First aid

DEFINITION OF FIRST AID
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First Aid is the initial assistance or treatment
given to a casualty for any injury or sudden
illness before the arrival of an ambulance,
doctor, or other qualified personnel.

AIMS OF FIRST AID
• Preserve life
• Prevent the casualty’s condition from becoming
worse
• Promote recovery
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RESPONSIBILITIES AS A
FIRST AIDER
• Assess the situation quickly and safely and summon appropriate help.
• Protect casualties and others at the scene from possible danger.
• To identify, as far as possible, the nature of illness or injury affecting
casualty.
• To give each casualty early and appropriate treatment, treating the
most serious condition first.
• To arrange for the casualty’s removal to hospital or into the care of a
doctor.
• To remain with a casualty until appropriate care is available.
• To report your observations to those taking care of the casualty, and
to give further assistance if required.
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PRIORITY OF CASUALTIES
• Save the conscious casualties before the unconscious ones as they have a higher
chance of recovery.
• Save the young before the old.
• Do not jeopardize your own life while rendering First Aid. In the event of
immediate danger, get out of site immediately.
• Remember: One of your aims is to preserve life, and not endanger your own in
the process of rendering First Aid.
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• Casualties should always be treated in the order of priority,
usually given by the “3 Bs”:
• Breathing
• Bleeding
• Bones

RECOVERY POSITION
• For people who are unconscious, or semiconscious, but are
still breathing.
• If there are spinal or neck injuries, do not attempt to place
the casualty in the recovery position.
• NOTE: Leaving the victim in this position for long periods
may cause them to experience nerve compression.
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STEP 1: Kneel next to the person.
Place the arm closest to you
straight out from the body.
Position the far arm with the back
of the hand against the near cheek.
STEP 2: Grab and bend the
person’s far knee.
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STEP 3: Protecting the head with
one hand, gently roll the person
toward you by pulling the far
knee over and to the ground.
STEP 4: Tilt the head up slightly
so that the airway is open. Make
sure that the hand is under the
cheek. Place a blanket or coat
over the person (unless he/she
has a heat illness or fever) and
stay close until help arrives.
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HYPERVENTILATION
SYMPTOMS:
• Unnaturally fast, deep breathing
• Attention-seeking behaviors
• Dizziness, faintness, trembling, or marked tingling in hands, feet and lips
• Headache
• Chest pain
• Slurred speech
• Cramps in the hands and feet
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Hyperventilation, also known as excessive breathing, causes a
reduction of carbon dioxide concentration (below normal) of the
blood.

Cont.….
CAUSES:
• Stress or anxiety
• Consequence of lung diseases, head injuries or stroke
TREATMENT:
• When speaking to casualty, be firm but kind
• If possible, lead the casualty to a quiet place where he may be
better able to regain control of his breathing
• Let him re-breathe his own exhaled air from a paper bag.
• (Paper bag is preferred over plastic bag as plastic bag may cause the
casualty to suffocate)
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FAINTING
SYMPTOMS:
• A brief loss of consciousness causing the casualty to
fall to the floor
• A slow pulse
• Pale, cold skin and sweating
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Fainting is a brief loss of consciousness that is
caused by a temporary reduction of blood
flow to the brain.

Cont.….
CAUSES:
• Taking in too little food and fluids (dehydration)
• Low blood pressure
• Lack of sleep
• Over exhaustion
TREATMENT:
• Lay casualty down, and slightly elevate legs
• Make sure she has plenty of fresh air
• As she recovers, reassure her and help her sit up gradually
• Look for and treat any injury that has been sustained through falling
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SHOCK
Shock occurs when the circulatory system fails, and insufficient
oxygen reaches the tissues. If the condition is not treated quickly,
vital organs can fail, ultimately causing death. Shock is made worse
by fear and pain.
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Shock can be divided into 4 types:
• Hypovolemic shock
• Cardiogenic shock
• Distributive shock
• Obstructive shock
Cont.…

SYMPTOMS:
Clammy skin (cool, pale and damp)
Restlessness and nervousness
Thirst
Loss of blood
Confusion
Fast breathing
Nausea or vomiting
Blotched or bluish skin (especially around the mouth and lips)
Often perspires freely
May pass out.
CAUSES:
Hypovolemic shock: caused by the loss of blood volume (such as through
bleeding) or profound dehydration.
Cardiogenic shock : a result of a weakened heart that is unable to pump blood
as efficiently as it once did. Commonly occurs after a massive heart attack
Distributive shock: a result of the lack of distribution of blood to the organs
Obstructive shock: results from an obstruction to blood flow at a site other than
the heart
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Cont.…

TREATMENT:
• “P.E.L.C.R.N.” (Pronounced Pell-Crin)
• Position the casualty on their back
• Elevate the Legs
• Loosen clothing at neck waist or wherever it is binding
• Climatize (prevent too hot or too cold)
• Reassure (keep the casualty calm)
• Notify medical personnel (Help, Get a medic!!)
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CRAMPS
Cramps are painful sensations caused by contraction or over
shortening, usually of muscles.
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CAUSES:
• Cold or overexertion
TREATMENT:
• Stretch the muscle and apply heat or cold (preferably
heat)
• Cramps from lack of salt and water: Stretch the muscle,
drink water and increase salt intake

