chapter 1.pdf

For psychiatric nursing students
By. Birhanu .D
1
1/30/2020

1.What is first aid ?
2. When and where the victim needs
first aid?
2. Who is first aider ?
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 Objectives
 Define first aid
 Explain the aim and values of first aid
 Understand general directions of first aid

FIRST AID:
 Is the immediate care given to a person, who has
been injured or has been suddenly taken ill.
 Is the initial/temporary assistance/treatment given to
the casualty.
 It is an emergency treatment before professional help
arrives.
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 To be a first aider:
 Good reliability, disposition and communication skills.
 An aptitude and ability to absorb new skills and
knowledge.
 An ability to cope with stressful and physically
demanding emergency procedures.
 Normal duties in the workplace that can be left, to
respond immediately and rapidly to an emergency
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AIMS OF FIRST AID:
To sustain (preserve) life
E.g. mouth to mouth respiration when breathing has
stopped
To prevent complications
E.g. Immobilizing the fractured bone
To promote healing & recovery
E.g., reassure the patient, relief pain
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VALUES OF FIRST AID TRAINING
 Help for others;
 Self help;
 Preparation for disaster.
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GENERAL DIRECTIONS FOR GIVING FIRST AID
 Assessment of the situation
 Remove the victim/danger from the area (scene size up)
 Identify the problem/the victim may have more than 1
problem
 Give immediate & adequate treatment/give priority.
 Arrange immediate transportation for medical care for life
threatening conditions.
 Prevent cross contamination.
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 Do first things first quickly, quietly and without fuss
or panic.
 Give artificial respiration if breathing has stopped-
every second counts.
 Stop any bleeding.
 Guard against or treat for shock by moving the
casualty as little as possible and handling him gently.
 Do not attempt too much-do the minimum that is
essential to save life and prevent the condition from
worsening.
 Reassure the casualty and those around and so help
to lessen anxiety.
 Do not allow people to crows round as fresh air is
essential.
 Do not remove clothes unnecessarily.
 Arrange for the removal of the casualty to the care of
a Doctor or hospitals soon as possible

Primary survey:
 Danger ;
 Response ;
 Airway and
 Breathing.
 Bleeding;
 Broken bones;
 Any other injuries;
 Recovery position.
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Recovery position:
 The tongue will not fall backwards and
 Vomit will run out of the mouth.
- Hence it prevents air way obstruction by these two
actions.
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 Remove the casualty's glasses and straighten both legs.
 Move the arm nearest you outwards, elbow bent with palm
uppermost.
 Bring the far arm across the chest, and hold the back of
that hand against the cheek.
 With your other hand, grasp the far leg just above the
knee, and pull it up, keeping the foot on the ground.
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 Keeping the casualty's hand pressed against their cheek, pull
on the leg to roll them towards you, onto their side.
 Adjust the upper leg so that the hip and knee are bent at right
angles and tilt the head back to keep the airway open.
 Call an ambulance.
 Check breathing regularly/if not do respond.
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 The history of the incident must be taken in to consideration and
an examination made to determine the signs and symptoms and
level of consciousness.
 History : The story of how the accident happened or the illness
began can be obtained from:
 The causality ( e.g. I slipped and fall down)
 A witness or a bystander(s) whether he/she saw the happenings.
 Points to be considered during history taking:
- Any history of illness: Eg. Epilepsy, Diabetes mellitus,
- For history of ingested material E.g. Drug, Alcohol, type of food
or fluid
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 Symptoms: Sensations and feelings that are described by the
casualty.
- E.g.
• I feel pain
• I feel cold
• my arm is numb
 Signs: variations from normal ascertained by the first- aider.
E.g. - Pallor of the inner surface of the eyelids or nail beds;
- 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.
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 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
 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).
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 Action:
- If the cause of the condition is still active, remove the
cause.
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The respiratory system consists of:
1. Upper respiratory system-
 Nose, sinus, pharynx, tonsil, larynx & trachea.
2. Lower respiratory system
 Bronchi, bronchioles, lung and alveoli.
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By Birhanu D. E.

The Breathing process
 Inhalation phase
 The muscles of the chest lift the ribs, expanding the chest.
 The diaphragm contracts and descends to ward the abdomen.
Chest cavity = inhalation
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By Birhanu D. E.

 Exhalation Phase
 The muscle relaxes, allowing the ribs & diaphragm to
resume their former positions.
 The chest cavity becomes smaller and air flows out
wards
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By Birhanu D. E.

Process of breathing:
 Air is drawn in through the mouth and nose, where it is
warmed, filtered and moistened.
 Air then travels through the throat and past the
epiglottis (the protective flap of skin that folds down
to protect the airway when we swallow).
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By Birhanu D. E.

 Air now enters the larynx (more commonly known
as the voice box or ‘Adam's apple’ It passes between
the vocal cords in the larynx and down into the
trachea.
 The trachea is protected by rings of cartilage that
surround it to prevent kinking.
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By Birhanu D. E.

 The trachea divides into two 'bronchi‘ that supply air
to each lung.
 The bronchi then divide into smaller air passages
called 'bronchioles'.
 At the end of the bronchioles are microscopic air sacks
called 'alveoli'
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By Birhanu D. E.

 The walls of the alveoli are only one cell in thickness, so
oxygen can pass through into the blood, which is carried in
capillaries that surround the alveoli.
 Carbon dioxide (a waste gas from the body) passes from the
blood into the alveoli, and is then breathed out.
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By Birhanu D. E.

 Each lung is surrounded by a two layered membrane called the
'pleura'.
 Between the two layers of the pleura is a thin layer of 'serous'
fluid, for lubrication & which enables the chest walls to move
freely.
 The thoracic cavity is protected by the ribs, which curl around
from the spine and connect to the sternum (breast bone) at the
front of the body.
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By Birhanu D. E.

Respiratory Emergency:
 Is one in which normal breathing stops or in which breathing is so
reduced that oxygen in taken is insufficient to support life.
Artificial Respiration:
 Is a procedure for making air to flow in to and out of a lung when
the natural breathing is inadequate or ceases.
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By Birhanu D. E.

 The trachea, bronchi, and lungs are contained in the 'thoracic
cavity' in the chest.
 To draw air down into the thoracic cavity, the diaphragm flattens
and the chest walls move out.
 This increases the size of the thoracic cavity, creating a negative
pressure which draws air in.
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By Birhanu D. E.

Causes of Respiratory Failure
A. Anatomic Obstruction
 Obstruction by tongue (most common cause).
 Other causes that constrict the air passages are:
 Asthma, croup, Diphtheria, Laryngeal spasm
 Swelling after burns of the face
 Direct injury caused by blow
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By Birhanu D. E.

B. Mechanical Obstruction
 Solid foreign objects
 Accumulation of fluid in the back of the throat
 Aspiration (inhalation of vomits)
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By Birhanu D. E.

C. Air depleted of Oxygen or containing toxic gases.
 Asphyxia may occur due to decreased oxygen or increased CO
or other toxic gases (mining area)
 Explosion hazard - Combustible gases that accumulate in
confined spaces.
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By Birhanu D. E.

 Drowning
 Circulatory collapse
(shock)
 Heart disease
 Strangulation
 Lung disease e.g.
pneumonia
 Poisoning by alcohol,
barbiturate, codeine etc.
 Electrical shock
 Compression of the
chest e.g. accident

Artificial Respiration and Mgt of Respiratory Accidents
 Objective:
 To maintain an open air way
 To restore breathing/life.
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By Birhanu D. E.

