FIRST AID, DISASTER

AND EMERGENCY PREPAREDNESS MANAGEMENT

CHAPTER ONE
INTRODUCTION TO FIRST AID
First aid is emergency care given immediately to an injured person. First aid refers to the
emergency or immediate care you should provide when a person is injured or ill until full
medical treatment is available. For minor conditions, first aid care may be enough. For serious
problems, first aid care should be continued until more advanced care becomes available. Acting
appropriately with first aid can make a difference between life and death.
Aims and Objectives of First Aid
Its main objective is not to treat people but to provide immediate attention to a sick or injured
person at the scene. First aid helps prevent the situation from getting worse while waiting for full
medical care.

Aims of First Aid

There are five main aims of first aid

 Provide pain relief

 Protect the unconscious
 Preserve life
 Prevent the escalation of illness or injury
 Promote recovery
Preservation of life
This implies that the person performing the first aid must ensure to save a life with the skills
acquired. Examples of life preservation in first aid are providing CPR or attending to a choking
person. Maintaining air circulation in the body and clearing blocked airways while waiting for
assistance prevents other severe conditions, like brain damage and even a heart attack, which can
happen within minutes.
Prevention of illness or injury from escalating
A First Aider must acquire the skill to provide immediate care to prevent the situation from
getting worse. For example, how to contain wounds and attend to injuries to prevent further
spread or damage. Such an incidence includes a First Aider who aims to stop bleeding in a
casualty with profuse hemorrhage until professional medical help arrives.
Promoting recovery

The promotion of recovery includes using all items available to help a victim in need. This can
involve washing, disinfecting, and bandaging a wound. In some cases, an antibiotic ointment can
be used to promote healing.
Relieving pain

Pain relief can be offered with both pharmacological (usually over-the-counter medications like
paracetamol) and non-pharmacological remedies. Offering pain relief (medication) should only
be done if it doesn’t present a risk to the patient. For example, if a person is bleeding, some pain

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relief medication is not advisable. It’s better to ask a medical expert first before offering any sort
of medication.
Protect the unconscious

Protecting an unconscious person includes safely removing them from a dangerous environment
like a fire or busy road to safer conditions nearby. In a first aid course, participants learn how to
position an unconscious person so that breathing airways aren’t obstructed. The goal of
protecting an unconscious person is to ensure their safety before medical help arrives.

Qualities of a First Aider

A first aider must be:

1. Organized
2. Self- confident
3. Prompt and quick
4. Well-informed
5. Compassionate and Considerate
6. Skillful and tactful
7. Ability to improvise
8. Possess leadership qualities
9. Brave
10. Vigilant/Alert
11. Enthused
Basic Principles in First Aid
1. Begin by introducing yourself to the injured or ill person. Explain that you are a first aid
provider and are willing to help. Assure and continue to reassure the victims to gain their
cooperation and confidence in you.
Note: In first aid the recipient of the care is known as a casualty or a victim.
2. The person must give you permission to help them; do not touch them until they agree to
be helped.
3. If you encounter a confused person or someone who is critically injured or ill, you can
assume that they would want you to help them. This is known as “implied consent.
4. Assess the situation and recognition the problem. Provide the needed help. You should
always call the emergency services immediately for assistance.
5. Prioritize the care provided by providing first aid according to the urgency of the
condition. For example, making use of triage when you are caring for multiple victims.
6. Assessing the safety of the surroundings is critical when approaching any scene. You do
not want to become another person who is injured or ill, so look for any potential
dangers. Remove the person from any dangers, such as the presence of water at the scene.
Be especially alert to avoid danger from automobile traffic.

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 7. Control all bystanders or onlookers and make sure you take charge of the situation.
8. Handwashing is essential in the prevention of disease and illness. Wash your hands after
each episode of care and after taking off gloves.
9. Using personal protective gear is an important strategy to minimize the risk of blood and
bodily fluid exposure. If the person is bleeding, always wear gloves and protective
eyewear when giving first aid care. (Practice correct donning and doffing techniques)
10. Move victims only when it is very necessary. Minimum movement is highly suggested.
11. Avoid removing casualties' clothing unnecessarily. If needed always remove the
uninjured side first.
12. Place unconscious victims who are breathing into a recovery position, unless
contraindicated.
13. Make use of bystanders as much as possible when needed.
14. Avoid giving anything by mouth to the victim that is bleeding, unconscious, in shock,
vomiting etc.
15. Handle fractured or suspected fractured victims with care to avoid worsening the
situation.
16. Make sure you take notes/write a report of what happened, the conditions that were
identified and what was done for the victim. This must be handed over to the medical
team when they arrive.
17. Arrange to send the victims to seek medical care immediately.
18. Engage other emergency departments such as the police, security, or firefighters if
needed.
First Aid Kits
You may consider purchasing a commercially available first aid kit or making your own. Placing
a kit in your home, your car, and at your place of work is essential to stay prepared.

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Common items found in a first aid kit are:
1. Bandages, roller bandages, and tape/safety pins
2. Sterile gauze
3. Antiseptic wipes and swabs
4. Absorbent compresses
5. Antibiotic cream
6. Mask for breathing (rescue breathing/CPR)
7. Chemical cold pack
8. Face/Eye shield (PPE)
9. Eyewash and Eye irrigator
10. Scissors
11. Cotton
12. Gloves
13. Alcohol based hand sanitizer
14. First aid reference guide that includes local phone numbers
15. Notebooks and pen to write reports
16. Touch light

Priorities of the First Aider during an Emergency

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There first aider must always remain calm and avoid panic responses. Always take a deep breath
before rushing to the scene and survey the scene logically and sensibly. After, apply the six main
priorities of the first aider.
1. Stop to assess the situation. Always watch out for danger. Your first aim is to avoid
anyone else being put at risk such as from oncoming traffic in a motor accident.
2. Make sure it is safe to approach the scene.
N.B: Never put yourself at risk, it is of no help if you become a second victim. If you
cannot help a casualty without endangering yourself or others, call or send for help
and keep others away.
3. Make the area safe. Do what you can to protect bystanders and others from danger.
Protect the patient from further danger.
4. Assess the victim. Check the patient’s response (By shouting their name and/or
tapping their shoulders) and condition
5. Call/Shout for help from people around, and the emergency unit. You can send
someone to call for help, if possible, while you stay with the victim.
6. Resuscitate by providing Cardiopulmonary Resuscitation (CPR) and treat injuries as
necessary.

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CHAPTER TWO
SHOCK
Shock is a critical condition that occurs because of the sudden drop in oxygenated blood flow to
the body particularly the vital organs. When a victim is in shock, their organs aren't getting
enough blood or oxygen to function normally. If untreated, this can lead to permanent organ
damage or even death. The severity of shock varies with the nature and extent of the injury.
Causes of Shock
 Severe allergic reaction

 significant blood loss

 Cardiac condition

 Blood infections

 Severe loss of fluids through a burn/scald injury, vomiting, diarrhea leading dehydration

 Poisoning
 Trauma leading to severe pain,
 Severe Infection
 Sudden news leading to emotional and psychological trauma
 Exposure to extreme heat or cold
Signs and Symptoms of Shock
Signs and symptoms of shock vary depending on circumstances and may include:
 Skin feels cool and clammy
 Pale or ashen skin
 Bluish tinge to lips or fingernails (or gray in the case of dark complexions)
 Enlarged/dilated pupils
 Fatigue
 Feeling like fainting
 Weakness
 Chest pain
 Alteration in mental state or behaviour, such as anxiousness, confusion or agitation
 Dizziness or blurred vision
 Irregular heart beat
 Rapid, weak, or absent pulse
 Rapid breathing
 Nausea or/and vomiting
 Decrease in urine
 Profuse sweating
 Unconsciousness which can later lead to death
 Low blood sugar
 Complains thirst
 Dry mouth

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Types of Shock
The causes of shock define the various types of shock.
1. Obstructive Shock: Obstructive shock occurs when blood can’t get where it needs to go
due to certain diseases or conditions. Diseases such as pulmonary embolism,
pneumothorax, and hemothorax can cause obstructive shock.
2. Cardiogenic shock: Damage to your heart can decrease the blood flow to your body,
leading to cardiogenic shock. For example, damage to the heart muscle can lead to a heart
attack.
3. Distributive shock: This type of shock is caused by conditions that make blood vessels
lose their tone. Blood vessels become open and floppy when they lose their tone leading
to a reduction in the pressure to supply blood to the various organs. Distributive shock
can lead to flushing, low blood pressure and loss of consciousness. The specific types of
distribution shock include:
A. Anaphylactic shock: This occurs from a severe allergic reaction called
anaphylaxis. Allergic reactions occur when the body mistakenly treats a
harmless substance as harmful. Examples are an allergic reaction from intake
of food, insects venom, medications etc.
B. Septic shock: This is due to severe infection in the blood. Septic shock occurs
when bacteria and their toxins cause serious damage to tissues or organs in
your body.
C. Neurogenic Shock: s caused by damage to the central nervous system, usually
a spinal cord injury. This causes blood vessels to dilate, and the skin may feel
warm and flushed. The heart rate slows, and blood pressure drops very low.

4. Hypovolemic Shock. This type of shock happens when there isn’t enough blood in your
blood vessels to carry oxygen to your organs. This can be caused by severe blood and
fluid loss, for example, from injuries.
5. Psychologic shock: This type of shock is caused by a traumatic event. It is also known as
acute stress disorder. This type of shock causes a strong emotional response and may
cause physical responses as well.
6. Traumatic shock: It occurs following an injury to the body tissues. There are two main
types of traumatic shock: primary and secondary shock.
 Primary shock: occurs immediately after injury or at time of injury. It is
usually caused by excessive stimulation of nerve endings at site.
Recovery is fast.
 Secondary shock: develops few hours after injury. Usually caused by
bleeding, emotional stress, dehydration, toxemia, exposure to extreme
temperature
First Aid Management of Shock
1. Assure the casualty and others around.
2. Lay the victim down and elevate the legs and feet slightly, unless you think this may
cause pain or further injury.
3. Keep the person still and don't move him or her unless necessary.

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 4. Continues reassuring the victim
5. Begin CPR if the person shows no signs of life, such as not breathing, coughing, or
moving.
6. If casualty in unconscious, breathing and pulse returns to normal put the casualty in the
recovery position.
7. Loosen tight clothing and, if needed, cover the person with a blanket to prevent chilling.
8. Don't let the person eat or drink anything.
9. Keep the casualty warm by covering lightly. Don’t overheat.
10. If you suspect that the person is having an allergic reaction, and you have access to an
epinephrine autoinjector, use it according to its instructions.
11. If the person is bleeding, hold pressure over the bleeding area, using a towel or sheet.
12. If the person vomits or begins bleeding from the mouth, and no spinal injury is suspected,
turn him or her onto a side to prevent choking.
13. Quickly arrange to send to the hospital for treatment in the appropriate position.
Signs of Recovery from Shock
1. The blood pressure increases and starts getting normal.
2. Skin feels warm and regains its normal color.
3. Urine output gets normal.
4. Pulse becomes normal and stronger.
5. The respiration is slower and deeper.

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CHAPTER THREE
HAEMORRHAGE
Definition: It is an escape of blood from blood vessels. Any type of blood vessel may be
involved, and hemorrhage may be internal or external
Causes
Hemorrhage can be caused by:
1. Direct injury to the blood vessel as a result of a wound or surgical intervention.
2. Disease of the blood vessel wall due to infection or malignancy.
3. Disease of the blood itself e.g. haemophilia (this is a disease characterized by delay in the
clotting time of blood due to the lack of specific factors in the blood (factor 8 which is
necessary for satisfactory clotting. This factor is known as anti-haemophilic factor)
Classifications of Hemorrhage
Hemorrhage can be classified in the following ways:
1. According to its situation.
2. According to its source.
3. According to the time it occurs.
1. Situation - This can be external or internal.
External hemorrhage is when the blood escapes from the blood vessels onto the surface of the
skin and can be seen.
In internal or concealed hemorrhage, the blood escapes from the blood vessels into a cavity or
organ of the body or into the tissues e.g. bruise or hematoma. It is possible for this type of
hemorrhage to become visible e.g. in bleeding from the alimentary tract, the person may vomit
out the blood if bleeding is from the upper part, but if it is in the lower part of the alimentary
tract, the person may end up passing melaena stools.
2. Source - Hemorrhage may be classified according to the type of blood vessels involved.
• Arterial Bleeding: - If an artery is severed, the blood would be:
a. Red in color due to the presence of oxygen in the blood.
b. Spurting from the wound. Each spurt coincides with a heartbeat.
c. Blood escaping from that part of the wound nearest to the heart.
d. Escaping from the wound under great pressure.

• Venous Bleeding - blood will be:

a. Dark red in color due to small amount of oxygen in the blood.
b. Flowing from the wound in a steady stream and would not spurt.
c. Escaping from the part of the wound farthest from the heart.

• Capillary Bleeding - This occurs in superficial wounds and the blood would be
a. Oozing from surface of wound
b. Neither bright red/dark red in color
c. The blood wells up from all over the place.
• Mixed Hemorrhage- In large lacerated wounds, all the three types of blood vessels may
be damaged and if the arteries and the veins are involved in the same time, the
hemorrhage may be alarming.

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3. Time of Hemorrhage - Hemorrhage may occur actually at the time of injury or operation or
during damage to the blood vessel latter or by a disease.
(A) Primary Hemorrhage - This occurs at the time of the injury or surgery.
(B) Reactionary Hemorrhage - This occurs within 24 hours after an injury or an operation.
This bleeding is due to the reaction of the body. In hemorrhage, nature employs three
strategies to prevent serious loss of blood and these are:
1. Lowered B.P. diminishing the flow of blood in that part of the body.
2. A blood clot forms and cuts the blood vessel.
3. Blood vessel walls turn in to hold the clot in position to prevent further loss
NB:
• Reactionary hemorrhage occurs after treatment.
• The blood pressure returns to normal and the clot is pushed up and further bleeding
occurs
• After treatment of shock, the blood pressure becomes high and pushes out the clot formed
due to increase pressure to begin the hemorrhage again.
(C) Secondary Hemorrhage - This type occurs anytime after the first 24hrs after the injury
or operation and is due to infection. Usually it takes place from the seventh and
fourteenth day following the injury, accident or operation. If microbes infect the wound,
they break down the clot. This usually takes several days to occur thus secondary
hemorrhage is slow to develop. It is very dangerous and shows the importance of keeping
wounds free from infection.
Signs and symptoms
It is important to recognize the signs/symptoms of hemorrhage and to know that they are the
same whether bleeding is internal or external. The signs and symptoms vary in degrees
depending on the amount of blood lost. It is very important to recognize internal hemorrhage to
save patient life.
1. The Skin - becomes pale and white, cold and clammy to touch because the blood is
shunted to internal organs and the superficial blood vessels are constricted.
2. Temperature is sub-normal because of the constriction of the superficial blood vessels.
The patient if conscious looks anxious, afraid and is restless.
3. The Pulse - it is rapid and weak, and depends on the severity of the bleeding. The heart
then tries to compensate and pumps blood as rapid as 140 bpm in adult the pulse becomes
imperceptible if bleeding persist and may fail.
4. The Respirations - described as air hunger respirations. The patient sighs and gasps for
air, there is less oxygen circulating in the bloodstream because of loss of red blood cell.
Respiration becomes quick and shallow
5. There is lowered blood pressure.
6. Patient complains of thirst due to the loss of fluid.
7. There is dehydration if fluid loss is not replaced.
8. If the brain is not receiving enough blood supply. Patient may complain of the following
A. Dimmed/blurred vision
B. Giddiness
C. Buzzing or ringing in the ears.
D. Pupils are dilated
E. There is mental confusion
F. There is collapse/ unconscious

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 G. There can be coma and finally death.
Treatment of Hemorrhage
1. Direct pressure on the wound using the thumb or fingers (digital pressure), pad and
bandage
2. Pressure around the wound using simple pad or ring pads
Pressure at the side of the wound (indirect pressure)
1. Pressure point
2. Tourniquets and constrictive bandages. It should not be used because of its much damage.
The only possible exception when a tight constrictive bandage might be needed is where a
limb has been so badly crushed that it can be of no further use.
First Aid Treatment for Hemorrhage
The principles are:
1. Arrest hemorrhage (elevating, applying and positioning)
This is the first live saving method demanding immediate and effective action. Pressure is
the main action. It must be applied where there is bleeding. This pressure should be hard
enough to stop the bleeding. In operation surgeon may stop the bleeding with his finger, a
ligature or with forceps or use a large swab
2. Treat for shock
3. Send the casualty to the hospital
Method of arresting hemorrhage
Application of tourniquet - raise the affected limb, place the clothing (scarf or handkerchief) over
the skin where the tourniquet is going to be applied, the tourniquet must be above the wound,
tightly enough to stop the bleeding.
It should be loosened every fifteen (15) minutes and it must be replaced if the bleeding comes
again.
If the tourniquet is left in position for too long in position gangrene or paralysis may occur
The use of pad and bandage - apply the dressing and use the pad and bandage on the wound
a. A pad and flexion -it is possible when there is a wound on the limb. A pad is place on the
popliteal space and the limb is tightened firmly into position or flexion can be used for
the hand.
b. Exertion of nressure on the nearest pressure point - These are areas of which the arteries
can be pressed to the bone-thus stopping the flow of blood.
Elevation - the higher the bleeding part can be raised above the level of the heart the less
the bleeding whatever its cause.
Natures Method - Three physiological tasks are performed by nature:
a. By the formation of clots
b. The elastic coat of the blood vessel walls recoils and turns in thus narrowing the
lumen of the vessel and holding the clot in place.
c. Blood pressure is lowered thus there is less blood volume.
Internal Hemorrhage
1. Rest and quite - the casualty must be laid down lying either on the floor, bed or couch
and movement must be limited to present further bleeding.
2. Reassure as he/she may be anxious or afraid.
3. Undo tight clothing around the neck, chest and waist to enable patient to breathe more
easily.

