PHARMAPLUS MEDICAL COLLEGE

Providing Basic First aid and

Emergency Response

BY: CHALTU H 11/15/2023

 INTRODUCTION TO FIRST AID

Learning Objectives: At the end of this session the

learner will be able to:-
1. Define the term first aid and an emergency situation
2. Recognize objectives of giving first aid
3. Appreciate values of first aid
4. Identify general directions for giving first aid
5. Recognize and manage immediate life threatening
conditions to emergency patients/ victims.
BY: CHALTU H 11/15/2023
 1. Definition of terms
3

 An emergency: is an urgent, unexpected, and usually dangerous

situation that poses an immediate risk to health, life, property, or
environment and requires immediate action.
 An Emergency Situation/accident: on the other hand, is a situation, if
not managed properly and avoided, that poses a substantial risk, threat,
obstruction or danger to the present or future physical impairment,
property and financial damage.
BY: CHALTU H 11/15/2023
 …
4

 Hazard is anything that may cause harm to an individual, such as

chemicals, electricity, open drawers, and inadequate ventilation.
 Physical hazards are the most normal occurrences in workplaces.
 Another reason may be due to lack of knowledge or people do not see
situations as hazards.

BY: CHALTU H 11/15/2023

 Definition of terms…
5

 First aid - is the immediate care given to a person who has

been injured or suddenly taken ill & before the patient
reaches to health facility by materials available at hand.
 It includes home care if medical assistance is not available or
delayed. It also encompasses reassurance using well selected
words of encouragement, evidence of willingness to help, and
promotion of confidence by demonstration of competence .
BY: CHALTU H 11/15/2023
 2. Objectives of First Aid provision
6

The 4Ps:
1. Preserve life.
E.g. mouth to mouth artificial respiration when breathing has
stopped.
2. Prevent further injury(complications)
E.g. - Immobilizing the fractured bones.
- cervical spine protection
3. Promote healing and recovery. e.g. reassure the patient, relief pain,
protect from cold and arrange for transfer.
4. Protect yourself – don’t be a 2nd victim!
BY: CHALTU H 11/15/2023
 3. Values of First Aid learning

• The need for first aid learning is increasing ever before. Why?
1. Population growth
2. Increased use of technological products
3. Change in Socio economic & spreading infrastructures . E.g.
Construction of roads, hotels, universities stadiums, factories,
dams, etc.
4. Change in epidemiology of diseases
a. Double burden of disease”- mainly in developing countries,
b. Prevalence of injuries(trauma): car accidents, Sport activities,
occupation related injuries… BY: CHALTU H 11/15/2023
 4. General directions to give first aid

1. Assessment of the situation - scene size up

- "Size-up" - the initial quick analysis of the scene upon
arrival.
 Nature of accident?
 What was the cause?
 Is the scene safe?
 How many victims were involved?
 The traffic patterns around the incident? etc
BY: CHALTU H 11/15/2023
 General directions….
9

 The five principles of scene size up:

1. Done appropriate body substance isolation (BSI).
2. Determine if scene/situation is safe.
3. Determine MOI/NOI
4. Determine number of patients.
5. Request additional help if necessary.

BY: CHALTU H 11/15/2023

 General directions….
10
Common hazards at the scene:
 Oncoming traffic

 Unstable surface (e.g. Wet or muddy, sliding , slope)

 Leaking fluid and fumes

 Broken utility poles and downed electric wires

 Hostile bystanders with a potential for violence

 Smoke or fire

 Possible hazards or toxic material (e. g hydrogen chloride)

 Violence and crime scene BY: CHALTU H 11/15/2023

 General directions cont’d
11

2. Extricating the victims

 Disentangling the patient from where they are entrapped.
 Can be simple or advanced
 Has two primary goals:
 To obtain safe access to the patients
 To ensure patient stabilization
BY: CHALTU H 11/15/2023
 One-Person Rapid Extrication
12

BY: CHALTU H 11/15/2023

 General directions cot’d
13

3 . Triaging/prioritizing
 A process of sorting patients based on the severity of each

patient’s conditions.
 A casualty may have more than one injury

 Some casualties will require more urgent attention than others.

 The aim depends on the situation of the event:

1. Severity
2. Number of victims/medical or trauma
3. Capacity of the facility or the area
BY: CHALTU H 11/15/2023
 General directions…. cont’d
14

4. Giving immediate and adequate treatment

_ ABC of life!
_ Always ‘A’ before ‘B’, ‘B’ before ‘C’, …
5. Arrangement for the transport of casualty
1. Without delay
2. Accompanied with brief written report
BY: CHALTU H 11/15/2023
 INITIAL ASSESSMENT OF EMERGENCY PATIENTS

15

 Also called primary survey

 Rapid thorough simultaneous assessment and management
of vital functions.
 A single, critical, all important goal: to identify and initiate
treatment of immediate or potential life threats.
 Performed on all patients after assuring scene and
personal safety.

BY: CHALTU H 11/15/2023

 The Primary Survey…..

16
It uses the systematic approach: DR.ABCDE.
 Dangers
 Response
 Airway
 Breathing
 Circulation
 Disability
 Exposure/Environment
BY: CHALTU H 11/15/2023
 D= DANGER

17

 Eliminate/minimize the hazards/dangers.

 If too dangerous to approach, keep at a safe distance and call the
ambulance services.
 Avoid only those hazards you can avoid; never attempt beyond
your training level
 If need arise, seek additional resource
 Use BSI/PPE - Gowns, face shields, eye glass,
BY: CHALTU helmet, boot etc
H 11/15/2023
 R = RESPONSIVENESS

18

• If you have more than one casualty, always treat the

unconscious ones first.
 Use the touch and talk approach
 Use the 'COWS' method: Can you hear me? Open your
eyes? What's your name? Squeeze my hands.
 NB: NEVER SHAKE an unconscious casualty.
BY: CHALTU H 11/15/2023
 Response cont’d
19

─If the casualty responds:

• Put on recovery position
• Move on to other victims
─ If the casualty is unconscious, not responding to talk & touch,
• Call your ambulance
• Move onto the airway.

