FIRST AID/trauma and

emergency
BY
MISS KARANJA
Course Outline
 Introduction
o Definition of First Aid
o Aims of First Aid
o Steps of First Aid
o Giving artificial ventilation
o Giving chest compressions
 Cardiovascular Emergencies
o Shock
o Fainting
o Angina pectoris
o Heart attack
o Acute heart failure
o Cardiac arrest
 Wounds and Bleeding
o Definition
o First aid
o Types of wounds
o Types of bleeding
-severe external bleeding
-bleeding at special sites
-wounds to the palm
 RESPIRATORY DISORDERS
o Asphyxia
o Chocking
o Drowning
o Hanging and strangulation
o Inhalation of fumes
o Hyperventilation
o Hiccups
 MUSCULOSKELETAL INJURIES
o Strains and sprains
o Dislocations
o Sublaxation
o Fractures
o Injuries of the chest
 HEAD AND NECK INJURIES
o Concussion
o Skull fracture
o Cerebral compression
o Convulsions
o Epilepsy
o Unconciousness
o Types of neck injuries
 BURNS AND EXTREMES OF
TEMPERATURE
o Classification
o Types
o Management
 BITES AND STINGS
o Animal bites
o Insect stings
o Marine stings
o Marine puncture wounds
o Snake bites
 BANDAGING
dEFINITION
 First Aid is the initial assistance or
treatment given to someone who is
injured or suddenly taken ill

 First Aid is the immediate care of an

injured or suddenly sick person. It is the
care a person applies as soon as
possible after an accident or sudden
illness
 This prompt care and attention prior to
the arrival of the ambulance can
sometimes mean the difference between
life and death or between a full or partial
recovery
Aims of First Aid
 Preserve life
This includes the life of the casualty,
bystander and rescuer
ABC of resuscitation
 Protect the casualty from further harm
Ensure the scene is safe
 Provide pain relief/promote recovery
This could include the use of ice packs or
simply applying a sling
 (a bandage used to suspend or support
an injured part of the body)

 Prevent the injury or illness from

becoming worse
Ensure the treatment you provide does
not make the condition worse
 Provide reassurance

 It is important to understand that first aid

has its limitations and does not take the
place of professional medical treatment
Objectives of First Aid
 To preserve life

 To alleviate suffering

 To promote recovery

 To prevent aggravation of the injury or

illness until veterinary assistance can be
obtained
Definition of terms
First Aider
A person who offers emergency care to
the casualty(ies)
Victim/casualty
A person suffering from a sudden injury
or trauma or illness and needs first aid
Emergency
An unexpected incidence serious in nature
that requires quick action,e.g poisoning, burns
etc
Scene
An area on incident
Incident
It’s a happening traumatic in nature that
requires first aid(it could be illness or injury)
The First Aider Qualities
 Highly trained i.e. have necessary
knowledge
 Examined and regularly re-examined
 Have empathy and understanding
 Are up-to-date in knowledge and skill
 Have initiative and sense of leadership
 Have ability to act quickly, make
decisions and improvise
 Appreciate that the less interference the
better
Responsibilities of a First Aider
 To assess the situation quickly and
safely and to summon appropriate help
 To protect casualties and others at the
scene from possible danger
 To identify as far as possible the injury
or nature of illness affecting a casualty
 To give each casualty early and appropriate
treatment, treating the most serious
conditions first
 To arrange how the casualty will get to
hospital or to his/her home
 To remain with the casualty until appropriate
care is available
 To report his/her observations to those
taking care of the casualty and to give
further assistance if required
 To prevent cross infection between yourself
and the casualty as much as possible
Protecting the casualty
 To prevent/avoid cross-infection when giving
first aid you should:
 Avoid contact with body fluids
 Wash your hands
 Wear protective gloves
 If gloves are unavailable, life saving treatment
must still be available
First Aid Priorities
 Assess the situation
Observe what has happened quickly and
calmly
Look for danger to yourself and to the
casualty
 Make the area safe
Protect the casualty from danger
Beware of your limitations
 Assess all casualties and give
emergency first aid
Assess each casualty to determine
treatment priorities and treat those with
life threatening conditions first.
 Get help
Quickly ensure that any necessary
specialist help has been summoned and
is on the way
 Assignment: General Rules of First Aid
Treatment
Triaging
This is sorting and classifying injured
patients to determine priority of need
The most critical are taken care of first
Direct assistance to casualties is given
by the casualty nurse
 The mnemonic START is used.
S-Simple
T-Triaging
A-And
R-Rapid
T-Treatment
Basics of First Aid

