FIRST AID

INTRODUCTION

First aid is the initial/ immediate help or treatment given to a person who is injured or taken to be
ill. In other words it is the temporary care given to the victim of an incident, accident or sudden
illness before being taken to hospital and or before arrival of an ambulance.

First aid care includes; assessing the victim for life threatening conditions, performing
appropriate interventions to sustain life, and keeping the casualty in the best possible physical,
and mental conditions until he or she can enter the emergence or casualty unit in the hospital.

UNDERSTANDING THE MEANING OF FIRST AID

F - Fast arrival

I – intelligent care

R –recording and reporting

S – Safety precautions

T – Timely action

A – Alertness

I – initiation and implementation

D – Decision making

AIMS OF FIRST AID

To preserve life or save life

To promote quick recovery

To prevent further injury or worsening of the illness

To relieve pain

To arrange for urgent transport to hospital

DEFINITION OF TERMS

A first aider; is a person capable of carrying the most satisfactory type of first aid/help

Casualty; any person who has sustained an injury or has got a sudden illness

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 Accident; is the unforeseen event or one without a clear cause. It is anything that occurs
unintentionally or by chance

A symptom; is the complaint that the casualty only feels and tells you, but you are not able to
see it by your own eyes e.g pain, nausea, (symptoms are subjective)

Sign; an abnormality felt or measured by a firs t aider.e.g bleeding, swelling. Fever etc (signs are
objective)

GENERAL PRINCIPLES OF FIRST AID/GOLDEN RULES OF FIRST AID

i. Do first things first quickly

ii. Remove the patient from danger or remove further danger from patient.
iii. Give artificial respiration if breathing has stopped every second count.
iv. Stop any bleeding
v. Guard against or treat for shock by moving the casualty as little as possible and handling him
gently.
vi. Do not attempt to do too much. Do the minimum that is essential to save life and prevent the
condition from worsening.
vii. Reassure the casualty and those around to help allay/lessen the anxiety.
viii. Do not allow people to crowd around as fresh air is essential for the victim.
ix. Unconscious patients should be place in semi-prone (lying on the side) or recumbent(lying
on back) with head turned to the side.
x. Unconscious patients should not be given anything to drink.
xi. Do not remove clothes unnecessarily. Maintain privacy and limit exposing the persons
private parts for everyone to see
xii. Arrange for removal of the casualty to the care of the doctor or to the hospital.

QUALITIES OF A GOOD FIRST AIDER

A first Aider being a person capable of carrying the most satisfactory type of first aid/help
shouldpossess certain qualities that should enable him or her to effectively perform and meet the
life saving needs of the casualty.

 Highly educated
 Updated in knowledge and skills of giving first aid care.
 Empathetic, and understanding towards the casualty i.e his injury and the general
condition when handling him or her.
 Have a sense of leadership; ability to organize the bystanders telling them what to do or
what should not be done.
 Should be observant: the ability to detect abnormalities on any part of the patient,
whether there is difficult in breathing somewhere, swelling, whether the condition is
improving or not etc

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  Should have the ability to make decisions and act quickly,
 Should be able to improvise with anything of help when giving first aid care
 Must be tactful /skillful so that without wasting time may learn and take confidence
history.
 Ability to improvise where necessary to prevent further injury/damaged.
 Indiscriminate; Must not discriminate

THE FIRST AID KIT

The first aid kit or box contains the following materials, where some of them may be of different
sizes and shapes:

Sterile Gauze dressing, Sterile pad, Water proof plasters, Sterile pads, Roller bandages,
Adhensive bandages, Mild antiseptics, Packet of oral rehydration salts, Torch, Soap, Triangular
bandages, Roll of absorbent cotton, Scissors, Safety pins or clips, Petroleum jelly, Ironed sheets
and cotton, Adhensive tape, Paper and a pen, Tongue depressor, Spirit, iodine, savlon, hydrogen
peroxide etc

RESPONSIBILITIES OF A FIRST AIDER

They Are As Follows;

 To assess situation quickly and safely and sermon appropriate help.

 To protect the casualty and other people at the scene from other possible dangers.
 To identify the injury or nature of the illness affecting the casualty.
 To give each casualty early and appropriate treatment treating the most serious first.
 To arrange for removal of the casualtyl into the care of a doctor/ hospital/home
 To remain with the casualty till appropriate care is available.
 To report observationsto those taking over the care of the casualty and give further
assistance if required.
 To prevent cross – infection between the self and the casualty.
 Organize the on lookers, telling them what they should do: calling the police. Fire
extinguishers, putting signs at the road side that an accident has occurred, helping to take
care of the casualty etc
 Make a written report on the casualty’s state and the treatment/care you have given to the
casualty, always refer the casualty with a written message because verbal messages may
be distorted and forgotten

FIRST AIDERS ROLE IN FULFILLING HIS OR HER RESPONSIBILITIES

This aids until the casualty is handed over o the doctors or nurses or any other person
responsible.

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1. Have common sense e.g
a) assess the situation
b) Diagnose what is wrong with the casualty
c) Give immediate and appropriate treatment
d) Dispose the casualty to the hospital or health centre or at home depending on the
seriousness of the condition.
2. Be calm and take care of the casualty

a) Give confidence to the casualty

-Listen to him/her
-Re- assure if conscious
- Talk to him/her
b) Ensure safety of the casualty and yourself
a) Guard any more casualty from arising e.g
- Road accident, put someone to control traffic, in case of fire or a collapsing houses,
move the casualty to a safe place
b) Electro caution;
Switch off the current and take precaution against electric shocks.
3. Get other people to help (occupy) i.e.
- The more they are occupied the less they will interfere
- There should be ambulance
- Telephone for ambulance
- Control the crowds or the traffic
- Assist in lifting/carrying

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 ACTION AT AN EMERGENCY

An emergency is a life threatening condition requiring quick action/ intervention in order

to save life.

The basic principles of first aid apply to all injuries or illnesses regardless of severity

Whatever the incident, the first aiders needs to act quickly, calmly and correctly in order to save
life, prevent deterioration of the casualty’s condition, promote recovery.

These objectives are best achieved by;

 Rapid but calm approach

 A quick assessment of the condition and the casualty
 A correct diagnosis of the condition based on the history of the incidence, the casualty’s
history and symptoms and signs.
 Immediate and appropriate treatment of the condition diagnosed

APPROACH

This should be speedy but calm and controlled

Ensure you are not placing yourself in danger when approaching the casualty

At arrival of any scene of an incidence, state that you are a trained first aider if there are no other
experienced personnel

Rule: whenever and wherever you come across an emergency, use your common sense, know
your limitations, and don’t attempt to do too much.

ASSESSING THE SITUATION

As soon as you have taken control of an incident it is crucial that you makes. Accurate
assessment of the situation and decide on the priorities of action

To do this you must. Consider;

•Whether you and the casualty are in any danger

• Whether casualty has any life threatening condition.

•If any bystander can help you

•Whether you need to call for assistance.

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Priority determining

In order to determine the condition of the casualty of his feeling you may ask him or ask the
bystanders.

If casualty does not respond to questions or touch, perform the following immediately. (ABC =
Airway, Breathing, and Circulation) I.e.

Air way

Check if the casualty’s air way is open and clear or blocked; therefore you need to open and clear
it.

Breathing;

It is important to note the rate, depth and ease with which casualty is breathing.

If casualty is unconscious and not breathing commence with artificial ventilation immediately

Circulation

Check pulse for Circulation. If absent commence with external chest compression. Check for any
severe bleeding and control it to minimize the risk of shock.

If unconscious casualty or one with noisy breathing put him in recovery (semi prone) position
and assess the level of responsiveness. If possibility of spinal injury lie him in recumbent a s
don't turn him till help comes.

Examination and diagnosis.

Examine the casualty comparing the deformity with the normal and there after ascertain the level
of injury. (Proper history, signs and symptoms) i.e.

Signs

E.g. swelling, bleeding, discoloration, deformity and smells that you can detect by observing and
feeling the casualty.

Use all you senses – look, listen, feel and smell and always compare the injured side with the
uninjured. You may also notice inability to perform normal function such as moving limbs or
standing.

Symptoms

Are complaints or feelings from the e.g. pain, dizziness, nausea, heat, cold, thirst etc.

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N.B Do not interrupt while the casualty is speaking but listen very carefully.

History – ask what happened leading to injury or sudden illness ad any relevant history (i.e.
event history & previous medical history).

A – Allergy- Does the person has any allergies?

M – Medications – is the person on any medication?

P – Previous medical history; do you know any preexisting condition?

L – Last meal when did the person last eat?

E – Event history -what happened?

Treatment

Appropriate treatment is given this is mainly the care given the casualty not necessarily drugs.
This should not delay the casualty taken to the hospital.

Do not attempt to do too much but do the little that is essential to save life.

Calling for help

Call for help as soon as you realize need. This may include; An ambulance, Police, fire brigade
etc. Don't leave the casualty unattended to .when calling for help, pass on the following
information

1. Your telephone number.

2. The exact location of the incidence using landmarks or nearby road junction.
3. An indication of the type and seriousness of the incidence and injury eg road accident,
two cars involved and five 5 people injured.
4. Request for special help.

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MONITORING VITAL SIGNS IN FIRST AID:

It is very important to assess and monitor the casualty vital observation or signs such as
breathing, pulse, level of response, and temperature if casualty has a condition that affect body
temperature such as fever, heat stroke or hypothermia.

Level of response

Assess the level of response using the AVPU scale ad make note of any deterioration or
improvement.

A – Is the casualty alert? Are eyes open and does she responds to questions.

V – Does the casualty respond to voice/ can she open her eyes and answer simple questions or
obey commands.

P – Does the casualty respond to pain? Does she open eyes or move if pinched?

U – Is the casualty unresponsive to any stimulus?(Unconscious)

BREATHING

When checking breathing, listen for breath and watch the casualty’s chest movements

Record the following information

Rate – count the number of breaths per minute

Depth – are t breaths deep or shallow

Ease – are the breaths easy, difficult or painful

Noise – is the breathing quiet or noisy and if noisy, what are the types of noise?

