UNIT XIV: FIRST AID

• First Aid

Definition, Basic Principles, Scope & Rules

• First Aid Management

 Wounds, Hemorrhage & Shock

Musculoskeletal Injuries, Fractures, Dislocation, Muscle

injuries
 Transportation of Injured persons
Respiratory Emergencies & Basic CPR
Unconsciousness

Foreign Bodies

Skin, Eye, Ear,

Nose, Throat & Stomach

 Burns & Scalds

Poisoning, Bites & Stings

 Frostbite & Effects of Heat

Community Emergencies
• First aid includes assessing the victim for life threatening
conditions, performing appropriate interventions to sustain life
and keeping the person in the best possible physical and mental
conditions until he/she can enter the emergency or casualty unit in
hospital.
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 other qualified person. The first aid
itself signifies that the casualty is in need of secondary aid.
 Aims
• Preserve life:
main aim is to save lives and minimize the threat of death
• Prevent further:
prevent the condition from worsening, or danger of further injury
• Promote recovery :
also involves trying to start the recovery process from the illness or
injury.
• The goals of first aid are:
1. To save the life

2. To ease the pain

3. Limit the effects of the condition

4. To promote recovery

5. Prevent conditions that might increase the original injury

6. To arrange for transportation to the hospital

Principles
• Make sure that:

Victim’s airway is not blocked

 The person is breathing, if not restore respiration

The person has pulse or no pulse, if no give CPR- restore circulation

• Check for bleeding; Take measures to control bleeding

• Act fast

• Arrange without delay for shifting of the victim to the hospital.

• Keep the victim/patient lying down and quiet.

• Have someone called for medical assistance

• Examine the victim gently

• Reassure the victim

• Do not give fluids to an unconscious or semi conscious persons

• Look for an emergency identification card for medical information

Scope

• To determine the nature of the case requiring attention so far

• To decide on the character and extent of the treatment to be

given

• To arrange for the disposal of the casualty

 General Rules
Go quickly and confidently to the person or persons needing first aid,
and decide what needs to be done without delay.

If breathing has stopped, immediately start artificial respiration.

Every second counts.

If there is bleeding control it.

Reassure the patient and others present , and so help to lessen the
anxiety.
Do not allow a crowd around the patient, who needs fresh air.

See that the patient is in the best position to recovery, usually lying down.

Loosen any tight clothing, do not remove clothing unnecessarily.

Arrange for medical aid as soon as possible.

Do not attempt too much, do the minimum that is required to save the lives.

Stay with the patient, continuing to observe and care for her until handing over to a
doctor
Golden Rules
• Do first things first quickly and without fuss or panic
• Give artificial respiration, if breathing has stopped and count every
second
• Stop any bleeding
• Guard against or treat for shock
• Do not attempt too much do the minimum that is essential to save life
• Reassure the casualty and those around
• Do not allow people to crowd round
• Do not remove clothes unnecessarily
• Arrange for the removal of the casualty to hospital as soon as possible.
 Essential Qualities of a First Aider

1. Prompt and quick

2. Calm and controlled
3. Wise and intelligent
4. Resourceful
5. Sweet tempered and sympathetic
6. Skillful and tactful
7. Dexterous and clever
8. Confidence and perseverance
 Key Words
• Abrasion : a type of wound in which the skin is scraped or rubbed off

• Contusion : a kind of closed wound, meaning that the skin is not broken

• Incision : a cut in the skin caused by sharp object

• Laceration : injury to skin that results in skin being cut or torn open

• Rupture : a break or tear in any organ or soft tissue

Definition

• Wound is a breakdown in the protective function of the skin;

the loss of continuity of epithelium, with or without loss of
underlying tissue.

• Wound is a physical injury to the body consisting of laceration

or breaking of the skin or mucous membrane often with
damage to underlying tissue.
Principles of First Aid in Wounds
Main principles are :

• Control bleeding
Rest

Elevation

Direct Pressure
• Prevent infections
Principles in wound care
•Clean

Removes debris and dirt

Prevents accumulation of bacteria
Normal saline is one of the best choice for wound cleaning
You can also use mild, unscented soap and water
Antiseptics are generally not recommended
Chlorhexidine based products are more effective
• Treat

Apply an antibiotic product on wound after cleaning

Prevent the growth of bacteria
Prevent the dressing adhering to the wound
Stop dry crusts from forming
• Protect

