First Aid and

Fundamentals of
Clinical Practice
https://www.youtube.com/wa
tch?v=NSEzg6TBheY
https://www.youtube.com/watch?v
=H04d3rJCLCE

General information
Faculty

Medical Faculty

Department
Semester (Terms Taught)

Second - Spring

Level (F, A, P, 1, 2, 3, M)

Freshman

Course Type

Obligatory

Unit Value (ECTS)

Contact Hours
Pre-requisites

Total

Lectures

Practicals

Seminars

45

15

30

Entrance Examination

Course relevant to other courses

Teaching Staff Faculty

Kenan Karavdi, Assistant Professor

Amila Alikadi-Husovi, Assistant Professor

Teacher, Course Co-ordinator

Other Teachers
Assistant

Prim. Sena Softi-Taljanovi, medical expert

AIMS OF THE COURSE

To train the student in the first year of study for the
smooth provision of first aid in situations when it is
necessary in terms of certain norms and standards.
In the first part of this course students will learn about
first aid to injured persons, the procedure for their
transportation as well as the treatment of aggressive
patients.

SPECIFIC AIMS OF THE

COURSE
Enable students to relate their knowledge
from basic science to clinical cases for
further follow-up studies and recognizing
and taking appropriate actions in critically
patients and for successful completion of
the study and the final independent work.
Active student participation in the
implementation of parts of the process of
health care through medical and technical
procedures.

EXPECTED RESULTS OF TEACHING PROCESS

INTENDED LEARNING OUTCOMES

After completed course the student should

adopt the following positions:
- To master the proper assessment of the
state of injured patients.
- Properly take all measures and procedures
that are most needed at this time to provide
first aid for critically ill person.
-Implement and support all the necessary
resuscitation
procedures
to
pointing
definitive medical care.

INTRODUCTION
It is very difficult for students of the School of Medicine study
program concepts of one case that carries a large segment of
the fundamental pre-clinical and clinical knowledge and skills
which they do not have realize any in the near future within
the study.
But on the other hand, expressed the need for teaching the
subject, such as medical emergency at the start of the
study is justified, because really in this period of medical
schools students are expected to be qualified to suggest
immediate medical assistance to the injured and sick in
every place, time or situation.
Therefore it is a great responsibility for teachers and assistants
in the creation lessons that need to be adapted to perform this
course with special emphasis in its practical implementation.

The importance of the role and

principles of urgent medical care of
the sick and injured patients

Kenan Karavdi, Assistant

Professor

European Council for

Resuscitation in 2010.
According to the guidelines of the European
Council for Resuscitation in 2010. measures
of cardiopulmonary resuscitation (CPR) are
classified as BLS (Basic Life Support) and ALS
(Advanced Life Support), ie. on measures
basic resuscitation (cardiac massage and
artificial
respiration)
and
advanced
resuscitation measures that require higher
level of knowledge and experience and
include the application of special equipment
and drugs.

Guidelines of the European Council

for Resuscitation in 2010

Guidelines of the European

Council for Resuscitation in 2010
BLS (Basic Life Support) measures
basic resuscitation (cardiac massage
and artificial respiration)
ALS (Advanced Life Support),
advanced resuscitation measures
that
require
higher
level
of
knowledge and experience and
include the application of special
equipment and drugs

Guidelines of the European

Council for Resuscitation in 2010
respiratory and/or heart failure
-check the state of mind and whether the patient
breathing.
cardiopulmonary resuscitation (CPR) is initiated
when the patient is unconscious, not breathing or
not breathing normally.
By fixing cardiorespiratory delays
-start as soon as possible with measures BLS, the
basics of life support
- call professional team for help whose will continue
with the implementation of measures advanced life
and hospitalize the patient.
BLS includes ensuring a patent airway, artificial
respiration and heart massage.