Breathing rate; adult 16 -20c/m children 20 -30c/m infant 40 – 60c/m

PULSE

When checking a pulse use your fingers (not your thumb) and press lightly against the skin at the
following points; wrist (radial pulse), the neck (carotid pulse), in babies upper arm (brachial
pulse ) is easier to find.

Record the following;

Rate (number of beats per minute)

Strength (strong or weak)

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Rhythm (regular or irregular)

Normal ranges of pulse; adults 60 – 80b/m children 60 -100b/m infant 60- 120b/m

TEMPERATURE

To assess body temperature you can feel exposed skin on the fore head, but use a thermometer to
obtain an accurate reading normal body temperature is 37 degrees celcious. A lower body
temperature may result from exposure to cold and or wet condition or it may be a sign of life
threatening infection or shock. A higher body temperature is usually caused by infection but also
can result from the exhaustion or heat stroke.

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 THE UNCONSCIOUS CASUALTY

Unconsciousness is a state of being unware of one’s environment Or a state of being

unresponsive to stimulation.

It is caused by factors that lead to reduced brain activity like low oxygen supply to the brain. In
hospital it can be induced deliberately during anesthesia.

FIRST AID PRIORITIES WHILE DEALING WITH UN CONSCIOUS CASUALTY:

 To maintain a clear and open air way

 To maintain blood circulation so that oxygenated blood reaches the tissue of the body
especially the brain
 To breath for the casualty so as to get oxygen into the body.

Note

Chest compressions are more important than rescue breaths in the initial phase of resuscitations
for adults because blood oxygen level remain higher immediately (a few minutes) after the heart
stops

In children and infants, a problem with breathing is the most likely reason for the hearts to stop
because of this they should therefore be given five initial rescue breaths before chest
compression are started.

FIRST AID TREATMENT FOR UNCONSIOUSNESS

AIMS

 To maintain a clear and open airway

 To assess and record the level of response
 To treat any other associated injuries
 To gather and retain any circumstantial evidence of the cause of the condition.

Treatment/management;

Open the airway by lifting the chin and tilting the head backward: check for breathing and pulse
and be prepared to carry out resuscitation (CPR).

Asses and record the level of consciousness by using AVPU Scale.

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If the casualty starts vomiting, place him/her in the recovery position with the head turned/tilted
to the side

If you suspect spinal injury treat the casualty gently with a lot of care not to cause pain and
further damage.

Examine the casualty quickly, rapidly and systematically to identify any life threatening
condition such as bleeding or major fractures.

As you work look for obvious injuries or conditions, smell the casually breath, and look for
needle marks; which may indicate an underlying condition like diabetes or even drug abuse

Also ask any bystanders for information to ascertain the cause of unconsciousness.

Place the casualty in recovery position and keep monitoring vital signs

If the casualty does not regain consciousness within a short time call an ambulance for
assistance.
N.B Resuscitation (commonly known as CPR) is a process of reviving or restoring someone
who is almost dying by performing cardiac massage and artificial respiration.

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 ASPHYXIA

This is when there is no enough oxygen in the tissues of the body a result of failure to breath.

CAUSES OF ASPHYXIA

 Blocked airway i.e. when someone has been chocked

 Blocked mouth and nose (suffocation)
 Compressed wind pipe (strangled)
 Compressed chest i.e. a person buried under sand
 Injured lungs due to accidents
 Fits e.g epilepsy (convulsion)
 Injury to the chest wall (person being crushed)
 Electrical injuries
 Asthma

SIGNS AND SYMPTOMS OF ASPHYXIA

 Difficulties in breathing
 Noisy breathing
 Lips and finger nails turns blue - cyanosis
 A person may be confused
 Frothing from the mouth

FIRST AID TRATMENT OF ASPHYXIA

o Remove the casualty from the danger

o Clear the airways
o If the person not breathing, start mouth to mouth artificial ventilation.
o Check the carotid pulse
o Apply external chest compression
o When the person recovers, place in a recovery position
o Transfer the casualty to h nearest hospital or health center immediately

Assignment:

Research about the different types of asphyxia and their management

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 SHOCK
This is a sudden collapse of the circulatory system and some vital centers characterized by a fall
in blood pressure.
It’s important to note that the circulatory system distributes blood around the body so that
oxygen and nutrients can reach the body tissues. When the system fails, shock results. If this is
not treated quickly vital organs like the heart and the brain may fail which can lead to death.

CAUSES OF SHOCK
Severe bleeding
Burns
Fracture or major injuries
Loss of fluids from the body
Excessive Fear
Severe pain
Stress
Very sad news
Sudden malfunctioning of the heart
TYPES OF SHOCK
Hypovolaemic shock:
This is a shock due to excessive loss body fluids e.g through bleeding, diarrhea, vomiting, severe
burns etc.
Septic shock (bacteraemic / endotixic shock)
This is a result of severe disease/ infections. The toxins released by the microbes may trigger
inflammation, cause multiple organ dysfunction, depression of myocardial contractility,
hypotension and eventually poor tissue perfusion
Psychogenic shock
This is result of stress, extreme fear (anxiety).
Neurogenic shock
This is shock as a result of severe pain, spinal cord injury.

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Cardiogenic shock
This is the shock as a result of heart failure or stroke. It occurs in acute heart disease when the
damaged heart muscles cannot maintain an adequate cardiac output. eg myocardial infarction
Anaphylactic shock:
This is shock due o allergic reaction to an allergen. Anaphylaxis a sudden severe response/
reaction against a certain substance in sensitive individuals. The reaction is an allergy whereas
the substance is an allergen
SIGNS AND SYMPTOMS OF SOCK
 Body weakness
 Dizziness/fainting
 Restlessness
 Anxiety & confusion
 Decreasing alertness
 Cold and clummy skin
 Pale skin
 Sweating but cool skin
 Fast but weak heart beat.
 Dry mouth and complain of thirsty
 Chest pain
 Rapid and shallow breathing
 Nausea and vomiting
 Numbness and paralysis
 Excessive thirst
 Bluish lips and finger nails ( cyanosis)
 Rapid and weak pulse
 Low blood pressure
 Unconsciousness.
Management of shock
Aims

- To recognize the type of shock.

- To treat any obvious cause
- To improve blood supply to the heart and brain
- To arrange for referral to hospital.

Mgt

- First call or help

- Try to determine the cause of sock
- Treat any cause of shock identified
- Lie a victim down on a blanket/piece of cloth to protect him/her and keep his/her head
lowered.

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 - Constantly reassure the casualty if conscious
- Raise the leg of the victim to improve blood supply to the vital organs.
- Take care of the limb if you suspect fracture
- Loosen or remove tight clothes around the neck, waist or chest to remove constriction.
- If the victim has got a venomous bite (snake bite) do not raise the bitten part.
- Keep the victim warm by covering him/her with coats or blanket.
- Check and record breathing pulse and level of response and be able to resuscitate where
necessary.
- Quickly arrange for transport of the casualty to the hospital.

Note:
Maintain the shock position during the management.
Does not the casualty eat, drink, walk or drink.
Lie the casualty down and raise the lower limbs.
Ensure monitory of breathing and pulse and ensure warmth.
Call for an ambulance as early as possible.

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 HAEMORRHAGE

This is the escape of blood from the blood vessel. Haemorrhage may be slight or severe. Severe
haemorrhage comes mainly from injury to arteries or veins where slight comes from injury the
capillaries.

CAUSES OF HAEMORRHAGE

1. TRAUMA OR INJURY

The injury may be direct to the blood vessel involving the neighboring tissues. This could be due
to accident and surgical operation or fractures

2. LABOR

This is an obstetric cause where the placental separation brings about excessive bleeding;
ruptured fallopian tube in ectopic pregnancy is another cause.

3. ABNORMALITY OF THE BLOOD VESSELS

Eg Aneurysm This refers to arterial dilation/ due to high pressure of blood, which weakens it.

Infection attack blood vessels, weakening them and become inflamed and eventually rapture.

4. NEOPLASM

This refers to new growth or malignant tumor and even cancer cells have the ability to destroy
blood vessels hence bleeding.

5. DISEASES OF THE BLOOD

Eg Hemophilia

Which is a blood coagulation disorder characterized by delayed clotting process even in minor
injuries. It is genetically determined and can be inherited parents to offsprings.

6. DISEASE OF INTESTINAL TRACT

These include ulcerative colitis, dysentery.

7. HYPERTENSION

Too much blood pressure exerted on the walls of blood vessels, especially on the arteries may
lead to rupture.

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CLASSIFICATION OF HAEMORRHAGE

Hemorrhage may be classified in the following ways

1. According to situation
2. According its source or type of blood vessel injured
3. According the time it occurs

 ACCORDING TO SITUATION

Haemorrhage can be External or Internal

EXTERNAL HAEMORRHAGE (revealed)

Is where blood is seen flowing out of the body tissues i.e there is a physical wound observed by a
first aider

INTERNAL HAEMORRHAGE (concealed)

Is where a casualty is bleeding but blood is accumulating inside the body e.g in the body cavities
or organs. There is no external wound observed.

Casualty may suffer one of the types or both depending on the nature of the trauma.

 CLASSIFICATION ACCORDING TO TYPE OF BLOOD VESSELS

Hemorrhage can either be classified as;

 Arterial Hemorrhage
 Capillary Hemorrhage
 Venous Hemorrhage
1. ARTERIAL HEMORRHAGE
- Blood is oxygenated
- Blood is bright red.
- Blood comes out at a high pressure from the heart
- Blood spurts from the wound in line with the heart beat
- This bleeding is difficult to control.
2. VENOUS HEMORRHAGE
- Blood is deoxygenated
- Blood is dark red
- It moves under less pressure
- It flows out like tap water
- It can easily be controlled.
3. CAPILLARY HEMORRHAGE

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 o Blood just oozes out
o Blood loss is usually slight
o Commonly occurs in lacerated wounds.