Use a dressing to cover

Not only protects but also provides a moist environment
Choice of dressing depends on several factors
 Wounds

Open Closed

Internal
Bruises
Bleeding

Incised Lacerated Punctured Abrasions

Avulsions
Wound wounds wounds

Penetrating Perforating
wound wound
• Bruises (c0ntusions):

An injury transmitted through unbroken skin to

underlying tissue causing rupture of small blood into the
tissue with resulting discoloration.
• Internal bleeding :
Also called internal hemorrhage.
Loss of blood from a blood vessel that collects inside
the body.
Usually not visible from outside
• Incised wound :

caused by sharp objects, such as knives or shards of

glass, slicing into skin. Depending on injury
underlying blood vessels can be punctured.
• Avulsions :

severe traumatic injury in which one or more pieces of

tissue are torn and detached from the body.
eg : road traffic accident, machine injuries
• Lacerated wound :
wound that is produced by the tearing of soft body tissue.
eg: cut, tear, slice etc
• Abrasions:
type of wound that is caused by the skin rubbing against a rough surface.
eg: scraped knee
• Perforated wound:
wound having an entrance and exit.
• Penetrating wound :
when object pierces the skin and enters a tissue of the body.
eg: gunshot,stab wound
 First Aid in Wounds
Minor Wounds Major Wounds
• Control bleeding immediately
• Use barrier between your hands and
• Put on disposable gloves
wound
• Cover wound with dressing
• Apply direct pressure to control • Apply pressure
bleeding • Add more bandages, never remove
• Wash wound • Monitor ABC
• Check for vital signs
• Apply triple antibiotic ointment

• Cover wound with sterile bandage

First Aid Measures in Minor Wounds
• Minor bleeding is easily controlled by pressure and elevation
• A small adhesive dressing is normally adequate
• If bleeding does not stop then seek medical help
Wash your hands thoroughly in soap and water
Avoid touching the wound with your fingers
Do not talk, cough and sneeze over the wound dressing
If the wound is dirty, clean it by rinsing lightly under running water
Pat gently dry with a sterile swab
 Temporarily cover the wound with sterile gauze
Clean the skin around it with soap and water
Use new swab for each stroke
Pat dry then cover the wound with an adhesive dressing
• Large foregin bodies, such as fragments of glass or metal, if projecting from
wound may be gently removed.
• If the foregin body is deeply embedded or there is any difficulty in
removing it, leave this alone.
• Put sterile gauze, cotton pad and bandage lightly.
• Send the patient to a doctor
• For asmall household scratch, antibiotic creams or antiseptic
solutions can be used; but not to large wounds.
• Contusionis a wound in which the deep tissues are torn
without overlying skin being broken.
• Bleeding beneath the skin leads to black and blue color
changes
• Dressing is not necessary; ice packs or cold compress applied
can relieve pain and bleeding.
Eye Injuries

• A bit of dust or speck of material lodges on the eyes surface; do

not rub either eyes
• Never attempt to remove the material with a tooth pick, match
or any other instrument
• Never attempt the eye until you have washed your hands
thoroughly.
• In case of harmful chemical or hot oil ;irrigate the eyes with
water. Tilt the head to drain water away from the face.
• Do not irrigate the eyes with a wound or foreign body sticked to
eyeball.
Prevention of Wound Infection

• Removal of germs embedded in wound at the time of injury.

• Protection of wound against germs implanted after injury
• Giving tetanus toxoids.
• Comfort of the victim can be provided in following manner:
After bandaging keep the injured part in a position of comfort.
If the head is injured, make the patient lie down with his head resting
upon a pillow and cushion covered with a clean towel.
If the forearm is injured, bring it across in front of the chest and
support it in a sling.
If the leg be wounded, it may be supported upon a cushion or
blanket.
In wounds of chest, raise the head and shoulders until the patient is
able to breathe comfortably.
If the abdomen be wounded, place the patient on his back with his
knees drawn up.
1. Why you selected nursing?
What will you be 5 years later.
First Aid Measures in Major Wounds
A. Chest Wounds
Penetrating wound may cause severe internal damage
The lungs are subject to injury as the air may enter the pleural space and excert
pressure on the lungs.

