Download MEDA116 – First Aid and CPR Breathing

Chapter 43: Assisting with Medical Emergencies and Emergency Preparedness
Lesson 2
Medical Emergencies
© 2009 Pearson Education
Lesson Objectives
Upon completion of this lesson, students should be able to …
 Define and spell the terms to learn for this
chapter.
 Explain ABCD as it applies to CPR and
obstructed airways.
 List the signs and symptoms of respiratory
distress and chest pain.
 Explain the difference between insulin shock and
diabetic coma.
© 2009 Pearson Education
Lesson Objectives
Upon completion of this lesson, students should be able to …
 Identify and describe various types of soft tissue
wounds.
 Discuss first-, second-, and third- degree burns
as well as the Rule of Nines
 Identify steps to take for a patient with syncope.
© 2009 Pearson Education
Causes of Respiratory and
Cardiac Arrest
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An occluded airway
Electrocution
Shock
Drowning
Heart attack
Trauma
Anaphylaxis
 Drugs
 Poisoning
 Traumatic head or
chest injury
General Guidelines for
Emergency Care
 Early access to EMS is important.
 Access for the adult patient is initiated by calling 911 as
soon as it has been determined that the patient is
unconscious and not breathing.
 In general, “Phone first” for an unresponsive adult.
 With children and infants, EMS access is made after 2
minutes of CPR.
 In general, perform “CPR first” for unresponsive
children and infants.
 The sequence normally followed is Airway, Breathing,
Circulation, and Defibrillation (ABCD).
MEDA116 – First Aid and CPR
Airway
 Roll pt onto his/her back, using the logroll
technique.
 Assess the pt for responsiveness.
 No response check the airway.
 Listen for air movement, look for chest
movement, feel for air movement.
© 2007 Pearson Education
MEDA116 – First Aid and CPR
Breathing
 Pinch the pt’s nose shut, seal your lips tightly
around the pt’s mouth and deliver 2 breaths.
 If pt’s chest rises, you have been successful.
© 2007 Pearson Education
MEDA116 – First Aid and CPR
Circulation
 Check for signs of circulation such as a defined
pulse, color & warmth of the skin, and pt
movement.
 After breaths delivered check for the pulse.
 If pulse is weak, erratic, or nonexistent & no
signs of circulation are present begin
compressions as appropriate to pt’s age.
© 2007 Pearson Education
MEDA116 – First Aid and CPR
Defibrillation
 AED is highly effective when provided
immediately after or within minutes of an adult
cardiac arrest.
 AED will give verbal directions to the rescuer or
rescue team that are easy and safe to follow.
 Not to be used on infants.
© 2007 Pearson Education
Critical Thinking Question
In what situations do airway obstructions
most frequently occur?
The Universal Choking Sign
Insert Figure 43-8 from PCMA 2e
The Heimlich Maneuver
 Ask the patient if he or
she is choking
 Vocalize your intent to
help the patient
 Stand behind the patient
with your feet slightly
apart, placing one foot
between the patient’s feet
and one to the outside.
 Place the index finger of
one hand at the person’s
navel or belt buckle.
Insert Figure 43-13
from PCMA 2e
The Heimlich Maneuver
 If the patient is a pregnant woman, place your finger
above the enlarged uterus.
 Make a fist with your other hand and place it, thumb
side to patient, above your other hand.
 If the person is very large or far along in pregnancy
you may have to do chest compressions.
 Place your marking hand over your curled fist and
begin to give quick inward and upward thrusts.
 There is no set number of thrusts to give to an adult
who remains conscious.
The Heimlich Maneuver
 Continue to give thrusts until the object is removed
or the patient becomes unconscious.
 If the patient becomes unconscious, gently lower
him/her to the ground.
 Activate EMS and put on gloves.
 Immediately begin CPR with 30 chest compressions
and 2 rescue breaths.
 Before administering the rescue breaths, open the
airway with the head-tilt chin lift and look for a
foreign body in the patient’s mouth and remove if
visible.
The Heimlich Maneuver
 Blind finger sweeps are no longer recommended and
should not be performed.
 Continue with cycles of 30 compressions and 2
rescue breaths until the foreign body is expelled or
advance medical personal arrive to relieve you.
 Wash hands and document the event in the patient’s
chart.
