FIRST AID

MADE EASY
INTRODUCTION

• Refers to the initial treatment given to someone who is injured or

suddenly ill with an aim of preserving life, promote recovery and
to prevent complications before proper medical treatment is given
Terms related to first aid
• Bystanders. These are people who are called by the first aider
and they help in saving the life of the causality.
• First aider: Refers to a person who is trained by a
recognized institution and qualifies to give first aid.
• Passer-by: Refers to people who only pass near the scene of
the accident and don’t give any help.
• On lookers: Refers to people who look at the injured person while
still at the scene of accident and do not give any help.
• Complications: Refers to the negative effects that occur due to
poor management of the condition.
Cont.
• Scene: A place where an accident has taken place
• Accident: Refers to asudden happening that results into injury to the
person
• Emergency: An urgent situation that needs immediate intervention
• Casualty: A person who is suddenly injured or ill and
requires immediate treatment
• Triage: A process of sorting casualties according to their degree
of injury giving priority to those with life threatening conditions
• First aid kit: A box that contains equipment and materials used to
give first aid
Objectives/importance of giving first aid
• To preserve life
• To promote recovery
• To prevent further complications
TO PRESERVE LIFE
• Ensure ABC (airway, breathing, circulation)
• A- airway: Ensure that the airway is open. If it’s closed,
tilt the head backwards to allow air circulation. It helps
the
trachea to open.
• B-Breathing: Ensure that the casualty is breathing. Check
for signs of breathing; chest movements, abdominal
movements, feel for the breath using your cheek and
listen for the breath sounds. If the casualty is not
breathing, do
artificial respiration either using mouth to mouth
respiration or by using anambubag.
Cont.
• C- Circulation: Check the causality for enough blood
flow. Observe the skin for cyanosis (bluish
discoloration commonly seen around the lips),
jaundice (yellowish discoloration of the skin and
the sclera of the eye),and pallor/paleness (whitish-
like
appearance of the skin). In case of poor or
insufficient cardiac function or cardiac arrest, perform
CPR
TO PROMOTE RECOVERY

•Apply splints incase of fractures.

•Apply dressing incase of wounds and
bleeding.
•Place the casualty in a recovery
position.
TO PREVENT COMPLICATIONS
• Maintain the casualty in good body alignment
• Arrange for transportation to hospital for
further management
QN: Explain the ABC principle of first aid
QN: Explain the DR. ABC principle of first aid.
MATERIALS AND GADGETS USED IN FIRST
AID

• First aid kit and its components: The kit contains equipment used
to give first aid
• Stretcher: Stretchers are used to transport the casualty from
one place to another
• Ambu bag: They are used to give artificial respiration
• Protective gears: like gloves, face mask, apron, gowns, gumboots,
caps, eye goggles. These help to protect the different parts of the
body from infections that may be transferred either from the
first aider to the casualty or from casualty to the first aider
FIRST AID KIT

•Defined as a box that contains all the

equipment and materials used by the
first aider to give first aid
Components of a first aid kit

• Sterile Gauze: For cleaning and dressing wounds

• Cotton wool: For cleaning around the wound
• Antiseptics like hydrogen peroxide, spirit, iodine, water and soap.
These solutions are used when dressing wounds and prevent growth of
microorganisms on the wound. H2O2 is used on dirty wounds and
the others on clean wounds
• Bandage: Used to limit swelling, immobilize fractures and keep dressing
in position
• Pain killers: Used to reduce pain especially in cases of cramps
• Safety pins: Used to secure roller bandages in position and to
make improvised sling bandages
CONT.
• Tourniquet: Used to arrest bleeding
• Gloves: For protecting the first aider from hand infections
• Scissor: For cutting gauze, and bandage
• Surgical blade/ razor blade: Used to make incisions
• Tweezer: Used in first aid management for tick bites
• Face mask: To protect the casualty from respiratory infections
• Small blanket: For covering the casualty to keep him warm
Types of a first aid kit

• Home first aid kit: it contains items that manage common home
accidents like burns, cuts, bleeding. It contains items like
bandages, gauze, scissor, tweezer, insect bite swabs
• Medical first aid kit: It contains items that manage common
medical conditions like heart attack, asthmatic attack, and
hypoglycemia. It contains inhalers, glucose powder, aspirin tablets
and others
• Office first aid kit: it is used by people working in offices. It contains
mainly common drugs used to manage common diseases like
ulcers
Cont.
• Sports first aid kit: It is carried by first aiders who give first aid
during football matches. It contains materials that manage
orthopedic
injuries like bandages, splints
• Military first aid kit: it is carried by soldiers during time of war. It
contains items that manage wounds and bleeding such as
tourniquet, clothing and wound dressings
• First responder kits: It contains items like BP machine,
thermometer, and stethoscope, used to take vital signs of the body.
Other items
includeshears, liniment etc
• Camping first aid kits: It is carried by people who go for camping. It
contains common items like tweezers, bandages, scissors,
dressings
HOW TO MAKE A HOME FIRST AID KIT
(steps)

• Choose a large plastic container which is flexible and water resistant

• Make a list of all the items needed in the first aid kit to manage
common home accidents. Items may include bandage, cotton, soap etc
• Stock the kit with all the items listed
• Inform all the adult members of the family about the kit
• Train all the adult members how to use the equipment in the first aid kit
• Label on the outer surface of the container as FIRST AID KIT
• Place the kit in a safe and easily accessible place at home, where
children can’t reach
• Keep checking that all items stocked in the kit are still there
 PILLARS AND GOLDEN RULES AND PRINCIPLES
OF
FIRST AID

• Pillars
• History taking
• Signs
• Symptoms
History taking
• This involves getting information concerning the
injury or sickness.
• It gives details at when the problem took place,
where it happened and what has been done so far.
• History can be obtained directly from a casualty if
he is conscious or directly from the bystanders if the
casualty is unconscious.
Signs

•These are clinical presentations of a

disease or injury as seen or discovered by
the first aider / medical personnel. For
example
bleeding is a sign of hemorrhage
Symptoms.

• These are clinical presentations of a disease or injury as

complained by the casualty. For example stomachache, toothache
etc
 SCOPE OF FIRST AID (MAIN
STEPS/ELEMENTS)

• Emergency assessment
• diagnosis
• immediate treatment
• referral
Emergency assessment
• Assessment refers to the process of finding out
the
problem of the casualty through history taking,
observation and physical examination.
Assessment ensures safety of the first aider
Methods for assessing a casualty

• History taking
• Physical examination (checking the casualty from
head to toe)
• Observation
Importance of assessing a casualty

•It helps to rule out any danger to the

first aider and the by- standers.
•It helps to collect symptoms and signs of
the disease or sickness.
•It can form a basis of triage.
Diagnosis.

• It refers to the casualty’s identified problem.

• The information obtained during assessment, helps
to reveal diagnosis. Take an example of bleeding.
Then
the diagnosis is hemorrhage.
Immediate treatment

• After identifying the diagnosis, immediate

treatment is given by the first aider with the help of
by –
standers. For example in case of bleeding, a
sterile dressing is applied or a tourniquet to arrest
hemorrhage.
Referral.

• It means transferring the casualty to hospital. After

giving immediate treatment, the first aider
arranges for transportation to the hospital.
• The method of transport depends on the nature
of injury or sickness
Principles and golden rules of first aid
• Be calm and active when giving first aid
• Emergency assessment-m involves history taking
, observation and physical examination
• Call for help: call by- standers or call 999
• Keep re- assuring the by-standers and the
casualty
• Consider ABC approach to save life.
• Promote recovery: put the casualty in recovery position and
cover with a blanket or sheet.
• Prevention of complications: the casualty should betaken to the
hospital for further management.
• Keep the casualty warm.
• Avoid unnecessary movement of the casualty as this may cause
more problems.
• Arrange for transportation to the hospital.
FIRST AIDER

•Refers to a person who is trained by a

recognized institution and qualifies to give first
aid
QUALITIES OF A GOOD FIRST AIDER

• Confidentiality. A good first aider should keep the secrets or information

about the casualty
• Knowledgeable: a good first shoulder have knowledge and skills of giving first
aid
• Observant/ critical: a good first aider should have the ability to see signs of
the problem
• Trustworthy: should keep the property of the casualty and return it all to him
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• Courageous: a good first aider should be brave when giving first aid
• Empathetic. A good first aider should give hope to the casualty and
put himself/herself in the shoes of the casualty
PRIMARY SURVEY (PRIMARY ASSESSMENT)
• Primary survey refers to the first quick
assessment done on the casualty to establish and
treat life
threatening conditions.
Sequence/steps of Primary survey (how to
carry out primary survey)
• The sequence of carrying out primary survey is abbreviated as
DR ABC
• Danger: Assess for any danger at the scene to ensure first
aider’s safety, casualty and bystanders
• Response: Find out if casualty responds to you or not. Observe the
casualty as you reach, introduce yourself and ask the casualty
what has happened. Give commands like open your eyes. For a
child, tap shoulders and for infants, tap the foot
• Airway: Check that the airway is open. Tilt the head
backwards; loosen tight clothing around the neck and waist
• Breathing: Look, Listen and feel for breathing. Observe for chest
movements, abdominal movements, feel for the breath using your
cheek and listen to the breath sounds. If the casualty is not
breathing, start artificial respiration
• Circulation: Check for normal blood flow and check for any bleeding
• NB: for purposes of answering objectives, Response is considered
the first step in primary survey
SECONDARY SURVEY (SECONDARY ASSESSMENT)

• Refers to a process done after primary assessment

to check for other injuries or illness by performing a
head-to-toe examination
• It involves history taking, observing for other signs
and symptoms
• Secondary survey includes checking for Disability (D)
and Examining casualty (E) from head to toe for
other injuries
Sequence for secondary survey
History
• Two forms of history should betaken; event history and
previous history. All history is taken following the order;
• A-Allergy
• M-Medication
• P-Previous history
• L-Last meal
• E-Event history
Cont.
• Signs: The first aider notes what he has seen, felt or smelton the
casualty for example smell of alcohol, swelling, bleeding, pin
point pupils, reddening
• Symptoms: The complaints of the casualty are recorded; Pain,
thirst, nausea, body weakness, faintness
• Qn.
• Define primary survey/assessment
• Describe how you carryout primary survey at the scene
• Outline the steps involved when carrying out primary assessment
TRIAGE

