CHAPTER I

INTRODUCTION
DR. HAYAT AL AKOUM
 Prequiz:
True or False?
•After an accident, immediately move the
victim to a comfortable position.
•If a person is bleeding, use a tourniquet.
•Signs of a heart attack include shortness
of breath, anxiety, and perspiration.
•All burns can be treated with first aid
alone; no emergency medical attention
is necessary.
 HELP! EMERGENCY!

Minutes could make a

difference
 DEFINITION OF FIRST AID

• First aid is the provision of immediate care to a victim with an injury or illness,
usually effected by a lay person, and performed within a limited skill range.
• First aid is normally performed until the injury or illness is satisfactorily dealt
with (such as in the case of small cuts, minor bruises, and blisters) or until the
next level of care, such as a paramedic or doctor, arrives
• First aid is an emergency aid or treatment given to someone injured, suddenly
ill, etc., Before regular medical services arrive or can be reached.
 OBJECTIVES OF FIRST AID/GUIDING PRINCIPLE

The key guiding principles and purpose of first aid, is often given in the mnemonic "3 PS". These
three points govern all the actions undertaken by a first aider.
• Prevent further injury
• Preserve life
• Promote recovery
 BASIC OF FIRST AID

• Check for BREATHING: lack of oxygen intake (through a , brain damage or death in few
minutes
• Check for BLEEDING: life cannot continue without an adequate volume of blood to carry
oxygen to tissues
• Check for SHOCK: unless shock is prevented, first aid performed, and medical treatment
provided, death may result even though the injury would not otherwise be fatal
 PHILOSOPHY OF FIRST AID

In the pre-hospital setting, the key contributors to survival and recovery from illness and injury are
prompt and effective maintenance of the body’s primary functions:
• Airway
• Breathing
• Circulation
• Bleeding control (life threatening)
Medical research data suggests that effective support of these basic functions provides the most
significant contributor to positive outcomes for casualties in the prehospital setting.
 IMPORTANCE OF FIRST AID

The importance of first aid is hard to overestimate. Among the major benefits of first aid are the
following:
• Providing quick medical treatment until professional assistance arrives.
• First aid helps ensure that the right methods of administering medical assistance are
provided.
• Knowledge in first aid also benefits the individuals themselves.
• It affords people with the ability to provide help during various emergency situations.
 EMERGENCY ACTION PRINCIPLES

1. Survey the scene

Once you recognized that an emergency has occurred and decide to act, you must make sure
the scene of the emergency is safe for you, the victim/s, and any bystander/s.
Element of the survey of the scene
• Scene safely
• Mechanism of injury or nature of illness
• Determine the number of patients and additional resources.
 EMERGENCY ACTION PRINCIPLES

2. Activate medical assistance and transfer facility

In some emergencies, you will have enough time to call for specific medical advice before
administering first aid. But in some situations, you will need to attend to the victim first.
Phone First and Phone Fast
Both trained and untrained bystanders should be instructed to Activate Medical Assistance
as soon as they have determined that an adult victim requires emergency care “Phone
First”. While for infant and children a “Phone fast” approach is recommended.
 EMERGENCY ACTION PRINCIPLES

3. Do a primary survey of the victim

In every emergency situation, you must first find out if there are conditions that are an immediate
threat the victim’s life.
• Check for consciousness
• Check for airway
• Check for breathing
• Check for circulation
 EMERGENCY ACTION PRINCIPLES
4. Do a secondary survey of the victim
It is a systematic method of gathering additional information about injuries or conditions that may
need care.
• Interview the victim
Begin HIT/HOPS
• Check vital signs  History
• Perform head-to-toe examination.  Inspection/Observation
 Palpation
 S/Testing (Special
testing)
 PRINCIPLES OF EMERGENCY CARE

• Collect the detailed history of accident either from the victim or from anyone who has
witnessed the accident .
• The victim’s injury should be examined thoroughly, taking note of every symptom, to know
the correct diagnosis.
• By the help of the diagnosis, treat the victim until the doctor arrives or shift the victim to the
hospital and aid the patient during transport.
• Call the doctors or shift the victim to the hospital as soon as possible, so that the patience
can recover soon from doctor’s treatment instead of prolonging the first aid.
 RESPONSIBILITIES OF A FIRST AIDER

Preserve life and provide initial emergency care and treatment to sick or injured
people
• Protect the unconscious
• Prevent a casualty’s condition from becoming worse
• Promote the recovery of the casualty.
 GOLDEN RULE’S OF FIRST AID
• Do first things first quickly, quietly and without fuss or panic.
• Give artificial respiration if breathing has stopped-every second counts.
• Stop any bleeding.
• Guard against or treat for shock by moving the casualty as little as possible and handling him gently.
• Do not attempt too much-do the minimum that is essential to save life and prevent the condition
from worsening.
• Reassure the casualty and those around and so help to lessen anxiety.
• Do not allow people to crows round as fresh air is essential.
• Do not remove clothes unnecessarily.
• Arrange for the removal of the casualty to the care of a doctor or hospitals soon as possible
 CONTENT OF THE FIRST AID KIT

