First aid course

Chapter -3
Wound & bleeding control

Learning Objectives
After learning this session, the student will be able
to:
 Definition of wound
 Classification of wound
 Approach of wound care with bleeding
JU, By: Mohammed A. (MSc.) 2

Wound
 Definition:
wound is a break in the continuity of the tissue of the
body either internal or external.
 Common causes
 Usually results from when external physical forces
applied:
– by objects, mechanism of injury, types and amounts of
force applied determines the damaged tissue
– most common causes of open wounds are
• MVA, accidental falls , sharp objects, machinery
and weapons.

Classification of wounds
Closed wound: - involves injury to underlying tissues
with out a break in the skin or mucous membrane.
Open wounds: is a break in the skin or the mucus
membrane.
Types of open wound
1. Abrasions
2. Incisions
3. Lacerations
4. Punctures
5. Avulsions

a. Abrasions
 Causes - occurs when the outer layers of the
protective skin are damaged
– usually resulted when the skin is scraped against a
hard surface.
 Bleeding - is limited
 Risks – high danger of contamination & infection

b. Incisions
Cause - occurs when body tissue is cut on knives, rough
edges of metal, broken glass or other sharp objects.
 Bleeding - may be rapid and heavy.
 Risks - Deep cuts may damage muscles, tendons & nerves.

c. Lacerations
 is irregular or blunt breaking or tearing of the soft tissues
 Causes - usually caused when great force is exerted
against the body.
 Bleeding - may be rapid and extensive.
 Risks - Destruction of tissue is greater in a lacerated
wound than in a cut.
 Deep contamination of the wound increases the chance for
later infection.

d. Punctures
 It is produced by an object piercing skin layers, creating a small
hole in the tissue.
 Causes – bullet, pointed objects like pins, nail & splinters.
 Bleeding –is usually quite limited externally and my resulted
internal damages & internal bleeding
 Risks- increased hazards of infection because of the limited
flushing action of external bleeding
 Tetanus may develop

e. Avulsions
 Causes - when the tissue is forcibly separated or torn off
from the victim’s body.
 Usually in motor vehicle, violence, wreck, gunshot,
explosions, animal bites & other crushing injuries.
 Bleeding – have heavy and rapid bleeding
 Risks - An incised wound, a lacerated wound, or both will
usually occur when a body part is avulsed.
 May be reattached by surgeon, send avulsed part with
victims to the hospital

General first aid interventions of wounds
Initial
• Insure ABC, before management of surface injury.
• Identify and treat other more serious injuries.
• Control bleeding with direct pressure or by elevating
the affected part.
• After bleeding controlled remove dirt and
contaminants from the wound
• Clean the wound using running water as an irrigating
solution
• Then, protect the wound with sterile or clean
dressing.

Bleeding/hemorrhage
• Bleeding: is loss of blood, usually through disease, injury, or
other physical conditions.
• Three Main Types of Bleeding
1. Capillary Bleeding
Capillaries are the smallest blood vessels in your body
Capillary bleeding usually occurs in superficial wounds,
such as abrasion,
the bleeding is almost always very slow and small in
quantity.
11
JU, By: Mohammed A. (MSc.)

2. Venous Bleeding
Vein bleeding typically results in a steady but relatively
slow flow of dark red blood.
The best way to stop most cases of venous bleeding is to
put direct pressure on the wound.
3. Arterial Bleeding
This is the least common and most dangerous type of
bleeding.
It involves bright red blood & comes out in large volume,
and in spurts that correspond with each beat of your
heart.
In most cases of arterial bleeding, direct and very firm
pressure on the wound is the best way of stopping it
12

Approaches to bleeding control
First aid
– take precautions ‒ wear gloves
1. Stop bleeding
2. Clean the wound
3. Cover the wound
Specific techniques to stop bleeding are:
Direct pressure
Elevation
Pressure point
Tourniquet

1. Stop bleeding
• Direct Pressure and Elevation
– Direct Pressure:
is applying direct pressure to the wound.
is best way to control bleeding
did not interference with normal blood
circulation
– Methods;
Place a sterile cover over wound /dressing/ and
firmly press directly on the entire area of an
open wound
– Elevation:
used with direct pressure

Stop bleeding…
• elevate injured site above heart level
– may also use a cold pack over the wound, along
with pressure and elevation.
• Check dressing regularly
– Do you remove a soaked dressing? No
• NB:
– Never apply pressure if there is an object in the
wound or a protruding bone.
– Avoid if there is evidence of a fracture

Stop bleeding…
• Unless there is evidence of a fracture,
►a severely bleeding open wound of the hand, neck,
arm or leg should be elevated above the level of the
victim’s heart

Pressure point on the supplying Artery
Pressure point:
– is used temporarily for short duration of time
– is in case of very severe bleeding that not controlled
with direct pressure
– is manual pressure by compressing the main artery
that supplies blood to the affected limb against the
underlying bone and nearby tissues
– it also stops circulation within the limb.

Tourniquet
• A tourniquet – may have dangerous effects
– should be used only for life threatening bleeding that
cannot be controlled by other means.
• Use only as a last resort !!!!!!!!!
• Precaution: Once it applied never removed off
– but release it every 15mins, and notify others as
tourniquet is applied not to forget in its applied site.
• Get Help at Once!!

2. Clean the wound
 Reduce chances of infection
 Rinse out the wound with clean water
 If debris remains use alcohol rinsed & tweezers to
remove it
 To clean area around wound, use soap and washcloths
 No need to use anti septic solution such as iodine, or
H2O2 for cleansing.