• Refers to a process of sorting casualties according to their degree

of injury or illness giving priority to those with life threatening
conditions
• Indications of triage
• For sorting casualties incase mass casualty accidents
• In theatre to determine patients who need emergency operations
• In emergency rooms at hospital to determine who should be
treated first
Cont.
• Advantages
• Triage helps to identify casualties who need immediate
treatment
• For easy provision of first aid
• It’sa Quick technique of saving life
 i o n r
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• Yellow tag. Labeled on casualties with stable conditions and need observation or monitoring
• Green tag. Labeled on casualties who have been treated and are able to walk but will still need
to see the doctor
• White tag. Labeled to those with minor injuries who don’t even need the doctor and
are dismissed home.
• Black tag. Labeled on the dead and for those whose injuries are so severe that they are
expected to die.
• Explain the roles of:
• First aider
• By-standers when giving first aid.
LIFE THREATENING CONDITIONS
• These are conditions that put the casualty at a risk
of death and therefore require immediate treatment
from the first aider
• Life support skills and techniques: These are
emergency skills and techniques used by the
first aider to save life. They include;
• Cardiopulmonary resurrection (CPR)
• Bandaging
Cont.
• Dressing
• Recovery positioning
• Delivery skills
• Assessment skills
Life threatening conditions

• Hemorrhage
• Shock
• Choking
• Burns and scalds
• Fractures
• Drowning
• Medical emergencies like asthmatic attack, heart attack
• Unconsciousness
• Epileptic seizures or fits
• Asphyxia
• Poisoning
LIFE SUPPORT SKILLS AND TECHNIQUES

• CARDIOPULMONARY RESUSCITATION (CPR)

• Refers to the procedure that involves artificial respiration and
chest compressions in order to support the heart and respiratory
functioning
• STEPS
• Emergency Assessment
• Assess the casualty for the level of consciousness using the
AVPU scale, take history and feel for pulse.
Give rescue breaths

• Check the airway for openness and breathing. Place one hand at
the forehead and the two fingers of the other hand at the chin,
then tilt the head backwards.
• Pinch the soft part of the nose and open the mouth.
• Take a deep breath to fill your lungs and place your lips over
the casualty’s lips.
• Give two breaths and watch the chest movements.
Cont.
• Position hands for chest compression. Locate the lower end of
the sternum.
• Place the heel of the other hand on the sternum and then place the
heel of the other hand on top of the hand, then interlock the
fingers.
• Give chest compressions
• Lean well over the casualty with the arms straight. Give 30
chest compressions. If no response, repeat the two rescue
breaths.
• Recovery position.
• Place the casualty in recovery position and protect them
from coldness by covering with a sheet or small blanket
Indications of CPR

• Cardiac arrest
• Unconsciousness
• Shock
• Drowning
• Asphyxia
• Fainting
 Contra indications (when not to CPR even
when
necessary)

• Fracture of the ribs

• Infectious fevers like cholera
• Epistaxis (nose bleeding)
• Pleural effusion
• Qns: Outline the steps of CPR
• List the indication and contra indication of CPR
 ARTIFICIAL RESPIRATION/ARTIFICIAL
VENTILATION

• It is defined as mouth-to-mouth or
mechanical initiation of breathing among
casualties with breathing problems
• TYPES/METHODS OF ARTIFICIAL RESPIRATION
• There are two methods of artificial respiration
• Schaffer’s method/ Schaffer’sartificial respiration
• Sylvester’s method/Sylvester’sartificial respiration
PROCEDURE

• Schaffer’s method is a method of artificial respiration in which the

casualty lies on the abdomen and pressure is applied at lower part
of the chest using first aider’s hands. The casualty lies on the
abdomen and the first aider kneels by straddling over casualty’s
thighs. One
hand is extended over head and the other is bent at the elbow,
face pointing outward and resting on hand or forearm so that nose
and mouth are free for breathing. The tongue is pulled forward,
but do not hold it. The first aider’s hands are placed over the ribs
with the little finger lying over the lowest rib and pressure is
applied
rhythmically for 12-15times per minute for a period of 1-3hrs.
Cont.
• Sylvester’s method is a method of artificial respiration where the
casualty lies on the back and air is drawn in by placing arms over
the head and air is expelled from the lungs placing arms over the
chest.
Place the casualty on his back and loosen tight clothing around the
chest and stomach. Put a pillow under the shoulders so that the
chest rises and head tilted backward. The tongue is pulled forward
and
held. The arms are placed over the head to allow inspiration and
then crossed over the chest to allow expiration.
RECOVERY POSITIONING

• Means placing the casualty in comfortable position that

supports breathing and promotes recovery
• Indications
• unconscious casualties
• fainting and suffocation
• after epileptic fits seizures
• shock
• asphyxia
Steps of recovery position

• 1.Emergency assessment. using AVPU scale

• Alert, Voice Pain Unresponsive
• Ensure first aider’s safety and check for level of consciousness
using the AVPU code.
• Check for pulse and call for help.
Cont.
• 2.Position the near armand straighten the legs.
Kneel beside the casualty remove spectacles and any bulky objects
like mobile phones and keys from the pockets. Make casualty’s legs
straight. Loosen any tight clothing’s and remove shoes. Place the
arm nearest to you at right angle to the casualty’s body with the
elbow
bent and the palm facing forward.
Cont.
• 3. Position far arm, hand and knee
• Bring the arm furthest from you across the casualty’s chest and
hold the back of hand against the cheek nearest to you.
• Your other hand grasps the far leg just above the knee and pulls it
up until the foot is lying flat on the floor.
Cont.
• 4. Roll the casualty to his side.
• Roll the casualty to his side.
• Adjust the upper leg so that both the hip and knee are bent at
right angles.
• Tilt the head back to ensure that airway remains open.
• 5. Call triple nine for an ambulance it was not done before.
ASSESSMENT SKILLS

• ASSESSMENT SKILLS
• Check response. Use the AVPU code. Give commands and see if
the casualty can follow; ask questions and hear if the casualty will
respond to the questions
• Open airway. Assess that the airway is open
• Check breathing. Look, listen and feel for breathing:
• Look for chest movement, listen for sounds of breathing and feel
for breath on your chic.
• Circulation; assess for pulse, skin color and any bleeding.
DELIVERY SKILLS

• A first aider should have some knowledge and skills

about childbirth. Skills like cutting the umbilical
cord, receiving the baby and should have knowledge
of the presenting part of a baby during child birth
and even protecting the baby from coldness
DRESSING

• Refers to the application of a sterile pad of gauze

at the injured part to stop bleeding
TYPES OF DRESSING

• Sterile dressing
• This type of dressing consists of a dressing pad attached to a
roller bandage.
• Non sterile dressing
• Is a type of dressing which is clean but not sterile
• Adhesive dressing
• A type of dressing consisting of a dressing pad with an
adhesive backing. It is commonly used for small cut wounds.
Cont.
• Cold compress
• Is a type of dressing made from materials immersed in cold water.
It’s commonly used in soft tissue injuries (sprains, strains and
cramps).
• Explain/outline the steps you take to dress a small cut wound on
the hand. (10mks)
• Petroleum dressing
• Is a dressing smeared with Vaseline to avoid the dressing getting
stuck on the wound. They are commonly used in burns and scalds.
RULES OR PRINCIPLES OF DRESSING

• Explain the procedure to the casualty and introduce yourself.

• Inspect the wound before dressing the wound
• Always wash hands before and after dressing a wound.
• Always put on gloves when dressing a wound
• Apply sterile technique when dressing a wound.
• Do not cough or sneeze on the wound.
• Clean the wound from inside out.
• When the first dressing is soaked, do not remove the soaked one but
add another dressing.
• Reassure the casualty.
ADVANTAGES OF DRESSING

• To keep the wound dry

• It prevents infection from entering the wound.
• Dressings help to stop bleeding because they exert direct pressure
on the wound.
• It helps to immobilize the wound.
• Absorbs blood and other fluids from the wound.
BANDAGING
• Is the technique of covering a wound or an
injured part using a bandage
ADVANTAGES

• To control bleeding i.e. due to the direct pressure exerted on

the wound.
• To immobilize the injured part.
• Helps to keep dressings and splints in position.
• Through immobilizing bandages reduce pain.
• Bandages help to limit swelling of the injured part.
• Restrict movement of the injured part.
QUALITIES OF A GOOD BANDAGE

• Elasticity: Should be able to stretch

• Appropriate size: Long enough in size
• Porous: Should have small holes on it to allow entry
of air
• Well aerated: A good bandage should allow
free circulation of air
• Should be made of non-hairy material
Types of bandages

• These are three main types of bandages

• Roller bandages: For dressing and supporting limbs.
• Tubular bandages: for banding of finger and toes
• Slings: armsling and triangular sling bandages
for bandaging arm related injuries. Other slings
are elevated sling and improved sling
• Bandaging patterns; spiral bandaging and figure of
8 bandaging pattern
Rules/principles of bandaging

• Explain the procedure to the casualty and introduce yourself

• Make the casualty comfortable in a sitting or lying position
• Wash hands before and after bandaging
• If the part is bleeding, put on gloves
• Inspect the injured part before bandaging
• Stand in front of the casualty and on the side of the injured part
while bandaging, except when bandaging the head.
• Keep reassuring the casualty while bandaging
Cont.
• Apply the bandage firmly but not tightly
• Assess the casualty for impaired circulation or pain after bandaging
• In case of slings, the bandaging process ends with a reef not
• Use a good or appropriate sizeable bandage
• Keep the injured part supported while bandaging it
• Secure a roller bandage in position using safety pins or bandage
clips
• Allergy to the adhensive tape
Assignment (practical on bandaging)

• Demonstrate how we bandage the following body parts;

• Elbow and knee
• Hand and foot
• Ankle
• Scalp/head
• Jaw
• Shoulder/clavicle bone
• Eye
• Ear
• Demonstrate how to carryout the four different improvised slings
 TRIANGULA BANDAG (cravats

•
3 6 cm
TRIANGULAR BANDAGE

3 6 cm

52cm base
It be used to make a fold bandages or a narrow fold
Procedure for applying roller bandage

• The tip of a roll of a bandage is called a tail whereas the roll is

called the head .
• Keep the head of the bandage upper most so that if you drop it
does not fall to the ground .
• Make the casualty comfortable and offer reassurance .work infront
of the casualty and start on the injured site .
• Apply the bandage with a firm and even pressure,not too tight,not
too loose
• Tie reef knots or secure with a tape
• Check the circulation .
 Method

• Place the tail of the bandage below the injury and work from inside
to outside and from the furthermost point to the near most part
• Roll the bandage around the limb and start with two overlapping turns
• Cover 2/3 of the previous turn with each new one and finish with
two overlapping
• Once you have finished,check the circulation and if it is too tight
unroll and reapply loosely
• Secure the end with adhensive tape or tie the ends of a bandage using
a reef knot
Bandaging the hand and foot
• When bandaging a foot start bandaging the big toe
• Hand
• Start at the wrist and make two straight turns working from inside
to outside of the wrist
• From the thumb of the wrist take the bandage diagonally across the
back of the hand until it is touching the nail of the little finger
• Leave the thumb free and take the bandage across the front of the
finger also keeping the fingertips free
• Now take the bandage across the back of the hand to the outside of
the wrist ,then around the wrist and backup to the little finger
• Repeat these turns and cover about 2/3 of the previous turn with each
new turn
Bandaging an elbow or knee joint .

