First aid nursing

FIRST AID NURSING
Sharon Treesa Antony
Junior Lecturer

FIRST AID
First aid is the temporary and immediate
treatment given to a person who is
injured/suddenly becomes ill, using facilities
or materials available at that time before
regular medical help is imparted.

OBJECTIVES
 To preserve life
 To prevent further injury and deterioration of the
condition
 To make the victim as comfortable as possible to
conserve strength
 To put the injured person under professional
medical care at the earliest

QUALITIES OF A FIRST AIDER
 ;Observant
 Able to act quickly
 Should not get panic or excited
 Ability to lead and control the crowd and take help
from the onlookers
 Self confidence
 Able to reassure the victim and his/her relative by
demonstrating competence, expressing sympathy
and providing good counselling
 Resourceful

PRINCIPLES
 Be in control, both of yourself and the problem
 Act calmly and logically
 Be gentle but firm
 Build up while talking to the casualty throughout the
examination and treatment
 Explain what you are going to do
 Answer honestly
 Never leave casualty alone
 Reassure the casualty
 Do not separate a child from its parents or guardian
 Casualty should be sent to a hospital or doctor by
quickest means of transport. Always inform police about
serious accidents
 Inform the relatives

CONT..
 An up to date first aid manual
 A list of emergency phone numbers
 Adhesive tapes
 Antiseptic wipes
 Soap
 Tooth preservation kit
 Sharp scissors
 Flash light with extra batteries
 Mouth piece for giving CPR

CONCEPT OF EMERGENCY
 An emergency is an acute injury or illness that
poses an immediate risk to a person’s life or long
term health.
Eg: severe bleeding, choking, fractures, shortness of
breath, severe burns, poisoning

POISONING
Poisons are harmful substances and when sufficient
doses are taken may kill the person

POISONS MAY BE CONSUMED:
 Accidently
 For suicidal purpose
 Intentionally for killing a person

ROUTES OF TAKING POISON
 By mouth
 Inhaling
 By injection
 Absorption through skin

GENERAL SIGNS AND SYMPTOMS
 Others/ the casualty informs about poisoning
 Seeing a container having poison
 Delirious convulsions
 Signs and symptoms of asphyxia
 Unconsciousness
 Vomiting/diarrhoea
 Burns of lips/mouth after contact with corrosive
poisons

TREATMENT
 Inform police
 Remove from offending agent like gaseous
atmosphere
 Collect information from any witness available
 Preserve any suspicious container for information
to doctor
 If the person has vomited, preserve the vomitus

TO INDUCE VOMITING
 Plenty of Luke warm water
 Egg white
 Milk
 Touching the fauces
 1 glass of water with two teaspoons of salt
 One teaspoon of mustard powder in luke warm
water

(CONT..)
 In case of burns to lips/mouth, cool them by
giving water/milk.
DO NOT INDUCE VOMITING

TO DILUTE POISON
Give
 Plenty of water
 Milk
 If alkali: lemon juice or vinegar in water

SLEEPING PILLS
 Induce vomiting
 Dilute poison
 Keep him awakened by giving tea/coffee/ piercing
pin
 If respiration is slow: artificial respiration

GAS POISONING
 CO
 CO2
 Inflammable gases
 Steam of ammonia
 Remove from the site
 If respiration stops, give artificial respiration
 Keep patient warm under blanket or bed sheet
 Immediate hospitalisation

FOOD POISONING
 Water
 Diluted fruit juice
 Weak tea
 If early recognised, can induce vomiting

ALCOHOL POISONING
 Make him sit and vomit
 Then give strong tea/coffee
 If unconscious/ head injury: hospitalise

CONT
 If unconscious, but breathing normally, place in
recovery position
 If breathing and heart beat stops, begin
resuscitation
 Shift to hospital immediately

TAKE CARE
 Do not contaminate yourself with any poison that may
be around the casualty’s mouth
 DO NOT INDUCE VOMITING IF the casualty has
swallowed:
 Any strong acid/alkali
 Ammonia
 Turpentine
 Bleachers
 Toilet cleaners
 Petrol
 Kerosene
 Paint thinner
 Polish

ANTIDOTES
 Acetyl salicylic acid:1 tsp soda bicarb in 1 glass of
water
 Conc. Acid: excess water& chalk/ soda bicarbonate
in 1 glass of water
 Conc. alkali: 1 tsp vinegar, orange/lemon
 CO: O2
 Cresol/lysol/dettol/lead: epsum salt in 1 glass water

IDENTIFICATION OF POISONOUS AND NON-
POISONOUS SNAKES

SIGNS AND SYMPTOMS
 Pain and numbness at site
 Drowsiness
 Swelling
 Area becomes bluish purple in 12 hours
 Dimness of vision
 Dribbling of saliva, paralysis
 Convulsions,coma

FIRST AID
 Help the patient to lie down. Keep the head above
the level of wounded part
 Reassure and help to be calm and still
 Gently wash the wound and pat dry with clean
swabs
 Lightly compress the limb above wound with a roller
bandage
 Use triangular bandages to immobilise the affected
area
 Take the killed snake if available to hospital for
identification

DO NOT
 Apply a tourniquet, slash the wound with a knife or
suck out the venom
 If the casualty becomes unconscious, open the
airway and check breathing, be prepared for cardio
pulmonary resuscitation

SCORPION BITE
 Signs and symptoms
 Severe burning
 Intolerable increasing pain
 Giddiness
 Vomiting
 Can become unconscious
 Itching
 Swelling
 Increased numbness near the site of bite

FIRST AID
 Help the casualty to sit or lie down , reassure her
 Raise the affected part if possible
 Apply ice packs/cold compress on the region to
slow down the absorption of poison
 Monitor vital signs-pulse, breathing, level of
response
 Watch for signs of allergy like wheezing
 Hospitalise
 If stings to mouth or throat, give ice cubes to suck
or cold water to drink

OTHER INSECT STINGS AND BITES
 Like bees
 Reassure the casualty. If the sting is visible,
brush/scrape it off sideways with your finger nail or
the blunt edge of a knife . Do not use tweezers
because more poison may be injected into the
casualty.
 Raise the affected part if possible and apply an ice
pack or cold compress .
 See doctor if pain and swelling persists
 Stings to mouth and throat: drink cold water or suck
ice cubes

