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Nyingi michael
FIRST AID/TRAUMA AND
EMERGENCY
CourseOutline
Introduction
oDefinition of First Aid
oAims of First Aid
oSteps of First Aid
oGiving artificial ventilation
oGiving chest compressions
Cardiovascular Emergencies
oShock
oFainting
oAngina pectoris
oHeart attack
oAcute heart failure
oCardiac arrest
Wounds and Bleeding
oDefinition
oFirst aid
oTypes of wounds
oTypes of bleeding
-severe external bleeding
-bleeding at special sites
-wounds to the palm
RESPIRATORY DISORDERS
oAsphyxia
oChocking
oDrowning
oHanging and strangulation
oInhalation of fumes
oHyperventilation
oHiccups
MUSCULOSKELETALINJURIES
oStrains and sprains
oDislocations
oSublaxation
oFractures
oInjuries of the chest
HEAD AND NECK INJURIES
oConcussion
oSkull fracture
oCerebral compression
oConvulsions
oEpilepsy
oUnconciousness
oTypes of neck injuries
BURNS AND EXTREMES OF TEMPERATURE
oClassification
oTypes
oManagement
BITES AND STINGS
oAnimal bites
oInsect stings
oMarine stings
oMarine puncture wounds
oSnake bites
BANDAGING
dEFINITION
First Aid is the initial assistance or treatment given to someone who is
injured or suddenly taken ill
First Aid is the immediate care of an injured or suddenly sick person. It
is the care a person applies as soon as possible after an accident or
sudden illness
This prompt care and attention prior to the arrival of the ambulance
can sometimes mean the difference between life and death or between
a full or partial recovery
AimsofFirstAid
Preserve life
This includes the life of the casualty, bystander and rescuer
ABC of resuscitation
Protect the casualty from further harm
Ensure the scene is safe
Provide pain relief/promote recovery
This could include the use of ice packs or simply applying a sling
(a bandage used to suspend or support an injured part of the body)
Prevent the injury or illness from becoming worse
Ensure the treatment you provide does not make the condition worse
Provide reassurance
It is important to understand that first aid has its limitations and does
not take the place of professional medical treatment
ObjectivesofFirstAid
To preserve life
To alleviate suffering
To promote recovery
To prevent aggravation of the injury or illness until veterinary
assistance can be obtained
Definition of terms
First Aider
A person who offers emergency care to the casualty(ies)
Victim/casualty
A person suffering from a sudden injury or trauma or illness and needs
first aid
Emergency
An unexpected incidence serious in nature that requires quick
action,e.g poisoning, burns etc
Scene
An area on incident
Incident
It’s a happening traumatic in nature that requires first aid(it could be
illness or injury)
The First Aider Qualities
Highly trained i.e. have necessary knowledge
Examined and regularly re-examined
Have empathy and understanding
Are up-to-date in knowledge and skill
Have initiative and sense of leadership
Have ability to act quickly, make decisions and improvise
Appreciate that the less interference the better
Responsibilities of a First Aider
To assess the situation quickly and safely and to summon appropriate
help
To protect casualties and others at the scene from possible danger
To identify as far as possible the injury or nature of illness affecting a
casualty
To give each casualty early and appropriate treatment, treating the
most serious conditions first
To arrange how the casualty will get to hospital or to his/her home
To remain with the casualty until appropriate care is available
To report his/her observations to those taking care of the casualty and
to give further assistance if required
To prevent cross infection between yourself and the casualty as much
as possible
Protecting the casualty
To prevent/avoid cross-infection when giving first aid you should:
Avoid contact with body fluids
Wash your hands
Wear protective gloves
If gloves are unavailable, life saving treatment must still be available
First Aid Priorities
Assess the situation
Observe what has happened quickly and calmly
Look for danger to yourself and to the casualty
Make the area safe
Protect the casualty from danger
Beware of your limitations
Assess all casualties and give emergency first aid
Assess each casualty to determine treatment priorities and treat those
with life threatening conditions first.
Get help
Quickly ensure that any necessary specialist help has been summoned
and is on the way
Assignment: General Rules of First Aid Treatment
Triaging
This is sorting and classifying injured patients to determine priority of
need
The most critical are taken care of first
Direct assistance to casualties is given by the casualty nurse
The mnemonic START is used.
S-Simple
T-Triaging
A-And
R-Rapid
T-Treatment
BasicsofFirstAid
Basic First Aid refers to the initial process of assessing and addressing
the needs of someone who has been injured or is in physiological
distress due to chocking, a heart attack, allergic reactions,drugs,alcohol
or other medical emergencies
1.Evaluate the situation
Are there things that might put you at risk of harm? Are you or the
victim threatened by fire, toxic smoke or gases, an unstable building,
live electrical wires or other dangerous scenario? Do not rush into a
situation where you could end up as a victim yourself
If approaching the victim will endanger your life, seek professional help
immediately; they have higher levels of training and know how to
handle this situations
2.Remember your A,B,C.
The A,B,C refer to the three critical things you need to look out for
Airway-Does the person have an obstructed airway?
Breathing-Is the person breathing
Circulation-Does the person show a pulse at major pulse points(wrist,
carotid artery and groin)
3.Avoid moving the victim
Avoid moving the victim unless they are in immediate danger. Moving a
victim will make the injury worse especially in cases of spinal cord
injuries
4.Call emergency services/call for help
or tell someone else(a specific person if possible) to call for help as soon
as possible
If you are the only person on the scene, try to establish breathing
before calling for help and do not leave the victim alone for an extensive
amount of time
5.Determine responsiveness
If a person is unconscious, try to rouse them by gently shaking and
speaking to them
6.If the person remains unresponsive, carefully roll them onto their
back and open his/her airway
Keep head and neck aligned
Carefully roll them onto their back while holding his head
Open the airway by lifting the chin
7.Look,listen and feel for signs of breathing
Look for the victims chest to rise and fall, listen for sounds of
breathing(place your ear near the nose and mouth and feel for breath
on your cheek)
If the victim is not breathing, check for circulation
If the victim is breathing but unconcious,roll them onto their side,
keeping the head and neck aligned with the body. This will help drain
the mouth and prevent the tongue or vomit from blocking the airway
8.Check victims circulation
Look at the victims color and check for pulse(the carotid artery is a good
option, its located on either side of the neck below the jaw bone)
If the victim does not have pulse, start CPR(Cardiopulmonary
resuscitation)
9.Treat bleeding, shock or other problems as needed
After you have established that the victim is breathing and has a pulse,
your next priority should be to control any bleeding
Stop bleeding by applying direct pressure
10.Stay with the victim until help arrives
Be a calming presence for the victim until assistance arrives
If the victim is not breathing
Follow this steps to restore breathing in an unconscious victim
This steps assume you have already performed the chin lift described
above
oCheck for a clear airway: Remove any obvious blockage
oCover the victims mouth with your own(kiss of life)
oPinch the victims nose closed
oFill victims lungs with two slow breaths. If breaths are blocked,
reposition the airway. Make sure the head is tilted slightly back and the
tongue is not obstructing it.
oIf breaths are still blocked, give 5 quick forceful abdominal thrusts. This
is the equivalent of Heimlich maneuver in a standing person.
Straddle the victim
Place a fist just above the belly button and below the breast bone
Thrust upward to expel air from the lungs
Sweep the mouth to remove any foreign object
Try two slow breaths
Repeat until you are successful in clearing the object from the windpipe
o With open airway begin rescue breathing. Give one breath every 5 seconds
and check that the chest rises every time
o Administer CPR if the victim does not have a pulse until help arrives
How to do CPR on an adult
Check the scene for immediate danger
Make sure you are not putting yourself in danger/harm by administering
CPR to someone unconscious. Is there fire? Is the person lying on a
roadway? do whatever is necessary to move yourself and the other
person to safety.
You can open a window, turn off the stove or put out the fire if possible.
However, if there is nothing you can do to counteract the danger, move
the victim. The best way to move the victim is by placing a blanket or
coat underneath their back and dragging it
Assess the victims consciousness
Gently tap his/her shoulder and ask: Are you ok’ in a loud clear voice. If
he/she responds,CPR is not required
If the victim does not respond, continue with the following steps
Send for help
Send someone to call for emergency services. Give the dispatcher your
location and notify him or her that you are going to perform CPR.If you
are alone, get off the phone and start compressions.
If you have someone else with you, have him or her stay on the line
while you do CPR on the victim
Check for breathing
Put your ear close to the victims nose and mouth and listen for
breathing. If the victim is coughing or breathing normally, DON’T
perform CPR.Doing so could cause the heart to stop beating
Place the victim on his/her back and make sure he/she is lying flat as
possible. This will prevent injury while doing the chest compressions
Place the heel of one hand on the victims breastbone, exactly between
the nipples
Place your second hand on top of the first hand palms down
Position your body directly over your hands so that your arms are
straight and somewhat rigid
Perform 30 chest compressions
Press down with both hands directly over the breastbone to perform a
compression which helps the heart beat
Chest compressions are more critical for correcting abnormal heart
rhythms.
some of the abnormal heart rhythms include ventricular fibrillation and
pulseless ventricular tachycardia
You should depress the breastbone approximately 4-5cm(1.5-2 inches)
Minimize pauses in chest compressions
Attempt to limit interruptions to less than 10 seconds
Make sure the airway is open. Place two fingers under the point of
casualty's chin, lift the jaw. At the same time, place your other hand on
the casualty's and gently tilt the head well back
If you suspect a neck injury, pull the jaw forward rather than chin
lifting. If jaw thrust fails to open the airway, do a careful head tilt and
chin lift
If there are no signs of life, place a breathing barrier(if available) over
the victims mouth
Give two rescue breaths
Keeping the airway open, take the fingers that were on the forehead
and pinch the victims nose closed. Make a seal with your mouth over
the victims mouth and breath out for about one second. Breath slowly
to ensure air goes in the lungs and not the stomach
If the breath goes in, you should see the chest slightly rise and also feel
it go in. Give a second rescue breath
If the breath does not go in, reposition the head and try again. If it
does not go in again, the victim may be chocking
Repeat the cycle of 30 chest compressions and 2 rescue breath. Do
CPR for 2 minutes(5 cycles) before checking for signs of life.
Continue CPR until someone takes over, emergency personnel arrive,
you are too exhausted to continue, an AED(automated external
defibrillator) is available for immediate use or signs of life return.
AED is used to jumpstart the victims heart
How to use an AED
Make sure there are no paddles or standing water in the immediate
area
Turn on the AED.It should have voice prompts that tell you what to do
Fully expose the victims chest. Remove any metal necklaces or
underwire bras
Check foe any body piercings or evidence that the victim has a
pacemaker(should be indicated by a medical bracelet)
Make sure the the chest is absolutely dry
Attach sticky pads with electrodes to the victims chest. Move the pads
at least one inch(2.5 cm) away from the metal piercings or implanted
devices
Press analyze on the AED machine. If a shock is needed it will notify
you
If you do shock the victim, make sure no one is touching him/her
Remove the electrode pads and resume CPR for other 5 cycles before
using the AED again
First Aid Steps
Before attending to a casualty, you must survey the whole scene
Your first responsibility is to make that the area is safe
Where the danger is too imminent or great, you may need to move the
casualty even at risk of aggravating injury
Only when the casualty is safe can you begin to treat illness and injury
Ensure personal safety so that you don’t become a casualty
Send for help
1)ASSESSMENT
When safe to do so, quickly perform a brief examination of the casualty.
This is to check for any life threatening conditions that need urgency
and to preserve life
You do assessment before making a full diagnosis and if necessary, be
prepared to carry out appropriate steps to resuscitate the casualty first
i)Check consciousness
If casualty does not respond when spoken to, he might be unconscious.
Try to elicit a response and be careful not to move the head or tilt the
neck
ii)Open the airway
An unconscious casualty’s airway may be blocked by the tongue falling
back. Open airway by tilting the head back
iii)Check for breathing
Once airway is open, establish whether the casualty is breathing, if not,
place in recovery position.
Give artificial breaths
iv)Check for circulation
If the heart is beating, you should be able to feel a pulse in the
neck(carotid pulse) or wrist(radial pulse).
For the babies, check brachial pulse
v)Check for bleeding
Severe loss of blood reduces circulation to the vital organs and can
cause shock
Control serious bleeding as soon as breathing and pulse have been
established
As soon as you establish the condition of the casualty, take action
depending on
Unconcious,not breathing and without pulse
Unconcious,not breathing and with a pulse
Unconcious,breathing and with a pulse
2.DIAGNOSIS
Requires thorough physical examination
Made on the basis of history and clues to any medical condition and
signs and symptoms
Circumstances will determine how detailed the examination will be
History
Is full story of how the incident happened, how the injury was
sustained or how the illness began and continued including any
previous conditions
Question the casualty but if he is unconscious, talk to any
witness(es).They give useful information but can be unreliable if upset
Take into account
When the casualty last had something to eat or drink
Whether the casualty has any illness or is taking any medication
The amount of force involved and how it was applied to the body
The environment e.g. hot and stuffy, cold room or exposed to wind or
rain
Casualty's age and state of health e.g a young fit adult who trips may
sprain a wrist but an elderly lady who does the same is more likely to
have broken her arm or hip
Establish who the casualty is and where he/she lives
External clues
If casualty is unable to co-operate or is unconscious, look through
pockets and bags for clues(Beware of syringes if you suspect drug
abuse)
There may be an appointment card for hospital or clinic or a card
indicating history of allergy,diabetes,epilepsy etc
Medication carried by casualty may give valuable clues about the
emergency e.g. glyceryl trinitrate for angina,phenytoin for epilepsy and
inhalers for asthmatics or angina patients
Take care of any such clue and return it to the casualty
Signs and symptoms
i) Symptoms verbalized by the casualty
Pain,anxiety,heat,cold,loss of normal movement, loss of
sensation,thirst,nausea,tingling,faintness,stiffness,memory
loss,dizziness,sensation of broken bone
ii)Signs you may see
Anxiety and painful expression, unusual chest
movement,burns,sweating,wounds,bleeding from orifices, response to
touch, response to speech,bruising,abnormal skin colour,muscle
spasm,swelling,deformity,foreign bodies, needle
marks,vomit,incontinence,containers and other circumstantial evidence
iii)Signs that you may feel
Dumpness,abnormal body temperature,swelling,a deformity, abnormal
pulse, grating bone ends
iv)Signs that you may hear
Noisy or distressed breathing,groaning,response to speech, grating
bone ends(crepitus)
v)Signs that you may smell from patients breath
Acetone,alcohol,solvents or glue, cannabis
Examining a casualty
Do a head to toe examination
Run your hands carefully over the scalp to feel for bleeding, swelling or
depression that may indicate possible fracture
Be careful not to move any casualty who you feel/think might have
injured her/his neck
Speak clearly to the casualty and check for response. Check for blood
or clear fluid discharge from the ears or a mixture of both. It could a
sign of intracranial damage
Examine both eyes, noting if open. size of the pupil. Are the pupils
reacting to light(should shrink when light falls on it),foreign bodies,
blood or bruising in the whites of the eyes.
Examine the nose
Record the rate, depth and nature of breathing. Note any odor on
breath, check the mouth, open airway, look for any wounds or lost teeth
and examine lips for burns
Note the color, temperature and state of the skin. If its pale, flushed or
cyanosed. Is it hot, dry or dump.Pale,cold and sweaty skin suggest
shock, a flushed hot face suggests heat stroke or fever. Blue
skin(cyanosis)-look for it at the lips, ears and face
Loosen clothing around the neck and check for a tracheostomy tube.
Palpate the spine from the base of the skull downwards without
disturbing/moving the patient. Check for any swelling, tenderness or
any other irregularity.
Ask the patient to breath deeply and check if the chest expands evenly,
easily and equally on both sides. Feel the rib cage for any
deformities,irregularity,tenderness or granting sensation on breathing
Feel along the collar bones and the shoulder for any deformity,
irregularity or tenderness
Check the movements of elbows, wrists and fingers. Ask the casualty
to bend and straighten the arm at the joints. Check for any abnormal
sensation at he limbs and note color
If there is any sign of impairment of movement or loss of sensation in
the limbs, do not move the casualty to examine the spine. Gently pass
your hand under the hollow of the back and feel along the spine
without disturbing without disturbing the casualty checking for swelling
and tenderness
Gently feel the front of the abdomen for evidence of bleeding and to
identify any rigidity or tenderness of the muscular wall
Feel both sides of the hips and gently move the pelvis to look for signs
of fracture. Note any incontinence or bleeding from orifices
Ask the casualty to raise each leg in turn and to move her ankles and
knees. Look and feel for bleeding, swelling or any other deformity and
tenderness
Check movement and feeling in all toes. Also color
Treatment and aftercare
Treat each condition methodically and calmly in order of priority
Re-assure the casualty and listen to them. Don't keep questioning the
casualty and do not let people crowd around
Avoid moving the casualty unnecessarily
Treatment priorities
Follow ABCs
Maintain clear airway and breathing. If unconcious,place in recovery
position
Control bleeding
Treat large wounds and burns
Immobilize bone and joint injuries
Give appropriate treatment for other injuries and conditions
Check airway, breathing and pulse regularly and deal with any problem
immediately.
Arranging appropriate
aftercare
Ascertain whether casualty needs medical treatment and if so, what is
needed.