• Bandaging an elbow or knee joint .

• This is done in partly flexed position and these bandages need to
be applied using a figure of 8
• Put the tail of the bandage on the inside of the elbow , wind the
bandage around the joint twice
• Now move the head of the bandage above the joint and wind two turns
diagonally , making sure that you have covered half of the previous turn
.
• Move the head to below the joint,cover half of the initial straight
turns and do two diagonal turns
• Continue doing two diagonal turns above and the below the joint in
the finger of 8 and then finally finish off with two straight turns
How to bandage ahead

• assisgnment
LIFE THREATENING CONDITIONS
HAEMORRHAGE AND WOUNDS
• HAEMORRHAGE
• Refers to loss of blood from a bloodvessel
• Causes
• Cuts from sharp objects like razorblade
• Delivery
• Hemorrhagic fever e.g. Ebola and Marburg
• Surgical operations like circumcision
• Trauma
• RTA [road traffic accident]
• Sports injuries
Types of haemorrhage

• The types of haemorrhage follow the types of

blood vessels i.e. arteries, veins and capillaries and
are
therefore called;
• Arterial haemorrhage
• Venous haemorrhage
• Capillary haemorrhage
Arterial haemorrhage

• In arterial haemorrhage blood spurts at high pressure and its

bright red in color. This is because arteries carry oxygenated blood
apart from the pulmonary artery.
• In venous haemorrhage, blood oozes from the vessel and it is
dark red in color. This is because veins carry deoxygenated blood
apart from the pulmonary vein
• In capillary haemorrhage, blood oozes from the capillary and is
purplish in color. The purplish appearance of blood in capillary
haemorrhage is because capillaries carry a mixture of oxygenated
and de-oxygenated blood.
Classification of haemorrhage

• Haemorrhage can be classified according to location

of bleeding site, bloodvessel and time of bleeding
• According to location of bleeding site
• It can be internal or external haemorrhage
• i] Internal haemorrhage
• Bleeding occurs inside the body and blood mayor may
not be seen outside .The commonest causes is ulcers
 Sign and symptoms of internal
hemorrhage

• Rapid pulse
• Subnormal temperature
• Pallor or pale skin
• Cyanosis
• Low blood pressure
Cont.
• Haematesis; vomiting of blood
• Hemoptysis; coughing of blood
• Hematuria – appearance of blood in urine
• Sweating
• Confusion
• Restlessness
ii] External bleeding
•Bleeding occurs on the outer surface of
the body
•Signs and symptoms
•Blood is seen outside the body
•Low blood pressure
•Cyanosis
•Pale skin
Cont.
• Confusion
• Sweating
• Restless
• Subnormal temperature
• Rapid pulse
• Thirst
• Low urine output
• Fatigue
According to bloodvessel

• Refer to the types of haemorrhage (arterial, venous and

capillary haemorrhage
• According to time
• i] Primary haemorrhage: It occurs immediately after injury
• ii] Secondary haemorrhage: It occurs within 24hrs and few days
after injury
• iii) Reactionary haemorrhage: It occurs within 10days to 2 weeks
after injury.
First aid Management of external haemorrhage

• Emergency assessment: carryout emergency assessment on the area

and casualty
• Call for help: help can be from bystanders or call 999
• Remove casualty from danger
• Check for ABC
• Arrest bleeding using the red method by; resting the bleeding
part, elevate the bleeding part if possible and applying direct
pressure;
• Direct pressure method can be through pressure point or applying
a dressing.
Cont.
• To apply a dressing, clean the wound with sterile gauze and
antiseptic, and apply gauze to the site followed by a
bandage
• Treat for shock
• Reassure the casualty if conscious or bystanders if the casualty
is unconscious
• If possible, put the causality in recovery position
• Arrange for transportation to the health facility
Complications of haemorrhage

• Respiratory failure
• Kidney failure
• Shock
• Unconsciousness
• Cardiac failure
SPECIAL FORMS OF BLEEDING
• Epistaxis
• It is defined as bleeding through the nose
• Causes of epistaxis
• Infections: diseases caused by microorganisms
• Cardiac diseases like hypertension HTN
• Trauma to the nasal cavity
• Putting sharp objects into the nose
• Direct pressure to the nose
• Head injury
Signs and symptoms/clinical manifestation
or presentation of epistaxis
• Blood is seen through the nose
• Severe headache
• High pulse rate
• Difficulty in breathing
• Pallor /pale skin
• Cyanosis; due to less oxygen in the blood
• Confusion
• Restlessness
• Sweating
• Low blood pressure
First aid Management for epistaxis

• Emergency assessment-asses the nose for the cause of bleeding

• Call for help if necessary
• Remove the casualty from danger and move him/her to a safe place
• Make the casualty sit and instruct him to bend forward while
pinching the soft part of the nose
• Instruct the casualty to breathe through the mouth
• Apply a cold compress on the forehead
Cont.
• If bleeding doesn’t stop pack the nose with tetracycline or
adrenaline soaked gauze pieces
• Clean blood from the nostrils using clean gauze and lukewarm water
• Reassure the casualty
• Check if bleeding has stopped
• Arrange for transportation to the healthy facility
VAGINAL BLEEDING [bleeding through vaginal
canal]

• Causes
• Menstrual periods
• Sexual assault
• Cervical cancer
• Cervical polyps
• PID [pelvic inflammatory disease]
Management

• Move the woman to a private place or arrange for screening

around her.
• Take brief history
• Find a sanitary pad or clean towel and give her to use
• Put her in a comfortable position
• Reassure the casualty
• Provide painkillers incase of menstrual cramps
FAINTING

• Fainting is when someone becomes unconscious for a short period of

time .
• Fainting happens because for a short time the brains does not
have oxygen
• Someone who has fainted usually recovers very fast .
Causes of fainting

• Standing /sitting around for along time especially in the sun

• A sudden shock
• Pain
• Exhaustion , being very tired
• Lack of food /low glucose level
• Emotional stress
Signs and symptoms
• Collapse and loss of consciousness
• Paleness
• Skin cold
• Have a slow pulse which will get faster as a casualty gets better
 First aid management
• Aims
• Improve blood supply to the brain
• To reassure the casualty and make him or her comfortable
• Mgt
• Assess for DR ABC respond as needed and treat any more
urgent conditions or injuries
• Lay the casualty down and gently raise and support the legs so
more blood goes to the brain
• Make sure there is fresh air if possible
Cont.
• Reassure the casualty and keep bystanders away
• When the casualty recovers,sit him /her up slowly
• If the casualty sits up so quickly,he /she may faint again
• If the casualty does feel pain again ,lay him /her down again and
raise and support the legs
• If the casualty does not gain consciousness quickly , then
reassess RABC , place in recovery position and call for help .
• Remember to keep checking the casualty’
WOUNDS

• Is the breakin the continuity of the skin or body surface

• Causes of wounds
• Road traffic accidents
• Surgical operations
• Sports injuries
• Burns and scads
• Fractures
• Cuts from sharp objects like razor blades, panga,
• Gunshots
Types of wounds

• Open wounds: The wound is external and bleeding is seen.

• Closed wounds: Bleeding is confined inside or blood does not
appear the body.
• Classification of wounds (varieties of wounds)
• Punctured wounds/penetrating wounds
• Septic wounds
• Gunshot wounds
Cont.
• Incised wounds
• Stab wounds
• Bruises (contusions)
• Abrasions (grazes)
• Scrape
• Lacerated wound
Cont.
• Penetrating /punctured wounds
• Caused by sharp pointed objects like nails, needles
• Lacerated wounds
• Caused by blunt objects like brick. It has much bleeding and tears
at the site
• The wound can easily be infected and bleeding is much by bacteria.
Cont.