Chest Thrusts and Back Blows
on an Infant
Insert Figure 43-15A
from PCMA 2e
Insert Figure 43-15B
from PCMA 2e
Steps for Adult rescue Breathing
and One-Rescuer CPR
 Assess the patient and determine if help is needed.
 Shout, “Are you OK?” while gently shaking the
patient’s shoulders.
 If the adult patient is determined to be unresponsive,
activate EMS immediately by calling 911 and get an
AED if available.
 Assess the ABCs.
Insert Figure 43-9 from
PCMA 2e
Assessing the ABCs
 Airway: perform a head-tilt chin lift, or, if a neck
injury is suspected, a jaw thrust.
 Look and feel for breath and chest movements.
 Attempt to get another person to call 911.
 If you are alone, begin the rescue sequence for 1
minute and then attempt to call 911 yourself.
 If gloves are available, put them on.
 If you have a ventilator mask, place it on the patient.
Performing Breaths
 If breathing is absent, put on a mouth guard and
administer two rescue breaths.
 If your breaths do not cause the chest to rise, look in
the patient’s mouth and remove an object if one is
seen.
 If no object is seen, make a second attempt to
administer a rescue breath.
 If the breaths cause the chest to rise, assess the
patient’s circulation by feeling for a pulse at the
carotid artery.
Feeling a Pulse
 If you feel a pulse,
begin rescue
breathing.
 Administer 1 breath
every 5 seconds, or
10–12 every minute.
 After 1 minute,
reassess the patient
for breathing and
pulse.
Insert Figure 43-12 from
PCMA 2e
Performing Chest
Compressions
 If you do not feel a pulse, begin chest compressions.
 Kneel at the patient’s side and place your hand in
the center of the chest between the nipples.
 Place your other hand on top of the first hand,
making sure to lift your fingers off the chest, using
only the heels of your hands to administer
compressions.
 Keep your shoulders directly over your hands
 Compress the chest 1-1/2 to 2 inches, then allow the
sternum to relax.
Performing Chest
Compressions
 Do not lift your hands off the
chest.
Insert Figure 43-5 from
 Continue to compress the
PCMA 2e (middle image)
chest a total of 30 times, then
administer 2 breaths.
 Repeat this sequence for 4
total cycles. Reassess the
patient.
 If necessary, continue CPR
until pulse and breathing
return or you are relieved by
more advanced medical
personnel.
Steps for Infant or Young Child Rescue
breathing and One-Rescuer CPR
 Assess the patient and determine if help is needed.
 Shout the infant or child’s name and sharply poke at
the feet.
 Never shake an infant.
 If the infant patient is determined to be
unresponsive, perform CPR for 2 minutes prior to
activating EMS immediately by calling 911 and get
an AED if available.
 Carefully place the patient on their back, be cautious
not to move the head or allow the neck to twist,
especially if a spinal cord injury is suspected.
Steps for Infant or Young Child Rescue
breathing and One-Rescuer CPR
 Gently, with two fingers, tilt the patients head
and open the airway.
 Place your ear close to the patient’s ear to
listen for breathing sounds, watch to see if
the chest rises or falls indicating breathing,
try to feel for any breathing from the patient’s
nose or mouth.
 If breathing is absent, secure a mouth guard
over the patient’s mouth and nose.
Administering Rescue Breaths
 Administer 2 rescue breaths.
 If your breaths do not cause the chest to rise, look in
the patient’s mouth and remove an object if one is
seen.
 If no object is seen, make a second attempt to
administer a rescue breath.
 If the breaths cause the chest to rise, check the
patient’s pulse at the brachial artery.
 If you feel a pulse begin rescue breathing by
administering 1 breath every 5 seconds, or 10 to12
every minute.
Administering Chest Compressions
 If you do not feel
a pulse, begin
chest
compressions.
 Place two fingers
in the center of
the chest just
below the nipple
line.
Insert Figure 43-7C
from
PCMA 2e
Administering Chest Compressions
 Compressions should be made one-third to
one-half the depth of the chest. Perform
quick 30 compressions.
 Give 2 more rescue breaths followed by 30
more compressions. Continue the 30:2
compressions and breaths.
 After 2 minutes, leave the infant and call 911
if you are still alone.
 Continue compressions and breaths until the
infant recovers or EMS arrives.
Automated External Defibrillation
(AED)
 Highly effective when provided immediately
after or within minutes of an adult cardiac
arrest.
