First Aid Series

WHAT IS FIRST AID?

First Aid is the initial treatment or assistance given to a casualty for any injury or sudden illness
before the arrival of an ambulance or a medical person.

AIMS OF FIRST AID

• Preserve life

• Prevent the casualty’s condition from worsening

• Promote recovery

RESPONSIBILITIES OF FIRST AIDER

In General-

• A-Assess situation

• M-Make area safe

• E-Emergency Aid

• G-Get help

• A-Aftermath

Specifically-

• Assess the situation

• Identify the problem

• Give treatment

• Remain with the casualty until handing him/her to somebody responsible

• Take casualty to hospital

• Make and pass on a report

CASUALTY MANAGEMENT (DR.ABC)

• D Danger (To the First Aider and to the casualty) protect yourself.

• R Response

• A Airway

• B Breathing

• C Circulation

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ALWAYS GET HELP

• Quickly ensure that any necessary specialist help has been summoned.

• Call 999 or an Ambulance

• Shout for help

SOME IMPORTANT TERMINOLOGIES

• Pulse – this is the wave that passes along arteries created by each heartbeat. It is felt
where an artery passes close to the body surface. The average rate is –72/min, (range
60-80). (Take it at the wrist for the conscious casualty and at carotid for the
unconscious casualty).

• Respiration Rate – Average 16 breaths/ min, (range 12 to 22)

• Blood Pressure – this is the force that is exerted on the circulatory system by the heart.
It ranges from 90/60 to 140/90 mm/hg (mercury).

• Temperature-36.9oc, (36.6 to 37.2).

THE RESPIRATORY SYSTEM

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RESUSCITATION

• Definition- restarting, restoring, and sustaining a stopped heart (cardiac arrest) and/ or
stopped breathing (respiratory arrest).

• For life to be sustained, a constant supply of oxygen to the brain must be maintained.
The oxygen is delivered to the tissues by circulating blood. The oxygen is delivered to
the lungs by act of breathing through the nose.

THE ABC OF RESUSCITATION

• A- Airway - Tilting the casualty’s head back and lifting the chin will “open the airway” –
the tilted position lifts the casualty’s tongue from the back of the throat so that it does not
block the airway.

• B- Breathing - If a casualty is not breathing, you can breathe for him or her and thus
oxygenate the blood by giving “artificial ventilation”- blowing your own expelled air into
the casualty’s lungs.

• C- Circulation -If the heart has stopped, “chest compression” can be applied to force
blood through the heart and around the body. The chest compression must be combined
with artificial ventilation so that the blood is oxygenated.

ASSESS THE CASUALTY’S CONDITION AND ACT ON THE FINDINGS

NO FINDING ACTION
1. If unconscious, no pulse and (1) Start and continue artificial ventilation and chest
no breathing compression.
(2) Dial 999 or an Ambulance
2. Unconscious, no breathing, (1) Start artificial ventilation
pulse present (2) Call an Ambulance
(3) Continue artificial ventilation
3. Unconscious, no pulse, 1) Chest compression (cardiac massage)
gasping breathe (2) Monitor breathing, start artificial ventilation if need
arises
(3) Call an Ambulance
4. Unconscious, breathing and (1) Treat any life threatening injury.
pulse present (2) Place casualty in the recovery position
(3) Summon help
5. Conscious, breathing and (1) Treat as appropriate
pulse present (2) Get help if necessary.

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ARTIFICIAL VENTILATION

CHEST COMPRESSION

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The Holger-Nielsen Technique

o Referred to as a "back pressure arm lift," you should perform the Holger-Nielsen
technique for someone on his or her stomach. Before placing the victim on the stomach,
check to make sure there is nothing blocking the airways of the nose and mouth.
o Carefully place the victim face down, bending his/her elbows and placing the hands
overlapping beneath the head. Turn the victim's head to one side and place it on his or
her hands.
o Kneel on one knee a little in front of and to the side of the patient’s head, with the
other foot at the patient’s elbow so that you midline should be inline the with patient’s.
Place your hands over the patient’s shoulder blades and your arms should be
outstretched. Gently press your hands on to patient’s shoulder blades to drive air out of
the lungs -Approximate time two seconds.
o Let your hands slide quickly down to the patient’s arms - taking approximately half a
second
o Raise his/her arms and shoulders slightly, at the same time moving your body
backwards, this induces air to enter the lungs - approximate time two seconds.
o Lower the patient’s arms again until they touch the ground and return your hands to
the original position on his/her shoulders and resume pressure as before.
Repeat the movements described in above steps so that the whole process occupies
approximately six seconds. Keep at it till the patient breathes on his/her own.
NB

Note that this resuscitation method of Holger Nielson Technique is out dated.

