1 INTRODUCTION TO FIRST AID.pdf

FIRST AID AND ACCIDENT
PREVENTION
CHAPTER ONE
INTRODUCTION TO FIRST AID
By: Adem H. (BSc, MSc in Medical-Surgical N.)
7/7/2022 9:51 PM 1
Set By Adem Hussein (BSc, MSc)

Brain Storming
1.What is first aid ?
2. Who is first aider ?
3. What is first aid kit ?
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Choking
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Definition: -
First aid is:
•The immediate care given to a person, who
has been injured or has been suddenly ill.
•Is treatment given when an accident or
sudden illness occurs.
•Is the initial assistance or treatment given to
an injured or sick person before professional
medical care becomes available with the
material available at hand.
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Who do you think be a first aider?
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Simple and Basic Questions For First Aider
Working In The Community
Who will give first aid for casualty who is in
emergency condition?
o Any first aider who is equipped with principle of
first aid management
Why? To save life
When? At any time when injury occurs
Where? Any where or place
To whom is applied? To all who needs to be helped
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Characteristics of first aider
working in the community
To be a first aider:-
 Good reliability, character and communication
skills.
An aptitude and ability to absorb new skills and
knowledge.
An ability to cope with stressful and physically
demanding emergency procedures.
 Normal duties in the workplace that can be left, to
respond immediately and rapidly to an emergency
7/7/2022 9:51 PM 7

First Aid kits & Supplies
•First aid kit is a collection of supplies and
equipments that is used to give medical treatment.
•First aid kits can be assembled in almost any type of
container, and this will depend on whether they are
commercially produced or assembled by an
individual.
•Standard kits often come in durable plastic boxes,
fabric pouches or in wall mounted cabinets.
8

Continue…..
•The type of container will vary depending on
purpose, and they range in size from wallet sized
through to large rucksacks (a bag carried on the
back supported by straps).
•It is recommended that all kits are in a clean,
waterproof container to keep the contents safe
and aseptic.
•Kits should also be checked regularly and
restocked if any of the items are damaged or are
out of date
•Septic V aseptic
9

The International Organization for
Standardization (ISO) sets a standard for first
aid kits of being green, with a white cross, in
order to make them easily recognizable to
anyone requiring first aid.
10

ISO First Aid Kit Symbols
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•There are two general types of first Aid kits.
1. The unit type
2. The Cabinet type kits
1. Unit type kit
• Has a complete assortment of first aid materials
in unit size or multiples of the unit size,
•Contains 16,24,or 32 units
•16 and 24 unit kits are the most popular.
12

2. Cabinet Type Kits
• Are made for a wide variety of uses.
• Range in size from pocket versions to large industrial
kits.
• Made to accept packages in different shapes & size
13

Components of First Aid Kit
Common Items
The common kits mostly found in the homes may
contain:
Alcohol or non alcohol antiseptic wipes
Cotton Balls
Cotton Swabs
Iodine
Bandages
Hydrogen Peroxide
Gauze
Saline
Dressings
Eye wash 14

All kits are satisfactory if the following
points are observed in their selection:
•The kit should be large enough & have proper
contents
•Contents should be arranged so that the
desired package can be found quickly
•Material should be wrapped so that unused
portions don't become dirty through handling.
•It should be made up of metal or plastic
•Should be easy to open
•Should be labeled and placed out of children
reached
15

Scope of first aid
Determined the nature of the cause
Decide the extent of the treatment
Dispose the causes to the nearest hospital
Principles
Observe carefully
Think clearly and
Act quickly.
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Steps in giving Emergency Care
Look at the general situation of the causality quickly
(observation)
 Decide what is wrong and how severe or dangerous
the injury is.
 Give the appropriate first aid
 Notify your senior and arrange transport to health
institution
 Give follow up care during the journey
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Reasons for First Aid (Purposes)
To sustain (preserve) life
E.g. mouth to mouth respiration when
breathing has stopped.
To promote healing & recovery
e.g., reassure the patient, relief pain, protect
from cold and arrange patient transfer
To prevent complication.
E.g. Immobilizing the fractured bone.
To keep the injured or ill alive.
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Values of First Aid Training
The need for first aid training is greater because
of;
Population growth through out the world
Increased use of technological products; such as
mechanical and electrical appliances in everyday
use
There is an ever growing demand for first aid
training for personal use.
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Values of first Aid Training
In general first aid is aimed to
 Self help
 Help for others
 Preparation for disaster
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GENERAL DIRECTIONS FOR
GIVING FIRST AID:-
Assessment of the situation
Remove the victim/danger from the area
Identify the problem/the victim may have more
than 1 problem (Diagnosis)
Give immediate & adequate treatment/give
priority (Treatment).
Arrange immediate transportation for medical
care for life threatening conditions.
Prevent cross contamination.
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CHAPTER TWO
SPECIFIC INJURIES
(Eye, Head, Neck, Chest,
Abdomen)
22
7/7/2022 9:51 PM Set By Adem Hussein (BSc, MSc)