3. Cover the wound
• Cover the wound with a clean dressing and bandage
– This helps to keep the wound clean and protect from
harmful bacteria
• Dressing
– Made of sterile pad or compress
– Should be large enough to cover wound margin on all
sides beyond of the wound
• Bandages
– used to secure dressing in place and to control bleeding

Cover the wound ….
PURPOSE OF DRESSINGS
 Control bleeding
 Prevent infection &
contamination
 Absorb blood and fluid
drainage
 Protect the wound from further
injury
PURPOSE OF BANDAGES
Hold a dressing in place
Prevent or reduce swelling
Provide stability for an
extremity
Extend (e.g. broken bones)

Dressing Application
 Communication with a patient
 Getting things ready
 Washing hands
 Patients should be comfortable
position
 GLOVES !
 Keep sterility if necessary/do
not touch the wound
 Wound cleaning
 Dressing application
 Bandaging

Penetrated foreign objects
• Foreign objects
– DO NOT REMOVE!
– Lift out those objects embedded just
beneath the skin
– deeply embedded objects in the
tissues, regardless of size should be
left for removal by health personnel.
– a fixed objects or protruding objects
– cut it off and or Immobilize it and
refer

2. Closed wound
• Happens in intact skin and underlying tissue
• Types
– Contusion /bruises/ – blunt force injury
– Hematomas – due to damage to blood vessels, blood
collection under skin
– Crush injury – compression of body between two
objects or due to pressure from heavy objects

First aid for closed wound
• First aid
– apply direct pressure with cold compression and
– Elevation of affected body parts

Internal bleeding

• Bruising under eyes
(raccoon eyes)
• Bruising behind ears
(Battle’s sign)
• Unequal pupils
• An object impaled in
skull
Signs of a Skull
Fracture
27

Internal Bleeding - Signs and Symptoms
• Injury evidence such as
– pattern bruising to abdomen or chest, seatbelt sign,
battle sign, ecchymosis (raccoon eyes), deformed upper
thigh, etc…
– Pain and information from mechanisms of injury
• Evidence of shock
– restlessness, anxiety; cool, clammy skin; weak, rapid
pulse; rapid breathing
– Confusion, possible collapse, & unconsciousness.
• Other signs depend on source of bleeding;
– Bleeding from body openings (orifices)

Internal Bleeding: First Aid
 Activate EMS first.
 Establish & maintain open airway, and monitor
ABCDs.
 Assess for fractures; apply a splint if needed.
 Keep the victim quiet.
 Position & treat the victim for shock; keep warm.
 If the victim vomits, place in recovery position.
 Monitor victims every 5 minutes until EMS arrive.

3. Nasal bleeding / epistaxis
– bleeding inside of the nose is epistaxis
– Is fairly common and seen in all age groups
– resulted from injury, disease, activity, temperature
extremes, or other causes
– incidence increases during dry & cold winter
month, after stressful activity or exposure to high
altitude.
– most are self limited and treated conservatively
• but dangerous if uncontrolled, it can lead to
shock
• may requires meticulous & individualized
approach. JU, By: Mohammed A. (MSc.) 30

What can causes nose bleeds
• Local – any process that
causes mucosal
hyperemia including
digital trauma, blow &
injury to the soft tissue
• Systemic – numerous
– including bleeding
disorders, malignancy,
chronic renal
insufficiency,
hypertension and others

Types of nasal bleeding
• Anterior nasal bleeding -
– From Kiesselbach’s
Plexus or “Little’s Area”
– Commonest is 85-90%
• Posterior nasal bleeding
– Systemic causes
– Severe – life
threatening

The difference between Anterior and Posterior
Epistaxis
Anterior Epistaxis Posterior Epistaxis
Incidences More common Less common
Site Little area’s or anterior part of the
lateral wall
Mostly from poster superior part
of the nasal cavity
Age Mostly occurs on children or young
age
After older ages, mostly >40 age
Causes Mostly trauma Mostly HTN or arteriosclerosis
Bleeding Usually mild, can be easily controlled
by local pressure or anterior pack
Bleeding is severe requires
hospitalization; postnatal pack is
required

First aid measures
1. Patient should be kept in the sitting
position with the head slightly
lowered forwards and the mouth
open.
2. Pinching of the nose.
3. Ice packs.
4. Cotton packs soaked with
vasoconstrictor solutions (not used in
hypertensives)

How to tell a patient to hold pressure
• Blow out all the clots from nose before starting
• Tilt head forward and lean forward(sniffing position)
• Pinch the soft part of the nose b/n thumb and index
finger
• Spit out blood, didn’t swallow it
• Hold pressure for 10min straight.

CHAPTER-4
DRESSING & BANDAGING

Learning Objectives
• Describe about what is dressings and bandages.
• Describe the basic principles of dressing and
bandaging wounds.
• Demonstrate how to apply a dressing and bandage

DRESSING
• A dressing is a sterile covering of wound to promote
healing and prevent further injury.
 All open wounds should be covered to
►Prevent infection
►Control bleeding
►Prevent further injury and pain
• Large or deep wounds should always be cleaned and
treated at a medical facility
• Note: A dressing is a sterile wound covering; a
bandage holds a dressing in place.

Types of dressing
1. Adhesive dressing
– Is sticky dressing used for cover small cuts and grazes.
– They consist of a gauze and an adhesive backing.
2. Non adhesive dressing
– is a type of dressing used to dress large size area wound
unlike that of adhesive dressing.
39

40
Adhesive dressing None adhesive dressing

Dressing Principles
• Handle carefully to prevent contamination.
• Don’t remove original dressing if blood soaks through.
• Ensure that the dressing completely covers the wound.
• Cover all edges of the dressing with the bandage
• Do not touch or breathe or cough on the surface of a
dressing that is to be placed next to wound

– A bandage is a long narrow piece of cloth used to hold a
wound dressing or splint in place. It helps to immobilize,
support and protect an injured part of the body.
42
Gauze bandage Elastic bandage
BANDAGES

Bandages…
• Bandages must
►Hold a dressing in place over a wound.
►Create pressure that controls bleeding.
►Help keep the edges of a wound closed.
►Secure a splint to an injured body part.
►Provide support for an injured body part.
►Help prevent or reduce swelling.

