bystander first aid techniques that can be used, little or no need of medical equipment for acute and critically ill patients to take emergency measures. Some of the medical knowledge, we need everyone to grasp. For example, brain hemorrhage should be reduced handling; to prevent aspiration (into the trachea), vomiting should be in the side head; limb replantation, and so need to prepare for cold storage. First aid techniques include: trauma first aid, non-invasive disease, first aid, cardiopulmonary resuscitation.

trauma first aid emergency treatment of trauma assessment and classification of non-invasive disease first aid section of non-traumatic acute laryngeal obstruction disease emergency airway obstruction Section II first fatal allergic reactions four electric shock drowning V VI VII poisoning acute coronary syndrome acute left heart failure, VIII IX, section X of hypertensive emergencies with acute cerebrovascular disease status asthmaticus in section XI XII Section XIII of low-temperature section of severe arrhythmia Section XIV of heat shock section XV XVI XVII of massive hemoptysis section section section epilepsy hanging section XIX of the eighteenth section of respiratory failure, coma Article: CPR 1. identification 3. Artificial respiration 4 chest compressions first aid trauma trauma assessment and classification of 1 hour after injury is the key to life and death decisions, evaluation refers to the life-threatening and non life-threatening short-term separation of the wounded, according to first re-light, after the first life-saving focus on the principles of diagnosis rescue require emergency personnel have a unique sense of critical thinking, assessment of classification quickly and accurately. 1.1 Early assessment and airway and ventilation is the first, and then must determine the nature of the patient's respiratory, circulatory perfusion and control of bleeding, and then to determine the possible damage to the limbs. Promote patient breathing shallow, wheezing, trouble, respiratory depression; assess the skin, oral mucosa, nail bed color determine whether there is adequate oxygenation, to check whether the mouth of the throat vomit, blood or foreign body obstruction. 1.2 by DRABC checks: D (danger) refers to the risk that the presence of risk factors, such as the intestine to leak out, the wound to continue bleeding, airway obstruction, cervical spine fractures, the need to take immediate measures. R (reaction) refers to the reaction, that is, check the wounded to the stimuli. A (airway) refers to the respiratory tract, which checks whether the airway patency, oral secretions, immediately sucked out, keep the airway open. B (breath) means breath, or to observe the movement of the injured thoracic ventilation or for feeling wounded case. The three most commonly affect the ventilation conditions are tension pneumothorax, open pneumothorax, massive pulmonary contusion and flail chest. Contradictions can be seen breathing, and crepitus may be, and with rib fractures bone fricative. Auscultation dullness show pleural effusion, pleural drum sound show large number of product gas. C (circulation) refers to the cycle, that hit the carotid or femoral artery to determine the circulation. In the critical condition of the wounded for a long time, only for blood pressure assessment, if they can reach the radial artery, femoral artery, carotid artery pulse and systolic blood pressure of at least 10.7,9.3 8.0Kpa. There are three shock-site assessment of the accident very practical approach: First, monitoring the pulse of the estimated blood pressure evaluation of cardiac output. Mild shock, pulse 100 to 120 beats / min, systolic blood pressure 12 ~ 13.3Kpa estimated reduction in cardiac output. Moderate shock, pulse> 120 to 140 beats / min, systolic blood pressure 8-12Kpa estimated cardiac output decreased significantly. Severe shock, hard to reach or pulse> 140 beats / min, estimated systolic blood pressure 5.3 ~ 8Kpa. Second, the capillary refill test (Gently press the wounded hand end of the nail or nail bed to slide gently press the oral mucosa, from red to white if the time period in the normal 2s, if> 2s for the slow speed of capillary refill ), slow filling speed is inadequate tissue perfusion one of the earliest indications. Third, assess the state of consciousness, in the case of non-traumatic brain injury, the level of consciousness is insufficient cerebral perfusion reliable indication. If significant changes in level of consciousness can be considered seriously inadequate tissue perfusion and hypoxemia. 