First Aid Treatment

Dr. Mohamed Jowhar

Pegawai Perubatan
Pusat Kesihatan
Universiti KebangsaanMalaysia
Being a First Aider
Doing Your Best
A casualty may not respond as you hoped, some conditions
are inevitably fatal, even with the best medical care.
Assessing Risk
First do no harm,
Calculated risk,
Do not use treatments that are not sure about, just for the
sake of doing something.
Your Responsibility
Talk to casualty-reassure him
and obtain information about
his condition
Treat casualty-in position
found,
By stander –may able to help
in giving first aid
Giving Care with confidence
Being in control both of your own reaction & of the problem,

Acting calmly &logically,

Being gentle but firm, Speaking to casualty kindly but in clear& purposeful way.

Building up Trust,

Talking to relatives,

Coping with children

Looking after yourself
Personal safety -Do not put yourself at
risk,
The fight or flight response- increase
heart rate& breathing, sweating,
Staying calm-remember first aid
procedures.

Feelings after an accident

Satisfaction & pleasure,
Confusion & doubt,
Anger & sadness.
 Recording first aid treatment
name, address, occupation, date& time, place
&circumstance of accident, details concerning&
treatment given .
Actions at an Emergency
Assess the situation,
Make the area safe,
Give emergency aid,
Get help from others.
Topics for today Discussion
13. How to observe Unconscious patient
1. Fever
14. Burns
2. Bruising /Abrasions/ Lacerations
15. Dyspepsia/Gastritis/Peptic Ulcer
16. Diarrhea
3. Headache 17. Anxiety /Hyperventilation/Panic
4. Back pain Attack
5. Musculoskeletal injury/Pain
6. Dysmenorrhoea (Period Pain)
7. Common Cold-Upper Respiratory Tract Infection (Flu)
8. Asthma
9. Severe bleeding-Eg.MVA
10. Shock
11. Head injury
12. Eye injury
Fever
 Oral Temperature >37.2.C, Ear drum T >37.7.C,
 Is a sign of disease and occurs in response to infection(mainly viral)
 Abrupt onset of fever with chill and rigor is a feature of some disease.

Treatment
 Paracetamol 500mg 2 tablets 3-4x/day
 High fever- Tepid sponging for first 30minutes combined with Paracetamol.
 Adequate fluid intake /increased fluid 2-3Litre/day-frequent small drinks of light
fluids/water
 Dress in light clothing, do not over heat with too many clothes
Bruising /Abrasions/ Lacerations
Bruising- (contusion) caused by a blunt force trauma that damages tissue under the skin,
bleeding in subcutaneous or deeper tissue while leaving the skin basically intact.

Abrasions (grazes)- superficial wounds in which the topmost layer of the skin (the epidermis) is

scraped off, common with motor vehicle accident.

Lacerations - Lacerations, irregular tear-like wounds caused by some blunt trauma.

Management
 RICE- Rest, Ice, Compression, Elevation (large Bruises/Haematomas)
 Clean /remove all ground - in dirt, metal,clothing and other
material(Abrasions/Lacerations)
 Scrub out dirt with sterile water
 Clean with Acraflavine solution,apply protective dressing(some
wound may left open
 Immobilise a joint that may be affected by a deep wound( eg. Arm
sling)
 Analgesic- Paracetamol/Ponstan
Headache
Tension Headache……tension or muscle contraction headache
Lasts for hours and recurs each day
Associated with cervical dysfunction and stress or tension
Migraine……sick headache-10%, > in female
Pain usually half of the head, +/- eye pain
Classic Migraine-Headache, vomiting and aura
Common Migraine- Without aura
Explanation and reassurance
Advise stress reduction-relaxation, meditation
Avoid trigger factors-food (chocolate, cheese, nuts, coffee),
moving round, watching TV
Medication
Musculoskeletal Injury/Pain(PRICE)
-Can apply for Sports Injury/MVA
Protect
Rest
Ice
Compression
Elevation
Dysmenorrhea (Period Pain)
• Period pain in reproductive age of
female
Low midline abdominal pain
Varies from to dull to severe cramping
pain
Usually lasts for 24hrs up to 2-3 Ds
Asso with nausea and sometimes
vomiting
Period Pain Management