Bandages cont…
• Kinds of Bandages
– Gauze bandages
– Elastic bandages
– Triangular bandages
– Combinations of dressing and bandages
44

A: Gauze bandages
– Most common type of bandage is the gauze bandage
– A gauze bandage be in any number of widths and lengths
and used for almost any bandage application
45

Gauze Bandages…
• Gauze Bandages can be used on any part of the body in
different ways
• Circular bandages
• Spiral bandages
• Figure of eight (joint areas)
• Fingertip bandages (recurrent)
46

– A bandage applied alternately to two parts, usually two se
gments of limb above and below the joint, in such a way
that the turns describe the figure 8.
– used for treatment of fractures of the clavicle, etc
47
Figure of eight bandage

B: An elastic bandage
– is a "stretchable bandage used to create localized
pressure.
– Elastic bandages are commonly used to treat muscle
sprains and strains by reducing the flow of blood to a
particular area, which can restrict swelling at the place of
injury.
– Do not stretch too tightly (interfere with circulation).
48

Elastic Bandages
49

 Is a right-angled triangle bandage
 Used as an emergency cover for large areas.
 it is used as a sling for fracture or other injury of the arm or
hand
 It can be used to cover
– The entire scalp
– Foot or any large areas.
– Used as a sling for fracture of the arm.
– Folded as a normal bandage,
• The triangular bandage can be used as a circular, spiral or
figure of eight bandage
50
C:Triangular Bandage

Triangular Bandage
51
Arm Sling

General principles:
– A bandage should be snug (not too loose and not too tight)
– Leave the fingertips or toes exposed.
– Watch for swelling, changes of color & temperature of the tips
of fingers or toes indicating interference with circulation.
– If the victim complains of numbness or tingling sensation,
loosen the bandages immediately
– Never apply a tight circular bandage about a neck.
– Do not place bandages directly on wounds (only sterile
dressings).
52
Bandages…

Application of Bandages
• for Injury of
– Arm
– hand and wrist
– forehead
– Etc…
53

Arm Sling
1. Arm Sling (Supporting bandage)
• The purpose of an arm sling is to immobilize and protect an
injured arm .
• Though, broken arms are a common reason for wearing a sling,
you don't necessarily have to have a broken bone to wear one -
contusions, sprains, and dislocations can also require a
sling.
54
Arm Sling

Making Arm Sling…
55

Improvising Dressings and Bandages
• Some situations require improvisation.
• No hard-and-fast rules; use adaptability and
creativity.
• Use materials on hand and methods you can best
adapt.
• Use materials that are as clean as possible.
• Never touch the wound directly.
• Control bleeding. JU, By: Mohammed A. (MSc.) 56

Improvising….
• In an emergency we can use if clean
– Handkerchief
– Washcloth or towel
– Sheet or pillowcase
– Plastic wrap can be used as part of an occlusive dressing
• Never use
– Elastic bandages
– Fluffy cotton or cotton balls
– Paper towels, toilet tissue, or other materials cling when wet

Summary
• A dressing is a sterile cover for a wound.
• The ideal dressing is sterile, gauzy, and layered.
• Never use materials that could cling to, shred on, or
disintegrate over a wound as a dressing.
• A bandage holds a dressing in place and does not
touch the wound.
• Bandages should not be too tight or too loose.

1. Burn injuries
CHAPTER -5- Specific Injuries

Introduction
• Burn is
– an injury to skin or other organs that results from
exposure to energy source like heat, electricity,
chemical agents or radiation.
• Extent of burns are influenced by
intensity of the energy
duration of exposure
type of tissue injured
– the most physical & psychological devastating of all
injuries
– the 4th most common type of trauma globally
– almost (90%) occurs in low & middle income countries
– 75% of burn occurs in very careless

Classifications of Burn injuries
Can be classified based on
1. Causes of burn;
• Types - thermal, chemical, electrical, radiation
etc.
2. Degree of burn;
• Burn depth - first, second & third degree burns
3. Severity of burn; – Minor Vs Major burn
• Burn size - TBS A
• Part of the body burned

A. Types of burns based on causes
• (1) Cold exposure;
– also known as “frostbite”
– Causes - is due to contact with dry ice crystals,
freezing metals, and freezing vapors (e.g. liquid O2,
N)
– Resulted damages
• it interrupts tissue blood flows, and
• causing hemo-concentration and intravascular
thrombosis with tissue hypoxia.

... Cold injuries
• First aid for local cold injury?
– Do not delay
– Warmed blankets
• Re-warm frozen part
• Preserve damaged tissue
– Prevent infection
– Elevate exposed part
– Analgesics if available

(2) Chemical burns
• Causes – industrial chemicals,
– including inhaled fumes and corrosive gases. Or
– Household chemicals, strong acid and alkali, bleach,
weed killers etc.
• Alkalis generally cause worse damage
• NB:
– do not attempt to counteract ACID burns using
ALKALI or ALKALI burns with ACID
 Follow ABCD always
 speed is essential, and seek medical help ASAP

… Chemical burns
• Measures: remove all clothing
– Liquid – irrigate with copious amounts of water.
• 15-20Lt of water for 20-30 min
– Powder - brush off any dry powder or skin before
irrigations
• never apply H2O it may activate & exacerbate burn

(3) Thermal burns
• Dry heat burn - Caused by flame, contact with hot
objects, friction etc.
• Scald burn - is a burn due to contact with steam and
hot fluids. Most commonly occur in children
• Radiation burn - Sunburn over-exposure to ultra-
violet (UV) lamp and exposure to radioactive source.
• Inhalational injury

B. Depth/Degree/ of burns
• Based on depth of tissue damaged
1.First degree :-
2.Second degree:-
3.Third degree :-

1. First Degree Burn
• Depth - involves only the outermost layer of
skin(epidermis)
• Causes: overexposure to sun, light contact with hot
objects and scalding by hot water or steam
• Characteristics
– Redness, mild swelling and pain/tenderness
– Have rapid healing

2. Second Degree Burn
• affects layers of the epidermis and portions of
dermis(under skin),
– that giving rise to redness, blisters and the presence of a
clear fluid due to loss of plasma through damaged skin
layers.
– Can be fatal if it affects over 60% of the body surface.
• resulted from:
– flame, contact with hot liquids, flash burns from
gasoline etc.
• Characteristics;
– erythema, blisters, swelling and wet or waxy dry
appearance wounds
– Very painful when on touch or exposed to air

Signs of 2nd Degree Burns
Blisters `

3. Third Degree Burn
• Complete loss of all skin layers and damage to
– the underneath tissues (nerves, fat tissue and muscles)
• Urgent medical attention is required.
• Caused by – flame, burnt clothing, immersion in hot
water, contact with hot objects, or electricity.
Sign of 3rd degree burn
• Deep tissue destruction -
– Blot dry
– White or
– Charred appearance
– Nerve Damage –(Painless to touch)

Signs of 3rd Degree Burns

Firsts aids of thermal burn injuries
• The aims of first aid should be to
– stop the burning process,
– cool the burn,
– provide pain relief, and
– cover the burn

