Download RLSSA Emergency First Aid Certificate

RLSSA Emergency First Aid Certificate
CPR
Action Plan
D
anger
R
esponse
S
end for help
A
irway
B
reathing
C
PR
D
efibrillation
Danger
Check for dangers to:
• yourself
• bystanders
• patient
Walk 360o around the patient
Use all 6 senses
• Smell
• Sight
• Taste
• Touch
• Listen
• Common Sense
Response
Is the patient responsive?
•
•
•
•
C an you hear me?
O pen your eyes
W hat’s your name?
S queeze my hands and let go
If the patient is not responsive, and fluid
is suspected in the airway, roll the
patient into recovery position
Send for Help
Dial 000
Be prepared to give the following information
• location of the emergency (including nearby landmarks, closest
intersections etc..)
• the telephone number from where the call is being made
• what happened
• how many persons require assistance
• condition of the patient
• what assistance is being given
• any other information requested
* Never hang up before the emergency services operator hangs up
Airway
Open the airway
Tilt the patient’s head back to remove
tongue from the airway
Clear the airway
Check to see the airway is free from obstructions
In an unconscious patient, care of the airway takes precedence
over ANY injury
Breathing
Normal Breathing?
Check for signs of life
• consciousness, responsiveness, movement and normal breathing
Look, Listen, Feel
• Look - for rise and fall of the chest
• Listen - for breathing noises
• Feel - for rise and fall of chest and for
breath on cheek
* For drowning related emergencies give 2 rescue breaths prior to
commencing CPR
CPR - 30 : 2
If no signs of life are present give:
30 chest compressions,
followed by 2 breaths
Push FIRM
Push FAST
Centre of the chest
• compressions applied too high are ineffective
• compressions applied too low may cause regurgitation and/or
damage to the vital organs
The centre of the chest (sternum) should be depressed by a third of
the chest depth
2 Breaths
Pistol grip
Take a breath for yourself
Breath into patient
Watch for rise and fall of chest
Defibrillator
Automated External Defibrillator
Attach AED (if available) as soon as possible and follow the prompts
C – CPR
D – Dangers
Give 30 chest compressions
Followed by 2 breaths
Check for dangers
Continue until qualified help arrives
or normal breathing returns
For drowning related emergencies give 2 rescue
breaths prior to commencing CPR
R – Response
Check for response
No response
D – Defibrillation
S - Send for help
Attach AED
(automated external defibrillator)
Call 000
and follow prompts
A – Airway
Open Airway
Clear the airway
NO
Place in recovery position
Monitor vital signs
Provide oxygen
B – Breathing
Look, Listen & Feel for
breathing
Responsive? Breathing
normally?
YES
Rescue Breathing
Mouth to mouth
• used when no pocket mask is available
Mouth to mask
• should always be used by First Aiders
• minimises transfer of communicable diseases
• provides mouth to mouth & nose resuscitation
Mouth to nose
• can be administered in deep water
• mouth to mouth and nose
• used to resuscitate infants
Mouth to mouth and nose
• breath is applied to both the mouth and nose
• done to infants
Mouth to neck stoma
• breath is applied to tube in neck
Techniques
Head Tilt:
ADULTS
CHILDREN
INFANTS
Full
Full
Neutral
Breath Size:
Rise and fall of the chest
Compression
Depth:
1/3 depth of the chest
Compression
Point:
Visual – Centre of the chest
Compression
Method:
2 Hands
1 or 2 Hands
2 Fingers
DRSABCD
CPR is the technique of rescue breathing combined with chest
compressions
The purpose of CPR is to temporarily maintain a circulation
sufficient to preserve brain function until specialised treatment is
available
CPR should be continued until:
• signs of life return
• qualified help arrives and takes over
• it is impossible to continue
• danger returns
ADULTS
Aged 8 years old
plus
CHILDREN
Aged 1 year old to 8
years old
30 compressions
2 breaths
5 cycles in 2 minutes
Almost 2 compressions per second
INFANTS
Aged up-to 12
months
“Thirty & Two That’s All You Do”
Multiple rescuers
It is recommended that frequent rotation of rescuers is undertaken to
reduce fatigue
* approximately every 2 minutes
“Thirty & Two That’s All You Do”
DRSABC - Infant
D anger
The assessment for danger remains the
same
R esponse
• make loud noises such as clapping
• blow air in the infants face
• run fingers along the arches of the
feet
• place finger inside of hands
S end for Help
• Call 000
A irway
• Both mouth and nose should be cleared
- Nose can be cleared using the
‘milking’ technique
•
Open airway is achieved with head in
neutral position
B reathing – Normal Breathing
• Look, listen and feel
- Check for signs of life
C PR
• 30 compressions followed by 2 breaths
Mouth-to-mouth-and-nose rescue
breathing
• 2 fingers on lower half of the sternum
Vomit / Regurgitation
Vomit
Regurgitation
•
•
•
•
•
•
•
•
•
•
a voluntary response
abdominal muscular contraction
occurs
removal is often forceful and
projectile
often appears “chunky”
a good sign – something is
working
an involuntary response
the stomach distends
the contents ooze out
often appears “frothy”
a bad sign – often caused by:
• over inflation
• insufficient head tilt
• not allowing enough time
between breaths
• compressing on the
stomach
If the patient vomits or regurgitates during resuscitation they should
immediately be rolled onto their side and airway cleared.