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 4. Raise the lower limbs of the patient to help blood flow to brain in order to prevent
fainting or unconsciousness.
5. Warmth: cover the patient with blanket but prevent overheating.
6. If a doctor is around, an injection will reduce pain and restlessness.
7. If the hemorrhage is severe, the patient is transported to the hospital as soon as possible
with minimum amount of movement.
External Hemorrhage
The care of the patient will be same as for internal hemorrhage. If bleeding point can be seen,
then further local treatment would be necessary.
1. Cover the wound immediately with preferably the inside of a newly laundered
handkerchief and bandage in position to prevent micro-organism from entering leading to
infection.
2. If the part is a limb, it should be raised as high as possible and maintained in position, this
limits the amount of blood flow to the part thereby reducing bleeding
3. Pressure may be directly applied to the wound if no foreign body e.g. broken glass, stick
or stone is present. This is done by applying a pad over a clean dressing and bandage
firmly in position. A pad may be made from a rolled up scarf or hand towel.
4. Digital pressure can be applied to the nearest artery; the pressure is applied to the artery
supplying the part where it passes near the surface and superficially over a bone. This
area is described as a pressure point.
5. A tourniquet is applied only as a last resort. The following points are important when
applying tourniquet.
- It must be tight enough.
- There must be a piece of material between the tourniquet and skin.
- Must not be left on for more than fifteen 15 minutes.
- An indication of the presence of a tourniquet must be done use red ink to label the
forehead of the patient with capital letter "T* Plus the time of application.
Dangers Associated with the application of a Tourniquet
1. It's likely to damage nerves and muscles.
2. When it is not tight enough, it may limit only venous blood flow but not stop arterial
bleeding.
3. If narrow band is used, it usually damages the skin; broad rubber band is the best.
4. There is serious danger if the tourniquet is left on for more than 20 minutes.
Pressure point
A pressure point is that part of the body where an artery passes over a bone. These points are
used by the first aider to arrest hemorrhage.
A. Temporal artery - This artery supplies the side of the head. Pressure may be applied by
thumb or the tip of the fingers. They are placed over the zygomatic process of the
temporal bone about I inch in front of the external auditory meatus. The pressure will
stop superficial bleeding on the side of the skull.
B. Facial artery - This supplies the side of the face. Press a point 1 inch in front of the angle
of the jaw. The artery is pressed against the mandible.
C. Brachial artery - This artery supplies the arm and passes down the inner aspect of the
humerus beside the inner boarder of the biceps muscle. The arm should be straightened
and pressure applied by the finger on the inner aspect of the arm.

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 D. Radial artery - This artery is most commonly used for recording pulse. It is felt on the
wrist at the outer aspect. Pressure is applied by pressing the fingers very firm on the
artery.
E. Femoral artery - It's the main artery of the leg and passes down the front of the groin.
To arrest hemorrhage, the casualty lies down with the knees bent; the first aider them
grabs him/her tight with both hands, with the thumb one on top of the other. When the
artery is felt, press firmly downwards and upwards against the bone.

SPECIAL HAEMORRHAGE
1. Epistaxis - This simply means nose bleeding and it can be slight or severe. It is usually
venous in nature.
Causes
 Injury - It may arise from a fracture of the base of the skull resulting from a blow to the
nose, picking the nose.
 Tumors of the nose
 Specific infections: leprosy, syphilis, yaws, tuberculosis, AIDS
 Sinusitis
 Varicose veins. Small varicose veins are found in the nose and may rupture leading to
nose bleeding.
 Altitude - people who are susceptible may suffer this when at high altitude
 Foreign body- this is common in children as they push object in the nose.
 Blood disorders such as haemophilia, thrombocytopaenia
• High blood pressure - this occurs in advanced age. It is a warning sign of apoplexy.
 Toxins - Snake and certain other poisonous bites.
 Drugs: anticoagulants

First Aid Treatment

i. Sit casualty comfortably in a chair with the head bent forward, this prevents the blood
flowing to the back of the nose and throat and being inhaled or swallowed.
ii. Reassure casualty that the bleeding can be controlled.
iii. Loosen tight clothing around the neck, chest and waist and put the patient near a
window for proper ventilation.
iv. Ask casualty to breathe through the mouth.
v. Warn casualty not to blow the nose or sneeze to dislodge the blood clot formed.
vi. Ask casualty to spit collection of blood in the mouth.
vii. Pinch the nose/nostrils firmly against the septum with the thumb and forefinger for 10
minutes.
viii. A cold compress in the form of a handkerchief soaked in ice water or ice cube is
applied over the bridge of the nose and at the back of the neck.
ix. Keep the casualty still.
x. Casualty must be kept warm but not overheated since it would worsen the bleeding.
xi. lf unconscious make the casualty lie with neck extended.
xii. lf bleeding is severe and does not stop, the patient should be sent to the hospital with
all the swabs or any material used to assess blood lost.

2. Bleeding from a Tooth Socket

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This usually occurs during tooth extraction or after extraction. It could be accidental or from
fracture of the jaw.
First Aid Treatment
 Give ice to casualty to suck
 A plug of cotton wool or gauze is fitted into the socket and the casualty asked to clench
the teeth firmly for 10-15 minutes.
 Discourage the casualty from spitting and washing the mouth owing to the risk of
disturbing blood clot which are forming in the socket and aiding natural arrest of
hemorrhage.
 Discourage from spitting and washing out the mouth for at least 6 hours to prevent clot
form from dislodging.
 Support the chin with the hands
 Avoid hot drink for at least 4hours.
 A firmly applied narrow bandage beginning with its centre under the chin and tied tightly
on the top of the skull may be of help or value in preventing fatigue of the jaw clenched
muscles.
 Return the patient to the dentist if bleeding continues.
 If the casualty has lost teeth and it could be found, place it in a container and sent it with
the casualty to the hospital.
3. Hemoptysis - This is coughing up blood from any part of the respiratory tract commonly
from the lungs. The blood is quite bright red in color because of oxygen and frothy because
the blood is mixed up with air.
Causes
1. Usually, it is an indication of pulmonary tuberculosis
2. It could result from complication of rib fracture piecing the lungs.
3. In drowning a blood stained froth may be coughed up.
4. It may be seen in terminal event of acute pneumonia.
First Aid Treatment
1. The patient is placed in a comfortable position sitting up in a chair, or propped up in bed.

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 If these positions cannot be assumed keep the patient lying, turned to the affected side
and the shoulder slightly raised on pillows the head hanging down. This is to aid cough of
blood.
2. Loosen tight clothes around the neck, chest and waist.
3. Reassure patient and keep him still and quiet because any movement or excitement could
cause further bleeding.
4. Give ice to suck because it aids the arrest of hemorrhage.
5. No stimulants should be given as they tend to increase bleeding.
6. Apply cold compress to the chest.
7. Check the vital signs and the general condition of the patient every 10minutes.
8. Send the casualty to see a doctor for suitable treatment to be applied.
9. Keep all specimen and sputum for doctor's inspection.
4. Haematemesis/Coffee ground Sickness - This is vomiting blood from any part of the upper
gastrointestinal tract. The common cause is bleeding from a peptic ulcer. The blood is gritty
and dark red or dark brown in color due to its contact with fluids and gastric juice. It is
sometimes known as coffee ground sickness. It may be slight or severe but can endanger the
patient's life. A casualty who bleeds often will shows signs of shock. Suddenly, he/ she will
become pale and cold complaining of giddiness and fainting, and the pulse will become quick
and feeble.
Causes
1. It may occur in varicose veins at the lower end of the esophagus,
2. Previous swelling as a result of nose- bleeding
3. Fractures of the base of the skull or jaw.
4. Bleeding from peptic or gastric ulcers precipitated by sudden stress.
First Aid Treatment
 Reassure casualty to allay his fears and anxiety.
 Lie the casualty down and loosen tight clothing around the neck, waist and thigh.
 Keep the casualty absolutely still and quiet.
 Nothing shall be given by mouth except ice cubes to suck, to help reduce nasty taste in
the
 Raise the end of the bed so that the foot end is higher than the head.

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  Check the vital signs and the general condition every 1Ominutes.
 Apply cold compress to the abdomen.
 Send for medical aid or transport the casualty to the hospital.
 Save all specimen or vomits for doctor's inspection.
5. Melena - black, tarry stools. This is the presence of blood in the stool. If the bleeding is
from a vessel higher up, e.g. in duodenal ulcers, the stools appear black and tarry due to the
mixture of intestinal juices with the blood. If the color is bright red, then the damage may be
near the lower end of the intestine and this may be due to hemorrhoids, dysentery and
perforation of the blood, colitis or cancer of mostly the rectum.
Note: If the casualty has black stools, one should eliminate the presence of drugs that can
discolor the stool e.g. iron drugs.
First Aid Treatment
 Reassurance
 Keep the casualty quiet in bed.
 Keep specimens of stools and blood for inspection.
 Check the vital signs and the general condition every 10minutes.
 Seek medical aid.
6. Hematuria - This refers to blood in the urine. The blood may be from vessels in the kidney,
ureters, bladder or urinary tract. It may result from injury or disease of any of the organs
comprising the genito-urinary system. When the blood is light, the urine may appear smoky, if
it is severe, the urine may be bright red. In extreme cases, the urine may be black.
First Aid Treatment
 Reassure the casualty.
 Casualty should be kept in bed quiet and still.
 Save all specimen of urine for inspection.
 Loose tight clothing round the neck, chest and waist.
 If the casualty complains of thirst give sips.
 Apply cold compress to the lower abdomen.
 Transport the casualty to the hospital/ Arrange for medical aid
 Give nothing by mouth
 Treat for or prevent shock

16
 7. Bleeding from a Varicose Vein - These are enlarged, twisted veins most commonly found
on the legs and thighs. It is also common in pregnant women. This occurs most of the time
when the valves within the blood vessels are damaged.
Causes
1. Pregnancy due to pressure on the veins.
2. Obesity
3. Any occupation which requires standing for long periods e.g. nursing, surgeons
4. Congenitally defective venous valves (hereditary)
Signs and symptoms
1. Pain
2. Varicose veins can break to form ulcers
First Aid Treatment
1. Assure and continue reassuring the victims.
2. When there is no bleeding, put the casualty to rest and elevate the lower extremities.
3. Ask the casualty to put on elastic stocking or creep bandage to put external pressure on the
vein.
4. If there is bleeding, lay the casualty flat, apply clean pad to the bleeding part and bandage
firmly.
5. Elevate the lower extremities
6. Ask the casualty to stay in bed.
7. Prevent or treat for shock.
8. Check the vital signs and the general condition every 10minutes.
9. Save soiled items for the inspection of doctor.
10. Send the casualty to a hospital.
8. Uterine bleeding -This is any bleeding from the uterus not associated with the menstrual
period.
Cause
1. The commonest cause of uterine bleeding is threatened abortion
2. It may be a disease or occur as a complication in an obstetric case.
First Aid Treatment
1. Assure and continue reassuring the victims.

17
 2. Put the casualty to bed.
3. Elevate the foot end of the bed.
4. Reassure her and keep her quiet and still.
5. Loosen tight clothing round the neck, chest and waist
6. Apply pad to the vulva.
7. Keep all pads for the doctor's inspection. Cross the leg tight to allow the pad to be firm.
8. Check the vital signs and the general condition every 10minutes.
9. Treat or prevent shock
10. Take the casualty to the hospital if bleeding is severe
Complications of Haemorrhage
 Brain damage
 Renal failure
 Cardiac failure
 Shock
 Dehydration
 Cardiac arrest
 Atelectasis
 Anaemia
 Bed ridden
 Death

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CHAPTER FOUR
WOUNDS
A wound is an injury that causes any damage or breakage in the continuity of skin or body
tissues. A wound can also be defined as damage to the veracity of biological tissue, including
skin, mucous membranes, and organ tissues. A wound can be opened or closed. Open wounds
have a break in the skin and body tissues are exposed. On the other hand, closed wounds have
damage to tissues under the skin, and the skin is unbroken. Wounds include cuts, scrapes,
scratches, and punctured skin.
Causes of Wounds
 Surgery
 Sutures
 Accident.
 Heavy fall.
 Gunshot
 Burns and scalds
 Stabbing
 Pressure on bony prominence
 Disease conditions such as diabetes, cancers, Buruli ulcer
 Immobility / Bedridden patients
Classification of Wound
A wound is classified according to various factors.
1. According to the level of cleanliness. There are four classes, these are:
a. Clean: These are very clean wounds. Such wounds are usually closed, not infected nor
inflamed. An example of this is an incised wound or an uninfected surgical wound.
b. Clean contaminated: Wounds that are still clean without any sign of infection and
inflammation fall into this class. These wounds have a likelihood of being infected. An
example is a wound resulting in surgery such as tonsillectomy.
c. Contaminated: Wounds classified as contaminated are fresh open wounds that can be the
result of an injury with major breaks in sterile technique, or spillage from the
gastrointestinal tract. Additionally, cuts made that result in critical, or lack of purulent
inflammation can also be classified as contaminated wounds.
d. Dirty contaminated/Dirty-infected: In this class are wounds that get infected based on
various reasons. Traumatic wounds can get infected when they are not properly cared for.
Also, wounds that come into contact with feces or pus and get infected, can fall into this
class.

2. Internal or External cause of the injury/wound: Internal wounds are used caused by
factors inside the individual's body such as wounds from disease conditions. For

19
 example, wounds from diabetes and cancer. External wounds are wounds caused by
things outside the body. For example, a stab by a knife, or a surgical incision.
3. Opened or closed wound: Opened wounds have a break to the skin, this includes burn
wounds, incised wounds, penetrated wounds, abrasions, lacerations, and punctured
wounds. Closed wounds are usually injuries to the tissues with no breaks in the skin.
Examples include contused, hematomas, and crushed injuries.
Types of Wounds
There are various types of wounds. These are:
1. Incised wounds: These are wounds from a clean sharp edge such as a razor, glass, or
surgical blade. In this type of wound, blood vessels are cut straight across, and this can
cause profuse bleeding. Tendon may be cut in some incised wounds, especially in those at
the limbs. Healing is usually fast, and there is less or absent infection of the wound.

2. Lacerated wound: This type of wound results from crushing or ripping forces from rough
tears of the skin and tissues. They have rough edges. Lacerated wounds bleed less profusely
than clean-cut wounds, however, there is bruising and more tissue damage. Lacerated
wounds are also usually contaminated and have a high risk of infection, and delay in
healing.

20
 3. Abrased wound/Abrasions/Graze: Abrasions are superficial wounds in which the top
layer of the skin is scraped off, exposing a tender area of the skin. These types of wounds
are because of sliding falls or friction burns. Abrased wounds may contain foreign materials
that may cause infection.

4. Contused wounds/Bruises: Wounds that occur from a blunt blow or punch damaging
capillaries underneath the skin are referred to as contused wounds. Blood leaks into the
tissues and causes bruises. Contused wounds can be associated with other injuries such as
fractures, or damage to internal organs. There is swelling and hematoma.

21
 5. Punctured wound: Wounds that are due to a penetrated object such as a nail or stab are
punctured wounds. They have very small entries (opening) but have deep damage
internally. The risk for infection is high in punctured wounds. There is a delay in healing
and bleeding is less.

6. Gunshot Wounds: Bullets or other missiles may drive into or through the body. This can
cause severe damage to internal organs or/and tissues, and suck in contaminants from the
air. The entry wound may be small and neat, but exit wounds are ragged. Example is a
penetrated chest wound, which can cause damage to both chest and upper abdomen.
The penetration chest wound can lead to conditions such as pneumothorax or tension
pneumothorax. Signs and symptoms include difficult and painful breathing that is rapid,
shallow, and irregular, signs of shock, cyanosis, coughing up frothy red blood, blood

22
 bubbling out of the wound, the sound of air being sucked into the chest, and crackling
feeling of the skin around the site of the wound.

7. Crushed injuries: This injury is due to outside high pressure applied to the body.
Depending on the extent of this pressure, the impact could range from a small bruise to a
complete disfigurement of the body part. Prolong crushing may cause extensive damage to
tissues.

8. Avulsed wound: This is an open wound that involves partial or complete tearing of the skin
and tissues. It can occur during disasters such as earthquakes or an explosion. Bleeding is
heavy and rapid.

First Aid Management of Wounds

Aim of management.

23
 a. To control bleeding.
b. Treat for shock.
c. Prevent complication.

