INTRODUCTION

First aid is an important part of everyday’s

life; at home, work or playing grounds etc.
everybody should learn first aid and be
willing to administer basic care until
emergency assistance arrives.
• Not every incident requiring first aid is a life and
death situation
• First aid knowledge is commonly used to
manage minor injuries at home and work
DEFINITIONS
i. First aid is the immediate and temporal
treatment or care given to an injured or sick person
until the service of physician is obtained
• ii. First aid is an immediate and temporal
treatment given to victim of an accident or a
person with sudden illness until the casualty is
removed, if necessary to hospital or to a side
where appropriate skill and equipment are
available
• iii. First aid is an immediate care of an injured or
suddenly sick person
• It is the care a person applies as soon as
possible, after an accident or illness This is a
prompt care under tension prior to the arrival of
an ambulance or more experienced team
 AIMS / OBJECTIVES OF FIRST AID
• Preserve life: this includes life of the casualty, by
stander and the first aider.
• Protect the casualty from further harm:- ensure
scene is safe
• Provide pain relieve:- this include the use of ice
packs
• Prevent the injury from becoming worse:- ensure
the treatment you have given will not worsen the
injury
• Promote recovery
• Make transportation of the casualty easy and
comfortable
• Assist the doctor by supplying details of the
accident or injury and any first aid treatment
given
• Maintain individual health by preventing
accidents and illness thereby promoting human
dignity.
• Provide reassurance
NB: it is important to understand that first aid has
its limit
PRINCIPLES OF FIRST AID/GENERAL/GOLDEN RULES
OF FIRST AID

• Remove the patient, casualty or victim from

danger or danger from the patient to prevent
further harm.
• Treat the most urgent condition first in this order:
Restore breathe
 Control bleeding
Treat for shock
• Place unconscious patient in prone position if
this is impossible, a recumbent with head turned
to one side
• Do not give anything to an unconscious patient
to drink
• Do not give alcohol stimulant since they have
transient effect with subsequent depression of the
vital centers
• Reassure patient or bystanders
• Give written massage in case you are not
accompanying the patient to the nearest centre
 QUALITIES OF A FIRST AIDER

• Knowledge
• Observation
• Self-confidence
• Resourceful
• Tactful
• Patient and understanding
• Cheerful
• Empathy
• Explicit:- thus, giving clear instruction to the
patient and advice to the assistants
 SHOCK
Is the depression of the vital centers in the brain
(medulla oblongata) due to deprivation of
sufficient blood supply
It is a pathophysiological condition characterized
by inadequate tissue and other organ perfusion
which seriously reduces the delivery of oxygen
and other essential substance to the vital centers
of the brain
 TYPES
TIME OF OCCURANCE:
• Primary shock
• Secondary shock
PRIMARY SHOCK
• It occurs immediately after the accident or injury
or sudden illness
SECONDARY SHOCK
• It occurs several hours after the accident or
sudden illness and is very serious
 SITUATION OF OCCURANCE

OLIGURIC (HYPOVOLAEMIC) :
• it occurs as a result of massive destruction of
tissue leading to loss of blood and body fluid
NEUROGENIC /PSYEHIC SHOCK:
• this occurs upon hearing sadness or as a result of
fear
• ANAPHYLACTIC SHOCK: shock as a result of
allergic reaction
• CARDIOGENIC SHOCK: shock caused by an
acute heart condition such as myocardial
infarction
• SEPTIC/ TOXIC SHOCK: shock due to
septicemia/toxemia
• SHELL SHOCK: this is a psychoneurotic
condition caused by the stresses of warfare
 CAUSES OF SHOCK
• Haemorrhage
• Fractures
• Burns and scalds
• Dehydration
• Severe pain
• After surgical operation
• Allergens
• Poison
• Heart attack
• Bacterial infection
 SIGNS AND SYMPTOMS

• Lowered blood pressure

• Weak and rapid pulse
• Sighing and irregular breathing
• Sweating
• Dilated pupils
• Blurred vision
• Cyanosis
• Cold clammy skin
• Pale face and anxious look
• Sub-normal temperature below 36oC
• Relaxed muscles
• Dazed and sunken eyes
• Dizziness
• Disorientation
 FIRST AID MANAGEMENT

• Casualty must rest at a convenient place

• Put him in prone position with the head turned to

one side (recovery position)

• Raise the foot side or end of bed if he is in the

hospital

•
• Keep casualty still and quiet

• Reassure casualty depending on the type of

shock

• Do not give any stimulant

• Arrest bleeding if any

• Transport casualty to the nearest health facility

 HAEMORRHAGE
Is the escape of blood from a broken
vessel
 TYPES OF HAEMORRHAGE

INTERNAL HAEMORRHAGE (concealed)

• Haemorrhage is said to be internal when the
escape of blood cannot be seen externally
• The bleeding area therefore becomes
oedematous
• In certain circumstance the patient may vomit it
out or pass it in stool
 EXTERNAL HAEMORRHAGE (revealed)
• Is when the escape of blood can be seen by the
first aider and the blood is either oozing as in a
bruised area or spurting out as in a severed artery
 CAUSES OF HAEMORRHAGE

• Direct injury to the blood vessels as a result of

cut by a sharp edge
• Disease of the blood vessel walls such as
infection, cancer etc.
• Disease of the blood itself e.g Haemophilia,
 CLASSIFICATION OF HAEMORRHAGE
• Bleeding can be classified according to:

• Situation

• Time it occurs

• Source
SITUATION: it can either be external or internal
bleeding

SOURCE: the source can either be arterial, venous

or capillary.
 ARTERIAL BLEEDING

Characteristics of arterial bleeding include:

• Bright red in colour ( due to presence of oxygen in blood)

• Spurting from the wound (each spurt coincides with the heart
beat)
• The escape is under pressure from wound

• The escape is from the part of the wound nearest to the heart
 VENOUS BLEEDING

The characteristics are:

• Blood is dark red in colour (because there is
small amount of oxygen present in the blood)
• The blood flows steadily
• Escape is from the part of wound farther away
from the heart
 CAPILLARY
• This occurs in superficial wounds and the blood
will be:
• Oozing from the wound
• Neither bright red nor dark red in colour
• Wells up from all over the wound
 TIME

• Time of haemorrhage may either be; primary,

secondary or reactionary

• Primary bleeding: it usually occurs at the time of

the injury when the blood vessel is damaged as in
surgery
• Secondary bleeding
• this usually comes few days after the initial
damage of the blood vessel from 2-10 days E.g
Post-operative wound
• Reactionary haemorrhage:
• this mostly occurs up to 24 hours after the initial
injury
• This bleeding is as a result of body reaction to
nature’s methods or in-built mechanisms that
tend to stop the initial haemorrhage
• When blood vessels are severed nature adopts
three ways to stop it
• CLOTTING:
• shed blood tends to clot when it comes into
contact with air and thus small clots of blood
may form in the wound and succeed in
plugging the injured vessels from which
blood is escaping
• These seals act like small corks placed in
the injured vessel
 CONTRACTION OF BLOOD VESSELS
The muscular and elastic coats of blood vessel
which has been damaged tends to contract (drawn
together) in such a way that the aperture through
which blood is escaping is reduced in size to such
an extent that bleeding ceases or is in a way
diminished
By this, clotting is also facilitated
REDUCED CIRCULATION
The strength of the heart beat becomes weaker
(blood pressure lowered) so that less blood
reaches the affected vessel
• Haemorrhage may thus temporally be arrested by
the above methods; to allow time for natural
repair to take place in the walls of the damaged
vessels
• In certain instances the body reacts to these
inbuilt mechanisms
• The blood pressure quickly and suddenly returns
to normal and the blood clot is pushed out and
bleeding is started again
• This type of bleeding is what is referred to as
reactionary bleeding and usually occurs up to 24
hours
 SIGNS AND SYMPTOMS
• Pallor, especially on the face and lips
• Cold and clammy skin
• Pulse becomes rapid and weaker
• Respiration become shallow followed by
yawning and sighing
• Casualty feels giddy, weak and may faint
• Ringing in the ears
• Dilated pupils
• Blurred vision
• Sub-normal temperature (less than 36oC)
METHODS OF ARRESTING BLEEDING
•By application of pressure
•Elevation of the bleeding area above
the level of the heart
•Use of pressure points
•Application of tourniquet
NB: Application of tourniquet is
the least acceptable method of
arresting haemorrhage and is
seldomly used.
 FIRST AID TREATMENT FOR
HAEMORRHAGE
Bleeding can cause death if a vessel is
cut or severed therefore;
•Do not waste time
•Put the casualty down and raise the
foot end of the bed if in the hospital or
health facility
•Raise the affected area
•Stop bleeding using any available clean
material eg clean handkerchief, clean
rag.
•Apply pressure dressing on the wound
•Apply digital pressure using the hand
•Ensure the casualty remains quite and
still
•Reassure the casualty:- work calmly,
intelligently and make the patient feel
at ease
•Loose tight cloths around neck, chest
and waist
•Seek medical attention or transport
the casualty safely to the nearest
facility
•SPECIFIC HAEMORRHAGE
•Epistaxis
•Haematamesis
•Haemoptysis
•Malaena
•Bleeding from tooth sockets
 EPITAXIS
•It means bleeding from the
nose
 MANAGEMENT
• Place the patient in a chair in a sitting position
with head slightly forward
• This will prevent the blood from flowing to
the back of the nose and throat and may
prevent it from being swallowed or inhaled
• Reassure casualty
• Loosen tight clothes around the neck, chest
and waist and place patient near an open
window
•Ask casualty to breathe through
mouth
•Pinch the nose firmly between the
thumb and the forefinger
•A cold compress in the form of a
handkerchief wrung out in iced water
can be applied over the bridge of the
nose and the back of the neck
• Keep patient sitting
• Warn casualty not to blow the nose
• Do not attempt to plug nose
• Seek medical aid if your measures fail
 HAEMOPTYSIS

• It means coughing up of blood that may be

coming from the upper part of the respiratory
tract; quite commonly from the lungs. The blood
when coughed up will be bright red in colour and
frothy. It is because it has mixed with air.
 TREATMENT

• Put patient in a comfortable position, sitting up in

a chair or if at home propped up in bed

• Tight clothes around neck, chest and waist should

be loosen

• Reassure patient to stay quiet

• Ice may be given to suck

• Transport casualty to the hospital

• Keep all specimen and sputum for doctors

inspections because by examining the
specimen, he may be able to access the amount
of damaged
 HAEMATEMESIS
•Is the term used for vomiting
of blood. It may come from the
upper alimentary tract. The
blood is usually gritty dark in
colour.
 MANAGEMENT
•Casualty should be made to lie down
•Undo tight clothes on him
•Reassure patient in order to calm
him/her down
•Patient should not be given anything
by mouth
•Refer casualty to see a doctor
•Specimens of vomit should be retained
for investigation. If there is the
presence of blood in the stool, then it
may be the result of ruptured vessel in
the alimentary tract. E.g bleeding
from the intestines, the stool is black
and tarry in nature.
 MELAENA
•This means blood in stool.
•Melaena may result from;
•Haemorrhoid
•Cancer of the anus and bowels
•Dysentery
•Colitis
 MANAGEMENT
•Patient should be made to rest
•Specimens of stool or blood
should be kept for inspection
•Refer patient to the nearest
hospital
 UTERINE BLEEDING
•Is the escape of blood from
the vagina and also during
threatened abortion
/miscarriage.
 MANAGEMENT
• Rest casualty in bed
• Foot of bed may be elevated
• Reassure patient and keep her calm
• Loosen tight clothes
• Clean the perineal area and pad with clean
suitable pad
• Keep all vulva pads for laboratory investigation
• Refer casualty to the nearest hospital
 BLEEDING FROM TOOTH
SOCKET
•This may result from tooth
extraction or from accident which
a tooth is broken.
 MANAGEMENT
•Give ice to patient to suck if available
•Plug of cotton wool or gauze may be
fitted into the socket and patient asked
to clench the teeth very firmly
•Refer casualty to the nearest hospital
 WOUND
•Is any break in the integrity of the
skin surface
 CAUSES

• Wounds are mostly caused by accidents such as:

• Road traffic accident, incidental cut by sharp

object e.g knife, blades, broken bottles, glass etc.

