First Aid Cases

1. FIRST AID CASES
Responding to Emergencies based on
Established Guidelines
Prepared by: Jennifer B. Garcia, RN

2. SHOCK

3. When a person is injured, the circulatory
system is affected to some degree. The victim
should be automatically treated for shock.
Shock refers to circulatory system failure. This
happens when oxygenated blood is not
sufficiently provided in every part of the body.
It is one of the common causes of death in an
injured victim. The damage caused by shock
depends on which body part is deprived of
oxygen and how long it is deprived.
SHOCK
Shock is a life-threatening condition that occurs when the body is not getting enough
blood flow. Lack of blood flow means the cells and organs do not get enough oxygen and
nutrients to function properly. Many organs can be damaged as a result. Shock requires
immediate treatment and can get worse very rapidly. As many 1 in 5 people who suffer
shock will die from it.

4. Some etiology of shock include:
 severe allergic reaction
 significant blood loss
 heart failure
 blood infections
 dehydration
 poisoning
 burns
*Etiology means the cause or origin of a disease or abnormal
condition.

5. Pathophysiology (consisting of the Greek origin words “pathos” = suffering; “physis” = nature, origin;
and “logos” = “the study of”) refers to the study of abnormal changes in body functions that are the
causes, consequences, or concomitants of disease processes.

6. Signs of Shock:
 restlessness, anxiety,
and weakness
 rapid breathing and
pulse
 pale or bluish skin,
nail beds, and lips
 moist and clammy
skin
 thirst
 nausea and vomiting
 unconsciousness
when shock is severe

7. The main types of
shock include:
1. Cardiogenic Shock
2. Hypovolemic Shock
3. Anaphylactic Shock
4. Septic Shock
5. Neurogenic Shock

8. 1. CARDIOGENIC SHOCK- due to heart problems. It
happens when the heart is damaged and unable to supply
sufficient blood to the body.
The condition is most often caused by a severe heart attack,
but not everyone who has a heart attack has cardiogenic
shock.
Cardiogenic shock is rare. It's often deadly if not treated
immediately. When treated immediately, about half the
people who develop the condition survive.

9. ETIOLOGY OF CARDIOGENIC SHOCK:
In most cases, a lack of oxygen to your heart, usually from a heart
attack, damages its main pumping chamber (left ventricle). Without
oxygen-rich blood flowing to that area of your heart, the heart muscle
can weaken and go into cardiogenic shock.
Rarely, damage to your heart's right ventricle, which sends blood to
your lungs to get oxygen, leads to cardiogenic shock.
Other possible causes of cardiogenic shock include:
 Inflammation of the heart muscle (myocarditis)
 Infection of the heart valves (endocarditis)
 Weakened heart from any cause
 Drug overdoses or poisoning with substances that can affect your
heart's pumping ability

10. SIGNS & SYMPTOMS OF
CARDIOGENIC SHOCK:
 Rapid breathing
 Severe shortness of breath
 Sudden, rapid heartbeat
(tachycardia)
 Loss of consciousness
 Weak pulse
 Low blood pressure
(hypotension)
 Sweating
 Pale skin
 Cold hands or feet
 Urinating less than normal or
not at all

11. RISK FACTORS OF CARDIOGENIC SHOCK:
If you have a heart attack, your risk of developing
cardiogenic shock increases if you:
 Are older
 Have a history of heart failure or heart attack
 Have blockages (coronary artery disease) in several of
your heart's main arteries
 Have diabetes or high blood pressure
 Are female

12. 2. HYPOVOLEMIC SHOCK- caused by too little blood volume. It is
caused by severe blood and fluid loss, such as from traumatic
bodily injury, which makes the heart unable to pump enough
blood to the body, or severe anemia where there is not enough
blood to carry oxygen through the body.
This severe fluid loss makes it impossible for the heart to pump a
sufficient amount of blood to your body. Hypovolemic shock can
lead to organ failure.
Hypovolemic shock is the most common type of shock, with very
young children and older adults being the most susceptible.

13. ETIOLOGY OF HYPOVOLEMIC SHOCK:
Hypovolemic shock results from significant and sudden blood or fluid losses
within your body. Blood loss of this magnitude can occur because of:
 bleeding from serious cuts or wounds
 bleeding from blunt traumatic injuries due to accidents
 internal bleeding from abdominal organs or ruptured ectopic pregnancy
 bleeding from the digestive tract
 significant vaginal bleeding
 Endometriosis
Blunt trauma, also called non-penetrating trauma or blunt force trauma, is an injury to the body caused by forceful
impact, injury, or physical attack with a dull object or surface.
Ruptured ectopic pregnancy – having an irregular vaginal bleeding or spotting. Cramping or pain on one side, or in the
lower abdomen.
Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your
uterus — the endometrium — grows outside your uterus. One of its symptoms include having heavy menstrual flow.

14. In addition to actual blood loss, the loss of body fluids can cause a
decrease in blood volume. This can occur in cases of:
 excessive or prolonged diarrhea
 severe burns
 protracted and excessive vomiting
 excessive sweating
Blood carries oxygen and other essential substances to your organs
and tissues. When heavy bleeding occurs, there is not enough blood
in circulation for the heart to be an effective pump. Once your body
loses these substances faster than it can replace them, organs in
your body begin to shut down and the symptoms of shock occur.
Blood pressure plummets, which can be life-threatening.

15. SIGNS & SYMPTOMS:
The symptoms of hypovolemic shock vary with the severity of the fluid or blood
loss. However, all symptoms of shock are life-threatening and need emergency
medical treatment. Internal bleeding symptoms may be hard to recognize until
the symptoms of shock appear, but external bleeding will be visible.
Some symptoms are more urgent than others.
Mild Symptoms
Mild symptoms can include:
 headache
 fatigue
 nausea
 profuse sweating
 dizziness

16. Severe Symptoms
Severe symptoms, which must be taken seriously and warrant emergency
medical attention, include:
 cold or clammy skin
 pale skin
 rapid, shallow breathing
 rapid heart rate
 little or no urine output
 confusion
 weakness
 weak pulse
 blue lips and fingernails
 lightheadedness
 loss of consciousness

17. 3. ANAPHYLACTIC SHOCK-
The terms "anaphylaxis" and "anaphylactic shock" are often used to mean
the same thing. They both refer to a severe allergic reaction. Shock is when
your blood pressure drops so low that your cells (and organs) don't get enough
oxygen. Anaphylactic shock is shock that's caused by anaphylaxis.
Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can
occur within seconds or minutes of exposure to something you're allergic to,
such as peanuts or bee stings.
Anaphylaxis causes your immune system to release a flood of chemicals that
can cause you to go into shock — your blood pressure drops suddenly and your
airways narrow, blocking breathing.
Anaphylaxis requires an injection of epinephrine and a follow-up trip to an
emergency room. If you don't have epinephrine, you need to go to an
emergency room immediately. If anaphylaxis isn't treated right away, it can be
fatal.

18. ETIOLOGY OF ANAPHYLACTIC SHOCK:
Your immune system produces antibodies that defend against foreign
substances. This is good when a foreign substance is harmful, such as
certain bacteria or viruses. But some people's immune systems
overreact to substances that don't normally cause an allergic reaction.
Allergy symptoms aren't usually life-threatening, but a severe allergic
reaction can lead to anaphylaxis. Even if you or your child has had only a
mild anaphylactic reaction in the past, there's a risk of more severe
anaphylaxis after another exposure to the allergy-causing substance.

19. The most common anaphylaxis triggers in children are food allergies, such as to
peanuts, and tree nuts, fish, shellfish and milk. Besides allergy to peanuts, nuts, fish and
shellfish, anaphylaxis triggers in adults include:
 Certain medications, including antibiotics, aspirin and other over-the-counter pain
relievers, and the intravenous (IV) contrast used in some imaging tests
 Stings from bees, yellow jackets, wasps, hornets and fire ants
 Latex
Although not common, some people develop anaphylaxis from aerobic exercise, such as
jogging, or even less intense physical activity, such as walking. Eating certain foods
before exercise or exercising when the weather is hot, cold or humid also has been
linked to anaphylaxis in some people. Talk with your doctor about precautions to take
when exercising.
If you don't know what triggers your allergy attack, certain tests can help identify the
allergen. In some cases, the cause of anaphylaxis is never identified (idiopathic
anaphylaxis).

20. SIGNS & SYMPTOMS:
You typically notice the first symptoms within 15 minutes of coming
into contact with the thing you're allergic to. They may start out mild,
like a runny nose or an uneasy feeling. But they can get much worse
very fast. Some typical symptoms include:
 Swelling of your mouth
 Tight feeling in your throat and difficulty breathing
 Hives – allergic disorder or urticaria
 Vomiting
 Dizziness
 Fainting
 Rapid heartbeat
In severe cases, people collapse, stop breathing, and lose
consciousness in just a couple of minutes.

21. Life-Saving Treatment:
A shot of epinephrine in your thigh is needed right away, and you should
call 911 because you're at risk for a second reaction (called a biphasic
reaction) within 12 hours. At the emergency room, doctors can keep an
eye on your symptoms and treat you in case of a second reaction.
If you don't have epinephrine, emergency room doctors can save your life.
They'll put a shot of epinephrine under your skin or in a muscle or vein.
Usually this gets your blood pressure, which drops during anaphylactic
shock, back to normal. You'll also get fluids, steroids, and antihistamines
(drugs used to treat allergic reactions) through a tube connected to one of
your veins until your symptoms are gone.
Other possible treatments include a breathing tube and medications to
help you breathe better, and a corticosteroid (a powerful anti-
inflammatory drug) to keep symptoms from coming back hours later.

23. 4. SEPTIC SHOCK- due to infections. It results from
bacteria multiplying in the blood and releasing toxins.

24. Septic shock is a life-threatening condition that happens when your blood
pressure drops to a dangerously low level after an infection.
Any type of bacteria can cause the infection. Fungi such as candida and
viruses can also be a cause, although this is rare.
At first the infection can lead to a reaction called sepsis. This begins with
weakness, chills, and a rapid heart and breathing rate.
Left untreated, toxins produced by bacteria can damage the small blood
vessels, causing them to leak fluid into the surrounding tissues.
This can affect your heart's ability to pump blood to your organs, which
lowers your blood pressure and means blood doesn't reach vital organs,
such as the brain and liver.