1. Eye Injuries
23
Enucleation

Foreign Body In The Eye
• Foreign objects are often blown or rubbed
into the eyes.
• Such objects are harmful not only because of
the irritating effect but also because of the
danger of their scratching the surface or
becoming imbedded in the eye.
24

Signs & Symptoms
•Redness of the eye
•Burning sensation
•Pain
•Headache
•Over production of tears
•Swelling
•Wound
•Presence of foreign body
25

Precautions
•Keep the victim from rubbing his eye
•Wash your hands thoroughly before examining the
victim's eye.
•Don't attempt to remove a foreign object
imbedded in the eyes.
•Refer the victim if some thing is embedded in the
eye.
26

•Procedures for Removal of a foreign body
from the eyeball
Pull down the lower lid
If the object lies on the inner surface, lift it
gently with clean handkerchief or tissue paper
If the object has not been located, it may be
lodged beneath the upper lid.
While the victim looks down, grasp the lashes
of the upper lid gently.
27

Pull the upper lid foreword & down over the lower
lid
Tears may dislodge the foreign object
If not dislodged, depress the victim's upper lid
with a match stick or similar object
Flash the eye with water/irrigation/
If not removed, apply a dry dressing & refer to
hospital.
If an acid or alkali gets in to the eyes, flood the
eyes with running water for several minutes and get
medical advice as soon as possible.
28

Eye irrigation and foreign body removal
29

Blunt Injury of the Eye
•A contusion occurs from direct blow, such as
fist, vehicle accident or explosions results in
block eye.
•In serious case, the structure of the eye may
be torn or ruptured.
• Secondary damage may occur by the effect
of hemorrhage and later by infection
NB. Eye contusion is a bruise around the eye. It may involve
the eye, eyelid, eye socket, and associated muscles and is
usually the result of a blunt injury to the eye
30

•Vision may be lost
•Bleeding may occur after several days
•The victim should be seen by the
Ophthalmologist
•A dry sterile or clean dressing should be applied
and the victim should be transported lying flat.
31

Blunt trauma of the eye
32

Blunt trauma of the eye
33

Ruptured eye globe
34

Penetrating Injuries of the Eye
•Occurs when an object pierces, penetrates or
punctures the eye and can result in blindness.
35

Penetrating Eye Injury
36

37

First Aid measures
•Don't try to remove the object or to wash the
eye.
•Cover both eyes loosely with a sterile or clean
dressing
•Secure with tap or bandage & cover both eyes
to eliminate movement of the affected eye
•Keep and transport the victim by stretcher
•Take the victim to the emergency room of
hospital to get quick medical attention
N.B: Foreign bodies lying on surface are only once that
can be removed safely by the first aider.
38

Eye padding
39

2. HEAD INJURIES
Scalp Injuries
•Bleed profusely
•May be complicated by fragment from skull fractures
•May contain hair, glass or other foreign materials
First Aid Measures
• Don't try to clean scalp wounds that is profusely
bleeding.
• Control bleeding by raising the victim's head &
shoulder
• Don't bend the neck
• Place a sterile dressing on the wound
• Apply Bandage to hold the dressing in place & to
provide pressure. 40

Head injury can be External (usually scalp)
injuries & Internal head injuries, which may
involve the skull, the blood vessels within the
skull, or the brain.
Concussion-temporary loss of neurological
function from which there is complete recovery.
Contusion-more sever cerebral injury with
possible hemorrhage and brain damage. 41

Assessment :-
Check the person's level of response using the
AVPU code:
A - is the person alert, eyes open and
responding to questions?
V - does the person respond to voice, obey
simple commands?
P - does the person respond to pain (eg, eyes
open or movement in response to being
pinched)?
U - is the person unresponsive?
42

Brain injury
 Causes of wounds to the scalp
•Open or closed fracture of the skull
•Stroke (impaired blood supply to brain)
•Tumor
Signs & symptoms
•Clear or blood tingled CSF draining from the nose or
ears following skull fracture.
•Temporary loss of consciousness.
•Partial or complete brain paralysis of muscle of the
extremities of the opposite side
•Facial paralysis on the same side
43

•Disturbance of speech
•Local or generalized convulsions
•Bleeding from the nose, ear canal or mouth (skull
fracture)
•Pale face
•Fast & weak pulse
•Headache & dizziness
•Vomiting
•Unequal size of pupils
•Loss of bowel & bladder control(incontinence)
44

First Aid Measures
•Obtain medical assistance quickly (call for
ambulance)
•Keep the victim down & treat for shock
•Insure an open air way
•Keep the victim NPO
•Apply dressing & bandage over the injury
•Record the level of consciousness.
•Refer to the nearest health institution
45

3. Neck Injuries
A. Blockage of the airway
Cause:
•Blunt force exerted on the face, mouth or jaw,
•Hard blow on the front of the neck
•Extensive swelling
First Aid Measures
•Artificial respiration
•Obtain immediate medical care
46

