First aid in traumatic injuries

Lecturer Cristina Petrișor MD,PhD,DESA

Accident is a fortuitous, unpredictable event, which
interrupts the normal course of things, resulting in
damage, injury, mutilation or even death
Is the definition of trauma assimilated with accident?
Who is responsible for trauma prevention ?
Medicine (medical education)
Other institutions involved in:
The education of the population regarding the
implementation of adequate traffic rules
The promotion and respect of laws on the status of
weapons and ammunition,
 The promotion of the mediation and non-violent
solution of conflicts
First aid in trauma
Trauma is the main cause of death in the population
aged between 1 and 45 years.
80% of the cases of death in young people
60% of the cases of death in children
The initiation of the first aid
According to the extension and the importance of the
injuries
The recognition and the opening of the obstructed
airway
The assistance of the ventilation,
The applying pressure on a wound in order to reduce
hemorrhage
The knowledge of basic measures

Stop to help;
Ask for help (the emergency number 112)
Evaluate the safety of the environment, then assess the
victim;
Start respiration;
Start CPR
Spinal imobilisation
Stop bleeding.
The recording of events
is recommended for any action or event
is compulsory for those who have the legal duty to
provide first aid treatment.
general rules:
The use of ink or a pen;
The correction of data is performed only by
crossing out with a horizontal line, (no correction
fluids);
The record is signed and dated;
The record is confidential;
The initial examination of the victims of
trauma (1)

The treatment and outcome of the victim largely

depends on the accuracy and the detailing of
information at the site of the trauma. !!
Check the presence of any potential danger for the
rescuers:
Fuel leakage,
Fallen electrical wires,
the load of a truck trailer
The initial examination of the victims of
trauma (2)

Record the number of victims!

Record the type of accident!
Diagnostic protocol of cardio-respiratory arrest
Avoid the useless and dangerous mobilization of the
cervical spine!!!!
If the patient is in cardio-respiratory arrest, basic vital
support is initiated!
The initial examination of the victims of
traumas (3)
When the number of rescuers is insufficient, the
basic vital support of the victim is not initiated if
there are other victims who need urgent care !!!
What happened?
What hurts most?
Can you breathe in deeply?
Asses the bleeding source!!!
The initial examination of the victims of
traumas (4)
Do not move the victims of road traffic accidents
unless there is a fire, a high risk of additional
collision, or this is required for the control of the
airways, in order to stop severe bleeding or for
basic vital support. In any other situation, the risk
of mobilization overcomes the benefits.
Head injury