• Promote life style -exercise, stopped smoking

and alcohol, relaxation techniques
• Place hot water bottle over painful area
• Avoid extreme cold
• Medication…eg., Ponstan
Common Cold-Upper Respiratory Tract Infection (Flu)
 Tiredness
 Running nose, Sneezing
 Sore throat
 Slight Fever
 Others—Headache,
Hoarseness, Cough
• Rest
• Drink ample amount of Water
• Stop Smoking
• Steamed Inhalation-with
Menthol
• Medicines-Paracetamol,
cough syrup…Bena
Expectorant
 Asthma Attack-Action
Allow Casualty to use reliever(blue) inhaler -S/s-difficulty
breath/speak , wheeze, grey-blue lips & skin, exhaustion
Make casualty comfortable- sitting forwards & supporting upper
body by leaning arms
Encourage casualty to breath slowly –if attack not ease within
1-3min,encourage to take another dose inhaler to breath slowly&
deeply
 For adults/children > 4 years old- 4 puff in every 20minutes(first hour)
 (One puff actuation at atime,4-5 normal breaths each time)
Anaphylactic Shock
Causes- Bee stings, food reactions- peanuts/fish, drugs
Treatment
1.Call Ambulance -pass info.-causes of allergy
2.Help to relieve symptoms -anxiety, puffy eyes, impaired breathing ,
shock
3.Monitor Casualty -response , pulse, breath
Before give medicine

Ask-
1.any drug allergy previously ?
2.Any disease?
 ADR(Adverse drug Reaction)

Drug should be prescribed only when there is very good indication

for its use.
“Confidence &Courage” to tell patient when a drug is not
required.
Severe bleeding-Eg.MVA
 Apply pressure to wound -direct pressure to wound , pad before
bandage
 Raise & support injured part -raise above heart
 Wound bandage -secure bandage firmly, check circulation
 Dial for Ambulance
 Treat for shock , monitor casualty -vital signs-level of response,
pulse, breathing
Head injury
.Control bleeding- put glove , replace skin flap,
Non fluffy pad over wound
.Secure dressing with bandage
.Help casualty to lie down-head & shoulders slight raise
.Dial ambulance
Eye injury
.Support casualty’s head -hold head on your knees , Keep
eye still
.Give eye dressing –dressing , keep uninjured eye close
.Send to hospital
Unconscious patient - Completely unresponsive to any stimulus.
1.Blackouts (episodic or transient loss of consciousness)- dizziness, weakness
1.Epilepsy – steps-- aura, initial rigid tonic phase, convulsion, drowsy, with tongue
biting, incontinence urine/faeces
3.Syncope – transient loss of consciousness but with warning symptoms and rapid
return of alertness following a brief period of unconsciousness (seconds to 3
minutes)
(1) Vasovagal attack - with standing, dizzy, faintness, blurred vision, sweating
4. Chocking - suddenly cyanosed, while eating meat, speechless, grasps throat
5. Drop attack - blackouts, suddenly falls, immediately get up again- middle aged
women, Dx- vertebrobasilar insufficiency, Parkinson’s disease and Epilepsy
6. Heart Attack - reduce blood flow to brain- ? Need CPR if Unconscious
7. Cardiac arrhythmias - elderly, sudden blackout in heart block, sick sinus syndrome,
ventricular tachycardia, increase heart rate, irregular rhythm
8. Vertebrobasilar insufficiency - Stroke, TIA -Transient Ischaemic
attack(minor stroke),
Hypoglycemia- lightheadedness, sweating, shaking, on Diabetics with
insulin/oral drugs
9. Head injuries – Brain injuries of Concussion, contusion, lacerations,
skull fracture, Eg. MVA
10. Shock - reduce blood flow to brain
11. Poisoning
12.Meningitis- Eg. Meningococcal Meningitis
Management of Unconscious patient
Keep the patient alive by maintaining airway and breathing and circulation(ABC)
Get the History from witness
Examine patient- Assess by checking level of response to stimuli using AVPU cod
A- Alert?, V- respond to Voice?, P- respond to Pain?, U- Unresponsive to any stimulus
Check for ABC - open Airway using jaw thrust method, check Breathing, Circulation,
prepare to give chest compressions and rescue breaths
Bleeding - Apply direct pressure to the wound
Head injury -should be treated as neck injury/spinal injury- use log- roll technique
Referral- Arrange removal of casualty to hospital if necessary, call to PK/Ambulance
Level of Response - Glasgow Coma Scale (GCS)
Eyes- Observe for reaction while testing other responses
Open spontaneously 4
Open to speech 3
Open to painful stimulus 2
No response 1
Speech- When testing responses, speak clearly
& directly close to casualty ears
Response sensibly to questions 5
Seems confused 4
Uses inappropriate words 3
Incomprehensible sounds 2
No response 1
Movement -Apply painful stimulus, pinch ear lobe or back of hand
Obey commands 6
Points to pain 5
Withdraws from painful stimulus 4
Bends limbs in response to pain 3
Straighten limbs in response to pain 2
No response 1
coma score = E+M+V, minimun 3, maximun 15,
If 8-10: take care- Monitor the airway
Burns
Cool Burn -pour cold liquid/water for 10mins
Watch for smoke inhalation- difficult
breathing
Remove any constrictions-put glove, do not
apply lotion, ointment, do not touch , do not
remove sticks to burn
Cover Burn -dressing
Refer to Hospital
Dyspepsia/Gastritis/Peptic Ulcer

