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Standard First Aid With CPR & AED Course Objectives • Safely assess emergency situations and carry out appropriate action; contacting emergency services • Identify and understand the limits of first aid • Discuss and demonstrate the appropriate care for a casualty • Perform CPR, demonstrate appropriate first aid care, and know how to use an AED • Identify strategies that will promote a safe and healthy lifestyle Introduction to First Aid First Aiders Roles & Responsibilities First Aid Terms • First aid is the care given by first person on scene • First aider is a person who takes charge and provides care to casualties • Medical care is given by professionals, doctors, nurses, paramedics and firefighters Goals of First Aid • Preserve life • Prevent injuries or illnesses becoming worse • Promote recovery Priorities of a First Aider 1. Airway – open and clear 2. Breathing – effective breathing 3. Circulation – effective circulation (skin temperature, colour and sweating) Casualty • Adults – Puberty + years • Child – 1 to Puberty • Infant – less than 1 year old Signs & Symptoms • Signs: conditions we can see by observing a casualty (see, feel, smell, hear) • Symptoms: conditions that are reported by a casualty 5 Common Fears • Doing the wrong thing / making things worse • Personal safety • Diseases • Dealing with blood / gross situations • Getting sued The Good Samaritan Act • Identify yourself • Ask Permission • Act Reasonable ( no cutting, sewing or poking) • Stay with casualty Principle of Abandonment Once you start providing first aid to a casualty, you must continue helping unless: • It is necessary in order to activate EMS • Someone with equal or greater training takes over • Continuing to provide assistance would be unsafe • You are physically exhausted Personal Protective Equipment (PPE) • When providing first aid or CPR at a minimum put on gloves ( latex free ) • Eye protection • Use masks or face shields • Gowns Emergency Medical Services Activating EMS • Provide the dispatcher with: • the number of casualties • age and gender of casualties • condition of casualties • location of emergency • Stay on line until the dispatcher tells you it is okay to hang up • Ask dispatcher the estimated time of arrival for EMS • If a bystander calls EMS, ask them to report back to you to ensure that EMS has been activated Utilizing Bystanders • • • • • • • • Phone EMS Wait for EMS AED available Remove hazards from scene Crowd control Get supplies (e.g., blankets) Protect casualty’s belongings Write down details of incident Emergency Scene Management (ESM) Emergency Scene Management • Emergency Scene Management (ESM) is a rapid, systematic and orderly manner used to treat a casualty in an emergency • Steps to ESM • Scene Survey • Primary Survey • Secondary Survey • On Going Care Scene Survey • Check for hazards (ladder, glass, chemicals, etc.) • What is the risk to you? What, if any, further risk is there to the casualty? • What happened? • Possible spinal injury? • How many casualties are there? • Is the scene changing? • Is there an AED or First Aid kit close by? Primary Survey • Check responsiveness Level of Consciousness (1) Alert (2) Verbal (3) Painful (4) Unconscious Primary Survey • Check Airway • Check Breathing • Check Signs of Circulation Secondary Survey Talk to a responsive casualty, or ask bystanders to find out more about what happened and the casualty’s history Happened? Hurt? History? On-Going Care • Give first aid for any injuries or illness discovered during assessment • While waiting for help: • Monitor the casualty • With serious injury, repeat the ABCs, every 5 minutes • Record condition and treatment given Recovery Position An unconscious adult or child who is breathing and has no other life threatening emergencies should be placed in the recovery position Triage Assessment Breathing Bleeding Burns Bones Review: ESM Unconscious • Scene Safety • • • • M.O.I. Id. self / consent Unresponsive Call 911 • Primary survey • Secondary survey • Ongoing casualty care Conscious • Scene Safety • M.O.I. • Id. self / consent • Responsive • • • • Primary survey