Burn first aid…
• The principles of first aid are:
– Ensure rescuer safety
– Stop the burning process.
• Covering with blanket, or use water, and, do not run,
roll on the ground
– Start ABCD / CPR if needed
– Cool the burn wound –
• with cool tap water (15°-25°C) for 20min or until
pain is relieved.
– Check for other injuries – no miss to other injuries
– Elevate burned body part

… First aids
• Other first aid measures
– remove jewelry
– remove clothing gently if it is NOT stuck to skin.
• Carefully cut around stuck to remove loose fabrics
– never use ICE for cooling, ointments, spray, or home
remedy on a severe burn.
– cover burned area and leave blisters intact as it is
– provide emotional support
– maintain body temperature
– call EMS or contact burn unit for further help
– arrange for casualty to be sent to the hospital

2. Eye injuries/emergencies
• Ocular emergency- is injury or illness that poses an
immediate threat to a person's vision
• Foreign bodies in the eye
– often by metallic foreign body following work
injury
– harmful not only because of their irritating effect
but also have the danger of scratching the eye
surface or becoming embedded in.
– Signs & symptoms: foreign body sensation,
tearing, red, or painful eye.

First Aid…
• If not impaled objects
– depress the victim’s upper lid with a match stick or
similar object placed horizontally on the top of the
cartilage and
– Evert the lid to its place by pulling down gently
• If the object is not removed, cover and refer

Impaled Objects or Extruded Eyeball
 Impaled objects should be removed only by a
physician
 Stabilize the object to prevent movement
 Cover both eyes loosely with a sterile or clean
dressing.
 Activate the EMS immediately.
 Treat the victim for shock.

Ruptured eye Globe
• First aids
– Do not try to remove the object or to wash the eye.
– Cover both eyes loosely with a sterile or clean
dressing
– Cover with metal eye shield or styrofoam cup.
– DO NOT PATCH.
– Nothing per mouth(NPO) and Refer to immediately
– Decrease risk of Valsalva (sneezing… etc) or
movement which could increase IOP.

First Aid …
• Precautions
– Wash your hands carefully before approaching eye.
– Never put direct pressure on the eyeball.
– Keep the victim from rubbing his eye.
– Don’t irrigate except for chemical burns or foreign
objects.
– Do not attempt to remove foreign objects by sharps
materials
– Refer the victim if something is embedded in the eye,
or thought to be embedded but can not be located.

3. Head injury, Brain injury and skull fracture
• Head injury to the scalp are caused by:
– Contusions, lacerations, abrasions, avulsions
– Bleeding may be minimal or severe
• First aid in injured scalp
– Apply direct pressure with dry sterile dressing.
– Avoid pressure over possible fracture site.
– Consider management for spinal injury as well.

Brain injury and skull fracture…
• Brain injury is:
– occur from open or closed fracture of the skull, and
– also in the case of an illness such as a stroke or
tumor.
• Signs and symptoms of brain injury
– Main symptom is altered mental status
– Clear or blood tinged CSF draining from the nose
or ears following skull fracture
– Partial or complete paralysis of extremities
– Disturbance of speech and convulsions

Brain injury…..
• Besides to bleeding from the nose, ear canal or mouth
other indicators of skull fracture.
– Pale or flushed face.
– Fast and weak pulse.
– Headache and dizziness.
– Seizure
– Vomiting.
– Unequal size of pupils.
– Loss of bowel /bladder control.

First aid for suspected brain injury
• Evaluate level of consciousness
• Call for EMS & obtain assistance as soon as possible.
• Give particular attention to insuring an open air way.
• Control hemorrhage (if any).
• Do not give any fluid by mouth (keep NPO).
• Apply dressing and bandage over the skull if
wounded.
 Do NOT elevate the legs.

Summary of HI
• ABC management
• Use the jaw-thrust to open airway
• Manually stabilize the head and neck
• Don’t let patient move
• Closely monitor mental status
• Control bleeding; No direct pressure on skull
fracture
• Monitor vital signs
• Immediate transport to hospital
85

4. Spinal Cored injury (SCI )
• SCI frequently occur with head injuries
– 2% risk of injury to cervical spine after blunt force
– 78% of victims are males, typically young b/n 10-
30yrs.
– MVA- most common cause about ½ of spinal
injuries
– Other causes: falls, violence, sport injuries
– Life Expectancy is 5 years less than same age
without injury
– 90% go home after hospitalization

Cont’d..
• SCI typically occurs from indirect injury from
– vertebral bones compressing cord
– may be caused by direct trauma from knives,
bullets, etc
• If the cervical spine is injured, the spinal cord may be
unprotected, and
– further injury (20 SCI) resulted from stresses to the
cord that occur when the victim is manipulated or
moved.
– could result in permanent neurological damage
including quadriplegia.

Mechanism of SCI
Compression - By
force from above, as
hit on head Or from
below as landing on.
Hyperextention -
chin hitting a
surface area,
Flexion (hyperflexion) –
Most common type
Flexion/Roatation –
Most unstable form, &
usually results in
serious neurologic
deficits.

…. Spinal Injury
• Symptoms:
– Change in consciousness, difficulty of breathing
– Impaired vision,
– Tingling or numbness in hands, fingers, feet and/or
toes,
– Loss of balance,
– Headache & vomiting
• Complications of Spinal Injury
– Inadequate or breathing arrest (high in cervical
region)
– Paralysis – extremity & ,or loss of sensation

First Aid in spinal injury
• Ensure ABC, call for ambulance/EMS
• Spinal immobilization:
– manually stabilizing the head so that the motion of
head, neck, and spine is minimized.
– Immobilization devices
– Keep lying down, & leave in position found in,
avoid unnecessary movement.
– support head and neck

5. chest Injury
Blunt Trauma
• Steering –wheel injury to
chest
• Shoulder harness seat belt
injury
• Crushing injury (e.g., heavy
equipment, crushing thorax)
Common related injuries
• Fractured clavicle, dislocated
shoulder, rib fracture,
pulmonary/cardiac contusion,
cardiac temponade.
• Hemopneumothorax, flail
chest, great vessel tears and
rupture
91

Common Chest Injuries …..
Penetrating trauma
• Gun shoot or
• Stab wound to chest
Common related injuries
• Open Pneumothorax, tension
pneumothorax,
hemopneumothorax, cardiac
tamponade, esophageal damage,
trachea tear, and great vessels
tears
92