BY: CHALTU H 11/15/2023

 A= Air way assessment & Mgt

20

 Keeping the head in the position you found, look in

to the mouth.
 See for the patency; Presence of any foreign body or
secretions
 See whether the tongue is falling back to obstruct the
airway.
BY: CHALTU H 11/15/2023
 Air way assessment ….

21

 See for any facial bone deformity, whether the trachea

is central or not.
 Look for neck swelling, over distended neck vessels,
chest deformities
 Look for symmetric chest movements
 Listen for any abnormal sounds during breathings
BY: CHALTU H 11/15/2023
 Indicators of air way problem

22

 Facial/ chest deformity

 Tracheal deviation from center.
 Neck swelling, over distended neck vessels,
 Asymmetric chest movements
 Abnormal breathing sounds
 Conscious pts prefer to sit up and lean forward.
 Fast breathing /RR> 25/min.
BY: CHALTU H 11/15/2023
 Air way management

23

Air way opening with cervical spine protection

 If any solid or liquid is found, place the casualty onto their
side and clear the airway.
 If nothing is found but not breathing adequately, open the
airway.
 Use either the head tilt-chin lift or jaw thrust
BY: CHALTU H 11/15/2023
 Techniques of opening air way
24

1. Head tilt/chin lift

 Place one hand on the casualty's forehead and two fingers
under the chin.
 Tilt the head back and lift the chin up to open the airway.
 Used for victims with no suspicion of cervical spine
injuries.
BY: CHALTU H 11/15/2023
 Techniques of opening air way…
25

Head tilt/chin lift

BY: CHALTU H 11/15/2023
 Air way tec cont’d…
26

2. Jaw thrust – lifting the mandible using both mandible

angles and pushing forward and upward.
 use especially in patients with suspicion of cervical spine
injury (see picture below).

BY: CHALTU H 11/15/2023

 B = BREATHING
27

Check the casualty's breathing

How?
by placing your ear and cheek near their mouth and nose whilst
looking at their chest:
Look for movement of their chest and upper abdomen.
Listen for normal breathing
Feel for breath on the side of your cheek
Assess their breathing for no longer than 10 seconds before
deciding whether breathing is normal or not.

BY: CHALTU H 11/15/2023

28

BY: CHALTU H 11/15/2023

 Indicators of abnormal breathing
29

 Absence of breath sound/gush of air

 Absence of chest movement
 Deviation of trachea
 Use of accessory muscles of respiration
- Sternocleido- mastoid muscle
- Substrenal retractions
 Sweating, restlessness, cyanosis
BY: CHALTU H 11/15/2023
 Figure: 24. Mouth to mouth respiration for adult casualty
30

BY: CHALTU H 11/15/2023

 Action
31

1. If the patient has adequate breathing effort, place in

recovery position - Putting unconscious pt with good
breathing and have a pulse with the patient leant over on
their side

BY: CHALTU H 11/15/2023

 Action …
32

2. If the casualty’s breathing is absent or inadequate, shout for

help, give2 artificial respiration/rescue breaths
 Note: If breathing problem persists,
 Rescue breathing should
be continued at 8 -10/min.

BY: CHALTU H 11/15/2023

 C=Circulation assessment and Mgt
33

 Pulse – carotid, radial, femoral, apical, Brachial

 Skin color / cyanosis
 Temperature
 Check blood pressure
 Mental status examination
 Look for any visible bleeding or signs of internal bleeding.

BY: CHALTU H 11/15/2023

 Action

34

After assessing pulse for circulation on the carotid artery for 9-

10sec,
 If no pulse, start CPR)
CAB/ ABC ( 30:2) – 5 cycles
If there is visible is bleeding,
control bleeding.
Treat for shock BY: CHALTU H 11/15/2023
 D= Disability
35

 Level of consciousness with AVPU /GCS

 A= Alertness

 V= Verbal response

 P= Pain response

 U =Unresponsive

BY: CHALTU H 11/15/2023

 Disability…
36

 Assessing responsiveness and orientation

a. Use AVPU scale to asses responsiveness.
1. Alert
a. Eyes open spontaneously as you approach
b. Patient follows commands
c. Eyes track people and objects
2. Responsive to Verbal stimulus
a. Eyes do not open spontaneously
b. Patient’s eyes do open to verbal stimuli
BY: CHALTU H 11/15/2023
 Disability….
37

3. Responsive to Pain
a. Patient does not respond to questions
b. Patient cries out or moves in response to painful stimuli
4. Unresponsive
a . The patient does not respond to verbal or painful stimuli

BY: CHALTU H 11/15/2023

 Disability….
38

b. For a person who is alert and responsive to verbal

stimulus, evaluate orientation.
 Orientation test mental status by checking a patient’s memory

and thinking ability.

 The most common test evaluates a patient ability to

remember four things:

 Person—remembers his or her name
 Place—identifies the current location
 Time—the current year, month, and approximate date
 Event—describes what happened BY: CHALTU H 11/15/2023
 Disability….
39

 Unresponsive patient is always priority

 First aid measures:
 Manage A & B
 Head elevation, 300
 C-spine precautions
 Dextrose

BY: CHALTU H 11/15/2023

40
E= Exposure and Environmental control
 Remove all wet or contaminated clothing
 log roll the patient to examine the back and buttocks
 Keep the patient warm

to prevent hypothermia

BY: CHALTU H 11/15/2023

 Summary of Emergency pt ass’t
41

BY: CHALTU H 11/15/2023

 k
42 BY: CHALTU H 11/15/2023
 Self assessment questions
43

Assess how well you have achieved objectives of the chapter

by attempting the ff questions
1. Define the term first aid
2. List 4 objectives of giving first aid
3. Outline the systematic approach to emergency victims

BY: CHALTU H 11/15/2023

 First Aid for complete air way obstruction/ Choking
44

 The treatment for a choking person varies with the age.