The importance of the role and principles of

urgent medical care of the sick and injured
patients

Possession of the concept and principles of

complete and integrated assessment of the
general condition and risk patient. It is carried out
immediately and on the spot.
Determination of logical sequential priority. The
patient's vital functions must be quickly and
effectively assessed. Priorities have to be the same
for adults, children and infants.
Initiation of primary and secondary management
-rapid simultaneous examination,
-diagnosis
-treatment) to be implemented within the "golden
hour"for urgent treatment and care in all lifethreatening situations.

ABCDE
A (airway), establishing a patent
airway and release
B (Breathing), establishment of
breathing
C (Circulation), the establishment of
circulation with control of bleeding
D (Disability), neurological
examination
E (Expose), a complete overview

Airway, Breathing, Circulation,

Disability, Exposure (ABCDE)
The Airway, Breathing, Circulation, Disability, Exposure (ABCDE)
approach is a systematic approach to the immediate assessment
and treatment of critically ill or injured patients. The approach is
applicable in all clinical emergencies. It can be used in the street
without any equipment or, in a more advanced form, upon arrival of
emergency medical services, in emergency rooms, in general wards
of hospitals, or in intensive care.
The aims of the ABCDE approach are:
to provide life-saving treatment
to break down complex clinical situations into more manageable
parts
to serve as an assessment and treatment algorithm
to establish common situational awareness among all treatment
providers
to buy time to establish a final diagnosis and treatment

Anatomy of the upper

respiratory tract
Topographic anatomy of the
heart and great
blood vessels and places to
palpation
pulse

Anatomy of the upper respiratory tract

Anatomy of the upper respiratory tract

Anatomy of the upper

respiratory tract
The respiratory system divided into
upper and lower respiratory tract.
The two compartments:
conductive zones
respiratory zones

Anatomy of the respiratory tract

Conductive zone
Conductive zone begins with the nose (respiratory
system) which passes into the nasal cavity
The primary functions are:
1) filtration,
2) heating
3) wetting
4) allowing resonance in speech.
) The nasal cavity is continuing in the mouth and lip in
the throat, and down to the chest cavity where it
divides the left and right bronchi ie. passes into the
left or right lung. Bronchi are further broken down to
more smaller and narrower parts.

Anatomy of the respiratory tract

Respiratory zone
Respiratory system consists of: nasal cavity, pharynx,
larynx and windpipe (trachea), which is divided into two
bronchus (bronchi), and lungs.
Circulation through the nasal cavity, the air is purified in
the mucosa of dust and is moistened and heated to
normal body temperature. Purification was carried out in
all of the above parts of the respiratory system to the
lungs. The purified air goes into the pharynx to the
larynx.
To the beginning of the larynx is laryngeal Lid
(epiglottis). It as a cover at an intersection opens the
way the trachea while we breathe, and closes it when
passing food.

Lungs
The lungs are the respiratory organ. Their primary
function is to transport oxygen from the
atmosphere
into
the
bloodstream
and
transmission of carbon dioxide out of the
bloodstream into the atmosphere. It covers most
of the chest cavity taking her the most part, are
protected by the ribs, and consist of lungs.
Left lung wing has two and right lung has three
lobes from the outside are wrapped in a
membrane. Pulmonary muscles have the main
function contraction and relaxation of the lung, ie.
movements of breathing: inhaling and exhaling.
The inner part between the lung wings called the
pleura (the pleura) and external to the ribs

Mechanics of breathing
Inspiration (inhalation): the volume of the thorax increases the spread
of thoracic walls, mainly contraction the diaphragm. Between the visceral
and parietal pleura both papers sliding each other but can not be
separated. With expansion of the thorax increases in a virtual cavity
between both pleural ie negative pressure. Pressure is less than
atmospheric. Visceral pleura must follow the parietal and consequently are
crucifying the lungs in which then the air pressure falls. This is caused by
air movement;atmospheric pressure outside air (conventional zero) and
negative pressure in the lungs (which the entry of air immediately
compensates with "zero"). This process is possible only while the pressure
is negative (- 5 to - 10 mmHg) in the pleural space.
Expiratory (exhaling): by means of elastic fibers lung alveoli, expiratory
muscles (abdominalare the most important) in the lungs creates pressure
that is slightly higher than atmospheric air and so displaces the lungs.
Intrapleural pressure is still negative (approximately 0 to - 5 mm Hg) and
the lungs and the exhaling pressed against the walls of the thorax. The
negative intrapleural pressure is therefore necessary for mechanics

