The document provides information on first aid and accident prevention. It defines first aid and outlines its importance, including preserving life, preventing further injury, and promoting healing. It also discusses general directions for providing first aid, such as assessing safety, identifying the problem, prioritizing patients, extricating victims, and arranging transportation. Additionally, it covers topics like the definition of important terms, reasons for giving first aid, values of training, and emergency patient assessment techniques.

1. First aid and accident prevention
8/26/2023 BY: MEAZA LEMA 1

2. Introduction to first aid
8/26/2023 BY: MEAZA LEMA 2
Learning Objectives
After studying the material in this chapter, the student will be
able to:-
1. Define first aid
2. Describe the reasons why first aid is given
3. Appreciate values of first aid
4. Identify general directions for giving first aid

3. Introduction to first aid
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• Definition: First aid is the immediate care given to a person who has
been injured or suddenly ill.
• It includes home care if medical assistance is not available or
delayed.
• It also includes well selected words of encouragement, evidence of
willingness to help, and promotion of confidence by demonstration
of competence (American red cross, 1998).

4. Definition of important terms
 Accident: is an unfortunate incident that happens
unexpectedly and unintentionally, typically resulting in damage
or injury.
e.g. crashing of automobiles
 Casualty: somebody who has a fatal accident or a serious injury
 Cardiac arrest: is the sudden stopping of the heartbeat.
 Resuscitation: is a process of correcting physiological
disorders in an acutely ill patient.
 Cardiopulmonary resuscitation: is a procedure performed to
restore spontaneous blood circulation and breathing in a
person who is in cardiac arrest.
8/26/2023 BY: MEAZA LEMA 4

5. Definition of important terms conti.
 Breathing: act of taking air in and out of the lung.
 Respiration: process of supplying oxygen to cells.
 Artificial respiration: is the act of assisting or
stimulating respiration
 ABC is a word used to remember essential steps when
dealing with a patient.
• It stands for Airway, Breathing and Circulation
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6. Reasons why first aid is given
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1. To preserve life
 E.g. mouth to mouth respiration when breathing has
stopped.
2. To prevent further injury(complication)
 E.g. -immobilizing the fractured bone.
 -Cervical spine protection
3. To promote healing and recovery
 E.g. reassuring the patient, relief pain, protecting from cold
and arranging for transfer.
• NOTE: Protect yourself – don’t be the victims!

7. Values of First Aid Training
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The need for first aid training is greater than ever.
Why?

8. Values of First Aid Training
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The need for first aid training is greater than ever because of:
Population growth through out the world
Increased use of technological products; such as
mechanical and electrical appliances in everyday use at
home, working place and play areas which make more
people at risk of injury.
In Ethiopia, infrastructure is developing like high speed-
roads, hotels, universities, dams, etc
Thus, there is an ever growing demand for first aid training
for personal use and from the demand for certified first-
aiders as part of industrial and commercial establishments.

9. General directions to give first aid
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A. Assessment of the situation - scene size up
–Is the scene is safe?
–What was the cause?
–How many victims were involved?
–The traffic pattern? etc
B. Identifying the problem
–Type - Mechanism of injury
–Severity

10. General directions to give first aid conti.
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C. Prioritizing: a casualty may have more than one injury and that
some casualties will require more urgent attention than others.
D. Extricating the victims: disentangling the patient from difficulty
E. Giving immediate and adequate treatment
F. Arrangement of transportation for casualty with out delay
accompanied with brief written report

11. Extrication
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 Definition: the process of safe removal of the patient from
source of accident
 Two primary extrication goals:
1. To obtain safe access to the patients
2. To ensure patient stabilization

12. Keep in mind these basic guidelines
1. Know the limitations of your training, equipment, and skill.
2. Identify any hazards (eg, gasoline, power lines or wires,
hazardous materials).
3. Control those hazards for which you are trained and equipped.
4. Gain access to the patients.
5. Provide patient care and stabilization.
6. Move patients only if absolutely necessary.
8/26/2023 BY: MEAZA LEMA 12

13. Emergency patient assessment
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Triage
French word “trier”, literally means: “to sort out”.
A method of ranking sick or injured people.
 According to the severity of their sickness or injury.
 According to the capacity of the facility (mass
causality or multiple causality.)