DOG BITE
 Put on disposable gloves if available
 Wash the bite wound thoroughly with soap and
water in order to minimise the risk of infection
 Pat dry with clean gauze swabs and cover with an
adhesive dressing or a small sterile dressing
 Immediately hospitalise if wound is large or deep
or suspecting rabies

CONT....
 If the wound is deep, control bleeding by applying
direct pressure and raising the injured part or apply
a tight dressing and bandage
 Seek medical advice if tetanus immunisation not
taken/ it is more than 10 years since the casualty’s
last injection

FOREIGN BODY IN THE EYE
 Can be a speck of dust, a loose eyelash etc
 Usually such objects can be easily be rinsed off
 Do not touch anything that
 Sticks to the eye
 Penetrates the eyeball
 Rests on the iris

 Advise the casualty to sit down facing the light; tell
them not to rub their eye
 Stand behind the casualty. Gently separate the
eyelids with your finger and thumb. Examine every
part of her eye

 If you can see a foreign object on the eye, wash it
out by pouring clean water from a glass
 If this is unsuccessful, lift the object off with a moist
swab or the damp corner of a tissue or clean hand
kerchief.
 If you can’t still remove it, seek medical help

FOREIGN BODY UNDER THE UPPER EYELID
 Ask the casualty to grasp her lashes and pull the
upper lid over the lower lid.
 Blinking under water is also useful

FOREIGN OBJECT IN THE EAR
 Young children push objects into their ears
 Adults may leave cotton in ear
 Arrange to take or send the casualty to hospital as
soon as possible. Do not try to remove a lodged
foreign object yourself.
 Reassure the casualty during the journey or until
medical help arrives

INSECT INSIDE THE EAR
 Reassure the casualty and ask her to sit down.
 Support the head with the affected ear upper
 Gently flood the ear with tepid water so that the
insect floats out
 If this flooding does not remove the insect, take or
send the casualty to hospital

FOREIGN BODY IN THE NOSE
 Young children may push small objects up their
nose
 There may be:
 Difficult or noisy breathing through the nose
 Swelling of the nose
 Smelly or blood stained discharge

CONT.....
 Do not try to remove the objects ; you may cause
injury or push it further into the airway
 Try to keep the casualty quiet and calm
 Tell him to breathe through his mouth at a normal
rate. Advise him not to poke inside his nose to try to
remove the object himself
 Send to hospital

INHALED FOREIGN OBJECT
 There may be
 Some noise of choking, which quickly passes
 Persistent dry coughing
 Difficulty breathing

 Small smooth objects can slip past the throat and
enter into the air passages leading to lungs
 Dry peanuts which can swell up when in contact
with body fluids can be a real danger
 Peanuts can be inhaled into the lungs , resulting in
serious damage
 Management same as choking

CHOKING ADULT
 A foreign object that is stuck at the back of the
throat may block the throat or cause muscular
spasm
 Ask the casualty ΄΄ Are you choking? ˝
Mild obstruction
 Casualty able to speak, cough and breathe
Complete obstruction
 Casualty unable to speak, cough or breathe and
eventual loss of consciousness

CONT..
 If the casualty is breathing, encourage him to
continue coughing. Remove any obvious
obstruction from the mouth
 If the casualty cannot speak or stops coughing or
speaking, carry out back blows.
 Stand to the side and slightly behind him
 Support his chest with one hand and help him to
lean well forwards .
 Give upto 5 sharp blows between the scapulas
with the heel of your hand.
 Stop if the obstruction clears. Check his mouth.

CONT..
 If back blows fail to clear the obstruction, try abdominal
thrusts. ( Heimlich manoeuvre)
 Stand behind the casualty put both arms around the
upper part of his abdomen
 Make sure that he is still bending well forwards.
 Clench your fist and place it (thumb inwards) between
the navel and the bottom of the sternum. Grasp your fist
with your other hand. Pull sharply inwards and upwards
up to five times

CONT..
 Check his mouth if the obstruction is still not
cleared, repeat back blows and abdominal thrusts
up to 3 times, checking the mouth after each step.
 If the obstruction still has not cleared, continue until
help arrives or the casualty becomes unconscious

 If at any stage casualty becomes unconscious
Open the airway and check breathing
 If not breathing,
Give 30 chest compressions to try to relieve the
obstructions, then two rescue breaths

CHOKING CHILD
 Give upto five back blows, check mouth
 Give upto 5 abodominal thrusts. Check mouth
 Repeat the sequence upto 3 times .then call
ambulance
 Repeat sequence until help arrives or child
becomes unconscious

CHOKING INFANT
 Give upto five back blows, check mouth
 Give upto 5 chest thrusts. Check mouth
 Repeat the sequence upto 3 times .then call
ambulance
 Repeat sequence until help arrives or child
becomes unconscious

SWALLOWED FOREIGN BODY
 Reassure the casualty and try to find out exactly
what has swallowed
 If the swallowed object is small and smooth, take
or send the casualty to hospital
 Always seek medical advice if you know the
casualty has swallowed a battery
 If he has swallowed something large or sharp, or
has difficulty breathing or swallowing, get an
ambulance to reach hospital soon
 Do not allow the victim to eat or drink or smoke
because a general anaesthetic may need to be
given

ASPHYXIA
 Asphyxia is a deficiency of oxygen in blood and
an increase of carbon dioxide in the blood and
tissues.
 It occurs due to an interruption in the normal
exchange of oxygen and carbon dioxide between
the lungs and outside air
 Lungs do not get sufficient supply of oxygen for
breathing

CAUSES
 Drowning
 Electric shock
 Foreign body in air passages (choking)
 Inhalation of smoke and poisnous gases
 Suffocation under earth
 Hanging, strangulation by tight rope

SIGNS AND SYMPTOMS
 First stage
 Increased rate of breathing
 Breath gets shorter
 Veins of the neck becomes swollen
 Face , lips, nails, fingers and toes turns blue
 Pulse gets feebler and faster

CONT......
 Second stage
 Partial or complete loss of consciousness
 Froth may appear at the mouth and nostrils

MANAGEMENT
 Remove the cause if possible
 Ensure the airway is not obstructed Eg: loosen the tight
collar
 Place the individual on his back. Support the nape of the
neck on your palm and press neck back wards. Then
press the angle of the jaw forward from behind.
 Provide 5 mouth to mouth breathing
 Give artificial respiration until natural breathing is
established to ensure proper ventilation of lungs
 If heart beat stops, give external cardiac massage
 After breathing is restored, arrange for medical help