25. People with a weakened immune system have an increased
risk of developing septic shock.
This includes:
 newborn babies
 elderly people
 pregnant women
 people with long-term health conditions, such as
diabetes, cirrhosis or kidney failure
 people with lowered immune systems, such as those
with HIV or AIDS or those receiving chemotherapy

26. ETIOLOGY OF SEPTIC SHOCK:
A bacterial, fungal, or viral infection can cause sepsis. Any
of the infections may begin at home or while you are in the
hospital for treatment of another condition.
Sepsis commonly originates from:
 abdominal or digestive system infections
 lung infections like pneumonia
 urinary tract infection
 reproductive system infection

27. SIGNS & SYMPTOMS OF SEPSIS:
There are three stages of sepsis: sepsis, severe sepsis, and septic shock.
Sepsis can happen while you’re still in the hospital recovering from a
procedure, but this isn’t always the case. It’s important to seek immediate
medical attention if you have any of the below symptoms. The earlier you
seek treatment, the greater your chances of survival.
Sepsis
Symptoms of sepsis include:
 a fever above 101ºF (38ºC) or a temperature below 96.8ºF (36ºC)
 heart rate higher than 90 beats per minute
 breathing rate higher than 20 breaths per minute
 probable or confirmed infection
You must have two of these symptoms before a doctor can diagnose sepsis.

28. Severe sepsis
Severe sepsis occurs when there’s organ failure. You must have one or
more of the following signs to be diagnosed with severe sepsis:
 patches of discolored skin
 decreased urination
 changes in mental ability
 low platelet (blood clotting cells) count
 problems breathing
 abnormal heart functions
 chills due to fall in body temperature
 unconsciousness
 extreme weakness

29. Septic shock
Symptoms of septic shock include:
 low blood pressure (hypotension) that makes you feel
dizzy when you stand up
 a change in your mental state, such as confusion or
disorientation
 diarrhea
 nausea and vomiting
 cold, clammy and pale skin
Septic shock is a medical emergency. Dial 999 to ask for an
ambulance if you think that you or someone in your care
has septic shock.

30. 5. NEUROGENIC SHOCK- caused by
damage to the nervous system. It is
caused by spinal cord injury, usually
as a result of a traumatic accident
or injury.
It is extremely dangerous because it
can cause your blood pressure to
drop drastically and suddenly, and
can leave irreversible damage to
your body tissues. If left untreated,
neurogenic shock can be fatal.

31. ETIOLOGY:
Neurogenic shock is often a result of injury or trauma to the spinal cord. As a
result, your body loses function and stimulation of the sympathetic nervous
system. Your sympathetic nervous system maintains bodily functions during
physical activity. That includes strengthening your heart beat, raising your
blood pressure, and opening your airways to improve breathing.
If your sympathetic nervous system doesn’t function well, your blood pressure
could drop and can affect your brain, tissues, and spinal cord.

32. Other causes of neurogenic shock include:
 car accidents that cause central nervous system damage or spinal
cord injury
 sport injuries causing trauma to the spine
 gunshot wounds to the spine
 medications that affect the autonomic nervous system, which
regulates breathing and other automatic bodily functions
 improper administration of anesthesia to the spinal cord

33. SIGNS & SYMPTOMS:
One of the main symptoms of neurogenic shock is low blood pressure
from irregular blood circulation. However, this condition can cause a
number of other symptoms:
 dizziness
 nausea
 vomiting
 blank stares
 fainting
 increased sweating
 anxiety
 pale skin

34. In more severe cases of neurogenic shock, you may experience:
 difficulty breathing
 chest pain
 weakness from irregular blood circulation
 bradycardia, or a slower heart rhythm
 faint pulse
 cyanosis, or discolored lips and fingers
 hypothermia, or decreased body temperature
If left untreated, neurogenic shock can cause irreversible tissue
damage and death. If you begin experiencing any of these symptoms,
seek immediate medical attention.

35. Treat the victim with shock even if signs and symptoms have not yet appeared.
This is to prevent shock from getting worse:
1.If the victim is talking or conscious, the airway is open.
2. Check if the victim is breathing or having breathing difficulties or unusual
breathing sounds.
3. Check circulation by feeling for a heartbeat (pulse) at the side of the neck.
4. Check for severe bleeding (hemorrhage) by looking over the entire body.
5. Lay the victim down on his/her back. Those with head injuries or stroke
victims should not lay flat on their back. Slightly raise their head if no spinal
cord injury is suspected.
First Aid to be applied to Shock:

36. 6. Those with breathing difficulties, chest injuries, or a heart attack should be
placed in a half sitting position to help breathing.
7. Do not place unconscious or vomiting victims on their back. Place them in a
“recovery position.” Follow these steps to place a victim in a recovery position:
a. Roll the victim on his/her side (if no head or neck injury is present).
b. Place your hand under the chin to support his/her head.
c. Flex the leg to prevent from rolling.

37. 8. Raise the victim’s legs 8 to 12 inches from the ground. It will allow the
blood to drain from the legs back to the heart. Do not raise the legs more
than 12 inches because it will affect breathing of the victim by having the
abdominal organs pushed up against the diaphragm. However, if the victim
has chest injuries, has breathing difficulty, and is conscious, the legs should
not be raised. Place them flat on the ground.
9. Prevent body heat loss by wrapping blankets, coats, etc. around the
victim. Do not warm the victim unless he/she is hypothermic (a condition
when the body fails to maintain normal body temperature).

38. 10. Do not give victim anything to eat or drink
because it may cause nausea and vomiting. It
could also cause complications if surgery is
needed. Sucking on a clean cloth soaked in water
will relieve the victim’s dry mouth.
11. Seek medical help right away.

39. BLEEDING

40. Bleeding is also known as hemorrhage or hemorrhaging. It is an
escape of blood from a ruptured blood vessel, especially when
profuse. It is the name used to describe blood loss.
Bleeding can occur internally, or externally either through a
natural opening such as the mouth, nose, ear, urethra, vagina or
anus, or through a wound in the skin.
BLEEDING

41. A. External Bleeding
External bleeding is when blood
can be seen coming from an open
wound. An average-sized adult has
about 6 quarts (5.7 liters) of blood
and can safely lose a pint during a
blood donation. Rapid blood loss of
1 quart or more can lead to shock
and death. A child losing 1 pint of
blood is in extreme danger.

42. There are many causes of external bleeding, which fall in to
seven main categories, which are:
1. Abrasion
2. Excoriation
3. Laceration
4. Incision
5. Puncture wound
6. Contusion
7. Gunshot wounds

43. 1. Abrasion - Also called a graze, this is caused by
transverse action of a foreign object against the skin, and
usually does not penetrate below the epidermis.
*epidermis - the thin outer layer of the skin.

44. 2. Excoriation - is common with abrasion, this is caused
by mechanical destruction of the skin, although it usually
has an underlying medical cause.

45. 3. Laceration - Irregular wound caused by blunt impact to
soft tissue overlying hard tissue or tearing such as in
childbirth.

46. 4. Incision - a clean 'surgical' wound, caused by a sharp
object, such as a knife.

47. 5. Puncture Wound - Caused by an object penetrated the
skin and underlying layers, such as a nail, needle or knife.

48. 6. Contusion - Also known as a bruise, this is a blunt
trauma damaging tissue under the surface of the skin.
*blunt - thick, or dull edge or point; rounded; not sharp

49. 7. Gunshot wounds - Caused by a projectile weapon, this
may include two external wounds (entry and exit) and a
contiguous wound between the two.
*projectile - is any object thrown into space (empty or not) by the exertion of a force.
*contiguous - used to describe things that touch each other or are immediately next to each other.

50. The type of external bleeding can be classified according to the source:
1.Arterial bleeding - the blood spurts from the wound. This is the most
serious type of bleeding because the blood is being pumped out at a faster
rate, leading to quarter blood loss. This type of bleeding is less likely to clot.
2. Venous bleeding – the blood flows or gushes. It is easier to control than
arterial bleeding. Most veins collapse when cut.
3. Capillary bleeding – the blood oozes from capillaries. This is the most
common type of bleeding and is easily controlled. Quite often, this type of
bleeding clots off by itself.
Types of External Bleeding:

52. The body naturally responds to bleeding by:
1. Blood vessel spasm – the arteries contain small amounts
of muscle tissues in their walls.
2. Clotting – special elements (platelets) in the blood form
a clot, which will seal the hole in 5 to 10 minutes.
*clot - a thrombus, solidified mass of blood.
*platelets - also called thrombocytes ( "blood clot cell"), are a component of blood whose function is to stop bleeding
by clumping and clotting blood vessel injuries.

53. What to DO when external bleeding occurs:
1. Protect yourself against diseases by wearing disposable latex
gloves. If not available, use several layers of gauze pads, plastic
wraps or bags, or let the victim apply pressure into his/her hands.
2. Expose the wounds by removing or cutting the victim’s clothing
to see where the blood is coming from.
3. Place sterile gauze pad or clean cloth (handkerchief, washcloth,
or towel) over the entire wound and apply direct pressure with
your finger or palm. The gauze or cloth allows pressure to be
applied evenly. Direct pressure stops most bleeding.

54. 4. If the bleeding does not stop in 10 minutes, the pressure may be
too light or in the wrong location. Press harder over a wider area for
another 10 minutes. If the bleeding is coming from an arm or leg,
elevate the injured area above the heart’s level to reduce blood
flow. Elevation must be used in combination with the direct
pressure over the wound.
5. If bleeding still continues, apply pressure at a pressure point to
slow the flow of blood in combination with direct pressure over the
wound. A pressure point is located where an artery is near the skin’s
surface and where it passes close to a bone against which it can be
compressed.

55. 6. After the bleeding stops, or if you need to attend to
other injuries or victims, apply a pressure bandage on the
wound. Wrap a roller gauze bandage tightly over the
dressing above and below the wound site.
7. Treat the victim for possible shock by raising the legs 8
to 12 inches from the ground and cover with a coat or
blanket to keep the victim warm.

56. 8. Check blood circulation in the arm or leg by monitoring
the pulse and using the capillary nail refill test.
9. When direct pressure cannot be applied because of
protruding bone, skull fracture, open fracture, or
embedded object, use a doughnut-shaped (ring) pad to
control bleeding. Make a ring pad by using a narrow
bandage (roller) to form a loop around one hand and
wrapping one end of the bandage several times around
your four fingers. Pass the other end through the loop and
wrap it around several times until the entire bandage is
used and a ring is made.

57. What NOT to do when there is bleeding:
1. Do not touch a victim’s blood with your bare hands; it should be a
last resort. After the bleeding has stopped and the wound has been
cared for, wash your hands vigorously with soap and water.
2.Do not use direct pressure on an eye injury wound with an
embedded object, skull fracture, or open fracture.