1.3 No response to particular attention to the ability of the injured. Shock caused by a variety of reasons, those who have not been corrected; bleeding, failed to effectively stop bleeding; airway obstruction, respiratory dysfunction, extreme difficulty in breathing; blood pneumothorax, open pneumothorax, tension pneumothorax, flail chest; high blood pressure risk like, acute cerebral vascular accident, traumatic brain injury with deep coma, increased intracranial pressure, etc. give priority treatment. Trauma associated with deterioration of lung function may have different reasons, reasons to be processed for each potential cause for the deterioration in cardiopulmonary function, including: ① severe central nervous system damage associated with cardiovascular events; ② central nervous system damage, airway obstruction, open chest or airway collapse, fracture-induced respiratory disorders, and the emergence of oxygen; ⑧ direct damage to vital organs such as heart, aorta, lungs; ④ potential cause of iatrogenic injury or other circumstances, such as electrical injury or the driver of sudden ventricular fibrillation; ⑤ tension pneumothorax or pericardial tamponade leading to reduced cardiac output; ⑥ blood loss leading to low blood volume to decrease oxygen-carrying capacity; ⑦ cold environments lead to serious secondary low. 1.4 Classification of the wounded to mark the eye-catching card said. Usually red, yellow, green, black four-color system to identify the priorities of the disease. 2. First deal with the emergency treatment of life-threatening disease, unobstructed airway, maintaining breathing and circulation. 2.1 to maintain airway patency: ⑴ items can be used to remove bad bleeding, vomit and other secretions, double chin can be lifted so that the airway open (cervical spine may be curved); multiple injuries or a single head, neck injury, spinal cord must be given a fixed protection. Such as spinal cord injury should maintain a neutral position of head and neck and longitudinal traction, fixed. ⑵ awareness noninvasive, head, face and neck trauma, those with no spontaneous breathing or difficulty breathing, should be outside the hospital early endotracheal intubation, artificial respiration and high flow oxygen. ⑶ does not affect the first-aid treatment in case of lying to help the wounded, the first partial side, or to impose recovery position to prevent aspiration. . 2.2 artificial respiration: If lost or inadequate breathing (shallow or slow), must be assisted ventilation. When mask ventilation devices such as the head, spine must be fixed. If ventilation is no expansion of the chest, it may produce a tension pneumothorax or hemothorax, should slow down breathing, surgery. Flail chest should control the abnormal breathing, or sandbags can be covered in thick pad floating zone, and then fixed with tape pressure, posterior type who can still take control of chest wall injury, lateral position to float. Open pneumothorax should be closed wounds, first aid dressings may be used to cover the wound; simple tension pneumothorax immediately with a thick needle in the middle of the second intercostal clavicle piercing exhaust, tied in a thick needle end of the rubber finger along the side of the mouth can immediately vacuum exhaust. 2.3 cycle: appropriate use of cardiac massage or defibrillation, save for the cause of shock, such as tension pneumothorax, massive bleeding, choking, multiple rib fractures, cardiac tamponade and so on. Shock patients should take the shock that is lying about the head and legs of the elevation 30 ℃ immediately opening (two) venous access, add volume, dopamine infusion. Patients with active bleeding in addition to actively rapid infusion, blood transfusion, additional blood volume, we must also stop the bleeding as soon as possible; pain, but severe traumatic brain injury, breathing difficulties, acute abdomen patient diagnosis is not clear who is disabled; of pale, clammy , a cold sweat blanket insulation should be promptly added. 2.4 Other treatment ⑴ hidden injury: fall injuries, car accident injuries such as blunt trauma injury prone occult, the patient surface, traumatic wet lung, blood pneumothorax. If suspicious, to the hospital for examination, observation. ⑵ traumatic brain injury: patients with maxillofacial trauma, skull fracture, deep coma, difficulty breathing, nose bleeding or discharge should be controlled in the airway, intubation. The exposed part of the cranial cavity foreign bodies do not dial in addition, to be protected, fixed with dressing. Ear, nose bleeding can not be filling (possibly due to cerebrospinal fluid), but should be promptly wiped. Convulsions were injected with stability, coma naloxone infusion, intracranial hypertension with 20% mannitol infusion 250ml. ⑶ burns: is burning, do not cry, run or bare flame, may be lying to scroll. Wound surface immersed in cold water as soon as possible, but not more than 10 minutes with ice water. Wet chemical burn or cut clothes, immediately rinse with cold water for 30 minutes; corrosive chemical burns (including the pharynx, esophagus burns) can be used in weak acid or weak base and, sometimes no suitable liquid, diluted with water, then use the milk or egg white, vegetable oil to protect the mucosal wound; respiratory tract burns, can be expressed as sputum, difficulty breathing, should be used early high-dose corticosteroids, laryngeal