FIRST AID

Irfan Omer Ali

Master Student in Medical Surgical Adult Nursing

Kurdistan Technical Institute/Nursing Department

Irfan.ali@kti.edu.iq

Tel: 00964 (0)772 152 2737

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Hardy Hassan Rasul

Master Science in Public Health

Kurdistan Technical Institute/Nursing Department

Hardy.rasul@kti.edu.iq

Tel:00964(0)7705401518

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OUTLINES:

• Introduction
• Definition And Importance Or Goals Of First Aid
• Why Learn First Aid
• Role And Responsibility First Aider
• Important Systems In First Aid
• First Aid Action Plan
• BLS
• Drowning
• Fainting
• Bleeding
• Fracture
• Seizure
• Chocking

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INTRODUCTION

• First aid covers the steps taken to help an injured or sick person in the first minutes ( golden time) “ the critical time between life and death” after an illness or injury.
• Accidents or illness can happen to anyone at any time, whether at home, at work or at school.
• If an accident happens in the workplace, you cannot be a helpless witness, since simply standing by can potentially worsens the situation. This is why it's important to have at least a basic knowledge of first aid.

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DEFINITION

First aid is the first and immediate assistance given to any person suffering from either a minor or serious illness or injury, it includes initial intervention in a serious condition prior to ambulance or medical staff being available, such as performing cardiopulmonary resuscitation (CPR) while waiting for an ambulance, as well as the complete treatment of minor conditions, such as applying a plaster to a cut.

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IMPORTANCE OR GOALS OF FIRST AID

Preserve live:

Every year, millions of people are hurt or killed from medical emergency (ex: traffic accident, airway obstruction and cardiac arrest), most cases of deaths occur early in the events

The biggest difference between victims who survive and those who don’t is the bystander’s willingness to help. Performing any sort of first aid on victims while the ambulance is on the way doubles or triple the person’s chance of survival.

Prevent further harm: 

Prevention of further harm includes addressing both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, such as applying pressure to stop a bleed becoming dangerous.

Promote recovery: 

First aid also involves trying to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound.

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WHY LEARN FIRST AID

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• Learning basic first aid techniques can help you cope with an emergency. You may be able to keep a person breathing, reduce their pain or minimise the consequences of injury or sudden illness until an ambulance arrives. This could mean the difference between life and death for them.
• If you learn the basics of first aid, you might one day save the life of a loved one, colleague or stranger.
• First aid is an important skill and should be taught to everyone who has the ability to learn.
• If more people knew first aid, more lives would be saved.

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ROLES AND RESPONSIBILITY OF FIRST AIDERS

• Assess the situation quickly and safely and summon appropriate help.

• Protect , his/her self, casualties and others at the scene from possible danger.

• Give each casualty early and appropriate treatment, treating the most serious condition first.

• Arrange for the casualty's removal to hospital .

• Remain with a casualty until appropriate care is available.

• To report his/her self observations to those taking care of the casualty, and to give further assistance if required.

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PRIORITY OF CASUALTIESS

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• Save the conscious casualties before the unconscious ones as they have a higher chance of recovery.

• Save the young before the old.

• Do not jeopardize your own life while rendering first aid.

• In the event of immediate danger, get-out of site immediately.

• Remember: one of your aims is to preserve life, and not endanger your own in the process of rendering first aid.

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IMPORTANT SYSTEMS FOR FIRST AIDERS

• The human body is composed of a number of ‘systems’, each with a specific role in the function of the body as a whole. The function of these individual systems is known as the body’s physiology.
• It is important that first aiders have a basic awareness of the major systems and their functions.
• The major systems include:

Nervous system

Cardiovascular system

Respiratory system

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NERVOUS SYSTEM

The nervous system is considered in two main parts, the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). The Central Nervous System comprises the brain and spinal cord. This is the control centre for all functions of the body, and is the most complex of all body systems. The brain regulates all body functions, including the respiratory and cardiovascular systems. It is easy to see how damage to the central nervous system (e.g: a spinal cord injury) can have disastrous effects to body functions.

