UNIT 4 FIRST AID

UNIT FOUR

FIRST AID

It is the immediate care given to an injured or suddenly ill person before seeking proper medical care / attention.  It includes the things that people can do for themselves to save bad situations.

Aims of First Aid

• To preserve life or keep person alive
• To prevent condition from getting worse
• To promote recovery
• To stop further bleeding

First-Aid Kit

A first-aid kit is a bag, case or a box containing basic medical supplies that are designed to be used on someone who is injured or who suddenly becomes ill. The International Organization for Standardization (ISO) sets a standard for first aid kits of being green, with a white cross, in order to make them easily recognizable to anyone requiring first aid.

The common kits used in the school may contain: Alcohol or non-alcohol antiseptic wipes, band- aids, cotton balls Iodine, bandages, hydrogen peroxide, gauze, Saline, dressings ,eyewash antiseptic solution, Ice pack, blade, pair of scissors, etc

Function of Items in First aid Kit

• Alcohol-free wipes disinfect a wound.
• Ointment disinfects and kick starts treatment of a wound.
• Pads clean the area around a wound, wipe away any liquid, or use with tape as a secured cushion
• Gloves protect a wound from infection, as well as your hands.
• Masks protect your mouth from inhaling any fumes or particles. Plus, who wants to breath all over a person when you’re tending to their wound
• Standard bandages are long, thin, and rolled up. This type of bandage is used to stop bleeding and act as support for joint injuries.
• Triangle bandages are bandages that have a triangle shape. This type of bandage is easily foldable and perfect for sterilization or putting pressure on large wounds.
• Wound dressing is a large sterilized pad that is typically used for more major injuries. This type of dressing applies enough pressure to minimize or even stop bleeding while emergency services are on their way.
• Band aids are typical bandages that are usually small in size. They have sticky ends and a plush middle that applies pressure, so a wound is covered and stops bleeding. Band aids are typically used for minor injuries.
• Pain relievers, such as paracetamol which lessen pain from an injury.
• Scissors to cut bandages and other products that come rolled up.
• Tape to secure bandages and dressings.
• Tweezers to clean a wound.
• First aid guide where you can refer to product information and general step-by-step processes, so you can practice good first aid.

 

Some Conditions That Calls for First Aid

Bleeding
It is the escape / loss / flow of blood from a damaged blood vessels
Hemorrhage – large amount of bleeding in a short time or a heavy release of blood within or from the body.
External bleeding –seen blood coming from an open wound (outside the body)
– often overestimated
Internal bleeding – inside the body
– often underestimated

There are 3 kinds of external bleeding according to the blood vessel that is damaged:

1. Arterial Bleeding

• 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 Bleeding

• dark red colour
• low pressure
• blood flow steadily
• it is easier to control
• most veins collapse when cutbut
• bleeding from deep veins can be as massive as arterial bleeding

1. Capillary bleeding

• blood oozes
• usually not serious
• easily controlled
• often it clots and stops itself

      Bleeding – clinical symptoms

• Sudden loss of a large quantity of blood results in shock:
• cold and pale skin
• weak, and fast pulse
• mental disorders, fear, unconsciousness

What to do?

• The first aid is the same regardless of the type of bleeding
• The most important thing is to control bleeding

External bleeding

Steps:

1. Protect yourself (gloves or improvisations)
2. Manual control of external haemorrhage

1. Expose the wound (remove or cut clothing) to find the source

1. Place sterile pad or clean cloth and apply direct pressure (fingers, palm, hand) = pressure over the wound

5. If bleeding from arm or leg – elevate extremity above the heart level + pressure over the

Wound

1. If bleeding continues – continue + apply pressure against the bone at pressure points

(Brachial or femoral points)

1. Use pressure bandage – you have free hands for help to other victims

1. For application of direct pressure – use ring pad

1. Tourniquets – rarely on the extremities – it can damage nerves and vessels
2. When you need it – use wide, flat materials and write the time of application.

 

Internal bleeding

• skin is not broken
• blood is not seen
• difficult to detect
• can be life threatening
• traumatic and non-traumatic origin

What to look for?

• “Swelling“ on extremities in case of trauma
• Contusion of the skin
• Painful, rigid, tender abdomen
• Vomiting or coughing up blood
• Black stools or stool with bright red blood

What to do?

• Steps:

1. Check ABCs
2. Expect vomiting – keep the victim on his/her left side
3. Treat for shock:

• Elevate legs
• Cover the victim to keep him/her warm
• Do not give a victim anything to eat and drink (prevention of lung aspiration, can cause complications during surgery)
• Splinting extremities
  • ↓bleeding
  • ↓ pain

4. Prevents nerve and vessels injury

Nose injuries – nosebleeds

Two types

– anterior – most common (90%)

– posterior – serious and requires medical attention

 

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

Shock

It is a circulatory system failure when insufficient amount of blood is provided for different parts of body.