58. 3. Do not remove a blood-soaked dressing. Apply another dressing on
top and keep pressing.
4. Do not apply a tight pressure bandage because it may cut off
circulation.
5. Do not use a tourniquet. They are rarely needed. A tourniquet can
damage nerves and blood vessels and may cause the loss of an arm or
leg. If tourniquet is required, use wide, flat materials instead.
*tourniquet - is a constricting or compressing device, specifically a bandage, used to control venous
and arterial circulation to an extremity for a period of time.

59. B. Internal Bleeding
Internal bleeding occurs when the skin is not broken and blood is not seen. It
can be difficult to detect and can be life-threatening.

60. o Non-traumatic causes:
These can include:
1. Damage to a blood vessel: Minor tears can occur with an injury.
Not enough clotting factors: Your body makes proteins to stop any
bleeding if you’re cut or injured. If your body doesn’t make enough
clotting factors, you may bleed freely.
2. Certain medications: Certain medicines, like blood thinners, can
prevent clotting and lead to severe bleeding if you’re injured or
have an accident. Certain over-the-counter medicines, including
aspirin, can damage the lining of your stomach, too.

61. 3. Chronic high blood pressure: High blood pressure weakens blood vessel
walls. Weak walls can form aneurysms that can rupture and bleed.
Inherited bleeding disorders: Hemophilia is a genetic condition that prevents
your blood from properly clotting. A minor injury may bleed heavily if it’s not
properly treated.
4. Gastrointestinal (GI) causes: Bleeding in your abdomen or stomach may be
caused by one of several GI conditions. These include colon polyps, colitis,
Crohn’s disease, gastroenteritis, esophagitis, peptic ulcers, and more.
5. Lifestyle factors: Alcohol, smoking, and illicit drugs can irritate the lining of
your stomach.
*colon polyp is a small clump of cells that forms on the lining of the colon.
*Colitis - is a chronic digestive disease characterized by inflammation of the inner lining of the colon.
*Crohn's disease is a type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract.
*Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine.

62. o Life-threatening causes:
These can include:
1. Trauma: Car accidents, falls, physical assaults, and
dropping a heavy object on yourself are all examples of
ways you can damage your body’s organs, blood vessels,
and bones. You may experience internal bleeding
without cutting your skin.
2. Aneurysms: Weak blood vessel walls can bulge and
form pockets of blood. Many aneurysms don’t cause any
symptoms, but a burst aneurysm is life-threatening.

63. 3. Broken bones: Most broken bones are nothing to be
worried about, but breaking your body’s largest bones, such
as the femur, can cause significant internal bleeding
4. Ectopic pregnancy: A pregnancy outside the uterus can
cause internal bleeding as the fetus grows. The condition
can be life-threatening.
5. Surgery: Before a surgeon completes an operation, they
make sure all the bleeding has stopped. If they miss
something, bleeding may continue even after the incision is
closed. In some cases, this bleeding can be severe.

64. Signs of internal bleeding may take days to appear. The
following are signs of internal bleeding:
1. Bruise or contusions of the skin
2. Painful, tender, rigid, and bruised abdomen
3. Fractured ribs or bruises on chest
4. Weakness, dizziness, and fainting
5. Rapid pulse
6. Cold, moist skin
7. Vomiting or coughing up blood
8. Stools that are black and contain bright red color

65. The following should be done when severe internal bleeding occurs:
1. Check if the airway is open and if the victim is talking. Check the
victim’s breathing and blood circulation by feeling the heartbeat
(pulse) at the side of the neck (carotid artery), and check for a spinal
cord injury.
2. Expect vomiting. Keep the victim lying on his/her left side to prevent
vomiting, for drainage, and to protect the lungs from inhaling the
vomit. Do not give the victim anything to eat or drink.
3. Treat the victim for possible shock by raising the legs 8 to 12 inches,
and cover the victim with a coat or blanket to keep warm.
4. Seek medical attention immediately.

66. For bruises:
1. Apply an ice pack over the bruised area for 20 minutes.
Protect the victim’s skin from frostbite by placing a wet
cloth between the ice and skin. The wet cloth transfers
cold better than a dry one, which insulates the skin.
2. If the bruise is on an arm or leg, raise it if it is not
injured.
If an arm or leg is involved, apply an elastic bandage with a
pad over the bruise and between the bandage and the
skin.

67. HEART ATTACK

68. A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most
often a buildup of fat, cholesterol and other substances, which form a plaque in the
arteries that feed the heart (coronary arteries).
Sometimes, a plaque can rupture and form a clot that blocks blood flow. The interrupted
blood flow can damage or destroy part of the heart muscle.
A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved
dramatically over the years. It's crucial to call 911 or emergency medical help if you think
you might be having a heart attack.
HEART ATTACK

69. ETIOLOGY:
A heart attack occurs when one or more of your coronary arteries becomes blocked.
Over time, a buildup of fatty deposits, including cholesterol, form substances called
plaques, which can narrow the arteries (atherosclerosis). This condition, called
coronary artery disease, causes most heart attacks.
During a heart attack, a plaque can rupture and spill cholesterol and other
substances into the bloodstream. A blood clot forms at the site of the rupture. If the
clot is large, it can block blood flow through the coronary artery, starving the heart
of oxygen and nutrients (ischemia).
You might have a complete or partial blockage of the coronary artery.
A complete blockage means you've had an ST elevation myocardial infarction
(STEMI).
A partial blockage means you've had a non-ST elevation myocardial infarction
(NSTEMI).

71. SIGNS & SYMPTOMS:
Common heart attack signs and symptoms include:
- Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms
that may spread to your neck, jaw or back
- Nausea, indigestion, heartburn or abdominal pain
- Shortness of breath
- Cold sweat
- Fatigue
- Lightheadedness or sudden dizziness
*lightheadedness - is a feeling that you are about to faint or "pass out."
*nausea - is a sensation of unease and discomfort in the upper stomach with an involuntary urge to
vomit.

72. Heart attack symptoms vary
Not all people who have heart attacks have the same symptoms or
have the same severity of symptoms. Some people have mild pain;
others have more severe pain. Some people have no symptoms. For
others, the first sign may be sudden cardiac arrest. However, the more
signs and symptoms you have, the greater the chance you're having a
heart attack.
Some heart attacks strike suddenly, but many people have warning
signs and symptoms hours, days or weeks in advance. The earliest
warning might be recurrent chest pain or pressure (angina) that's
triggered by activity and relieved by rest. Angina is caused by a
temporary decrease in blood flow to the heart.

73. What to DO when a heart attack happens:
1. Call the emergency medical service or go to the nearest hospital emergency
department that offers 24-hour emergency cardiac cases.
2. Examine the airway if it is open. Check the patient’s breathing and blood
circulation by feeling for a heartbeat (pulse). Give cardiopulmonary
resuscitation (CPR) if necessary and if you are properly trained.
3. Help the victim to get to the least painful position, usually sitting with the
legs up and bent at the knees. Loosen the clothing around the neck and
midriff. Be calm and reassuring.
4. Determine if the victim is known to have coronary heart disease and is using
nitroglycerin. If so, place the tablet under the tongue, or place an ointment on
the skin to relieve chest pain. Nitroglycerin dilates the coronary arteries, which
increases blood flow to the heart muscle, It lowers the blood pressure and
dilates the veins, which decrease the work of the heart and the heart muscle’s
need for oxygen.

74. STROKE

75. It is a result of cerebrovascular disease --- a disease of the
blood vessels supplying the brain. It impairs circulation to the
brain.
A stroke happens when a blood vessel in the brain bursts or is
clogged by a blood clot or some other particle. Because of the
rupture or blockage, part of the brain does not get the blood
flow it needs. Without oxygen, brain cells in the affected areas
cannot function and die within minutes. The effects of stroke
are often permanent because dead brain cells are not
replaced.
A stroke is a medical emergency, and prompt treatment is
crucial. Early action can reduce brain damage and other
complications.
STROKE/Cerebrovascular Accident

76. ETIOLOGY:
There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or
bursting of a blood vessel (hemorrhagic stroke). Some people may have only a
temporary disruption of blood flow to the brain, known as a transient ischemic attack
(TIA), that doesn't cause lasting symptoms.
1. Ischemic stroke
This is the most common type of stroke. It happens when the brain's blood vessels
become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked
or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or
by blood clots or other debris that travel through your bloodstream and lodge in the
blood vessels in your brain.
Some initial research shows that COVID-19 infection may be a possible cause of ischemic
stroke, but more study is needed.

77. ISCHEMIC STROKE

78. 2. Hemorrhagic stroke
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or
ruptures. Brain hemorrhages can result from many conditions that
affect your blood vessels. Factors related to hemorrhagic stroke
include:
 Uncontrolled high blood pressure
 Overtreatment with blood thinners (anticoagulants)
 Bulges at weak spots in your blood vessel walls (aneurysms)
 Trauma (such as a car accident)
 Protein deposits in blood vessel walls that lead to weakness in the
vessel wall (cerebral amyloid angiopathy)
 Ischemic stroke leading to hemorrhage
A less common cause of bleeding in the brain is the rupture of an
abnormal tangle of thin-walled blood vessels (arteriovenous
malformation).

79. HEMORRHAGIC STROKE

80. Transient ischemic attack (TIA)
A transient ischemic attack (TIA) — sometimes known as a ministroke
— is a temporary period of symptoms similar to those you'd have in a
stroke. A TIA doesn't cause permanent damage. They're caused by a
temporary decrease in blood supply to part of your brain, which may last
as little as five minutes.
Like an ischemic stroke, a TIA occurs when a clot or debris reduces or
blocks blood flow to part of your nervous system.
Seek emergency care even if you think you've had a TIA because your
symptoms got better. It's not possible to tell if you're having a stroke or
TIA based only on your symptoms. If you've had a TIA, it means you may
have a partially blocked or narrowed artery leading to your brain. Having
a TIA increases your risk of having a full-blown stroke later.

81. TRANSIENT ISCHEMIC ATTACK

82. RISK FACTORS
Many factors can increase your stroke risk. Potentially treatable stroke
risk factors include:
Lifestyle risk factors
 Being overweight or obese
 Physical inactivity
 Heavy or binge drinking
 Use of illegal drugs such as cocaine and methamphetamine

83. Medical risk factors
• High blood pressure
• Cigarette smoking or secondhand smoke exposure
• High cholesterol
• Diabetes
• Obstructive sleep apnea
• Cardiovascular disease, including heart failure, heart defects, heart
infection or abnormal heart rhythm, such as atrial fibrillation
• Personal or family history of stroke, heart attack or transient
ischemic attack
• COVID-19 infection
*Obstructive sleep apnea (OSA) is a condition in which breathing stops involuntarily for brief periods
of time during sleep. Normally, air flows smoothly from the mouth and nose into the lungs at all
times. Periods when breathing stops are called apnea or apneic episodes.