Choking is the mechanical obstruction of the flow of
air from the environment into the lungs.
CAUSES:
• Introduction of foreign object into airway, which becomes
stuck
• Respiratory diseases
• Compression of airway (e.g. Strangling)
CHOKING
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Cont.…
SYMPTOMS:
• Unable to speak or cry out
• Face turns blue from lack of oxygen
• Victim grabbing at his/her throat
• Weak coughing, laboured breathing produces
high-pitched noise
• Unconsciousness
TREATMENT:
• Encourage victim to cough
• Back slaps: Use of hard blows with heel of the
hand on the upper back of the victim
• Abdominal thrusts:
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Abdominal thrusts
• Ask a person to speak or cough
• Deliver 5 back blows
• Perform abdominal thrusts
• Repeat sequence of back blows and abdominal
thrusts

FRACTURES
SYMPTOMS:
• Pain at or near fractured site
• Tenderness on gentle pressure
• Swelling over the fracture site
• Deformity e.g. irregularity of bone, angulation or
rotation of limb, depression of bone etc.
• Loss of power
• Signs and symptoms of shock
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A fracture is a break or crack in the continuity of the bone.

Fracture Types
Simple little or no bone displacement
Compound fracture ruptures the skin & bone protrudes
Green stick occurs mostly in children whose bones have not calcified or hardened
Transverse crack perpendicular to long axis of the bone - displacement may occur
Oblique diagonal crack across the long axis of the bone
Spiral diagonal crack involving a "twisting" of the bone about the longitudinal
axis
Comminuted "crushing" fracture - more common in elderly
Impacted one end of bone is driven up into the other
Depressed broken bone is pressed inward (skull fracture)
Avulsion fragment of bone is pulled away by tendon
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DISLOCATIONS
SYMPTOMS:
• Pain at the site of injury
• Limited movement at joint
• Deformity
• Swelling
• Tenderness
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A dislocation is the displacement of one or more
bones at a joint. It usually occurs in the
shoulders,
elbow, thumb, fingers and the lower jaw.

FRACTURES AND DISLOCATIONS
TREATMENT:
• Support and immobilize the injured limb
• Use a splint (if possible) in order to prevent
movement of the injured part
• Arrange for casualty to be removed to hospital
• In doubtful cases, always treat as for a fracture
• Do not attempt to replace the bones
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STRAINS
SYMPTOMS:
• Localised pain
• Stiffness
• Inflammation
• Bruising
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A strain is an injury to a muscle in which the Muscle fibres
tear as a result of overstretching. (Sprain – to a ligament)

SPRAINS
SYMPTOMS:
• Pain at site of injury
• Swelling and later bruising
• Pain on movement
• Loss of function
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A sprain occurs at a joint where there is tearing or
over-stretching of the ligaments and tissues.
TREATMENT:
• Support the joint in most comfortable position
• P.R.I.C.E. (Protect, Rest, Ice, Compression, Elevation) treatment
• When a sprained ankle occurs outdoors, do not remove the shoe
• If unsure whether there is a fracture, always assume it is one

FOREIGN BODIES IN MINOR WOUNDS
TREATMENT:
• Control bleeding by applying firm pressure on either side
of the object and by raising wounded part
• Cover the wound with gauze to minimize the risk of
infection
• Pad around the object until you can bandage over it without
pressing down
• Hold the padding in place while finishing the bandaging
• If you cannot pad high enough, bandage around the object
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First aid
in special situations
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BleedingBleeding
= escaped blood from the blood vessels
Hemorrhage – large amount of bleeding in a short
time
External bleeding –seen blood coming from an open
wound –outside the body
- often overestimated
Internal bleeding – inside the body
- often underestimated
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BleedingBleeding
3 kinds according to its source:
1. Arterial
• bright red colour
• under pressure, comes out in spurts
• the most serious
• fast rate
• large blood loss
• less likely to clot (clot only when blood flow is slow)
• dangerous : it must be controlled
2. Venous
• dark red colour
• low pressure
• blood flow steadily
• it is easier to control
• most veins collaps when cut
but
• bleeding from deep veins can be as massive as arterial bleeding !!!

