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K S Chew
School of Medical Sciences
Universiti Sains Malaysia
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 Minimize delay (30
compressions should
be accomplished in
approx 18 seconds)

 The A-B-C sequence

starts with the most
difficult steps!
(impediment to
initiate CPR)
  
 
D ook, listen, and feel for
breathing͟ has been
removed from algorithm.
After delivery of 30
compressions, the rescuer
opens the victim͛s airway
and delivers 2 breaths.
       
 As a general rule a victim should not be
moved
 The indications to move the victim include
1. If the area is unsafe for the rescuer or victim
2. If the victim is face down and is unresponsive
3. If the victim has difficulty breathing because
of copious secretions or vomiting
4. If the victim shows evidence of shock
 
 

 Assume all chest
discomfort is cardiac origin
until proven otherwise.

 The most important

intervention is to CA FOR
THE EMS or AMBU ANCE.
Ô Call EMS rather than drive
themselves to hospital
 
 

 hile waiting for the EMS arrival, encourage
victim to take a tablet of crushed aspirin

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 ISIS-2 study clearly established the beneficial
effects of aspirin within the first 24 hours to
reduce mortality in patients with acute MI.
 ISIS-2 (Second International Study of Infarct Survival)
Collaborative Group. Randomised trial of intravenous
streptokinase, oral aspirin, both, or neither among
17,187 cases of suspected acute myocardial infarction.
ancet. 1988;2:349ʹ360
 Early pre-hospital administration of aspirin
reduces mortality in acute MI
   
 6o not administer anything by mouth for any
poison ingestion unless advised to do so by
the Poison Center
 (Note: In Malaysia, the National Poison Center is
located in Universiti Sains Malaysia Penang. Tel:
+604-657 2924)
 There is insufficient evidence that dilution of
the ingested poison with water or milk is of
any benefit as a first aid measure.
   
 6o not administer activated charcoal to a
victim who has ingested a poisonous
substance unless you are advised to. There is
insufficient evidence to recommend for or
against the administration of activated
charcoal in first aid setting although 2 small
studies suggest that it may be safe to
administer.
 

  

 Best controlled by
applying pressure
until bleeding stops
 Amount of pressure
applied and the time
the pressure is held
are the most
important factors
affecting successful
control of bleeding.
 

  

 Elevation and use of pressure points are no
longer recommended to control bleeding.


1. hemostatic effect of elevation has not been
studied
2. no effect on distal pulses was found
3. these unproven procedures may compromise
the proven intervention of direct pressure
 
 Superficial wounds and
abrasions should be
thoroughly washed.

 Irrigate with a large

volume of warm or room
temperature tap water
from a reliable source
(with or without soap).
 
 Higher irrigation pressures are more effective
than lower pressures

 Higher volumes are better than lower volumes

(within a range of 100 to 1000 m )

 Tap water is as good as (or better than) any

other irrigation solution in reducing infection
rates.
 
 The wounds actually heal better with less
infection if they are covered with an antibiotic
ointment or cream and a clean occlusive
dressing
 In first aid setting, this applies for abrasion or
a superficial injury only.
 Ensure that the victim has no known allergies
to the antibiotic ʹ if in doubt, do not apply
  



 RICE remains the main
components of
symptomatic treatment.

 R= Rest (the affected

extremity)
 I = Ice (cold) compression
 C = Compressive bandage
 E = Elevate the extremity
  




 Cold application is more effective

than heat application
 Cold application by mixture of ice
and water is more effective than ice
alone
 Cold application by mixture of ice
and water is more effective than
refreezable gel pack.
  




 Cold application is more effective

than heat application
 Cold application by mixture of ice
and water is more effective than ice
alone
 Cold application by mixture of ice
and water is more effective than
refreezable gel pack.
  



 Cold application decreases hemorrhage,
edema, pain, and disability.

 To prevent cold injury, limit each application of

cold to periods ч20 minutes.

 If that length of time is uncomfortable, limit

application to 10 minutes
 ´

   
 First aid for jellyfish
stings consists of two
important actions:

1. preventing further
nematocyst
discharge and
2. pain relief
 ´

   
 To inactivate venom load and prevent further
envenomation, jellyfish stings should be
liberally washed with vinegar (4% to 6% acetic
acid solution) as soon as possible for at least
30 seconds.

 If vinegar is not available, a baking soda slurry

may be used instead.
 ´

   
 For the treatment of
pain, after the
nematocysts are
removed or deactivated,
jellyfish stings should be
treated with hot-water
immersion when
possible.
 ´

   
 Instruct victim to take a hot shower or
immerse the affected part in hot water
(temperature as hot as tolerated, or 45°C if
there is the capability to regulate
temperature), as soon as possible, for at least
20 minutes or for as long as pain persists.
 If hot water is not available, dry hot packs or,
as a second choice, dry cold packs may be
helpful in decreasing pain but these are not as
effective as hot water.
 ´

   
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 Marine venoms consist of multiple proteins
and enzymes, and there is evidence that these
become deactivated when heated to
temperatures above 50 °C. 6irect heat
application leads to inactivation of the venom
and deactivation of heat labile proteins.
 Hot water immersion causes modulation of
pain receptors in the nervous system leading
to a reduction in pain.
 ´

   
 The Portuguese Man O͛
ar is not a jellyfish
 Is a cluster of several
organisms each highly
specialized, cannot sustain
themselves individually,
dependent for survival on
the others