B. Lacerations or Puncture Wound
•Bleeding from neck around is dangerous &
difficult to control.
Control Measures
•Exert direct pressure over the wound.
•Keep the victim's head & shoulder raised & his
air way open.
• Seek medical attention
•Cover wound by dressing
•Never apply a circular bandage around the neck.
47

4.Wounds of the Chest
Sucking wound of the chest /open
pneumothorax/
•Is injury in which air passes in & out of the
thoracic cavity through a hole in the chest.
•If the wounding object or instrument is still in
place, leave it undisturbed.
First Aid Measure
•Cover the open wound by large pad
•The palm of the hand may be applied until a
suitable bandage is obtained.
• Maintain open-air way & give artificial respiration
transport the victim with his injured side down. 48

Penetrating wounds of the heart or large blood
vessels of chest
•The penetrating object should be left undisturbed.
First Aid Measure.
•Elevate the victim's head
•Give artificial respiration
•Seek medical assistance
49

Compression of Lung Tissue
Causes:
•Blood /other fluids/, air that has escaped in to
the chest cavity from air into the chest cavity
from air passages through a tear in the surface of
the lung
First Aid Measure
•Position for mouth-to-mouth respiration
•Maintain on open air way
•Give artificial respiratory
•Seek medical help quickly.
50

5. Abdominal Injuries
Wound of the abdomen are particularly
dangerous because of the risk of damage to
internal organs
An injury to the chest any where below the
nipples is also called an injury to the abdomen.
A distended, tender abdomen after injury
indicates internal bleeding in the abdomen,
 Treat for shock, & transport immediately
51

First Aid Measures:
Don't try to replace protruding intestines or
abdominal organs but cover with sterile dressings
Hold the dressing in place with a firm bandage
Keep the victim NPO
Elevate the victim's head & shoulder to avoid
breathing difficulty.
Seek medical attention
52

CHAPTER THREE
POISONING
53

Definition
Poison is any substance solid, liquid or gas that tends to
impair health or cause death when introduced in to the
body or on to the skin surface in a sufficient quantity.
Poisons can enter the body in different ways:-
Ingested (through the mouth)
 Inhaled( mouth & nose)
Absorbed (on the skin )
 Injected (blood vessel)
54

A poison can either to be:-
Corrosive Such as: acids, bleach, ammonia, petrol,
turpentine, dishwasher powder, etc that can cause
tissue destruction after coming in contact with body.
Non-Corrosive Such as: tablets, drugs, alcohol,
plants, perfume etc.
55

Causes
• It can be caused knowingly or unknowingly.
•Over dose of drugs (e.g. ASA)
•Medicine left within reach of children
•Poisons transferred from the original
containers to jars or soft drink bottles
•Carelessness of the parent & lack of
supervision
•Improper storage & disposal of poisonous
substances
•Combining drugs & alcohol together
56

Examples of poisons around the home
•Cosmetics, hair preparations
•Kerosene
•Strong detergents like bleaches
•Acids & alkalis
•Non edible mushrooms
•Carbon mono oxide
•Bacterial toxins
57

Signs & symptoms of poisoning
Information from the victim from an observer;
•Presence of container known to cause poison
•Conditions of the victim (sudden illness)
•Burns around the lips or mouth (if acid or base is
taken)
•Breath odor
•Pupils of the eye contracted to pin point (over dose
of morphine)
58

Other signs that can accompany poisoning
may be:-
Vomiting, Abdominal pains.
Burning sensation around the entry area.
Breathing problems.
Confusion or hallucination.
Headache, Unconsciousness, Sometimes
fitting.
Cyanosis.
59

Objectives of emergency management:-
To remove or inactivate the poison before it is
absorbed.
To give supportive care to maintain vital organ.
To use the specific antidote to neutralize the
poison.
To give treatment to hasten/speed up the
elimination of the absorbed poison.
60

Poison management consists of five
phases:-
1. Stabilize the patient
2. Non specific treatment
3. Diagnose the type of poison
4. Specific treatment
5. Follow up of the victim
61

First Aid measures
Swallowed poisons
A. Conscious victim
•Give him a drink of tepid water with soap to induce
vomiting.
•Repeat the procedure of inducing vomiting until clear
vomitus comes
•Don't induce vomiting if the poison is:
•Corrosives (strong acid or alkalis)
•Hydrocarbons (kerosene)
•Iodides, silver nitrate,…..
Instead, give milk with egg, water or a mixture of flour &
water.
62

B. Unconscious victim
•Maintain an open air way
•Don't give fluid & not induce vomiting
•If the victim is vomiting, position him & turn the head so
that the vomitus drains out of the mouth
•Move the victim immediately to health facility
Contact with poisonous chemicals
•Produce chemical burns & need immediate first aid
First Aid Measures
•Remove contaminated clothing,
•Wash all contaminated skin
•Keep the victim air way be opened.
•Move the victim immediately to health facility 63

