The immediate help given during an injury before hospitalization

1. FIRST AID NURSING
Sharon Treesa Antony
Junior Lecturer

2. 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.

3. 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

4. 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

5. 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

6. FIRST AID KIT

7. TRIANGULAR BANDAGES

8. ROLLER TYPE BANDAGES

9. DRESSING/GAUZE PADS

10. BANDAGE SHEETS

11. EYE PROTECTOR

12. STICK FOR TOURNIQUET

13. BLANKET

14. PILLOW

15. UPPER EXTREMITY SPLINT SET

16. LOWER EXTREMITY SPLINT SET

17. 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

18. 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

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

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

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

22. 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

23. 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

24. 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

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

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

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

28. 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

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

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

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

32. 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

33. 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

34. SNAKE BITE

35. IDENTIFICATION OF POISONOUS AND NON-
POISONOUS SNAKES

36. 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

37. 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

38. 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

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

40. 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

41. 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

42. 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

43. 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

44. 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

45.  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

46.  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

47. 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

48. 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

49. 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

50. 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

51. 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

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

53.  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

54. 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

55. 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.

57. 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

59. 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

60.  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

61. 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

62. 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

63. 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

64. 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

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

66. 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

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

68. 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

69. 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

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

71. 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

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

73. 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

74. 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

75. 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

76. 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

77. 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

78. 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.

79. 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

80. 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

81. 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

82. 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

83. 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

84. 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

85. 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

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

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

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

89. 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

90. 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

91. 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

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

93. WOUNDS AND BLEEDING

94. 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

95. 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.

102.  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

103. 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

104. 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

105.  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

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

107. 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

108. 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.

109. 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

110. 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(???)

111.  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

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

113. 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

114.  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

115.  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

116. 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

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

118. 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

119. ABDOMINAL WOUND
Crush injury
Gunshot
Stab wound

120. 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

121. 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

122. 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

123. 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

124. INJURIES TO BONES, JOINTS AND MUSCLES

125. 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

126. 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

127. 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

128. 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

129. 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

130. 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
 Monitor and record v/s

131. 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

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

133. 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

134.  Transport to hospital
 Treat for shock
 Monitor and record v/s
 Check the circulation beyond the bandage every 10
minutes

135. 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

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

137. 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

138. 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

139. 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.

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

141. 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

142. 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

143. FALL
 Builders , electricians, miners , painters are at high
risk
 Causes can be oily or wet working surface, poor
lighting, wrinkled carpets, poor lighting, missing a
step while walking, falling eyesight, carelessness,
climbing high levels in trees, suicidal attempts etc.

144. FIRST AID
 Check and monitor for consciousness.
 Check for pulse, airway, breathing
 Use jaw thrust maneuver to open the airway
 Commence CPR if necessary
 Cover the victim with a blanket to reduce the
chance of shock
 Look for signs of fractures and dislocations and do
first aid as needed
 Shift to hospital immediately

145. THANK YOU