Sign and symptoms
BLUNT TRAUMA
 SOB
 increasing respiratory rate
 chest pain
 bruising
 restlessness / anxiety
 signs of shock
 tracheal deviation
PENETRATING TRAUMA
 As per blunt trauma
 open wound +/- sucking wound
foreign body
 Surface findings: Asthmatic
chest movement
93

Chest Injury Complications

First Aids for chest injury
• Ensure patient air way
• Remove clothing to assess injury
• Stabilize impaled objects with bulky dressing / Do not
remove it.
• Stabilize flail rib segment with hand followed by
application of large pieces of tape horizontal across the flail
segment.
• Assess for other significant injuries and treat appropriately.
• Place patient in a semi-Fowler’s position or position victim
on the injured side if breathing is easier after cervical spine
has been ruled out.
• Ongoing Monitoring

penetrating chest wounds
• Leave penetrating object in site
– seal open (sucking) wound
on 3 sides with sterile
occlusive dressing (or
plastic).
• consult EMS
• If condition of patient worsens
after application of dressing,
remove dressing and reevaluate
patient
• NPO
• Occlusive dressing: idea is to
create a valve effect, so that air
can escape but not enter the chest
cavity

6. Abdominal Trauma
• In abdominal trauma identifying the:
– Mechanism is important - Common source are
• Bike accident over the handlebars & MVC with
steering wheel trauma
– also suspect possibility of chest trauma
– pose risks for chemical or bacterial complications
due fluids spilled from abdominal organs
– Closed injury pose grave risks for internal
bleeding, shock, organ damage
• Can be asymptomatic early

Open wounds of the abdomen:
• 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, but
don't tighten the bandage.
– Nil by mouth
– Keep the victim’s head and shoulders elevated to
avoid breathing difficulty.
– Refer as rapidly as possible and take extreme care
to gently transportation

7. Pelvic fracture
 Significant force can cause pelvic fracture
High index of suspicion
 Have significant associated
abdominal & genitourinary injury
heavy pelvic bleeding due to injury to great blood
vessels
Occur as open or closed injuries

Pelvic fracture …
• Typical manifestation is
– Leg-length discrepancy, external/internal rotation
– unstable pelvis – with palpation of pelvic ring
– Hemorrhagic shock
• Avoid repeated manipulation of a fractured pelvis

First aid for Pelvic fracture
• A&B as usual, and
• on C: Control hemorrhage with pelvic wrap/binder
• Method of pelvic wrap
– wrapping of sheet/other clothes all surround pelvis
and apply knot at suprapubic area
– gently bind victim on the bottom board
– avoid any movements and urgent referral

102

CHAPTER SIX-
Sudden illness and unconsciousness

 Common acute illness
1. Shock
2. Heart attack
3. Stroke
4. Seizures (fits)
5. Fainting
6. Allergic reactions
“Knowing basic first aid and what to do in an emergency
can be the difference between life and death”

Learning Objectives
At the end of this chapter the students will be able
to:
– Identify common acute illness
– Identify symptoms of common acute illness,
– Provide first aid for someone who is having of
common acute illness including
shock,
Heart attack
fainting,
seizure and allergic reactions

Shock
Shock is characterized by inability of circulatory
system to supply adequate oxygen and nutrients to
the tissues, causing body organ malfunctions.
Shock is a critical condition brought on by the
sudden drop in blood flow through the body.
It is most often accompanied by hypotension,
termed
decompensated shock.
High mortality - 20-90%, but early intervention
reduces mortality

Con’t….
Causes of shock
– Trauma
– Infection
– Blood or fluid loss
– Severe burn
– Heart problems
– Allergic reaction

Classification of shock
 Shock states are classified according to the underlying
physiologic derangement.
1. Hypovolemic shock
Hemorrhage
Fluid loss/dehydrations
2. Cardiogenic shock
Pump failure
Valvular disorder
Cardiac dysrhythmia

Classification…
3. Distributive shock
 sepsis
Anaphylaxis and intoxications
Neurogenic
4. Obstructive shock
 Tension pneumothorax
 Cardiac temponade
 Massive pulmonary embolus

Clinical presentations
Cardinal findings
 hypotension(absolute/rel
ative),
 oliguria,
 abnormal mental status
 metabolic acidosis, and
 cool and clammy skin
Suggestive finding
 Increased breathing rate &
work of breathing
 Pallor or bluish skin color
 Increased heart rate
 Reduced pulse volume
(weak pulse)
 Reduced conscious level

First aid
ABCD Resuscitation (airway, breathing, circulation,
dextrose)
What can I do about it?
Direct pressure /
tourniquet
STOP
the
bleeding!
pelvic
wrap
Positioning
Splint
fractures
Prevent

First aid for shock
• Treat the obvious causes of shock such as severe
bleeding, fractures and burns
• First aid - “P.E.L.C.R.N.” (Pronounced Pell-Crin)
– P- Position the casualty on their back
– E- Elevate the Legs
– L- Loosen clothing at neck waist or wherever it is
binding
– C- Climatize (prevent too hot or too cold)
– R- Reassure (keep the casualty calm)
– N- Notify medical personnel (Get Help)

Heart attack
 Heart attack (MI) is a serious medical emergency in
which supply of blood to the heart is suddenly blocked,
usually by atherosclerosis and blood clots.
 Prompt response and medical attention is critical in
limiting damage to the heart muscle
 Blockage of a coronary artery causes the patient to
experience immediate and severe chest pain
 It have three serious consequences: sudden death,
cardiogenic shock and CHF

Signs and Symptoms
 Persistent chest pain.
 Gasping and shortness of breath.
 Extreme pallor or bluish discoloration of the lips, skin
and finger nails.
 Sweating
 Extreme prostration- near death feeling
 N.B. The two principal symptoms are shortness of
breath and chest pain

Management
 Carry out primary assessment,
 Call EMS immediately for anyone with heart attack.
 If conscious and breathing is adequate, place the
casualty in a stable side position,
 If the victim has their medication encourage to take
their drugs (e.g. aspirin)
 If the person becomes unconscious, prepare for
potential cardiac arrest follow (CPR and AED).
 Transfer to hospital immediately

