FIRST AID/TRAUMA

AND EMERGENCY
Nyingi michael
Course Outline
Introduction
oDefinition of First Aid
oAims of First Aid
oSteps of First Aid
oGiving artificial ventilation
oGiving chest compressions
Cardiovascular Emergencies
oShock
oFainting
oAngina pectoris
oHeart attack
oAcute heart failure
oCardiac arrest
Wounds and Bleeding
oDefinition
oFirst aid
oTypes of wounds
oTypes of bleeding
-severe external bleeding
-bleeding at special sites
-wounds to the palm
RESPIRATORY DISORDERS
oAsphyxia
oChocking
oDrowning
oHanging and strangulation
oInhalation of fumes
oHyperventilation
oHiccups
MUSCULOSKELETAL INJURIES
oStrains and sprains
oDislocations
oSublaxation
oFractures
oInjuries of the chest
HEAD AND NECK INJURIES
oConcussion
oSkull fracture
oCerebral compression
oConvulsions
oEpilepsy
oUnconciousness
oTypes of neck injuries
BURNS AND EXTREMES OF TEMPERATURE
oClassification
oTypes
oManagement
BITES AND STINGS
oAnimal bites
oInsect stings
oMarine stings
oMarine puncture wounds
oSnake bites
BANDAGING
dEFINITION
First Aid is the initial assistance or treatment given to someone
who is injured or suddenly taken ill

First Aid is the immediate care of an injured or suddenly sick

person. It is the care a person applies as soon as possible after an
accident or sudden illness
This prompt care and attention prior to the arrival of the
ambulance can sometimes mean the difference between life and
death or between a full or partial recovery
Aims of First Aid
Preserve life
This includes the life of the casualty, bystander and rescuer
ABC of resuscitation
Protect the casualty from further harm
Ensure the scene is safe
Provide pain relief/promote recovery
This could include the use of ice packs or simply applying a sling
 (a bandage used to suspend or support an injured part of the
body)

Prevent the injury or illness from becoming worse

Ensure the treatment you provide does not make the condition
worse
Provide reassurance

It is important to understand that first aid has its limitations and
does not take the place of professional medical treatment
Objectives of First Aid
To preserve life