84. Other factors associated with a higher risk of stroke include:
 Age — People age 55 or older have a higher risk of stroke than
younger people.
 Race — African Americans have a higher risk of stroke than do
people of other races.
 Sex — Men have a higher risk of stroke than women. Women are
usually older when they have strokes, and they're more likely to
die of strokes than are men.
 Hormones — Use of birth control pills or hormone therapies that
include estrogen increases risk.

85. Emergency Procedure:
1. Call for help
2. Provide ventilation, if needed.
3. If the person is conscious, assist him into a comfortable,
safe position. Position paralyzed extremities in proper body
alignment.
4. Ensure that the person can spit out his saliva. If he is
lying down, position him on his side for drainage.
5. Do not give him anything to eat or drink.
6. Remain with him and reassure him that help is coming.

86. ELECTRIC SHOCK

87. An electric shock happens when an electric
current passes through your body. This can
burn both internal and external tissue and
cause organ damage.
People can be electrocuted when they touch
high-tension wires that fall during a storm or
are struck by lightning.
A bolt of lightning carries as many as 30 million
volts, more than 250,000 times the voltage of
ordinary household current.
July is the most dangerous month for lightning.
ELECTRIC SHOCK

88. CAUSES OF ELECTRIC SHOCK:
 power lines
 lightning
 electric machinery
 electric weapons, such as Tasers
 household appliances
 electrical outlets
While shocks from household appliances are usually less severe,
they can quickly become more serious if a child chews on an electric
cord or puts their mouth on an outlet.

89. Aside from the source of the shock, several other factors
affect how serious an electric shock is, including:
 voltage
 length of time in contact with the source
 overall health
 electricity’s path through your body
 type of current (an alternating current is often more
harmful than a direct current because it causes muscle
spasms that make it harder to drop the source of
electricity)

90. SIGNS & SYMPTOMS:
The symptoms of an electric shock depend on how severe it is.
Potential symptoms of an electric shock include:
 loss of consciousness
 muscle spasms
 numbness or tingling
 breathing problems
 headache
 problems with vision or hearing
 burns
 seizures
 irregular heartbeat
Electric shocks can also cause compartment syndrome. This happens when muscle
damage causes your limbs to swell. In turn, this can compress arteries, leading to
serious health problems. Compartment syndrome might not be noticeable
immediately after the shock, so keep an eye on your arms and legs following a shock.

91. FIRST AID – High Voltage Electric Shock:
1. Do not try to remove the person from the wire and stay at least 20 feet away.
Make an emergency call to the power company right away. Be able to state the
location of the high voltage wire. Act fast. Call for medical assistance and state
the problem quickly.
2. Do not remove the victim from the electric source until the power source has
been shut off.
3. Check for heartbeat and breathing. Feel for a pulse along the neck, under the
earlobe, on the chest or on the wrist. Watch the rise and fall of the chest to see
if the person is breathing. If there is no heartbeat and no breathing, administer
CPR.
4. If there is a heartbeat, but no breathing immediately start rescue breathing.

92. 5. Check for burns and treat as third degree burns.
6. If the person is breathing, put them in the recovery position.
7. Separate the person from the source of electric current using a dry broom
handle or other type of non-conducting material such as wood or rubber. It
may be easier to loop dry rope or cloth, throw it around a person’s arm or leg
and drag the person away from the live wire.
8. Dry your hands and put on dry gloves or use a dry cloth. Stand on something
dry like a stack of newspapers, a thick book or rubber door mat before
removing the person from the source of the electric shock. Unless you do this
first, you may also get a shock when you touch the person.

93. FIRST AID – Low Voltage Electric Shock
1. Switch off the current, if possible, by removing the fuse or switching off the circuit
breaker.
2. Do not touch the person who is in contact with electricity.
3. If you can’t turn off the source of current, use a board, wooden stick, rope or other
non-insulating device to pull the victim away from the source of the electric current.
Make sure your hands and feet are dry and you are standing on a dry surface.
4. If it is safe for you to touch the victim:
- Check for heartbeat and breathing. Feel for a pulse along the neck, under the
earlobe, on the chest or on the wrist. Watch for the rise and fall of the chest to see if
the person is breathing, administer CPR.
- If there is a heartbeat, but no breathing, immediately start rescue breathing.
- Check for burns and treat as third degree burns.

94. Electric Shock – Prevention:
1. Take a first aid course that covers electrical rescue and resuscitation
(CPR).
2. Install Ground Fault Circuit Interrupters(GFCIs) in wall outlets located
in bathroom, kitchens, basements, garages and outdoor boxes. These
act as circuit breakers. When an electrical appliance falls into the water,
the current is instantly cut off.
3. Cover all electric sockets with plastic safety caps so children can’t
stick
4. Replace worn cords and wiring.

95. 5. Never use an electrical appliance, like a radio or curling iron, near
water. Only buy hair dryers and curling irons that have built-in shock
protectors.
6. Never turn electrical switches on or off, or touch an electric
appliance with wet hands, while standing in water or sitting in a bath
tub.
7. Know the location of fuse bones and circuit breakers in your home
and place of work.
8. Remove the appropriate fuse or switch off the circuit breaker before
doing household electrical repairs.

96. 9. Turning off the appliance or light switch is not enough – pay
attention to weather warnings.
10. Find a safe place inside, away from windows and doors.
And, don’t iron or use the telephone during a thunderstorm.
11. Avoid tall trees, metal items, open water and high ground during a
thunderstorm. If you are caught outside, look for a ravine or other low-
lying place and crawl in.
*ravine - a small narrow steep-sided valley that is larger than a gully
and smaller than a canyon and that is usually worn by running water.
11. Install a lightning rod on your house.
12. Take care when rescuing someone who has been electrocuted so
you do not become a victim as well.

97. DROWNING

98. Drowning is the process of experiencing respiratory impairment from
submersion/immersion in liquid; outcomes are classified as death,
morbidity and no morbidity.
DROWNING

99. In 2016, an estimated 320 000 people died from drowning, making
drowning a major public health problem worldwide. In 2015, injuries
accounted for over 9% of total global mortality. Drowning is the 3rd
leading cause of unintentional injury death, accounting for 7% of all
injury-related deaths.
Due to the country's geography, exposure to water, and thus risk of
drowning, is a daily occurrence. It is estimated that an average of 3276
deaths due to accidental drowning occurred in the Philippines between
2006 and 2013, a rate of 3.5 per 100,000 population.

100. It takes very little water for a child to drown. In fact, as little as two inches of
water in a bath tub, sink or shower can kill a toddler.
Adults drown under different conditions. When the water is hot, for example,
adults are tempted to cool off with alcoholic beverages while swimming and
boating. Alcohol interferes with good judgment and is a major factor in adult
drownings.

101. CAUSES of DROWNING:
1. Leg or stomach cramps
2. Loss of consciousness
3. Playing in water too deep and too rough for one’s ability
to swim
4. Not knowing how to swim
5. Stroke/Heart attack
6. Falling through the ice while fishing, skating or
snow-mobiling during winter
7. Not wearing life preservers

102. NOTE:
Saving a drowning person carries risk. Before swimming out to
someone in trouble, be sure you can handle the situation. Many
people drown in the brave effort of trying to save someone else
because they are not well trained and have not properly thought
through the risks of the situation.

103. The emergence of the Severe Acute Respiratory Syndrome
Coronavirus-2 (SARS-CoV-2) has led to a pandemic of the
COVID-19 disease. The virus spreads through respiratory
secretions and by touching contaminated surfaces.
Maintaining physical distance from other people is one of the
most important preventive public health measures at this
point in time.
Drowning is a hypoxic event that can occur in a setting with
rescuers who have a duty to respond. COVID-19 has
confronted individuals who respond to aquatic emergencies,
such as lifesavers, lifeguards and lifeboat crews, with a unique
challenge. Rescuers who are tasked with the duty and
responsibility to respond to life-threatening emergencies such
as drowning, have an intrinsic motivation to help others and
are trained in resuscitation. Since January 2020, the decision to
provide resuscitation to a drowned person is not as
straightforward as it was previously.
Resuscitation of the Drowned Persons During COVID-19 Era
*Hypoxia is a condition in which the body or a region of the body is deprived of adequate oxygen
supply at the tissue level.

104. The updated International Liaison Committee on Resuscitation (ILCOR)
recommendations released for laypersons to reduce the risk of virus
exposure state that most unconscious persons are not to be
ventilated.
For drowned persons, however, this would mean that the probability
of survival would be greatly reduced.
As a result, rescuers will likely feel conflicted, as they weigh their duty
to respond against the need to try and keep themselves safe during
the rescue.
How, and under what circumstances, ventilations should be provided
is likely to be the most difficult and controversial element of these
recommendations. It is clear that a new way of working is needed to
ensure the risk of infection is reduced in the COVID-19 era.

105. There are several situations where ventilations during drowning
resuscitation are still best practice.
The first is where there is a low likelihood that the person is infected,
such as in facilities that have an adequate admission screening process
or in communities with low disease burden. Additionally, ventilations
are still recommended in patients that are a low risk to the rescuer,
such those with no medical comorbidities, or when appropriate PPE is
available.
Ventilations are recommended when a child has drowned. At the
moment there is sufficient data confirming that the prevalence of
COVID-19 under children is very low. 25-27 Children also have played a
very limited role in the spread of the virus. The ILCOR
recommendations advise to perform mouth-to-mouth ventilations in
children, as there is a high likelihood they will benefit from
resuscitation.

106. Ventilations should be performed in cases where a family member or
close contact from the same household as the drowned person is
present, trained, and willing to provide ventilations. Due to the close
nature of their living situation, there is a high likelihood that infection
spread between the contact and the drowned person has already
occurred, thus resulting in minimal additional risk of infection to the
family member or close contact.
If proceeding with CPR, including ventilations, in adults, there is expert
consensus from the ILCOR and other international guidelines, that
rescuers should abandon the practice of mouth-to-mouth/nose
ventilations without any barrier device (e.g. pocket mask or bag-valve-
mask).
In-water ventilations should not be attempted and instead rescuers
should focus on removal from water where PPE and first aid equipment
can be used.