If you require help send someone else if possible, in the event that the
casualty's condition alters or worsens. Stay with the casualty until help
arrives
According to your assessment of the casualty, you may:
Call a doctor/senior nurse for advise
Call an ambulance or arrange transport to hospital
Pass care of the casualty to a doctor, nurse or ambulance crew
Take the casualty to a nearby house or shelter to await medical help
Allow the casualty to go home accompanied if possible
Ask if somebody will be at least home to meet him/her or you can
arrange this
Advice the casualty to see a doctor
Do not allow home a casualty who has been unconscious(other than a
faint),had severe breathing difficulty or signs of shock. Stay with him or
her until help arrives
Do not give anything by mouth to any casualty who may have internal
injuries or otherwise need hospital care
Passing on information
Having summoned medical aid, make notes on the incident and the
condition of the casualty so that you can pass on all the information you
have gathered
The observation chart overleaf will enable you to not tour observations
such as breathing, level of response at a ten minute interval
Make a brief written report to accompany your observations
Your report should include:
The casualty's name and address
History of the accident or illness
A brief description of any injuries
Any unusual behavior
Any treatment given and when
Breathing, pulse and level of response
RESUSCITATION TECHNIQUES
RESUSCITATION SEQUENCE
Check response
Open airway
Check breathing
Assess for circulation
Commence CPR
Assignment: resuscitation for children
<1 year
1-7 years
8 years and above
Cardiovascular
emergencies
1.SHOCK
A shock state exists when the tissue perfusion decreases to the point of
cellular metabolic dysfunction.
Shock is classified according to the causative event.
Types of shock
1.Hematogenic/hemorrhagic/hypovolemic
Occurs when blood volume is insufficient to meet metabolic needs of the
tissues as with severe hemorrhage.
2.Cardiogenic shock
Occurs when cardiac failure results in decreased tissue perfusion as in
MI.
3.Distributive shock conditions
Characterized by displacement of a significant amount of vascular
volume.
Types of distributive shock
1.Neurogenic shock
Results from a neurologic event such as head injury that causes massive
vasodilatation and decreased perfusion pressures.
2.Anaphylactic shock
Caused by a severe systemic response to an allergen resulting in massive
vasodilatation, increased capillary permeability, decreased perfusion,
decreased venous return and subsequent decreased cardiac output.
3.Septic shock
Occurs when bacterial toxins cause an overwhelming systemic infection.
Circulatory shock
The circulatory system distributes blood round the body so that oxygen
and nutrients can pass through and perfuse the tissues. When the
system fails, circulatory shock ensue. If not treated swiftly, vital organs
such as the heart and the brain may fail leading to death.
Worsened by fear and pain.
Causes of circulatory shock
1.Heart attack
2.Severe infection and anaphylactic shock-blood vessels dilate reducing
the blood pressure
3.Blood loss
4.Loss of body fluids through burns, severe diarrhea or vomiting
-The body responds to fluid loss initially by diverting the blood supply
from the surface to the vital organs.
continuation
As the brain’s oxygen supply weakens
Restless, anxious and aggressive
Air hunger-yawn and gasp for air
Unconscious
Heart stops
Signs and symptoms
At first, the release of adrenaline causes
A rapid pulse
Pale,grey-blue skin especially inside the lips.
Sweating, cold and clammy skin.
As shock develops
Weakness and giddiness
Nausea and vomiting
Thirst
Rapid shallow breathing
A weak thready pulse. When the pulse at the wrist disappears, about half
the blood volume will have been lost.
Treatment
AIMS
To recognize shock
To treat any obvious cause
To improve the blood supply to the brain, heart and lungs
To arrange removal to hospital
Treatment
Treat any cause of shock you identify such as external bleeding.
Lay the casualty down on a blanket to protect her from the cold ground
keeping her head low.
Raise and support her legs to improve the blood supply to the vital
organs. Take care if you suspect a fracture.
Loosen tight clothing such as belts and braces to reduce constriction at
the neck, chest or waist.
 keep the casualty warm by covering her with coats and blankets.
Check and record breathing, pulse and the level of response.
Be ready to resuscitate if necessary.
2.FAINTING/SYNCOPE
Is a brief loss of consciousness that is caused by temporary reduction of
blood flow to the brain.
The pulse becomes very slow although it soon picks up and returns to
normal.
Recovery is rapid and complete.
Signs and symptoms
A brief loss of consciousness causing causing the casualty to fall to the
floor.
Slow pulse
Pale cold skin
Sweating
Aims of treatment
To improve blood flow to the brain
To reassure as she recovers and make her comfortable
Treatment
Lay the casualty down, raise and support her legs
Make sure that she has plenty of fresh air
As she recovers, reassure her and help her sit up gradually
Look for and treat any injury that has been sustained through falling
If she does not regain consciousness quickly, do ABC and be ready to
resuscitate if necessary. If the patient starts to feel faint again tell her to
lie down and raise and support her legs until she fully recovers.
3.ANGINA PECTORIS
Its constriction of the chest and describes the pain that a person
experiences when narrowed coronary arteries are unable to deliver
sufficient blood to the heart muscle to meet the demands of exertion or
excitement.
The pain is relieved by rest.
Signs and symptoms
Gripping central chest pain, spreading
often to the jaw and down to the left arm
Shortness of breath
Weakness-sudden and extreme
Anxiety
TREATMENT
Aims
To ease strain on the heart by ensuring that the casualty rests
To obtain medical help if necessary
Actual treatment
Help the casualty to sit down. make her comfortable and reassure her.
If the casualty has medicine for angina such as tablets or a “puffer”
aerosol let her administer it herself. If necessary help her to take it.
continuation
Encourage the casualty to rest and keep bystanders away. The attack
should ease within a few minutes.
If the pain persists or returns suspect a heart attack. Dial 999 for an
ambulance.
Monitor and record breathing and pulse rates every ten minutes.
4.HEART ATTACK
Occurs when the blood supply to part of the heart muscle is suddenly
obstructed e.g. coronary thrombosis
The main risk is that the heart will stop.
The effect of the heart attack depends on how much of the muscle is
affected.
Drugs that aid recovery include thrombolytic (dissolve the clot) and
asprin (thins the blood).
Signs and symptoms
Persistent central chest pain spreading to the jaw and down to the left
arm. Unlike angina pectoris the pain does not ease once the casualty is
at rest and may occur at rest.
Breathlessness and discomfort high in the abdomen.
Sudden faintness or giddiness
A sense of impending doom
‘’Ashen” skin and blueness at the lips
Rapid weak irregular pulse
Sudden collapse
Aims of treatment
To minimize the work of the heart
To summon urgent medical help and arrange removal to hospital
treatment
Put the patient on a half sitting position, with the casualty’s head and
shoulders well supported and his knees bent
Call for help and state that you suspect a heart attack
Constantly monitor and record the casualty’s breathing and pulse rate and
be prepared to resuscitate if necessary
If the casualty has medicine for angina(“puffer "aerosol) help him take it if
he has. If the pain persists and the casualty is fully conscious give him one
tablet of ordinary aspirin to chew
5.ACUTE HEART FAILURE
The heart muscle is strained and fatigued e.g. following coronary
thrombosis and becomes increasingly inefficient.
Acute attacks may occur at night
Signs and symptoms
Similar to heart attack
Treatment
Follow the treatment for heart attack
6.CARDIAC ARREST
Sudden stoppage of the heart. Its characterized by the absence of pulse
and breathing. You must commence resuscitation immediately.
Causes
Heart attack
Severe blood loss
Suffocation
Electric shock
Anaphylactic shock
Hypothermia
Signs and symptoms
Absence of pulse
Absence of breathing
Aims of treatment
To arrange urgent removal to hospital.
To keep the heart muscle and brain supplied with oxygen until help
arrives.
Treatment
Begin CPR
WOUNDS AND BLEEDING
Introduction
Definition of wound
Its any abnormal break in the skin or the body surface.
Wounds can be daunting if there is a lot of bleeding but prompt action
is needed to reduce blood loss and shock.
FIRST AID PRIORITIES
Control blood loss by applying pressure over the wound and raising the
injured part
Take steps to minimize shock
Cover any open wound with a dressing to protect it from infection and
promote natural healing
Observe hygiene to prevent cross infection between the casualty and
yourself
Types of Wound
1.Incised wound
A clean cut from a sharp edge such as broken glass such as broken glass
causes an incision. The blood vessels at the wound edges are cut
straight across so there may be profuse bleeding.
2.Laceration
Crushing or ripping forces result in rough tears or lacerations.
Bleed less profusely than clean-cut wounds but there is more tissue
damage and bruising.
they are often contaminated by germs. The risk of infection is high.
Types of wounds
3.Abrasion(graze)
This is a superficial wound in which the top layers of the
skin are scraped off, leaving a raw, tender area.
Caused by a sliding fall or a friction burn.
They can contain embedded foreign particles that may
result in infection.
4.Contusion(bruise)
A blunt blow or punch can rupture capillaries
beneath the skin. Blood then leaks into the tissues
causing bruising. The skin splits occasionally.
Severe contusion may indicate deeper, hidden
damage such as fracture or internal injury.
Types of wounds
5.Puncture wound
Standing on a nail or being stabbed.
Has small entry site but a deep track of internal damage.
Germs and dirt can be carried far into the body and therefore the risk of
infection is high.
6.Gunshot wound
A bullet or other missile may drive into or through the body causing
serious internal injury and sucking in contaminants from the air. The
entry wound may be small and neat while the exit wound may be large
and ragged.
Types of bleeding
Classified by the type of blood vessel that is damaged:artery,vein or
capillary.
Arterial bleeding can be very dramatic but copious venous bleeding is
potentially more serious.
1.Arterial bleeding
Richly oxygenated blood is bright red.
Under pressure from the heart, it spurts from a wound in time with the
heart beat.
A severed main artery may jet blood several feet high and rapidly
reduce the volume of circulating blood.
Types of bleeding
2.Venous bleeding
Venous blood is dark red.
Its under less pressure.
Vein walls are capable of great distension and therefore blood can pool
within them.
Blood from a severed major vein may gush profusely.
3.Capillary bleeding
Occurs at the site of all wounds.
At first may be brisk but blood loss is usually slight.
A blunt blow may rupture capillaries under the skin causing bleeding under
the skin causing bleeding into the tissues(bruise)
Severe external bleeding
Bleeding at the face or neck can impede the airway.
Shock is likely to happen and the casualty may loose consciousness.
Aims of treatment
To control the bleeding
To prevent and minimize the effects of shock
To minimize the risk of infection
To arrange urgent removal of the casualty to hospital.
Treatment
1.Remove or cut clothing to expose the wound. Watch out for sharp
objects such as glass that may injure you.
2.Apply direct pressure over the wound with your fingers or palm
preferably over a sterile dressing or clean pad. Do not waste time
hunting for a dressing.
If you cannot apply direct pressure e.g. if an object is protruding, press
down firmly on either side.
Treatment
3.Raise and support the injured limb above the level of the casualty’s
heart.
4.Lay the casualty down. This will reduce blood flow to the site of the
injury and minimize shock.
5.Leaving any original pad in place, apply a sterile dressing. Bandage it in
place firmly but not so tightly as to impede circulation. If blood seeps
through the dressing, bandage another firmly over the top.
If there is a protruding foreign body, build up padding on either side of
the object until high enough to bandage over the object without
pressing on it.
Continuation
6.Secure and support the injured part with bandaging
7.Call for help. Treat shock, check dressing for seepage and check for
circulation beyond the bandage.
BLEEDING AT SPECIAL SITES
Scalp and Head Wounds
Aims of treatment
To control blood loss
To arrange transport to hospital
Actual treatment
Wearing disposable gloves, if possible replace any displaced skin flaps.
Apply firm direct pressure over a sterile dressing or clean pad.
Secure the dressing with a roller bandage. Lay the casualty down with
head and shoulders slightly raised. If he becomes unconcious,ABC.
Take or send the casualty to hospital in the final treatment position.
Wounds To The Palm
Aims of treatment
To control blood loss
To arrange transport to hospital
Treatment
Press a sterile dressing or clean pad firmly into the palm and ask the
casualty to clench his fist over it. If he finds it difficult to press hard, he may
grasp the fist with his uninjured hand.
Bandage the casualty’s fingers so that they are clenched over the pad. Tie
the knot over his fingers
Support the casualty’s arm in an elevation sling and take him or send him
to hospital.
Wounds At Joint Creases
Aims of treatment
To control blood loss
To arrange transport to hospital
Treatment
Press a clean pad over the injury. Bend the joint as firmly as possible
With the joint firmly bent to press on the pad, raise the limb. Lay the
casualty down to reduce shock
Take or send the casualty to hospital in the treatment position. Release
the pressure briefly every ten minutes to restore normal blood flow.
Bleeding Varicose Veins
A varicose vein has taut, thin walls and is often raised stretching the skin to give
a characteristic ”knobbly” appearance. It can burst by gentle knocks and will
bleed profusely.
Aims of treatment
To control blood loss
To arrange urgent removal to hospital
To minimize shock
Treatment
Lay the casualty on her back and raise the injured leg to reduce or stop
bleeding
Expose the site of bleeding and apply firm direct pressure over sterile
dressing or clean pad with a securing bandage or with your fingers until
bleeding is controlled. Remove garments such as garters or elastic-
topped stockings that may be impeding blood flow back to the heart.
Put a large soft pad over the dressing. It should exert even pressure yet
not impede blood flow.
Keep the injured leg raised and supported until the ambulance arrives.
MAJOR WOUNDS
Cause serious internal injury without severe external bleeding esp. trunk
wounds.
1.Abdominal Wounds
Severity is evident in external bleeding and protruding abdominal
contents. There could be hidden internal injury and bleeding
The risk of infection and shock is high
Treatment
Aims
To minimize the risk of infection
To minimize shock
To arrange urgent removal to hospital
Treatment
Lay the casualty down on a firm surface. Loosen any tight clothing
Put a large dressing over the wound and secure it lightly in place with a
bandage. If part of the intestine is protruding, do not touch it but cover
with a plastic bag or kitchen film to prevent it from drying out.
Alternatively use a sterile dressing.
Call for help. If casualty becomes unconscious, do ABC.
INTERNAL HAEMORRHAGE
Its of great importance that any first aid worker takes prompt action.
Management
Rest and quiet
The patient must be laid down lying flat and kept absolutely still. If the
patient is allowed to move about in any way, there is danger of further
bleeding
Reassurance
Reassure the casualty as he or she will be anxious and possibly afraid
Position
If possible the lower end of the bed or couch can be raised. This
Facilitates the flow of blood by gravity to the brain and may prevent
fainting or unconsciousness
continuation
Clothing
Undo tight clothing round the neck, chest or waist. This helps the
patient to breath more easily and prevent the feeling of suffocation.
Medical aid
Alert the EMS or arrange patient’s removal to hospital.Ensure minimal
movement of the casualty when handling him or her.
Epistaxis
Its bleeding from the nose.
Can be severe or slight.
Management
Place the patient on a chair in a sitting position with the head held
forward. In severe bleeding this will prevent the blood flowing to the
back of the nose and throat an may prevent it from being swallowed or
inhaled.
Loosen tight clothing round the neck, chest and waist and place the
patient near an open window
Ask the patient to breath through his or her mouth
Pinch the nose firmly between the thumb and the forefinger
CONTINUATION
A cold compress in the form of a handkerchief wrung out in iced water
can be applied over the bridge of the nose and at the back of the neck.
Keep the patient sitting very still
If the bleeding is very severe and does not stop within several minutes,
arrange how the patient will get to hospital.
Bleeding from a tooth socket
If a tooth has been extracted, it is possible for the socket to continue
bleeding.
First aid management
Fit a plug of gauze or cotton wool into the socket and ask the patient to
clench the teeth very firmly. The roughness of the gauze and pressure
on the bleeding vessels stop the bleeding in about ten minutes.
If bleeding does not cease, arrange the patients removal to hospital.
RESPIRATORY
DISORDERS
Asphyxia
Arises when one is not able to inhale or exhale air.
The body does not receive sufficient oxygen and there is accumulation
of carbon dioxide in the blood causing unconciousness,death or
suffocation
Causes of asphyxia
Occlusion or obstruction of the upper respiratory tract.
This may be due to:
1. Strangulation
2. Smothering with a pillow
3. Impaction of foreign body such as bone in the throat or a piece of
food inhaled into the larynx or trachea
4. Pressure on the chest e.g. by fallen masonry
5. Drowning
6. A complication of another condition such as swelling due to burning
of the mouth and throat
Continuation
 Paralysis of the muscles of respiration
Can be due to:
1. Electric shock
2. Being struck by lightening
3. Poisons e.g. strychnine and morphine
4. Diseases such as poliomyelitis
Continuation
Effects of certain gases
Include CO, ammonia and chlorine
Breathing in smoke
If someone has been trapped in a burning building
Signs and symptoms of
asphyxia
Difficulty in breathing, restlessness and agitation
The patient begins to struggle trying to remove the obstruction
Coughing and spluttering
Cyanosis occurs
If the patient struggles to overcome the asphyxiation, the face becomes
congested with blood ,neck veins become distended and the pupils dilate
If the individual does not struggle and appears to go to sleep, suspect CO
poisoning
Management of asphyxia
Remove the source of danger from the patient. For example a pillow
from the face and a bone from the throat. Or remove the patient from
the source of danger such as smoke or gas filled room or take the
patient out of the water in case of drowning.
Undo tight clothing round neck, chest and waist.
Continuation
Clear the mouth of any obstruction such as vomit as far as possible
If breathing and pulsation have ceased start CPR
In cold weather, keep the person reasonably warm.
CHOCKING
This is most common with children. A marble, a weed or a button may
get stuck in the air passage. In adults too, food may go down the wrong
way and cause choking.
Management in the case of an adult.