DROWNING
 Death by drowning occurs when air cannot get into
the lungs
 While a drowning person is rescued, do not attempt
to force water from stomach because the casualty
may vomit and then inhale it
 If you are rescuing a casualty from water to safety,
keep his head lower than the rest of body to reduce
the risk of him inhaling water
 Lay the casualty down on her back on a cloth.
 If breathing, place in recovery position
 Be prepared to give chest compressions and
rescue breaths if necessary

CONT..
 Treat hypothermia
 Remove wet clothing
 Cover with dry blankets
 If fully conscious, give a hot drink

SHOCK
 Life threatening condition
 Occurs when the circulatory system fails and as a
result, vital organs such as heart and brain are
deprived of oxygen

CAUSES
 Severe blood loss(>1.2 litres)
 Diarrhea
 Vomiting
 Blockage in intestine
 Severe burns
 Inability of heart to pump
 Overwhelming infections
 ....

RECOGNITION
Initially
 A rapid pulse
 Pale, cold, clammy skin, sweating
As shock develops,
 Cyanosis of lips, fingernails
 Weakness and dizziness
 Nausea, possibly vomiting
 Thirst
 Rapid, shallow breathing
 Weak, thready pulse
 Change in level of consciousness

FIRST AID
 Treat any possible causes that you can detect Eg:
bleeding
 Lay the casualty down on a blanket to insulate him
from cold ground.
 Constantly reassure her
 Raise and support her legs to improve the blood
supply to the vital organs. Take care if you suspect
a fracture
 Loosen tight clothing at the neck, chest, waist
 Keep him warm by covering her body and legs
with coats or blankets

CONT..
 Keeping head low may prevent casualty from losing
consciousness
 Do not let the casualty eat, drink, smoke or move
unnecessarily. If thirsty, moisten lips with a little water
 Monitor and record vital signs
 Be prepared to give resuscitation

FROST BITE
 Occurs in freezing or cold and windly conditions
 Usually the fingers or toes freeze due to low
temperatures
 can lead to permanent loss of sensation and
gangrene

RECOGNITION
 At first “ pins-and- needles’’ sensation
 Pallor, followed by numbness
 Hardening and stiffening of the skin
 A colour change to the skin of the affected area, first
white, then mottled and blue.
 On recovery, the skin may be red, hot, painful and
blistered.
 Where gangrene occurs, the tissue may become black
due to loss of blood supply

FIRST AID
 Move casualty into warmth
 Remove constricting clothes (rings, boots)
 Warm the affected part with your hands/in your lap/
in the casualty’s armpits
 DO NOT RUB AFFECTED AREA (????)

Place the affected part in warm water at around 40˚c
Dry carefully
Apply light dressing with dry gauze

 Raise and support the affected limb to reduce
swelling
 An adult casualty may take 2 paracetamol tablets
for intense pain
 Take or send the casualty to hospital

 Do not put the affected part near direct heat
 Do not allow the casualty to smoke

HEAT STROKE
 Caused by failure of the thermostat in the brain
 Body becomes dangerously overheated, usually
due to a high fever or prolonged exposure to heat
 Can develop with little warning, causing
unconsciousness within minutes of the casualty
feeling unwell

RECOGNITION
 Headache, dizziness, discomfort
 Restlessness, confusion
 Hot flushed and dry skin
 Rapid deterioration in the level of response
 Full bounding pulse
 Body temperature above 40˚C

FIRST AID
 Quickly move the casualty to a cool place.
 Remove as much of his outer clothing as possible
 Wrap the casualty in a cold, wet sheet until his
temperature falls to 37.5˚C
 If no sheet is available, fan the casualty, or sponge
him with cold water
 Once the casualty’s temperature appears to have
returned to normal, replace the wet sheet with a dry
one

CONT...
 Monitor and record vital signs
 If his temperature rises again, repeat the cooling
process again

BURNS AND SCALDS
 Skin has mainly 3 layers
 Epidermis
 Dermis
 Layer of fat tissue
 Blood vessels, nerves and hair roots are contained
within the dermis

TYPES OF BURNS
 Dry burns: flames, hot objects
 Scald :steam, hot liquids
 Electrical burns
 Cold injury: frost bite, contact with freezing metals,
freezing vapours
 Chemical burns: strong acids/ alkalies
 Radiation burns: sunburn, over exposure UV rays,
radioactive source

DEPTH OF BURNS
 Superficial burns: involves only the outer most
layer, epidermis
Eg: sunburn
 Partial thickness burns: destroy the epidermis
and are very painful. The skin becomes red and
blistered
 Full- thickness burns: pain sensation is usually
lost. Skin looks waxy, pale or charred.

BURNS THAT NEED HOSPITAL TREATMENT
 All cases of burns to children
 All full-thickness burns
 All burns involving the face, hands, feet or genital
area
 All burns that extend right around an arm or leg
 All partial thickness burns larger than 1% of the
body surface ( an with the size of the palm of
casualty’s hand)
 All superficial burns larger than 5% of the casualty’s
body surface
 Burns with a mixed pattern of varying depths
 Unsure about severity of burns

SEVERE BURNS AND SCALDS
 Help the casualty to lie down if possible. Try to
prevent burnt area from coming in contact with
ground.
 Douse the burn with plenty of cold liquid or at least
10 minutes, but do not delay the casualty’s removal
to hospital
 Continue cooling the affected area until the pain is
relieved
 Put on disposable gloves if available. Gently
remove any rings, watches, belts or shoes.
Carefully remove burnt clothing , unless it is sticking
to the burn

CONT....
 Cover the injured area with a sterile dressing to
protect it from infection. If a sterile dressing is not
available, use a folded triangular bandage or part of
a sheet. A clean plastic bag can be used to cover a
hand or foot,; secure it with a bandage or adhesive
tape applied over the plastic not the skin

CONT...
 Gather and record details of the casualty’s injuries.
Regularly monitor and record her vital signs
 While waiting for help to arrive, reassure the
casualty and treat her for stroke.
 If the casualty has a facial burn, do not cover the
injury. Keep cooling the area with water to relieve
pain until help arrives

CAUTION
 Do not over cool the casualty. ( babies and elder
people)
 Do not remove anything sticking to the burn
 Do not touch or otherwise interfere with the burnt
area
 Do not burst any blisters
 Do not apply lotions, ointment or adhesive tape to
the burnt area