1. Assure and reassure the casualty.

2. Remove or cut clothing to expose the wound.
3. Cover wound with clean material and bandage firmly to apply direct pressure. This will
also arrest the hemorrhage.
4. In case of a penetration object in the wound, apply pressure to the side of the wound by
pressing down firmly.
5. If the wound is abrasion, wash with clean water and cover where necessary.
6. In case of a penetrated chest wound, cover the wound immediately with your hand or the
hand of the conscious casualty. Cover immediately with a sterile dressing or a clean
cloth, apply a plastic bag or foil, and secure firmly with adhesive tapes on three sides or
bandage so that the dressing is firm.
7. If an eye wound occurs, lay the casualty on the back and tell the casualty to keep both
eyes still, as the movement of an affected eye can cause further damage to the affected
eye. Place an eye pad/sterile dressing/clean cloth on the injured eye. Ask the casualty to
hold on to it or bandage lightly to hold the pad in place. Do not try to remove anything
from the eyes.
8. If there was an amputation of any of the limbs, toes, or fingers, cover the wound with a
clean material of sterile dressing. Rub the amputated part in a clean or sterile dressing
soaked in warm saline water and send the casualty immediately to the hospital.
9. Raise and support the injured limb above the level of the heart.
10. Handle the limb gently to prevent further injury in case of a fracture.
11. Apply more padding/sterile dressing if available to the initial and bandage firmly but not
tightly.
12. In case of the protruded foreign object apply padding to the sides and bandage without
pressing on the object.
13. Lay the casualty down or allow the casualty to rest. This will reduce the bleeding from
the wound and help prevent shock.
14. In case of signs and symptoms of shock, treat for shock.
15. Call the emergency services or send the casualty to the hospital.
Wound Healing
Wound healing is the process of repairing the damaged skin and tissues after an injury.
Forms of Healing
 First intention or primary union.
 Second intention or granulation.
 Third intention or secondary suture.
First intention

24
Incised wounds such as surgical wounds heal by first intention. This is characterized by little scar
formation, the healing is fast, less damage to the skin with invisible granulation tissue, less
infection, and straight edges after wound healing.
Second intention
Wounds from gunshot, stabbing usually heal by second intention. This is characterized by
irregular edges of the wound, the formation of pus, delayed healing due to infection, scar
formation and visible granulation.
Third intention
Delay in the suturing of deep wounds and gaped wound can cause healing by third intention.
This is characterized by hyper granulation tissue growth, delayed healing of wound, presence of
pus is formation of deep and wider scars and high infection rate.
Signs and Symptoms of Wound Infection
1. Increased pain in the wound area
2. Fever
3. Redness and/or the warmth of the wound area
4. Pus drainage from the wound
5. Foul odour from the wound
6. Swelling and feeling of heat around the injury

Factors that Promote Wound Healing

 Adequate balance diet
 Application of heat
 Prescribe antibiotics
 Elevation of part
 Rest part involved
 Blood transfusion.
 Aseptic wound dressing
 Debridement
Factors Impeding Wound Healing.
 Low immunity.
 Anaemia.
 Wound Infection
 Infection in the blood
 Drugs
 Dehydration.
 Hypoxia
 Advancement in age
 Malnutrition
 Lack of rest

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  Disease conditions
 Hemorrhagic shock
 Hematoma
 Unprofessional suturing
 Foreign body in wound
Complications of Wound.
 Scar formation
 Loss of organ function
 Keloids
 Infection
 Contracture
 Bleeding
 Anemia
 Evisceration – protrusion of body content
 Dehiscence – split opening of the wound
 Death of cell.

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CHAPTER FIVE
INJURIES TO THE BONES, JOINTS, MUSCLES, AND LIGAMENTS
It can be challenging to distinguish between injuries to the bones, joints, and muscles. This
chapter discusses four types of injuries that can occur in the bones, joints, and muscles of the
body. These are Fractures, Dislocations, Sprains and Strains.
FRACTURE
A fracture is a break or cracks in the continuity of a bone. Fractures range from small partial
cracks to complete breaks and can occur in any bone.
Causes of fracture
1. Direct force
o Severe blow
o Road traffic accident
2. Indirect force
o Severe fall leading to landing on the feet causing pelvic injury
o Sudden jerk or violent contractions of the muscles can fracture a bone
3. Medical conditions e.g., osteoporosis, some cancers, tuberculosis, Vitamin D deficiency
4. Aging e.g., brittle bones of old age
Types of Fractures
Types of fractures can be either opened (associated with an open wound) or closed. Also, the
pattern of the break or crack in the bone can be used to describe the type of fracture.

27
This is according to the condition or involvement of the bone itself or tissues around the
fractured bone.
 Simple or close fracture: Closed fractures have intact skin over a broken bone. Usually
has bruising and swelling around the fractured site.
 Compound or open fracture: Open or compound fractures have broken skin (wound),
and the bone is exposed. Open fractures are exposed to bacteria and air.
 Complicated fracture: Here as the bone breaks, it injures the internal organs. Fracture of
the skull where the broken bone may press on the brain. Fracture to the Rib can pierce the
lungs. Fracture of the vertebrae where the broken bones may be pressing on and
damaging the spinal cord.
 Greenstick: This affects children under the age of 10 years. The fractured bone is like a
partially broken green stick as the child’s bones are still soft and not fully solidified
 Comminuted Fracture: In this type of fracture, the bone is broken into several pieces
(more than two fragments) or crushed. It is usually caused by direct violence/force to the
bone.
 Impacted Fracture: With an impacted fracture, the broken end of the bones are driven,
interlocked or pushed into each other, known as impaction. It is common in the shaft of
the femur or when the head of the femur is pushed into the acetabulum, the upper end of
the humerus, or at the end of a long bone. It is caused by compression force.
 Transverse Fractures: This type of fracture occurs when your bone is broken
perpendicular to its length.
 Spiral Fracture: A spiral fracture is a bone fracture that occurs when a long bone is
broken by a twisting force.
 Oblique Fracture: An oblique fracture is when the break is on an angle through the bone
 Longitudinal Fracture: These are fractures that occur along the axis of the bone.
 Depressed Fracture: A break that pushes the portion of bone inwards. One of the
fragments is depressed below the normal level. It occurs when the vault of the skull has
been fractured and a piece of the bone pressed inward. This may damage the brain.
 Double fracture: In this type of fracture, there are double or two different breaks in the
bone.
 Pathological Fracture: This is due to diseases of bone such as cancer, tuberculosis,
vitamin D deficiency, and osteomyelitis

Signs and Symptoms of Fracture

1. Difficulty in moving the affected limb normally
2. Distortion of the affected part
3. Swelling and bruising at the site of injury
4. Severe pain and tenderness
5. Coarse grating of the boned (crepitus) when the part is moved by the victim
6. Loss of function or power at injured part
7. There is a deformity. Bending, twisting, or shortening of the affected limb

28
 8. Bruises at the site of injury
9. Signs and symptoms of shock
General First Aid Management of Fracture
Aim of Treatment:
a. Prevent blood loss, movement, and infection at the site of injury.
b. To arrange removal with the hospital with comfortable support.

1. Assure and reassure the casualty.

2. Tell the casualty to remain still and support the injured part with your hands until it is
immobilized. The first aider should place his hand above and below the fracture in such a
way as to support and prevent further movement when moving.
3. Check airway breathing and circulation. Begin CPR in case breathing and pulse is upsent.
4. Loosen tight clothing around the chest, neck and waist.
5. Get help to support the limb while taking care of any wound. Arrest hemorrhage and
cover any open wound immediately. Bandage firmly but loosely.
6. Do not move the casualty until all injured parts have been immobilized, unless in danger.
Do not give anything by mouth. Do not try to replace dislocated bones in its socket.
7. Where bone is sticking out of a wound, place a clean pad around and bandage diagonally.
Do not press down directly on protruding bones.
8. Immobilize the injured part for all fractures by using mechanical, or body splinting.
9. Treat signs and symptoms of shock.
10. Place padding in between the joint and bandage firmly.
11. Elevate the part involved after bandaging to minimize discomfort and swelling.
12. Check for circulation above every bandage every ten minutes and loosen if needed.
13. With 2 or more people, carry unto firm board and transport to the hospital.

Factors that Promote Healing of a Fracture

o The location of the fracture. Fractures at the end of long bones heal faster than that of
mid-shaft.
o Adequate rest and sleep.
o Immobilization of affected part.
o Age of a person. The younger the person, the faster it heals.
o The general condition of the individual. Healing is faster in healthy individuals than
in the sick.
o Adequate nutrition especially foods reach in vitamins C, D, calcium and phosphate.

Splinting. This is the device which is used to immobilize the fractured limb or prevent the
movement of a fractured. There are two types of splinting:
Mechanical splinting: Mechanical splinting: involves the usage of items like sticks,
cardboard, and newspaper. Rules for mechanical splinting:

29
 1. The splint must be strong enough to prevent movement of the broken ends while the
patient is being moved.
2. It must be long enough to fix the joint above and below the fracture, but never over the
site of the fracture.
3. The splint must be well padded with some soft material such as a towel on the side near
the body to fill the holes and protect bony prominences by preventing direct pressure on
the injured part.
4. It must be firmly bandaged in place using ties, belts, handkerchiefs or towels.
Body splinting: Body splinting is when the part of the casualties' body is used in splinting.
Examples of a body part that can be used as a split of the lower limb used to immobilize a
fractured lower limb, or the chest used to immobilize a fractured arm limb. The rule for body
splinting:

1. A bandage should never be allowed to encircle the limb at the actual site of the
fracture, owing to the risk of causing complications it is desirable to apply the bandage
well above and below the site of injury.
2. The bandage above the fracture is always tied before the other one is tied below the
fractured part.
3. Pad should be placed between the injured and supporting parts to supply comfort and
assist in immobilizing
4. The bandage must be firmly applied to prevent further movement of the fragments.
Care must be taken so that the bandage is not too tight to impede circulation. Swelling
may continue to develop after the bandage is applied, therefore adjustment may become
necessary later. Continuing observation is essential.
5. When the patient is lying down, the bandage must be passed under his body to prevent
unnecessary movement. Each bandage is folded over a splint which is then pushed under
his body until it appears on the opposite side. The natural hollows of the body should be
used when necessary.
6. The treatment must be purposeful, gentle and unhurried. The comfort of the patient and
avoidance of movement of the injured part must be the foremost consideration

30
31
Complication of Fracture
Early complication
o Shock
o Avascular necrosis
o Infection
o Pulmonary embolism
Late complication
o Hypostatic pneumonia: As a result of prolonged bed rest
o Paralysis
o Mal-union: There is a faulty union of bone
o Non-union: Failure of ends of the bone to unite
o Delay union: Healing is delayed beyond the average time frame.
SPECIAL FRACTURES
Facial Fractures: Facial fractures can cause distortion to the eye sockets, nose, upper teeth and
palate. There is swelling, bruising, and bleeding from the month and nose. There may be
displaced tissues as well. This may cause difficulty in breathing, and sign of head and neck
injury may be present.

Management:
1. Check the casualties airway. Open and clear the airway if necessary.
2. Place the casualty in a recovery position and transport casualty in the same position
to the hospital for further management.

Fractured skull: Damage to the bone of the skull may not be obvious, however the fracture can
lead to an injury to the brain. There may be discharge of clear cerebrospinal fluid or watery
blood leakage from the ear or nose indicating serious injury. There is a wound or bruise to the
head, soft are of the scalp, impaired consciousness, blood in white of the eye, distortion of the
head or face, and progressive deterioration of response. Fracture to the skull can cause
concussion and compression head injuries.
A. Concussion: This is also known as the brain shaken disease. There is shaking up of the
brain caused by direct force such as collision or a hard blow to the head. This may cause
widespread but temporary disturbance to the brain. Unconsciousness may occur briefly
followed by complete recovery. Advice victims to see the doctor in case they have
headache, feel sick, or tired after recovering.
B. Compression: Compression occurs when part of the cranial bone presses on the brain.
The bone exerts pressure on the brain and there may be bleeding. The accumulation of
blood or swelling can also cause pressure to the brain. The cause is also due to direct
force such as collision or a hard blow to the head. Compression may develop
immediately after the injury to the skull or some hours or even days after the injury. This

32
 is characterized by: deterioration of level of responsiveness, intense headache, noisy
breathing, slow, but full and strong pulse, weakness or paralysis of one side of the face or
body, dilated or unequal pupil, high temperature or flushed face, drowsiness, and
irritability.
Management
1. Injury to the skull should be referred to the hospital immediately because of its role
in protection the brain.
2. Place unconscious casualties in the recovery position.
3. If casualty is conscious, help the casualty to lie down with the head and shoulders
raised.
4. Monitor the casualty's breathing, pulse and level of responsiveness. Get ready to
provide CPR when breathing stops and pulse is absent.
5. In case of an opened fracture to the skull, components of the brain may be
exposed. Do not attempt to push any brain component back.
6. Cover the exposed component with a clean non fluffy material or sterile dressing if
available soaked in warm saline water and transport the victim immediately to the
hospital.
7. If the wound has not exposed matter, cover the wound with a sterile dressing and
bandage firmly but not tightly to stop the bleeding and prevent bacteria from
entering.
8. Transport the victim to the hospital immediately for appropriate management.
Fracture to the cheekbone and Nose: This is a common type of fracture and is usually due to a
blow from fighting. There is swelling of the check and nose, and blockage of the airways.
Casualty must be sent to the hospital for further management.
Management:
1. Apply a cold compress to reduce swelling.
2. Stop nose bleeding if necessary.
3. If there is cerebrospinal fluid discharge from the nose. Treat as a skull fracture.
4. Transport the casualty to the hospital immediately.
Fracture mandible- This is normally because of a direct force such as a heavy blow to the jaw
or a direct fall of the chin to the ground. A blow to one side of the jaw may cause a fracture to
the other side.
Management
1. Sit the casualty down comfortably in a chair and warn them not to speak
2. Instruct him to lean slightly forward to allow any blood, or fluid to drain away.
3. Place the palm of your hand against the injured side and press it gently.
4. Encourage casualty to spit out any loose teeth.
5. Maintain a patent airway.
6. Apply a clean dressing to any wound.
7. Place a soft padding against the jaw and ask casualty to support if able. Or the
upper jaw can act best as a splint: therefore, press the lower jaw up against the
33
 upper jaw (clenched teeth position) and apply a barrel bandage to maintain this
position.
8. Treat for shock or prevent it
9. The casualty should be transported to hospital for an X-ray as quickly as possible
in a sitting up position unless contraindicated.

Fractured clavicle – This part of the body also referred to as the collar bone. Rarely do collar
bones occur from a direct force. They are usually caused by indirect force transmitted from the
shoulder or a fall on to an untrenched hand
Management
1. Immediately support the arm on the injured side with the aid of an assistant.
2. Sit the casualty down place the arm on the injured side across the chest and ask
casualty to support it at the elbow.
3. Support the arm with an elevation or arm sling.
4. Apply pad between the upper arm and the chest.
5. Bind the arm to the casualty’s trunk by another sling.
6. Check for signs and symptoms of shock. Treat for shock if present.
7. Transport the casualty to the hospital.

34
Fracture of the spine - All injuries to the neck should be considered as fracture until after the
diagnosis. The casualty should be seen by the doctor within a short time.
The danger lies in the injury of the spinal cord.
Management
1. In a spinal injury, the casualty should be treated as with the possibility of further
injury to the spinal cord.
2. Warn the casualty to lay absolutely still without a pillow and must not be moved until
sufficient people are present to lift him on to a stretcher without the back being bent.
3. Do not allow the casualty to lift his head.
4. There is difficulty in “splinting the back” therefore try to immobilize the whole body
by placing pads between the ankles, knees and thighs and tie the legs firmly together.
5. When lifting the casualty on to a stretcher keep the body absolutely still and lift the
body in a straight line.
6. If a neck injury is suspected, place a rolled up blancket or materials on either side of
the casualties’ neck and shoulder. Immobilize the neck with a neck collar or any soft
material available.
7. In an unconscious state, ensure the breathing is not obstructed. Keep the mouth clear
of saliva and the tongue forward. Perform CPR when necessary. Use the Log-Roll
Techniques to place the unconscious spine injury casualty on the back to perform
CPR. Six people are needed to do perform this technique. The Log-Roll technique
will also be used to roll the casualty onto the stretcher.
8. Treat shock if it is present.
9. If the neck is broken, transport him lying flat on his back and keep the head
absolutely still by placing a padded stone, brick or other suitable rigid splint on either
side of the head.
10. Arrange to transport the casualty to hospital as quickly as possible

35
Things to be cautious of when transporting a casualty with spinal injuries
When transporting an injured person with a suspected spinal injury the first aider must avoid the
following actions:

a. Sit down or lift the victim, try to move him.

b. Transport the patient sitting or on his side.
c. Change the position of the limbs, pull them or pull.
d. Try to straighten the vertebrae.
e. Giving medication without the patient's permission.
f. Raise your head.
g. Give a drink, even if the victim really asks.
h. It is forbidden to deliver the victim to the hospital on their own, this should be done by a
team of ambulance doctors. Self-transportation is allowed only in emergency cases.

Fracture of the humerus: This can occur at any part of the humerus. There are three main parts
namely
 Upper third – nearest to the shoulder
 Middle third – nearest to the shaft

36
  Lower third – nearest to the elbow
Management
1. Do not try to move the injured arm. However, for elbows that can bend, if the pulse at
the elbow is absent, gently straighten the elbow until the pulse returns and support the
arm.
2. Sit the casualty down gently and support the affected arm.
3. Place a triangular bandage on the unaffected shoulder.
4. Carry gently the fractured arm over the chest and rest it on the opposite shoulder.
5. Carry the tip of the hanging ends of the triangular bandage over the shoulder.
6. Secure the bandage in position at the back of the neck.
7. Hold the tip of the triangular bandage and fold it inn and secure with a pin.
8. For fractured elbow that cannot bend, lay the casualty flat on the back. Apply a soft
padding such as towel or cushion around the elbow to provide comfort and support.
9. Check the injured wrist pulse every 10 minutes.
10. Transport the casualty to the hospital.
11. To transport a casualty with an injury to the elbow that cannot bend. Place a padding
in between the injured arm and the body. Bandage the injured limb to the trunk. First
at the wrist and hip, then above and below the injured elbow.