external injuries, usually involving the scalp

bleeding, sometimes severe
internal head injuries, which may involve the skull,
the blood vessels within the skull, or the brain
Blunt head trauma cerebral
contusion/intracranial bleeding
Intracranial hypertension herniation
arrest
Symptoms and signs
Headache
Vomiting
Aggitation
Consciousness :
Somnolence/coma
Abnormal breathing
Wound bleeding
Clear fluid from the nose, ear
Disturbance of speech or vision
Pupils of unequal size
Weakness or paralysis
Neck pain or stiffness
Signs of severity
an infant
has lost consciousness, even briefly;
won't stop crying
complains of head and neck pain (younger or
nonverbal children may be more fussy)
vomits several times
does not awaken easily
becomes hard to console
isn't walking or talking normally
If your child is not an infant, has not lost consciousness,
and is alert and behaving normally after the fall or blow:
Apply an ice pack or instant cold pack to the injured
area for 20 minutes every 3 to 4 hours. If you use ice,
always wrap it in a washcloth or sock; ice applied
directly to bare skin can injure it.
Watch your child carefully for the next 24 hours. If you
notice any of the signs of internal injury, call your
doctor right away.
If the incident happens close to bedtime or naptime
and your child falls asleep soon afterward, check in a
few times while he or she sleeps.
Unconscious child:
Do not try to move your child in case there is a neck or
spine injury.
Call for help.
Turn a child who is vomiting or having a seizure onto
his or her side while trying to keep the head and neck
straight. This will help prevent choking and provide
protection in case of neck and spine injury.
The victims of accidents should be asked if their memory is
unaffected
The state of consciousness will always be evaluated
Facial injuries can compromise the permeability of the
airways.
Manifestations suggests the coexistence of cranial trauma:
 A head wound;
 Cranial deformation;
 Altered consciousness;
 Flowing of cerebrospinal fluid from the ears or the nose;
 Uneven pupils;
 Headache;
 Neurological manifestations such as: agitation, irritability, speech
disorders
First aid measures in cranial trauma
Asking for help (call 112)
Immobilization of the cervical area by the placement of a
cervical collar (if this is available and the rescuer knows the
technique of its application!!!);
Treatment of wounds;
Adoption of the lateral safety position for unconscious
victims;
The cerebrospinal fluid is allowed to flow freely – if the
lateral position is necessary, the wounded part is placed in
a downward position;
The victims with a contusion are not allowed to “jump
about”
Netter; Atlas of Human Anatomy
Neck hyperextension
Subluxation of the mandible
Cervical spine trauma with medular
involvement
Guedel airway
 First aid in spinal trauma
 The injuries of the spine are dangerous
because the concomitant injury of the spinal
cord may cause a number of severe
complications such as: tetraplegia (complete
limb paralysis), paraplegia (lower limb
paralysis), loss of cutaneous sensitivity, loss
of urinary control, sphincter control, chronic
pain, etc.
 Any conscious or unconscious patient
with a cranial trauma is considered to
have an associated spinal injury until the
contrary is demonstrated.
 First aid in spinal trauma
 The signs suggestive of spinal trauma
include:
– Trauma occurring at a high speed, in contact
sports, falls from a height;
– Unnatural position of the neck, spine;
– Pale, cold, perspiring skin;
– Tingling sensation and absence of sensitivity in the
limbs;
– Absence of pain in the limbs in spite of the present
lesions;
– Inability to move the limbs;
– Signs of shock.
 First aid in spinal trauma
First aid consists of:
 Asking for help (call 112);
 Immobilization of the cervical spine by the placement
of a cervical collar; this will be removed only if it
prevents airway desobstruction;
 Maintenance of the head aligned with the spine,
without moving it in any direction;
 Treatment of shock;
 Maintenance of the body temperature;
 Mobilization is performed by rolling the victim using
two or three assistants, with the maintenance of the
axis of the spine aligned with the axis of the head
Rolling of the victim with a
cervical spinal trauma
Dorsal spine trauma T7-T8
FRACTURET12
 Haemorrhage
 External
 Internal – thorax, abdomen, pelvic
fractures, long bone fractures, scalp
lacerations
First aid in external hemorrhage
 The rapid loss of half the circulating blood
volume is fatal even in young healthy
organisms, while the loss of 80% of the
erythrocyte volume under conditions of
relatively maintained volemia is much better
tolerated, without significant consequences.
 Without adequate blood flow, the
organism will very rapidly undergo
collapse and shock, followed by
irreversible failure of various organs and
systems.
 Type of bleeding
 The lesions of arteries are accompanied
by pulsed bleeding, with light red blood
 The lesions of veins are accompanied by
bleeding with a darker continuous blood
flow
 The capillaries blood is light red, with a
slow diffuse flow
 First aid in external hemorrhage
 Asking for help! (call 112);
 Wearing protection gloves (if available);
 Examination of the wound for foreign bodies;
 Application of pressure to the wound with a sterile or an as clean as
possible compress (the victim can initiate or continue self-
compression);
 Positioning of the victim on the back;
 Elevation (if possible) and maintenance of the affected part (scalp,
neck, head, upper limbs) above the heart level;
 Application of a sufficiently tight bandage in order to maintain the
dressing;
 Checking of the circulation in order to make sure that the dressing is
not too tight;
 Reevaluation every 30 minutes, with the assessment of
consciousness, pulse and respiration;
 Treatment of shock if needed and if available;
 Application of a tourniquet if bleeding cannot be controlled;
 First aid in internal hemorrhage
 can be visible hidden (internal bleeding)
 becomes visible as a result of externalization through
natural orifices (vomiting or stool with blood, urine with
blood, etc.)
 Signs suggestive of internal bleeding include:
– Pale, wet and cold skin;
– Thirst;
– Rapid and weak pulse (tachycardia);
– Rapid and superficial breathing (polypnea);
– Pain, discomfort;
– Nausea, vomiting;
– Progression to shock (agitation, confusion, coma,
seizures caused by ischemic brain damage).
 First aid in internal hemorrhage
 Asking for help (call 112);
 The conscious victim is positioned on the back with
the legs raised
 The unconscious victim – lateral safety position and
raised legs
 Reevaluation at short time intervals
 Treatment of the other lesions
 Nothing is administered by oral route!!!!
 The rescuer should always assume that internal
bleeding is present and that he/she can do nothing to
control it. The patient’s life depends on the time
elapsed until qualified medical assistance is
provided.
 First aid in the shock of the
traumatized patient
 Shock is a life threatening condition!!!
 Traumatic shock may have multiple causes:
 - Bleeding
 - High spinal lesions accompanied by medullary cord lesions
 - Crush injuries
 The signs of shock are:
– Pale, wet and cold or cyanotic skin (in the absence of hemorrhage)
– Thirst;
– Rapid and weak pulse;
– Rapid and superficial breathing;
– Pain, discomfort (or their absence under conditions of massive
trauma or severe neurological disorder);
– Collapse (collapsing blood pressure)
– Altered sensorium, agitation, apathy or unconsciousness;
– Gradual arrest of vital functions.
 First aid in the shock of the
traumatized patient
 A rescuer who evaluates a traumatized
victim should anticipate the risk of
traumatic shock and ask himself/herself
several questions:
– Is the injury severe?
– Is the victim in shock?
– In the absence of intervention, does the victim
have a high risk of developing shock ?
If YES! Apply the measures from internal
bleeding + keep the patient normothermic
Thoracic trauma
 First aid in thoracic trauma
 The main thoracic injuries are rib fractures,
flail chest and penetrating wounds.
 Any of these injuries can be complicated by
pneumothorax or hemothorax
 Rib fractures represent a problem because
they can affect breathing. The victim has
chest pain, particularly during inspiration,
rapid and superficial breathing, accelerated
pulse.
 Flail chest is a multiple rib fracture, occurring
in at least 2 places, which dramatically affects
the dynamics of respiratory movements
 First aid in thoracic trauma
 Penetrating thoracic wounds are extremely
severe and should be considered so
regardless of their size and the initial good
state of the patient.
 It is vital that the penetrating object remains
in place. Even if this is too long (pole, tree
branch), help will be asked for urgently, but
under no circumstances will the rescuer
remove the object penetrating the chest .
Tension PNEUMOthorax
CT scan
 First aid in abdominal trauma
 can be accompanied by considerable
bleeding
 Evisceration is the protrusion of an abdominal
viscus (usually intestines or epiploon) through
the wound.
 Dressing is applied to such a wound, clean,
preferably wet sterile compresses will be
used, which do not adhere to the organ.
 The organs will not be reintroduced in the
abdomen
 The victim can also be in shock, with severe
hemorrhage and torn intestines.
Abdominal blunt trauma
 The triage of patients with traumas
severity and therapeutic priorities
generally applied to multiple victims
some seriously injured persons must be temporarily
ignored, to the detriment of much more severe
victims.
the person performing the triage should answer three
questions:
Who needs a life saving intervention?
Who will really benefit from an intervention and
who will not?
If one person is treated, will there be another one
who will suffer from lack of attention?
The triage of patients with traumas
 when first aid is given with limited
resources, try to prioritize:
1. the safety of the victim,
2. the permeability of the airways,
3. the maintenance of respiration and
circulation,
4. the control of severe hemorrhage,
5. to diagnose of shock of any cause
6. burns
The triage of patients with traumas
Cardio-respiratory arrest will be treated only if
there are no other victims whose lives are
threatened !!!!
Level 1 on priority
◦ An unconscious patient lying on his back, a patient with severe
hemorrhage, a patient with cranial trauma in shock
Level 2 on priority
◦ Conscious patient with a leg fracture
Level 3 on priority
◦ Conscious patient who walks and shouts as loud as he can that his elbow
hurts
Burned patients
 History