Secondary survey Call 911 ? Ongoing casualty care Head & Spinal Injuries Responsive Casualty Head Injuries • Concussion - bruising or swelling of the brain • Hematoma - pooling of blood in the brain • Laceration - tearing of the brain tissue General Signs & Symptoms Head Injuries •Deformity •Black Eye(s) •Bruising •Disabling headache or one of sudden onset •Unequal pupils •Paralysis •Ringing in ears •Confusion •Blood/Fluid from Eyes/Ears/Nose •Projectile vomiting Spinal Injuries • Falls from heights, sports injuries, car accidents and direct blows to spine are common causes of spinal injuries • Spinal injuries are also associated with head injuries Spinal Injuries Signs & Symptoms of a Spinal Injury • Numbness, tingling, weakness in arms and/or legs • Respiratory distress • Fluid in the ears • Deformity • Pain in back or neck • Inability to move arms and/or legs • Loss of sensation or paralysis in upper or lower extremities or below injury site Spinal Injuries • Do not move the casualty any more than necessary • Support the head and neck to prevent worsening the injury Pelvic Injuries • Broken pelvis may cause severe internal bleeding and organ damage • Foot on injured side usually turns outward • Can be a life-threatening injury even if no significant injuries can be seen • Complications include: injury to the spine and damage to the bladder Signs & Symptoms of Pelvic Injuries • Signs of pain and tenderness around the hips • Inability to walk or stand • Signs and symptoms of shock Fainting & Shock Shock Failure of the cardiovascular system to provide oxygen to cells and tissue Causes include: •External / internal bleeding •Allergies •Infection •Dehydration •Burns •Trauma •Heart attack •Nervous system injuries Signs & Symptoms of Shock • Pale Skin • Anxiety • Sweating/Clammy • Cyanosis Skin (blueness) of lips/ears • Cold • Weakness • Trembling • Nausea • Labored breathing • Thirst • Weak/rapid pulse Shock Treat the cause Rest & Reassure Warm Elevating the legs is no longer recommended The risk of further injury outweighs the benefit of elevation when a person is injured. Fainting • Fainting occurs when there is a temporary lack of oxygen to the brain, causing a person to ‘black out’ temporarily • Casualty will usually be responsive within 10 seconds Bleeding & Wound Care Bleeding • Many injuries cause external or internal bleeding • Bleeding may be minor or life threatening Types of External Bleeds Arterial Bleeding – squirting, bright red Venous Bleeding – steady flow, dark red Capillary Bleeding – dark red Control of Bleeding Direct Pressure Rest Signs of Infection Swelling Heat Ache Redness Pus External Bleeding • Amputations (partial & complete) • Embedded Objects • Nosebleeds • Scalp or Ear • Gums, tongue and cheek • Palm of the hand Abdominal Injuries • Includes closed and open wounds • Commonly result from a blow or a fall • May involve internal and/or external bleeding • Can be a life-threatening injury even if no significant injuries can be seen Abdominal Injuries • Closed abdominal injury can be life threatening. Internal organs may have ruptured and there may be serious internal bleeding • Open abdominal injury can be life threatening. May involve significant bleeding. Organs possibly protruding from wound Abdominal Injuries – Symptoms • • • • • • • Trouble breathing/shallow breath Tenderness at site of injury Deformity and bruising of chest Pain upon movement Bluish lips or nail beds May cough up blood Crackling feeling upon touching victim’s skin (ie. like “Rice Crispies”) Bites & Stings • Animal Bites • Snake Bites • Insect Bites and Stings • Leeches and Ticks • Jellyfish Stings Internal Bleeding • Any bleeding within body when blood does not escape from wound • Closed wound may cause local bruise • More serious injury can cause deeper organs to bleed severely • Can be life threatening Internal Bleeding Minor: Major: • Bruise • Abdominal • Chest • Pelvis • Head Seek Medical Attention • • • • • • • Bleeding is not easily controlled Any deep or large wound Wound is infected Any bite from an animal or human Foreign object or material embedded in the wound The casualty is unsure about tetanus vaccination