• Septic wounds
• These are wounds which are invaded by micro-organisms.
• They are characterized by bleeding, pain and pus formation.
• It is commonly seen with lacerated wounds.
• Incised wounds
• Caused by clean cut from sharp edged objects like razor
blade, surgical blade and there is profuse bleeding.
Cont.
• Bruises (contusions)
• These are caused by a blunt blow or punch which can rapture capillaries
under the skin. Bleeding occurs under the skin and blood leaks to the body
tissues.
• It has minimal bleeding the wound is small and bleeding occurs
into tissues.
• The area becomes red.
• Abrasions
• Is caused by sliding falls and much friction occurs on the surface of the
skin; some layers may be scrapped off.
• Some small objects may be embedded in the wound and become source
of infection.
Cont.
• Gunshot wounds
• Caused by gun bullets. Point of entry is small and the point of exit
is large and tears.
• There is too much bleeding and is very painful.
• Stab wounds: These are wounds caused by long bladed objects
like panga. The wound is made of a long cut, bleeding and pain
•
• Scrape: These are wounds where there is a deep pointed object
being embedded on the wound. There is much pain and bleeding
Cont.
• Avulsion: a form of wound in which deeper layer of the skin
is scrapped off. There is much bleeding
• Signs and symptoms of open wounds
• The wound is seen
• Bleeding
• Pain at the site of injury
• Swelling
Cont.
• Headache
• Tenderness
• Difficulty in breathing incase of chest wounds
• High pulse rate
• Subnormal temperatures
• Reddening at the site
• There will be signs of hemorrhage like cyanosis
First aid management for open wounds

• Emergency assessment
• Call for help
• Remove the casualty from danger.
• Check for ABC
• Arrest bleeding following the red method
• R-rest the bleeding part
• E-elevate it if possible
• D-apply direct pressure using tourniquet, pressure point method or dressing
• Treat for shock.
• Reassure the casualty if conscious or by-standers if the casualty is
unconscious.
• Arrange for transportation to a health facility.
Complications of wounds

• Shock
• Hemorrhage
• Unconsciousness
• Infections
Whiplash injury

• Refers to injuries on the head and neck caused by rapid backward

and forward movements of the neck
• It’s common to drivers wearing seat belts and get involved in
car crash. Whiplash injury is sometimes called sprain of the
neck
S/s of whiplash injury

• Wounds on the head and neck

• Neck pain
• Swelling of the neck
• Stiffness of the neck
• Neck tenderness
• Severe headache
• Loss of memory
• Bleeding from the head and neck
• Casualty may be unconscious
• High pulse rate
• Low blood pressure
• Cyanosis
• F/A management: as for haemorrhage and
wounds •
HEAD INJURY

•Refers to any trauma to the scalp, skull

or brain
•Causes: sports injuries, RTA, assault
are the common causes with RTA
being
number one
Types of H. I

• Open had injury

• Closed head injury
• Classification of head injury
• Concussion; occurs due to a blow or over shaking of
the head and trunk and is characterized by
temporary loss of consciousness.
Cont.
• Contusion; it occurs due to a blow to the head and is characterized
by long term loss of consciousness and localized bleeding
• Skull fracture; This is characterized by fracture or break to the
skull bones
• Primary and secondary head injury; it is said to be primary head
injury if it has just happened and no complications have
developed and it is said to be secondary head injury if
complications have
already developed.
S/s of open head injury

• Wounds are seen on the head

• Bleeding
• Low blood pressure
• Subnormal temperature
• High pulse rate
• Vomiting
• Dilated pupils
• Difficulty in breathing
• Battle’s sign (purplish coloration on the skin behind the ear)
• Raccoon eyes (swollen and dark ringed eyes)
• Loss of consciousness
• Severe headache
First aid management for open head injury
• Emergency assessment: use the AVPU code to assess the level of consciousness and find
out the cause of head injury
• Call for help from ambulance and bystanders
• Remove the casualty from danger.
• Check for ABC
• Arrest bleeding following the red method
• R-rest the bleeding part
• E-elevate the head to about 30o
• D- apply dressings and bandage to the wound
• Treat for shock.
• Reassure the casualty if conscious or by-standers if the casualty is unconscious.
• Arrange for transportation to a health facility.
Road traffic accidents (RTAs)
• Refers to fatal accidents that occurs on the road involving vehicles
and human beings
• Causes of RTAs
• Over loading
• Playing on the road
• Drunken drivers
• Narrow roads
• Slippery roads
• Absence of road signs
• Overtaking in corners
EYE INJURIES

• Eye flash
• It is defined as injury to the eye caused by spilling of chemicals to
the eye
• Sign and symptoms
• There is history of contact with the chemical
• Itching in the affected eye
• Burning sensation
Cont.
• Tears in the affected eye
• The affected eye is unable to use
• Swelling of the affected eye
• Pain on the affected eye
• Photophobia [fear of light]
• The eye turns red
First aidmgt of eye splash

• Emergency assessment: Quickly asses the type of chemical that caused danger
• Create report and reassure the casualty
• Remove the casualty from danger
• Put on protective equipment like gloves .eye goggles
• Wash the affected eye under running water from the tap
• If the eye is shut, gently but firmly open both
• Ensure that contaminated water does not splash to the sound eye [normal
eye]
• Instruct the casualty no to rub theye
• Apply a sterile eye pad and bandage the eye
• Take the casualty to the ophthalmologist
SHOCK

•
• Shock is a life threatening condition resulting from inadequate
blood supply to the vital organs of the body like the brain
• Causes of shock
• Hemorrhage
• Cardiac conditions like heart failure
• Bad news or good news
• Severe vomiting and diarrhea
Cont.
• Drug overdose
• Infection/sepsis
• Hypersensitivity; allergic reaction to drugs and other
substances
• Burns and scalds
• Electricity
• Septicemia
Types of shock

• Hypovolemic shock
• Distributive shock
• HYPOVOLEMIC SHOCK
• is a type of shock that results from low blood volume in the
body.
• Causes of Hypovolemic shock
• Hemorrhage
• Severe diarrhea and vomiting
• Burns and scalds
DISTRIBUTIVE SHOCK

• is a type of shock that results from poor distribution of blood to

the vital organs.
• Forms or types of distributive shock
• Neurogenic shock
• Septic shock
• Electric shock
• Cardiogenic
• Anaphylactic
Cont.
• Neurogenic shock results from excessive nervous stimulation. it
can be due to sudden good or bad news.
• Septic shock results from invasion of the body by micro-organisms.
• Anaphylactic shock results from hypersensitivity or allergic reaction
to some drugs or substances.
• Cardiogenic shock occurs due to the weak pumping action of
the heart. It can becaused by heart diseases like cardiac arrest,
pericarditis, endocarditis, myocardial infarction.
• Electric shock results from electric related problems.
Signs and symptoms of shock

• Low blood pressure

• There maybe bleeding
• Subnormal temperature
• Pallor
• The skin is cold and clammy (sticky with small white particles)
• Rapid pulse rate
• Difficulty in breathing
• Cyanosis
• Casualty maybe unconscious.
• Restlessness
• Confusion
First aid Management/ first aid actions of shock

• Emergency assessment: Asses the casualty and site of occurrence and level of
consciousness using the AVPU code
• Call for help
• Remove casualty from danger and lay him down on a blanket.
• Check for ABC
• Loosen all the tight clothing around the neck, and waist. This helps to allow free circulation of
air.
• Elevate the legs; keep the head low to allow blood supply to brain cells.
• Arrest any bleeding if present.
• Reassure the casualty if conscious or bystanders if the casualty is unconscious.
• Protect the casualty from coldness by covering with a sheet or blanket.
• Put the casualty in recovery position
• Arrange for transportation to the health facility.
Complications of shock

• Cardiac failure
• Unconsciousness
• Respiratory failure
• Kidney failure
• Hepatic failure
• Multiple organ failure
Qns:
• Mr. Tom was found shocked by electricity on one of the TV
connecting wires to the main switch. Describe the first aid
management of this
casualty.
• Apart from electricity, outline other ten causes of shock.
• Describe the different types of shock.
• List ten signs and symptoms of shock.
• Mention five complications of shock
Fainting
• Is a brief loss of consciousness caused by a temporary reduction
of blood flow to the brain
• Causes of fainting
• Hunger
• Long periods of standing
• Fasting
• Fatigue
• Alcohol consumption
• Emotional stress
Signs and symptoms

• Temporary loss of consciousness

• The pulse rate becomes very slow and then becomes normal
• Recovery is rapid and complete
• Pale cold skin
• Subnormal temperature
• Sweating
Management of fainting

• Manage as shock but legs are elevated higher to the first

aiders’ shoulders.
• Open the windows if the casualty is in a room.
• Ask by-standers to stand clear.
• Check for ABC
• Give
CPR •
SUFFOCATION

• Inadequate oxygen supply from the surrounding to the lungs

Causes
• Excessive smoke in a room
• Choking
• Wrapping polythene bag around the head
• Poisonous gases
• Management
• Manage as fainting
Other terms related to oxygen supply

•Hypoxia; low level of oxygen in blood

•Asphyxia; low level of oxygen and high level
of CO2 in blood
UNCONSCIOUSNESS
• Is the inability of a casualty to know what is happening to him/her and the
surrounding
• Causes of unconsciousness
• Hemorrhage
• Shock
• Burns and scalds
• Fractures
• Poisoning
• Fainting
• Alcohol intoxication
• Hypoglycemia
• Hyperglycemia
• Heart attack
Levels of consciousness
• Alert: Full awareness of what is happening to him and
surrounding.
• Drowsy: Is aware of most things but not all.
• Stupor: Is aware of few things.
• Coma: Casualty is not aware of anything at all.
• Assessing level of consciousness using the AVPU code
THE AVPU CHART
Management of unconsciousness

• Emergency assessment: Asses the casualty’s level of consciousness using the AVPU code
• Call for help from bystanders and ambulance
• Remove casualty from danger and lay him down on a blanket.
• Check for ABC
• Loosen all the tight clothing around the neck, and waist. This helps to allow
free circulation of air.
• Treat for shock
• Arrest any bleeding if present.
• Reassure the bystanders.
• Put the casualty in recovery position
• Protect the casualty from coldness by covering with a sheet or blanket.
• Arrange for transportation to the health facility.
CHOKING

• Is the obstruction of the airway by food or any other foreign

body causing difficulty in breathing
Signs and symptoms
• Difficulty in breathing
• Tears in the eyes
• Frequent coughing
• Casualty is unable to talk well
• Cyanosis
Management

• Procedure for adults

• Give up to five gentle back slaps in between the shoulder blades
• Check mouth and remove any obstruction.
• If it fails, give five abdominal thrusts (Heimlich maneuver) and
check mouth for any obstruction.
• If it fails, call 999 for an ambulance.
Cont.
• Procedure for 1-7 years
• Give five gentle back slaps in between the shoulder blades
• Check the mouth and remove any obstruction
• If it fails, give five chest thrusts and then five abdominal
thrusts.
• If it fails, call 999 for an ambulance.
Cont.
• Procure for infants
• Give five gentle back slaps in between the shoulder blades;
• Check the mouth and remove any obstruction
• If it fails, give five chest thrusts and check the mouth for
any obstruction.
• If it fails, call 999 for an ambulance.
FRACTURES AND DISLOCATION

• A fracture is a breakin the continuity of a bone.