 Basic First Aid refers to the initial

process of assessing and addressing
the needs of someone who has been
injured or is in physiological distress due
to chocking, a heart attack, allergic
reactions,drugs,alcohol or other medical
emergencies
1.Evaluate the situation
Are there things that might put you at
risk of harm? Are you or the victim
threatened by fire, toxic smoke or gases,
an unstable building, live electrical wires
or other dangerous scenario? Do not
rush into a situation where you could
end up as a victim yourself
 If approaching the victim will endanger your
life, seek professional help immediately;
they have higher levels of training and know
how to handle this situations
2.Remember your A,B,C.
The A,B,C refer to the three critical things
you need to look out for
Airway-Does the person have an obstructed
airway?
Breathing-Is the person breathing
Circulation-Does the person show a
pulse at major pulse points(wrist, carotid
artery and groin)
3.Avoid moving the victim
Avoid moving the victim unless they are
in immediate danger. Moving a victim
will make the injury worse especially in
cases of spinal cord injuries
4.Call emergency services/call for help
or tell someone else(a specific person if
possible) to call for help as soon as
possible
 If you are the only person on the scene,
try to establish breathing before calling
for help and do not leave the victim
alone for an extensive amount of time
5.Determine responsiveness
If a person is unconscious, try to rouse
them by gently shaking and speaking to
them
6.If the person remains unresponsive, carefully
roll them onto their back and open his/her
airway
Keep head and neck aligned
Carefully roll them onto their back while
holding his head
Open the airway by lifting the chin
7.Look,listen and feel for signs of breathing
Look for the victims chest to rise and
fall, listen for sounds of breathing(place
your ear near the nose and mouth and
feel for breath on your cheek)
If the victim is not breathing, check for
circulation
 If the victim is breathing but unconcious,roll
them onto their side, keeping the head and
neck aligned with the body. This will help
drain the mouth and prevent the tongue or
vomit from blocking the airway
8.Check victims circulation
Look at the victims color and check for
pulse(the carotid artery is a good option, its
located on either side of the neck below the
jaw bone)
 If the victim does not have pulse, start
CPR(Cardiopulmonary resuscitation)
9.Treat bleeding, shock or other problems as
needed
After you have established that the
victim is breathing and has a pulse, your
next priority should be to control any
bleeding
 Stop bleeding by applying direct
pressure
10.Stay with the victim until help arrives
Be a calming presence for the victim
until assistance arrives
If the victim is not breathing
Follow this steps to restore breathing in
an unconscious victim
This steps assume you have already
performed the chin lift described above
o Check for a clear airway: Remove any
obvious blockage
o Cover the victims mouth with your
own(kiss of life)
o Pinch the victims nose closed
o Fill victims lungs with two slow breaths. If
breaths are blocked, reposition the airway.
Make sure the head is tilted slightly back
and the tongue is not obstructing it.
o If breaths are still blocked, give 5 quick
forceful abdominal thrusts. This is the
equivalent of Heimlich maneuver in a
standing person.
 Straddle the victim
 Place a fist just above the belly button and
below the breast bone
 Thrust upward to expel air from the lungs
 Sweep the mouth to remove any foreign
object
 Try two slow breaths
 Repeat until you are successful in clearing
the object from the windpipe
o With open airway begin rescue breathing.
Give one breath every 5 seconds and check
that the chest rises every time
o Administer CPR if the victim does not have a
pulse until help arrives
How to do CPR on an adult
 Check the scene for immediate danger
Make sure you are not putting yourself
in danger/harm by administering CPR to
someone unconscious. Is there fire? Is
the person lying on a roadway? do
whatever is necessary to move yourself
and the other person to safety.
You can open a window, turn off the
stove or put out the fire if possible.
 However, if there is nothing you can do
to counteract the danger, move the
victim. The best way to move the victim
is by placing a blanket or coat
underneath their back and dragging it
 Assess the victims consciousness
Gently tap his/her shoulder and ask: Are
you ok’ in a loud clear voice. If he/she
responds,CPR is not required
 If the victim does not respond, continue
with the following steps
 Send for help
Send someone to call for emergency
services. Give the dispatcher your
location and notify him or her that you
are going to perform CPR.If you are
alone, get off the phone and start
compressions.
 If you have someone else with you,
have him or her stay on the line while
you do CPR on the victim
 Check for breathing
Put your ear close to the victims nose
and mouth and listen for breathing. If the
victim is coughing or breathing normally,
DON’T perform CPR.Doing so could
cause the heart to stop beating
 Place the victim on his/her back and
make sure he/she is lying flat as
possible. This will prevent injury while
doing the chest compressions
 Place the heel of one hand on the
victims breastbone, exactly between the
nipples
 Place your second hand on top of the
first hand palms down
 Position your body directly over your
hands so that your arms are straight and
somewhat rigid
 Perform 30 chest compressions
Press down with both hands directly
over the breastbone to perform a
compression which helps the heart beat
Chest compressions are more critical for
correcting abnormal heart rhythms.
 some of the abnormal heart rhythms
include ventricular fibrillation and
pulseless ventricular tachycardia
 You should depress the breastbone
approximately 4-5cm(1.5-2 inches)
 Minimize pauses in chest compressions
Attempt to limit interruptions to less than
10 seconds
 Make sure the airway is open. Place two
fingers under the point of casualty's
chin, lift the jaw. At the same time, place
your other hand on the casualty's and
gently tilt the head well back
 If you suspect a neck injury, pull the jaw
forward rather than chin lifting. If jaw
thrust fails to open the airway, do a
careful head tilt and chin lift
 If there are no signs of life, place a breathing
barrier(if available) over the victims mouth
 Give two rescue breaths
Keeping the airway open, take the fingers
that were on the forehead and pinch the
victims nose closed. Make a seal with your
mouth over the victims mouth and breath out
for about one second. Breath slowly to
ensure air goes in the lungs and not the
stomach
 If the breath goes in, you should see the
chest slightly rise and also feel it go in.
Give a second rescue breath
 If the breath does not go in, reposition the
head and try again. If it does not go in
again, the victim may be chocking
 Repeat the cycle of 30 chest compressions
and 2 rescue breath. Do CPR for 2
minutes(5 cycles) before checking for signs
of life.
 Continue CPR until someone takes over,
emergency personnel arrive, you are too
exhausted to continue, an
AED(automated external defibrillator) is
available for immediate use or signs of
life return.
 AED is used to jumpstart the victims
heart
How to use an AED
 Make sure there are no paddles or
standing water in the immediate area
 Turn on the AED.It should have voice
prompts that tell you what to do
 Fully expose the victims chest. Remove
any metal necklaces or underwire bras
 Check foe any body piercings or evidence
that the victim has a pacemaker(should be
indicated by a medical bracelet)
 Make sure the the chest is absolutely dry
 Attach sticky pads with electrodes to the victims
chest. Move the pads at least one inch(2.5 cm)
away from the metal piercings or implanted
devices
 Press analyze on the AED machine. If a shock is
needed it will notify you
 If you do shock the victim, make sure no one is
touching him/her
 Remove the electrode pads and resume CPR for
other 5 cycles before using the AEDagain
 First Aid Steps
 Before attending to a casualty, you must
survey the whole scene
 Your first responsibility is to make that the
area is safe
 Where the danger is too imminent or
great, you may need to move the
casualty even at risk of aggravating injury
 Only when the casualty is safe can you
begin to treat illness and injury
 Ensure personal safety so that you don’t
become a casualty
 Send for help
1)ASSESSMENT
When safe to do so, quickly perform a
brief examination of the casualty. This is
to check for any life threatening
conditions that need urgency and to
preserve life
 You do assessment before making a full
diagnosis and if necessary, be prepared
to carry out appropriate steps to
resuscitate the casualty first
i)Check consciousness
If casualty does not respond when
spoken to, he might be unconscious. Try
to elicit a response and be careful not to
move the head or tilt the neck
ii)Open the airway
An unconscious casualty’s airway may
be blocked by the tongue falling back.
Open airway by tilting the head back
iii)Check for breathing
Once airway is open, establish whether
the casualty is breathing, if not, place in
recovery position.
Give artificial breaths
iv)Check for circulation
If the heart is beating, you should be
able to feel a pulse in the neck(carotid
pulse) or wrist(radial pulse).
For the babies, check brachial pulse
v)Check for bleeding
Severe loss of blood reduces circulation
to the vital organs and can cause shock
 Control serious bleeding as soon as
breathing and pulse have been
established
 As soon as you establish the condition of
the casualty, take action depending on
 Unconcious,not breathing and without
pulse
 Unconcious,not breathing and with a pulse
 Unconcious,breathing and with a pulse
2.DIAGNOSIS
Requires thorough physical examination
Made on the basis of history and clues
to any medical condition and signs and
symptoms
Circumstances will determine how
detailed the examination will be
History
 Is full story of how the incident
happened, how the injury was sustained
or how the illness began and continued
including any previous conditions
 Question the casualty but if he is
unconscious, talk to any
witness(es).They give useful information
but can be unreliable if upset
 Take into account
 When the casualty last had something to
eat or drink
 Whether the casualty has any illness or
is taking any medication
 The amount of force involved and how it
was applied to the body
 The environment e.g. hot and stuffy, cold
room or exposed to wind or rain
 Casualty's age and state of health e.g a
young fit adult who trips may sprain a
wrist but an elderly lady who does the
same is more likely to have broken her
arm or hip
 Establish who the casualty is and where
he/she lives
External clues
 If casualty is unable to co-operate or is
unconscious, look through pockets and bags for
clues(Beware of syringes if you suspect drug
abuse)
 There may be an appointment card for hospital
or clinic or a card indicating history of
allergy,diabetes,epilepsy etc
 Medication carried by casualty may give
valuable clues about the emergency e.g. glyceryl
trinitrate for angina,phenytoin for epilepsy and
inhalers for asthmatics or angina patients
 Take care of any such clue and return it
to the casualty
Signs and symptoms
i) Symptoms verbalized by the casualty
Pain,anxiety,heat,cold,loss of normal
movement, loss of
sensation,thirst,nausea,tingling,faintnes
s,stiffness,memory
loss,dizziness,sensation of broken bone
ii)Signs you may see
Anxiety and painful expression, unusual
chest
movement,burns,sweating,wounds,bleeding
from orifices, response to touch, response
to speech,bruising,abnormal skin
colour,muscle
spasm,swelling,deformity,foreign bodies,
needle marks,vomit,incontinence,containers
and other circumstantial evidence
iii)Signs that you may feel
Dumpness,abnormal body
temperature,swelling,a deformity,
abnormal pulse, grating bone ends
iv)Signs that you may hear
Noisy or distressed
breathing,groaning,response to speech,
grating bone ends(crepitus)
v)Signs that you may smell from patients
breath
Acetone,alcohol,solvents or glue, cannabis
Examining a casualty
 Do a head to toe examination
 Run your hands carefully over the scalp to
feel for bleeding, swelling or depression
that may indicate possible fracture
 Be careful not to move any casualty who
you feel/think might have injured her/his
neck
 Speak clearly to the casualty and check
for response. Check for blood or clear
fluid discharge from the ears or a
mixture of both. It could a sign of
intracranial damage
 Examine both eyes, noting if open. size of
the pupil. Are the pupils reacting to
light(should shrink when light falls on
it),foreign bodies, blood or bruising in the
whites of the eyes.
 Examine the nose
 Record the rate, depth and nature of
breathing. Note any odor on breath, check
the mouth, open airway, look for any wounds
or lost teeth and examine lips for burns
 Note the color, temperature and state of
the skin. If its pale, flushed or cyanosed.
Is it hot, dry or dump.Pale,cold and
sweaty skin suggest shock, a flushed
hot face suggests heat stroke or fever.
Blue skin(cyanosis)-look for it at the lips,
ears and face
 Loosen clothing around the neck and
check for a tracheostomy tube.
 Palpate the spine from the base of the skull
downwards without disturbing/moving the
patient. Check for any swelling, tenderness
or any other irregularity.
 Ask the patient to breath deeply and check
if the chest expands evenly, easily and
equally on both sides. Feel the rib cage for
any deformities,irregularity,tenderness or
granting sensation on breathing
 Feel along the collar bones and the
shoulder for any deformity, irregularity or
tenderness
 Check the movements of elbows, wrists
and fingers. Ask the casualty to bend
and straighten the arm at the joints.
Check for any abnormal sensation at he
limbs and note color
 If there is any sign of impairment of
movement or loss of sensation in the
limbs, do not move the casualty to
examine the spine. Gently pass your
hand under the hollow of the back and
feel along the spine without disturbing
without disturbing the casualty checking
for swelling and tenderness
 Gently feel the front of the abdomen for
evidence of bleeding and to identify any
rigidity or tenderness of the muscular
wall
 Feel both sides of the hips and gently
move the pelvis to look for signs of
fracture. Note any incontinence or
bleeding from orifices
 Ask the casualty to raise each leg in turn
and to move her ankles and knees. Look
and feel for bleeding, swelling or any
other deformity and tenderness

 Check movement and feeling in all toes.