obstruction, the time to tracheostomy. Burns should be removed particles of lime and then wash. Phosphorus burn wound should be immersed in water or covered with wet gauze. Rinse eye, face, eyes must be opened, exposing the upper and lower dome. ⑷ limb: Do not be impatient in the limbs torn from the machine, the machine can not be reversed to remove limbs, should be power, open the machine out, use ice packs and other cold storage (separated limbs and ice to prevent frostbite) transport. ⑸ spinal cord injury: Diagnosis: local pain, deformity, or numbness in the corresponding limb movement disorder, incontinence, or stroke from the penis. ⑹ surface damage treatment: first aid to the injured limb should be considered in the implementation of cooling treatment. Lay rescuer to the skin surface trauma wounds tap water is recommended. Skin or eye contact with corrosive poison, rinse with plenty of water is the most basic and the most appropriate first aid measures. Lay rescuers damage or injury to the skin using the antibiotic ointment, and use three or more antibiotic ointment is better than using two or one type of antibiotic ointment. ⑺ Other: ① open throat injury, to prevent mediastinal emphysema, promptly closed the wound, gauze packing hemostasis, larynx or trachea or tracheal tube should be placed in plastic tubes. ② oral, maxillofacial injury, oral foreign body should be removed, lift the tongue falling, jaw displacement caused by asphyxia immediately reset, coma or shock, who preferred prone position. ③ The main risk of major bleeding is venous air embolism, should be temporarily hand or bandage. ④ open wounds and applied dressing. Such as intestinal prolapse, can be used wet gauze or a clean bowl and other coverage. ⑤ Do not mouth sucking snake bites, can be tied limb with a bandage (not too tight). ⑥ sharp piercing do not set aside, the application of dressing fixed, so that sharp objects do not move (relative to the body). 3. Bleeding: ① Acupressure artery hemostasis, oppression superficial temporal artery, facial artery, brachial artery, radial artery, ulnar artery, femoral artery and other bleeding proximal end. Carotid artery injury above the clavicle can push it directly to the cervical transverse process. ② pressure bandage to stop bleeding, the most common and reliable, that is, hard covers with gauze and other compression bandage. ③ tourniquet method, use rubber or cloth wind be limbs of bleeding. Note: arm bar in the upper 1 / 3 or 1 / 3, the lower limbs in the femur in the lower 1 / 3 junction; dressing at the proper liner; elastic to not touch the pulse of the right distal; per hour should be relaxed 1-2 minutes. 4. Fixation is fixed to prevent movement and damage to the fracture line blood vessels, nerves, internal organs and implemented. Mainly used for fixed limbs, pelvis and spine. Pre-hospital head or neck injury, first aid is unable to determine whether the damaged cervical cervical fixation are recommended care; serious injury or trauma, although mild symptoms of the wounded but also recommended a fixed line of emergency cervical spine. Fixed multi-purpose splint and bandage materials, in an emergency can make the best use of bamboo sticks, sticks, twigs, and so on. Fixed purpose is not to fracture reduction, but to prevent the movement of fracture fragments, fracture thorn out of the wound should not be returned. Fixed to solid, moderately elastic, to cushion between skin and splint the right amount of soft material. For pinched limbs to prevent crush syndrome, should be lifted as soon as possible oppression mbt sale, temporary brake, cooling the injured limb, to avoid pressure bandage or tourniquet. 5. Moving and handling transit spinal cord injury, the response to the injured spinal axis, the spinal fixation or reduce bending, rolling the body on a stretcher to move hard, supine position. Or 2 to 3 coherent, flat from the flat, curved Shen Wu, cuddle or a disabled person looked up, lift one foot method. Patients with cervical spine: the cervical neck collar to prevent secondary injury, if there is no collar, to have someone care help head up slightly along the longitudinal axis of traction, the head, neck and torso with scrolling, non-random force moving the head, In the back of the mat soft pillow, the neck slightly extended backward, head on both sides of the soft pillow or pad folded clothing. Patients with thoracic spine: thoracolumbar soft pillow or pad should be folded clothing to prevent displacement, to avoid secondary damage. Transit close observation of changes in vital signs, including sensory, reflex, and toilet and so on, with particular attention to changes in respiratory rate. Continuous ECG monitoring and oxygen therapy, continuous expansion of treatment and step-up. Coma, head injury should be wounded foot forward, head-to place after. Non-invasive disease emergency Section 1 of acute laryngeal obstruction. Cause: The acute throat inflammation is caused most commonly causes acute laryngeal obstruction, laryngeal edema, laryngeal foreign body, larynx true religion, laryngeal trauma and bilateral vocal cord paralysis, there laryngospasm, laryngeal cancer, congenital deformities, laryngeal diphtheria etc. can be acute laryngeal obstruction. 