When victim is standing, the First Aider should stand behind the victim
and wrap his arms around the waist. Grasp the fist with your other hand
and place the thumb of the fist against the abdomen (belly) slightly
above the navel and below the rib cage.
Press your fist into the victim's abdomen with a quick upward thrust.
Repeat several times if necessary till the foreign body is expelled out of
the windpipe. When the victim is sitting, the First Aider stands behind
the chair and performs the same maneuver.
CONTINUATION
If the victim is lying, turn him supine (face up). Facing the victim, kneel
astride the victim's legs. With your hands one on top of another, place
the heel of your bottom hand over the abdomen (belly) between the
naval and the ribcage. Press into the victim's abdomen with a quick
upward thrust repeat several times, if necessary. Should the patient
vomit, place him on his side and wipe to prevent asphyxia. Following
the expulsion of food particle/foreign body it may be necessary to give
artificial respiration.
Management incase of an
infant
 Hold the child upside down by the legs and smack his/her back hard
three or four times.
If not successful, lay the child prone with his head hanging downwards
over the knee and give sharp smacks between shoulders.
If still not successful, induce vomiting by passing two fingers right to
the back of the throat.
DROWNING
Drowning is the result of complete immersion of the nose and mouth in
water (or any other liquid). Water enters the windpipe and lungs, clogging
the lungs completely.
Management
Aim
 To drain out water (or other matter) from lungs and to give artificial
respiration.
Act quickly. Remove the casualty from the water , seaweeds and mud
from the nose and throat. Start artificial ventilation immediately.
Turn the victim face down with head to one side and arms stretched
beyond his head. Infants or children could be held upside down for a short
period.
Continuation
Raise the middle part of the body with your hands round the belly. This
is to cause water to drain out of the lungs.
Give artificial respiration until breathing comes back to normal. This
may have to go on for as long as two hours.
Remove wet clothing.
Continuation
Keep the body warm, cover with blankets.
When victim becomes conscious, give hot drinks such as coffee or tea.
Do not allow him to sit up.
After doing the above, remove quickly to hospital as a stretcher case.
Hanging and Strangulation
Cut or remove the band constricting the throat.
If suspended, raise the body and loosen or cut the rope.
Give artificial respiration.
To do the above do not wait for the policeman.
INHALATION OF FUMES
Carbon monoxide poisoning
This gas is present in car-exhaust fumes, in household coal gas: during
incomplete combustion of charcoal stoves and in coal mines.
Management
The first aid treatment consists of removing the person from the area,
applying artificial respiration and giving pure oxygen, if available.
Ensure circulation of fresh air before entering the room by opening the
doors and windows.
Before entering the enclosed space take two or three deep breaths
and hold your breath as long as you can.
Continuation
Crawl along the floor (as the gas is lighter than air)
Remove the casualty as quickly as possible to fresh air.
Loosen his clothes at neck and waist and give artificial respiration, if
asphyxiated.
Carbon dioxide poisoning
This gas is found in coal mines, deep unused wells and sewers. Various
other gases such as leaking refrigerator gases; compressed gases used
for cooking and lighting may also cause suffocation.
Management
Observe all the precautions mentioned above.
Enter in an upright position (as the gas is heavier than air and collects
near the floor)
Continuation
Remove the casualty as quickly as possible to fresh air.
Wherever ventilation is not possible and deadly poisonous gas is
suspected, use a gas mask to protect yourself.
Hyperventilation
 Is the state of breathing faster or deeper than normal (hyperpnoea), causing
excessive expulsion of circulating carbon dioxide. This means that the arterial
concentration of CO2 tension is falling (Paco2) below normal (35–45 mmHg).
Causes
 Panic attack
 Metabolic acidosis, also known as Kenny's Syndrome,
 Yogic practice of Bhastrika.
It often occurs together with labored breathing, which, in contrast, can also be a
response to increased carbon dioxide levels.
Lung disease
Head injury
Stroke
Signs and symptoms
Numbness or tingling in the hands, feet and lips
Lightheadedness
Dizziness
Headache
Chest pain
Flexor spasm of hands and feet (carpopedal spasm)
Slurred speech
Nervous laughter
Fainting, particularly when accompanied by the Valsalva maneuver.
Continuation
The hyperventilation itself reduces the carbon
dioxide concentration of the blood to below its normal level because
one is expiring more carbon dioxide
than what is being produced in the body, thereby raising the blood's pH
value (making it more alkaline),
initiating constriction of the blood vessels which supply the brain, and
preventing the transport of oxygen and other molecules necessary for
the function of the
nervous system. At the same time, hypocapnia,causes a higher affinity
of oxygen to hemoglobin, known as
the Bohr effect, further reducing the amount of oxygen
that is made available to the brain.
Management
Call 911 if the person has:
Chest pain that is crushing or squeezing or feels like a heavy weight on the chest
Difficulty breathing
1. Reassure the Person
To help reduce anxiety.
2. Help the Person Relax Breathing
Have the person sit down and try these strategies:
Breathe through pursed lips as if blowing out a candle
Cover the mouth and one nostril and breathe only through the other nostril
Breathe slowly, taking 1 breath every 5 seconds
Take deep, slow breaths from the abdomen ("belly breathing")
. When to Get Medical Help
Go to a hospital emergency room if:
The person's symptoms don't get better after
several minutes.
Symptoms get worse or the person is in pain.
HICCUPS
Hiccups are sudden, involuntary spasmodic contractions of the
diaphragm and intercostals muscles. Irritation of the nerves from the
neck to the chest can cause hiccups. When these nerves are triggered, a
signal is sent to the nerve, which controls the diaphragm. The
diaphragm signals back to the hiccup center in the brain. Within a
second, a structure called the glottis closes off the windpipe, leading to
a rapid reduction in intrathoracic pressure, thereby producing the
characteristic sound of a hiccup.
CONTINUATION
Hiccups start suddenly, usually last for a few minutes and stop on their
own. However, hiccups can sometimes be a serious medical problem
due to their chronicity and underlying causes. Several serious underlying
diseases such as brain infection or tumor, lung tumor, pneumonia,
gastroesophageal reflux and heart attack are linked with hiccups and
should be investigated if the hiccups are persistent or associated with
weight loss.
Causes
 stretching of the stomach after rapid eating
drinking or swallowing air or fizzy drinks
indigestion due to eating hot and spicy food,
sudden change of air temperature,
 excess alcohol consumption or excess smoking.
Stress and emotional excitement.
Management
Hold the breath for few seconds.
Breathing deeply through the nose, then exhaling slowly through the mouth.
Place a teaspoon of dry granulated sugar on the back of the tongue and swallow it.
Press tongue hard against roof of mouth.
Drink slowly a glass filled with ice cubes and water (the rapid change of temperature in
the esophagus may stop the hiccup).
Bite a lemon or eat a piece of fresh ginger.
Drink plenty of water.
While sitting, lean forward and compress the chest and diaphragm against the knees.
Distraction from one’s hiccup such as being startled.
In babies, hiccups are usually stopped immediately by the suckling reflex, either by
breastfeeding or sucking a bottle teat or nipple.
MUSCULOSKELETAL INJURIES
STRAINS AND SPRAINS
Strain
Caused by forcible wrenching and stretching of the muscles, ligaments
and tendons which surround a joint
Sprain
Caused by forcible wrenching and stretching of the muscles, ligaments
and tendons which surround a joint and there is tearing of some of
these structures
Sprains and strains occur mostly at the ankle and the wrist
Signs and symptoms
Severe pain that increases in severity with any movement of the part
Marked tenderness over the site of injury and swelling
Bruising due to bleeding of the torn structures
If pain is severe, shock will be present and the patient may faint
Loss of power in part but not so marked as in a fracture
treatment
Expose the joint and apply firm pressure to it.
This can be done by surrounding the joint with a pad of cotton wool and
bandaging it firmly in position. If the pad is made wet with cold water,
this will help tighten it.
The area should be kept at rest
Arrange patients’ removal to hospital
Dislocations
A dislocation occurs when a bone or bones forming a joint become
displaced.
There is usually stretching or tearing of tendons and ligaments
Causes
Sudden impact to the joint following a blow, fall or any other trauma
Symptoms
Numbness or tingling at the joint or beyond it
intensely painful especially if you try to use the joint or bear weight on
it
Limited in movement
Swollen or bruised
Visibly out of place and discoloured
Management
Call 911 especially if the accident causing the injury is life threatening
If on the upper limb, apply a sling to support the part
If on the lower limb apply a splint
Arrange patient’s removal to hospital
Sublaxation
Is when one or more of the bones of your spine (vertebrae) move out of
position and create pressure on, or irritate spinal nerves. Spinal nerves are the
nerves that come out from between each of the bones in your spine. This
pressure or irritation on the nerves then causes those nerves to malfunction
and interfere with the signals traveling over those nerves.
symptoms
Pain, tenderness, soreness and stiffness in the neck and/or back
Headaches
Dizziness or balance problems
Spinal muscle spasms, tightness or weakness
Reduction in spinal mobility
Pain, numbness or tingling in the extremities
Joint pain or stiffness
Low energy
Poor overall health
Reduced ability to heal tissue
Management
pain medication
exercise
stretching
FRACTURES
Definition of a fracture
A fracture is a complete or partial breakage of the bone on account of
stress or high impact forces. People suffering from certain medical
conditions like osteoporosis and bone cancer are more prone to bone
fractures.
Types of fractures:
All fractures can be broadly classified into simple and compound
fractures.
A simple fracture is one where the skin remains intact. A compound
fracture on the other hand, also involves open wounds. Since open
injuries are prone to infection, compound fractures are more severe and
are susceptible to infection.
Fractures are further classified
into
Comminuted fracture
Produces multiple bone fragments.
It’s a simple fracture
Greenstick fracture
A split in a young immature bone. Common in children
It’s a simple fracture
Impacted fracture
The ends of the broken bone are pushed into one another and tightly
wedged together.
This can happen in a fracture of the shaft of the femur or when the
head of the femur is pushed into the acetabulum
Complicated fracture
Not only damage to the bone takes place but injury to internal organs
Examples of complicated fractures are
Fracture of the skull where the broken bone may press on the brain
Fracture of the vertebrae where the broken bones may be pressing on
and damaging the spinal cord.
Fracture of a rib where the broken bone may pierce the lung
Signs and symptoms of
fractures
There is history of some injury except in cases of pathological fractures
Pain at the site of the fracture. The pain is usually very severe and is
accentuated by movement
The area is tender and swollen
Bruising occurs due to damage and rupture of superficial blood vessels
Shock. When a bone is broken, there is rupturing of blood vessels in
the bone which leads to internal hemorrhage and this with the
presence of pain causes shock
Loss of function and power in the affected part
Irregularity in outline at the site of the fracture. There may be a gap in
the bone or a lump may be seen. In compound fractures a piece of bone
may pierce the skin.
If a limb bone is broken there may be deformity of the limb due to
displacement of the broken ends. The limb may be shorter due to over-
riding or it may lie at an unnatural angle. Over-riding occurs due to the
pull of strong muscles which pull the lower part of the bone over the
upper part
Management of fractures
Aims
To prevent a simple fracture becoming a compound fracture
To arrange patients removal to hospital
General principles of first aid
treatment for all fractures
1.Position
The patient should be kept lying down unless the particular fracture
makes this position unsuitable e.g. it is more convenient to have a
person with fracture of ribs sitting up on a chair
2.To prevent infection
Any wound should be covered immediately with a clean dressing.
3.To stop hemorrhage
4.To treat shock
Pain and hemorrhage predisposes to shock and should be treated
5.To immobilize the injured part
Are two methods: body splinting and mechanical splinting
6.To arrange transport to hospital
Management
Remember
Keep RICE in mind, as a first aid treatment for all fractures, sprains and
dislocations. RICE stands for Rest, Ice, Compression and Elevation.
Rest
Give plenty of rest to the immobilsed limb. Move it as little as possible
so that there is no strain.
Ice
Apply ice to the injured area. No heat treatment or massage should be
given. Use an ice pack or wrap up some ice cubes in a damp towel and
apply it to the injured area. You could also use anything frozen such as a
packet of frozen peas.
Do not massage the injured area, and don't apply any ointments like
Iodex.
Compression
Wrap up the injured area with a crepe bandage if possible, or use any
clean, fresh cloth available. Wrap it as tight as is comfortable. However,
ask the doctor before bandaging the area. This will relieve the pain
somewhat.
Elevation
The injured limb should preferably be raised above the level of the
heart. This could be done with the help of a pillow while sleeping.
Injuries of the chest
Fractures of the ribcage
Ribs may be fractured by direct force to the chest, from a blow or fall or
by indirect force produced in a crush injury
If the fracture is complicated by a penetrating wound, breathing may
be seriously impaired
Flail chest injuries
Cause paradoxical breathing resulting to severe respiratory difficulties.
Signs and symptoms
Sharp pain at the site of the fracture
Pain on taking a deep breath
Shallow breathing
Paradoxical breathing
An open wound over the fracture through which you might hear air being
sucked into the chest cavity
Treatment
Aims
To support the chest wall
To arrange removal to hospital
For open or multiple fractures
Immediately cover and seal any wounds to the chest wall. Use sterile dressing
and kitchen foil
Place the casualty in a half- sitting position with head, shoulders and body
turned towards the injured side. support the limb on the injured side on an
elevation sling
Dial 911.
If the Casualty becomes unconscious or breathing becomes difficult or noisy,
place him in the recovery position with the uninjured side uppermost
Penetrating chest wounds
1.PNEUMOTHORAX
Is an abnormal collection of air in the pleural space that separates the
lung from the chest wall and interferes with normal breathing
Types
Primary pneumothorax-occurs without an apparent cause and in the
absence of a significant lung disease
Secondary pneumothorax-occurs in the presence of an existing lung
pathology
Tension pneumothorax-the amount of air in the chest increases
markedly when a one way valve is formed by an area of damaged tissue.
Its a medical emergency.
Signs and symptoms
Difficult and painful breathing-rapid,shallow and uneven
An acute sense of alarm
Signs of shock
Coughed-up frothy red blood
Cyanosis
A cracking feeling of the skin around the site of the wound caused by
air collecting in the tissues
Blood bubbling out of the wound
The sound of air being sucked into the chest as the casualty breathes in
Treatment
Aims
To seal the wound and maintain breathing
To minimize shock
To arrange urgent removal to hospital
First aid
Immediately use the palm of your hand or if the casualty is conscious
his own hand to cover the wound
Place a sterile dressing or clean pad over the wound and surrounding
area. Cover with a plastic bag, foil or kitchen film. Secure it firmly so
that it doesn’t come out
Provide firm support to the most comfortable position
Call for help
Hemothorax
Definition
Hemothorax is a collection of blood in the space between the chest wall and the
lung (the pleural cavity).
Causes
The most common cause of hemothorax is chest trauma. It can also occur in
patients who have:
A defect of blood clotting
Death of lung tissue (pulmonary infarction)
Lung or pleural cancer
Placement of a central venous catheter
Thoracic or heart surgery
Tuberculosis
Signs and symptoms
Anxiety
Chest pain
Low blood pressure
Pale, cool and clammy skin
Rapid heart rate
Rapid, shallow breathing
Restlessness
Shortness of breath
Management
Call 911 if you have:
Chest pain or shortness of breath
Dizziness, fever, or a feeling of heaviness in your chest
Severe chest pain
Severe difficulty breathing
Management
Stop the bleeding
Prevent shock
Arrange patient transfer to hospital
Hydrothorax
Results from serous fluid accumulating in the pleural cavity. This
specific condition can be related to cirrhosis with ascites in which ascitic
fluid leaks into the pleural cavity. Hepatic hydrothorax is often difficult
to manage in end-stage liver failure and often fails to respond to
therapy.
Causes
 Cirrhosis. In cirrhosis of the liver, the liver function is declined by
scarring, nodule formation, and fibrosis, which are all the outcome
of the liver fixing itself after the damage created by alcoholism,
hepatitis B, and fatty-liver infection and other determinants. It is
unidentified exactly how cirrhosis of the liver directs to
hydrothorax, but it is accepted that the malfunction of the liver
causes an imbalance in the fluids of the body, and that excess can
display up in the lungs.
Causes
lung cancer
pleural cancer
pulmonary embolism
tuberculosis complications.
Signs and symptoms
anxiety
respiratory failure
restlessness
shortness of breath
tachycardia (rapid heart rate)
varying degrees of chest pain.
Management
Allow the person to adopt the most comfortable position that does not
hinder breathing
Evacuate the victim immediately
HEAD AND NECK INJURIES
A scalp wound may raise your suspicions but deeper underlying damage will
leave little visible evidence
CONCUSSION
Concussion is the sudden but short-lived loss of mental function that occurs
after a blow or other injury to the head. Concussion is the most common
but least serious type of brain injury.
It can safely be diagnosed once the casualty has completely recovered.
