ACCIDENTS AND EMERGENCY:

First aids:

Can be defined as the first, immediate and temporary treatment

carried out in the cases of emergency, sudden illness or accident prior
to the arrival of medical help or the transportation of the patient to
hospital.

Aims/Objective of First Aid:

1. To save life.
2. To prevent illness or injuries becoming worse.
3. To relieve pain as far as possible.
4. To aid recovery.
5. To prepare for medical treatment.

Accident:

Is an unplanned or unintentional acts or events resulting in injury or

death or damage to property.

Common accidents in Nigeria:

i. Road Traffic Accident
ii. Fire outbreak
iii. Building collapse
iv. Flooding
v. Poisoning
vi. Electrocution
vii. Falls
viii. Body overload

causes of accidents:

 Immaturity.
 Overactivity.
 Carelessness.
 Being unduly adventurous.
 Taking risks.
  Having contact with, exposed to or falling in to sources of
accident in the environment.

General preventive measures of accidents:

 Provision of adequate and decent sanitary facilities.

 Provision of facilities for solid wastes disposal.
 Removal of all objects and structures capable of inflicting injuries
to children and adult in the environment.
 Provision of fire extinguishers at strategic places.
 Establishment of safety code of conduct to be strictly adhered to
by both private and public individual.
 Proper construction and maintenance of facilities and equipment.
 Wearing a seat belt while in transit.
 Provision of adequate first aids and health care services.
 Supervision of play ground and activities.

Common emergency conditions in the community:

i. Convulsion.
ii. Poisoning.
iii. Shock.
iv. Animal bite e.g dogs.
v. Insect stings scorpion.
vi. Acute abdomen.
vii. Severe anemia.
viii. Severe dehydration
ix. Fracture
x. Burns and scald.

Fracture:

Is the break in the continuity of a bone which may occur as a result of

direct orindirect, force and/or by muscular violence.
Types of fractures:

 Green stick fracture.

 Communated fracture.
 Simple or closed fracture.
 Compound or open fracture.
 Depressed fracture.
 Complicated fracture.

Signs and symptoms of fracture:

 History of injury to the affected part of body.

 There is pain at the site of the fracture.
 The area is tender and swollen.
 Bruishing occurs.
 There is shock.
 Loss of function and power in the affected part.
 Deformity.
 Unnatural movement.

First aid treatment of fractures:

1. The patient should be kept lying down unless the particular

fracture makes this position unsuitable.
2. Prevent infection by immediately covering any wound with as
clean dressing as possible.
3. Stop haemorrhage by all known mean.
4. Treat shock.
5. Immobilze the injured part.
6. Splint part of the body to immobilize it wwhere necessary.
7. Arrange for transportation to hospital.

Wound:
Is a break in the continuity of the skin or mucous membrance paving
ways for microorganism to invade the affected part of the body.

Types of wound:

 Incised wound.
 Punctured wound.
 Lacerated wound.
 Contused wound.
 Abrasion wound.

Causes of wound:

 Chemicals.
 Radiation.
 Burns.
 Heat or cold.
 Sharp, dull or blunt object.

Signs and symptoms of wounds:

 Pain.
 Bleeding.
 Damage to the skin.
 Bruises in lacerated wound.

Complications associated with wounds.

There are several complications which can occur when the skin or

mucous membrane is damaged.

1. Infection: The skin acts as one of the main defences against

infection. When it is broken microorganisms can easily enter and

thus infection occurs.

 2. Haemorrhage: When blood vessels are severed, loss of blood

occurs. The subsequent haemorrhage may be slight or severe

and may be internal or external.

3. Shock: Depending upon the extent of the damage varying

degrees of shock may be present. In severely lacerated and

confused wounds the shock may be quite considerable.

4. Injury to deeper organs: In punctured wounds it is quite possible

for deep organs such as the liver, spleen or the lungs to be

damaged. If deep organs are damaged there is danger on

internal haemorrhage.

5. Fractures: If limbs are injured, particularly in road accidents, or if

they are caught up in machinery a fracture of one or more bones

may occur.

