Les antibiotiques sont produits sous des formes pharmaceutiques telles que des pilules acheter du amoxil
elles permettent d'injecter la quantité de préparation strictement nécessaire.
Part 17: First Aid
2010 American Heart Association and American Red Cross Guidelines for
David Markenson, Co-Chair*; Jeffrey D. Ferguson, Co-Chair*; Leon Chameides; Pascal Cassan;
Kin-Lai Chung; Jonathan Epstein; Louis Gonzales; Rita Ann Herrington; Jeffrey L. Pellegrino;
Norda Ratcliff; Adam Singer
Modern, organized first aid evolved from military experi-
Red Cross (Red Cross) cofounded the National First Aid
ences when surgeons taught soldiers how to splint and
Science Advisory Board to review and evaluate the scien-
bandage battlefield wounds. Two British officers, Peter Shep-
tific literature on first aid in preparation for the 2005
herd and Francis Duncan, are said to have been the first to
American Heart Association (AHA) and American Red
expand the concept to civilians and to develop the first
Cross Guidelines for First Aid.
1 In preparation for the 2010
curriculum in first aid.4 Organized training in civilian first aid
evidence evaluation process, the National First Aid Advi-
began in the United States in 1903 when Clara Barton,
sory Board was expanded to become the International First
president of the Red Cross, formed a committee to establish
Aid Science Advisory Board with the addition of repre-
instruction in first aid among the nation's industrial workers,
sentatives from a number of international first aid organi-
where, under dangerous conditions, accidents and deaths
zations (see Table). The goal of the board is to reduce
were all too frequent.
morbidity and mortality due to emergency events bymaking treatment recommendations based on an analysis
The Evidence Evaluation Process
of the scientific evidence that answers the following
The International First Aid Science Advisory Board first
identified 38 questions in first aid practice that either were not
raised in previous evidence evaluations or were in need of
In which emergency conditions can morbidity or mortality
updating. Two or more board members volunteered to review
be reduced by the intervention of a first aid provider?
the scientific literature independently and develop an
How strong is the scientific evidence that interventions
evidence-based review worksheet summarizing the literature
performed by a first aid provider are safe, effective, and
relevant to each question (see Part 2: "Evidence Evaluation
and Management of Potential or Perceived Conflicts of
A critical review of the scientific literature by members of
Interest"). After each worksheet was presented to, and re-
the International First Aid Science Advisory Board is sum-
viewed by, the full board, a summary draft of the scientific
marized in the 2010 International Consensus on First Aid
evidence and a treatment recommendation were crafted. The
Science With Treatment Recommendations
evidence-based review for each question was presented and
from which these guidelines are derived.2
discussed a second time at a subsequent board meeting. All
That critical review evaluates the literature and identifies
first aid worksheets, co-copyrighted by the American Heart
knowledge gaps that might be filled through future scientific
Association and the American Red Cross, can be viewed
through hyperlinks in the 2010 American Heart Associationand American Red Cross International Consensus on First
Aid Science with Treatment Recommendations.2 Each ques-
The history of first aid can be traced to the dawn of organized
tion, evidence-based review, draft summary of science, and
human societies. For example, Native American Sioux med-
draft treatment recommendation was presented, discussed,
icine men of the Bear Society were noted for treating battle
and debated on 2 separate occasions until a consensus was
injuries, fixing fractures, controlling bleeding, removing ar-
reached. These guidelines are based on the scientific consen-
rows, and using a sharp flint to cut around wounds and
sus findings reported in the 2010 International Consensus on
First Aid Science with Treatment Recommendations
The American Heart Association and the American Red Cross request that this document be cited as follows: Markenson D, Ferguson JD, Chameides
L, Cassan P, Chung K-L, Epstein J, Gonzales L, Herrington RA, Pellegrino JL, Ratcliff N, Singer A. Part 17: first aid: 2010 American Heart Associationand American Red Cross Guidelines for First Aid. Circulation
. 2010;122(suppl 3):S934 –S946.
*Co-chairs and equal first co-authors.(Circulation. 2010;122[suppl ]:S934 –S946.)