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3. Capillary bleeding
• oozing out, leaking
• most common
• blood oozes
• usually not serious
• easily controlled
• often it clots and stops itself
4. Mixed bleeding

Bleeding - clinical symptomsBleeding - clinical symptoms
• Depend on - the quantity of the blood loss
- the rapidity of the blood loss
!!! Sudden loss of a large quantity of blood results in shock:
- skin - cold, pale
- pulse - weak, fast
- mental disorders, fear, unconscioussness
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Animal bites
What to do
• dogs – similar to other injuries – often face, extremities, risk of bleeding
• snakes – toxins -neurotoxins
-cardiotoxins
-clotting disorders
-cytotoxic and hydrolytic effect
not all snake bite has toxic risks (rat snake)
First aid:
• calm down the patient
• immobilisation of extremity
• not invasive therapeutic procedures
• shock therapy
• ABC
• immediate transfer to the hospital
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1.Non Poisonous Snakes
2. Poisonous Snakes
TYPE OF SNAKES

SNAKE BITE
Non Poisonous Snakes do not have fangs with which to inject venom.
Non Poisonous Snakes

SNAKE BITE
Poisonous
Snakes
Poisonous snakes have fangs to inject venom.

SNAKE BITE-
Venom Tissues Absorbed
network of tubes that drains fluid
(lymph) from the body’s tissues and
empties it back into the bloodstream
Rarely venom reaches blood stream
into the lymphatic
system

SIGNS AND SYMPTOMS
puncture marks, or parallel scratches on the skin - rarely any
pain
•anxiety
•pale, cool skin with progressive onset of sweating
•rapid, weak pulse
•rapid, shallow breathing
•blurred vision, drooping eyelids
•difficulty swallowing and speaking
•abdominal pain
•nausea and/or vomiting
•collapse - progressing to a comatose state

FIRST AID & TREATMENT
pressure immobilization bandage’
This bandage is applied as firmly as bandaging
a sprained ankle, and is designed to slow the
movement of venom through the lymphatic
system.
Bandaging the wound firmly tends to compress the lymph vessels, which
helps to slow or prevent the venom from leaving the bite site.
CONTD…

•reassure
•complete rest
•apply direct pressure over
the bitten area
•obtain a history
•immobilize the limb with a
splint
•avoid elevating the limb
•DO NOT use an arterial
tourniquet
•DO NOT remove the bandage
and splint once it has been

Animal bites
What to do
• spiders – danger very rarely – arachnophobia
toxins – neurotoxic therapy as snakes
• scorpions – very painful bite
- rarely very high toxicity
- vegetative neurotoxicity
-therapy as snakes
• insects – most danger is hornet (yellow jacket)
bee – 100 bites = lethal dosis
pain, swelling, alergic reactions
therapy – cooling, antiallergic therapy
neck bites – swelling, airways obstruction
ABC
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BEE/HORNET STING
SYMPTOMS:
 Redness and swelling in injured area
TREATMENT:
 Remove stinger as fast as possible
 Reduce pain and swelling with cold compress
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ALLERGY, ANAPHYLAXISALLERGY, ANAPHYLAXIS
Definition: A powerful reaction to substances (eaten,
injected, contacted…) Reaction antigene + antibody.
Anaphylaxis = severe allergic reaction
Characteristics:
 Occurs within minutes or seconds
 Fast progression
 Can cause death if not treated immediatelly
Common cause:
Medications, food + food additives, insect stings, plant and
flowers pollen, parfumes…
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54
CONT…..CONT…..

Symptoms
 Sneezing, coughing, wheezing
 Shortness of breath
 Suffocation (swelling in the throat, tongue, mouth, neck = Quincke oedema…
 Tightness in the chest
 Increased pulse rate
 Dizzines
 Nausea + vomiting
 Diarrhoea
 Anaphylactic shock
 Urtica with skin itching (pruritus), blisters, quickly spreading exanthema
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Treatment
 Immediatelly interrupt the contact with allergene
 Check ABCs
 Seek immediate medical attention
 Help the victim to use epinephrine, if he/she is provided with

StrangulationStrangulation
Removing the body from the noose - prevention of body fall and other injuries
Suspected injury of
- the brain
- cervical spine, larynx, cervical vessels
(thrombosis of the carotid artery, of the jugular vein)
What to look for?
- Status of vital functions
What to do?
• ABC
• stabilize head against movement
• seek medical attention
• admission to the hospital ICU
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SeizuresSeizures (convulsions)(convulsions)
Seizure (convulsions)
- is a burst of electrical activity from the brain that results in
involuntary movements, loss of consciousness (LOC), or both.
Basic classification
• generalised - always LOC -
convulsive - tonic or combination of tonic with
- clonic convulsions (seizures) - urinary iincontinence or
tongue biting may occur
nonconvulsive - absence, myoclonic
• partial - no LOC
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CONT…..CONT…..

Risk factors:
• Serum electrolyte disturbances - Na <120 or >160 mmol/l,
Ca<1mmol/l, Mg<0,5mmol/l
• Drugs - amphetamine, cocaine, ethanol, TCAs
• CNS infection - meningitis, encephalitis
• Miscellaneous - CNS tumour
- hypertensive encephalopathy
- severe hypoxemia
- Head injury
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CONT…..CONT…..

Clinical signs:
• Seizures have abrupt onset and last 1-5 minutes
• the period of altered mental status can last up to 30
minutes
• Status epilepticus - defined as seizures lasting >30
minutes or two or more seizures without lucid
interval in between.
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CONT…..CONT…..