Factors affecting wound healing:

1. Malnutrition.
2. Radiation.
3. Blood supply.
4. Steroid.
5. Vitamin.
6. Age.
7. Infection.

Shock:
May be defined as a depression of the vital centres in the medulla
oblongata due to its being depleted of sufficient blood supply. It could
manifest as cardiogenic, hypovolemic, septic, neurogenic and
anaphylactic shock.

Causes of shock:

1. Infection.
2. Burn.
3. Psychological distress.
4. Accident.
5. Electrocution.

Signs and symptoms of shock:

 The pulse may be slow, but gradually it becomes rapid and

feeble.
 Breathing is rapid, sighing and shallow.
 The skin becomes cold ad clammy to touch.
 The temperature will be subnormal.

 The blood pressure will be lower lower than normal

Types of shock:

1. Cardiogenic shock: result from a failure of the heart to pump

sufficient blood. For example, a major heart attack can cause
severe damage to the heart muscle so that the heart cannot
squeeze and thereby cannot push the blood through the blood
vessels.
2. Hypovolemic shock: It happens with the loss of a significant
amount of fluid from the system. If the loss is blood, this type of
shock is best known as haemorrhagic shock. People experience
 dehydration due to vomiting, diarrhea, diabetes, insufficient fluid
intake or misuse of diuretics can lose large amount of fluid.
3. Neurogenic shock:It is common with sudden sad new. The blood
vessels may enlarge and the blood supply may be insufficient to
fill them when the nervous system is damaged. It can also occur
in damage to the spinal cord.
4. Septic shock: It develops in some victims with bacterial infection
when damaged blood vessels lose their ability to contract.

Acute abdomen: an abnormal condition characterized by the acute

onset of severe pain within the abdominal cavity. An acute abdomen

requires immediate evaluation and diagnosis because it may indicate a

condition that calls for surgical intervention.

Common causes of acute abdomen:

 Infection e.g. Typhoid,

 Appendicitis,
 Cancer,
 Strangulated Hyenia,
 Road Traffic Accidents due to rupture of the spleen and liver etc,
 Poisoning
 Intestinal obstruction.
 Ruptured ectopic pregnancy
 Acute cholectystitis.
 Acute pancreatitis.
 Salphingitis.

Burns:
Burns may be defined as a lesion or injury to tissues of the skin due to
chemicals, acids, dry heat, electricity, flame, friction or radiation,
classified as partial or full thickness according to the depth of the skin
destroyrd.

Causes:

 Flames from a fire.

 Hot metals.
 Electric or gas fires or coming in contact with live electric wires.
 Lighting.
 Friction.
 Strong acids e.g HCL and Lysol.
 Strong alkalis e.g caustic soda.

Description of Burn while looking at the skin surface

1. First degree burns (superfieral): These burns affect the skin’s out
layer (epidemia) characterized by redness, mild swelling,
tenderness and pain. Healing occur without scaring, usually
within a week.
2. Second degree burns (Partial thickness): These burns extend
through the entire outer layer and into the inner skin layer.
Blister information, swelling, weeping of fluids and severe pain,
these occurs because the capillary blood vessels in the dermis
are damaged and give up fluid into surrounding tissues.
3. Third degree burns (Full thickness): These severe burns extend
through all the skin layers and into the underlying fat, muscles
and bone. Discoloration and a parchment like dry
appearance in the absence of blisters or leaking fluid, indicate
this degree of burns.

Rule of Nine for Assessment of Burns:

 PARTS OF THE BODY PERCENTAGE OF SURFACE
(Anetomic) (Strucutre) AREA
i. Head and Neck 9%
ii. Anterior Thorax 18%
iii. Posterior Thorax 18%
iv. Arm (each) 9%
v. Legs (front and back) 18%
vi. Perineus 1%
General treatment for burns.
 Remove patient from the source or the cause if possible.
 Treat for shock immediately
 Reassure the patient, if thought necessary send for medical aid or
arrange immediate transport to hospital.
 Cover the burn with a dry dressing. The dressing should be sterile
if possible e.g. inside of freshly laundered handkerchief, pillow
sheet can be used.