Artificial respiration (Breathing for the patient) should always
be continued until:
 The victim begins to breathe for him self
 Is pronounced dead by a doctor or
 He is dead beyond any doubt.
Videos
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By Birhanu D. E.

Mouth to Mouth (Mouth to Nose) Method:
 Steps in mouth to mouth (mouth to mouth and Nose) Respiration:
 Determine consciousness(ask ''Are you OK?'')
 Tilt the victim's head back & chin lift.
 Place your cheek and ear close to the victim's mouth & nose.
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By Birhanu D. E.

 listen air to be exhaled for about at 10 seconds.
 Feel the carotid pulse with your fingers (avoid simultanious
assessment).
 Look at the victim's chest to see if it rises and falls.
 Look, listen & feel are done simultaneously.
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37 By Birhanu D. E.

If no breathing:
 Pinch the victim's nostril shut with the thumb and index finger of
your hand.
 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 below in to the victim's
mouth.
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By Birhanu D. E.

 Initially give four quick full breaths with out allowing the lungs
to fully deflate between each breath.
 Maintain the head tilt and again look, listen, feel for exhalation
of air & check the pulse for at least 5 but not greater than 7
seconds.
 If no pulse and breath - Do CPR
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By Birhanu D. E.

If there is pulse & no breath:
Provides at least 1 breathe every 5 seconds or 12 per minute for
adults.
 Watch the victim's chest to see when it rises.
Stop blowing when the victim's chest is expanded and check for
exhalation.
Watch chest to see that it falls. Repeat the blowing/puff cycle.
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By Birhanu D. E.

Obstructed Airway - Unconscious Victim
 If you are not getting air exchange, reposition the head and again
attempt to ventilate,
 If still no air exchange immediately turn the victim on his side to
wards you resting his chest against your knees and administer four
sharp blows between the shoulder blades.
 Place the victim on back
 Open the victims air way
 If the procedure is not effective repeat the sequence
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By Birhanu D. E.

Obstructed Airway - Conscious Victim
 Choking
 A small piece of food or a bone (foreign body) may be inhaled in
to the wind pipe when eating.
 Most people on such occasions are able to cough it up at once.
 Sometimes however, help is needed.
 Clenching of the neck is the universal sign of chocking
Don't try hook the foreign body out with your fingers for conscious rescue.
video
 First Aid Training Video - How To Perform ABC's of CPR
(Adult-23:50)
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By Birhanu D. E.

 Lay infant on your arm in head down
position
 Give 5 blows to the infants back with heel
of hand
 If obstruction persists turn over and give 5
chest thrusts with 2 fingers, 1 finger
breadth below nipple level in midline
 If obstruction persists check infants mouth
for any object which can be easily removed
 If necessary repeat sequence with back
slaps again

 History of aspiration of foreign body plus
increasing respiratory distress requires
immediate management
 Techniques are based on forced expiration
rather than mechanical means
 Techniques such as blind finger sweep of
mouth should be avoided in children as they
may result in trauma and are likely to push
object further down into airway

 Tell the patient to lean over the back of the chair
holding on to the seat and then bang him sharply
three or four times between his shoulder blades.
 Whichever method you use, the foreign body
should be coughed out.
 When a very soft food, drink, blood or vomitus
has been breathed in, place the patient in the
recovery position and clear his mouth off any
food or vomitus with your finger (wrapped in a
soft clean cloth).
 If the breathing has stopped begin mouth-to –
mouth respiration.

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By Birhanu D. E. 53
 Mouth- to- mouth and -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 in to 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).
 The amount of air is determined by the size of the victim.

External Cardiac Massage (CPR)
 Is an emergency procedure consisting of external cardiac
massage and artificial respiration.
Purpose:
 To squeeze blood manually out of the heart for victim’s with
cardiac arrest.
 To provide oxygenated blood to the brain and heart.
 To restore blood circulation
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By Birhanu D. E.

Indications:
 Respiratory Arrest: Respiratory arrest refers to the absence of
breathing.
 Cardiac Arrest: When the heart stops, there is no pulse.
 The CPR Must begins within 4-6 minutes of collapse b/c brain is
very sensitive to O2.
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By Birhanu D. E.

Relative Contraindications for CPR:
 Ribs fractured
 Burn of sternum( full thickness )
Video?
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By Birhanu D. E.

CPR procedure:
 Assessment of the Situation.
 Check the Victim for unresponsiveness.
 Call for Help
 Positioning the victim.
 Airway-‘Head tilt- chin lift’, Jaw thrust - remove foreign body to
open airway.
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By Birhanu D. E.

Jaw thrust
 If the patient is breathing but the tongue is starting to
obstruct the airway (usually makes snoring type noises) the
jaw thrust technique can be used to keep the airway open:
 Kneel above the head of the patient, knees apart to give you
balance.
 With your elbows resting on your legs (or the floor) for
support, hold the patient's head with your hands to keep
their head and neck in line with the body.
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By Birhanu D. E.

 Place your middle and index fingers under the jaw line of the
patient (under their ears).
 Keeping the head still, lift the jaw upwards with your fingers
 This gently lifts the tongue from the back of the throat
 DO NOT attempt the jaw thrust technique during CPR - tilt
the head to open the airway instead
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By Birhanu D. E.

 Breathing - look, listen & feel for 10 second.
- Give 2 breaths
- Watch for chest rise and allow time for exhalation
(3-3.5 sec).
 Circulation: if there is no pulse & breathing is not initiated,
give other 2 breath & start CPR => cardiac arrest
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By Birhanu D. E.

CPR:
 Place the heel of one hand in the centre of the
casualty's chest,
 Then place the heel of your other hand on top and
interlock your fingers.
 Position yourself vertically above the casualty's chest
with your arms straight and shoulders above your hands,
 Depress the chest 4 to 5 cm (1.5-2 inch)
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 Ensure that pressure is not applied over the casualty's ribs, the
upper abdomen or the bottom end of the breastbone.
 Compression & release should take an equal amount of time.
 Continue repeating cycles of 30 chest compressions and 2
rescue breaths 5 times in 2 minutes.
 After 5 cycles of compressions and 6 cycle of ventilations
reassess the victim.
 After all apply AED (if available)
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By Birhanu D. E.

 For a child over 1 year, use one or two hands to compress
the chest by about one third of its depth.
 For a baby under 1 year, use two fingers to compress the
chest by about one third of its depth.
 But the number of breath & chest compression is the same
with the adults
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By Birhanu D. E.

 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:
The aim of first aid is to drain out water (or other
matter) from lungs and to give artificial respiration.
 Act quickly. Remove seaweeds and mud from the
nose and throat.
 Start artificial ventilation immediately.
 This is possible even when the casualty is in
water.

 Turn the victim face down with head to one side and arms
stretched beyond his head.
 Infants or children could be help upside down for a short
period.
 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.
 Keep the body warm, cover with blankets.
 When victim becomes conscious, give hot drinks like
coffee or tea.
 Do not allow him to sit up.
 After doing the above, remove quickly to hospital as a
stretcher case.

 CO is a gas 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 in 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.
 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.