1. Abdominal thrusts (“Heimlich maneuver")
 The quick, upward abdominal thrusts is applied.
 This pushes the diaphragm upward very suddenly
 used for adults and children older than
one year of age.
BY: CHALTU H 11/15/2023
 How to perform abdominal thrusts
45
A. Lean the person forward slightly and stand behind him or her.
B. Make a fist with one hand.
C. Put your arms around the person and grasp your fist with your other
hand in the midline just below the ribs.
D. Make a quick, inward and upward hard movement five times in an
attempt to assist the person in coughing up the object.
E. This maneuver should be repeated until the person is able to
breathe or loses consciousness. BY: CHALTU H 11/15/2023
46

BY: CHALTU H 11/15/2023

 If the person loses consciousness

47

A. Gently lay him or her flat on their back on the floor.

B. clear/open the airway
C. kneel next to the person and put the heel of your hand
against the middle of the abdomen, just below the ribs.
D. Place your other hand on top and press inward and upward
five times with both hands/Abdominal trust.
E. If the airway clears and the person is still unresponsive,
begin CPR

BY: CHALTU H 11/15/2023

 Clearing a Blocked Airway in Infants
48

Back blows/slap
Used for an infant instead of abdominal thrust.
1. The infant is turned face down, the chest resting on
the rescuer's forearm, with the head lower than the
body.
2. The rescuer then strikes the infant between the
shoulder blades 5 times using the heel of the hand.
Note: The strikes should be firm but not hard enough to
cause injury.
3. The rescuer then checks the mouth, removing any
visible objects. BY: CHALTU H 11/15/2023
 Choked infant cont’d…
49
4. If the airway remains blocked, the rescuer turns
the infant face up with the head down,
5. Using the second and third fingers,
thrusts inward and upward on the
infant's breastbone 5 times (chest thrusts).
6. The rescuer then checks the mouth again.

BY: CHALTU H 11/15/2023

 Step of Chocking Management for adult & children more than 1
ages
50

1. Encourage coughing
2. Provide x 5 back slap
3. Perform x 5 Abdominal thrust
4. Continue no. 2 & 3 interchangeably Until:-
I. the object removed
II. The patient becomes unconscious - CPR
5. Reassure the patient, if necessary provide oxygen

BY: CHALTU H 11/15/2023

 Chocking Mgt for Infant
51

1.Check level of consciousness

2. Provide x5 back slap on your thigh
3. Provide x 5 chest thrust by 2 finger
4. Continue no. 2 & 3 until the foreign objects remove or
the infant becomes unconsciousness
5. If the infant becomes unconscious start CPR

BY: CHALTU H 11/15/2023

 Cardiac arrest
52

Cardiac arrest remains a substantial public health problem

 Leading cause of death in many parts of the world.
 Cardiac arrest occurs both in and out of the hospital.

BY: CHALTU H 11/15/2023

 Causes of cardiac arrest
53

─ Cardiac origin: ventricular fibrillation, Pulseless

tachyarrhythmia's due to ischemic heart disease, shock, stroke.
─ Respiratory origin: upper airway obstruction, drowning,
smoke inhalation, drug overdose, physical trauma.
─ Metabolic disturbance: electrolyte imbalance, acid base
imbalance.
BY: CHALTU H 11/15/2023
 Cardiac arrest…
54

 Common presentations:
1. Breathing /absent or is not normal
2. Labored breath
3. Absence of pulse
4. Unresponsiveness
BY: CHALTU H 11/15/2023
CPR
 What does CPR stand for?
56
 C = Cardio (heart)

 P = Pulmonary (lungs)

 R = Resuscitation (recover)

 It is the activity w/c is performed for the pt who is in state of cardiac

arrest & respiratory arrest

Oxygen is the basic requirement for breathing

and every Living cell in the body
BY: CHALTU H 11/15/2023
 Indication of CPR
57

1. Cardiac Arrest ( Pulseless pt)

2. Respiratory Arrest ( Respiratory Distress, No breathing pt
3. Burn Pt
4. Unconscious pt

Contra Indication Of CPR

a. Rib fracture
b. Excessive Wound on the Chest
BY: CHALTU H 11/15/2023
CARDIOPULMONARY RESUSCITATION
 Cardiopulmonary Resuscitation(CPR)
59

 Term used to describe a combined technique of mouth to

mouth ventilation and closed cardiac chest compressions
in a pulse-less pt.
 It is a combination of artificial respiration and manual

artificial circulation.
 The aim of heart message is to:
 press the heart between the breast bone (sternum) and the backbone (spine)
thus literally squeezing blood out of it.
 Maintain blood flow/oxygenation through the body enough to give a person a
chance for survival
BY: CHALTU H 11/15/2023
 Goal of CPR
60

 Restore effective oxygenation & ventilation

 Restore circulation
 Return of intact neurological functions
 “Resuscitate the heart protect the brain”

BY: CHALTU H 11/15/2023

 What types of situations might cause a victim to need
CPR?
61

 Heart attack  Choking

 Drug overdose  Poisoning
 Accidents  Smoke Inhalation
 Stroke  Epilepsy
 Diabetes  Suffocation
 Drowning

BY: CHALTU H 11/15/2023

62
Chain of survival
For effective result of resuscitation there should be:
 Early access to the patient or victim

 Early CPR initiation

 Early defibrillation/control of massive bleeding

 Early & effective post resuscitation care

BY: CHALTU H 11/15/2023

 Sequence of Adult CPR

63

A. Check the Victim for unresponsiveness.

Gently shake them and ask “Are you all right,
are you okay?”