MINOR BURNS AND SCALDS
 Caused by touching a hot iron or spilling boiling
water on the skin
 Flood the injured part with cold water for at least 10
minutes to stop the burning and relieve pain.
 Put on disposable gloves if available.
 Gently remove any jewellery, watches, belts or
constricting clothing from the injured area before it
begins to swell
 cover the area with a sterile dressing or a clean,
pad and bandage loosely in place
 Do not break blisters/ apply adhesive tape to skin
 Do not apply ointments to damaged tissues

BURNS TO THE AIRWAY
 Air passages rapidly become swollen
 Suspect damage to airway if burns have sustained
in a confined space

RECOGNITION
 Soot around nose or mouth
 Singeing of the nasal hairs
 Redness, swelling or actual burning of tongue
 Damage to skin around mouth
 Hoarseness of voice
 Breathing difficulties

FIRST AID
 Call ambulance and inform that you suspect burns to
airway
 Take any steps possible to improve the casualty’s air
supply, such as loosening clothing around his neck
 Offer ice or small sips of cold water to reduce swelling
and/or pain
 Reassure the casualty. Monitor and record vital signs

ELECTRICAL INJURIES/ELECTROCUTION
 Passage of electric current through the body may cause
the breathing and heart to stop
 Electrical current may cause burns both where it enters
the body and where it exits the body
 Can cause muscular spasms which may prevent the
casualty from breaking contact with source
 People who are electrocuted by a high voltage current
rarely survive

LIGHTNING
 A natural burst of electricity discharged from the
atmosphere, lightning forms an intense trail of light
and heat
 May set clothing on fire, knock the casualty down,
or even cause instant death
 Clear everyone from the site of a lightning strike as
soon as possible

HIGH VOLTAGE CURRENT
 Power lines and over-head high tension cables
 Contact is usually immediately FATAL
 If survived will have severe burns
 Muscular spasm may propel the victim some
distance causing fractures

FIRST AID
 Safe distance is at least 18m.Cut off the power
before approaching the casualty.
 The casualty is likely to be unconscious.
 Once it is safe to do so, open the casualty’s airway
and check breathing; be ready to give chest
compressions and rescue breaths if necessary
 If he is breathing, place in recovery position
 Monitor and record vital signs- level of response,
pulse and breathing

LOW-VOLTAGE CURRENT
 Can cause serious injury or even death
 Break the contact between the casualty and the
electrical supply by switching off the current at the
mains or meter point if can be reached easily

 If you cannot reach the cable, socket or mains,
do the following:
 To protect yourself, stand on some dry insulating
material such as wooden box, a plastic mat or a
telephone directory
 Using something made of wood ( such as a broom),
push the casualty’s limbs away from the electrical
source or push the source away from the casualty

CONT..
 If it is not possible to break the contact with a
wooden object, loop a length of rope around the
casualty’s ankles or under the arms, taking great
care not to touch him, and pull him away from the
source of the electrical current
 If absolutely necessary, pull the casualty free by
pulling at any articles of loose, dry clothing . Do
this only as a resort because the casualty may still
be ‘live’

WARNING
 Do not touch the casualty if he is in contact with
the electrical current; he will be ‘live’ and you risk
electrocution
 Do not use anything metallic to break the
electrical contact. Stand on some dry insulating
material and use a wooden object
 If the casualty stops breathing, be prepared give
chest compressions and rescue breaths until
emergency help arrives

ELECTRICAL BURN
 Flood the site of injury, at the entry and exit points
of the current, plenty of cold water to cool the
burns
 Put on disposable gloves if available. Place a
sterile dressing, a clean, folded triangular bandage
or some other clean material over the burns to
protect them against airborne infection
 Reassure the casualty and treat him for shock

CHEMICAL BURN
 Caused by acids/ alkalies and other corrosive
chemicals

RECOGNITION
 Evidence of chemicals in the vicinity
 Intense stinging pain
 Later, discoloration, blistering , peeling and swelling
of the affected area

CAUTION
 Do not attempt to neutralise acid or alkali unless
trained to do so
 Do not delay starting treatment by searching for an
antidote

FIRST AID
 Make sure that the area around the casualty is safe
 Ventilate the area to disperse fumes, seal the
chemical container.
 Flood the burn with water for at least 20 minutes to
disperse the chemical and stop burning. If treating a
casualty on the ground, ensure that the water does
not collect underneath her
 Gently remove any contaminated clothing while
flooding the injury
 Arrange to take the casualty to the hospital

CHEMICAL BURN TO EYE
 Can damage the surface of the eye, resulting in
scarring and even blindness
 Priority should be to wash out the eye so that the
chemical is diluted dispersed.
 Put on protective gloves and be careful for not to
splash the contaminated water on you or casualty
while irrigating

FIRST AID
 Put on gloves
 Hold the casualty’s affected eye under gently
running cold water for at least 10 minutes
 Irrigate the eyelid thoroughly both inside and out
 If the eye is shut in a spasm of pain, gently but
firmly pull the eyelids open.
 Be careful that contaminated water does not splash
the uninjured eye

 Place or bandage a pad loosely over the affected
eye
 Identify chemical if possible and send him to
hospital

TYPES OF BLEEDING
 Arterial : bright red blood, will spurt out in force
 Venous: dark red blood, relatively slow bleeding,
but injuries to major veins can result in gush of
blood

TYPES OF WOUNDS
 Incised wound: caused by clean cut from a sharp
edged object s/a a razor.
 Laceration: crushing or ripping forces result in tears
or lacerations. Bleeding is less profuse. More tissue
damage. Often contaminated with germs
 Abrasion: superficial wound in which the topmost
layers of skin are scraped off leaving a raw, tender
area. By a sliding fall
 Contusion(bruise):a blunt blow or punch can
rupture capillaries under the skin causing blood to
leak into tissues.