Stroke
• Stroke or “brain attack” is an abrupt onset that interrupts
blood flow to the brain and cause neurologic damage
• Strokes are a common cause of sudden death
• Disruption in flow is either from an occlusion (ischemic)
or rupture (hemorrhagic) of the blood vessel.
• Stroke Type: classified as resulting from two major
mechanisms: ischemia and hemorrhage.
– Ischemic strokes - thrombotic, embolic, or
hypoperfusion related) accounts for 84% of all
strokes
– Hemorrhagic strokes – intra-cerebral and
subarachnoid hemorrhage

General feature
Most cerebrovascular diseases are manifest by the
abrupt onset of a focal neurologic deficit, as if the
patient was “struck by the hand of God”
The clinical manifestations of stroke are highly
variable because of the complex anatomy of the brain
and its vasculature
Paralysis of the contralateral face, arm, and leg;
sensory impairment
Motor aphasia: Motor speech area of the dominant
hemisphere

Con’t…
Warning signs of stroke
 Sudden weakness or numbness
 Sudden change in vision
 Sudden difficulty of speaking or understanding
 Sudden dizziness or loss of balance
 Sudden headache
119

Apply the F.A.S.T. diagnostic tool:
 F - Face - does the face look uneven
 A - Arm - does one arm drift down when both at equal
positions
 S - Speech - does their speech sound different
 T - Time - call for an ambulance immediately if you
suspect someone has had a stroke.
Timely access the victim is an important, in treating
patients with advanced care and drugs.
The window of opportunity to effectively treat
STROKE is 3hrs (180 min)

Management
• Time is a critical component in the care of stroke
patients.
• First aider should quickly ascertain the time of onset of
the patient's symptoms
• Carry out primary assessment,
• Seek medical attention
• If unresponsive and breathing is adequate, place the
casualty in a stable side position
• Loosen any tight clothing
• Immediately transfer to health care center

Seizure
• Seizure is an episode of abnormal, excessive discharge of
electrical activity in the brain.
• It can be caused by something interrupting the electrical
activity in the brain.
– this leads the muscles to contract uncontrollably and
usually causes the person to lose responsiveness.
A seizure that is prolonged or recurring is a serious
medical emergency and, if untreated, can result in death.
Seizure is the most common symptom of epilepsy,
– but can be caused by other causes including a head
injury, alcohol poisoning or hypoglycemia (too low
blood glucose)

… seizure
• Epilepsy
– A disease characterized by spontaneous recurrence
of seizures (at least 2)
– is a condition which affects the brain and causes
repeated seizures, which are often sudden and
dramatic.
• Epilepsy = “seizure disorder”
• Seizures are symptoms, while epilepsy is a disease, so
should not be used interchangeably

Sign and symptoms of seizure
1. Abrupt onset and termination
2. Sudden loss of responsiveness
3. Rigid body movement with an arching back
4. Noisy and difficulty of breathing
5. Loss of bladder and bowel control
6. Post-ictal confusion, lack of recall, lethargy and fall
into a deep sleep

What to look for - seizures
• the main objective of first aid is
– to ensure adequate brain oxygenation & cardio-
respiratory function, and
– to protect them from injury.
• With any kind of seizure it is really important to keep
checking:
– their level of response and pulse
– airway and the person is breathing.
• It is also important to protect them from harming
themselves during the fit

First aid for seizures
 Don’t restrain or move them.
 Protect them from hurting themselves.
 Clear away any potentially dangerous objects, like hot
drinks or sharp objects.
 Make a note of the time when the seizure started and
how long it lasts.
 Protect their head by placing something soft
underneath it, like a towel, and loosen any clothing
around their neck.

First aid …
• Once the seizure has stopped, they may fall into a
deep sleep if they do, open their airway and check
their breathing.
• If they’re breathing, put them in the recovery position.
• If they stop breathing at any point, prepare to treat
someone who is unresponsive and not breathing (start
CPR).
• Keep checking their breathing, pulse and level of
response.

First aid for seizures
Seek a medical attention if:
– it’s the casualty's first seizure, or the cause is
unknown
– they’re having repeated seizures
– the seizure lasts more than five minutes
– they’re unresponsive for more than ten minutes.

Fainting/syncope
 Fainting is a brief loss of consciousness that is caused
by a temporary reduction of blood flow to the brain.
 Fainting can occur when blood pools in the legs,
reducing the blood flow to the brain.
– Thus people may faint when they are standing for a
long time in the heat.
– Fainting can also be brought on by stress.

Fainting
Causes:
– Taking in too little food and fluids (dehydration)
– Low blood pressure
– Lack of sleep
– Over exhaustion or stress
Symptoms:
– A brief loss of consciousness causing the casualty
to fall to the floor
– A slow pulse
– Pale, cold skin and sweating

First Aid for Fainting
• Make sure the person airway clear
• Check for breathing
• CPR if necessary
• Call EMS if more than a few
minutes
• If conscious, lay the victim down
with feet elevated
• Loosen any tight clothing.
• Then allow the person to rest for
10 or 15 minutes
• Look for and treat any injury that
has been sustained through falling
Make sure s/he has plenty of fresh air

Unconsciousness/coma
•Is a state of altered level of consciousness usually
defined by clinical assessment
 Appearance of being asleep
Incapable of responding to external stimuli
Incapable of responding to inner needs
Unable to interact appropriately with environment
• Is a medical emergency
• Prompt diagnosis and appropriate management to save
life
132

Definitions of levels of arousal (consciousness)
• Alert (Conscious) - Appearance of wakefulness,
awareness of the self and environment
• Lethargy - mild reduction in alertness
• Obtundation - moderate reduction in alertness.
Increased response time to stimuli.
• Stupor - Deep sleep, patient can be aroused only by
vigorous and repetitive stimulation.
Returns to deep sleep when not continually
stimulated.
• Coma (Unconscious) - Sleep like appearance and
behaviourally unresponsive to all external stimuli
(Unarousable, unresponsiveness, eyes closed)
133

Coma…
The patient is not arousable at all to verbal or
physical stimuli, and no attempt is made to avoid
painful or noxious stimuli
The level or grade of consciousness to be assessed:
1. GCS, and 2. AVPU scale :
A---alert & aware
V---responds to verbal stimuli
P---responds to painful stimuli
U---unresponsive
134

CAUSES OF COMA
• Extra cranial or Intracranial disorders.
• Extra cranial Disorders
 hypoxia,
 hypoglycemia
 sepsis
135

Immediate assessment of the comatose patient
Airway Make sure that the airway is clear
Breathing Ensure the patient is breathing
Give oxygen if they are hypoxic
Circulation Check for a pulse ,check the blood pressure
Do Glucose test
136

Allergic reactions(Anaphylaxis)
It is unexpected reaction of the body’s to something it
has come into contact with.
Allergen– any thing that triggers an allergic reaction
It occurs when body’s immune system mistakes the
allergen for a threat, and tries to fight it off, this
produce a severe histamine release, causing a sharp
drop in blood pressure, hives and breathing
difficulties.

