Introduction Purpose of First Aid Principle of First Aid (4 Cs)

Action Plan
Assessing Skills of a First Aider Responsibilities of First Aider DR ABC

First aid is the immediate medical assistance given to an injured person, within the available resources before getting to a qualified medical help.

Every one should know something about first aid as you never know when you may be called upon to use it.
At the most unexpected of times, accidents could occur, involving loved ones, close relatives or total strangers. Whoever is in need of help, you should be in a position to offer first aid.

To Sustain life
To Prevent suffering To Prevent secondary complications To Promote speedy recovery

DOS

DONTs

Before handling the casualty use:

Mask Gloves Head Cover Apron

First never

Aider

can

Prescribe Medicine Declare Death

Call for Help Calmly Take Charge Check the scene & the causality Carefully apply First Aid

Assess the Situation

Safety of yourself & the casualty. Assess the casualty

Treat the Casualty

Arrange removal of casualty to hospital or safe area. Write a Report / Communicate the status.

Observer
Listen Feel Talk Touch

Provide
Build Trust

To assess a situation quickly & safely & call for appropriate help
To identify the level of injury or the nature of the illness affecting the casualty/victim To give early and appropriate treatment in a sensible order of priority

To make & pass on a report, & give further help if required

DANGER RESPONSE

AIRWAY
BREATHING CIRCULATION

 To To To

Yourself
Others Casualty

Gently Shake & Shout at the casualty Is the casualty alert? Is the casualty drowsy or confused ?

Is the casualty unconscious, but reacting ?

Is the casualty unconscious with no reaction ? If unconscious, place the casualty in the stable side position.

Is the airway open & clear ? Is there noisy breathing ?

Are the Potential obstruction such as blood etc ?

If so , open & clear the airway!

Tilt Head Back & Lift Chin up with fingers under jaw to establish Airway (Move head as little as possible if there may be a neck injury).

Look for chest movements Listen for sounds of breathing Feel for breathes on your cheek If not breathing give 2 rescue breathes.

Look, Listen & feel for Breathing Is chest moving ? If not give 2 breathes

d. when and how to put someone in the recovery position How to check if someones breathing. What three senses could you use? Click to see.

Look along the body to see if the 1 chest is moving up and down.

Listen for breathing. Put your 3 to ear close unconscious persons mouth and nose.

Feel for breath on 2 your cheek.

Check for ten seconds

B is for Breathing

Is there a carotid pulse ? Is it strong ? Is it regular ? Is there major blood loss ?

IF NO PULSE PRESENT THEN START CPR (CIRCULATION PULSE RESPIRATION)

Check for circulation Is there a pulse ? Place two fingers in groove of neck.

Giving First Aid can be dangerous.

Always be careful for your personal safety. Do Not Put Yourself @ Risk

HIV & Hepatitis

Gloves & Respiratory Barrier devise are a must to prevent transmission of diseases
Tuberculosis

Artery

Spurting
Steady flow

Veins

Capillary

Oozing

Internal Injuries

Open Wounds

A break in the skins surface that results in external bleeding and may allow bacteria to enter the body that can cause infection
Abrasion
The top layer of skin is removed with little or no blood loss Scrape A cut skin with jagged, irregular edges and caused by a forceful tearing away of skin tissue

Laceration

Incisions

Smooth edges and resemble a surgical or paper cut

Open Wounds Cont.

Punctures
Deep, narrow wounds such as a stab wound from a nail or a knife in the skin and underlying organs

Avulsion
Flap of skin is torn loose and is either hanging from the body or completely removed

Amputation
Cutting or tearing off of a body part such as a finger, toe, hand, foot, arm, or leg

What to Do:
Wear gloves (if possible) and expose wound Control bleeding Clean wounds
To prevent infection Wash shallow wound gently with soap and water Wash from the center out / Irrigate with water

Severe wound?
Clean only after bleeding has stopped

Wounds Care
Remove small objects that do not flush out by irrigation with sterile tweezers. If bleeding restarts, apply direct pressure. Use roller bandages (or tape dressing to the body) Keep dressings dry and clean Change the dressing daily, or more often if it gets wet or dirty.

Signs of Wound Infection:

Swelling, and redness around the wound A sensation of warmth Throbbing pain Fever / chills Swollen lymph nodes Red streaks
Tetanus (lock jaw), should receive injection in first 72 hours.

The purpose of a dressing is to:

Control bleeding Prevent infection and contamination Absorb blood and fluid drainage Protect the wound from further injury

What to Do:
Always wear gloves (if possible) Use a dressing large enough to extend beyond the wounds edges. Cover the dressing with bandages.

Bandage can be used to:

Hold a dressing in place over an open wound Apply direct pressure over a dressing to control bleeding Prevent or reduce swelling Provide support and stability for an extremity or joint Bandage should be clean but need not be sterile.