If no signs of life are present, rescuer should continue with rescue breathing
and compressions.
If regurgitation is suspected you may be required to adjust:
•
head tilt
•
breath size
•
breath frequency
DRSABCD - Choking
Choking can be present in a conscious or unconscious patient
• varied severity
• some typical causes:
• relaxation of the airway muscles due to unconsciousness
• inhaled foreign body
• trauma to the airway
• anaphylactic reaction
• may be gradual or sudden onset
Some of the signs in a conscious patient:
• anxiety, agitation, gasping sounds, coughing, loss of voice, clutching
at neck with thumb and fingers
Mild Obstruction
• breathing is labored
• breathing may be noisy
• some escape of air can be felt from the mouth
Severe Obstruction
• there may be efforts at breathing
• there is no sound of breathing
• there is no escape of air from nose and/or mouth
The simplest way to determine the severity of a foreign body
airway obstruction is to assess for ineffective or effective cough
Effective cough (Mild Airway Obstruction)
•
•
•
give reassurance
encourage to keep coughing
if obstruction is not relieved, rescuer should CALL 000
Ineffective cough
(Severe Airway Obstruction)
Conscious patient - CALL 000
Perform up to 5 sharp back blows
• heel of hand between shoulder blades
• check for removal of obstruction between each back blow
If back blows aren’t successful, perform up to 5 chest thrusts
• use CPR compression point
• similar to CPR compressions but sharper and delivered at a slower rate
• check for removal of obstruction between each chest thrust
Continue to alternate between back blows and chest thrusts if obstruction
is not relieved
Ineffective cough
(Severe Airway Obstruction)
Unconscious patient:
CALL 000
If solid material is visible in the airway sweep it out using your fingers
Commence CPR
Assess Severity
Effective Cough
Mild Airway Obstruction
Ineffective Cough
Severe Airway Obstruction
Conscious
Unconscious
Encourage Coughing
Continue to check
patient until recovery
or deterioration
Call ambulance
Call ambulance
Call ambulance
Give up to 5
Back Blows
If not effective
Give up to 5
Chest Thrusts
Commence CPR
Left Lateral Tilt
When a heavily pregnant women is lying on her back, the fetus can compress a
major blood vessel of the mother (inferior vena cava).
This can be minimised by providing sufficient padding under her right buttock, to
provide an obvious pelvic tilt to the left whilst leaving the shoulders flat on the
floor.
“Mothers are always right, padding the right buttock”
Talking In An Untrained Bystander
If you believe that there is a responsible bystander that you could use
for 2-operator CPR
and
the patient would benefit more from receiving 2-operator CPR, you have
the choice of talking in an untrained bystander in the situation that you do
not have a second trained person to assist.
There are many ways to approach talking in an untrained bystander.
Some examples:
•
•
ask whether the bystander is prepared to help
establish whether they have any First Aid experience
• ask them to kneel on the opposite side and place hands on the
ground and do what you are doing
• ask them to place their hands on top of yours to gauge the depth of
compressions
• ask them to count the compressions for you
• ask them to place their hands on the patient and compress with
you
• when you believe they are ready, let them take over the
compressions
• do not rush the change over
• the experienced rescuer must always remain at the head
First Aid
Definition
Emergency care provided for injury or sudden illness before medical
care is available
THE 5 P’s
Preserve life
Prevent further injury
Protect the unconscious
Promote recovery
Procure medical aid (access medical aid)
Responsibilities of the First Aid provider
Ensure personal health and safety
• maintain a caring attitude
• maintain composure
• maintain up to date knowledge and skills
Priorities of Care –
Approach to an incident
Approach to an incident:
• Primary survey
• Assessment of vital signs
• Secondary survey
This approach will
• reduce risk to yourself or others
• provide a more thorough examination
• prioritise the patient’s injuries so as to enable management in
order of severity
OH&S
Duties of employers
Employers are expected to make every reasonable effort to provide a
safe & healthy workplace.