Treatment
• Restrain the victim as necessary to protect from self-
injury and from secondary injury - cars and traffic on the
road, sharp objects in the proximity of the patient
• Bring the patient gently into recovery position to prevent
aspiration in the case of vomiting - rough treatment
could provoke other paroxysm
• ABC as soon as the seizures stop
• Call for help and arrange transport to the hospital
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DrowningDrowning
• Drowning is death from asphyxia secondary to submersion in a liquid
(usually water) or within 24 hours of submersion.
• Near drowning is survival of suffocation secondary to submersion in a
liquid.
• Mechanisms of near drowning
with aspiration - aspiration of water and vomitus
→ in fresh water → loss of surfactant – fast absorbtion to the
circulation
→ in sea water → flooding of alveoli → hypoxemia (80-90%)
no aspiration – laryngospasm → spastic closure of glottis (vocal cords)
→ hypoxemia (in 10-20%) = dry drowning.
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Near drowningNear drowning
What to do?
• Extrication of the victim from the water - very dangerous
- protect yourself !!!rotect yourself !!!
• ABCs - the earliest as possible - Airways + oxygenation
+ ventilation
• The airway should be checked for foreign material and
vomitus
• Prevent additional hypothermia
• Seek for medical attention
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Heat strokeHeat stroke
• Heat stroke - defined as a heat injury + altered mental
status in consequence of failure of the body
temperature control.
• Rectal (core) body temperature is above 40°C -
usually there is a history of exposure to exercise or increased
temperature and humidity.
Causes:
• high ambient or environmental temperature
• increased endogenous heat production
• decreased ability to dissipate heat
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CONT…..CONT…..

Clinical signs:
• hyperpyrexia
• altered mental status
• lack of or minimal sweating
• ataxia
• neurological deficit – paralysis (hemiplegia, Babinsky reflex)
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What to do?
• ABC
• Reduction of core temperature – water should be
- sprayed on undressed patient with breeze from fans or
- wrap the patient in wet packsheet till the temperature 
falls to 38,5°C, then stop the cooling Continuation of cooling could cause the
uncontrolled drop of body temperature.
• Cold water immersion or air-cooling
• Seek medical attention

wounds
• Abrasion - the top level of skin is removed = painful -
(nerve endings)
• Laceration - skin is cut with jagged, irregular edge
• Incision - smooth edges (surgery) - bleeding depends on
the depth, the location and the size of the wound
• Punctures - deep narrow wounds (nail, knife), the
object may remain impaled in the wound
• Amputation , avulsion - the cutting or tearing off of a
body part – finger, toe, hand, foot, arm or leg
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Types

Open wounds - wound care
• Shallow wounds should be cleaned to prevent infection For
severe bleeding, leave the pressure bandage in place until
medical attention.
• To clean a shallow wound
- wash inside the wound with soap and water
- irrigate the wound with water from a faucet (tap)
- for a wound with a high risk for infection (animal bite, very
dirty or ragged wound or a puncture) seek medical attention for
wound cleaning
• Cover the area with a sterile dressing
• Control the bleeding
• Treat the victims shock
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Open wounds - impaled objects
What to do
• Expose the area - remove or cut away clothing surrounding the
injury
• Do not remove or move an impaled object - movement of any kind
could produce additional bleeding and tissue damage
• Control any bleeding with pressure around the impaled object
• Shorten the object if necessary - stick or trunk of the
tree, wooden or iron bar..
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Burns and scalds
Rank among the most serious and painful injuries.
Can be classified -
1. Thermal (heat) burns - contact with hot objects, flammable vapour, steam or
liquid
i)Dry burn
Caused by flame, contact with hot objects, friction etc.
ii)Scalds
Contact with steam and hot fluids
iii)Cold injury
Contact with freezing metals, dry ice, freezing vapours e.g. liquid oxygen and liquid
nitrogen
2. Chemical burn- acids, alkalis and organic compounds (petroleum,
kerosene…)
3. Electrical burn- severity of injury depends on the type of current, the
voltage, the area of body exposed and the duration of contact
4. Radiation burn
• Sunburn over-exposure to ultra-violet (UV) lamp and exposure to radioactive
source.
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Anterior
and
posteror
part of the
trunk
Calculation of the burned surface extent

• 1st-degree burns1st-degree burns (superficial):(superficial): surface (outer layer) of thesurface (outer layer) of the
skin is affectedskin is affected
characteristicscharacteristics -- redness, mild swelling,redness, mild swelling,
tenderness andtenderness and painpain
• 2nd-degree burns2nd-degree burns:: affect partial thickness of the skinaffect partial thickness of the skin
characteristicscharacteristics -- blistering and swelling,blistering and swelling, severe painsevere pain
• 3rd-degree burns3rd-degree burns:: penetrates the entire thickness of the skinpenetrates the entire thickness of the skin
and deeper tissuesand deeper tissues
characteristicscharacteristics -- no painno pain, skin looks waxy or pearly, skin looks waxy or pearly
grey or charredgrey or charred
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DEGREE OF BURN