2010 American Heart Association, Inc., and American Red Cross.
Circulation is available at http://circ.ahajournals.org
Markenson et al
Part 17: First Aid
International First Aid Science Advisory Board
sound and based on scientific evidence or, in the absence
of such evidence, on expert consensus. Administration offirst aid must not delay activation of the emergency
American Academy of Pediatrics
medical services (EMS) system or other medical assistance
American Burn Association
when required. We strongly believe that education in first
American College of Emergency Physicians
aid should be universal: everyone can learn first aid and
American College of Occupational and Environmental Medicine
American College of Surgeons
The scope of first aid is not purely scientific; it is
American Heart Association
influenced by both training and regulatory issues. The defi-
American Pediatric Surgical Association
nition of scope is therefore variable, and should be defined
American Red Cross
according to circumstances, need, and regulatoryrequirements.
American Red Cross Advisory Council on First Aid, Aquatics, Safety andPreparedness (ACFASP)
American Safety & Health Institute (ASHI)
Calling for Help
Austrian Red Cross
A first aid provider must be able to recognize when help is
Canadian Red Cross
needed and how to get it. First aid providers should learn
Divers Alert Network
how and when to access the EMS system, how to activatethe on-site emergency response plan (ERP), and how to
European Reference Center on First Aid Education
contact the Poison Control Center (see "Poison Emergen-
Egyptian Red Crescent
Grenada Red Cross
Positioning the Victim
Hong Kong Red Cross
As a general rule a victim should not be moved, especially if
Hungarian Red Cross
you suspect, from the victim's position or the nature of the
International Federation of Red Cross and Red Crescent Societies
injury, that the victim may have a spinal injury (see "Spine
Medic First Aid International
Stabilization" below). There are times, however, when the
National Association of EMS Educators
victim should be moved:
National Association of EMS Physicians
If the area is unsafe for the rescuer or the victim, move the
National Athletic Trainers' Association
victim to a safe location if it is safe to do so.
National Safety Council
If the victim is face down and is unresponsive, turn the
Norwegian Red Cross
victim face up.
Occupational Safety and Health Administration
If the victim has difficulty breathing because of copious
Red Cross Society of China
secretions or vomiting, or if you are alone and have to leave
Resuscitation Council of Asia
an unresponsive victim to get help, place the victim in a
St. John Ambulance, UK
rm IN E
recovery position:9,10 Extend one of the victim's arms
above the head and roll the body to the side so the victim's
Previous reports5–8 have noted the paucity of scientific
head rests on the extended arm. Bend both legs to stabilize
evidence supporting many interventions in prehospital emer-
the victim (Class IIb, LOE C).
gency care. In reviewing the medical literature, members of
If a victim shows evidence of shock, have the victim lie
the International First Aid Science Advisory Board once
supine. If there is no evidence of trauma or injury, raise the
again found a paucity of evidence to guide first aid interven-
feet about 6 to 12 inches (about 30° to 45°) (Class IIb, LOE
tions. Very little research is being conducted in first aid, and
C). Do not raise the feet if the movement or the position
many of the following recommendations are extrapolated
causes the victim any pain.
from the experience of healthcare professionals. It is impor-tant to recognize the limitations of the evidence that supports
The evidence for a benefit to raising the feet is extrapolated
many of these guidelines so that research can be undertaken
from leg raising studies on volume expansion; there are no
and future guidelines can be based on a larger body of
studies on the effect of leg raising as a first aid maneuver for
shock. The results of the volume expansion studies arecontradictory with some showing an increase in cardiac
Definition of First Aid
output,11–13 while others show no change in cardiac output ormean arterial pressure14–18 with leg raising.
We define first aid as the assessments and interventionsthat can be performed by a bystander (or by the victim)with minimal or no medical equipment. A first aid provider
is defined as someone with formal training in first aid,
There is insufficient evidence to recommend routine use of
emergency care, or medicine who provides first aid. First
supplementary oxygen by a first aid provider for victims
aid assessments and interventions should be medically
complaining of chest discomfort19,20 or shortness of breath21
November 2, 2010
(Class IIb, LOE C). Supplementary oxygen administration
epinephrine may be given if symptoms of anaphylaxis
may be beneficial as part of first aid for divers with a
persist (Class IIb, LOE C).
decompression injury (Class IIb, LOE C22).
The general principles of first aid management of seizuresare to
Ensure an open airway.