Sign and symptoms

o Breathing difficult and painful
o Signs of shock
o Frothy blood on coughing
o Mouth, nail and skin appears blue
o Blood bubbles out of the wound
• First aid measures for chest wound include:

o Cover the open wound by palm of your hand

o Cover the wound by sterile dressing or pad, then cover the pad by plastic wrap,
which should be non porous
o The covering is sealed along the edges by adhesive tapes. If a gauze dressing is
used,it is covered with petroleum jelly to make it airtight.
o support a conscious casualty in a comfortable position, inclined towards the
injured side
o If the casualty becomes unconscious, check pulse, breathing and place him in
the recovery position lying on injured side
o Send for doctor or ambulance or arrange stretcher for transportation
 B. Abdominal wound
• Wounds which penetrate the abdominal wall may damage stomach or bowels
• Hence give nothing to eat or drink
• Dress the wound and adjust the position ;so that the wound does not gap
• Send to hospital on stretcher
• If the intestines have come out :
Cover with clean pads
Do not give anything to eat or drink
Obtain medical aid; till then give casualty rest in bed
Patient has to be transported to the hospital
• Any abdominal organs lying outside abdominal cavity must therefore kept moist.
• If sterile dressings and sterile water are not available, it is preferable to cover the
organs with a clean moist cloth and risk infection than to risk necrosis and loss of
tissue.
Sl
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 Hemorrhage
• Hemorrhage or bleeding is a flow of blood from an artery, vein or
capillary
General considerations :
Hemorrhage is a prime concern in ABC and one should take step to
control bleeding early on.
Attempt to minimize contamination of the wound by using sterile
dressings.
Body substance isolation should be observed whenever contact with
blood and Blood products
Evaluate carefully any torniquet applied prior to arrival of EMS.
Should not probe wounds or use hemostatic clamps. Tourniquets are
rarely needed
Classification :
Class I : 15% of blood volume ; typically no change

Class II : 15-30% blood volume ; tachycardia, skin become pale and

cool, volume resuscitation with NS and RL is required. Blood
transfusion is not required.

Class IV: 30-40% blood volume; BP drops, HR increases,shock,

mental status worsens, fluid resuscitation and blood transfusion.

Class V : > 40% blood volume; bodys compensation is reached and

aggressive resuscitation is required to prevent death
• Assessment of hemorrhage

a. History
Determine mechanism of injury.
Attempt to estimate the amount of blood loss.
Is patient experiencing chest pain, trouble breathing, or
becoming faint or lightheaded.
Obtain past medical history: has the patient had high blood
pressure, diabetes,stroke,angina
Does the patient have COPD, asthma, pneumonia, emphysema?
Has the patient had any surgeries in past?
What medications has the patient been, or supposed to be
taken(over the counter medication)
b. Physical examination
Perform an initial assessment.
Perform a focused history and physical examination.
Obtain a complete set of vital signs
Assess for signs of shock .
Note wounds
• Control of bleeding by pressure dressing
Adding a further dressing on the outer side and bandaging more tightly
Pressing on the dressing with the palm of the hand.

• Indirect pressure :
For wound of the scalp or temple, compress the temporal artery.
For a wound of lower face (below the eyes), apply pressure to the facial
artery along the lower border of the mandible.
For a neck wound, compress the wound site. Do not compress the carotid
artery, as this could cause stroke.
For a shoulder wound or hemorrhage of the upper arm, compress the
subclavian artery against clavicle.
For a wound of lower part of the upper arm or of the elbow, press the brachial
artery against the humerus.
For foot wounds, compress the entire network of arteries in the ankle.
For a wound of the lower arm, press the ulnar and radial arteries.

For a thigh wound, apply great pressure to the femoral artery

For the wound of the lower leg, apply pressure to the popliteal artery

 Internal hemorrhage
Reassure the patient
Place the casuality in flat position with feet raised
Keep the casuality warm and at complete rest.

Check and record breathing, pulse and level of response every 10 min.
Do not give food or drinks by mouth
Transport the casualty to hospital as quickly as possible,
Shock
• Shock results from the failure of the cardiovascular system to provide
sufficient blood circulation to all parts of the body.
Causes of shock
Severe loss of blood
Intense pain
Extensive trauma
Burns
Poisoning
Emotional stress or intensive emotion