Contact with poisonous plants
• Remove contaminated clothing
•Wash all exposed areas thoroughly
• Apply calamine lotion
• Seek medical advice
64

Poisoning through Inhalations
• E.g. Carbon monoxide (Co) poisoning
•Move the pt to fresh air, open all doors & windows
•Loosen all tight clothing
•Prevent chilling wrap the pt in blankets.
•Keep the pt as quite as possible
•Position for artificial respiration
•Give moth - to - mouth respiration & cardiac massage if
required.
•Take the victim immediately to health facility
•Anti dote is oxygen
65

Poisoning through Injection (Snakebites)
•The vast majority of snakes are not poisonous. Pit vipers are
poisonous.
Characteristics of snakes
Poisonous non poisonous
•Vertical pupils  round pupils
•Single row of teeth  double row of upper teeth
•Two erectile fangs (Teeth)  not leave fang marks
66

S/Sx
• Start instantaneously, with burning pain or
numbness at the site of the bite.
•Swelling
•Ecchymosis
•Hemorrhagic blisters
•Systemic symptoms
•Tingling sensation,
•Twitching of muscle,
•Signs of shock (nausea, vomiting, sweating,
weakness, light headiness).
67

First Aid Measures
•Get the pt away from the snake
•Calm the pt
•Remove constrictive items
•Keep the victim recumbent (horizontal lying)
•Immobilize the bitten extremity
•Don't allow the victim to walk
•Avoid alcohol (aggravate CNS depression)
•Don't delay transport to hospital
•Get description of snake & notify the hospital.
68

Prevention & precaution
Keep all medicine out of reach of children
Be sure all medicine bottles are labeled correctly
All un labeled medicines should be destroyed
Keep medicines that are poisonous in locked cup
bard away from other medicines
Read the labeled three times
Never eat any food that does not appear good or
never eat when you have a question in your mind
about it.
69

CHAPTER FOUR
DRESSING & BANDAGES
70

Objectives
At the end of this session students will be able to:-
• Describe the concept of dressing
• Identify the purpose of dressing
• Describe type, application and methods of applying
bandage
• Identify types of first aid kit
•Apply dressing and bandaging.
71

Definition:
Dressing:-
•Is the immediate protective cover placed over a
wound.
Sterile dressings are those, which are free from
germs before use & are preferable than non-
sterile dressings.
Purpose:
•To assist in the control of bleeding
•To absorb the blood & wound secretions
•To prevent contamination
•To relieve pain
72

Clean Dressing Procedure
•To use at home
Hand washing
Boiling the dressing material for 15 minutes
Drying the dressing materials with out
contamination
(use ironed clothes if available).
Clean the wound area
Dry it
Apply the dressing material
Secure it with adhesive tape or bandage
73

Bandages:
Definition: is a strip of material used to hold a wound dressing
or splint in place.
•Help to immobilize, support & protect an injured part of the
body.
Bandages are used:-
• To hold splint in proper place
• To maintain direct pressure over dressing to control
bleeding.
• To retain dressings and splints in position
• To prevent or reduce swellings
• To restrict movement etc
•Bandage should never be used directly over a wound
•Bandaging a wound should be applied firmly enough to keep
dressing and splints in position. 74

Types of Bandages
1. Elastic bandages
2. Gauze bandages
3. Triangular bandages
4. A binder of Muslin (rarely used)
75

1. Elastic Bandages
•Are expensive
•Can be laundered & used repeatedly
•Don`t stretch too tightly (interferes circulation)
76

2. Gauze Bandages
•Can be used on any part of the body
•Can be used in different ways
Circular
Spiral
Figure of eight (joint areas)
Finger tip bandages (recurrent)
77

Circular
Techniques the layers of bandage
are applied over the top of each
other
Wrap with continuous application
in small place such as wrist.
Stabilizes ankle, wrist, fingers,
toes….
78

•It is the simplest of roller bandaging technique.
•Where in the bandage is rolled over the affected
area in circular motion, such that each layer is
overlapping the previous layer completely.
•This technique is mostly used on parts of the
body with uniform circumference such as leg
forearm or finger
79

Spiral
Part of the preceding
turn is covered generally
by 1/3 of the width of th
bandage
Wrap a limb in ascending
path particularly covering
previous wrapping while
moving up the limb
Promote venous return
Effective around arms,
leg, or wrist
Used to hold dressing in
place.
80

•Like circular bandage it uses on body parts with uniform
circumstance.
•The two differ with respect to the way the bandage is
wrapped and the area covered.
•As opposed to circular the. Where in each layer only
overlapped 2/3 of the preceding layer
•Can be Used to cover the entire limb.
81

Figure of Eight
Over lapping application
alternating with ascending
and descending wrap with
each pass of the bandage
cross each other over
previous wrap.
Stabilizes joints such as wrist
ankle and help to maintain
immobility
82