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The motor and sensory nerves, which involve movement, are known as the peripheral nervous system, and these function as directed by the brain. Some peripheral nerves function without conscious thought, and these are known as autonomic nerves. Breathing is a function that is attributable to these nerves.

CARDIOVASCULAR SYSTEM

• This system involves the heart, blood vessels and blood. The heart is the pump that drives the circulation of the blood around the body. The body’s main vessels are arteries, which take the blood from the heart, and veins, which return the blood to the heart.
• There are smaller blood vessels such as arterioles, venules and capillaries, most of which are located at the body’s extremities and usually close to the skin.

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CONT.

• Blood is the medium that transports oxygen, from the respiratory system to the body’s cells. Blood also transports sugars, chemicals, proteins, hormones, and many other substances around the body for use and elimination.
• The amount of blood circulating within an individual depends on their size and weight, but the average human adult has nearly 5 litres of circulating blood. The heart is a powerful muscle that beats without stopping throughout a lifetime. It pumps about 55-80 ml (1/3 cup) of blood with each beat for adults and around 25-85 ml per beat for children, it means than adult heart pumps about 5 litre of blood per minute and pumps about 6,000-7,500 litres of blood daily.

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CONT.

• As the heart pumps blood a pulse beat can be felt at various locations in the body, and each pulse beat corresponds to one heartbeat. The heart rate of the average adult at rest is between 60 to 100 beats per minute, depending on age, medical conditions and general fitness. The most accessible pulse points are the carotid (neck) and radial (wrist) arteries. Information.
• A working knowledge of the locations of these pulse points is important for the first aid provider. However, finding a pulse can sometimes be extremely difficult, and looking for other signs of circulation, such as skin colour, warmth, movement or coughing is essential. 

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RESPIRATORY SYSTEM

• This system is composed of the airway (mouth, nose, trachea, larynx, bronchi, bronchioles) and the lungs (including the small air sacs called alveoli).
• The function of the respiratory system is to provide oxygen to the blood, and take away the waste product called carbon dioxide.
• Oxygen is extracted from the air that is inhaled via the airway, and is passed into the blood stream through the membranes of the lungs. For the first aid provider, the maintenance of a casualty’s airway is of primary importance.

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CONT.

• The air a person normally breathes contains approximately 21% oxygen, 5% is extracted by the lungs. The extracted oxygen is passed to the blood within the capillaries of the lungs. Red blood cells are responsible for carrying oxygenated blood from the lungs through the body’s cardiovascular system and venous systems to the brain and the rest of the body.
• Brain uses about 20% of the body’s oxygen supply, which allows it to perform conscious and autonomic processes.
• Brain cells are very sensitive to a lack of oxygen. Some brain cells start dying within 3 minutes after their oxygen supply disappears.
• At 30-60 seconds of oxygen deprivation, humans may lose their consciousness.
• At three minutes, brain cells begin dying, neurons suffer more extensive damage, and lasting brain damage becomes more likely.
• At five minutes, death becomes imminent.
• At 10 minutes, even if the brain remains alive, a coma and lasting brain damage are almost inevitable.
• At 15 minutes, survival becomes nearly impossible.
• The remaining 16% of unabsorbed oxygen is breathed out. This is extremely important in the context of mouth-to-mouth ventilation; the air that we ventilate into a cardiac arrest casualty can deliver sufficient oxygen to save and sustain life.

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ACTION PLAN OF A FIRST AIDER

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In any situation, apply the DRSABCD action plan to identify any immediately life-threatening

Conditions.

BASIC LIFE SUPPORT (BLS)

• Basic life support (BLS) is performed to support the patient’s circulation and respiration through the use of cardiopulmonary resuscitation (CPR) until advanced life support arrives.
• Sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary and/or cardiac arrest
• Cardiopulmonary resuscitation (CPR) performed by anyone who knows how to do it, anywhere, immediately, without any other equipment.

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DRSABCD IN BLS

D = Danger

• Ensure the area is safe for you, others and the victim, always consider your safety first, followed by the safety of the patient/victim and then lastly the safety of any bystanders, as a rescuer, you must be able to quickly assess the situation for any potential dangers or hazards to yourself or others in the immediate environment. ...... If the area is not safe the victim should be transferred for a safe area.