B. If the victim doesn’t respond, SEND SOMEONE

TO GET HELP. Call local emrgency and return to
the victim.

BY: CHALTU H 11/15/2023

 Sequence of Adult CPR…

64

C. Use the head tilt, chin lift method to

open airway.
D. Look, listen and feel for breathing.
E. If the victim is not breathing normally,
pinch the nose and cover their mouth
with yours.
- Give 2 full breaths until you see the
chest rise. Each breath should last about
1 second.
- With each breath the chest should lower
BY: CHALTU H 11/15/2023
and rise so you know that air is getting in.
 Sequence of Adult CPR….

F. After giving two breaths, asess pulse and

65

immediately begin chest compressions.

- Use the nipple line (“armpit over”) to
determine the proper place to do chest
compressions.
- Push down on the chest 1 1/2 to 2
inches, 30 times right between the nipples
where the heart lies. (ratio 30:2)
- Push at the rate of 100 compressions / 1
minute
- If you see chest movement, put the victim
in the side position in case theyBY:
vomit.
CHALTU H 11/15/2023
 Chest compressions should be performed on the
lower
½ of the sternum
66 BY: CHALTU H 11/15/2023
 Locate the center of the chest
67

BY: CHALTU H 11/15/2023

Proper position of the hand
68

BY: CHALTU H 11/15/2023

 CPR – 1 Rescuer
69

 Assess
responsiveness
 Summon EMS
 Position the
patient

BY: CHALTU H 11/15/2023

 CPR – 1 Rescuer
70

Open the airway

BY: CHALTU H 11/15/2023

 CPR – 1 Rescuer
71

 Look, listen, and

feel for breathing

BY: CHALTU H 11/15/2023

 CPR – 1 Rescuer
72

 If there is no breathing,
give two breaths, each
lasting 1 second

BY: CHALTU H 11/15/2023

 CPR – 1 Rescuer
73

 Check for a pulse (≤

10 seconds)

BY: CHALTU H 11/15/2023

 CPR – 1 Rescuer
74

 If there is no pulse,
find your landmarks,
lower half of the
sternum, between the
nipples

BY: CHALTU H 11/15/2023

 CPR – 1 Rescuer
75

 Begin chest
compressions

BY: CHALTU H 11/15/2023

 CPR – 1 Rescuer
76
 Perform 30 chest
compressions
 Push hard; Push fast
 Allow the chest to
recoil after each
compression

BY: CHALTU H 11/15/2023

 CPR – 1
77
Rescuer
 Administer two
ventilations
then return to
compressions

BY: CHALTU H 11/15/2023

 CPR – 2 Rescuer
78

1 2

3 4

BY: CHALTU H 11/15/2023

79
Con…
NOTICE
 Interruptions should be avoided/ minimized

 Provide chest compressions continuously during CPR.

BY: CHALTU H 11/15/2023

 For each compression it is important to push down
far enough and to be sure the chest is completely
relaxed after each compression.
This will allow the heart to fill with blood after each
80 compression. BY: CHALTU H 11/15/2023
 CPR - Children
81

 Use heel of one hand

 Keep airway open with

other hand
 30 compressions:2

ventilations if alone
 If 2 rescuers, use 15:2
BY: CHALTU H 11/15/2023
 CPR - Infant
82

 Give chest thrusts

and puffs of air
 30 compressions:2

ventilations if alone
 15 compressions: 2

ventilations with 2
rescuers
BY: CHALTU H 11/15/2023
 Compression Techniques
Position:
for all ages: compress the lower third of the
sternum

Number of hands:
• In infants: two thumbs or two fingers
• in children: use one or two hands: depressing
the sternum by approximately one third of the
depth of the chest
BY: CHALTU H
11/15/2023 83
 When do we discontinue CPR?
84

 The victim responds. HOW CAN U RECOGNIZE

THAT?
 The rescuer collapses.

 A doctor pronounces the victim dead.

 Someone with equal or more training takes over.

 With a child/infant – stop after 1 minute to call

emergency call if you are alone or no one will be

coming.
BY: CHALTU H 11/15/2023
 Algorithms of CPR
85

1.Enviromental Assessment / Scene size up

2. Check level of consciousness (Loc)
3. Call to Emergency Department (Zone/woreda/health
office / Driver of Ambulance
4. Open Air way & clear any secretion ( Either Head tilt-Chin
lift /Jaw Thrust
5. Assess breathing by LLF & provide 2Ventilation as needed
6. Assess Circulation ( Carotid pulse, Brachial Pulse)
BY: CHALTU H 11/15/2023
86

7. Start chest compression if there is no pulse ( 30 Chest

compression)
Place= measure 2 finger from xiphoid process ,Always
being at right side of the patient
 2 hands – for Adult

 1 hand – for Child

 2 finger – for Infant

 For all performed for 5 cycle

BY: CHALTU H 11/15/2023

87

8. Continues 2V : 30CC = For 5 cycle

9. Reassess pulse, breathing , if the present Add 2 ventilation
then place in `
So total Chest compression to Ventilation ratio would be___??
10. Refer , communicate to the health institution you are
referring the patient,
11. Document your activities in two copies

BY: CHALTU H 11/15/2023

 Self Assessment Questions
88

1. Define First Aid

2. List Aims/ Objectives of First Aid
3. Define chocking & List adult chocking Mgt
4. Discuss ABC
5. Define CPR, then:
A. List Indication of CPR
B. Contra indication of CPR
C. Write down algorithms of Adult CPR
6. How do you Control External Bleeding?
7. How do you provide First aid for a person who suffered by poisoning?
BY: CHALTU H 11/15/2023
 Bleeding/hemorrhage control
89

 loss of blood, usually through diseased body part, or injured

body part by other physical conditions.
 Can be Internal or external

Internal bleeding:
 Bleeding inside body cavity

 may follow an injury, such as a fracture or a penetrating

wounds;
 Can also occur spontaneously, eg. bleeding from a stomach

ulcer
BY: CHALTU H 11/15/2023
 Bleeding/hemorrhage
90

 Is loss of blood from the body due to any factor.