Also color
Treatment and aftercare
 Treat each condition methodically and
calmly in order of priority
 Re-assure the casualty and listen to
them. Don't keep questioning the
casualty and do not let people crowd
around
 Avoid moving the casualty unnecessarily
Treatment priorities
 Follow ABCs
 Maintain clear airway and breathing. If
unconcious,place in recovery position
 Control bleeding
 Treat large wounds and burns
 Immobilize bone and joint injuries
 Give appropriate treatment for other injuries
and conditions
 Check airway, breathing and pulse regularly
and deal with any problem immediately.
Arranging appropriate aftercare
 Ascertain whether casualty needs
medical treatment and if so, what is
needed.
 If you require help send someone else if
possible, in the event that the casualty's
condition alters or worsens. Stay with
the casualty until help arrives
 According to your assessment of the
casualty, you may:
 Call a doctor/senior nurse for advise
 Call an ambulance or arrange transport
to hospital
 Pass care of the casualty to a doctor,
nurse or ambulance crew
 Take the casualty to a nearby house or
shelter to await medical help
 Allow the casualty to go home
accompanied if possible
 Ask if somebody will be at least home to
meet him/her or you can arrange this
 Advice the casualty to see a doctor
 Do not allow home a casualty who has
been unconscious(other than a
faint),had severe breathing difficulty or
signs of shock. Stay with him or her until
help arrives
 Do not give anything by mouth to any
casualty who may have internal injuries
or otherwise need hospital care
Passing on information
 Having summoned medical aid, make
notes on the incident and the condition
of the casualty so that you can pass on
all the information you have gathered
 The observation chart overleaf will
enable you to not tour observations such
as breathing, level of response at a ten
minute interval
 Make a brief written report to
accompany your observations
 Your report should include:
 The casualty's name and address
 History of the accident or illness
 A brief description of any injuries
 Any unusual behavior
 Any treatment given and when
 Breathing, pulse and level of response
RESUSCITATION TECHNIQUES
 RESUSCITATION SEQUENCE
 Check response
 Open airway
 Check breathing
 Assess for circulation
 Commence CPR
Assignment: resuscitation for children
 <1 year
 1-7 years
 8 years and above
CARDIOVASCULAR
EMERGENCIES
1.SHOCK
A shock state exists when the tissue
perfusion decreases to the point of
cellular metabolic dysfunction.

Shock is classified according to the

causative event.
Types of shock
1.Hematogenic/hemorrhagic/hypovolemic
Occurs when blood volume is insufficient to
meet metabolic needs of the tissues as with
severe hemorrhage.
2.Cardiogenic shock
Occurs when cardiac failure results in
decreased tissue perfusion as in MI.
3.Distributive shock conditions
Characterized by displacement of a significant
amount of vascular volume.
Types of distributive shock
1.Neurogenic shock
Results from a neurologic event such as head injury that
causes massive vasodilatation and decreased
perfusion pressures.
2.Anaphylactic shock
Caused by a severe systemic response to an allergen
resulting in massive vasodilatation, increased capillary
permeability, decreased perfusion, decreased venous
return and subsequent decreased cardiac output.
3.Septic shock
Occurs when bacterial toxins cause an overwhelming
systemic infection.
Circulatory shock
 The circulatory system distributes blood
round the body so that oxygen and
nutrients can pass through and perfuse
the tissues. When the system fails,
circulatory shock ensue. If not treated
swiftly, vital organs such as the heart
and the brain may fail leading to death.
 Worsened by fear and pain.
Causes of circulatory shock
1.Heart attack
2.Severe infection and anaphylactic shock-
blood vessels dilate reducing the blood
pressure
3.Blood loss
4.Loss of body fluids through burns, severe
diarrhea or vomiting
-The body responds to fluid loss initially by
diverting the blood supply from the surface to
the vital organs.
continuation

As the brain’s oxygen supply weakens

 Restless, anxious and aggressive
 Air hunger-yawn and gasp for air
 Unconscious
 Heart stops
Signs and symptoms
At first, the release of adrenaline causes
 A rapid pulse
 Pale,grey-blue skin especially inside the lips.
 Sweating, cold and clammy skin.
As shock develops
 Weakness and giddiness
 Nausea and vomiting
 Thirst
 Rapid shallow breathing
 A weak thready pulse. When the pulse at the wrist
disappears, about half the blood volume will have been
lost.
Treatment
AIMS
 To recognize shock
 To treat any obvious cause
 To improve the blood supply to the brain,
heart and lungs
 To arrange removal to hospital
Treatment
 Treat any cause of shock you identify such as external
bleeding.
 Lay the casualty down on a blanket to protect her from the
cold ground keeping her head low.
 Raise and support her legs to improve the blood supply to
the vital organs. Take care if you suspect a fracture.
 Loosen tight clothing such as belts and braces to reduce
constriction at the neck, chest or waist.
 keep the casualty warm by covering her with coats and
blankets.
 Check and record breathing, pulse and the level of
response.
 Be ready to resuscitate if necessary.
2.FAINTING/SYNCOPE
Is a brief loss of consciousness that is
caused by temporary reduction of blood
flow to the brain.
The pulse becomes very slow although
it soon picks up and returns to normal.
Recovery is rapid and complete.
Signs and symptoms
 A brief loss of consciousness causing
causing the casualty to fall to the floor.
 Slow pulse
 Pale cold skin
 Sweating
Aims of treatment
 To improve blood flow to the brain

 To reassure as she recovers and make

her comfortable
Treatment
 Lay the casualty down, raise and support her legs
 Make sure that she has plenty of fresh air
 As she recovers, reassure her and help her sit up
gradually
 Look for and treat any injury that has been
sustained through falling
 If she does not regain consciousness quickly, do
ABC and be ready to resuscitate if necessary. If
the patient starts to feel faint again tell her to lie
down and raise and support her legs until she
fully recovers.
3.ANGINA PECTORIS
 Its constriction of the chest and
describes the pain that a person
experiences when narrowed coronary
arteries are unable to deliver sufficient
blood to the heart muscle to meet the
demands of exertion or excitement.
 The pain is relieved by rest.
Signs and symptoms
 Gripping central chest pain, spreading
often to the jaw and down to the left arm
 Shortness of breath
 Weakness-sudden and extreme
 Anxiety
TREATMENT
Aims
 To ease strain on the heart by ensuring that
the casualty rests
 To obtain medical help if necessary
Actual treatment
 Help the casualty to sit down. make her
comfortable and reassure her.
 If the casualty has medicine for angina such as
tablets or a “puffer” aerosol let her administer it
herself. If necessary help her to take it.
continuation