 Most cardiac arrests in adults are related to
fatal electrical arrhythmias of the heart and
are correctable with defibrillators.
 Defibrillator gives verbal directions to the
rescuer or rescue team that are easy and
safe to follow.
 AED is not applied to infants.
The Respiratory System
Insert Figure 29-1 from PCMA 2e
Body cells require constant exchange of fresh
oxygen and removal of carbon dioxide.
Reasons for Respiratory Distress
 Reaction to a long-term debilitating disease,
such as chronic pulmonary obstructive disease
(COPD)
 Reaction to an emergency situation, such as
anaphylactic response to medication.
 Due to the result of other disease processes
such as obstructive conditions, such as asthma,
chronic bronchitis, and emphysema,
pneumonia, and acute pulmonary edema.
Symptoms of Respiratory
Distress
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Acute anxiety with gasping breaths
Bradypnea, abnormally slow breathing
Cyanosis
Failure of the chest to rise and fall
Nasal flaring
Pursing of the lips
Noisy breathing
Tachypnea (abnormally rapid breathing)
Steps for Administering Oxygen
 Gather all needed equipment and perform hand
hygiene.
 Identify the patient and confirm the physician’s order for
oxygen therapy.
 Check the pressure reading on the oxygen tank to
make sure it has enough oxygen in it.
 Start the flow of oxygen by opening the cylinder.
 Attach the cannula tubing to the flow meter.
 Adjust the oxygen flow to the physician’s order.
 Hold the cannula tips over the inside of your wrist,
without touching the skin, to determine if oxygen is
flowing.
Steps for Administering Oxygen
 Apply gloves, if
necessary.
 Place the tips of the
nasal cannula into the
patient’s nostrils.
 Wrap the tubing
behind the patient’s
ears.
 Instruct the patient to
breathe normally
through the mouth and
nose.
Insert Figure 43-7 from
PCMA 2e
Steps for Administering Oxygen
 Some patients instinctively hold their breath or avoid
breathing through the nose when an object is placed in
the nostrils.
 Check the patient’s oxygen level with an oximeter.
 Place the probe over the index finger and record the
reading.
 If necessary, have the patient take a short walk to verify
that the oxygen flow rate is sufficient for activity.
 Wash hands and document the procedure in the
patient’s chart.
MEDA116 – First Aid and CPR
Shortness of Breath
 Patient needs immediate intervention.
 Patent, or unobstructed, airway is necessary in
moving in and out.
 Ask about the onset and what activity caused it.
 Patient may be gasping for air, looking pale or
cyanotic, and exhibiting nasal flaring and
extreme anxiety.
 Patient should be sitting in an upright position.
© 2007 Pearson Education
Hyperventilation
 Quick, shallow breathing or rapid, deep
breathing that results in decreasing
carbon dioxide in the blood, dilation of
blood vessels, and lowered blood
pressure.
Symptoms and Treatment of
Hyperventilation
Symptoms
 Light headed
 Chest tightness
 Cardiac palpitations
 Rapid pulse
 Deep sighing breaths
 Anxiety
Treatment
 Inform the physician and
encourage the patient to
breathe slowly.
 Have the patient breathe
into an oxygen mask (not
connected to any
oxygen), block one
nostril, or breathe into a
brown paper bag. One of
these methods is usually
effective.
MEDA116 – First Aid and CPR
Chronic Obstructive Pulmonary Disease
 Asthma, chronic bronchitis, and emphysema
are all COPD’s
 Air is trapped in the lungs and carbon dioxide is
unable to expel from the alveoli.
 A person with COPD has sob, rapid hear rate,
and experiences weakness.
© 2007 Pearson Education
MEDA116 – First Aid and CPR
Pulmonary Edema
 Fluid accumulation in the lung tissue and alveoli
 Pt has difficulty breathing, wheezing sounds,
cyanosis, rapid heartbeat, distended neck
veins, extreme anxiety, and orthopnea.
 Place pt in sitting position with feet and legs up
on a bed or cart.
© 2007 Pearson Education
Chest Pain
 Heart attacks are the leading cause of death for
both men and women.
 The primary complaint will be pain in the middle
or left side of the chest, described as sharp,
stabbing, crushing, squeezing, or aching.
 The pain may radiate to the left arm, to the
back, or up the neck.
 Sometimes the pain is brought on by exertion,
but other times onset is sudden and
unexplained.