37
Fracture to the forearm and wrist: This is injury to the radius and ulna due to a heavy blow.
These fractures are often open with wounds. When the lower end of the radius is fractured this is
known as Colles’ fracture. The Colles’ fracture is the most common fracture to the wrist usually
suffered by older women who fall on their outstretched hands.
Management
1. Sit casualty down gently and support the injured forearm across the chest.
2. Carefully expose and treat any wound if present.
3. Place a triangular bandage between the chest and the injured arm and
surround the forearm with a soft padding or material.
4. Tie the arm and the padding in arm sling to immobilize the part.
5. If necessary, secure the limb to the chest using the broad fold.
6. Transport the casualty to the hospital in a siting up position.

38
Injury to the Lower Limb: This is injury to the hip, thigh, knees, and lower leg. This may be
due to a direct force such as from a road traffic accident or a fall from a height, violent twist, and
a strain.
Management
1. Lay casualty down on the back and support the injured limb.
2. Straighten the limbs gently.
3. Treat for shock and cover the casualty to provide warmth.
4. Do not elevate the limbs.
5. Immobilize the limb by doing body splinting with the uninjured limbs.
a. Gently bring the uninjured limb towards the injured one.
b. Gently slide two bandages under the knees, and put one above the
fractured site, and the other one below the fractured side by sliding
backwards and forward.
c. Place one bandage under the knees if there is no fracture to the knees
and place a second one under the ankle to support the feet.
d. Place paddings in between the thigh, knees, and ankles before tying.
e. If injury is to the knees, place a soft padding on the injured knees and
bandage carefully in place.
f. Gently expose any wound and treat before immobilizing the injured
limbs.
g. Transport the casualty to the hospital. If transporting the casualty to
the hospital, place extra padding such as a blanket on either side of
the limb and secure it with a broad fold.

39
DISLOCATIONS
This involves the displacement of one or more bones from a joint. The structures surrounding the
joint such as the ligaments, muscles, tendons, and blood vessels are usually affected. Tendons
and ligaments are usually stretched or torn. The joints most frequently affected are the elbow,
shoulder, thumbs, fingers, and the lower jaw.
Type of Dislocation
1. Fracture with Dislocation: In this type, there is a fracture accompanying the
dislocation, usually caused by a fall or a blow.
2. Compound Dislocation: In this type there is communication with the joint from the
outside via an external wound.
3. Complete Dislocation: This type is associated with complete separation of the joint
surfaces.
4. Congenital Dislocation: This type of dislocation is present from birth.
Signs and symptoms
1. Pain at the affected site.
2. Shock may occur depending on the severity of the pain.

40
 3. There is swelling and tenderness at the joint.
4. There is deformity of the part.
5. Inability to move the part.
6. There is discoloration of the tissues around the part involved.
Management
1. Remove the casualty from danger or vice versa and reassure.
2. Advise the casualty to be still
3. Immobilize the injured limb or joint.
4. Apply a sling to support the part of the dislocation on the upper part.
5. Prevent or treat shock.
6. Apply cold compress to the swollen part.
7. Check for pulse and respiration rate, the level of responsiveness
8. Check the circulation beyond the bandage every 10miutes
9. Send casualty to the hospital.

SPRAIN
This is an injury from the tearing of ligament, muscles and tendons connected to a joint. There
may be partial or complete tearing during a sprain injury. This may be caused by extreme
twisting motion as in acrobatics gymnastic, vigorous exercises and falls

Signs and Symptoms

1. Inability to move the joint
2. Bruising may appear later
3. Pain around the joint that is severe on movement.
4. Swelling and tenderness at the joint or over the point of injury.
5. Discoloration of the skin over the area due to rupture of small vessels.
6. Shock may occur
Note: Unless it is properly treated, it may occur repeatedly and cause disability.
Management
1. Sit the casualty down and support the affected part.
2. Reassure the casualty to alley anxiety.
3. Support the injured part in a comfortable position.
4. Restrict movement until a protective support has been applied.
5. Apply cold compress initially to relieve swelling, pain and bruising and after 24 hours
apply warm compress
6. Raise the affected limb to reduce swelling
7. Treat or prevent shock
8. Seek medical aid.

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STRAIN
This is an injury from the over stretching of muscles, ligaments and tendon around a
joint. Most serious strains are those involving muscles of the back which are usually
caused by lifting heavy, falls or vigorous exercises during a sporting activity. An example
is a muscle pull.
Signs and Symptoms
1. Pain around the joint and severe on movement
2. Swelling and tenderness at the joint or over the point of injury
3. Inability to move the joint
4. Discoloration of the skin over the area due to rupture of small vessels.
5. Bruising may appear later
6. There may be shock if pain is severe
Management
1. Study the part and support if for back strain.
2. Lay casualty on a firm surface.
3. Apply cold compress if present.
4. When in doubt, treat as a fractured spine.
5. Send casualty to the hospital.

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CHAPTER SIX
UNCONSCIOUSNESS
Unconsciousness is when a person is unable to respond to people and activities/ Unconsciousness
is the state in which a person is unable to respond to stimuli and appears to be asleep. It usually
results from interruption of the brains normal activities. Follow the rules below when managing
an unconscious casualty:
1. Ensure that the airways are clear. If the unconscious casualty is lying on the back with the
face up there is usually an obstruction in the airways.
2. Keep checking for the level of responsiveness. Make a rapid assessment using the AVPU
code. Make a detailed assessment using the simplified Glasgow Coma scale (Figure
below). Repeat checks every 10 minutes.
A-Alertness
V-Response to Voice
P-Response to Pain
U-Unresponsiveness time
3. Examine the casualty thoroughly. Unconsciousness maybe associated with other injuries
so it is important to examine the casualty completely to prevent further injury.

43
Examination of an Unconscious Patient
1. Find out from observers whether the onset was sudden or gradual.
2. Examine if the unconsciousness is complete or partial.
3. The pulse may be weak and rapid, find out if the pulse beat is regular. Check the apex
beat of the heart.
4. Breathing – Watch the chest and abdomen for the movement of the respiratory muscles.

44
 5. Eyes – The patient will blink in any state of consciousness when the eyeball is touched
with light. the pupil become large in the following: shock and excitement and alcoholic
poisoning
6. The position of the patient whether he or she is laying in a natural or unnatural position.
7. Color of the face, be it pallor, cyanosis, blue on the skull.
8. Whether there is any hemorrhage.
9. Whether there are wounds present particularly on the skull
10. Whether there is any specific odor from the patient’s mouth (breath). Such as alcohol or
sickly sweet smell which may be present in diabetic coma.
11. Whether there are convulsive movements or whether the patient is absolutely still.
12. Whether the pulse rate is rapid and weak or slow and bounding.
13. Whether the respirations are rapid and slow deep and shallow “air hunger” type.
14. Whether there is any specific container around the casualty.
15. Whether the casualty is wearing any specific identification tag.
16. Find out the level of consciousness of the casualty.
Do not try to arouse the patient and protect him from embarrassment by preventing
onlookers.
Levels of Conscious State
1. Fully conscious.
2. Disorientation in time and space, although the person is still capable of answering simple
questions such as his name and address although he does not know where he is
o The person cannot answer questions but can obey instructions or orders such as
sitting down and lying down.
o The person does not respond to the spoken words but responds to the painful stimulus
as pricks with pain.
o The person is completely unresponsive to spoken words or painful stimuli.
Stages of Unconsciousness
1. Stupor – partial consciousness.
2. Coma – a state of complete unconsciousness.
3. Coma Vigil – a state of complete unconsciousness when the casualty’s eyes are wide
open.
Causes of Unconsciousness
1. Shock
2. Poisoning by alcohol, gases or fumes, drugs e.g. cocaine.
3. Cerebro-vascular accidents (CVA) sudden unconsciousness
4. Asphyxia and its various causes
5. Diabetic and insulin coma
6. Injury to the brain
7. Disease of the brain (e.g. tumor)
8. Fainting (syncope)
9. Uremia and eclampsia
45
 10. Cerebral anemia
11. Epilepsy.
General Care of the Unconscious Patient
1. If there are no particular injuries and the patient’s face is pale with cold, clammy skin,
place him in the prone position with the head turned to the side.
2. Clear any saliva from the mouth and ensure that the tongue is well forward.
3. If the face is flushed, the patient should be placed on his or her back with his head and
shoulders raised slightly on one pillow.
4. Undo tight clothing around the neck, chest and waist.
5. Ensure sufficient fresh air around the patient by opening windows if indoors or keeping
onlookers at a distance if out of doors.
6. If breathing has ceased, start artificial respiration.
7. If the heart beat stops or pulse is absent start cardiac massage
8. Give nothing by mouth.
9. Keep the patient reasonably warm, place coat and rug under and over the patient.
10. Examine the patient for hemorrhage or injuries of any kind.
11. Treat the patient for any visible injuries hemorrhage or fracture.
12. Find the cause of the unconsciousness from the accompanying relatives if known to them.
13. Conduct a thorough examination and look for any bracelet or a warning card
14. Treat for shock or prevent it
15. Send for medical aid or arrange for immediate transportation to the hospital
Fainting (Syncope)
Definition: It is a brief loss of consciousness resulting from a temporary reduction of blood flow
to the brain, causing a lack of oxygen supply to the brain. Fainting can be classified as a mild
form of shock. As compared to shock the pulse for fainting is very slow but returns to normal
soon. Recovery is also faster and more complete. Signs and symptoms include brief loss of
consciousness, slow pulse, and pale, cold skin, and sweating. There are various causes of
fainting.
Causes of Fainting
o Fatigue
o Fight
o Pain
o Anemia
o Poor ventilation
o Exhaustion
o Anxiety
o Severe emotion (Bad news or Fear)
o Starvation
o Injury to part of the body
o Debilitating illness

46
Management of Fainting
1. Assure and reassure the casualty.
2. Lay the casualty down, and raise the legs and support the legs.
3. Ensure casualty has enough well by keeping the environment well ventilated.
4. As casualty recovers, support into a sitting up position gradually.
5. If the casualty does not regain consciousness. Open the air, and check for breathing and
pulse. Perform CPR when necessary.
6. Encourage the casualty to take deep breaths.
7. If the individual is standing on a parade ground or in a crowd, advised to tighten and
relax the leg muscles, especially the toe until circulation improves.
8. Call the emergency services for help.
Stroke/Apoplexy
This is a condition in which there is a sudden and serious impairment of blood supply to the
brain due to a blood clot or a ruptured artery. Stroke is common in persons with high blood
pressure or other circulatory disorders and usually occurs in later life. The effect depends on the
part of the brain that is affected. People who suffer minor strokes recover completely. Major
strokes can be fatal.
Signs and Symptoms
o Sudden severe headache
o Confusion and altered emotional mental state
o Sudden or gradual loss of consciousness
o Signs of weakness or paralysis
o Drooping and dribbling mouth
o Slurred speech
o Loss of movement of the limb
o Unequal size pupil
o Loss of bladder and bowel control
Management
1. Call the emergency services immediately
2. Open the airway, check for breathing and pulse. Perform CPR when necessary.
3. Place casualty in the recovery position if breathing and pulse is normal.
4. Monitor and record breathing, pulse, and the level of consciousness every ten minutes.
5. Loosen all tight clothing around the neck, chest, and waste.
6. While waiting for help to arrive, put casualty down with the head and shoulders slightly
elevated and turn the head to one side. Place a towel or cloth on the shoulder to absorb
the dribbling.
7. Do not give anything by mouth.
Epileptic Seizures
Definition. This is a symptomatic condition that affects nerve function, characterized by sudden
recurrent fits and unconsciousness.

47
Incidence
o Affects all ages.
o Commonly affect adolescence and young adults.
o Affect males more than females.
Risk Factors
o The main cause of epilepsy is not known.
o Injury to the brain and spinal cord.
o It may be hereditary.
o Brain tumors or abscesses.
o High blood pressure.
o Birth trauma.
o Congenital malformation.
o Infections such as septicemia, and meningitis.
o Drugs or alcohol intoxication.
Types of Seizures
1. Grand mal or major.
2. Petit mal or minor.
Minor or Petit Mal
Minor epilepsy last for few seconds. It is characterized by fleeting periods of
unconsciousness which may pass unnoticed. Casualty may become pale with eyes fixed
and staring. There is slight and localized twitching of lips, eyes, head or limps. Period is
so short that casualty may not fall down. Casualty may assume previous activity as
though nothing has occurred

Major or Grand Mal

This follows particular sequence of events namely:
o Aura phase or stage of warning.
o Tonic phase
o Clonic phase
o Coma phase
Aura phase
This stage lasts for few seconds. The casualty may have a feeling that he is about to
experience an epileptic seizure. The casualty may also have an unpleasant taste or smell. May
experience symptoms such as restlessness, feeling of lethargy headache or smell.
Tonic phase
Last for 30 seconds. Casualty suddenly losses consciousness and falls to the ground with a
cry making no attempt to save himself. The whole muscles of the body become rigid with hands
and teeth clenched. Breathing becomes obstructed by the tonic contraction of respiratory
muscles. The face becomes cyanosed with engorged veins around the neck.

48
Clonic phase
Last for 60 seconds or 1 minute. The rigid muscles relax and contract rapidly again, and the
whole body is convulsed with twitching and jerking. The tongue may be badly bitten.
Casualty begins to foam at the mouth. There may be incontinence of urine and feces.
Twitching will gradually become less violet and cease.
Coma phase
Last for 30 minutes. Casualty falls into a deep sleep. During this period, muscles relax. Colour of
face return to normal. Breathing becomes normal.
Management of seizures
Aura phase
o Educate the casualty to find a safe place to sit when about to experience an attack.
Tonic phase.
o Remove casualty to a safe environment if possible or remove dangerous objects
around.
o Lay him flat on the back.
o Insert a firm padded article in between the teeth before muscles go into spasms to
prevent biting tongue.
o Ensure proper ventilation.
o Loosen tight clothing around chest, neck and waist.
Clonic phase
o Support casualty’s head with pillow or any soft material.
o Guide the movement of the body to prevent injury.
o Wipe any foam / frothy substance from the mouth.
o Keep careful watch for possible recurrence and do not leave casualty alone.
o Do not restrain during twitching.
Coma phase
o Put in a comfortable position.
o Allow to gain consciousness gradually and don’t attempt to wake him up.
o Keep a careful watch for possible recur.
o After recovery, advice victim to see a doctor with a written document with
observation during the attack.
Observation During seizure
o Duration of fits and exact time.
o Part of the body is involved during the attack.
o Presence of incontinence of urine or feces.
o Any particular attitude present e.g. twitching of head to one side or side of the
body involved more than the other.
o Where twitching started.
Health education on seizures

49
 o Victims are encouraged to join an epileptic association.
o Victims should always have to carry epileptic cards wherever they go.
o Persons with the disease must be advised against alcohol intake.
o They should be advised against certain jobs like driving, mason, carpentry etc.
o Victims are advised to look for safe place to sit or rest, whenever there is a
warning sign.
Status Epilepticus
This is a medical emergency or life-threatening neurologic disorder from prolonged epileptic
crisis. The person experiences prolonged seizures which usually last longer than 5 minutes or the
person has more than 1 seizures within 5 minutes or the seizures occur very close together.
Usually the person does not recover fully and needs immediate medical attention to prevent the
persons from experiencing a permanent brain damage or death.

Infantile Convulsions (fits in children)

A convulsion of fit consists of involuntary contractions of many muscles in the body because of
disturbance in the function of the brain.
Causes of Convulsions
o Infectious diseases such as measles, malaria, ear and throat infections.
o Worm infestations.
o Teething
o Severe constipation.
o Head injury
o Gastrointestinal upset.
o Birth injury
o Hypoglycemia
o Hypoxia
Signs and Symptoms of Convulsions
o There is violent muscle contraction with clenched teeth and an arched back.
o The head is thrown backwards with a stiff neck.
o Skin is pale.
o High temperature occurs in infections and teething.
o Rolling up of eyeball with dilated pupils.
o Breath ceases for about 2 seconds.
Management is the same as that of epilepsy.
Preventive management of convulsions
o Children must be educated on proper hand washing with soap and water before
eating and after visiting the washroom.
o There should be a high intake of clean water and a fluid diet.
o Mothers should immunize their children against childhood diseases.

50
 o Infections and injuries should be treated well in the health sector.
o Cups, toys and other utensils used by children must be washed with soap and
water.
o There should be proper toilet training for children.
o Children must be educated on the habit of putting objects in their mouths.
o Mothers must be encouraged to give fresh fruit and vegetables to children.
Diabetic and Inulin Comas
This is a condition which is experienced by known diabetics. Diabetic coma can lead to
unconsciousness and can be life-threatening. High blood sugar (hyperglycemia) or dangerously
low blood sugar (hypoglycemia) can lead to a diabetic coma. If it's not treated, a diabetic coma
can result in death. Insulin Coma is usually due to hypoglycemia.
Signs and symptoms of Hyperglycemia
o Increased thirst
o Frequent urination
o Blurred vision
o Tiredness or weakness
o Headache
o Nausea and vomiting
o Shortness of breath
o Stomach pain
o Fruity breath odor (faint smell of acetone)
o A very dry mouth
Signs and symptoms of Hypoglycemia
o Shakiness
o Anxiety
o Tiredness or drowsiness
o Weakness
o Sweating
o Hunger
o A feeling of tingling on your skin
o Dizziness or lightheadedness
o Headache
o No sugar trace in urine
o Difficulty speaking
o Blurry vision
o Confusion
o Loss of consciousness

Management

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 1. Sugar – Before unconsciousness, give two lumps of sugar with a copious drink of water
to be repeated in fifteen minutes if symptoms persist.
2. Rest – The patient should be advised to lie down and rest quietly. A movement of the
body involves the use of sugar, and the symptoms of insulin poisoning are caused by a
lack of sugar in the blood.
3. If unconscious, open the airway and check for breathing and pulse. Perform CPR of
necessary.
4. Place the casualty in a recovery position
5. Monitor and record breathing, pulse and level of responsiveness every 10 minutes.
6. Send for medical aid when the patient becomes unconscious.
NB: Some diabetic patients carry on themselves their identity cards and in case of emergency,
the first aider can pick it up and call his or her doctor for treatment. They also carry some sugar
with them to take at the slightest sign of insulin reaction.