 Encourage the casualty to rest and keep

bystanders away. The attack should
ease within a few minutes.
 If the pain persists or returns suspect a
heart attack. Dial 999 for an ambulance.
 Monitor and record breathing and pulse
rates every ten minutes.
4.HEART ATTACK
Occurs when the blood supply to part of
the heart muscle is suddenly obstructed
e.g. coronary thrombosis
The main risk is that the heart will stop.
The effect of the heart attack depends
on how much of the muscle is affected.
Drugs that aid recovery include
thrombolytic (dissolve the clot) and
asprin (thins the blood).
Signs and symptoms
 Persistent central chest pain spreading to the jaw
and down to the left arm. Unlike angina pectoris the
pain does not ease once the casualty is at rest and
may occur at rest.
 Breathlessness and discomfort high in the
abdomen.
 Sudden faintness or giddiness
 A sense of impending doom
 ‘’Ashen” skin and blueness at the lips
 Rapid weak irregular pulse
 Sudden collapse
Aims of treatment
 To minimize the work of the heart
 To summon urgent medical help and arrange removal to
hospital
treatment
 Put the patient on a half sitting position, with the casualty’s
head and shoulders well supported and his knees bent
 Call for help and state that you suspect a heart attack
 Constantly monitor and record the casualty’s breathing and
pulse rate and be prepared to resuscitate if necessary
 If the casualty has medicine for angina(“puffer "aerosol)
help him take it if he has. If the pain persists and the
casualty is fully conscious give him one tablet of ordinary
aspirin to chew
5.ACUTE HEART FAILURE
The heart muscle is strained and fatigued
e.g. following coronary thrombosis and
becomes increasingly inefficient.
Acute attacks may occur at night
Signs and symptoms
Similar to heart attack
Treatment
Follow the treatment for heart attack
6.CARDIAC ARREST
Sudden stoppage of the heart. Its
characterized by the absence of pulse and
breathing. You must commence resuscitation
immediately.
Causes
 Heart attack
 Severe blood loss
 Suffocation
 Electric shock
 Anaphylactic shock
 Hypothermia
Signs and symptoms
 Absence of pulse
 Absence of breathing
Aims of treatment
 To arrange urgent removal to hospital.
 To keep the heart muscle and brain
supplied with oxygen until help arrives.
Treatment
Begin CPR
WOUNDS AND BLEEDING
Introduction
Definition of wound
Its any abnormal break in the skin or the
body surface.
 Wounds can be daunting if there is a lot
of bleeding but prompt action is needed
to reduce blood loss and shock.
FIRST AID PRIORITIES
 Control blood loss by applying pressure
over the wound and raising the injured part
 Take steps to minimize shock
 Cover any open wound with a dressing to
protect it from infection and promote
natural healing
 Observe hygiene to prevent cross infection
between the casualty and yourself
Types of Wound
1.Incised wound
A clean cut from a sharp edge such as broken glass
such as broken glass causes an incision. The blood
vessels at the wound edges are cut straight across so
there may be profuse bleeding.
2.Laceration
Crushing or ripping forces result in rough tears or
lacerations.
Bleed less profusely than clean-cut wounds but there
is more tissue damage and bruising.
they are often contaminated by germs. The risk of
infection is high.
Types of wounds
3.Abrasion(graze)
This is a superficial wound in which the top
layers of the skin are scraped off, leaving a raw,
tender area.
Caused by a sliding fall or a friction burn.
They can contain embedded foreign particles
that may result in infection.
4.Contusion(bruise)
A blunt blow or punch can rupture
capillaries beneath the skin. Blood then
leaks into the tissues causing bruising.
The skin splits occasionally.
Severe contusion may indicate deeper,
hidden damage such as fracture or
internal injury.
Types of wounds
5.Puncture wound
Standing on a nail or being stabbed.
Has small entry site but a deep track of internal
damage.
Germs and dirt can be carried far into the body and
therefore the risk of infection is high.
6.Gunshot wound
A bullet or other missile may drive into or through the
body causing serious internal injury and sucking in
contaminants from the air. The entry wound may be
small and neat while the exit wound may be large and
ragged.
Types of bleeding
Classified by the type of blood vessel that is
damaged:artery,vein or capillary.
Arterial bleeding can be very dramatic but copious
venous bleeding is potentially more serious.
1.Arterial bleeding
Richly oxygenated blood is bright red.
Under pressure from the heart, it spurts from a
wound in time with the heart beat.
A severed main artery may jet blood several feet
high and rapidly reduce the volume of circulating
blood.
Types of bleeding
2.Venous bleeding
Venous blood is dark red.
Its under less pressure.
Vein walls are capable of great distension and therefore
blood can pool within them.
Blood from a severed major vein may gush profusely.
3.Capillary bleeding
Occurs at the site of all wounds.
At first may be brisk but blood loss is usually slight.
A blunt blow may rupture capillaries under the skin
causing bleeding under the skin causing bleeding into the
tissues(bruise)
Severe external bleeding
Bleeding at the face or neck can impede
the airway.
Shock is likely to happen and the casualty
may loose consciousness.
Aims of treatment
 To control the bleeding
 To prevent and minimize the effects of shock
 To minimize the risk of infection
 To arrange urgent removal of the casualty to
hospital.
Treatment
1.Remove or cut clothing to expose the
wound. Watch out for sharp objects such
as glass that may injure you.
2.Apply direct pressure over the wound with
your fingers or palm preferably over a
sterile dressing or clean pad. Do not waste
time hunting for a dressing.
If you cannot apply direct pressure e.g. if
an object is protruding, press down firmly
on either side.
Treatment
3.Raise and support the injured limb above the level of
the casualty’s heart.
4.Lay the casualty down. This will reduce blood flow to
the site of the injury and minimize shock.
5.Leaving any original pad in place, apply a sterile
dressing. Bandage it in place firmly but not so tightly
as to impede circulation. If blood seeps through the
dressing, bandage another firmly over the top.
 If there is a protruding foreign body, build up padding
on either side of the object until high enough to
bandage over the object without pressing on it.
Continuation
6.Secure and support the injured part with
bandaging
7.Call for help. Treat shock, check
dressing for seepage and check for
circulation beyond the bandage.
BLEEDING AT SPECIAL
SITES
Scalp and Head Wounds
Aims of treatment
 To control blood loss
 To arrange transport to hospital
Actual treatment
 Wearing disposable gloves, if possible
replace any displaced skin flaps.
 Apply firm direct pressure over a sterile
dressing or clean pad.
 Secure the dressing with a roller
bandage. Lay the casualty down with
head and shoulders slightly raised. If he
becomes unconcious,ABC.
 Take or send the casualty to hospital in
the final treatment position.
Wounds To The Palm
Aims of treatment
To control blood loss
To arrange transport to hospital
Treatment
 Press a sterile dressing or clean pad firmly into the
palm and ask the casualty to clench his fist over it. If he
finds it difficult to press hard, he may grasp the fist with
his uninjured hand.
 Bandage the casualty’s fingers so that they are
clenched over the pad. Tie the knot over his fingers
 Support the casualty’s arm in an elevation sling and
take him or send him to hospital.
Wounds At Joint Creases
Aims of treatment
 To control blood loss
 To arrange transport to hospital
Treatment
 Press a clean pad over the injury. Bend the joint as
firmly as possible
 With the joint firmly bent to press on the pad, raise
the limb. Lay the casualty down to reduce shock
 Take or send the casualty to hospital in the
treatment position. Release the pressure briefly
every ten minutes to restore normal blood flow.
Bleeding Varicose Veins
A varicose vein has taut, thin walls and is
often raised stretching the skin to give a
characteristic ”knobbly” appearance. It can
burst by gentle knocks and will bleed
profusely.
Aims of treatment
 To control blood loss
 To arrange urgent removal to hospital
 To minimize shock
Treatment
 Lay the casualty on her back and raise the injured leg
to reduce or stop bleeding
 Expose the site of bleeding and apply firm direct
pressure over sterile dressing or clean pad with a
securing bandage or with your fingers until bleeding is
controlled. Remove garments such as garters or
elastic-topped stockings that may be impeding blood
flow back to the heart.
 Put a large soft pad over the dressing. It should exert
even pressure yet not impede blood flow.
 Keep the injured leg raised and supported until the
ambulance arrives.
MAJOR WOUNDS

Cause serious internal injury without

severe external bleeding esp. trunk
wounds.
1.Abdominal Wounds
Severity is evident in external bleeding and
protruding abdominal contents. There could
be hidden internal injury and bleeding
The risk of infection and shock is high
Treatment
Aims
 To minimize the risk of infection
 To minimize shock
 To arrange urgent removal to hospital
Treatment
 Lay the casualty down on a firm surface.
Loosen any tight clothing
 Put a large dressing over the wound and
secure it lightly in place with a bandage. If
part of the intestine is protruding, do not
touch it but cover with a plastic bag or
kitchen film to prevent it from drying out.
Alternatively use a sterile dressing.
 Call for help. If casualty becomes
unconscious, do ABC.
INTERNAL
HAEMORRHAGE
Its of great importance that any first aid worker takes prompt
action.
Management
 Rest and quiet
The patient must be laid down lying flat and kept absolutely still.
If the patient is allowed to move about in any way, there is
danger of further bleeding
 Reassurance
Reassure the casualty as he or she will be anxious and possibly
afraid
 Position
If possible the lower end of the bed or couch can be raised. This
Facilitates the flow of blood by gravity to the brain and may prevent
fainting or unconsciousness
continuation
 Clothing
Undo tight clothing round the neck, chest
or waist. This helps the patient to breath
more easily and prevent the feeling of
suffocation.
 Medical aid
Alert the EMS or arrange patient’s removal
to hospital.Ensure minimal movement of
the casualty when handling him or her.
Epistaxis
Its bleeding from the nose.
Can be severe or slight.
Management
 Place the patient on a chair in a sitting position with the
head held forward. In severe bleeding this will prevent
the blood flowing to the back of the nose and throat an
may prevent it from being swallowed or inhaled.
 Loosen tight clothing round the neck, chest and waist
and place the patient near an open window
 Ask the patient to breath through his or her mouth
 Pinch the nose firmly between the thumb and the
forefinger
CONTINUATION
 A cold compress in the form of a
handkerchief wrung out in iced water
can be applied over the bridge of the
nose and at the back of the neck.
 Keep the patient sitting very still
 If the bleeding is very severe and does
not stop within several minutes, arrange
how the patient will get to hospital.
Bleeding from a tooth socket
If a tooth has been extracted, it is possible
for the socket to continue bleeding.
First aid management
 Fit a plug of gauze or cotton wool into the
socket and ask the patient to clench the
teeth very firmly. The roughness of the
gauze and pressure on the bleeding vessels
stop the bleeding in about ten minutes.
 If bleeding does not cease, arrange the
patients removal to hospital.
RESPIRATORY
DISORDERS
Asphyxia
Arises when one is not able to inhale or
exhale air.
The body does not receive sufficient
oxygen and there is accumulation of
carbon dioxide in the blood causing
unconciousness,death or suffocation
Causes of asphyxia
 Occlusion or obstruction of the upper respiratory
tract.
This may be due to:
1. Strangulation
2. Smothering with a pillow
3. Impaction of foreign body such as bone in the throat
or a piece of food inhaled into the larynx or trachea
4. Pressure on the chest e.g. by fallen masonry
5. Drowning
6. A complication of another condition such as swelling
due to burning of the mouth and throat
Continuation
 Paralysis of the muscles of respiration
Can be due to:
1. Electric shock
2. Being struck by lightening
3. Poisons e.g. strychnine and morphine
4. Diseases such as poliomyelitis
Continuation
 Effects of certain gases
Include CO, ammonia and chlorine
 Breathing in smoke
If someone has been trapped in a
burning building
Signs and symptoms of asphyxia
 Difficulty in breathing, restlessness and agitation
 The patient begins to struggle trying to remove the
obstruction
 Coughing and spluttering
 Cyanosis occurs
 If the patient struggles to overcome the asphyxiation,
the face becomes congested with blood ,neck veins
become distended and the pupils dilate
 If the individual does not struggle and appears to go
to sleep, suspect CO poisoning
Management of asphyxia
 Remove the source of danger from the
patient. For example a pillow from the
face and a bone from the throat. Or
remove the patient from the source of
danger such as smoke or gas filled room
or take the patient out of the water in
case of drowning.
 Undo tight clothing round neck, chest
and waist.
Continuation
 Clear the mouth of any obstruction such
as vomit as far as possible
 If breathing and pulsation have ceased
start CPR
 In cold weather, keep the person
reasonably warm.
CHOCKING
This is most common with children. A marble, a weed or a
button may get stuck in the air passage. In adults too, food
may go down the wrong way and cause choking.

Management in the case of an adult.