THE RED CROSS RECOMMENDS THAT ALL FIRST AID KITS FOR A FAMILY OF FOUR INCLUDE THE
FOLLOWING:

Bandages Medications
Dressing
• 1 roller bandage (3 inches • 2 hydrocortisone ointment
• 2 absorbent compress
wide) packets (approximately 1
dressings (5 x 9 inches)
• 1 roller bandage (4 inches gram each)
• 25 adhesive bandages
wide) • 5 antibiotic ointment
(assorted sizes)
• 5 sterile gauze pads (3 x 3 packets (approximately 1
• 1 adhesive cloth tape
inches) gram)
(10 yards x 1 inch)
• 5 sterile gauze pads (4 x 4 • 5 antiseptic wipe packets
• Sterile eye dressing
inches) • 2 packets of aspirin (81 mg
• Gauze pad
• 2 triangular bandages each)
 CONTENT OF THE FIRST AID KIT
Equipment’s
• Tweezers-to pull out stings Others
• Scissors-to cut dressing/bandage • 1 blanket (space blanket)
• Oral thermometer (non- mercury/non- • 1 breathing barrier (with one-way valve)
glass) • 1 instant cold compress
• 2 pair of nonlatex gloves (size: large) • First aid instruction booklet
• Safety pin
VITAL SIGNS
 VITAL SIGNS

• Vital signs are physical signs that

indicate an individual is alive,
such as heart beat, breathing rate,
temperature, blood pressures and
recently oxygen saturation
 VITAL SIGNS

• These signs may be observed,

measured, and monitored to assess
an individual's level of physical
functioning.
 VITAL SIGNS

• Normal vital signs change with

age, sex, weight, exercise
tolerance, and condition.
 GUIDELINES FOR OBTAINING
VITAL SIGNS

The first aider must be able to do all of the following:

• Measure vital signs correctly
• Understand and interpret the values
• Communicate findings appropriately
• Begin interventions as needed
TEMPERATURE
VITAL SIGNS
 TEMPERATURE

• Old people, people with disabilities,

babies and young children typically
feel more comfortable at higher
temperatures.
 TEMPERATURE

• Temperature is measured in either

celcius or farenheit, with a fever
defined as greater then 38-38.5 C
or 101-101.5 f.
 TEMPERATURE
Two types of body temperature
1. Core temperature
• Temperature of the deep tissues of the body
• Remains relatively constant unless exposed to severe extremes in environmental
temperature
• Assessed by using a thermometer
2. Surface temperature
• Temperature of the skin
• May vary a great deal in response to the environment
• Assessed by touching the skin
 TEMPERATURE

Temperature measurements are obtained by several methods.

1. Heat-sensitive patches
• Patch placed on the skin; color changes on the patch indicate temperature readings
2. Electronic thermometers
• Consist of a rechargeable battery-powered display unit, a thin wire cord, and a
temperature processing probe
3. Tympanic thermometer
• Special form of electronic thermometer; inserted into auditory canal
 TEMPERATURE

1. Pyrexia, febrile, or hyperthermia

• When the temperature is above normal
• Fever is actually a body defense; it will destroy invading bacteria.
2. Classification of fevers
• Constant: remains elevated consistently
• Intermittent: rises and falls
• Remittent: temperature never returns to normal until the patient becomes well
3. Hypothermia
• An abnormally low body temperature
 HYPOTHERMIA

• Hypothermia is defined as a drop in

body temperature below 95° f.
PULSE
VITAL SIGNS
 PULSE RATE

• The normal pulse for

healthy adults ranges
from 60 to 100 beats
per minute.
 PULSE RATE

• The pulse rate may fluctuate

and increase with exercise,
illness, injury, and emotions.
Girls ages 12 and older and
women, in general, tend to
have faster heart rates than
do boys and men.
 PULSE: QUANTITY

• If the rate is particularly slow or fast,

it is probably best to measure for a
full 60 seconds in order to minimize
the error.
 PULSE: REGULARITY

Is the time between beats

constant?. Irregular
rhythms, are quite common.
 PULSE: VOLUME

Does the pulse volume feel normal? This reflects changes in stroke
volume. In hypovolemia, the pulse volume is relatively low
 PULSE

1. Tachycardia
• The pulse is faster than 100 beats per minute.
• It may result from shock, hemorrhage, exercise, fever, acute pain, and drugs.
2. Bradycardia
• The pulse is slower than 60 beats per minute.
• It may result from unrelieved severe pain, drugs, resting, and heart block.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)

A, Point of maximum impulse is at fifth intercostal space.