 Type: fire, chemical, electrical

 Substances involved
 Associated trauma
 Closed space?
 Timing
 Smoke inhalation?
 Others:
- Allergies
- Medication
- Other diseases
- Last meal
 First aid in burns
 Burns are lesions of tissues caused by a
flame, hot objects or fluids, chemical
substances, radiation or a combination of
these
 Electrical burns, although less common, are
usually more severe and deeper than they
seem to be, being sometimes accompanied
by cardiac arrhythmias.
 Most important

 Rescuers’ safety
 Stop electricity, gases
 Remove the victim away from the source
 First aid in burns
 Asking for help (call 112)
 Personal protection (wearing of gloves);
 Cooling of the burned extremities with clean water (up to 20 minutes
for a flame, at least 20 minutes for chemical burns, at least 30
minutes for bitumen). Bandaging by covering with a dressing;
 Removal of clothes and objects that are fixed tightly to the
extremities (rings, jewels).
 Medical examination is compulsory if:
- The burn is larger than the size of the palm of the victim;
- The victim has inhaled smoke, hot air (explosions in closed spaces);
- The victim is a child;
- The burn involves the palm, the face or the genital organs;
- The burn is caused by laser radiation, microwaves, infrared, ultraviolet
or other radiation;
 Open airways- CPR if necessary
 Remove clothes if possible
 Wet clothes in burned areas

 Spinal imobilisation
 The following will be avoided:

 vesicles will not be broken

 bitumen will not be removed from the eyes
or skin
 no creams or other lotions will be used;
 the burned area and the victim will not be
excessively cooled in order to avoid
shiver.
 Smoke inhalation

- Explosion
- Closed spaces
- Unconscious victim
- Throat soreness
- Stridor
- Dispnea
- Dispnea
- Hyperventilation
- Facial burns
 First aid in electrocution
 The victim should be urgently disconnected from the
power source by the interruption of power or by moving
the victim using non-conducting materials – wood,
blankets.
 The rescuer has the duty to protect himself and the
others and will not expose himself to the additional risk
of electrocution
 First aid consists of:
- Asking for help (call 112), with the mention of the type of electric
power;
- Protection of the rescuer and the victim against electrocution;
- Personal protection (wearing of gloves);
- Application of vital support measures if indicated;
- Application of the first aid protocol in the case of the presence of
burns.
Final take home message
Trauma is a leading cause of death and serious
long-term disability in developed nations.
By continuous education, medicine can prevent the
impact and consequences of trauma.
The high quality of First aide at the scene of injury
can be lifesaving.