The casualty may need stitches for: • • • Cuts on the face or hands when the edges do not close together Gaping wounds Cuts longer than 1 inch Burns Burns • Burns are injuries to the skin and other tissues caused by heat, radiation, electrical or chemical • They are the leading cause of injuries in the home – how can we prevent?? Severity of the Burn • The depth of the burn (degree) • The amount of body surface that is burned (rules of nine) • The part(s) of the body that is burned • The age and physical conditions of the casualty Burn Depth First Degree Second Degree Third Degree Complications • • • Shock Infection Swelling Medical Conditions Diabetes, Seizures, Asthma & Allergies Diabetic Emergency • Problem of maintaining a balance of blood sugar and insulin in body • Without treatment, can quickly progress to a medical emergency • Diabetics may carry glucose tablets in case of low blood sugar Diabetic Emergency • Type 1 - Insulin Dependent • Type 2 - Non-Insulin Dependent Low Blood Sugar = Insulin Shock (hypoglycemia) High Blood Sugar = Diabetic Coma (hyperglycemia) Low Blood Sugar • Sudden dizziness, shakiness, or mood change (even combativeness) • Headache, confusion, difficulty paying attention • Pale skin, sweating • Hunger • Clumsy, jerky movements • Possible seizure High Blood Sugar • • • • • • • Frequent urination Drowsiness Dry mouth, thirst Shortness of breath, deep rapid breathing Breath smells fruity Nausea, vomiting Eventual unresponsiveness Seizures • Caused by a sudden disruption of the brain cells • Epilepsy, brain injury, diabetes, fever, drugs, alcohol and poisoning can all cause seizures Seizures 1. Clear Area 2. Protect Head 3. 9-1-1 4. Recovery •3 H’s •Happen, Hurt, History •Follow-Up Asthma • In an asthma attack, airway becomes narrow and person has difficulty breathing • Many asthma casualties know they have the condition and carry medication for emergencies • Untreated, a severe asthma attack can be fatal Rescue 7 Inc. © Asthma • Asthmatic attacks are often caused by triggers such as cold, pollen, paint, smoke, pet hair, foods, insect bites, etc • During an attack, airflow is restricted or reduced to the lungs one of three ways: • Muscles around the air passage tighten • Inner linings of air passages swell • Amount and thickness of mucous increases Anaphylaxis • Anaphylaxis is a severe and potentially lifethreatening allergic reaction, which needs immediate medical attention • Causes include: • Insect bites and stings • Foods • Inhaled substances • Chemicals • Medications Rescue 7 Inc. © Epinephrine • Epinephrine helps the victim breathe by relaxing constricted airways in the lungs • It increases heart rate, diverts blood to the muscles, constricts blood vessels and opens the airways • The epinephrine auto-injectors delivers its dose directly into muscle Cardiovascular Diseases (CVD) Risk Factors Preventable Not preventable • • • Hereditary • Age • • • • • • • Diabetes High Blood Pressure (HBP) High Blood Cholesterol (HBC) Stress Lack of exercise Smoking Obesity Alcohol Diet Stroke & TIA Stroke & TIA Signs and Signals • • • • • • Numbness Sudden weakness Trouble speaking Vision problems Severe headache Dizziness Anatomy of the Heart The function of the heart is to circulate (pump) blood throughout the body to provide oxygen and nutrients and to remove waste products Angina & Heart Attacks Angina: A disease caused by the narrowing of the coronary artery Heart Attack: Death to an area of the HEART muscle due to a lack of oxygen Heart Attack Heart Attack Pale Indigestion Anxious Tightness S.O.B. Overall Weakness Sweat Nausea Rescue 7 Inc. © Sudden Cardiac Arrest & Cardiopulmonary Resuscitation (CPR) Sudden Cardiac Arrest Sudden cardiac arrest occurs when the heart's electrical system malfunctions and the heart stops beating effectively Time is Critical Adult CPR (One Rescuer Sequencing) 1. 2. 3. 4. 5. 6. 7. 8. 