for at least 48 hours.

69. Head injuries
Diffuse brain injury
Concusion
Diffuse axonal injury

70. Head injuries
Concusion Is a brief, temporary interruption
of neurological function following head trauma
clinical features
 Headache
 Nausea, vomiting
 Tachycardia
 Amnesia for the event
 Unconsciousness – short lasting

71. Head injuries
Concussion – treatment
 ABCs
 Treatment for scalp wounds, aplication of
pressure dressings to prevent hemorrhage
 Seek medical attention
 Transport to the hospital for diagnostics
 Admision to the hospital for monitoring,
observation (mental status, consciousness
assessment, pupils, …)

72. Head injuries - what to do
When the patient is unconscious
 ABC - monitor vital functions. By the application of airway
management (head position tulted backward) keep in mind the
possibility of cervical spine injury.
 Examine the head gently and cover the external injuries with sterile
dressings (bandage) - don’t press on the wound,
stabilize the victims neck against movement
 Examine the state of pupils - size, similarity, reaction on the light
 Examine also the thorax, abdomen and extremities
 When the circulation and breathing are stable bring the
patient into recovery (stable -side) position (beware of
cervical spine injury) and monitor vital functions.
 Call for help

73. Head injuries - what to do
When the patient is conscious:
 Bring the patient into supine position with a little elevated
head if there is no suspicion of cervical spine
injury
 Treat the wounds in the same way as above
 Call for help
 Keep in mind, that even if the patient is conscious, the
status of consciousness can alter due to the brain
injury or intracranial bleeding and therefore all the
time monitor the mental status of the victim

74. Eye injuries - penetrating eye injuries
 Result when a sharp object (knife, needle)
penetrates the eye.
 Seek immediate medical attention - any
penetrating eye injury should be managed in
the hospital
 Stabilize any protruding object with bulky
dressings or clean cloth
 Cover the undamaged eye
 Do not wash out eye with water
 Do not try to remove an object stuck in the eye
 Do not press on an injured eyeball or
penetrating object

75. Eye injuries - chemical burns of the eye
 Chemical burn of the eyes are extremely sight-
threatening
 Alkalis cause greater damage than acids - they
penetrate deeper and continue to burn longer
 Damage can happen in 1 to 5 minutes - the chemical
must be removed immediately
What to do
 - use your fingers to keep the eye as wide as
possible
 - flush the eye with water immediately - irrigate
from the nose side of the eye towards the outside,
to avoid flushing material into other eye
 - loosely bandage both eyes with cold, wet
dressings
 Seek immediate medical attention

76. Nose injuries - nosebleeds
Two types
- anterior - most
common (90%)
- posterior –
serious and requires
medical attention

77. Nose injuries - nosebleeds
What to do
 Place victim in a seated position
 Keep his/her head tilted slightly forward so blood can run
out, not down the back of the throat,
which can cause choking, nausea or vomiting
 Pinch (or have victim pinch) all the soft parts of the nose
together between thumb and two fingers for 5 minutes
 Apply an ice pack over the nose and cheeks
 Seek medical attention - if the bleeding continues or you
suspect a broken nose or posterior nosebleed

78. Spinal injuries

79. Spinal injuries are often associated with head injuries
The head may have been moved suddenly in one
or more directions, damaging the spine
What to look for
- painful movement of the arms or legs
- numbness, tingling, weakness or burning
sensation in the arms or legs
- loss of bowel or bladder control
- paralysis of the arms or legs
Spinal injuries

80. Spinal injuries
What to do
 Stabilize the victim against any movement
- to stabilize head against movement - place
heavy objects on each side of the head
 Check ABCs
 Transfere the patient by 3 – 4 pairs of hands
 Transfere patient on the vacuum matrace or on
the board
 Seek medical attention

81. Chest injuries
All chest injury victims should be rechecked for ABC
Broken ribs - main symptom is pain by breathing,
coughing and movements
What to do
 help the victim find comfortable position
 stabilize the ribs using pillow or other soft object fixed
by bandage over the injured area
 some victims find comfort by lying on the injured side
 seek medical attention

