First aid

1. FIRST AID.

2. • Look for situations that threaten life:
– Breathing difficulties
– Cardiac arrest
– Uncontrolled severe bleeding
– Head injury
– Chest injury
– Abdominal injuries
– Shock
– Serious medical problem eg heart attack.

3. • Evaluate victims condition: by examination
– Check for adequate airway and breathing
– Check heart beat, pulse and pupils
– Stop any bleeding – pressure pack
– Check for head injury
• Level of consiciousness
• Pupils size and reaction to light
• Pulse (slowing) BP increasing
• Bleeding from ear, nose and mouth
• Palpate scalp for haematoma , fracture.
• Examine cervical spine for fracture.

4. • Examine chest:
– Movement with respiration
– Fracture rib , sternum etc
– Any wound chest wall (open wound,
penetrating etc)

5. • Examine abdomen:
– Distension
– Tenderness
– Rigidity(muscle guarding)
– Movement with respiration.
• Examine spine,pelvis and limbs for
fracture.
• Note: do not move the patient for making
out fractures.

6. Asphyxia (suffocation)
• Assessment of a victim:
– Breathing:
• Movement of chest
• Listen near nose for air movement
• Skin colour for cyanosis.

7. observation inference
No respiration, ashen
grey colour, death like
appearance.
Respiratory arrest.
Rapid, shallow,irregular
resp, struggling In bed.
Airway obstruction,
shock, heart attack.
Frothy blood at nose Lung damage, FB in
airway or pulmonary
oedema.

8. • Pulse (radial , carotid)
– Absent – cardiac arrest
– Rapid and strong – hypertension stroke or
fear
– Rapid and weak – shock or haemorrhage
– Slow and strong – head injury.

9. • Pupils:
– Size – dilated – shock, cardiac arrest, head
injury
– Not reacting to light : coma or death.

10. • Causes of asphyxia:
– High altitude or deep coal mines
– Obstruction to airway – FB chicken bone etc.
– Drowning – water entering lungs
– Compression of air passages – throttling,
hanging
– Resp.centre affections- barbiturate poisoning.

11. • Signs:
– Dizziness
– Struggling to breath
– Cyanosis
– Swollen neck veins
– Rapid pulse
– Coma
– Death.

12. • Treatment:
– Remove casuality from site
– Remove cause
– Make airway free
– Resort to artificial respiration
• Till natural breathing or ventilator in the hospital.

13. • Steps of kiss of life(mouth to mouth breathing)
– If possible get someone to help you
– Turn the casuality if only possible to lie on his back.
– Loosen cloths round the casuality’s chest and waist
– Clean casuality’s mouth and nose, remove any saliva,
dentures, vomit ,food or blood
– Place one of your hands under hs neck and other
hand on his forehead and extend his neck fully.

14. – Using the hand under his neck, lift his chin upwards ,
this clears his airway and keep the head in this
position until consciousness returns.
– Pinch the casualitys nose with upper hand, take deep
breath yourself. Place your mouth on his mouth and
cover fully his mouth and breath out fully into his
lungs.
– From the corner of your eye,see whether his chest
expands
– Repeat the procedure at the rate of 13 to 18 times per
minute.
– For a child or infant your mouth can cover mouth and
nose of him, but gently blow out.

15. • Cardio pulmonary resuscitation:
– Involves artificial respiration combined with
external heart compression.( external cardiac
massage)-rhythmic pressure on
sternum(lower half of sternum) during cardio
pulmonary arrest.

16. • Causes of sudden cardiac arrest:
– Heart attack (myocardial infarction)
– Electric shock
– Asphyxia – due to any cause(chocking,
drowning etc)
– Severe injury
– Anaphylactic shock.
(after heart stops, vital centres of brain remain
viable for 4 minutes. So if CPR is started
immediately he can be saved).

17. • Diagnosis of cardiac arrest:
– Patient unconscious
– Pulse not felt
– Pupils widely dilated
– No breathing
– Cyanosis
– Heavy perspiration (cold).

18. • Method (CPR)
– Patient lies flat on hard surface
– Open airways by head tilt and neck tilt
– Deliver mouth to mouth ventilation
– Kneel on firm surface
– Give pressure on precardial area pressing well
– Repeat process 60 – 70 per minute
– In between mouth to mouth breathing periodically.

19. The artificial respiration:
If mouth to mouth breathing not possible eg. Face damaged or fracture
of jaw bones.
Steps:
– Send for ambulance
– Place casuality face downwards, arms bent and his head rest on his
hands
– Kneel above the casuality’s head
– Place your hands on casuality’s back just below the shoulder blades.
– Now rock forward with your arms held straight until your arms are
vertical on his back at the same time pressing down to compress the
chest.
– At the end of compression allow your hands to slide sideways and
outwards to casuality arms.
– Then rock backwards lifting casualtys elbows.
– This movement of compression and expansion should last for 21/2
seconds at the rate of about 12 times per minute.

20. Management priorities for seriously
injured:
• ABC:
– Airway:ensure clear airway – remove
FB,mucous etc.intubate if necessary.
– Breathing:
• Ventilate if not breathing (artificial respiration)
• Seal – open chest wounds
• Relieve tension pneumothorax (water seal
drainage)
• Drain- haemothorax.

21. – Circulation maintenance:
• Control haemorrhage(pressure pack art. Forceps
etc)
• Replace blood volume(iv fluids, blood etc)
• Relieve cardiac tamponade(aspiration)
• External cardiac massage(if cardiac arrest)

22. • Treating life threatening injuries:
– Burr hole – increased intra cranial pressure –
haemorrhage
– Thoracotomy – if injury to heart, great vessels
or lungs.
– Laparotomy – if GI perforation, rupture liver or
spleen
– Repair or peripheral vascular injuries.

23. • Treating major fractures and dislocations:
– When life threatening conditions are treated
and patients condition is stable.
• Treat less serious injuries:
– Wound toilet, suture, repair of injuries to
tendons, nerves etc.