Finger tip (recurrent)
Anchored (tied)at the top
with several spiral wraps
then back and forth across
the end of extremity.
Binds amputated stump in
preparation for
prosthesis(artificial limb)
fitting.
Holds dressing on the
head (end of amputated
area).
Used for blunt body part
83

Triangular Bandage
•Used to cover the entire scalp, foot or any large
areas
•Used as a sling for fracture of the arm
•Sling is a kind of hanging bandage put around the
neck in which a wounded arm or hand is supported
84

Binder of muslin (Mosul, Iraq)
Is an item made of muslin cloth of various shape and size
used to:
-Provide compression,
-Prevent drying,
-Prevent motion,
-Retain surgical dressings and
-prevent an injury
from external contamination.
86

Combination of Dressing and Bandages
•Adhesive strips with attached gauze dressing are available
in wide variety of sizes & shapes.
•Bandage compresses are the most useful and efficient
combination of bandage & dressing.
•The dressing portion bulks over which pressure may be
applied for control of sever bleeding
87

Application of Bandages
General principles:
•A bandage should be snug (comfortable) (not too
loose and not too tight)
•To ensure that circulation is not interfered with;
•Leave the person's fingertips or toes exposed.
•Watch for swelling, changes of color & coldness.
•If the victim complains of numbness or tingling
sensation, loosen the bandages immediately
•Never apply a tight circular bandage about a person's
neck.
88

Methods of Applying Bandages
1. Arm Sling
•Prepare triangular bandage
•Place one end of the bandage over the injured
shoulder and let the other end hang down in front
of the chest
•Carry the point behind the elbow of the injured
arm
•Carry the second end of the bandage up over the
shoulder and tie the two ends together at the side
of the neck
89

Arm Sling…
commercially available arm sling
90

•Bring the point of the bandage fore ward and pin
it to the front of the slings.
• Make sure the end of the fingers extend just
beyond the base for observation
• Adjust the sling so that the hand elevated 10 - 12
cm above the level of the elbow
92

2. Triangular bandage folded as cravat
• Prepare triangular bandage first
• Bring the point of a triangular bandage to the
middle of the base
• Fold length wise along the middle until you
obtain the desired width
93

3. Triangular Bandage for the scalp &
forehead
• Fold a hem(edge) about 5 cm wide along the
base.
•Place compress and put dressing in place with
the hem on the out side.
•Place the bandage on the head so that the
middle of the base lies on forehead.
94

Triangular Bandage folded as cravat for
the scalp & forehead
95

Triangular Bandage for the scalp &
forehead
96

4. Cravat bandage for forehead, ear &
eyes
•Place the center of cravat over the compress
that covers the around area.
•Carry the ends around to the opposite side &
cross them
•Bring them back to the starting point ad tie.
97

5. Cravat Bandage for cheek or ear
•Use a wide cravat
• Carry one end over the top of the head and
the other & under the chin
• Cross the ends at the opposite side
98

Cravat Bandage for cheek or ear
99

Special Pads
•Large thick layered, bulky pads with an outer water
proofed surface area
• Available in several sizes
•Often used in the treatment of victims with circular
burns
•Are sometimes called "burn pads" or general-purpose
dressings
101

BLEEDING CONTROL
7/7/2022 By Adem H (Bleeding) 102

Objectives
At the end of the session students will be able to:-
Understand means of bleeding
Understand techniques to stop sever bleeding

Bleeding
Definition:
Rushing out or oozing of blood from blood vessels
(Hemorrhage).
Types of bleeding (based on the sites of bleeding)
• Arterial bleeding- bright red in color, flow from the
wound site.
Sever blood loss
• Venous bleeding – dark red in color, flow is steady
• Capillary bleeding –oozing from bed of capillaries,
red in color, usually less bright than arterial blood with
slow flow.

Generally, there are 2 types of bleeding
1. External bleeding is when blood is leaving the
body through some types of wound.
2. Internal bleeding is a loss of blood that occurs
from the vascular system in to the body cavity
(space).

Duty of First Aider for sever bleeding
•To Stop bleeding
•To prevent infection
•Treat for shock/ Complication

Techniques to stop sever bleeding
Bleeding control measures
1. Direct pressure
 By placing the palm of the hand over a thick
pad
Manual pressure the main artery
Apply the pressure bandage & tie
Safest & effective
2. Elevation (hand, neck, or leg) above the victim's
heart
3. Apply indirect Pressure on the supplying
artery
•Brachial artery for arm wound
•Femoral artery for leg wound

4. Apply Tourniquet
Used only for life threating hemorrhage that can
not be control by others.
Never use rope wire
Do not apply too tightly & flesh part
Apply on body surface where blood vessels can
be pressed (facial ,temporal, carotid, subclavian,
femoral, brachial arteries).