 

Three components:

1. Heart pump – failure
2. Network of pipes (vessels)  –  enlargement
3. Adequate volume of circulated fluids  –  fluid loss

            – blood

– plasma

– extracellular fluids (vomit, diarrhoea, sweating, urine…)

What to look for?

1. Altered mental status, restlessness
2. Pale, cold, clammy skin, livid lips
3. Limited perfusion of peripheral parts of the body
4. Capillary refill phenomenon – nail beds
5. Nausea and vomiting
6. Rapid breathing
7. Rapid weak pulse or pulseless on peripheral arteries
8. Unresponsiveness, when shock is severe

What to do?

1. Treat life-threatening injuries
2. Lay the victim on his/her back
3. Raise the victim´s legs (if no evident injury) – drain of blood from legs to the heart
4. Prevent body heat loss (blankets)
5. Splinting of long bones fractures
6. Seek immediate medical attention

7. ABC
8. In case of severe shock – prevent per oral intake

              nausea + vomiting

🡻 inhaling foreign material into the lungs     

            🡻complications during surgery

9. Provision of Oxygen …

Bruises (suffusions) = a form of internal bleeding, but not life threatening

 

Open wounds – types

• 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

Open wounds – What to do?

• Protect yourself – use medical gloves if possible or several layers of gauze or clean cloth and apply pressure on the wound (your bare hand should be used only as a last resort)
• Expose the wound – to see where the blood is coming from
• Control the bleeding
• Do not clean large extremely dirty or life threatening wounds.

Let hospital emergency department personnel to do the cleaning

• Do not scrub a wound

 

Wound care

• Shallow wounds should be cleaned to prevent infection – risk of restarting of bleeding by disturbing the clot
• 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

Open wounds – Amputations

• Control the bleeding
• Treat the victim of shock
• Recover the amputated part, take it with the victim

– it does not need to be cleaned

– wrap it with a dry sterile gauze or clean cloth and put it in the plastic bag

– keep it cool, but do not freeze

• Seek medical attention immediately – 18 hours is the maximum time allowable for a part that has been cooled properly. Muscles without blood lose viability within six hours.

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..

 

Burns and Scalds

Rank among the most serious and painful injuries.

Can be classified –

• thermal (heat) burns – contact with hot objects, flammable vapour, steam or liquid
• chemical – acids, alkalis and organic compounds (petroleum, kerosene…)
• electrical – severity of injury depends on the type of current, the voltage, the area of body exposed and the duration of contact
• 1st-degree burns (superficial): surface (outer layer) of the skin is affected

characteristics – redness, mild swelling, tenderness and pain

• 2nd-degree burns: affect partial thickness of the skin

characteristics – blistering and swelling, severe pain

• 3rd-degree burns:penetrates the entire thickness of the skin and deeper tissues

characteristics – no pain, skin looks waxy or pearly grey or charred

What To Do

• Stop the burning
• Check ABCs
• Determine the depth (degree) of the burn
• Determine the extentof the burn – rule of nine – how much body surface area is affected by burns – head 9%, complete arm 9%, front torso 18%, back 18%, each leg 18%, victims hand excluding the fingers and the thumb, represents about 1% of victims body surface
• Determine which parts of the body are burned – burns of the face, hands, feet and genitals are more severe
• Seek medical attention

Burns and scalds – what to do in case of 1st and small 2nd-degree burns

Aim of the care – reduce pain

– protect against infection

– prevent evaporation

• Cooling – immerse the burned area in cold water – apply cold until the part is pain free (10-45 minutes)
• Sterile bandage or clean cloth
• Fluids orally
• Analgesia
• Shock treatment

 

Burns and scalds – what not to do

• Do not remove clothing stuck to the skin – pulling will further damage the skin
• Do not forget to remove jewellery as soon as possible – swelling could make jewellery difficult to remove later
• Do not apply cold to more than 20% of an adult´s body surface (10% for children) – widespread cooling can cause hypothermia. Burn victims lose large amount of heat and water evaporation)
• Do not apply ointment, butter or any other coatings on a burn except of sterile dressing or clean cloth
• Do not break any blisters – intact blisters serve as excellent burn dressings

 

Burns and scalds – what to do in case of large 2nd and 3rd-degree burns

• Do not apply cold because it may cause hypothermia
• Cover the burn with a dry, non-sticking dressing or a clean cloth
• Treat the shock by elevating the legs and keeping victim warm with a clean sheet or blanket
• Seek medical attention

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) – protectyourself

• 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

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 Save the container or label for the chemical´s name.

Fractures   

–  closed fractures –  skin is intact

– open fractures – skin over the fracture is damaged or broken

 

What to look for: D-O-T-S

• Deformity – abnormal position
• Open wound
• Tenderness
• Swelling

 

What to do

• Determine what happened and the location of the injury
• Gently remove clothing covering the injured area
• Examine the area by looking and feeling for D-O-T-S
• Check – C-S-M – circulation, sensation, movement
• First aid: R-I-C-E procedures (rest, ice, compression, elevation)
• Use a splint to stabilize the fracture – 1 joint above and 1 joint under broken bone
• Seek medical attention

 

Joint injuries

– the most frequently affected are shoulders, elbows, fingers, hips, knees and ankles

Signs and symptoms

• Deformity (main sign)
• Pain
• Swelling

 

What to do?

