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  2. CHAPTER ONE INTRODUCTION TO FIRST AID AND ACCIDENT PREVENTION Learning Objectives  At the end of this chapter the student will be able to:-  Define first aid  Identify reasons for first aid  List value of first aid  Identify general directions for giving first aid 2
  3. Definition  First aid :- is the immediate care given to a person who has been injured or suddenly taken ill.  It includes home care if medical assistance is not available or delayed.  It also includes well selected words of encouragement, evidence of willingness to help and demonstration competence (American red cross,1998) 3
  4. Defn con…  First Aid is care given to an injured/suddenly ill person to stabilize and keep him/her safe until he/she can receive professional medical attention. 4
  5. Reasons for First Aid giving  To sustain (preserve) life. E.g. • Mouth to mouth respiration when breathing has stopped. • Recovery position • Control bleeding & shock  To prevent worsening of the problem (complication). E.g.  Immobilizing the fractured bone  Cover wounds  Handle gently & carefully at all times 5
  6. Reasons for First Aid giving cont…  To promote healing and recovery. e.g. • Reassure the patient • Relief pain • Place the casualty in correct & comfortable position • Protect from cold • Arrange pt. for transfer 6
  7. VALUES OF FIRST AID TRAINING  The need for first aid training is greater than ever because of……. 1. Population growth 2. Increased Use of technological products;  such as mechanical and electrical appliances  Thus, there is an ever growing demand for first aid training (for personal use as well as for institution).  In general first aid is aimed:-  to help for others  to know what to do during disaster &  to help self 7
  8. 1. Resourceful: - use to the best advantage, who ever and what ever is at hand, to prevent further damage. 2. Tactful: - without the unnecessary questions, learn the symptoms and history of the case, and secure the confidence of the causality and the bystanders in the treatment of the causality. 3. Dexterous:- handle a causality without causing unnecessary pain and use appliances efficiently, effectively and quickly. CHARACTERISTIC OF A FIRST AIDER 8
  9. 4. Explicit:- give clear instructions to the causality and for the bystanders how best to assist him. 5. Persevering: - able to continue his efforts, though not at first successful, until relieved by a superior medical authority or death of the causality is known. 6. Discriminating:- decide which of several causalities and injuries should be treated first. 7. Sympathetic:- give real comfort and encouragement to the suffering, first principles of humanity. X-TICS OF FIRST AIDER CON’T… 9
  10. • Assessing the situation • Identify the problem • Giving immediate and adequate treatment • Referring of the casualty to higher health institutions(arrangement for transport) • Prevent cross infection THE GENERAL DIRECTIONS TO GIVE FIRST AID AND RESPONSIBILITY OF FIRST AIDER IN THE MANAGEMENT OF CAUSALITY 10
  11. ASSESSMENT  Be calm, take charge and be confident.  Talk, listen and reassure the conscious casualty.  Check safety of casualty and of yourself and check for breathing, bleeding and level of consciousness.  Get others to help. 11
  12. Assessment cont….  The first rule of first aid and the primary concern is: Safety  ASSES THE SITUATION o Are there any risks to you or the casualty? o If yes put on your safety first and deal any danger when it is safe. o If there is no risk, assess the casualty responsiveness. 12
  13.  R is for Responsiveness  Is the victim conscious?  Touch their shoulder, ask if they are alright.  Ask if they need help. If they say no (I don’t need), then proceed no further  If they say yes (I need), or no response, then proceed to A  A is for Activate, emergency medical service or dial for ambulance.  Shout for help, open the airway, check for breathing. RAP ABCH 13
  14. 1. Your name (who) 2. The emergency (what) 3. The location of the emergency (where) 4. Condition of the victim  What are the four things you need to remember when making a call? • Stay on the line with the operator until help arrives. HOW TO USE THE CALL SYSTEM 14
  15.  Check the victim for responsiveness. If they do not respond or if they tell you that they need help, then contact EMS. When should EMS be called? 15
  16. When To Move An Injured Person  P is for Position  Only re-position the victim if the victim is in further danger in their present location.  And/or there does not seem to be spinal injury. (additional care requires when moving them) 16
  17. 17  If there are suspected spinal injuries, do not move the victim (except when the victim is in a life threatening situation). Explain when an injured person should and should not be moved?