 Puncture wound: caused by sharp, pointed objects
like nail/ needle. It has a small entry site but deep
track of internal damage.
 Stab wound: caused by long or bladed instrument,
usually a knife penetrating the body.
 Gun shot wound: a bullet or other missile may drive
into or through the body, causing serious internal
injury

SEVERE BLEEDING
 Shock may develop and the victim may lose
consciousness
 Check first whether there is an object embedded in
the wound; take care not to press on the object

FIRST AID
 Put on disposable gloves if available. Remove or
cut clothing as necessary to expose the wound
 Apply direct pressure over the wound with fingers
or palm, preferably over a sterile dressing/ clean
pad/ ask the casualty to apply direct pressure by
himself
 Raise and support the injured limb above the level
of heart. Handle the limb very carefully if suspecting
fracture
 Help the casualty to lie down and if you suspect
shock, raise his legs above the level of heart

 Secure the dressing with a bandage that is tight
enough to maintain pressure, but not so tight to
impair the circulation
 If further bleeding occurs, apply a second dressing
on the top of first. If blood seeps, through this
dressing, remove both dressings and apply a fresh
one, ensuring that pressure is applied accurately to
the point of bleeding
 Monitor and record v/s , call ambulance

AMPUTATION
 A limb can partially or completely be severed
 Put on disposable gloves if available.
 Control blood loss by applying pressure and raising
the injured part
 Apply a sterile dressing/ clean pad and secure it
with a bandage.
 Do not allow to eat or drink
 Get the casualty and amputated part to hospital as
soon as possible.
 Monitor and record v/s: treat for shock if needed

CARE OF THE AMPUTATED PART
 Put on gloves
 Wrap the severed part in plastic bag
 Wrap the package in gauze; place it in a container full of
ice
 Clearly mark the container with the time of injury and the
casualty’s name.
 Do not wash the severed part.
 Do not allow the severed part to come into direct contact
with ice

CRUSH INJURY
 Traffic and building site incidents, earth quakes,
train crushes
 It may include a fracture, swelling and internal
bleeding
 It can also result in impaired circulation resulting in
numbness at or below the site of injury

DANGERS OF PROLONGED CRUSHING
 Extensive damage to body tissues especially
muscles
 As pressure is removed, Shock may develop
rapidly as tissue fluid leaks into injured area
 Toxic substances built up in muscle tissue ,
released into circulation may result in kidney
failure

IF CRUSHED FOR LESS THAN 15 MINUTES
 Release the casualty quickly. Put on gloves if
available. Control external bleeding and cover any
wounds
 Secure and support any suspected fractures. Treat
the casualty for shock.
 Call for ambulance and give details of the incident.
Monitor and record vital signs-level of response,
pulse and breathing

IF CRUSHED FOR MORE THAN 15 MINUTES
 Cal the ambulance and Give clear details of the
incident
 Comfort and reassure the casualty. Monitor and
record vital signs-level of response, pulse and
breathing.
 Do not release a casualty who has been crushed
for more than 15 minutes

CUTS AND GRAZES
 Bleeding can be controlled by pressure and
elevation
 An adhesive dressing is enough

MEDICAL AID IS NEEDED
 If the bleeding does not stop
 If there is foreign object embedded in the cut
 If the wound is at particular risk of infection
 If an old wound shows signs of becoming infected

FIRST AID
 Wash your hands thoroughly, and put on
disposable gloves if available
 If the wound is dirty, clean it by rinsing lightly
under running water, or use an alcohol free wipe.
Pat the wound dry using a gauze swab and cover
with sterile gauze
 Elevate the injured part above the level of heart
supporting it with one hand
 Avoid touching the wound directly
 Clean the surrounding area with soap and water;
use clean swabs for each stroke. Remove the
wound covering and apply an adhesive dressing.

FOREIGN OBJECT IN A CUT
 Remove he foreign objects like pieces of glass/
gravel using tweezers
 If the object is bigger, control bleeding by *applying
pressure on either side of the object *raising the
injured part

 Cover the wound with gauze
 Build up padding around the object until you can
bandage over it with out pressing down

 If the object is particularly large, bandage around
the object
 Enquire about tetanus immunaisation

EYE WOUND
 Help the casualty to lie and hold her head to keep it
as still as possible
 Instruct him to keep both eyes still
 Do not touch or attempt to remove an embedded
foreign object in the eye
 Place or bandage a clean pad over the affected eye
and send to hospital

BLEEDING FROM THE EAR
 Usually due to perforated ear drum
 Caused by a foreign object, blow to the side of the
head, or an explosion
 Sharp pain, then ear ache
 Deafness
 Possible dizziness
 Watery blood is a serious sign(???)

 Help the casualty into a half sitting position, with his
head tilted to the injured side (??)
 Place/ bandage a clean pad on the ear and send to
hospital

NOSE BLEED
 Caused by
 Blow to nose
 Sneezing
 blowing/ picking the nose
 High blood pressure

FIRST AID
 Ask the casualty to sit down
 Ask him to tilt his head forward for the blood to
drain out
 Ask to breathe through mouth and to pinch the soft
part of the nose

 Advise him not to speak, swallow, cough/ spit
 Give a clean cloth to mop up any dribbling
 After 10 minutes, tell the casualty to release the
pressure.
 If the bleeding has not stopped, tell him to reapply
the pressure for 2 further periods of 10 minutes

 Advise the casualty to rest quietly for a few hours
once the bleeding has stopped.
 Tell him to avoid exertion and not to blow the nose

CAUTION
 Do not let head to tip back; blood may run down the
throat and induce vomiting
 If bleeding stop and then restarts, tell the casualty
reapply pressure
 If the nose bleed is severe or if it lasts more than 30
minutes, take or send the casualty to hospital in the
treatment position

BLEEDING FROM THE MOUTH
 Cuts to the tongue, lips, or lining of mouth

FIRST AID
 Ask the casualty to sit down with his head
forwards and tilted slightly to the injured side
 Put on gloves if available. Place a gauze pad over
the wound
 Ask the casualty to squeeze the pad between the
finger and thumb and press on the wound for 10
minutes
 If bleeding persists, replace the pad. Tell the
casualty to let the blood dribble out; if swallowed, it
may induce vomiting
 Avoid hot drinks for 12 hours

BLEEDING SOCKET
 Take a gauze pad that is thick enough to stop the
casualty’s teeth meeting, place across the empty
socket and tell her to bite down on it

CAUTION
 If the wound is large, or bleeding> 30 minutes, seek
medical advise
 Do not wash the mouth out

KNOCKED OUT TOOTH
 If an adult tooth is knocked out,
 Keep it in socket immediately and keep it in place
with a gauze pad between bottom and top teeth
OR
 Keep it inside cheek
OR
 Place in a small container of milk
 Send to the dentist