Signs and symptoms
brief loss of consciousness
memory loss
disturbances in vision, such as 'seeing stars‘
confusion
signs and symptoms
There may also be:
Dizziness or nausea on recovery
Loss of memory of events at the time of or immediately preceding the
injury
Mild generalized headache
Aims of treatment
To ensure that the casualty recovers fully and safely
If necessary, to seek medical aid
Treatment
Place an unconscious casualty in the recovery position. Monitor and
record breathing, pulse and level of response every ten minutes
If the casualty is unconscious after 3 minutes, suspect a more serious
injury
Call 911
If the casualty regains consciousness within 3 minutes, watch closely
for any deterioration in the level of response even after an apparent full
recovery
Place the casualty in the care of a responsible person
Advice the casualty to see his/her own doctor if headache, sickness or
tiredness occur after injury
Skull fracture
There may be brain damage
Germs that cause infection may enter the brain
CSF leaking from the ear or nose is a sign of serious injury and an entry
point for germs
Signs and symptoms
Wound or bruise on the head
A soft area or depression of the scalp
Impaired consciousness
Progressive deterioration in the level of response
Clear fluid or watery blood coming from the nose or ear
Blood in the white of the eye
Distortion of the head or face
Treatment
Aims
To resuscitate if necessary
To maintain an open airway
To arrange urgent removal to hospital
If unconcious,do ABC
Help a conscious casualty to lie down with the head and shoulders
raised. If there is discharge from an ear, position the casualty so that the
affected ear is lower. Cover the ear with a sterile dressing or clean pad
lightly secured with a bandage. Do not plug the ear
Control any bleeding from the scalp. Look for and treat other injuries
Call 911 for an ambulance
Monitor and record breathing, pulse and level of response every 10
minutes until help arrives.
Cerebral compression
It occurs when pressure is exerted on the brain within the skull e.g.by an
accumulation of blood or by swelling of an injured brain
Causes
Head injury
Skull fracture
Stroke
Infection
tumor
Can develop immediately after head injury or may be delayed for some
hours or even days
Signs and symptoms
Level of response deteriorates as the condition develops
A recent injury followed by an apparently full recovery. Later on the
casualty may deteriorate and become disoriented
Intense headache
Noisy breathing, becoming slow
A slow yet full and strong pulse
Unequal or dilated pupils
Weakness or paralysis down one side of the face or body
High temperature, flushed face
Drowsiness
Irritability
Treatment
Call for help
If unconscious…
If concious,support him or her in a comfortable position
Monitor and record breathing, pulse and level of response every ten
minutes
Convulsions
Consists of involuntary contractions of many of the muscles in the body
caused by a disturbance in the function of the brain
Result in loss of or impaired consciousness
Causes
Head injury
Shortage of oxygen to the brain
poisons
Continuation
Fevers in children
A feature of epilepsy
Minor epilepsy
Cause a brief blurring of consciousness like day dreaming. On recovery
the casualty may have lost thread of what he or she was doing
Signs and symptoms
Sudden ‘switching off'. The casualty stares blankly ahead
Slight or localized twitching or jerking of the lips,eyelids,head or limbs
Odd automatic movements such as lip- smacki ng,chewing or making
noises
Treatment
Aims
To protect the casualty until she is fully recovered
Help the casualty to sit down in a quiet place. Remove any possible
sources of harm
Reassure her/him
Do not pester with questions. Stay with her until you are sure she is
herself again
Major epilepsy
There is recurrent, major disturbances of brain activity resulting in
violent seizures(Tonic-clonic) and severe impairment of consciousness.
Can be sudden and dramatic but the casualty may have aura e.g. a
special smell or taste or a strange feeling
Signs and symptoms
Casualty suddenly falls unconsciousness often letting out a cry
He becomes rigid, arching his back(tonic phase)
Breathing may cease
Convulsive movements begin(clonic phase).The jaw may be clenched
and breathing may be noisy. May be loss of bladder and bowel control
The muscles relax and breathing become normal. The casualty
recovers within a few minutes. He may feel dazed or behave strangely in
a state of automatism being unaware of his actions. fit may be followed
by deep sleep.
There may be evidence of injury such as burns or scars from previous
fits
Treatment
Aims of treatment
To protect the casualty from injury while the fit
lasts
To provide care when consciousness has been
Regained
If you see the casualty falling try to support him or ease his falling. Make
space around him and ask bystanders to move away
Loosen clothing around his neck and protect his head
When convulsions cease place him in the recovery position. Check
breathing and pulse and be ready to resuscitate if necessary. Stay with
the casualty until he fully recovers
If he is unconscious for more than ten minutes or convulsing for more
than five, is having repeated fits or is unaware of his condition, call 911.
Note the next time and duration of a fit
Unconsciousness
Causes
Head injury
Stroke,fainting,heart attack, shock
Stroke,infections,tumours
Hypoxia,poisoning,hypoglycemia
Epilepsy, abnormal body temperature
Aims of treatment
To maintain an open airway
To assess and record the level of response
To treat any associated injuries
To arrange urgent removal to hospital if necessary
To gather and retain any circumstantial evidence of the cause of the
condition
Management
CAB and resuscitate if necessary
Control bleeding. Note and protect any suspected fractures
 look for less obvious injuries. Smell the casualty's breath and look for
needle marks. Ask bystanders for information
Place the casualty in the recovery position
If the casualty does not regain full consciousness within 3 minutes, call
for help
Continuation
Monitor and record breathing, pulse and level of response every ten
minutes using the observation chart
If the casualty regains full consciousness within 3 minutes as soon as
possible and remains well further ten minutes, advise her to see her
doctor
Types of neck injuries
Crick
A "crick" or "kink" is a term often used to describe the pain you wake
up with after sleeping with your neck in an awkward position. It may
also be due to working at the computer for long hours, or sudden
movements of the neck. "Crick in the neck" is not a medical diagnosis.
Usually a muscle spasm, arthritis or a disc problem is the real culprit. At-
home therapies can take care of a crick in the neck most of the time,
but if the pain lasts longer than a week or disrupts your usual activities,
get it checked by a doctor.
Neck sprain
Sprains are injuries to ligament. Neck sprains are often caused by falls
or sudden twists that overload or overstretch the joint. Another cause
is repeated stress to the joint. Symptoms include swelling, reduced
flexibility and pain. Sprains can be mild, moderate or severe.
 If you suspect someone in your environment has a severe neck injury
(of any kind), you should immobilize their spine and call 911
immediately. For minor and moderate sprains, rest and ice the area,
take an anti-inflammatory, and get it checked by a doctor.
Neck fracture
Is a break in a cervical bone. It may be caused by trauma, a fall or
degenerative changes in the spine.
The angle of force hitting the neck and the head's position at impact
often determine the type and severity of the break. Football players
who block with their head are at high risk. Elderly people with
osteoporosis are particularly at risk for neck fractures because their
bones are very fragile. The most serious neck fractures are generally
accompanied by a dislocation. Treatment depends on a lot of things
including your age, other medical conditions and extent of damage to
your spine. If a fracture destabilizes your neck, you may need to wear a
halo brace.
Management for Neck Injuries
What to Do - Or Not to Do
If someone has suffered a severe neck injury, call 911 for life support and
help.
Do not move the person, especially the head or neck unless failure to do so
presents an immediate threat or urgent danger.
Exceptions to Immobility
You can move a person with a possible neck injury when:
Not moving them would be an immediate threat to their life.
They are vomiting.
They are choking on blood.
You need to check for breathing and/or pulse so you can determine if they
need CPR.
keep their head and neck immobile and move their entire body as one
unit. Do the same if you need to roll them over. To roll a victim over, you
will need at least two people - one at the
victim's head and one at the feet.
After checking breathing and pulse, determine if CPR is necessary.
DO NOT NOT LIFT VICTIM'S HEAD BACK WHEN OPENING THEIR
AIRWAY TO ADMINISTER CPR.
Instead open the jaw by placing fingers on either side.
BURNS AND EXTREMES OF
TEMPERATURE
Types of burns
Dry burn
Scald
Electrical burn
Cold injury
Chemical burn
Radiation burn
Classification of burns
1.According to surface area
Uses a simple formula, the rule of nines
2.According to depth of burns
Adult
Anterior head 9%
Posterior head 9%
anterior torso 18%
Posterior torso 18%
Anterior leg each 9%
Posterior leg each 9%
Anterior arm each 4.5%
posterior arm each 4.5%
Genitalia/perineum 1%
According to depth of burns
1.Superficial burn
Involves only the outermost layer of the skin’
Characterized by redness, swelling and tenderness
Heals well if first aid is given promptly.
2.Partial-thickness burn
any one percent burn affecting layers of the epidermis giving rise to
rawness and blisters.
Can heal well but if but if they affect very large areas(over 60%),can be fatal
3.Full-thickness burns
All the three layers of the skin are burnt.
Damage to nerves, fat tissue and muscles present
The skin looks waxy, pale or charred
Urgent medical aid is essential
Management of minor burns
and scalds
Aims
To stop the burning
To relieve pain and swelling
To minimize the risk of infection
Flood the injured part with cold water for at least ten minutes to stop
the burning and relieve pain. If water is not available any cold harmless
liquid such as milk or canned drinks will do
Remove any jewellery,watches,belts or constricting clothing from the
injured area before it begins to swell
Cover the area with a sterile dressing, or any clean, non-fluffy material
and bandage loosely in place. A plastic bag or some kitchen film make
good temporary covering
Do not break blisters
Do not apply adhesive dressings or adhesive tape to the skin: the burn
may be more extensive
Do not apply lotions, ointments or fats to the injury. They further
damage the tissue and increase the risk of infection
Severe burns and scalds
Aims of treatment
To stop the burning and relieve pain
To maintain an open airway
To treat associated injuries
To minimize the risk of infection
To arrange removal to hospital
To gather relevant information for the
emergency services
Management
Lay the casualty down. Protect the burned area from contact with the
ground
Douse the burn with plenty of cold liquid. Thorough cooling may take
at least ten minutes.
While cooling the burn, watch for signs of DIB and be ready to
resuscitate if necessary
Remove any rings,watches,belts,shoes or shouldering clothing from
the injured area before it begins to swell
Cover the injury with a sterile dressing to protect it from infection. If
the burn is on the face, don't cover it. Keep cooling a facial injury with
water to relieve pain until help arrives
Gather and record details of the casualty's injury, circumstances and
potential hazards such as gas
While waiting for help, reassure the casualty and treat for shock
Burns to the Airway
Signs and symptoms
Soot around the nose and mouth
Singeing of the nasal hairs
Redness, swelling or actual burning of the tongue
Damaged skin around the mouth
Hoarseness of the voice
Breathing difficulties
Aims and treatment
To obtain specialist medical aid as quickly as possible
To maintain an open airway
Call for help
Loosen tight clothing around his neck, give oxygen if available
Reassure the casualty for him/her to stay calm
Electrical burns
Causes
Lightning strike
Low or high voltage current
Aims of treatment
To treat the burn and the shock
To arrange removal of the casualty to hospital
Treatment
Make sure that contact with the electrical source is broken
If unconcious,resuscitate if necessary
Flood the sites of injury with plenty of cold water to cool the burns and
cut away any burnt clothing if necessary
Place a sterile dressing, a clean folded triangular bandage or some
clean non-fluffy material over the burns
Call for help
Reassure the casualty and treat for shock
Chemical burns
If possible note the name or brand name of the substance
Sign and symptoms
Evidence of chemicals in the vicinity
Intense stinging pain
Later,discolouration,blistering,peeling and swelling of the affected area
Treatment
Aims
To disperse the harmful chemical
To arrange transport to hospital
To make the area safe and inform relevant
Authority
Make the area safe. Ventilate the area, seal the chemical container.
Remove the casualty from the area if necessary
Flood the affected area with water to disperse the chemical and to
stop the burning. Do this for at least 20 minutes
Gently remove contaminated clothing while flooding the injury
Take or send casualty to hospital. Note and pass any information about
the chemical to the medical personell.If at work place notify the local
safety officer or emergency services
Chemical burns to the eye
Chemicals result in scarring and even blindness
Signs and symptoms
 intense pain in the eye
Inability to open the injured eye
Redness and swelling round the eye
Copious watering of the eye
Evidence of chemical substances or containers in the immediate area
Ask the casualty to hold a sterile eye pad over the injured eye. If some
time elapse elapses before the casualty receives medical attention,
bandage the pad loosely in position
Arrange casualty's removal to hospital
Sunburn
Aims
To move the casualty out of the sun
To relieve discomfort and pain
Cover the casualty's skin with light clothing or towel. Help her into the
shade or preferably indoors
Cool her skin by sponging with cold water or by soaking the affected
area in a cold water bath for ten minutes. If there is extensive blistering
or other skin damage, seek medical advice
Give her frequent sips of cold water. If the burns are mild, calamine or
an after-sun preparation may sooth them
EFFECTS OF HEAT AND COLD
First Aid Priorities
Remove or protect the casualty from excessively hot or cold
surroundings
Restore normal body temperature
Obtain appropriate medical attention
Effects of Extreme Cold
Frost bite
Hypothermia
Effects of Extreme Heat
Heat exhaustion
Heatstroke
Bites and Stings
First Aid Priorities
Make sure that you are in no danger, then remove the casualty from
further danger
Treat visible wounds or painful symptoms. Minimize the risk of further
injury and infection
Obtain medical attention if necessary
Note time and nature of injury. Identify the attacking creature. This
facilitates specific management and anticipation of complications such
as anaphylactic reactions.
Animal Bites
Aims of treatment
To control bleeding
To minimize the risk of infection
To obtain medical attention
For serious wounds
Control bleeding by applying direct pressure and raising the injured
part
Cover the wound with a sterile dressing or a clean pad bandaged in
place
Arrange patient’s removal to hospital
For superficial bites
Wash the wound thoroughly with soap and warm water
Pat the wound dry with clean gauze swabs and cover with an adhesive
dressing or a small sterile dressing
Advice the casualty to see a doctor incase inoculation is needed
Insect Stings
Bee, wasp and hornet stings are painful rather than dangerous
Aims of treatment
To relieve swelling and pain
To remove to hospital if necessary
For a sting in the skin
If the casualty shows signs of anaphylactic shock, call 911
If the sting is in the wound, pluck it out firmly with fine tweezers
Apply a cold compress to relieve pain and minimize swelling. Advice
the casualty to see a doctor if the pain and swelling persist
For a sting in the mouth
Give the casualty ice to suck or cold water to sip to minimize the
swelling
Call for help.
Reassure the casualty
Marine Stings
Aims of treatment
To reassure the casualty
To inactivate stinging cells before they release their venom and to
neutralize any free venom
To relieve pain and discomfort
Reassure the casualty and sit him or her down. Pour copious amounts
of vinegar or sea water over the injury to incapacitate stinging cells that
have not yet released venom
Alcohol may aggravate the injury and should not be used
Avoid rubbing sand on the affected area
Dust a dry powder over the skin around the affected area to make any
remaining stinging cells stick together. You can use talcum powder or
meat tenderiser.Meat tenderiser contains papain which inactivates
venom
Gently brush off the powder with a clean, non-fluffy pad
If severe call for help
Marine Puncture Wounds
Aims
To inactivate the venom
To obtain medical aid
Put the injured part in water as hot as the casualty can bear for at least
30 minutes. Top up the water as it cools being careful not to scald the
casualty
Take or send the casualty to hospital where spines remaining in the
skin may have to be removed
Snake Bites
The only poisonous snake native to mainland Britain is the adder
Aims of treatment
To reassure the casualty
To prevent the spread of the venom
To arrange urgent removal of the casualty to hospital
Lay the casualty down. Tell her to keep calm and still
Wash the wound well and pat dry with clean swabs. Call 911.
Do not apply a torniquet,slash the wound with a knife or suck out the
venom
Lightly compress the limb above the wound with a roller
bandage.Immobilise the injury
If she stops breathing, be ready to resuscitate
BANDAGING
Definition of a bandage
A strip of material mainly used to support and immobilize a part of the
body
USES
To support-fractured bone
To immobilize-dislocated shoulder/jaw
To apply pressure-stop bleeding and improve venous blood flow
To secure a dressing in place
To retain splints in place
PRINCIPLES AND PROCEDURES FOR APPLYING BANDAGES
Wash hands and wear gloves when necessary
Assist victim to assume a comfortable position on bed or on chair and
support the body part to be bandaged.