Modern CPR combining mouth to mouth and Chest compression is encouraged.

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THE RECOVERY POSITION

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ELECTRICAL INJURIES

• SHOCK The passage of electrical current through the body causes a jarring,
shaking sensation, and may render the casualty unconsciousness with cessation of
breathing and stoppage of the heart or instant death.

• BURNS The current may cause burns at the entry point and where it leaves the
body.

• INJURIES AT VARIOUS CURRENT LEVELS

i. A current of 1mA (0.001A) mild sensation (mild shock)

ii. At 10mA (0.01A) shock severe enough to paralyze the muscles so as the casualty is
unable to release the conductor (painful & unconsciousness)

iii. At 100mA (0.1A) the shock is fatal.

iv. At 0.1A to 1A burning (but the casualty may survive)

v. Over 1A burning and death

LOW-VOLTAGE CURRENT

Domestic current, is mostly alternating current, which causes muscle spasms preventing the
casualty from letting go of an electric cable. (as in i and ii above)

ACTION Break contact by switching off the current, at the mains

Stand on dry insulating material such as a wooden box, a rubber or plastic mat, use a
broom, wooden chair to push the casualty's limbs away from the source.

Without touching the casualty, loop a rope around his feet or under the arms and pull him
away from the source.

As a last resort only, tug at the casualty’s loose, dry clothing

Once the contact is broken

• If the casualty is unconscious check breathing and pulse,

• Be prepared to resuscitate

• Treat burns

• Put him in recovery position and summon help

• If the casualty seems unharmed, should be advised to rest.

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HIGH-VOLTAGE CURRENT

• Contact with high-voltage current is usually immediately fatal, with severe burns and the
sudden muscular spasm produced by the shock may propel the casualty some distance
from the point of contact, causing other injuries, such as fractures.

ACTION

• Call the emergency services immediately.

• The casualty will almost certainly be unconscious; once it is safe to do so, check
breathing and pulse, and be prepared to resuscitate if necessary.

• Place him in the recovery position

• Treat any burns and associated injuries.

• Take steps to minimize shock.

BURNS AND SCALDS

Damage to the tissues due to excessive heat:

• Burns- Dry heat e.g. flames, friction, and corrosive substances

• Scalds- Wet heat e.g. hot liquids, and vapors.

AIMS OF THE FIRST AIDER

• To stop the burning process and relieve pain

• To minimize the risk of infection

• Treat associated injuries

• To resuscitate if necessary

• Arrange removal to hospital

FUNCTIONS OF THE SKIN

• Coat –physical covering of the body

• Water regulation

• Heat regulation

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• Excretion

• Sensory

DEPTH OF BURNS

• Superficial burns (1st degree) involves only the outer layer of the skin characterized by
redness swelling and tenderness

• Partial-thickness burns (2nd degree) the skin looks raw and has blisters

• Full thickness burns (3rd degree) involves all layers of the skin are burned. Usually
extends beyond the skin to affect nerves, muscle, and fat. The skin may be pale, waxy,
charred and skin has come off.

EXTENT OF BURNS

• Extent is expressed in terms of a percentage of the body’s total surface area. Surface
area is calculated using the palm which is equal to 1% or using the “rule of nine”, which
divide the body into areas of approximately 9% (head & neck 9%, front of trunk 18%
(2*9%), back of trunk 18%, one upper limb 9%, one lower limb18% sexual organ 1%).
Quickly gives approximate indication of the degree of shock that will develop.

TREATMENT

• Pour copious amounts of water on the burned surface for as long as 10 minutes to halt
the burning process.

• Remove restrictive rings, watches, belts, & shoes—before swelling sets in.

• Cover the injury with sterile gauze, sheet or any suitable material.

• Carefully remove burned clothing, but clothing sticking on to the burns should be left
undisturbed.

• Summon help as you prepare to take the casualty to hospital

• DO NOT TOUCH OR OTHERWISE INTERFERE WITH THE INJURED AREA

• DO NOT BURST ANY BLISTERS

• DO NOT APPLY LOTIONS, OINTMENT, OR FAT TO THE INJURY

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FRACTURES

A fracture is a break or crack in a bone.