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COMMON TYPES OF VICTIM TRANSPORTATION

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• One rescuer handing technique

Cradle carry

Pick back carry

Shoulder pull

Log roll technique

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• Two rescuer handing technique

Extremities carry

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ONE RESUER

• Cradle lift

This only works with a child or a very light person, used for both leg injury, unconscious victim

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Technique:

Place your arms under the victim’s knees and around their back.

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CONT.

• Pick back carry

When injuries make the rescuer carry unsafe ( such as fire), this method is better for longer distances than the cradle lift.

Technique:

1. Place both the victim’s arms over your shoulders.

2. Cross the victim’s arms, grasping the victim’s opposite wrist.

3. Pull the arms close to your chest.

4. Squat slightly and drive your hips into the victim while bending slightly at the waist.

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CONT.

• Shoulder pull

The shoulder pull is the fastest method for moving a victim a short distance over a smooth surface. It supports the head of the victim. The negative is that it requires the rescuer to bend over at the waist while pulling.

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Technique:

1. Grasp the victim by the clothing under the shoulders, shoulder it self.
2. Keep your arms on both sides of the head.
3. Support the head.
4. Try to keep the pull as straight and in-line as possible

LOG ROLL

• Log roll or logrolling is a technique used to move a patient without flexing the spinal column. 
• If you suspect a spinal injury to the back or neck of a person in need of help, do not move him or her if there is no immediate need to.
• Assume an injured person has a spinal injury if:, ① they complain of severe spinal pain (neck of back), ②they can't move their neck or limbs, ③they feel weakness or numbness in their limbs, ④ they lose control of their bowel or bladder, ⑤ they've fallen from a significant height (height greater than 10 feet) or⑥ been hit by car ............... permanent paralysis and other serious life-threatening complications can result from moving a person with a spinal injury.
• Then determine how many people are around who want to help. The more people around (up to five), the better because more hands can stabilize the injured person while log rolling them and prevent unwanted spinal motion (five or six people is the ideal number to log roll in most situations in order to stabilize the neck / head, arms, low back / pelvis and legs.), A minimum of at least two people are needed to log roll an injured person in an emergency — one to stabilize the neck / head, and one to stabilize the lower spine / pelvis.
• Enlist 3 or 4 people to help, with a leader positioned at the injured person’s head, other helpers kneeling to one side, and one in charge of sliding the stretcher under the person.
• Roll the injured person onto their side, keeping the head and neck aligned with the body, and place the injured person on the stretcher.

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CONT.

• Extremities carry

This is perhaps the most suitable way in which two rescuers can handle an unconscious casualty., The casualty is prepared in the same way as for the removal down stairs method ie, the wrists are tied together.

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1) the first rescuer stoops at the rear of the casualty. Reaching under the casualty's arms, the first rescuer grips the casualty's wrists.

2) the second rescuer stoops between the casualty's legs grasping them underneath the knees. The standard lift orders are given and the casualty is lifted to the carrying position.

Should the casualty have a leg injury, the effects of this can be minimised by the front rescuer crossing the casualty's legs over, then carrying them.

• The advantage of this method is that the rescuer supporting the casualty's feet has a free hand with which to open doors, clear debris, etc.

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R = RESPONSE

• After transport the patient to a safe area, check for responsiveness., Assess the collapsed victim’s response to verbal and tactile stimuli (‘talk and touch’) ensuring that this does not cause or aggravate any injury.
• ①Tap or shake the victim`s shoulder gently (tap/shake the victims foot ) and ②shout loudly “hey! Hey! Are you OK?” Or give simple command such as “open your eyes, can you hear me?”

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• If the victim respond
• Place the victim in comfortable position
• Check for injuries
• If there is no other life-threatening conditions, place victim in recovery position
• Monitor response

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RECOVERY POSITION

• If a person is conscious or unconscious but is breathing, heart beating normally and has no other life-threatening conditions, they should be placed in the recovery position.
• When someone is put into the recovery position their airway is kept open and any vomit would drain away without interfering with their breathing (won't cause them to choke.)