9. Assess environment Determine unresponsiveness Activate EMS Attempt to get AED Open airway Check for breathing Landmark and begin compressions Provide two rescue breaths 30 compressions:2 breaths until EMS arrives or victim responds to treatment Reminders • Ensure chest rises with each breath • Location of Hands • Depth rate: 2 inches • Allow chest to recoil completely or return to its normal position • Compression rate: 100/minute Automated External Defibrillator (AED) Introduction What is an AED??? • • • An Automated External Defibrillator (AED) is a machine that can monitor heart rhythms It can tell if the heart has stopped beating effectively If required, the machine can then deliver an electric shock to the heart How AED Units Work Defibrillators work by giving the heart a controlled electric shock, forcing all the heart muscles to contract at once, and, hopefully jolting it back into a normal heart rhythm Do AED units replace the use of CPR? • CPR's function is to circulate blood and oxygen throughout the body • The AED does not take the place of CPR • The function of an AED is to restore a normal heart rhythm Using an AED • Turn “ON” AED unit • Voice and visual instructions occur immediately • Follow prompts When pads are attached to the patient the AED will automatically assess the patient. Prompts: “Assessing heart rhythm” and “Do not touch the patient” When ready to deliver a shock, the unit will advise: • “Press the shock button now” • Button will illuminate when system is charged AED Algorithm Chain of Survival • • • • • Early activation of EMS Early CPR Early defibrillation Effective advanced life support Integrated post-cardiac arrest care Choking Effective vs. Ineffective Breathing • Effective breathing can be defined as having: a good air supply, an open airway, an intact chest wall and one functioning lung • Ineffective breathing occurs when the body is not getting enough oxygen to function Choking • • • • Unable to speak Unable to cough Hands at throat Face changing colour Choking 1. Determine severity of obstruction. 2. If mild, encourage coughing and reassure victim. 3. If severe, shout for help, start cycles of 5 back blows and 5 abdominal thrusts until airway is clear, or victim becomes unconscious. Choking 1. 2. 3. 4. 5. 6. 7. Assess environment Determine responsiveness Activate EMS Attempt to obtain AED Open airway Assess breathing Landmark and provide 30 chest compressions 8. Look in mouth for object (remove only if object seen) 9. Give one rescue breath, if it fails reposition head and try again 10. Repeat sequence until successful or EMS arrives Special Considerations Special Considerations for: • Pregnant casualty • Obese casualty • Self-Rescue END of DAY 1- Questions? Day 2 Two-Rescuer CPR Adult Two-Rescuer CPR • One rescuer delivers ventilations • The other rescuer gives chest compressions • Compressions and ventilations should remain rhythmic and uninterrupted Switch Positions • The rescuer giving chest compressions may get tired if performing CPR for an extended time • Switching positions after every five cycles improves quality of compressions • Should be accomplished smoothly and quickly Child Resuscitation Child CPR • Child is defined as a person between 1 year of age and the onset of puberty (12 to 14 years) • Depth of compressions is 1/3 the depth of the chest. • One or two hands depending on the size of the child. • Five cycles of compressions and breaths are performed before activating EMS. Infant CPR: Differences • Scratch foot to determine responsiveness. • Compression depth is 1/3 the depth of the chest. • Two fingers used for compressions (just below nipple line). • Breaths are puffs and mouth and nose are sealed with your mouth. • Five cycles of compressions and breaths are performed before activating EMS. Choking: Infant Conscious to Unconscious 1. Determine severity of obstruction. 2. Perform five back blows followed by five chest thrusts. 3. Continue until airway becomes clear or victim becomes unconscious. 