Extreme heat and cold

Electrical shock

Allergic reaction

A sudden or severe illness

Types of shock
• Hypovolemic shock
• Cardiogenic shock
• Neurogenic shock
• Septic shock
• Psychogenic shock
• Anaphylactic shock shock
• Signs and symptoms
Change in level of consciousness
Skin becomes pale, cold to touch, later cyanosis develops
over lips and nail beds.
Decrease in blood pressure.
Pulse rate is increased but becomes weak and thready
Respiratory rate is increased, it may be shallow, labored or
irregular
Urine output is decreased.
Decreased oxygen to the tissues result in weakness and
tremors of arm and legs
Victim may complain of thirst, nausea, vomiting and dry
mucous membranes may be present
• First aid measures
Take measures to establish airway.
Take steps to control bleeding if it is present.
Take steps to reduce pain.
Appropriate positioning of the victim which is determined by type and
extent of injury.
 The victim should lie flat with the slightly lower than the rest of the body
unless the victim has sustained head and chest injuries.
 If victim is unconscious, position on the side to keep airway patent and
encourage drainage.
 If victim has difficulty in breathing, the head and shoulders should be
elevated
 If neck or spinal injuries are suspected, not to move the victim to prevent
further injuries.
Maintain victim’s body temperature by keeping him dry and
warm
Take measures to relieve pain
Give emotional support and reassurance
Do not let crowd gather around the patient
Arrange for transportation
Anaphylactic Shock

Severe body response to allergic substance or protein.

Causes
• Pollen
• Particular food
• Wasp sting/bee sting
• Drugs like penicillin, iron, serum etc
 Signs and symptoms
• Nausea, vomiting
• Diarrhea
• Anxiety
• Widespread red, hives
• Utricaria
• Swelling of the face
• Rapid pulse
• Wheezing and gasping for air
• Itchy, red watery eyes
First Aid Management
Person urgently needs oxygen and a life saving injection of
adrenaline. There is no particular first aid measure, except
assisting in breathing and minimizing shock till the doctor
arrives.
Remove the allergen if possible and call for assistance.
Keep the person cool and loosen any constrictive clothing.
Reassure the person, stay with him until emergency aid
arrives.
Help the person for easy breathing by making him sit up and
leaning forward a little.
If the person stops breathing, administer CPR
First aid in unconsciousness
• The state in which a person is unable to respond to stimuli and appears
to be asleep.
• Person may be unconscious for a few seconds and in fainting for longer
period of time.
• People who become unconscious don’t respond to loud sounds or
shaking.
• They may even stop breathing or their pulse may become faint.
• Causes
Unconsciousness can be brought on by a major illness or injury, or
complications from drug use or alcohol misuse. Common causes include :
 Car accident
 Severe blood loss
 Blow to chest or head
 Drug overdose
 Alcohol poisoning
• Common causes of temporary unconsciousness include:
Cardiac arrest
Low blood sugar
 Low blood pressure
Syncope or loss of consciousness due to lack of blood flow
Neurologic syncope, or loss of consciousness caused by a
seizure, stroke, or transient ischemic attacks.
Dehydration
Problems with heart rhythm
Straining
Hyperventilating
Any sudden loss of consciousness is a medical emergency,
bystanders should call for medical help immediately.
First Aid Measures
• If person is breathing:
Place him in recovery position, this will help to maintain a clear airway
and decrease the risk of chocking.
For providing recovery position, follow the instructions listed below:
First aid and law
• Simple ethics include always displaying respectful behavior towards the
casualty, maintaining respect for their belief, privacy, dignity and paying
careful attention to consent and confidentiality.
•
Equipments for first aid kit

• Wound cleanser/ mild antiseptic (100 ml)

• Swabs for cleaning wounds
• Cotton wool for padding
• Sterile Gauze (minimum quantity 10)
• 1 pair of forceps
• 1 pair of scissors
• 1 set of safety pins
• 4 triangular bandages
• 4 roller bandages (75mm)
• 4 roller bandages (100mm)
• Crepe bandages
• 1 roll of elastic adhesive (25x3mm)
• 1 roll of non-allergenic adhesive strip(25x3mm)
• 1 packet of adhesive dressing strips
• 4 first aid dressing (75x100mm)
• 4 first aid dressing(150x200mm)
• 2 straight splints
• 2 pairs large and 2 pairs medium sized disposable
latex gloves
• 2 CPR mouth pieces or similar devices
• Thermometer
• Bulb syringe
• Sterile eye dressings (at least 2 dressing)
Solutions used in First Aid
• Dettol :
• Savlon
• Pottasium Permanganate
• Spirit
• Boric acid
• Iodine
• Acriflavine
• Nitrofurazone
• Hydrogen Peroxide
• Gentian violet
• Carbolic acid