SCALP AND HEAD WOUND
 Cover the wound with sterile dressing/ clean pad
and apply firm direct pressure on the pad
 Secure the dressing with roller bandage
 Help him to lie down with his head and shoulders
slightly raised
 Monitor and record v/s

ABDOMINAL WOUND
Crush injury
Gunshot
Stab wound

1ST AID
 Put on disposable gloves
 help to lie down
 Raise and support the knees to reduce strain on
wound
 Loosen any tight belt/ shirt
 Put a dressing over the wound and apply adhesive
tape, Treat for shock

WARNING
 If a casualty with an open wound, coughs/ vomits,
press firmly on the dressing
 do not touch any protruding intestine, cover with a
plastic bag
 Get ready for resuscitation if needed

BLEEDING VARICOSE VEIN
 Veins contain one-way valves
 If these valves fail, blood will collect behind them
and makes the veins swell
 Varicose veins are taut and may burst even by
gentle stroke
 Shock will develop if bleeding is not controlled

FIRST AID
 Put on disposable gloves
 Make the casualty lie down on his back
 Raise and support the injured leg as high as
possible
 Expose the site of bleeding
 Apply firm direct pressure on the area, using sterile
dressing, until the bleeding is controlled
 Put a large soft pad, and bandage it tightly
 Keep the injured leg raised and supported until the
ambulance arrives
 Monitor & record v/s

INJURIES TO BONES, JOINTS AND MUSCLES

FRACTURES
 Break or crack in a bone
 can be
1. Stable: broken ends do not move
2. Unstable: broken ends can move and cause
injury to blood vessels and nerves
Or
1. Open: broken ends pierce the overlying skin
2. Closed: overlying skin is intact

RECOGNITION
 Deformity, swelling and bruising at the fracture site
 Pain, difficulty to move
 Shortening, bending
 Coarse grating of bone ends (crepitus) can be
heard
 A wound possibly both bone ends protruding

CLOSED FRACTURE
 Advise him to keep still
 Support the injured part with your hands above and
below the injury, until it is immobilised
 For firmer support, bandage the injured part to an
unaffected part of the body
 Make sure the bandage is tied on the uninjured side
1. Upper limb fracture : bandage to the trunk
2. Lower limb fracture : bandage to unaffected leg

CONT...
 Transport to hospital
 Treat for shock, do not raise the injured limb if it
causes more pain
 Check for circulation beyond a bandage every 10
minutes
 If the circulation is impaired, loosen the bandages
 Do not allow the casualty to eat/ drink

APPLYING TRACTION
 Applied When a limb is bent or angled
 Pull steadily in the line of bone until the limb is
straight
 Hold it until the limb is immobilised
 Do not persist if traction causes intolerable pain

OPEN FRACTURES
 Put on gloves
 Loosely cover the wound with a large pad.
 Apply pressure to control bleeding, but do not
press on protruding bone
 Carefully place clean pad around the dressing
 Secure the pad with a bandage firmly
 Immobilise the part
 Treat for shock

DISLOCATED JOINT
 An injury in which the bones are partially or
completely pulled out of position
 Usually affects the shoulders, jaw, joints in thumbs
and fingers

RECOGNITION
 Severe pain
 Difficulty in moving the area
 Swelling and bruising around the area
 shortening, bending or twisting of the area

FIRST AID
 Advise the casualty to keep still
 Support the injured part in a position of maximum
comfort
 Immobilise the part with padding, bandages and
slings
 For firm support, bandage the injured part to an
unaffected part of the body

 Transport to hospital
 Treat for shock
 Check the circulation beyond the bandage every 10
minutes

STRAINS AND SPRAINS
STRAIN
 occurs when a muscle is stretched and may be
partially torn.
 Occurs at the junction of the muscle and the
tendon that joints the muscle to a bone
 Usually accompanied by bleeding into surrounding
tissues
 SPRAIN
 Tearing of a ligament at or near a joint

INITIAL TREATMENT
R - Rest the injured part
I - Apply ice or a cold compress
C - Compress the injury
E - Elevate the injured part

CONT..
 Advise the casualty to sit or lie down
 Support the injured part in a comfortable position
 If the injury has just happened, cool the area by an
ice pack
 Apply gentle, even pressure by surrounding the
area with a thick layer of soft padding s/a a cotton/
wool/ plastic and secure it with a bandage
 Check the circulation beyond the bandaging every
10 minutes

CONT..
 Raise and support the injured part to reduce the
flow of blood to injury
 If severe pain/ the casualty can’t move the part,
take him to hospital. Otherwise advise him to take
rest and see doctor if necessary

MAJOR FACIAL FRACTURE
 The main danger is the blood, saliva and swollen
tissue may obstruct the airway
 When examining, check for damage to skull, brain
and neck

RECOGNITION
 Pain around affected area
 If jaw is affected, difficulty speaking, chewing or
swallowing
 Difficulty breathing
 Swelling and distortion of face
 Bruising

FIRST AID
 If the casualty is conscious, get him to spit out any
blood, displaced teeth or dentures from his mouth
 Gently apply cold compress to the casualty’s face
to help reduce pain and limit potential swelling
 Treat for shock
 Regularly monitor and record vital signs until
medical help arrives

CAUTION
 Do not apply a bandage to the lower part of the
face or lower jaw, if there is difficulty breathing

 If he is breathing, place him in recovery position
with his injured side downwards to allow any blood
or other body fluids to drain away and keep the
airway clear
 Keep the casualty’s hand away from the face and
place soft padding under his head
 Be aware of the risk of spinal injury
 be ready to give resuscitation if needed

CHEEK BONE AND NOSE FRACTURES
 Usually the result of deliberate blows to face
 Swollen facial tissues are likely to cause discomfort and
the air passages in the nose become blocked
 Apply cold compress
 If there is nosebleed, try to stop the bleeding
 Arrange for transport to hospital

LOWER JAW INJURY
 If the casualty is not seriously injured, help him to sit
with his head tilted forward to allow fluids to drain
from his mouth
 Encourage him to spit out loose teeth, and keep them
to send to hospital with him
 Give him a soft pad to hold against the jaw and support
it
 Take or send the casualty to hospital, keeping his jaw
supported

FRACTURED COLLAR BONE/ CLAVICLE
 As a result of sports activities, fall on out stretched
arm

RECOGNITION
 Pain and tenderness
 Swelling
 Attempts by the casualty to relax muscles and
relieve pain
 He may support the arm at the elbow and incline
the head to the injured side

FIRST AID
 Help to sit down
 Lay the affected arm diagonally across his chest
with his finger tips resting against the opposite
shoulder
 Ask him to support the elbow with his other hand
 Support the arm on the affected side in an elevation
sling
 Gently place some soft padding between the arm
and the body to make him more comfortable
 Secure the arm with a broad fold bandage and
send to hospital

SHOULDER INJURY
 Caused by Fall on the shoulder / an outstretched
arm

RECOGNITION
 Severe pain, increased by movement; the pain may
make the casualty reluctant to move
 Attempts by the casualty to relieve pain by
supporting the arm and inclining the head to the
injured side
 A flat, angular look to the shoulder

FIRST AID
 Help the casualty to sit down.
 Gently place the arm on the affected side across
his body in most comfortable position.
 Place a triangular bandage between the arm and
the chest, in preparation for trying an arm sling
 Insert a soft padding , such as a folded towel,
between the arm and the chest, inside the
bandage.