Nose Bleeding (Epistaxis)
 Sit the patient down, head tilted forward.
 Nip the soft part of the nose for 10 minutes.
 Tell the patient to breathe through the mouth.
 Give the patient a cloth to clean up any blood
whilst the nose is nipped

Advise the patient not to breathe through
or blow their nose for a few hours after
bleeding has stopped.
If bleeding persists for more than 30
minutes, or if the patient takes
‘Vasoconstrictor' drugs (such as Adrenalin),
take or send them to hospital in an upright
position.
Advise a patient suffering from frequent
nosebleeds to visit their doctor.

Sites of
bleeding
Position victim
in a sitting position
Keep head tilted
slightly forward
Pinch soft parts of
both nostrils

General rules in managing bleeding
wounds
Place the injured in suitable position
Elevate the bleeding part except in case of
fracture.
Exposed the wound
Do not disturb any blood clot
Remove any foreign body
Apply & maintain pressure
Immobilize the injured part

Mild Bleeding
•Wash your hands with soap & water
•Wash in and around the wound
•Rinse the wound thoroughly by flushing with
clean water
•Dry with sterile gauze/clean cloth
•Apply dry bandage or clean dressing
•Inform the victim to see physician immediately
N.B: protect the hand contact to the blood in
order to prevent HIV/AIDS ,HBV transmission.
• If direct pressure on the wound does not stop
the bleeding, put pressure on the pressure points.

Prevention of contamination and infection
• Hand washing before and after wound care (when possible)
• By avoiding contaminants
• By using clean materials as much as possible
•E.g. cotton gauze, towels etc...
• Wash in and around the victim’s wound to remove bacteria
and other foreign Matters.
• Wash the wound thoroughly by flushing with clean water,
preferable running tab water.(don’t wash wound with sever
bleeding)
• Apply a dry sterile bandage or clean dressing and secure it
firmly in place
• Small wounds even can be taken care at home
• If their is infection refer the victim to the health institution.

Safe Guards
•Don't remove the cloth pad initially placed on the
wound.
•Don't try to cleanse wound with sever bleeding.
•Watch for sign of shock.
•Immobilize the injured area.
•Adjust the victim in lying position so that the
affected limb can be elevated.

Removal of foreign Body
•Use tweezers sterilized over a flame or in
boiling water
•Lift out those objects imbedded just beneath
the skin with a tip of a sterilized needle.
• Deeply embedded foreign objects in the
tissues, regardless of size should be left for
removal by health personnel.

Dressing the wound
Helps to protect from
•Injury,
•Contamination, and
•Assist in the control of bleeding

Infection
•If bacteria get inside tissues of the body, serious
infection may develop with in hours or days.
•This results in delay of wound healing.
S/S
•Swelling, Redness,
•Sensation of heat
•Throbbing pain
•Fever
•Pus formation
•Swelling of lymph nodes

Emergency care for Infection
•Keep the victim lying down & quiet.
•Immobilize the entire infected area.
•Elevate the affected body part if possible.
•Apply heat to the area
•Don't delay medical care

CHAPTER FIVE
BONE & JOINT
INJURIES
122

Musculoskeletal system consists of bones, ligaments,
joints, muscles, tendons and bursa of the body.
The function of musculoskeletal system includes:
protection, support, locomotion, mineral storage,
hematopoiesis formation of blood & heat production.
Consists of 206 bones & 600 muscles.
124

1. Fracture
Is a break or crack in the continuity of bone.
Fractures occur when the bone is subjected to stress
greater than it can absorb/hold.
Fracture can be caused by direct blow, crushing force,
sudden twisting motion and even extreme muscle
contraction.
125

Types of fracture
A. Closed (simple) :–
In which the over lying skin is intact.
A. Open (Compound):-
•In which there is a wound over the fracture
site(there is a break in the skin)
•Have greater potential for complication.
126

•Complete fracture- involves the entire
cross section of the bone.
•Incomplete- involves a portion of the cross
section of the bone.
•Simple fracture- only there is a fracture to
the bone and no other injuries.
•Compound fracture-fracture with skin and
muscle damage.
• -Fractured bone seen outside.
•Pathogenic – fracture because of the
disease in the bone.
127

Patterns Of Fracture
•Green stick fracture
•Transverse fracture
•Oblique fracture
•Spiral fracture
•Comminuted fracture
•Depressed fracture
•Compression fracture
•Avulsion fracture
•Impacted fracture
•Dislocation 128

Green stick ..
One side of the bone is broken and other side is
bent.
129

Transverse
•Fracture straight across the bone.
130

Oblique fracture
•A fracture occurring at an angle across the bone.
131

Spiral fracture
•A fracture twisting around the shaft of the bone.
132

Comminuted fracture
•A fracture in which bone splintered in to more than
three fragments or several fractures.
133

Depressed fracture
•A fracture in which fragments of driven inward
(commonly seen in skull fractures).
134

Compressed fracture
•A fracture in which bone has been compressed.
135

Avulsion fracture
•Pulling away of a fragment of bone by a ligament or
tendon.
136