107. Expert consensus recommendations regarding ventilations identify
three techniques. Each technique is characterized by the manual skills
required, the amount of oxygen delivered, the risk of infection, costs for
purchase, and maintenance & training.
Skill level O2 delivery Infection risk Costs
1. Two rescuer
bag-mask-
ventilation with
HEPA filter (BVM)
Difficult High Low High
2. Mouth-to-mask
ventilation with
HEPA filter
Moderate Moderate Moderate Moderate
3. Passive
oxygenation
Simple Low Low Moderate

109. PREVENTION in DROWNING:
To prevent a child from drowning:
1. Never leave a child alone near water, swimming pools or any large
container of water.
2. Never turn away from an infant in a baby bath tub or one sitting in a bath
tub “supporting ring”. A child could drown or get seriously injured in the
seconds it takes to answer a phone or go to the door.
Teach your child to swim Classes for children as young as six months teach
them how to kick so if they fall in the water, they can break through the
water surface.
Tell your child never to swim alone and never to swim too far from shore
without the company of an experienced adult swimmer.
Warn your children to always check the depth of water before diving in.
Build a secured fence around your swimming pool and install self-closing and
self-latching gates. Make sure the gates are always locked.

110. SEIZURES

111. SEIZURES
A seizure is a sudden, uncontrolled
electrical disturbance in the brain. It can
cause changes in your behavior,
movements or feelings, and in levels of
consciousness. Having two or more
seizures at least 24 hours apart that
aren't brought on by an identifiable cause
is generally considered to be epilepsy.
There are many types of seizures, which
range in symptoms and severity. Seizure
types vary by where in the brain they
begin and how far they spread. Most
seizures last from 30 seconds to two
minutes. A seizure that lasts longer than
five minutes is a medical emergency.

112. Seizures are more common than you might think. Seizures can happen after a
stroke, a closed head injury, an infection such as meningitis or another illness.
Many times, though, the cause of a seizure is unknown.
Most seizure disorders can be controlled with medication, but management of
seizures can still have a significant impact on your daily life. The good news is
that you can work with your doctor to balance seizure control and medication
side effects.

113. TWO MAJOR CLASSES OR GROUPS OF SEIZURES:
1. FOCAL ONSET SEIZURES
Focal onset seizures start in one area and can spread across the brain and
cause mild or severe symptoms, depending on how the electrical discharges
spread.
2. GENERALIZED SEIZURES
Generalized seizures can start as focal seizures that spread to both sides of
the brain. They also can occur as “generalized onset” seizures in which
seizure activity starts simultaneously over both sides of the brain.
Generalized onset seizures usually start during childhood and are similar to
a thermostat surge or a light flash — abnormal regulation between parts of
the brain causes the seizures.
Seizures of all kinds are most commonly treated with medication, and, if they are difficult
to control, with diet therapy, nerve stimulation or surgery.

114. FOCAL SEIZURES
Focal seizures result from abnormal electrical
activity in one area of your brain. Focal
seizures can occur with or without loss of
consciousness:
Focal seizures with impaired awareness. These
seizures involve a change or loss of
consciousness or awareness that feels like
being in a dream. You may seem awake, but
you stare into space and do not respond
normally to your environment or you perform
repetitive movements. These may include
hand rubbing, mouth movements, repeating
certain words or walking in circles. You may
not remember the seizure or even know that it
occurred.

115. Focal seizures without loss of consciousness
These seizures may alter emotions or change the way things look, smell, feel,
taste or sound, but you don't lose consciousness. You may suddenly feel angry,
joyful or sad. Some people have nausea or unusual feelings that are difficult to
describe. These seizures may also result in difficulty speaking, involuntary
jerking of a body part, such as an arm or a leg, and spontaneous sensory
symptoms such as tingling, dizziness and seeing flashing lights.
Symptoms of focal seizures may be confused with other neurological disorders,
such as migraine, narcolepsy or mental illness.

116. GENERALIZED SEIZURES
Seizures that appear to involve all areas
of the brain are called generalized
seizures. Different types of generalized
seizures include:
1. Absence seizures
Absence seizures, previously known as
“petit mal” seizures, often occur in
children and are characterized by staring
into space or by subtle body
movements, such as eye blinking or lip
smacking. They usually last for five to 10
seconds but may happen up to
hundreds of times per day. These
seizures may occur in clusters and cause
a brief loss of awareness.

117. 2. Tonic and Atonic seizures
(“Drop Attacks”)
Tonic seizures cause stiffening of
your muscles. These seizures
usually affect muscles in your
back, arms and legs and may
cause you to lose consciousness
and fall to the ground.
Atonic seizures cause a loss of muscle
control, which may cause you to
suddenly collapse, fall down or drop your
head.

118. 3. Myoclonic seizures
Myoclonic seizures usually appear as sudden brief jerks or twitches of
your arms and legs. There is often no loss of consciousness.

119. 4. Tonic-clonic seizures
Tonic-clonic seizures, previously known as “grand mal seizures”, are the
most dramatic type of epileptic seizure and can cause an abrupt loss of
consciousness, body stiffening and shaking, and sometimes loss of bladder
control or biting your tongue. They may last for several minutes.

120. CAUSES
Nerve cells (neurons) in the brain create, send and receive electrical impulses,
which allow the brain's nerve cells to communicate. Anything that disrupts
these communication pathways can lead to a seizure. Some types of seizure
disorders may be caused by genetic mutations.

121. The most common cause of seizures is epilepsy. But not every person who has a
seizure has epilepsy. Sometimes seizures may be caused or triggered by:
 High fever, which can be associated with an infection such as meningitis
 Lack of sleep
 Flashing lights, moving patterns or other visual stimulants
 Low blood sodium (hyponatremia), which can happen with diuretic therapy
 Medications, such as certain pain relievers, antidepressants or smoking cessation
therapies, that lower the seizure threshold
 Head trauma that causes an area of bleeding in the brain
 Abnormalities of the blood vessels in the brain
 Autoimmune disorders, including systemic lupus erythematosus and multiple
sclerosis
 Stroke
 Brain tumor
 Use of illegal or recreational drugs, such as amphetamines or cocaine
 Alcohol misuse, during times of withdrawal or extreme intoxication
 COVID-19 virus infection

122. SIGNS & SYMPTOMS
With a seizure, signs and symptoms can range
from mild to severe and vary depending on the
type of seizure. Seizure signs and symptoms may
include:
 Temporary confusion
 A staring spell
 Uncontrollable jerking movements of the
arms and legs
 Loss of consciousness or awareness
 Cognitive or emotional symptoms, such as
fear, anxiety or déjà vu
Doctors generally classify seizures as either focal
or generalized, based on how and where
abnormal brain activity begins. Seizures may
also be classified as unknown onset, if how the
seizure began isn't known.

123. There are many types of seizures. Most seizures end in a few minutes.
These are general steps to help someone who is having any type seizure:
 Stay with the person until the seizure ends and he or she is fully awake. After
it ends, help the person sit in a safe place. Once they are alert and able to
communicate, tell them what happened in very simple terms.
 Comfort the person and speak calmly.
 Check to see if the person is wearing a medical bracelet or other emergency
information.
 Keep yourself and other people calm.
 Offer to call a taxi or another person to make sure the person gets home
safely.
FIRST AID FOR ANY TYPE OF SEIZURE

124. FIRST AID FOR GENERALIZED TONIC-CLONIC (Grand-mal)
SEIZURES:
When most people think of a seizure, they think of a generalized tonic-clonic
seizure, also called a grand mal seizure. In this type of seizure, the person may cry
out, fall, shake or jerk, and become unaware of what’s going on around them.
Here are things you can do to help someone who is having this type of seizure:
 Ease the person to the floor.
 Turn the person gently onto one side. This will help the person breathe.
 Clear the area around the person of anything hard or sharp. This can prevent
injury.
 Put something soft and flat, like a folded jacket, under his or her head.
 Remove eyeglasses.
 Loosen ties or anything around the neck that may make it hard to breathe.
 Time the seizure. Call 911 if the seizure lasts longer than 5 minutes.

125. DON’Ts:
Knowing what NOT to do is important for keeping a person safe during or
after a seizure.
• Stop sign with hand
• Never do any of the following things:
 Do not hold the person down or try to stop his or her
movements.
 Do not put anything in the person’s mouth. This can injure
teeth or the jaw. A person having a seizure cannot swallow his
or her tongue.
 Do not try to give mouth-to-mouth breaths (like CPR). People
usually start breathing again on their own after a seizure.
 Do not offer the person water or food until he or she is fully
alert.

126. BURNS

127. BURNS
Burns are tissue damage that results from heat, overexposure to the sun or
other radiation, or chemical or electrical contact. Burns can be minor medical
problems or life-threatening emergencies.

128. CAUSES:
Burns are caused by:
 Fire
 Hot liquid or steam
 Hot metal, glass or other objects
 Electrical currents
 Radiation, such as that from X-rays
 Sunlight or other sources of ultraviolet
radiation, such as a tanning bed
 Chemicals such as strong acids, lye, paint
thinner or gasoline
 Abuse

129. TYPES OF BURNS:
1. Thermal Burns – occur due to any external heat source capable of raising the
temperature of skin and deeper tissues to a level that causes cell death and
protein coagulation or charring. The most common causes are flame, scalding
liquids, and hot objects or gases contacting the skin.
2. Electrical Burns – these result from the generation of heat, which may reach
5000 C (9032 F). Because most of the resistance to electric current occurs
where the conductor contacts the skin, electrical burns usually affect the skin
and subjacent tissues; they may be of almost any size and depth.
3. Chemical Burns – these may be due to strong acids or alkalis, phenols, cresols,
mustard gas, or phosphorus. All of these agents produce necrosis, which may
extend slowly for several hours.
4. Radiation Burns – these are most commonly due to prolonged exposure to the
sun’s ultraviolet radiation (sunburn) but may be due to prolonged or intense
exposure to other sources of ultraviolet radiation (e.g., from tanning beds) or
to sources of X-ray or other radiation.

130. CLASSIFICATIONS OF BURNS
Burns are classified as: first-, second-, third-degree, or fourth-degree depending on
how deeply and severely they penetrate the skin's surface.
1. FIRST-DEGREE (superficial) BURNS
First-degree burns affect only the outer layer of skin, the epidermis. The burn
site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long
-term tissue damage is rare and often consists of an increase or decrease in the
skin color.

131. 2. SECOND-DEGREE (partial thickness) BURNS
Second-degree burns involve the epidermis and part of the lower
layer of skin, the dermis. The burn site looks red, blistered, and may
be swollen and painful.

132. 3. Third-degree (full thickness) burns
Third-degree burns destroy the epidermis and dermis.
They may go into the innermost layer of skin, the subcutaneous
tissue. The burn site may look white or blackened and charred.

133. 4. FOURTH-DEGREE BURNS
Fourth-degree burns go through both layers of the skin and underlying
tissue as well as deeper tissue, possibly involving muscle and bone.
There is no feeling in the area since the nerve endings are destroyed.