This involves the provision of safe equipment, safe plant, safe
procedures, appropriate training and welfare facilities
Duties of employees
Employees are expected to make every reasonable effort to secure the
health and safety of both themselves and others at work
Role of the occupational First Aid provider
Duties may include:
•
•
•
•
provision of first aid
maintenance of first aid kits and facilities
identification of potential hazards
maintenance of records & other tasks
First Aid Kits
Pocket mask
Gloves (disposable)
Telephone numbers of
emergency services
First Aid manual
Cotton bandages
(various sizes)
Triangular bandages
Adhesive tape
Sterile wound dressings
(various sizes)
Sterile saline
(for wound irrigation)
Sterile eye pads
Scissors
Notebook
Alcohol swabs
Accident report forms
Pens
Additional Items (home or specialized kits)
Sun Screen
Tweezers
Vinegar
Asthma reliever &
spacer
Space blankets
Band-Aids
Cross Infection
Can be minimised by:
•
•
•
•
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attempting to avoid contact with blood and other bodily fluids
use of protective devices such as disposable gloves & resuscitation masks
being vigilant for sharp objects such as syringes or broken glass
always washing hands thoroughly following, and if possible prior to the
provision of first aid
being immunised against communicable diseases such as Hepatitis B
Seek medical advise in the
case of exposure
Legalities
There is no legal obligation to act as a “Good Samaritan”. You may
have a moral obligation to help someone in need, otherwise you may
owe a duty of care.
Duty of Care
Common examples:
Teachers
 Students
Employer
 Employees
Gym Instructor  Gym Patrons
Motorist
 Other Motorists & Pedestrians
A duty of care is established if:
• it is a legal obligation and / or
• once first aid begins
Negligence
• For a First Aid provider to be found negligent (civil liability), the following
need to be considered:
• Did the provider owe a duty of care to the patient?
• Did the provider act outside their level of training (standard of care)?
• Did the provision of First Aid result in damage or loss to any persons or
property?
Consent
• Consent must be gained before initiating any First Aid
• verbally ask for permission/consent
• if a minor, ask parent or guardian
• if unconscious, consent is assumed
Secondary Survey
Vital Signs Survey
Vital Signs Survey
• Checking the patients vital signs at regular intervals (e.g., 1 minute)
Breathing rate and depth
• (Average adult 10-20 breaths per minute)
• (Average infant 30-50 breaths per minute)
Heart rate
• (Average adult resting 60-90 beats per minute)
• (Average child resting 70-110 beats per minute)
• (Infants resting up to 150 beats per minute)
Responsiveness
• Hearing, movement in the eyes
• Able to answer questions, movement from limbs
Secondary Survey
We are looking for:
B leeding
B urns
F ractures
O ther things - Signs & Symptoms
Secondary Survey - DOLOR
Assessment of responsive patient (DOLOR)
D escription
- ask the patient to describe the problem
O nset & Duration - ask the patient when the problem arose & how it
has progressed
L ocation
- ask the patient where on the body the problem is
O ther Signs and Symptoms
• Signs: Things you can see
• Symptoms: Things the patient can feel
• Do you notice any other signs?
• Is the patient aware of any other symptoms?
R elief - has anything provided relief? For example:
• rest
• position
• medication
Secondary Survey
Assessing Conscious / Unconscious patient using Head to Toe examination
Head
• look and feel for bleeding and bumps
• check for fluid discharge from ears and nose
• check the eyes for any signs of injuries
Neck
Look at and feel the back of the neck gently for
tenderness & irregularities.
If there are any concerns of potential spinal injuries,
do not move the patient, unless they become
unresponsive or are in immediate life threatening
danger
Back / chest / abdomen
• ask a responsive patient to inhale deeply and
see if it causes discomfort
• look at & feel the chest, back and abdomen
for irregularities and tenderness
Limbs
• look for an injury and/or deformity
• check from the extremities moving toward the
trunk, feeling for irregularities
• check for altered strength and sensation
Check gloves after each section for bodily fluids
Prioritising Patients
Multiple Patients
Treat unconscious patients first because they are unable to protect
their airway or protect themselves from external dangers
Triage – prioritises patients in order of urgency of management
Reporting
All items included in reports must be factual,
and not express personal opinion
Example:
The patient appeared intoxicated
(incorrect)
Vs.
The patient’s breath smelt ‘fruity’
(correct)
Medical Emergencies
Fainting and Shock
Condition
Fainting is caused by an inadequate blood
supply to the brain.
It’s reduced in severity compared to shock.
Shock is caused by lack of oxygen supply
to the vital organs.