  18. “ABCH ”system Four Steps of Victim Assessment  A is for airway  Use your finger to sweep the mouth to remove any seen object.  If this fails, then perform the abdominal thrusts. • Check to see if the airway is blocked. 18
  19.  B is for breathing  Look, listen and feel breathing by watching the chest and placing your cheek a few inches above the mouth of the victim to sense any movement of air.  If the victim is breathing, place in recovery position and deal for ambulance  If the victim is not breathing, they may need their head repositioned.  If they are still not breathing they need rescue breathing(#2), do not give unless you are trained, instead, find other trained person. 19
  20. 20  C is for circulation  If there is no a pulse, then this person needs CPR.  The best place to check for a pulse is the carotid artery along the side of the neck along the windpipe.  If you are not trained in CPR, then find someone who is. H is for Hemorrhaging  If the victim is bleeding, then provide the necessary care.
  21. Note:  Bleeding and respiratory problems are the top urgent emergency conditions that need fast decision and action.  Perform secondary survey. • Examine the victim for other injuries and wait for medical attention to arrive. 21
  22. PROBLEM IDENTIFICATION (DIAGNOSIS)  The history of the incident must be taken in to consideration.  An examination made to determine the signs and symptoms and level of consciousness. 22
  23. HISTORY  The story of how the accident happened or the illness began can be obtained from:-  The causality  A witness or a bystander(s) whether he/she saw the happenings  Points to be considered during history taking:  Any history of illness: E.g. Epilepsy, DM,..  For history of ingested material E.g. Drug, Alcohol, type of food or fluid. 23
  24. CON’T.… Symptoms  Sensations and feelings that are described by the casualty E.g. I feel pain, I feel cold Signs  Variations from normal ascertained by the first aider. E.g. blueness (cyanosis) of face, lips, fingers and toes.  There may be evidence of poisoning E.g. medications, alcoholic smell, bottles and other containers beside the victims 24
  25. CONT.…  Level of consciousness  Recognition of any change of level of consciousness is important.  Full consciousness:- the casualty is able to speak and answer questions normally.  Drowsiness:- the casualty is easily aroused but lapses in to unconscious state. 25
  26. CON’T.…  Stupor:- the casualty can be roused with difficulty, aware of painful stimuli. E.g. pin prick, but not of other external elements like being spoken to.  Coma:- cannot be roused by any stimuli. In general make full use of your senses to obtain maximum information (Look, smell, listen and touch). 26
  27. Action  If the cause of the condition is still active, remove the cause.  Essential Points (actions) to be considered while giving first aid treatment:- To sustain (preserve) life: o Emergency resuscitation o Control bleeding and shock 27
  28.  To promote healing and recovery  Place the casualty in correct and comfortable position  Reassure  Give any other treatment needed  Relieve pain To prevent worsening of problem (complication) • Cover wounds • Immobilize fractures • Handle gently and carefully at all times • Move as little as possible • Protect from cold 28
  29. CON’T…. Finally  Convey the causality with out delay to home or to hospital (Transport the victim).  A brief written report should accompany the causality.  A tactful message should be sent to the family if necessary, to tell the family for:-  What was happened  Where he/she has been taken, unless it has been done by the other. (police,…) 29
  30. Chapter Two Respiratory Emergencies and Artificial Respiration Learning objectives  At the end of this chapter , the student will be able to:-  Define respiratory emergencies and artificial respiration.  Identify causes of respiratory failure  Prevent respiratory accident  Give artificial respiration and manage respiratory accident. 30
  31. Definition Respiratory emergency  Is one in which normal breathing stops or in which breathing is reduced so that oxygen intake is insufficient to support life. Artificial respiration  Is a procedure for making air to flow into and out of a person’s lungs when his natural breathing is inadequate or ceases. 31
  32. THE BREATHING PROCESS Natural breathing  Is accomplished by increasing & decreasing the capacity of the chest & the lungs.  Has 3 phases: Inspiration Expiration Pause RR=16-18/min for adult RR=20-30/min for children & infant 32
  34. Causes of Respiratory Failure 1. Anatomical Obstruction • The most common cause of respiratory emergency is interference with breathing caused by the drooping of the tongue back and obstructing the throat. • Other causes of obstruction that constrict the air passages are:  Asthma  Diphtheria  Laryngeal spasm  Swelling after burns of the face  Swallowing of corrosive poisons  Direct injury caused by a blow 34
  35. 2. Mechanical Obstruction • Solid foreign objects lodging in the respiratory passage. e.g. choking of food • Accumulation of fluids in the back of the throat. e.g. mucous, blood or saliva • Aspiration (Inhalation of any solid or liquid substance) 35
  36. CON’T… 3. Air Depleted of Oxygen(Containing Toxic Gases)  Asphyxia  Is a condition in which there is a lack of oxygen in the blood and the tissue do not receive an adequate supply of oxygen.  It may occur due to:  Decreased oxygen in the air or  Increased carbon monoxide (CO) or other toxic gases e.g., mining area, sewer 36