 When victim is standing, the First Aider should stand behind
the victim and wrap his arms around the waist. Grasp the fist
with your other hand and place the thumb of the fist against
the abdomen (belly) slightly above the navel and below the
rib cage.
 Press your fist into the victim's abdomen with a quick upward
thrust. Repeat several times if necessary till the foreign body
is expelled out of the windpipe. When the victim is sitting, the
First Aider stands behind the chair and performs the same
maneuver.
CONTINUATION
 If the victim is lying, turn him supine (face up).
Facing the victim, kneel astride the victim's legs.
With your hands one on top of another, place
the heel of your bottom hand over the abdomen
(belly) between the naval and the ribcage. Press
into the victim's abdomen with a quick upward
thrust repeat several times, if necessary. Should
the patient vomit, place him on his side and
wipe to prevent asphyxia. Following the
expulsion of food particle/foreign body it may be
necessary to give artificial respiration.
Management incase of an infant
 Hold the child upside down by the legs
and smack his/her back hard three or four
times.
 If not successful, lay the child prone with
his head hanging downwards over the
knee and give sharp smacks between
shoulders.
 If still not successful, induce vomiting by
passing two fingers right to the back of the
throat.
DROWNING
Drowning is the result of complete immersion of the nose
and mouth in water (or any other liquid). Water enters the
windpipe and lungs, clogging the lungs completely.
Management
Aim
 To drain out water (or other matter) from lungs and to give
artificial respiration.
 Act quickly. Remove the casualty from the water ,
seaweeds and mud from the nose and throat. Start artificial
ventilation immediately.
 Turn the victim face down with head to one side and arms
stretched beyond his head. Infants or children could be held
upside down for a short period.
Continuation
 Raise the middle part of the body with
your hands round the belly. This is to
cause water to drain out of the lungs.
 Give artificial respiration until breathing
comes back to normal. This may have to
go on for as long as two hours.
 Remove wet clothing.
Continuation
 Keep the body warm, cover with
blankets.
 When victim becomes conscious, give
hot drinks such as coffee or tea.
 Do not allow him to sit up.
 After doing the above, remove quickly to
hospital as a stretcher case.
Hanging and Strangulation
 Cut or remove the band constricting the
throat.
 If suspended, raise the body and loosen
or cut the rope.
 Give artificial respiration.
 To do the above do not wait for the
policeman.
INHALATION OF FUMES
Carbon monoxide poisoning
This gas is present in car-exhaust fumes, in household
coal gas: during incomplete combustion of charcoal
stoves and in coal mines.
Management
 The first aid treatment consists of removing the person
from the area, applying artificial respiration and giving
pure oxygen, if available.
 Ensure circulation of fresh air before entering the room
by opening the doors and windows.
 Before entering the enclosed space take two or three
deep breaths and hold your breath as long as you can.
Continuation
 Crawl along the floor (as the gas is
lighter than air)
 Remove the casualty as quickly as
possible to fresh air.
 Loosen his clothes at neck and waist
and give artificial respiration, if
asphyxiated.
Carbon dioxide poisoning
This gas is found in coal mines, deep
unused wells and sewers. Various other
gases such as leaking refrigerator gases;
compressed gases used for cooking and
lighting may also cause suffocation.
Management
 Observe all the precautions mentioned
above.
 Enter in an upright position (as the gas is
heavier than air and collects near the floor)
Continuation
 Remove the casualty as quickly as
possible to fresh air.
 Wherever ventilation is not possible and
deadly poisonous gas is suspected, use
a gas mask to protect yourself.
Hyperventilation
 Is the state of breathing faster or deeper than normal
(hyperpnoea), causing excessive expulsion of circulating carbon
dioxide. This means that the arterial concentration of CO2 tension
is falling (Paco2) below normal (35–45 mmHg).
Causes
 Panic attack
 Metabolic acidosis, also known as Kenny's Syndrome,
 Yogic practice of Bhastrika.
It often occurs together with labored breathing, which, in contrast,
can also be a response to increased carbon dioxide levels.
 Lung disease
 Head injury
 Stroke
Signs and symptoms
 Numbness or tingling in the hands, feet and lips
 Lightheadedness
 Dizziness
 Headache
 Chest pain
 Flexor spasm of hands and feet (carpopedal spasm)
 Slurred speech
 Nervous laughter
 Fainting, particularly when accompanied by the
Valsalva maneuver.
Continuation
The hyperventilation itself reduces the carbon
dioxide concentration of the blood to below its normal level
because one is expiring more carbon dioxide
than what is being produced in the body, thereby raising the
blood's pH value (making it more alkaline),
initiating constriction of the blood vessels which supply the
brain, and preventing the transport of oxygen and other
molecules necessary for the function of the
nervous system. At the same time, hypocapnia,causes a
higher affinity of oxygen to hemoglobin, known as
the Bohr effect, further reducing the amount of oxygen
that is made available to the brain.
Management
Call 911 if the person has:
 Chest pain that is crushing or squeezing or feels like a heavy weight on the
chest
 Difficulty breathing
1. Reassure the Person
To help reduce anxiety.
2. Help the Person Relax Breathing
Have the person sit down and try these strategies:
Breathe through pursed lips as if blowing out a candle
Cover the mouth and one nostril and breathe only through the other nostril
Breathe slowly, taking 1 breath every 5 seconds
Take deep, slow breaths from the abdomen ("belly breathing")
3. When to Get Medical Help
Go to a hospital emergency room if:
The person's symptoms don't get better after several minutes.
Symptoms get worse or the person is in pain.
HICCUPS
Hiccups are sudden, involuntary spasmodic
contractions of the diaphragm and intercostals
muscles. Irritation of the nerves from the neck to
the chest can cause hiccups. When these
nerves are triggered, a signal is sent to the
nerve, which controls the diaphragm. The
diaphragm signals back to the hiccup center in
the brain. Within a second, a structure called the
glottis closes off the windpipe, leading to a rapid
reduction in intrathoracic pressure, thereby
producing the characteristic sound of a hiccup.
CONTINUATION
Hiccups start suddenly, usually last for a few
minutes and stop on their own. However,
hiccups can sometimes be a serious medical
problem due to their chronicity and underlying
causes. Several serious underlying diseases
such as brain infection or tumor, lung tumor,
pneumonia, gastroesophageal reflux and
heart attack are linked with hiccups and
should be investigated if the hiccups are
persistent or associated with weight loss.
Causes
 stretching of the stomach after rapid
eating
 drinking or swallowing air or fizzy drinks
 indigestion due to eating hot and spicy
food,
 sudden change of air temperature,
 excess alcohol consumption or excess
smoking.
 Stress and emotional excitement.
Management
 Hold the breath for few seconds.
 Breathing deeply through the nose, then exhaling slowly through the
mouth.
 Place a teaspoon of dry granulated sugar on the back of the tongue and
swallow it.
 Press tongue hard against roof of mouth.
 Drink slowly a glass filled with ice cubes and water (the rapid change of
temperature in the esophagus may stop the hiccup).
 Bite a lemon or eat a piece of fresh ginger.
 Drink plenty of water.
 While sitting, lean forward and compress the chest and diaphragm
against the knees.
 Distraction from one’s hiccup such as being startled.
 In babies, hiccups are usually stopped immediately by the suckling
reflex, either by breastfeeding or sucking a bottle teat or nipple.
MUSCULOSKELETAL
INJURIES
STRAINS AND SPRAINS
Strain
Caused by forcible wrenching and stretching of the
muscles, ligaments and tendons which surround a joint
Sprain
Caused by forcible wrenching and stretching of the
muscles, ligaments and tendons which surround a joint
and there is tearing of some of these structures
Sprains and strains occur mostly at the ankle and the
wrist
Signs and symptoms
 Severe pain that increases in severity with
any movement of the part
 Marked tenderness over the site of injury
and swelling
 Bruising due to bleeding of the torn
structures
 If pain is severe, shock will be present and
the patient may faint
 Loss of power in part but not so marked as in
a fracture
treatment
 Expose the joint and apply firm pressure
to it.
This can be done by surrounding the
joint with a pad of cotton wool and
bandaging it firmly in position. If the pad
is made wet with cold water, this will
help tighten it.
 The area should be kept at rest
 Arrange patients’ removal to hospital
Dislocations
A dislocation occurs when a bone or
bones forming a joint become displaced.
There is usually stretching or tearing of
tendons and ligaments
Causes
 Sudden impact to the joint following a
blow, fall or any other trauma
Symptoms
 Numbness or tingling at the joint or
beyond it
 intensely painful especially if you try to
use the joint or bear weight on it
 Limited in movement
 Swollen or bruised
 Visibly out of place and discoloured
Management
 Call 911 especially if the accident
causing the injury is life threatening
 If on the upper limb, apply a sling to
support the part
 If on the lower limb apply a splint
 Arrange patient’s removal to hospital
Sublaxation
Is when one or more of the bones of your
spine (vertebrae) move out of position and
create pressure on, or irritate spinal nerves.
Spinal nerves are the nerves that come out
from between each of the bones in your
spine. This pressure or irritation on the
nerves then causes those nerves to
malfunction and interfere with the signals
traveling over those nerves.
symptoms
 Pain, tenderness, soreness and stiffness in the neck
and/or back
 Headaches
 Dizziness or balance problems
 Spinal muscle spasms, tightness or weakness
 Reduction in spinal mobility
 Pain, numbness or tingling in the extremities
 Joint pain or stiffness
 Low energy
 Poor overall health
 Reduced ability to heal tissue
Management
 pain medication