14. Emergency patient assessment conti.
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 Patients are sorted with a scientific triage scale in order of
urgency.
 The aim is to bring:
 The greatest good to the greatest number of people.
 The patient with the greatest need is helped first.
 to place them in one of the following categories:
E= Emergency
P= Priority and
Q= Queue (non-urgent)

15. Emergency patient assessment conti.
• EMERGENCY signs: who require immediate emergency
treatment
• PRIORITY signs: who should be given priority in the queue,
rapidly assessed and treated without delay
• NON-URGENT cases: who can wait their turn in the queue.
The majority of seen will be non-urgent cases.
8/26/2023 BY: MEAZA LEMA 15

16. Emergency patient assessment conti.
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• Life threatening problems are identified and dealt with
FIRST.
• This is done in a strict order of priorities in order to ensure
that the most important steps are undertaken in a logical
order ensuring nothing is missed.

17. Emergent Severity Index (ESI)
• ESI 1- (RED): Emergency signs are sorted in order of priority
as: ABCDO
A = Airway
B = Breathing
C = Circulation, Coma, Convulsions
D = Dehydration
O= Others (bleeding, trauma with open fracture, Acute
poisoning)
8/26/2023 BY: MEAZA LEMA 17

18. Emergent Severity Index (ESI)
ESI 1- (RED): Immediately life threatening
 Respiratory failure, severe respiratory distress
 facial, neck, chest injuries,
 severe hemorrhage, unstable vital signs (shock),
 Coma with airway obstruction, convulsions, chest
pain with unstable v/s.
8/26/2023 BY: MEAZA LEMA 18

19. Emergent Severity Index (ESI)
ESI 2 – (Orange): Emergent imminently/potentially life
threatening if care is not given within 15min
–pending respiratory failure
–altered consciousness with out airway obstruction
–moderate trauma with stable vital signs
–Such patients require frequent re-triage until they
are seen by the professional and they are the second
in priority following the red
–If any deterioration appears, they may be
categorized accordingly
8/26/2023 BY: MEAZA LEMA 19

20. Emergent Severity Index (ESI)
ESI 3 - (Yellow): less urgent, potentially serious, could be
delayed up to 1hr
E.g
 injuries to the Lower genitourinary tract,
 peripheral nerves and vessels,
 splinted fractures
 soft tissue lesions
They also require re triaging until they are assessed by the
health professional and if any deterioration appears they
may be categorized accordingly.
8/26/2023 BY: MEAZA LEMA 20

21. Emergent Severity Index (ESI)
ESI 4 (Green):
 They will require a professional care in several hours
to days but not immediately.
 May wait for a number of hours or be told to go home
and come back the next day, non urgent.
 Can be send to near by health institution
8/26/2023 BY: MEAZA LEMA 21

22. Emergency patient assessment conti.
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The Primary Survey uses the systematic approach: DR.ABCD.
 Dangers
 Response
 Airway
 Breathing
 Compressions
 Defibrillation
if available

23. D- DANGER
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1. Eliminate/minimize the dangers before you approach.
2. Ensure the safety of yourself, any bystanders and the
casualty.
3. If it is too dangerous to approach, keep at a safe distance
and call the emergency services.
4. Only move the casualty/casualties if absolutely necessary.
5. Use bystanders to assist you where possible i.e. controlling
traffic, phoning for help.
6. Use barrier devices where possible i.e. use a face shield and
gloves.

24. R - RESPONSE
 If you have more than one casualty, always treat the
unconscious ones first.
 Question: If someone is screaming and shouting and one is
on their back quiet which one would be your priority?
 If they are screaming and shouting, they are
breathing.
 Use the touch and talk approach.
 NEVER SHAKE an unconscious casualty.
 The best way to see if the casualty responds is to use the
'COWS' method: touch and talk approach
 Can you hear me?
 Open your eyes!
 What's your name?
 Squeeze my hands!
8/26/2023 BY: MEAZA LEMA 24

25. R – RESPONSE conti.
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 If the casualty responds, ask their name and carry out
the ‘history, signs & symptoms' assessment principle
 If the casualty is unconscious, not responding to talk
and touch, call your ambulance now and move onto the
airway.