The incidence of acute asthma is increasing, especially in
urban populations.23 Many victims with asthma take a pre-scribed bronchodilator medication and can self-administer
Do not restrain the victim during a seizure. Do not try to
it.24–26 First aid providers are not expected to make a
open the victim's mouth or try to place any object between
diagnosis of asthma, but they may assist the victim in using
the victim's teeth or in the mouth. Restraining the victim
the victim's prescribed bronchodilator medication (Class IIa,
may cause musculoskeletal or soft-tissue injury. Placing an
LOE B) under the following conditions:
object in the victim's mouth may cause dental damage or
The victim states that he or she is having an asthma attack
aspiration (Class IIa, LOE C). It is not unusual for the
or symptoms associated with a previously diagnosed
victim to be unresponsive or confused for a short time after
breathing disorder, and the victim has the prescribed
medications or inhaler in his or her possession.
The victim identifies the medication and is unable to
administer it without assistance.24
Because it is very difficult, even for the healthcare profes-sional, to differentiate chest discomfort of cardiac origin from
First aid providers should become familiar with inhalers so
other chest discomfort, the first aid provider should assume
that they can assist a victim with an acute asthma attack in
that chest discomfort is cardiac until proven otherwise.
using the inhaler.
Cardiac chest discomfort is often described as "crushing" or"pressing" and is often accompanied by shortness of breath or
perspiration. But cardiac chest discomfort may not have these
Allergies are relatively common, but only a small proportion
classical characteristics, especially in women. Call EMS
of people with allergies develop anaphylactic reactions. An
immediately for anyone with chest discomfort. Do not delay
anaphylactic reaction is a progressive series of signs and
and do not try to transport the patient to a healthcare facility
symptoms characterized by swelling, breathing difficulty,
an itching rash, and eventually shock, which, if left
While waiting for EMS to arrive, the first aid provider may
untreated, may lead to death. Some of these signs and
encourage the victim to chew 1 adult (not enteric coated) or
symptoms can also be present in other conditions, and first
2 low-dose "baby" aspirin if the patient has no allergy to
aid rescuers should not be expected to make a diagnosis of
aspirin or other contraindication to aspirin, such as evidence
of a stroke or recent bleeding (Class IIa, LOE A).44–46
Older patients who suffer from anaphylactic reactions
know their signs and symptoms and many carry a lifesavingepinephrine auto-injector. With proper training, parents can
be taught to correctly use an auto-injector to administerepinephrine to their allergic children.31 All too often, how-
ever, neither the victim nor family members know how to
Control of bleeding is a basic skill of first aid and one of the
correctly use an auto-injector.32–34 First aid providers should
few actions with which a first aid provider can critically
be familiar with the epinephrine auto-injector so that they can
help a victim with an anaphylactic reaction to self-administerit. First aid providers should also know how to administer the
auto-injector if the victim is unable to do so, provided that the
Bleeding is best controlled by applying pressure until bleed-
medication has been prescribed by a physician and state law
ing stops47–53 or EMS rescuers arrive (Class I, LOE A). The
permits it (Class IIb, LOE B).
amount of pressure applied and the time the pressure is held
In retrospective studies35–37 18% to 35% of patients
are the most important factors affecting successful control of
having signs of anaphylaxis required a second dose of
bleeding. The pressure must be firm, and it must be main-
epinephrine if symptoms persisted or progressed after the
tained for a long time. Methods of applying pressure include
first dose. Because of the difficulty in making a diagnosisof anaphylaxis27–30,38,39 and the potential harm from epi-
Manual pressure on gauze or other cloth placed over the
nephrine if the diagnosis is incorrect,40 – 43 first aid provid-
bleeding source. If bleeding continues, do not remove the
ers are advised to seek medical assistance if symptoms
gauze; add more gauze on top and apply more pressure.