2. Symptoms and diagnosis: inspiratory dyspnea, respiratory rate is characterized by essentially the same and extend deeper breathing, inhale more obvious when the three concave disease (supraclavicular fossa, suprasternal fossa, intercostal three depressions), and smoking gas when wheezing sound. Voice changes (hoarseness) there must be a common rather than the symptoms. May have irritability, sweating, pale or cyanosis and other symptoms. Non-invasive disease first aid 3. Processing: ④ ① application of antibiotics and hormones: proper application of adrenal cortical hormones such as dexamethasone, reduce laryngeal edema, improve obstructive symptoms, can be inhaled and intravenous infusion. ② prevention and treatment of heart failure and pulmonary edema: Heart failure is one of the main symptoms of acute laryngeal obstruction, especially in children, often become the cause of death. ③ tracheotomy: Ⅱ degree of difficulty in breathing should be actively treated, close observation. Such as airway foreign body, should be immediately removed, remove the cause. Ⅲ degree of difficulty in breathing, such as cancer, trauma due to tracheotomy immediately, such as inflammation caused by, should be observed for l ~ 4h treatment, does not relieve the tracheotomy. Ⅳ degree of difficulty in breathing, no matter what causes laryngeal obstruction, must race against time performed a tracheotomy, artificial airway to save lives. Some patients, particularly dangerous condition, could first tracheal intubation, and then for routine tracheotomy. Those of the very few difficult intubation, the epiglottis and hypopharynx extreme edema, can be used for coarse root tip 2-3 cricothyroid membrane puncture. Figure 1 Emergency airway difficulties, other methods sometimes can not be implemented, can puncture the cricothyroid membrane, the cricothyroid membrane is located between the cricoid and thyroid cartilage (Adam's apple under 1.3cm at highest point), when the first fixed thyroid cartilage, neck Department of hyperextension position, with suction syringe with salt water, into a horizontal angle of 30 ~ 40 ° to the direction of the foot puncture, piercing the trachea can be sucked out the air. Section airway obstruction 1. The patient's symptoms: there is a clear history of foreign body obstruction. Part of the obstruction can often be a strong cough, and wheezing can be heard and the sound of noisy air flow; with poor ventilation, coughing, weakness, with a high-profile end-inspiratory wheezing, difficulty breathing, cyanosis or pale complexion. Complete airway obstruction, suddenly unable to speak, cough or breathing, extreme difficulty in breathing, often involuntary patients with first-hand thumb and index finger was affixed to the anterior V-shaped throat face pain Yuyan silent, such as asking live it? Loss of consciousness and cardiac arrest occurs when the tongue is falling on the most common cause of airway obstruction. Blood and vomit may block airway causing respiratory obstruction. 2. First Aid: If you can own 2.1 cough cough its best.

2.2 Heim Rickettsia maneuver (abdominal impact method): ⑴ the patient quite awake and able to stand, the ambulance people clinging to its abdomen from behind, hand make a fist, place the thumb side of the slightly on the abdomen of patients on the} {navel, one hand holding the hand of the rapid impact of a fist, the inward above the oppression of their abdomen, repeated rhythmic force to impact the formation of the air out of the foreign body can impact 6-8 times. Patients should head slightly, mouth open to spit out foreign objects. ⑵ If a patient is unconscious can not stand, then the preferred supine position, legs apart ambulance man kneeling on the ground outside the patient's thigh with both hands stacked. Withstand the abdomen with the palm of your hand with the (slightly on the navel) to impact. Such as foreign bodies had been pulled out quickly clean up. ⑶ for young children, first aid, the ambulance crew to take back seat for children to sit in the ambulance man's lap, and then the ambulance people use both hands above the index and middle fingers backward extrusion force on the abdomen in children, the pressure immediately after the relaxation, children can also be flat supine, ambulance people use the above method stamping. ⑷ patients in an emergency if no one around there, then the table can stand up on their abdomen quickly and violently squeezed, the pressure immediately after the relaxation. 2.3 burp law: for patients with clear minds, especially children,

so that the patient's head lower than chest level, palm root in his spine scapular region given 6-8 times a rapid beat. 2.4 chest impact law: for obese or pregnant women during late pregnancy.

