First Aid - Lecture notes 1 PDF

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Introduction to First Aid...

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FIRST AID

CHAPTER 1 “The fate of the wounded rests in the hands of the ones who applies the first dressing” (Nicholas Senn (1898) 49th president of the American medical association)

Introduction 1.1History of first aid The first recorded history of first aid dates to 1099, when a religious order of knights trained to administer medical treatment was formed. The Order of St John to which the modern day St John Ambulance organization traces its roots in the specialized in the treatment of battlefield injuries. In 1792, the French Army Surgeon General, formed the first official army medical corps in the treatment of injured soldiers. During the 1860‟s the first Geneva Convention and the International Red Cross came into being to protect and deal with sick and injured soldiers on the battlefield.

1.2 Chapter objectives a) What is first aid b) Responsibilities of a first aider c) Legal aspects of providing first aid

Definition First aid is the initial assistance or treatment given to a casualty for any injury or sudden illness before the arrival of an ambulance, doctor or qualified personnel. A first aider is a person who takes this action while taking care to keep everyone involved safe and to cause no further harm when doing so.

1.3Aims and responsibilities as a first aider The aims of first aid include a) Preserve life b) Prevent the casualty’s condition from becoming worse c) Promote recovery The responsibilities of a first aider include: a) Assess the situation quickly and safely summon appropriate help. b) Protect casualties and others at the scene of danger. c) To identify, as far as possible, the nature of illness or injury affecting casualty. d) To give each casualty early and appropriate treatment, treating most serious condition first. e) To arrange for the casualty’s removal to hospital or in the care of a doctor. f) To remain with a casualty until appropriate care is available. g) To report your observations to those taking care of the casualty, and to give further assistance if required.

Priorities of the casualties are; a) Save the unconscious casualties before the conscious one as they have a higher chance of recovery b) Save the young before the old c) Do not jeopardize your own life while rendering first Aid. In the event of immediate danger, get out of site immediately d) Remember: one of your aims is to preserve life and do not endanger your own in the process of rendering first Aid.

1.4 Legal aspects of providing first aid The Good Samaritan principle prevents someone who has voluntarily helped another in need from being sued for „wrongdoing‟ . Since governments want encourage people to help others, they pass specific Good Samaritan laws or apply principles of common law. You are generally protected from liability as long as a) You are reasonably careful b) You act in „good faith‟ ( not for a reward) c) You do not provide care beyond your skill level

1.5 Chapter review questions 1) What are the priorities of a first aider 2) Discuss the good Samaritan principle

CHAPTER 2 BASIC MEASURES FOR FIRST AID 2.1 Chapter objectives 1. What are the DRA,B and Cs of first aid 2. Describe the importance of primary survey 3. Describe the first aid management of a bleeding patient 4. Discuss the action plan in a chocking victim 2.1SECTION 1 2.11 Action at an emergency In any emergency one must follow a clear plan of action. This will enable a person prioritize demands that may come upon him or her, and help decide of the response. The principle steps include a) Assessing the situation b) Making the area safe c) Giving emergency help

2.12 Assessing the situation Evaluating the scene accurately is one of the most important factors in the management of an incident. You should stay calm if there are no medical personnel in attendance calmly take charge. All incidents should be handled in a similar manner Safety what are the dangers and do they still exist? Is it safe for you to approach? Scene what factors are involved in the incident? How many casualties are there? Situation what happened? How many people are involved? Are they young or old

2.13 Making an area safe The conditions that give rise to an incident may still present a danger and must be eliminated if possible. If not safe or at any time becomes unsafe call for emergency help and stand clear of the incident.

2.14 Giving emergency help Once an area has been made safe use the primary survey to quickly carry out an initial assessment of the casualty attends those with life threatening conditions first 2.2 PRIMARY SURVEY The primary survey is a quick systematic assessment of a person to establish if any conditions or injuries sustained are life threatening. By following a methodical sequence using established techniques each life threatening condition can be identified in a priority order and dealt with. Response Make a quick assessment to find out whether the casualty is conscious or unconscious. Observe the casualty as you approach. Introduce yourself if he does not appear to be responding to you. Ask the casualty some questions like „what happened?‟ or give a command like „open your eyes?‟ if there is no response, gently shake the casualty‟s shoulders. If there is still no response he is unconscious and urgent treatment is needed. Airway The first step is to check that a casualty‟ s airway is open and clear. If the casualty is alert and talking to you, it follows that the airway is open and clear. If unconscious, open and clear the airway do not move to the next stage until it is open and clear. The tongue is the single most common cause of an airway obstruction in most cases using head- tilt/chin-lift technique can clear the airway. This action pulls the tongue form the air passage in the throat. If foreign material is present in the mouth it should be removed. Figure 1 Head tilt and chin lift technique

The airway can also be opened using the jaw thrust technique. This may be accomplished by the first aider grasping the angles of the casualty‟ s lower jaw and lifting with both hands, one on each side displacing the jaw forward and up. The jaw thrust is the safest first approach to opening airway of a casualty with suspected neck injury because in most cases it can be accomplished without extending the neck. Figure 2 Jaw thrust technique safe for suspected neck injury

2.21 Breathing Is the casualty breathing normally? Look, listen and feel for breaths. Always maintain airway as you check for breathing. Often the act of opening the airway will allow the casualty to breathe properly failure to maintain airway will prevent the casualty from receiving adequate oxygen. Look for chest rise and fall Listen for air escaping during exhalation by placing your ear next to the casualty‟s mouth Feel for flow of air on your cheek If the casualty is not breathing the heart will stop, chest compressions and rescue breaths must be started immediately. If the casualty resumes breathing monitor and maintain open airway.