26. A - AIRWAY
 Assessing the airway of the casualty without turning onto
the side.
 Keeping the head in the position you found it, look in the
mouth.
 If any solid or liquid is found, place the casualty onto their
side and clear the airway.
 If nothing is found but not breathing adequately, open the
airway using the head tilt-chin lift technique, head tilt-neck
lift technique or jaw thrust method.
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27. A – AIRWAY conti.
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Head tilt-chin lift
 Place one hand on the casualty's forehead and two fingers
under the chin.
 Tilt the head back and lift chin up opening the airway.
 The maneuver is performed by tilting the head backwards in
unconscious patients, often by applying pressure to the
forehead and the chin.
What are contraindications?

28. Head tilt-neck lift maneuver
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29. Jaw-thrust maneuver
 Is performed by placing the index and middle fingers to
physically push the posterior aspects of the mandible upwards
while their thumbs push down on the chin to open the mouth.
 When the mandible is displaced forward, it pulls the tongue
forward and prevents it from obstructing the entrance to
the trachea.
 Lifting the mandible using both mandible angles and pushing
forward and upward.
 Use jaw thrust especially in patients with suspicion of cervical
spine injury(see picture below)
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30. 8/26/2023 BY: MEAZA LEMA 30

31. Advanced airway management
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32. B - BREATHING
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Check the casualty's breathing by placing your ear and cheek
near their mouth and nose whilst looking at their chest:
 Look for movement of their chest and upper abdomen.
 Listen for normal breathing
 Feel for breath on the side of your cheek
 Assess their breathing for no longer than 10 seconds
before deciding whether breathing is normal or not.

33. B – BREATHING conti.
• If the patient has adequate breathing effort place in recovery
position, with the patient leant over on their side (see the
picture below).
• this has an effect of clearing the tongue from the pharynx
• Avoids a common cause of death in unconscious patients,
choking on regurgitated stomach contents.
• It also avoids aspiration.
8/26/2023 BY: MEAZA LEMA 33

34. C – Compressions
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 Asses for circulation on the carotid artery
for pulse for 9-10sec.
 If no pulse, start chest compression.
 Compress the chest 30 times at a rate of
100 compressions per minute and give 2
rescue breathe.

35. C – Compressions conti.
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 The goal of resuscitation interventions for a patient in
respiratory or cardiac arrest is to:
1. Restore effective oxygenation & ventilation
2. Restore circulation
3. Return of intact neurological functions
A compression depth of at least 4 cm in infants and 5 cm in
children PUSH HARD

36. C – Compressions conti.
 Once you have carried out 30 chest compressions, and 2
rescue breaths,
 Continue at a ratio of 30:2 until either:
 Professional arrives to relieve you.
 It becomes too dangerous to continue
 The casualty begins to breathe normally
 You become too exhausted to continue
 Another competent first aider takes over from you
 The casualty begins to vomit
8/26/2023 BY: MEAZA LEMA 36

37. Reassurance
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 Easing of discomfort and anxiety is a very important process
of first aid.
 Many first aiders forget that they are treating a 'person', as
well as the injury/illness.
 By combining reassurance with good first aid management,
and possibly distracting or diverting the casualty's attention
to something else, you will, in most circumstances, actually
ease the anxiety and pain levels of the casualty.

38. Reassurance conti.
 By easing anxiety and pain levels you will help to
promote recovery of the injured/ill casualty.
 This will in turn:
 Decrease blood loss
 Which will in turn slow down the shock process
 Decreasing the heart rate
8/26/2023 BY: MEAZA LEMA 38

39. REMEMBER:
 Any resuscitation is better than no resuscitation at all.
 If you are unwilling or unable to carry out rescue breaths,
then carry out chest compression alone.
 If you don't do anything they will stay dead
8/26/2023 BY: MEAZA LEMA 39

40. Summary of Emergency patient assessment
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41. CHAPTER TWO
RESPIRATORY EMERGENCIES AND ARTIFICIAL RESPIRATION
8/26/2023 BY: MEAZA LEMA 41
Learning Objectives
After studying the material in this chapter, the student will be able to:-
1. Define respiratory emergencies and artificial respiration.
2. Explain the breathing process.
3. Identify causes of respiratory failure
4. Give artificial respiration and manage respiratory accident.
5. Demonstrate cardiopulmonary resuscitation

42. Definition of terms
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 Respiratory emergency- is one in which normal breathing stops or in
which breathing is reduced so that oxygen intake is insufficient to
support life.
 Respiratory failure- is a syndrome in which the respiratory system fails in
one or both of its gas exchange functions: oxygenation and carbon
dioxide elimination.
 Artificial respiration- is a procedure for making air to flow into and out
of a person’s lungs when natural breathing is inadequate or ceases.