The method is to stand behind the patient, upper arm by patients around the chest up, the other with abdominal impact method. 2.5 airway law: the tongue falling this method to solve such problems, remove your fingers visible foreign body generally apply only to foreign bodies, professional implementation. 2.6 external cardiac massage: For coma, respiratory or circulatory arrest discount spyder, should be using this method can remove foreign bodies. 2.7 Professional for unconscious patients with airway obstruction release: If you find patients lying on the ground, and clear the airway obstruction caused by foreign body, you can: ① CPR, first aid personnel if the presence of second, so he called. ② Open the airway with the tongue on jaw formulation, such as visibility, oropharyngeal foreign body removal with your fingers. ③ try ventilation, such as ventilation in patients with no chest rise and fall, reposition the head position, and then try to ventilation. ④ If after repeated attempts can not be effective ventilation, the impact of laws can be implemented abdomen. ⑤ If this fails, use the cricothyroid membrane incision, or foreign body using a special apparatus (with Kelly clamp, Magilla tweezers). Section fatal allergic reaction. Symptoms: a history of allergy and pathogens. Difficulty in breathing, hypotension, flushing or pale skin or rash, abdominal pain, dysphonia and so on. 2. Of fatal airway obstruction handle 2.1 close observation: For the larynx, vocal cord edema, pharyngeal, laryngeal swelling in patients with early airway intubation is the right choice, if dysfunctional breathing, should not hesitate, immediately intubation. (If the delay intubation if the patient in the short term (0.5-3 h) deterioration of the pilot will only increase intubation caused by laryngeal edema or respiratory tract bleeding, glottic stenosis, airway intubation or cricothyroid membrane incision will be very difficult or impossible, or even impossible mask ventilation.) 2.2 ventilation may consider the following methods: fiberoptic endoscopic intubation; fingers inserted under the guidance of less than 7mm endotracheal intubation; cricothyroid membrane puncture needle ventilation; cricothyroid membrane diffuse swelling of the neck incision for patients. 3. Circulatory support: rapid expansion in the short term should input a lot of liquid, conventional isotonic solution to the 2-4l. Drugs, including: ⑴ high-dose intravenous epinephrine (quickly reach large doses): In all patients with cardiac arrest should be no hesitation applications, conventional 1-3mg intravenous injection, and then 4 -10mg/min intravenous drip. ⑵ anti-group amine drugs intravenously. ⑶ cortisol: an effective recovery after resuscitation. ⑷ atropine: due to allergies caused by cardiac arrest, heart and more as PEA or asystole, so recommended. ⑸ inhaled β-adrenergic: If the main bronchospasm, inhaled salbutamol; if there is hypotension, inhaled salbutamol in front of epinephrine. Β-blockers in patients when there is airway spasm ipratropium amine application is particularly effective. 4. Extend the time for cardiopulmonary resuscitation: a result of slow recovery response (the more common reasons). 5. General measures: position should be conducive to open the airway and ventilation; give high flow oxygen therapy. Remove residual disease poison: a few were bitten insects such as bees, there will be disease-causing toxic residue in the organization, will increase the toxicity of local extrusion, cold applications apply slow antigen absorption. The patient and his family should be the use of epinephrine aerosol. Such as frequent seizures, should carry. Section 1 of drowning. Emergency tried to approach the water drowning patients, rescue personnel should use some means of transport (ships, life raft, true to the boat, flotation devices), as soon as patients arrive at rescue workers must always pay attention to their own safety, and patients to reduce their own risk. 2. All patients should be considered possible spinal cord injury, treatment should be given, fixed neck, thoracic spine. Patients with neck in neutral position fixed (no flexion without extension), the level of the patient supine floating on the back support device, and then lift off the water. If you must flip the patient should be maintained along the long axis of the head, neck, chest, body care line into the roller-like go to the level of supine position. 3. Keep your head in a neutral position at the same time, open the airway by lifting the lower jaw. Once the patient's airway can be opened, to begin breathing treatment, which is usually the patient is in shallow water or out of the water to complete. If rescue personnel in the water pinch the nostrils of patients, support the head, difficult airway, can be replaced by mouth to nose breathing mouth to mouth breathing. Should clear the mouth, the nose of the mud, weeds, vomit, dentures, etc., do not have to clear the airway error absorbent points. Recovery should not be routinely used in patients with drowning Anaheim Rickettsia law. Wrap underwear, belts should be release. 