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Technique of recovery position

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① Kneel by the casualty and straighten their legs. If they are wearing glasses, or have any bulky items in their pockets, remove them. Do not search their pockets for small items.

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CONT.

② Place the arm that is nearest to you at a right angle to their body, with the elbow bent and their palm facing upwards.

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③ Bring their other arm across their chest and place the back of their hand against the cheek nearest to you. Hold it there.

④ With your other hand, pull their far knee up so that their foot is flat on the floor.

CONT.

⑤ Keeping the back of the casualty’s hand pressed against their cheek, pull on the far leg to roll the casualty towards you on to their side. You can then adjust the top leg so that it is bent at a right angle.

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⑥Gently tilt the casualty’s head back and lift their chin to make sure their airway stays open. You can adjust the hand under their cheek to do this.

Call 122 for emergency help, Monitor their level of response while waiting for help to arrive.

• If they remain in the recovery position for 30 minutes, roll them into the recovery position on the other side.

S = SEND FOR HELP

• After put the victim on recovery position call 122.
• If the victim dose not respond immediately call 122 or send someone to do that.

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A = AIRWAY

Check airway:

A clear, unobstructed/open airway is required for effective breathing. Absence of a clear airway will be recognized by absent or noisy breathing and/or failing to respond to ‘touch and talk’.

The airway must be cleared and open

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In a normal, unobstructed airway, the air

can flow freely through the nose or mouth

to the lungs.

Air flow can be restricted at different

locations including the nose and soft palate

with the uvula and the tongue base.

The narrowing or blockage of the airways

can be fatal.

MANAGEMENT AIRWAY : ADULT & CHILD

• Inspect the airway observing for any foreign body or obstruction from mouth.
• Clear the airway either using the rescuers’s fingers (‘finger sweep’) or a suction apparatus (if available) if the rescuer is proficient in its use. Be careful not to push the material in further causing an obstruction. Remove any loose fitting dentures if required;
• Do not routinely roll the victims to their side unless the airway is obstructed by liquid (blood or vomit) or the victim has suffered a submersion injury. Instead turn the mouth slightly downwards and sideways to allow secretion drainage by gravity.
• Open the airway by using a backward head tilt together with chin lift. Opening of the airway by JAW THRUST man oeuvre can be used by health professionals who are knowledgeable and practiced in this methodology. If a cervical spine injury is suspected, then JAW THRUST becomes the preferred methodology for healthcare providers.
• Please note that in an unconscious victim, care of the airway takes precedence over any injury, including the possibility of spinal injury. If you suspect spinal injury, use gentle JAW THRUST.

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CONT.

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<<=========Heat tilt chin lift

Jaw thrust =====🡺

MANAGEMENT OF THE AIRWAY: INFANTS

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• A jaw thrust technique better to be used on infants.
• Due to the soft and pliable nature of the infant’s narrow nasal and trachea passages, using a head tilt/chin lift on an infant may cause excessive distortion of the airway. When managing the airway of an infant, the head should be kept in a neutral position to minimise distortion of the airway.
• If airway patency needs to be acquired in infants a jaw thrust is used. Head tilt – chin lift used when required such as during rescue breathing.

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B = BREATHING

Check breathing:

• LOOK for movement of the upper abdomen or lower chest.
• LISTEN for the escape of air from nose and mouth.
• FEEL for movement of chest and upper abdomen.

Assess for breathing should be performed in less than 10 second.

Respiratory arrest: if the pt. Is not breathing but has a definitive pulse, the pt. Is in respiratory arrest, to treat respiratory arrest rescue breath( ventilation ) must be given.

if a person collapses and stops breathing, start mouth-to-mouth breathing, after the airway has been cleared and opened.

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REUSE BREATHING

• By breathing into another person's lungs (rescue breathing), you can supply enough oxygen to preserve life. Act quickly, because brain damage can occur after only 3 minutes without oxygen.