To alleviate suffering

To promote recovery

To prevent aggravation of the injury or illness until veterinary

assistance can be obtained
Definition of terms
First Aider
A person who offers emergency care to the casualty(ies)
Victim/casualty
A person suffering from a sudden injury or trauma or illness and
needs first aid
 Emergency
An unexpected incidence serious in nature that requires quick
action,e.g poisoning, burns etc
Scene
An area on incident
Incident
It’s a happening traumatic in nature that requires first aid(it
could be illness or injury)
The First Aider Qualities
Highly trained i.e. have necessary knowledge
Examined and regularly re-examined
Have empathy and understanding
Are up-to-date in knowledge and skill
Have initiative and sense of leadership
Have ability to act quickly, make decisions and improvise
Appreciate that the less interference the better
Responsibilities of a First Aider
To assess the situation quickly and safely and to summon
appropriate help
To protect casualties and others at the scene from possible
danger
To identify as far as possible the injury or nature of illness
affecting a casualty
To give each casualty early and appropriate treatment, treating
the most serious conditions first
To arrange how the casualty will get to hospital or to his/her
home
To remain with the casualty until appropriate care is available
To report his/her observations to those taking care of the
casualty and to give further assistance if required
To prevent cross infection between yourself and the casualty as
much as possible
Protecting the casualty
To prevent/avoid cross-infection when giving first aid you should:
Avoid contact with body fluids
Wash your hands
Wear protective gloves
If gloves are unavailable, life saving treatment must still be
available
First Aid Priorities
Assess the situation
Observe what has happened quickly and calmly
Look for danger to yourself and to the casualty
Make the area safe
Protect the casualty from danger
Beware of your limitations
Assess all casualties and give emergency first aid
Assess each casualty to determine treatment priorities and
treat those with life threatening conditions first.
Get help
Quickly ensure that any necessary specialist help has been
summoned and is on the way
 Assignment: General Rules of First Aid Treatment
Triaging
This is sorting and classifying injured patients to determine
priority of need
The most critical are taken care of first
Direct assistance to casualties is given by the casualty nurse
The mnemonic START is used.
S-Simple
T-Triaging
A-And
R-Rapid
T-Treatment
Basics of First Aid
Basic First Aid refers to the initial process of assessing and
addressing the needs of someone who has been injured or is in
physiological distress due to chocking, a heart attack, allergic
reactions,drugs,alcohol or other medical emergencies
1.Evaluate the situation
Are there things that might put you at risk of harm? Are you or
the victim threatened by fire, toxic smoke or gases, an unstable
building, live electrical wires or other dangerous scenario? Do not
rush into a situation where you could end up as a victim yourself
 If approaching the victim will endanger your life, seek
professional help immediately; they have higher levels of training
and know how to handle this situations
2.Remember your A,B,C.
The A,B,C refer to the three critical things you need to look out
for
Airway-Does the person have an obstructed airway?
 Breathing-Is the person breathing
Circulation-Does the person show a pulse at major pulse
points(wrist, carotid artery and groin)
3.Avoid moving the victim
Avoid moving the victim unless they are in immediate danger.
Moving a victim will make the injury worse especially in cases of
spinal cord injuries
4.Call emergency services/call for help
or tell someone else(a specific person if possible) to call for help
as soon as possible
 If you are the only person on the scene, try to establish breathing
before calling for help and do not leave the victim alone for an
extensive amount of time
5.Determine responsiveness
If a person is unconscious, try to rouse them by gently shaking
and speaking to them
6.If the person remains unresponsive, carefully roll them onto their
back and open his/her airway
Keep head and neck aligned
Carefully roll them onto their back while holding his head
Open the airway by lifting the chin
7.Look,listen and feel for signs of breathing
Look for the victims chest to rise and fall, listen for sounds of
breathing(place your ear near the nose and mouth and feel for
breath on your cheek)
If the victim is not breathing, check for circulation
 If the victim is breathing but unconcious,roll them onto their side,
keeping the head and neck aligned with the body. This will help
drain the mouth and prevent the tongue or vomit from blocking
the airway
8.Check victims circulation
Look at the victims color and check for pulse(the carotid artery
is a good option, its located on either side of the neck below the
jaw bone)
 If the victim does not have pulse, start CPR(Cardiopulmonary
resuscitation)
9.Treat bleeding, shock or other problems as needed
After you have established that the victim is breathing and has a
pulse, your next priority should be to control any bleeding
Stop bleeding by applying direct pressure
10.Stay with the victim until help arrives
Be a calming presence for the victim until assistance arrives
If the victim is not breathing
Follow this steps to restore breathing in an unconscious victim
This steps assume you have already performed the chin lift
described above
oCheck for a clear airway: Remove any obvious blockage
oCover the victims mouth with your own(kiss of life)
oPinch the victims nose closed
oFill victims lungs with two slow breaths. If breaths are blocked,
reposition the airway. Make sure the head is tilted slightly back
and the tongue is not obstructing it.
oIf breaths are still blocked, give 5 quick forceful abdominal
thrusts. This is the equivalent of Heimlich maneuver in a standing
person.
Straddle the victim
Place a fist just above the belly button and below the breast bone
Thrust upward to expel air from the lungs
Sweep the mouth to remove any foreign object
Try two slow breaths
Repeat until you are successful in clearing the object from the
windpipe
o With open airway begin rescue breathing. Give one breath every 5
seconds and check that the chest rises every time
o Administer CPR if the victim does not have a pulse until help arrives
How to do CPR on an adult
Check the scene for immediate danger
Make sure you are not putting yourself in danger/harm by
administering CPR to someone unconscious. Is there fire? Is the
person lying on a roadway? do whatever is necessary to move
yourself and the other person to safety.
You can open a window, turn off the stove or put out the fire if
possible.
 However, if there is nothing you can do to counteract the danger,
move the victim. The best way to move the victim is by placing a
blanket or coat underneath their back and dragging it
Assess the victims consciousness
Gently tap his/her shoulder and ask: Are you ok’ in a loud clear
voice. If he/she responds,CPR is not required
 If the victim does not respond, continue with the following steps
Send for help
Send someone to call for emergency services. Give the
dispatcher your location and notify him or her that you are going
to perform CPR.If you are alone, get off the phone and start
compressions.
 If you have someone else with you, have him or her stay on the
line while you do CPR on the victim
Check for breathing
Put your ear close to the victims nose and mouth and listen for
breathing. If the victim is coughing or breathing normally, DON’T
perform CPR.Doing so could cause the heart to stop beating
Place the victim on his/her back and make sure he/she is lying
flat as possible. This will prevent injury while doing the chest
compressions
Place the heel of one hand on the victims breastbone, exactly
between the nipples
Place your second hand on top of the first hand palms down
Position your body directly over your hands so that your arms are
straight and somewhat rigid
Perform 30 chest compressions
Press down with both hands directly over the breastbone to
perform a compression which helps the heart beat
Chest compressions are more critical for correcting abnormal
heart rhythms.
 some of the abnormal heart rhythms include ventricular
fibrillation and pulseless ventricular tachycardia
You should depress the breastbone approximately 4-5cm(1.5-2
inches)
Minimize pauses in chest compressions
Attempt to limit interruptions to less than 10 seconds
Make sure the airway is open. Place two fingers under the point
of casualty's chin, lift the jaw. At the same time, place your other
hand on the casualty's and gently tilt the head well back
If you suspect a neck injury, pull the jaw forward rather than chin
lifting. If jaw thrust fails to open the airway, do a careful head tilt
and chin lift
 If there are no signs of life, place a breathing barrier(if available)
over the victims mouth
Give two rescue breaths
Keeping the airway open, take the fingers that were on the
forehead and pinch the victims nose closed. Make a seal with
your mouth over the victims mouth and breath out for about one
second. Breath slowly to ensure air goes in the lungs and not the
stomach
If the breath goes in, you should see the chest slightly rise and
also feel it go in. Give a second rescue breath
If the breath does not go in, reposition the head and try again. If
it does not go in again, the victim may be chocking
Repeat the cycle of 30 chest compressions and 2 rescue breath.
Do CPR for 2 minutes(5 cycles) before checking for signs of life.
Continue CPR until someone takes over, emergency personnel
arrive, you are too exhausted to continue, an AED(automated
external defibrillator) is available for immediate use or signs of
life return.
AED is used to jumpstart the victims heart
How to use an AED
Make sure there are no paddles or standing water in the
immediate area
Turn on the AED.It should have voice prompts that tell you what
to do
Fully expose the victims chest. Remove any metal necklaces or
underwire bras
Check foe any body piercings or evidence that the victim has a
pacemaker(should be indicated by a medical bracelet)
Make sure the the chest is absolutely dry
Attach sticky pads with electrodes to the victims chest. Move
the pads at least one inch(2.5 cm) away from the metal piercings
or implanted devices
Press analyze on the AED machine. If a shock is needed it will
notify you
If you do shock the victim, make sure no one is touching him/her
Remove the electrode pads and resume CPR for other 5 cycles
before using the AED again
 First Aid Steps
Before attending to a casualty, you must survey the whole scene
Your first responsibility is to make that the area is safe
Where the danger is too imminent or great, you may need to
move the casualty even at risk of aggravating injury
Only when the casualty is safe can you begin to treat illness and
injury
Ensure personal safety so that you don’t become a casualty
Send for help
1)ASSESSMENT
When safe to do so, quickly perform a brief examination of the
casualty. This is to check for any life threatening conditions that
need urgency and to preserve life
 You do assessment before making a full diagnosis and if
necessary, be prepared to carry out appropriate steps to
resuscitate the casualty first
i)Check consciousness
If casualty does not respond when spoken to, he might be
unconscious. Try to elicit a response and be careful not to move
the head or tilt the neck
ii)Open the airway
An unconscious casualty’s airway may be blocked by the tongue
falling back. Open airway by tilting the head back
iii)Check for breathing
Once airway is open, establish whether the casualty is breathing,
if not, place in recovery position.
Give artificial breaths
iv)Check for circulation
If the heart is beating, you should be able to feel a pulse in the
neck(carotid pulse) or wrist(radial pulse).
For the babies, check brachial pulse
v)Check for bleeding
Severe loss of blood reduces circulation to the vital organs and
can cause shock
Control serious bleeding as soon as breathing and pulse have
been established
As soon as you establish the condition of the casualty, take
action depending on
Unconcious,not breathing and without pulse
Unconcious,not breathing and with a pulse
Unconcious,breathing and with a pulse
2.DIAGNOSIS
Requires thorough physical examination
Made on the basis of history and clues to any medical condition
and signs and symptoms
Circumstances will determine how detailed the examination will
be
History
Is full story of how the incident happened, how the injury was
sustained or how the illness began and continued including any
previous conditions
Question the casualty but if he is unconscious, talk to any
witness(es).They give useful information but can be unreliable if
upset
Take into account
When the casualty last had something to eat or drink
Whether the casualty has any illness or is taking any medication
The amount of force involved and how it was applied to the body
The environment e.g. hot and stuffy, cold room or exposed to
wind or rain
Casualty's age and state of health e.g a young fit adult who trips
may sprain a wrist but an elderly lady who does the same is more
likely to have broken her arm or hip
Establish who the casualty is and where he/she lives
External clues
If casualty is unable to co-operate or is unconscious, look
through pockets and bags for clues(Beware of syringes if you
suspect drug abuse)
There may be an appointment card for hospital or clinic or a card
indicating history of allergy,diabetes,epilepsy etc
Medication carried by casualty may give valuable clues about the
emergency e.g. glyceryl trinitrate for angina,phenytoin for epilepsy
and inhalers for asthmatics or angina patients
Take care of any such clue and return it to the casualty
Signs and symptoms
i) Symptoms verbalized by the casualty
Pain,anxiety,heat,cold,loss of normal movement, loss of
sensation,thirst,nausea,tingling,faintness,stiffness,memory
loss,dizziness,sensation of broken bone
ii)Signs you may see
Anxiety and painful expression, unusual chest movement,burns,
sweating,wounds,bleeding from orifices, response to touch,
response to speech,bruising,abnormal skin colour,muscle spasm,
swelling,deformity,foreign bodies, needle marks,vomit,
incontinence,containers and other circumstantial evidence
iii)Signs that you may feel
Dumpness,abnormal body temperature,swelling,a deformity,
abnormal pulse, grating bone ends
iv)Signs that you may hear
Noisy or distressed breathing,groaning,response to speech,
grating bone ends(crepitus)
v)Signs that you may smell from patients breath
Acetone,alcohol,solvents or glue, cannabis
Examining a casualty
Do a head to toe examination
Run your hands carefully over the scalp to feel for bleeding,
swelling or depression that may indicate possible fracture
 Be careful not to move any casualty who you feel/think might
have injured her/his neck
Speak clearly to the casualty and check for response. Check for
blood or clear fluid discharge from the ears or a mixture of both. It
could a sign of intracranial damage
Examine both eyes, noting if open. size of the pupil. Are the
pupils reacting to light(should shrink when light falls on it),foreign
bodies, blood or bruising in the whites of the eyes.
Examine the nose
Record the rate, depth and nature of breathing. Note any odor on
breath, check the mouth, open airway, look for any wounds or lost
teeth and examine lips for burns
Note the color, temperature and state of the skin. If its pale,
flushed or cyanosed. Is it hot, dry or dump.Pale,cold and sweaty
skin suggest shock, a flushed hot face suggests heat stroke or
fever. Blue skin(cyanosis)-look for it at the lips, ears and face
Loosen clothing around the neck and check for a tracheostomy
tube.
 Palpate the spine from the base of the skull downwards without
disturbing/moving the patient. Check for any swelling, tenderness
or any other irregularity.
Ask the patient to breath deeply and check if the chest expands
evenly, easily and equally on both sides. Feel the rib cage for any
deformities,irregularity,tenderness or granting sensation on
breathing
Feel along the collar bones and the shoulder for any deformity,
irregularity or tenderness
Check the movements of elbows, wrists and fingers. Ask the
casualty to bend and straighten the arm at the joints. Check for
any abnormal sensation at he limbs and note color
If there is any sign of impairment of movement or loss of
sensation in the limbs, do not move the casualty to examine the
spine. Gently pass your hand under the hollow of the back and
feel along the spine without disturbing without disturbing the
casualty checking for swelling and tenderness
Gently feel the front of the abdomen for evidence of bleeding
and to identify any rigidity or tenderness of the muscular wall
Feel both sides of the hips and gently move the pelvis to look for
signs of fracture. Note any incontinence or bleeding from orifices
Ask the casualty to raise each leg in turn and to move her ankles
and knees. Look and feel for bleeding, swelling or any other
deformity and tenderness

Check movement and feeling in all toes. Also color

Treatment and aftercare
Treat each condition methodically and calmly in order of priority
Re-assure the casualty and listen to them. Don't keep
questioning the casualty and do not let people crowd around
Avoid moving the casualty unnecessarily
Treatment priorities
Follow ABCs
Maintain clear airway and breathing. If unconcious,place in
recovery position
Control bleeding
Treat large wounds and burns
Immobilize bone and joint injuries
Give appropriate treatment for other injuries and conditions
Check airway, breathing and pulse regularly and deal with any
problem immediately.
Arranging appropriate
aftercare
Ascertain whether casualty needs medical treatment and if so,
what is needed.
If you require help send someone else if possible, in the event
that the casualty's condition alters or worsens. Stay with the
casualty until help arrives
According to your assessment of the casualty, you may:
Call a doctor/senior nurse for advise
Call an ambulance or arrange transport to hospital
Pass care of the casualty to a doctor, nurse or ambulance crew
Take the casualty to a nearby house or shelter to await medical
help
Allow the casualty to go home accompanied if possible
Ask if somebody will be at least home to meet him/her or you
can arrange this
Advice the casualty to see a doctor
Do not allow home a casualty who has been unconscious(other
than a faint),had severe breathing difficulty or signs of shock. Stay
with him or her until help arrives
Do not give anything by mouth to any casualty who may have
internal injuries or otherwise need hospital care
Passing on information
Having summoned medical aid, make notes on the incident and
the condition of the casualty so that you can pass on all the
information you have gathered
The observation chart overleaf will enable you to not tour
observations such as breathing, level of response at a ten minute
interval
Make a brief written report to accompany your observations
Your report should include:
The casualty's name and address
History of the accident or illness
A brief description of any injuries
Any unusual behavior
Any treatment given and when
Breathing, pulse and level of response
RESUSCITATION
TECHNIQUES
RESUSCITATION SEQUENCE
Check response
Open airway
Check breathing
Assess for circulation
Commence CPR
Assignment: resuscitation for children
<1 year
1-7 years
8 years and above
Cardiovascular
emergencies
1.SHOCK
A shock state exists when the tissue perfusion decreases to the
point of cellular metabolic dysfunction.