Impacted fracture
•A fracture in which a bone fragment is driven into an
another bone fragments.
137

Causes of fracture:-
 Motor vehicle accidents
 Accidental falls
 Recreational & sport activities
 Direct blow on the bone
 Repetitive force such as that caused by running
can cause stress fracture in the specific area
involved such as the foot, ankle, tibia or hip
Risk factors for fracture are:–
► Old age
► Osteoporosis
► Infection 138

Sx/Sx
Pain,
Tenderness,
Deformity,
Lose of use,
Swelling,
Ecchymosis,
Exposed bone ends (compound) &
discoloration.
139

First Aid Measure
•Protect against further injury
•Call for an ambulance (medical assistance)
•Prevent movements of the injured part
•Elevate involved extremities
•Apply splint
•Remove the victim's clothing
•Control hemorrhage
•Don't wash & don't insert your finger in the
wound if it is open fracture.
•Don't replace any bone fragments
•Traction
140

Traction: Is the application of pulling force
to a part of the body.
Sling: A flexible strap or belt used in the form
of a loop to support or raise a hanging weight.
Splint: Devices that can be used to
immobilize injured parts when fractures,
dislocations and other similar injuries are
present or suspected.
141

Splints:
•Are devices applied to arms, legs, or trunk to immobilize the
injured part when a fracture is suspected
•Protect further injury during transportation
•There are many varieties of splints commercially available
•Can be made locally from different materials
•It should be long enough to pass the joints
•It should be padded
•Joints must be immobilized above& below the fracture
•Inform the victim not to move the affected part
•Never test for fracture by moving the victim's broken body
part.
• Straighten & splint a deformed limb as necessary
142

Fracture of the skull
•Profuse bleeding is common
•Deep scalp wounds may be complicated by fragment
from skull, my contain hair glass or other foreign
material
First aid measures:
•Don't clean scalp wound
•Raise the victim's head & shoulder
•Don't bend the neck
•Apply sterile dressing & bandage
•Move the victim to health institution
143

Brain Injury
Causes –
•Trauma of the skull
•Wound of the skull
•Open or closed fracture of skull illnesses ,
•Stroke,
•Tumor
First Aid measures
•Call for ambulance
•Keep the victim lying down & treat for shock.
•Insure an open airway
•Control hemorrhage
•Keep NPO
•Record the level of consciousness
144

Face & Jaw fracture
Causes
• automobile accidents
•Accidental falls
•Other violent injuries
Immediate problems:
• Obstruction of the air way
• Swelling & sever hemorrhage
145

First Aid Measures
•Seek immediate medical assistance
•Provide continues support
•Lean foreword to drain secretion
•If the victim stops breathing, give artificial
respiration
•Treat for shock
•Apply protective dressing as necessary
•Transfer to the nearby health facility
146

Fracture of The Scapula
Cause:
• Fall or automobile
collision
• Dislocation of the
shoulder joint, and
• Sprain are common.
First Aid Measures
Apply sling & bandage the
victim's upper arm to his
chest
148

Fracture of Clavicle
•Occur at the weakest portion, middle 3rd of its
length (1/3 of the distance from the tip of the
shoulder to the sternum)
•Common in children
•Applying a sling to elevate the victims arm &
shoulder
•Bind the arm to the victim's chest
149

Fracture of the Humerus
First Aid Measures
Closed fracture:
• Place a pad in the victim's
armpit
• Apply splint
• Support his forearm with sling
• Bind the victim's upper arm to
his chest
Open fracture:
• Cover the wound with large
sterile or clean dressing
• Apply split (don't press the
wound)
• Don't attempt to cleanse the
wound .
150
Remember that the three places to immobilize a fracture of the
upper arm are:
 Broken bone ends
 Shoulder
 Elbow

Forearm & Wrist (Fracture)
•Bones involved (ulna & radius)
First Aid Measures
•Immobilize the broken bone ends(joints), the wrist
and the elbow
•Splint the affected area
•Bend the elbow & apply sling
151

Fracture of Upper leg
•Result from falls or traffic injuries
•The limb is shortened
First Aid Measures
•Place a blanket between the legs & bind them together
Apply board splint (well padded)
•Cover open wounds
•Apply traction if possible
Fracture of Kneecap (patella)
•Patella - is front of the knee joint.
•Cause: direct blow
152

First Aid Measures
•Apply pillow splint or padded splints from the victim's
heel to his buttocks along the back of the leg.
Fracture of lower leg (tibia & fibula)
First Aid Measures
•Apply well padded splints on both sides of leg & foot
•Insert blankets or towels between the leg & tie them
together
•Keep the victim's foot pointing upward
•The best way to detect deformity or any other
abnormality in an extremity is to compare it to the
extremity on the other side.
153