B, Assessing apical pulse.
 PULSE

• Apical pulse represents the actual

beating of the heart.
• Pulse deficit: difference between the
radial and apical rates; signifies that
the pumping action of the heart is
faulty.
RESPIRATION RATE
VITAL SIGNS
 RESPIRATORY RATE

• Try to do this as surreptitiously as

possible. Observing the rise and
fall of the patient's hospital gown
while you appear to be taking
their pulse.
 RESPIRATORY RATE

• Respiration rates may increase with

fever, illness,…. When checking
respiration, also note whether a person
has any difficulty breathing.
 ABNORMAL RESPIRATORY RATE

UNDER 12
• Respiration rates over 25 or
under 12 breaths per minute BREATHS
(when at rest) may be considered
over 25 breaths
abnormal
BLOOD PRESSURE
VITAL SIGNS
 REMEMBER THE FOLLOWING FOR
ACCURACY OF YOUR READINGS

• Instruct your patients to avoid

coffee, smoking or any other
unprescribed drug with
sympathomimetic activity on the
day of the measurement
 POSITION OF THE PATIENT

• Sitting position
• Arm and back are supported.
• Feet should be resting firmly
on the floor
• Feet not dangling.
 POSITION OF THE ARM

• Raise patient arm so that the brachial artery is roughly at the same height as the
heart. If the arm is held too high, the reading will be artifactually lowered, and vice
versa.
 BLOOD PRESSURE

The pressure exerted by the circulating volume of blood on the arterial walls,
veins, and chambers of the heart.
1. Systolic
• The higher number; represents the ventricles contracting
2. Diastolic
• The second number; represents the pressure within the artery between
beats
3. Pulse pressure
• Difference between the systolic and diastolic
 BLOOD PRESSURE

• If it is too small, the readings

will be artificially elevated.

• The opposite occurs if the

cuff is too large.
 TECHNIQUE OF BP MEASUREMENT

• Listen for auditory vibrations

from artery "bump, bump,
bump" (korotkoff)
 IN ORDER TO MEASURE THE BP

• Systolic blood pressure is the

pressure at which you can first
hear the pulse.
 IN ORDER TO MEASURE THE BP

• Diastolic blood pressure is the last pressure at which you

can still hear the pulse
 IN ORDER TO MEASURE THE BP

• Avoid moving your hands or the

head of the stethoscope while
you are taking readings as this
may produce noise that can
obscure the sounds of koratkoff.
 REMEMBER THE FOLLOWING FOR
ACCURACY OF YOUR READINGS

• If the BP is surprisingly high or

low, repeat the measurement
towards the end of your exam
(repeated blood pressure
measurement can be
uncomfortable).
WHAT ABNORMAL RESULTS
MEAN
 BLOOD PRESSURE

• The minimal SBP required to

maintain perfusion varies with the
individual. Interpretation of low
values must take into account the
clinical situation.
 BLOOD PRESSURE FOR ADULT

• Physician will want to see multiple

blood pressure measurements over
several days or weeks before making a
diagnosis of hypertension and initiating
treatment.
 WHAT ABNORMAL RESULTS MEAN

• Pre-high blood pressure: • Stage 1 high blood pressure:

systolic pressure consistently systolic pressure consistently
120 to 139, or diastolic 80 to 89 140 to 159, or diastolic 90 to
99
 WHAT ABNORMAL RESULTS MEAN

• Stage 2 high blood pressure:

systolic pressure consistently
160 or over, or diastolic 100
or over
 WHAT ABNORMAL RESULTS MEAN

• Hypotension (blood pressure

below normal): may be indicated
by a systolic pressure lower than
90, or a pressure 25 mm hg lower
than usual
 HYPERTENSION

• High blood pressure greater than 139-

89..
 BLOOD PRESSURE (MM HG)

• Normal blood pressure 100/60

and 139/89.
• Prehypertension 120,139-
80,89…
BLOOD PRESSURE MAY BE AFFECTED
BY MANY DIFFERENT CONDITIONS
 BLOOD PRESSURE MAY BE AFFECTED BY
MANY DIFFERENT CONDITIONS

• Cardiovascular disorders
• Neurological conditions
• Kidney and urological disorders
 BLOOD PRESSURE MAY BE AFFECTED BY
MANY DIFFERENT CONDITIONS

• Pre eclampsia in pregnant

women
• Psychological factors such as
stress, anger, or fear

Eclampsia
ORTHOSTATIC
HYPOTENTION
 REMEMBER THE FOLLOWING FOR
ACCURACY OF YOUR READINGS

• Orthostatic (postural)
measurements of pulse and blood
pressure are part of the assessment
for hypovolemia.
 REMEMBER THE FOLLOWING FOR
ACCURACY OF YOUR READINGS

• First measuring BP when the patient

is supine and then repeating them
after they have stood for 2 minutes,
which allows for equilibration.
OXYGEN SATURATION
VITAL SIGNS
 OXYGEN SATURATION

• Over the past decade, oxygen

saturation measurement of
gas exchange and red blood
cell oxygen carrying capacity
has become available in all
hospitals and many clinics.
 OXYGEN SATURATION

Oxygen saturation provide

important information about
cardio-pulmonary dysfunction and
is considered by many to be a fifth
vital sign.