Always stand infront of the part/victim to be bandaged except when
applying a bandage to the head, eye and ear
Be sure the bandage is rolled firm
Make sure the body part to be bandaged is clean and dry
Assess skin before applying bandage for any breakdown
Observe circulation by noting pulse, surface temperature, skin color
and sensation of the body part to be wrapped
Always start bandaging from inner to outer aspect and far to near end
When bandaging a joint, ensure flexibility of the joint except if
immobilization of joint is required
Cover the area two inches above and two inches below the affected
area
Overlap turns and slightly stretch the bandage
Cover 2/3 of the previous turn
Where possible, leave fingertips or toe tips exposed for
observation(adequacy of circulation)
End the bandage on the outer side of the body. Do not end a bandage
on wound or at the back of the body
TYPES OF BANDAGES
Triangular
Could be used on many parts of the body to support and immobilize
Crape bandage
Type of woven gauze which has the quality of stretching
Gauze/cotton bandage
Lightly woven cotton material. Frequently used to retain dressings on
wounds on fingers,hands,toes,feet,ears,eyes and head
Adhesive bandage
Used to retain dressing and also used where application of pressure to
an area is required
METHODS OF APPLYING BANDAGES
Circular
Spiral
Reverse spiral
Figure of eight
CIRCULAR TURN
Used to anchor bandages and to terminate bandages
Apply the end of the bandage to the part of the body to be bandaged
Encircle the body part a few a few times or as needed, each turn
directly covering the previous turn
Secure the end of the bandage with tapes, metal clips or a safety pin
over an uninjured area
SPIRAL TURN
Bandage cylindrical parts of the body that are fairly uniform in
circumference such as the upper arm or leg
Make two circular turns to begin the bandage
Continue spiral turns at about a 30 degree angle, each turn
overlapping the preceding one by 2/3 the width of the bandage
Terminate the bandage with two circular turns and secure the end as
described for circular turns
SPIRAL REVERSE TURN
Begin with two circular turns and bring the bandage upward at about a
30 degree angle
Place the thumb of the free hand on the upper edge of the bandage
The thumb will hold the bandage while it is folded on itself
Unroll the bandage about 4-6 and turn the hand so that the bandage is
folded down
Terminate the bandage with two circular turns and secure the end as
described for circular turns
FIGURE EIGHT TURN
Applied on ankle, knee and joint
Begin the bandage with two circular turns
Carry the bandage above the joint, around it and then below it. Make a
figure 8.Continue above and below the joint, overlapping the previous
turn by 2/3 the width of the bandage
Terminate the bandage above the joint with two circular turns and
secure the end appropriately

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.First aid notes_

  • 2. CourseOutline Introduction oDefinition of First Aid oAims of First Aid oSteps of First Aid oGiving artificial ventilation oGiving chest compressions
  • 4. Wounds and Bleeding oDefinition oFirst aid oTypes of wounds oTypes of bleeding -severe external bleeding -bleeding at special sites -wounds to the palm
  • 5. RESPIRATORY DISORDERS oAsphyxia oChocking oDrowning oHanging and strangulation oInhalation of fumes oHyperventilation oHiccups
  • 7. HEAD AND NECK INJURIES oConcussion oSkull fracture oCerebral compression oConvulsions oEpilepsy oUnconciousness oTypes of neck injuries
  • 8. BURNS AND EXTREMES OF TEMPERATURE oClassification oTypes oManagement
  • 9. BITES AND STINGS oAnimal bites oInsect stings oMarine stings oMarine puncture wounds oSnake bites BANDAGING
  • 10. dEFINITION First Aid is the initial assistance or treatment given to someone who is injured or suddenly taken ill First Aid is the immediate care of an injured or suddenly sick person. It is the care a person applies as soon as possible after an accident or sudden illness
  • 11. This prompt care and attention prior to the arrival of the ambulance can sometimes mean the difference between life and death or between a full or partial recovery
  • 12. AimsofFirstAid Preserve life This includes the life of the casualty, bystander and rescuer ABC of resuscitation Protect the casualty from further harm Ensure the scene is safe Provide pain relief/promote recovery This could include the use of ice packs or simply applying a sling
  • 13. (a bandage used to suspend or support an injured part of the body) Prevent the injury or illness from becoming worse Ensure the treatment you provide does not make the condition worse
  • 14. Provide reassurance It is important to understand that first aid has its limitations and does not take the place of professional medical treatment
  • 15. ObjectivesofFirstAid To preserve life To alleviate suffering To promote recovery To prevent aggravation of the injury or illness until veterinary assistance can be obtained
  • 16. Definition of terms First Aider A person who offers emergency care to the casualty(ies) Victim/casualty A person suffering from a sudden injury or trauma or illness and needs first aid
  • 17. Emergency An unexpected incidence serious in nature that requires quick action,e.g poisoning, burns etc Scene An area on incident Incident It’s a happening traumatic in nature that requires first aid(it could be illness or injury)
  • 18. The First Aider Qualities Highly trained i.e. have necessary knowledge Examined and regularly re-examined Have empathy and understanding Are up-to-date in knowledge and skill Have initiative and sense of leadership Have ability to act quickly, make decisions and improvise
  • 19. Appreciate that the less interference the better Responsibilities of a First Aider To assess the situation quickly and safely and to summon appropriate help To protect casualties and others at the scene from possible danger To identify as far as possible the injury or nature of illness affecting a casualty
  • 20. To give each casualty early and appropriate treatment, treating the most serious conditions first To arrange how the casualty will get to hospital or to his/her home To remain with the casualty until appropriate care is available To report his/her observations to those taking care of the casualty and to give further assistance if required
  • 21. To prevent cross infection between yourself and the casualty as much as possible Protecting the casualty To prevent/avoid cross-infection when giving first aid you should: Avoid contact with body fluids Wash your hands Wear protective gloves If gloves are unavailable, life saving treatment must still be available
  • 22. First Aid Priorities Assess the situation Observe what has happened quickly and calmly Look for danger to yourself and to the casualty Make the area safe Protect the casualty from danger Beware of your limitations
  • 23. Assess all casualties and give emergency first aid Assess each casualty to determine treatment priorities and treat those with life threatening conditions first. Get help Quickly ensure that any necessary specialist help has been summoned and is on the way
  • 24. Assignment: General Rules of First Aid Treatment Triaging This is sorting and classifying injured patients to determine priority of need The most critical are taken care of first Direct assistance to casualties is given by the casualty nurse
  • 25. The mnemonic START is used. S-Simple T-Triaging A-And R-Rapid T-Treatment
  • 26. BasicsofFirstAid Basic First Aid refers to the initial process of assessing and addressing the needs of someone who has been injured or is in physiological distress due to chocking, a heart attack, allergic reactions,drugs,alcohol or other medical emergencies
  • 27. 1.Evaluate the situation Are there things that might put you at risk of harm? Are you or the victim threatened by fire, toxic smoke or gases, an unstable building, live electrical wires or other dangerous scenario? Do not rush into a situation where you could end up as a victim yourself
  • 28. If approaching the victim will endanger your life, seek professional help immediately; they have higher levels of training and know how to handle this situations 2.Remember your A,B,C. The A,B,C refer to the three critical things you need to look out for Airway-Does the person have an obstructed airway?
  • 29. Breathing-Is the person breathing Circulation-Does the person show a pulse at major pulse points(wrist, carotid artery and groin)
  • 30. 3.Avoid moving the victim Avoid moving the victim unless they are in immediate danger. Moving a victim will make the injury worse especially in cases of spinal cord injuries 4.Call emergency services/call for help or tell someone else(a specific person if possible) to call for help as soon as possible
  • 31. If you are the only person on the scene, try to establish breathing before calling for help and do not leave the victim alone for an extensive amount of time 5.Determine responsiveness If a person is unconscious, try to rouse them by gently shaking and speaking to them
  • 32. 6.If the person remains unresponsive, carefully roll them onto their back and open his/her airway Keep head and neck aligned Carefully roll them onto their back while holding his head Open the airway by lifting the chin
  • 33. 7.Look,listen and feel for signs of breathing Look for the victims chest to rise and fall, listen for sounds of breathing(place your ear near the nose and mouth and feel for breath on your cheek) If the victim is not breathing, check for circulation
  • 34. If the victim is breathing but unconcious,roll them onto their side, keeping the head and neck aligned with the body. This will help drain the mouth and prevent the tongue or vomit from blocking the airway 8.Check victims circulation Look at the victims color and check for pulse(the carotid artery is a good option, its located on either side of the neck below the jaw bone)
  • 35. If the victim does not have pulse, start CPR(Cardiopulmonary resuscitation) 9.Treat bleeding, shock or other problems as needed After you have established that the victim is breathing and has a pulse, your next priority should be to control any bleeding Stop bleeding by applying direct pressure
  • 36. 10.Stay with the victim until help arrives Be a calming presence for the victim until assistance arrives If the victim is not breathing Follow this steps to restore breathing in an unconscious victim This steps assume you have already performed the chin lift described above
  • 37. oCheck for a clear airway: Remove any obvious blockage oCover the victims mouth with your own(kiss of life) oPinch the victims nose closed oFill victims lungs with two slow breaths. If breaths are blocked, reposition the airway. Make sure the head is tilted slightly back and the tongue is not obstructing it.
  • 38. oIf breaths are still blocked, give 5 quick forceful abdominal thrusts. This is the equivalent of Heimlich maneuver in a standing person. Straddle the victim Place a fist just above the belly button and below the breast bone Thrust upward to expel air from the lungs
  • 39. Sweep the mouth to remove any foreign object Try two slow breaths Repeat until you are successful in clearing the object from the windpipe o With open airway begin rescue breathing. Give one breath every 5 seconds and check that the chest rises every time o Administer CPR if the victim does not have a pulse until help arrives
  • 40. How to do CPR on an adult Check the scene for immediate danger Make sure you are not putting yourself in danger/harm by administering CPR to someone unconscious. Is there fire? Is the person lying on a roadway? do whatever is necessary to move yourself and the other person to safety. You can open a window, turn off the stove or put out the fire if possible.
  • 41. However, if there is nothing you can do to counteract the danger, move the victim. The best way to move the victim is by placing a blanket or coat underneath their back and dragging it Assess the victims consciousness Gently tap his/her shoulder and ask: Are you ok’ in a loud clear voice. If he/she responds,CPR is not required
  • 42. If the victim does not respond, continue with the following steps Send for help Send someone to call for emergency services. Give the dispatcher your location and notify him or her that you are going to perform CPR.If you are alone, get off the phone and start compressions.
  • 43. If you have someone else with you, have him or her stay on the line while you do CPR on the victim Check for breathing Put your ear close to the victims nose and mouth and listen for breathing. If the victim is coughing or breathing normally, DON’T perform CPR.Doing so could cause the heart to stop beating
  • 44. Place the victim on his/her back and make sure he/she is lying flat as possible. This will prevent injury while doing the chest compressions Place the heel of one hand on the victims breastbone, exactly between the nipples Place your second hand on top of the first hand palms down
  • 45. Position your body directly over your hands so that your arms are straight and somewhat rigid Perform 30 chest compressions Press down with both hands directly over the breastbone to perform a compression which helps the heart beat Chest compressions are more critical for correcting abnormal heart rhythms.
  • 46. some of the abnormal heart rhythms include ventricular fibrillation and pulseless ventricular tachycardia You should depress the breastbone approximately 4-5cm(1.5-2 inches) Minimize pauses in chest compressions Attempt to limit interruptions to less than 10 seconds
  • 47. Make sure the airway is open. Place two fingers under the point of casualty's chin, lift the jaw. At the same time, place your other hand on the casualty's and gently tilt the head well back If you suspect a neck injury, pull the jaw forward rather than chin lifting. If jaw thrust fails to open the airway, do a careful head tilt and chin lift
  • 48. If there are no signs of life, place a breathing barrier(if available) over the victims mouth Give two rescue breaths Keeping the airway open, take the fingers that were on the forehead and pinch the victims nose closed. Make a seal with your mouth over the victims mouth and breath out for about one second. Breath slowly to ensure air goes in the lungs and not the stomach
  • 49. If the breath goes in, you should see the chest slightly rise and also feel it go in. Give a second rescue breath If the breath does not go in, reposition the head and try again. If it does not go in again, the victim may be chocking Repeat the cycle of 30 chest compressions and 2 rescue breath. Do CPR for 2 minutes(5 cycles) before checking for signs of life.
  • 50. Continue CPR until someone takes over, emergency personnel arrive, you are too exhausted to continue, an AED(automated external defibrillator) is available for immediate use or signs of life return. AED is used to jumpstart the victims heart
  • 51. How to use an AED Make sure there are no paddles or standing water in the immediate area Turn on the AED.It should have voice prompts that tell you what to do Fully expose the victims chest. Remove any metal necklaces or underwire bras Check foe any body piercings or evidence that the victim has a pacemaker(should be indicated by a medical bracelet)
  • 52. Make sure the the chest is absolutely dry Attach sticky pads with electrodes to the victims chest. Move the pads at least one inch(2.5 cm) away from the metal piercings or implanted devices Press analyze on the AED machine. If a shock is needed it will notify you If you do shock the victim, make sure no one is touching him/her Remove the electrode pads and resume CPR for other 5 cycles before using the AED again
  • 53. First Aid Steps Before attending to a casualty, you must survey the whole scene Your first responsibility is to make that the area is safe Where the danger is too imminent or great, you may need to move the casualty even at risk of aggravating injury Only when the casualty is safe can you begin to treat illness and injury
  • 54. Ensure personal safety so that you don’t become a casualty Send for help 1)ASSESSMENT When safe to do so, quickly perform a brief examination of the casualty. This is to check for any life threatening conditions that need urgency and to preserve life
  • 55. You do assessment before making a full diagnosis and if necessary, be prepared to carry out appropriate steps to resuscitate the casualty first i)Check consciousness If casualty does not respond when spoken to, he might be unconscious. Try to elicit a response and be careful not to move the head or tilt the neck
  • 56. ii)Open the airway An unconscious casualty’s airway may be blocked by the tongue falling back. Open airway by tilting the head back iii)Check for breathing Once airway is open, establish whether the casualty is breathing, if not, place in recovery position. Give artificial breaths
  • 57. iv)Check for circulation If the heart is beating, you should be able to feel a pulse in the neck(carotid pulse) or wrist(radial pulse). For the babies, check brachial pulse v)Check for bleeding Severe loss of blood reduces circulation to the vital organs and can cause shock
  • 58. Control serious bleeding as soon as breathing and pulse have been established As soon as you establish the condition of the casualty, take action depending on Unconcious,not breathing and without pulse Unconcious,not breathing and with a pulse
  • 59. Unconcious,breathing and with a pulse 2.DIAGNOSIS Requires thorough physical examination Made on the basis of history and clues to any medical condition and signs and symptoms Circumstances will determine how detailed the examination will be
  • 60. History Is full story of how the incident happened, how the injury was sustained or how the illness began and continued including any previous conditions Question the casualty but if he is unconscious, talk to any witness(es).They give useful information but can be unreliable if upset
  • 61. Take into account When the casualty last had something to eat or drink Whether the casualty has any illness or is taking any medication The amount of force involved and how it was applied to the body The environment e.g. hot and stuffy, cold room or exposed to wind or rain
  • 62. Casualty's age and state of health e.g a young fit adult who trips may sprain a wrist but an elderly lady who does the same is more likely to have broken her arm or hip Establish who the casualty is and where he/she lives
  • 63. External clues If casualty is unable to co-operate or is unconscious, look through pockets and bags for clues(Beware of syringes if you suspect drug abuse) There may be an appointment card for hospital or clinic or a card indicating history of allergy,diabetes,epilepsy etc Medication carried by casualty may give valuable clues about the emergency e.g. glyceryl trinitrate for angina,phenytoin for epilepsy and inhalers for asthmatics or angina patients
  • 64. Take care of any such clue and return it to the casualty Signs and symptoms i) Symptoms verbalized by the casualty Pain,anxiety,heat,cold,loss of normal movement, loss of sensation,thirst,nausea,tingling,faintness,stiffness,memory loss,dizziness,sensation of broken bone
  • 65. ii)Signs you may see Anxiety and painful expression, unusual chest movement,burns,sweating,wounds,bleeding from orifices, response to touch, response to speech,bruising,abnormal skin colour,muscle spasm,swelling,deformity,foreign bodies, needle marks,vomit,incontinence,containers and other circumstantial evidence
  • 66. iii)Signs that you may feel Dumpness,abnormal body temperature,swelling,a deformity, abnormal pulse, grating bone ends iv)Signs that you may hear Noisy or distressed breathing,groaning,response to speech, grating bone ends(crepitus)
  • 67. v)Signs that you may smell from patients breath Acetone,alcohol,solvents or glue, cannabis Examining a casualty Do a head to toe examination Run your hands carefully over the scalp to feel for bleeding, swelling or depression that may indicate possible fracture
  • 68. Be careful not to move any casualty who you feel/think might have injured her/his neck Speak clearly to the casualty and check for response. Check for blood or clear fluid discharge from the ears or a mixture of both. It could a sign of intracranial damage
  • 69. Examine both eyes, noting if open. size of the pupil. Are the pupils reacting to light(should shrink when light falls on it),foreign bodies, blood or bruising in the whites of the eyes. Examine the nose Record the rate, depth and nature of breathing. Note any odor on breath, check the mouth, open airway, look for any wounds or lost teeth and examine lips for burns
  • 70. Note the color, temperature and state of the skin. If its pale, flushed or cyanosed. Is it hot, dry or dump.Pale,cold and sweaty skin suggest shock, a flushed hot face suggests heat stroke or fever. Blue skin(cyanosis)-look for it at the lips, ears and face Loosen clothing around the neck and check for a tracheostomy tube.
  • 71. Palpate the spine from the base of the skull downwards without disturbing/moving the patient. Check for any swelling, tenderness or any other irregularity. Ask the patient to breath deeply and check if the chest expands evenly, easily and equally on both sides. Feel the rib cage for any deformities,irregularity,tenderness or granting sensation on breathing
  • 72. Feel along the collar bones and the shoulder for any deformity, irregularity or tenderness Check the movements of elbows, wrists and fingers. Ask the casualty to bend and straighten the arm at the joints. Check for any abnormal sensation at he limbs and note color
  • 73. If there is any sign of impairment of movement or loss of sensation in the limbs, do not move the casualty to examine the spine. Gently pass your hand under the hollow of the back and feel along the spine without disturbing without disturbing the casualty checking for swelling and tenderness
  • 74. Gently feel the front of the abdomen for evidence of bleeding and to identify any rigidity or tenderness of the muscular wall Feel both sides of the hips and gently move the pelvis to look for signs of fracture. Note any incontinence or bleeding from orifices
  • 75. Ask the casualty to raise each leg in turn and to move her ankles and knees. Look and feel for bleeding, swelling or any other deformity and tenderness Check movement and feeling in all toes. Also color
  • 76. Treatment and aftercare Treat each condition methodically and calmly in order of priority Re-assure the casualty and listen to them. Don't keep questioning the casualty and do not let people crowd around Avoid moving the casualty unnecessarily
  • 77. Treatment priorities Follow ABCs Maintain clear airway and breathing. If unconcious,place in recovery position Control bleeding Treat large wounds and burns Immobilize bone and joint injuries Give appropriate treatment for other injuries and conditions Check airway, breathing and pulse regularly and deal with any problem immediately.