Con’t…
A severe allergic reaction can develop within just a few
seconds of coming into contact with the allergen.
The reaction may be fatal if emergency treatment,
including epinephrine (adrenaline) injections, is not
given immediately.
 Causes by: plant pollen, animal hair, insect stings,
specific drugs, and foods (fruit, shellfish and nuts).

Symptoms of Allergic reactions
 These are the six key signs to look for:
1. Difficulty breathing (e.g. tight chest and wheezing)
2. Swelling of the tongue and throat
3. Itchy or puffy eyes
4. An outbreak of blotchy skin (mottled & spotty )
5. Anxiety
6. Signs of shock

What you need to do – first aid
 If you notice the symptoms
– get emergency help by transporting them to
hospital as fast as you can (even if the symptoms
are mild or have stopped).
 Call EMS straight away.
– and give any information you have on what may
have triggered it (e.g. an insect sting, or certain
food, like peanuts).

first aid ….
 If they have medication with them,
– help the victims to use it or do it yourself following
the instructions (adrenaline/ epinephrine),
 Help them into a comfortable sitting position, leaning
forward slightly, to help their breathing.
 If they become unresponsive, open their airway and
check breathing.
 Follow the instructions for treating someone who is unresponsive

Learning Objectives
At the end of this lesson the student will be able to:
– Define poison and poisoning
– Identify different causes of poisoning
– Explain signs and symptoms of poisoning
– Give first aid for different types of poisoning
– Give first aid for bites(stings)

Poisoning
• Poisoning occurs when exposure to a substance
adversely affects the function of any system within an
organism
• A poisons
– are any substances (solid, liquid or gas) that tends to
impair health or cause death when introduced in to
the body or on the skin surface.
• Poisoning can
– occur accidentally or non accidentally (self
poisoning)
– 90% of accidental poisoning occur within the home.
– Mortality is also highest in the 1-5yr age group.

Cont’d…
• Poisoning - can be swallowed, inhaled, injected or
absorbed through the skin.
– Ingestion is commonest (77%) route of exposure
• Approximately 50% of cases involve nondrug substances
– common household products (cosmetics, cleaning
solutions, plants, hydrocarbons).
• Common causes of poisoning in our setup are
– rat poisons (intentional in adolescents or unintentional
in children), hydrocarbons s. kerosene, improperly
placed drugs , cosmetics etc.

Causes of poisoning
• Carelessness –
– leaving agents within reach of children
• Illiteracy –
– Inadequate labeling of drugs and chemicals
• Over doses of drugs
– taken either accidentally or with suicidal intent
• Accessibility of the agent -
– Children of health workers
– Improper storage and disposal of poisonous
substances

Types of poisoning agents
Poisons Descriptions Agents
Man-made
poisons
found in the home
and industry.
- chemicals such as bleach, cosmetics &
hair preparations, paint stripper (glue), &
pesticides.
- Acids, Ammonia, Glue, Dry cell, DDT, and
Malathine etc.
- Gasoline, and kerosene petroleum
products.
Natural
poisons
Products of plants,
insects, animals, and
bacteria poisons
Poisonous plants -Non edible mushrooms
Snake venoms

Routes of Exposure
Ways in which poisoning may occur includes
1. Through the mouth (by ingestion)- Most poisoning
happens this way
2. Through the skin (by absorption)
3. Through the lung (by inhalation)
4. By injection –include biting

The effect of poison depend on several factors:
1. Dosage of a substance
2. Toxicity of a substance
3. Age and body weight of the victim
4. The condition of the stomach (mouth route), (empty
stomach - more absorption)
5. Individual tolerance for the particular substance
6. The way in which the poison enters the body (route of
entry) JU, By: Mohammed A. (MSc.) 149

General management
150
I. Provision of supportive care
II. Prevention of poison absorption
III. Enhancement of elimination of poison
IV. Administration of antidotes

Poisoning by Ingestion
• whether or not a victim has swallowed poison
determine from
– Information by the victim/from an observer.
– Presence of known poison container
– Conditions of the victim (sudden pain/illness)
– Burns around the lips or mouth.
– Breath odor, like chemicals
– Pupils of the eyes contracted to pinpoint size (opoid
overdose)
– Large pupil =cocaine, hallucination, anticholinergic

Sign and symptoms of poisoning
– Nausea and vomiting (sometimes blood-stained)
– Cramping stomach pains
– A burning sensation
– Partial loss of responsiveness
– Seizures
– sleepiness, difficulty of breathing,

First aid for ingested poisons
The objectives of first aid is:
– to dilute the poisons quickly as possible.
– to seek medical advice
– to maintain respiration or circulation.
– to preserve vital functions and to seek medical
assistance without delay.

First aid for swallowed poisons
If the person is conscious, ask them
– what they have swallowed,
– how much and when.
– look for clues, like plants, berries or empty
packaging and containers.
• Call for medical help and give information as
possible.
• Keep checking of breathing, pulse and level of
response.