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CHAPTER SEVEN
ASPHYXIA
Asphyxia is when the body doesn’t get enough oxygen through the process of inhalation. An
asphyxiated person is unable to inhale and exhale air.

Causes of Asphyxia
There are many causes of asphyxia. This includes:
 Drowning
 Inhalation of chemicals
 Strangulation (squeezing the throat tightly)
 Foreign body in the throat
 Severe allergic reactions
 A condition such as Asthma
 Incorrect body position
 Seizures
 Overdose of drug

Signs and Symptoms of Asphyxia

 hoarse voice
 sore throat
 difficulty swallowing
 shortness of breath
 hyperventilation
 worsening of existing asthma
 anxiety
 poor concentration
 headache
 blurry or reduced vision

53
  loss of consciousness

Management of Asphyxia
1. Artificial respiration
2. Cardiopulmonary Resuscitation (CPR)
3. Heimlich maneuver
4. Oxygen therapy

ARTIFICIAL RESPIRATION
This is the forcing of air into the lungs of someone who has stopped breathing, usually
by blowing through their mouth or nose, in order to keep them alive and to help them
to start breathing again. There are various types of Artificial respiration

1. Schaffer’s Method
Schaffer's method is one of the methods of artificial respiration.
a. Casualty is laid on the belly, with one arm extended directly overhead and the other arm
bent at the elbow.
b. The face is turned outward and resting on the forearm. This position allows the nose and
mouth to be free for breathing.
c. Kneel to the casualty’s waist and put your palm on the patient’s loin.
d. Apply the pressure by bending forward, and pushing the abdominal viscera to bring about
the expiration. Pressing forward expiration takes place and the bending backwards
inspiration takes place.
e. Expiration lasts for 3 seconds, and the inspiration lasts for 2 seconds.
Advantages: Performed in prone position, so that water from the abdomen and lungs can be
easily drained, it is a very simple method, non-tiring, and it can be continued for a long time.
This method can be used when there are injuries to to the thorax or back.
Disadvantage: Inspiration is passive and the expiration is active, which is not physiological. This
method is not applied to patients with injuries in the abdomen.

54
55
2. Sylvester’s Method
a. Casualty is put in the supine position with a pillow below the shoulder and the neck is
fully extended.
b. During this method, kneel near the victim’s head, facing the victim.
c. Catch the victim’s wrist and by bending pull the victims’ arms up, this will result in
inspiration.
d. Then bending forward put deep pressure on the chest with the victims hand, this will
cause expiration.
e. In this method, inspiration should last for 3 seconds and expire for 2 seconds.
Advantages: Both inspiration and expiration are active, so good ventilation is obtained.
Disadvantage: There is no drainage of water from the lungs, due to the supine position of the
patient, so this method should not be used in cases of drowning. This method is quite tiring, so
assistance is required for this and if there is a rib fracture or thorax this method cannot be
applied.

56
Mouth-to-Mouth Respiration: This is one of the best methods of artificial respiration.

Steps in Mouth-Mouth Respiration.

1. Lay the victim flat on the back (supine).

2. Kneel beside the casualty closer to the shoulder.
3. Remove any obstruction from the mouth.

57
 4. Keep the airway open by tilting the head back and pinching the nose.
5. Take in a deep breath, place lips over the mouth of the victim and make a seal around the
lips.
6. Blow air into casualty’s mouth until chest rises.
7. Release the nose after each breath.
8. If victim responds to breathing, place in recovering position.
9. In absence of breathing, continue with effective breaths until medical aid is sought.
10. Make no more than 5 attempts to give 2 effective breaths before moving on to the next
step.

Adult Mouth-to-Mouth Respiration

To give mouth-to-mouth to a child and Infant:
1. Open the child’s airway by placing one hand on the forehead or top of the head and your
other hand under the chin to tilt the head back.
2. Pinch the soft part of the nose closed with your index finger and thumb.
3. Open the child’s mouth with your thumb and fingers.
4. Take a breath and place your lips over the child's mouth, ensuring a good seal. For an
infant, cover the mouth and the nose with your mouth, creating a seal.
5. Give 2 gentle breaths for about 1 second, watching to see the chest rise and then release.
6. Following the breath, look at the child’s chest and watch for the chest to fall. Listen and
feel for signs that air is being expelled. Maintain the head tilt and chin lift position.
7. If their chest does not rise, check the mouth again and remove any obstructions. Make
sure the head is tilted and the chin lifted to open the airway. Check that your mouth and
the child’s mouth and/or nose are sealed/closed together, so that air cannot easily escape.
Take another breath and repeat.
8. If breathing does not return to normal and pulse is absent begin CPR immediately.Give
30 compressions followed by 2 breaths, known as “30:2”. Aim for 5 sets of 30:2 in about
2 minutes
9. Continue the cycle until the child/infant recovers. If breathing and pulse return to normal
put the child in a recovery position while waiting for the emergency team.
10. Transport casualty to the hospital immediately.

58
Child Mouth-to-Mouth Respiration Infant Mouth-to-Mouth Respiration

CARDIOPULMONARY RESUSCITATION (CPR)

CPR is a procedure that involves chest compressions to promote blood and oxygen circulation,
and artificial respiration when breathing is absent. It’s used when a person’s heart stops beating
(Cardia arrest). After 3 – 4 minutes, without oxygen, the brain can suffer irreversible damage.

Follow the CAB steps of resuscitation

Circulation
Check for the presence of a pulse, if there is no sign, start cardiac massage or chest
compressions. Cardiac massage or chest compressing is more often combined with
artificial respiration e.g. mouth-to-mouth, etc. as a means of resuscitation.

Airways
 Check and clear the airway by removing obvious objects from the mouth.
 The Head is tilted backwards, and the chin lifted up to allow easy flow of air to the lungs.
 It prevents the weak tongue from blocking the airway.

Breathing
 Check for breathing by putting ears closer to the nose to listen to the possible nose.
 Watch for up and down movement of the chest.
 Draw chicks closer to the mouth to feel for warmth and aim for air from the mouth.
 When the casualty is not breathing normally, start artificial respiration.

59
60
CPR For Adults

a. Kneels beside the patient and place the heels of the hand on top of the other and interlock
it on the lower part of the sternum as seen in the photo below.
b. Keep shoulders and arms straight and press down on the chest against the backbone.
c. Compress the chest at a rate of 100 compressions per minute. It should be faster than 1
second.
d. After 30 compressions, you must give 2 rescue breaths (30:2). To give the rescue breaths
o Open the airway to a past-neutral position using the head-tilt/chin-lift technique
o Ensure each breath lasts about 1 second and makes the chest rise; allow air to exit
before giving the next breath
e. Aim at 5 sets of 30:2 for 2 minutes.
f. Observe the face for possible reactions or cough while applying chest compressions.
g. If there is no response, continue 2 breaths per 30 compressions until medical aid is
sought.
h. Use an AED as soon as one is available.

CPR in Children
1. Place the child on their back and kneel beside them.
2. For a child, place the heel of one hand in the center of the child's chest, with your other
hand on top and your fingers interlaced and off the child's chest.
3. Position your shoulders directly over your hands and lock your elbows.
4. Keep your arms straight.
5. Push down hard and fast about 2 inches at a rate of 100 to 120 compressions per minute.
Perform 30 chest compressions to 2 rescue breaths.
6. Allow the chest to return to normal position after each compression.
For a small child
I. Use a one-handed CPR technique.
61
 II. Place the heel of one hand in the center of the child's chest.
III. Push down hard and fast about 2 inches at a rate of 100 to 120 per minute. Perform 30
chest compressions to 2 rescue breaths.
7. Give 2 breaths open the airway to a slightly past-neutral position using the head-tilt/chin-
lift technique.
8. Blow into the child mouth for about 1 second and ensure each breath makes the chest
rise.
9. Allow the air to exit before giving the next breath.
10. If the first breath does not cause the chest to rise, retilt the head and ensure a proper seal
before giving the second breath. If the second breath does not make the chest rise, an
object may be blocking the airway. Check and ensure there is a patent airway, and
remove any foreign materials blocking the airways.
11. Continue giving sets of 30 chest compressions and 2 breaths until:
a. You notice an obvious sign of life
b. An AED is ready to use
c. Another trained responder is available to take over compressions.
d. Emergency services arrive and begin their care.
e. You are alone and too tired to continue.
f. The scene becomes unsafe.
g. You have performed approximately 2 minutes of CPR (5 sets of 30:2), you are
alone and caring for a baby, and you need to call the emergency services.

CPR for an Infant

62
 1. Position on the back while supporting the neck and head. As shown in the photo below
2. Cover your mouth and nose with your mouth to provide artificial respiration
3. Give one (1) slow gentle breath, lasting for a second with the rise of the chest.
4. This should be gentle to avoid damage to the lungs.
5. In the absence of a pulse, start chest compressions.
6. Place 2 fingers or two thumbs at the centre of the chest or breastbone, below the
imaginary line between the nipples.
7. Push down 1/3 the thickness of the chest at a rate of 100/minute.
8. Give two rescue breaths after every 30 compressions. Cover the mouth and the nose with
your mouth, creating a seal, and give 2 gentle breaths, watching to see the chest rise and
then release.
9. Continue with infant compressions and rescue breaths until help arrives.

CARE AND USE OF RESUSCITATIVE DEVICES

Nebulizer
A device that turns liquid medicine into a mist. It can also serve as a delivery device used to
administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly
used for the treatment of respiratory diseases or disorders such as cystic fibrosis, asthma, COPD.
As the casualty breathes breath, the mist of medicine moves into your lungs. The medicine may
be antibiotic or other medicine for the lungs.

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How to use a nebulizer
1. Wash hands with soap and water before preparing the device for use.
2. Prepare the machine.
3. Place the device on a hard surface
4. Check to see if the air filter is clean; if dirty rinse using cold water and let it air dry.
5. Plug in the machine.
6. Prepare the medicine.
7. Place medicine in the nebulizer medicine container.
8. Add saline if needed.
9. Connect the container to the machine using the tubing.
10. Connect the mask or mouthpiece to the top of the container.
11. Place the mouthpiece between the casualties teeth, and close to the lips around it, or
instead place the mask on the face.
12. Turn on the machine, keep the medicine container in an upright position.
13. Ask the casualty to breath in and out slowly and deeply through your mouth until the mist
is gone.
14. The treatment is over when all the medicine is gone or there is no more mist coming out.
15. The whole treatment may take up to 10-20 minutes

Care for a nebulizer

o After each treatment, rinse the nebulizer cup thoroughly with warm water, shake off excess
water, and let it air-dry.
o Every third day, after washing your equipment, disinfect it with either a vinegar/water
solution or a disinfectant solution.
o Cover the compressor with a clean cloth when you’re not using it. Wipe it with a clean, damp
cloth if necessary.

64
 o Don’t put the air compressor on the floor, either for treatments or for storage.
o Store medications in a cool, dry place. Some need to be kept in a refrigerator, and others
should be kept out of the light. Check them often. If they’ve changed color or formed
crystals, throw them out and replace them
The humidifier
Humidifier therapy adds moisture to the air to prevent dryness that can cause irritation.

Using the humidifier

1. Rinse out the water reservoir; remove the water reservoir and wash with mild soap and
water before use.
2. Add water to the reservoir, once the reservoir is cleaned add some distilled water.
3. Position the humidifier; must be on a level, the raised surface at least 12inches away from
a wall.
4. Turn on and adjust any settings.
5. Clean the humidifier after each use.

Ambu bag
An Ambu bag is a handheld tool that is used to deliver positive pressure ventilation to any
subject with insufficient or ineffective breaths.

65
Method of using the Ambu bag
1. A one-person technique requires the "E-C seal" method where the first and second digits
form a "C" over the mask with the thumb pressing down by the nasal bridge, the second
digit over the bottom of the mask by the mouth, and your remaining three digits forming
an "E" over the mandible to hold the mask tight. There should be no gaps between the
mask and the face. You can also perform the “head-tilt chin lift” maneuver or a “jaw-
thrust” if indicated to maintain airway patency.
2. In a two-person technique, the second rescuer squeezes the bag while the first rescuer
uses the same E-C technique with both hands. This is more effective in delivering the
required tidal volume and also creates a better seal.
3. Ensure that the soft tissue around the neck is not compressed by the rescuer's fingers.

Care of an Ambu bag

o Keep clean after use, wipe with the recommended disinfectant solution
o Always keep the Ambu bag at the patient bedside and make sure that the mask and the
bag are always assembled
Respirator
This is a piece of protective respiratory equipment designed to protect the wearer from inhaling
harmful particulate matter (as In dust, including airborne microbes), fumes, vapour or gases.
There are two main categories of respirator.
1. Air purifying respirator forces contaminated air through a filtering element.
2. Air supplied respirator fresh air is delivered alternatively.

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Care of the respirator
• Inspect before and after each use
• Inspect equipment designated for emergency use
• Make sure there are no holes in the nose piece
• Inspect for cracked and scratched or loose-fitting lenses
• Ensure the metal nose click forms easily over the bridge of the nose on a disposable
respirator
• Do not clean with solvent, wash with a mild dish detergent
• Use a brush and warm water.
DEFIBRILLATOR
Defibrillators are devices that send an electric pulse or shock to the heart to restore a normal
heartbeat. They are used to prevent or correct an arrhythmia, an uneven heartbeat that is too slow
or too fast. If the heart suddenly stops, defibrillators can also help it beat again.

Types of defibrillator
1. AED-automatic external defibrillator
2. MED-manual external defibrillator (used at the theatre)
3. WCD-wearable cardioverter defibrillator
4. ICD-implantable cardioverter defibrillator

What to do before using the defibrillator

 Confirm cardiac arrest.
 Try to wake the person up
 Call an ambulance as soon as you assess is an emergency situation
 Start CPR

How to use the defibrillator

67
 • Make sure the patient is dry. Before you turn on and use an AED, you need to make
sure that the person you are helping is not wet. If they are, you need to dry them off. If
there is water in the immediate area, you need to move the person to a dry place. Water
conducts electricity. If the patient is wet or if there is water nearby, he can be seriously
injured
• Turn on the AED. Once you are sure there is no water, you need to turn on the AED.
When it comes on, it will give you instructions of how to handle the situation. It will
likely tell you to attach the cables for the pads into the AED machine. You typically hook
them up above the blinking light on the top of the machine. It will also instruct you to
prepare the person once the pads are plugged in.
• Prepare the chest area. To use the AED pads, you must remove certain things from the
victim. Open or cut through his shirt. If his chest is very hairy, you will have to shave it.
You should also look for signs of implanted devices, such as a pacemaker. If you see any
metal jewellery or accessory, remove it. The metal will conduct electricity.
• Apply the pads. The electrodes for the AED are typically adhesive pads. The AED will
advise you to put the electrodes or pads in place. You need to make sure that they are
placed correctly so the victim will get the maximum amount of shock necessary. One pad
should be placed below the collarbone on the upper right side of the victim's bare chest.
The other should be placed below the peck or breast on the left, at the bottom of his heart,
slightly along his side.
• Let the AED analyse. Once the pads are properly in place, you need to get everyone
clear of the victim. When everyone has moved back, press the analyse button on the
AED. It will begin to analyse the heart rhythm of the victim.
• Shock the victim if necessary. If the AED advises that you need to shock the patient,
you need to make sure, once again, that the victim is clear. Once you do, push the shock
button on the AED. This will send an electric shock through the electrodes to help restart
the heart. The AED will only give one shock at a time. It doesn't last that long, but expect
him to move with the force of the shock.
• Shock the victim if necessary. If the AED advises that you need to shock the patient,
you need to make sure, once again, that the victim is clear. Once you do, push the shock
button on the AED. This will send an electric shock through the electrodes to help restart
the heart. The AED will only give one shock at a time. It doesn't last that long, but expect
him to move with the force of the shock.
• Continue CPR. Once you have given the victim a shock, you need to continue CPR. You
should do it for 2 additional minutes and then let the AED check for a heart rhythm again.
Keep this up until emergency services arrive. You should also stop if the victim can
breath on his own or if he regains consciousness
• The AED will likely remind you when 2 minutes has passed and tell you to stop CPR

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ECG-ELECTROCARDIOGRAM
An electrocardiogram (ECG) is a simple test that can be used to check your heart's rhythm and
electrical activity. It is used to measure the amount of current passing through the heart muscles
and finds the cause of unexplained chest pain and pressure in the heart. ECG is also used to
detect where the heart walls become thickened or enlarged and the supply of blood to the heart is
suddenly blocked by factors such as a build-up of fatty substances.