  37. 4. Additional Causes of Respiratory Failure  Drowning  Circulatory collapse (shock)  Heart disease  Strangulation(Choking)  Lung disease e.g. pneumonia  Poisoning by alcohol, barbiturate, codeine  Electrical shock  Compression of the chest e.g. accident 37
  38.  Sings and symptoms of respiratory failure  Unable to breath  Loss of consciousness  General pallor (paleness)  Cyanosis  Difficult in breathing  May be no visible breathing 38
  39. ARTIFICIAL RESPIRATION AND MANAGEMENT OF RESPIRATORY ACCIDENTS Objectives:-  To maintain an open air way through the mouth and nose  To restore breathing by maintaining an alternating increase and decrease in the expansion of the chest 39
  40. GENERAL INFORMATION  The average person may die with in 4-6 minutes if his/her oxygen supply is cut off.  Recovery is usually rapid except incase of carbon monoxide poisoning, over dosage of drugs or electrical shock.  In such cases, it is often necessary to continue artificial respiration for a long time.  When a victim revives he/she should be treated for shock. 40
  41. CON’T …  Artificial respiration should always be continued until:-  The victim begins to breath by himself  He/she is pronounced dead by a doctor or he/she is dead beyond any doubt.  A medical care is necessary during the recovery period. 41
  42.  Steps in mouth- to- mouth or mouth- to- nose respiration 1. Check for safety first, if its safe then 2. Determine consciousness by tapping the victim on shoulder and asking loudly ''Are you OK''? If not responsive call for EMS. Then 3. Open the Air way Tilt the victim’s head back so that his/her chin is pointing upward.  This can be applied in two way,  i.e. head tilt and neck lift and head tilt- chin lift MOUTH-TO-MOUTH (NOSE) METHOD OR ” KISS OF LIFE” (RESCUE BREATHING) 42
  44. STEPS CON’T… 4. Check for Breathing  Place your cheek and ear close to the victim’s mouth and nose:  Listen and feel for air to be exhaled  Look at the victim’s chest to see if it rises and falls; for about 5 seconds. 5. If there is no breathing  Pinch the victim’s nostrils to shut, with the thumb and index finger of your hand 44
  45. con’t… 6. Blow air in to the victim’s mouth  You Should:- • Open your mouth wide &Take a deep breath. • Seal your mouth tightly around the victim’s mouth and with your mouth forming a wide open circle and blow into the victim’s mouth  Initially give two(2) quick effective full breaths each lasts 2 seconds without allowing the lungs to fully deflate (empty) between each breath. 45
  48. CON’T…. 7. Maintain the head tilt and check again for breathing by looking, listening and feeling for exhalation of air and check the pulse (circulation) for at least 5 seconds 8. If no pulse and no breath (cardiac arrest) do cardiopulmonary resuscitation (CPR). 9. If there is pulse and no breath (respiratory arrest), provide rescue breathing. 48
  49. RESCUE BREATHING  Provide at least one breath every 5 seconds (12 per minute) for about one minute.  Then re-check for signs of circulation  If the person is still not breathing, but has signs of circulation (pulse), then continue rescue breathing. Continue rescue breathing until:  EMS arrives  The person began breath/vomit  Losses signs of circulation  The person pronounced dead by a doctor or he/she is dead beyond any doubt. 49
  50. SIGN OF CIRCULATION  Effective breathing  Coughing  Appropriate color of the skin  Movement of the victim  Presence of pulse (carotid artery) 50
  51. TIPS TO CONSIDER  Open the airway with a jaw thrust.  If a head or spinal injury is suspected, lift jaw upward using index fingers.  Be sure not to move head or neck.  To prevent disease transmission, use protective equipment (if available).  If the person is breathing, place them in recovery position and monitor the breathing and keep the air way open.  If the person begins to vomit, place them in recovery position to prevent aspiration. 51
  52. Note:  Mouth-to-mouth (nose) resuscitation are administered for infants and children as described above, except that the backward head tilt should not be as extensive as that of adult.  Both the mouth and nose of the infant or child should be sealed off by your mouth.  Blow into the infant’s mouth and nose once every 3 seconds (about 20 times per minutes).  But in the case of children blow once every 4 seconds (about 15 times per minute). 52
  53. CARDIAC ARREST  Definition: This is a serious condition in which the heart suddenly stops beating.  Causes  Extensive coronary obstruction  Heart failure  Poisoning 53
  54. WHAT DOES CPR STAND FOR? Cardio Pulmonary Resuscitation  C = Cardio (heart)  P = Pulmonary (lungs)  R = Resuscitation (recover)  External cardiac message(CPR) is a combination of:-  Artificial respiration and  Manual artificial circulation.  The aim of heart message is to press the heart between the breast bone (sternum) and the backbone (spine) thus literally squeezing blood out of it. 54
  56. ADULT; CPR 56 A. Use the head tilt, chin lift method to open airway. B. Look, listen and feel for breathing. C. If the victim is not breathing normally, pinch the nose and cover their mouth with yours. Give 2 full breaths until you see the chest rise. Each breath should last about 2 seconds. D. With each breath the chest should lower and rise so you know that air is getting in.