 CLASSIFICATION ACCORDING TO TIME

In this case, hemorrhage, can be classified as primary hemorrhage, secondary hemorrhage,

reactionary hemorrhage.

1. PRIMARY HEMORRHAGE

This occurs at the time of injury i.e. it is immediate as a result of direct injury of the blood
vessel.

2. REACTIONAL HEMORRHAGE.
This is hemorrhage that occurs between 12 -24 hrs after injury or operation. This is
caused by change of blood pressure from normal to higher which results in dislodgement
of a clot or ligatures. It can also be defined as any bleeding that occurs at any time after
haemostasis during primary hemorrhage.
3. SECONDARY HEMORRHAGE

This is a hemorrhage that occurs one 7-10days after injury or operation and it commonly due
to infections.

SIGNS AND SYMPTOMS OF HEMORRHAGE

- Evidence of major external blood loss.

- Rapid and weak pulse
- Anxiety
- Thirsty
- Cold and clammy skin
- Restlessness and irritability
- Face and lips may become pale
- History of medical condition that could cause internal bleeding e.g – peptic or intestinal
ulcers, dysentery.
- Pain and tenderness around the affected area
- Shock
- Sub – normal temperature (below 36⁰c) hypothermia
- Patient may go in comma
- Blurred vision
- Tinnitus (ringing in the ear) due to extreme blood loss.

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CONTROL OF HEMORRHAGE

There are two ways:

i) Natural control
ii) Artificial control ways.
A) NATURAL CONTROL

An enzyme thromboplastin is released by damaged blood vessels.

Thromboplastin acts on prothrombonin in the presence of calcium ions to form thrombin.

Thrombin in turn acts on fibrinogen to form fibrin.

Fibrin forms a network which traps blood cells and thus forms a blood clot.

B) ARTIFICIAL CONTROL WAYS.

Elevation of the bleeding part
Application of pressure to the bleeding area

MANAGEMNT OF HEMORRHAGE

AIM:

- Control bleeding
- Prevent and minimize the risk of infection
- To arrange urgent transport of causing to hospital.

Management:

Watch out for and remove sharp objects like pieces of glass or metals that caused the injury.

Remove or cut clothes to expose the wound.

Apply direct pressure on the wound preferably on a sterile dressing in order to arrest
haemorrhage.

Any foreign body stuck in the wound should not be removed as this may cause over bleeding but
pressure and dressing are applied on its sides.

Lie the casualty down, quiet and advised to limit body movements to avoid further bleeding and
to minimize shock.

If the injured part is the limb, it should be raised above the level of the heart

Reassure the casualty to avoid anxiety

Apply more sterile or clean dressing and bandage around the wound

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If bleeding is severe, arrange urgent transport to hospital.

SPECIAL BLEEDING FROM ORIFICES

EPISTAXIS (NOSE BLEEDING)

This is bleeding from the nose.

It can be anterior nose bleeding (affecting the front part before the septum) or posterior nose
bleeding (affecting the deeper part of the nose and the back of the mouth)

Causes

Injuries e.g. a blow to the nose,

Dryness of the nasomucosa

Severe headache,

Serious sneezing/nose picking

High blood pressure,

Blood clotting disorders

Allergies

Medication like aspirin

and infections.

Nose bleeding cans be dangerous if the patient loses a lot of blood.

FIRST AID MANAGEMENT
AIMS
To control blood loss o
To maintain an open airway
Mgt

- Sit the casualty down with the head forward.

- Ask the casualty to breathe through the mouth and pinch the nose just below the nosal
bridge.
- Help the casualty if necessary using the thumb and index finger.

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 - Instruct the casualty to breathe through the mouth and to not to speak, cough, or sneeze as
this may disorganize the forming of blood clot.
- Tell the casualty to spit into the bowl but not swallowing the blood as this may cause
nausea and vomiting.
- Loosen the tight clothes around the chest and waist.
- Re-assure the casualty.
- Apply a cold compress over the bridge of the nose and at the back of the neck, and fore
head using a cloth soaked in cold water.
- After ten (10) minutes of pinching, tell the casualty to release pressure on the nose,
observe for bleeding and if still, re-apply the pinching.
- If the blood persists for over 30 minutes, send the casualty to the hospital maintaining the
treatment position.
- Once bleeding has stopped, maintain the treatment position for at least 30 minutes, gently
clean the casualty around the nose and mouth with water.
- Advise the casualty to rest quietly for few hours.
- Advise the casualty to avoid exertion of pressure on the nose as this will disturb the clot
formed.
PREVENTION

Keep finger nails short

Quit smoking

Open your mouth when sneezing

Use humidifier at when weather is dry

BLEEDING FROM THE MOUTH

This can be due to cuts to the tongue, lips or lining of the mouth.
It commonly occurs as a result of injuries by the casualty’s own teeth and dental extraction
FIRST AID MANAGEMENT
Aims
o To control bleeding.
o To safe guard the air way by preventing an inhalation of blood.

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Management
Sit the casualty down with the head well forward and inclined toward the injured side to
allow blood to drain easily.
Place a gauze pad over the wound. Ask the casualty to squeeze the wound with pad using the
thumb and finger.
Squeeze for ten minutes and reassess.
If bleeding persists, replace the pad with a fresh one.
Tell the casualty to let any escaping blood to dribble if swallowed may induce vomiting.
In case of a tooth socket, apply a gauze pad that is thick enough to stop the casualty’s teeth
from meeting. Tell the casualty to bite on it.
Do not wash the mouth out as this may disturb (wait for some hours after bleeding has
stopped)
Advise the casualty to avoid hot drinks for twelve hours (12hrs).
If the wound is large or if bleeding persists beyond thirty minutes or re-occurs, transport the
casualty to a hospital in a treatment position.

OTORRHEA and AUTORRHAGIA (BLEEDING FROM EAR)

Autorrhagia is bleeding that originate from inside the ear generally following a rapture of the
inner parts of the ear. And otorrhea refers to any discharge from the ear
CAUSES INCLUDE:
A foreign body pushed into the ear
A blow to the side of the head
Etc

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The casualty may experience a sharp pain as the ear drum rupture followed by ear ache and
later deafness. If bleeding follow head injury, the blood may appear or a watery discharge
that indicates CSF is leaking from around the brain through the ear.
FIRST AID MGT
AIMS
To allow blood drain away
To minimize the risk of infection
To arrange urgent transport to a hospital
MGT
Help the casualty sit down in a half sitting position with a head inclined to the injured side to
allow blood to drain.
Cover the ear with a sterile light dressing or a clean pad lightly held in place.
Re –assure the casualty that everything possible is being done to help him or her
Arrange for argent transport to hospital if necessary
Monitor the vital signs

VAGINAL BLEEDING
Bleeding from the vagina is most likely to be menstrual bleeding unless it’s severe. Other
cause of vaginal bleeding could include:-
Recent abortion
Injury as a result rape (sex assault)
Infection of the reproductive system

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 The history of the condition is vital to diagnosis and has some impact on the first aid to be
given.
If bleeding is severe, shock may develop.
Always be sensitive to woman’s feeling. She may be embarrassed by presence of a male first
aider or by passes and may resist your help.
Male first aiders should if possible seek help of female assistant.
FIRST AID MGT
AIMS

- To make the lady comfortable

- To observe for shock and treat it if present
- To arrange for transport to a hospital if present.

Management
Remove the woman if possible to the place with privacy and or arrange for screening to be set
up.
Re assure the lady intensively about her condition.
Give her sanitary pads if available or clean towel.
Allow the casualty to lie or sit up prepare her up with clothes rolled up, can sit on a cushion if
available.
If the casualty problem is related to menstruation, give her sanitary pads and if she has pain, pain
killers may be given.
It bleeding continues and is severe call for an ambulance and transport the casualty to the
hospital.
Note:
If a woman has been sexually assaulted, it is vital to preserve the evidence as much as possible
e.g Kindly encourage her to avoid washing her private parts or using a toilet until a forensic
examination has been performed by a trained police officer or doctor.
If she wishes to remove the clothes, keep them intact in a clean plastic bag if possible.

HAEMOPTYSIS

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This refers coughing out of blood. It common in people with internal bleeding
CAUSES OF HAEMOPTYSIS
1. TB (tuber culosis)
2. Cancer of the lungs
3. Penetrating injury to the chest e.g following road traffic accident, a fall from height, a
sturb by knife or spear, a heavy blow on the chest etc .
FIRST AID MANAGEMENT
AIMS
To minimize shock
To arrange urgent transport to hospital
Management

- Put a casualty in comfortable position preferably sitting up in chair or bed.

- Re assure the casualty
- Loosen tight clothes around chest, neck, and waist
- Keep the casualty quiet
- Ice may be given for the casualty to suck if available
- In case of blood sputum, keep a sputum specimen for a doctor to examine
- Transport the casualty to hospital as early as possible

HAEMATEMESIS
This is the act of vomiting blood.
The blood may come from any part of the upper alimentary tract:
The blood appears dark reddish brown resembling coffee grounds.
CAUSES OF HAEMATEMESIS

 Bleeding gastric ulcers

 Cancer of the esophagus
 Duodenal ulcers
FIRST AID CARE
AIM
To control bleeding
Safe guard the air way by preventing any in halation of blood/ vomitus

25
To arrange urgent transport to hospital
Management
Make the patient lie down immediately preferably in semi prove /recovery positions to prevent
vomits from blocking the air passage
Loosen clothes around the neck, waist and chest
Re assure the patient, usually the patient is very afraid if vomiting are large and severe.
Give nil per mouth i.e. don’t give anything through the mouth.
You may give ice for sucking the mouth to keep the mouth moist.
Transport the patient to nearest hospital as urgent as possible.

MALAENA
This refers to passing out black terry faeces due to presence of partially digested blood from the
upper digestive tract.
It often occurs after vomiting blood.
CAUSES OF MALAENA
Disease of the small intestine or upper colon such as; carcinoma, hemorrhage
Dysentery
Colitis (inflamation of colon)
Injury to the anus
NB: if the patient is passing black stool, it is important to first ask about use of some drugs e.g
iron tablets because this leaves side effects of coloring stool black.
First aid mgt
AIM
To minimize shock
To arrange for transport to the hospital
Mgt
Put the patient in bed in a comfortable.