• Disease: disease causing pathogens such as

staphylococcus infection that causes pus formation
results in wounds.
 TYPES OF WOUNDS

• ABRASED WOUNDS: here the skin is scraped off

but there is no deeper injury

• INCISED WOUND: It occurs as a result of a sharp

instrument cutting or breaking the skin such as knife,
or piece of glass. This wounds usually bleed freely but
heals quickly .The length is greater than the depth
• PUNCTURED WOUND: is a type of wound caused
by a pointed instrument such as spokes, needle, and
bayonet or by gunshot. The depth is greater than
the length and there is danger of deep organs being
damaged. Punctured wounds are usually not
sutured unless exploration is done.
•PENETRATING WOUNDS:
these are usually caused by
gunshots, shrapnel etc. they may
be inlet and outlet holes and
vital organs are usually or often
penetrated by the missile.
• LACERATED WOUND: is a type of wound with
broken area of the skin torn with irregular edges.
The skin and other surrounding tissues may be
crushed. This type of wound is caused when a part
of the body is caught up in a machine. There is less
bleeding as compare to the incised wound but there
is more skin and tissue damage.
• CONTUSED WOUND: with this type of wound,
there is relatively little damage to the skin but
underlying tissues may be severely damaged with
bleeding from blood vessels under the skin.

Contused wounds are caused by violence from blunt

instruments such as hammer, truncheon, etc.
 GENERAL FIRST AID MANAGEMENT OF
WOUNDS

• Control bleeding by digital pressure or

otherwise
• Raise the part if possible

• Treat shock if any

• apply clean dressing over area

• Prevent the spread of infection by handling

wound with care

• Immobilize the part if fracture is suspected

• Refer casualty to the nearest hospital

 COMPLICATIONS OF WOUNDS
INFECTION
• The skin act as one of the main defenses
against infection, therefore invasion of the
wound by pathogens such as staphylococcus
organism (bacteria) results in infection.
 HAEMORRHAGE
•This is loss of blood as a result of
severed blood vessels. The
haemorrhage may be slight or severe,
external or internal.
 SHOCK
•This occurs according to the extent of
damage and quantity of blood lost.
The shock also varies in degrees.
 INJURY TO DEEPER
ORGANS
•In punctured and penetrating
wounds deeper structures such
as the heart, lungs, liver and
bowels could be damaged
resulting in bleeding.
 FRACTURES
•These are breaks in the continuity
and integrity of the bone tissue.
This usually occurs during
accident.
 BURNS AND SCALDS
• They are accidental damage to the skin,
mucous membrane or conjunctiva.
• Burns are caused by;
• Dry heat like fire
• Contact with hot metals
• Electricity
• Radiation Chemicals, acids, ammonia, caustic
soda
Scalds result from moist heat due to;
• Boiling water
• Steam
• Hot oil and coaltar
• Burns may be superficial or deep.
Superficial burns involve skin and blister
formation takes place. All other burns are
deep burns.
• The simplest way to find out the extent of
burns is to apply Wallace’s rule 9.
• Head and neck 9%
• Each upper limb 9%
• Front of trunk 2 x 9% = 18%
• Back of trunk 2 x 9% = 18%
• Each lower limb 2 x 9% = 18%
• Perineum 1%
 Signs and symptoms:
•Intense burning and pain in the
affected area
•Enhanced thirst
•Skin is reddened and blisters form in
superficial burns
•Skin is black in colour in deep burns
•Shock
 First aid measure:
• Put out the fire by dowsing with water or wrapping
the person in a blanket or rug
• The blanket or rug is to be held in front of the
person
• Do not allow the person on fire to run about
especially into fresh air
• Immerse the burnt part in cold water, using a bucket
• Keep the part in cold water for 15-20 minutes or
until pain disappears
• If water is not available, cover burnt area
with sterile dressing or freshly laundered
linen
• Avoid exposure to air
• In case of burns over face, make the
dressing in the shape of a mask, with holes at
the level of the nose for breathing
• Remove rings, bracelets, shoes and any other
tight fitting articles, as swelling may develop
later on, making it difficult to remove them
•Arrange for immediate transfer to
hospital
•When a large area is damaged, pack
ice in a towel and apply it to the burnt
area during transfer to hospital
•Do not put lotions, ointments or oil
over the burnt area
•Do not break blisters
•Do not pull away burnt clothing
stuck to body
•Do not touch the patient
unnecessarily
 In chemical burns, take the following
steps:
•Remove the contaminated cloth
carefully after soaking it in water
•Wash the affected area with cold water
for 10 – 15 minutes by flooding
•Use sodium bicarbonate solution to
wash acid burns, and vinegar to wash
alkali burns, before washing with water:
First aid treatment for electrical burns and
shock:
• Switch off current and remove plug from
socket
• If the patient is in contact with a live wire,
separate the wire from the patient using a
wooden stick
• Wear rubber gloves, if available
•Give artificial ventilation and external
cardiac massage, if necessary
•Treat shock if any
•Clean and cover the burnt area with
sterile dressing and immediately
transfer to hospital
•Give tea or coffee once the patient
becomes conscious.
 FRACTURES
• Fracture: a fracture is a break in the
continuity of a bone. A complete fracture
involves a break across the entire cross
section of the bone which is frequently
displaced.
• In an incomplete fracture, the break occurs only
through a part of the cross section of the bone
which is usually undisplaced

• An open fracture is one that extends through the

skin and mucous membrane

• A closed fracture does not communicate with the

outside area
 TYPES OF FRACTURE

•Simple (closed) fracture: the broken

ends of the bone do not cut open the
skin and show on the outside
•Compound (open) fracture: it extends
through the skin and mucous
membrane
•Complicated fracture: in
addition to the fracture, an
important internal organ like
brain or major blood vessels,
spinal cord, lungs, liver spleen,
etc, may also be injured.
• Greenstick: a fracture in which one side
of a bone is broken and the other side is
bent
• Transverse: the fracture is straight across
the bone
• Spiral: it is a fracture twisting around the
shaft of the bone
• Comminuted fractures: the bone is
broken into several pieces
 SIGNS AND SYMPTOMS
•Pain at or near the site of fracture
•Tenderness on palpation at the
site of fracture
•Swelling at the site of fracture
•Deformity
FIRST AID MEASURES FOR ANY FRACTURE
• Reassure the patient
• Control haemorrhage
• Cover any wound with sterile dressing
• Immobilize the injured part immediately so that
no movement is possible
• Do not apply bandage over the area of fracture
• Do not give the patient anything orally
• Fracture of skull: in most cases, the patient

becomes unconscious
• There are other features like vomiting, slow pulse

rate, paralysis of limbs, disturbance of eye

movements, distortion of face, and speech disorders

The signs of fracture from nose, ear or mouth and

bleeding around eyes are seen

• First aid measures:

• place the patient in supine position

• Elevate the head with a pillow under it

• Turn the head to one side

• If the bleeding is from an ear, turn the head to that side

• If there is wound on the scalp, trim hair around it and

cover the wound with sterile dressing

 Fracture of face
• Cover the wound with clean cloth

• Support the broken lower jaw with a bandage,

looped under the jaw, and over the top of the head
• Tilt the head forward over a bowl as blood and

fluid may be falling to the back of the throat

• Keep the air way clean

• Put the patient in supine position with

head turned to one side if he is

unconscious
• Transport the patient to a hospital
• Spinal fracture: Paralysis is a complication of
spinal fracture
• Check whether the patient can move ankles and
joints
• Check the loss of sensations in the lower limb
• Make the patient lie still on a flat surface
• Get a doctor immediately
• If a doctor is not available, place a pad between
the patient’s ankles and bandage the feet
together with figure of eight bandage
• Place the pad between knees and thighs
• Tie the legs together, using broad bandage
• Transfer the patient to a hospital
• While moving the patient, take the help of four
persons
• Lift and move the patient as one piece in a
stretcher
• Fracture humerus: place a pad of rolled
handkerchief, towel or small clothes in the armpit
Lightly tie the arm to the chest
• Bend the elbow and place the hand on the opposite
shoulder and apply a collar and cuff sling
• Fracture of ribs: if the fracture is not complicated,
apply two broad bandages round the chest.
• The centre of the first bandage should be below the
area of pain and the centre of the second above it.
• Do not tie knots too tight. Keep knots on the using
side
• Support the arm, in a large armsling, on the
affected side
• Shift the patient to hospital
• Fracture of collar bone: do not remove
patient’s clothes
• Ask the patient to support the injured arm
with the other hand
• Place a pad of cotton or small towel in the
armpit
• Bandage the upper arm to the side of the chest
with a broad bandage
• Support the upper limb and place the injured
side arm in a large armsling
• Transport the patient to Hospital
 First Aid:
• Do not remove casualty’s shirt
• Don’t apply a collar and cuff sling
• Bend his elbow and lay the injured limb against his chest,
the fingers just touching the opposite shoulder. Apply
adequate padding between the limb and the chest. Secure
the limb firmly to the chest by two broad bandages
• The first with its upper border, level with the top of the
shoulder
• The second with its lower border, level with the tip of the
elbow. Tie both bandages at the opposite side of the body
• Feel pulse on the injured side to ensure that there is no
interference with the circulation of the limb
• Transport to hospital as a sitting or walking case
• Fracture of pelvis: this is always the result
of direct forces, e.g., a heavy fall. When
pelvis is fractured the pelvic organs,
especially, the bladder and urinary
passages may be injured.
• Signs and symptoms:

• Pain in the region of hips and loins

increased by moving and coughing
• Inability to stand
• Internal haemorrhage may occur, which may be
severe
• There may be desire to pass urine frequently
though with difficulty or inability to do so, If
passed, the urine may be of dark colour from
blood
• Treatment: Lay the patient in the position which gives the
greatest comfort
• This should be preferably on his back, with knees
straight
• Bind the pelvis with a towel at the level of the iliac bones
Place a wooden board on the canvas of the stretcher to
provide a rigid, strong, unbending surface
• Keep pads between knees and ankles and tie broad
bandages around both the legs
 Fracture femur:
• Signs and Symptoms
• Leg appears short
• Pain and swelling over the site of fracture
• The foot on that side lies flat and turned to the
outer side
• Shock due to internal haemorrhage.
First Aid
• If shock is present, treat for shock

• Make two splints, an inner one from the groin to

the heel, and an outer one from the armpit to the

head of femur
• Apply seven broad bandages at the following places

• Chest, below armpit

• At the level of hip joints

• Both ankles and feet

• Both thighs above fracture if the shaft is broken

• Below the fracture including both thighs

• Both legs

• Both knees
 Fracture of patella
• Signs and symptoms:

• Swelling, pain and sometimes bleeding

• Muscles above the knee, which move the knee,

become helpless
 First Aid
• Place the casualty in a fowlers position
• The injured leg should be raised to a
comfortable position
• Tie the injured limb to the other limb
from thigh to below knee, after padding
knees
• Apply a broad bandage around the upper
part of thigh, and a narrow figure of eight
bandage around ankle and foot
• Tie the bandage over the broken piece of
the knee cap
• Elevate the injured limb, on a blanket and
then, transport the patient to hospital
 Fracture of tibia and fibula
•Signs and symptoms: pain,
swelling, deformity, if both
bones are broken. If only
fibula is broken, only minimal
deformity is observed.
•First aid treatment:
•The broken limb should be tied to the
sound limb, after proper padding
• Apply bandage at the upper part of
the thigh, on the knee, above the
fracture and below the fracture
Transport the patient to hospital in a
stretcher.
 Fracture of ankle:
•Signs and symptoms: pain, swelling
and sharp restriction of movements
in the ankle joint and inability to
stand
• Immobilize the ankle using an L-
shaped splint and transport to
hospital
 Sprain and Dislocations of
Joints
•Sprains: A sprain is the
tearing of ligaments of a
joint or tissues around the
joint.
 Causes:
•Sudden twist
•Wrench or slip
•Signs and symptoms: Bruising
at the site, pain and swelling,
severe pain on movement.
 First aid:
•Place the limb in a comfortable
position
•Do not move the limb unnecessarily
•Apply a firm bandage to the joint
•Keep the bandage wet with cold
water
Dislocation: in dislocation, there is
tearing of tissues around the joints and
dislocation of bones
Signs and symptoms:
•Severe pain around the joint
•Inability to move the joint
•Swelling, deformity
 First aid treatment:
•Support the joint
• In case dislocation occurs in arm, put
it in a sling and arrange a stretcher
• In the case of leg, after immobilizing
the limb, take the casualty to
hospital immediately.
 BANDAGES
•Bandage is a strip or roll of
gauze or other material for
wrapping or binding any part
of the body.
 Types of bandage
•Triangular bandage
•Roller bandage
•T-bandage
•Many tailed bandage
•Tubular gauze bandage
•Elastic net (crepe bandage)
•Barrel bandage
• Triangular Bandage: it is a bandage of
38” square diagonally into two pieces
• A triangle bandage has three borders
• The longest is called the base and the
other two, the sides
• There are three corners, the upper one is
called the point and the others, the ends
• It can be used as a whole cloth, as a
broad bandage and as a narrow bandage.
• Reef knot: to secure the cuds of a bandage, a reef
knot must be used

• To make a reef knot, take the ends of the bandage,

one in each hand

• Cross the end in the right hand under and then

over the end in the left hand thus making a turn
Then, cross the end now in the right hand over and
• The knot must be placed where it does not
cause discomfort. After the reef knot is
completed, the ends of the bandage should be
tucked away out of sight.