Shock is classified according to the causative event.

Types of shock
1.Hematogenic/hemorrhagic/hypovolemic
Occurs when blood volume is insufficient to meet metabolic needs
of the tissues as with severe hemorrhage.
2.Cardiogenic shock
Occurs when cardiac failure results in decreased tissue perfusion
as in MI.
3.Distributive shock conditions
Characterized by displacement of a significant amount of vascular
volume.
Types of distributive shock
1.Neurogenic shock
Results from a neurologic event such as head injury that causes
massive vasodilatation and decreased perfusion pressures.
2.Anaphylactic shock
Caused by a severe systemic response to an allergen resulting in
massive vasodilatation, increased capillary permeability, decreased
perfusion, decreased venous return and subsequent decreased
cardiac output.
3.Septic shock
Occurs when bacterial toxins cause an overwhelming systemic
infection.
Circulatory shock
The circulatory system distributes blood round the body so that
oxygen and nutrients can pass through and perfuse the tissues.
When the system fails, circulatory shock ensue. If not treated
swiftly, vital organs such as the heart and the brain may fail
leading to death.
Worsened by fear and pain.
Causes of circulatory
shock
1.Heart attack
2.Severe infection and anaphylactic shock-blood vessels dilate
reducing the blood pressure
3.Blood loss
4.Loss of body fluids through burns, severe diarrhea or vomiting
-The body responds to fluid loss initially by diverting the blood
supply from the surface to the vital organs.
continuation

As the brain’s oxygen supply weakens

Restless, anxious and aggressive
Air hunger-yawn and gasp for air
Unconscious
Heart stops
Signs and symptoms
At first, the release of adrenaline causes
A rapid pulse
Pale,grey-blue skin especially inside the lips.
Sweating, cold and clammy skin.
As shock develops
Weakness and giddiness
Nausea and vomiting
Thirst
Rapid shallow breathing
A weak thready pulse. When the pulse at the wrist disappears, about half the
blood volume will have been lost.
Treatment
AIMS
To recognize shock
To treat any obvious cause
To improve the blood supply to the brain, heart and lungs
To arrange removal to hospital
Treatment
Treat any cause of shock you identify such as external bleeding.
Lay the casualty down on a blanket to protect her from the cold
ground keeping her head low.
Raise and support her legs to improve the blood supply to the
vital organs. Take care if you suspect a fracture.
Loosen tight clothing such as belts and braces to reduce
constriction at the neck, chest or waist.
 keep the casualty warm by covering her with coats and blankets.
Check and record breathing, pulse and the level of response.
Be ready to resuscitate if necessary.
2.FAINTING/SYNCOPE
Is a brief loss of consciousness that is caused by temporary
reduction of blood flow to the brain.
The pulse becomes very slow although it soon picks up and
returns to normal.
Recovery is rapid and complete.
Signs and symptoms
A brief loss of consciousness causing causing the casualty to fall
to the floor.
Slow pulse
Pale cold skin
Sweating
Aims of treatment
To improve blood flow to the brain

To reassure as she recovers and make her comfortable

Treatment
Lay the casualty down, raise and support her legs
Make sure that she has plenty of fresh air
As she recovers, reassure her and help her sit up gradually
Look for and treat any injury that has been sustained through
falling
If she does not regain consciousness quickly, do ABC and be
ready to resuscitate if necessary. If the patient starts to feel faint
again tell her to lie down and raise and support her legs until she
fully recovers.
3.ANGINA PECTORIS
Its constriction of the chest and describes the pain that a person
experiences when narrowed coronary arteries are unable to
deliver sufficient blood to the heart muscle to meet the demands
of exertion or excitement.
The pain is relieved by rest.
Signs and symptoms
Gripping central chest pain, spreading
often to the jaw and down to the left arm
Shortness of breath
Weakness-sudden and extreme
Anxiety
TREATMENT
Aims
To ease strain on the heart by ensuring that the casualty rests
To obtain medical help if necessary
Actual treatment
Help the casualty to sit down. make her comfortable and
reassure her.
If the casualty has medicine for angina such as tablets or a
“puffer” aerosol let her administer it herself. If necessary help her
to take it.
continuation
Encourage the casualty to rest and keep bystanders away. The
attack should ease within a few minutes.
If the pain persists or returns suspect a heart attack. Dial 999 for
an ambulance.
Monitor and record breathing and pulse rates every ten minutes.
4.HEART ATTACK
Occurs when the blood supply to part of the heart muscle is
suddenly obstructed e.g. coronary thrombosis
The main risk is that the heart will stop.
The effect of the heart attack depends on how much of the
muscle is affected.
Drugs that aid recovery include thrombolytic (dissolve the clot)
and asprin (thins the blood).
Signs and symptoms
Persistent central chest pain spreading to the jaw and down to
the left arm. Unlike angina pectoris the pain does not ease once
the casualty is at rest and may occur at rest.
Breathlessness and discomfort high in the abdomen.
Sudden faintness or giddiness
A sense of impending doom
‘’Ashen” skin and blueness at the lips
Rapid weak irregular pulse
Sudden collapse
Aims of treatment
To minimize the work of the heart
To summon urgent medical help and arrange removal to hospital
treatment
Put the patient on a half sitting position, with the casualty’s head
and shoulders well supported and his knees bent
Call for help and state that you suspect a heart attack
Constantly monitor and record the casualty’s breathing and pulse
rate and be prepared to resuscitate if necessary
If the casualty has medicine for angina(“puffer "aerosol) help him
take it if he has. If the pain persists and the casualty is fully
conscious give him one tablet of ordinary aspirin to chew
5.ACUTE HEART FAILURE
The heart muscle is strained and fatigued e.g. following
coronary thrombosis and becomes increasingly inefficient.
Acute attacks may occur at night
Signs and symptoms
Similar to heart attack
Treatment
Follow the treatment for heart attack
6.CARDIAC ARREST
Sudden stoppage of the heart. Its characterized by the absence
of pulse and breathing. You must commence resuscitation
immediately.
Causes
Heart attack
Severe blood loss
Suffocation
Electric shock
Anaphylactic shock
Hypothermia
Signs and symptoms
Absence of pulse
Absence of breathing
Aims of treatment
To arrange urgent removal to hospital.
To keep the heart muscle and brain supplied with oxygen until
help arrives.
Treatment
Begin CPR
WOUNDS AND BLEEDING
Introduction
Definition of wound
Its any abnormal break in the skin or the body surface.
Wounds can be daunting if there is a lot of bleeding but prompt
action is needed to reduce blood loss and shock.
FIRST AID PRIORITIES
Control blood loss by applying pressure over the wound and
raising the injured part
Take steps to minimize shock
Cover any open wound with a dressing to protect it from
infection and promote natural healing
Observe hygiene to prevent cross infection between the casualty
and yourself
Types of Wound
1.Incised wound
A clean cut from a sharp edge such as broken glass such as
broken glass causes an incision. The blood vessels at the wound
edges are cut straight across so there may be profuse bleeding.
2.Laceration
Crushing or ripping forces result in rough tears or lacerations.
Bleed less profusely than clean-cut wounds but there is more
tissue damage and bruising.
they are often contaminated by germs. The risk of infection is
high.
 Types of wounds