 exercise

 stretching
FRACTURES
Definition of a fracture
 A fracture is a complete or partial breakage of the bone on
account of stress or high impact forces. People suffering
from certain medical conditions like osteoporosis and bone
cancer are more prone to bone fractures.
Types of fractures:
 All fractures can be broadly classified into simple and
compound fractures.
 A simple fracture is one where the skin remains intact. A
compound fracture on the other hand, also involves open
wounds. Since open injuries are prone to infection,
compound fractures are more severe and are susceptible
to infection.
Fractures are further classified into
Comminuted fracture
 Produces multiple bone fragments.
 It’s a simple fracture
Greenstick fracture
 A split in a young immature bone.
Common in children
 It’s a simple fracture
Impacted fracture
 The ends of the broken bone are
pushed into one another and tightly
wedged together.
 This can happen in a fracture of the
shaft of the femur or when the head of
the femur is pushed into the acetabulum
Complicated fracture
 Not only damage to the bone takes place but
injury to internal organs
 Examples of complicated fractures are
 Fracture of the skull where the broken bone may
press on the brain
 Fracture of the vertebrae where the broken bones
may be pressing on and damaging the spinal
cord.
 Fracture of a rib where the broken bone may
pierce the lung
Signs and symptoms of fractures
 There is history of some injury except in cases of
pathological fractures
 Pain at the site of the fracture. The pain is usually
very severe and is accentuated by movement
 The area is tender and swollen
 Bruising occurs due to damage and rupture of
superficial blood vessels
 Shock. When a bone is broken, there is rupturing
of blood vessels in the bone which leads to
internal hemorrhage and this with the presence of
pain causes shock
 Loss of function and power in the affected part
 Irregularity in outline at the site of the fracture.
There may be a gap in the bone or a lump may
be seen. In compound fractures a piece of bone
may pierce the skin.
 If a limb bone is broken there may be deformity of
the limb due to displacement of the broken ends.
The limb may be shorter due to over-riding or it
may lie at an unnatural angle. Over-riding occurs
due to the pull of strong muscles which pull the
lower part of the bone over the upper part
Management of fractures
Aims
 To prevent a simple fracture becoming a
compound fracture

 To arrange patients removal to hospital

General principles of first aid treatment
for all fractures
1.Position
The patient should be kept lying down
unless the particular fracture makes this
position unsuitable e.g. it is more
convenient to have a person with
fracture of ribs sitting up on a chair
2.To prevent infection
Any wound should be covered
immediately with a clean dressing.
3.To stop hemorrhage
4.To treat shock
Pain and hemorrhage predisposes to shock
and should be treated
5.To immobilize the injured part
Are two methods: body splinting and
mechanical splinting
6.To arrange transport to hospital
Management
 Remember 

 Keep RICE in mind, as a first aid treatment for all fractures,

sprains and dislocations. RICE stands for Rest, Ice,
Compression and Elevation. 
 Rest
Give plenty of rest to the immobilsed limb. Move it as little as
possible so that there is no strain. 
 Ice 
Apply ice to the injured area. No heat treatment or massage
should be given. Use an ice pack or wrap up some ice cubes
in a damp towel and apply it to the injured area. You could
also use anything frozen such as a packet of frozen peas. 
Do not massage the injured area, and don't apply any
ointments like Iodex. 
 Compression
Wrap up the injured area with a crepe bandage
if possible, or use any clean, fresh cloth
available. Wrap it as tight as is comfortable.
However, ask the doctor before bandaging the
area. This will relieve the pain somewhat. 
 Elevation
The injured limb should preferably be raised
above the level of the heart. This could be done
with the help of a pillow while sleeping.
Injuries of the chest
Fractures of the ribcage
 Ribs may be fractured by direct force to
the chest, from a blow or fall or by
indirect force produced in a crush injury
 If the fracture is complicated by a
penetrating wound, breathing may be
seriously impaired
Flail chest injuries
Cause paradoxical breathing resulting to severe
respiratory difficulties.
Signs and symptoms
 Sharp pain at the site of the fracture
 Pain on taking a deep breath
 Shallow breathing
 Paradoxical breathing
 An open wound over the fracture through which you
might hear air being sucked into the chest cavity
Treatment
Aims
To support the chest wall
To arrange removal to hospital
For open or multiple fractures
 Immediately cover and seal any wounds to the chest wall. Use
sterile dressing and kitchen foil
 Place the casualty in a half- sitting position with head, shoulders
and body turned towards the injured side. support the limb on the
injured side on an elevation sling
 Dial 911.
 If the Casualty becomes unconscious or breathing becomes difficult
or noisy, place him in the recovery position with the uninjured side
uppermost
Penetrating chest wounds
1.PNEUMOTHORAX
Is an abnormal collection of air in the
pleural space that separates the lung
from the chest wall and interferes with
normal breathing
Types
 Primary pneumothorax-occurs without
an apparent cause and in the absence
of a significant lung disease
 Secondary pneumothorax-occurs in the
presence of an existing lung pathology
 Tension pneumothorax-the amount of air
in the chest increases markedly when a
one way valve is formed by an area of
damaged tissue. Its a medical
emergency.
Signs and symptoms
 Difficult and painful breathing-rapid,shallow and
uneven
 An acute sense of alarm
 Signs of shock
 Coughed-up frothy red blood
 Cyanosis
 A cracking feeling of the skin around the site of the
wound caused by air collecting in the tissues
 Blood bubbling out of the wound
 The sound of air being sucked into the chest as the
casualty breathes in
Treatment
Aims
 To seal the wound and maintain
breathing
 To minimize shock
 To arrange urgent removal to hospital
First aid
 Immediately use the palm of your hand or if
the casualty is conscious his own hand to
cover the wound
 Place a sterile dressing or clean pad over
the wound and surrounding area. Cover with
a plastic bag, foil or kitchen film. Secure it
firmly so that it doesn’t come out
 Provide firm support to the most comfortable
position
 Call for help
Hemothorax
Definition
 Hemothorax is a collection of blood in the space between
the chest wall and the lung (the pleural cavity).
Causes
 The most common cause of hemothorax is chest trauma.
It can also occur in patients who have:
 A defect of blood clotting
 Death of lung tissue (pulmonary infarction)
 Lung or pleural cancer
 Placement of a central venous catheter
 Thoracic or heart surgery
 Tuberculosis
Signs and symptoms

 Anxiety
 Chest pain
 Low blood pressure
 Pale, cool and clammy skin
 Rapid heart rate
 Rapid, shallow breathing
 Restlessness
 Shortness of breath
Management
Call 911 if you have:
 Chest pain or shortness of breath
 Dizziness, fever, or a feeling of
heaviness in your chest
 Severe chest pain
 Severe difficulty breathing
Management
 Stop the bleeding
 Prevent shock
 Arrange patient transfer to hospital
Hydrothorax
 Results from serous fluid accumulating
in the pleural cavity. This specific
condition can be related to cirrhosis with
ascites in which ascitic fluid leaks into
the pleural cavity. Hepatic hydrothorax is
often difficult to manage in end-stage
liver failure and often fails to respond to
therapy.
Causes
 Cirrhosis. In cirrhosis of the liver, the liver
function is declined by scarring, nodule
formation, and fibrosis, which are all the
outcome of the liver fixing itself after the
damage created by alcoholism, hepatitis B,
and fatty-liver infection and other
determinants. It is unidentified exactly how
cirrhosis of the liver directs to hydrothorax, but
it is accepted that the malfunction of the liver
causes an imbalance in the fluids of the body,
and that excess can display up in the lungs.
Causes

 lung cancer
 pleural cancer
 pulmonary embolism
 tuberculosis complications.
Signs and symptoms
 anxiety
 respiratory failure
 restlessness
 shortness of breath
 tachycardia (rapid heart rate)
 varying degrees of chest pain.
Management
 Allow the person to adopt the most
comfortable position that does not
hinder breathing

 Evacuate the victim immediately

HEAD AND NECK
INJURIES
A scalp wound may raise your suspicions but deeper
underlying damage will leave little visible evidence
CONCUSSION
Concussion is the sudden but short-lived loss of
mental function that occurs after a blow or other
injury to the head. Concussion is the most common
but least serious type of brain injury.
It can safely be diagnosed once the casualty has
completely recovered.
Signs and symptoms
 brief loss of consciousness

 memory loss

 disturbances in vision, such as 'seeing

stars‘

 confusion
signs and symptoms
There may also be:
 Dizziness or nausea on recovery
 Loss of memory of events at the time of
or immediately preceding the injury
 Mild generalized headache
Aims of treatment
 To ensure that the casualty recovers
fully and safely