persist, rather than routinely administering a second dose
If it is not possible to provide continuous manual pressure,
of epinephrine. In unusual circumstances, when advanced
wrap an elastic bandage firmly over gauze to hold it in
medical assistance is not available, a second dose of
place with pressure.54–57
Markenson et al
Part 17: First Aid
Although tourniquets have been shown to control bleedingeffectively on the battlefield58–60 and during surgery and have
been used by paramedics in a civilian setting without com-
Cool thermal burns with cold (15° to 25°C) tap water as soon
plications,61 there are no studies on controlling bleeding with
as possible and continue cooling at least until pain is relieved
first aid provider use of a tourniquet. Potential dangers of
(Class I, LOE B).86–93 Cooling reduces pain, edema, and
prolonged tourniquet application include temporary62 or per-
depth of injury. It speeds healing and may reduce the need for
manent63 injury to the underlying nerves and muscles,64 and
excision and grafting of deep burns. Don't apply ice directly
systemic complications resulting from limb ischemia,65 in-
to a burn; it can produce tissue ischemia (Class III, LOE B).
cluding acidemia, hyperkalemia, arrhythmias, shock, and
Prolonged cold exposure to small burns, and even brief
death. Complications are related to tourniquet pressure66 and
exposure if the burn is large, can cause further local tissue
duration of occlusion,67 but there is insufficient evidence to
injury93–95 and hypothermia.
determine a minimal critical time beyond which irreversiblecomplications may occur. Because of the potential adverse
effects of tourniquets and difficulty in their proper applica-
Loosely cover burn blisters with a sterile dressing but leave
tion, use of a tourniquet to control bleeding of the extremities
blisters intact because this improves healing and reduces pain
is indicated only if direct pressure is not effective or possible
(Class IIa, LOE B).96–99
(Class IIb, LOE B). Specifically designed tourniquets appearto be better than ones that are improvised,60,68–71 but tourni-
quets should only be used with proper training (Class IIa,
The severity of electric injuries can vary widely, from an
LOE B). If a tourniquet is used, make sure that you note the
unpleasant tingling sensation caused by low-intensity cur-
time it was applied and communicate that time to EMS
rent to thermal burns, cardiopulmonary arrest, and death.
Thermal burns may result from burning clothing that is incontact with the skin or from electric current traversing a
Pressure Points and Elevation
portion of the body. When current traverses the body,
Elevation and use of pressure points are not recommended to
thermal burns may be present at the entry and exit points
control bleeding (Class III, LOE C). This new recommenda-
and along its internal pathway. Cardiopulmonary arrest is
tion is made because there is evidence that other ways of
the primary cause of immediate death from electrocu-
controlling bleeding are more effective. The hemostatic effect
tion.100 Cardiac arrhythmias, including ventricular fibrilla-
of elevation has not been studied. No effect on distal pulses
tion, ventricular asystole, and ventricular tachycardia that
was found in volunteers when pressure points were used.72
progresses to ventricular fibrillation, may result from
Most important, these unproven procedures may compromise
exposure to low- or high-voltage current.101 Respiratory
the proven intervention of direct pressure, so they could be
arrest may result from electric injury to the respiratory
center in the brain or from tetanic contractions or paralysisof respiratory muscles.
Do not place yourself in danger by touching an electro-
Among the large number of commercially available hemo-
cuted victim while the power is on (Class III, LOE C).
static agents, some have been shown to be effective.73–76
Turn off the power at its source; at home the switch is
However, their routine use in first aid cannot be recom-
usually near the fuse box. In case of high-voltage electro-
mended at this time because of significant variation in
cutions caused by fallen power lines, immediately notify
effectiveness by different agents and their potential for
the appropriate authorities (eg, 911 or fire department). All
adverse effects, including tissue destruction with induction of
materials conduct electricity if the voltage is high enough,
a proembolic state and potential thermal injury (Class IIb,
so do not enter the area around the victim or try to remove
wires or other materials with any object, including awooden one, until the power has been turned off by
Wounds and Abrasions
Superficial wounds and abrasions should be thoroughly
Once the power is off, assess the victim, who may need
irrigated with a large volume of warm or room temperature
CPR, defibrillation, and treatment for shock and thermal
potable water with or without soap77–82 until there is no
burns. All victims of electric shock require medical assess-
foreign matter in the wound (Class I, LOE A). Cold water
ment because the extent of injury may not be apparent.
appears to be as effective as warm water, but it is not ascomfortable. If running water is unavailable, use any source
of clean water. Wounds heal better with less infection if they
There is approximately a 2% risk of injury to the cervical
are covered with an antibiotic ointment or cream and a clean
spine after blunt trauma that is serious enough to require
occlusive dressing (Class IIa, LOE A).83–85 Apply antibiotic
spinal imaging in an emergency department,102,103 and this
ointment or cream only if the wound is an abrasion or a
risk is tripled in patients with craniofacial injury.104 Most
superficial injury and only if the victim has no known
victims with spinal injuries are males between the ages of
allergies to the antibiotic.