MINOR BURNS
(FIRST DEGREE BURNS)
TREATMENT:
• Rinse the injured part with cold water for at least 10 minutes
to stop burning and relieve pain
• Gently remove any jewelry, watches, belts or constricting
clothing from injured area before it begins to swell
• Cover area with sterile dressing, or any clean, non-fluffy
material and bandage loosely in place.
• NOTE: Cold burns should not be rinsed with cold water
and cold water should never be applied to anyone with
extensive burns.
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SEVERE BURNS
(SECOND AND THIRD DEGREE BURNS)
TREATMENT:
• Lay the casualty down and protect the burnt area
from contact with the ground if possible
• Rinse burn with plenty of cold water for at least 10
minutes or use burn-cooling gel
• Arrange for casualty to be sent to the hospital
• While cooling the burn, watch for signs of difficulty
in breathing and be ready to resuscitate if necessary
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Cont…..

• Remove any rings, watches, belts, shoes or burning clothing
from injured area before it begins to swell
• Remove burnt clothing, unless it is sticking to the burn
• Cover dressing with sterile dressing or some other suitable
material to prevent infection and germs (this is not necessary if
burn is on face)
• Do NOT burst any blisters, touch infected area or apply any
lotions to the injury as this will retain heat within the burn.
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Chemical burns - what to do
• Immediately remove chemical by flushing the area with
water - brush dry powder chemicals from the skin
before flushing (water may activate a dry chemical) -
protect yourself
• Remove contaminated clothing and jewellery while
flushing the water
• Flush for 20 minutes all chemical burns (skin, eyes)
• Cover the burned area with a dry, sterile dressing or
clean pillowcase or sheet
• Seek medical attention immediately for all chemical
burns
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Chemical burns - what not to do
• Do not apply water under high pressure - it will drive
the chemical deeper into the skin
• Do not neutralize a chemical even if you know which
chemical is involved - heat may be produced,
resulting in more damage. Some product
labels for neutralizing may be wrong. Save the
container or label for the chemical´s name.
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Electric current injury
Effects of electricity on the body are determined by 7 factors:
• type of current - skin offers greater resistance to direct
current than alternating current
• amount of current
• pathway of current
• duration of contact
• area of contact
• resistance of the body
• voltage - high voltage accident (>1000 V) is regularly
accompanied with burns, while
low voltage (<1000 V) injury causes electric
damage, most often arrhythmia.
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Electric current injury - what to do
• Make sure the area is safe - unplug, disconnect or turn off power,
if not possible, call for help
• Check ABCs - remember - ventricular fibrillation !!! - start CPR
• If the victim fell, check for a spinal injury
• Seek medical attention immediately, victims with cardiac
dysrythmias need in hospital observation for 48 - 72 hrs
• Electrical injuries with burns (high voltage) - cover them by
sterile dressing, victims usually require burn centre care
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Cold injuryCold injury - hypothermia- hypothermia
Shivering
• Besides goose pimples - as a part of “cold stress reaction“  protective reaction
• = an early response to cold stress
• Shivering is able to increase the basal metabolism rate two-to five fold
• Heart oxygene and energetic consumption is increased by 500%
• It is operative between 30-37°C
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Clinical signs:
• gradually deteriorating mental status incoordination → confusion → lethargy → coma
• body is cold to touch, dysarthria
• Tachycardia → bradycardia - ventricular fibrillation occurs at temperatures 28°C
• Hypertension → hypotension
• Tachypnea (↑rate of breathing) → bradypnea (↓ rate of breathing)
• Hyperreflexia → areflexia – fixed and dilated pupils with coma at temperature below 22°C
• Asystole - at 22º C

Cold injuryCold injury - frostbite- frostbite
Frostbite - a cold-related contact injury characterised by
freezing of tissues
Most often affected parts of body = peripheral - face, ears,
nose, hands, feet, penis and scrotum
Most cases - in soldiers, winter outdoor enthusiasts, e.g.
mountain climbers
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CONT…..CONT…..

Treatment
• Examine vital functions, start ABC when necessary
• Replace wet clothing with dry, soft clothing to minimise
further heat loss. Remove constricting clothing.
• Initiate rewarming of affected area as soon as possible.
• Avoid rubbing affected area with warm hands or snow, as
this can cause further injury.
• Transport patient to the warm environment and give him
warm fluids.
• Active re-warming of the frost-bitten part via immersion in
circulating clear water at 40-41°C
• Dry sterile dressing of the frostbite
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Head injuries
• Mechanism of injury – motor vehicle crashes, falls, hits,
gunshots and stab wounds, mortality rate 30-50%
• The main types of head injury
- scalp wounds
- scull fractures - basilar, linear and comminuted
- intracranial lesions - contusion, subarachnoid
haemorrhage, subdural hematoma,
epidural hematoma
- diffuse brain injury – concussion, diffuse axonal injury
• Scull fracture is always associated with the brain injury
• In case of suspicion of the brain injury, the patient has to be
hospitalised, examined and monitored for at least 48
hours.
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Diffuse brain injury
• Concusion
• Diffuse axonal injury
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Concussion
• Is a brief, temporary interruption of neurological function folloving head
trauma
clinical features
• Headache
• Nausea, vomiting
• Tachycardia
• Amnesia for the event
• Unconsciousness – short lasting
• ABCs
• Treatment for scalp wounds, aplication of pressure dressings to prevent hemorrhage
• Transport to the hospital for diagnostics
• Admision to the hospital for monitoring, observation (mental status, consciousness assessment,
pupils, …)
Treatment