CONT...
 Finish tying the arm sling so that the arm
and its padding are well supported
 Secure the limb to the chest by tying a broad-fold
bandage around the chest and over the sling
 Do not attempt to replace a dislocated bone into its
socket
 Do not allow to eat/ drink

UPPER ARM INJURY
 Most common is fracture of humerus
 Fracture of humerus at the shoulder end is common
among elderly which is a stable fracture and the
casualty may cope with pain and left untreated for
some time.

RECOGNITION
 Pain, increased by movement
 Tenderness and deformity over the site
 Rapid swelling
 Bruising, which may develop slowly

FIRST AID
 Gently place the forearm horizontally across the
body and ask him to support the elbow if possible
 Place the soft padding beneath the injured arm. Tie
the arm and its padding in an arm sling to support
it.
 Secure the arm by a broad-fold bandage.
 Try to avoid bandaging over the fracture site if
possible.
 Take or send to hospital

ELBOW INJURY
 Usually result from fall on to the hand
 Fracture of humerus above the elbow is common
among children and it is an unstable fracture which
can damage blood vessels
 Never try to force the elbow to bend

RECOGNITION
 Tenderness over the site
 Swelling, deformity, Bruising
 Fixed elbow

FOR AN ELBOW THAT CAN BEND
 Check the pulse in the affected wrist regularly
 If the pulse is not present, gently straighten the
elbow until the pulse returns and support the arm in
this position

FOR AN ELBOW THAT CANNOT BEND
 Help the casualty to lie down.
 Place padding such as cushions or towels around
the elbow for comfort and support
 Check the pulse in the injured arm until medical
help arrives

CAUTION
 Do not try to move the injured arm
 Do not attempt to apply bandages if help is on its
way

PREPARING FOR TRANSPORT
 Put padding between the injured limb and body.
Then use three folded triangular bandages to
immobilise the injured limb against the trunk, at
1. the wrist and hips, then
2. above and
3. below the elbow
 Tie bandages firmly on the non-injured side

FOREARM AND WRIST INJURIES
 Broken ends of radius and ulna may pierce the
skin, producing an open fracture

RECOGNITION
 Swelling, deformity, Bruising
 In an open fracture, a wound and bleeding

FIRST AID
 Place the injured forearm across the body and support it
 Expose and treat any wound that you find, wearing
disposable gloves
 Place a triangular bandage between the chest and the
injured arm, as for an arm sling
 Surround the forearm in soft padding, such as a small
towel

CONT..
 Fasten the arm sling around the arm and its padding
using a reef knot.
 Tie the knot at the hollow of the clavicle on the injured
side
 If the journey to hospital is likely to be prolonged, secure
the arm to the body by tying a broad bandage over the
sling.
 Position the bandage close to the elbow
 . Then take or send to the hospital

HAND AND FINGER INJURIES
 Fractures and dislocations

FIRST AID
 If there is any bleeding, put on gloves, if available.
 Apply a clean dressing to the wound.
 Remove any rings before the hand begins to swell,
and keep the hand raised to reduce swelling.
 Protect the injured area by wrapping the hand in
folds of soft padding.

INJURY TO RIBCAGE
 One or more ribs can be fractured
 If a fractured rib pierces the lungs or the skin,
breathing may be seriously impaired
 An area of fractured ribs can get detached from the
chest wall producing a ‘flail chest’ resulting in
paradoxical breathing
 Fracture of lower ribs can result in injury to liver
and spleen

RECOGNITION
 Sharp pain at the site of fracture
 Pain on taking a deep breath
 Shallow breathing
 An open wound over the fracture through which we may
hear air being ‘sucked’ into the chest cavity
 Paradoxical breathing

FIRST AID
 For fractured ribs, support the arm on the injured
side in an arm sling and take or send him to
hospital
 If there is a penetrating chest wound, lean the
casualty towards the affected side and cover and
seal the wound along 3 edges (???)
 Help the casualty to settle into the most comfortable
position inclined towards the injured side(???)
 Use an elevation sling to support the arm on the
injured side

FRACTURED PELVIS
 May be complicated by injuries to pelvic organs like
bladder

RECOGNITION
 Inability to walk or even stand, although the legs
appear uninjured
 Pain and tenderness in the region of hip and back
which increases with movement
 Hematuria/dysuria
 Signs of shock and internal bleeding

FIRST AID
 Help the casualty to lie down on his back
 Keep his legs straight/flat/ knees slightly bent
 Place padding between bony points of knees and ankles
 Immobilise the legs by bandaging them together with folded
triangular bandages; secure the feet and ankles and then the
knees
 Treat for shock, call for ambulance

HIP AND THIGH INJURIES
 Femur fracture is the most serious injury.
 The broken bone ends can pierce the major blood
vessels
 The most common injury in hip joint is dislocation

RECOGNITION
 Pain at the site of injury
 Inability to walk
 Signs of shock
 Shortening of leg and turning outwards of the knee
and foot

FIRST AID
 Help the casualty to lie down
 If possible, ask a helper to gently steady and support the
inured limb
 Gently straighten the casualty’s lower leg
 If necessary apply traction at the ankle, in line of limb to
help straighten the leg
 Call ambulance and keep the leg supported in the same
position until the ambulance arrives

CONT..
 Do not allow the casualty to eat or drink
 Do not raise the casualty’s legs even if he shows
signs of shock (???)