4. Chest compressions immediately after the patient began to check out of the water cycle indications, indications ordinary circulation (breathing, coughing, or response to treatment of respiratory movement), and pulse. Vomiting, chest compressions during resuscitation or vomiting may occur when breathing treatment, the patients head to the side, with your fingers, clothing, suction clear vomit. If possible spinal cord injury, should be given to fixed, mobile to keep head, neck, torso as a whole moves. 5. Clear what the best water containing toxic. Drowning can occur with primary or secondary hypothermia, rewarming should be. Section V electric shock immediately rescue the injured person must be from the shock, low voltage power supply (220-380 ∨) can wind up power when electric shock, or with a dry stick, bamboo, rubber, etc. Remove power; 1000 ∨ more high voltage electrical injury, only wind up with a special insulated tools or power. High-voltage off point outside the 20 m off the ground there is the possibility of electric shock pressure step, the line should be jumping on one leg. Figure 5, such as electrical injury occurs in inaccessible locations, such as a column in the top, rescue the injured person must be as down. 119 can please help. Recovery indications (indications) is extensive, even those who appear signs of death. If the victim does not respond, you should immediately ABCD standard first aid measures. If the victim has a head or neck trauma, where the need to protect the spinal cord. Usually caused by electrical injury-related trauma, including spinal cord injury, muscle spasms, stiffness caused by the fracture. Patients should be off the clothes, shoes and belts to prevent further damage. Section VI poisoning. Principles of treatment of acute poisoning (1) First the A, B, C (airway, breathing, heart, dirty) recovery process. (2) to correct abnormal vital signs, blood pressure, pulse, and respiration. All cardiac and respiratory arrest should prompt CPR. Of shock, severe arrhythmia, toxic pulmonary edema, respiratory failure, toxic encephalopathy, cerebral edema, brain herniation should be immediately symptomatic treatment. 2. Cut off the source of the toxic drug exposure in patients with rapidly from the environment. On-site first aid, such as toxic spills the source continued, should be cut off as soon as possible sources of drugs. So that patients in the ventilation is good, no toxic pollution at the first aid safety. Exposure to poisoning should immediately remove contaminated clothing, wash skin with water. Note Do not use hot water to avoid washing the skin to increase absorption of poison; toxic reaction can occur, such as water, should be wiped with a dry cloth contaminants, and then wash with water. Clear respiratory secretions and maintain airway. Eye exposed to toxins (droplets, particles) within the human eye or conjunctival splash exposure to toxic gases, with plenty of water. 3. Clear history of exposure to toxins as soon as possible. Including history of exposure to toxic name, physical and chemical properties and the state, contact time and absorption, if not immediately clear, gastric washing specimens to be timely, vomit and excrement sent to test, or poison manufacturer. 4. Sufficient quantities to use as soon as possible antidote. ① alcohol poisoning: naloxone. ② organophosphate poisoning: atropine and pralidoxime chloride. ③ carbon monoxide poisoning: from the scene, keeping the airway, increasing oxygen concentration. ④ drug use: maintain airway patency, naloxone. ⑤ cyanide poisoning: Cyanide-resistant drugs should be given quickly. 5. When the toxic poisoning of unknown to symptomatic treatment first. The general coma, in addition to oxygen (nasal cannula or oxygen mask) to give ① intravenous naloxone 0.8-1.6 mg, children 0.01 mg / kg; ② intravenous 50% glucose 50 ml; ③ intramuscular injection of vitamin B1 100 mg (in addition to children outside). And low-temperature heat treatment, prevention and treatment of acute renal failure is the principle of effective control of the primary disease. 