2.22 Rescue breathing (artificial respiration) The sooner you begin rescue breathing, the more likely you are to restore the casualty‟s breathing. There are several methods of administering rescue breathing. The mouth to mouth is preferred; however it cannot be used in all situations. If the casualty has severe jaw fracture of mouth wounds use mouth to nose method 2.23 Mouth to mouth method In this method of rescue breathing, you inflate the casualty‟s lungs with air from your lungs. This can be accomplished by blowing air into the person‟s mouth. If the casualty is not breathing, place your hand on his forehead, and pinch his nostrils together with the thumb and index finger of this hand. Let this same hand exert pressure on his forehead to maintain the backward head tilt and maintain an open airway. Take a deep breath and place your mouth (in an airtight seal) around the casualty‟s mouth. Blow two full breaths into the casualty‟ s mouth (1 to 1 1/2 seconds per breath), taking a breath of fresh air each time before you blow. Watch out of the corner of your eye for the casualty‟s chest to rise. If the chest rises, sufficient air is getting into the casualty‟s lungs. Figure 3 mouth to mouth breathing

2.24 Mouth to nose breathing With this technique you blow into the nose while you hold the lips closed with one hand at the chin. You then remove the mouth to allow the casualty to passively exhale

2.25 Circulation Conditions that affect blood circulation can also be life threatening. Injuries that cause blood loss from the circulatory system must be treated immediately to minimize the risk of life threatening condition known as shock. After giving two slow breaths, which cause the chest to rise, attempt to locate a pulse on the casualty. Feel for a pulse on the side of the casualty‟ s neck closest to you by placing the first two fingers (index and middle fingers) of your hand on the groove beside the casualty‟s Adam‟s apple (carotid pulse). (Your thumb should not be used for pulse taking because you may confuse your pulse beat with that of the casualty.) Allow 5 to 10 seconds to determine if there is a pulse. Figure 4 feeling for pulse in the carotid artery

If the pulse is not present immediately start cardiopulmonary resuscitation (CPR). 

Correct Hand Position:

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First, kneel next to the victim's chest.

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Find the notch at the tip of the breastbone where the lower ribs meet the sternum, called the xyphoid process.

Never push directly on the xyphoid process. (Liver rupture). Place one hand on the center of the casualty‟ s chest. Place the heel of your other hand on top of the first and interlock your fingers. Lean directly over the casualty‟ s chest and press down vertically about 4-5 cm. 100/min Release the pressure, but do not remove your hands.

Figure 4 position for hand placement during adult CPR

After you do CPR for 1 minute, check for a pulse. If there is no pulse, continue CPR, beginning with chest compressions and rechecking for a pulse every few minutes. If you find a pulse, check for breathing. If the victim has a pulse but is not breathing, go to Rescue Breathing.

Figure 5 Adult CPR

2.26 CPR in an infant An infant's pulse is checked at the brachial artery, which is located inside of the upper arm, between the elbow and the shoulder. An infant's delicate ribcage is especially susceptible to damage if chest compressions are improperly performed; therefore it is important to use caution when rescuing an infant. Place three fingers in the center of the infant's chest with the top finger on an imaginary line between the infant's nipples. Raise the top finger up and compress with the bottom two fingers. Count aloud as you perform five compressions and follow up with one breath. Repeat this cycle 20 times before checking the infant for breathing and pulse. Figure 6 CPR in a child

Continue CPR until emergency help arrives, the casualty starts to breath normally or you are too exhausted to continue. If you are unwilling or unable to give rescue breaths, you can give chest compressions alone.

2.3 Secondary Survey. The Secondary Survey should be done quickly and systematically, first checking for major bleeding and then broken bones. 2.31Bleeding  Do a quick head to toe check for bleeding.  Check the hidden area such as under the arch of the back.  Control any major bleeding that you find.

2.32 Head and neck    

Clues to injury could be bruising, swelling, deformity or bleeding. Check the whole head and face. Feel the back of the neck. Has the patient had an accident that might have injured the neck?

2.33 Shoulders and chest   

Place your hands on opposite shoulders and compare them. Run your fingers down the collar bones checking for signs of a fracture. Gently squeeze and rock the ribs.

2.34 Abdomen   

Push the abdomen with the palm of your hand to check for and pelvis abnormality or response to pain. Gently check the pelvis for signs of a fracture. Look for incontinence or bleeding.

2.35 Legs and arms  Feel each leg for the signs of a fracture.  Feel each arm for the signs of a fracture.  Look for other clues (medic alert bracelets, needle marks etc). 2.36 Pockets Look for clues and make sure nothing will injure the patient as you roll them into the recovery position.  Have a witness if you remove items from pockets.  Be very careful if you suspect there could be sharp objects such as needles.  Loosen any tight clothing. 2.37 Recovery 

Place the patient in the recovery position. If you suspect neck injury, get someone to help you keep the head in line with the body as you turn the patient. Be careful not to cause further damage to any suspected injuries.

2.4 Obstructions in the Airway If an individual is choking - but can speak or cough forcibly - there is an exchange of air encourage the victim to continue coughing while you just stand by if a victim is choking, but CANNOT speak or cough, an airway obstruction exists which must be treated immediately.

2.41 HEIMLICH MANEUVER 

Stand behind the victim.

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Wrap your arms around the victim's waist.

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Make a fist with one hand and place the thumb side of the fist against the victim's abdomen just above the navel and well below the lower tip of the breast bone.

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Grasp your fist with your other hand, with elbows out, and press your fist into the victim's abdomen with quick, upward thrusts. Each thrust is a distinct, separate attempt to dislodge the foreign object.

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Repeat thrusts until foreign object is cleared or the victim becomes unconscious.

Figure 7 Heimlich maneuver (abdominal thrusts)...