• Bandages may be improvised from

handkerchief, belts, straps, or any piece of linen
•Sling: a sling is used to afford
support and rest to an upper
limb, and to prevent the
weight of an upper limb,
pulling on or moving the chest,
shoulder or neck
•Arm Sling: it supports the fore
arm and is used in cases of
fractured ribs, in cases of wounds
and injuries of the upper limbs,
and in cases of fracture of the
forearm when splints are being
used.
•To apply an arm sling, face the casualty
and put one ends of a spread out
triangular bandage over his shoulder on
the sound side, with the point towards
the injured side, pass it round his neck
so that it appears over the shoulder of
the injured side, and let the other end
hang down in front of chest.
• Carry the point behind the elbow of the
injured limb, and place the forearm over the
middle of the bandage, right angle to the
upper arm
• Carry the second end up to the first, and tie
them in the hollow, just above the collar bone
• Tuck the bandage into the back of the elbow,
bring the point forward and secure with a
safety pin, to the front of the bandage
• Finger nails should be exposed for
observation
• A cotton pad is kept on the neck to prevent
•Collar and cuff sling: this gives support
to the wrist
• Bend the casualty’s elbow and lay his
forearm across his chest with his fingers
touching the opposite shoulder
• Pass a clove hitch round his wrist and
tie the ends of the bandage in the
hollow, just above the collar bone
•To make a clove hitch, take a narrow
bandage and make a loop
• Make a second loop and lay it on top of
the first, then lay the top behind the
first without turning
•Triangular sling: this is used in
case of fractured collar bone
•The arm is raised and kept up
by the sling
•Place the patient’s forearm across his
chest so that his fingers point towards
shoulder and the centre of the palm
rest on the breast bone
• Lay an open bandage over the forearm
with one end over the limb, and tuck
the base of bandage well under the
hand and forearm so that lower end
may be brought under the bent elbow.
• Tie it at the uninjured side just above the
collar bone. the loose point of the bandage is
then tucked well in-between the forearm and
the bandage in front, and the fold, thus,
formed is turned backwards over the lower
part of the upper arm and pinned.
•Application of sling for the scalp: fold
a hem inwards along the base of an
open bandage. Stand behind the
casualty and place the open bandage
on his head so that the hem lies on his
forehead, close down to his eye brows,
and the point hangs down at the back
of his head.
•Carry the ends round the head just
above ears to the back, cross the ends
over the point of the bandage, low down
near the nape of the neck, bring them
forward, round the head, above ears
and tie them in a knot on the forehead,
close to the lower border of the
bandage. Pin it up in the front after
tightening it.
•Bandage for the front of the chest:
stand in front of the casualty and place
the centre of an open bandage over the
dressing with the point over his
shoulder on the same side.
• Fold a three inch hem inwards along the base of
the bandage, carry the ends round the
casualty’s body and tie them, leaving one end
lower than the other
• Draw the point over his shoulder and tie it to
the longer end
• For the elbow: Bend the casualty’s elbow to
right angle
• Fold a narrow hem inwards along the base of
an open bandage
• Lay the point on the back of the forearm
Cross the ends in front of the elbow, then,
round the upper arm and tie above the elbow
• Bring the point down over the knot and
elbow, and pin it.
• For the hand: Keep the injured hand on a
triangular bandage so that the base of the bandage
is towards the wrist and the pointed end toward the
fingers. Now, turn pointed end from the fingers
back, towards the wrist. Carry both the side ends
around the writs, tie knot and turn the pointed end
over the knot, cover and apply safety pins.
• On the hip: Sit on the support of knees
towards the upper side of the affected hip
• Tie a narrow bandage round the wrist like a
girdle
• Now, take the triangular bandage and take its
pointed end, and hook this point under the
girdle
• Carry the ends round the thigh and over the
knot of the girdle and pin it to the bandage on
the thigh.
• For the knee: Bend the casualty’s knee to a right
angle. Fold a narrow hem inwards along the base of
an open bandage. Lay the point on his thigh and
the middle of the base below the knee. Cross the
ends behinds his knee, then, round his thigh and tie
above his knee on the front of this thigh. Bring the
point down over the knot and knee, and pin it.
• For the foot: Place the casualty’s foot on
the centre of an open bandage with his
toes towards the point. Draw up the point
over his instep, bring the ends forward so
that his heel is covered, and cross them,
pass the ends, round the ankle, cross at
back and, then, tie them in front. Draw
the point forward and pin into the
bandage over the instep.
 Roller Bandages
• Roller bandages are made of various materials of
various lengths according to use:
• Fingers 1 inch broad
• Head and arm 2 – 2.5 inch broad
• Leg 3 – 3.5 inch broad
• Trunk 4 – 6 inch broad
• Purpose:
• To keep the dressing in position
• The roller bandages should be rolled tightly
and neatly
• When partly unrolled, the roll is called the head
(or drum) and the unrolled free end, the tail
 General Rules for Application:
• Face the patient.
• Hold the head of the bandage in the right
hand when bandaging a left limb and vice –
versa.
• Apply the outer side of the free end to the
part and, where possible, lock it, in
position, by super-imposed turn.
• Bandage firmly, from below upwards, and, from
within outwards, over the front of the limb
• Apply each layer of bandage so that it covers
two-thirds of the preceding one
• Bandage should not be too tight or too loose
• When completed, secure the bandage by a
safety pin or other suitable method such as
adhesive strapping
 Principal Methods of applying the Roller
Bandage
• The simple spiral: It should be used only when
the part to be bandaged is of uniform thickness
as, for instance, the finger of wrist and a short
portion of the forearm above it. The bandage is
carried round in spiral direction.
• The reverse spiral: It is made by a number of
spiral turns in which the bandage is reversed
downwards upon itself at each circuit of the
limb.
• The figure of eight: It is applied by passing the
bandage obliquely round the limb, alternately
upward and downward, the loops resembling the
figure of 8. It is used for bandaging at or in the
neighborhood of a joint such as the knee or elbow.
• The spica: It is a modified figure of 8, and is used
for bandaging shoulder, groin or thumb.
• The divergent spica: It is a form of figure of 8, in
which the turns go alternately above and below a
fixed starting turn, ending above and is used for
bent joints, as the elbow or heel.
 Hand Bandage:
• Keep the palm of the hand downwards.
• Fix the bandage by a turn round the wrist and
carry the roll obliquely, over the back of the
hand, to the side of the little finger.
• Carry the bandage round the palm, rounding
the fingers with one horizontal turn, so that
the lower border of the bandage just reach the
root of the nail of the little finger.
•Carry the bandage once more round
the palm and, then, return obliquely to
the wrist.
•The figure of 8 turns round the wrist
and hand are repeated until the hand
is covered and the bandage is finished
with a spiral turn around the wrist.
Wrist, forearm and upper
arm bandages: They are
bandaged by simple and
reverse spiral until the elbow.
Figure of 8 can be used at the
elbow.
Elbow bandage:
• Bend the elbow at right angles.
• Lay the outer side of the bandage on the
inner side of the joint and take one
straight turn, carrying the bandage over
the elbow tip, round the limb, at the elbow
level.
• The second turn is made to encircle the
arm, and the third, the forearm.
•Each of these turns is made to cover
the margins of the first turn.
•Continue the turns alternately below
and above the first turn, allowing each
to cover a little more than 2/3 rds of
the previous turn.
•The upper arm is bandaged by reverse
spiral.
 Finger Bandage:
• Keep the palm downwards
• Fix a one inch bandage by two circular
turns, round the wrist, leaving the end
free for tying afterwards.
• Carry the bandage obliquely, over the
back of the hand, to the base of the finger,
to be bandaged, taking the fingers in the
order, starting from the little finger side.
• Take one spiral turn to the base of the finger nail
and, then, cover the finger by single spiral turns.
• Then, carry the bandage across the back of the
hand to the wrist and complete it with one
straight turn round the wrist. Secure the bandage
by a safety pin.
• If more than one finger is to be bandaged take a
turn round the wrist between each of two fingers;
continue as above until the bandage is complete.
 Thumb Spica Bandage:
• Keep the back of the thumb upper most.
• Take two turns round the wrist and carry the
bandage over the back of the thumb.
• Encircle the thumb with one or two straight turns
so that the lower border of the bandage is level with
the root of the nail.
• Carry the bandage back, over the back of the
hand, round the wrist, and repeat the figure of
eight turns, round the thumb, and wrist, until
the ball of the thumb is completely covered.
• Complete the bandage with one straight turn
round the wrist.
 Spica Bandage for Shoulder:
• Place a small pad of cotton wool in each
armpit.
• Take 3 – 4 inch bandage and fix it with two
spiral turns round the upper part of the arm
until the bandage reaches the point of the
shoulder.
• Then, carry the bandage over the shoulder,
across the back, and under the opposite
armpit.
• Bring it back, across the chest and arm,
round under the armpit and over the
shoulder again, covering two threads of
the previous turn,
• This forms a figure of eight round the
arm of the body, and the turns are
repeated until the whole shoulder is
covered.
• The bandage should be secured by a pin
immediately over the injured shoulder.
 FOOT AND ANKLE BANDAGE
• Keep the foot slightly elevated on a stool.
• Take one or two turns round the ankle to fix the bandage,
and, then, take it obliquely, across the foot, to the root of the
little toe.
• Make one horizontal turn, right round the foot, at this level,
and, then, carry the bandage, back over the foot, and take a
turn, round the ankle, just above the heel.
•Figure of 8 turns are, then,
repeated round the foot and
ankle, each turn overlapping
the preceding turn by two
thirds of its width, until the
whole foot is covered.
 KNEE BANDAGE
• Bend the knee.
• Lay the outer side of the bandage against
the inner side of the knee and take one
straight turn over the knee cap.
• The bandage is, then, brought round the
knee, just below and just above, so that
the margins of the bandage, covering the
knee cap, are covered as in the elbow and
heel bandages.
•The turns are repeated, below
and above the joint, until the
whole knee is covered and the
bandage is, then, secured by
one straight turn, round the
thigh.
Capeline Bandage of the Head: A double
headed roller bandage is used.
• The casualty should be seated.
• Stand behind the patient.
• Place the centre of the outer surface of the
bandage in the centre of the forehead, the
lower border of the bandage lying just
above the eyebrow.
•The head of the bandages are brought
round over the temples, and above the
ears, to the nape of the neck.
•The ends are crossed, the upper
bandage being carried on, round the
head, and the other, brought over the
centre of the top of the scalp, to the
root of the nose.
• The bandage which encircles the head is
now brought over the forehead, covering
and fixing the bandage which crosses the
scalp.
• This bandage is, then, brought back over
the scalp, slightly to one side of the centre,
thus covering one margin of the original
turn.
•At the back, it is again crossed
and fixed by the encircling
bandage, and is turned back over
the scalp, to the opposite side of
the centre line, now covering the
other margin of its original turn.
• These backward and forward turns are
repeated to alternate sides of the centre,
each one being, in turn, fixed by the
encircling bandage until the whole scalp is
covered.
• The bandage is completed by a circular
turn, round the head, and pinned in the
centre of the forehead.
 Ear Bandage:
• Lay the outer surface of the bandage against the
forehead, and carry the bandage round the head,
in one circular turn, bandaging away from the
injured ear, towards the sound side.
• Carry the bandage round to the back of the
head, low down in the nape of the neck, and
bring it up, over the lower edge of the dressing,
to the forehead and continue across the top of
the head, to the nape of the neck region.
• Repeat each turn being slightly higher
than the previous one till it covers the
dressing, but slightly lower as it covers the
hair.
• Continue until the whole dressing is
covered, and complete the bandage, by
one straight turn, round the forehead,
pinning where all the turns cross one
another.
 Eye Bandage
• Lay the outer surface of the bandage
against the forehead, and take one
circular turn round the head, bandaging
away from the injured eye.
• Carry the bandage on round the head
until it reaches the ear on the sound side
for the second time.
• Take it obliquely to the back of the head,
under the prominence at the back of the skull,
and, from these, bring it upwards, beneath the
ear of the affected side, over the pad on the
eye, to the circular turn, and continue over the
head to the starting point.
• Repeat this turn two or three times until the
dressing is covered, finishing with the safety
pin just above the good eye.
 STUMP BANDAGE
•Using 4” bandage, place the end of the
bandage, in the centre of the upper
side of the limb, and carry the
bandage over the centre of the stump,
to the same level, behind, holding the
turns back and front with the thumb
and fingers of the other hand.
• Repeat the recurrent turn, over the end of
the stump, first on the left and, then, on
the right side of the original turn, until
the whole dressing is covered.
• Fix the loops, with a straight turn, round
the stump, and continue the bandage with
the figure of eight turns, round the limb,
until the dressing is completely covered,
and secure with a safety pin.
 UNCONSCIOUNESS
• During sleep, a person may be easily aroused to
wakefulness or consciousness by cerebral arousal
through stimuli such as pain or unusual noise. The
return of wakefulness shows that the reticular
activating system is still functioning and is capable
of screening and discriminating
•Loss of consciousness or
unconsciousness is the stage of
unawareness
• It is the interruption of impulses
from the reticular activating system or
response to incoming impulses, thus
producing loss of consciousness.
 STAGES OF CONSCIOUSNESS
• Full consciousness: in full consciousness the
patient’s eyes are opened, he is oriented to
person, time and place
• Speech is coherent and voluntary motor
reflex is intact.
• Disorientation: patient eyes are opened to
speech, oriented to time, person and place is
altered
• The patient may obey command slowly with
repeated request
• Partial response to stimuli: patient eyes are opened
to painful stimuli, conversation is neither initiated
nor sustain
• Words are incoherent
• He tries to remove painful stimuli or reflex to pain
• Unconsciousness: generally patient eyes are closed
• He moans and groans
• He flexes or extends to painful stimuli
• Coma: no response of any kind
TERMS USED IN UNCONSCIOUSNESS

• Stupor: the patient exhibits stages 2, 3, or

4

• Coma: this is complete unconsciousness

where all reflexes are absent.
•Coma vigil: patient eyes are widely
opened, pupils may be dilated
• It is an indication of exhaustion
and prostration sometimes
accompanied by muthering and
delirium. (prostration – extreme
exhaustion)
 CAUSES OF UNCONSCIOUS
•Fainting / syncope
•Asphyxia
•CVA/apoplexy
•Epilepsy
•Diabetic and insulin coma
•Electric shock
•Uremia
•Head injury eg fracture of the skull
•Poisoning by alcohol, poisonous gas
•Cardiac arrest
•Eclampsia/fitting in pregnancy
 FIRST AID MANAGEMENT