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RESCUE BREATH FOR ADULT AND CHILDREN ( AGE 1 YEAR TO PUBERTY):

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• Keep the head tilt and chin lift.
• Pinch the victim's nostrils together with your thumb and first finger, Or follow your face mask instructions.
• If you don't have a protective barrier, seal your lips over the victim's open mouth. 
• Note: If the victim's mouth can't be opened, you can seal your lips over the victim's nose.
• Start with 2 rescue Breathe into the victim's mouth, each breath over 1 second. Give the first rescue breath while you Watch for the chest to rise
• If the chest rises, breathe into the victim's mouth a second time.
• If the chest doesn't rise, tilt the victim's head back and chin up again. Then breathe into the victim's mouth a second time.
• After 2 rescue breath check the carotid pulse( for 5 to 10 second), if there is a pulse, continue with rescue breath over 1 second every 5 second and After one minute assess the breathing and pulse.

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RESCUE BREATH FOR INFANT ( UNDER 1 YEAR):

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• Keep the head tilt and chin lift.
• Cover the baby's nose and mouth with your mouth or a protective barrier.
• Start rescue breath to the infant one breath over one second, every 3 second, during giving the first rescue breath watch for the chest to rise, if the chest doesn't rise, tilt the victim's head back and chin up again.
• Continue for about 2 minute and then check brachial pulse , if there is a pulse repeat rescue breath for another 2 minute and then check brachial artery again and repeat that if there a pulse without breathing.

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C = CIRCULATION

Check for pulse

If pulse is not definitely felt with in 10 second the patient is in cardiac arrest

If there is no breathing, no pulse and the pt. Is unresponsive, the pt. Is in cardiac arrest.

Cardiac arrest: is a life-threatened Situation in which the electrical and/or mechanical systems of the heart Malfunctions result in complete cessation of the heart´s ability to function and circulate blood efficiently.

If patient is in cardiac arrest start CPR with chest compression

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HOW TO CHECK CIRCULATION

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Checking pulse should take less than 10 second, it is better to check circulation simultaneously with breathing Do not check for a pulse for more than 10 seconds. If you have not felt a pulse within 10 seconds, assume that the patient has no pulse.

• In adults, the best place to check for a pulse is the carotid artery.

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• In children under 5 year, the brachial arteries is first choices.

If patient is in cardiac arrest start CPR with chest compression

CARDIOPULMONARY RESUSCITATION (CPR)

• Cardiopulmonary resuscitation (CPR) is a lifesaving technique. It aims to keep blood and oxygen flowing through the body when a person’s heart and breathing have stopped, chest compressions recreate this pumping motion so the blood circulates to vital organs and the rest of the body, according to the American heart association (AHA), CPR can double or triple the chances of survival after cardiac arrest. The primary goal of CPR is to keep blood flow active until medical professionals arrive.
• The steps of CPR are a bit different according to whether the person is an adult, child, or infant. The primary difference is whether chest compressions are performed with two hands (adults),two hand or one hand (children), or thumbs or tow finger (infants).
• Position of the victim during CPR must be supine on a firm flat surface to CPR to be effective

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RULES FOR ACHIEVING EFFECTIVE CHEST COMPRESSIONS:

• 100 – 120 compressions per minute (for all ages).
• Push down firmly on the sternum to 1/3 of the depth of the chest.
• Push in a regular rhythm, for example counting ‘1, 2, 3’
• Compression/relaxation ratio should be 50:50 with complete recoil of chest between each compression.
• Avoid compression below lower limits of sternum as may cause regurgitation and/or damage to liver/spleen/stomach.
• Interruptions to chest compressions should be minimized.
• After each 30 compressions there is an interruption in chest compressions for two (2) rescue breaths.
• For gasping or agonal breathing we should start with chest compression and continues until breathing stops.