10 and 30 years. Motor vehicles cause approximately half
November 2, 2010
of all spinal injuries; many of the remainder are caused by
thin towel, between the cold container and the skin (Class IIb,
falls (especially from a height or diving), sports, and
It is not clear whether a compression bandage is helpful for
If the cervical spine is injured, the spinal cord may be
a joint injury. Heat application to a contusion or injured joint
unprotected, and further injury (secondary spinal cord
is not as good a first aid measure as cold application.115
injury) could result from stresses to the cord that occurwhen the victim is manipulated or moved. This could
result in permanent neurological damage including quad-
Assume that any injury to an extremity includes a bone
riplegia.106,107 Only one controlled but underpowered study
fracture. Cover open wounds with a dressing. Do not move
with some methodological problems108 has examined this
or try to straighten an injured extremity (Class III, LOE C).
question. In the study, the group of injured victims with
There is no evidence that straightening an angulated
spinal immobilization by emergency medical technicians
suspected long bone fracture shortens healing time or
using equipment failed to show any neurological benefit
reduces pain prior to permanent fixation. Expert opinion
compared with a group of injured victims without spinal
suggests that splinting may reduce pain130 and prevent
further injury. So, if you are far from definitive health care,
Because of the dire consequences if secondary injury
stabilize the extremity with a splint in the position found
does occur, maintain spinal motion restriction by manually
(Class IIa, LOE C). If a splint is used, it should be padded
stabilizing the head so that the motion of head, neck, and
to cushion the injury. If an injured extremity is blue or
spine is minimized (Class IIb, LOE C). First aid providers
extremely pale, activate EMS immediately because this
should not use immobilization devices because their ben-
could be a medical emergency. A victim with an injured
efit in first aid has not been proven and they may be
lower extremity should not bear weight until advised to do
harmful (Class III, LOE C). Immobilization devices may
so by a medical professional.
be needed in special circumstances when immediate extri-cation (eg, rescue of drowning victim) is required, but first
Human and Animal Bites
aid providers should not use these devices unless they have
Irrigate human and animal bites with copious amounts of
been properly trained in their use.
water (Class I, LOE B). This irrigation has been shown to
First aid rescuers cannot conclusively identify a victim
prevent rabies from animal bites131,132 and bacterial
with a spinal injury, but they should suspect spinal injury
if an injured victim has any of the following risk factors(these have been modified slightly from the 2005 Ameri-
can Heart Association and American Red Cross First Aid
Do not apply suction as first aid for snakebites (Class III,
LOE C). Suction does remove some venom, but the amountis very small.134 Suction has no clinical benefit135 and it may
aggravate the injury.136–138
Driver, passenger, or pedestrian, in a motor vehicle, mo-
Applying a pressure immobilization bandage with a pres-
torized cycle, or bicycle crash
sure between 40 and 70 mm Hg in the upper extremity and
Fall from a greater than standing height
between 55 and 70 mm Hg in the lower extremity around the
Tingling in the extremities
entire length of the bitten extremity is a reasonable way to
Pain or tenderness in the neck or back
slow the dissemination of venom by slowing lymph flow
Sensory deficit or muscle weakness involving the torso or
(Class IIa, LOE C139,140). For practical purposes pressure is
sufficient if the bandage is comfortably tight and snug but
Not fully alert or is intoxicated
allows a finger to be slipped under it. Initially it was theorized
Other painful injuries, especially of the head and neck
that slowing lymphatic flow by external pressure would only
Children 2 years of age or older with evidence of head or
benefit victims bitten by snakes producing neurotoxic
venom,140 but the effectiveness of pressure immobilizationhas also been demonstrated for bites by non-neurotoxic
American snakes in an animal model.141 This treatmentrequires further study to prove its efficacy in humans. The
Sprains and Strains
challenge is to find a way to teach the application of the
Soft-tissue injuries include joint sprains and muscle contu-
correct snugness of the bandage because inadequate pressure
sions. Cold application decreases hemorrhage, edema, pain,
is ineffective and too much pressure may cause local tissue
and disability,115–120 and it is reasonable to apply cold to a
damage. It has also been demonstrated that, once learned,
soft-tissue injury. Cooling is best accomplished with a plastic
retention of the skill of proper pressure and immobilization
bag or damp cloth filled with a mixture of ice and water; the
application is poor.142,143
mixture is better than ice alone.121–123 Refreezable gel packsdo not cool as effectively as an ice-water mixture.124,125 To
prevent cold injury, limit each application of cold to periods
This section is new to the First Aid Guidelines. First aid
ⱕ20 minutes.126–128 If that length of time is uncomfortable,
for jellyfish stings consists of two important actions:
limit application to 10 minutes.129 Place a barrier, such as a
preventing further nematocyst discharge and pain relief.