Head injuries - what to do
When the patient is unconscious
• ABC - monitor vital functions. By the application of airway management
(head position tulted backward) keep in mind the possibility of cervical
spine injury.
• Examine the head gently and cover the external injuries with sterile
dressings (bandage) - don’t press on the wound, stabilize the
victims neck against movement
• Examine the state of pupils - size, similarity, reaction on the light
• Examine also the thorax, abdomen and extremities
• When the circulation and breathing are stable bring the patient into
recovery (stable -side) position (beware of cervical spine injury) and
monitor vital functions.
• Call for help
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Head injuries - what to do
When the patient is conscious:
• Bring the patient into supine position with a little elevated head
if there is no suspicion of cervical spine injury
• Treat the wounds in the same way as above
• Call for help
• Keep in mind, that even if the patient is conscious, the status
of consciousness can alter due to the brain injury or
intracranial bleeding and therefore all the time monitor the
mental status of the victim.
08/17/18 84

Eye injuries - penetrating eye injuries
• Result when a sharp object (knife, needle) penetrates the eye
• Seek immediate medical attention - any penetrating eye
injury should be managed in the hospital
• Stabilize any protruding object with bulky dressings or
clean cloth
• Cover the undamaged eye
• Do not wash out eye with water
• Do not try to remove an object stuck in the eye
• Do not press on an injured eyeball or penetrating object
08/17/18 85

Eye injuries - chemical burns of the eye
• Chemical burn of the eyes are extremely sight-threatening
• Alkalis cause greater damage than acids - they penetrate
deeper and continue to burn longer
• Damage can happen in 1 to 5 minutes - the chemical must
be removed immediately
What to do
• - use your fingers to keep the eye as wide as possible
• - flush the eye with water immediately - irrigate from the
nose side of the eye towards the outside, to avoid flushing material
into other eye
• - loosely bandage both eyes with cold, wet dressings
• Seek immediate medical attention
08/17/18 86

Nose injuries - nosebleeds(Epistaxis)
Two typesTwo types
-- anterior - most common (90%)most common (90%)
-- posterior - serious and requiresserious and requires medical attentionmedical attention
08/17/18 87

08/17/18 88
What to do
• Place victim in a seated position
• Keep his/her head tilted slightly forward
so blood can run out, not down the back
of the throat,
• which can cause choking, nausea or
vomiting
• Pinch (or have victim pinch) all the soft
parts of the nose together between
thumb and two fingers for 5 minutes
• Apply an ice pack over the nose and
cheeks
• Seek medical attention - if the bleeding
continues or you suspect a broken
nose or posterior nosebleed

Spinal injuries
Spinal injuries are often associated with head injuries
The head may have been moved suddenly in one or more directions, damaging
the spine
What to look for - painful movement of the arms or legs
- numbness, tingling, weakness or burning sensation in the arms or legs
- loss of bowel or bladder control
- paralysis of the arms or legs
08/17/18 89
What to do
• Stabilize the victim against any movement
- to stabilize head against movement - place heavy objects on each side of the
head
• Check ABCs
• Transfer the patient by 3 – 4 pairs of hands
• Transfer patient on the vacuum matrace or on the board

Chest injuries
All chest injury victims should be rechecked for ABC
Broken ribs - main symptom is pain by breathing, coughing and movements
What to do
•help the victim find comfortable position
•stabilize the ribs using pillow or other soft object fixed by bandage over the
injured area
•some victims find comfort by lying on the injured side
•seek medical attention
08/17/18 90
Impaled object in chest- what to do
• Stabilize the object in place with bulky (wide) dressing
• Do not try to remove an impaled object - bleeding and air in the chest cavity can
result
Sucking chest wound - results when a chest wound allows air to pass into and out
of the chest cavity with each breath

Chest injuries
Pneumothorax
• open - persisting opening to the chest
• closed - no external communication
• tension (valve)- air can enter pleural cavity during inspiration and cannot
escape during expiration
08/17/18 91
Air entered into pleural cavity – results in
Pneumothorax

Collaps of the lung + increasing intrapleural pressure

mediastinum shift to the healthy side

stopped venous return to the heart

cardiac arrest

Pneumothorax – clinical features
• Sudden onset chest pain
• Chest wall deformity
• Crepitus
• Agitation
• Air hunger
• Tachycardia
• Hypotension
08/17/18 92
What to do
• Cover the wound immediately
• Seal the wound with anything available to stop air from entering the chest
cavity - plastic wrap or plastic bag, if not available, you can use your
gloved hand
• Seek medical attention urgently !!!
• Pleural puncture should be done as soon as possible