Pressure point:

Is where an important artery (takes blood away from the heart) can be
compressed against an underlying bone to prevent the flow of blood
beyond that point.

The common pressure points are:

1. Brachial pressure point.

2. Femoral artery pressure point.
3. Radial pressure point.
4. Sub-clavian pressure point.
5. Carotid pressure point.
6. Temporal pressure point.
7. The facial pressure.
Signs or indicators of internal bleeding:

 Extensive bruising.
 Pain and tenderness over affected area.
 Signs of shock.
 Patient is weak, faint and giddy.
 Patient anxious and restless.
 Possible swelling and tenderness.
 He may be nauseous and vomit.
 There may be evidence of a fracture.

Signs of external bleeding:

 Visible evidence of blood loss.

 Patient feels faint, giddy and weak.
 Patient/causality’s skin grows cold and clammy.
 Anxious, restless and talkative.
 Pulse becomes fast and weaker.
 Sweating.
 Complains of thirst.
 Breathing becomes shallow.
 Face and lips grow pale.
 Nausea and vomiting.

First aid treatment of internal bleeding:

1. The casuality should be placed at a position of rest with the leg.

2. Ensure that all clothing around his chest, neck and waist are
loosened.
3. Give him psychological first aid.
4. Ensure that no other injuries are present.
5. Guard him against cold.
6. Transport him to the hospital gently and immediately.
 7. Monitor his breathing and pulse rates.

Epistaxis:

Is bleeding through the nose.

 Fractured skull.
 Foreign body in the nose.
 Strenuous activities.
 Varicose vein.
 Haemophilia.
 Trauma.
 Growth in childhood.
 High blood pressure.
 Sinusitis/infections.
 Injury.

Management of epitasis:

 Reassure the patient.

 Place the patient in a sitting position with head bent slightly
forward in an airy or well-ventilated area.
 The patient should pinch his/her nose firmly for at least ten
minute.
 Loosen tight clothing round the neck chest and waist.
 Ask the patient to open and breath through the mouth.
 Apply cold compress to the forehead over the bridge of the nose
and the back of the neck.
 If bleeding continues put several drops of aquous (solution)
adrenaline on the nose and place firmly for 10 – 15 minutes.
 Repeat several times if necessary.
 Advise patient to stop blowing his nose to avoid reoccurrence of
the bleeding.
  But if bleeding continues after several trials or attempts to stop
refer.

Eight (8) conditions that could result in mass casuality:

 Poisoning,
 Road Traffic Accident,
 Flooding,
 building collapse,
 earthquake,
 terror attack,
 bomb explosion,
 war,
 violent demonstration,
 suffocation,
 air crash,
 fuel tanker explosion,
 drowning,

Types of Surgical Emergencies:

 Abdomen: Obstructed/Strangulated hernia.
 Intususception.
 Bowel perforation (infective typhoid traumatic)
 Ruptured spleen.
 Acute cholecyctitis.
 Anorrectal Anomalies.
 Volvulus.
 Tumours.
 Severe acute appendicitis.
  Testicular Torsion.
 Haemorrhoids.
 Acute epidiymo-orchitis
 Urinary retention.
 Stone disease.
 Enlarge prostrate.

Four (4) causes of Gangrene:

- Crushing injuries.
- Frost bite.
- Bacterial toxins
- Pressure from bandage.
- Tourniquet.
- Post operation gangrene.
- Strangulated hernia.

Three (3) physiological tasks (nature’s method of arresting

haemorrhage).

1. By the formation of a clot. The clot when formed acts as a “cork”

to the injured blood-vessel and prevents further loss of blood.
2. The elastic coat of blood vessel recoil and turns in, thus
narrowing the lumen of the vessel and holding the clot in place.
3. The blood pressure is lowered, thus there is less volume and
pressure of blood in the vessel. This gives the walls of the blood
vessels time to turn in and the clot time to form.

Concealed Haemorrhage: In this type of haemorrhage, blood

escapes from blood vessel into a cavity or organ of the body or into the
tissue e.g. bruise or haematome.