3.Abrasion(graze)
This is a superficial wound in which the top layers
of the skin are scraped off, leaving a raw, tender
area.
Caused by a sliding fall or a friction burn.
They can contain embedded foreign particles that
may result in infection.
4.Contusion(bruise)
A blunt blow or punch can rupture capillaries
beneath the skin. Blood then leaks into the
tissues causing bruising. The skin splits
occasionally.
Severe contusion may indicate deeper, hidden
damage such as fracture or internal injury.
Types of wounds
5.Puncture wound
Standing on a nail or being stabbed.
Has small entry site but a deep track of internal damage.
Germs and dirt can be carried far into the body and therefore the
risk of infection is high.
6.Gunshot wound
A bullet or other missile may drive into or through the body
causing serious internal injury and sucking in contaminants from
the air. The entry wound may be small and neat while the exit
wound may be large and ragged.
TYPES OF BLEEDING
Classified by the type of blood vessel that is damaged:artery,
vein or capillary.
Arterial bleeding can be very dramatic but copious venous
bleeding is potentially more serious.
1.Arterial bleeding
Richly oxygenated blood is bright red.
Under pressure from the heart, it spurts from a wound in time
with the heart beat.
A severed main artery may jet blood several feet high and
rapidly reduce the volume of circulating blood.
Types of bleeding
2.Venous bleeding
Venous blood is dark red.
Its under less pressure.
Vein walls are capable of great distension and therefore blood can pool
within them.
Blood from a severed major vein may gush profusely.
3.Capillary bleeding
Occurs at the site of all wounds.
At first may be brisk but blood loss is usually slight.
A blunt blow may rupture capillaries under the skin causing bleeding
under the skin causing bleeding into the tissues(bruise)
Severe external bleeding
Bleeding at the face or neck can impede the airway.
Shock is likely to happen and the casualty may loose
consciousness.
Aims of treatment
To control the bleeding
To prevent and minimize the effects of shock
To minimize the risk of infection
To arrange urgent removal of the casualty to hospital.
Treatment
1.Remove or cut clothing to expose the wound. Watch out for
sharp objects such as glass that may injure you.
2.Apply direct pressure over the wound with your fingers or palm
preferably over a sterile dressing or clean pad. Do not waste time
hunting for a dressing.
If you cannot apply direct pressure e.g. if an object is protruding,
press down firmly on either side.
Treatment
3.Raise and support the injured limb above the level of the
casualty’s heart.----will help reduce the gravity and rate of flow of
blood. This will ensure control of bleeding
4.Lay the casualty down. This will reduce blood flow to the site of
the injury and minimize shock.
5.Leaving any original pad in place, apply a sterile dressing.
Bandage it in place firmly but not so tightly as to impede
circulation. If blood seeps through the dressing, bandage another
firmly over the top.
If there is a protruding foreign body, build up padding on either
side of the object until high enough to bandage over the object
without pressing on it.
Continuation
6.Secure and support the injured part with bandaging
7.Call for help. Treat shock, check dressing for seepage and check
for circulation beyond the bandage.
BLEEDING AT SPECIAL
SITES
Scalp and Head Wounds
Aims of treatment
To control blood loss
To arrange transport to hospital
Actual treatment
Wearing disposable gloves, if possible replace any displaced skin
flaps.
Apply firm direct pressure over a sterile dressing or clean pad.
Secure the dressing with a roller bandage. Lay the casualty down
with head and shoulders slightly raised. If he becomes unconcious,
ABC.
Take or send the casualty to hospital in the final treatment
position.
Wounds To The Palm
Aims of treatment
To control blood loss
To arrange transport to hospital
Treatment
Press a sterile dressing or clean pad firmly into the palm and ask
the casualty to clench his fist over it. If he finds it difficult to press
hard, he may grasp the fist with his uninjured hand.
Bandage the casualty’s fingers so that they are clenched over the
pad. Tie the knot over his fingers
Support the casualty’s arm in an elevation sling and take him or
send him to hospital.
Wounds At Joint Creases
Aims of treatment
To control blood loss
To arrange transport to hospital
Treatment
Press a clean pad over the injury. Bend the joint as firmly as
possible
With the joint firmly bent to press on the pad, raise the limb. Lay the
casualty down to reduce shock
Take or send the casualty to hospital in the treatment position.
Release the pressure briefly every ten minutes to restore normal
blood flow.
 Bleeding Varicose Veins
A varicose vein has taut, thin walls and is often raised stretching the skin
to give a characteristic ”knobbly” appearance. It can burst by gentle
knocks and will bleed profusely.
Aims of treatment
To control blood loss
To arrange urgent removal to hospital
To minimize shock
Treatment
Lay the casualty on her back and raise the injured leg to reduce
or stop bleeding
Expose the site of bleeding and apply firm direct pressure over
sterile dressing or clean pad with a securing bandage or with your
fingers until bleeding is controlled. Remove garments such as
garters or elastic-topped stockings that may be impeding blood
flow back to the heart.
Put a large soft pad over the dressing. It should exert even
pressure yet not impede blood flow.
Keep the injured leg raised and supported until the ambulance
arrives.
MAJOR WOUNDS

Cause serious internal injury without severe external bleeding esp.

trunk wounds.
1.Abdominal Wounds
Severity is evident in external bleeding and protruding
abdominal contents. There could be hidden internal injury and
bleeding
The risk of infection and shock is high
Treatment
Aims
To minimize the risk of infection
To minimize shock
To arrange urgent removal to hospital
Treatment
Lay the casualty down on a firm surface. Loosen any tight
clothing
Put a large dressing over the wound and secure it lightly in place
with a bandage. If part of the intestine is protruding, do not touch
it but cover with a plastic bag or kitchen film to prevent it from
drying out. Alternatively use a sterile dressing.
Call for help. If casualty becomes unconscious, do ABC.
INTERNAL
HAEMORRHAGE
Its of great importance that any first aid worker takes prompt action.
Management
Rest and quiet
The patient must be laid down lying flat and kept absolutely still. If the
patient is allowed to move about in any way, there is danger of further
bleeding
Reassurance
Reassure the casualty as he or she will be anxious and possibly afraid
Position
If possible the lower end of the bed or couch can be raised. This
Facilitates the flow of blood by gravity to the brain and may prevent
fainting or unconsciousness
continuation
Clothing
Undo tight clothing round the neck, chest or waist. This helps the
patient to breath more easily and prevent the feeling of
suffocation.
Medical aid
Alert the EMS or arrange patient’s removal to hospital.Ensure
minimal movement of the casualty when handling him or her.
Epistaxis
Its bleeding from the nose.
Can be severe or slight.
Management
Place the patient on a chair in a sitting position with the head held
forward. In severe bleeding this will prevent the blood flowing to the
back of the nose and throat an may prevent it from being swallowed
or inhaled.
Loosen tight clothing round the neck, chest and waist and place the
patient near an open window
Ask the patient to breath through his or her mouth
Pinch the nose firmly between the thumb and the forefinger
CONTINUATION
A cold compress in the form of a handkerchief wrung out in iced
water can be applied over the bridge of the nose and at the back
of the neck.
Keep the patient sitting very still
If the bleeding is very severe and does not stop within several
minutes, arrange how the patient will get to hospital.
Bleeding from a tooth
socket
If a tooth has been extracted, it is possible for the socket to
continue bleeding.
First aid management
Fit a plug of gauze or cotton wool into the socket and ask the
patient to clench the teeth very firmly. The roughness of the
gauze and pressure on the bleeding vessels stop the bleeding in
about ten minutes.
If bleeding does not cease, arrange the patients removal to
hospital.
RESPIRATORY
DISORDERS
Asphyxia
Arises when one is not able to inhale or exhale air.
The body does not receive sufficient oxygen and there is
accumulation of carbon dioxide in the blood causing
unconciousness,death or suffocation
Causes of asphyxia
Occlusion or obstruction of the upper respiratory tract.
This may be due to:
1. Strangulation
2. Smothering with a pillow
3. Impaction of foreign body such as bone in the throat or a piece
of food inhaled into the larynx or trachea
4. Pressure on the chest e.g. by fallen masonry
5. Drowning
6. A complication of another condition such as swelling due to
burning of the mouth and throat
Continuation
 Paralysis of the muscles of respiration
Can be due to:
1. Electric shock
2. Being struck by lightening
3. Poisons e.g. strychnine and morphine
4. Diseases such as poliomyelitis
Continuation
Effects of certain gases
Include CO, ammonia and chlorine
Breathing in smoke
If someone has been trapped in a burning building
 Signs and symptoms of
asphyxia
Difficulty in breathing, restlessness and agitation
The patient begins to struggle trying to remove the obstruction
Coughing and spluttering
Cyanosis occurs
If the patient struggles to overcome the asphyxiation, the face
becomes congested with blood ,neck veins become distended and the
pupils dilate
If the individual does not struggle and appears to go to sleep, suspect
CO poisoning
Management of asphyxia
Remove the source of danger from the patient. For example a
pillow from the face and a bone from the throat. Or remove the
patient from the source of danger such as smoke or gas filled
room or take the patient out of the water in case of drowning.
Undo tight clothing round neck, chest and waist.
Continuation
Clear the mouth of any obstruction such as vomit as far as
possible
If breathing and pulsation have ceased start CPR
In cold weather, keep the person reasonably warm.
CHOCKING
This is most common with children. A marble, a weed or a
button may get stuck in the air passage. In adults too, food may
go down the wrong way and cause choking.

Management in the case of an adult.