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CPR FOR ADULT 1 AND 2 RESCUER

• Remember to spell C-A-B: The American Heart Association uses the letters C-A-B to help people remember the order to perform the steps of CPR. C: compressions A: airway B: breathing

Compressions: Restore blood flow

• Put the person on his or her back on a firm flat surface.
• Kneel next to the person's neck and shoulders.
• Place the lower (heel) of your hand over the centre of the person's chest, between the nipples.
• Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.
• Push straight down on (compress) the chest at least 2 inches (5 centimetres') but no more than 2.4 inches (6 centimetres'). Use your entire body weight (not just your arms) when doing compressions.
• Push hard at a rate of 100 to 120 compressions a minute, Allow the chest to spring back (recoil) after each push.
• If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to opening the airway and rescue breathing.

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Give rescue breath

• After opening the airway (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.
• Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises.
• If the chest rises, give a second breath.
• If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give a second breath. 30 chest compressions followed by 2 rescue breaths is considered one cycle.

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When 2 or more rescuers available,. Switch the compressor about every 2 minutes (or after 5 cycles of compressions and ventilations at a ratio of 30:2).. Accomplish this switch in ≤5 seconds.

And count chest compressions loudly from 25^th .

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CPR FOR CHILD

• Push straight down on (compress) the chest at least 2 inches (5 centimetres)
• 1 rescuer : CPR ratio: perform 30 chest compressions followed by 2 rescue breaths.
• 2 rescuer : CPR ratio: perform 15 chest compressions followed by 2 rescue breaths.

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One had CPR

Two hand CPR

CPR FOR INFANT

Step 1: Check for responsiveness.

Gently tap the infant’s foot or shoulder and yell. If the baby is unresponsive, move on to the next step and call 122 immediately.

Step 2: Give 30 chest compressions.

Put the baby on a hard, flat surface. Take 2 fingers and find the centre of the chest just below the imaginary line between the nipples. Push down 4cm at a rate of 100-120/minute. For 1 rescuer CPR ratio 30:2 and for 2 rescuer at ratio of 15:2

Step 3: Open the airway.

Gently tilt the head back, being careful to not tilt it too far, chin lift

Step 4: Give 2 breaths.

Cover the mouth and the nose with your mouth, creating a seal, and give 2 gentle breaths, watching to see the chest rise and then release.

Step 5: Continue giving infant CPR until help arrives.

CPR keeps blood flowing to the brain and other vital organs until advanced medical help can take over.

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One resuer

Two rescuer

AED ARRIVE

• An Automated External Defibrillator (AED) is a machine that is used to treat cardiac arrest, a life-threatening condition where the heart suddenly stops beating properly. By sending an electric shock to the heart of a person in cardiac arrest, the AED restores a normal heart rhythm.
• If available, attach an Automated External Defibrillator (AED) as soon as possible and follow the prompts. The use of an Automated External Defibrillator (AED) is now part of the BLS algorithm.

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AED STEPS

1 As soon as an AED is available, turn it on and follow the voice prompts

2 remove clothing and attach pads correctly

• Remove all clothing covering the chest. If necessary, wipe the chest dry
• Place one pad on the upper right side of the chest
• Place the other pad on the lower left side of the chest, a few inches below the left armpit

Note: if the pads may touch, place one pad in the middle of the chest and the other pad on the back, between the shoulder blades

�3 Plug the pad connector cable into the aed, if necessary

4 Prepare to let the AED analyse the heart’s rhythm

• Make sure no one is touching the person
• Say, “clear!” In a loud, commanding voice

5 Deliver a shock, if the AED determines one is needed

• Make sure no one is touching the person
• Say, “clear!” In a loud, commanding voice
• Push the “shock” button to deliver the shock

6 After the aed delivers the shock, or if no shock is advised, immediately start cpr, beginning with compressions

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DROWING

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BLEEDING

• Bleeding is the loss of blood from the circulatory system. Causes can range from small cuts and abrasions to deep cuts and amputations. Injuries to the body can, range from minor (seen as superficial bruising) to massive bleeds.��First aid for severe bleeding is critical in order to limit the loss of blood until emergency medical aid arrives.
• External bleeding
• Amputation
• Nose bleed

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TYPES OF BLEEDING

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EXTERNAL BLEEDING FIRST AID

Apply direct pressure to the bleeding wound

• Apply firm pressure over the wound. Use a sterile or clean bulky pad and apply it firmly with hand pressure. Apply a bandage to keep the dressing in place. 
• If bleeding is severe, DO NOT waste time looking for suitable padding, but be prepared to use the patient’s hand or your hand to hold the wound together if the patient is unable to do this unaided.