26
Re- assure the patient/casualty.
Keep the specimen of stool or blood for inspection by medical personnel.
Arrange transport for the patient to the hospital.

HAEMATURIA
This is the process of passing blood in urine that may come from the bleeding kidney or urethra
as result of disease or infection.
The urine appears red or smoky and occasionally with blood.
CAUSES OF HAEMATURIA
1. Nephritis ( inflammation of the kidney)
2. Cystitis (inflammation of the urinary bladder)
3. Urethritis (inflation of the urethra)
FIRST AID MGT
AIM
To minimize shock
Arrangement
MGT
 Advise patient to go to bed
 Keep the patient still and quiet
 Re – assure the patient
 Keep the specimen of urine for examinations
 Send the patient to hospital for further mgt.

WOUNDS
A wound is a break in the continuity of a tissue. Wounds can be classified as;
Open where there is a break in the skin, mucus membrane or where the protective layer is
damaged.
Closed wound has no connection with the outside environment.
Causes
-Cut with a sharp instrument
27
-A blow with a blunt instrument
-A broken bone whose sharp point pierces through the muscle or skin
TYPES OF OPEN WOUNDS

 Incised Wounds
These are wounds caused by sharp instruments like knives, razor blades, pieces of
glasses.
The wound edges are clean cut or regular and bleed profusely. When they kept
uncontaminated or stitched they heal with no or little scars.
 Lacerated Wounds
These are wounds caused by multi- edged sharp instrument e.g. after a road accident by a rough
ground or from claws of some animals and commonly when is caught in machinery.
Edges of such wounds are irregularly.
They bleed less profusely than incised wounds.
They cause much skin and tissue damage.
They are more painful than incised wounds.

 Punctured wounds
These are wounds caused by sharp pointed objects like needles, and spears, or gun shoot. The
depth is greater than the length of the wound there is danger of damage to the internal organs.

 Contused wounds:
Wounds where there is relatively little damage to the skin but underlying tissues may be severely
damaged
They are caused by blunt instruments e.g. hitting by a hammer
External bleeding may be minimal whereas more of internal bleeding may occur

 Abrasions:
These are scrapping or rubbing against rough surfaces. the wound is shallow, wide, oozing off
blood and are usually dirty
Signs and symptoms
-Pain and swelling in the affected limb
-Bluish-purple discoloration at the site of injury esp in contused wounds
-bleeding (external or internal)

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 - loss of function signs of shock may occur
MEDICAL CLASSIFICATION OF WOUNDS

 Infectious / septic wounds

These are wounds in which sepsis has developed due presence of bacteria.

 Aseptic wounds (clean)

These are wounds that have no micro-organisms and such wounds heal with first
intention.

 Potentially infected wounds.

These are wounds produced by non sterile instrument or by contaminated contacts
First aid management
Aims
To control bleeding
To minimize risks of infections
To arrange for urgent transport to the hospital
procedure
Remove the clothing as necessary to expose the wound
Cover the wound immediately to prevent infection, use sterile dressings if available.
Secure the dressing in position with the bandage. If blood shows through the wound apply
another dressing on top of the first ones
Arrest hemorrhage as quickly as possible by applying direct and indirect pressure and raising and
supporting the injured part
Treat for shock if present, and monitor and record the vital signs such as level of response pulse
and respiration
Ensure re – assurance to a patient.
If deeper organs are involved arrange urgent transport to hospital.
Amputated organs should be saved and transported with the patient to the hospital
If there is a fracture immobilize the limb after dressing the wound.
NB: a first aider should not temper with a presence of a glass or any other foreign body in the
wound i.e. leave it there apply aring pad around it (not on it) and bandage in position.

29
 Complications associated with wounds

 Infections/ Sepsis e.g tetanus

 Fracture
 Hemorrhagic shock due to pain
 Injury to the deep organs
 Osteomylitis
 Keloids
 Amputations

Managing a fracture or dislocation

 Follow DRSABCD action plan.

 Control any bleeding and cover any wounds.

 Check for fractures – open, closed or complicated.

 Ask patient to remain as still as possible.

 Immobilize fracture: 

30
o use broad bandages (where possible) to prevent movement at joints above and below the fracture

o support the limb, carefully passing bandages under the natural hollows of the body

o place a padded splint along the injured limb

o place padding between the splint and the natural contours of the body and secure firmly

o for leg fracture, immobilize foot and ankle

o check that bandages are not too tight (or too loose) every 15 minutes.

 Watch for signs of circulation loss to hands and feet

 Ensure an ambulance has been called – triple zero (000).

Notes on first aid

 Do not attempt to force a fracture or dislocation back into place – this could cause further injuries.

 It can be difficult for a first aider to tell whether the injury is a fracture, dislocation, sprain or strain. If in doubt, always

treat the injury as a fracture.

 If collarbone is fractured, support arm on injured side in a St John sling.

 If you suspect the joint is dislocated, rest, elevate and apply ice to the joint.

Where to get help

 For emergency or life-threatening conditions, visit an emergency department or dial triple zero (000) to call an

ambulance.

This information provided by

FRACTURES
This refers to the break in the continuity of a bone.
CLASSIFICATIONS OF FRACTURES
Open/compound fractures; this is one in which broken bone ends pierce the skin surface and
communicate to the external environment. There will be a wound at the site of a fracture.

31
Closed/simple fracture; this fracture where the skin a round he fracture site remains intact and
there is no communication to the external environment.
Varieties of fractures
Oblique Fracture
The fracture lines runs diagonally (obliquely) through the bone.
Impacted fracture
The broken bone end is pushed into one another
Green stick fracture
The bone is partially broken. The bone cracks and bends without breaking. Commonly occurs in
young children.
Transverse fracture
The break line (fracture) runs across the bone.
Complicated fracture
The fracture bone ends trap serious organs like nerves or blood vessels, spinal, cord, brain
leading to complication like, paralysis or severe haemorrhage
Depressed fracture
The structure is driven inwards. Common in fractures of the skull due to the nature of its bones

A comminuted fracture

is where the bone breaks into several pieces fragments.

Spiral fractures

The break line twists around the bone, and sometimes called torsion

CAUSES OF FRACTURES
Direct violence; bone breaks at the point where the force was applied eg blow or a fall.
Indirect violence; force is transmitted to another bone other than where the force was applied
e.g a fall from a stretcher onto the hands may cause fracture of the clavicle, and it leads to a
fracture of spine.

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Pathological causes e.g osteoporosis, osteomyelitis
etc
Prolonged stress on the bone

PRE – DISPONSING FACTORS

 AGE:
Elderly people are highly pre-disposed to fractures due to osteoporosis,
 Occupation
E.g heavy lifters, sports men, drivers, architectures and builders
 Position of certain bones
E.g tibia bone is highly exposed to fractures and injuries.
 Diet
Low calcium (Ca2+ intake leads to weak bones.
 Chronic diseases
Sickle cell diseases, diabetes mellitus, cancer etc
 Exercise
Strenuous exercise pre-dispose to fracture
 Agricultural seasons e.g farmers working in fruit plantation commonly suffers fractures
during harvesting seasons.

SIGNS AND SYMPTOMS

Crepitation (crippling)
Swelling
Pain and tenderness at the site
Deformity -normal shape is altered
History of the cause like a fall from a height
Discoloration (reddening of the site)
Physical observation of a compound fracture

33
X – Ray will reveal a fracture.
Impaired limb function
Shock due to severe pain or bleeding
Anemia
Anxiety states
PRINCIPLES OF MGT OF FRACTURES

- Pain management
- Reduction
- Immobilization (involves bandaging and splitting).
- Rehabilitation and Nursing care through resuscitation

FIRST AID MANAGEMENT OF FRACTURES

AIMS
o To reduce displacement of the fracture
o To maintain immobility ( reducing pain)
o Rehabilitation
o Provide general nursing care i.e the general principles are:

Mgt
Remove the casualty from cause or cause from the casualty
Re assures the casualty if conscious.
Check for ABCs if unconscious.
Place the casualty in a comfortable position on or recovery position if unconscious
If there is any hemorrhage stop it as urgent as possible in order to prevent shock.
If there is a wound, cover it with a clean cloth.
Immobilize the fracture with splints, bandages or slings.
NB: Pad the pressure areas if there are any involved
Handle the patient with care especially the fractured part.
Arrange or transport of the casualty to hospital and prevent further injury during transporting.

DISLOCATION

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This is where bones forming the joint are partially or completely displaced from their normal
position/alignment. It is always accompanied by tearing of the tendons, ligaments and damage to
the synovial membranes
CAUSES
Strong force wrenching the bone
Violent muscle contraction
SIGNS AND SYMPTOMS OF A DISLOCATED JOINT
Severe pain at the site
Inability to move the joint
Swelling around the affected joint
Shortening, bending or deformity of the area
FIRST AID MANAGEMENT OF A DISLOCATED JOINT
Aims;

 To prevent movement at the injury site

 To arrange transport to hospital with comfortable support during transport
Advise the casualty to keep still and help him to support the injured part in a comfortable
position
Don’t replace the dislocated bone into its socket as this may cause further injury and pain
Immobilize the injured part with a bandage. If it is an arm, for extra support secure it on the chest
by tying with a broad fold bandage.
Don’t move the casualty until the injured part is secured and supported, unless she is in
immediate danger.
Don’t allow the casualty to eat or drink because anaesthesia may be needed.
Treat for shock if necessary
Arrange for removal of the casualty to hospital
Monitor and record vital signs as you wait for help to arrive
Check for circulation beyond the bandaged area every 10 minutes

SPRAINS AND STRAINS

These are injuries to soft tissues around the bones and joints.