Abdominal trauma
•Nausea
•Vomiting
•Dyspnea
•Heartburn
•Abdominal pain
•Abdominal distension
•Ecchymoses over the abdomen
•Presence of open penetrating wounds
•Abdominal tenderness
•Hypotension
•tachycardia
Treatment
08/17/18 93
clinical features
• ABCs is priority
• Immobilization
• Monitoring of vital signs
• Transport to the hospital

Abdominal injuries
Blow to the abdomen - observe for pain, tenderness,
muscle tights, or rigidity
What to do - place the victim in a comfortable position and expect vomiting
check general condition – shock can develope
do not give any food and drink
seek medical attention
Penetrating wound - expect internal organs to be damaged
What to do - if the penetrating object is still in place,
stabilize the object and control bleeding,
seek medical attention
do not try to remove the object
08/17/18 94
Protruding abdominal organs - what to do
• Position - the victim with the head and shoulders slightly raised, and knees bent
and raised
• Cover protruding organs with the (moist) sterile dressing or clean cloth
• Place towel lightly over the dressing to help maintain warmth
• Do not try to reinsert protruding organs into the abdomen - you could introduce infection or
damage the intestines
• Do not give anything to eat or drink

Pelvic injuries
• If you suspect broken pelvis, press the sides of the pelvis gently
downward and squeeze them inward at the iliac crests (upper point of
the hips)
- broken pelvis will be painful
What to do
• Treat the victims shock
• Place padding between victims thighs, then tie the knees and
ankles together
• Keep the victim on a firm surface - do not move the victim
08/17/18 95
Cont…

Most often causes
• ingestion - drugs, alcohol, or both of them, toxic food (mushrooms) or fluids
• inhalation - narcotics and carbon monoxide or other toxic gases
• intravenous, transcutaneous or intramuscular application of drugs in addict
people
Clinical sings
- polymorphous
- mostly altered mental status
- altered vital functions
- Convulsions
08/17/18 96
Cont…

Cont…
Evaluation of vital functions –
examine ABCs followed by
history +
physical examination.
History is of primary importance, but
at altered mental status may be difficult
Obtain as much information as possible from the patient, from the family and
from anyone else who was at the scene.
The most important questions
•What poison is involved?
•How much was taken?
•By what route was the poison taken (e.g. by mouth, iv., i.m., skin
exposure)?
•When was it taken?
•What else was taken with it? (combination of drugs and ethanol)
08/17/18 97

Cont…
Besides vital functions are regularly examined, observe:
•Pupillary size - mydriasis - (atropine, cocaine, ethanol),- miosis (opiates,
organophosphates and barbiturates)
• Oral examination - the odour of the breath is diagnostic clue hydration
(opiates, atropine vs. organophosphates, strychnine)
•Examination of the skin - marks of i.v. drugs use, cyanosis, red skin colour
(due to cyanide or carbon monoxide) dry skin (atropine, anticholinergics
drugs)
•Call for help and transport the patient to the hospital
•Monitor vital function during the transport - ABCs
•Bring with the patient to hospital all drugs, empty blisters and boxes of the
drugs that are present at the scene.
•Provoke vomiting in co-operative person
•Don't give any fluids and do not provoke the vomiting in people with altered
state of consciousness
08/17/18 98

Poisoning - specific antidotes
Specific poisonings antidotes:
• Ethyleneglycol → alcohol
• Methylalcohol → alcohol
• Alkali → juice or vinegar or lemon
• Acid → milk ?
• Be careful !!!
08/17/18 99

Chest pain•Several causes
•Always think about heart attack first
•Medical care at the onset of a heart attack is vital to survive

•Seek medical atention immediatelly
08/17/18 100
Heart attack
Signs and symptoms
•Uncomfortable pressure
•Squeezing or pain in the center of the chest lasting more than a few minutes or going away
and coming back
•Pain spreading to the shoulders, neck or arms
•Chest discomfort, nausea, shortness of breath
•Not always typical signs
What to do
•Call emergency medical servis or get to the nearest hospital
•The least painful position (sittin with legs up and bent at the knees)
•Give Nitroglycerin tablets or spray (dilates coronary arteries) – Caution: possible hypotension
•Avoid Nitroglycerin application if patient used VIAGRA within last 48 hours
•If unresponsive victim – check ABC and start CPR

Stroke (Brain attack)
• Blood vessels rupture – bleeding or
• blood vessels plugged
• Nerve cells dies within minutes
• Transient attack – closely associated with strokes-
• short duration from minutes to several hours (mini-strokes)
• serious warning sign of a potential stroke
What to look for
• Weakness, paralysis
• Decreased vision
• Speaking or understanding problems
• Dizziness or loss of ballance
• Severe headache
• Differentiate pupils from “Pupils equal and reactive for light“
What to do
• If victim unresponsive – ABC
• Call emergency medical servis
• If breathing – recovery position
• Supine position with slightly elevated head and shoulders (neutral position)
• Do not give anything to drink and eat (restricted swallowing, throat paralysis, tendency to vomit…)
•
08/17/18 101