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Raise the injured area

• If the wound is on a limb, raise it in a supported position to reduce blood flow to the injured area. 
• Try to avoid any direct contact with the patient’s blood or other body fluids. Use disposable gloves if possible. If gloves are not available, place your hands inside a plastic bag.
• If there has been any contact with blood or any other body fluids, wash your hands or any blood splashed on the skin thoroughly with soap and water as soon as possible after the incident.

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CONT.

Keep the patient at total rest

• Even if the injury involves the arm or upper part of the body, the patient should rest in a position of greatest comfort for at least 10 minutes to help control the bleeding. 

Seek medical assistance

• If the wound appears to be minor and the patient is able to travel by car, arrange an urgent appointment with a local doctor to assess and treat the injury. 
• If the injury is severe or the patient is very unwell – call 122 for an ambulance as soon as possible.
• While waiting for an ambulance to arrive, observe the patient closely for any change in condition.

If blood leaks through the pressure pad and bandage

• Apply a second pad over the first. Use a tea towel or similar bulky fabric and apply maximum pressure to the area. 
• For major uncontrolled bleeding quickly remove the blood-soaked pad and bandage and replace with a fresh bulky pad and bandage. The continuing bleeding may be due to the pad slipping out of position when the first bandage was applied.

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CONT.

If a foreign body is embedded in the wound

• DO NOT remove it but apply padding on either side of the object and build it up to avoid pressure on the foreign body. 
• Hold the padding firmly in place with a roller bandage

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AMPUTATION

Control any bleeding

Use a bulky pad and apply it firmly to the bleeding area. Raise if possible.

Recover the severed part

• If possible, gently place it into a plastic bag. Seal the bag with a little air inside to protect the severed part with a ‘cushion’ of air. 
• Place the inflated bag into a container or bucket of cold water to which several ice cubes have been added. 
• Ensure the severed part is transferred to hospital with the patient.

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SEIZURE

• A seizure or convulsion can occur at any age and is due to abnormal electrical activity in the brain resulting in uncontrollable muscular activity and loss of consciousness. 

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SEIZURE FIRST AID

Protect the patient from injury

• Check the immediate area for hazards and remove them if possible. Move furniture away from the person.
• If the patient is close to a wall or hard furniture, pad the area with clothing or a pillow to avoid further injury.
• DO NOT move or try to restrain the patient’s movements because this may result in a broken bone or soft tissue injury.
• DO NOT try to pad between the patient’s teeth because this may damage the tissues in the mouth.

Manage the seizure or convulsion

• Stay with the patient until the seizure ends.
• If in a public place, keep bystanders clear and reassure them that the seizure will end soon.

After the seizure

• As soon as the seizure ends, quickly roll the unconscious patient onto their side and open and clear the airway ( recovery position).
• Cover the patient lightly with a coat or blanket. Check that normal breathing has resumed.
• Allow the patient to sleep until fully recovered, but check for a response every few minutes.

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NOSE BLEED FIRST AID

• If someone is having a nosebleed, ask them to sit down and lean with their head tilted forward.
• Do not tell them to lean their head back as this could cause the blood to trickle down the back of their throat and block the airway.
• Ask them to breathe through their mouth and pinch the soft part of their nose. Give them a clean tissue to catch any blood.
• After 10 minutes they can release the pressure on their nose. Ask them to pinch their nose again if the bleeding has not stopped. They should do this for two further periods of 10 minutes.
• Once the bleeding has stopped, ask them to keep leaning forwards while you clean around their nose with lukewarm water. Once clean, advise them to rest, avoid exertion or blowing their nose to prevent disturbing the clots.
• If the bleeding is severe, or if it lasts more than 30 minutes, call 122 or for emergency help.