 If pressure is exerted on the outside of the neck, the
airway is squeezed and the flow of air to the lungs is
cut off.
 The three main reasons or causes why this could
happen are:
 Hanging= suspension of the body by a noose around
the neck
 Strangling= constriction around the neck
 Throttling = squeezing the throat.
 Hanging and strangulation may occur accidentally for
 example, by tie or clothing caught in machinery.
 Ranging (ring) may also cause a broken neck, so the
casualty must be handled carefully.

 There may be a constricting article around
the neck.
 Marks around the casualty‟s neck where a
constriction has been removed.
 Uneven breathing, impaired consciousness;
greyblue skin (cyanosis).
 Congestion of the face, with prominent veins
and possible; tiny red spots on the face or on
the whites of the eyes.

 Immediately remove any constriction from around the
casualty‟s neck, Support the body while you do so if it
is still hanging
 Do not move the casualty unnecessarily in case of
spinal injury
 Do not destroy or interfere with any material, such as
knotted rope, that police may need as evidence.
 Lay the casualty on the floor. Open the airway and
check breathing.
 If not breathing be prepared to resuscitate
 If breathing is well, place her in the recovery position

 What is the universal sign of chocking?
 What is the breathing compression ratio in CPR in unconscious
adult victim by two rescuer?
 We can assess both carotid arteries pulse (right and left side)
simultaneously. True/false
 What are the techniques used for chocking management?
 What is the most common cause of chocking in unconscious
adult victim?

Definition:
 A wound is a break in the continuity of the tissue of the body
either external or internal.
 Is a disruption or break in the normal integrity of the skin.
 Any wound will to some extent result in bleeding, either
internally or externally. And bleeding cause shock.
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Common Causes:
 Accidental falls
 Handling of sharp objects
 Machinery
 Weapons
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Types of Wound(GENERAL):
1. Open wound
 A break in the skin or the mucus membrane
 Prone to infection.
 Cause external bleeding
2. Close wound
 Involves injury to underlying tissues without a break in the skin or
mucus membrane.
 Cause internal bleeding.
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Types of open wounds(SPECIFIC)
Abrasions:
 The outer layer of the protective skin damaged
 Bleeding is limited
 Danger of contamination & infection is high
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Incisions:
 Occur when the skin is broken by sharp instruments
(knife, broken glass)
 May damage muscles, tendons,
& nerves

Lacerations
 It is jagged/rough, irregular or blunt
 Breaking or tearing of the soft tissues
 Usually causes when great force is exerted against the body
 Bleeding may be rapid & extensive.
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Puncture
 Is produced by an object piercing/penetrating skin layers,
creating a small hall.
 External bleeding is usually quite limited.
 Internal bleeding may occur.
 Risk of infection is high.
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Avulsion
 Results when tissue is forcibly separated or torn off
the victim's body
 There will be heavy & rapid bleeding
 Avulsed body part may be reattached
to a victim's body by a surgeon.
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First Aid for sever bleeding
 Stop bleeding.
 Identify bleeding as arterial, venous or capillary
 Treat for shock- hemorrhagic shock/ hypovolemic shock.
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Techniques to stop sever bleeding
Steps:
1. Direct pressure
 By placing the palm of the hand over a thick pad
 Apply manual pressure over the main artery
 Apply the pressure bandage & tie
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Step: 2. Elevation
 A severely bleeding open wound of the hand, neck, arm or leg
should be elevated above the level of the victim’s heart.
 Elevation uses the force of gravity to help reduce blood pressure
in the injured area and slows down the loss of blood through the
wound.
 If there is fracture elevation is contraindicated unless
immobilized.
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Step: 3. Pressure on the Supplying Artery /Indirect pressure/
 Is applicable if step1&2 are not effective.
 Pressure can be applied to the artery supplying the area.
 Apply indirect pressure for a maximum of 10 minutes.
 Apply 8-10 cm above the injured area.
 The two main indirect pressure points are brachial & femoral arteries
for upper & lower extremity respectively
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Step: 4. Tourniquet
 The use of a tourniquet is dangerous and the tourniquet should
be used only for a severe life threatening hemorrhage that
cannot be controlled by other means.
 Release the tourniquet every 10 minutes, and notify others as
tourniquet is applied not to forget in its applied site.
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Dressing the wound
Is application of pad over the wound and fasten it with plaster in
order to:-
 Helps to protect from further Injury,
 Help to protect infection/contamination, and
 Assist in the control of bleeding.
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Nose bleeding
 Sit the patient down, head tilted forward.
 Nip the soft part of the nose for 10 minutes.
 Tell the patient to breathe through the mouth.
 Give the patient a cloth to mop up any blood whilst the nose
is nipped.
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 Advise the patient not to breathe through or blow their nose
for a few hours after bleeding has stopped.
 If bleeding persists for more than 30 minutes, or if the patient
takes 'anticoagulant' drugs (such as warfarin), take or send them
to hospital in an upright position.
 Advise a patient suffering from frequent nosebleeds to visit
their doctor.
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BITES
 Bites from fleas, mosquitoes, lice and other common insects
produce local pain.
 Sting(venom) from ants, bees, & wasps(ተርብ) snake can cause
death due to acute allergic reaction.
 Animal bite like dog, cut, wolf etc.
 Human bite.
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First Aid Measures for bite:
1. Minor bite
 Cold application.
 Soothing lotions.
 Scrub the area with soap & water.
 Give antipain.
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2. Snake bite
 Snake venom consists primarily of proteins.
 The venom kills platelets & cause internal bleeding.
 Hence it results body swelling.
 Multiple organ system neurological, cardiovascular, & respiratory
systems may be affected.
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First aid management
 Put the victim at rest
 Remove constrictive items like rings.
 Provide warmth
 Cleanse the wound & cover with light sterile dressing
 Immobilize the injured part below the level of the heart
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3. Human Bite
 May become seriously infected because many bacteria exist in
the mouth.
 Cleanse the wound thoroughly with clean water,
 Dry it and seek medical attention
 Do not cover the wound
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4. Animal Bite
 May result in open wound. Dog and cat bites are common
 There is no known cure for rabies in human beings or animals
 A bite on the face & neck should receive immediate medical
attention because of proximity to brain.
 Keep the animal under observation if possible
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First Aid Measures
 Wash the wound, flush the bitten area
 don’t cover the wound
 Avoid moving the affected part
 Refer the victim to health institution
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Definition:
 Dressing is the immediate protective cover placed over a wound.
 A dressing should be:
 Sterile and just large enough to cover the wound.
 Absorbent and preferably non-adherent‘.
 Should not restrict blood flow to the rest of the limb
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Purpose of dressing
 To provide proper environment for wound healing.
 To absorb the blood & wound secretions
 To splint or immobilize wound
 To protect the wound from further injury
 To protect the wound from contamination
 To provide mental & physical comfort.
 To relieve pain
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There are two types of dressing
1. Adhesive dressing, this type of dressings are used for
dressing small cuts and grazes. They consist of a gauze or
cellulose pad and an adhesive backing.
2. Non adhesive dressing is a type of dressing used to dress
large size area wound unlike that of adhesive dressing.
Use of gauze, bandage and dressing
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Clean dressing procedure
 To use at home:
 Hand washing
 Boiling the dressing material for 15 minutes
 Drying the dressing materials with out contamination
 Use ironed clothes if available
 Do not touch or breathe or cough on the surface of
a dressing that is to be placed next to wound.
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Bandages:
 Is a strip of woven material used to hold a wound dressing or
splint in place.
 Help to immobilize, support & protect an injured part of the
body.
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A. To assist in the control of bleeding
B. To absorb blood and wound secretion
C. To prevent additional contamination
D. To ease pain
E. Control or reduce swelling
F. Lift and transport casualty
G. Secure dressing and splint in position
H. Assist in immobilization
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Kinds of Bandages
Gauze bandages
Elastic bandages
Triangular bandages
A binder of Muslin (many tailed bandage) to be applied to
the chest or abdomen
Others: such as emergency, special pads
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A. Elastic Bandages
They are expensive but can be laundered and used repeatedly for
a
number of purposes. In using elastic bandages the first -aider must
take great care not to stretch the material too tightly. Putting an
elastic bandage too tight will hinder or constrict blood flow.
B. Gauze Bandages
Skill is necessary in applying a gauze bandage to prevent its
slipping and stretching. Gauze can be used as a bandage, almost
on any part of the body. Never apply wet gauze it will shrink as it
dries and become too tight.
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A gauze bandage can be used in different ways:
• Circular bandages
• Spiral bandages
• Figure of eight bandages (for joint areas )
• Finger tip bandages ( formerly called recurrent)
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C. Triangular Bandages
 Triangular bandages are useful as an emergency cover
for the entire scalp, and foot or any large areas.
 Such a bandage also is used as a sling for fracture or
other injury of the arm or hand.
 The triangular bandage can be used as a circular, spiral or
figure of eight bandage.
It can also be used as a tie for a splint, as a constricting
band or as a tourniquet.
D. Adhesive - Strip Dressings
 It is used for small wounds following through cleaning
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Application of Bandages
General principles:
 A bandage should be snug (not to loose and not to tight)
To ensure that circulation is not interfered with:
 Leave the person's fingertips or toes exposed.
 Watch for swelling, changes of color & coldness.
 If the victim complains of numbness or tingling sensation, loosen the
bandages immediately
 Never apply a tight circular bandage about a person's neck
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 • Definition: Poor circulation to the vital organs.
Shock is very serious and
 life threatening. The casualty may not know that
they are in shock.
 • Causes: Dilated blood vessels, bleeding, severe
dehydration, all leading to
 a drop in blood pressure, which results in poor
circulation. These can be
 caused by severe emotional trauma, physical
injury, illness, etc.
 .