  • 78. Arranging appropriate aftercare Ascertain whether casualty needs medical treatment and if so, what is needed. If you require help send someone else if possible, in the event that the casualty's condition alters or worsens. Stay with the casualty until help arrives According to your assessment of the casualty, you may:
  • 79. Call a doctor/senior nurse for advise Call an ambulance or arrange transport to hospital Pass care of the casualty to a doctor, nurse or ambulance crew Take the casualty to a nearby house or shelter to await medical help Allow the casualty to go home accompanied if possible
  • 80. Ask if somebody will be at least home to meet him/her or you can arrange this Advice the casualty to see a doctor Do not allow home a casualty who has been unconscious(other than a faint),had severe breathing difficulty or signs of shock. Stay with him or her until help arrives
  • 81. Do not give anything by mouth to any casualty who may have internal injuries or otherwise need hospital care Passing on information Having summoned medical aid, make notes on the incident and the condition of the casualty so that you can pass on all the information you have gathered
  • 82. The observation chart overleaf will enable you to not tour observations such as breathing, level of response at a ten minute interval Make a brief written report to accompany your observations
  • 83. Your report should include: The casualty's name and address History of the accident or illness A brief description of any injuries Any unusual behavior Any treatment given and when Breathing, pulse and level of response
  • 84. RESUSCITATION TECHNIQUES RESUSCITATION SEQUENCE Check response Open airway Check breathing Assess for circulation Commence CPR
  • 85. Assignment: resuscitation for children <1 year 1-7 years 8 years and above
  • 87. 1.SHOCK A shock state exists when the tissue perfusion decreases to the point of cellular metabolic dysfunction. Shock is classified according to the causative event.
  • 88. Types of shock 1.Hematogenic/hemorrhagic/hypovolemic Occurs when blood volume is insufficient to meet metabolic needs of the tissues as with severe hemorrhage. 2.Cardiogenic shock Occurs when cardiac failure results in decreased tissue perfusion as in MI. 3.Distributive shock conditions Characterized by displacement of a significant amount of vascular volume.
  • 89. Types of distributive shock 1.Neurogenic shock Results from a neurologic event such as head injury that causes massive vasodilatation and decreased perfusion pressures. 2.Anaphylactic shock Caused by a severe systemic response to an allergen resulting in massive vasodilatation, increased capillary permeability, decreased perfusion, decreased venous return and subsequent decreased cardiac output. 3.Septic shock Occurs when bacterial toxins cause an overwhelming systemic infection.
  • 90. Circulatory shock The circulatory system distributes blood round the body so that oxygen and nutrients can pass through and perfuse the tissues. When the system fails, circulatory shock ensue. If not treated swiftly, vital organs such as the heart and the brain may fail leading to death. Worsened by fear and pain.
  • 91. Causes of circulatory shock 1.Heart attack 2.Severe infection and anaphylactic shock-blood vessels dilate reducing the blood pressure 3.Blood loss 4.Loss of body fluids through burns, severe diarrhea or vomiting -The body responds to fluid loss initially by diverting the blood supply from the surface to the vital organs.
  • 92. continuation As the brain’s oxygen supply weakens Restless, anxious and aggressive Air hunger-yawn and gasp for air Unconscious Heart stops
  • 93. Signs and symptoms At first, the release of adrenaline causes A rapid pulse Pale,grey-blue skin especially inside the lips. Sweating, cold and clammy skin. As shock develops Weakness and giddiness Nausea and vomiting Thirst Rapid shallow breathing A weak thready pulse. When the pulse at the wrist disappears, about half the blood volume will have been lost.
  • 94. Treatment AIMS To recognize shock To treat any obvious cause To improve the blood supply to the brain, heart and lungs To arrange removal to hospital
  • 95. Treatment Treat any cause of shock you identify such as external bleeding. Lay the casualty down on a blanket to protect her from the cold ground keeping her head low. Raise and support her legs to improve the blood supply to the vital organs. Take care if you suspect a fracture. Loosen tight clothing such as belts and braces to reduce constriction at the neck, chest or waist.  keep the casualty warm by covering her with coats and blankets. Check and record breathing, pulse and the level of response. Be ready to resuscitate if necessary.
  • 96. 2.FAINTING/SYNCOPE Is a brief loss of consciousness that is caused by temporary reduction of blood flow to the brain. The pulse becomes very slow although it soon picks up and returns to normal. Recovery is rapid and complete.
  • 97. Signs and symptoms A brief loss of consciousness causing causing the casualty to fall to the floor. Slow pulse Pale cold skin Sweating
  • 98. Aims of treatment To improve blood flow to the brain To reassure as she recovers and make her comfortable
  • 99. Treatment Lay the casualty down, raise and support her legs Make sure that she has plenty of fresh air As she recovers, reassure her and help her sit up gradually Look for and treat any injury that has been sustained through falling If she does not regain consciousness quickly, do ABC and be ready to resuscitate if necessary. If the patient starts to feel faint again tell her to lie down and raise and support her legs until she fully recovers.
  • 100. 3.ANGINA PECTORIS Its constriction of the chest and describes the pain that a person experiences when narrowed coronary arteries are unable to deliver sufficient blood to the heart muscle to meet the demands of exertion or excitement. The pain is relieved by rest.
  • 101. Signs and symptoms Gripping central chest pain, spreading often to the jaw and down to the left arm Shortness of breath Weakness-sudden and extreme Anxiety
  • 102. TREATMENT Aims To ease strain on the heart by ensuring that the casualty rests To obtain medical help if necessary Actual treatment Help the casualty to sit down. make her comfortable and reassure her. If the casualty has medicine for angina such as tablets or a “puffer” aerosol let her administer it herself. If necessary help her to take it.
  • 103. continuation Encourage the casualty to rest and keep bystanders away. The attack should ease within a few minutes. If the pain persists or returns suspect a heart attack. Dial 999 for an ambulance. Monitor and record breathing and pulse rates every ten minutes.
  • 104. 4.HEART ATTACK Occurs when the blood supply to part of the heart muscle is suddenly obstructed e.g. coronary thrombosis The main risk is that the heart will stop. The effect of the heart attack depends on how much of the muscle is affected. Drugs that aid recovery include thrombolytic (dissolve the clot) and asprin (thins the blood).
  • 105. Signs and symptoms Persistent central chest pain spreading to the jaw and down to the left arm. Unlike angina pectoris the pain does not ease once the casualty is at rest and may occur at rest. Breathlessness and discomfort high in the abdomen. Sudden faintness or giddiness A sense of impending doom ‘’Ashen” skin and blueness at the lips Rapid weak irregular pulse Sudden collapse
  • 106. Aims of treatment To minimize the work of the heart To summon urgent medical help and arrange removal to hospital treatment Put the patient on a half sitting position, with the casualty’s head and shoulders well supported and his knees bent Call for help and state that you suspect a heart attack Constantly monitor and record the casualty’s breathing and pulse rate and be prepared to resuscitate if necessary If the casualty has medicine for angina(“puffer "aerosol) help him take it if he has. If the pain persists and the casualty is fully conscious give him one tablet of ordinary aspirin to chew
  • 107. 5.ACUTE HEART FAILURE The heart muscle is strained and fatigued e.g. following coronary thrombosis and becomes increasingly inefficient. Acute attacks may occur at night Signs and symptoms Similar to heart attack Treatment Follow the treatment for heart attack
  • 108. 6.CARDIAC ARREST Sudden stoppage of the heart. Its characterized by the absence of pulse and breathing. You must commence resuscitation immediately. Causes Heart attack Severe blood loss Suffocation Electric shock Anaphylactic shock Hypothermia
  • 109. Signs and symptoms Absence of pulse Absence of breathing Aims of treatment To arrange urgent removal to hospital. To keep the heart muscle and brain supplied with oxygen until help arrives. Treatment Begin CPR
  • 111. Introduction Definition of wound Its any abnormal break in the skin or the body surface. Wounds can be daunting if there is a lot of bleeding but prompt action is needed to reduce blood loss and shock.
  • 112. FIRST AID PRIORITIES Control blood loss by applying pressure over the wound and raising the injured part Take steps to minimize shock Cover any open wound with a dressing to protect it from infection and promote natural healing Observe hygiene to prevent cross infection between the casualty and yourself
  • 113. Types of Wound 1.Incised wound A clean cut from a sharp edge such as broken glass such as broken glass causes an incision. The blood vessels at the wound edges are cut straight across so there may be profuse bleeding. 2.Laceration Crushing or ripping forces result in rough tears or lacerations. Bleed less profusely than clean-cut wounds but there is more tissue damage and bruising. they are often contaminated by germs. The risk of infection is high.
  • 114. Types of wounds 3.Abrasion(graze) This is a superficial wound in which the top layers of the skin are scraped off, leaving a raw, tender area. Caused by a sliding fall or a friction burn. They can contain embedded foreign particles that may result in infection.
  • 115. 4.Contusion(bruise) A blunt blow or punch can rupture capillaries beneath the skin. Blood then leaks into the tissues causing bruising. The skin splits occasionally. Severe contusion may indicate deeper, hidden damage such as fracture or internal injury.
  • 116. Types of wounds 5.Puncture wound Standing on a nail or being stabbed. Has small entry site but a deep track of internal damage. Germs and dirt can be carried far into the body and therefore the risk of infection is high. 6.Gunshot wound A bullet or other missile may drive into or through the body causing serious internal injury and sucking in contaminants from the air. The entry wound may be small and neat while the exit wound may be large and ragged.
  • 117. Types of bleeding Classified by the type of blood vessel that is damaged:artery,vein or capillary. Arterial bleeding can be very dramatic but copious venous bleeding is potentially more serious. 1.Arterial bleeding Richly oxygenated blood is bright red. Under pressure from the heart, it spurts from a wound in time with the heart beat. A severed main artery may jet blood several feet high and rapidly reduce the volume of circulating blood.
  • 118. Types of bleeding 2.Venous bleeding Venous blood is dark red. Its under less pressure. Vein walls are capable of great distension and therefore blood can pool within them. Blood from a severed major vein may gush profusely. 3.Capillary bleeding Occurs at the site of all wounds. At first may be brisk but blood loss is usually slight. A blunt blow may rupture capillaries under the skin causing bleeding under the skin causing bleeding into the tissues(bruise)
  • 119. Severe external bleeding Bleeding at the face or neck can impede the airway. Shock is likely to happen and the casualty may loose consciousness. Aims of treatment To control the bleeding To prevent and minimize the effects of shock To minimize the risk of infection To arrange urgent removal of the casualty to hospital.
  • 120. Treatment 1.Remove or cut clothing to expose the wound. Watch out for sharp objects such as glass that may injure you. 2.Apply direct pressure over the wound with your fingers or palm preferably over a sterile dressing or clean pad. Do not waste time hunting for a dressing. If you cannot apply direct pressure e.g. if an object is protruding, press down firmly on either side.
  • 121. Treatment 3.Raise and support the injured limb above the level of the casualty’s heart. 4.Lay the casualty down. This will reduce blood flow to the site of the injury and minimize shock. 5.Leaving any original pad in place, apply a sterile dressing. Bandage it in place firmly but not so tightly as to impede circulation. If blood seeps through the dressing, bandage another firmly over the top. If there is a protruding foreign body, build up padding on either side of the object until high enough to bandage over the object without pressing on it.
  • 122. Continuation 6.Secure and support the injured part with bandaging 7.Call for help. Treat shock, check dressing for seepage and check for circulation beyond the bandage.
  • 123. BLEEDING AT SPECIAL SITES Scalp and Head Wounds Aims of treatment To control blood loss To arrange transport to hospital Actual treatment Wearing disposable gloves, if possible replace any displaced skin flaps. Apply firm direct pressure over a sterile dressing or clean pad.
  • 124. Secure the dressing with a roller bandage. Lay the casualty down with head and shoulders slightly raised. If he becomes unconcious,ABC. Take or send the casualty to hospital in the final treatment position.
  • 125. Wounds To The Palm Aims of treatment To control blood loss To arrange transport to hospital Treatment Press a sterile dressing or clean pad firmly into the palm and ask the casualty to clench his fist over it. If he finds it difficult to press hard, he may grasp the fist with his uninjured hand. Bandage the casualty’s fingers so that they are clenched over the pad. Tie the knot over his fingers Support the casualty’s arm in an elevation sling and take him or send him to hospital.
  • 126. Wounds At Joint Creases Aims of treatment To control blood loss To arrange transport to hospital Treatment Press a clean pad over the injury. Bend the joint as firmly as possible With the joint firmly bent to press on the pad, raise the limb. Lay the casualty down to reduce shock Take or send the casualty to hospital in the treatment position. Release the pressure briefly every ten minutes to restore normal blood flow.
  • 127. Bleeding Varicose Veins A varicose vein has taut, thin walls and is often raised stretching the skin to give a characteristic ”knobbly” appearance. It can burst by gentle knocks and will bleed profusely. Aims of treatment To control blood loss To arrange urgent removal to hospital To minimize shock
  • 128. Treatment Lay the casualty on her back and raise the injured leg to reduce or stop bleeding Expose the site of bleeding and apply firm direct pressure over sterile dressing or clean pad with a securing bandage or with your fingers until bleeding is controlled. Remove garments such as garters or elastic- topped stockings that may be impeding blood flow back to the heart. Put a large soft pad over the dressing. It should exert even pressure yet not impede blood flow. Keep the injured leg raised and supported until the ambulance arrives.
  • 129. MAJOR WOUNDS Cause serious internal injury without severe external bleeding esp. trunk wounds.
  • 130. 1.Abdominal Wounds Severity is evident in external bleeding and protruding abdominal contents. There could be hidden internal injury and bleeding The risk of infection and shock is high Treatment Aims To minimize the risk of infection To minimize shock To arrange urgent removal to hospital
  • 131. Treatment Lay the casualty down on a firm surface. Loosen any tight clothing Put a large dressing over the wound and secure it lightly in place with a bandage. If part of the intestine is protruding, do not touch it but cover with a plastic bag or kitchen film to prevent it from drying out. Alternatively use a sterile dressing. Call for help. If casualty becomes unconscious, do ABC.
  • 132. INTERNAL HAEMORRHAGE Its of great importance that any first aid worker takes prompt action. Management Rest and quiet The patient must be laid down lying flat and kept absolutely still. If the patient is allowed to move about in any way, there is danger of further bleeding Reassurance Reassure the casualty as he or she will be anxious and possibly afraid Position If possible the lower end of the bed or couch can be raised. This Facilitates the flow of blood by gravity to the brain and may prevent fainting or unconsciousness
  • 133. continuation Clothing Undo tight clothing round the neck, chest or waist. This helps the patient to breath more easily and prevent the feeling of suffocation. Medical aid Alert the EMS or arrange patient’s removal to hospital.Ensure minimal movement of the casualty when handling him or her.
  • 134. Epistaxis Its bleeding from the nose. Can be severe or slight. Management Place the patient on a chair in a sitting position with the head held forward. In severe bleeding this will prevent the blood flowing to the back of the nose and throat an may prevent it from being swallowed or inhaled. Loosen tight clothing round the neck, chest and waist and place the patient near an open window Ask the patient to breath through his or her mouth Pinch the nose firmly between the thumb and the forefinger
  • 135. CONTINUATION A cold compress in the form of a handkerchief wrung out in iced water can be applied over the bridge of the nose and at the back of the neck. Keep the patient sitting very still If the bleeding is very severe and does not stop within several minutes, arrange how the patient will get to hospital.
  • 136. Bleeding from a tooth socket If a tooth has been extracted, it is possible for the socket to continue bleeding. First aid management Fit a plug of gauze or cotton wool into the socket and ask the patient to clench the teeth very firmly. The roughness of the gauze and pressure on the bleeding vessels stop the bleeding in about ten minutes. If bleeding does not cease, arrange the patients removal to hospital.
  • 138. Asphyxia Arises when one is not able to inhale or exhale air. The body does not receive sufficient oxygen and there is accumulation of carbon dioxide in the blood causing unconciousness,death or suffocation
  • 139. Causes of asphyxia Occlusion or obstruction of the upper respiratory tract. This may be due to: 1. Strangulation 2. Smothering with a pillow 3. Impaction of foreign body such as bone in the throat or a piece of food inhaled into the larynx or trachea 4. Pressure on the chest e.g. by fallen masonry 5. Drowning 6. A complication of another condition such as swelling due to burning of the mouth and throat
  • 140. Continuation  Paralysis of the muscles of respiration Can be due to: 1. Electric shock 2. Being struck by lightening 3. Poisons e.g. strychnine and morphine 4. Diseases such as poliomyelitis
  • 141. Continuation Effects of certain gases Include CO, ammonia and chlorine Breathing in smoke If someone has been trapped in a burning building
  • 142. Signs and symptoms of asphyxia Difficulty in breathing, restlessness and agitation The patient begins to struggle trying to remove the obstruction Coughing and spluttering Cyanosis occurs If the patient struggles to overcome the asphyxiation, the face becomes congested with blood ,neck veins become distended and the pupils dilate If the individual does not struggle and appears to go to sleep, suspect CO poisoning
  • 143. Management of asphyxia Remove the source of danger from the patient. For example a pillow from the face and a bone from the throat. Or remove the patient from the source of danger such as smoke or gas filled room or take the patient out of the water in case of drowning. Undo tight clothing round neck, chest and waist.
  • 144. Continuation Clear the mouth of any obstruction such as vomit as far as possible If breathing and pulsation have ceased start CPR In cold weather, keep the person reasonably warm.