• Types of fractures
• Simple fractures (closed fractures)
• Compound fractures (open fractures)
Cont.
• Simple fracture (closed fractures)
• Is the type of fracture where the skin surface remains intact.
• Is a type of fracture where the broken bone protrudes to the
skin surface.
• Compound fracture (open fractures)
• Is the type of fracture where the broken bone protrudes out of
the skin surface
Classification/varieties of fractures
• Green stick fractures: These occur in children and the bone does
not break but bends.
• Comminuted fractures: The bone breaks into two or more fragments.
• Complicated fractures: This is where the broken bone damages
the neighboring structures.
• Impacted fractures: These are fractures where the broken
fragments enter into each other.
• Stable fracture: This is where the broken bone remains fixed
or immovable
• Unstable fracture: This is where the broken bone becomes
immovable
Bone patterns

• Oblique fractures.
• This is where the bone breaks and forms a diagonal line.
• Transverse fractures.
• This is where the bone breaks and forms a perpendicular line to
the midline
• Linear fractures.
• This is where the bone breaks and forms a straight line.
Causes of fractures

• Road traffic accidents

• Sports injuries
• Falls
• Infections
Signs and symptoms of fractures
• Broke bone maybe seen out of the skin
• Pain around the fractured part
• Bleeding
• Swelling
• Reddening at the site
• Tenderness at the site
• Crepitation
• Subnormal temperature
• Loss of function to the affected bone
• Signs of shock may be seen like high pulse rate
First aid management of fractures
Principles of fracture management

• Emergency assessment: Assess for the type of fracture and which bone
has been involved.
• Call for help from by-standers and ambulance.
• Apply splints to support the broken bone
• Reassurance-reassure the casualty if conscious or by-standers if
the casualty is unconscious.
• Arrest any bleeding.
• Cover any wound with sterile dressing.
• Keep the casualty warm.
• Prevent complications by transporting the casualty to the hospital.
• Qns: describe how you would diagnose a fracture.
General first aid management of fractures

• Emergency assessment of the situation

• Call for help
• Remove casualty from danger
• Check for ABC
• Arrest any bleeding
• Treat for shock
• Immobilize the injured part using splints
• Apply a sterile dressing on the wound
• Keep the casualty warm
• Put the casualty in a comfortable position
• Arrange for transportation to the health facility
SPINAL INJURY

• It is defined as a breakin the vertebral column causing damage to the

spine
• Signs and symptoms
• Casualty is unable to sit or stand
• Severe back pain
• Bleeding from the back
• Tenderness around the back region
• Paralysis of the lower limbs
Cont.
• Casualty may be unconscious
• Difficulty in breathing
• There may be signs of shock like cold skin
• Absence of patella reflexes
• Casualty is unable to walk
• Low blood pressure
• Subnormal temperature
• Foot drop
First aid management of a fractured spine

• Emergency assessment: assess the level of consciousness using

the AVPU code
• Instruct the casualty not to move and hold the head in one
neutral position
• Call for help from by-standers /ambulance
• One bystander replaces the first aider to support the head in
one position
• Check for ABC and paralysis
• Make the casualty liestillon his back on a flat firm surface
• Do CPR
Cont.
• Place a pad of gauze between the casualty’s ankles and bandage the feet together
using figure of 8 patterns
• Place a fracture board on the stretcher, then folds a blanket twice and place it on
a fracture board.
• Four to five people then gently shift the casualty to the stretcher.
• Support the casualty’s back when lifting to avoid bending of the back
• In case of cervical vertebra, place a massive bandage of cotton wool at the neck
to prevent bending of the neck
• Reassure the casualty if conscious or bystanders if the casualty is unconscious
• Transport the casualty to the hospital using an ambulance
NB: This method of immobilizing a fractured spine with three bandages and 5-7 people
is known as logroll method
• For fractures of the upper limbs do triangular sling, armsling or elevation sling bandaging
Question

• Mr. Tom fell from a mango tree and he was suspected to

have sustained fracture of the spine.
• A] Outline the clinical manifestation of Mr. Tom
• B] Describe the first aid actions you would take to help Mr. Tom
• C] List atleast 5 complications of fractures
Dislocation

• Refers to the sudden displacement of a bone from its original

position at a joint
• Signs include severe pain, swelling, tenderness, warmth, redness
and loss of function
•
• Splints
• A splint is a fixed or movable device used to support and maintain
an injured bone in position
Advantages of splints

• Splints support the injured bone in position

• Restrict movement of the injured bone
• Help to properly align the bone
• Prevent swelling of the injured part
• Splints reduce pain at the site
Types of splints

• Ankle splints
• Arm splints
• Toe splints
• Finger splints
• Posterior Lower leg splints
• Posterior full leg splints
• Elbow splints
Principles of applying splints

• Emergency assessment: assess the injury before splinting

• Explain the procedure to the casualty before splinting
• Always apply sterile dressings before splinting
• Ensure the bone is in good anatomical alignment before splinting
• If the bone is cannot be aligned, splint it in that position
• Check for circulation after splinting
• Always wash hands before and after splinting
• Always splint the casualty if you’re going to move or transport the
casualty
• Apply a splint firmly (snug) but not tightly
SOFT TISSUE INJURIES
• Soft tissue injuries are injuries that affect muscles and ligaments
and they include; cramps sprain and strain
• A cramp is a sudden severe smooth muscle pain due to
prolonged contraction
• A strain is the overstretching of a muscle at a joint with or
without tear
• A sprain is the over stretching and tearing of a ligament at a joint
Signs and symptoms of STIs

• Severe paint at the site

• Swelling
• Reddening at the site
• Loss of function
• Area becomes warm
• Bleeding
• Tenderness
General first aid management of sprainstrains
and dislocation
• RICE
• R -Rest
• I – Immobilize; dressing and bandaging
• C -cold compress
• E-Elevation
Question

• A] Define the following terms; Strain, sprain

and dislocation
• B] Outline four cardinal sign and symptoms of a
sprain
• C] Describe the f/amgt of a 12yr old boy with a
sprain at the left ankle joint
BURNS AND SCALDS
• Burns
• Are injuries to body tissue caused by dry heat
• Causes of burns
• Hot metal
• Burning coal
• Fire flames
• Electricity
• Concentrated acid
• Frostbite [burning sensation due to exposure to very cold temperatures]
• Ultraviolet rays
• Bomb blast
Sign and symptoms of burns

• The burnt area is seen

• Reddening at the site
• Severe pain at the site
• Subnormal temperature
• Tenderness
• Swelling
• Blisters
• Loss of function
• Sign of shock like cyanosis skin
• High pulse rate
• Sweating
• The casualty may be unconscious
Classification of burns

• Burns are classified according to severity

• A] Severity
• They can be mild, moderate or severe
• Children
• <10%-mild
• 10%-20%-moderate
• >20%-severe
Cont.
• Adults
• <15% mild
• 15%-25% moderate
• >25% severe
• B) Depth
• Here burns are classified as first degree, second degree and
third degree burns
Cont.
• 1st degree burns
• Only superficial layer of the involved and it is very painful
• 2nd degree burns
• The superficial layer and the dermis of the skin are involved
• 3rd degree burns
• The epidermis subcutaneous, muscle and blood muscles and
blood vessel are burnt.
• These burns are also called anesthetic burns [no pain]
C] Classification according to burnt parts

• For example, chest burn, eye burns

• Classification according to cause
• For example chemical burns, nuclear burns,
electric etc.
• According to percentage of body surface area burnt
• This is obtained using Wallace’s rule of 9 in adults or
7 in children
People at risk of burns/ predisposing factors
for burns in the community
• People with mental illness
• Young children
• Patients with epileptic fits
• Alcoholic people
• Elderly people
• Firefighters
• Patients with diabetes mellitus
• Patients with leprosy
• People with eye blindness
First aid management for burns
• Emergency assessment .assess the degree of burns and the percentage of surface area burnt.
• Call for help from by –standers or fire brigade
• Remove the casualty from danger
• Pour cold water at the burnt site
• It possible, wrap the casualty in a blanket to stop burning fire
• Check for ABC
• Treat for shock
• Give casualty a cold drink
• Do not puncture the blisters
• Do not remove constrictive material from the burnt area
• Apply a sterile burn sheet or any other non-fluty material over the burnt area
• Reassure the casualty
• Arrange for transportation to the health facility
Complication of burns
• Shock
• Infection
• Deformity
• Unconsciousness
• Contractures
• Keloid formation
• Respiratory failure
• Circulatory failure
Question

• Mr. Brian is 24 years old male who sustained burns of the chest,
back and left arm
• A] Calculate for the percentage of the surface area burnt
• B] List 5 signs and symptoms Mr. Brian is most likely to present with
• C] Describe the first aid mgt of this casualty
• D] Outline five complications of burns
• E] Describe the preventive measures of burns in the community
• F] Outline the predisposing factors of burns
Chemical burns

• These are injuries in the body caused by chemicals like concentrated

acids
• Sign and symptoms
• Pain
• Reddening
• Swelling
• Itching
• Blisters
• Burning
• There is history of contract with chemical
First aid management

• Assess the types of chemical that has caused danger

• Create a report and reassure
• Call for help if necessary
• Ensure personal protection through handwashing and gloving
• Check for ABC
• Wash the burnt area under running water for 20minutes
• Do not puncture the blisters
• Do not rub the area
• Apply a sterile burn sheet at the site of injury
• Arrange for transportation to the health facility
EPILEPTIC FITS/ SEIZURES

• Refers to convulsions that occur in known epileptic patients

• Risk factors / predisposing factor /causes of epileptic fits
• Stress
• Alcohol consumption and substance use
• Anemia
• Infection
• Hypoglycemia [reduced blood sugar ]
• Dehydration
• Brain tumor
• High altitude
• Drug withdrawal
Stages of an epileptic fit

• There are four stages of an epileptic fit;