43. The breathing process
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Natural breathing is accomplished by increasing and decreasing
the capacity of the chest and the lung.
 During the inhalation phase of breathing
1. The muscles of the chest contracts and lift the ribs,
expanding the chest.
2. At the same time, the diaphragm contracts and descends
toward the abdomen. In this way, the chest cavities
increased in size and air flows in

44.  When all muscles relax, the ribs and diaphragm resume their
normal position, the chest cavity becomes smaller, and air
flows out.
 In all manual methods of artificial respiration, the objective is
to cause an alternate decrease and increase in size of the chest
cavity.
 When this is done, air flows in and out if there is no obstruction
8/26/2023 BY: MEAZA LEMA 44
Breathing process conti…

45. Respiratory physiology
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• The act of respiration engages 3 processes:
1. Transfer of oxygen across the alveolus
2. Transport of oxygen to the tissues
3. Removal of carbon dioxide from blood into the alveolus
and then into the environment.
• Any disruption in one or more of these leads to Respiratory
failure.

46. Types of respiratory failure
8/26/2023 BY: MEAZA LEMA 46
1. Hypoxemic respiratory failure (type I)
2. Hypercapnic respiratory failure (type II)
1. Hypoxemic respiratory failure (type I)
 characterized by:
 an arterial oxygen tension (Pa O2) lower than 60 mm Hg
 with a normal or low arterial carbon dioxide tension (Pa
CO2).
 The most common form of respiratory failure.

47. Causes of Respiratory Failure
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A. Anatomical Obstruction
 The most common cause of respiratory emergency which
interfere with breathing caused by the dropping of the
tongue back and obstructing the throat.
 Other causes of obstruction that constrict the air passages
are:
Asthma
Croup
Diphtheria
Laryngeal spasm
Swelling after burns of the face
Swallowing of corrosive poisons

48. 8/26/2023 BY: MEAZA LEMA 48
B. Mechanical Obstruction
 Solid foreign objects lodging in the respiratory passage
e.g. choking of food
 Accumulation of fluids in the back of the throat (mucous,
blood or saliva)
 Aspiration (inhalation of any solid or liquid substance)
Causes of Respiratory Failure conti.

49. 8/26/2023 BY: MEAZA LEMA 49
C. Air depleted of oxygen or containing toxic gases
Asphyxia: Is a condition in which there is a lack of oxygen in the
blood
 The tissue do not receive an adequate supply of oxygen.
 It may occur due to decreased oxygen in the air or
increased carbon monoxide (CO) or other toxic gases
D. Additional causes of Respiratory Failure are:-
 Drowning – submerging in water
 Circulatory collapse (shock)
 Heart disease
 Poisoning by alcohol, barbiturate, codeine etc
Causes of Respiratory Failure conti.

50. Management of Respiratory Accidents
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Artificial Respiration
Purpose:
1. To maintain open air way through the mouth and nose.
2. To restore breathing by maintaining an alternating increase
and decrease in the expansion of the chest.
General Information
 The average person may die with in 4-6 minutes if his/her
oxygen supply is cut off.
 Recovery is usually rapid except in case of carbon monoxide
poisoning, over dosage of drugs or electrical shock.
 In such cases, it is often necessary to continue artificial
respiration for a long time.

51. Recognition of respiratory emergencies
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The underlying problem in most cases of Respiratory Failure is
hypoxia and this is recognized by
tachypnea
tachycardia
sweating
peripheral vasoconstriction
central and peripheral cyanosis
restlessness
mental confusion
bradycardia accompanied by gasping respirations,
which warn of the impending cardiac arrest.