Can be
1. Internal bleeding- The bleeding comes from internal body cavities or hole.
Example From EAR, EYES, MOUTH ,ANUS, VAGINA, URETHRA &
NOSE.
MGT:
 Maintain ABC
 Positioning
 Refer
1. External bleeding- the bleeding comes from External body parts. Example
arm & leg bleeding
BY: CHALTU H 11/15/2023
 Effects of Internal bleeding
91

 Shock (main risk)- Inability of circulatory system to meet

tissues demand for oxygenated blood.
 Blood can build up around organs(lungs or brain and Heart)
 Exert damaging pressure on them.
 Anemia

BY: CHALTU H 11/15/2023

 How to recognize internal bleeding

92

 Signs of shock without obvious blood loss

 Initially, pale, cold, clammy skin
 If bleeding continues, skin may turn blue- grey (cyanosis).
 Rapid, weak pulse
 Rapid , shallow breathing
 Confusion, restlessness, and irritability.
 Possible collapse and unconsciousness
 Any bleeding from body openings (orifices)
such as the ear, mouth, urethra, or anus
BY: CHALTU H 11/15/2023
 Severe Bleeding

93

 There appears to be a significant mechanism of injury.

 Patient has a poor general appearance.
 The patient exhibits signs and symptoms of shock.
 There is a significant amount of blood loss noted
 The blood loss is rapid.
 Bleeding cannot be controlled.
BY: CHALTU H 11/15/2023
 Characteristics of bleeding

94

A) Arterial bleeding
Arterial bleeding is bright red (high in oxygen) and
spurts in time with the pulse.
The pressure that causes the blood to spurt also makes this
type of bleeding difficult to control.
As the amount of blood circulating in the body drops, so
does the patient’s blood pressure, eventually, the arterial
spurting

BY: CHALTU H 11/15/2023

 Characteristics of bleeding
95
B) Venous
- Much darker (low in oxygen) and flows steadily.
 B/c its under less pressure, most venous blood does not
spurt.
This makes it easier to control bleeding.
C) Capillary bleeding
 dark red and oozes from a wound steadily but slowly.
Venous and capillary blood is more likely to clot
spontaneously than arterial blood

BY: CHALTU H 11/15/2023

 Types of bleeding
96

BY: CHALTU H 11/15/2023

 Direct pressure and elevation

97

 The most effective way to control external bleeding.

 Pressure also permits coagulation.
 Holding uninterrupted pressure for at least 5 minutes and
elevating a bleeding extremity by as little as 6'' often stops
venous bleeding
Apply pressure with your gloved finger or handover the top
of a sterile dressing. BY: CHALTU H 11/15/2023
 Direct pressure con’d…
98

 If there is an object protruding from the wound, apply bulky

dressing to stabilize the object in place.
 Remember to never elevate an open fracture to control bleeding.
 Maintain the pressure by firmly wrapping a sterile, self-
adhering roller bandage around the entire wound.
 Cover the entire dressing above and below the wound.

BY: CHALTU H 11/15/2023

 Direct pressure cont’d
99

 Techniques of External bleeding Control

1. Direct Pressure

2. Elevation

3. Pressure Point

4. Tourniquet

BY: CHALTU H 11/15/2023

 Direct pressure…
100

BY: CHALTU H 11/15/2023

 Direct pressure, pressure points
101 and elevation

BY: CHALTU H 11/15/2023

 First Aid measures for a person with External bleeding
102

1. Control the bleeding

2. ABC
3. Reassuring the pt
4. Facilitate referring

BY: CHALTU H 11/15/2023

 Precautions in using a tourniquet

103

Do not apply it directly over any joint.

Keep it as close to the injury as possible.
Use the widest bandage possible.
Make sure that it is tightened securely.
Never use narrow material, such as a rope, belt, wire; It
could cut into the skin
Should not be stay for more than 10-15’
 Never cover a tourniquet with a bandage; Leave it open and
in full view.
BY: CHALTU H 11/15/2023
 General first aid interventions of wounds

104

Initial
 Secure ABC before management of surface injury.

 Identify and treat other more serious injuries.

 Control bleeding with direct pressure and/or by

elevating the affected part.

 Initial bleeding may help remove dirt and contaminants

from the wound; should be encouraged.

BY: CHALTU H 11/15/2023

 Initial intervention cont’d…
105
 Assess for impaled object.
 DO NOT TRY TO REMOVE, stabilize for removal
under controlled environment.
 Clean the wound using running water as an irrigating
solution and mild soap as a cleansing agent.

BY: CHALTU H 11/15/2023

 Head injury
106

BY: CHALTU H 11/15/2023

 Contributions to Injuries
107
Recreational
Falls
Sports
Alcohol

Violence MVC

BY: CHALTU H 11/15/2023

 Injury to the head
108

 Any head injury is potentially serious. WHY IT IS SO

SERIOUS?
 Bleeding inside skull
 Leads to C-spine injury -Any injury above the level of the
clavicles is considered to involve the C-spine until proven
otherwise.
 If not properly treated, those that at first seem minor may
end up becoming life threatening.