When victim is standing, the First Aider should stand behind the
victim and wrap his arms around the waist. Grasp the fist with
your other hand and place the thumb of the fist against the
abdomen (belly) slightly above the navel and below the rib cage.
Press your fist into the victim's abdomen with a quick upward
thrust. Repeat several times if necessary till the foreign body is
expelled out of the windpipe. When the victim is sitting, the First
Aider stands behind the chair and performs the same maneuver.
CONTINUATION
If the victim is lying, turn him supine (face up). Facing the victim,
kneel astride the victim's legs. With your hands one on top of
another, place the heel of your bottom hand over the abdomen
(belly) between the naval and the ribcage. Press into the victim's
abdomen with a quick upward thrust repeat several times, if
necessary. Should the patient vomit, place him on his side and
wipe to prevent asphyxia. Following the expulsion of food
particle/foreign body it may be necessary to give artificial
respiration.
Management incase of an
infant
 Hold the child upside down by the legs and smack his/her back
hard three or four times.
If not successful, lay the child prone with his head hanging
downwards over the knee and give sharp smacks between
shoulders.
If still not successful, induce vomiting by passing two fingers
right to the back of the throat.
DROWNING
Drowning is the result of complete immersion of the nose and mouth in
water (or any other liquid). Water enters the windpipe and lungs, clogging
the lungs completely.
Management
Aim
 To drain out water (or other matter) from lungs and to give artificial
respiration.
Act quickly. Remove the casualty from the water , seaweeds and mud
from the nose and throat. Start artificial ventilation immediately.
Turn the victim face down with head to one side and arms stretched
beyond his head. Infants or children could be held upside down for a short
period.
Continuation
Raise the middle part of the body with your hands round the belly.
This is to cause water to drain out of the lungs.
Give artificial respiration until breathing comes back to normal.
This may have to go on for as long as two hours.
Remove wet clothing.
Continuation
Keep the body warm, cover with blankets.
When victim becomes conscious, give hot drinks such as coffee
or tea.
Do not allow him to sit up.
After doing the above, remove quickly to hospital as a stretcher
case.
Hanging and Strangulation
Cut or remove the band constricting the throat.
If suspended, raise the body and loosen or cut the rope.
Give artificial respiration.
To do the above do not wait for the policeman.
INHALATION OF FUMES
Carbon monoxide poisoning
This gas is present in car-exhaust fumes, in household coal gas:
during incomplete combustion of charcoal stoves and in coal mines.
Management
The first aid treatment consists of removing the person from the
area, applying artificial respiration and giving pure oxygen, if
available.
Ensure circulation of fresh air before entering the room by opening
the doors and windows.
Before entering the enclosed space take two or three deep breaths
and hold your breath as long as you can.
Continuation
Crawl along the floor (as the gas is lighter than air)
Remove the casualty as quickly as possible to fresh air.
Loosen his clothes at neck and waist and give artificial
respiration, if asphyxiated.
Carbon dioxide poisoning
This gas is found in coal mines, deep unused wells and sewers.
Various other gases such as leaking refrigerator gases;
compressed gases used for cooking and lighting may also cause
suffocation.
Management
Observe all the precautions mentioned above.
Enter in an upright position (as the gas is heavier than air and
collects near the floor)
Continuation
Remove the casualty as quickly as possible to fresh air.
Wherever ventilation is not possible and deadly poisonous gas is
suspected, use a gas mask to protect yourself.
Hyperventilation
 Is the state of breathing faster or deeper than normal (hyperpnoea), causing
excessive expulsion of circulating carbon dioxide. This means that the arterial
concentration of CO tension is falling (Paco2) below normal (35–45 mmHg).
2

Causes
 Panic attack
 Metabolic acidosis, also known as Kenny's Syndrome,
 Yogic practice of Bhastrika.
It often occurs together with labored breathing, which, in contrast, can also
be a response to increased carbon dioxide levels.
Lung disease
Head injury
Stroke
Signs and symptoms
Numbness or tingling in the hands, feet and lips
Lightheadedness
Dizziness
Headache
Chest pain
Flexor spasm of hands and feet (carpopedal spasm)
Slurred speech
Nervous laughter
Fainting, particularly when accompanied by the Valsalva maneuver.
Continuation
The hyperventilation itself reduces the carbon
dioxide concentration of the blood to below its normal level
because one is expiring more carbon dioxide
than what is being produced in the body, thereby raising the
blood's pH value (making it more alkaline),
initiating constriction of the blood vessels which supply the
brain, and preventing the transport of oxygen and other molecules
necessary for the function of the
nervous system. At the same time, hypocapnia,causes a higher
affinity of oxygen to hemoglobin, known as
the Bohr effect, further reducing the amount of oxygen
that is made available to the brain.
Management
Call 911 if the person has:
Chest pain that is crushing or squeezing or feels like a heavy weight on the chest
Difficulty breathing
1. Reassure the Person
To help reduce anxiety.
2. Help the Person Relax Breathing
Have the person sit down and try these strategies:
Breathe through pursed lips as if blowing out a candle
Cover the mouth and one nostril and breathe only through the other nostril
Breathe slowly, taking 1 breath every 5 seconds
Take deep, slow breaths from the abdomen ("belly breathing")
. When to Get Medical Help
Go to a hospital emergency room if:
The person's symptoms don't get better after
several minutes.
Symptoms get worse or the person is in pain.
HICCUPS
Hiccups are sudden, involuntary spasmodic contractions of the
diaphragm and intercostals muscles. Irritation of the nerves from
the neck to the chest can cause hiccups. When these nerves are
triggered, a signal is sent to the nerve, which controls the
diaphragm. The diaphragm signals back to the hiccup center in
the brain. Within a second, a structure called the glottis closes off
the windpipe, leading to a rapid reduction in intrathoracic pressure,
thereby producing the characteristic sound of a hiccup.
CONTINUATION
Hiccups start suddenly, usually last for a few minutes and stop
on their own. However, hiccups can sometimes be a serious
medical problem due to their chronicity and underlying causes.
Several serious underlying diseases such as brain infection or
tumor, lung tumor, pneumonia, gastroesophageal reflux and heart
attack are linked with hiccups and should be investigated if the
hiccups are persistent or associated with weight loss.
Causes
 stretching of the stomach after rapid eating
drinking or swallowing air or fizzy drinks
indigestion due to eating hot and spicy food,
sudden change of air temperature,
 excess alcohol consumption or excess smoking.
Stress and emotional excitement.
Management
Hold the breath for few seconds.
Breathing deeply through the nose, then exhaling slowly through the mouth.
Place a teaspoon of dry granulated sugar on the back of the tongue and swallow it.
Press tongue hard against roof of mouth.
Drink slowly a glass filled with ice cubes and water (the rapid change of temperature in
the esophagus may stop the hiccup).
Bite a lemon or eat a piece of fresh ginger.
Drink plenty of water.
While sitting, lean forward and compress the chest and diaphragm against the knees.
Distraction from one’s hiccup such as being startled.
In babies, hiccups are usually stopped immediately by the suckling reflex, either by
breastfeeding or sucking a bottle teat or nipple.
MUSCULOSKELETAL
INJURIES
STRAINS AND SPRAINS
Strain
Caused by forcible wrenching and stretching of the muscles,
ligaments and tendons which surround a joint
Sprain
Caused by forcible wrenching and stretching of the muscles,
ligaments and tendons which surround a joint and there is tearing
of some of these structures
Sprains and strains occur mostly at the ankle and the wrist
Signs and symptoms
Severe pain that increases in severity with any movement of the
part
Marked tenderness over the site of injury and swelling
Bruising due to bleeding of the torn structures
If pain is severe, shock will be present and the patient may faint
Loss of power in part but not so marked as in a fracture
treatment
Expose the joint and apply firm pressure to it.
This can be done by surrounding the joint with a pad of cotton
wool and bandaging it firmly in position. If the pad is made wet
with cold water, this will help tighten it.
The area should be kept at rest
Arrange patients’ removal to hospital
Dislocations
A dislocation occurs when a bone or bones forming a joint
become displaced.
There is usually stretching or tearing of tendons and ligaments
Causes
Sudden impact to the joint following a blow, fall or any other
trauma
Symptoms
Numbness or tingling at the joint or beyond it
intensely painful especially if you try to use the joint or bear
weight on it
Limited in movement
Swollen or bruised
Visibly out of place and discoloured
Management
Call 911 especially if the accident causing the injury is life
threatening
If on the upper limb, apply a sling to support the part
If on the lower limb apply a splint
Arrange patient’s removal to hospital
 Sublaxation
Is when one or more of the bones of your spine (vertebrae) move out of
position and create pressure on, or irritate spinal nerves. Spinal nerves
are the nerves that come out from between each of the bones in your
spine. This pressure or irritation on the nerves then causes those
nerves to malfunction and interfere with the signals traveling over those
nerves.
symptoms
Pain, tenderness, soreness and stiffness in the neck and/or back
Headaches
Dizziness or balance problems
Spinal muscle spasms, tightness or weakness
Reduction in spinal mobility
Pain, numbness or tingling in the extremities
Joint pain or stiffness
Low energy
Poor overall health
Reduced ability to heal tissue
Management
pain medication