134. ASSESSMENT in BURNS:
The extent of burns in a patient is assessed in terms of % BSA (Body Surface
Area) to plan the line of management and to determine the prognosis.
The involved areas are outlined on a burn diagram.
Rules of Nines in Burns:
For adults, the extent of the burn (% BSA) is estimated by comparing the
patient’s diagram with the rule of nines.
1. Head and neck – 9%
2. Trunk (anterior and posterior) – 18%
3. Arm – 9% (each)
4. Genitalia and perineum– 1%
5. Leg – 18% (each)

135. RULE OF NINES

136. LUND-BROWDER CHART
For children, the % BSA can be more
accurately estimated using the Lund-
Browder Chart.
The Lund and Browder chart is a tool
useful in the management of burns for
estimating the total body surface area
affected.
This chart takes into consideration the
age of the person, with decreasing
percentage BSA for the head and
increasing percentage BSA for the legs
as the child ages, making it more useful
in pediatric burns.

137. Relativepercentageofbodysurfaceareas(%BSA)affectedbygrowth
0yr 1yr 5yrs 10yrs 15yrs
a–½ofhead 91/2 81/2 81/2 51/2 41/2
b–½of1thigh 2¼ 31/4 4 41/2 41/2
C–½oflowerleg 21/2 21/2 21/4 3 31/4

138. Myths about treating burns – and what to do instead:
MYTH #1: The colder the water, the better
No. While administering running water to a burn for 20 minutes is the best first-aid
advice, it should be cool water – not freezing cold.
Cool water is best at stopping the burning process, while ice-cold water damages the
skin and makes the burn go deeper.
MYTH #2: Ice is a good substitute for water
Definitely not.
Not only does the flowing nature of running water conduct heat away from a burn far
better than a block of ice can, extreme cold in the form of ice can also damage the skin.
Ice is a big no-no because it causes the blood vessels in the skin to shut down, which
deprives the skin of oxygen-rich blood and causes the burn to get worse – it can even
cause a superficial burn to become a deep one.

139. MYTH #3: If you can’t put a burn under running water immediately, there’s no point.
Not true. Doing this for 20 minutes as soon after the burn as possible is best, but it’s
still useful for reducing the chances of the burn getting deeper, up to three hours
following a burn injury.
MYTH #4: If a burn isn’t painful it doesn’t need medical attention
Don’t be fooled.
Third degree or fourth degree burns may be less painful than more minor burns
because the sensory fibers in the skin have been destroyed by the burn.
While first-degree burns are the least severe, third-degree burns or fourth degree
burns are the most severe and may cause the skin to appear white or leathery.
If a burn is larger than a 20-cent piece or it is deep, always seek medical help.
Packing essentials: Your first aid travel checklist

140. MYTH #5: Covering a burn with a clean towel is a good idea
Covering a burn on the way to hospital is a good idea – but not with a
towel.
One of the greatest enemies to a burn wound is infection because that
can cause the burn to deepen and – in large burns – can even cause
death.
After you’ve placed a burn under cool running water for 20 minutes,
cling-film is a good temporary dressing.
Most people have this in the house and because it’s pure plastic, there’s
very little for bacteria and viruses to cling to, making it one of the
cleanest, safest and most comfortable temporary dressings for burns.

141. MYTH #6:
Your favorite tube of toothpaste contains cooling, refreshing ingredients like
sodium fluoride, baking soda, and menthol. That’s why lots of people swear by it as
a DIY first-aid remedy for everything from acne to first-degree burns.
However, while toothpaste can scrub off plaque, protect tooth enamel, and prevent
gum disease, it’s not an effective remedy for burns (or acne, for that matter).
First-degree burns should be treated with first aid. Toothpaste is not an effective
home remedy for these.
Sodium fluoride in toothpaste works to coat and prevent tooth decay. But when you
apply it to your skin, it can seal in heat as well as bad bacteria.
Even fluoride-free toothpaste formulas that contain baking soda or other “natural”
whitening agents will only prolong the healing process of your burn.

142. FIRST AID in GENERAL:
 Stop the burn source. For example, turn off electric
current, “stop, drop and roll” on the floor or ground or
douse with cold water or wrap the victim in a cotton
blanket or rug to put out flames.
 Remove clothing, but only if it doesn’t stick to burned
area. Cut unstuck clothing away. Don’t pull it off.
 Remove jewelry, if you can.

143. FIRST AID in 1st DEGREE BURNS:
 Cool the area right away. Place the affected area in a container of cold water
or under cold running water. Do this for at least 5-10 minutes or until the
pain is relieved. This will also reduce the amount of skin degree. (If the
affected area is dirty, gently wash it with soapy water first).
 Do not apply ice or cold water for too long a time. This may result in
complete numbness leading to frostbite.
 Keep the area uncovered and elevated, if possible. Apply a dry dressing, if
necessary.
 Do not use butter or other ointments (e.g. Vaseline).
 Avoid using local anesthesia sprays and creams. They can slow healing and
may lead to allergic reactions in some people.
 Call your doctor if after 2 days you show signs of infection (fever of 101 F or
higher, chills, increased redness, swelling or pus in the infected area) or if the
affected area is still painful.
 Take Aspirin, Paracetamol, Ibuprofen, or Naproxen Sodium to relieve pain.

144. FIRST AID in 2nd DEGREE BURNS:
 Immerse the affected area in cold water (not ice) until the pain subsides.
 Dip clean cloths in cold water, wring them out and apply them over and
over again to the burned area for as long as an hour. Blot the area dry. Do
not rub.
 Do not break any blisters that have formed.
 Avoid applying antiseptic sprays, ointments, and creams.
 Once dried, dress the area with a single layer of loose gauze that does not
stick to the skin. Hold in place with bandage tape that is placed well away
from the burned area.
 Change the dressing the next day and every two days after that.
 Prop the burnt area higher than the rest of the body, if possible.
 Call your doctor if there are signs of infection (fever of 101 F or higher,
chills, increased redness and swelling, and pus) or if the burn shows no sign
of improvement after 2 days.

145. FIRST AID in 3rd DEGREE BURNS:
 If the arm(s) or leg(s) are burned, elevate them above heart level. If the
burn is on the face, sit up or have the victim sit up.
 Cool the burned skin with cool water, not ice. Don’t use cold water on large,
third degree burns. Don’t immerse in ice water. Use cold cloth compresses
on burns of the hands, feet, and face, but don’t leave on longer than 15-20
minutes.
 Cover the burned area with a clean cloth or sterile dressing. Don’t use
plastic.
 Don’t apply any type of ointment, cream, butter or antiseptic sprays on the
burn
 Calm the victim
 Don’t give the victim anything to drink or eat
 Monitor for breathing and pulse and shock.

146. FIRST AID in 4th DEGREE BURNS:
The precise treatment for your fourth-degree burn will depend on the
extent of the damage to your body, as well as your overall health.
While waiting for an ambulance to arrive, you can help a burn victim
by:
 Raising the injured body part above the heart, if possible
 Covering the affected area with a loose bandage or cloth
 Placing a light sheet or blanket over them, especially if they appear
cold from reduced blood pressure
 Flushing the area with water (for chemical burns only)

147. The actions you don’t take are perhaps just as important as the ones you do take.
As you wait for emergency medical attention, make sure you:
 Don’t apply ice
 Don’t apply creams or ointments to the burns
 Don’t remove clothing that may be stuck to the burn
 Don’t pick at skin or peel away any blisters
Once the victim get to the burn unit, the doctor may take a variety of approaches
to treatment. They’ll first clean the burn and remove any dead tissues.
Much of the treatment depends on how much of the bones, muscles, and nerves
are affected, as well as the location of the burn itself. the doctor might do one or
more of the following:
 Prescribe pain medications
 Apply antibiotic ointments in the case of an infection
 Order a tetanus shot, if you haven’t had one in the last 10 years
 Use intravenous fluids to help prevent dehydration and low body
temperature

148. At this time, you’re also at a high risk of experiencing shock. This is due
to the large inflammatory response from your body as it contends with
the changes the burn has suddenly made to the affected area. Your
major organs can also become susceptible to inflammation, including
your heart.
As the burn heals, your doctor will be able to determine the overall
extent of the damage to your body. Cosmetic reconstruction methods,
such as skin grafting, may be necessary if your skin doesn’t generate
any new tissues.
You may also need to consider other treatments, such as physical
therapy, if you’ve lost feeling in the area. Further medical treatments
may be necessary for damaged joints and lost muscles.
*Shock is a life-threatening condition that occurs when the body is not getting enough blood flow.
*Skin grafting is a surgical procedure that involves removing skin from one area of the body and moving
it, or transplanting it, to a different area of the body.

149. SKIN GRAFTING. Preferred donor
sites are the abdomen, groin,
forearm, or area above the clavicle
(collarbone).
*Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing
potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic,
and by maggot therapy.
DEBRIDEMENT

150. Sofra-Tulle may be used in the management of wounds, including
minor traumatic injuries, ulcers, burns, and other lesions that are
clinically infected by organisms shown to be sensitive to framycetin.
organisms that are resistant to the antibiotic.

151. FAINTING

152. FAINTING
Fainting, or syncope, is a sudden and
temporary loss of consciousness.
This usually occurs due to a lack of
oxygen reaching the brain.
Many things can cause oxygen
deprivation to the brain, including
low blood pressure.
Fainting is not usually serious.
However, sometimes it can indicate a
serious medical issue. People should
treat every case of fainting as a
medical emergency until they have
uncovered the cause and treated the
symptoms.

153. Fainting usually results from a lack of oxygen to the brain, such as
from problems with the lungs or blood circulation or carbon monoxide
poisoning.
Fainting is a survival mechanism. If blood and oxygen levels in the
brain drop too low, the body immediately starts shutting down
nonvital parts to direct resources to vital organs.
When the brain detects lower levels of oxygen, breathing will speed
up to increase the levels.
The heart rate will also increase, so that more oxygen reaches the
brain. This reduces blood pressure in other parts of the body. The
brain then receives extra blood at the expense of other body areas.
Hyperventilation plus hypotension may result in short term loss of
consciousness, muscle weakening, and fainting.
CAUSES

154. Causes of Fainting:
 Low blood sugar (hypoglycemia)
which is common in early pregnancy
 Anemia
 Any condition in which there is a
rapid loss of blood. This can be from
internal bleeding such as with a
peptic ulcer; or a tubal pregnancy or
ruptured ovarian cyst in females.
 Heat and circulatory problems such
as abnormal heart rhythm, heart
attack or stroke.
 Heat stroke or heat exhaustion
 Eating disorders such as anorexia,
bulimia, etc.
 Toxic shock syndrome
 A sudden change in body position
like standing up too quickly (postural
hypotension)
 Extreme pain
 Any procedure in women that stretches the
cervix such a shaving an IUD inserted,
especially in women who have never been
pregnant.
 Sudden emotional stress or fright
 Anxiety
 Taking some prescription medicines.
Examples are: some that low high blood
pressure, tranquilizers, antidepressants, or
even some over-the-counter medicines
when taken in excessive amounts.
 The risk for fainting increases if you are in
hot, humid weather, are in a stuffy room or
have consumed excessive amounts of
alcohol.
 Just before fainting, a person may:
 Feel a sense of dread.
 Feel dizzy.
 See spots before his or her eyes.
 Have nausea.