52. Recognition of respiratory emergencies
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S/s of hypercapnia
peripheral vasodilatation
Sweating
dilatation of the pupils
drowsiness: A very sleepy state
muscle twitching
coma

53. Features of obstructed airway
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Upper Airway
 The most common cause of upper airway obstruction is a
state of coma.
 Loss of tone in the muscle of the tongue causes it to fall back
into the pharynx.
 In both causes, noisy breathing similar to snoring
 The clinical picture often includes stridor (noisy breathing
particularly on inspiration).

54. Features of obstructed airway conti.
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Lower Airway
 The commonest cause is asthma which
presents a similar picture to upper
airway obstruction except respiratory –
wheeze rather than inspiratory stridor.
 Always consider the possibility of an
inhaled foreign body in a child with
unexplained dyspnea, stridor, wheeze
or pneumonia.

55. Artificial respirations
8/26/2023 BY: MEAZA LEMA 55
Modalities:
 Mouth to mouth
 Mouth to nose breathing
 Mouth to mouth and nose
 Mouth to mask
 Bag valve mask
 Mechanical resuscitator

56. Artificial respirations conti.
• Mouth to mouth and nose
– Used on infants (usually up to around 1 year old), as this forms the
most effective seal
• Mouth to mask
– Most organizations recommend the use of some sort of barrier
between rescuer and patient to reduce cross infection risk. One
popular type is the 'pocket mask'. This may be able to provide higher
tidal volumes than a Bag Valve Mask
.
8/26/2023 BY: MEAZA LEMA 56
'pocket mask

57. Artificial respirations conti.
 Ventilation with a Bag- valve- mask
• Select a mask of the correct size.
• Position yourself at the patient's vertex.
• Tilt the patient's head back.
• Hold the mask securely to the patient's face.
• Use your other hand to squeeze the bag
• Squeezing the bag once every 5–6 seconds for an adult or once every 3
seconds for an infant or child.
8/26/2023 BY: MEAZA LEMA 57
Ambu bag

58. Mouth- to- mouth (mouth- to- nose) method or” kiss
of life”
8/26/2023 BY: MEAZA LEMA 58
Steps
1. Determine consciousness by tapping the victim on shoulder and asking
loudly ''Are you OK''?
2. Open air way using the head tilt- chin lift or Jaw thrust.
3. Place your cheek and ear close to the victim’s mouth and nose to
assess for respiration.
4. If absent/insufficient, pinch the victim’s nostrils shut with the thumb
and index finger of your hand i.e. pressing on the victim’s forehead,
5. Blow air in to the victim’s mouth- give 2 rescue breaths given/2
seconds..

59.  Maintain the head tilt and again look, listen, feel for
exhalation of air & check the pulse for at least 5-7 sec. but
not greeter than 10 sec.
 If no pulse and no breath do CPR
 If there is pulse & no breath provide at least 1 breath
every 5 sec. or 12 /minute for adults.
 Watch the victim's chest to see when it rises.
 Stop blowing when the victim's chest is expands and falls by
it self.
8/26/2023 BY: MEAZA LEMA 59
Mouth- to- mouth (mouth- to- nose) method or” kiss
of life” cont…

60. 6. If the chest doesn’t rise when you blow air
A. Reopen the airway by tilting the head and lifting the jaw
B. Pinch the nose again
C. Make a better seal around the mouth
D. Try blowing again
7. If the chest still doesn’t rise, give first aid for choking
8/26/2023 BY: MEAZA LEMA 60
Mouth- to- mouth (mouth- to- nose) method or” kiss
of life” cont…

61. For children & infant
Both the mouth & nose should be sealed off by your mouth (mouth
-to-mouth and nose resuscitation).
Blow into the infant's mouth & nose once every 3 seconds
(once every 4 seconds for a child) with less pressure &
volume.
N.B. The amount of air is determined by the size of the victim.
The head tilt should not be as extensive as that for adults.
8/26/2023 BY: MEAZA LEMA 61

62. Mouth to mouth respiration
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63. Mouth to nose respiration
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64. Mouth to mouth and nose
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65. Recognition of choking person
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 Ask the person “Are you choking?”
 If the person is able to answer you by speaking, it is a partial airway
obstruction.
 Stay with the person and encourage him or her to cough until the
obstruction is cleared.
 Do not give the person anything to drink because fluids may take up
space needed for the passage of air.
 Someone who cannot answer by speaking and can only nod the head
has a complete airway obstruction and needs emergency help.