35
They occur when he tissues are over stretched and partially or completely torn (ruptured) by
violent or sudden movements.
Strains and sprains are commonly associated with sports activities.
A strain; occurs when the muscle is overstretched and partially torn oftenly at the junction
between the muscle and the tendon that joins it to the bone.
A sprain is an injury to the ligament. A ligament is a tough, fibrous tissue that connects bones
together.
Common form of ligament injury that occurs when there sudden or unexpected wrenching
motion that pulls the bones in the joint too far apart and tears the surrounding tissues.

SIGNS A SYMPTOMS OF SPRAINS AND STRAINS

Pain and tenderness
Difficulty in moving the injured part especially the joint
Swelling and bruising
Note; strains and sprains should be treated initially the ‘RICE’
Procedure:
R –rest the injured part
I –apply ice pack or cold pad
C –provide comfortable support
E –elevate the injured part
This procedure may be sufficient to relieve the symptoms, but if you are in any doubt as to the
severity of the injury, treat as a fracture

First aid management

Aims;
To reduce pain and swelling
To obtain medical help if necessary
Help the casualty sit or lie down and support the injured in part raised position

36
Cool the area by applying a cold compress such as ice pack. This helps to reduce swelling,
bruising and pain
Apply a comfortable support to the injured part; leave the cold compress in place or wrap with a
soft pad and secure it in place with a bandage
Continue support the injured part in a raised position to help minimize bruising and swelling in
the area
Check the circulation beyond the bandage area every 10 minutes
If the pain is severe, or the casualty is unable to use the injured part, arrange to take or send the
casualty to hospital.

Assignment:
Give the Signs and symptoms and Management of the following
fractures
Fracture of the spine, fracture of the clavicle, pelvis, fore arm.

BURNS AND SCALDS

Burn is an accidental damage to the tissues (especially the skin) caused by dry heat or wet heat.
Burns result from dry heat, corrosive substances, friction or radiation or extreme cold or strong
chemicals
Types of burns
Dry burns

37
Caused by flames, contact with the hot object, friction etc.
Electric burn
Caused by lightning strikes, high or low voltage current in domestic applied.
Chemical burn
Caused by industrial chemicals, including inhaled corrosive fumes and gases, herbicides,
domestic chemicals
Cold burn
Caused by contact with freezing metals (frostbite)
Radiation burns
Caused by strong sun rays (sun burn) or over expose to ultraviolet rays, exposure to radioactive
source like X- ray
Scalds
Caused by steam and hot liquids (wet heat)
The most significant and immediate problem following burns is Shock. This is due to partly the
traumatic experience, but mainly due to the loss of body fluids (serum) from the burned area.
This is why the size of the burnt area is a better guide to the severity of the burn compared to the
depth of the burnt tissues.
SIGNS AND SYMPTOMS

 Blisters
 Swelling
 Redskin
 Pealing skin
 Pain at the site
 Signs of sock
 Difficulties in breath if burns of head, neck and face.
 History of incidence
 Horsiness of voice (alarming voice)
CLASSIFICATION OF BURNS
Burns can be classified according to the depth of skin and tissue involved or according to the
extend.
CLASSIFICATION ACCORDING TO DEPTH
1. Superficial Burns
Only the outer most layer (epidermis) of the skin is burnt.
The burn usually heals well if first aid is given promptly.
38
 There is redness of the site, swelling and tenderness.
May not require hospital attention.

2. Partial thickness burns.

This involves the burn of the Dermis and Epidermis layers of the skin.
Medical attention may be needed.
They are more painful
Blisters may form
3. Full thickness burns.
All the layers of the skin are burnt.
There is damage to nerves, fat tissue & muscles
Pain sensation is lost
An urgent medical attention is needed.
CLASSIFICATION ACCORDING TO EXTEND (PERCENTAGE OF BURNS)
Mild (Minor) burns
Partial thickness burns less than 15%in adults and 10 % in children, full thickness burns less than
2%.
Moderate burns
Partial thickness burns of 15-25% but not involving the eyes, ears, hands, feet, and perineum.
Major (severe) burns
All full thickness burns of 20%in children and 25% in adults
It is important to assess the extent of the affected area as the greater the surface area, the greater
the fluid loss and hence the higher the risk of shock.
The extend of a burnt is based assessed using the Wallace’s rule of Nine (9) for adults and
Seven(7) for children

39
BODY PART ADULTS (rule of nine) CHILDREN (rule of seven)
Head and neck 9% 28%

Front chest and abdomen 9x2 =18% (7x2) 14%

Back of chest and abdomen 9x2 =18% (7x2) 14%

Upper limbs 9x2 18 % (7x2) 14%

Lower limbs 18x2 =36% (14x2) 28%

Genital area (perineum) 1% 2%

Total 100% 100%

40
If 40% of the skin surface area is burnt the casualty is said to have sustained severe burns.
FIRST AID TREATMENT FOR BURNS
Prevent further burning by removing the cause or casualty through putting off flames, or
switching off the power socket
Flood the burnt area to with cold water stop the burning and to relieve pain for at least 10
minutes. The casualty should not be over cooled as this may lead to hypothermia
While cooling, assess for air way patency and signs of difficulty in breathing
Gently remove any tight clothes, jewellery like rings, watches, or belts from the injured area
before it begins to swell.
Assess the percentage or depth of the burn before beginning treatment.
If blisters have formed, do not break them do not apply lotions, ointments, or fats to the injury
because they can further damage the tissues or increase the risks of infection.
Do not apply adhensive dressing to the injury as it causes rupture of the skin when removing it.
In case the burn is large than the palm of our arm, transport to hospital. Keep burns cool with
cold water pack on the top of a dressing.
Cover the injury with a sterile or a clean cloth and bandage loosely to avoid infections.
Record details of the casualty’s injury, cause, and care given.
As you wait for help/an ambulance keep reassuring the casualty and monitoring and recording
the pulse and breathing.
Give a pain killer(eg paracetamol).
BURNS THAT NEED HOSPITAL TREATMENT

 All full thickness burns

 All burns involving the face, hands , feet, or genital area
 All burns that extend right around an arm or leg
 All partial thickness burns larger than 1% (one percent) i.e an area the size of the
casualty’s palm of the hand
 All superficial burns greater than five percent (5%) i.e equivalent to 5 five palm area.
 Burns comprising of mixed patterns of varying depth

(BRAIN STORM AND DISCUSS)

HOW TO PREVENT BURNS
 Rise any cooking off crown with children

41
  Always empty hot ash into a pit
 Ensure your cloth do not attach with flames.
 When transferring fire carry it with a converting container with high side.
 When cooking the handles of the saucepan should be turned away so that children do not
touch.
 Dry off vegetable or meat before putting them in boiling fat to stop flashing and catching
fire.
 When cooking fat/oil put the fire out quickly b covering the saucepan and leaves it.
 Store fuel like petrol, kerosene, wood chips, and cotton sheets away from the kitchen.
 Do not smoke cigarette when lying in bed.
 Use proper ash trays and ensure all fires are completely out before throwing fags.
 Ensure all electric wires have their insulators or coverage

POISONING
A Poison is any a substance that causes temporary or permanent damage when taken or
absorbed into the body in sufficient quantity
Poisons can be swallowed, inhaled, absorbed through the skin, injected or splashed into the eyes
once in the body poisons may enter the blood stream, and get carried swiftly to the rest of the
organs and tissues.
SIGNS ANDSYMPTOMS OF POISONING
These largely depend on the type, amount or mode of entry of the poison into the body.
Severe a cute abdominal pain
-A cute vomiting
-A cute diarrhea
-Convulsion/seizures like in cerebral attack by organic poisons
-A smell characterized by certain poison coming from patients’ body or orifice A fume – filled
room
-Presence of a suspect container
-Excessive thirsty
-Presence of suicide note
-Burns around the mouth and along the upper GIT like if someone took a strong acid
-Signs of shock
-Confusion

42
-Delirium
-Dysphagia (difficult in swelling)
-At time patients may cough blood
-Difficulty in breathing like in case of fumes
-A conscious patient or and on looker may tell that poisoning has taken place.
-If patient is unconscious the following external features may guide to suspecting or confirming
poisoning
-Anemia if haemolysis has resulted.
-Blurred vision
-hypoxia
FIRST AID MANAGEMENT
If casualty is conscious, ask him or her what he/she has swallowed and how much (quantity)
Preserve the sample/ leftover/container if any for evidence
If chemicals are on the skin wash away with plenty of water but do not contaminate yourself in
the process.
Reassure the casualty
For swallowed poisons, give concentrated milk
Call for an ambulance or urgently organize for a medical/hospital visit.
Monitor and record the casualty’s vital signs carefully.
Common house hold poisoning
These poisons includes:-Medical drugs, Paraffin, Glue, Pesticides (herbicides), Bleaching
substances like Jik, Petrol, Alcohol, Wild plants

ALCOHOL POISONING
Alcohol is a substance that depresses the activity of the central nervous system.
Alcoholic poisoning occurs when the person has taken excessively large amounts of the
substance causing both physical and mental impairment that puts the casualty in a state of
unconsciousness.
Signs and symptoms

43
Strong smell of alcohol
Empty alcohol cans/ bottles
Deep noisy breathing
Flashed and moist face
Impaired consciousness
Shallow breathing
Weak rapid pulse
FIRST MANAGEMENT
AIMS
To maintain an open airway
To assess for other conditions
To seek medical help if necessary
Procedure
Recovery position with head tilted for a clear air way and easy flow of secretion or vomiting
Smell the person’s breathe to ascertain alcohol as the main cause
Assessing the level of responsiveness
Cover the casualty with a coat/ blanket to conquer hypothermia
If casualty is conscious, but weak and drowsy, give sweetened drink to conquer hypoglycemia
And don’t show a judgmental attitude towards the casualty if you are to help him
If unconscious, organize for urgent transport the hospital.