First aid for swallowed poisons
• Dilution or inducing vomiting
– Evidences are insufficient
– Only for conscious victims
• Dilution with milk or water
– Give him a drink of tepid water with soap in it.
– Continue inducing vomiting until it become clear

First aid ….
• Do not induce vomiting
– if the poison is one which burns or if it is petrol or
kerosene.
– Instead, give milk with egg or a water.
• If the victim vomits
– save a sample of the vomited material into a bag or
container for analysis to identify the poison
• If Become unresponsive
– Check ABC and do CPR.
– don’t give fluids or try to induce vomiting
– if vomiting - position with turning the head

First aid …
• NB;
Take care of victims of severe poisons (e.g rat
poison)
Do not leave the victim alone.
Never administer -
vomit inducing syrups (e.g Epicac syrups) or
activated charcoal if you don’t know to do so
• Prevention of Re-exposure
 Adult - education
 Child- proofing
 Notification of regulatory agencies & psychiatric
referral JU, By: Mohammed A. (MSc.) 157

Prevention of ingested poisoning
1. Safe storage of drugs and household agents, out of
reach of children.
2. Safe packaging of drugs and chemicals containers.
3. Containers of food and beverages should not be used
to store drugs or harmful chemical agents.
4. Health workers should give health education on safe
use of drugs dispensed to patients.
5. Unused medication should be disposed of.
6. Chemicals and drugs should be clearly labeled with
the pharmacological or chemical names.

Corrosives Poisoning
159
• Corrosives are chemicals primarily acids and alkali that
cause tissue injury to a burn.
• Acids cause coagulation necrosis with scar formation that
limits penetration and depth of injury.
• Alkali cause liquefaction necrosis and penetrate more
deeply.
• Some corrosives can cause severe systemic toxicity and
profound electrolyte disturbance

Clinical features
160
Gastrointestinal symptoms:
• Chemical burns of oral cavity
• Esophagitis or gastric mucosa with associated
nausea and vomiting,
• Epigastric pain,
• Dysphagia or odynophagia(painful swallowing in
mouth).
Significant injury:
• Airway compromise or gastrointestinal
perforation complicated by peritonitis, sepsis and
shock.

Management
161
• Maintain ABC of life
• Gastric lavage & induction of vomiting are
contraindicated.
• Consider small amounts of milk or water orally to
dilute corrosive.
• Antacids are used for subsequent ulcer treatment

Carbon monoxide poisoning
162
• CO is an odorless, tasteless, colorless, non irritating
gas.
• Atmospheric concentration is generally below
0.001%, but higher in urban areas & closed
environment.
• Smoke inhalation is responsible for most severe
cases of CO Poisonings.

Cont…
163
• CO binds to Hgb with much higher affinity than
oxygen forms carboxyhemoglobin & tissue
oxygenation is impaired.
• Patients may manifest symptoms ranging from mild
confusion to coma.
• Dx: is based on a compatible Hx and physical exam
in addition with an elevated carboxyhemoglobin
level measured

Clinical features
• Clinical: History of prolonged exposure to smoke
from charcoal in closed environment
• Acute poisoning result in headache, nausea and
vomiting, mental confusion and agitation.
• Sever toxicity causes confusion, impaired thinking,
and may progress to coma, convulsions, and death.
164

Management
165
• The most important interventions in the management
are removal from the CO source & give artificial
respiration
• Hyperbaric oxygen is needed
• In addition to general supportive measures, let the
patient to open air
• Comatose patients should be intubated &
mechanically ventilated using 100% oxygen.
• Send to higher health institution immediately

Poisoning by Bites
• The bite of any animal or a pet may result in an open
wound.
– May cause punctures, lacerations or avulsions.
– Dog and cat bites are common,
– Have a danger of infection such as Tetanus and
– Rabies- is a viral infection which can be
transmitted from infected animals such as dogs and
cats to human being.
• Human bite
– May break the skin, and become seriously infected
because many bacteria exist in the mouth.

First aid for bites
• Rapid primary assessment and commence BLS if
required
– Irrigate animal bites with copious amounts of
water.
– It has been shown to prevent rabies and bacterial
infection from animal bites.
– Call and Contact medical help
• Human bite
– Cleanse the wound thoroughly with clean water,
dry, cover it and seek medical attention.

First aid …
• Dog and other animal bites
– Irrigate wound thoroughly with soap and water,
flush the bitten area.
– avoids movement of the affected part until a victim
receives the medical care.
– Refer to health institution
– All animal bite wounds are not recommended to be
sutured and dressed.

First aid …
• A bite on the face or neck should receive immediate
medical attention, because of the proximity to brain.
• Do not kill the animal unless necessary.
• Keep the animal under observation if possible at least
for 10 days.

Snake bites
• is aggravated by acute fear and anxiety
• Factors affecting outcomes of snake bites are
– the amount of venom injected,
– the speed of absorption to the victim circulation,
– time to access to specific anti venom therapy
ASP
• the speed of absorption of the venom depends on
– the size of the victim,
– location of the bite, and
– protection from clothing shoes and gloves …
• Do all kinds of snakes are poisonous?

Signs & symptoms of snake envenomation
• Local signs:
– Puncture marks (not always visible), &
– Oedema
– Petechiae (non-blanches)
– Bruising
– Sites may NOT be painful
– May no signs at all

Systemic envenomation signs
• mainly systemic envenomation signs includes
– Signs of bleeding
• gums or nose bleed .
– Neurologic sign
• ptosis, confusion, and
• note any paralysis of limbs
• At < 1hr after bite
– Vomiting, Headache, Sweating
– transient hypotension,
– confusion or unconsciousness

Snake bites…
• NB : -
– Snakebites are not necessarily painful
– Most of snakes cause an asymptomatic
coagulopathy, while the patient feels OK.
– In all cases of large envenomation the victim will
be critical in minutes rather than hours

First Aid Interventions
• Objectives of first aid
– To reduce the circulation of blood through the bite
area
– To delay absorption of venom.
– To prevent aggravation of the local wound and to
sustain respiration

First aid for Snake bites
• Principles of the first aid interventions includes
– Conduct RAPID primary ASSESSMENT
– Reassuring –
• Keep CALM and as STILL, movement will
promote the movement of venom into the
bloodstream.
– Delay venom movement
• pressure immobilization bandage (PIB) and
• splinting limb
– Refer to hospital ASP
– Continue monitoring

Snake bites ...
• Do not apply suction as first aid for snakebites.
– Suction does remove venom, since the amount is
very small and may also aggravate the injury
– Do not wash the area of the bite
• Avoid any movement –
– as it will promote the movement of venom into the
bloodstream.
• Bandage can be left in place for longer if required

Snake bites ...
• Refer to hospital ASP
– All people with snake bite or suspected snake bites
should be admitted and observed
• Continue monitoring level of consciousness and
– for respiratory failure (usual cause of death, &
carry out BLS as required) and
– for signs of systemic envenomation.

End

First aid course

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