82. Chest injuries - what to do
Impaled object in chest
 Stabilize the object in place with bulky
(wide) dressing
 Do not try to remove an impaled object -
bleeding and air in the chest cavity
can result
 Seek medical attention

83. Chest injuries
Sucking chest wound - results when
a chest wound allows air to pass into and
out of the chest cavity with each breath

84. Chest injuries
Pneumothorax
 open- persisting opening to the chest
 closed - no external communication
 tension (valve) - air can enter pleural
cavity during inspiration and cannot
escape during expiration

85. Chest injuries
Air entered into pleural cavity – results in
Pneumothorax

Collaps of the lung + increasing intrapleural pressure

mediastinum shift to the healthy side

stopped venous return to the heart

cardiac arrest

86. Chest injuries
Pneumothorax – clinical features
 Sudden onset chest pain
 Chest wall deformity
 Crepitus
 Agitation
 Air hunger
 Tachycardia
 Hypotension

87. Chest injuries
Pneumothorax – treatment
 ABCs is priority
 Immobilization
 Transport to the hospital

88. Chest injuries
Pneumothorax
What to do
 Cover the wound immediately
 Seal the wound with anything available to
stop air from entering the chest cavity -
plastic wrap or plastic bag, if not
available, you can use your gloved hand
 Seek medical attention urgently !!!
 Pleural puncture should be done as soon as
possible

89. Pneumothorax (PNO)
What to do
 Always change the open pneumothorax into the
closed
 Plastic bag – place on the chest wound and fix it
by adhesive tape (plaster) from 3 sides with the
fourth side free (pocket)

90. Abdominal trauma clinical features
 Nausea
 Vomiting
 Dyspnea
 Heartburn
 Abdominal pain
 Abdominal distension

91. Abdominal trauma clinical features
 Ecchymoses over the abdomen
 Presence of open penetrating wounds
 Abdominal tenderness
 Hypotension
 tachycardia

92. Abdominal trauma - treatment
 ABCs is priority
 Immobilization
 Monitoring of vital signs
 Transport to the hospital

93. Abdominal injuries
Blow to the abdomen - observe for pain, tenderness,
muscle tights, or rigidity
What to do - place the victim in a comfortable position and
expect vomiting
check general condition – shock can develope
do not give any food and drink
seek medical attention
Penetrating wound - expect internal organs to be damaged
What to do - if the penetrating object is still in place,
stabilize the object and control bleeding,
seek medical attention
do not try to remove the object

94. Abdominal injuries
Protruding abdominal organs - what to do
 Position - the victim with the head and shoulders slightly
raised, and knees bent and raised
 Cover protruding organs with the (moist) sterile dressing or clean
cloth
 Place towel lightly over the dressing to help maintain warmth
 Seek medical attention
 Do not try to reinsert protruding organs into the abdomen
- you could introduce infection or damage the intestines
 Do not give anything to eat or drink

95. Pelvic injuries
 If you suspect broken pelvis, press the sides of the pelvis
gently downward and squeeze them inward at the iliac
crests (upper point of the hips)
- broken pelvis will be painful
What to do
 Treat the victims shock
 Place padding between victims thighs, then tie the knees
and ankles together
 Keep the victim on a firm surface - do not move the victim
 Seek medical attention

96. Bone, joint and muscle injuries
Fractures
- closed fractures - skin is intact
- open fractures - skin over the fracture is
damaged or broken
What to look for: D-O-T-S
• Deformity – abnormal position
• Open wound
• Tenderness
• Swelling

97. Bone, joint and muscle injuries
What to do:
 Determine what happened and the location of the
injury
 Gently remove clothing covering the injured area
 Examine the area by looking and feeling for D-O-T-S
 Check – C-S-M - circulation, sensation, movement
 First aid: R-I-C-E procedures
(rest, ice, compression, elevation)
 Use a splint to stabilize the fracture – 1 jount above
and 1 joint under broken bone !!!
 Seek medical attention