2. Dislocation
•Is displacement of a bone end from its articular
surface (joint).
•The principal symptom of dislocation is pain & the
principal sign of dislocation is deformity
•Always check the pulses, strength, and sensation
distal to musculoskeletal injury
•Types of Dislocation:-
1. Subluxation:-
•Partial dislocation, Incomplete separation between 2
articulating bones.
2. Luxation:- Complete dislocations, Total
154

Dislocation can be
Congenital- Present at birth due to some mal
development, most often noted at hip.
Spontaneous/pathological:- Due to disease of the
articular or peri-articular structure.
Traumatic :- Due to injuries. The most common site
for traumatic dislocation are the knee cap, shoulder,
jaw, thumb or a finger.
155

S/S of Dislocation
•Swelling
•Obvious deformity
•Pain upon motion
•Tenderness and discoloration
First Aid Measures
•Splint & immobilize the effected joint
•Apply a sling if needed, seek medical attention& never
attempt to reduce dislocation
157

3. Sprains
•It is defined as an injury to the ligaments and other soft
tissues at a joint.
•Usually caused by the sudden twisting of a joint beyond
its normal range of motion
•The ankle & the knee are the joints most commonly
affected
•It differs from dislocation in that the continuity of the
joint is not disrupted in sprain although the structures
that support the joint are separated
158

Sprain:-
The function of a ligament is to maintain stability
while permitting mobility.
A torn ligament losses its stabilizing ability.
As is the case with contusion, blood vessels are
ruptured and ecchymosis and edema occur.
159

Grades of Sprain:-
1st degree sprain:- Caused by tearing of a few ligament fibers.
2nd degree sprain:- Caused by tearing of more ligament fibers.
3rd degree sprain:- Occurs when a ligament is completely torn
Signs & Symptoms:
• Severe Pain,
•Tenderness,
•Swelling,
•Discoloration & abnormal joint motion
160

The best treatment for a sprain or strain is to follow the
RICE mnemonic:
Rest: Rest the injury. e.g. don't allow a sports player to carry on
playing for a certain period of time.
Immobilize - Sprains, strains and dislocations can be slinged;
fractures should be splinted and singed.
Cold Compression: Apply an ice pack to the injury as soon as
possible.
oThis will help reduce swelling, pain, which will speed recovery.
oPlace a tea towel or triangular bandage between the skin and
the ice pack.
oDo this for 10 minutes, every 2 hours, for 24 hours for
maximum effect.
Elevation : Elevate the injury. This also reduces swelling and
Anti pain: give NSAIDs.
161

S/Sx:
 Swelling  Pain upon motion
 Tenderness  Discoloration
N.B: treat every sever sprain as if it were a fracture
Fist Aid Measures
• Don't allow to walk
•Remove or loosen the victim's shoes
•In mild sprains, keep the injured part raised for at least
24 hrs
•Apply cold
•If swelling persist seek medical assistance
163

4. Strains
Are soft tissue injuries or muscle spasms around a joint & are
characterized by pain on active movement
A strain is defined as an injury to muscle/muscle pull.
Usually caused by sudden wrenching movements, overstretches,
overuse or excessive stress on muscle which results in tearing the
surrounding muscle or ligament.
Are microscopic, incomplete muscle tears with some bleeding
into the tissue.
No deformity
First Aid Measures
• Bed rest, heat & use of board under mattress for a person with
strained back
• Other strains apply heat & rest 164

Strain….
Commonly strains occur on the back muscles due to
improper lifting techniques.
Common sites: Hamstring, Quadriceps, Hip flexor, Biceps
Latissimus dorsi.
Grade 1:- Some muscle fibers stretched or torn.
- Some tenderness/pain with AROM
Grade 2:- Number of muscle fibers torn
- Active contraction of muscle extremely painful.
Grade 3:- Complete rupture of muscle
- Significant impairment or total loss of movement.
165

Strain….
Signs & Symptoms:-
 Localized swelling, Cramping, Inflammation, Loss of
function, Pain, General weakness, Discoloration.
Strain:-
Prevention:-
Proper warm-up, Stretch, Proper mechanics, Proper
cool-down/ stretch, Proper nutrition & hydration.
Treatment:-
Reduce swelling & pain, NSAIDs.
Severe - Hard cast, Surgery 166

How to care for dislocation, sprain, and
strain
R. I. C. E.
• Rest
• Ice
• Compression
• Elevate
168

Prevention of Accidents Resulting in skeletal &
muscular Injuries:
Motor vehicle accidents
•Good driving skill & judgment
•Driver's attitude toward accident prevention
•Periodic check up of vehicle condition
•Confirmed condition of the driver
•Speed & distance b/n vehicles must be adjusted
•Special caution near schools, churches
Other accidents
As the condition we can prevent it
169

Complication
Six Ps of compartment syndrome are:-
1. Paresthesia (unrelieved by narcotics)
2. Pain (unrelieved by narcotics
3. Pressure,
4. Paralysis
5. Pallor (loss of normal color, coolness)
6. Pulselessness (decreased/absent pulses
170

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