Acute psychic (mental) disorders
What to do
• very difficult situation
• risk of auto and heteroagresivity
• risk of suicidal attemts
• calm, trustful approach needed
• patience to listen to the patient
• direct isntructions to undergo the therapy …
• use of physical limitations – delicate situation – only in cases with risk of
autoagressivity and risk of exposure of the patient or his neighbourhood
• seek emergency medical services to secure safe transfer to the hospital
08/17/18 102

CPR
CardioPulmonary
Resuscitation

C.P.R.
Cardiopulmonary Resuscitation (CPR) consists of mouth-to-
mouth respirations and chest compressions. CPR allows
oxygenated blood to circulate to vital organs such as the brain
and heart. CPR can keep a person alive until more advanced
procedures (such as defibrillation - an electric shock to the
chest) can treat the cardiac arrest. CPR started by a bystander
doubles the likelihood of survival for victims of cardiac arrest.

CPR
CPR AGE CATEGORIES
ADULT Puberty and Higher
CHILD 1yr - Onset of Puberty
INFANT 0 -1yr

ADULT CPR
CPR SEQUENCE: C – A- B
CALL for help
Check the victim for
unresponsiveness. If there is no
response, “Call 911 and Get the
AED” and return to the victim.
In most locations the emergency
dispatcher can assist you with
CPR instructions.

1. Chest Compression
Begin chest compressions. Push down
on the chest at least 2 inches (5 cm) 30
times right between the nipples.
Pump at the rate of 100-120 minute.
Allow for complete chest recoil after
each compression. Minimize
interruptions in chest compressions.
2. Airway and
3. Breathing
Tilt the head back and lift the chin. If not
breathing, pinch nose and cover the mouth
with yours and blow until you see the chest
rise. Give 2 breaths. Each breath should take 1
second.

CHILD CPR
Sequence: C-A-B
CONTINUE WITH 2 BREATHS AND 30
COMPRESSIONS (5 Cycles) UNTIL HELP
ARRIVES NOTE: This ratio is for one-person
& two-person CPR. In two-person CPR the
person pumping the chest stops while the other
gives mouth-to-mouth breathing.
• CPR for children is similar to performing CPR for adults. There
are, however, 3 differences.
1. If you are alone with the child give 5 cycles (2 minutes) of CPR
before calling 911.
2. Use the heel of one hand for chest compressions. The compression
rate is 100-120/minute.
3. The compression depth is at least 1/3 of the anterior-posterior
diameter of the chest (about 2 inches).

INFANT CPR
Give 30 Compressions
•Give 30 gentle chest compressions at the
rate of at least 100-120minute. Position
your 3rd and 4th fingers in the center of
the chest half an inch below the nipples.
The compression depth is at least 1/3 of
the anterior-posterior diameter of the
chest (approximately 1 ½ inches).
Repeat
•Repeat with 2 breaths and 30
compressions. After five cycles, if you
are alone, call 911 and continue the
sequence.

TRANSPORTATION OF
CASUALTY
With stretcher:
• Keep the stretcher level to the ground
• Carry the casualty with his feet facing the direction of move
• Bring the stretcher to the casualty and not the casualty to the
stretcher
Types of stretcher:
• Wooden stretcher
• Collapsible stretcher with telescopic handle
• Improvised stretcher
08/17/18 111

IMPROVISED STRETCHERS
• Rolled blanket
• Blanket with 2 poles
• Chair method
• Shirts/Gunnysacks with 2 poles
08/17/18 112
An improvised stretcher
made from a blanket
and two poles

EMERGENCY METHODS OF
MOVING CASUALTIES
One Man Human Crutch
• Conscious
• Able to walk with some assistance
Pick-a-back
• Conscious
• Light weight
• Able to hold on using arms
Cradle method
• Light weight
• A child
08/17/18 113
Cont….

EMERGENCY METHODS OF
MOVING CASUALTIES
08/17/18 114
Fore Method
• When pick-a-back or fireman’s life method cannot be
used to carry a heavy casualty down the staircase
Fireman’s Lift
• Conscious
• Unconscious
• Light-weight
Double Human Crutch
• Conscious
• Able to walk with some assistance

Cont…. 08/17/18 115
Two-handed Seat
• Unable to walk with assistance
• Able to use his arms to support
Three-handed Seat
• Unable to walk with assistance
• Usually with injury on one leg
• Able to use his arms to support

Cont…. 08/17/18
116
Four-handed Seat
Unable to walk with assistanceUnable to walk with assistance
Able to use his arms to supportAble to use his arms to support

08/17/18 117
Fore and Aft Method
• Unconscious
• Sustained abdominal injury

08/17/18 119
CONT…..CONT…..

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