• Place the casualty in prone position with head

turned to one side

• Clear the airway and depress the tongue with

spatula if available

• Control by standers to allow more air, if it is in a

room open windows
• Undo tight clothes from chest, neck and waist

• Do not give anything by mouth

• Keep casualty warm

• Treat obvious cause

• Seek medical attention

 TREATMENT OF
UNCONSCIOUSNESS IN SPCECIFIC
CASES
FAINTING OR SYNCOPE: This is
temporary loss of consciousness due to
cerebral ischaemia. Most often, the
cause is dilatation of the periphery
blood vessels and a sudden fall in blood
pressure
 CAUSES
• Blood loss especially in accidents
• Shock
• Confind ment in a hot, moist and stuffy
• Severe pain
• Standing for long hours
• Emotional upset
• Physical exhaustion
 SIGNS AND SYMPTOMS
• Pallor
• Giddiness
• Rapid and feable pulse with quick and
shallow respiration
• Skin is cold and clammy to touch
• Unconsciousness
 TREATMENT
• Sit the casualty down and put the head
between your knees
• Undo tight clothes
• Air the environment
• If the casualty is unconscious, place him
in the prone position, clear air ways and
control bystanders
•Seek medical attention if he
does not become conscious
•Give sips of water if conscious
•Educate patient on his
condition
 EPILEPSY
•It is the convulsive attack
resulting from disordered
electrical activity in the brain
cells. There are 2 types.
•Grand mal (major)
•Petit mal (minor)
 GRAND MAL EPILEPSY (Generalized
seizure)
• In grand mal epilepsy, the patient falls to
the ground unconscious following the
aura, tonic, clonic, coma and final phase.
There are two types of grand mal
epilepsy.
• Idiopathic
• Symptomatic
• IDIOPATHIC: in this type of epilepsy the
cause is not known and may begin in
childhood or adolescent.
• SYMPTOMATIC: There are known
pathological factors which are directly or
indirectly responsible for the seizure
 SIGNS AND SYMPTOMS OF GRAND MAL
• These are usually in sequence
• Aura phase (warning): in this phase, patient may
experience irritability, tension or headache for a few
seconds before the episode. A brief sensory or perceptual
alteration of consciousness occurs. The aura may cause
auditory, visual, olfactory and gustatory disturbance and
numbness or tingling sensation in any area of the body
• Tonic phase: this phase follows the aura phase, the patient
falls to the ground with tonic spasm which causes rigidity
of the body. An involuntary cry may be heard as a result
of sudden contraction of the thoracic and abdomen
muscles forcing the air through the spastic glottis. There
is temporary sensation of respiration and patient becomes
cyanosed. The jaws are fixed and clenched, eyes widely
opened and pupil dilated.
Clonic phase: in this phase, there are regular
jerky movements, breathing is restored but is
stertorous, blowing out frothy saliva which
cannot be swallowed due to spasm. Bleeding
may occur due to the tongue being bitten.
There may be urine incontinence.
•Coma phase: in this phase, all
twitching stop and the patient goes
into deep sleep for several hours
awakening with no memory of seize
and brief consciousness interlude.
•Final phase: the patient recovers
consciousness and becomes
disoriented and may complain of
headache, fatigue and muscular
soreness. Some become irritable,
aggressive and violent
 PETIT MAL
• In petit mal seizures, there is sudden cessation
of activity with temporary loss of
consciousness for up to thirty seconds. The
patient stares into space blankly and may
drop objects being held. There may be a few
involuntary movements and falling, such
episode may happen unnoticed and the
individual may resume his activities without
awareness.
 CAUSES OF EPILEPSY
• Fever (in children)
• Worm infestation
• Hypoxemia of any cause (low oxygen in
blood)
• Cerebrovascular disease
• Head injury (RTA)
• Central nervous system infection
• 1`2q. ```
•Metabolic and toxic condition e.g
hypoglycemia, pesticides,
hypocalcaemia and renal failure
•Brain tumor/ space occupying lesions
•Drugs and alcohol withdrawal
•Allergies
•Birth injuries
 OBSERVATION TO BE MADE ON A PATIENT WITH
EPILEPTIC ATTACK
• Onset
• The body involved i.e the part involved
• Type of movement in the part involved e.g
jerking, twitching etc
• The eyes character e.g closed or opened and
pupil size; whether fixed or reacting to lights
etc.
•Note the duration of each phase
•Note incontinence
•Note the state of consciousness and
duration of consciousness if exists
•Note kind of movement after seizure
•Note cognitive state whether confuse
or disoriented
 MANAGEMENT OF EPILEPSY
Care during seizure
• Provide privacy and protect patient from
curious onlookers
• Take patient to a safe environment or remove
danger from patient
• Ease patient to the floor if possible
• Protect the head with a pad, prevent him from
striking his head on the floor
• Loose constricting clothing
• Push aside furniture or items that may
injure patient
• If he is in bed, remove all pillows and raise
side rails
• If aura proceeds seizure, insert an oral air
way or spatula to reduce patient biting the
tongue or the cheeks. This can cause
bleeding that patient may aspirate
NB: do not attempt to pre-open the
jaws that are clenched in spasms or
to insert anything as this may
injured tongue and lips or break his
teeth.
No attempt should be made at restricting patient
during the seizure because the muscular
contractions are strong and restraint can cause
injury. If possible place him on his side with head
relaxed forward, this facilitates drainage and
prevent tongue from obstructing the airway.
 CARE AFTER A SEIZURE
• Keep patient on his side to prevent
aspiration
• Be with patient since he may be confused
(common after grand mal seizure)
• Give oxygen if necessary if in hospital
• When he recovers, orientate him on his
environment after assessing his orientation
to place, time and person.
• If he becomes agitated after a seizure, use
calm persuasion and gentle restraint
• Check vital signs especially pulse, blood
pressure, respiration and oxygen saturation
if possible
• Tidy up if incontinence
• Bed should be low with side rails if in
hospital
• Stay with patient through the period
 POST SEIZURE EDUCATION
•Educate him on the causes of seizure
•Educate him on his medication
•Educate him on life styles and also
known causes
•Educate family on support
 COMPLICATION OF SEIZURES
• Injuries e.g fractures, head injuries,
abortion
• Aspiratory pneumonia/pneumonitis
• Brain damage from repeated attacks
• Psychosis
• The condition may become chronic
• Stigmatization
 POISONING
• A poison is a substance which, when taken into the
body, in sufficient quantity, will harm or destroy life.
• Common routes of Poisoning
• Oral: Insecticides, alcohol, drugs, acid, alkali and food
poisoning
• Inhalation: Carbon monoxide, carbon dioxide,
anesthetic agents.
• Injection: Narcotics, sedatives
• Bites: Snake, scorpion, dogs
• Skin: Pesticides.
 Classification of poisons
• 1. Corrosives
• a. Acids such as nitric acid and hydrochloric acid
• b. Alkaline like ammonia and caustic soda
• 2. Gas poisons
• a. Carbon monoxide, Hydrogen sulphide
• 3. Noncorrosives
• a. Narcotics such as strychnine and belladonna
• b. Irritants such as Lead and poisonous berries or
fungi
 Precaution to be taken to avoid poisoning:
• Do not leave medicines within reach of
children.
• Do not store medicines for long periods.
• Do not take drugs in the dark; always read
the label before taking medicine.
• Do not pour harmful liquids into bottles of
lemonade or other drinks.
• Do not keep detergents, domestic cleaners and
acids under sink, where children can find them.
• Do not take medicines without medical advice.
• Do not burn coal in closed rooms as it produces
carbon monoxide.
• Use household cooking gas with care.
• Avoid contact with dogs which are not
immunized for rabies.
• Avoid possible contact with snakes, scorpions
 FIRST AID MEASURES IN CASE OF POISONING
• If the patient is conscious, try to find out what
he has consumed, quantity and time.
• If there are empty bottle and wrappers of
medicines, keep them for examination.
• If the patient vomits, keep the vomit for
examination.
• If the patient is conscious, induce vomiting by
tickling the back of the throat or by making him
swallow concentrated salt solution.
• (Do not induce vomiting if the patient is
unconscious or if there is suspicion that the
patient has ingested strong acid or alkali).
• After vomiting is over, give the patient milk or
egg albumin, tea or coffee to smoothen the
area
• Take the patient to the doctor as early as
possible.
• For poisoning through skin, wash the area
thoroughly with clean cold water.
•Remove the contaminated clothing.
•Encourage the patient to drink as much
water as possible.
•Observe for the development of
twitching or fits.
•Administer universal antidote.
2 parts of activated
charcoal
1 part of milk of magnesia
1 part of strong tea (tannic
acid)
 If the poison has been ingested,
•Administer a specific antidote, e.g.
weak acid for strong alkali, weak alkali
for strong acid, and starch for iodine.
•Inform police.
 In case of acid or alkali poisoning
• Put the patient in a comfortable position.
• Do not induce vomiting.
• For strong acid poisoning, give chalk, milk of
magnesia or sodium bicarbonate in water.
• For strong alkali poisoning, give lemon juice,
vinegar, butler milk, etc.
• Give olive oil, ghee, white of an egg and milk
orally.
 SNAKE BITE
Signs and Symptoms:
• Pain is immediate, rapid and swelling, skin
becomes dark purple; generally, the puncture
marks of the fangs can be seen.
• Systemic Effects: Extreme weakness and
faintness, rapid weak pulse, shortness of breath,
blurring of vision, nausea and vomiting and
unconsciousness.
 First Aid
•Keep the patient flat and quiet.
•Tie a constricting band firmly around
the limb just above the bite to prevent
the return flow of blood.
•Loosen band if swelling causes too
much constriction.
•Apply cold compress to reduce swelling.
•Take the patient to health facility
immediately.
•Food Poisoning: This occurs when 2 or
more people have abdominal pain and
diarrhoea after eating from the same
pot.
 SYMPTOMS
•Discomfort in the upper abdomen
•Pain and cramping in the abdomen
•Nausea and vomiting
•Diarrhea
•Weakness
• First aid:
• Personal cleanliness is to be observed in
preparing and serving food.
• Avoid handling of food when there is any
infection of fingers and arms.
• Protect all foods from flies and insects
• Call for a doctor
• Induce vomiting
 SCORPION STING
Signs and symptoms
• Severe burning
• Intolerable, increasing pain in the bitten area,
giddiness, vomiting and unconsciousness.
• First aid: make the patient comfortable and
apply soothing cream to the bitten area. If the
patient feels giddy, send him immediately to
the hospital. If blister formation occurs, dress
the wound with an antibiotic ointment.
 Dog Bite
Signs and Symptoms
•1. Scratch or abrasion of the site
•2. Pain
•3. Slight bleeding
•4. Itching around the site
 FIRST AID TREATMENT
•Keep part low
•The bitten area should be washed
immediately with soap and water
•An antibiotic cream be applied after
cleaning the wound with disinfectants
•Send the patient immediately to
hospital
 Foreign bodies in various organs
•Foreign body in Throat: fish bone,
coins, piece of food, false teeth,
etc., may be lodged in throat
•Symptoms: there may be violent
coughing and difficulty in breathing
or swallowing
 First aid
• Call for a doctor
• Do not try to remove foreign body with
your fingers or with food or cotton
• Hold the patient upside down and give him
a slap on the back to remove the
obstruction
• Artificial respiration may be needed
•Foreign body in nose: if a
foreign body like a grain, corn,
pea, bean, etc., that is likely to
swell, has lodged in the nose, a
few drops of mineral oil may be