BY: CHALTU H 11/15/2023

 Types
109

 There are two general types of head injuries.

 Closed - in which the brain has injured but there is
no opening into the brain.
 Open- one in which an opening from the brain to
the outside world exists.

BY: CHALTU H 11/15/2023

110
Types of Brain Hemorrhage
 Classified according to
location:
 Epidural
 Subdural
 Subarachnoid
 Cerebral(intraparench

ymal)
BY: CHALTU H 11/15/2023
 Epidural Hematoma
111
 Bleeding between durra & skull
 Associated with skull fracture

● Classic: middle meningeal artery tear

 Lucid interval- talk and die
• rapid build of in intracranial
• signs of increasing intracranial pressure (vomiting,
headache, AMS, body paralysis),
● Can be rapidly fatal- early evacuation is essential
BY: CHALTU H 11/15/2023
 Skull Fracture
112

 Fracture or compression to the skull.

 Life threatening surgical emergency
 It is an indication of a significant force applied to
the head.
 The fracture may be open or closed.
 Brain damage could be involved

BY: CHALTU H 11/15/2023

 Signs of a Skull
113
Frx
 Bruising under
eyes (raccoon
eyes)
 Bruising behind
ears (Battle’s sign)
 Unequal pupils
 An object impaled
in skull
BY: CHALTU H 11/15/2023
 Emergency Care for Skull Fractures
114

 Care as for any head/spinal injury

 Don’t clean wound, press on it, or remove impaled
objects
 Cover wound with sterile dressing
 Immediate transport

BY: CHALTU H 11/15/2023

 Brain Injury
115

Signs and Symptoms

 Severe or persistent headache
 AMS(confusion, unresponsiveness)
 Lack of coordination, movement problems
 Weakness, numbness, loss of sensation, paralysis
 Nausea and/or projectile vomiting
BY: CHALTU H 11/15/2023
 S/S of brain injury…
116

 Seizures
 Unequal pupils
 Problems with vision or speech
Breathing problems or irregularities
Any of the signs suggestive of skull injury

BY: CHALTU H 11/15/2023

 First aid for suspected brain injury
117

 Keep the victim lying down and treat for shock.

 Give particular attention to insuring an open air way.

 Control hemorrhage.

 Do not give fluid by mouth to the victim (keep NPO-

may be surgically exploriated).

 Apply dressing & bandage over the skull if wound is

present.
 Record the level of consciousness.
BY: CHALTU H 11/15/2023
 Summary of HI
118

 ABC management
 Use the jaw-thrust to open airway
 Manually stabilize the head and neck
 Don’t let patient move
 Closely monitor mental status
 Control bleeding; No direct pressure on skull fracture
 Monitor vital signs
 Immediate transport to hospital
BY: CHALTU H 11/15/2023
 Spinal injuries

119

 The spinal column injuries can occur even without

injuring the spinal cord
 But cord injuries can also occur in the absence of obvious
spinal column damage.
 COMMON S/S
 localized pain,
 Paralysis
 sensory loss.
BY: CHALTU H 11/15/2023
 Nose injuries and nose bleeds
120

 Nose is the commonly injured body part.

 Injury to the soft tissue of the nose may or may not include
fracture.
 Can result from injury or disease E.g. hypertension.
 It can also occur after cold, stressful activity or exposure to
high altitude.
BY: CHALTU H 11/15/2023
 Sites of nose bleed
121

 Appropriate control of epistaxis calls for identification

of the bleeding site.
 Nose bleeds are classified mainly into:
 anterior nosebleeds, and
 posterior nosebleeds.
 Bleeding may, however, occur from any other sites!

BY: CHALTU H 11/15/2023

 Anterior nose bleed
122

 Almost invariably associated with Kiesselbach’s

Plexus /Little’s Area/.
 Most commonly occurs in children and young adults.
 Represents 85-90% of all nosebleeds.

BY: CHALTU H 11/15/2023

 Posterior nose bleed
123

 Infrequently linked with the sphenopalatine

artery /”Woodruff’s Plexus”/.
 Accounts for 10-15%
 Mostly involves those older than 50
 Not infrequently controlling becomes a challenge -- ?
Accessibility! Assoc./coexisting ailment/s/

BY: CHALTU H 11/15/2023

 Treatment of Epistaxis :

124

General Measures
 Calm the patient; calm yourself !
 Sit up the patient, head bent fwd,
 mouth breathing,
 pinching the nostrils
 Cold application – nape of neck, nasal root
 Lower BP, d/c anticoagulant
 IV fluid, blood transfusion
BY: CHALTU H 11/15/2023
 Neck injuries

125

 Penetrating vs blunt
block the air way.
 Blockage may also result due

to hard blow
on the front of the
neck especially if the laryngeal area is affected and throat
tissue are bruised,
.
BY: CHALTU H 11/15/2023
 first aid measures

126

-Apply mouth- to -mouth or mouth- to- nose respiration.

-Place the victim on his back (supine position) to relax the
abdominal muscles.
-Control bleeding;
- Give first aid for shock

BY: CHALTU H 11/15/2023

 Open wounds of the abdomen:

127

 Wounds of the abdomen are particularly dangerous.

 risk of damage of the internal organs.
 Intestines may be eviscerated

BY: CHALTU H 11/15/2023

 General First aid of abdominal injury
128

 Secure ABC
 Don't give food or fluid because surgery may be
necessary.
 Keep the victim’s head and shoulders elevated to avoid
breathing difficulty.
 Seek medical attention as rapidly as possible.
 take extreme care to gently transport the victim.