155. UNDERLYING CAUSES
Different underlying causes can cause a
person to faint. We discuss some of them in
detail below:
Neurocardiogenic syncope
Neurocardiogenic syncope develops due to a
short term malfunction of the autonomous
nervous system (ANS). Some people call it
neurally mediated syncope (NMS).
The ANS controls automatic body functions,
including heart rate, digestion, and
respiration rate.
In NMS, a drop in blood pressure slows the
heartbeat and pulse rate. This temporarily
interrupts the brain’s blood and oxygen
supply.

156. Possible triggers of
neurocardiogenic syncope
include:
 an unpleasant or shocking
image, such as seeing blood
 sudden exposure to an
unpleasant sight or
experience
 abrupt emotional upset,
such as after receiving
tragic news
 extreme embarrassment
 standing still for a long time
 being in a hot and stuffy
environment for a long time

157. Occupational syncope
Occupation, or situational, syncope
is a type of neurocardiogenic
syncope with physical rather than
emotional, mental, or abstract
triggers. Triggers include:
 laughing or swallowing
 passing stools or urine
 coughing or sneezing
 strenuous physical activities,
such as lifting a heavy weight
 having blood drawn

158. When experiencing the trigger condition, the person often becomes
pale and feels nauseated, sweaty, and weak just before losing
consciousness. Situational syncope is caused by a reflex of the
involuntary nervous system called the vasovagal reaction. The
vasovagal reaction leads the heart to slow down (bradycardia), and at
the same time it leads the nerves that serve the blood vessels in the
legs to permit those vessels to dilate (widen). The result is that the
heart puts out less blood, the blood pressure drops, and circulating
blood tends to go into the legs rather than to the head. The brain is
deprived of oxygen, and the fainting episode occurs.
Situational syncope is also known as vasovagal syncope, vasodepressor
syncope, and Gower syndrome.

159. Orthostatic hypotension
Orthostatic hypotension refers to
fainting after standing up too
quickly from a seated or horizontal
position.
Gravity pulls blood into the legs,
bringing down blood pressure
elsewhere in the body. The nervous
system usually reacts to this by
increasing the heartbeat and
narrowing the blood vessels. This
stabilizes blood pressure.
However, if something undermines
this stabilization process, there may
be poor blood and oxygen supply to
the brain, leading to fainting.

160. Triggers include:
Dehydration: If body fluid levels drop, so will blood pressure. This can
make it harder for the blood pressure to stabilize. Therefore, less
blood and oxygen reaches the brain.
Uncontrolled diabetes: A person with diabetes may need to urinate
frequently, leading to dehydration. High blood sugar levels can
damage certain nerves, especially those that regulate blood pressure.
Some medications: Taking diuretics, beta-blockers, and
antihypertensive drugs may cause orthostatic hypotension in some
people.
Alcohol: Some people faint if they consume too much alcohol in a
short amount of time.

161. Some neurological conditions: Parkinson’s disease and other
neurological conditions affect the nervous system. This may lead to
orthostatic hypotension.
Carotid sinus syndrome: The carotid artery is the main artery that
supplies blood to the brain. When there is pressure on the pressure
sensors, or carotid sinus, in the carotid artery, it can cause fainting.
If a person’s carotid sinus is very sensitive, blood pressure may drop
when they turn the head to one side, wear a tight collar or tie, or
move over the carotid sinus while shaving. This may result in
fainting.
This is more common among older males.

162. Cardiac syncope
An underlying heart problem may reduce blood and oxygen supply to the brain.
Possible heart conditions include:
 arrhythmias, or an abnormal heartbeat
 stenosis, or a blockage of the heart valves
 hypertension, or high blood pressure
 a heart attack, in which the heart muscle dies due to lack of blood and oxygen
This cause of fainting usually requires immediate medical treatment and extensive monitoring.

163. TYPES:
Apart from distinguishing episodes of fainting by their
underlying cause, one of two different types of fainting
might occur:
1. Pre- or near-syncope: This occurs when a person can
remember events or sensations during the loss of
consciousness, such as dizziness, blurred vision, and
muscle weakness. They may remember falling before
hitting their head and losing consciousness.
2. Syncope: This occurs when a person can remember the
feelings of dizziness and loss of vision but not the fall
itself.

164. SIGNS AND SYMPTOMS:
Losing consciousness is the primary symptom of fainting. The following
symptoms may occur leading up to a fainting episode:
 a feeling of heaviness in the legs
 blurred or “tunnel” vision
 confusion
 feeling warm or hot
 lightheadedness, dizziness, or a floating feeling
 nausea
 sweating
 vomiting
 Yawning
When a person faints, they may:
 fall over or slump
 appear unusually pale
 have reduced blood pressure and a weak pulse

165. DO’s and DON’Ts when someone is about to faint or faints:
Fainting – DO’s:
 Catch the person before he or she fall.
 Have the person lie down with the head below the level of the heart. Raise the
legs 8 to 12 inches. This promotes blood flow to the brain. If a victim who is
about to faint can lie down right away, he or she may not lose consciousness.
 Turn the victim’s head to the side so the tongue doesn’t fall back into the
throat.
 Loosen any tight clothing.
 Apply moist towels to the person’s face and neck.
 Keep the victim warm, especially if the surroundings are chilly.
Fainting –DON’Ts:
 Don’t slap or shake anyone who’s just fainted
 Don’t try to give the person anything to eat or drink, not even water, until they
are fully conscious.
 Don’t allow the person who’s fainted to get up until the sense of physical
weakness passes.

166. Fainting – SELF-CARE / FIRST AID:
When you feel you’re about to faint:
 Sit down, bend forward and put your head between your knees, or
 Lie down and elevate both legs 8 to 12 inches.
If you faint easily:
 Get up slowly from bed or from a sitting position.
 Follow your doctor’s advice to treat any medical condition which may lead to
fainting. Take medicines as prescribed, but let your doctor know about any side
effects so he/she can monitor your condition.
 Don’t wear tight-fitting clothing around your neck.
 Avoid turning your head suddenly.
 Stay out of stuffy rooms and hot, humid places. If you can’t, use a fan.
 Avoid activities that can put your life in danger if you have frequent fainting spells.
Examples include: driving and climbing high places.
 Drink alcoholic beverages in moderation.

167. For pregnant women:
 Get out of bed slowly.
 Keep crackers by your bedside and eat a few before getting out of bed. Try
other foods such as dry toast, graham crackers, bananas, etc.
 Eat small, frequent meals instead of a few large ones. Have a good food
source of protein, such as lean meat, low-fat cheese, milk, etc. with each
meal. Avoid sweets. Don’t skip meals or go for a long time without eating.
 Don’t sit for long periods of time.
 Keep your legs elevated when you sit.
 When you stand, as in a line, don’t stand still. Move your legs to pump
blood up to your heart.
 Take vitamin and mineral supplements as your doctor prescribes.
 Never lay on your back during the 3rd trimester. It is best to lie on your left
side, if you can’t lay on your right side.

168. UNCONSCIOUSNESS

169. UNCONSCIOUSNESS
Unconsciousness is caused by illness, injury or emotional shock. An
unconscious person is hard to rouse or cannot be made aware of his or
her surroundings.
Levels of Unconsciousness:
 Brief – examples are fainting or blacking out.
 Longer – the victim is incoherent when roused.
 Prolonged – a person in coma, for example, can be motionless and
not at all aware of his or her surroundings for a very long time.

170. CAUSES OF
UNCONSCIOUSNESS:
 Carbon Monoxide poisoning
 Hypothermia (low body temperature
usually caused by over-exposure to
cold temperatures or cold water.
 Stroke
 Shock
 Epilepsy
 Heat exhaustion
 Diabetic coma
 Excessive bleeding
 Alcohol abuse
 Drug overdose
 Poisoning
 Head injury/concussion
 Low blood sugar
 Too fast, too slow and/or
irregular heartbeats
 Heart attack
 Medications
 Hypothermia (very low body
temperature)
 Heart valve disease

171. COMMON SIGNS:
 Loss of all special
senses: Vision, Smell,
Hearing, Touch
 Inability to swallow any
fluid poured in the
mouth
 Loss of control of
bowel & bladder
movements

172. GENERAL FIRST AID:
 Ensure an abundant supply of fresh air. Open windows & doors, if
indoors.
 Remove false teeth, if any, turn the head to one side and pull the
tongue out for free passage of air.
 If breathing has stopped, turn the patient into supine position and
commence rescue breathing CPR.
 If breathing is noisy, turn the patient into recovery position.
 Untie all tight clothing around the neck, chest & waist.
 DO NOT leave the patient alone until expert help arrives.
 DO NOT attempt to give food or fluids.

173. INJURIES

174. INJURIES
TYPES of INJURIES:
 Cuts (Lacerated &
Incised Wounds)
 Scrapes (Abrasions)
 Punctures
 Sprains
 Contusions

175. Wound is a break in the continuity of
the soft tissues of the body, mainly
skin.
Cuts, scrapes, and punctures can all
result in bleeding. Sprains result in
pain and swelling.
 Cuts slice the skin open.
 Scrapes hurt only the top part of the
skin.
 Punctures stab deep.
 Strain occurs when a muscle or tendon
is overstretched or overexerted.
 Contusion is the medical term for a
bruise. It is the result of a direct blow or
an impact, such as a fall. Contusions are
common sports injuries.

176. FIRST AID in CUTS:
 Press on the cut to help slow down the bleeding. You may have to
apply pressure for 10 minutes or more for a bad cut. Sometimes a
cut needs stitches.
 Apply a bandage over the cut.
 Leave the bandage on for 24 hours. Change the bandage every day
or two or more often if you need to.
 Be careful when you take the bandage off. You don’t want to make
the cut bleed again. If you have used gauze, wet it before you pull it
off.
 Let the wound bleed to clean itself out.
 Remove the object that caused the puncture. Use clean tweezers.
Hold a lit match to the ends of the tweezers to sterilize them.
 Note – Don’t pull anything out of a puncture wound if blood gushes
from it, or if it has been bleeding badly. Get emergency care.