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CHAPTER EIGHT
POISONS
A poison is any substance that when introduced into the body or applied externally in a
sufficient amount causes harm and destroys tissues. Poison may enter the body via the following
routes:
o By ingestion (through the mouth) – eating drinking and swallowing food or water.
o By inhalation (by being breathed in) – inhaling gases such as coal, carbon monoxide,
fume or chlorine.
o By absorption (through the skin) – occasionally through wounds caused by chemicals,
animal bites or insects stings.
Causes of Poisoning
1. Accidental Poisoning – This is the commonest cause and may occur in several ways.
(a) By eating contaminated food
(b) By drinking contaminated water or drinking poisonous liquid from wrongly labeled
bottles.
(c) By accidentally taking an overdose of a medication or sleeping tablets. This
frequently happens with children as they may gain access to drugs and eat them
mistakenly for their sweets.

2. Suicidal Poisoning – Attempted suicide must always be suspected when a healthy person
is found obviously ill but has made no effort to come or send for help. Usually, there has
been a history of mental depression and threat to commit suicide.

3. Murder or attempted murder may be carried out by the introduction of poison which may
be given in large dose or repeated small doses.

General Signs and Symptoms of poison

The Signs and Symptoms of poisoning vary depending upon the type of poison the casualty has
taken. The presence of a container around the casualty
1. The casualty may be delirious and may have a convulsive attack without a previous
history of epilepsy.
2. There may be Signs and Symptoms of asphyxia
3. Unconsciousness.
4. There may be burns around the casualty’s mouth
5. There may be vomiting
6. The casualty may be having diarrhea which may be blood-stained.
7. There may be a smell of poison in the breath and mouth of the casualty.
Observations to be made
i. look around the casualty to identify any container containing the poison
ii. Observe the lips for burns or edema

70
 iii. Smell the breath to find out if the casualty has taken any poisonous chemicals
iv. Observe the position in which the casualty is lying whether natural or unnatural
v. Observe for any foaming of the mouth
Aims of First Aid Treatment in Poisoning
1. To remove or counteract the effect of the poison.
2. To send for medical help.
3. To arrange for transportation to the hospital as soon as possible because medical
treatment is essential.
4. To identify the poison. All containers, medicine bottles, empty glasses, remains of food
should be kept for doctor’s inspection.
5. Any feces or vomitus should be kept for doctor’s inspection.
6. If death occurs, the police must be informed and nothing in the vicinity of the body
should not be removed or touched until their arrival.

Principles of management of first Aid:

1. Removal of Poisons – This is achieved through the use of the following:
a. Emetics – It is a substance capable of producing vomiting to remove the poison from the
stomach before absorption into the bloodstream. In most cases, the first step in removing a
poison from the digestive system is to give an emetic. It should be given as soon as possible after
ingestion of the poison for the person to vomit the content of the stomach before it passes
through into the intestine. Two table spoonful of salt dissolved in glass of lukewarm (30◦) water
is a common emetic.
b. Aperients – When the stomach has been completely emptied by vomiting, it is often
desirable to give an aperients in order to remove the poison from the bowels which may be
passed through the intestines before the emetics has had time to take effect. The use of aperients
in the form of castor oil or Epson salt is of particular importance in most cases of poisoning.
c. Antidotes – These are remedies which neutralize the effect of poison while it is still in the
body. Some antidotes act by preventing absorption into the blood stream. Others combine with
the poison which has been taken and convert it into a relatively harmless substance. If the poison
is an alkaline, an acid drink can be given. The acid drink is prepared by adding about three table
spoonfuls of soda to five ounces of water or 150mls of water. In some cases of poisoning, it is
possible to give an antidote which in itself is absorbed into the blood stream to neutralize the
harmful effects on the tissue themselves.
d. Demulcents; a demulcent is a substance which soothes irritating mucous membrane. It is given
after the patient has vomited freely. Many poisons produce severe shock and others lower the
action of vital systems of the body. Opium causes a profound depression of the respiratory
system so that artificial respiration may become necessary. Measures to counteract the effects of
a poison on the digestive system includes the administration of demulcent drinks (soothing) like
Mainly water, thick Barley water, Olive oil, liquid paraffin or a paste made of flour and water,
milk which is most palatable. These exert a soothing effect on the digestive organs which may
have been burned or irritated by the poison which has been taken.
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Classification of Poison
The numerous chemicals which can cause poisoning are usually classified into three (s). These
are:
A. Irritant.
B. Narcotics.
C. Corrosive
Irritant Poisoning
These are poisons which irritate and cause inflammation of the tissues of the alimentary canal
which may come into contact. It may be described in three forms.
1. Contaminated animal or food irritants. For example, bad meat, decaying fish,
contaminated tinned (canned) food, paste, make-up foods, imported meat, foods which
are likely be re-heated.
2. Vegetable irritants or poisonous berries or fungi. E.g. Toadstools which may be mistaken
for mushrooms and ingested.
3. Chemical irritants: e.g. mercury, phosphorus and iodine, lead, arsenic, etc. some of the
chemical substances are present in pain and weed killers

Signs and Symptoms of Irritant Poisoning

1. There is burning pain in the mouth, neck, throat and stomach to be followed by nausea
and vomiting.
2. The vomit often contains blood and sometimes shredded (cut or tear) mucous membrane
from the damaged stomach.
3. There are acute abdominal pains which are gripping types to be accompanied by diarrhea.
4. Faintness, shock and great prostration. (extreme physical weakness)
5. Eventual unconsciousness.
The above signs and symptoms appear few minutes to about 36 hours after taking the irritant.
First Aid and Treatment
1. Give an emetic until copious vomiting has occurred.
2. Give an antidote if the actual poison is known.
3. After vomiting profusely, give a demulcent.
4. About 10 minutes after vomiting has ceased, give an aperients.
5. Treat for shock if present or prevent from occurring.
6. Send for medical aid.
Narcotic Poisoning
A narcotic poisoning is any drug which acts on the nervous system and produces a tendency to
sleep. It also reduces the activity of the body function. The effects vary. Examples are:
1. Hypnotics: These drugs induce sleep and unconsciousness. E.g. opium,morphine, heroin,
cocaine and barbiturates such as medical, luminal and phenobarbitone.
Signs and Symptoms of Hypnotic Poisoning

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 o Drowsiness
o Slow respiration.
o Feeble pulse.
o Pin-point pupil.
o Coma and subsequent death.
Treatment
1. If unconscious, keep the patient awake by allowing him to walk about despite the
drowsiness.
2. Give an emetic before the patient passes into coma and repeat at frequent intervals if
necessary.
3. Give an antidote for opium which is potassium permanganate, a dose of 10mg.
4. After vomiting, give a stimulant in the form of hot strong black coffee.
5. Strong aperients such as Cascara or Epson salt should be administered.
6. When the patient is unconscious, check the pulse and breathing carefully and undertake
resuscitation should the respiration show signs of failure and send the patient tot her
hospital without delay for specialized treatment.

2. Delirient: They produce excitement and delirium but these soon lead to unconsciousness e.g.
belladonna and atropine.
Signs and Symptoms
o Dryness of the mouth and throat.
o Thirst.
o Dilated pupils.
o Unsteadiness.
o Delirium.
o Coma
Treatment
1. Give an emetic.
2. Give strong tea or strong black coffee after vomiting
3. Arrange for transportation to the hospital.
4. Send for medical aid: give artificial respiration if the patient is unconscious.

3. Convulsant: They produce twitching of the limbs and eventual unconsciousness e.g. prussic
acid.
Signs and Symptoms
 Anxiousness
 Feeling of suffocation
 Twitching of muscles leading to epileptics from convulsions
Treatment
1. Give an emetic.

73
 2. Give strong tea after vomiting.
3. Arrange for transportation to the hospital.
4. Apply artificial respiration if breathing cease
Corrosive Poisoning
It is one which burns the part of the body when it comes into contact with corrosives. Corrosive
poisoning is of two forms; corrosive acids and corrosive alkaline.
1. Corrosive acids: An acid may be described as a chemical substance which has a sour
taste and which possess the power of changing the color of a blue litmus paper red. The
more important corrosive acids are sulphuric acid, hydrochloric acid and nitric acid.
2. Corrosive alkaline – An alkaline is a chemical substance which readily dissolved in
water to produce a solution with a soapy feel. It has the property of changing red litmus
paper blue. The common corrosive alkalis are caustic soda, caustic potash and ammonia.
Signs and Symptoms of Corrosive Poisoning
 Severe burns around the mouth and lips.
 Difficulty in breathing and speaking.
 Severe pains in the mouth and throat, chest and abdomen.
 There may be nausea and vomiting.
 Severe shock may occur.

Treatment
1. Do not give an emetic to prevent further burns of the mucous membrane when the patient
vomits.
2. Give an antidote if the type of poison is unknown; give copious amount of drink or water.
3. Give a demulcent like milk, oil and thick barley water to soothe the damaged mucous
membrane.
4. Give full treatment of shock.

Carbolic and Detergent Poisoning

Carbolic acid and disinfectants. Action on the human body is a little different from the other
corrosives because they have the effect of hardening the tissues with which they come into
contact in addition to causing burns.
Signs and Symptoms
 There will be a burning sensation in the mouth, throat, neck, chest and abdomen.
 Initially, there may be severe pains also in these parts but the pain soon becomes dulled
due to the anesthetic effect of carbolic and Lysol.
 The patient may vomit.
 The breath presents a characteristic odor of the poison.
 The lips and corner of the mouth are strained with brownish color
 The inside of the cheeks and gums will appear white
 Severe shock is present
First Aid and Treatment
74
 1. An emetic should be given.
2. An antidote should be given after the emetic – ten ounces of medical liquid paraffin
which also acts as a demulcent. Either liquid paraffin or one teaspoonful of Epson salt
dissolved in half a pint of milk can be given.
3. Treat for shock.
4. In severe pain, apply warm fermentation to the neck.
5. Send for medical aid as quickly as possible.

Food Poisoning
Food poisoning can occur when a person ingests or takes in contaminated food or fluids. This is
usually due to taking in food that is not cooked properly or contaminated with bacteria such as
salmonella or E. coli.

Signs and Symptoms

1. Stomach-ache
2. Diarrhea
3. Nausea and Vomiting
4. Fever
5. Dehydration in severe cases
First Aid Management
1. Assure and continue to reassure casualty.
2. Encourage the person to lie down and rest.
3. Ask the casualty to take in sips of water in case of severe vomiting and diarrhoea to
prevent dehydration.
4. Avoid the administration of medication such as anti-diarrhoea unless advised by the
health care professional.
5. When casualty complains of hunger advise them to take light meals or dry foods but
avoid oily and spicy foods, alcohol etc.
6. Ask casualty to seek medical advice if casualty:

a. Has blood in stools.

b. Is an elderly or person with underlying health problems.
c. Is a pregnant woman.
d. Is having severe vomiting and unable to retain fluids when taken in.
e. Is observed to become dehydrated, especially among the population at risk such as the
elderly, babies, or young children.
7. Encourage the casualty to wash their hands frequently with soap and running water to
prevent infection.
8. Encourage the casualty to take a lot of rest even after symptoms have subsided.

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Alcoholic Poisoning/Alcohol intoxication
Alcohol poisoning is when a person takes to much alcohol over a period or a lot at a time, which
becomes toxic in the person’s body. Since alcohol is a depressant, too much of it in the blood of
the individual causes a shutdown in part of the brain. It is sometimes referred to as an alcohol
overdose.
Signs and Symptoms
This starts from mild and later gets severe.
a. A strong smell of alcohol
b. Bluish, gray, or pale skin
c. Dilated pupils
d. Full, bounding pulse, which later becomes a weak, and rapid.
e. Low body temperature
f. Moist and reddened face sometimes flushed
g. Seizures
h. Severe confusion
i. Sleeping a lot
j. Deep, noisy breathing which later becomes shallow
k. Slow responses (such as a gag reflex)
l. Slow heartbeat
m. Vomiting
First Aid Management
1. Assure and continue reassuring casualty.
2. Provide casualty with adequate warmth by covering them but do not overheat.
3. Check the casualty out for injuries such as head injuries or other conditions. If a head
injury is suspected ask casualty to see the doctor.
4. Call the emergency services if you are not sure of the severity of the injury or suspect the
condition is severe.
5. Place the casualty in a recovery position to prevent choking or aspiration from any
vomiting.
6. Monitor the casualties' level of response until they recover or until there is someone to
watch over or take care of them.
7. If the casualty becomes unresponsive provide CPR when necessary.
8. Give the casualty sips of water to drink if there are no signs of injury and casualty is not
vomiting.

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CHAPTER NINE

FOREIGN BODIES
This refers to object living or non-living things which are not part of the body that enters the
body and cause harm and discomfort.
Foreign bodies can be classified into 2 namely animate and inanimate objects.
1. The animate object can be referred to as living things which include flies, worms, and
ants.
2. An inanimate object can be referred to as a non-living thing and can also be classified
into 2 that is vegetative and non-vegetative objects.
o Vegetative objects include grains, leaves, peas, seeds
o Non-vegetative include stones, pins, nails, beads, and buttons.

Foreign bodies in the eye

This is when unwanted substances enter the eyes and cause pain and discomfort
Foreign bodies that can get into the eye include dust, loose eyelash, contact lenses, pepper and
pieces of wood or metals. This can be due to a strong wind blowing, an accident or a person's
carelessness.
Signs and symptoms of foreign bodies in the eye
 Itching
 Blurred vision
 Redness of the eye
 Excessive tears from the eyes
 Eyelids screwed up in spasm
First aid treatment for foreign bodies in the eye
1. Make casualty comfortable by sitting down.
2. Stand beside or just behind the casualty and gently separate her eyelids with your thumb
or finger. Examine every part of her eye.
3. Flush out the foreign body by pouring clean water or immersing the affected eye in a
bowl of water.
4. Encourage the casualty to continuously blink the affected eye to dislodge the foreign
body.
5. If all the above measures fail, apply an ointment like petroleum gel on the eyes, cover
with an eye pad and bandage lightly.
6. Send to the hospital for treatment.
Foreign bodies in the ear
Foreign bodies such as a piece of cotton wool, pieces of broomsticks, small insects like flies, or
an ant and pieces of chalk can get into the ears and get stuck.
First aid treatment

77
 1. Reassure the casualty and ask him to sit down
2. Examine ears to check if the foreign body is removable.
3. If removable, gently bring it out.
4. Where foreign is stuck inside. Advise not to push objects down the inner ear.
5. Send casualty to the hospital.
6. If the foreign body is an insect, pour olive oil into the ears. This will help with the
floating of the insect.
7. Remove the insect when it floats out.
Foreign bodies in the throat
Foreign bodies that can be swallowed and lodged into the throat include coins, safety pins, fish
bones, meat bolus or bone, plastic materials, dentures, beads, and hair grips. Foreign bodies in
the throat can cause choking.
First aid treatment
1. Encourage the casualty to cough.
2. Give up to five back blows. That is let the individual bend slightly downwards and hit the
back five times.
3. Give a sizeable soft food to swallow to push the object down the Gastrointestinal Tract.
4. Call for emergency or help if objects do not remove.
5. Continue monitoring general condition until help arrives.
6. Send casualty to a hospital.
Choking
Choking is a true medical emergency that requires fast, appropriate action by anyone
available. Choking is caused when a piece of food or another object gets stuck in the upper
airway.
Signs and Symptoms
Coughing or gagging
Hand signals and panic (sometimes pointing to the throat)
Sudden inability to talk
Clutching the throat: The natural response to choking is to grab the throat with one or
both hands. This is the universal choking sign and a way of telling people around you
that you are choking.
 Wheezing
 Passing out
 Cyanosis, a blue colouring to the skin, can be seen earliest around the face, lips, and
fingernail beds. You may see this, but other critical choking signs would appear first
 In a choking infant, more attention must be paid to an infant's behaviour. Look out for
signs such as difficulty breathing, weak cry, weak cough, or both.
FIRST AID MANAGEMENT
Choking Adult

78
 1. Have someone call the emergency services
2. Obtain consent from the victim.
3. Lean the person forward and give 5 back blows with the heel of your hand.
4. Give 5 quick, upward abdominal thrusts (Heimlich maneuver).
5. Continue alternating back blows and abdominal thrusts until:
 The obstructing object is forced out.
 The person can breathe or cough forcefully.
 The person becomes unconscious.
If the victim becomes unconscious, follow the steps below for an unconscious choking adult.
1. Give 2 rescue breaths. (If available, use a protective barrier airway, resuscitation mask or
face shield. Rescue breaths should not be delayed because you do not have a barrier or do
not know how to use one).
2. If breaths do not go in, tilt the head farther back. Try 2 rescue breaths again.
3. If the chest does not rise - give 30 chest compressions. Look for an object in the airway.
4. Remove if one is seen.
5. Try 2 rescue breaths.
6. Repeat until emergency services arrive, or the obstruction is removed, and the patient
begins to breathe on his or her own.
7. If the obstruction is removed and breathing and pulse in normal, put the casualty in the
recovery position.

Choking in Children
1. Call the emergency services immediately.
2. Stand behind the child. Wrap your arms around the child's waist.
3. Make a fist with one hand, thumb side in. Place your fist just below the chest and slightly
above the navel.
4. Grab your fist with the other hand.

79
5. Press into the abdomen with a quick upward push. This helps to make the object or food
come out of the child's mouth.
6. Repeat this inward and upward thrust until the piece of food or object comes out.
7. Once the object comes out, take the child to the doctor. A piece of the object can still be in
the lung. Only a doctor can tell you if your child is fine.