Chest Pain
 Other symptoms are nausea, weakness, SOB,
apprehension, and the feeling of impending
doom.
 The skin may be clammy, moist, pale, or
cyanotic
 Denial is common, as the individual tries to
explain the pain as heartburn or indigestion.
Care of Chest Pain
 Have the individual stop what he or she is
doing and sit down, feet elevated if possible.
 Ask a coworker to stay with the patient while
you inform the physician of the situation.
 If instructed by the physician, or if a physician
is unavailable, call EMS.
 If oxygen is available, administer it according
to office protocol by nasal cannula at 6 to 8
liters per minute until the physician or
emergency personnel arrive.
Care of Chest Pain
 If the patient has previously been diagnosed
with angina and has nitroglycerin tablets, insert
one tablet under the tongue.
 Tablets may be administered every 5 minutes
up to three doses.
 If the pain is not relieved, inform the physician
or EMS on the scene.
MEDA116 – First Aid and CPR
Telephone Call with Complaint of Chest
Pain
 Keep the caller on the line while asking for help
from another office staff member.
 Write down the caller’s name and location.
 Follow office protocol regarding assisting pts
with chest pain. A lot of the time offices will
want all pts calling with chest pain to go to the
ER (ED). If this is the case, call EMS for the pt
and remain on the phone with them until EMS
has arrived.
© 2007 Pearson Education
Shock
 Collapse of the cardiovascular system caused
by insufficient cardiac output.
 Blood supply and nourishment (oxygen and
nutrients, including glucose) to the tissue and
perfusion to the organs are inadequate.
 Untreated shock can progress very rapidly to
death.
Causes of Shock
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Anaphylaxis
Cardiac failure
Hemorrhage
Extreme emotional upset
Respiratory distress
Neurological collapse
Severe metabolic insult
Sepsis
General Signs of Shock
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Weakness
Rapid heartbeat
Thirst
Nausea
Dizziness
Restlessness
Pallor
Cool skin
Clammy skin
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Cyanosis
Confusion
Disorientation
Unresponsiveness
Shallow breathing
Anaphylactic Shock
 Severe allergic reaction to a foreign substance such as
medications, bug bites, and latex gloves.
 Inform the physician immediately, and call EMS.
 The physician may order epinephrine and/or an
antihistamine.
 An IV may also be started.
 Prevention is the most important factor in anaphylactic
shock.
MEDA116 – First Aid and CPR
Most Common Signs of Shock
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Pale, gray, or bluish skin
Moist, cool skin
Dilated pupils
Weak, rapid pulse
Shallow, rapid respirations
Extreme thirst
© 2007 Pearson Education
General Treatment for Shock in
the Medical Office
 Encourage the patient to lie down with feet
elevated
 Cover the patient with blankets for warmth
 Keep the patient calm
 Inform the physician, contact
EMS for further assessment
Critical Thinking
 and transport, monitor the
Question
patient’s vital signs, and provide What other treatment
may you give while
emotional support
waiting for the patient to
be transported?
More Specific Treatment for Shock
in the Medical Office
Cause
Treatment
Anaphylactic Shock Epinephrine
Cardiogenic Shock
IV dopamine (pacemaker), stat transport to ED
Hemorrhagic shock
Stop bleeding, replace volume, stat transport
Hypovolemic shock
Replace volume
Insulin shock
Sugar, given to patient by any means tolerated
Neurogenic shock
IV dopamine, immediate transport to the emergency room
Poisoning
Consult poison center for treatment specific to the poison
Respiratory shock
Intubation and immediate transport to the emergency room
Sepsis
Fluids, IV dopamine and immediate transport to the
emergency room
Diabetic
Emergencies
 Hypoglycemia: Low blood sugar
• Blood sugar is below 70mg/dL
• May have skipped a meal, vomiting after taking diabetic
medications, excessive exercise, or an unknown reason
 Hyperglycemia: High blood sugar
 Both of these conditions cause a rapid onset of altered
levels of consciousness, although there is a greater risk
for those with hypoglycemia.