  57. CPR Con’t… E. After giving two breaths, immediately begin chest compressions. G. Use the nipple line (“armpit over”) or 2 finger above the bottom of the sternum to determine the proper place to do chest compressions.  Lay the patient on a firm flat surface.  Kneel close to his side, at right angles to him and alongside his chest. H. Push down on the chest, 30 times and give 2 slow breathing. (ratio 30:2) J. Pump at the rate of 100 compressions/1 minute 57
  58. CPR CON’T…  Re-check the carotid pulse to see if the heart beat has re-started.  If the person still not breathing and has no sign of blood circulation, continue CPR.  Continue CPR until:  EMS arrive and take over  Signs of circulation return  If you see chest movement, put the victim in the side position incase they vomit. 58
  59. CPR CON’T… When giving compression o Keep your arms at 90 degree angle to the body o Use pressure from your shoulders. o Keep elbows locked o Compress sternum 1.5-2 inches o Keep fingers off the chest o Do, 15 compressions and 2 breath at the rate of 100 compressions per minute for adult. 59
  60.  In children enough pressure is obtained by using the heel of only one hand at the rate of 80 to 90 per minute and  For babies, use only two fingers at the rate of 100 per minute  The ratio of lung inflation and heart compression  (2:15 by one first aider)  (1: 5 by two first aider) 60
  61. 61
  62. RECOVERY POSITION What is the Recovery Position?  First Aid procedure to use if the person is unconscious, breathing and have a pulse.  It is a safe position to put them in while you are waiting for the EMS to arrive  Allows them to breathe easily and prevents them from choking on their tongue or any vomit. 62
  63. DROWNING Definition  It is a type of asphyxia related to either aspiration of fluid or obstruction of the airway caused by spasm of the larynx while the victim is in the water.  It is kinds of water accidents  It occurs in swimming, diving, boating and hand dug well, bathtubs and washtubs. 63
  64. SIGNS OF DROWNING Drowning person may be seen either struggling in water, making ineffective movements Floating face down on the surface of the water or Lying motionless under water. 64
  65. FIRST AID MEASURE FOR DROWNING  Keep the head lower than the rest of his body to reduce the risk of inhaling water.  Put him in recovery position. 65
  66. FIRST AID MEASURE FOR DROWNING CONT…  Begin artificial respiration  Keep the victim from becoming chilled and transport him to medical care, as rapidly as possible.  Lay casualty  Do not allow a person who survives a near drowning to walk 66
  67. PREVENTION OF ACCIDENTAL DROWNING Supervision during swimming Protection of the swimming areas & the swimmer Training of the swimming & live savers 67
  68. OBSTRUCTED AIRWAY (CHOKING)  A small piece of food (foreign body), may be inhaled in to the wind pipe when eating.  Fully obstructed airway:- victim cannot make any sounds  The most common cause of an airway obstruction in a conscious person is food or a foreign object.  The most common cause of an airway obstruction in an unconscious person is the tongue. 68
  69. CON’T…  Young children especially are prone to choking.  A child may choke on food, or may put small objects into their mouth and cause a blockage of the airway.  If the blockage of the airway is mild, the casualty should be able to clear it.  If it is severe they will be unable to speak, cough, or breathe, and will eventually lose consciousness. 69
  70. CHOKING • Ask the victim: “Are you choking?” • If the victim nods yes, ask them “Would you like my help?” 70
  71. TREATMENT FOR ADULT  Your aims are to remove the obstruction and to arrange urgent removal to hospital if necessary.  If the obstruction is mild:  Encourage them to continue coughing  Remove any obvious obstruction from the mouth.  If the obstruction is severe:  Give up to five back blows  Check the mouth and remove any obvious obstruction.  If not…do….. 71
  72. ADULT CHOKING; CONSCIOUS THE HEIMLICH MANEUVER  Position yourself by placing one of your legs between the legs of your victim.  Give 5 abdominal thrusts and continue as needed.  For a pregnant or obese person, perform chest thrusts.  Repeat thrusts until:-  The object is expelled and the obstruction is relieved OR  The victim becomes unresponsive/unconscious. 72