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FRACTURE FIST AID

Don't move the person except if necessary to avoid further injury. Take these actions immediately while waiting for medical help:

Follow DRSABS

• Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.
• Immobilize the injured area. Don't try to realign the bone or push a bone that's sticking out back in. Apply a splint to the area above and below the fracture sites. Padding the splints can help reduce discomfort.
• Apply ice packs to limit swelling and help relieve pain. Don't apply ice directly to the skin. Wrap the ice in a towel, piece of cloth or some other material.
• Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.

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FAINTING

• Fainting occurs when brain temporarily doesn't receive enough blood supply, causing patient to lose consciousness. This loss of consciousness is usually brief.

People with the following medical conditions are at an increased risk of fainting:

• Low blood sugar (hypoglycaemia)
• Low blood pressure
• Anaemia
• Any condition in which there is a rapid loss of blood, such as from internal bleeding
• Heat stroke or heat exhaustion
• Eating disorders (eg, anorexia and bulimia)

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FIRST AID FOR FAINTING

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1. If possible, try to prevent someone who is fainting from hitting the ground.
2. Lay the person down on the ground, face up, and elevate his/her feet above heart level 30 centimetres.
3. Loosen any constrictive clothing.
4. Apply a cool, wet compress to the person's forehead.
5. Attempt to keep the person from standing up until fully recovered, don't get the person up too quickly.
1. Note:�If the person vomits while he/she is unconscious, quickly turn him/her to recovery position for allow the fluid to drain while protecting the person's airway.
2. Do not attempt to give an unconscious person anything by mouth.
3. Do not shake or slap a person who has fainted to attempt to make him/her regain consciousness.
4. If the person doesn't regain consciousness within two minute, call 122 for help.

CHOCKING

Choking occurs when a foreign object lodges in the throat or windpipe, blocking the flow of air. In adults, a piece of food often is the culprit. Young children often swallow small objects. Because choking cuts off oxygen to the brain, give first aid as quickly as possible.

The universal sign for choking is hands clutched to the throat. If the person doesn't give the signal, look for these indications:

• Inability to talk
• Difficulty breathing or noisy breathing
• Squeaky sounds when trying to breathe
• Cough, which may either be weak or forceful
• Skin, lips and nails turning blue
• Loss of consciousness

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FIRST AID FOR CHOKING IN ADULT & CHILD

• If the person is able to cough forcefully, the person should keep coughing. If the person is choking and can't talk, cry or laugh forcefully, the American Red Cross recommends a "five-and-five" approach to delivering first aid:
• Give 5 back blows. Stand to the side and just behind a choking adult. For a child, kneel down behind. Place one arm across the person's chest for support. Bend the person over at the waist so that the upper body is parallel with the ground. Deliver five separate back blows between the person's shoulder blades with the heel of your hand.
• Give 5 abdominal thrusts. Perform five abdominal thrusts (also known as the Heimlich maneuver).
• Stand behind the person. Place one foot slightly in front of the other for balance. Wrap your arms around the waist. Tip the person forward slightly. If a child is choking, kneel down behind the child.
• Make a fist with one hand. Position it slightly above the person's navel.
• Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
• Alternate between 5 blows and 5 thrusts until the blockage is dislodged.

The American Heart Association doesn't teach the back blow technique, only the abdominal thrust procedures.

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FIRST AID CHOCKING FOR INFANT

1 Place the infant with their head downwards on your forearm, supporting the head and shoulders on your hand.

2 Hold the infant’s mouth open with your fingers.

3 Give up to 5 sharp blows to the back between the shoulders with the heel of one hand, checking if the blockage has been removed after each blow.

4 If the blockage has come loose or been removed, turn the infant into the recovery position and remove any object that may have come loose with your little finger.

5 If the blockage has not been removed after 5 back blows, place the infant on their back on a firm surface.

6 Place 2 fingers on the lower half of the sternum and give up to 5 chest thrusts, checking if the blockage has been removed after each thrust. Support the infant’s head with the other hand.

8 If the blockage has not been removed after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts until medical aid arrives.

9 If the infant becomes unconscious, start CPR.

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