Signs of Insulin Shock or Diabetic Coma
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Very low or very high blood sugar
Vomiting
Balance disturbances
Uncharacteristic behavior
Sweet, fruity odor to the breath
Loss of consciousness
Appear to be intoxicated
Cold clammy skin
Anxious
Combative
Care for Diabetic Crisis
 If victim is conscious,
• Ask about the last intake of food and diabetic
medication
• Glucose paste
• Orange juice with added sugar
 If victim is unconscious
• IV glucose
MEDA116 – First Aid and CPR
Bleeding
 External
• Occurs when skin is broken
 Internal
• Occurs with tissue damage and intact skin
 Originate from 3 types of blood vessels:
• Arteries
• Veins
• Capillaries
© 2007 Pearson Education
Arterial Bleeding
 Usually copious, rapid, and bright red.
 Blood often spurts, echoing the heartbeat.
 Must be brought under control as soon as
possible.
 Pressure applied directly over the exit wound
may halt the flow of blood.
 If not successful, external pressure on the
pressure points may be.
 Elevating the injured part higher than the heart
may also slow the blood flow.
Bleeding from Veins and Capillaries
Venous blood
 flows more slowly
 darker in color
 can usually be
controlled by direct
pressure.
Blood from capillaries
 oozes rather than
flows
 can be halted with
direct pressure.
Critical Thinking Question
What is the danger of persistent blood
loss?
Pressure Points
Insert Figure 43-21
from PCMA 2e
 Use pressure
points if external
bleeding cannot be
stopped by
localized pressure.
 Most often you will
use the brachial
and femoral
pressure points.
Open Wounds
 Generally not life threatening unless they penetrate
the head, chest, throat, or abdomen.
 Typically require irrigation, debridement, sutures,
and antibiotics.
 If involves nerve or muscle tissue, genitalia, eyes,
and possibly hands will require specialized care.
Critical Thinking
Question
In what cases are open
wounds life
threatening?
Classification of Open Injuries
Insert Figure 43-29 from PCMA 2e
Abrasions
 Occurs when the outer layer of skin is scraped away,
leaving the underlying tissue exposed.
 Common types of abrasions include friction burns,
rug burns, road rashes, and scrapes.
 Bleeding is usually in the form of oozing and the
injury is quite painful because nerve endings are
exposed or damaged.
Avulsions
 Tearing away of skin or tissue.
 Usually occur on limbs and appendages, including
fingers, toes, hands, arms, feet, legs, nose, and
penis.
Avulsions
 Body part may become entangled in machinery
or be injured in a motor vehicle accident or a
confrontation with an animal.
 Cleanse minor avulsion wounds with soap and
water and return any skin flap to its normal
position.
 Apply direct pressure, then apply a dressing
when bleeding is controlled.
Amputation
 If body part has been recovered, cleanse the
dismembered part with sterile saline.
 Wrap it with moist, sterile gauze, seal it in a plastic
bag, and place the plastic bag in a container on
ice.
 Prompt medical attention and preservation of the
body part enhance the chances for successful
reattachment.
Critical Thinking Question
What do you do if someone’s finger is not
entirely amputated, but it is just
hanging by some skin?
Lacerations
 An open wound in which the skin and underlying tissue
are torn.
 Usually has jagged edges that may interfere with the
healing process.
 Cleanse the laceration with soap and water or an
antiseptic solution, remove all debris and foreign
matter.
 If a minor laceration, place a Band-aid, Steri-strip, or
sterile butterfly.
 If bleeding is severe, a physician should direct the
cleansing process.
 Lacerations over a joint may require joint immobilization
for a few days while healing progresses.
Incisions
 A cut with smooth edges made with a knife or other
sharp object.
 Treated in the same manner as any laceration.
 If the wound is deep or extensive, the physician usually
performs a surgical intervention consisting of
debridement, hemostasis, and trimming away of the
jagged wound edges.
 If there is damage to underlying tissue, such as a
tendon or ligament, further surgical intervention is
required.
Puncture Wounds
 Results from a pointed foreign body penetrating
the skin and tissue.
 Often times edges close trapping pathogens
and debris in the tissue.
 Cleansing may consist of simply soaking the
area or may require invasive irrigation.
 After cleansing, a dressing is applied.
 Bleeding is usually minimal.
Impaled Objects
 Requires special treatment.
 General rule is to leave the object in place until it can be
safely removed by trained personnel.
 Stabilizing the object is critical to preventing further
damage.
 Control bleeding and stabilize the impaled object with a
bulky dressing held in place with tape or other bandages.
 Splint the area to prevent movement.