Markenson et al
Part 17: First Aid
To inactivate venom load and prevent further envenoma-
clude placing the victim near a heat source and placing
tion, jellyfish stings should be liberally washed with
containers of warm, but not hot, water in contact with the
vinegar (4% to 6% acetic acid solution) as soon as possible
for at least 30 seconds (Class IIa, LOE B). The inactivationof venom has been demonstrated for Olindias sambaquien-
144 and for Physalia physalis (Portuguese man-of-
Frostbite usually affects an exposed part of the body such as
war).145 If vinegar is not available, a baking soda slurry
the extremities and nose. In case of frostbite, remove wet
may be used instead.145
clothing and dry and cover the victim to prevent hypothermia.
For the treatment of pain, after the nematocysts are
Transport the victim to an advanced medical facility as
removed or deactivated, jellyfish stings should be treated with
rapidly as possible. Do not try to rewarm the frostbite if there
hot-water immersion when possible (Class IIa, LOE B). The
is any chance that it might refreeze161,162 or if you are close to
victim should be instructed to take a hot shower or immerse
a medical facility (Class III, LOE C).
the affected part in hot water (temperature as hot as tolerated,
Minor or superficial frostbite (frostnip) can be treated with
or 45°C if there is the capability to regulate temperature), as
simple, rapid rewarming using skin-to-skin contact such as a
soon as possible, for at least 20 minutes or for as long as pain
persists.146–149 If hot water is not available, dry hot packs or,
Severe or deep frostbite should be rewarmed within 24
as a second choice, dry cold packs may be helpful in
hours of injury and this is best accomplished by immersing
decreasing pain but these are not as effective as hot water
the frostbitten part in warm (37° to 40°C or approximately
(Class IIb, LOE B146,150,151). Topical application of aluminum
body temperature) water for 20 to 30 minutes (Class IIb, LOE
sulfate or meat tenderizer, commercially available aerosol
C161–170). Chemical warmers should not be placed directly on
products, fresh water wash, and papain, an enzyme derived
frostbitten tissue because they can reach temperatures that
from papaya used as a local medicine, are even less effective
can cause burns (Class III, LOE C171). Following rewarming,
in relieving pain (Class IIb, LOE B147,152).
efforts should be made to protect frostbitten parts from
Pressure immobilization bandages are not recommended
refreezing and to quickly evacuate the patient for further care.
for the treatment of jellyfish stings because animal stud-
The effectiveness of ibuprofen or other nonsteroidal antiin-
ies153,154 show that pressure with an immobilization bandage
flammatory drugs (NSAIDs) in frostbite has not been well
causes further release of venom, even from already fired
established in human studies.170,172–175
nematocysts (Class III, LOE C).
Heat-induced symptoms, often precipitated by vigorous ex-
Traumatic dental injuries are common. The first aid for an
ercise, may include heat cramps, heat exhaustion, and heat
avulsed tooth is as follows:
Heat cramps are painful involuntary muscle spasms that
Clean bleeding wound(s) with saline solution or tap water.
most often affect the calves, arms, abdominal muscles, and
Stop bleeding by applying pressure with gauze or cotton.
back. First aid includes rest, cooling off, and drinking an
Handle the tooth by the crown, not the root (ie, do not
electrolyte-carbohydrate mixture, such as juice, milk, or a
handle the part that was beneath the gum).
Place the tooth in milk, or clean water if milk is not
commercial electrolyte-carbohydrate drink.176–185 Stretching,
icing, and massaging the painful muscles may be helpful.