Choking in an Infant
1. Call the emergency services immediately.
2. Next, place the baby face down on your forearm.
3. Your arm should be resting on your thigh.
4. With the heel of your other hand, give the child five quick, forceful blows between the
shoulder blades.
5. If this fails, turn the infant on her back so that the head is lower than the chest.
6. Place two fingers in the center middle of the breastbone, just below the nipples.
7. Press inward rapidly five times. Continue this sequence of five back blows and five chest
thrusts until the foreign object comes out or until the infant loses consciousness (passes out).
8. If the infant passes out start to resuscitate.
9. Never put your fingers into the infant's mouth unless you can see the object. Doing so may
push the blockage farther into the airway.

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81
CHAPTER TEN
DROWNING
Drowning is the process of experiencing respiratory impairment from submersion/immersion in
liquid. This can result in death, injury or no injury (WHO, 2021). Drowning is also regarded as a
type of suffocation. Drowning is not always fatal, usually, those that result in death a situation
where the victim is all by themselves or people around are unaware of what is happening to the
victim or cannot save the victim. When a person survives a drowning incident it is regarded as
Non-fatal drowning. Nonfatal drowning has a range of outcomes, from no injuries to very serious
injuries such as brain damage or permanent disability. Children are usually at risk of drowning,
however, anyone can be a victim of drowning.

Types of Drowning
Drowning can be classified into five different types
Near drowning: This type of drowning is used to describe non-fatal drowning when the person
is rescued before the point of death.
Dry drowning: The victim is unconscious but still breathing. As they try to breathe water enters
the pharynx causing closure of the larynx and epiglottis. This leads to water diverting into the
stomach thus the patient to suffocate with the airways closed. Although the patient has drowned
water has not entered the lungs.
Freshwater drowning: When the exchange of gasses in the lungs is interfered with by
freshwater entering the lungs, the body will absorb the water into the blood. This can distort the
normal pH (7.4) of the blood. When the dilution in the blood is severe this can lead to cardiac
arrest when rescue does not happen within 2-4 minutes.
Saltwater drowning: Saltwater drowning is the opposite of freshwater drowning. In this type of
drowning the water is drawn from the blood into the lungs. There is an increase in the thickness
of the blood, causing circulation to become sluggish, and the heart rate gets slow leading to
cardiac arrest. When the victim is not rescued within 12 minutes, cardiac arrest may occur.
Secondary drowning: When a drowning victim is successfully rescued and resuscitated, they
may appear to be fully recovered. But their lives could still be in danger.

Factors that can Lead to Drowning

1. Not being able to swim
2. Lack of close supervision
3. Lack of close supervision
4. Location
5. Not wearing life jackets
6. Drinking Alcohol
7. Using drugs and prescription medications
8. Concussion, seizure, or heart attack while in water

Signs and Symptoms of a Drowning Person

1. Head low in the water with mouth at water level
2. Head tilted back with mouth open
3. Hair over forehead or eyes
4. Eyes closed
5. Eyes glassy and unable to focus

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6. Trying to swim in a particular direction without making progress
7. Appears to be trying to climb an invisible ladder
8. Hyperventilating or gasping
9. Trying to roll over on their back
10. Vertical in the water

Signs and Symptoms of a Drowned Victim

1. Cold or bluish skin
2. Bluish, purple or white colour in face or lip
3. Abdominal swelling
4. Chest pain
5. Cough
6. Shortness or lack of breath/difficulty in breathing
7. Vomiting
8. Lethargy

First Aid Management of Drowning

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 1. Use safety objects, such as life rings and throw ropes, to help the victim if they’re still
conscious.
2. You should only enter the water to save an unconscious person if you have the swimming
skills to safely do so.
3. Make a quick assessment of the casualty.
4. If the casualty is unresponsive or not breathing, call the emergency services.
5. Ask bystanders to locate an AED device if available (do not leave the casualty all by
themselves to find one yourself.)
6. While on the phone with the emergency services (use speaker phone if alone), begin
administering CPR.
7. Start by checking the airway is open and administering five rescue breaths.
8. Follow the rescue breaths with chest compressions. After 30 chest compressions at a rate of
100-120 per minute, provide two rescue breaths. Repeat at a ratio of 30 chest compressions:
2 rescue breaths until the casualty regains consciousness, an AED device becomes
available, or medical help arrives.
9. Be very careful when handling the person and performing CPR, as the individual could
have a neck or spinal injury. Do not move or turn their neck or head. Stabilize the neck by
manually holding the head and neck in place or placing towels or other objects around the
neck to support it.
10. If the person has near-drowned in cold water, remove their wet clothes and cover them in
warm blankets or clothing to prevent hypothermia. Be careful to support the neck while
removing clothing.
11. If the casualty regains consciousness, place them into the recovery position, keep them
warm, monitor their vital signs, and offer reassurance until the emergency services arrive.

Prevention of Drowning
1. Teaching children and adults to swim
2. By avoiding swimming alone
1. Have at least one person present who knows cardiopulmonary resuscitation (CPR).
2. Supervise all children in the water, even if they know how to swim.
3. Limiting or blocking access to water; install a four-sided isolation fence that is equipped
with a self-latching gate and a child-proof lock.
4. Using flotation devices and a life jacket.
5. Avoiding water while under the influence of alcohol or drugs.

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85
CHAPTER ELEVEN
BURNS AND SCALDS
Burns are injuries to the body tissues caused by dry heat while scalds are tissue injuries caused
by wet or moist heat.
Causes of burns
1. Radiation example sunburns, Ultraviolet lights
2. Dry Burn example iron, flames, friction
3. Electricity such as electric current
4. Chemical agents
5. Cold Injury
Scalds
1. Hot water
2. Hot soup
3. Hot porridge
4. Hot oil
5. Steam
Signs and symptoms of the site of burns & scalds
1. Redness
2. Severe pain
3. Increase warmth at the site.
4. Local tenderness.
5. Edema or swelling at the site.
6. Signs and symptoms of shock may occur
7. There be blister formation
Classification of burns & scalds
This is classified according to: Depth of burns (degree) and Extent of burns (area covered)

1. Depth of burns: The deeper the burns the higher the injury. Depth of injury include:
1st Degree (superficial)
2nd Degree (partial)
3rd Degree (full thickness)
4th Degree
Superficial or first-degree burns
 Healing occurs within 3-7 days without treatment.
 No actual destruction of tissues
 Mild swelling at the affected part.
 Only the Superficial layer is affected.
Partial or second degree burns

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  Tissue destruction of both dermis and epidermis.
 Fluid is collected between two layers of skin causing blister.
 Primary shock occurs.
 Heals without treatment 1-4 weeks.
 If it is neglected may turn into third degree.
Full thickness or Third-degree and Fourth degree Burns
 Complete destruction of epidermis, dermis, supporting structures, nerve and bones.
 Absence of pain due to nerve ending destruction.
 Skin is firm to touch like leather.
 There may be no bleeding.
 Skin is insensitive to pin pricks.
 Body is bloated up.
 Blister formation is absent.
 Area involved is black
The Extent of Burns and Scalds
Due to the large surface area of a burn injury, the extent is considered larger than the depth. The
larger the surface area the higher the risk of fluid loss even for superficial burns. If 60% of the
body surface is burnt, the casualty’s chances of survival are low. When 30% of the body surface
is involved, the casualties' chances of recovery is good but will be seriously ill. If the surface
area is larger the casualty is at risk of shock making their condition a fatal one. Therefore,
knowing the surface area of a burn injury is very significant. The extent of burns and scalds must
immediately be estimated. This is usually done by the usage of the ‘Wallace Rule of Nine’
universally. However, some institutions may use other tools to calculate the surface area such as
the Palmers method and the Lund and Browder chart.
Note the part of the body sustaining the burns injury can also contribute to the severity of the
injury.
Wallace Rule of Nine Adults

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 Estimated BSA
Body Part
Adults Children

Entire left arm 9% 9%

Entire right arm 9% 9%

Head & neck 9% 18%

Entire chest 9% 9%

Entire
9%+ 1% (Genitals) 9%
abdomen

Entire back 18% 18%

Entire left leg 18% 14%

Entire right leg 18% 14%

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89
 First aid management of burns and scald.
Aim of management
 Prevent or treat for shock.
 Prevent infection.
 Relieve pain
 Reduce effect of heat.
Don’ts for the First Aid Management of Burns
 don’t apply ice
 don’t apply creams or ointments to the burns
 don’t remove clothing that may be stuck to the burn
 don’t pick at skin or peel away any blisters
Management
1. Remove casualty from the source of danger or danger from casualty.
2. Place injured part under running water or immerse part in cold water for at least 10 min.
3. Remove promptly any constricting objects or material such as rings, or belt bangles before
swelling occurs.
4. Gentle remove clothing soaked in chemical or hot liquid
5. Treat signs and symptoms of shock.
6. Cover area with clean material and secure with a bandage.
7. In superficial burns, Vaseline can be applied if not avoid applying any creams to a burn.
8. Arrange and send to the hospital.
Special Types of Burns
Electric burns: This results when enough electric current passes through the human body. The
extent of injury depends on the amount of electric current that passes through the body. Usually
external injuries are minimum but there is usually injury to the internal organs. This type of burn
can affect both breathing and heat action.

Management
 Flood the site of injury with cold water and cover with a clean cloth.
 Do not approach casualty unless you are officially informed that the current has been
switched off.
 Separate casualty from the source of injury by switching off the source of electric current
by using dry wood.
 If the switch cannot be put off, use dry wood or cloth to cut the casualty off the source.
 Reduce the risk of falls after separating the casualty from the source.
 If unconscious, open the airway to check the breathing pattern.
 In the absence of breathing commence artificial respiration.
 Arrange and send to the hospital.

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Burns to the Airway
Burns to the face and inside the mouth or throat can be dangerous because the air passage can
easily become swollen. In serious cases, immediately send the casualty to the hospital. There is
soot around the nose or mouth, singeing nasal air, redness, swelling and burning of the togue,
damage to the skin around the mouth, hoarseness of voice, and difficulty in breathing.
Management
1. Call the emergency services immediately.
2. Loosen all tight clothing around the neck chest and waist to improve casualties breathing.
3. If the casualty becomes unconscious open airways, check for breathing, and check for a
pulse. Resuscitate if needed.
Chemical burns
Chemical burns can occur on the skin or in the eyes. This may be fatal when the chemical sips
into the bloodstream.
Management
If the chemical is on the skin:
1. Make sure the area is safe.
2. Flood the affected area with running water for at least 20 min to prevent further damage and
to relieve pain.
3. Gently remove contaminated clothing while flooding the injured part, precaution must be
taken to avoid self - contamination.
4. Do attempt to neutralize the chemical.
5. Don’t delay starting the treatment by looking for an antidote.
6. Arrange and send to the hospital.
If the chemical is in the eyes:
1. Hold the affected eyes under running cold water or irrigate the eyes with an irrigator, a jar, or
a glass.
2. If eyes are shut gently firmly pull the eyelids open. Be careful not to splash contaminated
water into the unaffected eyes.
3. Cover the affected eye with an eye pad or a clean non-fluffy material and bandage in
position.
4. Send casualty to the hospital immediately.
Cold Burns
A cold burn is an injury caused by the skin being exposed to extremely low temperatures or ice.
They are sometimes referred to as frostbite. Cold burns can also be caused by the cooled liquid
LPG when it pours on the skin Cold burns are less common and recovery is usually fast.
Signs and Symptoms

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 1. Oedema of the affected site
2. Burning sensation at the affected site.
3. Skin becomes white, pale/gray or bluish-white.
4. The skin at the affected site becomes cold and hard density
5. Numbness of the affected site
6. Maybe blister formation or peeling of layers of the skin
7. The skin may become black.
8. Necrosis of the skin may occur
9. Bruising may occur.
First Aid Management
1. Assure and continue to reassure the casualty.
2. Move casualty away from danger when necessary.
3. In case of LPG spillage remove the affected clothes.
4. For cold burns rewarming of the affected site is done in water between the temperatures
of 37 to 40 degrees Celsius for 15-20 minutes.
5. Avoid massaging the site during rewarming.
6. After rewarming the site should be covered with clean cloth.
7. Avoiding the breaking of blisters.
Complications of burns and scalds
a. Shock
b. Deformity of part
c. Contracture
d. Pneumonia
e. Scar formation
f. Infection of wounds
g. Renal failure
h. Septicemia
i. Dehydration
Calculation of Fluids Required to treat Burns Patients in the Hospital

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93
CHAPTER TEN
BITES AND STINGS
Bites and stings are usually caused by animals and insects. Sting injuries are usually minor and
might not need hospital management after first aid is received unless severe allergic symptoms.
However, injuries after a bite always require medical attention after first aid treatment, because
of infections such as rabies and tetanus. Snake bites also causes additional risk by poisoning the
victim.
DOG BITE
Dogs can cause an injury and cause rabies infection when it bites a human being.
Signs and symptoms

a. Red
b. Swollen
c. Warm
d. Tender to the touch
e. Pain at the affected site
f. Later sign sounds like a bark of a dog
g. Muscle spasm as late sign

First Aid Management

1. Assure and reassure the casualty.
2. Wash the wound with soap (Carbolic soap preferred if available) and warm water.
3. Gently press a clean cloth over the wound to stop the flow of blood.
4. Apply an antibacterial ointment to the wound.
5. Cover with a sterile bandage.
6. Watch for signs of shock.
7. Ask the casualty to go to the hospital for further treatment.

SNAKE BITE
Snakes can cause an injury through a bite and further damage to the body from their poison.
Some snakes are poisonous while others are not, the fang mark from the wound can
determine if the snake was a poisonous one.
Signs and Symptoms
a. A pair of punctured mark from the fangs of the snake

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 b. Severe pain at the site
c. Redness and swelling
d. Nausea and Vomiting
e. Laboured breathing
f. Disturrbed vision
g. Increase heart rate
First Aid Management
1. Lay the casualty down and ask the casualty to keep calm.
2. Wash the wound well and pat dry.
3. Lightly compress the part above the site with a roller bandage.
4. If breathing stops be ready to perform CPR.
5. If the bite is at the lower limbs immobilize the limb as done for fractures.
6. Send the casualty immediately to the hospital for further management.
Don’t use the tourniquet
Don’t cut across the punctured site
Don’t suck the venom from the wound.
BEE AND WASP STING
Bees and wasps can sting a person and this can be painful.
Signs and Symptoms
a. Initial sharp pain
b. Soreness
c. Reddening of the site
d. Swelling
e. Signs of anaphylactic shock
f. Stings in the mouth and throat can cause obstruction in the airways
First Aid Management
1. Assure casualty and continue to reassure.
2. Call the emergency services if the casualty shows signs of anaphylactic shock
3. If the sting is still in the wound, use the side of the pair of tweezers to squeeze it out
4. Apply cold compress to relieve pain and minimize swelling.
5. Advice casualty to go to the hospital if swelling and pain persist.
6. In case of stings in the mouth. Give casualty ice to suck to minimize swelling.
HUMAN BITES
Human bites is when a person bites another human being. It may lead to infections because of
the bacteria and viruses that maybe present in the mouth of the human being.

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Signs and symptoms
1. Discharge from the wound
2. Fever or chills
3. Heat around the wound
4. Pain
5. Redness around the wound
6. Swelling around the wound
7. Tenderness
8. Infection of the wound may occur.
First Aid Management
1. Assure and continue to reassure casualty.
2. Wash your hands with soap and water before attending to the bite. If possible, wear clean
gloves to reduce the risk of transmitting any bacteria into the wound.
3. If the wound is mild and there’s no blood, wash it with soap and water. Avoid scrubbing the
surface of the wound.
4. Cover the wound with a clean bandage. Avoid using adhesive tape to close the wound as
this may trap bacteria in the wound.
5. In case of any bleeding, raise that area of the body and arrest hemorrhage by applying
pressure to the wound site using a clean cloth or towel.
6. Arrange for the casualty to see the doctor immediately.

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CHAPTER TWELVE
BANDAGING
A bandage is any length of material applied in a manner to fit a part of a body. Bandages are
available in different widths commonly 1.5 to 7.5cm (0.5 to 3 inches). Usually, they are supplied
in rolls for easy application.
Uses
1. To retain and support or secure a dressing on a wound and the splint in position.
2. To control bleeding.
3. To immobilize limbs.
4. To correct deformity in case of injury. Example sprain
5. To exert pressure as in the treatment of hemorrhage and varicose veins.
6. To supply warmth

Materials Used for Bandaging

1. Cotton – This is the commonest material used. It is absorbent, washes well and can be
used over and over again. It can also be sterilized by boiling.
2. Flannel – It is soft, warm and elastic, useful or rheumatic joints, in the groin and
breast
3. Domette – It is a loosely woven flannel. It washes well, it light, warm and elastic. It is
made of cotton and wool. It is durable but expensive; therefore it cannot be used for
discharging wounds.
4. Gauze – It is light and porous and cannot give much support like the other materials.
It can only be used once because it is easily soiled. It used to support dressing on
wounds and allow circulation.
5. Calico– It is used with splint for support. It can be very comfortable when used for
support. It is used as partial stocking for varicose veins and provides support and
improves circulation.
RULES FOR APPLICATION OF BANDAGES
1. Sit the casualty or lie him/her down.
2. Face the casualty and the part to be bandaged except in the cases of capelin or head
bandage.
3. The bandage must be neatly and tightly rolled when commencing.
4. Place the limb to be bandaged in a position in which it is to remain
5. Unroll short length at the beginning of the procedure.
6. Hold the head or drum of the bandage in the right or left (dominant hand and keep the
rolls uppermost.
7. Make a firm turn when beginning to fix the bandage.
8. Maintain even pressure throughout.
9. Bandage from below upwards and from within outwards over the front of the limb.
10. Let each succeeding turn of the bandage overlap 2/3 of the preceding turn.