98. Bone, joint and muscle injuries
Joint injuries
- the most frequently affected are shoulders,
elbows, fingers, hips, knees and
ankles
Signs and symptoms
 Deformity (main sign)
 Pain
 Swelling

99. Bone, joint and muscle injuries
What to do:
• Check – C-S-M - circulation, sensation, movement
• First aid: R-I-C-E procedures
- rest, ice, compression, elevation
• Use a splint to stabilize the joint in the position in
which it was found
• Do not try to put displaced parts into their normal
position - nerve and blood vessel damage could result
• Seek medical attention

100. Poisoning
Most often causes –
 ingestion - drugs, alcohol, or both of them, toxic food
(mushrooms) or fluids
 inhalation - narcotics and carbon monoxide or other
toxic gases
 intravenous, transcutaneous or intramuscular
application of drugs in addict people
Clinical sings
- polymorphous
- mostly altered mental status
- altered vital functions
- Convulsions

101. Poisoning
Evaluation of vital functions –
examine ABCs followed by
 history +
 physical examination.
History is of primary importance, but
at altered mental status may be difficult
Obtain as much information as possible from
the patient, from the family and from anyone
else who was at the scene.

102. Poisoning
The most important questions
 What poison is involved?
 How much was taken?
 By what route was the poison taken (e.g. by mouth,
iv., i.m., skin exposure)?
 When was it taken?
 What else was taken with it? (combination of drugs
and ethanol)

103. Poisoning
Besides vital functions are regularly examined, observe:
 Pupillary size - mydriasis - (atropine, cocaine, ethanol),
- miosis (opiates, organophosphates and
barbiturates)
 Oral examination - the odour of the breath is diagnostic clue
hydration (opiates, atropine vs.
organophosphates, strychnine)
 Examination of the skin - marks of i.v. drugs use,
cyanosis, red skin colour (due to cyanide or carbon monoxide)
dry skin (atropine, anticholinergics drugs)

104. Poisoning - specific antidotes
Specific poisonings antidotes:
 Ethyleneglycol  alcohol
 Methylalcohol  alcohol
 Alkali  juice or vinegar or lemon
 Acid  milk ?
 Be careful !!!

105. Children suffocation disease
 Croup: laryng- tracheo-bronchitis - age 1-3 years
- barking cough
- intercostal retractions
 Epiglottitis - age 3-7 years, sore throat
- air hunger
- anxiety
- sitting position, hyperextended head
- swallow problems, salivation

106. Children suffocation disease
Large airways obstruction
 Inspiratory stridor
 Soft tisues af the neck and chest
(intercostal) retractions
 Noisy breathing
 Hoarseness
 “Cock“ voice

107. Children suffocation disease
What to do
 Very urgent life-threatening disease !!!
 Death from suffocation can develop within tens
of minutes or several hours from normal
healthy status !!!
 Organize transfer to the hospital (emergency,
anaesthesiology, ICU) as soon as possible by
prehospital emergency services !!!

108. Children suffocation disease
What to do
Before transfer: Could weather can help
 Take the child outside
 Aply cold compress on the neck (Prieznitz)
 Assure inhalation of air with high humidity

109. Several causes
Always think about heart attack first
Medical care at the onset of a heart attack is
vital to survive

Seek medical atention immediatelly
Chest pain

110. Heart attack
Signs and symptoms
 Uncomfortable pressure
 Squeezing or pain in the center of the
chest lasting more than a few minutes
or going away and coming back
 Pain spreading to the shoulders, neck
or arms
 Chest discomfort, nausea, shortness of
breath
 Not always typical signs

111. Heart attack
What to do
 Call emergency medical servis or get to the
nearest hospital
 The least painful position (sittin with legs up
and bent at the knees)
 Give Nitroglycerin tablets or spray (dilates
coronary arteries) – Caution: possible
hypotension
 Avoid Nitroglycerin application if patient
used VIAGRA within last 48 hours
 If unresponsive victim – check ABC and start
CPR

