First Aid

By:
Laarni D. Reyes, RN
Clinical Instructor
Soft Tissue Injuries

Two classifications of wounds:

 Closed Wound- Involves the underlying tissue with out break/damage

in the skin or mucous membrane

Causes:

 Blunt object result in contusion or bruises.

 Application of external forces such as motor vehicle accidents and falls.

Factors or other injuries which may be involved:

 Damage beneath the epidermis depends on varying depth

 Depending on the extent of force, cells are damaged and small

blood vessels are usually torn.

 Varying amount of edema fluid and blood leak into damaged

area.

 Possible fracture.
Signs and symptoms:

 Pain and tenderness.

 Swelling
 Discoloration (black or blue which is called within the
damaged tissue)
 Hematoma may occur (pool of blood collected within the
damaged tissue)
 Uncontrolled restlessness
 Thirst
 Symptoms of shock
 Vomiting and cough of blood
 Passage of blood in the urine and feces
 Signs of blood along mouth, nose and ear canal.
 First aid management:

 Ice application. Ice or cold packs can be effective in helping control of

both pain and swelling and cause the blood vessels to constrict, which
will slow bleeding.

 Compression. Manual compression over the area of injury will

compress the blood vessels and also decrease the bleeding.

 Elevation. Elevating the injured part will decrease the amount of

swelling.

 Splinting. Immobilizing the soft tissue injury with a splint is another

way to decrease bleeding.
2. Open Wound- a break in the skin or mucus

 Puncture Wound. Penetrating pointed instruments such as

nails, ice picks, gaggers, etc.
Characteristics: Deep and narrow; serious or slight bleeding
 Abrasion Scrapping or rubbing against rough surfaces.
Characteristics: Shallow; wide; oozing of blood; dirty
 Laceration. Blunt instruments such as sharpnel’s rock, broken
glasses, etc.
Characteristic: Torn with irregular edges; serious or slight
bleeding.
 AvulsionExplosion, animal bites, mishandling of tools, etc.
Characteristics: Tissue forcefully separated from the body

 
Dangers:
 Hemorrhage – lost of 1 glass (approximately 250 cc) is
normal; 2 to 4 glasses – victim becomes anemic and
predisposes to infection; and 4 to 6 glasses will be fatal.

 Infection – delays the healing of the wound; gangrene may

develop; amputation may be necessary to prolong life; may
itself lead to death.

 Shock – predisposes body infection; may lead to loss of body

part; may itself lead to death
Kinds of bleeding:

 Arterialbleeding – Occurs when the artery is severe or

opened. Characteristics by the irregular spurting of blood.

 Venous bleeding - Occurs when a venous is severed on

punctured. Charaterized by an even flow of blood.

 Capillary bleeding – Described as “capillary oozing”. This

type of bleeding expected in all minor cuts, scratches and
abrasions.
 First Aid Management

Wound with severe bleeding

1. Control bleeding by:

 Direct pressure (Main help) with the use of a compress, pressure is

applied directly over the wound; can be applied to any kind of bleeding
and to any body part. Do not apply direct pressure on.

 Eye injury
 Wound with embedded object
 Head injury with possibility of skull fracture.

 Elevation raises the bleeding part above level of victim’s more pain.
 Pressure point bleeding control (pressure on
supplying artery) – if direct pressure or elevation
don’t control the bleeding from uninjured arm or leg
compress the major artery that supplies the blood to
the injured area while direct pressure and elevation
are maintain.

 Brachial artery (between the large muscles {biceps and triceps]

on the inside of the upper arm) for arm injury
 Femoral artery (in the groin at the top of the leg bends) for leg
injury
2. Cover the wound with dressing and secure with a bandage.

3. Care for shock.

4. Consult or refer to physician.

Wound with bleeding not severe (home care )

1. Clean the wound with soap and water

2. Apply mild analgesics

3. Cover wound with dressing and bandage

Reminders:

 All wounds must be thoroughly inspected and covered with a

dry dressing to control bleeding and prevent further
contamination
 Once bleeding is controlled by compression, the limb should
be splinted to further control the bleeding, stabilized the
injured part, minimize the victims pain and facilitate the
patient’s transport to the hospital.
 As with closed soft tissues injuries, the injured part should be
elevated to just above the level of the victim’s heart to
minimize severity.
 Amputated body parts should be saved, wrapped in dry gauze,
place in a plastic bag, kept cool, and transported with the
patient.
 Do not induce further bleeding to cleaning the wound.
 Do not use absorbent cotton as a dressing.
Burns – is an injury involving the skin, including muscles,
bones, nerves and blood vessels. This is result from heat,
chemicals, electricity or solar or other forms of radiation.