Direct Pressure

Elevation

Pressure bandage Cold Applications

Where the artery passes over a bone close to the skin

Temporal Facial Carotid Sub-clavian Brachial Radial Ulnar

Femoral Popliteal Pedal

Adults / Child / Infant

Recognizing early warning signs of cardiac arrest (reassure victim/activate EMS). Provide immediate BLS. Provide ACLS. Transfer to hospital

Early signs of cardiac arrest

Unresponsiveness No breathing No signs of circulation

Causes of cardiac arrest:

Trauma, drowning, choking, heart attack.etc

CPR: Consists of series of assessments & interventions that support cardiac and respiratory functions. Main purpose of CPR is to provide oxygenated blood to the brain and heart NO SPECIAL EQUIPMENTS ARE NEEDED- JUST HANDS AND MOUTH & STEP BY STEP PROCEDURE.

Tap or gently shake the victim and shout Are you ok. To elicit a response a painful stimulus can be applied such as pinching the earlobe and pressing over the eyelid and observing for grimacing. Other associations recommend rubbing on the sternum using the knuckles of the fingers.

Rescuer who is alone should alter sequence of rescue based on most likely cause. Sudden witnessed collapse (likely VF) arrest activates EMS, get AED, do CPR. Hypoxic arrest (i.e., suffocation give 5 cycles of CPR (about 2 minutes) before alerting EMS. If there is no response, and return to the victim. In most locations the emergency dispatcher can assist you with CPR instructions

Place the victim first on His/ Her back on hard surface. If the victim is lying face down, turn or roll the victim as unit, supporting the head and neck

Open the airway by the head tilt / chin lift maneuver for all victims Health care personnel use:
Jaw thrust in trauma patient CHIN LIFT

Assessment of breathlessness (5-10 seconds) Place your ear just one inch above the mouth and the nose of the victim and perform the following:

LOOK: for the chest to rise and fall LISTEN: for air escaping during exhalation, and FEEL: for the flow of air on your cheek

If breathing is not present or is inadequate, begin rescue breathing by giving two slow breaths: pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths. Time: Each breath should take one second and watch for chest rise and allow time for exhalation. Volume:
Sufficient volume. No large volume or forceful breathing.

Assessment of pulselessness (510 secs.): check for carotid/femoral artery pulse. While maintaining the head tilt with one hand, locate the victims Adams apple (thyroid cartilage) with two or three fingers of the other hand. Slide your fingers into the groove between the Adams apple and the muscle on the side nearest you where the carotid pulse can be felt. Femoral artery pulse also can be checked. If pulse is not definitely felt within 10 seconds, proceed with chest compression

The technique of costal margin that is as follows: 1. Run your index and middle fingers up the lower margin of the rib cage and locate the sternal notch with your middle finger. The index finger is place next to the middle finger on the lower and of the sternum.

2. The heel of the other hand (the one nearest the victims head) is placed on the lower half of the sternum, and the other hand is placed on the top of the hand on the sternum so that the hands are parallel.

3. Your fingers may be either extended or interlaced but must be kept off the chest.

4. Lock your elbows into position, the arms are straightened and shoulders directly over the victims sternum. Keep the heel of your hand lightly in contact with the chest during the relaxation phase of chest compression to maintain correct hand position.

PUSH HARD- PUSH FAST: equal compression and relaxation allowing recoil of chest wall. Chest compression ventilation 30: 2, for 5 cycles (2 minutes rate of 100 per minute. Depth of 1.5 to 2 inches.

After 5 cycles of compressions and ventilations (30:2), check for return of carotid pulse/ femoral pulse and spontaneous breathing. According to the findings (after 2 minutes):

There is pulse place in the recovery position, monitor vital signs until EMS arrives. There is pulse but no breathing: continue rescue breathing every 5- 6 seconds (10-12 breaths). Recheck pulse every 2 minutes. No pulse or breathing continue CPR 30:2. , until AED arrives or ACLS provider arrives.

HOW TO PLACE THE VICTIM IN THE RECOVERY POSITION

Assessment of unresponsiveness

Tap the child and shake and shout ARE YOU OK to elicit a response, the same as in adult. If unresponsive shout for help and start CPR immediately. If second rescuer or some one is available, have him or her activate the EMS system.

Activate EMS after 2 minutes CPR except in sudden witnessed collapse, activate immediately.