exercise

stretching
FRACTURES
Definition of a fracture
A fracture is a complete or partial breakage of the bone on account
of stress or high impact forces. People suffering from certain
medical conditions like osteoporosis and bone cancer are more
prone to bone fractures.
Types of fractures:
All fractures can be broadly classified into simple and compound
fractures.
A simple fracture is one where the skin remains intact. A compound
fracture on the other hand, also involves open wounds. Since open
injuries are prone to infection, compound fractures are more severe
and are susceptible to infection.
Fractures are further
classified into
Comminuted fracture
Produces multiple bone fragments.
It’s a simple fracture
Greenstick fracture
A split in a young immature bone. Common in children
It’s a simple fracture
Impacted fracture
The ends of the broken bone are pushed into one another and
tightly wedged together.
This can happen in a fracture of the shaft of the femur or when
the head of the femur is pushed into the acetabulum
Complicated fracture
Not only damage to the bone takes place but injury to internal
organs
Examples of complicated fractures are
Fracture of the skull where the broken bone may press on the
brain
Fracture of the vertebrae where the broken bones may be
pressing on and damaging the spinal cord.
Fracture of a rib where the broken bone may pierce the lung
Signs and symptoms of
fractures
There is history of some injury except in cases of pathological
fractures
Pain at the site of the fracture. The pain is usually very severe
and is accentuated by movement
The area is tender and swollen
Bruising occurs due to damage and rupture of superficial blood
vessels
Shock. When a bone is broken, there is rupturing of blood vessels
in the bone which leads to internal hemorrhage and this with the
presence of pain causes shock
Loss of function and power in the affected part
Irregularity in outline at the site of the fracture. There may be a
gap in the bone or a lump may be seen. In compound fractures a
piece of bone may pierce the skin.
If a limb bone is broken there may be deformity of the limb due
to displacement of the broken ends. The limb may be shorter due
to over-riding or it may lie at an unnatural angle. Over-riding
occurs due to the pull of strong muscles which pull the lower part
of the bone over the upper part
Management of fractures
Aims
To prevent a simple fracture becoming a compound fracture

To arrange patients removal to hospital

General principles of first aid
treatment for all fractures
1.Position
The patient should be kept lying down unless the particular
fracture makes this position unsuitable e.g. it is more convenient
to have a person with fracture of ribs sitting up on a chair
2.To prevent infection
Any wound should be covered immediately with a clean dressing.
3.To stop hemorrhage
4.To treat shock
Pain and hemorrhage predisposes to shock and should be
treated
5.To immobilize the injured part
Are two methods: body splinting and mechanical splinting
6.To arrange transport to hospital
Management
Remember

Keep RICE in mind, as a first aid treatment for all fractures,

sprains and dislocations. RICE stands for Rest, Ice, Compression
and Elevation.
Rest
Give plenty of rest to the immobilsed limb. Move it as little as
possible so that there is no strain.
Ice
Apply ice to the injured area. No heat treatment or massage
should be given. Use an ice pack or wrap up some ice cubes in a
damp towel and apply it to the injured area. You could also use
anything frozen such as a packet of frozen peas.
Do not massage the injured area, and don't apply any ointments
like Iodex.
Compression
Wrap up the injured area with a crepe bandage if possible, or use
any clean, fresh cloth available. Wrap it as tight as is comfortable.
However, ask the doctor before bandaging the area. This will
relieve the pain somewhat.
Elevation
The injured limb should preferably be raised above the level of the
heart. This could be done with the help of a pillow while sleeping.
Injuries of the chest
Fractures of the ribcage
Ribs may be fractured by direct force to the chest, from a blow or
fall or by indirect force produced in a crush injury
If the fracture is complicated by a penetrating wound, breathing
may be seriously impaired
 Flail chest injuries
Cause paradoxical breathing resulting to severe respiratory difficulties.
Signs and symptoms
Sharp pain at the site of the fracture
Pain on taking a deep breath
Shallow breathing
Paradoxical breathing
An open wound over the fracture through which you might hear air
being sucked into the chest cavity
 Treatment
Aims
To support the chest wall
To arrange removal to hospital
For open or multiple fractures
Immediately cover and seal any wounds to the chest wall. Use sterile
dressing and kitchen foil
Place the casualty in a half- sitting position with head, shoulders and body
turned towards the injured side. support the limb on the injured side on an
elevation sling
Dial 911.
If the Casualty becomes unconscious or breathing becomes difficult or
noisy, place him in the recovery position with the uninjured side uppermost
Penetrating chest wounds
1.PNEUMOTHORAX
Is an abnormal collection of air in the pleural space that
separates the lung from the chest wall and interferes with normal
breathing
Types
Primary pneumothorax-occurs without an apparent cause and in
the absence of a significant lung disease
Secondary pneumothorax-occurs in the presence of an existing
lung pathology
Tension pneumothorax-the amount of air in the chest increases
markedly when a one way valve is formed by an area of damaged
tissue. Its a medical emergency.
Signs and symptoms
Difficult and painful breathing-rapid,shallow and uneven
An acute sense of alarm
Signs of shock
Coughed-up frothy red blood
Cyanosis
A cracking feeling of the skin around the site of the wound caused
by air collecting in the tissues
Blood bubbling out of the wound
The sound of air being sucked into the chest as the casualty
breathes in
Treatment
Aims
To seal the wound and maintain breathing
To minimize shock
To arrange urgent removal to hospital
First aid
Immediately use the palm of your hand or if the casualty is
conscious his own hand to cover the wound
Place a sterile dressing or clean pad over the wound and
surrounding area. Cover with a plastic bag, foil or kitchen film.
Secure it firmly so that it doesn’t come out
Provide firm support to the most comfortable position
Call for help
Hemothorax
Definition
Hemothorax is a collection of blood in the space between the chest wall and the
lung (the pleural cavity).
Causes
The most common cause of hemothorax is chest trauma. It can also occur in
patients who have:
A defect of blood clotting
Death of lung tissue (pulmonary infarction)
Lung or pleural cancer
Placement of a central venous catheter
Thoracic or heart surgery
Tuberculosis
Signs and symptoms
Anxiety
Chest pain
Low blood pressure
Pale, cool and clammy skin
Rapid heart rate
Rapid, shallow breathing
Restlessness
Shortness of breath
Management
Call 911 if you have:
Chest pain or shortness of breath
Dizziness, fever, or a feeling of heaviness in your chest
Severe chest pain
Severe difficulty breathing
Management
Stop the bleeding
Prevent shock
Arrange patient transfer to hospital
Hydrothorax
Results from serous fluid accumulating in the pleural cavity. This
specific condition can be related to cirrhosis with ascites in which
ascitic fluid leaks into the pleural cavity. Hepatic hydrothorax is
often difficult to manage in end-stage liver failure and often fails
to respond to therapy.
Causes
 Cirrhosis. In cirrhosis of the liver, the liver function is declined
by scarring, nodule formation, and fibrosis, which are all the
outcome of the liver fixing itself after the damage created by
alcoholism, hepatitis B, and fatty-liver infection and other
determinants. It is unidentified exactly how cirrhosis of the
liver directs to hydrothorax, but it is accepted that the
malfunction of the liver causes an imbalance in the fluids of
the body, and that excess can display up in the lungs.
 Causes
lung cancer
pleural cancer
pulmonary embolism
tuberculosis complications.
Signs and symptoms
anxiety
respiratory failure
restlessness
shortness of breath
tachycardia (rapid heart rate)
varying degrees of chest pain.
Management
Allow the person to adopt the most comfortable position that
does not hinder breathing

Evacuate the victim immediately

 HEAD AND NECK
INJURIES
A scalp wound may raise your suspicions but deeper underlying
damage will leave little visible evidence
CONCUSSION
Concussion is the sudden but short-lived loss of mental function
that occurs after a blow or other injury to the head. Concussion is the
most common but least serious type of brain injury.
It can safely be diagnosed once the casualty has completely
recovered.
Signs and symptoms
brief loss of consciousness

memory loss

disturbances in vision, such as 'seeing stars‘

confusion
signs and symptoms
There may also be:
Dizziness or nausea on recovery
Loss of memory of events at the time of or immediately
preceding the injury
Mild generalized headache
Aims of treatment
To ensure that the casualty recovers fully and safely