6. Oral poisoning should induce vomiting, gastric lavage, catharsis law to exclude not absorb the poison. Common symptoms are: vomiting with a spatula or a mechanical finger touch pharyngeal arch palate and posterior pharyngeal wall to induce vomiting, spit can make it before the first drink some warm water; gastric lavage is not removed by absorption of toxic poisoning mouth primary method of , paying particular attention to the following: ① gastric lavage within 6 h in the most effective poison. ② gastric washing with water and more appropriate, avoid using hot water. ③ to 300-500 ml per recharge is appropriate, the total time gastric washing 8 000-10 000 ml. ④ gastric lavage should be taken to prevent aspiration pneumonia, water intoxication and brain edema. ⑤ deep coma, poisoning, corrosive, volatile hydrocarbon chemicals (such as gasoline) poisoning, gastric lavage should not be. 7. To promote the excretion of toxins: diuretic detoxification, blood transfusion therapy, the blood perfusion. If the patient swallow a moderate dose of a poison (known to be activated carbon adsorption), consider giving activated charcoal. If the poisoning is not perfect protection of the airway, activated carbon can not be used. Swallow a large number of industrial strength abrasives or corrosive solids in patients can be considered to give plenty of water. 8. Poisoning: ① significant bradycardia: atropine little. Acute organophosphorus pesticide poisoning or carbamate poisoning exception. Pesticide poisoning, the first dose of atropine is 2 ~ 4 mg. Blockers were given large doses of toxic dose of isoproterenol. Atropine and pacing for tachycardia with resistance. Β-agonists should be used. ② tachycardia: should avoid the use of conventional treatment measures, such as adenosine and synchronized cardioversion. For control of heart rate, antipsychotic drugs safe and effective, but can reduce the sense to avoid the use or need assisted breathing can cause the stability of drugs. ③ hypertensive emergency: acute drug-induced hypertension is often short-lived, without intensive treatment, stability is the first-line therapy, not react, the use of short-acting anti-hypertensive drugs (such as sodium nitroprusside) as second-line therapy . Propranolol should be disabled. ④ acute coronary syndrome: stability and nitroglycerin are first-line drugs, second-line drugs is phentolamine, propranolol is disabled. ⑤ ventricular tachycardia when the heart suddenly into a wide QRS complex, and there is hypotension, is likely to be VT, and this was the indication for cardioversion. Hemodynamically stable VT for patients using anti-arrhythmic drugs that lidocaine is safe and effective. ⑥ For mild to moderate poisoning. Dopamine is the most effective step-up drugs. ⑦ cardiogenic shock: the need to apply the positive inotropic effect of the drug. Including calcium, amrinone, insulin, isoproterenol and dobutamine. Section VII of acute coronary syndrome. Acute coronary syndrome (ACS) or sudden cardiac death is the main reason for angina. After the onset of acute myocardial infarction in 4 hours before the main danger is that VF, defibrillation should be early. Main causes of death include: VF / VT, congestive heart failure, cardiogenic shock and left ventricular pump failure, or re-clogging of the infarct vessel appeared expansion, accompanied by structural damage to cardiac rupture or cardiac mechanical complications. 2. Family members should learn to recognize the disease's symptoms: chest pain or chest area mostly left while left back, a small number of positive chest, neck or left arm. Nature of the squeeze-like chest pain, dull-like, often accompanied by chest tightness, suffocation, sweating or difficulty breathing. May have an incentive: tired, excited, too cold, fullness, and so on. 3. Disease, to give the oxygen inhalation, sublingual nitroglycerin 1, aspirin 200-300mg, sedation, analgesia morphine available. If you can, preferably intravenous nitroglycerin, do 12-lead ECG, and even pre-hospital thrombolysis. Whether relief should be promptly sent to the hospital emergency, call 120 or ambulance. Family must be absolute bed rest for patients is diet and urine are not up; family should have a home treatment method used to win the heart rate recovery time. 4. Hypotension (systolic blood pressure less than 90mmHg), may be complicated by cardiogenic shock, disable, nitroglycerin and morphine, in the absence of acute pulmonary edema under the premise, can implement monitoring of blood pressure, heart rate and lung auscultation. Transferred to the hospital. Section VIII of acute left heart failure 1. Symptoms: difficulty breathing after exertion or history of paroxysmal nocturnal dyspnea, hypertension, pneumonia, over-transfusion and other incentives. Difficulty in breathing, slightly pink foam phlegm, forced sitting, sweating, lips slightly cyanotic, lungs and other end can hear the blisters. 