 Unusual behavior (e.g. Very calm or very
anxious),
 Lack of pain to an injury
 Rapid breathing
 Rapid but weak pulse
 Bluish skin (cyanosis)
 Unconsciousness.

 Activate the ambulance right away.
 Assist the person to lie on their side to
improve circulation, treat any injuries, help
them take any medication for an illness

Chapter -5
Specific injures
1/30/2020
By Birhanu D
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7

Eye injuries and first aid:
 Eye emergencies include cuts, scratches, objects in
the eye, burns, chemical exposure, and blunt
injuries.
 Since the eye is the most sensitive organ it will be
damaged easily by these injuries and will result in
permanent blindness or disability.
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By Birhanu D

Signs & Symptoms: …
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 Bleeding /discharge from
or around the eye,
 Bruising, Decreased vision,
 Double vision,
 Eye pain,
 Headache,
 spasm of the eyelids,
 Itchy eyes,
 Loss of vision,
 Pupils of unequal
size,
 Redness -bloodshot
appearance,
 Sensation of
something in the
eye,
 Sensitivity to light
and
 Stinging or burning
By Birhanu D

1. Removal of a foreign body:
 Tell the patient not to rub the eye.
 Check whether the foreign material is visible
on the white part of the eye.
 Ask the patient to blink several times to try to
remove the foreign body by washing it out
with tears.
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By Birhanu D

 If the object is not removed after several
attempts, do not continue because of the
risk of scratching the eye surface and
causing scarring.
 If the foreign object cannot be seen clearly
or is over the colored part of the eye, do
not try to remove it.
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By Birhanu D

2. If unsuccessful, the foreign body may not be
removed by gentle flushing of the affected eye:
 Uses a clean jug filled with water and pours a stream
of fluid across the injured eye and into a bowl or
hand basin.
 Tilt the victim's head over a basin or sink with the
affected eye down and gently pull down the lower lid,
encouraging the causality to open his or her eyes as
wide as possible.
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By Birhanu D

 Flush for up to 15 minutes, checking the eye
every 5 minutes to see if the foreign body
has been flushed out.
 If unsuccessful, and rinsing doesn't help,
close eye, bandage it lightly, and advice go
for advanced care.
1/30/2020
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By Birhanu D

Object stuck or embedded in eye:
 Leave the object in place.
 DO NOT try to remove the object.
 DO NOT touch it or apply any pressure to it.
 Calm and reassure the person.
 Wash your hands.
 Bandage both eyes.
 Get medical help immediately.
1/30/2020
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By Birhanu D

Chemicals in the eye
 Turn the person's head so the injured eye is
down and to the side.
 Flush with cool tap water immediately for 15
minutes, by holding the eyelid open,
1/30/2020
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By Birhanu D

 If both eyes are affected, or if the
chemicals are also on other parts of the
body, have the person take a shower.
 Continue to flush the eye with clean water
or saline while seeking urgent medical
attention.
 Seek medical help immediately.
1/30/2020
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By Birhanu D

Head injuries:
 Injuries to the head involves trauma to the
scalp, skull, & brain.
 At least half of severely head-injured patients
have significant injuries to the other parts of the
body.
1/30/2020
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By Birhanu D

First Aid:
 Check the person's level of response using the AVPU code:
 A - is the person alert, eyes open and responding to
questions?
 V - does the person respond to voice, obey simple
commands?
 P - does the person respond to pain (eg, eyes open or
movement in response to being pinched)?
 U - is the person unresponsive?
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By Birhanu D

 Regularly monitor and record vital signs.
 Advise the person to go to hospital if signs &
symptoms reappear.
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By Birhanu D

Assess level of
consciousness/responsiveness
highest possible score - 15
 lowest possible score - 3
score 3- 7 is coma
Eyes open:
Spontaneously………4
To speech……………..3
To pain……………… 2
No response…..…….1
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Best motor response:
Obeys verbal command…………………………………..6
Localizes
pain………………………………………...........5
Withdrawal from
stimulus…………………………………….….4
Flexion
abnormal……………………………………….....3
Extension
abnormal…………………………………..……2
No response…………………………………………… ….1
Verbal response:
Oriented……………………………………………………5
Confused
conversation……………………………….....…...4
In appropriate
speech……………………………….…..….3
By Birhanu D

If the person is conscious:
 Keep them supported in a comfortable resting
position and reassure them.
 Regularly monitor and record vital signs - level
of response, pulse, and breathing - until
medical help arrives.
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By Birhanu D

If the person is unconscious:
 Open the airway using the jaw thrust method
and checks breathing .
 Be prepared to give CPR if necessary.
 If the person is breathing, try to maintain the
airway in the position the person was found.
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By Birhanu D

Skull fracture:
 Skull fracture is a break in the continuity of
the skull
 Caused by trauma with or without brain
damage.
 It can be open/dura is torn or closed/dura is
not torn.
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By Birhanu D