4. If the infant becomes unconscious begin the infant CPR sequence. Automated External Defibrillator (AED) How AEDs work • Heart’s electrical system keeps chambers of the heart synchronized and working together • With heart attack or other heart problems, this rhythmic electrical system may be disrupted How AEDs work • Ventricular fibrillation is an abnormal heart rhythm that does not circulate blood • A shock from the AED may restore a regular rhythm—called defibrillation How AEDs work • VF is the most common cause of sudden cardiac arrest (SCA)! • The only definitive treatment for SCA is defibrillation - an electric current that "shocks" the heart so that a normal rhythm may resume Time is Important Not everyone can be saved from SCA, even with defibrillation. But early defibrillation, especially when delivered within three minutes of a person's collapse from SCA, does provide the best chance How AEDs work • Defibrillation works only if there is already electrical activity going on in the heart • A defibrillator doesn't work if a person is in flat line. Since a defibrillator stops the heart, it wouldn't make sense to stop a heart that is already stopped AED Algorithm Are AED Units Hard to Use? • AED units are very accurate and easy to use • They are automated and wont let you administer a shock unless it is necessary • If a shock is not necessary you can not override it and shock anyway • There are many different brands of AED units, but the same basic steps apply to all of them Special Cases • The casualty has a hairy chest • The casualty is immersed in water or water is covering the casualty’s chest • The casualty has an implanted defibrillator or pacemaker • The casualty has a medical patch or other objects (i.e. jewelry or metal) on the surface of the skin • The casualty is pregnant Special Cases - Hypothermia • Determining signs of circulation in hypothermia can be difficult • Handle a hypothermic casualty very carefully; jarring may cause cardiac arrest • Follow your local guidelines for AED use if you find no signs of circulation • Typically, only 3 shocks are given and then CPR is performed AED Reports The delegating medical authority should review all incidents of AED use through: 1. Review of written patient care report 2. Review of ECG tapes if the AED is so equipped, or 3. Review of the AED memory module if so equipped Secondary Survey Secondary Survey • Ask the “Three Questions” known as the THREE H’s 1. What …HAPPENED? 2. Where does it …HURT? 3. Do you have a …HISTORY? • Vital Signs • Head to toe assessment • First aid as required Vital Signs •Level of Consciousness (LOC) •Rate of Breathing •Skin Head-To-Toe Assessment • HEAD • NECK • CHEST • ABDOMEN • PELVIS • LEGS • ARMS Musculoskeletal Injuries Fractures • Bone may be completely broken or only cracked • Closed fracture is when bone does not break through skin. • Open fracture is when the bone breaks through skin. Rescue 7 Inc. © Sprains & Dislocations • Sprains are the stretching or tearing of ligaments. • Dislocations are caused by bones getting displaced in joints. Both injuries may appear like a fracture Dislocation First Aid Rest Ice Compress Elevate Splints • Any object used to immobilize a body part is called a splint • Splints help prevent further injury, reduces pain, and minimizes bleeding and swelling • Types of Splints • • • • Rigid splints Soft splints Anatomic splints Improvised splints Guidelines for Splinting • • • • • • Expose injury Control any open wound before splinting Don’t replace protruding bones Splint to immobilize entire area Put padding between splint and skin Monitor extremities (fingers or toes) to make sure circulation is not reduced Femur Fractures • Great force is normally needed to fracture the femur; therefore, assess for a spinal injury if you suspect a broken femur • Complications for a femoral fracture often include internal bleeding and severe shock Strains • Strains happen when muscles and tendons are stretched or torn • Repetitive Strain Injury (RSI) occurs when muscles and tendons are injured when they do the same movements repetitively, causing stress on the tissues Eye Injuries Common Causes of an Eye Injury • Scrap materials, waste, and windblown dust • Flying material particles or slivers from wood, metal, plastic, and cement • Chemicals or chemical products • Falling or misdirected objects • UV light from welding torches Eye Injuries Signs & Symptoms of Eye Injuries • Redness • Pain • Visual problems • Watery Eyes Eye Examinations • Compare one eye to the other • Assess for abnormalities • Assess pupils for size, shape, equality