If necessary, to seek medical aid

Treatment
Place an unconscious casualty in the recovery position. Monitor
and record breathing, pulse and level of response every ten
minutes
If the casualty is unconscious after 3 minutes, suspect a more
serious injury
Call 911
If the casualty regains consciousness within 3 minutes, watch
closely for any deterioration in the level of response even after an
apparent full recovery
Place the casualty in the care of a responsible person
Advice the casualty to see his/her own doctor if headache,
sickness or tiredness occur after injury
Skull fracture
There may be brain damage
Germs that cause infection may enter the brain
CSF leaking from the ear or nose is a sign of serious injury and
an entry point for germs
Signs and symptoms
Wound or bruise on the head
A soft area or depression of the scalp
Impaired consciousness
Progressive deterioration in the level of response
Clear fluid or watery blood coming from the nose or ear
Blood in the white of the eye
Distortion of the head or face
Treatment
Aims
To resuscitate if necessary
To maintain an open airway
To arrange urgent removal to hospital
If unconcious,do ABC
Help a conscious casualty to lie down with the head and
shoulders raised. If there is discharge from an ear, position the
casualty so that the affected ear is lower. Cover the ear with a
sterile dressing or clean pad lightly secured with a bandage. Do
not plug the ear
Control any bleeding from the scalp. Look for and treat other
injuries
Call 911 for an ambulance
Monitor and record breathing, pulse and level of response every
10 minutes until help arrives.
Cerebral compression
It occurs when pressure is exerted on the brain within the skull e.
g.by an accumulation of blood or by swelling of an injured brain
Causes
Head injury
Skull fracture
Stroke
Infection
tumor
 Can develop immediately after head injury or may be delayed for
some hours or even days
Signs and symptoms
Level of response deteriorates as the condition develops
A recent injury followed by an apparently full recovery. Later on
the casualty may deteriorate and become disoriented
Intense headache
Noisy breathing, becoming slow
A slow yet full and strong pulse
Unequal or dilated pupils
Weakness or paralysis down one side of the face or body
High temperature, flushed face
Drowsiness
Irritability
Treatment
Call for help
If unconscious…
If concious,support him or her in a comfortable position
Monitor and record breathing, pulse and level of response every
ten minutes
Convulsions
Consists of involuntary contractions of many of the muscles in
the body caused by a disturbance in the function of the brain
Result in loss of or impaired consciousness
Causes
Head injury
Shortage of oxygen to the brain
poisons
Continuation
Fevers in children
A feature of epilepsy

Minor epilepsy
Cause a brief blurring of consciousness like day dreaming. On
recovery the casualty may have lost thread of what he or she was
doing
Signs and symptoms
Sudden ‘switching off'. The casualty stares blankly ahead
Slight or localized twitching or jerking of the lips,eyelids,head or
limbs
Odd automatic movements such as lip- smacki ng,chewing or
making noises
Treatment
Aims
To protect the casualty until she is fully recovered
Help the casualty to sit down in a quiet place. Remove any
possible sources of harm
Reassure her/him
Do not pester with questions. Stay with her until you are sure she
is herself again
Major epilepsy
There is recurrent, major disturbances of brain activity resulting
in violent seizures(Tonic-clonic) and severe impairment of
consciousness.
Can be sudden and dramatic but the casualty may have aura e.g.
a special smell or taste or a strange feeling
Signs and symptoms
Casualty suddenly falls unconsciousness often letting out a cry
He becomes rigid, arching his back(tonic phase)
Breathing may cease
Convulsive movements begin(clonic phase).The jaw may be clenched
and breathing may be noisy. May be loss of bladder and bowel control
The muscles relax and breathing become normal. The casualty recovers
within a few minutes. He may feel dazed or behave strangely in a state of
automatism being unaware of his actions. fit may be followed by deep
sleep.
There may be evidence of injury such as burns or scars from previous fits
 Treatment
Aims of treatment
To protect the casualty from injury while the fit
lasts
To provide care when consciousness has been
Regained
If you see the casualty falling try to support him or ease his falling.
Make space around him and ask bystanders to move away
Loosen clothing around his neck and protect his head
When convulsions cease place him in the recovery position.
Check breathing and pulse and be ready to resuscitate if
necessary. Stay with the casualty until he fully recovers
If he is unconscious for more than ten minutes or convulsing for
more than five, is having repeated fits or is unaware of his
condition, call 911.
Note the next time and duration of a fit
Unconsciousness
Causes
Head injury
Stroke,fainting,heart attack, shock
Stroke,infections,tumours
Hypoxia,poisoning,hypoglycemia
Epilepsy, abnormal body temperature
Aims of treatment
To maintain an open airway
To assess and record the level of response
To treat any associated injuries
To arrange urgent removal to hospital if necessary
To gather and retain any circumstantial evidence of the cause of
the condition
Management
CAB and resuscitate if necessary
Control bleeding. Note and protect any suspected fractures
 look for less obvious injuries. Smell the casualty's breath and
look for needle marks. Ask bystanders for information
Place the casualty in the recovery position
If the casualty does not regain full consciousness within 3
minutes, call for help
Continuation
Monitor and record breathing, pulse and level of response every
ten minutes using the observation chart
If the casualty regains full consciousness within 3 minutes as
soon as possible and remains well further ten minutes, advise
her to see her doctor
Types of neck injuries
Crick
A "crick" or "kink" is a term often used to describe the pain you
wake up with after sleeping with your neck in an awkward position.
It may also be due to working at the computer for long hours, or
sudden movements of the neck. "Crick in the neck" is not a
medical diagnosis. Usually a muscle spasm, arthritis or a disc
problem is the real culprit. At-home therapies can take care of a
crick in the neck most of the time, but if the pain lasts longer than
a week or disrupts your usual activities, get it checked by a doctor.
Neck sprain
Sprains are injuries to ligament. Neck sprains are often caused
by falls or sudden twists that overload or overstretch the joint.
Another cause is repeated stress to the joint. Symptoms include
swelling, reduced flexibility and pain. Sprains can be mild,
moderate or severe.
 If you suspect someone in your environment has a severe neck
injury (of any kind), you should immobilize their spine and call 911
immediately. For minor and moderate sprains, rest and ice the
area, take an anti-inflammatory, and get it checked by a doctor.
Neck fracture
Is a break in a cervical bone. It may be caused by trauma, a fall
or degenerative changes in the spine.
The angle of force hitting the neck and the head's position at
impact often determine the type and severity of the break.
Football players who block with their head are at high risk. Elderly
people with osteoporosis are particularly at risk for neck fractures
because their bones are very fragile. The most serious neck
fractures are generally accompanied by a dislocation. Treatment
depends on a lot of things including your age, other medical
conditions and extent of damage to your spine. If a fracture
destabilizes your neck, you may need to wear a halo brace.
Management for Neck
Injuries
What to Do - Or Not to Do
If someone has suffered a severe neck injury, call 911 for life support and
help.
Do not move the person, especially the head or neck unless failure to do so
presents an immediate threat or urgent danger.
Exceptions to Immobility
You can move a person with a possible neck injury when:
Not moving them would be an immediate threat to their life.
They are vomiting.
They are choking on blood.
You need to check for breathing and/or pulse so you can determine if they
need CPR.
 keep their head and neck immobile and move their entire body
as one unit. Do the same if you need to roll them over. To roll a
victim over, you will need at least two people - one at the
victim's head and one at the feet.
 After checking breathing and pulse, determine if CPR is
necessary.
DO NOT NOT LIFT VICTIM'S HEAD BACK WHEN OPENING THEIR
AIRWAY TO ADMINISTER CPR.
Instead open the jaw by placing fingers on either side.
BURNS AND EXTREMES
OF TEMPERATURE
Types of burns
Dry burn
Scald
Electrical burn
Cold injury
Chemical burn
Radiation burn
Classification of burns
1.According to surface area
Uses a simple formula, the rule of nines

2.According to depth of burns

Adult
Anterior head 9%
Posterior head 9%
anterior torso 18%
Posterior torso 18%
Anterior leg each 9%
Posterior leg each 9%
Anterior arm each 4.5%
posterior arm each 4.5%
Genitalia/perineum 1%
According to depth of
burns
1.Superficial burn
Involves only the outermost layer of the skin’
Characterized by redness, swelling and tenderness
Heals well if first aid is given promptly.