Signs & symptoms:
 Wound or bruise on the head, Soft area or
 depression on the scalp,
 Blood in the eye/nose/mouth.
 Distortion or lack of symmetry of the head or face.
 Progressive deterioration in the level of response.
• Fast and weak pulse.
• Headache and dizziness.
• Vomiting, Pale or flushed face.
• Unequal size of pupils.
• Loss of bowel and bladder control
1/30/2020
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By Birhanu D

First Aid
If the person is conscious:
 Help them to lie down.
 Do not turn the head in case there is a neck
injury.
 Control any bleeding from the scalp by
applying pressure around the wound.
 Look for and treat any other injuries.
1/30/2020
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By Birhanu D

 Activate EMS/Emergency medical support.
 If there is discharge from an ear, cover the ear
with a sterile dressing or clean pad, lightly
secured with a bandage.
 Monitor and record vital signs - level of
response, pulse, and breathing - until medical
help arrives.
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By Birhanu D

 If the person is unconscious:-
 Open the airway using the jaw thrust
method and checks for breathing .
 Be prepared to give CPR if needed.
 Activate EMS
 Place the patient in comfortable position.
1/30/2020
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By Birhanu D

 Neck injuries includes Strains, Sprains,
Fractures/ Dislocation/Spinal Cord injury (SCI),
Nerve damage, etc.
 Symptoms:
 Ache/ stiffness to neck muscles
 Radiating pain to shoulder/ head region
 Dizziness - headache
1/30/2020
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By Birhanu D

 Severe pain or inability to move extremities,
generally found in severe neck trauma
 Muscle spasms
 Neurological signs disruption of nerve
function: Weakness, Reduced Sensation,
Reduced Reflexes, Muscle Atrophy
1/30/2020
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By Birhanu D

First aid:
 Call medical help as soon as possible
 Immobilization of neck for acute injury
 Ice to area 24 - 48 hours after injury (15
minutes on, 15 minutes off)
 If skin is cut, clean gently and bandage with
sterile gauze
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By Birhanu D

 Sling or splint the injury in its original
position
 If injury is serious, check for breathing, If
not provide CPR.
 Advice for advanced treatment
1/30/2020
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By Birhanu D

1/30/2020
By Birhanu D
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The neck is not
designed to be a
weight-bearing part of
the body.

First Aid Management of Spinal Injuries.
 Unconscious patient with suspected spinal injury:
Follow DRSABCD.
 Danger, Response, Shout for help, Airway,
Breathing , Circulation and Defibrillation
 Place unconscious patient in recovery position
supporting neck and spine at all times.
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By Birhanu D

 Maintain a clear and open airway.
 Hold head and spine steady with supports, to
prevent twisting or bending movement.
 Call for ambulance.
 Take extreme care at all times to maintain
alignment of neck and spine.
1/30/2020
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By Birhanu D

Conscious patient with suspected spinal injury:
1. Calm the patient.
2. Loosen tight clothing.
3. Do not move patient unless in danger.
4. Support head and neck.
5. Call for ambulance.
6. Take extreme care at all times to maintain alignment
of neck and spine
1/30/2020
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By Birhanu D

 A chest injury is any form of physical injury to
the chest
 It includes the heart, blood vessels and lungs.
 Chest injuries account for 25% of all deaths
from traumatic injury.
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By Birhanu D

1/30/2020
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Respiratory findings
• Dyspnea, respiratory distress
• Cough with or with out hemoptysis
• Cyanosis of mouth, face, nail beds, mucous
membranes
• Tracheal deviation
• Audible air escaping from chest wound
• Frothy secretions
By Birhanu D

Six Immediate Life Threats of chest injuries:
1. Airway obstruction
2. Tension pneumothorax
3. Massive hemothorax
4. Flail chest
5. Cardiac tamponade
1/30/2020
14
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By Birhanu D

Six Potential Life Threats of chest injuries
1. Lung contusion
2. Heart contusion
3. Esophagus trauma
4. Aortic rupture
5. Diaphragmatic rupture
6. Trachea-bronchial tree injury - larynx,
trachea, bronchus
1/30/2020
15
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By Birhanu D

First Aid for chest injuries:
 Activate EMS /EMA /Emergency medical assistance
1. After ABC assessment Begin CPR, if Necessary
2. Cover an Open Wound
3. Stop Bleeding, (if any)
4. Position Person to Make Breathing Easier
5. Monitor Breathing: If breathing becomes weak,
apply CPR as instructed above.
6. Follow Up.
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By Birhanu D

 Usually peas, beans, piece of pencil are put
into the nose by children.
 Signs/Symptoms: uncomfortable, complains
of pain, inability to breath
1/30/2020
By Birhanu D
15
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 Make the victim to sit
 Ask the victim to breathe through mouth to
prevent foreign body to aspirate in to
respiratory tract from nose.
 Make the patient sneeze by passing the end
of a piece of thread in the opposite nostril.
 Do not attempt to remove it with a pin or a
hook.
 Seek medical help
1/30/2020
By Birhanu D
15
3

 Peas, beans, piece of slate pencil can be
pushed by children during play. Sometime
insect also can be present.
 Signs/symptoms: pain blocked ear, ringing in
the ear
1/30/2020
By Birhanu D
15
4

 Put warm oil in the ear to float out an insect.
 Do not attempt to remove any other form of
foreign body as the tympanic membrane may
be damaged during such attempts.
 Take the patient to a doctor.
1/30/2020
By Birhanu D
15
5

1/30/2020
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First aid measures
• Don't try to replace protruding intestines or
abdominal organs but cover with sterile
dressings.
• Hold the dressing in place with a firm
bandage, but don't tighten the bandage.
• Don't give food or fluid because surgery may
be necessary.
• Keep the victim‟s head and shoulders elevated
to avoid breathing difficulty.
• Seek medical attention as rapidly as possible
and take extreme care to gently transport the
victim.
By Birhanu D

Musculoskeletal injury and its first aid

Definition: A break or crack in a bone is called a
fracture.
 In most cases the damage to the bone will be
under the skin, which is called a closed
fracture,
 But sometimes bits of the bone can puncture
through the skin to become an open fracture.
 In both cases you'll need to treat the casualty
for shock.
 Even if you can't see any blood, the break
might have caused some internal bleeding.

Signs:
 The seven things to look for are:
 Swelling
 Difficulty moving
 Movement in an unnatural direction
 A limb that looks shorter, twisted or bent
 A grating noise or feeling
 Loss of strength
 Shock

 For open fracture,
 cover the wound with a sterile dressing and
secure it with a bandage.
 Apply pressure around the wound to control any
bleeding.
 Support the injured body part to stop it from
moving. This should ease any pain and prevent
any further damage.
 Once you‟ve done this, call medical help.
 Protect the injured area by using bandages to
secure it to an uninjured part of the body to stop
it from moving.
 Keep checking the casualty for signs of shock.
 If they lose responsiveness at any point, open
their airway, check their breathing and prepare
for CPR

1. PRICES: P-Protect/prevent, R -Rest, I -Ice,
C -Compression, E-Elevation, S-Stabilize
2. DRABC:-D - Danger, R-Response, A-
Airway, B-Breathing, C-Circulation

Definition:
 This is an injury to a bone, a joint, a ligament, or
a tendon.
 Joint injuries usually involve a dislocation.
 Incomplete dislocation---sub-luxation
– This is where the bone has popped out of its
socket.
– This may be accompanied with a fracture, a
strain, or a sprain.
– It may pop back in spontaneously /it may not.
– Either way seek medical help.
– Do not push it back into place

 When a tendon tears it is called a strain.
 When they become torn they take a very
long time to heal,
 sometimes surgery is required to reattach
them.
 When a ligament is torn it is called a sprain.