112. Stroke (Brain attack)

113.  Blood vessels rupture – bleeding or
 blood vessels plugged
 Nerve cells dies within minutes
 Transient attack – closely associated with strokes-
 short duration from minutes to several hours (mini-
strokes)
 serious warning sign of a potential stroke
.
Stroke (Brain attack)

114. Stroke (Brain attack)
What to look for
 Weakness, paralysis
 Decreased vision
 Speaking or understanding problems
 Dizziness or loss of ballance
 Severe headache
 Differentiate pupils from “Pupils equal
and reactive for light“

115. Stroke (Brain attack)
What to do
 If victim unresponsive – ABC
 Call emergency medical servis
 If breathing – recovery position
 Supine position with slightly elevated
head and shoulders ( neutral position)
 Do not give anything to drink and eat
(restricted swallowing, throat paralysis,
tendency to vomit…)

116. Several causes
Always think about heart attack first
Medical care at the onset of a heart attack is
vital to survive

Seek medical atention immediatelly
Chest pain

117. Diabetic emergencies
Diabetes mellitus (DM)

118. Diabetes mellitus (DM)
Definition: condition, in which insulin is either lacking or
inefective.
Insulin = a hormon produced by pancreas.
Role of insulin: helps the body to use energy from food. It
takes sugar from the blood and carries it into cells to be
used.
In Diabetes:
No insulin  sugar remains in the blood  body cells must
rely on fat as fuel.
Blood sugar is a major body fuel.
Diabetic emergencies

119. Diabetic emergencies
2 types of DM
Type I (juvenile-onset) = insulin
dependent
External insulin is required to allow sugar
to pass from the blood into cells
Type II. (adult - onset) = insulin-
non-dependent
Not dependent on external insulin
If insulin level is low  known problems
as discussed above

120. Diabetic emergencies
The body is continuously balancing sugar
and insulin.
Much insulin + not enough sugar

low blood sugar (insulin shock)
Much sugar + not enough insulin

high blood sugar (diabetic coma)
Both low and high blood sugar
= life threatening situation ( coma)

121. Diabetic emergencies
Low blood sugar = hypoglycemia
Signs:
• sudden onset
• poor coordination
• anger, bad temper
• pale colour
• confusion, desorientation
• sudden hunger
• excessive sweating
• unconsciousness – hypoglycemic coma

122. Diabetic emergencies
High blood sugar = hyperglycemia
Causes:
• inactivity
• insuficient insulin
• forgotten application of insulin before eating
• overeating (inadequate ingurgitation of food)
• illness
• stress
• combination

123. Diabetic emergencies
High blood sugar = hyperglycemia
Signs
• gradual onset
• drowsiness
• extreme thirst
• frequent urination of high volume
• flushed skin
• vomiting
• fruity breath odor
• haevy deep breathing
• unconsciousness - coma

124. Diabetic emergencies
High blood sugar = hyperglycemia
What to do:
• If you are not sure whether victim has high or low
blood sugar, give the person food or drink with
sugar
• If you do not see improvement, seek medical care
Or:
• Check blood sugar by glucometer
• Help the patient to apply insulin in case of high blood
sugar

125. Emergencies during pregnancy
Try to remain calm and considerate of the
mother during stressful situation
What to look for?
• vaginal bleeding
• cramps in lower abdomen
• swelling of the face or fingers
• severe continuous headache
• dizziness or fainting
• uncontrolled vomiting
• baby

126. What to do during bustling (fast) delivery
• try to be quiet
• try to co-operate with delivering lady
• protect the baby´s head
• if child is delivered, place him between mother´s
thighs and cover him with dry blanket
• congratulate to the mother
• thank her for her co-operation
• wait for the end of funis (umbilical cord) pulsation
• close it by tape
• seek medical attention
• .
Diabetic emergencies

127. Diabetic emergencies
The body is continuously balancing sugar
and insulin.
Much insulin + not enough sugar

low blood sugar (insulin shock)
Much sugar + not enough insulin

high blood sugar (diabetic coma)
Both low and high blood sugar
= life threatening situation ( coma)