Position the victim in supine, on a firm, flat surface. Careful handling of the neck during positioning of victim

AIRWAY Open the airway: perform head-tilt, chin lift maneuver BREATHING Assessment of breathlessness (5-10 seconds) Place your ear just one inch above he mouth and the nose of the victim and perform the following.
1.LOOK for the chest to rise and fall 2.LISTEN for air escaping during exhalation, and 3.FEEL for the flow of air on your cheek

If breathing is not present or is inadequate, begin rescue breathing by giving two slow breaths: pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths. Time: Each breath should take one second and watch for chest rise and allow time for exhalation. Volume sufficient volume. No large volume or forceful breathing.

Assessment of Pulselessness (5-10 seconds) CHECK COROTID/ FEMORAL PULSE If the pulse is weak or absent begin external chest compressions Nipple line technique is not to be used; that is as follows:

Run your index and middle fingers along the lower rib cage until the middle finger reaches the notch. The index finger is placed next to the middle finger. The heel of the same hand is placed next hand is placed next to the point where the index finger was located. (One or two hands can be used.)

Lock your elbows into position, the arms are straightened and shoulders directly over the victims sternum. Keep the heel of your hand lightly in contact with the chest during the relaxation phase chest compression to maintain correct hand position.

PUSH HARD- PUSH FAST WITH OUT ANY INTERUPTION RATE OF COMPRESSION: 100 PER MINUTE DEPTH OF COMPRESSIN: 1/3 -1/2 THE DEPTH OF THE CHEST COMPRESSION /VENTILATION RATION: 30:2 COMPRESSION / RELAXATION CYCLE SHOULD BE EQUAL

Reassessment:-

After 5 cycles of compressions and ventilations (30:2), check for Return of carotid pulse/ femoral pulse and spontaneous breathing. According to the findings (after 2 minutes):

There is pulse place in the recovery position carefully; monitor vital signs until EMS arrives. There is pulse but no breathing: continue rescue breathing every 3-5 seconds (12-20 breaths per minute). Recheck pulse every 2 minutes.

No pulse or breathing continue CPR 30:2. , until AED arrives or ACLS provider arrives

Cardio pulmonary arrest in infants and children is not usually a sudden event. Instead, it is often the end- result of a progressive deterioration in respiratory an circulatory function. Assessment of unresponsiveness. Tap the child and shake and shout ARE YOU OK to elicit a response, If unresponsive start CPR immediately. If second rescuer or some one is available, have him or her activate the EMS system. Activate EMS after 2 minutes CPR except in sudden witnessed collapse, activate immediately. Position the victim in supine, firm and flat surface.

Open the airway: apply head tilt- chin lift to sniffing or neutral position. HCP CAN USE JAW THRUST IN TRAUMA PATIENT

Assessment of breathlessness (5-10 seconds) Place your ear just one inch above the mouth and the nose of the infant and perform the following. LOOK for the chest to rise and fall LISTEN for air escaping during exhalation FEEL for the flow of air on your check If the breathing is not present or is inadequate , make a tight seal over the mouth and the nose of the infant and begin rescue breathing by giving two slow breaths. Time 1 second per breath and watch chest rise and allow time for exhalation. Volume enough to see the chest of the infant rise during ventilation.

Assessment of pulselessness: Brachial pulse (5-10 seconds) Feel for the brachial pulse while maintaining head tilt with the other hand, The brachial pulse is located on the inside of the upper arm, between elbow and shoulder. If pulse is absent or below 60 per minute give 5 cycles of external 30 chest compressions followed by 2 slow breaths. Each breath over one second.

Nipple line technique. The area of compression is just below the imaginary line, using the middle and ring fingers. RATE OF COMPRESSION: 100 PER MINUTE DEPTH OF COMPRESSION: 1/3-1/2 THE DEPTH FO THE CHEST COMPRESSION / VENTILATION RATIO: 30:2 COMPRESSION / RELAXATION CYCLE SHOULD BE EQUAL

Reassess the infant after every 5 cycles of 30 compressions and 2 ventilations (2 minutes). According to the findings:

There is pulse and breathing, place the infant in the recovery position, monitors vital signs until EMS arrives There is pulse but no breathing continue rescue breathing one breath every 3-5 seconds (12-20 per minute) and reassess. No pulse or breathing continue CPR 30:2. ratio, assess for pulse and breathing after 5 cycles (2minutes)

CAUSES: Meat is common cause of obstruction Other food & foreign body may cause obstruction in children and adults. Alcohol elevated blood level Elderly with dysphagia may be at risk Air way obstruction may be Partial /Mild
Patient choking but able to cough, Low pitch sound during inhalation Gaseous exchange is normal

Complete / severe- It can be mild gradually or severe from the start.

Treatment: Do not interfere at this stage. Encourage the victim to cough. If condition of the victim is worsening, immediately interfere.