 For a small penetrating object, a small paper cup may be
used. Make a hole in the bottom of the cup, place it over the
object with the lip of the cup against the skin, and secure it
with bandages.
Soft Tissue Injuries
 involves both the skin and underlying tissue.
 Avulsions, amputations, and thermal insults are
considered soft-tissue injuries because tissue as well
as skin is involved.
 Damage to the underlying tissue may involve blood
vessels, nerves, muscles, and subcutaneous tissue.
 The tearing of minute to larger blood vessels results in
bleeding into the tissue and discoloration of the area.
 Swelling may exert pressure on nerve endings, creating
pain.
Crush Injuries
 Result when force is applied to the tissue.
 Depending on the area involved, the crush may be
similar to pinching of tissue or it may be so severe as to
involve organs and bones.
 Elevating the body part above the heart and applying
cold are often the only intervention needed.
 With a more severe injury, the body part should be
immobilized.
 Monitoring vital signs and observing skin color,
temperature, and moisture are essential to deciding
whether more extensive intervention is needed.
MEDA116 – First Aid and CPR
Wound Care Pointers
 A dressing is a sterile covering placed directly
over a wound to absorb blood and other body
fluids, prevent contamination, and protect the
wound from further trauma.
 A bandage is a strip of binding material used to
hold a dressing in place.
 Simple direct pressure with a dressing will
usually stop bleeding from a soft tissue injury.
 Priority is to preven infection by dressing the
wound properly.
© 2007 Pearson Education
Open Wounds
Open wounds can be:
 Superficial—penetrating only the skin
 Deep—penetrating the fascia, or connective layer
beneath the skin, and other structures that lie deeper
still
Typically open wounds require:
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Irrigation
Debridement (or surgical trimming)
Sutures
Antibiotics
Open Wound Care
Stop the bleeding
 Apply direct pressure to the wound.
 If necessary, use a bulky dressing.
 Don’t remove the layers of dressing you’ve used to
stop the bleeding until a physician directs you to.
Open Wound Care
Clean the wound
 It is very important to do this well because it is essential
to preventing infection.
 Cleanse the would from the center outward, beginning
with vigorous irrigation using disinfecting solution
prescribed by the physician.
 Wipe the edges of the wound in all directions away from
the wound with sterile gauze.
Critical Thinking
Question
What do you do if the
wound is more serious than
what you have cared for in
the past?
Open Wound Care
Dress and bandage the wound
 Cover with a sterile dressing and fasten the dressing
in place.
 The physician will specify whether or not to use
antibacterial ointments or creams.
Open Wound Care
Post bleeding control and dressing
 Get a good set of vitals
 Allow patient to remain in a comfortable position
 Watch for signs of shock
 Assist patient into a sitting position and make sure he
or she is not dizzy
 Make sure the patient understands home instructions
 Help the patient to a standing position, ensuring
stability
 If there are signs of shock, notify the physician
immediately; he or she may have you contact EMS
Applying a Triangular Bandage
 Keep the injured arm as immobile as possible.
 Carefully slide the triangular bandage under the area to
be held.
 Two shorter sides should be pointing toward the elbow,
and the remaining longer edge should be parallel to the
opposite body side.
 Bring the lowest side up and over the arm.
 Tie the ends of the bandage behind and slightly to the
side of the neck.
 Tuck the peak of the bandage in toward the elbow point
of the bandage.
Applying a Figure-Eight Bandage
 Place the thumb of one hand on one end of the
bandage
 Anchor the bandage with your other hand, then
complete one circle around the extremity or
body part.
 Continue to alternate wrapping above and
below the body joint or dressing and circling
behind the joint or dressing area until the
injured area is covered adequately.
Applying a Figure-Eight Bandage
 If applying a bandage to a foot, ensure that toes
are exposed to evaluate circulation.
Insert Figure 43-24 from
PCMA 2e
Applying a Tubular Bandage
 Choose an applicator that is larger than the extremity to
be bandaged.
 Cut an approximate amount of tubular gauze bandage
and slide the gathered bandage onto the applicator.
Insert Figure 43-25 from
PCMA 2e
Applying a Tubular Bandage
 Slide the applicator over the extremity.
Insert Figure 43-26 from
PCMA 2e
Applying a Tubular Bandage
 Hold the bandage against the proximal end of the
extremity and pull the applicator approximately 1 inch
past the distal end.