177. FIRST AID in PUNCTURES:
 Wash the wound with warm water and soap, or take a bath or shower to
clean it.
 Leave the wound open. Cover it with a bandage if it is big or still bleeds a
little.
 Soak the wound in warm, soapy water 2 to 3 times a day.

178. SPRAIN and STRAIN
A sprain is a stretching or tearing of ligaments — the tough bands of
fibrous tissue that connect two bones together in your joints. The
most common location for a sprain is in your ankle.
Initial treatment includes rest, ice, compression and elevation. Mild
sprains can be successfully treated at home. Severe sprains sometimes
require surgery to repair torn ligaments.
The difference between a sprain and a strain is that a sprain injures
the bands of tissue that connect two bones together, while a strain
involves an injury to a muscle or to the band of tissue that attaches a
muscle to a bone.
 Treatment for sprains and strains will depend on the extent of
damage done to the muscle, ligament or tendon.
 Self-help measures may be all that are needed for mild injuries.
 Severe sprains may require medical treatment. Some sprains
require a cast. Others may need surgery if the tissue affected is
torn.

179. FIRST AID in SPRAIN:
 Apply RICE:
 R – est the injured area for 24 to 48 hours.
 I – ce the area for 5 to 20 minutes every hour for the first 48 to
72 hours or until the area no longer looks or feels hot.
 C – ompress the area by wrapping it tightly with an elastic
bandage for 30 minutes, then unwrap it for 15 minutes. Begin
wrapping from the point farthest from the heart and wrap
toward the center of the body. Repeat several times.
 E – levate the area to reduce swelling. Prop it up to keep it
elevated while you sleep.
 Remove rings right away if you have sprained a finger or other part of
your hand. (if swelling occurs, the rings may have to be cut off.)
 Use crutches for a badly sprained ankle. Crutches keep you from putting
weight on the ankle which could cause further damage. Using them will
help speed healing.

180. First Aid Guide for Contusion/Bruises:
If there is external bleeding in addition to bruising, attempt to stop the bleeding before
attending to the bruising. General measures for stopping bleeding are as follows:
 Locate the source of the bleeding.
 Wash your hands and, when possible, wear gloves or use a barrier between you and
the wound.
 Remove any loose debris. Note: Do NOT pull debris from a wound that is embedded.
 With a sterile or clean dressing, apply direct pressure.
 Unless a broken bone is suspected, elevate the injured area above the heart.
If the bleeding does not stop after 15 minutes of the above measures, seek prompt medical
care.
 Self-care measures for bruises are as follows:
 Apply a cold compress to the affected area to reduce the swelling. Note: Do not put
ice directly on the skin. Cold compresses can be applied for 30–60 minutes a day
until the bruising subsides.
 If the bruise is on an extremity (eg, arm or leg), raise it above the heart to reduce the
flow of blood to the affected area.
 Take a pain reliever (eg, acetaminophen, Tylenol) for pain, if needed.

181. PREVENTION OF SLIPS, TRIPS & FALLS
Slips, trips and falls cause numerous
deaths and injuries in workplaces,
schools and in homes.
Slips usually are a result of the heel
slipping forward as the individual is
transferring weight, which causes the
individual to fall backwards.
A trip is the result of a foot striking or
colliding with an object, which
causes a loss in balance, and usually
a fall.
Studies show that 66% of falls occur
on the same level as a result of slip
or trip.

183. CAUSES:
Slips
Slips happen where there is too little
friction or traction between the
footwear and the walking surface.
Common causes of slips are:
•wet or oily surfaces
•occasional spills
•weather hazards
•loose, unanchored rugs or mats
•flooring or other walking surfaces
that do not have same degree of
traction in all areas

184. Trips
Trips happen when your foot
collides (strikes, hits) an object
causing you to lose the balance
and, eventually fall.
Common causes of tripping are:
•obstructed view
•poor lighting
•clutter in your way
•wrinkled carpeting
•uncovered cables
•bottom drawers not being closed
•uneven (steps, thresholds)
walking surfaces

185. FALLS
•Lower body weakness
•Vitamin D deficiency (that is, not enough
vitamin D in your system)
•Difficulties with walking and balance
•Use of medicines, such as tranquilizers,
sedatives, or antidepressants. Even some over-
the-counter medicines can affect balance and
how steady you are on your feet.
•Vision problems
•Foot pain or poor footwear
•Home hazards or dangers such as
• broken or uneven steps, and
• throw rugs or clutter that can be
tripped over.
Most falls are caused by a combination of risk
factors. The more risk factors a person has, the
greater their chances of falling.

186. DO’s and DON’Ts of PROPER LIFTING:
DO’s:
 Wear good shoes with low heels, not sandals or high heels.
 Stand close to the thing you want to lift.
 Plant your feet squarely, shoulder width apart.
 Bend at the knees, not at the waist. Keep your knees bent as you
lift.
 Pull in your stomach and rear-end. Keep your back as straight as
you can.
 Hold the object close to your body.
 Lift slowly. Let your legs carry the weight.
 Get help or use a dolly to move something that is too big or very
heavy.

187. DON’Ts:
 Don’t bend at the waist to pick something up.
 Don’t arch your back when you lift or carry.
 Don’t lift too fast or with a jerk.
 Don’t twist your back when you are holding something. Turn your
whole body, from head to toe.
 Don’t lift something heavy with one hand and something light with
the other. Balance the load.
 Don’t try to lift one thing while you hold something else. For
example: don’t try to pick up a child while you are holding a
grocery bag and the child at the same time.

188. FIRST AID FOR FALLS:
Slips, trips and falls commonly result in sprains, strains or even broken bones.
Find out how you can help below if someone has an accident at work.
Sprains and strains
Sprains and strains describe when muscles or joints are overstretched which
can be painful.
If someone trips and falls they could twist their ankle or wrist or overstretch a
muscle in their shoulder, back or leg. Sprains or strains are usually swollen and
painful and can sometimes bruise. You should take the following steps:
 Get the person to rest.
 Apply an ice pack to the injury - This will help to reduce the pain and
swelling.
 If there is no improvement, advise them to seek medical advice.

189. Broken bones
Broken bones can happen as a result of a fall if someone falls from a
height or if they land in an awkward position.
Someone who has a broken bone will usually have pain, swelling and
bruising, and may have difficulty moving their limb. If you suspect your
colleague has a broken bone, you should take the following steps:
 Encourage them to support the injury with their hand, or use a
cushion or items of clothing to prevent unnecessary movement -
Supporting the injury may help to reduce pain and prevent further
damage
 Arrange for the person to go to hospital. Call 999 if necessary.
 Continue supporting the injury until help arrives.

190. SNAKEBITES

191. SNAKEBITES
A snakebite is an injury caused by the bite of a snake, especially a venomous
snake.
 Every year about 40,000 people are killed by snake bite according to a
conservative estimate made by WHO. About 70% of the deaths occur in
Asia.
 Of the 2,500 varieties of snakes that exist in the world, less than 200
varieties are dangerous to man.
 In India, out of some 300 species of land snakes, 40 are poisonous and out
of 30 sea snakes, 23 are poisonous.
 The dangerous snakes are cobras, kraits, sea snakes, Horned and Russel’s
Vipers.
 Snakes are recognized by their size, color, shape of the head and tail,
arrangements of the scales and by the position and type of fangs.

192. IDENTIFYING VENOMOUS SNAKES
If you are unfamiliar with the different types of snakes and
unable to distinguish between venomous and non-
venomous ones, it can be difficult to know how to respond
in the event of a bite. Always treat a snake bite as if it’s
venomous.
While most snakes in the U.S. are not venomous, several
types do contain venom. In the U.S., all of the venomous
snakes, except for the coral snake, are pit vipers. Pit vipers
are distinguishable by a noticeable depression between the
eye and nostril. This pit is the heat-sensing area for the
snake. While all pit vipers have a triangular head, not all
snakes with a triangular head are venomous.
If you or someone you are with has been bitten by a snake,
you will know immediately. It’s possible, though, for the
bite to happen quickly and for the snake to disappear.

193. Some venomous snakes also
cause symptoms specific to their
type:
 Rattlesnakes
Rattlesnakes are easily identifiable.
They have rings at the end of their
tails that shake when they feel
threatened. This makes a rattling
sound and is a warning for you to
back away. Rattlesnakes are the
largest of the venomous snakes and
account for many of the venomous
bites in the U.S. each year. These
snakes can be found in nearly any
habitat across the country. They like
open areas where they can rest in the
sun such as rocks, and logs.

194. Symptoms
Symptoms specific to rattlesnake bites are immediate and include:
 severe pain
 drooping eyelids
 low blood pressure
 thirst
 tiredness or muscle weakness

195.  Water moccasins or
cottonmouths
The water moccasin is another type of
pit viper. This snake is also known as a
cottonmouth, because the inside of its
mouth is lined with a white, cottony
material. The water moccasin’s average
size is between 50 to 55 inches. Adults
have dark tan to black skin with faint
dark brown or black crossbands. Young
snakes have brown or orange
crossbands with a yellow tail. These
snakes are found in the southeastern
states, usually in or near water. They
don’t scare easily, and will defend
themselves should they feel
threatened.

196. Symptoms
Water moccasin bites share symptoms with copperhead bites.
Specific symptoms include:
 immediate pain and symptoms
 change in skin color
 shock
 low blood pressure
 weakness

197.  Copperheads
Copperheads are reddish or
gold in color with hourglass-
shaped bands. This snake is
typically 18 to 36 inches in
length. Copperheads are
mostly found in forests,
swamps, rocky areas, and
rivers in the eastern states (as
far as Texas). They are not
aggressive. Most copperhead
bites occur if you accidentally
step on or near one.

198. Symptoms
Copperhead snake bites share symptoms with water
moccasin snake bites. Symptoms can include:
 immediate pain and symptoms
 change in skin color
 shock
 low blood pressure
 weakness

199.  Coral snakes
Coral snakes have black, yellow, and
red banding and are often confused
with non-venomous king snakes. You
can distinguish a coral snake by the
fact that the red bands touch the
yellow bands. They live in the woods,
marshes, and sandy areas of the
South. Coral snakes typically hide
underground and in leaf piles.

200. Symptoms
Symptoms specific to coral snake bites include:
 pain that is not immediate
 symptoms that set in hours after the bite
 convulsions
 drooping eyelids
 change in skin color
 stomach pain
 difficulty swallowing
 headache
 shock
 paralysis