Contact the patient's dentist or take the tooth and victim to
Exercise should not be resumed until all symptoms have
an emergency care center as quickly as possible (Class IIa,
Heat exhaustion is caused by a combination of exercise-
induced heat and fluid and electrolyte loss as sweat. Signs andsymptoms may start suddenly and include: nausea, dizziness,
muscle cramps, feeling faint, headache, fatigue, and heavysweating. Heat exhaustion is a serious condition because it
can rapidly advance to the next stage, heat stroke, which can
be fatal. Heat exhaustion must be vigorously treated by
Hypothermia is caused by exposure to cold. The urgency of
having the victim lie down in a cool place, taking off as many
treatment depends on the length of exposure and the victim's
clothes as possible, cooling the victim with a cool water
body temperature. Begin rewarming a victim of hypothermia
spray, and encouraging the victim to drink cool fluids,
immediately by moving the victim to a warm environment,
preferably containing carbohydrates and electrolytes.
removing wet clothing, and wrapping all exposed body
Heat stroke includes all the symptoms of heat exhaustion
surfaces with anything at hand, such as blankets, clothing,
plus signs of central nervous system involvement, including
and newspapers. If the hypothermia victim is far from
dizziness, syncope, confusion, or seizures. The most impor-
definitive health care, begin active rewarming (Class IIa,
tant action by a first aid provider for a victim of heat stroke
LOE B159,160) although the effectiveness of active rewarming
is to begin immediate cooling, preferably by immersing the
has not been evaluated. Active rewarming should not delay
victim up to the chin in cold water.186–189 It is also important
definitive care. Potential methods of active rewarming in-
to activate the EMS system. Heat stroke requires emergency
November 2, 2010
treatment with intravenous fluids. Do not try to force the
victim to drink liquids.
Brush powdered chemicals off the skin with a gloved hand orpiece of cloth. Remove all contaminated clothing from the
victim, making sure you do not contaminate yourself in the
Drowning is a major cause of unintentional death. Methods of
process. In case of exposure to an acid or alkali on the skin196–202
preventing drowning include isolation fencing around swim-
or eye,203–208 immediately irrigate the affected area with copious
ming pools (gates should be self-closing and self-latching),190
amounts of water (Class I, LOE B).
wearing personal flotation devices (life jackets) while in,around, or on water, never swimming alone, and avoidingswimming or operating motorized watercraft while intoxi-
Toxic Eye Injury
cated. Outcome following drowning depends on the duration
Rinse eyes exposed to toxic substances immediately with a
of the submersion, the water temperature, and how promptly
copious amount of water (Class I, LOE C203,209,210), unless a
CPR is started.191,192 Occasional case reports have docu-
specific antidote is available.203,210,211
mented intact neurological survival in children followingprolonged submersion in icy waters.193,194
Remove the victim rapidly and safely from the water, but
do not place yourself in danger. If you have special training,
Treatment With Milk or Water
you can start rescue breathing while the victim is still in the
Do not administer anything by mouth for any poison
water195 providing that it does not delay removing the victim
ingestion unless advised to do so by a poison control center
from the water. There is no evidence that water acts as an
or emergency medical personnel because it may be harmful
obstructive foreign body, so do not waste time trying to
(Class III, LOE C). There is insufficient evidence that
remove it with abdominal or chest thrusts. Start CPR and, if
dilution of the ingested poison with water or milk is of any
you are alone, continue with about 5 cycles (about 2 minutes)
benefit as a first aid measure. Animal studies212–216 have
of chest compressions and ventilations before activating
shown that dilution or neutralization of a caustic agent
EMS. If 2 rescuers are present, send 1 rescuer to activateEMS immediately.
with water or milk reduces tissue injury, but no humanstudies have shown a clinical benefit. Possible adverseeffects of water or milk administration include emesis and
If the patient exhibits any signs or symptoms of a life-threatening condition, (eg, sleepiness, seizures, difficulty
breathing, vomiting) after exposure to a poison, activate the
Do not administer activated charcoal to a victim who has
ingested a poisonous substance unless you are advised to doso by poison control center or emergency medical personnel
Poison Control Centers
(Class IIb, LOE C). There is no evidence that activated
There are many poisonous substances in the home and
charcoal is effective as a component of first aid. It may be
worksite. It is important to understand the toxic nature of the
safe to administer,217,218 but it has not been shown to be
chemical substances in the environment and the proper
beneficial, and there are reports of it causing harm.219–221 In
protective equipment and emergency procedures in case of
addition the majority of children will not take the recom-
toxic exposure. The Poison Help hotline of the American
Association of Poison Control Centers (800-222-1222) is anexcellent resource in the United States for information abouttreating ingestion of, or exposure to, a potential poison.