The victim clutches his neck with the thumb & index finger. Inability to speak, inability to cough. High pitched sounds or no sound during inhalation Increased difficulty to breathe Bluish skin color (cyanosis)

Stand behind the adult/ child victim. Try to release his/ her hands clutching the neck and wrap our arms around the waist. Head should be bent forward and slightly downward.
Apply the Heimlich maneuver as described below.

Make a fist with one hand and place the thumb side of the fist against the victims abdomen above the navel and well below the xiphoid process. Grasp the fist with the other hand exert a series of inward upward thrusts until the foreign body is expelled, or the victim becomes unconscious.

CHEST THRUSTS FOR SPECIAL CASES

Chest thrusts should be used in the following conditions
Advanced stages of pregnancy Markedly obese victim

THE VICTIM BECOMES OR IS FOUND UNCONSCIOUS If the victim with FBAO becomes unresponsive, the rescuer should carefully support the patient to the ground , immediately activate EMS , and then begin CPR. Each time the airway is opened during CPR, the rescuer should look for an object in the victims mouth and remove it.

CONSCIOUS CHOKING INFANT Determine airway obstruction, observe breathing difficulties. If breathing difficulty increases or persists or breathing is absent perform back slaps and chest thrusts. Hold the infant in a prone position, resting on your forearm. Support the infants head firmly by holding the jaw. The rescuers forearm should rest on / her thigh to support the infant. Deliver five back slaps forcefully between the infants shoulder blades, using the heel of the hand.

After delivering the back slaps, turn the infant while the head and neck are firmly supported between your hands, with the head lower than trunk. Deliver up to 5 quick chest thrusts in the same location for infants CPR. The series of 5 back slaps and 5 chest thrusts should be continued until the foreign is expelled or infant becomes unconscious.

Call out HELP if others respond, activate the EMS system. Position the infant: keep the infant face up. Immediately start CPR. For 5 cycles (2 minutes) then activate EMS if you are alone. Each time the airway is opened during CPR, the rescuer should look for an object in the victims mouth and remove it.

If breathing is not present or is inadequate, begin rescue breathing by giving two slow ventilations using any available barrier device, e.g. Bag- valve-mask, pocket mask or face shield. Be sure the proper size of mask to provide a good fitting to prevent leakage during ventilation.

HEALTH CARE PROFESSIONAL SHOULD NOT PERFORM MOUTH TO MOUTH BREATHING. THE USE OF A BARRIER DEVICE IS HIGHLY RECOMMENDED, E.G. FACE SHIELD, POCKET MASK OR BAG VALVE MASK.

AED is recommended to be used in adults and children 1 year of age and older. Not recommended for infants below one year and neonates. Indications: unresponsiveness, absence of breathing, absence of

detectable pulse.
detectable pulse.

Contra indications: responsiveness, presence of breathing, presence of For sudden witnessed collapse in adult and child, use the AED once it is available. For un-witnessed cardiac arrest in the pre-hospital setting, use the AED after 5 cycles of CPR (about 2 minutes) The AED machine must be able to accurately and reliably recognise paediatric shockable rhythms and be capable of delivering energy dose.

Uses: for adult and children 1 year and above, anywhere, Health care provider who holds valid certificate in BLS.

Most AEDs are equipped with small pads and means of reducing the energy dose. If child pads/ system is not available, adult's pads/system can be used but paediatric pads can not be used for adults.

Check for shockable rhythm only after completion of 5 cycles of CPR If indicated for shocks deliver one single shock and continue CPR. TYPE OF WAVEFORM: Monophasic Shock 360 Joules biphasic truncated 150 200 Joules No shock is indicated Check for pulse and breathing. If breathing is adequate, place the victim carefully in the recovery position. If breathing and pulse not present, continue CPR. (Reassessment of patient is carried out if recovery was not achieved. CPR to continue for 2 minutes, recheck for pulse and analyze for shockable rhythm and if required, single shock and CPR 5 cycles to be continued.)

It is the therapeutic use of kinetic energy in the form of joules to be delivered to a chaotic rhythm in the heart known as ventricular fibrillation immediately using a proper defibrillator by qualified ACLS providers. Physiologically the shock depolarizes the myocardium, terminating ventricular fibrillation or pulse less Ventricular tachycardia allowing normal sinus electrical activity to be restarted. It is part of the chain of survival

A manual machine which necessitates the presence of certified physician to diagnose and interpret the rhythm and properly use the defibrillator to shock the patient. It has two modes of delivering the shock: asynchronized defibrillation and synchronized cardioversion AED has been introduced as an effective DC. It has only a synchronized mode of shock which allows paramedics, first responders, public at large trained, equipped with and authorized to use such a device in prehospital setting.

Wet person or wet conditions Excessive hair on the chest Moving vehicle Pacemaker and GTN patch In presence of inflammable anaesthetics or concentrated oxygen

Thank

you