  • 145. CHOCKING This is most common with children. A marble, a weed or a button may get stuck in the air passage. In adults too, food may go down the wrong way and cause choking. Management in the case of an adult. When victim is standing, the First Aider should stand behind the victim and wrap his arms around the waist. Grasp the fist with your other hand and place the thumb of the fist against the abdomen (belly) slightly above the navel and below the rib cage. Press your fist into the victim's abdomen with a quick upward thrust. Repeat several times if necessary till the foreign body is expelled out of the windpipe. When the victim is sitting, the First Aider stands behind the chair and performs the same maneuver.
  • 146. CONTINUATION If the victim is lying, turn him supine (face up). Facing the victim, kneel astride the victim's legs. With your hands one on top of another, place the heel of your bottom hand over the abdomen (belly) between the naval and the ribcage. Press into the victim's abdomen with a quick upward thrust repeat several times, if necessary. Should the patient vomit, place him on his side and wipe to prevent asphyxia. Following the expulsion of food particle/foreign body it may be necessary to give artificial respiration.
  • 147. Management incase of an infant  Hold the child upside down by the legs and smack his/her back hard three or four times. If not successful, lay the child prone with his head hanging downwards over the knee and give sharp smacks between shoulders. If still not successful, induce vomiting by passing two fingers right to the back of the throat.
  • 148. DROWNING Drowning is the result of complete immersion of the nose and mouth in water (or any other liquid). Water enters the windpipe and lungs, clogging the lungs completely. Management Aim  To drain out water (or other matter) from lungs and to give artificial respiration. Act quickly. Remove the casualty from the water , seaweeds and mud from the nose and throat. Start artificial ventilation immediately. Turn the victim face down with head to one side and arms stretched beyond his head. Infants or children could be held upside down for a short period.
  • 149. Continuation Raise the middle part of the body with your hands round the belly. This is to cause water to drain out of the lungs. Give artificial respiration until breathing comes back to normal. This may have to go on for as long as two hours. Remove wet clothing.
  • 150. Continuation Keep the body warm, cover with blankets. When victim becomes conscious, give hot drinks such as coffee or tea. Do not allow him to sit up. After doing the above, remove quickly to hospital as a stretcher case.
  • 151. Hanging and Strangulation Cut or remove the band constricting the throat. If suspended, raise the body and loosen or cut the rope. Give artificial respiration. To do the above do not wait for the policeman.
  • 152. INHALATION OF FUMES Carbon monoxide poisoning This gas is present in car-exhaust fumes, in household coal gas: during incomplete combustion of charcoal stoves and in coal mines. Management The first aid treatment consists of removing the person from the area, applying artificial respiration and giving pure oxygen, if available. Ensure circulation of fresh air before entering the room by opening the doors and windows. Before entering the enclosed space take two or three deep breaths and hold your breath as long as you can.
  • 153. Continuation Crawl along the floor (as the gas is lighter than air) Remove the casualty as quickly as possible to fresh air. Loosen his clothes at neck and waist and give artificial respiration, if asphyxiated.
  • 154. Carbon dioxide poisoning This gas is found in coal mines, deep unused wells and sewers. Various other gases such as leaking refrigerator gases; compressed gases used for cooking and lighting may also cause suffocation. Management Observe all the precautions mentioned above. Enter in an upright position (as the gas is heavier than air and collects near the floor)
  • 155. Continuation Remove the casualty as quickly as possible to fresh air. Wherever ventilation is not possible and deadly poisonous gas is suspected, use a gas mask to protect yourself.
  • 156. Hyperventilation  Is the state of breathing faster or deeper than normal (hyperpnoea), causing excessive expulsion of circulating carbon dioxide. This means that the arterial concentration of CO2 tension is falling (Paco2) below normal (35–45 mmHg). Causes  Panic attack  Metabolic acidosis, also known as Kenny's Syndrome,  Yogic practice of Bhastrika. It often occurs together with labored breathing, which, in contrast, can also be a response to increased carbon dioxide levels. Lung disease Head injury Stroke
  • 157. Signs and symptoms Numbness or tingling in the hands, feet and lips Lightheadedness Dizziness Headache Chest pain Flexor spasm of hands and feet (carpopedal spasm) Slurred speech Nervous laughter Fainting, particularly when accompanied by the Valsalva maneuver.
  • 158. Continuation The hyperventilation itself reduces the carbon dioxide concentration of the blood to below its normal level because one is expiring more carbon dioxide than what is being produced in the body, thereby raising the blood's pH value (making it more alkaline), initiating constriction of the blood vessels which supply the brain, and preventing the transport of oxygen and other molecules necessary for the function of the nervous system. At the same time, hypocapnia,causes a higher affinity of oxygen to hemoglobin, known as the Bohr effect, further reducing the amount of oxygen that is made available to the brain.
  • 159. Management Call 911 if the person has: Chest pain that is crushing or squeezing or feels like a heavy weight on the chest Difficulty breathing 1. Reassure the Person To help reduce anxiety. 2. Help the Person Relax Breathing Have the person sit down and try these strategies: Breathe through pursed lips as if blowing out a candle Cover the mouth and one nostril and breathe only through the other nostril Breathe slowly, taking 1 breath every 5 seconds Take deep, slow breaths from the abdomen ("belly breathing")
  • 160. . When to Get Medical Help Go to a hospital emergency room if: The person's symptoms don't get better after several minutes. Symptoms get worse or the person is in pain.
  • 161. HICCUPS Hiccups are sudden, involuntary spasmodic contractions of the diaphragm and intercostals muscles. Irritation of the nerves from the neck to the chest can cause hiccups. When these nerves are triggered, a signal is sent to the nerve, which controls the diaphragm. The diaphragm signals back to the hiccup center in the brain. Within a second, a structure called the glottis closes off the windpipe, leading to a rapid reduction in intrathoracic pressure, thereby producing the characteristic sound of a hiccup.
  • 162. CONTINUATION Hiccups start suddenly, usually last for a few minutes and stop on their own. However, hiccups can sometimes be a serious medical problem due to their chronicity and underlying causes. Several serious underlying diseases such as brain infection or tumor, lung tumor, pneumonia, gastroesophageal reflux and heart attack are linked with hiccups and should be investigated if the hiccups are persistent or associated with weight loss.
  • 163. Causes  stretching of the stomach after rapid eating drinking or swallowing air or fizzy drinks indigestion due to eating hot and spicy food, sudden change of air temperature,  excess alcohol consumption or excess smoking. Stress and emotional excitement.
  • 164. Management Hold the breath for few seconds. Breathing deeply through the nose, then exhaling slowly through the mouth. Place a teaspoon of dry granulated sugar on the back of the tongue and swallow it. Press tongue hard against roof of mouth. Drink slowly a glass filled with ice cubes and water (the rapid change of temperature in the esophagus may stop the hiccup). Bite a lemon or eat a piece of fresh ginger. Drink plenty of water. While sitting, lean forward and compress the chest and diaphragm against the knees. Distraction from one’s hiccup such as being startled. In babies, hiccups are usually stopped immediately by the suckling reflex, either by breastfeeding or sucking a bottle teat or nipple.
  • 165. MUSCULOSKELETAL INJURIES STRAINS AND SPRAINS Strain Caused by forcible wrenching and stretching of the muscles, ligaments and tendons which surround a joint Sprain Caused by forcible wrenching and stretching of the muscles, ligaments and tendons which surround a joint and there is tearing of some of these structures Sprains and strains occur mostly at the ankle and the wrist
  • 166. Signs and symptoms Severe pain that increases in severity with any movement of the part Marked tenderness over the site of injury and swelling Bruising due to bleeding of the torn structures If pain is severe, shock will be present and the patient may faint Loss of power in part but not so marked as in a fracture
  • 167. treatment Expose the joint and apply firm pressure to it. This can be done by surrounding the joint with a pad of cotton wool and bandaging it firmly in position. If the pad is made wet with cold water, this will help tighten it. The area should be kept at rest Arrange patients’ removal to hospital
  • 168. Dislocations A dislocation occurs when a bone or bones forming a joint become displaced. There is usually stretching or tearing of tendons and ligaments Causes Sudden impact to the joint following a blow, fall or any other trauma
  • 169. Symptoms Numbness or tingling at the joint or beyond it intensely painful especially if you try to use the joint or bear weight on it Limited in movement Swollen or bruised Visibly out of place and discoloured
  • 170. Management Call 911 especially if the accident causing the injury is life threatening If on the upper limb, apply a sling to support the part If on the lower limb apply a splint Arrange patient’s removal to hospital
  • 171. Sublaxation Is when one or more of the bones of your spine (vertebrae) move out of position and create pressure on, or irritate spinal nerves. Spinal nerves are the nerves that come out from between each of the bones in your spine. This pressure or irritation on the nerves then causes those nerves to malfunction and interfere with the signals traveling over those nerves.
  • 172. symptoms Pain, tenderness, soreness and stiffness in the neck and/or back Headaches Dizziness or balance problems Spinal muscle spasms, tightness or weakness Reduction in spinal mobility Pain, numbness or tingling in the extremities Joint pain or stiffness Low energy Poor overall health Reduced ability to heal tissue
  • 174. FRACTURES Definition of a fracture A fracture is a complete or partial breakage of the bone on account of stress or high impact forces. People suffering from certain medical conditions like osteoporosis and bone cancer are more prone to bone fractures. Types of fractures: All fractures can be broadly classified into simple and compound fractures. A simple fracture is one where the skin remains intact. A compound fracture on the other hand, also involves open wounds. Since open injuries are prone to infection, compound fractures are more severe and are susceptible to infection.
  • 175. Fractures are further classified into Comminuted fracture Produces multiple bone fragments. It’s a simple fracture Greenstick fracture A split in a young immature bone. Common in children It’s a simple fracture
  • 176. Impacted fracture The ends of the broken bone are pushed into one another and tightly wedged together. This can happen in a fracture of the shaft of the femur or when the head of the femur is pushed into the acetabulum
  • 177. Complicated fracture Not only damage to the bone takes place but injury to internal organs Examples of complicated fractures are Fracture of the skull where the broken bone may press on the brain Fracture of the vertebrae where the broken bones may be pressing on and damaging the spinal cord. Fracture of a rib where the broken bone may pierce the lung
  • 178. Signs and symptoms of fractures There is history of some injury except in cases of pathological fractures Pain at the site of the fracture. The pain is usually very severe and is accentuated by movement The area is tender and swollen Bruising occurs due to damage and rupture of superficial blood vessels Shock. When a bone is broken, there is rupturing of blood vessels in the bone which leads to internal hemorrhage and this with the presence of pain causes shock
  • 179. Loss of function and power in the affected part Irregularity in outline at the site of the fracture. There may be a gap in the bone or a lump may be seen. In compound fractures a piece of bone may pierce the skin. If a limb bone is broken there may be deformity of the limb due to displacement of the broken ends. The limb may be shorter due to over- riding or it may lie at an unnatural angle. Over-riding occurs due to the pull of strong muscles which pull the lower part of the bone over the upper part
  • 180. Management of fractures Aims To prevent a simple fracture becoming a compound fracture To arrange patients removal to hospital
  • 181. General principles of first aid treatment for all fractures 1.Position The patient should be kept lying down unless the particular fracture makes this position unsuitable e.g. it is more convenient to have a person with fracture of ribs sitting up on a chair 2.To prevent infection Any wound should be covered immediately with a clean dressing.
  • 182. 3.To stop hemorrhage 4.To treat shock Pain and hemorrhage predisposes to shock and should be treated 5.To immobilize the injured part Are two methods: body splinting and mechanical splinting 6.To arrange transport to hospital
  • 183. Management Remember Keep RICE in mind, as a first aid treatment for all fractures, sprains and dislocations. RICE stands for Rest, Ice, Compression and Elevation. Rest Give plenty of rest to the immobilsed limb. Move it as little as possible so that there is no strain. Ice Apply ice to the injured area. No heat treatment or massage should be given. Use an ice pack or wrap up some ice cubes in a damp towel and apply it to the injured area. You could also use anything frozen such as a packet of frozen peas. Do not massage the injured area, and don't apply any ointments like Iodex.
  • 184. Compression Wrap up the injured area with a crepe bandage if possible, or use any clean, fresh cloth available. Wrap it as tight as is comfortable. However, ask the doctor before bandaging the area. This will relieve the pain somewhat. Elevation The injured limb should preferably be raised above the level of the heart. This could be done with the help of a pillow while sleeping.
  • 185. Injuries of the chest Fractures of the ribcage Ribs may be fractured by direct force to the chest, from a blow or fall or by indirect force produced in a crush injury If the fracture is complicated by a penetrating wound, breathing may be seriously impaired
  • 186. Flail chest injuries Cause paradoxical breathing resulting to severe respiratory difficulties. Signs and symptoms Sharp pain at the site of the fracture Pain on taking a deep breath Shallow breathing Paradoxical breathing An open wound over the fracture through which you might hear air being sucked into the chest cavity
  • 187. Treatment Aims To support the chest wall To arrange removal to hospital For open or multiple fractures Immediately cover and seal any wounds to the chest wall. Use sterile dressing and kitchen foil Place the casualty in a half- sitting position with head, shoulders and body turned towards the injured side. support the limb on the injured side on an elevation sling Dial 911. If the Casualty becomes unconscious or breathing becomes difficult or noisy, place him in the recovery position with the uninjured side uppermost
  • 188. Penetrating chest wounds 1.PNEUMOTHORAX Is an abnormal collection of air in the pleural space that separates the lung from the chest wall and interferes with normal breathing Types Primary pneumothorax-occurs without an apparent cause and in the absence of a significant lung disease
  • 189. Secondary pneumothorax-occurs in the presence of an existing lung pathology Tension pneumothorax-the amount of air in the chest increases markedly when a one way valve is formed by an area of damaged tissue. Its a medical emergency.
  • 190. Signs and symptoms Difficult and painful breathing-rapid,shallow and uneven An acute sense of alarm Signs of shock Coughed-up frothy red blood Cyanosis A cracking feeling of the skin around the site of the wound caused by air collecting in the tissues Blood bubbling out of the wound The sound of air being sucked into the chest as the casualty breathes in
  • 191. Treatment Aims To seal the wound and maintain breathing To minimize shock To arrange urgent removal to hospital
  • 192. First aid Immediately use the palm of your hand or if the casualty is conscious his own hand to cover the wound Place a sterile dressing or clean pad over the wound and surrounding area. Cover with a plastic bag, foil or kitchen film. Secure it firmly so that it doesn’t come out Provide firm support to the most comfortable position Call for help
  • 193. Hemothorax Definition Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity). Causes The most common cause of hemothorax is chest trauma. It can also occur in patients who have: A defect of blood clotting Death of lung tissue (pulmonary infarction) Lung or pleural cancer Placement of a central venous catheter Thoracic or heart surgery Tuberculosis
  • 194. Signs and symptoms Anxiety Chest pain Low blood pressure Pale, cool and clammy skin Rapid heart rate Rapid, shallow breathing Restlessness Shortness of breath
  • 195. Management Call 911 if you have: Chest pain or shortness of breath Dizziness, fever, or a feeling of heaviness in your chest Severe chest pain Severe difficulty breathing
  • 196. Management Stop the bleeding Prevent shock Arrange patient transfer to hospital
  • 197. Hydrothorax Results from serous fluid accumulating in the pleural cavity. This specific condition can be related to cirrhosis with ascites in which ascitic fluid leaks into the pleural cavity. Hepatic hydrothorax is often difficult to manage in end-stage liver failure and often fails to respond to therapy.
  • 198. Causes  Cirrhosis. In cirrhosis of the liver, the liver function is declined by scarring, nodule formation, and fibrosis, which are all the outcome of the liver fixing itself after the damage created by alcoholism, hepatitis B, and fatty-liver infection and other determinants. It is unidentified exactly how cirrhosis of the liver directs to hydrothorax, but it is accepted that the malfunction of the liver causes an imbalance in the fluids of the body, and that excess can display up in the lungs.
  • 199. Causes lung cancer pleural cancer pulmonary embolism tuberculosis complications.
  • 200. Signs and symptoms anxiety respiratory failure restlessness shortness of breath tachycardia (rapid heart rate) varying degrees of chest pain.
  • 201. Management Allow the person to adopt the most comfortable position that does not hinder breathing Evacuate the victim immediately
  • 202. HEAD AND NECK INJURIES A scalp wound may raise your suspicions but deeper underlying damage will leave little visible evidence CONCUSSION Concussion is the sudden but short-lived loss of mental function that occurs after a blow or other injury to the head. Concussion is the most common but least serious type of brain injury. It can safely be diagnosed once the casualty has completely recovered.
  • 203. Signs and symptoms brief loss of consciousness memory loss disturbances in vision, such as 'seeing stars‘ confusion
  • 204. signs and symptoms There may also be: Dizziness or nausea on recovery Loss of memory of events at the time of or immediately preceding the injury Mild generalized headache
  • 205. Aims of treatment To ensure that the casualty recovers fully and safely If necessary, to seek medical aid
  • 206. Treatment Place an unconscious casualty in the recovery position. Monitor and record breathing, pulse and level of response every ten minutes If the casualty is unconscious after 3 minutes, suspect a more serious injury Call 911 If the casualty regains consciousness within 3 minutes, watch closely for any deterioration in the level of response even after an apparent full recovery
  • 207. Place the casualty in the care of a responsible person Advice the casualty to see his/her own doctor if headache, sickness or tiredness occur after injury
  • 208. Skull fracture There may be brain damage Germs that cause infection may enter the brain CSF leaking from the ear or nose is a sign of serious injury and an entry point for germs
  • 209. Signs and symptoms Wound or bruise on the head A soft area or depression of the scalp Impaired consciousness Progressive deterioration in the level of response Clear fluid or watery blood coming from the nose or ear Blood in the white of the eye Distortion of the head or face
  • 210. Treatment Aims To resuscitate if necessary To maintain an open airway To arrange urgent removal to hospital If unconcious,do ABC Help a conscious casualty to lie down with the head and shoulders raised. If there is discharge from an ear, position the casualty so that the affected ear is lower. Cover the ear with a sterile dressing or clean pad lightly secured with a bandage. Do not plug the ear
  • 211. Control any bleeding from the scalp. Look for and treat other injuries Call 911 for an ambulance Monitor and record breathing, pulse and level of response every 10 minutes until help arrives.