Cellular respiration

The main but not the only function of the lungs is the
process of respiration and cellular respiration:
Breathing takes oxygen from inhaled air and concomitant
creates carbon dioxide. The process is actually the reverse
of photosynthesis.
The main pulmonary functional units for gas exchange is
alveoli. The diameter is approximately 0.1 or 0.2 mm and
around each are capillaries.
The walls of the alveoli and capillaries containing flattened
squamous epithelial cells separated from each other
basement membrane. As a result, the barrier between the
air in the alveoli and the blood in the capillaries.
The gases between air and blood is exchanged by diffusion.
Lungs have about 300 million alveoli generating respiratory
area of about 70 m2.
Transportation and modification of gases Oxygen (O2) come
by diffusion from the air within the alveolar capillaries. In

Heart and circulation

The heart is a muscular organ the size of a fist
and weighing about 300 g, which is located in the
chest. The exterior is wrapped the core (the
pericardium), which serves to protect the heart
from sudden jolts and friction lungs. Only heart is
built of striated muscle and is divided
transversely ie. prevents amend arterial and
venous blood. Schematic is divided into right and
left venous arterial half Each half has a lobby or
atrium, atrium (atrium) and ventricle (ventricle).
From both ventricle - two arteries. From the right
pulmonary artery (lat. Arteria pulmonary) from
the left aorta.
The right atrium enters the upper and lower vena

Heart and circulation

In the atrium enters the blood of a large or small blood flow and
ventricular contraction of its powerful musculature forcing blood into the
large or the small blood circulation. In the right atrium enters the venous
blood from the whole body, except the lungs, through the upper and the
inferior vena cava and the coronary venous sinus that collects venous
blood from the walls of the heart. In the left atrium enter four pulmonary
veins that bring blood from the arterial lungs. From the right atrium
comes venous blood in the right ventricle ejects blood that contraction in
pulmonary artery ostium through arteriosum dextrum. That blood goes to
the lungs. Oxygenated
blood from the lungs comes through the
pulmonary veins into the left atrium, and from there passes through the
mitral mouth of the left ventricle. From the left ventricular arterial blood
goes through the mouth of the left artery into the aorta and so all over
the body. Designation artery or vein, does not mean that the respective
blood vessel flowing arterial or venous blood. That name means the only
direction in which blood flows. If blood flows from the heart to an organ
such blood

Heart and circulation

Court always called arteries, even through it flowed and venous
blood. For example, a. pulmonary venous blood lead from the
heart to the lungs. If a blood vessel causes blood to the heart, it
is always called veins, whatever it was and arterial blood.
Heart supplies two coronary arteries: arteriy coronaria cordis
and arteriy coronaria cordis sinistra .
Left heart away from the right atrium in the area of the thin wall
(septum interatriale), and in the field of ventricular thick septum
interventrikulare. Between the atrium and the ventricle are
located valves. Valve between the right atrium and the
chamber's three-part (tricuspid valve), and between the left
atria and ventricles two-piece (mitral or mitral valve). The
function of valves is to provide one-way the flow of blood from
the atria into the ventricle and prevent the return of blood from

Heart and circulation

Right coronary artery supplies blood to the right
atrium, right ventricle, Keith - Flackov node, the
back of the septum and posterior part of the left
ventricle, posterior papillary muscle in the left
ventricle and bulbus aortae.
Left coronary artery supplies blood to the front of
the interventricular septum, the left atrium and
ventricle, anterior papillary muscle of the left
ventricle, a small portion of the right ventricle,
anterior papillary muscle in the right ventricle and
the pulmonary conus.
Venous blood of the heart collects sinus coronarius