44
BITES:
Bites from sharp pointed teeth cause deep punctured wounds that can damage the tissues and
introduce infections into the body and thus need prompt first aid.
The first serious infection risk is Rabies which is spread through the bite of an animal and it
affects the central nervous system.
The second risk is tetanus infection for every bite or wound.
MANAGEMENT
Wash the bite wound with warm water and soap in order to minimize the risks of infection.
Raise and support the wound and pat in it with a dry gauze
Control haemorrhage and cove the wound with a sterile/ clean cloth.
Ensure the animal is secured by the owner for it may get investigated for rabies infection.
Arrange to take the casualty to the hospital where anti-rabies and tetanus toxoid can be offered.
SNAKE BITES
A snake bite is dangerous due to absorption of the Poison called venom.
Depending on the snake, the venom may;

 Cause local tissues destruction

 Spread blocking nerve impulses
 Cause heart and breathing to stop.
 Nausea and vomiting
 Pain, redness and swelling at the site
 Disturbed vision
 Increased sweating and salivation
MANAGEMENT
Aims
Prevent venomous spreading
Arrange for urgent transport to the hospital
Procedures
Help casualty sit /or lid down
Advise casualty to stop moving the limbs to minimize spreading of venoms.
Reassure the casualty to minimize anxiety and stress

45
 Lower the bitten limb below the level of the heart to stop spreading of poison to the heart.
Do not give anything to drink even if someone is thirst do not incise the bitten part
Mark the type of the snake to help the doctor identify the correct antivenom.
STINGS
Stings are caused by scorpion, spider, and insects like bees or wasps.
Stings may not be Poisonous, but people may react violently to them (in people who are
hypersensitive)

Rx
Bees normally leave their sting into the wound as foreign body and must be removed
immediately.
Bath the area thoroughly with weak ammonium solution or an antihistamine to reduce the
allergic reaction may be applied.
Any symptoms such as headache or pain, give mild pain killer.

Epileptic seizure

Epilepsy is a chronic non- infectious neurological disease characterized by recurring seizures

An epileptic seizure is sudden and wrong electrical discharge from the brain, causing a change in
behavior, sensation, or consciousness of the victim. People may have varying symptoms
depending of the type of seizure. The symptoms include;

Staring, jerking movements of the arms and or legs, stiffening of the body, loss of consciousness,
breathing problems or stops, loss of bowel or bladder control, sudden falling for no apparent
reason and appearing confused

CAUSES

-Brain infection

-Brain trauma

46
 -Metabolic disorders eg hypogycaemia

-Brain tumors

-Congenital malformations

Hereditary

Epileptic seizure first aid

If you are with someone having a tonic-clonic seizure (a generalised seizure in which the
muscles suddenly stiffen and the person may fall), you should try to:

 Stay calm and remain with the person

 Time the seizure from the beginning until it has ended

 Protect the person from injury – remove any hard objects that are near the person

 Place something soft under the head and loosen any tight clothing at their neck

 Gently roll the person onto the side as soon as it is possible to do so and firmly push the angle of
the jaw forward to assist with breathing.

 Reassure the person and minimise embarrassment during recovery

 Stay with them until they recover – this may range from five to 20 minutes or longer.

Do not Force anything into their mouth

 Do not Restrain the person unless they are in danger

 Epileptic seizure emergency response

 The seizure lasts for five or more minutes or a second seizure quickly follows the first

 The person is not conscious within five minutes of the seizure stopping

 The person does not fully recover after the seizure or has trouble breathing

 The seizure occurs in water

 The person is injured

47
 The person is pregnant

 You believe it is the person’s first seizure or you do not know – this applies regardless of how
long the seizure lasts

Asthma

This is a respiratory disorder characterized by wheezing and difficulty in breathing as a result of

narrowing and spasms of the respiratory tract (airway).

The obstruction of the airways is however reversible

Asthma can start at any age but the incidence is highest in children. It can be acute or chronic

CAUSES

There is usually a hereditary link in the development of asthma, but an allergic basis also exists;
therefore the causes include

1. Hereditary
2. Infections
3. Dust or pollen
4. Drugs and food
5. Exercise
6. Stress

48
Asthma is characterized by episodes of shortness of breath accompanied by wheezing. This is
produced by a temporary narrowing of the bronchi (small tubes) by muscle spasm and the
increased secretion of mucus. 

The efficiency of the lungs is reduced and the patient may become very distressed.

A typical episode of asthma, which may occur at any time, occurs suddenly and may be preceded
by a ‘tight’ feeling in the chest. Breathing out (exhalation) becomes difficult and wheezing is
heard.

Signs and symptoms

Difficulty in breathing(shortness of breathe)

Wheezing

49
Coughing

Distress and anxiety

Chest tightness

Difficulty in speaking

Confusion (delirium)

Cyanosis (blue discoloration of the skin and nails), exhaustion and possible loss of consciousness
(in severe attack)

First aid management of an asthma attack

1. Help the person sit in an upright position.

2. If the person is wearing tight clothing, especially around the neck,
loosen it.
3. Help the person use their own inhaler or administer medication, if
they have it.
4. Help the person use their own inhaler or administer medication, if
they have it. Encourage him/ her to take 1-2 puffs in every two
minutes until he makes at least 10 puffs.
5. If the attack is severe and the casualty becomes exhausted and
breathlessness worsens, call for an ambulance
6. Mean while monitor and record the casualty’s vital signs.
7. Prepare to perform CPR if casualty deteriorates before the arrival
of the doctor /ambulance.

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STROKE

Stroke is a neurological deficit of cerebral vascular cause that persists beyond

24 hours or is interrupted by death within 24 hours.

Stroke occurs when the blood supply to part of the brain is interrupted or
severely reduced, depriving brain tissue of oxygen and nutrients. Within
minutes, brain cells begin to die.

A stroke is a medical emergency.

Symptoms

 Trouble with speaking and understanding. 

 Paralysis or numbness of the face, arm or leg. 
 Trouble with seeing in one or both eyes. 
 Headache. A sudden, severe headache, which may be accompanied by
vomiting, dizziness or altered consciousness, may indicate you're having
a stroke.
 Trouble with walking. You may stumble or experience sudden
dizziness, loss of balance or loss of coordination.
 Seek immediate medical attention if you notice any signs or
symptoms of a stroke, even if they seem to fluctuate or disappear.
Think "FAST" and do the following:

 Face. Ask the person to smile. Does one side of the face droop?
 Arms. Ask the person to raise both arms. Does one arm drift downward?
Or is one arm unable to raise up?
 Speech. Ask the person to repeat a simple phrase. Is his or her speech
slurred or strange?

51
  Time. If you observe any of these signs note the time and if they stop
note the time again and watch the person carefully while waiting for
emergency assistance.

Causes

A stroke may be caused by a blocked artery (ischemic stroke) or the leaking

or bursting of a blood vessel (hemorrhagic stroke). Some people may
experience only a temporary disruption of blood flow to their brain (transient
ischemic attack, or TIA).

Ischemic stroke

About 85 percent of strokes are ischemic strokes. Ischemic strokes occur

when the arteries to your brain become narrowed or blocked, causing
severely reduced blood flow (ischemia). The most common ischemic strokes
include:

 Thrombotic stroke. A thrombotic stroke occurs when a blood clot

(thrombus) forms in one of the arteries that supply blood to your brain. A
clot may be caused by fatty deposits (plaque) that build up in arteries and
cause reduced blood flow (atherosclerosis) or other artery conditions.
Embolic stroke. An embolic stroke occurs when a blood clot or other
debris forms away from your brain — commonly in your heart — and is
swept through your bloodstream to lodge in narrower brain arteries. This
type of blood clot is called an embolus.
Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in the brain ruptures.

Brain hemorrhages can result from many conditions that affect your blood
vessels, including uncontrolled high blood pressure (hypertension),
overtreatment with anticoagulants and weak spots in your blood vessel walls
(aneurysms).

52
. Types of hemorrhagic stroke include:

 Intracerebral hemorrhage. 

In an intracerebral hemorrhage, a blood vessel in the brain bursts and

spills into the surrounding brain tissue, damaging brain cells. Brain cells
beyond the leak are deprived of blood and also damaged.

High blood pressure, trauma, vascular malformations, use of blood-

thinning medications and other conditions may cause an intracerebral
hemorrhage.

 Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery

on or near the surface of the brain bursts and spills into the space
between the surface of your brain and your skull. This bleeding is often
signaled by a sudden, severe headache.

Transient ischemic attack (TIA

Ischemic stroke

A transient ischemic attack (TIA) — also known as a mini-stroke — is a brief

period of symptoms of stroke. A temporarydecrease in blood supply to part of
brain causes TIAs, which often last less than five minutes.TIA occurs when a
clot or debris blocks blood flow to part of brain. A TIA doesn't leave lasting
symptoms because the blockage is temporary.

Risk factors

Many factors can increase your risk of a stroke. Some factors can also
increase your chances of having a heart attack. Potentially treatable stroke
risk factors include:

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risk factors

 Being overweight or obese

 Physical inactivity
 Heavy cigarette drinking
 High fat intake/ High cholesterol
 alcoholism

 High blood pressure

 Cigarette smoking or exposure to secondhand smoke.
 Diabetes
 Cardiovascular disease, including heart failure, heart defects, heart
infection or abnormal heart rhythm.

First aid management

Calm down the casualty

Observe for the signs and symptoms of stroke

Take vitals and record them

Reassure casualty and organize removal for hospitalisation

Complications

A stroke can sometimes cause temporary or permanent disabilities,

depending on how long the brain lacks blood flow and which part was
affected. Complications may include:

 Paralysis or loss of muscle movement. 

 Difficulty talking or swallowing
 Memory loss or thinking difficulties. 

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 Emotional problems. 

 Pain. 
 Changes in behavior and self-care ability

Prevention

 Controlling high blood pressure (hypertension). One of the most

Exercising, managing stress, maintaining a healthy weight, and limiting
the amount of sodium and alcohol you eat and drink are all ways to keep
high blood pressure in check.. In addition to recommending lifestyle
changes, your doctor may prescribe medications to treat high blood
pressure.