BY: CHALTU H 11/15/2023

 First aid measure for Evisceration
129

 Don't try to replace protruding intestines or abdominal

organs
 Cover it with sterile gauze compresses moistened with sterile
saline solution.
 Secure with a sterile dressing and secure the dressing in
place with a bandage and tape.
 Do not use any material that is adherent or loses its
substance when wet.
 Transport the patient promptly
BY: CHALTU H 11/15/2023
 First aid measures for impaled object into abdomen
130

-If the penetrating object is still

in place, apply stabilizing
bandage around it to control
external bleeding & to minimize
movement of the object in order to
reduce further damage.

BY: CHALTU H 11/15/2023

 Fainting/syncope
131
 Partial or complete loss of consciousness due to a
reduced supply of blood to the brain for a short time.
 Occasionally a person collapsed suddenly without
warning signs.

BY: CHALTU H 11/15/2023

 Fainting…
132

 How it occurs?
 via impaired blood flow to the reticular activating
system or both cerebral hemispheres.
 Transient impaired blood flow to the brain may be due to
systemic hypotension and rapid increase in ICP (eg,
subarachnoid hemorrhage).
 Reduced cerebral blood flow results in loss of postural
tone and unconsciousness.
BY: CHALTU H 11/15/2023
 Risk Factors.
133

 Elderly
 CV disease, Dehydration, anemia
 Medications (eg, diuretics, beta` blockers),
 Pregnancy (inferior vena cava compression by the
uterus).

BY: CHALTU H 11/15/2023

 Fainting manifestations

134

 Extreme paleness ,
 Sweating, Nausea
 Coldness of the skin
 Dizziness, light headedness
 Numbness and tingling of the hands and feet
 Syncope mimickers- Psychogenic, hypoglycemia, hypoxia,
or seizures.

BY: CHALTU H 11/15/2023

 First Aid Measures

135


Leave the victim lying down and raise leg up.
 Loosen any tight clothing and keep crowds away.

 Turn the head to the side.

 Maintain an open air way.

 Do not give any liquid unless the victim has revived.

 Unless recovery is prompt, seek medical assistance

BY: CHALTU H 11/15/2023

 First aid Measures
136

 Prevent victim from hurting himself

 Give artificial respiration if indicated
 Do not place a blunt object between the victims teeth
 Do not restrain him
 Do not pour any liquid in to his mouth
 Do not place a child in a tub of water
 Avoid overcrowding
 Reassure and advise to seek medical attention
BY: CHALTU H 11/15/2023
 Epilepsy/seizure

137
 Epilepsy is a chronic disease usually of unknown cause characterized by
repeated convulsions.
Primary/unprovoked:
-Occur in the setting of persistent brain pathology
Secondary /provoked:
-Triggered by certain provoking factors in otherwise healthy brain.
Common provoking factors are
 Metabolic abnormalities (hypoglycemia and hyperglycemia,

hyponatremia , hypocalcaemia
 Alcohol withdrawal

 High fever in children

BY: CHALTU H 11/15/2023
 First Aid Measures

138
 Keep air way open and give artificial respiration, if breathing
stops
 Push away nearby objects
 Do not force a blunt object between the victim’s teeth.
 If the victim’s mouth is open you might place a soft object such
as rolled hand kerchiefs between his side teeth.
 When jerking is over, loosen the clothing around his neck.
 Keep him lying down.
 After the seizure, allow the victim to sleep and rest
BY: CHALTU H 11/15/2023
 BONE AND JOINT INJURIES

139

Learning Objectives:
After studying this chapter, the student will be able to:
1. Define fracture, dislocation, sprain and strain.
2. Recognize f/a principles for bone and joint injuries.
 3. Demonstrate how to splint specific fractures.
 4. Demonstrate first aid management for dislocation.
 5. Apply first aid management for sprain .
BY: CHALTU H 11/15/2023
 Definition of terms
140

 Fracture -is a complete or incomplete break in the

continuity of bones.
 Dislocation -is complete or Partial separation of the
joint
 Sprain- is a joint injury caused by excessive stretching
of the supporting ligaments.
 Strains- are caused by stretching or tearing of a muscle.

BY: CHALTU H 11/15/2023

 Mechanism of injury
141

 Motor vehicle accident

 Industrial accident (machine)
 Gunshot injury
 Fall from a height, trivial
 Fighting injury
 Pathologic fractures
 Stress fractures

BY: CHALTU H 11/15/2023

 Types of Fracture

142

1. Closed fractures- closed (simple) fractures are those

not associated with open wounds on the surface of the
body.
2. Open fractures – open (compound) fractures are those
associated directly with open wounds.

BY: CHALTU H 11/15/2023

 Examination

143
A. General patient assessment
1. Assess threats to life before focusing your attention on any
injured limb.
2.Limb injuries are not life threatening unless there is excessive
bleeding from an open wound.
Note:
 Fx to each ribs bleeds 150ml,
 Fx to humerus =0.5-1L bleeds,
 Fx to pelvic = 3L bleeds ,
 Fx to femoral =1-1.5 bleeds,
 Fx to tibia = 0.5-1 L bleeds. BY: CHALTU H 11/15/2023
 B. Examination of the injured limb

144

1. Inspect the injured limb and compare it with the opposite,

uninjured limb.
2. Gently and carefully cut away any clothing covering the wound, if
necessary.
3. When you examine the limb, you may find any one of the
following:
a. Open wound
b. Deformity
c. Swelling
d. Bruising
BY: CHALTU H 11/15/2023
 Examination ctd
145
4. Gently feel the injured limb for points of tenderness- is
the best indicator of an underlying fracture, dislocation,
or sprain.
4.To detect limb injury, start at the top of each limb and
using both hands, squeeze the entire limb in a systematic,
firm manner, moving down the limb and away from the
body.
5.As you conduct the hands-on examination, ask the
patient where it hurts most.
BY: CHALTU H 11/15/2023
146
C. Evaluation of circulation, sensation, and movement.
1.Once you suspect limb injury, you must evaluate the
circulation and sensation in that limb.
2.Any injury may have associated blood vessel or nerve
damage.
3.It is essential to check circulation and sensation after any
movement of the limb.