• These stages are aura, tonic, Clonic and recovery stage
• Aura stage
• This is a warning stage offit. The casualty experience flickering of light
in eye, changes in smell, taste, feeling of vomiting and there may be
an epileptic cry
Cont.
• Tonic stage
• There is contraction of muscles of the respiratory tract causing difficulty
in breathing, noisy breathing, cyanosis and high pulse rate and mostly an
epileptic cry occurs here due to contraction of muscles of the larynx
(voice box).
• The casualty is unconscious
• Clonic stage
• There is generalized convulsion of the body. The whole body becomes
rigid
• There is arching of the back, urine incontinence, fecal incontinence and
the casualty is still unconscious
Cont.
• Recovery stage
• Convulsions stop, all muscles relax. The casualty feels very tired
and goes deep asleep. Breathing becomes normal. And this is when
the casualty should placed in a recovery position
 General signs and symptoms of an epileptic
fit

• The casualty is a known epileptic patient

• There is a warning stage with strange feeling of smell, taste and vomiting
• Difficulty in breathing
• Noisy breathing [strider]
• Arching of the back
• Convulsion
• Frothing
• Sudden loss of consciousness
• Cyanosis
• Urine and fecal incontinence
• After convulsion the person feels very tired and goes to deep sleep
F/a management of epileptic fit/seizures
• Assess the casualty to determine the stage of the fit. Help the casualty
take medication if is still in aura stage
• Note the time and minutes when convulsion started
• Call for help from bystanders
• Make space around the casualty
• Remove dangerous objects around the casualty
• Protect the casualty’s head by wrapping it with clothing but not covering the
face
• Loosen tight clothes around the neck and waist
• When the convulsionstops check for ABC and put the casualty in
recovery position
• Reassure the casualty if conscious and bystanders if the casualty is unconscious
• Then arrange for transportation to the nearest health facility
DROWNING
• Is the complete immersion of the nose and mouth into water
• Sign and symptoms
• Difficulty in breathing
• Unconsciousness
• History of drowning
• Abdominal distension
• There are signs of shock e.g. cyanosis
• Subnormal temperature
• Low blood pressure
• Strider [noisy inspiration]
• General body weakness
First aid management

• Emergency assessment: Assess for the types of water source and level of consciousness
• Call for help from bystanders
• Remove the casualty from the water source. Hold a long stick and support the casualty
to come out. if you can swim, then swim and remove the casualty
• Position the casualty with the head lower than the legs
• Check for ABC
• Immediately start artificial respirations and CPR
• Compress the abdomen to expel the water
• Treat for shock
• Reassure the casualty if conscious or bystanders if unconscious
• Place casualty in recovery position
• Arrange for transportation to hospital
POISONING

• A poison is any substance which causes injury/illness

when introduced into the body.
• Types of poisons
• Plant poisoning
• Paraffin poisoning
• Drugs
• Organophosphate
• Venom
Ways through which poison can enter the body

• Ingestion: This is when poison enters the body through the mouth.
It can be contaminated food or any other substance.
• Inhalation: This is when poison enters the body through
• Through the skin: An absorbed poison enters the body after it
comes into contact with the skin surface.
• Through injection: Poison enters the body through drugs
or medications which are injected with a needle.
• Bites and stings: Poison enters the body through bites or stings.
For example dog bites, snake bites
Signs and symptoms of ingested poison
• Smell of poison
• Pinpointed pupils
• Subnormal temperature
• Sweating
• Abdominal distension
• Diarrhea
• Vomiting
• Nausea
• Hematemesis
• Difficulty in breathing
• Abdominal pain
Cont.
• Casualty may be unconsciousness
• Open or spilled poison containers may be found near the
casualty
• White stains on the mouth
• Noisy breathing (strider)
• High pulse rate
• Cyanosis.
General first aid management for ingested
poison

• Emergency assessment; identify the type of poison taken time

and quantity. Check casualty’s level of consciousness using AVPU
scale.
• Ensure first aider’s safety by not coming into contact with the poison.
• Keep the poison container.
• If the victim vomits, keep the vomited material for the doctor to see.
• If the casualty is conscious, induce vomiting by giving a concentrated
salt solution.
• After vomiting, give milk or egg white (they have albumin).
• Administer an antidote if available.
• Check for ABC
• Encourage the casualty to take plenty of water orally.
Cont.
• Reassure the casualty if conscious.
• Put the casualty in a recovery position
• Transport the casualty to hospital.
• Signs of alcohol poisoning
• There is smell of alcohol
• The casualty is confused
• Drowsiness
• Difficulty in breathing
• Blurred vision
• Pupil dilation/ dilated pupils
• General body weakness
BITES AND STINGS
Dog bites
• Signs and symptoms of dog
bites
• The wound is seen
• Pain at the site

• Bleeding
• History of the dog bite
• Subnormal temperature
• Restlessness
High pulse
•• Swelling ratesite
at the
First aid management

• Emergency assessment; note the time of the bite and if possible the
dog
• Call for help from bystanders
• Check for ABC
• Remove casualty from danger
• Put on gloves and wash the injured part with warm water and soap.
• Arrest bleeding using the through resting the bleeding part, elevate
if possible and apply dressing and bandage.
• Treat for shock
• Reassure the casualty if conscious or by-standers if the casualty
is unconscious
• Arrange for transportation to hospital for rabies vaccine.
Complications of dog bites

• Hemorrhage
• Rabies/ infections
• SNAKE BITES
• There are different types of snakes that can cause bites.
Types of snakes
• Poisonous snakes
• Have two fangs, flat heads, and oval eyes and produce venom
• Non-poisonous snakes
• Have no fangs, have oval heads, don’t produce venom and have round
eyes
• Signs and symptoms of snakebites
• The fang marks are seen
• Swelling around the bitten site
• Mild bleeding
• Severe pain at the site
Cont.
• Paralysis
• Loss of function of the limb
• Restlessness
• Excessive salivation
• Dilated pupils
• Increased pulse rate
• Subnormal temperature
• Difficulty in breathing
• General body weakness
• Blurred vision
• Nausea (feeling like vomiting)
• Vomiting
First aid management of snakebites
• Emergency assessment; assess for the type of snake that has bitten the
casualty to determine if it poisonous.
• Assess for the level of consciousness using the AVPU code and note the time.
• Call for help from by-standers and ambulance.
• Remove casualty from danger and tell him not to move any more to
avoid spreading of venom.
• Check for ABC
• Put on gloves and using a razor blade or surgical blade, make two cuts
through the fang /bite marks to allow some bleeding.
• Wash the area with clean water and soap.
• Tie above and below the bitten site and immobilize the leg with a bandage
but not a tourniquet.
Cont.
• Reassure the casualty if conscious or by-standers if casualty
is unconscious.
• Treat for shock.
• Arrange for transportation to a health facility.
• NB: when immobilizing the bitten leg, tie it together with the
normal leg.
TICK BITES
• Signs and symptoms
• Itching
• Severe pain
•
Reddening •
• First aid management
• Using a pair of tweezers, grasp the head of the tick and remove
it.
• Do it gently so that mouth parts do not remain in the skin.
Cont.
• Keep the tick for identification in the hospital.
• Reassure the casualty.
• Advice casualty togo to the hospital.
• Bee stings or wasp stings
• Management
• Brush off the sting using your finger nails.
• Elevate the injured part.
• Apply a cold compress for atleast 10 minutes.
Signs and symptoms

• Swelling
• Reddening
• Headache
• Severe pain
MEDICAL EMERGENCY

• These are medical conditions that require quick management

from the first aider or medical team.
• Examples of medical emergencies
• Heart attack (myocardial infarction)
• Asthmatic attack (status asthmaticus)
• Sickle cell crisis
• Hypoglycemia
• Hyperglycemia
• Hypertensive emergency
Cont.
• Heart attack (myocardial infarction)
• Is the sudden obstruction of blood supply to heart muscles characterized by persistent
severe chest pain
• Signs and symptom
• Central severe chest pain
• Difficulty in breathing
• Diaphoresis/ profuse sweating
• Cyanosis
• Tachycardia/ high pulse rate
• Gasping respiration
• Restlessness
• Sudden fainting
• High or low blood pressure
Cont.
• First aid management
• Emergency assessment
• Call 999 for help and tell them you suspect a heart attack.
• Check for ABC
• Make casualty in a half sitting position with the knees bent.
• Loosen tight clothes around the waist and neck.
• Give aspirin tablet 300mg.
• Advice the casualty to chew the tablet slowly.
• If the casualty has been on medication, help and give them the drugs.
• Reassure the casualty.
• Wipe the casualty with a cold compress
• Arrange for transportation to hospital.
Asthmatic attack (status asthmaticus)
• Asthmatic attack is a sudden condition caused by the obstruction of
the airways and characterized by wheezing and difficulty in
breathing.
• Signs and symptoms
• Noisy breathing
• Difficulty in breathing
• Cyanosis
• Sweating
• Gasping respiration
Cont.
• High pulse rate
• Wheezing
• Cough
• Tight chest
• First aid management
• Assess (emergency assessment).
• Call for help.
• Help the casualty attain sitting position
Cont.
• Check for ABC
• Help the casualty find an inhaler.
• Encourage the casualty to breath slowly.
• Reassure the casualty.
• Arrange for transportation
Hypoglycemia

• Defined as low blood sugar level in the body

• Causes of hypoglycemia
• Infections
• Drugs like quinine
• High dosage of insulin in diabetic patients.
• Fasting
• Alcohol consumption
Signs and symptoms

• General body weakness

• Tremors/ shivering
• Light headedness
• Confusion
• Pale, cold, clammy skin
• Visual disturbance
• Reduced level of consciousness
Management of hypoglycemia