Causes:
 Any kind of force that is greater than what
the tissue can withhold will cause such an
injury.
 Some common activities include falling,
twisting, getting hit, etc.
Prevention:
 Use safety equipment and wear it properly.
 Use seat belts and car seats.
 Keep joints and bones strong through weight
bearing physical activities.

• A „snapping‟ noise.
• Pain.
• Deformity.
• Inability to move.
• Swelling.
• Bruising

Apply the RICE principle.
• Rest the injured body part and the entire
casualty.
• Immobilize the injured body part.
• Cold compress over the injury to reduce
swelling.
• Elevate the injured body part if it can be done
without causing further injury.

 Seek medical help.
 Do not rub or move the injured body part.
 If there is a protruding bone then bleeding
will need to be taken care of by applying
indirect pressure.
 Never straighten or realign an injured body
part.

1. PRICES: P-Protect/prevent, R -Rest, I -Ice, C -
Compression, E-Elevation, S-Stabilize
2. DRABC:-D - Danger, R-Response, A-Airway, B-
Breathing,
C-Circulation
3. TOTAPS:-T-Talk, O-Observe, T-Touch, A-Active
movement,
P-Passive movement, S-Skills test.

1/30/2020
By Birhanu D
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Please help me!!!

 A poison is any substance solid, liquid or
gas that tends to impair health or cause
death when introduced in to the body or on
to the skin surface in a sufficient quantity.
 Poisons can enter the body in 4 ways:
 Ingested, Inhaled, Absorbed or Injected
1/30/202
0
By Birhanu
D. D. E.
1
7
6

A poison can either be:
 Corrosive Such as: acids, bleach, ammonia,
petrol, turpentine, dishwasher powder, etc
that can cause tissue destruction after
coming in contact with mucus membrane.
 Non-Corrosive Such as: tablets, drugs,
alcohol, plants, perfume that can cause
functional impairment .
1/30/2020
By Birhanu D. D. E.
17
7

Examples of poisons around the home
 Cosmetics, hair preparations
 Kerosene
 Strong detergents
 Bleaches, Acids
 Non edible mushrooms
1/30/2020
By Birhanu D. D. E.
17
8

Signs & symptoms of poisoning:
 Information from the victim from an observer.
 Presence of container known to contain
poison.
 Conditions of the victim (sudden illness).
 Burns around the lips or mouth, Breath odor
 Pupils of the eye contracted to pin point (over
dose of morphine)
1/30/2020
By Birhanu D. D. E.
17
9

Other signs that can accompany poisoning may be:
 Vomiting or retching(kuak), Abdominal pains.
 Burns (or burning sensation) around the entry
area.
 Breathing problems.
 Confusion or hallucination.
 Headache, Unconsciousness, Sometimes fitting.
 Cyanosis.
1/30/2020
By Birhanu D. D. E.
18
0

Objectives of emergency management:
 To remove or inactivate the poison before it
is absorbed.
 To maintain vital organ.
 To use the specific antidote to neutralize the
poison.
 To give treatment to hasten the elimination
of the absorbed poison.
1/30/2020
By Birhanu D. D. E.
18
1

Poison management consists of five phases:
1. Stabilize the patient
2. Non specific treatment
3. Diagnose the type of poison
4. Specific treatment
5. Follow up of the victim
1/30/2020
By Birhanu D. D. E.
18
2

First aid management for poison
For swallowed poisons
A. Conscious victim
 Give him a drink of tepid water with soap.
 Inducing vomiting with ipecac, MgSo4
 Give activated charcoal if the poison is
absorbed by charcoal.
1/30/2020
By Birhanu D. D. E.
18
3

 Don't induce vomiting if the poison take:
 Corrosives (strong acid or alkalis),
Hydrocarbons (kerosene), Iodides, silver
nitrate, & strychnine
 Instead, give milk with egg & water or a
mixture of flour & water.
1/30/2020
By Birhanu D. D. E.
18
4

B. Unconscious victim
 Maintain an open air way
 Maintain cardiovascular function
 Administer O2, treat shock.
 Don't give fluid & not induce vomiting
 Call poison control center.
 If the victim is vomiting position him & turn
the head so that the vomits drains out of the
mouth (recovery position)
1/30/2020
By Birhanu D. D. E.
18
5

• Do not attempt to restrain the victim but
position him in a way that he should not injure
him self
• Loosen tight clothes at the victims neck and
west
• Watch for an obstruction of air way and
attempt to correct by head positioning, if
necessary give artificial respiration.
• Do not give any fluid
• Do not induce vomiting
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Contact with poisonous chemicals:
 Remove contaminated clothing,
 Wash all contaminated skin,
 Identify types of chemical,
 Provide standard burn treatment,
 Keep the victim air way be open.
1/30/2020
By Birhanu D. D. E.
18
7

 Caused by transfer of energy from heat source to the
body.
 Burns can be categorized as thermal, Electrical,
Chemical, Radiation,.
 Tissue destruction results from coagulation, protein
denaturation, or ionization of cellular contents.
 The depth of the injury depends on temperature of the
burning agent & duration of contact with the agent.
1/30/2020
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By Birhanu D. E.

Systemic response:
 Loss of capillary integrity, leading to increased
capillary permeability resulting in massive fluid
losses/fluid shift from IC to EC.
 Decrease CO, drop in BP.
 Evaporative fluid loss through the burn wound
may reach 3-5 liters/24hrs.
 These all results in hypovolemic shock
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By Birhanu D. E.

Potential complications of burn includes:
 Fluid electrolyte & plasma loss,
 Infection , Acidosis ,
 Decrease temperature,
 Increase epinephrine release,
 Renal & hepatic damage, Formation of scar.
1/30/2020
19
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By Birhanu D. E.

Estimating the severity of a burn:
There are 5 factors that combine to affect the
severity of burn:
 Size : The larger the area of the burn, the
more severe.
 Cause: The cause of the burn will influence
the overall severity.
1/30/2020
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By Birhanu D. E.

Estimating the severity of a burn:
 Age: The age of the patient will affect the
recovery rate and severity.
 Location: The location of the burn can affect
the severity.
 Depth: The deeper the burn, the more
severe.
1/30/2020
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By Birhanu D. E.

 NEVER burst blisters (the layer of skin is protecting
against infection).
 NEVER touch the burn.
 NEVER apply lotions, ointments or fats - they
might introduce infection.
 NEVER apply adhesive tape or dressings - the burn
may be larger than it first appears.
 NEVER remove clothing that has stuck to the burn.
1/30/2020
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By Birhanu D. E.

Seek medical advice if:
 The burn is larger than 1-inch square.
 The patient is a child.
 The burn goes all the way around a limb.
 Any part of the burn appears to be full
thickness (third degree burn).
 The burn involves hands, feet, genitals or the
face.
1/30/2020
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By Birhanu D. E.

First aid for burns:
For major burns (second and third degree
burns)-
 Remove the victim from the burning area,
remembering not to put the rescuer in danger.
 Remove any burning material from the patient.
 Activate the emergency response system or
Emergency Medical system (EMS). Give plenty
of water
1/30/2020
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By Birhanu D. E.