Insert Figure 43-27 from
PCMA 2e
Applying a Tubular Bandage
 Twist the bandage gauze one complete turn.
 Next, slide the applicator toward the proximal end of the
injury.
Insert Figure 43-28 from
PCMA 2e
Applying a Tubular Bandage
 Hold the proximal end of the tubular bandage
gauze in place, and pull the applicator toward
the distal end.
 After pulling past the distal end, complete one
twist.
 Slide back and forth and twist the distal end of
the dressing until the injured area is adequately
covered.
 Cut excess dressing, but remember to anchor
the bandage at the proximal end.
Epistaxis (Nosebleeds)
 Usually Non-life-threatening
 Tend to occur most commonly in dry weather
or in dusty conditions, and are usually easy to
treat.
 More serious if bleeding from both nostrils.
Critical Thinking
Question
When should you worry
about a nosebleed?
When to Worry About Persistent
Nosebleeds
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When a nosebleed occurs after a head injury and
does not stop.
If the person has high blood pressure, especially if
he or she has stopped or changed medicines for
the condition.
If the person has a clotting disorder.
A patient has a history of nosebleeds that have
caused shock in the past.
Caring for Nosebleeds
 The physician will twist a facial tissue and
pack the patient’s nose.
 A chemical cold pack should be held against
the bridge of the patient’s nose.
 A patient may need electrocautery if the
bleeding doesn’t stop.
MEDA116 – First Aid and CPR
Burns
 Occurs when an area of tissue is destroyed by
the action of physical heat, chemical activity,
high electrical current, or heavy exposure to
radiation.
 Severity depends on the amount and depth of
the tissue injury.
 Destruction of skin surface is important since all
the skin functions are lost.
 May help stop the burning and remove any
metal jewelry from the burn pt.
© 2007 Pearson Education
Classification of Burns
 Surface area of body
 Depth of burn into the skin
The Rule of Nines
Insert Figure 43-30 from PCMA 2e
Classification of Burns
 First-degree burns
• Reddening, swelling of epidermis (like a mild sunburn)
• Extremely painful
 Second-degree burns
• Reddening, swelling of epidermis and outer dermis; blisters
noted
• Extremely painful
 Third-degree burns
• Charring of all layers of skin and at least some deeper structures
• Tend not to be painful immediately, destroys the sensory nerve
ending.
Special Considerations to
Determine Seriousness
 Mortality is higher in:
• Elderly
• Very young
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Burned in enclosed area
Burns of genitalia
Presence of other injuries
Chemical burns
Electrical burns
Treatments for Burns
First degree
 Cool water if involves less than 10% of the body.
 Use analgesics and ointments, if ordered by the
physician.
Second degree
 Cool water as long as there are no broken blisters.
 Do not use analgesic creams and ointments.
 Cover with a dry sterile dressing.
Treatments for Burns
Third degree

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Transport to a trauma center.
Debride dead skin or damaged tissue (physician only).
Cover burns with dry sterile dressing.
Manage pain with injectable analgesics as ordered by a
physician.
 Burns of any kind that involve broken skin may have
to be debrided (removal of dead or damaged tissue.
 All burn victims should be monitored for signs of
shock.
Treatments for Burns
Upper Airway Burns
 Prompt intubation by the physician or EMS with the
largest tube that can be inserted.
 Transport to a trauma center.
 Listen for strider (noisy breathing).
 Administer oxygen as ordered by physician.
Large Surface Area Burns
 Dress with dry, sterile sheets
 Prompt transport to trauma center
 Monitor and treat for shock
Now You Guess!
Classify this burn.
Insert Figure 41-40 from
Frazier/Malone MA, p. 896
Third-degree burn
Heat and Cold Exposure
Hyperthermia
 Elevated body temperature
 Results from prolonged exposure to extremely
hot temperatures often
Hypothermia
 Lowered body temperature (below 95 degrees)
 Results from prolonged exposure to cold or
cold water
Hyperthermia
 Heat exhaustion
• Extreme fatigue
due to heat
• Occurs as the
result of sodium
and water
depletion form the
body.
• Strenuous activity
often precedes
heat exhaustion
 Heat stroke
• Advanced heat
exhaustion, body
temperature ≥105˚
• Many patients will not
sweat.
• Eventually brain cells
begin to die and
permanent brain damage
or death may result.