• Emergency assessment
• Call for help
• Move the casualty to a safe place
• Help the casualty to sit
• Give a sugar solution
• Give more sugary food like biscuits.
• Reassure the casualty if conscious or by-standers if
unconscious.
• Allow casualty to rest.
• Arrange for transportation to hospital.
EXTREMES OF BODY TEMPERATURE
HYPOTHERMIA AND HYPERTHERMIA
• Hypothermia: a condition that develops when body temperature
falls below 35oC
• Causes
• Prolonged exposure to coldness
• Fatigue
• Chronic illness
• Alcohol intoxication
• Poor heating in houses
• Signs
• Shivering
Cont.
• Headache
• Chills
• General body weakness
• Slow and shallow breathing
• Slow and weak pulse
• First aid management for hypothermia
• Emergency assessment: Assess for level of consciousness
• Call for help
• Take the casualty to a sheltered place
Cont.
• Check for ABC
• Lay the casualty on a blanket or any thick soft dry clothing
• Cover the casualty with a blanket and ensure the headiscovered
• Give the casualty a warm drink
• Give a sugary food like chocolate
• Monitor body temperature
• Reassure the casualty
• Arrange for transportation to the healthy facility
Frostbite
•
• Burning sensation due to exposure to very cold conditions
• F/a magt
• Advise the casualty to put his hands in the armpits
• Move the casualty to a warm place
• Place the affected part in warm water at about 40oC
• Apply a light dry dressing at the site
Effects of overheating

• Hyperthermia: a condition that develops when body

temperature rises above 38oC.
• Heat exhaustion: a condition caused by excessive loss of salts
and water from the body through excessive sweating
• Sunburn: Injury to the skin due to over-exposure to the sun
• Signs of overheating
• Excessive Sweating
• Headache
Cont.
• Loss of appetite
• Dizziness
• Confusion
• High pulse
• High respiratory
rate
• Nausea
• Abdominal pain
FIRST AID AND THE LAW

• Whereas giving first aid is part of your job as a trained person, giving first
aid at emergency scene needs you to apply the Good Samaritan
principles.
• The Good Samaritan principles
• Consent: always introduce yourself to the casualty and seek permission
to help the casualty. Consent can be expressed or implied consent
• Reasonable skills and care: Always apply reasonable skills and care
when giving first aid. Your help should be in the best interest of the
casualty
• Negligence: avoid any mistakes when giving first aid to the casualty.
This helps to ensure that the casualty is safe
• Abandonment: Never leave the casualty alone when he is under your
care. Stay with the casualty until you handover to the safe hands
TRANSPORTATION OF CASUALTIES

• Outline the different methods of transporting casualties.

• Outline the different types of stretchers.
• State the methods of transporting casualties that involves;
• One person’s carry
• Two or more person’s carry
METHODS OF TRANSPORTING CASUALTIES

• Walking assist; is a method of moving a victim in which a single

rescuer functions as a crutch in assisting the casualty to walk.
• Dragging: Blanket, sheets are used to drag the casualty. In this method,
a rescuer places the victim on a blanket and drags to safety.
• Fireman’s carry; it involves lifting and carrying a victim in which
one rescuer carries the victim over his shoulder.
• Two handed Seat carry; is a method of lifting and moving a casualty
in which two rescuers form a seat with their arms.
• Three persons carry method:
• Pick a back
• Ankle pull method
Cont.
• Shoulder pull method
• Hammock carry
• One-person lift
• Four handed seat method:
• Fore and aft carry:
• Chair lift: This can use to victims who do not have contradicting
injuries and if the chair is available, you can use the chair. Sit the
victim in a chair; one first aider then carries the back of the
chair while the other carries the side of the legs.
• Use of stretchers
VITAL OBSERVATIONS/VITAL SIGNS/CARDINAL
SIGNS
• There are four cardinal signs of the body and they include temperature (T), pulse
(P), respiration (R) and blood pressure (BP) and are normally abbreviated as
TPR/BP to indicate the order in which they are measured or taken
• Timing of vital signs (when to take vital signs)
• On admission
• During patient’sor client’s visit at the clinic
• Before and after any surgical procedure
• Before and after administration of medicine that affect cardiovascular,
respiratory and temperature control functioning
• Before and after any nursing intervention that influences any of the vital
signs •
•
Cont.
• In the hospital on routine schedule according to the hospital policy
• On discharge or transfer of a patient
• When there is any change in the general physical condition of the
patient
• Reasons/purpose of taking vital signs
• To help in the diagnosis of patient’s condition
• To assess the health status of the individual
• To understand the effectiveness of the treatment
• To guide modification or change of treatment
• To plan and implement appropriate nursing care
• It’sa routine way of complete physical examination
TEMPERATURE

• Refers to the measurement of heat in the body expressed in

degree centigrade or Fahrenheit
• Purpose/Reasons for taking temperature
• To determine the temperature of the patient’s body or client
• To assist in making a diagnosis
• To evaluate patient’s response to treatment
• It helpsto pan appropriate nursing interventions
• To recognize any variation from the normal temperature
Factors affecting body temperature
• Time of the day
• Age
• Gender
• Emotion
• Drugs
• Diseases
• Hormonal control
• Sympathetic nervous stimulation
• Sleep
• Change in atmospheric temperature
• Muscle activity/exercise
Cont.
• Metabolism. Fasting lowers the body temperature because of decreased rate
of metabolism
• Types of thermometers used in nursing
• Digital thermometer.
• Advantages
• Easy to store
• Easy to read
• Extremely accurate
• Rapid recording.
• Disadvantages
• Very expensive.
Mercury thermometers

• Advantages
• Easy to store
• Cheap
• Readily available
Disadvantages of mercury thermometers
• Accuracy depends on viewer’s skills and knowledge
• Mercury column is difficult to read
• Temperature recording is very slow
• Stands a risk of glass breakage
• Sites for taking body temperature
• Oral, Axilla, Rectal, Groin and
ear •
Reasons for using mercury in thermometers
• It is highly heat sensitive and therefore recognizes small changes
in body temperature
• Mercury makes uniform expansion
• Mercury is thick (13.5times thicker than water)
• Mercury has a high boiling point of 357oC and a high freezing point
of 39oF
• It has a silver appearance and so easy to read
• Mercury does not wet the glass wall
Care for thermometers
• Grasp the thermometer by the upper end of the stem; never hold
it by the bulb
• Washit clean using lukewarm water and soap but not using hot
water
• Thermometers should be cleaned and disinfected immediately
after use
• Handle thermometers carefully to avoid falls which may cause
glass breakage
• Store thermometers in cool dry place; do not expose to
strong sunlight
Requirements for taking vital observations

• Observation tray containing

• Clinical thermometer in the jar with a disinfectant solution such
as hibitane
• Rectal thermometer
• Galipot of water
• Galipot with clean cotton swabs
• Receiver for used swabs
• A watch with a seconds hand or pulse-
oxymeter •
Cont.
• A pen
• A sphygmomanometer
• Clean gloves in case of rectal method
• Stethoscope
• Lubricant such as k-y or jar with Vaseline
• Galipot of hibitane
• A vital observation chart.
General Procedure for temperature taking

• Determine the suitable site of taking temperature.

• Follow the general rules
• Position the patient either sitting or lying
• Remove the thermometer from the jar of lotion. Wipe it dry
using clean cotton swab in rotation movement from bulb to
stem.
• Hold thermometer between thumb and forefinger at the tip of stem,
shakedown the mercury till it reads below 35oC or 94oF.
• Inspect thermometer for cracks
Cont.
• Place the thermometer at the right site
• Leave it there for three minutes
• After three minutes, remove it, read and record on the
temperature chart
• Wipe the thermometer clean using cotton swabs
• Give a feed back of the thermometer reading to the patient or
client
• Thank the patient for co-operation
• Leave the patient comfortable and clear away
Oral/mouth

• Position patient, either sitting or lying down.

• Ask the patient to lift the tongue then place bulb of thermometer
at the base of the tongue on the lower surface of the tongue.
• Instruct patient to close the lips, not the teeth around
the thermometer and not to talk while it is in position.
AXILLA
• Position patient
• Inspect the axilla
• Remove the thermometer from the jar of lotion. Wipe it dry
using clean cotton swab in rotational movement from bulb to
stem.
• Hold the thermometer between the thumb and forefinger at the tip
of the stem, shakedown the mercury till it reads below 35oC or
94oF
• Place thermometer bulb in the center of the Axilla with the
tip pointing towards patient’s head.
• Request patient to place the arm across the chest and grasp
the opposite shoulder
Cont.
• Leave thermometer in place for 3 minutes.
• Grasp the end of the thermometer and remove it from the Axilla.
• Read and record the thermometer reading on the vital
observation chart.
• Wipe thermometer with a wet swab dipped in antiseptic solution.
• Place it back in its jar.
• Give the patient a feed back and reassure accordingly
• Leave the patient comfortable
• Clear away
Rectal indications

• Neonates
• Unconscious
patients •
• Procedure for rectal
• Provide privacy and put patient in lateral position.
• Fold back the bed linen to expose the anus
• Put on clean gloves.
• Apply lubricant on the bulb of thermometer using cotton swab.
• Instruct the patient to breathe deeply and insert the thermometer 3.5-4
cm in adult, 1.5 cm in infant, 2.5 cm in children, directing it gently along the
rectal wall towards the umbilicus.
Cont.
• Do not force insertion.
• Leave thermometer in place for 2-3 minutes
• Carefully remove the thermometer, wipe with a dry swab, read and
record
• Cleanse the patient anal area to remove any lubricant or faces.
• Wipe thermometer with a wet swab dipped in antiseptic solution.
• Place it back in its jar.
• Give the patient a feedback.
• Leave the patient comfortable
• Clear away
GROIN

• Follow the general rules.

