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

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Updates on first aid

  1. 1. American Heart Association and American Red Cross Guidelines 2010 K S Chew School of Medical Sciences Universiti Sains Malaysia First Aid Updates
  2. 2. Why Change From A-B-C to C-A-B? <ul><li>Minimize delay (30 compressions should be accomplished in approx 18 seconds) </li></ul><ul><li>The A-B-C sequence starts with the most difficult steps! (impediment to initiate CPR) </li></ul>
  3. 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. 4. Positioning of Victim <ul><li>As a general rule a victim should not be moved </li></ul><ul><li>The indications to move the victim include </li></ul><ul><li>If the area is unsafe for the rescuer or victim </li></ul><ul><li>If the victim is face down and is unresponsive </li></ul><ul><li>If the victim has difficulty breathing because of copious secretions or vomiting </li></ul><ul><li>If the victim shows evidence of shock </li></ul>
  5. 5. Chest Discomfort <ul><li>Assume all chest discomfort is cardiac origin until proven otherwise. </li></ul><ul><li>The most important intervention is to CALL FOR THE EMS or AMBULANCE. </li></ul><ul><ul><li>Call EMS rather than drive themselves to hospital </li></ul></ul>
  6. 6. Chest Discomfort <ul><li>While waiting for the EMS arrival, encourage victim to take a tablet of crushed aspirin </li></ul>provided the patient has no allergy to aspirin or contraindication such as bleeding tendencies, recent bleeding, or a stroke.
  7. 7. Aspirin <ul><li>ISIS-2 study clearly established the beneficial effects of aspirin within the first 24 hours to reduce mortality in patients with acute MI. </li></ul><ul><ul><ul><li>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 </li></ul></ul></ul><ul><li>Early pre-hospital administration of aspirin reduces mortality in acute MI </li></ul>
  8. 8. Poisoning <ul><li>Do not administer anything by mouth for any poison ingestion unless advised to do so by the Poison Center </li></ul><ul><ul><li>(Note: In Malaysia, the National Poison Center is located in Universiti Sains Malaysia Penang. Tel: +604-657 2924) </li></ul></ul><ul><li>There is insufficient evidence that dilution of the ingested poison with water or milk is of any benefit as a first aid measure. </li></ul>
  9. 9. Poisoning <ul><li>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. </li></ul>
  10. 10. Bleeding Control <ul><li>Best controlled by applying pressure until bleeding stops </li></ul><ul><li>Amount of pressure applied and the time the pressure is held are the most important factors affecting successful control of bleeding. </li></ul>
  11. 11. Bleeding Control <ul><li>Elevation and use of pressure points are no longer recommended to control bleeding. </li></ul><ul><li>Why? </li></ul><ul><li>hemostatic effect of elevation has not been studied </li></ul><ul><li>no effect on distal pulses was found </li></ul><ul><li>these unproven procedures may compromise the proven intervention of direct pressure </li></ul>
  12. 12. Wounds <ul><li>Superficial wounds and abrasions should be thoroughly washed. </li></ul><ul><li>Irrigate with a large volume of warm or room temperature tap water from a reliable source (with or without soap). </li></ul>
  13. 13. Wounds <ul><li>Higher irrigation pressures are more effective than lower pressures </li></ul><ul><li>Higher volumes are better than lower volumes (within a range of 100 to 1000 mL) </li></ul><ul><li>Tap water is as good as (or better than) any other irrigation solution in reducing infection rates. </li></ul>
  14. 14. Wounds <ul><li>The wounds actually heal better with less infection if they are covered with an antibiotic ointment or cream and a clean occlusive dressing </li></ul><ul><li>In first aid setting, this applies for abrasion or a superficial injury only. </li></ul><ul><li>Ensure that the victim has no known allergies to the antibiotic – if in doubt, do not apply </li></ul>
  15. 15. Soft Tissue Injuries <ul><li>RICE remains the main components of symptomatic treatment. </li></ul><ul><li>R= Rest (the affected extremity) </li></ul><ul><li>I = Ice (cold) compression </li></ul><ul><li>C = Compressive bandage </li></ul><ul><li>E = Elevate the extremity </li></ul>
  16. 16. Soft Tissue Injuries <ul><li>Cold application is more effective than heat application </li></ul><ul><li>Cold application by mixture of ice and water is more effective than ice alone </li></ul><ul><li>Cold application by mixture of ice and water is more effective than refreezable gel pack. </li></ul>
  17. 17. Soft Tissue Injuries <ul><li>Cold application is more effective than heat application </li></ul><ul><li>Cold application by mixture of ice and water is more effective than ice alone </li></ul><ul><li>Cold application by mixture of ice and water is more effective than refreezable gel pack. </li></ul>
  18. 18. Soft Tissue Injuries <ul><li>Cold application decreases hemorrhage, edema, pain, and disability. </li></ul><ul><li>To prevent cold injury, limit each application of cold to periods ≤20 minutes. </li></ul><ul><li>If that length of time is uncomfortable, limit application to 10 minutes </li></ul>
  19. 19. Jellyfish Sting <ul><li>First aid for jellyfish stings consists of two important actions: </li></ul><ul><li>preventing further nematocyst discharge and </li></ul><ul><li>pain relief </li></ul>
  20. 20. Jellyfish Sting <ul><li>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. </li></ul><ul><li>If vinegar is not available, a baking soda slurry may be used instead. </li></ul>
  21. 21. Jellyfish Sting <ul><li>For the treatment of pain, after the nematocysts are removed or deactivated, jellyfish stings should be treated with hot-water immersion when possible. </li></ul>
  22. 22. Jellyfish Sting <ul><li>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. </li></ul><ul><li>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. </li></ul>
  23. 23. Jellyfish Sting <ul><li>How does hot water immersion work? </li></ul><ul><li>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. </li></ul><ul><li>Hot water immersion causes modulation of pain receptors in the nervous system leading to a reduction in pain. </li></ul>
  24. 24. Jellyfish Sting <ul><li>The Portuguese Man O’ War is not a jellyfish </li></ul><ul><li>Is a cluster of several organisms each highly specialized, cannot sustain themselves individually, dependent for survival on the others </li></ul>