More common in Male, Smoking, Stress, Family H/o,

Medication with pain killers, H.pylori infection
• Dyspepsia ( Indigestion)
Pain or discomfort centered at upper abdomen
Heartburn due to acid regurgitation
Water brash
• Gastritis
Pain m/b severe, +/- vomiting, related with meal
• Peptic Ulcer (Gastric or Duodenal Ulcer)
Ulcer in Stomach or in Early part of Small Intestine
 Management
• Stop smoking, alcohol and coffee drinking
• avoid unnecessary use of pain killer(NSAID)
• Avoid spicy and pickled foods
• Small and frequent intake of easily digestable food
food at the time of disease
• Followed by of regular meals
• Antacids…eg., gelucil, zellox & relcers syrups
 Diarrhea • Awareness for Signs of
• Frequent passage of Dehydration
Sunken eyes,dry skin, skin turger,
loose/watery stools peripheral pulse, reduce Blood
Bacterial Diarrhoea….Acute Pressure(hypotension)
Gastroenteritis,
• Fluid Replacement
Viral Diarrhoea …Rota Virus
in children ORS, Increased fluid intake…
coconut water, fruit juice,
Antibiotic Reaction…eg.,
Penicillins
Irritable bowel syndrome
(Chronic Diarrhoea)…spicy
food, milk,stress
 Anxiety /Hyperventilation/Panic Attack
• Anxiety- worry about various life circumstances
• Hyperventilation- lightheadedness, dizziness, aerophagy, hand
spasm(numb), sweating, palpitation
• Panic Attack (Discrete period of intense fear or discomfort) -SOB,
unsteady feeling, palpitation, shaking, uncontrolled fear of doing
something, +/- chest pain and numbness
For Anxiety and Panic Attack:
Use non-medication methods
Explanation, reassurance
Coping skills, stress management
For Hyperventilation:
breathe in and out of paper bag
Stop excessive taking of coffee and smoking
 Carta Alir Rawatan Di Kolej

Mangsa

Ahli BSMM

Rawatan awal di tempat

kejadian
Rawatan lanjut Tidak SERIUS
di Bilik Rawatan Ya
Masa Telefon Dr.
Masa
Lain Oncall
Waktu
Bekerja

Bawa ke Pusat Rawatan oleh Doktor

Kesihatan UKM
Penggunaan Ubat-Ubatan
Zellox suspension-sakit gastric,minum sebanyak 15ml( 2 -3penutup botol)
x3 kali/hari,
Actal/ GELUSIL tab.-sakit gastric, 2bijix3 kali/hari
Panadol –sakit kepala, badan sakit, demam-500mg 2 biji x3-4 kail/hari,
Ponstan 250mg-sakita kepala,badan, senggunggut dan sakit lain-con: terseliuh, 2
biji x 3 kal
Ultracarbon/Eucarbon- Keracunan makanan ringan& cirit- birit, 1 bijix3 kali/hari,

ORS(Oral Rehydration Solution) - 250ml air masak/mineral bagi sebungkus,

Menzza cream -sakit otot, sendi,terseliuh & kekejangan otot- sapukan

Burnol plus cream - luka kecil, ruam,melecet dan gigitan serangga-sapukan

Flavine/Acraflavine lotion - antiseptic,luka sahaja

Calamine lotion - alergi kulit,ruam& kulit gatal

Pusat Kesihatan-Bahagian Kecemasan Dan Kemalangan
Kes-Kes Kecemasan bagi perkhidmatan rawatan Kecemasan selepas waktu Pejabat@Atas Panggilan( Oncall)-Contoh:
Kesukaran bernafas/Lelah/Asma Akut
Tercekik
Sakit Jantung/Dada yang berturusan
Tidak sedarkan diri(koma) atau mengalami renjatan(shock)
Kemalangan jalanraya dengan kecederaan serius
Wanita hamil yang mengalami sakit perut/turun darah
Keracunan Makanan Kes-kes Kecemasan
”Overdose” Ubat-Ubatan
Luka atau melecur yang teruk akibat kebakaran
yg. Membahayakan
Sengatan binatan berbisa(spt: Ular,Lipan,Kain Jenking,Tebuan dan sbg.) nyawa
Serangan sawan/epilepsi &memerlukan
Pesakit jiwa yang mengganggu Ketenteraman awam
Kes hendak bunuh diri(Attempt suicide)
rawatan paling
Demam panas yang tinggi(>39.5.C) segera hendaklah
Sakit yang kuat hingga pesakit tidak bermaya/terlalu lemah dihantar terus ke
unit Kecemasan
Hospital
Serdang/Kajang