• Inspect the groin.
• Dry the groin thoroughly with a clean cotton swab.
• Shake the thermometer until the mercury falls below 35oC or
94oF.
• Ask the patient to abduct the thigh.
• Request the patient to cross the thigh over the opposite
thigh. •
•
•
Contra indication of various sites
Mouth
• Unconscious, delirious patient
• Surgery of the oral cavity
• Children under five years
• Patients with mental problems
• Patients with diseases of the month
Rectal
• Patient with diarrhea
• Patients with analsores and fissure
• Rectal surgery
• Inflamed rectum
• Fecal impaction
Groin
•
• Patient with sore or burns at the site
Axilla
• Patient with sore or burns at the site
• Severely emaciated patients
Vagina
• Patients with congenital vaginal abnormalities
• Vaginal bleeding
• Sores on the vaginal
wall Pelvic surgery
Parts of a clinical thermometer

• A thermometer is mainly made of two parts;

• Bulb: The bulb is the upper end of a thermometer near the kink and it’s
made of different size and shape for example oral thermometers are made
of long and slender bulbs while rectal thermometers are made of short
and fat bulbs. The bulb contains mercury that responds to any changes in
temperature.
• Stem: The stem is an elongated part of the thermometer made of a glass
tube externally. The glass tube encloses a mercury column and there is a
graduated scale on the stem that represents the degree of temperature.
Just after where the bulb separates from the stem, there is a bent part
on the mercury column called a kink that prevents back flow of mercury
Cont.
Terms related to temperature

• Fever: refers to raised body temperature > 37.7oC

• Pyrexia: any raised body temperature as for fever
• Hyperpyrexia: Thermometer reading > 40oC
• Hyperthermia: Thermometer reading >38.5oC
• Hypothermia: Thermometer reading of <35oC
• Intermittent temperature: A temperature pattern where there is
elevated temperature for several hours of the day and then temperature
falls back to normal
• Remittent temperature: A pattern of temperature in which temperature
does not touch the baseline and remains above the normal throughout the
day
PULSE
• Refers to the expansion and recoil of the artery caused by the
blood being pumped into it by heart
• Pulse rate: is the number of expansions and contractions (beats)
per minute.
• Normal ranges of pulse rates
• Adult range 60-90 beats per minute.
• Children 80-130 beat per minute.
• Infants 80-140 beat per minute.
• New born 120-160 beat per minute.
Sites used in checking pulse

• Temporal artery in front of the ear.

• Facial artery 2.5 cm in front of the angle of the jaw.
• Carotid artery in the neck.
• Radial artery at the thumbs side of the wrist.
• Femoral artery in the groin.
• Posterior tibia artery on the posterior tibial surface.
• Fontanelles in infants
• Dorsalis Pedi's artery on the foot
• Brachial artery at the elbow
• Popliteal artery at just above the knee
Factors that affect pulse or heart rate of an
individual
• Age: Pulse rate is low in old age and faster in children
• Sex: Men have low pulse compared to women
• Position: The pulse rate is slower in lying position than in
standing position
• Exercise: The pulse rate is increase during exercise than when at
rest
• Emotions: Anger or excitement increase the pulse rate of
an individual
• Hormones: Epinephrine and norepinephrine hormone increases the
pulse rate
Cont.
• Sympathetic nerve stimulation: SNS activation increases the
pulse rate
• Drugs: some drugs increase contractility of the heart decrease
heart rate
• Change in atmospheric air. At high altitude, the partial pressure
of oxygen is low and this calls for high pulse rate
• Blood volume: Pulse rate is inversely proportional to blood volume
• Body temperature: pulse rate increases with body temperature
• Cardiac diseases: They may increase or decrease the heart rate of
an individual
Terms used
•
• Bradycardia: Low pulse rate of less than 60 beats per minute. It’s
common in conditions like heart block, cerebral hemorrhage.
• Dicrotic: This is characterized by double beat
• Tachycardia: High pulse rate of above 100 beats per minute. Common
in conditions like fever, thyrotoxicosis and stress, anger and anxiety
• Arrhythmias: Refers to absence of a heart rhythm
• Orthopnea: Difficulty in breathing unless patient is in sitting up position
• Corrigan’s pulse or Water hammer pulse: It is a full volume pulse.
This type of pulse is found in aortic regurgitation
Equipment

• Watch with secondhand ticker

• Pen
• Vital observation chart
• Procedure for taking pulse
• Wash hands
• Position the patient or client in sitting position with the elbow bent at
90o on the chest. Slightly extend the wrist with palm facing down
• Place tips of the index and middle finger over the radial artery on the
side of the thumb
• Palpate well to feel the pulse
Cont.
• If the pulse is palpable, look at the watch and start counting the
pulse rate
• Assess the pulse for regularity, strength and frequency
• If the pulse is regular, count for only 30sec and multiply the figure by
2 to obtain a full one minute pulse
• If the pulse is irregular, count for a full minute
• Complete the counting and record pulse rate expressed as beats
per minute
• Leave patient comfortable
Points to note when taking pulse

• Rate: number of times the heart beats per minute

• Regularity of the rhythm: note whether the pulse is regular
or irregular
• Volume of the beat: Note the strength of the beat and record
weak pulse or full volume pulse
• Resistance of the pulse: This is arterial wall resistance
RESPIRATION

• Define respiration
• Identify requirements for measurement of respiration
• Measure respiration
• Interpret and record correctly
Cont.
• Respiration
• This is the process that occurs in the lungs and involves
interchange of respiratory gases between the atmosphere and the
circulating
blood.
• Normal breathing rates
• New born baby 30-44 breath per minute
• Child 20-30 per minute
• Adult 16- 20 per minute
Factors that affect the respiratory rate of an
individual
• Sex: females have slightly higher respiratory rate than males
• Exercise: it increases the respiratory rate
• Rest and exercise: At rest, the respiratory rate is normal and it
decreases during sleep
• Emotions: sudden fear increases the respiratory rate
• Change in atmospheric air: At high altitude, the partial pressure of
atmospheric oxygen is low and this increases the demand for oxygen
thus calls for an increased respiratory rate
• Infections: they cause an increase in the respiratory rate
• Drugs: Opioids decrease the respiratory rate
Points to note on respiration

• Respiratory Rate: Number of times breathed in and out per

minute
• Depth: Note whether the respiration is shallow or deep
• Sound: Note if the breathing is noisy or normal
• Regularity: Note whether the respirations are normal or irregular
Procedure

• Do not inform the patient about taking respirations

• After taking pulse, maintain the fingers over the radial artery.
• Note the raise and the patient’s chest with each inspiration and
expiration
• Count respiration for one minute noting the rate, rhythm, regularity,
and depth.
• Wash hands
• Record findings, and report any abnormalities detected.
• Thank the patient
• Clear way used equipment's
Disorders of respirations

• Wheezing: Difficult and louder expiration due to obstruction in the bronchi

and bronchioles for example in status asthmaticus. Its best heard on expiration
• Strider: Noisy respiration due to obstruction in the upper airway
• Dyspnoea: Painful or difficulty in
breathing Causes
• Diseases of the heart and blood.
• Foreign body
• New growth in the respiratory tract.
• Lung diseases
• Obstruction in the air passage caused by infections
Cont.
• Apnoea: This the periodic absence of breathing due to
excessive oxygen and absence of carbon dioxide
• Orthopnoea: This is difficulty or inability to breathe unless in
sitting up position common in CCF.
• Tachypnoea: This is very rapid breathing
• Stetorous Breathing: Noisy breathing which occurs in the patient
who is unconscious.
• Croup: Is the difficult noisy breathing due to laryngeal spasms
for example as seen in diphtheria
Cont.
• Cheyne stokes: This a form of breathing that becomes periodically
deeper and more rapid, then gradually declines in rate and
amplitude, until breathing ceases for a few seconds and the cycle
begins again.
• Kussumaul’s respiration: Increased respiration which is
abnormally deep but regular for example in DKA patients
• Biot’s respiration: Shallow breathing interrupted by irregular
periods of apnoea. It is commonly seen in CNS disorders
• Rhonchi sound: Course gurgling louder sounds heard as air
passes through fluid filled bronchi and is best heard on expiration
• Rales: fine crackling sounds best heard on inspiration
BLOOD PRESSURE

• Refers to the force exerted by blood on the walls of the

bloodvessels
• BP is measured using asphygmomanometer and a stethoscope
• The wordSphygmomanometer is derived from the following words;
• Sphygmo= pulse
• Mano=pressure
• Meter=measure
Normal BP is 120/80mmHg in adults

Type of patient Systolic Diastolic Pulse pressure

pressure/mmHg pressure/mmHg
Adults 120 80
Infants 70-90 50
New Born 30-50 10
Types of pressure

• Systolic pressure is the highest degree of pressure exerted by

blood against the arterial wall as the left ventricle contracts and
forces
blood to the aorta
• Diastolic pressure is the lowest degree of pressure when the heart
is in its resting period just before contraction of the left ventricle
• Pulse pressure is the difference between systolic and
diastolic pressure. For example in a normal adult, systolic
pressure is
120mmHg and diastolic pressure is 80mmHg, pulse pressure
is therefore 40mmmHg
Factors affecting blood pressure
• Blood volume: BP increases with blood volume
• Smoking: cigarette contains nicotine which is avasoconstrictor
• Drugs: antihypertensive drugs decrease blood pressure
• Cardiac diseases: they increase or decrease blood pressure
• Position of the patient: BP changes according to the position of
the patient
• Age: BP increases in elderly people because of increased
peripheral vascular resistance
• Stress: increases BP
Cont.
• Pregnancy: BP decreases during pregnancy due to
progesterone hormone
• Exercise: increases BP
• Peripheral vascular resistance: increases BP
• Hormonal control: adrenaline and noradrenaline increase BP
• Sympathetic nerve stimulation: increases BP
• Force of ventricular contractions: BP increases with the FOVC
Disorders of blood pressure

• Hypertension: Prolonged increase in BP above 140/90mmHg

• Hypotension: Low blood pressure below
90/60mmHg •
•
•
• Procedure
• Explain the procedure to the patient
• Wash hands and provide privacy
• Bring the vital observation tray to the bedside
• Position the patient either in sitting position or lying
position •
Cont.
• Apply the sphygmomanometer cuff evenly and firmly around the
patient’sarm, about 2.5cm above the palpable point of the brachial artery
• Palpate the brachial artery for pulse at the elbow using fingertips of the
index and middle finger
• Place the earpieces in the ears, directing them forward into the auditory canal as
the tubes are hanging freely and place the bell of the stethoscope on the
brachial pulse.
• Close the valve on the bulb and inflate the cuff slowly. Pulse sounds heard
during this phase, they fade and disappear.
• Open the valve slowly and permit air to escape. Note the manometer
reading when sound is first heard as you’re releasing and this is the systolic
pressure
• Continue to release the pressure slowly. The sound becomes louder and clear
Cont.
• Note the manometer reading when sound disappears and this is
the diastolic pressure
• Allow the air to deflate until manometer reading is at zero
• Record the findings as systolic pressure over diastolic pressure on
the vital observation chart and report any abnormalities found
• Give a feedback and leave the patient comfortable
• Thanks patient and clear away
Cont.
• Thank you may God bless you throughout your stay at school.