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Updates on first aid

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My slides for facilitators to update them during a preparatory meeting for First Aid Block In MD Year 1

My slides for facilitators to update them during a preparatory meeting for First Aid Block In MD Year 1

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  • 1. American Heart Association and American Red Cross Guidelines 2010 K S Chew School of Medical Sciences Universiti Sains Malaysia First Aid Updates
  • 2. Why Change From A-B-C to C-A-B?
    • Minimize delay (30 compressions should be accomplished in approx 18 seconds)
    • The A-B-C sequence starts with the most difficult steps! (impediment to initiate CPR)
  • 3. BLS Algorithm “ Look, listen, and feel for breathing” has been removed from algorithm. After delivery of 30 compressions, the rescuer opens the victim’s airway and delivers 2 breaths.
  • 4. Positioning of Victim
    • As a general rule a victim should not be moved
    • The indications to move the victim include
    • If the area is unsafe for the rescuer or victim
    • If the victim is face down and is unresponsive
    • If the victim has difficulty breathing because of copious secretions or vomiting
    • If the victim shows evidence of shock
  • 5. Chest Discomfort
    • Assume all chest discomfort is cardiac origin until proven otherwise.
    • The most important intervention is to CALL FOR THE EMS or AMBULANCE.
      • Call EMS rather than drive themselves to hospital
  • 6. Chest Discomfort
    • While waiting for the EMS arrival, encourage victim to take a tablet of crushed aspirin
    provided the patient has no allergy to aspirin or contraindication such as bleeding tendencies, recent bleeding, or a stroke.
  • 7. Aspirin
    • ISIS-2 study clearly established the beneficial effects of aspirin within the first 24 hours to reduce mortality in patients with acute MI.
        • ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. Lancet. 1988;2:349–360
    • Early pre-hospital administration of aspirin reduces mortality in acute MI
  • 8. Poisoning
    • Do not administer anything by mouth for any poison ingestion unless advised to do so by the Poison Center
      • (Note: In Malaysia, the National Poison Center is located in Universiti Sains Malaysia Penang. Tel: +604-657 2924)
    • There is insufficient evidence that dilution of the ingested poison with water or milk is of any benefit as a first aid measure.
  • 9. Poisoning
    • Do not administer activated charcoal to a victim who has ingested a poisonous substance unless you are advised to. There is insufficient evidence to recommend for or against the administration of activated charcoal in first aid setting although 2 small studies suggest that it may be safe to administer.
  • 10. Bleeding Control
    • Best controlled by applying pressure until bleeding stops
    • Amount of pressure applied and the time the pressure is held are the most important factors affecting successful control of bleeding.
  • 11. Bleeding Control
    • Elevation and use of pressure points are no longer recommended to control bleeding.
    • Why?
    • hemostatic effect of elevation has not been studied
    • no effect on distal pulses was found
    • these unproven procedures may compromise the proven intervention of direct pressure
  • 12. Wounds
    • Superficial wounds and abrasions should be thoroughly washed.
    • Irrigate with a large volume of warm or room temperature tap water from a reliable source (with or without soap).
  • 13. Wounds
    • Higher irrigation pressures are more effective than lower pressures
    • Higher volumes are better than lower volumes (within a range of 100 to 1000 mL)
    • Tap water is as good as (or better than) any other irrigation solution in reducing infection rates.
  • 14. Wounds
    • The wounds actually heal better with less infection if they are covered with an antibiotic ointment or cream and a clean occlusive dressing
    • In first aid setting, this applies for abrasion or a superficial injury only.
    • Ensure that the victim has no known allergies to the antibiotic – if in doubt, do not apply
  • 15. Soft Tissue Injuries
    • RICE remains the main components of symptomatic treatment.
    • R= Rest (the affected extremity)
    • I = Ice (cold) compression
    • C = Compressive bandage
    • E = Elevate the extremity
  • 16. Soft Tissue Injuries
    • Cold application is more effective than heat application
    • Cold application by mixture of ice and water is more effective than ice alone
    • Cold application by mixture of ice and water is more effective than refreezable gel pack.
  • 17. Soft Tissue Injuries
    • Cold application is more effective than heat application
    • Cold application by mixture of ice and water is more effective than ice alone
    • Cold application by mixture of ice and water is more effective than refreezable gel pack.
  • 18. Soft Tissue Injuries
    • Cold application decreases hemorrhage, edema, pain, and disability.
    • To prevent cold injury, limit each application of cold to periods ≤20 minutes.
    • If that length of time is uncomfortable, limit application to 10 minutes
  • 19. Jellyfish Sting
    • First aid for jellyfish stings consists of two important actions:
    • preventing further nematocyst discharge and
    • pain relief
  • 20. Jellyfish Sting
    • To inactivate venom load and prevent further envenomation, jellyfish stings should be liberally washed with vinegar (4% to 6% acetic acid solution) as soon as possible for at least 30 seconds.
    • If vinegar is not available, a baking soda slurry may be used instead.
  • 21. Jellyfish Sting
    • For the treatment of pain, after the nematocysts are removed or deactivated, jellyfish stings should be treated with hot-water immersion when possible.
  • 22. Jellyfish Sting
    • Instruct victim to take a hot shower or immerse the affected part in hot water (temperature as hot as tolerated, or 45°C if there is the capability to regulate temperature), as soon as possible, for at least 20 minutes or for as long as pain persists.
    • If hot water is not available, dry hot packs or, as a second choice, dry cold packs may be helpful in decreasing pain but these are not as effective as hot water.
  • 23. Jellyfish Sting
    • How does hot water immersion work?
    • Marine venoms consist of multiple proteins and enzymes, and there is evidence that these become deactivated when heated to temperatures above 50 °C. Direct heat application leads to inactivation of the venom and deactivation of heat labile proteins.
    • Hot water immersion causes modulation of pain receptors in the nervous system leading to a reduction in pain.
  • 24. Jellyfish Sting
    • The Portuguese Man O’ War is not a jellyfish
    • Is a cluster of several organisms each highly specialized, cannot sustain themselves individually, dependent for survival on the others

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