Common causes:

 1. Carelessness with match and cigarette smoking.

 2. Scald from hot liquid.
 3. Defective heating, cooking and electrical equipment.
 4. Immersion in overheated bath water
 5. Use of such chemical, as lye, strong acids and strong
detergents.
Factors to Determining the Seriousness of Burns:

1. DEPTH

The deeper the burn, the more severe it is. Making an

assessment of burns depth will help you decide whether to
seek medical care for the victim. Generally, three depth
classifications are used:
 Superficial (First-degree) burns - involve only top layer of the skin, the
epidermis. The skin turns red but does not blister or actually burn through.
The burn site is painful. Sunburn is a good example of a superficial burn.

A. First Degree Burn

 Partial-thickness (second degree) burns - involve the epidermis
and some portion of the dermis. These burns do not destroy the
entire thickness of the skin, nor is the subcutaneous tissue injured.
Typically, the skin is moist, mottled, and white to red. Blisters are
common. Partial-thickness burns cause intense pain.

B. Second Degree Burn

 A full-thickness (third-degree) burn extends through all skin layers and
may involve subcutaneous layers, muscle, bone, or internal organs. The
burn area is dry and leathery and may appear white, dark brown, or even
charred. Some full-thickness burns feel hard to touch. Clotted blood
vessels or subcutaneous tissue may be visible under the burned skin. If
severely burned area may have no feeling. However, the surrounding, less
severely burned areas may be extremely painful.

C. Third Degree Burn

2. The extent to the affected body surface area

This means estimating how much body surface area the

burns covers. A rough guide known as the Rule of Nine
assigns a percentage value each part of the body. The rule
of nine must be modified to take into account the different
proportions of a small children and infant. For small
scattered burns, Use the rule of Palm. The victims’ hands,
excluding the fingers and the thumb, represent about 1
percent of his or her total body surface. For a very large
burn, estimate the unburned area in number of hands and
subtract from 100 percent.
 9%
18% - back
18%

9% 9%
18%
18% - back
1% 18%
9% 9%

1%
18% 18%

13.5% 13.5%

Rule of Nine. I s quick way to estimate the amount of surface area that has been burned.
3. Location of the Burns
Burns on the face, hands, feet, and genitals are more severe than the
other on the body parts. A circumferential burn (one of that goes
around a finger, toe, arm, leg, neck, or chest) is considered more
severe than a non-circumferential one because of the possible
constriction and in some cases, breathing. All these burns require
medical care.

A. Face B. Hand
4. Victim’s age and medical condition.

Determine if other injuries or pre-existing medical

problems exist or if the victim is elderly (over 55) or very
young (under 5). A medical problem or belonging to one of
those age group increases a burns severely. In general,
people under age 5 and over age 55 have thinner skin and
often burn more severely. People with chronic medical
problems also tends to have more severe burns, especially if
they are not well nourished, have heart or kidney problems,
or are exposed to the burn source for a prolonged period
because they are unable to escape.
2. Moderate Burns

 Full-thickness burns involving 2% to 10% of the body’s

total surface area (excluding hands, feet, face, genitalia,
or upper airway)
 Partial-thickness burns covering 15% to 30% of the
body’s total surface area
 Superficial burns covering more than 50% of the body’s
total surface area.
3. Minor Burns

 Full-thickness burns covering less than 2% of the total

body’s surface area.
 Partial-thickness burns covering less than 15% of the
body’s total surface area.
 Superficial burns covering less than 50% of the body’s
total surface area.
1. Care for Thermal burns

 Care of First-Degree and Second-Degree Burns

 Relieve pain by immersing the burned area in cold water

or by applying a wet cold cloth. Apply cold until the part
is pain free both in and out of the water (usually in 10
minutes, but it may take up to 45 minutes). Cold also stop
the burns progression into deeper tissue. If cold water is
unavailable, use any cold liquid you drink to reduced the
burn skin temperature.