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 11. Keep the turns parallel with one another.
12. The bandage should neither be too tight nor too loose.
13. Where a limb is involved, ensure that the toe nails or finger nails are exposed. Form a
figure of eight over a joint.
14. Add plenty of padding between the limbs and the body and also the natural hollow
places e.g. the armpit.
15. Finish with a straight turn and fasten the loose ends neatly by stitching, using a safety
pin adhesive strapping or tie a reef knot over a padding or dressing.
16. Knots should never be tied over a fracture, not so tight to stop circulation, never over
the sight of fracture.
17. Padding must be placed between the ankles, knees, armpit if body splinting becomes
necessary.
TYPES OF BANDAGES

ROLLER BANDAGES –
A roller bandage is a continuous strip of material that can be rolled on. It is usually made of
gauze or any other material made in various sizes.

Body Part Size of Bandage by Width

Head and arm 2-2½ inches/5-6cm
Leg 3½ inches or 7-9cm
Trunk 4-6 inches or 10-15cm
Hand 2 inches or 5cm
Finger 1 inch or 2-5cm

General rules for Applying Roller bandages

 Expose the limb to be bandaged. The limb should be as dry and clean as possible.
 Position the body part to be bandaged in a normal resting position (position of function).

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  Check the circulation at a point below where the bandage will be applied.
 Choose the appropriate sized roller bandage. Roller bandages range from 1/2 inch to 6
inches in width. The wider widths are used for the larger body parts. The 2-inch roller
bandage is primarily used for the hand. The 3-inch roller bandage is used for the forearm,
lower leg, and foot. The 4-inch and 6-inch roller bandages are used for the thigh and
chest.
 Pad bony areas and/or between skin surfaces (such as between fingers) that will be
covered by the roller bandage.
 Apply the roller bandage. A roller bandage applied to a limb is normally applied
beginning with the most distal point to be wrapped. The roller bandage is normally
secured with an anchor wrap at the beginning and with a circular wrap at the end.
 Tape, clip, or tie the end of the bandage in a position that is easy to reach.
 Check the circulation below the wrapping. If the wrapping is interfering with the
casualty's circulation, loosen the roller bandage and apply it again.
 Elevate the injured limb to help control swelling.
Basic Turns for Roller Bandages
(a) Circular turns – they are used to anchor bandages but not directly over the wound.
Holds the bandage in your dominant hand, keeping the roll uppermost and unroll about
8cm (3 inches)
1. Hold the end of the unrolled bandage with the thumb of the other hand.
2. Encircle the body part of few times or as often as needed making sure that each layer
over 2/3 two-thirds of the previous layer to provide even support.
3. Bandage should not be too tight or too loose.
4. Secure the end of the bandage with tape or safety pin over the injured part to avoid
exerting localized pressure and irritation.

(b) Simple spiral turn – they are used to bandage parts of the body that are fairly uniform in
circumference e.g. upper arm and upper leg.
1. Make two circular turns to anchor the bandage.

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 2. Continue spiral turns at about a 30 degree angle covering 2/3 of the previous turn.
3. Terminate with two circular turns and secure with a tape or safety pin over an injured.

The spiral wrap

(c) The reverse spiral – It is used mainly for cone shaped parts such as the leg and forearm.
1. Anchor the bandage with two circular turns and bring the bandage upward at about a 30
degree angle.
2. Place the thumb of your free hand on the upper edge of the bandage. The thumb will hold
the bandage while it is folded in itself.
3. Unroll the bandage about 15cm (6in) and then turn your hand so that the bandage falls
over itself.
4. Continue the bandage around the limb; over lapping each previous turn by two-thirds the
width of the bandage. Make each bandage turn at the same position on the limb so that
the turns of the bandage will be aligned.
5. Terminate with two circular turns and secure with a tape or safety pin over an injured.

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 (d) The figure of eight – the bandage is applied around the limb alternating upwards and
downwards resembling the figure of eight. It is used for bandaging arm in the neighborhood
of the joints, knees, ankle or elbow.
1. Anchor the bandage with two circular turns.
2. Carry the bandage above the joint, around it and below it making a figure eight.
3. Continue above and below the joint overlapping the previous turn 2/3 width of the
bandage.
4. Terminate the bandage above the joint with two circular turns and then secure the end
appropriately.

(e) Recurrent turns – They are used to cover the distal parts of the body e.g. the end of a
finger, the skull or the stump of an amputation.
1. Anchor the bandage with two circular turns.
2. Fold the bandage back on itself and bring it centrally over the distal end of the body to be
bandaged.
3. Holding the bandage with the other hand, bring the bandage back over the end to the right
of the center bandage but overlap it by two – thirds the width of the bandage.
4. Bring the bandage back on the left side, also overlapping the first turn by 2/3 of the
previous turn.
5. Continue this pattern of alternating right and left until the area is covered.
6. Terminate the bandage with two circular turns.

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f) Capelin – This pattern is mostly applied to the head, shoulder or thumb. A double-head roller
bandage is used for this particular pattern.

(g) Spica – it is a variation or a modified figure of eight used on the thumb, breast, shoulder, hip,
great toe and hernia of the groin.
a. Thumb Spica
1. Anchor the bandage with two circular turns around the wrist.
2. Bring the bandage to the distal aspect of the thumb and encircle the thumb, leaving the
tip.
3. Bring the bandage back to the wrist and then back around the thumbs over lapping the
previous turns by 2/3.
4. Repeat until the thumb is covered.
5. Anchor the bandage with two circular turns around the wrist and secure.

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 b. Divergent spica – Used to cover large prominences as heel, knee and elbow.

TRIANGULAR BANDAGE - This is a piece of calico in a triangular shape. It is largely used in

first aid treatments either as a sling or folded in various sizes for fixing splints and dressings.
Any material can be used in an emergency.

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The triangular Bandage can be can either be put in a broad fold or narrow fold (Cravat bandage)
to immobilize various parts of the body.

A. Triangular arm sling/bandage:

1. Ask the client to flex the elbow to an 80◦ angle or less with the thumb facing upward or
inward toward the body. This 80◦ angle gives support and prevents swelling of the hand.
2. Place one end of the unfolded triangular bandage over the shoulder of the uninjured side
with the apex under the elbow of the injured side.
3. Bring the lower corner of the bandage up over the arm to the shoulder of the injured side.
Use a square knot to secure.
4. Fold the sling neatly at the elbow and secure it with safety pins or tape.
a. Note: a small arm sling is called cravat bandage. Make a cravat bandage by
folding the triangular bandage on itself starting from the apex.
5. Lay the triangular bandage on a flat surface.

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 6. Fold the point up toward the base of the bandage.
7. Fold the bandage over on itself to make a smooth edge.
8. Fold to the desired width.

Cravat Bandaging

B. Triangular Arm Elevation Sling

1. Flex the client’s arm so that the hand on the clavicle of the uninjured side.
2. Place the bandage over the shoulder of the uninjured side and over the arm so that the
apex extends beyond the elbow of the uninjured side.
3. Tuck the base of the binder under the arm; bring the free end across the client’s back,
with square knot tie or the knot to rest in the hollow of the clavicle to prevent friction.
4. Bring the apex of the sling toward the back tuck and secure it with a safety pin.

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C. Triangular Bandage as a Hand Mitt or Foot Mitt
1. Lay the triangular bandage on a flat surface.
2. Place the hand in the center with the wrist at the base.
3. Fold the apex over the wrist.
4. Wrap the corners around the hand.
5. Bring the corners around the wrist.
6. Tie a square knot on the dorsum of the wrist.

D. Borsch’s – An eye bandage for both eyes.

FOUR TAILED BANDAGE OR MANY TAILED BANDAGE – It consists of a series of

stripes 4-6 inches of bandage of required length. It is used for the trunk, chest, abdomen and

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limbs incisions. It is used for large abdominal incisions vulnerable to burst when the patient
coughs.

T- BINDERS AND BANDAGE. These bandages look like letter T with either a single or
double tails. T – binder and bandage secures rectal or perineal dressings or pad. The belt of the
bandage fits around the waist with the tail passing between the legs from back to front. It soils up
easily and needs frequent change. We need 2 safety pins for the single tail and 3 for the double T
– bandage.

IMPREGNATED BANDAGES: Comprises Plaster of Paris, Silica, Rubber and Stockinet

Has the power of solidifying during application.

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Note: Always cover the dressing with a bandage at least 5cm (2in) beyond the edges of the
dressing to prevent the dressing and wound from becoming contaminated.

Disadvantages of Bandages
If not applied firmly, they are useless because dressings or splints will slip out of place, bleeding
will not be controlled. Also, if applied too tightly to a limb, it may injure a part or impede
circulation.

Monitoring a casualty in a bandage

After you have wrapped a casualty's limb with an elastic bandage, monitor the limb.
1. Check for Impaired Circulation. Even if the circulation was not impaired when you
finished the wrap, pressure caused by swelling (edema and/or internal bleeding) may
result in impaired circulation. If impaired circulation is discovered, loosen and apply the
wrap again.
2. Check the pulse.
3. Perform the blanch test.
4. Ask the casualty about numbness, tingling, or cold sensations in the limb.
5. Observe the skin below the bandage wrap for discoloration.
6. Check for Skin Irritation. Check for rubbing or wrinkles in the bandages. Correct the
source of the irritation. If the bandage is removed, check the wrapped area for redness
and sores.

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CHAPTER TWELVE
MEDICAL AND SURGICAL EMERGENCIES
ASTHMA
Definition: Asthma is a respiratory disorder characterized by attack of wheezing, difficulty in
breathing due to reversible narrowing of the airway.
Types
1. Extrinsic asthma/allergic asthma: This is more common in children
2. Intrinsic asthma/non-allergic: Common in adults.
Causes
1. Hereditary
2. Allergy (oversensitivity) such as dust, pollens, perfumes, spray, cigarettes, etc.
3. Emotional factor, stress, cold dumpy weather.
4. Food additives e.g. monosodium glutamine sell fish.
5. Drug e.g. aspirin (NSAID)
6. Hormonal factors e.g. women close to the menstrual cycle.
7. Occupation e.g. sawmill worker, mine.
8. Infection of the upper respiratory tract.

Signs and symptoms

1. Tightness, pain and pressure to the chest
2. Wheezing respiration
3. Difficulty in breathing
4. Fatigue and sweating
5. Cough
6. Hyperventilation

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 7. Shortness of breath
8. Tachycardia
9. Use of accessory muscle of respiration.

Treatment
1. Reassure the victim
2. Put casualty in an cardiac position
3. Loose tight clothing around the neck and waist.
4. Serve prescribed medication drug as indicated.
5. Most known asthma patients have an inhaler. Assist the casualty to use an inhaler if available.
6. Transport casualty to the hospital.

How to use the inhaler

1. Shake the inhaler before use.
2. Breathe out fully.
3. Hold the inhaler in the right position.
4. Breathe in deeply as you puff the medicine into your mouth, then hold your breath for as long
as possible (and for at least 5 seconds).
5. Make sure you shake the inhaler in between puffs.
6. Make sure Casualty does not breathe out into the inhaler.

CARDIAC ARREST
This is a sudden cessation of the heart. Cardiac arrest may be due to several reasons including

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 1. Haemorrhage
2. Electrocution
3. Drug overdose
4. Heart attack
5. Suffocate
6. Hypothermia (very low)
7. Anaphylactic shock
8. Other cardiac conditions

Signs and Symptoms

1. Absence of pulse and absence of breathing.
First aid Management
1. Arrange to transport the casualty to the hospital.
2. Check on the level of reposiveness, breathing, and pulse.
3. Begin cardio-pulmonary resuscitation (CPR) if the pulse is absent.

MEDICATION REACTIONS
Medication reactions are responses to drugs that are unintended and occurs at doses normally
used for the prophylaxis, diagnosis or therapy of disease or for modification of physiological
function.
OR
It is a harmful or significantly unpleasant effect caused by a drug at doses intended for
therapeutic effects which warrants reduction of dose or withdrawal of the drug.
Signs and symptoms of medication reactions
1. Skin rash or hives
2. Itching
3. Wheezing
4. Swelling
5. Anaphylaxis
6. Dizziness
7. Rigor
8. Death
9. Shivering
10. Headache
11. Nausea
12. Vomiting
13. Trouble breathing
First Aid Treatment
1. Arrange to transport the casualty to the hospital.
2. Check on the level of responsiveness/consciousness, breathing, and pulse.
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 3. Begin cardiopulmonary resuscitation (CPR) if the pulse is absent.

ACUTE ABDOMEN
Acute abdomen is an emergency condition that needs urgent attention and treatment. There is
usually a sudden onset of severe abdominal pain of less than 24 hours. This emergency medical
condition usually needs immediate emergency surgery.
Causes of Acute Abdomen
1. Perforated peptic ulcer
2. Ruptured ectopic pregnancy
3. Trauma to the abdomen
4. Appendicitis
5. Acute pancreatitis
6. Bowel perforation
7. Intestinal obstruction
Signs and Symptoms
1. Sudden severe abdominal pains/cramps
2. Nausea or vomiting
3. Abdominal tenderness/discomfort
4. Bloating
5. Rapid heartbeat
6. Decrease in appetite
7. Fever
8. Shock and altered mental state may occur in severe cases.
9. Difficult passing stool or flatulence

First Aid Management

1. Assure and reassure the casualty.
2. Allow the casualty to rest and observe closely.
3. Arrange to send the casualty to the hospital as soon as possible for an emergency surgery.

HYPERTENSIVE CRISES
A hypertensive crisis is a sudden severe increase in the blood pressure of a person. This is
usually presented with a blood pressure of 180/120 mm Hg or greater. This can be due to a
person's untreated hypertension, a known hypertensive defaulting to taking antihypertensives or
someone taking over-the-counter medications. A hypertensive crisis can lead to damage to major
organs in the body.
Signs and Symptoms
1. Headache or blurred vision
2. Increasing confusion
3. Seizure

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4. Increasing chest pain
5. Increasing shortness of breath
6. Swelling or edema (fluid buildup in the tissues)

First Aid Management

1. Assure and reassure the casualty.
2. Allow the casualty to rest.
3. Observe and monitor casualty closely.
4. Arrange to send the casualty to the hospital as soon as possible.

SICKLING CRISES
A sickle cell crisis is experienced by a person with sickle cell disease. Usually, the crisis occurs
when a sickled red blood cell blocks the blood vessels at particular parts of the body interrupting
blood flow.
Causes
The following can trigger a crisis in a person with sickle cell.
1. Stress
2. Infections
3. Dehydration
4. Change in temperature
5. Altitude
Signs and Symptoms
1. Pain in any part of the body especially the arms, legs, chest, feets and lower back
2. Shortness of breath
3. Pain when breathing
4. Extreme tiredness
5. Jaundice
6. Swellings at the joint
7. Pallior
8. General body weakness
9. Headache
10. Dizziness
11. Painful erections in males
First Aid Treatment
1. Assure and continue reassuring the casualty.
2. Contact the emergency services for help or arrange to send the casualty to the hospital.
3. Provide pain relief initially by using non-pharmacological means. Pain relief medication
can be administered if the casualty has prescribe analgesics from their doctor.
4. Put the casualty in the most comfortable position.
5. Protect the casualty from extreme heat or cold.
6. Observe and monitor the casualties' pulse and respiratory rate.
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 7. Encourage casualty to rest while waiting to be sent to the hospital.

Reading assignment: Read on the following Psychiatric conditions. Make short notes on a brief
explanation of these conditions, causes, their signs and symptoms and the first aid management.
a. Attempted Suicide
b. Aggression
c. Puerperal Psychosis
d. Delirium Tremens

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CHAPTER THIRTEEN
TRIAGE
The term triage originated from the French verb trier meaning to sort. Triage is prioritizing the
care provided to casualties or patients based on the severity of their injuries or illness and the
availability of resources during a disaster or in the hospital. Triage is simply sorting injured
persons into the most effective order so that life-threatening issues can be dealt with in advance
of less serious injuries, guaranteeing more lives are saved. Triage is often used when there are
multiple victims or patients to attend to during a disaster, on the battlefield and in the Emergency
Department. Triage tags are practical methods of communication used to label each casualty
before transporting them to the hospital. The tags must contain findings during the assessment
and interventions provided.
Significance of Triage
1. To identify persons that need immediate resuscitation.
2. To assign patients to the predesignated area.
3. To prioritize the care of victims and patients.
4. To initiate diagnostic/therapeutic measures as appropriate.

Types of Triage Systems

There are four major triage systems used globally, and each system contains 5-levels. The major
focus of these systems is to fit casualties and patients into categories as to who needs to be
attended to first.
Manchester Triage System: The Manchester Triage System is used most frequently throughout
Europe. Its stated objective is to rapidly assess a patient and assign a priority based on clinical
need.
Australasian Triage Scale: The Australasian Triage Scale is used throughout Australia and has
become the foundation for various international triage systems. Its stated objectives are to ensure
patients or casualties are treated in order of clinical urgency and to allocate patients or casualties
to the most appropriate treatment area.

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Canadian Triage and Acuity Scale: The Canadian Triage and Acuity Scale rely on a catalogue
of standardized chief complaints that determines the time in which the patient should be seen by
a provider.
South African Triage Scale
The South African Triage Scale (SATS) is very similar to the other non-ESI scales. The stated
objective of the SATS is to prioritize medical urgency in contexts where there is a mismatch
between demand and capacity.

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In Triage, the most severely injured are prioritized as a first to be attended to, but if someone is
in cardiac arrest then other life-threatening conditions will be treated first. First Aiders must
ensure to act safely.

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