2. First Aid: acute left heart failure should be promptly sent to the hospital emergency, call 120 or ambulance. Patients taking sitting position, drooping lower limbs, giving alcohol wet oxygen inhalation; strong heart mulberry handbags, but in early disease, acute myocardial infarction within 24 h of caution cedilanid other cardiac drugs the north face sale, those who have atrial fibrillation may be a small amount of application cedilanid; stable blood pressure, furosemide, nitroglycerin or urapidil; such as low blood pressure, may be given morphine, and furosemide; comprehensive treatment, asthma, sedative, vasodilator and application of hormone therapy. Keep the airway clear, timely and clear respiratory secretions, the establishment of bedside ECG monitoring. Respiratory failure, to endotracheal intubation and positive pressure breathing. Section IX of acute cerebrovascular disease 1. Condition observation: through dialogue, calling and giving stimulation to determine awareness; observe the pupil is so large and round; blood pressure, pulse, body temperature, breathing conditions, observation of paralysis, seizure situation. 2. Cerebral hemorrhage may be a brief dizziness, headache true religion outlet, vomiting, Kouyanwaixie, unilateral paralysis of limbs, then let the patient fully ambulatory, slightly elevate the head slightly back side to vomit discharged, to avoid suffocation , can be given oxygen. Emergency stretchers to the hospital as soon as possible, and to avoid vibration, reducing move. Acute phase, if the systolic blood pressure greater than 210mmHg, diastolic blood pressure greater than 110mmHg be considered when the application of antihypertensive drugs, preferred labetalol, captopril, blood pressure before treatment is generally reduced to 20% -30% is appropriate, while Dehydration should be treated to reduce intracranial pressure. 3. Ischemic stroke: When the diastolic blood pressure greater than 130mmHg general, the blood pressure to be careful to 110mmHg, is generally used sodium nitroprusside, nicardipine and phentolamine. For acute ischemic stroke, rtPA value affirmed. Section X. hypertensive emergency 1. Conventional treatment: (1) shall be placed immediately, bed rest, to a comfortable position, oxygen. To comfort the patient to physical and mental quiet. Appropriate to give stability and other sedatives. (2). Close observation of changes, watch for headaches, nausea, vomiting, blurred vision, seizures, convulsions and other symptoms, careful observation of blood pressure, consciousness, heart rate, heart rate, respiration, urine output changes. (3). Rapid establishment of effective venous access, sublingual nitroglycerin and nifedipine. (4). Prepare a variety of first aid supplies and medicines, and to master its use, such as respirators, defibrillators, mannitol, Pune nitrate, nitroglycerin, etc. (5). Vomiting in patients with its head to one side, suction, clear the mouth vomit, keep the airway open. When necessary, endotracheal intubation to prevent suffocation. (6). Should be rapid and early hospital emergency department contact, notify the relevant departments or CT room to do the rescue work. Help patients avoid bus or walk to the hospital. 2. Personalized treatment: acute cerebrovascular disease, myocardial infarction in the relevant section. ① hypertensive emergency associated with myocardial ischemia, pulmonary edema, nitroglycerin, diuretics, or if heart failure increases with opiate drugs. Such patients, systolic blood pressure target is to drop 10% ~ l5%. ② hypertensive encephalopathy: advocate use nitrendipine, phentolamine, captopril, or labetalol. The average pressure in hypertensive encephalopathy within 2-3 hours by 20% to 30%. ③ acute aortic dissection, the preferred intravenous administration of β-blockers such as esmolol or metoprolol, while giving the SNP, the first phase of step-down target blood pressure to the desired level, so that within 30 minutes systolic blood pressure below 120 mmHg. Drug treatment is only temporary, eventually need surgery. ④ catecholamine-induced hypertensive crisis: this disease is characterized by a sudden increase in tension adrenaline. Preferred intravenous administration of β-blockers. ⑤ acute hypertension during pregnancy, magnesium sulfate, methyldopa and hydralazine is a better choice. With pre-eclampsia pregnancy induced hypertension so systolic blood pressure below 90 mmHg. Section XI status asthmaticus 1. Clinical manifestations: progressive increase in asthma, a sense of suffocation, forced to sit, head to bend forward, shoulders arched, hands supporting on his knees on the table or bed, breathing hard, talking on and off, sweating, irritability, or drowsiness, cyanosis lips nails can smell the breath sound. 2. And cardiac asthma identification: to determine whether there is incentive to attack, simply ask whether there is a history of asthma, allergies, hypertension, coronary heart disease, rheumatic heart disease history. Simple understanding of the main history, if pink foam phlegm, mostly for acute left ventricular failure. 3. 4. 2. 3. 4. 5. 2. 3. 2. 2. 3. 4. 5. 6. 8. 2. 3. 2. 3. . 4. 5. 2. 2. 3. 4. 5. 6. 7. 2. 3.Topics related articles：

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