 Once the victim is in a safe place, keep
them warm .
 Try to wrap the injured areas in a clean
sheet if available.
 DO NOT use cold water on the victim; this
may drop the body temperature and cause
hypothermia
1/30/2020
20
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By Birhanu D. E.

For minor burns (1st & 2nd degree burns involving a small
area of the body):
 Gently clean the wound with warm water, Avoid Butter.
 Remove potentially constricting articles like Rings,
bracelets,
 The burn may be dressed with a topical antibiotic
ointment like Bacitracin or Neosporin, Silvadene (silver
sulfadiazine).
 Tetanus immunization should be updated if needed.
1/30/2020
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By Birhanu D. E.

For electrical burns: Always seek medical care.
 It is usually deep.
 It results cardiac arrest due to the electric current
passing through his heart.
 The first- aider must insure that the patient is no
longer in contact with the current before
touching him; otherwise you too will be
electrocuted.
 If it is not possible to switch the current off,
remove the
patient from it by using clothing or wooden sticks.
 Do not use any thing metal/ wet things.
 If cardiac arrest has occurred external cardiac
massage (CPR) must be carried out, together with
artificial respiration and treat the burn later.
1/30/2020
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By Birhanu D. E.

1/30/2020
By Birhanu D. E.
20
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 Identify the chemical that was involved.
 Many chemical burns may be treated with local wound
care.
 Some chemical burn need emergent intervention.
 Chemical burn involving the eyes should always seek
emergency care.
 Give anti pain, antibiotics
 Prevent from contamination

1/30/2020
By Birhanu D. E.
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1. Heart attack:
 Is the death of heart muscle due to inadequate
O2 supply b/c of reduced coronary blood flow.
 The cause of reduced blood flow is either:
Atherosclerosis, Thrombus & Shock/hemorrhage
 Coronary occlusion, heart attack, & myocardial
infarction are synonyms.

1/30/2020
By Birhanu D. E.
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Causes:-
 Deposits of calcium / cholesterol , Tobacco,
Emotional stress,
 Hereditary factors, Obesity,
 High blood pressure,
 Inflammatory disease of arteries,
 Trauma / disease of heart

1/30/2020
By Birhanu D. E.
20
7
Symptoms of Heart Attack:-
 Discomfort, pressure, heaviness, or pain in the
chest radiate to arm and shoulder
 Fullness, indigestion, or choking feeling
 Sweating, nausea, vomiting, or dizziness.
 Rapid or irregular heartbeats
 Diaphoresis (excessive sweating)
 Symptoms more than 30 minutes or not relieved
by rest or nitroglycerin.

1/30/2020
By Birhanu D. E.
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First aid
 Call EMS or get to the nearest hospital emergency
department with 24 hrs-emergency cardiac care.
 Monitor victim‟s condition.
 Reassure the victim.
 Help the victim to the least painful position, usually
sitting with legs up and bent at the knees.

1/30/2020
By Birhanu D. E.
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9
First aid:-
 Loosen clothing around the neck and midriff.
 Determine if the victim is known to have
coronary heart disease and is using nitroglycerin.
 If the victim is unresponsive, check ABCs and
start CPR, if needed.
 Continue till victim get the pulse back
 Send the victim to hospital for advanced care.

1/30/2020
By Birhanu D. E.
21
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STROKE:-
 A stroke occurs when blood flow to the brain is
stopped.
 Brain attack, Cerebro-vascular accident (CVA) &
stroke are synonyms.
 A stroke can cause paralysis and problems with
thinking, speaking and even expressing emotions.
 Stroke can be either Ischemic or hemorrhagic
stroke.

1/30/2020
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Symptoms of a stroke include
 A sudden numbness or weakness of face, arm
or leg, especially on one side of body.
 Dysarthria
 Sudden severe headache with no known cause

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The risk factors for a stroke are:
 High blood pressure,
 Heart disease,
 Head injury, obesity, and
 Sedentary life style diabetes or smoke.

1/30/2020
By Birhanu D. E.
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Follow the DRSABCD Action Plan.
 D - Check for DANGER: To you. To others. To the affected
person.
 R - Check for RESPONSE: Ask the person their name
 S - SEND for help to hospital.
 A - Check AIRWAY: Is the airway open?
 B-BREATHING: If the person is not breathing, proceed to
CPR.
 D-DEFIBRILLATION: If the person does not respond to CPR,
apply defibrillator (if available).

1/30/2020
By Birhanu D. E.
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Fainting:-
 Defined as a transient loss of consciousness and
postural tone.
 Syncope is the medical term for fainting or
passing out.
 Resulted form low blood flow to the brain/
hypotention.
 Symptoms: Nausea, Giddiness, Excessive
sweating, Dim/ blurred vision, Tachycardia or
palpitations, etc.

1/30/2020
By Birhanu D. E.
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Fainting:-
Common Causes:
 Anxiety, Emotional upset, Stress,
 Severe pain, skipping meals,
 Standing up too fast, Standing for a long time
in a crowd,
 Some medications, Diabetes, hypoglycemia,
Blood Pressure.

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 Allow the victim to lie down or sit down.
 Ask the victim to place head between knees if
he/she sit down.
 Stay calm and provide reassurance.
 Position the person on his or her back.
 Raising the person's legs above heart level by
30 degree
 Loosen belts, collars or other constrictive

1/30/2020
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 To reduce repetition, advise not to get up too quickly.
 If the person doesn't regain consciousness within one
minute, call EMS
 Check the person's airway , circulation if absent, begin
CPR.
 Assess for other injury during if they falldown
 Control bleeding with direct pressure.
 If the person is alert, give fruit juice
 Stay with the person until he or she is fully recovered

1/30/2020
By Birhanu D. E.
21
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Epilepsy:-
 Seizure/fit is "abnormal excessive or
unsynchronous neuronal activity in the brain".
 A repeated or recurrence of seizure is known as
epilepsy.
 International Classification of Epileptic Seizures:
1. Partial seizures - only part/one side of the brain
involved.

1/30/2020
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1.1. Simple partial seizures sometimes called
Focal or Jacksonian seizures.
 The person is aware of his/her surroundings
and does not totally lose consciousness,
although consciousness may be altered.
 1.2. Partial seizures evolving to secondarily
generalized seizures.

1/30/2020
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1.3. Complex partial seizures:
 Are the most common type of seizure.
 The person will lose contact with the
outside world.
 They may appear to be conscious and
become aggressive if restrained.
 These seizures usually last 1-3 minutes

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2. Generalized seizures –
 Whole brain is involved/Affects both sides of
the body.
2.1. Absence/petit mal.
 They occur most frequently in children.
 Difficult to recognize because they are very
brief (15 seconds or less) and may appear to
be day-dreaming or “tuning out.”

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2.2. Myoclonic seizures
 Are a brief (2-3 seconds) involuntary jerking of
the arms and/or legs.
 They occur most often in children and may be
mistakenly dismissed as clumsiness or a
nervoustic.
2.3. Tonic-Clonic/grand mal.
 These seizures are what most people think of
when they hear “epilepsy.”

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Tonic-Clonic/grand mal:-
 A person will lose consciousness become rigid, and
may twitch, convulse, and possibly salivate, urinate,
and/or vomit.
 Tonic refers to the stiffening of the muscles at the
beginning of the seizure.
 Clonic is the jerking or twitching of the muscles
which follows.
 Last 2-3 minutes, but they may last 5 minutes or
more.