• Check – C-S-M – circulation, sensation, movement
• First aid: R-I-C-E procedures – rest, ice, compression, elevation
• Use a splint to stabilize the joint in the position in which it was found
• Do not try to put displaced parts into their normal position – nerve and blood vessel damage could result
• Seek medical attention

 

Poisoning

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 signs

• polymorphous
• mostly altered mental status
• altered vital functions
• Convulsions

Evaluation of vital functions – examine ABCs followed by

• history +
• physical examination.

History is ofprimary 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, skin exposure)?
• When was it taken?
• What else was taken with it? (combination of drugs and ethanol)

 

Besides vital functions are regularly examined, observe:

• Papillary size – mydriasis – (atropine, cocaine, ethanol),
• Oral examination – the odour of the breath is diagnostic clue  hydration (opiates, atropine vs. organophosphates, strychnine)
• Examination of the skin – marks of drugs use, cyanosis, red skin colour (due to cyanide or carbon monoxide), dry skin
• 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.

 

Specific poisonings antidotes:

• Ethylene glycol → alcohol
• Methyl alcohol → alcohol
• Alkali → juice or vinegar or lemon
• Acid → milk

How to practice first Aid

The most common term referred to in first aid is ABC. This stands for airway, breathing, and circulation.

• Airway: Make sure the airway is clear. Choking, which results from the obstruction of airways, can be fatal.
• Breathing: Once the airways are confirmed to be clear, determine whether the person can breathe and if necessary provide rescue breathing.
• Circulation: If the person involved in the emergency situation is not breathing, the first aider should go straight for chest compressions and rescue breathing. The chest compressions will promote circulation. This saves valuable time. In emergencies that are not life-threatening, the first aider needs to check the pulse.

.As soon as ABC has been secured, the first aider can then focus on any additional treatments. The ABC process must be carried out in that order. However, there are times when a first aider might be performing two steps at the same time. This might be the case when providing rescue breathing and chest compressions to an individual who is not breathing and has no pulse.

Cardiopulmonary Resuscitation (CPR)

Breaking down these words helps to provide a description of the procedure:
-Cardio means heart.
-Pulmonary means lungs.
-Resuscitation means to restore to life.
Therefore, cardiopulmonary resuscitation is bringing the heart and lungs ‘’ back to life’

CPR   is a procedure involving repeated cycles of compression of the chest and artificial respiration performed to maintain blood circulation and breathing for a person who has stopped breathing (respiratory arrest) and/ or whose heart has stopped (cardiac arrest).The signs of cardiac arrest are unconsciousness, no reactivity, absence of normal breathing

Permanent brain damage or death can occur within minutes if blood flow stops. Therefore, it is very important that blood flow and breathing be continued until trained medical help arrives.

 

Purpose of CPR

It is to restore and maintain oxygen rich blood flowing to the brain and other vital organs if the heart or lungs stop working on their own.

Indication of CPR

• intoxication
• electrocution
• drowning
• acute suffocation
• severe trauma
• stroke and alike

 

First Aid Sequence   Of CPR

1. Unconscious victim

.

.Make sure the scene is safe. The victim should be flat on his back and his mouth should be checked for debris. Then tap the person on the shoulder and shout “Are you OK?” to ensure that the person needs help.

1. Shout for help

. If it’s evident that the person needs help,

call or ask a bystander to call 112,

begin administering assistance.

1. Open   Airway

Open the airway.

With the person lying on his or her back,

tilt the head back slightly to lift the chin.

1. Check breathing

 

 

 

Check for breathing. Listen carefully, for no more than 10 seconds, for sounds of breathing. (Occasional gasping sounds do not equate to breathing.) If there is no breathing begin CPR

1. Chest Compressions

 

Place your hands, one on top of the other, in the middle of the chest. Use your body weight to help you administer compressions that are at least 2 inches deep and delivered at a rate of at least 100 compressions per minute.

1.  Rescue breaths

7. Deliver rescue breaths
8. With the person’s head tilted back slightly and the chin lifted,
9. pinch the nose shut and place your mouth over the person’s mouth to make a complete seal. Blow into the person’s mouth to make the chest rise.
10. Deliver two rescue breaths, then continue compressions.

Note: If the chest does not rise with the initial rescue breath, re-tilt the head before delivering the second breath. If the chest doesn’t rise with the second breath, the person may be choking. After each subsequent set of 30 chest compressions, and before attempting breaths, look for an object and, if seen, remove it.

Continue CPR steps. Keep performing cycles of chest compressions and breathing until the person exhibits signs of life, such as breathing, or a trained medical responder arrives on scene

Summary of CPR First aid Sequence

Unconscious victim → Shout for help → Open airway   → Check breathing → Chest compressions → Rescue breaths