66. First Aid for Choking
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 The treatment for a choking person varies with the person's
age.
 Abdominal thrusts (“Heimlich maneuver")
 Used for adults & children older than one year of age.
 It may be forceful enough to clear the airway.
 The quick, upward abdominal thrusts force pushes the
diaphragm upward very suddenly, making the chest cavity
smaller.
 This has the effect of rapidly compressing the lungs and
forcing air out.
 The rush of air out will hopefully force out whatever is
causing the person to choke.

67. First Aid for Choking conti.
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How to perform abdominal thrusts for conscious
A. Lean the person forward slightly and stand behind him or
her.
B. Make a fist with one hand.
C. Put your arms around the person and grasp your fist with
your other hand in the midline just below the ribs.
D. Make a quick, hard movement inward and upward in an
attempt to assist the person in coughing up the object.
E. This maneuver should be repeated until the person is able to
breathe or loses consciousness.

68. 8/26/2023 BY: MEAZA LEMA 68

69. Abdominal trust for conscious
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70. Back slab for conscious
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71. First Aid for Choking conti.
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How to perform abdominal thrusts if the person loses consciousness
A. Gently lay him or her flat on their back on the floor.
A. To clear the airway, kneel next to the person & put the heel of
your hand against the middle of the abdomen, just below the
ribs.
B. Place your other hand on top and press inward and upward
five times with both hands.
C. If the airway clears & the person is still unresponsive, begin
CPR

72. 8/26/2023 BY: MEAZA LEMA 72
Back slab for unconscious victim

73. 8/26/2023 BY: MEAZA LEMA 73
Abdominal trust for unconscious

74. Clearing a Blocked Airway in an Infant
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Back blows/slap
Used for an infant instead of abdominal thrust.
1. The infant is turned face down, the chest
resting on the rescuer's forearm, with the head
lower than the body.
2. The rescuer then strikes the infant between the
shoulder blades 5 times using the heel of the
hand.
3. The strikes should be firm but not hard enough
to cause injury.
4. The rescuer then checks the mouth, removing
any visible objects.

75. Choked infant cont’d…
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 If the airway remains blocked, the rescuer
turns the infant face up with the head
down, and using the second and third
fingers, thrusts inward and upward on
the infant's breastbone 5 times (chest
thrusts).
 The rescuer then checks the mouth
again

76. 8/26/2023 BY: MEAZA LEMA 76
Back slap

77. Chest thrusts for babies
8/26/2023 BY: MEAZA LEMA 77

78. Mechanical suffocation (Strangulation)
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 If pressure is exerted on the outside of the neck, the air way
is squeezed and the flow of air to the lung is cut off.
 The main causes of such pressure are:
1. Hanging- suspension of the body by rope around the
neck or throat.
2. Strangulation- constriction or squeezing around the
neck or throat.
 Hanging may cause a broken neck; for this reason, a casualty
in this situation must be handled very carefully.

79. Recognition (signs)
 A constricting article around the neck
 Marks around the casualty’s neck
 Rapid, difficult breathing; impaired consciousness, cyanosis.
 Congestion of the face, with prominent veins and, possibly,
tiny red spots on the face or on the whites of the eyes.
Caution
 Do not move the casualty unnecessarily, in case of spinal injury.
 Do not destroy or interfere with any material that has been
constricting the neck, such as knotted rope; police may need it
as evidence.
8/26/2023 BY: MEAZA LEMA 79
Mechanical suffocation (Strangulation) conti.

80. First aid aim and interventions
8/26/2023 BY: MEAZA LEMA 80
The aims are:
To restore adequate breathing.
To arrange urgent removal to the hospital
Interventions/measurements
1. Quickly remove any constriction from around the
casualty’s neck. Support the body while you do so; if it is
still hanging. Be aware that the body may be very heavy.
2. Lay the casualty on the ground. Open the airway and
check breathing. If he/she is not breathing, be prepared
to give rescue breaths and chest compressions if
necessary.
If he/she is breathing, place her in the recovery position.