BY: CHALTU H 11/15/2023

 Signs and symptoms of fracture
147

 History of trauma
 Pain, swelling,
 Inability to use the injured body part
 Tenderness and bruising
 Deformity, abnormal movement (sure signs of
fracture).
 Altered neurovascular status

BY: CHALTU H 11/15/2023

 s/s continued
148

 tingling or numbness in the extremity;

- nerve damage or lack of circulation.
 After you have made a careful visual and hands-on

examination, and if the patient shows no sign of injury,

ask the patient to move the limb carefully.
 If there is an injury, the patient will report pain and

refuse to move the limb.

BY: CHALTU H 11/15/2023

 Objectives of first aid

149

 To prevent blood lose

 To keep the broken bone ends and the adjacent joints
from moving.
 To give care for shock.
 To relief pain
 To transport the victim to hospital

BY: CHALTU H 11/15/2023

 Management of a patient with fracture
150

GENERAL TREATMENT
 Associated life threatening injuries may be missed if
evaluation of the patient is not systematic.
 Fix ABC problems first
 Always assess the status of distal circulation and
neurological function.
 Administer anti pain and splint all fractures before
transferring to hospitals.
BY: CHALTU H 11/15/2023
 General Rx cont’d…
151

All limb injuries are treated in the same way in the field.
A. Cover open wounds with dry, sterile dressings.
B. Apply firm but gentle pressure to control bleeding, if
necessary.
C. Apply a cold pack to painful, swollen, or deformed
extremities.
D. Splint the injured limb and immobilize it.
E. Immoblization prevents displacement of reduced Fx, reduce
pain
BY: CHALTU H 11/15/2023
 Splinting
152

∆ All limb injuries should be splinted before the patient is

moved, unless the environment prevents effective splinting or
threatens the patient’s life.
Purpose:
∆ prevents the movement of broken bone ends, a dislocated joint,

or damaged soft tissues, thereby reducing pain.

∆ Controls bleeding and decreases the risk of additional damage.

∆ Prevents closed fractures from becoming open fractures during

movement or transport.
BY: CHALTU H 11/15/2023
 Splinting
153

BY: CHALTU H 11/15/2023

 Splinting
154

BY: CHALTU H 11/15/2023

 Splinting….
155
 General principles of splinting
1. Note and record PMS distal to the point of injury, both
before and after splinting.
2. Cover all open wounds with a dry, sterile dressing before
applying the splint.
3. Do not move the patient before splinting, unless there is an
immediate danger to the patient or the EMR.
4. Immobilize the joint above and the joint below the injury
site
BY: CHALTU H 11/15/2023
 Splinting ….
156
 5. When applying the splint, support the injury site and
minimize movement of the limb until splinting is
completed.
 6. Splint the limb without moving it unnecessarily.
 7. When in doubt, splint.

BY: CHALTU H 11/15/2023

 Poisoning:
157

 refers to any substance that if taken in to the body in sufficient

quantity can cause temporary or permanent damage.
Causes of poisoning:
a. Deliberate intake of poisons
b. Accidental intake of poisons

Types of poisons
1 . Household poisons 4. Drugs poisoning
2 . Plant poisons 5. Alcohol poisoning
BY: CHALTU H 11/15/2023
3. Food poisoning 6.chemical poisoning
S/SX poisoning
Vary according to on the nature of the poison and the method of entry into the
body (through the mouth, through the lung by inhalation, by injection and
by absorption through the skin).
A .Presence of container near the causality
B . Delirious and may have convulsion
C .S/SX of asphyxia
D. Signs of burn around the causality's mouth
E. loss of consciousnes
F. Loss of urine
G. stream foam covered in the mouth
BY: CHALTU H 158
H. Altered v/s 11/15/2023
 4. General treatment of poisoning

159

a. ABC

b. Do not attempt to induce vomiting

c. If the lips or mouth show signs of burn give water or milk to drink
d. If the causality is unconscious, but breathing normally place in the recovery
position.
e. If breathing and heart beat stop begin resuscitation immediately( CPR)
f. Remove to hospital immediately.

 Take care not to contaminate yourself with any poison that may be around the
causality's mouth 11/15/2023
BY: CHALTU H
 Shock:
160

It is the collapse of cardio vascular system due to insufficient blood

circulated to an organ
It is a condition resulting from a depressed state of many vital
body functions due to decreased tissue perfusion that could
threaten life as a result of;-
 severe pain (Neurogenic shock)

 electric burn (electric shock)

 massive bleeding (hemorrhagic shock)

 massive fluid loss (hypovolumic shock)

 hypersensitivity reaction (anaphylactic shock)

BY: CHALTU H 11/15/2023
 Sign and symptom of shock
161

 Pale or bluish skin /Mucus membrane

 Cold extremities to touch
 Moist and clammy skin
 Rapid and weak pulse
 Rapid and shallow breathing /especially in abdomen &
chest injuries)
 Low B/P and may be unresponsive

BY: CHALTU H 11/15/2023

 First aid management of shock
162
 Body positioning /lying down to improve circulation
 Maintain ABC

 Keep the head lower and turned on the side

 Body positing depends on the site & type of injury

 E.g. If the injury is on the neck & spine, do not move the

victim until he is
 Prepared for transport

 Keep the causality warm

 Loosen any tight clothing /assists breathing/ Don't give fluid

by mouth /moisten the lips/ CallBY:for ambulance

CHALTU H 11/15/2023 or refer.