• SYMPTOMS (what the casualty tells you).

• History of a recent violent blow or a wrenching force on a bone

• Snapping sound of a breaking bone

• SIGNS (what you see on the casualty

• Difficulty in moving the limb normally

• Pain at or near the site of injury made worse by movement.

• Distortion, deformity, swelling and bruising “an extra joint”

TYPES OF FRACTURES

CLOSED FRACTURES

• Broken bone but overlying skin is intact

• TREATMENT AIMS

• To prevent movement at the site of injury

• To arrange removal to hospital maintaining comfortable support during transport

• ACTION

• Tell the casualty to keep still and steady and support the injured part with your hands
until it is immobilized.

• For firmer support secure the injured part to a sound (normal) part of the body.

• For upper limb fractures always support the arm against the trunk with a sling.

• For lower limb fractures bandage the injured to the sound leg.

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• Dial for an ambulance or arrange transport to hospital. Treat for shock if necessary.

OPEN (COMPOUND) FRACTURES

• Where there is a fracture that is accompanied by a wound, we call it an open or

• TREATMENT AIMS

• To prevent movement at the site

• To prevent blood loss

• To prevent contamination and infection

• Arrange removal to hospital.

• ACTION

• Support the limb while you work on the wound.

• Cover the wound with a sterile dressing or clean pad and apply pressure to control
bleeding.

• Place padding over and around the dressing.

• Secure the dressing and padding, bandage firmly but not too tightly as to impede
circulation.

• Immobilize as for closed fracture.

Dial for an ambulance or arrange for transport to hospital. Be sure to treat shock if necessary.

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WOUNDS AND BLEEDING

Definition: --An abnormal break in the skin or mucus membrane.

OPEN WOUND: -- Blood escapes from the circulation and the body

CLOSED WOUND: --Blood escapes from the circulation but not from the body.

AIMS OF 1ST AIDER AT A WOUND/BLEEDING

• Stop bleeding

• Prevent infection

• Prevent shock (surgical shock) extreme low pressure.

TYPES OF BLEEDING

ARTERIAL BLEEDING

• Bright red blood spurts (pulsatile) from the wound in time with the heartbeat.

VENOUS BLEEDING

• Dark red blood gushes out profusely

CAPILLARY BLEEDING

• Oozing blood

STEPS IN CONTROLLING BLEEDING

• Apply direct pressure on the wound over a dressing.

• Elevate the limb

• Apply pressure over a pressure point

• Upper arm – brachial artery

• Lower limb – femoral artery

• As a last resort apply a tourniquet, (indicate the time it was applied and pin the card or
paper on the casualty).

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SHOCK

• DEFINITION: – Failure of the circulatory system to distribute blood to all parts of the
body leading to insufficient oxygen in the tissues.

• CAUSES

• 1) REDUCED CIRCULATING VOLUME

BLEEDING

• External (Open wounds)

• Internal (Closed wounds)

LOSS OF BODY FLUIDS

• Diarrhea

• Vomiting

• Burns

• 2) FAILURE OF THE HEART

• Heart attack

• Heart failure (congestive heart failure) leading to reduced pressure of the circulating
blood

• RECOGNITION OF SHOCK

• a) When the body is stressed it releases a hormone called Adrenaline, which causes:

• A rapid thready pulse

• A sweating, cold clammy (sticky) skin (sweat fails to evaporate)

• b) The casualty feels: -

• Weakness and giddiness

• Thirsty and Nauseated

• Rapid shallow breathing because of oxygen deficit

• As oxygen supply reduces the brain weakens and the casualty:-

• becomes Anxious and restless

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• Has air hunger (gasps and yawns)

• Unconsciousness sets in

• Finally the heart stops

Treat the cause –

• If bleeding (stop the bleeding)

• If diarrhea or burns (give fluids)

Improve supply to the brain, heart and lungs: -

• Lay the casualty down and keep his head low

• Raise and support his legs

• Loosen tight clothing braces straps and belts

• Keep him warm

• Record vital signs:- pulse, temperature, breathe rate and level of consciousness

• CHECKING LEVELS OF RESPONSE

• To make a rapid initial assessment of responsiveness, use the “AVPU” aide-memoire

• A - Alert

• V – Responds to Voice

• P – Responds to Pain

• U - Unresponsive

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