Indicators/signs and symptoms snake bite; include:

 1. Two small punctured marks from the fangs of the snake may be
seen on the site of the bite.
2. Mild or severe pain or sometimes no pain at all.
3. Swelling and bruising may occur.
4. Haemorrhage.
5. Nausea and vomiting.
6. Severe muscular pain.
7. Pain and tenderness.
8. Dizziness.
9. Localized swelling.
10. Abdominal pain.

Preventive measures of snake bite:

1. Minimize the food sources for snakes by removing anything that

may attract rodents or frogs
2. Reduce rubbish/materials where a snake could shelter
3. During high risk times or after holiday breaks, remind staff and
students of the increased risk of the presence of snakes
4. Wear gloves and boots when moving stored materials and
rubbish – they will give some protection.
5. An increased awareness of snakes is the best protection. The
snake will not be looking for you, so be alert and on the lookout
for snakes.

Susceptible group/risk factor drowning;

1. Age: Children under Five 5years have the higher mortality rate
worldwide.
2. Sex:Male have higher rates than female due to increased
exposure to water and riskier behaviour of swimming alone.
 3. Occupation: Communities dependent on water bodies for their
living e.g. fisher men have a high risk of drowning.
4. Floods: Large numbers of drowning death are associated with
flood.
5. Access to water: unfenced homes in proximity of bodies of
water increase the risk of drowning i.e. Pool. Dams and Irrigation
channels.
6. Transportation vessels: Vessels that are unsafe or
overcrowded and poor weather conditions are associated with
large number of death through drowning.

Prevention of drowning:
 Creating barriers to water bodies especially in villages.
 Promotion “Learn to” swim activities
 Training the community in resuscitations.
 Monitoring and evaluation which includes: removal of hazards,
e.g. drain unnecessary accumulation of water bath, ponds etc.
 Promotion, facilitation and implementation of drowning prevent
the measures and policies.

Prevention of poisoning:
 Combustion services should be adequately ventilated.
 Inhalation of spray or fumes should be prevented during painting,
or application of insecticides.
 Wear protection clothing, goggles and masks.
 Dispense medicines and dangerous chemicals in child proof,
tamper proof containers.
 Training of workers on safe use of chemicals
 Dyes, polishes, kerosene and other chemicals should never be
left on a lowshelf or on the floor.
  Medicines, pesticides and insecticides and other poisonous
substances should be stored in locked cabinets.

Activities to be recommended to LGA for building the capacity

on mass casualty management and preparedness of
community members:
1. Carry out preparedness training to teach community how to
survive without side help for a given period.
2. Carry out basic search and rescue, and first aid training for
community member and the emergency service staff.
3. Presentation to public gathering such as clubs, religious centres,
and community service organization.
4. Advertising or public information through the press and
electronic media or using posters, leaflets, and public
displays in market and shopping areas.

Causes of Ashyxia
1. Blockage of airway due to foreign body or spasm of the larynx or
bronchial muscles as in the case of asthmatic attack.
2. Disease of the lungs in which the air alveoli are been filled by
inhaled exudates from pneumonia or water.
3. Inhaled vapour or gas which replaces air, the victim is drawn in
vapour.
4. Drowning in which water rushes into the lungs.
5. Paralysis of the respiratory system.
6. A congenital or neonatal asphyxia arising from obstruction or
paralysis of the airway in this case the airways fails to expand
when the baby is born.
7. Pneumoothrax – collection of fluid in the lungs.
Kinds of forms of home accidents
1. Fails: This result from uneven floors, or one highly polished
containing holes or covered with split greasy food.
2. Fire: Fire accident is caused by home made and others lamps,
fires e.g. candles, naked light as well as electrical and gas
appliance that are poorly handled.
3. Drowning: This occurs in home with baths, ponds, pit latrines,
well water, tanks etc.
4. Poisoning: Children and adults may mistakenly ingest kerosene,
detergents, insecticides, medicines especially when they are not
properly labeled.
5. Gases: Fumes from charcoal fire, oil stoves especially in poor
ventilated rooms and exhaust, from cars.
6. Firearms, tools and sharp instrument, kitchen implements for
gardening tools or homes workshops tools, broken glass and
riffles left carelessly in the home can lead to wounds, cuts, death
etc.