 If necessary, to seek medical aid

Treatment
 Place an unconscious casualty in the recovery
position. Monitor and record breathing, pulse
and level of response every ten minutes
If the casualty is unconscious after 3 minutes,
suspect a more serious injury
 Call 911
 If the casualty regains consciousness within 3
minutes, watch closely for any deterioration in
the level of response even after an apparent
full recovery
 Place the casualty in the care of a
responsible person
 Advice the casualty to see his/her own
doctor if headache, sickness or
tiredness occur after injury
Skull fracture
There may be brain damage
Germs that cause infection may enter
the brain
CSF leaking from the ear or nose is a
sign of serious injury and an entry point
for germs
Signs and symptoms
 Wound or bruise on the head
 A soft area or depression of the scalp
 Impaired consciousness
 Progressive deterioration in the level of
response
 Clear fluid or watery blood coming from
the nose or ear
 Blood in the white of the eye
 Distortion of the head or face
Treatment
Aims
To resuscitate if necessary
To maintain an open airway
To arrange urgent removal to hospital
 If unconcious,do ABC
 Help a conscious casualty to lie down with the
head and shoulders raised. If there is discharge
from an ear, position the casualty so that the
affected ear is lower. Cover the ear with a sterile
dressing or clean pad lightly secured with a
bandage. Do not plug the ear
 Control any bleeding from the scalp.
Look for and treat other injuries
 Call 911 for an ambulance
 Monitor and record breathing, pulse and
level of response every 10 minutes until
help arrives.
Cerebral compression
It occurs when pressure is exerted on the
brain within the skull e.g.by an accumulation
of blood or by swelling of an injured brain
Causes
 Head injury
 Skull fracture
 Stroke
 Infection
 tumor
 Can develop immediately after head injury or
may be delayed for some hours or even days
Signs and symptoms
 Level of response deteriorates as the
condition develops
 A recent injury followed by an apparently full
recovery. Later on the casualty may
deteriorate and become disoriented
 Intense headache
 Noisy breathing, becoming slow
 A slow yet full and strong pulse
 Unequal or dilated pupils
 Weakness or paralysis down one side of
the face or body
 High temperature, flushed face
 Drowsiness
 Irritability
Treatment
 Call for help
 If unconscious…
 If concious,support him or her in a
comfortable position
 Monitor and record breathing, pulse and
level of response every ten minutes
Convulsions
Consists of involuntary contractions of
many of the muscles in the body caused
by a disturbance in the function of the
brain
Result in loss of or impaired
consciousness
Causes
 Head injury
 Shortage of oxygen to the brain
 poisons
Continuation
 Fevers in children
 A feature of epilepsy
Minor epilepsy
Cause a brief blurring of consciousness
like day dreaming. On recovery the
casualty may have lost thread of what
he or she was doing
Signs and symptoms
 Sudden ‘switching off'. The casualty
stares blankly ahead
 Slight or localized twitching or jerking of
the lips,eyelids,head or limbs
 Odd automatic movements such as lip-
smacki ng,chewing or making noises
Treatment

Aims
To protect the casualty until she is fully
recovered
 Help the casualty to sit down in a quiet
place. Remove any possible sources of
harm
 Reassure her/him
 Do not pester with questions. Stay with
her until you are sure she is herself again
Major epilepsy
There is recurrent, major disturbances of
brain activity resulting in violent
seizures(Tonic-clonic) and severe
impairment of consciousness.
Can be sudden and dramatic but the
casualty may have aura e.g. a special
smell or taste or a strange feeling
Signs and symptoms
 Casualty suddenly falls unconsciousness often letting out a
cry
 He becomes rigid, arching his back(tonic phase)
 Breathing may cease
 Convulsive movements begin(clonic phase).The jaw may
be clenched and breathing may be noisy. May be loss of
bladder and bowel control
 The muscles relax and breathing become normal. The
casualty recovers within a few minutes. He may feel dazed
or behave strangely in a state of automatism being
unaware of his actions. fit may be followed by deep sleep.
 There may be evidence of injury such as burns or scars
from previous fits
Treatment
Aims of treatment
To protect the casualty from injury while the fit
lasts
To provide care when consciousness has been
Regained
 If you see the casualty falling try to support
him or ease his falling. Make space around
him and ask bystanders to move away
 Loosen clothing around his neck and protect his
head
 When convulsions cease place him in the
recovery position. Check breathing and pulse
and be ready to resuscitate if necessary. Stay
with the casualty until he fully recovers
 If he is unconscious for more than ten minutes or
convulsing for more than five, is having repeated
fits or is unaware of his condition, call 911.
 Note the next time and duration of a fit
Unconsciousness
Causes
 Head injury
 Stroke,fainting,heart attack, shock
 Stroke,infections,tumours
 Hypoxia,poisoning,hypoglycemia
 Epilepsy, abnormal body temperature
Aims of treatment
 To maintain an open airway
 To assess and record the level of
response
 To treat any associated injuries
 To arrange urgent removal to hospital if
necessary
 To gather and retain any circumstantial
evidence of the cause of the condition
Management
 CAB and resuscitate if necessary
 Control bleeding. Note and protect any
suspected fractures
 look for less obvious injuries. Smell the
casualty's breath and look for needle marks.
Ask bystanders for information
 Place the casualty in the recovery position
 If the casualty does not regain full
consciousness within 3 minutes, call for help
Continuation
 Monitor and record breathing, pulse and
level of response every ten minutes
using the observation chart
 If the casualty regains full
consciousness within 3 minutes as soon
as possible and remains well further ten
minutes, advise her to see her doctor
Types of neck injuries
Crick
 A "crick" or "kink" is a term often used to describe
the pain you wake up with after sleeping with your
neck in an awkward position. It may also be due to
working at the computer for long hours, or sudden
movements of the neck. "Crick in the neck" is not a
medical diagnosis. Usually a muscle spasm,
arthritis or a disc problem is the real culprit. At-home
therapies can take care of a crick in the neck most
of the time, but if the pain lasts longer than a week
or disrupts your usual activities, get it checked by a
doctor.
Neck sprain
 Sprains are injuries to ligament. Neck sprains are
often caused by falls or sudden twists that overload
or overstretch the joint.  Another cause is repeated
stress to the joint. Symptoms include swelling,
reduced flexibility and pain. Sprains can be mild,
moderate or severe. 
 If you suspect someone in your environment has a
severe neck injury (of any kind), you should
immobilize their spine and call 911 immediately. For
minor and moderate sprains, rest and ice the area,
take an anti-inflammatory, and get it checked by a
doctor.
Neck fracture
Is a break in a cervical bone.  It may be caused by
trauma, a fall or degenerative changes in the spine.
The angle of force hitting the neck and the head's
position at impact often determine the type and severity
of the break.  Football players who block with their head
are at high risk. Elderly people with osteoporosis are
particularly at risk for neck fractures because their bones
are very fragile. The most serious neck fractures are
generally accompanied by a dislocation. Treatment
depends on a lot of things including your age, other
medical conditions and extent of damage to your spine. 
If a fracture destabilizes your neck, you may need to
wear a halo brace.
Management for Neck Injuries
What to Do - Or Not to Do
 If someone has suffered a severe neck injury, call 911 for life
support and help.
 Do not move the person, especially the head or neck unless
failure to do so presents an immediate threat or urgent
danger.
Exceptions to Immobility
You can move a person with a possible neck injury when:
 Not moving them would be an immediate threat to their life.
 They are vomiting.
 They are choking on blood.
 You need to check for breathing and/or pulse so you can
determine if they need CPR.
keep their head and neck immobile and
move their entire body as one unit. Do
the same if you need to roll them over.
To roll a victim over, you will need at
least two people - one at the
victim's head and one at the feet.
After checking breathing and pulse,
determine if CPR is necessary.
DO NOT NOT LIFT VICTIM'S HEAD
BACK WHEN OPENING THEIR
AIRWAY TO ADMINISTER CPR.
Instead open the jaw by placing fingers
on either side.
BURNS AND EXTREMES OF
TEMPERATURE
Types of burns
 Dry burn
 Scald
 Electrical burn
 Cold injury
 Chemical burn
 Radiation burn
Classification of burns
1.According to surface area
Uses a simple formula, the rule of nines

2.According to depth of burns

Adult
Anterior head 9%
Posterior head 9%
anterior torso 18%
Posterior torso 18%
Anterior leg each 9%
Posterior leg each 9%
Anterior arm each 4.5%
posterior arm each 4.5%
Genitalia/perineum 1%
According to depth of burns
1.Superficial burn
Involves only the outermost layer of the skin’
Characterized by redness, swelling and tenderness
Heals well if first aid is given promptly.

2.Partial-thickness burn
any one percent burn affecting layers of the epidermis
giving rise to rawness and blisters.
Can heal well but if but if they affect very large areas(over
60%),can be fatal
3.Full-thickness burns
All the three layers of the skin are burnt.
Damage to nerves, fat tissue and
muscles present
The skin looks waxy, pale or charred
Urgent medical aid is essential
Management of minor burns and scalds