and reactivity to light Types of Eye Injuries Types of Eye Injuries • • • • • Penetrating Blow Chemical Burns Extruding Eye Foreign Object in the Eye Guidelines for an Injured Eye • Flushing – only for chemical injury and if eye is not cut • Do not remove blood clots • Don’t force eye open unless flushing • Patch both eyes • Do not allow patient to eat or drink • Have patient see doctor Extruded or Impaled Eyeball • With an extruded eyeball or an impaled object in the eye you should cover both eyes but do not apply pressure. • With an extruded eyeball, do not try to replace it, cover it with moist dressings • With an impaled object, do not attempt removal of object. Keep patient still and keep talking to or touching the patient so they know you are there. Poisons Poisons Any substance that can be harmful to the body is known as a poison. Can cause: • serious illness and death often direct result of poisoning • commonly involve unsupervised children • Adults are frequently casualty’s of medication errors and exposure to industrial chemicals • accurate assessment can prevent serious effects Rescue 7 Inc. © Routes of Poisons Ingested - by mouth Inhaled - by breathing Absorbed - through the skin or tissues Injected - entered into the blood stream Determining the M.O.I • How did the poison enter the body? • Which poison was taken? • How much poison was taken? • When was the poison taken? Poison Control Centre 1-800-268-9017 GTA: 416-813-5900 Environmental Illnesses & Injuries Heat & Cold Emergencies • Cold or hot environments cause medical problems if the body is not protected • Injuries often begin gradually but become emergencies • Untreated, these injuries can lead to serious injury or death Heat emergencies • Heat cramps are least serious and usually first to occur • Heat exhaustion develops when body becomes dehydrated in hot environment • Heatstroke is a medical emergency and, if untreated, usually causes death Heat Exhaustion • Caused by exposure to hot, humid environment. • Heat exhaustion is caused by excessive water and salt loss. • Signs include sweating, thirst, headache, weakness and nausea • Untreated, heat exhaustion may develop into heatstroke, a true medical emergency Rescue 7 Inc. © Heat Stroke • Life-threatening condition • May develop slowly over several days or more rapidly with strenuous activity in the heat • Victim may be dehydrated and not sweating • Signs of heat stroke include, hot skin, not sweating, confusion and seizures Heat Injuries Cold Injuries • Cold injuries can occur when the body is exposed to excessive cold and/or wet conditions. • The result can be injury to the direct areas exposed to the cold (frostbite) as well as a lowering of the body’s core temperature (hypothermia). Mechanisms of Heat Loss The body loses heat in five ways • • • • • Breathing Radiation Conduction Convection Evaporation Risk Factors • Heat (decrease production/increase loss) • Exercise and strenuous activity • Age • Medical condition • Medications • Physical Health Cold Injuries •Frostbite - localized freezing of skin and other tissues •Hypothermia - lowering of whole body’s temperature Frostbite • Freezing of skin or deeper tissues • Most common in exposed skin areas on head or face, hands or feet • Wind chill increases risk of frostbite • Severe frostbite kills tissue and can result in gangrene and having to amputate body part Signs & Symptoms of Frostbite • Skin looks waxy and white, gray, yellow, or bluish • Area is numb or feels tingly or aching • Severe frostbite: • • • Area feels hard May become painless After warming, area becomes swollen and may blister Hypothermia • Occurs when body cannot make heat as fast as it loses it • Body temperature dropping below 350C • Can occur whenever and wherever a person feels cold, including indoors in poorly heated areas • May occur gradually or quickly, especially with a wind chill or if victim is wet Symptoms of Hypothermia • Changing levels of responsiveness • Shivering (but stops in severe hypothermia) • Confusion, or irrational • Lethargic, drowsiness • Pale, cool skin • Slow breathing Questions? 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