2.Partial-thickness burn
any one percent burn affecting layers of the epidermis giving rise to
rawness and blisters.
Can heal well but if but if they affect very large areas(over 60%),can be fatal
3.Full-thickness burns
All the three layers of the skin are burnt.
Damage to nerves, fat tissue and muscles present
The skin looks waxy, pale or charred
Urgent medical aid is essential
Management of minor
burns and scalds
Aims
To stop the burning
To relieve pain and swelling
To minimize the risk of infection
Flood the injured part with cold water for at least ten minutes to
stop the burning and relieve pain. If water is not available any cold
harmless liquid such as milk or canned drinks will do
Remove any jewellery,watches,belts or constricting clothing from
the injured area before it begins to swell
Cover the area with a sterile dressing, or any clean, non-fluffy
material and bandage loosely in place. A plastic bag or some
kitchen film make good temporary covering
Do not break blisters
Do not apply adhesive dressings or adhesive tape to the skin: the
burn may be more extensive
Do not apply lotions, ointments or fats to the injury. They further
damage the tissue and increase the risk of infection
Severe burns and scalds
Aims of treatment
To stop the burning and relieve pain
To maintain an open airway
To treat associated injuries
To minimize the risk of infection
To arrange removal to hospital
To gather relevant information for the
emergency services
Management
Lay the casualty down. Protect the burned area from contact
with the ground
Douse the burn with plenty of cold liquid. Thorough cooling may
take at least ten minutes.
While cooling the burn, watch for signs of DIB and be ready to
resuscitate if necessary
Remove any rings,watches,belts,shoes or shouldering clothing
from the injured area before it begins to swell
Cover the injury with a sterile dressing to protect it from
infection. If the burn is on the face, don't cover it. Keep cooling a
facial injury with water to relieve pain until help arrives
Gather and record details of the casualty's injury, circumstances
and potential hazards such as gas
While waiting for help, reassure the casualty and treat for shock
Burns to the Airway
Signs and symptoms
Soot around the nose and mouth
Singeing of the nasal hairs
Redness, swelling or actual burning of the tongue
Damaged skin around the mouth
Hoarseness of the voice
Breathing difficulties
Aims and treatment
To obtain specialist medical aid as quickly as possible
To maintain an open airway
Call for help
Loosen tight clothing around his neck, give oxygen if available
Reassure the casualty for him/her to stay calm
Electrical burns
Causes
Lightning strike
Low or high voltage current
Aims of treatment
To treat the burn and the shock
To arrange removal of the casualty to hospital
Treatment
Make sure that contact with the electrical source is broken
If unconcious,resuscitate if necessary
Flood the sites of injury with plenty of cold water to cool the
burns and cut away any burnt clothing if necessary
Place a sterile dressing, a clean folded triangular bandage or
some clean non-fluffy material over the burns
Call for help
Reassure the casualty and treat for shock
Chemical burns
If possible note the name or brand name of the substance
Sign and symptoms
Evidence of chemicals in the vicinity
Intense stinging pain
Later,discolouration,blistering,peeling and swelling of the
affected area
Treatment
Aims
To disperse the harmful chemical
To arrange transport to hospital
To make the area safe and inform relevant
Authority
Make the area safe. Ventilate the area, seal the chemical
container. Remove the casualty from the area if necessary
Flood the affected area with water to disperse the chemical and
to stop the burning. Do this for at least 20 minutes
Gently remove contaminated clothing while flooding the injury
Take or send casualty to hospital. Note and pass any information
about the chemical to the medical personell.If at work place notify
the local safety officer or emergency services
Chemical burns to the eye
Chemicals result in scarring and even blindness
Signs and symptoms
 intense pain in the eye
Inability to open the injured eye
Redness and swelling round the eye
Copious watering of the eye
Evidence of chemical substances or containers in the immediate
area
Ask the casualty to hold a sterile eye pad over the injured eye. If
some time elapse elapses before the casualty receives medical
attention, bandage the pad loosely in position
Arrange casualty's removal to hospital
Sunburn
Aims
To move the casualty out of the sun
To relieve discomfort and pain
Cover the casualty's skin with light clothing or towel. Help her
into the shade or preferably indoors
Cool her skin by sponging with cold water or by soaking the
affected area in a cold water bath for ten minutes. If there is
extensive blistering or other skin damage, seek medical advice
Give her frequent sips of cold water. If the burns are mild,
calamine or an after-sun preparation may sooth them
EFFECTS OF HEAT AND
COLD
First Aid Priorities
Remove or protect the casualty from excessively hot or cold
surroundings
Restore normal body temperature
Obtain appropriate medical attention
Effects of Extreme Cold
Frost bite
Hypothermia
Effects of Extreme Heat
Heat exhaustion
Heatstroke
Bites and Stings
First Aid Priorities
Make sure that you are in no danger, then remove the casualty
from further danger
Treat visible wounds or painful symptoms. Minimize the risk of
further injury and infection
Obtain medical attention if necessary
Note time and nature of injury. Identify the attacking creature.
This facilitates specific management and anticipation of
complications such as anaphylactic reactions.
Animal Bites
Aims of treatment
To control bleeding
To minimize the risk of infection
To obtain medical attention
For serious wounds
Control bleeding by applying direct pressure and raising the
injured part
Cover the wound with a sterile dressing or a clean pad bandaged
in place
Arrange patient’s removal to hospital
For superficial bites
Wash the wound thoroughly with soap and warm water
Pat the wound dry with clean gauze swabs and cover with an
adhesive dressing or a small sterile dressing
Advice the casualty to see a doctor incase inoculation is needed
Insect Stings
Bee, wasp and hornet stings are painful rather than dangerous
Aims of treatment
To relieve swelling and pain
To remove to hospital if necessary
For a sting in the skin
If the casualty shows signs of anaphylactic shock, call 911
If the sting is in the wound, pluck it out firmly with fine tweezers
Apply a cold compress to relieve pain and minimize swelling.
Advice the casualty to see a doctor if the pain and swelling persist
For a sting in the mouth
Give the casualty ice to suck or cold water to sip to minimize the
swelling
Call for help.

Reassure the casualty

Marine Stings
Aims of treatment
To reassure the casualty
To inactivate stinging cells before they release their venom and
to neutralize any free venom
To relieve pain and discomfort
Reassure the casualty and sit him or her down. Pour copious
amounts of vinegar or sea water over the injury to incapacitate
stinging cells that have not yet released venom
 Alcohol may aggravate the injury and should not be used
Avoid rubbing sand on the affected area
Dust a dry powder over the skin around the affected area to
make any remaining stinging cells stick together. You can use
talcum powder or meat tenderiser.Meat tenderiser contains
papain which inactivates venom
Gently brush off the powder with a clean, non-fluffy pad

If severe call for help

Marine Puncture Wounds
Aims
To inactivate the venom
To obtain medical aid
Put the injured part in water as hot as the casualty can bear for
at least 30 minutes. Top up the water as it cools being careful not
to scald the casualty
Take or send the casualty to hospital where spines remaining in
the skin may have to be removed
Snake Bites
The only poisonous snake native to mainland Britain is the adder
Aims of treatment
To reassure the casualty
To prevent the spread of the venom
To arrange urgent removal of the casualty to hospital
Lay the casualty down. Tell her to keep calm and still
Wash the wound well and pat dry with clean swabs. Call 911.
Do not apply a torniquet,slash the wound with a knife or suck out
the venom
Lightly compress the limb above the wound with a roller
bandage.Immobilise the injury
If she stops breathing, be ready to resuscitate
BANDAGING
Definition of a bandage
A strip of material mainly used to support and immobilize a part
of the body
USES
To support-fractured bone
To immobilize-dislocated shoulder/jaw
To apply pressure-stop bleeding and improve venous blood flow
To secure a dressing in place
To retain splints in place
PRINCIPLES AND PROCEDURES FOR APPLYING BANDAGES
Wash hands and wear gloves when necessary
Assist victim to assume a comfortable position on bed or on
chair and support the body part to be bandaged.
Always stand infront of the part/victim to be bandaged except
when applying a bandage to the head, eye and ear
Be sure the bandage is rolled firm
Make sure the body part to be bandaged is clean and dry
Assess skin before applying bandage for any breakdown
Observe circulation by noting pulse, surface temperature, skin
color and sensation of the body part to be wrapped
Always start bandaging from inner to outer aspect and far to
near end
When bandaging a joint, ensure flexibility of the joint except if
immobilization of joint is required
Cover the area two inches above and two inches below the
affected area
Overlap turns and slightly stretch the bandage
Cover 2/3 of the previous turn
Where possible, leave fingertips or toe tips exposed for
observation(adequacy of circulation)
End the bandage on the outer side of the body. Do not end a
bandage on wound or at the back of the body
TYPES OF BANDAGES
Triangular
Could be used on many parts of the body to support and
immobilize
Crape bandage
Type of woven gauze which has the quality of stretching
Gauze/cotton bandage
Lightly woven cotton material. Frequently used to retain
dressings on wounds on fingers,hands,toes,feet,ears,eyes and
head
Adhesive bandage
Used to retain dressing and also used where application of
pressure to an area is required
METHODS OF APPLYING BANDAGES
Circular
Spiral
Reverse spiral
Figure of eight
CIRCULAR TURN
Used to anchor bandages and to terminate bandages
Apply the end of the bandage to the part of the body to be
bandaged
Encircle the body part a few a few times or as needed, each turn
directly covering the previous turn
Secure the end of the bandage with tapes, metal clips or a safety
pin over an uninjured area
SPIRAL TURN
Bandage cylindrical parts of the body that are fairly uniform in
circumference such as the upper arm or leg
Make two circular turns to begin the bandage
Continue spiral turns at about a 30 degree angle, each turn
overlapping the preceding one by 2/3 the width of the bandage
Terminate the bandage with two circular turns and secure the
end as described for circular turns
SPIRAL REVERSE TURN
Begin with two circular turns and bring the bandage upward at
about a 30 degree angle
Place the thumb of the free hand on the upper edge of the
bandage
The thumb will hold the bandage while it is folded on itself
Unroll the bandage about 4-6 and turn the hand so that the
bandage is folded down
Terminate the bandage with two circular turns and secure the
end as described for circular turns
FIGURE EIGHT TURN
Applied on ankle, knee and joint
Begin the bandage with two circular turns
Carry the bandage above the joint, around it and then below it.
Make a figure 8.Continue above and below the joint, overlapping
the previous turn by 2/3 the width of the bandage
Terminate the bandage above the joint with two circular turns
and secure the end appropriately