Heart and circulation

Conduction of the heart consists of
-sinus knot (nodule sinuatrialis - Keith Flack) who is
the leader and accelerator of cardiac contraction
-atrial-ventricular
node
(Aschoff
nodule
atrioventricularis - Tawara), which is its conductor
and retarder. Since it is based Hiss bundle
(fasc.atrioventricularis).
The autonomic nervous system (sympathetic and
parasympathetic) governing the work of the
conduction
apparatus
or
speed
rhythmic
contractions

Heart and circulation

Systole is part of the cardiac cycle during which
the heart muscle contracts to release the blood
from the ventricle.
Diastole is part of the cardiac cycle during which
the heart muscle relaxes and fills with blood.
Cardiac output is the amount of blood that left
ventricular systole enters the aorta. Average
volume is 70mL.
Cardiac output is the product of stroke volume
and frequency or amount of blood that comes
from the heart in one minute

Blood pressure

Blood pressure is the pressure of blood on

the walls of blood vessels (arteries) in every
part of the body. Blood flows through the blood
vessels just because they are under a certain
pressure. In each ejection of blood from the heart
(systole), the pressure increases, and when
pouring blood to the heart (diastole), the pressure
is lowered. Therefore, measures two values of
blood pressure, the upper value (systolic) and the
lower value (diastolic) blood pressure.
Blood pressure is variable, changing throughout
the day and night and are subject to many
external and internal factors. The changes are
due to activation of many mechanisms by which
the organism strives to maintain adequate flow
depending on changes in living conditions.

Blood pressure

Blood pressure is measured by sphygmomanometer. The

artery, which is used for measuring blood pressure is
Brachial artery (a.brachialis). Cuff of sphygmomanonetar is
placed around the upper arm and inflated thereby blocking
blood flow (pressure inflated cuff is greater than the systolic
pressure). The pressure in the cuff over valve gradually
decreases and when the same systolic pressure people will
feel the auscultation powerful audible tones when the heart
contraction is trying to expel the blood in the blood court
which is still rationed. When the pressure in the cuff
completely discounts (deflation) and audible pulsations
disappear, blood flow is completely free and we can then
record the diastolic pressure.
In preterm infants blood pressure ranges around 80/45 mm
Hg (systolic pressure equivalent
in air pressure that supports the pillar live 80 mm high on
the barometer, and diastolic is equivalent to 45 mm Hg).
For adults moving average, 120/80 mm Hg. With age the

PULS
series of pressure

Pulse is a
waves in the
arteries of the systemic blood circulation,
resulting suppression of blood from the left
ventricle contractions. It is determined by
palpation of surface arteries:
- a. temporal,
- a. carotid
- a.brahialis
- a. radialis
- a. femoralis,
- a. poplitealis
- a. dorsalis pedis,.
- a.tibialis posterior.
- Typically measured is a. radialis where you put

PULS

When palpation is necessary to pay attention to the

frequency (frequency), regularity (rhythm), the fullness, the
speed of the rise and spread of the pulse wave (amplitude).
Pulse frequency is the number of heartbeats per minute.
A normal heart rate is 60-80 o / m, and in infants and young
children is around 90 - 160 r / m.
Bradycardia is a slow heart rate (less than 60 o / m), may
be physiological in athletes and heavy manual workers.
Pathological bradycardia occurs as a sign of disorder in the
autonomic
and
vascular
function
of
the
heart,
hyperthyroidism, elevated intracranial pressure, stimulation
n. vagal and application of some drugs.
Tachycardia is a rapid pulse (more than 80 o / m), may be
physiological and ephemera on exertion and excitement. In
pathological cases is a sign of heart failure, and
hyperthyroidism or result of taking sympathomimetics.