CONT..
 If the ambulance is not expected to arrive quickly,
immobilise the leg by splinting it to the uninjured
one.
 Gently bring the normal limb along side the injured
one
 Place padding between legs
 Position bandages at
1. Ankles and feet
2. Knees
3. Above the fracture site
4. Below the fracture site

PREPARING FOR TRANSPORT
 If the journey to hospital is likely to be long/ rough:
 Use a splint/ fence post reaching from armpit to the foot
 Place the splint against the injured side
 Insert padding between the splint and the casualty’s
body
 Tie the feet together with narrow fold bandage
 Secure the splint to the body with broad fold bandages
at the
1. Chest
2. Pelvis
3. Knees
4. Above and below the site &
5. At one extra point

 Do not bandage over the fracture site
 Move the patient to the stretcher using log-roll
technique

KNEE INJURY
 Possible knee injuries include:
 Fracture of patella
 Sprains
 Damage to the cartilage

RECOGNITION
 Pain, spreading from the injury to become deep-
seated in the joint
 If the bent knee has ‘locked’ , acute pain on
attempting to straighten the leg
 Rapid swelling at the knee joint

FIRST AID
 Help the casualty to lie down
 Place a soft padding under the injured knee to support it
in most comfortable position.
 Wrap soft padding around the joint.
 Secure with bandages that extend from mid thigh to the
middle of the lower leg
 Arrange for transportation in treatment position

CONT..
 Do not attempt to straighten the knee forcibly
 Do not allow the casualty to eat or drink
 Do not allow the casualty to walk

LOWER LEG INJURY
 May include
I. Fracture of tibia/fibula
II. Tearing of soft tissues like muscles, ligaments and
tendons

RECOGNITION
 Localised pain
 Swelling, bruising and deformity of the leg
 An open wound

FIRST AID
 Help the casualty to lie down, and carefully steady
and support the injured leg.
 If there is an open wound, gently expose the wound
and treat bleeding.
 Apply padding to protect the injury.
 Support the injured leg with your hands to prevent
any movement of the fracture site until the
ambulance arrives.

CONT..
 If the ambulance is delayed, support the injured leg
by splinting it to the other leg.
 Gently bring the normal limb along side the injured
one
 Place padding between legs
 Position bandages at
1. Ankles and feet
2. Knees
3. Above the fracture site
4. Below the fracture site
 Tie the bandages firmly, knotting them on the
uninjured side.

CONT..
 If the casualty’s journey to hospital is likely to be
long and rough, place soft padding on the outside
of the injured leg, from the knee to the foot.

ANKLE INJURY
 Most common is sprain.
 Consider the ankle fracture as a fracture of the
lower leg.
 Treatment of sprain: (?????)

RECOGNITION
 Pain, increased either by movement or by putting
weight on the foot
 Swelling

FIRST AID
 Rest, steady and support the ankle in the comfortable
position.
 If the injury has only recently occured, apply an ice pack
or a cold compress to the site of swelling.
 Wrap the ankle in thick padding and bandage firmly.
Raise and support the injured limb.
 Advise the casualty to rest the ankle and to see a doctor
if pain persists

FOOT AND TOE INJURIES
 Fractures affecting the many small bones of the foot
are usually caused by crushing injuries.
 Concentrate on relieving symptoms like swelling

RECOGNITION
 Difficulty in walking
 Stiffness of movement
 Bruising and swelling

FIRST AID
 Quickly raise and support the foot (????)
 Apply an ice pack or cold compress(????)
 Arrange to take or send to hospital.
 Keep the legs elevated during journey

SPINAL INJURY
 Can involve:
a. The bones (vertebrae)
b. The discs of the tissue that separate the vertebrae
c. The surrounding muscles and ligaments
d. The spinal cord
e. The nerves branching from spinal cord

THE MOST SERIOUS RISK ASSOCIATED WITH
SPINAL INJURY
IS
DAMAGE TO THE SPINAL CORD

WHEN TO SUSPECT SPINAL INJURY
 When abnormal forces have been exerted over
neck or back
 Forward or backward bending
 Twisting of spine

SOME CAUSES OF SPINAL INJURY
 Falling from a height
 Falling awkwardly like while doing gymnastics
 Diving into a shallow pool and hitting the bottom
 Being thrown from a horse/ motor vehicle
 A heavy object falling across the back
 Injury to the head or the face

RECOGNITION
Injury to vertebrae
 Pain in the neck or back
 Irregularity / twist in the normal curvature of spine
 Tenderness in the skin over the spine
Injury to spinal cord
 Loss of control over limbs
 Loss of sensation or abnormal sensation like
burning
 Loss of bowel&/or bladder control
 Breathing difficulties

FOR A CONSCIOUS CASUALTY
 Reassure the casualty and advise him not to move
 Kneel behind the casualty
 Grasp the sides of the casualty’s head firmly, with
your hands over the ears
 Steady and support his head in neutral head
position( head , neck and spine are alligned)
 Continue to support the head in the neutral position
until emergency medical services take over
 Monitor V/S: level of response, pulse and breathing

CAUTION
 Do not move the casualty from the position in which
you found unless he is in danger
 If the casualty has to be moved, use the log roll
technique

FOR UNCONSCIOUS CASUALTY
 Kneel behind the casualty
 Grasp the sides of the casualty’s head firmly, with
your hands over the ears
 Steady and support his head in neutral head
position( head , neck and spine are alligned)
 If necessary, open the casualty’s airway using jaw
thrust method

CONT..
 If the casualty is breathing, continue to support his
head
 Call ambulance
 If not breathing, rescue breaths
 If you need to turn the casualty, use the log-roll
technique

HANGING
 If pressure is exerted on the outside of the neck,
the airway is squeezed and the flow of air into the
lungs is cut off.

RECOGNITION
 A constricting rope around the neck
 Marks around the neck
 Rapid difficult breathing, impaired consciousness,
cyanosis
 Congestion of the face, with prominent veins

FIRST AID
 Quickly remove any constriction from around the
casualty’s neck
 Support the casualty’s body while doing so if he is
still hanging
 Lay the casualty on the ground.
 Open the airway and check breathing
 If not breathing, be ready for resuscitation
 If breathing, place in recovery position

CAUTION
 Cut the rope away from the casualty
 Do not destroy any material that has been
constricting the neck ( Police may need it as
evidence)
 Do not move the casualty unnecessarily in case of
spinal injury
 Call for an ambulance even if he appears to recover
fully

First aid nursing

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