Signs and Symptoms of Heat Exhaustion

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Dizziness
Nausea and vomiting
Headache
Muscle cramps
Diarrhea
Weakness
Moist, pale, cool skin
Treating Heat Exhaustion
 Move to a cooler environment.
 Encourage patient to lie down
 Apply cool, wet compresses and give sips of water.
Signs and Symptoms of Heat Stroke

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Failure to perspire
Temperature of 105˚ or higher
Skin that is dry, red, and hot to the touch
Headache
Shortness of breath
Nausea and vomiting
Dizziness
Weakness
Dry mouth
Initial rapid, strong pulse that grows weaker
Drop in blood pressure
Mental confusion, irritability, or hysterical behavior
Treating Heat Stroke
 Remove the patient from source of heat.
 Loosen the victim’s clothing.
 Cool the body as quickly as possible by pouring cool
water over the patient
 Contact EMS if physician is not available.
Hypothermia
 An unacceptable drop in body
temperature.
 Results from prolonged exposure to
cold or cold water
Signs and Symptoms of Hypothermia

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Shivering
Numbness and tingling throughout the body
Skin cool to the touch and is pale with blue or
ashy tinge
Shallow respirations
Disorientation
Treating Hypothermia
 Remove cold and wet clothes.
 Wrap the patient in warm blankets
 Heat packs may be used but not directly on the
skin
 Sips of warm liquid
 Transport to treatment facility for assessment
by a physician
Convulsions (Seizures)
 Produced by disorganized electrical activity in
the brain.
 Characterized by involuntary muscle
contractions that alternate between the
contraction and relaxation of muscles.
 In some cases the convulsions are generalized,
involving the entire body, or localized and limited
to a specific area of the body.
 Can result from a number of problems or
combinations of problems.
Care for Convulsions (Seizures)
 Convulsions are not life threatening themselves
 Muscle spasms of full body can restrict
breathing
 Victims may bite tongue causing bleeding and
swelling, which can the obstruct airway
 Prevent injuries
 Pay close attention to what the patient is
experiencing so that you can describe it later.
Fainting (Syncope)
 Sudden loss of consciousness.
 Seems to be caused by a brief interruption in the body’s
ability to control the brain’s circulation.
 Often occurs just after a patient has received an
emotional shock of some kind.
 Patient usually collapses and becomes unresponsive,
but within a minute, should awaken and return to
normal function.
 Patients seldom become incontinent or have seizures
as a result of simple fainting, but may be injured in the
course of a fall.
Caring for a Patient Who Has Fainted
 If the patient has fainted and there is no response,
provide oxygen if the physician orders this.
 Check the ABCs and call for help.
 If the patient is breathing well but will not wake up,
place him or her on the left side and contact the
physician.
 If the physician is unavailable, contact EMS
 Obtain a full set of vital signs and obtain a blood
sugar reading if possible.
MEDA116 – First Aid and CPR
Musculoskeletal Injuries
 Involve bones, muscles, tendons, and
ligaments
 Includes fractures, dislocations, sprains, and
strains.
 Diagnosis is made by x-ray
 Affected part must be immobilized
© 2007 Pearson Education
Fractures
 Types of fractures:
• Closed (simple)—the bone is broken but does not
penetrate the skin
• Open (compound)—the bone pierces the skin, or
the skin is torn open by the bone or by an external
force
Splinting Injuries
 Fractures of long bones
require immobilization by
splinting to prevent joint
movement above and
below the fracture.
 Splint also helps relieve
pain and allows safe
movement of the injured
part.
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
Immobilize the bones
above and below the
joint (joint fracture)
Clean and cover all
wounds before you
splint
Never try to move or
straighten a bone in a
compound fracture
Sprains and Strains
Sprain
Strain
 Occurs when muscles,
tendons, or ligaments
are torn.
 It may be the result of
trauma or cumulative
overuse of the joint.
 Often called a pulled
muscle
 Occurs when a muscle or
tendon is overextended
by stretching.
 Patient may be unable to
use the joint
 In the lower extremities,
weight-bearing is painful
and sometimes
impossible.
Dislocation
 Bone is actually pulled away from the joint,
stretching or tearing the ligaments and tendons.
 A deformity is generally noted.
 Must be reduced and the bone reinserted into
the joint.
 Injured body parts should be immobilized to
prevent additional damage and reduce pain.
 Applications of cold also help with the pain and
slow edema.
Questions?