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2.4. Atonic seizures/Drop Attacks:-
 Are also brief (2-3 seconds).
 In this type of seizure the person‟s muscles
become suddenly limp, floppy, flaccid,
causing them to fall.
 It is a period in which muscle loss its tone &
movement.

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 Status Epilepticus(SE):-
 Is a life-threatening condition in which the brain
is in a state of persistent seizure.
 It is defined as one continuous, unremitting
seizure lasting longer than 5 minutes, or
recurrent seizures without regaining
consciousness between seizures for greater than
5 minutes.

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 Do not restrain – just guide.
 Try to keep the victim under control.
 Do not use force to stop the convulsions.
 Remove any objects that may cause injury to the
convulsing patient.
 Wipe the froth from the mouth.
 Follow the general rules for treating an unconscious
patient.
 After regain of consciousness , place in recovery
position.

1/30/2020
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7
First Aid of a Convulsing Victim:-
 Watch for recurrence, if any.
 A seizure longer than five minutes and recurrence with in
30 min of first episode is a medical emergency.
 Close doors, guide away from stairs, traffic and other
perils.
 Do not leave the victim until you are sure that he is aware
of his surroundings.
 Advise the victim to see a doctor soon.

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 It is defined as a state of impaired consciousness
in which one shows no responsiveness to
environmental stimuli but may respond to deep
pain with involuntary movements.
Causes:- Remember: A, E, I, O, U
 A- accident, alcohol, asphyxia, anesthesia.
 E- eclampsia, epilepsy.
 I- injection, insulin, internal haemorrhage.
 O- opium poison,.
 U- uremia

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First Aid:-
 Check the person's airway, breathing, and pulse
frequently. Activate EMS.
 If necessary, begin rescue breathing and CPR.
 If the person is breathing and lying on the back,
and you do not think there is a spinal injury,
place in recovery position

1/30/2020
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First Aid:-
 Gently tilt the head back to keep the airway open.
 If breathing or pulse stops at any time; do CPR.
 If there is a spinal injury, leave the person where
you found them (as long as breathing continues).
 If the person vomits, roll the entire body at one
time to the side.

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First Aid:-
 Support the neck and back to keep the head
and body in the same position while you roll.
 Do not give an unconscious person any food
or drink.
 Keep the person warm until medical help
arrives.

Chapter-11.
Heat stroke, Heat cramps,
And Heat exhaustion
1/30/2020
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By Birhanu D. (Bsc, Msc EMCCN)

Extreme high temperature:-
 Hyper metabolism; increase RR, PR & body metabolic rate w/c
result in protein coagulation w/c intern result in cell death.
 Break down the thermoregulatory center of the body, no more
thermoregulation, protein denaturations & cell death.
Extreme low temperature:-
 Causes vasoconstriction, blood flow become sluggish & clot may
form, leading to ischemic damage in the involved tissue.
 With still lower temperature, ice crystal may form & cells may
burst.
1/30/2020
23
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By Birhanu D.

Heat stroke:
 It is a response to heat characterized by high body temperature (
usually 40-43 0C) and disturbance of sweating mechanism.
 It is an immediate, life-threatening emergency, which urgently
needs medical care.
Signs and Symptoms
 Hot red and dry skin b/c the sweating mechanism is blocked.
 The victim may be unconscious.
 Headache , vertigo, and fatigue.
 Increases pulse rate (160 to 180) & RR.
 Disorientation.
 Circulatory collapse and permanent brain damage.
1/30/2020
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By Birhanu D.

 Repeated sponging of the bare skin with cool
water or rubbing alcohol.
 Apply cold packs continuously
 Place the victim in a tub of cold water (do not add
ice) until his temperature is lowered sufficiently.
 Dry off with a towel if temperature lowered.
 Use fans or air conditioners, if available, since
drafts will promote cooling.
 Do not give the victim stimulants.
1/30/2020
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By Birhanu D.

 Heat cramps occur after exercise at higher ambient temperature (> 38
0C) when fluids lost through excessive sweating are replaced only by
water.
 The result is a relative loss of Na+ and occasionally K+ and Mg+.
 It involves muscular pains and cramps due to loss of large amount of
salt from the body in sweating or due to inadequate intake of salt.
Signs and symptoms:-
 Onset is often abrupt, with muscles of extremities affected first.
 Cramps are brief, intense, and tend to occur during rest
 Nausea, tachycardia, pallor, weakness, and
 profuse diaphoresis are often present.
 Vital signs are usually normal
1/30/2020
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By Birhanu D.

First Aid Measures:
 Rest and oral replacement of sodium and water resolve cramps.
 Elevation, gentle massage, and analgesia minimize pain
 Avoid strenuous activity for at least 12 hours
 Education on salt replacement during strenuous exercise in hot,
humid environment.
 Apply firm pressure with hands on the cramped muscles, or
gently massage them to help relieve the pain.
 Give the victim sips of salt water 1 teaspoonful of salt in a liter of
cool boiled water (half a glass every 15 minutes over a period of
about 1 hour).
1/30/2020
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By Birhanu D.

 Excessive fluid and electrolyte loss due to sweating,
resulting in hypovolemia and electrolyte imbalance.
 It is the body's response to loss of water and salt
through excessive sweating.
 The most common cause is working or exercising in hot
conditions.
 It occurs when the core body T raises above 38°C.
 If the problem is not treated, it can quickly lead to
heat stroke.
1/30/2020
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By Birhanu D.

Possible signs and symptoms:-
 Confusion, dizziness, Pale, sweaty skin.
 Nausea, loss of appetite, vomiting.
 Fast, weak pulse and breathing.
 Cramps in the arms, legs, abdomen,
 The casualty may say that they 'feel cold',
but they will be hot to touch.
1/30/2020
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By Birhanu D.

 Give the casualty plenty of water to re-hydrate
them.
 Have the victim lie down and raise his feet from 20
to 30 cm.
 Loosen the victim‟s clothing
 Apply cool, wet clothes or take him to an air
conditioned room.
 If the victim vomits, do not give him any more fluid.
 Have a rest for several days
1/30/2020
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By Birhanu D.

 Frostbite is a condition caused when an
extremity (such as a finger or an ear) is subject to
cold conditions.
 The cells of the limb become frozen.
 Ice crystals form in the cells, which causes
them to rupture and die.
 Serious frostbite can result in the complete loss
of a limb, particularly fingers or toes.
 i.e. it can cause gangrene
1/30/2020
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By Birhanu D.

Possible signs and symptoms:-
 Pins and needles, followed by numbness.
 Hardening and stiffening of the skin.
 Skin colour change - first white, then blue
tinges, then eventually black.
 On recovery, the injury will become hot,
red, blistered and very painful.
1/30/2020
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By Birhanu D.

Treatment:-
 Gently remove rings, watches etc.
 Stop the freezing becoming worse.
 Don't rub the injury-this will cause damage.
 Don't re-warm the injury if there is a risk of it
refreezing.
 Move the patient indoors before you treat them.
 Place the injury in warm water,
 Give antipain.
1/30/2020
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By Birhanu D.

 Yakenyelay!
 አመሰግናለሁ::
1/30/2020
By Birhanu D. E.
24
5

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