ADDIS ABABA UNIVERSITY
SCHOOL OF ALLIED HEALTH SCIENCE
DEPARTMENT OF NURSING AND MIDWIFERY
FIRST AID AND ACCIDENT PREVENTION
For Pharmacy Students
By: Fikrtemariam Abebe(Bsc, Msc)
1

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

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

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

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

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

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

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

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

• 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

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

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

 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

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

 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

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
 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?

“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

 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
 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.

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

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

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

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

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

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

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

 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

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

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

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

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

BREATHING PROCESS CONT…
33

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

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

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

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

 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

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

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

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

 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

STEPS OF MOUTH TO MOUTH RESPIRATION
(STEPS OF OPENING AIR WAY)
43

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

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

MOUTH- TO- MOUTH RESPIRATION
46

MOUTH-TO-MOUTH & NOSE VENTILATION CHILD
RESCUE BREATHS FOR AN INFANT
47

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

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

SIGN OF CIRCULATION
 Effective breathing
 Coughing
 Appropriate color of the skin
 Movement of the victim
 Presence of pulse (carotid artery)
50

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

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

CARDIAC ARREST
 Definition: This is a serious condition in which the
heart suddenly stops beating.
 Causes
 Extensive coronary obstruction
 Heart failure
 Poisoning
53

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

CPR STEPS AND PROCEDURES
55

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.

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

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

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

 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

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

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

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

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

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

PREVENTION OF ACCIDENTAL DROWNING
Supervision during swimming
Protection of the swimming areas &
the swimmer
Training of the swimming & live savers
67

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

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

CHOKING
• Ask the victim: “Are you
choking?”
• If the victim nods yes, ask
them “Would you like my
help?”
70

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

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

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

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

ADULT UNCONSCIOUS CHOKING
 Do not push down on the Xiphoid process!
75

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

BACK SLAPS
CHEST THRUSTS
FINGER SWEEP
77

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

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

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

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

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

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

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

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

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

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

THANK YOU!!!
88