Further information is available at www.aapcc.org. Similar
Do not administer syrup of ipecac for ingestions of toxins
resources may be available internationally, and their contact
(Class III, LOE B). Several studies223–225 found that there is
information (eg, 112 in Europe) should be standard in
no clinically relevant advantage to administering syrup of
international first aid training. When phoning a poison control
ipecac; its administration is not associated with decreased
center or other emergency medical services, know the nature
healthcare utilization.226 Untoward effects of ipecac admin-
and time of exposure and the name of the product or toxic
istration include intractable emesis and delayed care in an
advanced medical facility.227,228
Markenson et al
Part 17: First Aid
Guidelines Part 17: First Aid: Writing Group Disclosures
NYMC–Interim Chair; EMA–Chief
Brody School of Medicine, East
*Serving as an expert
witness in two ongoing
lawsuits involving EMS
related cases. Billing for
this service has not yet
occurred and will likely
represent less than
$10,000 per 12 months.
This payment is expected
to come directly to me
Emeritus Director Pediatric
Cardiology, Connecticut Children's
Medical Center, Clinical Professor,
University of Connecticut
French Red Cross, National Medical
Advisor and Coordinator of the
European Reference Centre for first
aid education Coordinator of the
Scientific Commission of First Aid
for the French Interior Ministry
Hong Kong Hospital Authority
Hospital Chief Executive
NorthEast Emergency Medical
*Volunteer: American Red
Services, Inc.– Regional EMS
Cross Advisory Council
Council: Provide EMS System
on First Aid, Aquatics,
Oversight. Also provide education
Safety and Preparedness
(First aid and CPR/AED) as an AHA
Training Center. Executive Director;
Isis Maternity: Pre-Natal and Post
Partum edu.- Provide CPR and First
Aid Training via AHA Curriculum.
City of Austin - Office of the
Medical Director: EMS System
Medical Director Staff–Performance
Management & Research
*Beginning July 1, 2009, I will
serve as a paid consultant to the
AHA ECC Product Development
Group as a Senior Science Editor.
This assignment will include
providing Science review of AHA
First Aid Products
Minute Clinic–Family Nurse
Kent State University–Assistant Dir
†Wilderness First Aid
Faculty Professional Dev. Center
consultant for StayWell
Bloomington Hospital Prompt
Stony Brook University-Physician
This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the
Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be "significant" if (a) the personreceives $10 000 or more during any 12-month period, or 5% or more of the person's gross income; or (b) the person owns 5% or more of the voting stock or shareof the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be "modest" if it is less than "significant" under thepreceding definition.
November 2, 2010
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KEY WORDS: emergency 䡲 injury
EMPRESA DE DESARROLLO URBANO DE BOLÍVAR S.A. NIT: 890.481.123-1 NOTAS A LOS ESTADOS FINANCIEROS A JUNIO 30 DE 2015 1. NOTAS DE CARÁCTER GENERAL 1. NATURALEZA JURIDICA, OBJETO SOCIAL ACTIVIDADES QUE DESAROLLA O COMETIDO ESTATAL. NATURALEZ-A JURIDICA La Empresa de Desarrollo Urbano de Bolívar -EDURBE S.A., es una Empresa Industrial y Comercial del estado, del Orden Distrital, constituida el 24 de Diciembre de 1981, mediante Escritura Número 2069 de la Notaria 2da de Cartagena, su capital es netamente público y sus
Full-mouth disinfection: another choice for periodontal therapy Artículo extraído de la revista RAOA, Revista de la Asociación Odontológica Argentina, Vol. 97 – Nº4 – Agosto/Septiembre de 2009 Resumen El raspaje radicular realizado por sectores ha mostrado mejorar el cuadro de la patología gingivo-periodontal. Este insume varias sesiones y determinado tiempo de tratamiento.