PULS

Heart pulse physiologically occur at regular intervals, and

such a pulse is referred to as a rhythmic pulse.
If clearances are incorrect, the pulse is antiarrhythmic.
Respiratory arrhythmias: during inhalation, the pulse is
rapid; during exhalation slowed. It occurs in children, young
people and vegetative labile person. It is not a sign of
illness.
Beats: regular rhythm pulse periodically interrupted in early
pulse beats which may occur individually, but in the proper
sequence as each second, third, fourth heart contraction.
Absolute arrhythmia: completely irregular and unevenly
filled heart rate, a sign of damage to the heart muscle.
Disturbances in the fill pulse are:
No pulse - does not feel the pulse
Filiform - poorly filled and protracted, difficult to be
palpated

BREATHING
Breathing is realized through respiration or exchange
of oxygen and CO2 between the cells of the organism
and the environment in which the organism lives.
Healthy and adult breathing through the nose,
without effort and barely audible 16-18 times a
minute. In children's breathing rate is higher and
depends on age: the younger children are frequency
is higher.
In assessing ways of breathing should pay attention
to the frequency, depth, rhythm and duration of
individual stages of breathing, the way in which the
patient breathes, and the dyspnea

BREATHING
Dyspnea is a subjective feeling of shortage of air. The most common
symptom of organic disease and functional disorders of the respiratory,
circulatory, blood, endocrine, nervous system, metabolism and psyche.
Frequency of breathing
eupnea - normal speed
tachypnea - rapid breathing is a reflection of many disorders in the body;
Respiratory diseases (bronchial asthma, acute pulmonary edema, etc.),
where the body lacks adequate air volume, high body temperature, which
stimulates the respiratory center and thus in unit time exchange of a
greater amount of hot air with a certain release of heat from the body. Is due
to compensation, reduced concentration of oxygen in the tissues or in the
inhaled air, or metabolic disorders where a decrease in blood pH (acidosis).
bradypnoea - slowed breathing occurs in some neurological diseases. May
be medication-conditioned intoxications, then damage to the respiratory
center located in the medulla (medulla oblongata) as a result of trauma, or
in some neurological diseases.
apnea - cessation of breathing

The depth of breathing

Normal - evenly with no effort
deepened - with effort, inhale a
larger volume of air
Nodding - imperceptibly inhaling and
exhaling small amounts of air
The rhythm of breathing is relatively
regular
shift
inhalation
and
exhalation with breaks. Inhaling is
shorter than exhalation

Pathological forms of breathing

Biot breathing: Deep breathing with sudden pauses
in breathing. It occurs in meningitis, diseases and
injuries of the brain.

Cheyne-Stokes
breathing:
breathe
with
periodically increasing and decreasing depth disanja.
The lesions of the brain stem and in strokes.
Kussmaul breathing: deep, stertorous breathing. It
occurs in metabolic acidosis and diabetic coma.
agonal respiration: irregular slowed breathing with
more or less deep breathing cycles. It occurs in dying
patients with kardipulmonalne resuscitation

Paradoxical types of breathing

These types of breathing are different from normal breathing,
in which the thorax and abdomen inspiratory symmetric
and synchronous lift in expirium also down. In paradoxical
types of breathing that is not the case and they are
expressed as:
thoraco-abdominal paradoxical breathing (bilaterally
symmetrical)
During inhalation the chest and abdomen descends raises
(puffs), and by breathing chest is lifted belly down. It occurs
in the entire cross-section of the spinal cord at the level of
the lower cervical spine and upper thoracic spine, which is
due to a innervation of thoracic respiratory muscles and its
non-participation in breathing. Breathing function takes the
diaphragm (the bars). This type of breathing is an example
of pure inferior breathing, but can also occur in the
obstruction of the upper airway foreign content or acute
inflammation of the epiglottis.
Thoracic paradoxical breathing (one-sided
asymmetric)