dropped to relieve irritation
and swelling.
 First Aid measures
•Take the patient to doctor as soon
as it can be done
•The nose should be blown not too
vigorously
•It should never be blown with one
nostril
•Foreign Bodies in Eye: foreign bodies
like dust, iron, coal or ashes maybe
carried into the conjunctival sac or may
adhere to cornea; particles may
penetrate the chambers of the eyes.
They produce scratchy feeling; patient
feels discomfort, and the eye is
sensitive to light.
 PRECAUTIONS
• Never rub the eye
• Never examine an eye for a foreign body
because dirt might enter and make the injury
worse
• Never attempt to remove foreign body with a
match, knife, blade or any instrument
• Send the patient to a physician if the foreign
body is imbedded in the eye ball.
 First aid
•Pull down the lower eye lid and
see if the body lies on the surface
of the lid’s lining membrane. If the
foreign body is floating, it can be
removed with a moistened sterile
cotton applicator.
• Grasp the lashes of the upper eyelid gently
between thumb and forefinger, ask the
patient to look upward and pull the upper
eyelid forward and downward over the lower
eyelid.
• Flush the eyelid out with a sterile plain water
•If these measures fail, put a drop of
castor oil or mineral oil in the eye and
fix a pad over the lid to keep it closed
and inactive until a doctor can treat the
condition
• Magnets are used to remove metal
fragments from the eye
• If an eye has been injured by chemicals,
irrigate the eye with plain water, normal
saline or boric acid solution for 5 minutes.
•Foreign body in Ear: solid substances
like pea, button can enter the ear.
Among these, some substances like
peas and seeds absorb moisture, swell
up and obstruct the ear. Flies,
mosquitoes or bedbugs can also enter
ear.
 First Aid
• Never use pin or piece of wire to take out
foreign bodies from ear because by using
them, ear drum may get ruptured
• In case of insects, pour warm olive oil into
the ear
• Then, send the patient to hospital
 EMERGENCY NURSING
SCOPE OF EMERGENCY NURSING
•DEFINITION
•Emergency (ER) nursing directs
attention to human responses to any
trauma or sudden illness that require
interventions ranging from minimal
care to life support
 GOAL
•The emergency nursing
common goal is to restore
physiological or psychological
status to the severely ill patient
or the severely injured victim.
 EMERGENCY SERVICES
•Prehospital care
•Emergency Telephone
•Intrahospital care
•Electronic Technology
 EMERGENCY DEPARTMENT (ED)
ENVIRONMENT
• Entrance Laboratory
• Triage Waiting room
• Offices Examination rooms
• Conference room Minor surgeries
• Orthopedic room Ambulance area
• X-ray room
 ER NURSE CHARTERISTICS
Knowledgeable and skillful for
•Basic knowledge of Principle and
techniques
•Sophisticated Equipment
•Nursing Process
 ER NURSE ROLE
•Care Provider
•Educator
•Manager
•Advocate
 ER NURSING
INTERVENTIONS
•Independent
•Dependent
•Interdependent
•ETHICAL & LEGAL ISSUES
•Consent Treatment
•Negligence Malpractice
•Confidentiality Fidelity
•Autonomy Report
•Gather Evidence Decision
Making
 MEDICAL EMERGENCIES
CONVULSION
They are seizures that have sudden episode of
disturbance of consciousness which may be
accompanied by uncoordinated purposeless
muscles contraction and changes in sensation or
behavior in young children.
Convulsions result from an increase in body
temperature to 400C due to infection, worm
infestation or malaria parasite.
 SIGNS AND SYMPTOMS
•Refer to epilepsy but there is
no aura
 FIRST AID MANAGEMENT
• Treat the casualty as of an unconscious
patient and protect him from injury during
convulsion attacks.
• Sponge patient if a child, bath patient if an
adult
• Apply cold compress to forehead and axilla
• Take care not to cause chills
• Send patient to hospital
 DIABETIC COMA (Hyperglycemic coma)
• This is also known as hyperglycemic coma
which results from abnormally high blood
sugar concentration. (Normal blood sugar
3.6/4.0 – 6.3mmol/L)
• SIGNS AND SYMPTOMS
• Headache
• Restlessness
• Drowsiness
• Abdominal pain
• Deep sighing respiration (air hunger)
• Dry skin
• Acetone in breath
• Unconsciousness
• Elevated sugar level
 CAUSES
•Too much food
•Too little or no diabetes
medication
•Emotional/ physical stress
•Poor absorption of insulin
 TREATMENT
•Give insulin if the patient is a known
diabetic, take note that this measure is
applied in first aid treatment
•The best measure is to treat as in an
unconscious patient and transport
patient to the nearest health facility
 INSULIN OR HYPOGLYCAEMIC COMA
•Hypoglycaemic coma results from low
blood sugar level in the body. E.g when
insulin is used in the treatment of
diabetes or when a diabetic misses his
meals or over exercise.
•Normal blood sugar level 3.6 – 6.3
mmol
 CAUSES
•Overdose of insulin injection
•Hunger
•Uncompensated exercise
•Intake of food with alcohol
 SIGNS AND SYMPTOMS
•Giddiness
•Faintness
•Convulsion
•Headache
•Numbness of fingers, toes, mouth
•Quite and shallow respiration
•The skin is moist/ sweating
•Tremors of hands and feet
•Unconsciousness progressing to
coma
 TREATMENT
•Give cubes of sugar
immediately
•Send the casualty to hospital
•Treat him as in unconscious
patient
 APOPLEXY/CEREBRO VASCULAR
ACCIDENT/STROKE
•This occurs when there is a
ruptured blood vessel leading to
haemorrhage in the brain
substance. It also results from the
blockage of vessels in the brain by a
clot.
 SIGNS AND SYMPTOMS
•Prior to the attack the signs and
symptoms are;
•Headache
•Giddiness
•Faintness
•Tinnitus/ringing in the ears
•Heaviness of the head
•Paralysis of the parts of the body
•Unconsciousness
•Increase BP with flush face
•Slow and pounding pulse
•Noisy and stertrous respiration with
puffy cheeks
 TREATMENT
•Handle patient with care if there are no
bystanders leave the patient at where
he is
•Raise the casualty head and shoulders
lightly and support with pillow
•Turn the head to the affected part
•Clear airways and remove
dentures if any
•Keep casualty warm
•Transport to hospital
 ASTHMA
•It is a condition which causes
episodes when all the bronchi
are narrowed. This causes
episodes of shortness of breath
and wheezing called attacks of
asthma.
 CAUSES
•Allergic reaction
•Emotional factors
•Infection (viral upper respiratory
infection)
•Hereditary
•Air pollution
•Excessive exercise
•Cold dry air
•Some drugs
•Food additives
•Occupational hazards exposure
•Hormones (menses)
 SIGNS AND SYMPTOMS
• Wheezing
• Cough
• Dyspnoea
• Chest tightness
• Restlessness
• Inappropriate behavior
• Increase pulse and BP
 MANAGEMENT
•Reassure patient
•Put patient in an upright position
•Loose tight clothes from the chest,
waist of patient
•Give him inhaler and help him to use it
•Provide patient with odour free fresh
air
•If he has his medication, help him to
take them
•Encourage liberal fluids intake to thin
the secretion
•Send patient to the nearest health
facility if not aborted and educate
patient on causes and correct use of
medication
 ACUTE ABDOMEN
•It is a medical term which refers to
a sudden onset of abdominal pain
that indicates an irritation of the
peritoneum (that is the thin
membrane that lines the entire
abdominal cavity)
 CAUSES
•Infection
•Penetrating abdominal wound
•Blunt injury severe enough to
damage abdominal organs
•Bowl obstruction
 SIGNS AND SYMPTOMS
•1. Severe abdominal pain
•2. Abdominal tenderness
•3. Abdominal distension
•4. Nausea and vomiting
•5. Anorexia
•6. Guarding behaviour
 MANAGEMENT
•Reassure patient
•Do not attempt to diagnose the cause
of acute abdomen
•Clear and maintain airway
•Anticipate vomiting
•Do not give the person anything by
mouth
• Document all pertinent/minute
information i.e onset, provocation, quality,
radiation, severity, time and treatment
• Treat for shock if any
• Make patient comfortable for transport
• Monitor vital signs
• Do not delay, transport casualty as quick
as possible
 CARDIAC ARREST
•The heart may cease to
function either due to some
disease conditions directly
acting on it or due to
respiratory failure
 MANAGEMENT
•External cardiac massage
•Place the patient on the ground or
on a flat hard surface with the face
upward
•Kneel on by one side of the patient
chest
•Place the heel of the right hand over
the lower half of the sternum
•Place the left hand on top of the right
hand
•Keep your elbows extended
•Push vertically downward for about
4cm in an adult
•Release the pressure
• Repeat the cycle 60-70 times in a minute in
an adult and 90-100 times softly in an
infant
• Check the carotid and femoral pulsations
• If artificial ventilation is required, an
assistant should give artificial respiration
• Once heart beat and respiration are
established, transfer patient to hospital
 ASPHYXIA
• It is a condition in which there is deficient
oxygen in the blood and an increase of carbon
dioxide in the blood either because there is
insufficient amount of oxygen in the air
breathed or the lungs and heart ceased to
function effectively. When there is deficient
oxygen in the blood, the tissue which it normally
supplies will cease to function and vital organs
such as the brain and heart are rapidly affected
and death may occur within minutes.
 CAUSES
•Obstruction of a respiratory tract. This
may be due to:
•The tongue falling to the back of the
throat in an unconscious patient lying
on his back or in the case of a fractured
jaw.
•Inhalation of substance such as blood,
vomitus, false teeth, food etc.
• Swollen of the tissue of the air passages due
to injuries such as scalding, swallowing of
corrosive and following infections.
• Drowning
• Spasms caused by smoke, bronchitis
External pressures such as
• Smothering (suffocation) due to piece of
material such as a pillow or a plastic bag etc
completely covering the nose and mouth
• Compression of the neck by strangulation
and hanging
• Paralysis of the muscles of respiration due
to;
• Electric shock
• Certain poison such as carbon dioxide &
morphine
• Disease of the nervous system e.g
poliomyelitis or injury to the spinal cord
Gross chest and lung damage such as a
collapse of the lungs due to rupture of lung
tissue or perforating wound of the chest
wall.
• Compressing of the chest by fall of earth,
sand or crushing against a hard object
Lung disease e.g acute pneumonia and
cancer
 CLINICAL MANIFESTATION
• Difficulty in breathing with increasing rate
and depth
• The individual becomes restless and
agitated
• Coughing and spluttering
• Cyanosis occurs shown by blueness of lips
and inside the mouth
•The face becomes congested and
the neck vein distended with blood
•Pupils may be dilated
•Consciousness is gradually lost and
breathing ceases
 VARIOUS METHODS OF ARTIFICIAL
RESPIRATION
•There have been several methods of
artificial respiration practice in first aid
but the most effective and common
one is the mouth to mouth or mouth to
nose.
 MOUTH TO MOUTH
• Place the casualty on the back. Hold his
head tilted back
• Take a deep breath with mouth opened
widely
• Keep nose of the casualty pinched
• Cover the mouth of the casualty with your
mouth snugly
• Watching the chest, blow into his lungs
until the chest expands. Withdraw your
mouth. Note the chest falls back
• Repeat the above 15-20 times per minute
• If the casualty is young (baby or child) the
operation is as above but your mouth
should cover both the mouth and nose of
the casualty and blow gently
•If the chest does not raise in 5 above,
look for an obstruction
•Use mouth to nose respiration if mouth
to mouth respiration is not possible
•If the heart is working continue
artificial respiration until normal
breathing occurs
• If the heart is not working, you will notice
the following
• The face is blue or pale
• Pupils are dilated
• Send casualty to the hospital or call for
ambulance
NB: cover your mouth with filter bag before
starting artificial respiration
Holger Nielsen Method:

Put the patient face down, the forehead

resting on the back of overlapping hands.
Keep the head straight so as to keep the air
passages completely open and free. Kneel
near the patient’s head,
•placing one knee near the head and the
opposite foot by the side of the
corresponding side elbow. The knee
and the foot may be alternated from
time to time. Place both hands over the
lower parts of the patient’s shoulder
blades, the fingers spread and the
thumbs near midline.
Keep the arms and forearms straight; lean
forwards so as to apply pressure by the
weight of the upper part of the body. Count
one, two, and then, lean back, sliding hand
to just above the elbows of the patient as
you count three.
•Grasp the arms of the patients
near the elbows, and lift them up
keeping your upper limbs straight.
Count four, five and then lower the
patient’s arms back to the original
position as you count six. Then,
start all over again.
•Sylvester’s Method:
•Place the patient’s face upwards. Place
a folded blanket under the patient’s
shoulder to raise them so that the head
falls backwards. Kneel near the head.
Grasp the patient’s forearms near the
wrists, cross them over the lower part
of the chest and then, lean forward to
press the crossed arms for 2 seconds.
•Then pull the arms upwards and
outwards with a sweeping movement
and place them on the ground by your
own knees for seconds. Repeat the
cycles 12 times a minute. This method
is useful when the patient cannot be
placed face down it is more effective
than the prone pressure method.
• Schafer’s Method:
• Place the patient in prone position, head
turned to one side, resting on the back of
overlapped hands. Kneel by the side of the
patient at the level of hips. Place the hands
on the lower part of the back, the wrists
almost touching, thumbs forward and
fingers opposed. Keep your upper limbs
straight
•as you lean forward so as to apply
pressure by the weight of the body.
Then rock backwards to release
pressure. Repeat the cycle 12 times
a minute
• Check his vital signs frequently to
assess his condition
 HOW CPR WORKS
• The air we breathe in travels to our lungs where
oxygen is picked up by our blood and then
pumped by the heart to our tissues and organs.
When a person experiences cardiac arrest –
whether due to heart failure in adults and the
elderly or an injury such as near drowning,
electrocution or severe trauma in a child – the
heart goes from a normal beat to an arrhythmic
pattern called ventricular fibrillation, and
eventually ceases to beat altogether.
•This prevents oxygen from circulating
throughout the body, rapidly killing
cells and tissues. In essence, Cardio
(heart) Pulmonary (lung) Resuscitation
(revive, revitalize) serves as an artificial
heartbeat and an artificial respirator
•CPR may not safe the victim
even when performed properly,
but if started within 4 minutes
of cardiac arrest and
defibrillation is provided within
10 minutes, a person has as
40% chance of survival.
• Invented in 1960, CPR is a simple but effective
procedure that allows almost anyone to sustain
life in the first critical minutes of cardiac arrest.
CPR provides oxygenated blood to the brain
and the heart long enough o keep vital organs
alive until emergency equipment arrives.
• To make learning of CPR easier, a system was
devised that makes remembering it as simple
as A-B-C:
• Airway
• Breathing
• Circulation
• Let’s begin emphasizing the very first step of
Basic Life Support
• When to dial 9-1-1
• It is critical to remember that dialing 911 may
be the most important step you can take to safe
a life.
•If someone beside you is present, they
should dial 911 immediately. If you’re
alone with the victim, try to call for
help prior to starting CPR on an adult
and after a minute on a child. Before
we learn what to do in an emergency,
we must first emphasize what not to
do.
• DO NOT leave the victim alone
• DO NOT try to make the victim drink water
• DO NOT throw water on the victim’s face
• DO NOT prompt the victim into a sitting
position
• DO NOT try to revive the victim by slapping
his face
Always remember to exercise solid common
sense
• When faced with an emergency situation
we may act impulsively and place ourselves
in harm’s way. Although time should not be
wasted, only approach the victim after
determining that the scene is safe: always
check for any potential hazards before
attempting to perform CPR.
 Can you save a life? In an emergency, when
every second is critical, would you know what to
do?
• According to recent statistics sudden cardiac
arrest is rapidly becoming the leading cause of
death in America. Once the heart ceases to
function, a healthy human brain may survive
without oxygen for up to 4 minutes without
suffering any permanent damage.
Unfortunately, a typical emergency situation
response may take 6, 8 or even 10 minutes.
•It is during those critical minutes that
CPR can provide oxygenated blood to
the victim’s brain and the heart,
dramatically increasing his chance of
survival. And if properly instructed,
almost anyone can learn and perform
CPR.
•Let’s begin with CPR basics
 CARDIOPULMONARY RESUSCITATION (CPR)
• ADULT CPR
• American Heart Association’s guidelines
dictate that Adult CPR is performed on any
person over the age of 8. The procedure
outlined in the following lessons is similar
to Children CPR and Infant CPR, although
some critical differences apply.
• Before you start any rescue efforts, you must
remember to check the victim for responsiveness.
If you suspect that the victim has sustained spinal
or neck injury, do not move or shake him.
Otherwise, shake the victim gently and shout “Are
you okay?” to see if there is any response. If the
victim is someone you know, call out his name as
you shake him.
• If there is no response, immediately dial 9-1-1 and
check the airway.
• AIRWAY
• “A” is for AIRWAY. If the victim is unconscious
and is unresponsive, you need to make sure
that his airway is clear of any obstructions. The
breaths may be faint and shallow – look, listen
and feel for any signs of breathing. If you
determine that the victim is not breathing, then
something may be blocking his air passage. The
tongue is the most common airway obstruction
in an unconscious person.
• With the victim lying flat on his back, place your
hand on his forehead and your other hand
under the tip of the chin. Gently tilt the victim’s
head backward. In this position the weight of
the tongue will force it to shift away from the
back of the throat, opening the airway. If the
person is still not breathing on his own after the
airway has been cleared, you will have to assist
him breathing.
 BREATHING
• “B” is for BREATHING. With the victim’s
airway clear of any obstructions, gently
support his chin so as to keep it lifted up
and the head tilted back. Pinch his nose
with your fingertips to prevent air from
escaping once you begin to ventilate and
place your mouth over the victim’s,
creating a tight seal.
•As you assist the person in breathing,
keep an eye on his chest. Try not to
over-inflate the victim’s lungs as this
may force air into the stomach, causing
him to vomit. If this happens, turn the
person’s head to the side and sweep
any obstructions out of the mouth
before proceeding.
•Give two full breaths. Between each
breath allow the victim’s lungs to relax
– place your ear near his mouth and
listen for air to escape and watch the
chest falls as the victim exhales. If the
victim remains unresponsive (no
breathing, coughing or moving), check
his circulation
•CIRCULATION
•“C” is for CIRCULATION. In order to
determine if the victim’s heart is
beating, place two fingertips on his
carotid artery, located in the depression
between the windpipe and the neck
muscles, and apply slight pressure for
several seconds
•If there is no pulse then the
victim’s heart is not beating,
and you will have to perform
chest compressions
 COMPRESSIONS
•When performing chest compressions,
a proper hand placement is very
important. To locate the correct hand
position place two fingers at the
sternum (the spot where the lower ribs
meet) then put the heel of your other
hand next to your fingers.
• Place one hand on top of the other and interlace
the fingers. Lock your elbows and using your
body’s weight, compress the victim’s chest. The
depth of compressions should be approximately
11/2 to 2 inches – remember: 2 hands, 2 inches. If
you feel or hear slight cracking sound, you may be
pressing too hard. Do not become alarmed and do
not stop your rescue efforts! Damaged cartilage or
cracked ribs are far less serious than a lost life.
Simply apply less pressure as you continue
compressions.
Count aloud as you compress 30 times at
the rate of about 3 compressions for
every 2 seconds. Finish the cycle by
giving the victim 2 breaths. This process
should be performed four times – 30
compressions and 2 breaths – after
which remember to check the victim’s
carotid artery for pulse and any signs of
consciousness.
If there is no pulse, continue performing 30
compressions /2 breaths, checking for pulse after
every 4 cycles until help arrives.
If you feel a pulse (i.e. the victim’s heart is
beating) but the victim is still not breathing,
rescue breaths should be administered, one
rescue breath every five seconds (remember to
pinch the nose to prevent air from escaping). After
the first rescue breath, count five seconds and if
the victim does not take on his own, give another
rescue breath.
 Review of Adult CPR
• In case of an emergency you may be the victim’s only
chance of survival. Until an ambulance arrives and
professional assistance is available, you can increase
that chance by 40% simply by remembering and
effectively administering Cardio Pulmonary
Resuscitation.
• Check for responsiveness by shouting and shaking
the victim. Do not shake or move the victim if you
suspect he may have sustained spinal injury.
• Call 9-1-1
• Remember your A-B-C:
• Airway” tilt the head back and lift the neck to
clear the airway
• Breathing: pinch the victim’s nose and give 2
breaths, watching for the chest to rise with
each breath.
• Circulation: if there is no pulse, perform 30
chest compressions – 2 hands, 2 inches.
• Check for pulse and if necessary perform the
cycle again.
 CHILD CPR
• According to the American Heart
Association’s guidelines Child CPR is
administered to any victim under the age
of 8. Although some of the material in the
next lesson may seem repetitive, we
strongly recommend that you do not skip
ahead as there are crucial distinctions that
apply to children efforts.
• The first thing to remember about Child CPR
is this: in children cardiac arrest is rarely
caused by heart failure but rather by an
injury such as poisoning, smoke inhalation,
or head trauma, which cause the breathing
to stop first. And since children are more
resilient than adult statistics have shown
that they tend to respond to CPR much
better if administered as soon as possible.
• If the child is unresponsive and you are
alone with him, start rescue efforts
immediately and perform CPR for at least 1
to 2 minutes before dialing 911. Before you
call an ambulance, immediately check the
victim for responsiveness by gently shaking
the child and shouting, “are you okay?” DO
NOT shake the child if you suspect he may
have suffered a spinal injury.
•If the child is clearly
unconscious, remember
your A-B-C and check the
child’s airway.
 AIRWAY
•“A” is for AIRWAY. Child breath may be
extremely faint and shallow – look,
listen and feel for any signs of
breathing. If there are none, the tongue
may be obstructing the airway and
preventing the child from breathing on
his own.
•Exercise extra caution when you open
the victim’s air passage using the head
tilt/chin lift technique. This will shift
the tongue away from the airway.
•If the child is still not breathing after his
airway has been cleared, you will have
to assist him in breathing
 BREATHING
•“B” is for BREATHING. If the child
remains unresponsive and still not
breathing on his own, pinch his
nose with your fingertips or cover
his mouth and nose with your
mouth creating a tight seal, and
give two breaths.
•Keep in mind that children’s lungs
have much smaller capacity than
those of adults. When ventilating a
child, be sure to use shallower
breaths and keep an eye on the