 Lowering the amount of cholesterol and saturated fat in your

diet. Eating less cholesterol and fat, especially saturated fat and trans
fats, may reduce the fatty deposits (plaques) in your arteries.
 Quitting tobacco use. Smoking raises the risk of stroke for smokers and
nonsmokers exposed to secondhand smoke. Quitting tobacco use
reduces your risk of stroke.
 Controlling diabetes. You can manage diabetes with diet, exercise,
weight control and medication.
 Maintaining a healthy weight. Being overweight contributes to other
stroke risk factors, such as high blood pressure, cardiovascular disease
and diabetes.
 Eating a diet rich in fruits and vegetables. A diet containing five or
more daily servings of fruits or vegetables may reduce your risk of stroke.
Exercising regularly. Aerobic or "cardio" exercise reduces your risk of
stroke in many ways. Exercise can lower your blood pressure, increase
your level of high-density lipoprotein cholesterol, and improve the overall
health of your blood vessels and heart. It also helps you lose weight,
control diabetes and reduce stress. Gradually work up to 30 minutes of
activity — such as walking, jogging, swimming or bicycling — on most, if
not all, days of the week.
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  Drinking alcohol in moderation, if at all. Alcohol can be both a risk
factor and a protective measure for stroke. Heavy alcohol consumption
increases your risk of high blood pressure, ischemic strokes and
hemorrhagic strokes. However, drinking small to moderate amounts of
alcohol, such as one drink a day, may help prevent ischemic stroke and
decrease your blood's clotting tendency. Alcohol may also interact with
other drugs you're taking. Talk to your doctor about what's appropriate
for you.
 Avoiding illicit drugs. Certain street drugs, such as cocaine and
methamphetamines, are established risk factors for a TIA or a stroke.
Cocaine reduces blood flow and can cause narrowing of arteries.
Preventive medications

If you've had an ischemic stroke or TIA, your doctor may recommend

medications to help reduce your risk of having another stroke. These include:

 Anti-platelet drugs. 

 Anticoagulants

Head injury

A head injury is any sort of injury to your brain, skull, or scalp. This can range from a mild bump
or bruise to a traumatic brain injury. Common head injuries include scalp wounds, skull
fractures, concussions (shaking of the brain), and contusions (bruising and bleeding in the brain).
The consequences and treatments vary greatly, depending on what caused your head injury and
how severe it is.

Head injuries may be either closed or open. A closed head injury is any injury that doesn’t break
your skull. An open, or penetrating, head injury is one in which something breaks your skull and
enters your brain.

Causes

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 motor vehicle accidents

 falls

 physical assaults

 sports-related accidents

Common symptoms of a minor head injury include:

 a headache

 lightheadedness

mild confusion

 nausea

 temporary ringing in the ears

The symptoms of a severe head injury include many of the symptoms of minor head injuries.
They can also include:

 a loss of consciousness

 seizures

 vomiting

 balance or coordination problems

 serious disorientation

 an inability to focus the eyes

 abnormal eye movements

 a loss of muscle control

 a persistent or worsening headache

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 memory loss

 changes in mood

 leaking of clear fluid from the ear or the nose

pathophysiolgy

Hematoma

A hematoma is a collection, or clotting, of blood outside the blood vessels. It can be very serious
if a hematoma occurs in the brain. The clotting can cause pressure to build inside your skull,
which can cause you to lose consciousness or result in permanent brain damage.

Hemorrhage

A hemorrhage is uncontrolled bleeding. There can be bleeding in the space around the brain,
which is a subarachnoid hemorrhage, or bleeding within your brain tissue, which is
an intracerebral hemorrhage.

Subarachnoid bleeds often cause headaches and vomiting. The severity of intracerebral

hemorrhages depends on how much bleeding there is, but over time any amount of blood can
cause pressure to build.

Concussion

A concussion is a brain injury that occurs when your brain bounces against the hard walls of
your skull. This causes loss of function associated with concussions is temporary.

Edema

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Any brain injury can lead to edema, or swelling. Because the skull can’t stretch to accommodate
the swelling, this leads to a buildup of pressure in your brain

First aid management

 Calm the casualty down apply a cold compress or treat any wound on the scalp by applying
pressure preferably on a clean or sterile dressing
 Regularly monitor and record vital signs; breathing, pulse and the level of consciousness.
 Do not allow the casualty to return to the play ground if the accident was sports related.
 Advise/ organize for the casualty to get medical help.
 When the casualty has recovered, ask a responsible person to take care of the casualty.
Whereas Treatment in hospital
 anti-seizure , diuretics, coma inducing medication . When one is in a coma, the brain doesn’t need as
much oxygen and nutrients as it normally needs. Surgery For example, doctors may need to operate
to remove a hematoma, repair the skull, or release some of the pressure in the skull. Rehabilitation to
regain full brain function.

 A

Cardiopulmonary Resuscitation(CPR)

Cardiopulmonary resuscitation or CPR is an emergency life-support procedure. It includes artificial

respiration and manual cardiac massage. Both these procedures are applied to prevent irreversible brain

damage or death. They should be performed only by someone trained in the technique after making sure

that the victim's heart has stopped or respiration has ceased.

Requirements ( a tray with the following )

Endo tracheal tube
Stethoscope
A small towel
Gloves
Baby warm sheet
An ambu bag
Resuscitation equipment

59
 In hospital an oxygen machine should be near
Procedure

 Be able to identify ceasation in breathing/ gasping.

 check the victim's pulse rate in the neck or groin (auscultation of the apex beat) and as soon as

you feel it,

 Gently and quickly Move the victim to a safer place, Place the victim on a firm flat surface, such

as the floor or the ground.

 Open airway by tilting the chin.

 give artificial respiration by applying the mask of the ambu bag sealing the mouth and the

nostrils and then start giving puffs/ventilations by pressing the ambu bag.

For mouth to mouth, -pinch the nose closed with your thumb and index finger, take a regular

breath and seal your lips around the victim’s mouth, creating an airtight seal.

 start by giving 5 (five) rescue breaths /ventilations but may continue for one minute ( i.e without

chest compressions)

 For adults, give 1 breath every 5 to 6 seconds making about 10 to 12 breaths per minute

whereas for infants and children, give 1 breath every 3 to 5 seconds, making about 12 to

20 breaths per minute and making sure each breath result in a visible chest rise.

 Failure for the patient to initiate a regular breathing with the rescue breaths, start External

Cardiac Massage aimng to cause the heart to pump blood to the other parts of the body,

However. N.B in a victim whose heart has stopped beating (i.e absent pulse in the neck or groin

60
 or on auscultation), external Cardiac Massage should be started simultaneously with artificial

respiration

 -place the heel of the palm of the hands over the lower part of the victim's sternum (breastbone).

 -Keeping the arms straight, and push down forcefully on the sternum.

 Give 3-4 chest compressions per oneventilation until the patient starts to breath slow-by –

slowly.

 If breathing restarts and becomes regular, the victim should be observed continuously

until medical help arrives.

 CPR is best performed by two trained persons. One should administer external cardiac

compression, and the other should provide artificial respiration. The rescuers should position

themselves on opposite sides of the victims and be able to exchange role if either becomes

fatigued.

 Treatment should continued until medical help arrives. In hospitals, emergency drugs like

adrenaline, aminophiline, hydrocortisone , dextrose 50% are administered, oxygen therapy or

intubation should be started if the patient is to be saved.

N b CPR is a lifesaving method used to restore breathing to a person whose breathing has stopped. If

breathing has stopped, the victim will soon become unconscious. There will be no movement, and the

skin will be pale or slightly bluish in colour (cyanosis). When breathing stops there is no oxygenation of

the blood and irreversible brain damage or death may occur in as little as three to six minutes.

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BANDAGING
Purpose of bandaging

 To hold dressing in position

 To control bleeding
 To reduce pain
 To immobilize fracture
 To reduce swelling
TYPES OF BANDAGING
There are three major types;
Triangular bandages or scalp bandages,
They are made of clot usually they are used as slings. They are used to secure dressing and also
help in immobilizing injured limbs.
The can be folded to improvise into other bandages.
Triangular bandages can be modified into two (2) types:

 Broad fold bandage

Used to support and immobilize limbs. Also used to secure splints and bulky bandages

 Narrow fold bandage

Used to immobilize feet and ankles and also used to secure dressings on limbs
Roller bandages
They are made of cotton gauzes, clearly perforated and are secured by pins, clips, tapes or tying
knots. Their use is;
 To secure dressing
 To apply pressure in order to control bleeding
 To give support to sprains
There are three (3) types of rollers bandages:-
a) Open- weave bandages
Used to hold light dressing in place
Allow good ventilation because of their loose weave.
However they can not apply pressure on wounds or give support to joints.
b) Comforting bandages

62
Secure dressings
Provide light support to injuries
c) Creep bandages
Secure dressings
Give firm support to injuries and joints.
Tubular bandages
These are used to secure dressing on digits.
They also help to provide support to injuries on joints to digits.

GENERAL RULES OF BANDAGING

Before applying a bandage
Keep re assuring the casualty
Make the casualty comfortable for example in alying position
Keep the injured part supported.
When applying a bandage
Work in front of a casualty and from the uninjured side where possible
If the casualty is lying down, pass bandages under the body‘s natural hallows e.g at the ankles,
behind the knees, neck, waist etc.
Apply bandage firmly enough to control any bleeding or hold dressing in place, but a bandage
should not be tight otherwise a tight bandage will impair blood circulation.
Leave fingers and towels on a bandaged limb exposed to enable checking of the blood
circulation i.e. fingers and these should not be bandaged.
Knots should not be tied exactly over the wound.
Use reef knots during bandaging especially the triangular bandage and don’t knot over bony
areas.
Keep re assuring the casualty.
After Bandaging
 Checking the circulation to the bandaged area every ten minutes.
 Ensure that blood flow is not impaired (commonly check for capillary refill) and;
Palor of the extremities

63
 Cyanosis of extremities (it becomes bluish).
Numbness.
NB: if bandaging is to immobilize a limb, strictly pad between the limbs with a cloth or towel or
cotton.
When checking for circulation press one of the finger nails or skin on the foot or hand until you
see color change, on releasing the pink color should return,
BANDAGING TECHNIQUES
A) circulation method
Each turn encircles the previous one covering it completing they use. This technique to
another bandages or dressing.
B) spiral method
Each turns over laps the previous one. Use these techniques to bandage a long straight body parts
with increasing circumference.
c) Spiral Reverse
Another bandage and then reverses the directions half way through each spiral turn. Use these
techniques to bandage body parts with and used circumference.
d) Figure “8”
Anchors below the joint and use alternating ascending and descending to bandage around joints
e) Recurrent method
This technique includes a combination of recurrent and circular turns.
Hold the bandage as you make each recurrent turn and then use the circular turn as the final
anchor. This method is commonly applicable while bandaging the scalp (head) and the stump.