  73. CON’T…  Give up to five abdominal thrusts  Check the mouth and remove any obvious obstruction.  If the obstruction does not clear after three cycles of back blows and abdominal thrusts  Dial for an ambulance  Continue until help arrives. 73
  74. ADULT CHOKING; UNCONSCIOUS A. Call EMS B. Open the airway. C. Perform a finger sweep to remove possible foreign object in mouth. D. Give 2 breaths. If air does not go in, reposition the head and give 2 more breaths. F. With the victim lying on the floor, give 5 abdominal thrusts G. Repeat the steps until victim is no longer choking or continue the steps of CPR as needed. 74
  75. ADULT UNCONSCIOUS CHOKING  Do not push down on the Xiphoid process! 75
  76. INFANT CHOKING; CONSCIOUS A. Check for breathing difficulty, ineffective cough, weak cry. B. Confirm signs of severe or complete airway obstruction. C. Give 5 back blows with your open hand and 5 chest thrusts, using your 3rd and 4th fingers. D. Repeat back blows and chest thrusts until object is expelled OR the victim becomes unresponsive. 76
  78. INFANT CHOKING; UNCONSCIOUS A. Call EMS B. Open the airway and if you see the object, remove it C. Try to give 2 breaths.  If the chest does not rise, re-open the airway and try to give 2 more breaths. D. If the air still does not go in they are choking.  Give 5 back blows, 5 chest thrusts and 2 breaths.  Re-open airway and give 2 more breaths. E. Repeat above steps until breathing is effective.  Perform CPR if needed. F. If the rescuer is alone and the airway obstruction is not relieved after 1 minute, call EMS. 78
  79. Con’t…. • Treat a conscious or unconscious child (1-8 yrs. old) with an airway obstruction  Like a conscious or unconscious adult with an airway obstruction. 79
  80. Con’t….  In a two person rescue situation, rescuers should rotate between compressions and breathing every 2 minutes to avoid fatigue.  Ideally, the rescuers should switch positions within 5 seconds so the victim is not left unattended for too long. 80
  81. Con’t…  When performing CPR, the victim must be placed on a firm, flat surface, in the “head-tilt, chin-lift” position  The universal sign for choking is two hands placed at the throat  If you give a victim 2 full breaths and they don’t seem to go in, you should re-tilt the head (head tilt, chin lift) and try again.  If the air still does not go in your victim may be choking. 81
  82. MECHANICAL SUFFOCATION (STRANGULATION)  If pressure is exerted on the outside of the neck, the air way is squeezed and the flow of air to the lung is cut off.  The main causes of such pressure are: • Hanging- suspension of the body by rope around the neck or throat. • Strangulation- constriction or squeezing around the neck or throat. 82
  83. CON’T… Sometimes, hanging or strangulation may occur accidentally. For example:  By ties or becoming caught in machinery. Hanging may cause a broken neck; for this reason, a casualty in this situation must be handled extremely carefully. 83
  84. CON’T…  Recognition (signs)  A constricting article around the neck  Marks around the casualty’s neck  Rapid, difficult breathing  Impaired consciousness  Grey-blue skin (cyanosis)  Congestion of the face, with prominent veins and  Possibly, tiny red spots on the face or on the whites of the eyes. 84
  85. CON’T…  Caution  Do not move the casualty unnecessarily, incase of spinal injury.  Do not destroy or interfere with any material that has been constricting the neck, such as knotted rope; police may need it as evidence. 85
  86. First aid aim and interventions  The aims are: • To restore adequate breathing. • To arrange urgent removal to the hospital  First aid measures are:  Quickly remove any constriction from around the casualty’s neck.  Support the body while you do so if it is still hanging.  Be aware that the body may be very heavy. 86
  87. CON’T…  Lay the casualty on the ground.  Open the airway and check breathing.  If he/she is not breathing  Be prepared to give rescue breaths and chest compressions if necessary.  If he/she is breathing, place her in the recovery position. 87
  88. THANK YOU!!! 88