victim’s chest to prevent stomach
distention.
•If this happens and the child vomits,
turn his head sideways and sweep all
obstructions out of the mouth before
proceeding. After you’ve administered
the child two breaths and he remains
unresponsive (no breathing coughing or
moving), check his circulation
 CIRCULATION
•“C” is for CIRCULATION. Check the
child’s carotid artery for pulse by
placing two fingertips and applying
slight pressure on his carotid artery for
5 to 10 seconds. If you don’t feel a
pulse then the victim’s heart is not
beating and you will have to perform
chest compressions.
 COMPRESSIONS
•When performing chest compressions
on a child proper hand placement is
even crucial than with adults. Place two
fingers at the sternum (the bottom of
the rib cage where the lower ribs meet)
and then put the heel of your other
hand directly on top of your fingers.
•A child’s smaller and more fragile body
requires less pressure when performing
compressions. The rule to remember is
1 hand, 1 inch. If you feel or hear slight
cracking sound, you may be pressing
too hard. Apply less pressure as you
continue.
•Count aloud as you compress 30 times,
followed by 2 breaths. Perform 5 cycles
of 30 compressions and 2 breaths
before checking the child for breathing
and pulse. Check the victim’s carotid
artery for pulse as well as any signs of
consciousness. DO NOT FORGET TO
DIAL 911.
 CHILD CPR REVIEW
• Children’s CPR is given to anyone under the
age of 8. The procedure is similar to that
for adults with some minor but important
differences.
• Check for responsiveness by shouting and
shaking the victim. Do Not shake the child
if he has sustained a spinal injury.
• Remember you’re A – B – C
•Airway: tilt the head back lift neck to
clear the airway
•Breathing: pinch the child’s nose or
cover his mouth and nose with your
mouth making a tight seal, and give
two breaths, watching for the chest to
rise with each breath.
•Circulation to perform CPR for 1
to 2 minutes before dialing 9-1-
1
•Check for pulse and if
necessary perform the cycle
again, checking for pulse every
minute.
 INFANT CPR
•According to generally accepted
guidelines, Infant CPR is
administered to any victim
under the age of 12 months.
• Infants, just as children, have a much better
chance of survival if CPR is performed
immediately. If you are alone with the infant,
do not dial 9-1-1 until after your have made an
attempt to resuscitate the victim. Check the
infant for responsiveness by patting his feet and
gently tapping his chest or shoulders if he does
not react (stirring, crying, etc), immediately
check his airway.
 AIRWAY
•“A” is for AIRWAY. It is normal for an
infant to take shallow and rapid
breaths, so carefully look, listen and
feel for breathing. If you cannot detect
any signs of breathing, the tongue may
be obstructing the infant’s airway.
•Although the head tilt/chin lift
technique is similar to adults and
children, when clearing an infant’s
airway it is important not to tilt the
head too far back. An infant’s airway is
extremely narrow and overextending
the neck may actually close the air
passage.
Tilt the head back into what is
called the “sniffer’s position” –
far enough to make the infant
look as if he is sniffing. If the
victim is still not breathing on
his own, you will have to assist
him breathing.
 BREATHING
“B” is for BREATHING. Cover the infant’s mouth
and nose with your mouth creating a seal, and
give a quick, gentle puffy from your checks. Let
the victim exhale on his own – watch his chest
and listen and feel for breathing. If he does not
breathe on his own, again place your mouth over
his mouth and nose and give another small puff.
If the infant remains unresponsive (no crying or
moving), immediately check his circulation.
 CIRCULATION
• “C” is for CIRCULATION. An infant’s pulse is
checked at the brachial artery, which is
located inside of the upper arm, between
the elbow and the shoulder. Place two
fingers on the brachial artery applying
slight pressure for 3 to 5 seconds. If you do
not feel a pulse within that time, then
infant’s heart is not beating, and you will
need to perform chest compressions.
 COMPRESSIONS
•An infant’s delicate ribcage is
especially susceptible to damage if
chest compressions are improperly
performed; therefore it is
important to use caution when
rescuing an infant.
• Place three fingers in the center of the infant’s
chest with the top finger on an imaginary line
between the infant’s nipples. Raise the top
finger up and compress with the bottom two
fingers. The compression should be
approximately 1/3 to ½ the depth of the
infant’s chest. Count aloud as you perform 5
cycles of 30 compressions and 2 breaths before
checking the infant for breathing and pulse.
 REMEMBER TO DIAL 9-1-1
•If there no pulse, continue
administering 30 compressions/ 2
breaths until an ambulance arrives. If at
any point the infant regains a pulse but
still does not breathe on his own, give
him one rescue breath every three
seconds.
 INFANT CPR REVIEW
• Infant CPR should be administered to any victim
under the age of 12 months (except for newborns in
the first hours after birth). The procedure is as
follows:
• Check for responsiveness by patting the infant’s
shoulders or chest.
• Remember you’re A-B-C:
• Airway: an infant’s head should be tilted into the
“sniffer position”. Do not overextend an infant’s neck
as this may close off the airway.
• Breathing: cover the infant’s nose and mouth
with your mouth and use gentle puffs,
breathing from your cheeks, not your lungs.
• Circulation: check for pulse at the brachial
artery, in the infant’s inside upper arm. If there
is none, perform five compressions – 2 fingers
(approximately ½ the size of a hand), 1/3 to ½
the depth of the infant’s chest.
• Perform rescue efforts for 1 to 2 minutes before
dialing 9-1-1.
•Continue performing
rescue efforts, checking
for pulse every minute
until help arrives
 CORONARY ARTERY DISEASES
• Coronary artery disease is a condition in which
plaque forms inside the coronary arteries and cause
it to harden or stenos. These arteries supply the
heart with oxygen rich blood, plague narrows the
arteries and reduce blood flow to the heart muscle.
• When plaque builds upon the arteries the condition
is called atherosclerosis. This leads to the following
heart diseases.
• Angina Pectoris
• Myocardial infarction
 ANGINA PECTORIS
• This is recurrent chest pain which radiates to
the shoulders, upper arm, neck, and jaw or
epigastric region often induced by exertion. The
pain is relieved by rest. It is associated with a
reduction in blood supply to the heart without
destruction of the heart muscle. Individuals
who experience angina pectoris are at a high
risk of developing myocardial infarction.
Causes of angina pain
•Physical exertion
•Exposure to cold causing
vasoconstriction
•Eating a heavy meal
•Use of over counter drugs
•Obesity
Types of angina
• Unstable angina (unpredictable):
progressive increase in frequency, intensity
and duration of angina attacks
• Chronic stable angina: predictable,
consistent angina occurs on exertion and is
relieved by rest
• Nocturnal angina: pain occurs at night and
is relieved y sitting
•Angina Decubitis; pain while lying
down
•Refractory intractable angina;
severe in capacitating angina
•Silent ischemia; objective evidence
of ischemia but patient is
asymptomatic.
Associated signs and
symptoms
•1. Shortness of breath
•2. Cold sweats
•3. Weakness
•Diagnostic investigations
• Blood test
• Electrocardiogram
• Exercise intolerance: The patient’s required
to walk or perform some form of exercise
until intermittent claudication occurs. The
length of time from start of activity until
the occurrence of pain is noted.
•Angiography: a radio opaque contrast
medium containing iodine is introduced
into the arteries and radiographs taken.
Arterial narrowing or obstruction may
be located in this way, and some
information regarding the amount of
collateral circulation present may also
be obtained.
 Management of Angina
•Purpose
•To relieve pain immediately
•To improve oxygen supply
•To reduce myocardial oxygen
demand
•Medical management
•Nitroglycerine: Reduce myocardial
oxygen consumption which decreases
ischaemia and relieve pain. They dilate
the blood vessels which cause venous
blood pooling throughout the body. As
a result less blood is returned to the
heart and reduction in filling pressure
occurs.
•Beta-Adrenergic Blockers are used if
nitroglycerine does not work eg.
Propranolol hydrochloride. It reduces
myocardial oxygen demand by blocking
the sympathetic impulses to the heart
which results in reduction in heart rate,
blood pressure and myocardial
contractility.
•Calcium ion antagonist or Channel
Blockers; increases myocardial oxygen
supply by dilating the smooth coronary
arterioles leading to decrease
myocardial oxygen demand by systemic
arterial pressure and thus the workload
of the ventricle. Eg. Nifedipine and
Verapamil.
 Surgical Management
• Obstruction by lesions may necessitate
atherectomy or coronary artery bypass or graft
is done by using graft.
• Nursing Intervention
• It is good to keep nitroglycerine for immediate
use
• Patient is told to call immediately when he feels
chest, arm or neck pain before taking the drug
• Vital signs are monitored especially blood
pressure
• Take a 12 lead ECG during angina before giving
the nitrates
• Duration of pain should be recorded
• If cardiac catheterization has been done
observe site for bleeding and check distal pulse
• Heparin and antibodies are ordered and should
be given as such.
 PATIENT EDUATION
• Avoid exposure to cold, strenuous exercise
and emotional excitement
• Eat regular but lightly
• If obsess, reduce weight
• Use of over the counter drugs should be
discouraged because some of them can
increase heart rate and decrease blood
pressure.
• Myocardial Infarction
• This results from a sudden and complete
occlusion/blockage of one or more
coronary arteries to their branches
resulting in irreversible tissue necrosis or
death. Permanent cessation of contractive
function occurs in the necrotic or infarcted
area of the myocardium. It usually affects
the left ventricle.
 Causes
• Diabetes mellitus
• Hypertension
• Cigarette smoking
• Obesity
• Individuals with angina pectoris
• Plasma lipid abnormalities
• Family history of heart disease
 Signs and symptoms
• Pain-the most common presenting
complaint of patients with myocardial
infarction is severe chest pain. The pain
may last for several hours or until relieved
by analgesics
• Nausea and vomiting
• Dyspnoea- this may be due to pulmonary
congestion or pain
• Skin – the skin may be cold and moist and
have a grayish colour in response to the
decreased cardiac output
• Heart rate – the pulse becomes rapid and
weak and may be imperceptible at the
time of the attack
• Weakness and tiredness – extreme
weakness may be experienced and may
persist for many days
Diagnosis
•ECG
•Cardiac enzymes
•Chest x-ray when patient’s condition
is stable
•Erythrocytes Sedimentation Rate
 MEDICAL MANAGEMENT
•Thrombolytic Therapy
•Streptokinase – intracoronary injection
•Tissue types plasminogen activator T-PA
is injected both IV and intracoronary
injection. Naturally occurring enzyme
decrease less risk of systemic bleeding
and allergic reaction
 NURSING INTERVENTION
• Administer analgesics as ordered
• Avoid intramuscular medication
• Patient’s care is organized to allow uninterrupted
rest
• Low cholesterol and low sodium is given
• Stool softening are given to avoid straining during
defecation
• Antiembolism stocking to help prevent venostasis
and thrombophlebitis
• Vital signs are monitored regularly
• ECG is monitored
• BP is checked after nitroglycerine
• During episode of chest pain monitor regularly
• Watch for crackles, cough ,tachycardia and oedema
which may indicate left ventricle failure
• Monitor daily weight of patient
• Oxygen administration while the rest are done
• Immobilized patients should be turned from side to
side
 PATIENT’S EDUCATION
•Avoid triggering factors
•Review patient’s diet e.g low Na
and cholesterol diet
 COMPLICATION OF MYOCARDIAL
INFARCTION
•Arrhythmia
•Heart failure
•Cardiogenic shock
•Mitral insufficiency
•Ventricular septal rupture
•Pericarditis
•Ventricular aneurysm
•Cerebral or ventricular
embolism
•Ventricular rupture