DEHYDRATION AND DIARRHEA

Diarrhea is the passing of watery stool more than three times a day or lasting more than 21 days.
Dysentery is passing close stool with mucus and blood
Dehydration is the loss of water from the body.
ORT (ORAL REHYDRATION THERAPY)
The administration of fluids by mouth prevents dehydration. This mixture of water, sugar and
salt. Rehydration salt from a sachet and sugar which is administered to children to prevent
diarrhea or dehydration is called ORS (oral rehydration solution).

64
 CAUSES OF DIARRHEA IN CHILDREN
Poor hygiene
Ingestion of parasites like gardialamblia
Bacterial infection like salmonella, shigella and E. coli
PREVENTION OF DIARRHEA IN CHILDREN
Breasting feeding should be encouraged
Cleaning everything such as utensils and cups
Improve drinking practices
Drink safe water
Proper wastage disposal
Have a pit latrine
Immunization against six killer’s disease
DANGERS OF DIARRHEA
 Loss of weight
 Dehydration and death
 Malnutrition
SIGNS AND SYMPTOMS OF DIARRHEA
 Sunken eyes
 Skin lose elasticity
 Watery stool
 Little or no urine
 Dry mouth arid thirsty
 Un well sleeping and unstable
 Pulse with be faster and weak
 Sudden weight loss

PREPARATION O TIME MADE ORS

Wash your hand
Eight leveled sugar and half spoon of salt (to make 1000mls)
Mix with water.

A G E AMOUNT OF ORS AFTER EACH LOSE OF STOOL AMOUNT OF ORS PROVED FOR USE AT HOME
L e s s 2 y r s 5 – 1 0 0 m l s 5 0 0 m l s p e r d a y

65
2 - 1 0 y r s 1 0 0 - 2 0 0 m l s 1 0 0 0 m l s p e r d a y
1 0 - m o r e A s m u c h n e e d e d 2 0 0 0 m l s p e r d a y

GENERAL FIRST AID MGT OF POISONING

The first aider should be aware that this is a serious first aid emergency and thus should act very
fast of he/she is to save or preserve life.
1. If the casualty is unconscious, ensure an open airway, monitor breathing and circulation.
2. Prevent further injury e.g remove the casualty from the danger area.
3. For swallowed poisons do not attempt to induce vomiting as this may further harm the
casualty if the poison had caused wounds on the oesophage. Vomiting also may promote
distribution of the poison along the GIT.
4. Concentrated milk may be give to the casualty who has eaten poison. Milk slows abortion
of poison into the GIT tissues.
5. For inhaled poisons quickly more the casualty to fresh air.
6. Put the casualty in seat – up if difficulty in breathing and maintain this position till
medical attention is obtained.
7. NB: never attempt to enter a fume – filled room unless you are equipped with protective
gear.
ALCOHOL POISONING
This is the commonest drug of dependence I domestic areas. Alcohol depresses the CNs acting.
Small quantities cause elevated mood, but prolonged intake results in physical and mental
disability (may be server). Deep unconsciousness can result.
DANGERS OF ALCOHOL
o Aspiration due to unconsciousness which can result into death.
o Hypothermia as alcohol leads to vasodillation.
o Misdiagnosis e.g if there is head injury and the casualty is smelling alcohol, healthy
works may treat the alcoholic coma and leave the head injury.
o Physical and mental impairment.

SIGNS AND SYMPTOMS

Smell of alcohol from patient
Unconsciousness – but the casualty may be arousable and quickly relapses.
A flushed and moist face
Deep noisy breathing
Dilated pupils that react poorly to light

66
Dehydrated skin
Incontinence of urine
A fall bounding pulse in later stage
Later there may be weak and rapid pulse like in shock.
Vomiting may also be present and vomitus may have the smell of alcohol.
First aid mgt
Check level of response by carefully shaking the shoulders of the casualty and shouting at him.
If unconscious check and ensure AB and C.
Positioning in recovery and resuscitate if unconscious
Prevent hypothermia by covering the patient with a blanket or a heavy coat.
If able to swallow, give him sugar to chew or give it as dissolved sweet water.
Be careful not to chock the patient
FAINTING
Causes;

 Prolonged period of standing in the sun

 Hunger
 Sad news or bad news
 Early pregnancy
FIRT AID TREATMENT OF FAINTING
o Remove the casualty from site and take in a cool place if necessary
o Loosen all tight clothes
o Lie the person such that the head is lower than legs
o Keep the airway clear
o Keep by standers away from the casualty
o If the casualty is recovering sit him or her up very slowly

EPILYPTIC FIT
This is a sickness due to some changes in the brain resulting in abnormal transmission of
impulses.
Signs and symptoms
 Person becomes stiff and jerking
 At the beginning he shows some movements with a lot of saliva from the mouth

67
  May urinate and pass stool
 He may injure himself more by falling on dangerous areas
First aid treatment
 Protect the casualty from hurting himself during jerking movements.
 As soon as feet slow down ensure an open airway by tilting the head backwards
and lifting the chin.
 Push a clean clothe into the mouth to stop him from eating the tongue
 Cover a person with a coat or jacket or a blanket if available to prevent
embracement incase of urinating or passing stool.
 After recovering the casualty will need to sleep so a first aider should take him
home.
Convulsions
This is a fit or sickness resulting from high fever and it is most common with children.
Signs and symptoms

- Rigidity
- Kicking and sweating
- Secretion of mucus
- Eyes changes
- Passage of urine & face
- High body temperature

First aid management

 Clear airway by lifting
 Put the child in recovery position
 Remove the clothing’s
 When he is fully aware give him plenty of fluids
 Transport the casualty to hospital.
HYSTERIA
This is a sickness due to the disorganization of the brain.
Signs and symptoms
o The casualty is usually noisy, excitable and moves violently.
o She usually falls in a safe place
o If she remains conscious but once too much concern is shown becomes unconscious
o First aid treatment
o Be firm and avoid being too sympathetic
o Clear away people because their presence and attention may lengthen the attack.
o When she becomes quiet find out the cause of hysteria
o Carry out counseling and re assurance about the cause
o Advise the casualty to always have work or a job to do so that she/he is always busy.

68
 o Find members of the family/friend to always give company.

FEVER
Is a condition where there is elevation or raise of temperatures above normal.
Normal body temperature ranges from36.5⁰c to 37.5⁰c.
Fever is considered to be assign or a symptom of underlying disease. For example malaria,
typhoid etc.
The beginning of fever may be sudden, acute or gradual. When the onset is gradual the temp may
take several days or weeks to reach its maximum level where as when the onset is sudden the
temperature may reach its highest level within an hour.
Signs and symptoms
 Increased breathing
 Increased pulse rate
 Loss of appetite
 Dry mouth
 Diarrhea
 Reduce urine out put
 General body weakness
 Loss of interest in the surrounding
 Restlessness
 Headache
In sudden and severe shivering attacks the casualty presents in three stages;-
Te casualty feels cold and shivers violently, the skin is pale and color turns blue.
Hot stage; this follows the third stage the skin is hot and dry and casualty complains of headache
and is very restless.
Sweating; the casualty begins sweating, profusion, temp later falls, the pulse, and casualty feels
better.
MGT
The casualty should not be left alone in cold stage.
The casualty should be provided with warmth
In hot stage extra blanket/clothing should be removed an given cold drinks
Sock a piece of cloth and apply it on the body
In the hot stage remove the coat and apply cold

69
 Reference: St Andrews’ first aid manual (2014): 10thedition written and authorized by
UK’S first aid provider

Review Questions :
1a) Give the meaning of the following terms; 8mks
i. First aid
ii. An accident
iii. An emergency
iv. Symptoms
b) What are the general principle of first aid 8mks
c) Mention at least eight equipments/items in a first aid kit 4mks
2. a) Explain the steps you would take to handle an emergency 12mks
b) list any four emergency conditions you know? 4mk
c) list four causes of unconsciousness 4mks
3 a) define shock 2mk
b) List any four causes of shock 4 mk
c) Mention the different types of shock 10mk
d) Briefly explain how you can care or manage a victim of shock 4mk
4. a) Define the term haemorrhage as applied in first aid 2mk
b) List four causes of haemorrhage 4mk
c) What are the kinds of haemorrhage under time classification 3mk
d) How can you manage a 12 year old boy who is having epistaxis 8mk
5 a) what is a wound 2mk
b) Write brief notes on the following types of wounds 6mk
i. Punctured wounds
ii. Lacerated wounds
iii. Incised wounds
d) Mention four complications associated with wounds 4mk
6a) give the meaning of the following terms 6mk
i. A fracture
ii. A dislocation
iii. Sprain
70
b) Explain you can manage a fracture of the fore arm sustained after a fall from a height 8mk

c) Give four complication of wounds 3mk

7 a) how do understand the term burns? 2mk
b) List four causes of burns 4mk
c) What first aid management can you give to someone who has sustained burns of the fore
arm 12mk?
d) Mention the complication that may result following burns 4mks
8 a) what is a poison 2mk
b) what are the manifestations of someone who has taken poison 5mk
c) how can you manage a 21 year old male who is semi-conscious after a history of excessive
alcohol consumption 12mk

71