 Cover the burn with a dry, non sticking, sterile dressing or

a clean cloth. Covering the burn reduces the amount of
pain by keeping the air from the exposed nerve endings.
The main purpose of a dressing over a burn is to keep the
burn clean, prevent evaporative loss, and reduce the pain.
Care for Third-Degree Burns

 It is usually is not necessary to apply cold to the third-

degree burns since pain is absent. Any pain felt with a
third-degree burn comes from accompanying first and
second-degree burns, for which cold applications can be
helpful.

 Cover the burn with a dry, non sticking, sterile dressing or

a clean cloth.

 Treat the victim for a shock by elevating the legs and

keeping the victim warm with a clean sheet or blanket.
 Care for Scald Burn.

 Cover scald burns with a cool, moist, grease, or butter to the

scalded area.
2. Chemical Burns
A wide range of chemical agents is capable of causing
tissue damage and death on contact with the skin. As with
thermal burns, the amount of tissue damage depends on the
duration of contact, and the strength of the chemical agent.
Chemicals will continue to cause tissue destruction until the
chemical agent is removed. Three types of chemicals-acids,
alkalis, and organic compounds are responsible for chemical
burns.

Chemical burn of the skin Chemical Burn of the

Eye
Care for Chemical Burn
 Immediately remove the chemical by flushing with water. If available, use a host or a
shower. Brush dry powder chemicals from the skin before flushing, unless large
amounts of water are immediately available. Water may activate a dry chemical and
cause more damage to the skin. Take precautions to protect yourself from exposure to
the chemical.

 Removes the victims contaminated clothing while flushing with water. Clothing can
hold chemicals, allowing them to continue to burn as long as they are in contact with
the skin.

 Flush for 20 minutes or longer. Let the victim wash with a mild soap before a final
rinse. Dilution with large amounts of water decreases the chemical concentration and
washes it away.

 Cover the burned area with a dry dressing or for large areas, pillowcase

 If the chemical is in the eye; flood it for at least 20 minutes, using low pressure.

 Seek medical attention immediately for all chemical burns.

3. Electrical Burns
The injury severity from exposure to electrical current
depends on the type current (direct or altering), the voltage,
the area of the body exposed, and the duration of the contact.

Electrical burn caused by biting an electrical cord

 Types of Electrical Burns:

1. Contact burns (when the current is most intense at the

entrance and exit sites.

2. Flash burns (when extremity is close to an electrical flash or

is struck by a flash of lightning).

3. Arcing injuries (when a current jumps from one surface to

another).
Care for Electrical burns

 Make sure the area is safe, Unplug or disconnect, or turn off the
power. If that is impossible, call the power company or ask for help.

 Check the ABC’s (Airway, Breathing, and Circulation). Provide R.B

or C.P.R if necessary.

 If the victim fell, check the spine injury.

 Treatthe victim for shock by elevating the legs 8-12 inches and
prevent heat loss by covering the victim with a coat or blanket.

 Seek medical attention immediately. Electrical injuries are treated in

burn center.
 Specific Body Injuries

Care for eye injuries

1. Blows to the Eye

 Apply an ice pack immediately for about 15 minutes to

reduce pain and swelling. Do not exert pressure on the eye
 Seek medical attention immediately in case of pain, reduced
vision, or discoloration (a black eye)
3. Eye Knocked Out

 Cover the eye loosely with sterile dressing that has been
moistened with clean water. Do not try to push the eyeball back
into the socket.

 Protect the injured eye with paper cup, cardboard folded into
cone, or doughnut shape cravat bandage.

 Cover undamaged eye with a patch to stop movement of the

damage eye (known as sympathetic movement).

 Seek medical attention immediately.

4. Foreign Object

 Try flushing the object out by rinsing the eye gently with warm
water. Hold the eyelid open and tell the victim to move the eye
as it is rinsed.

 Examine the lower lid by pulling it down gently.

 If you can see the object, remove it with moistened gauze or

clean cloth
Many foreign bodies lodge under the upper eyelid, requiring
some expertise in everting the lid and removing the object.
Examine the upper eyelid by grasping the lashes of the upper
eyelid, placing a match stick or cotton tip swab across the
upper lid and roll the lid upward over the stick or swab. If you
can see the object, remove it with a moistened gauzed or clean
cloth.

The presence of foreign object in the eye