Aims
To stop the burning
To relieve pain and swelling
To minimize the risk of infection
 Flood the injured part with cold water for
at least ten minutes to stop the burning
and relieve pain. If water is not available
any cold harmless liquid such as milk or
canned drinks will do
 Remove any jewellery,watches,belts or
constricting clothing from the injured
area before it begins to swell
 Cover the area with a sterile dressing, or
any clean, non-fluffy material and
bandage loosely in place. A plastic bag
or some kitchen film make good
temporary covering
 Do not break blisters
 Do not apply adhesive dressings or
adhesive tape to the skin: the burn may
be more extensive
 Do not apply lotions, ointments or fats to
the injury. They further damage the
tissue and increase the risk of infection
Severe burns and scalds
Aims of treatment
To stop the burning and relieve pain
To maintain an open airway
To treat associated injuries
To minimize the risk of infection
To arrange removal to hospital
To gather relevant information for the
emergency services
Management
 Lay the casualty down. Protect the burned area
from contact with the ground
 Douse the burn with plenty of cold liquid.
Thorough cooling may take at least ten minutes.
 While cooling the burn, watch for signs of DIB
and be ready to resuscitate if necessary
 Remove any rings,watches,belts,shoes or
shouldering clothing from the injured area
before it begins to swell
 Cover the injury with a sterile dressing to
protect it from infection. If the burn is on the
face, don't cover it. Keep cooling a facial
injury with water to relieve pain until help
arrives
 Gather and record details of the casualty's
injury, circumstances and potential hazards
such as gas
 While waiting for help, reassure the
casualty and treat for shock
Burns to the Airway
Signs and symptoms
 Soot around the nose and mouth
 Singeing of the nasal hairs
 Redness, swelling or actual burning of
the tongue
 Damaged skin around the mouth
 Hoarseness of the voice
 Breathing difficulties
Aims and treatment
To obtain specialist medical aid as
quickly as possible
To maintain an open airway
 Call for help
 Loosen tight clothing around his neck,
give oxygen if available
 Reassure the casualty for him/her to
stay calm
Electrical burns
Causes
 Lightning strike
 Low or high voltage current
Aims of treatment
 To treat the burn and the shock
 To arrange removal of the casualty to
hospital
Treatment
 Make sure that contact with the electrical source
is broken
 If unconcious,resuscitate if necessary
 Flood the sites of injury with plenty of cold water
to cool the burns and cut away any burnt clothing
if necessary
 Place a sterile dressing, a clean folded triangular
bandage or some clean non-fluffy material over
the burns
 Call for help
 Reassure the casualty and treat for shock
Chemical burns
If possible note the name or brand name
of the substance
Sign and symptoms
 Evidence of chemicals in the vicinity
 Intense stinging pain
 Later,discolouration,blistering,peeling
and swelling of the affected area
Treatment
Aims
To disperse the harmful chemical
To arrange transport to hospital
To make the area safe and inform relevant
Authority
 Make the area safe. Ventilate the area,
seal the chemical container. Remove the
casualty from the area if necessary
 Flood the affected area with water to
disperse the chemical and to stop the
burning. Do this for at least 20 minutes
 Gently remove contaminated clothing while
flooding the injury
 Take or send casualty to hospital. Note and
pass any information about the chemical to
the medical personell.If at work place notify
the local safety officer or emergency
services
Chemical burns to the eye
Chemicals result in scarring and even
blindness
Signs and symptoms
 intense pain in the eye
 Inability to open the injured eye
 Redness and swelling round the eye
 Copious watering of the eye
 Evidence of chemical substances or
containers in the immediate area
 Ask the casualty to hold a sterile eye
pad over the injured eye. If some time
elapse elapses before the casualty
receives medical attention, bandage the
pad loosely in position
 Arrange casualty's removal to hospital
Sunburn
Aims
To move the casualty out of the sun
To relieve discomfort and pain
 Cover the casualty's skin with light clothing or towel.
Help her into the shade or preferably indoors
 Cool her skin by sponging with cold water or by
soaking the affected area in a cold water bath for ten
minutes. If there is extensive blistering or other skin
damage, seek medical advice
 Give her frequent sips of cold water. If the burns are
mild, calamine or an after-sun preparation may sooth
them
EFFECTS OF HEAT AND
COLD
First Aid Priorities
 Remove or protect the casualty from
excessively hot or cold surroundings
 Restore normal body temperature
 Obtain appropriate medical attention
Effects of Extreme Cold
 Frost bite
 Hypothermia
Effects of Extreme Heat
 Heat exhaustion
 Heatstroke
Bites and Stings
First Aid Priorities
 Make sure that you are in no danger, then
remove the casualty from further danger
 Treat visible wounds or painful symptoms.
Minimize the risk of further injury and infection
 Obtain medical attention if necessary
 Note time and nature of injury. Identify the
attacking creature. This facilitates specific
management and anticipation of
complications such as anaphylactic reactions.
Animal Bites
Aims of treatment
To control bleeding
To minimize the risk of infection
To obtain medical attention
For serious wounds
 Control bleeding by applying direct
pressure and raising the injured part
 Cover the wound with a sterile dressing or
a clean pad bandaged in place
 Arrange patient’s removal to hospital
For superficial bites
 Wash the wound thoroughly with soap
and warm water
 Pat the wound dry with clean gauze
swabs and cover with an adhesive
dressing or a small sterile dressing
 Advice the casualty to see a doctor
incase inoculation is needed
Insect Stings
Bee, wasp and hornet stings are painful
rather than dangerous
Aims of treatment
 To relieve swelling and pain
 To remove to hospital if necessary
For a sting in the skin
 If the casualty shows signs of
anaphylactic shock, call 911
 If the sting is in the wound, pluck it out
firmly with fine tweezers
 Apply a cold compress to relieve pain
and minimize swelling. Advice the
casualty to see a doctor if the pain and
swelling persist
For a sting in the mouth
 Give the casualty ice to suck or cold
water to sip to minimize the swelling
 Call for help.

 Reassure the casualty

Marine Stings
Aims of treatment
To reassure the casualty
To inactivate stinging cells before they release
their venom and to neutralize any free venom
To relieve pain and discomfort
 Reassure the casualty and sit him or her
down. Pour copious amounts of vinegar or sea
water over the injury to incapacitate stinging
cells that have not yet released venom
 Alcohol may aggravate the injury and
should not be used
Avoid rubbing sand on the affected area
 Dust a dry powder over the skin around
the affected area to make any remaining
stinging cells stick together. You can use
talcum powder or meat tenderiser.Meat
tenderiser contains papain which
inactivates venom
 Gently brush off the powder with a
clean, non-fluffy pad

 If severe call for help

Marine Puncture Wounds
Aims
To inactivate the venom
To obtain medical aid
 Put the injured part in water as hot as
the casualty can bear for at least 30
minutes. Top up the water as it cools
being careful not to scald the casualty
 Take or send the casualty to hospital
where spines remaining in the skin may
have to be removed
Snake Bites
The only poisonous snake native to
mainland Britain is the adder
Aims of treatment
To reassure the casualty
To prevent the spread of the venom
To arrange urgent removal of the
casualty to hospital
 Lay the casualty down. Tell her to keep
calm and still
 Wash the wound well and pat dry with
clean swabs. Call 911.
 Do not apply a torniquet,slash the
wound with a knife or suck out the
venom
 Lightly compress the limb above the
wound with a roller bandage.Immobilise
the injury
 If she stops breathing, be ready to
resuscitate
BANDAGING
Definition of a bandage
 A strip of material mainly used to support
and immobilize a part of the body
USES
 To support-fractured bone
 To immobilize-dislocated shoulder/jaw
 To apply pressure-stop bleeding and
improve venous blood flow
 To secure a dressing in place
 To retain splints in place
PRINCIPLES AND PROCEDURES FOR
APPLYING BANDAGES
 Wash hands and wear gloves when necessary
 Assist victim to assume a comfortable position on
bed or on chair and support the body part to be
bandaged.
 Always stand infront of the part/victim to be
bandaged except when applying a bandage to the
head, eye and ear
 Be sure the bandage is rolled firm
 Make sure the body part to be bandaged
is clean and dry
 Assess skin before applying bandage for
any breakdown
 Observe circulation by noting pulse,
surface temperature, skin color and
sensation of the body part to be
wrapped
 Always start bandaging from inner to
outer aspect and far to near end
 When bandaging a joint, ensure
flexibility of the joint except if
immobilization of joint is required
 Cover the area two inches above and
two inches below the affected area
 Overlap turns and slightly stretch the
bandage
 Cover 2/3 of the previous turn
 Where possible, leave fingertips or toe
tips exposed for observation(adequacy
of circulation)
 End the bandage on the outer side of
the body. Do not end a bandage on
wound or at the back of the body
TYPES OF BANDAGES
 Triangular
Could be used on many parts of the body to
support and immobilize
 Crape bandage
Type of woven gauze which has the quality of
stretching
 Gauze/cotton bandage
Lightly woven cotton material. Frequently used
to retain dressings on wounds on
fingers,hands,toes,feet,ears,eyes and head
 Adhesive bandage
Used to retain dressing and also used
where application of pressure to an area
is required
METHODS OF APPLYING BANDAGES
 Circular
 Spiral
 Reverse spiral
 Figure of eight
CIRCULAR TURN
 Used to anchor bandages and to
terminate bandages
 Apply the end of the bandage to the part
of the body to be bandaged
 Encircle the body part a few a few times
or as needed, each turn directly
covering the previous turn
 Secure the end of the bandage with
tapes, metal clips or a safety pin over an
uninjured area
SPIRAL TURN
 Bandage cylindrical parts of the body
that are fairly uniform in circumference
such as the upper arm or leg
 Make two circular turns to begin the
bandage
 Continue spiral turns at about a 30
degree angle, each turn overlapping the
preceding one by 2/3 the width of the
bandage
 Terminate the bandage with two circular
turns and secure the end as described
for circular turns
SPIRAL REVERSE TURN
 Begin with two circular turns and bring the
bandage upward at about a 30 degree angle
 Place the thumb of the free hand on the upper
edge of the bandage
 The thumb will hold the bandage while it is folded
on itself
 Unroll the bandage about 4-6 and turn the hand
so that the bandage is folded down
 Terminate the bandage with two circular turns
and secure the end as described for circular turns
FIGURE EIGHT TURN
 Applied on ankle, knee and joint
 Begin the bandage with two circular turns
 Carry the bandage above the joint, around it
and then below it. Make a figure 8.Continue
above and below the joint, overlapping the
previous turn by 2/3 the width of the
bandage
 Terminate the bandage above the joint with
two circular turns and secure the end
appropriately