  • 212. Cerebral compression It occurs when pressure is exerted on the brain within the skull e.g.by an accumulation of blood or by swelling of an injured brain Causes Head injury Skull fracture Stroke Infection tumor
  • 213. Can develop immediately after head injury or may be delayed for some hours or even days Signs and symptoms Level of response deteriorates as the condition develops A recent injury followed by an apparently full recovery. Later on the casualty may deteriorate and become disoriented Intense headache Noisy breathing, becoming slow
  • 214. A slow yet full and strong pulse Unequal or dilated pupils Weakness or paralysis down one side of the face or body High temperature, flushed face Drowsiness Irritability
  • 215. Treatment Call for help If unconscious… If concious,support him or her in a comfortable position Monitor and record breathing, pulse and level of response every ten minutes
  • 216. Convulsions Consists of involuntary contractions of many of the muscles in the body caused by a disturbance in the function of the brain Result in loss of or impaired consciousness Causes Head injury Shortage of oxygen to the brain poisons
  • 217. Continuation Fevers in children A feature of epilepsy Minor epilepsy Cause a brief blurring of consciousness like day dreaming. On recovery the casualty may have lost thread of what he or she was doing
  • 218. Signs and symptoms Sudden ‘switching off'. The casualty stares blankly ahead Slight or localized twitching or jerking of the lips,eyelids,head or limbs Odd automatic movements such as lip- smacki ng,chewing or making noises
  • 219. Treatment Aims To protect the casualty until she is fully recovered Help the casualty to sit down in a quiet place. Remove any possible sources of harm Reassure her/him Do not pester with questions. Stay with her until you are sure she is herself again
  • 220. Major epilepsy There is recurrent, major disturbances of brain activity resulting in violent seizures(Tonic-clonic) and severe impairment of consciousness. Can be sudden and dramatic but the casualty may have aura e.g. a special smell or taste or a strange feeling
  • 221. Signs and symptoms Casualty suddenly falls unconsciousness often letting out a cry He becomes rigid, arching his back(tonic phase) Breathing may cease Convulsive movements begin(clonic phase).The jaw may be clenched and breathing may be noisy. May be loss of bladder and bowel control The muscles relax and breathing become normal. The casualty recovers within a few minutes. He may feel dazed or behave strangely in a state of automatism being unaware of his actions. fit may be followed by deep sleep. There may be evidence of injury such as burns or scars from previous fits
  • 222. Treatment Aims of treatment To protect the casualty from injury while the fit lasts To provide care when consciousness has been Regained If you see the casualty falling try to support him or ease his falling. Make space around him and ask bystanders to move away
  • 223. Loosen clothing around his neck and protect his head When convulsions cease place him in the recovery position. Check breathing and pulse and be ready to resuscitate if necessary. Stay with the casualty until he fully recovers If he is unconscious for more than ten minutes or convulsing for more than five, is having repeated fits or is unaware of his condition, call 911. Note the next time and duration of a fit
  • 224. Unconsciousness Causes Head injury Stroke,fainting,heart attack, shock Stroke,infections,tumours Hypoxia,poisoning,hypoglycemia Epilepsy, abnormal body temperature
  • 225. Aims of treatment To maintain an open airway To assess and record the level of response To treat any associated injuries To arrange urgent removal to hospital if necessary To gather and retain any circumstantial evidence of the cause of the condition
  • 226. Management CAB and resuscitate if necessary Control bleeding. Note and protect any suspected fractures  look for less obvious injuries. Smell the casualty's breath and look for needle marks. Ask bystanders for information Place the casualty in the recovery position If the casualty does not regain full consciousness within 3 minutes, call for help
  • 227. Continuation Monitor and record breathing, pulse and level of response every ten minutes using the observation chart If the casualty regains full consciousness within 3 minutes as soon as possible and remains well further ten minutes, advise her to see her doctor
  • 228. Types of neck injuries Crick A "crick" or "kink" is a term often used to describe the pain you wake up with after sleeping with your neck in an awkward position. It may also be due to working at the computer for long hours, or sudden movements of the neck. "Crick in the neck" is not a medical diagnosis. Usually a muscle spasm, arthritis or a disc problem is the real culprit. At- home therapies can take care of a crick in the neck most of the time, but if the pain lasts longer than a week or disrupts your usual activities, get it checked by a doctor.
  • 229. Neck sprain Sprains are injuries to ligament. Neck sprains are often caused by falls or sudden twists that overload or overstretch the joint. Another cause is repeated stress to the joint. Symptoms include swelling, reduced flexibility and pain. Sprains can be mild, moderate or severe.  If you suspect someone in your environment has a severe neck injury (of any kind), you should immobilize their spine and call 911 immediately. For minor and moderate sprains, rest and ice the area, take an anti-inflammatory, and get it checked by a doctor.
  • 230. Neck fracture Is a break in a cervical bone. It may be caused by trauma, a fall or degenerative changes in the spine. The angle of force hitting the neck and the head's position at impact often determine the type and severity of the break. Football players who block with their head are at high risk. Elderly people with osteoporosis are particularly at risk for neck fractures because their bones are very fragile. The most serious neck fractures are generally accompanied by a dislocation. Treatment depends on a lot of things including your age, other medical conditions and extent of damage to your spine. If a fracture destabilizes your neck, you may need to wear a halo brace.
  • 231. Management for Neck Injuries What to Do - Or Not to Do If someone has suffered a severe neck injury, call 911 for life support and help. Do not move the person, especially the head or neck unless failure to do so presents an immediate threat or urgent danger. Exceptions to Immobility You can move a person with a possible neck injury when: Not moving them would be an immediate threat to their life. They are vomiting. They are choking on blood. You need to check for breathing and/or pulse so you can determine if they need CPR.
  • 232. keep their head and neck immobile and move their entire body as one unit. Do the same if you need to roll them over. To roll a victim over, you will need at least two people - one at the victim's head and one at the feet.
  • 233. After checking breathing and pulse, determine if CPR is necessary. DO NOT NOT LIFT VICTIM'S HEAD BACK WHEN OPENING THEIR AIRWAY TO ADMINISTER CPR. Instead open the jaw by placing fingers on either side.
  • 234. BURNS AND EXTREMES OF TEMPERATURE Types of burns Dry burn Scald Electrical burn Cold injury Chemical burn Radiation burn
  • 235. Classification of burns 1.According to surface area Uses a simple formula, the rule of nines 2.According to depth of burns
  • 236. Adult Anterior head 9% Posterior head 9% anterior torso 18% Posterior torso 18% Anterior leg each 9% Posterior leg each 9% Anterior arm each 4.5% posterior arm each 4.5% Genitalia/perineum 1%
  • 237. According to depth of burns 1.Superficial burn Involves only the outermost layer of the skin’ Characterized by redness, swelling and tenderness Heals well if first aid is given promptly. 2.Partial-thickness burn any one percent burn affecting layers of the epidermis giving rise to rawness and blisters. Can heal well but if but if they affect very large areas(over 60%),can be fatal
  • 238. 3.Full-thickness burns All the three layers of the skin are burnt. Damage to nerves, fat tissue and muscles present The skin looks waxy, pale or charred Urgent medical aid is essential
  • 239. Management of minor burns and scalds Aims To stop the burning To relieve pain and swelling To minimize the risk of infection Flood the injured part with cold water for at least ten minutes to stop the burning and relieve pain. If water is not available any cold harmless liquid such as milk or canned drinks will do
  • 240. Remove any jewellery,watches,belts or constricting clothing from the injured area before it begins to swell Cover the area with a sterile dressing, or any clean, non-fluffy material and bandage loosely in place. A plastic bag or some kitchen film make good temporary covering
  • 241. Do not break blisters Do not apply adhesive dressings or adhesive tape to the skin: the burn may be more extensive Do not apply lotions, ointments or fats to the injury. They further damage the tissue and increase the risk of infection
  • 242. Severe burns and scalds Aims of treatment To stop the burning and relieve pain To maintain an open airway To treat associated injuries To minimize the risk of infection To arrange removal to hospital To gather relevant information for the emergency services
  • 243. Management Lay the casualty down. Protect the burned area from contact with the ground Douse the burn with plenty of cold liquid. Thorough cooling may take at least ten minutes. While cooling the burn, watch for signs of DIB and be ready to resuscitate if necessary Remove any rings,watches,belts,shoes or shouldering clothing from the injured area before it begins to swell
  • 244. Cover the injury with a sterile dressing to protect it from infection. If the burn is on the face, don't cover it. Keep cooling a facial injury with water to relieve pain until help arrives Gather and record details of the casualty's injury, circumstances and potential hazards such as gas While waiting for help, reassure the casualty and treat for shock
  • 245. Burns to the Airway Signs and symptoms Soot around the nose and mouth Singeing of the nasal hairs Redness, swelling or actual burning of the tongue Damaged skin around the mouth Hoarseness of the voice Breathing difficulties
  • 246. Aims and treatment To obtain specialist medical aid as quickly as possible To maintain an open airway Call for help Loosen tight clothing around his neck, give oxygen if available Reassure the casualty for him/her to stay calm
  • 247. Electrical burns Causes Lightning strike Low or high voltage current Aims of treatment To treat the burn and the shock To arrange removal of the casualty to hospital
  • 248. Treatment Make sure that contact with the electrical source is broken If unconcious,resuscitate if necessary Flood the sites of injury with plenty of cold water to cool the burns and cut away any burnt clothing if necessary Place a sterile dressing, a clean folded triangular bandage or some clean non-fluffy material over the burns Call for help Reassure the casualty and treat for shock
  • 249. Chemical burns If possible note the name or brand name of the substance Sign and symptoms Evidence of chemicals in the vicinity Intense stinging pain Later,discolouration,blistering,peeling and swelling of the affected area
  • 250. Treatment Aims To disperse the harmful chemical To arrange transport to hospital To make the area safe and inform relevant Authority Make the area safe. Ventilate the area, seal the chemical container. Remove the casualty from the area if necessary
  • 251. Flood the affected area with water to disperse the chemical and to stop the burning. Do this for at least 20 minutes Gently remove contaminated clothing while flooding the injury Take or send casualty to hospital. Note and pass any information about the chemical to the medical personell.If at work place notify the local safety officer or emergency services
  • 252. Chemical burns to the eye Chemicals result in scarring and even blindness Signs and symptoms  intense pain in the eye Inability to open the injured eye Redness and swelling round the eye Copious watering of the eye Evidence of chemical substances or containers in the immediate area
  • 253. Ask the casualty to hold a sterile eye pad over the injured eye. If some time elapse elapses before the casualty receives medical attention, bandage the pad loosely in position Arrange casualty's removal to hospital
  • 254. Sunburn Aims To move the casualty out of the sun To relieve discomfort and pain Cover the casualty's skin with light clothing or towel. Help her into the shade or preferably indoors Cool her skin by sponging with cold water or by soaking the affected area in a cold water bath for ten minutes. If there is extensive blistering or other skin damage, seek medical advice Give her frequent sips of cold water. If the burns are mild, calamine or an after-sun preparation may sooth them
  • 255. EFFECTS OF HEAT AND COLD First Aid Priorities Remove or protect the casualty from excessively hot or cold surroundings Restore normal body temperature Obtain appropriate medical attention
  • 256. Effects of Extreme Cold Frost bite Hypothermia Effects of Extreme Heat Heat exhaustion Heatstroke
  • 257. Bites and Stings First Aid Priorities Make sure that you are in no danger, then remove the casualty from further danger Treat visible wounds or painful symptoms. Minimize the risk of further injury and infection Obtain medical attention if necessary Note time and nature of injury. Identify the attacking creature. This facilitates specific management and anticipation of complications such as anaphylactic reactions.
  • 258. Animal Bites Aims of treatment To control bleeding To minimize the risk of infection To obtain medical attention For serious wounds Control bleeding by applying direct pressure and raising the injured part Cover the wound with a sterile dressing or a clean pad bandaged in place
  • 259. Arrange patient’s removal to hospital For superficial bites Wash the wound thoroughly with soap and warm water Pat the wound dry with clean gauze swabs and cover with an adhesive dressing or a small sterile dressing Advice the casualty to see a doctor incase inoculation is needed
  • 260. Insect Stings Bee, wasp and hornet stings are painful rather than dangerous Aims of treatment To relieve swelling and pain To remove to hospital if necessary For a sting in the skin If the casualty shows signs of anaphylactic shock, call 911
  • 261. If the sting is in the wound, pluck it out firmly with fine tweezers Apply a cold compress to relieve pain and minimize swelling. Advice the casualty to see a doctor if the pain and swelling persist For a sting in the mouth Give the casualty ice to suck or cold water to sip to minimize the swelling
  • 263. Marine Stings Aims of treatment To reassure the casualty To inactivate stinging cells before they release their venom and to neutralize any free venom To relieve pain and discomfort Reassure the casualty and sit him or her down. Pour copious amounts of vinegar or sea water over the injury to incapacitate stinging cells that have not yet released venom
  • 264. Alcohol may aggravate the injury and should not be used Avoid rubbing sand on the affected area Dust a dry powder over the skin around the affected area to make any remaining stinging cells stick together. You can use talcum powder or meat tenderiser.Meat tenderiser contains papain which inactivates venom
  • 265. Gently brush off the powder with a clean, non-fluffy pad If severe call for help
  • 266. Marine Puncture Wounds Aims To inactivate the venom To obtain medical aid Put the injured part in water as hot as the casualty can bear for at least 30 minutes. Top up the water as it cools being careful not to scald the casualty
  • 267. Take or send the casualty to hospital where spines remaining in the skin may have to be removed Snake Bites The only poisonous snake native to mainland Britain is the adder
  • 268. Aims of treatment To reassure the casualty To prevent the spread of the venom To arrange urgent removal of the casualty to hospital Lay the casualty down. Tell her to keep calm and still Wash the wound well and pat dry with clean swabs. Call 911.
  • 269. Do not apply a torniquet,slash the wound with a knife or suck out the venom Lightly compress the limb above the wound with a roller bandage.Immobilise the injury If she stops breathing, be ready to resuscitate
  • 270. BANDAGING Definition of a bandage A strip of material mainly used to support and immobilize a part of the body USES To support-fractured bone To immobilize-dislocated shoulder/jaw To apply pressure-stop bleeding and improve venous blood flow
  • 271. To secure a dressing in place To retain splints in place PRINCIPLES AND PROCEDURES FOR APPLYING BANDAGES Wash hands and wear gloves when necessary Assist victim to assume a comfortable position on bed or on chair and support the body part to be bandaged. Always stand infront of the part/victim to be bandaged except when applying a bandage to the head, eye and ear
  • 272. Be sure the bandage is rolled firm Make sure the body part to be bandaged is clean and dry Assess skin before applying bandage for any breakdown Observe circulation by noting pulse, surface temperature, skin color and sensation of the body part to be wrapped
  • 273. Always start bandaging from inner to outer aspect and far to near end When bandaging a joint, ensure flexibility of the joint except if immobilization of joint is required Cover the area two inches above and two inches below the affected area Overlap turns and slightly stretch the bandage
  • 274. Cover 2/3 of the previous turn Where possible, leave fingertips or toe tips exposed for observation(adequacy of circulation) End the bandage on the outer side of the body. Do not end a bandage on wound or at the back of the body
  • 275. TYPES OF BANDAGES Triangular Could be used on many parts of the body to support and immobilize Crape bandage Type of woven gauze which has the quality of stretching Gauze/cotton bandage Lightly woven cotton material. Frequently used to retain dressings on wounds on fingers,hands,toes,feet,ears,eyes and head
  • 276. Adhesive bandage Used to retain dressing and also used where application of pressure to an area is required METHODS OF APPLYING BANDAGES Circular Spiral Reverse spiral Figure of eight
  • 277. CIRCULAR TURN Used to anchor bandages and to terminate bandages Apply the end of the bandage to the part of the body to be bandaged Encircle the body part a few a few times or as needed, each turn directly covering the previous turn
  • 278. Secure the end of the bandage with tapes, metal clips or a safety pin over an uninjured area SPIRAL TURN Bandage cylindrical parts of the body that are fairly uniform in circumference such as the upper arm or leg
  • 279. Make two circular turns to begin the bandage Continue spiral turns at about a 30 degree angle, each turn overlapping the preceding one by 2/3 the width of the bandage Terminate the bandage with two circular turns and secure the end as described for circular turns
  • 280. SPIRAL REVERSE TURN Begin with two circular turns and bring the bandage upward at about a 30 degree angle Place the thumb of the free hand on the upper edge of the bandage The thumb will hold the bandage while it is folded on itself Unroll the bandage about 4-6 and turn the hand so that the bandage is folded down Terminate the bandage with two circular turns and secure the end as described for circular turns
  • 281. FIGURE EIGHT TURN Applied on ankle, knee and joint Begin the bandage with two circular turns Carry the bandage above the joint, around it and then below it. Make a figure 8.Continue above and below the joint, overlapping the previous turn by 2/3 the width of the bandage Terminate the bandage above the joint with two circular turns and secure the end appropriately