Causes of Fainting
• prolonged periods of standing
• emotional distress
• low fluids or food
Causes of Shock
• heart failure
• inadequate blood volume/blood loss
• external or internal bleeding
• leaky or dilated vessels
• inadequate O² in blood
With Shock the body responds by:
• vasoconstriction
• increased heart rate
• increased breathing rate
Signs & Symptoms
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tingling (poor circulation)
light-headedness, dizziness
nausea
pale, cold clammy skin
brief period of unresponsiveness (1 to 2 minutes)
rapid, weak pulse & Rapid, shallow breathing
altered responsiveness
thirst
weakness
collapse
Management of Fainting and Shock
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Primary survey
lay patient down with legs elevated
treat cause, if possible (i.e. bleeding)
reassurance
monitor & record vital signs
provide oxygen, if able
maintain thermal comfort
seek medical assistance
Easy to remember treatment
The easiest way to remember the treatment of Fainting or Shock is:
If the face is pale raise the tail,
If the face is red raise the head,
If the face is blue they’re almost through
Blood Vessels
Blood Vessels – Types
Arteries:
carry oxygenated blood through the body from the heart
to all other organs
Veins:
carry the carbon dioxide rich blood from the organs to the
heart
Capillaries:
are the smallest blood vessels where the exchange of the
O² to CO² happens
Bleeding
Arteries :
• rapid & profuse (usually spurts)
• bright red
Veins :
• flows from wound at steady rate
• dark red
Capillaries :
• gently oozes from wound
Blood consists of:
Plasma (50-60%) - contains salts, sugar, etc
Red blood cells (40-50%) - contain haemoglobin to carry oxygen
White blood cells - fight infection
Platelets - clotting agents
Wounds
Types Of Wounds
Abrasions
• scrapes on the surface of the skin with damage
to small capillaries
Lacerations & Incisions
• cuts, usually caused by sharp objects such as a
knife or piece of glass
• lacerations have ragged edges
• incisions have smooth edges
Avulsions
• where a flap of skin and/or flesh has been totally
or partially removed
Puncture Wound
• occurs when a sharp, pointy object has
penetrated the flesh
Embedded Object
• wound with an embedded object still in place
Amputation
• occurs when a body part has been severed
Minor Wounds
Definition:
•
•
•
superficial
small surface area
(<2.5cm)
bleeding ceases quickly
Seek medical attention if:
•
•
•
•
•
there is any doubt about the severity of the wound
the wound cannot be easily cleaned
infection is a concern (there is a greater risk of infection with large
abrasions)
stitches may be required
tetanus immunisation may be necessary
Management
•
wash in clean, running water
•
clean thoroughly, take special care with large abrasions to ensure
any debris is removed
•
dry using sterile gauze
•
cover with a clean dressing
Avulsions:
•
flap of skin should not be removed
unless it’s very small
•
large flaps of skin or appendages
should be returned to normal position
before applying the sterile dressing /
bandage
Nose Bleeds
Nose bleeds may occur as a result of a direct trauma
or may occur spontaneously.
Management
• ask the patient to firmly squeeze the fleshy part of the nose, below the
bone
• position the patient sitting upright, with their head slightly forward
• ask the patient to breathe through their mouth and avoid swallowing any
blood (can cause vomiting)
• seek medical aid if the bleeding time exceeds 10 minutes
It is best not to apply pressure to a suspected broken nose
Major Wounds
Puncture Wounds
With a deep puncture wound, even
though external bleeding may be
minimal, there is a risk that internal
organs may have been damaged.
There is also a high risk of infection so
medical aid should be sought.
Embedded Objects
Sometimes objects are embedded at the wound site.
Where possible, these objects should be left in place.
Attempting to remove the object can cause further
damage and can exacerbate the bleeding.
Management
• apply pressure to the wound site
• elevate the affected area
• apply a ring/donut bandage around the object
• dress around the wound without applying
pressure to the embedded object
Management
P.E.R.
•
•
•
•
•
•
•
•
•
Pressure – Elevation - Rest
conduct a primary survey & act accordingly
apply direct pressure to the wound site
apply a sterile dressing, followed by a pad & bandage where possible
elevate injured site if possible
call the ambulance (if required)
keep patient still and reassure them
monitor vital signs and treat for shock if required
provide supplemental oxygen (if available)
seek medical attention (if required)
If bleeding continues through the pad:
•
•
apply another pad and bandage (over the original pad and bandage)
continue to apply direct pressure
Amputations
Management of the stump
• P.E.R
Management of the Severed Part
• wrap the body part in a clean, sterile, nonadhesive dressing if possible
• place the body part in a sealed plastic bag or
container
• place the sealed body part in a container of icy
water
• do not allow part to come into direct contact with
ice or water
• seek urgent medical assistance
Crush Injury
A crush injury involves changes in blood, decreased volume of fluid in the
blood vessel (hypovolemic shock), and kidney failure.
Generally the patient is protected from these effects until the crush object is
released.
Management
ARC guidelines recommend if safe and physically possible,
all crushing forces should be removed as soon as possible
after the crush injury.
If a crushing force is applied to the head, neck, chest or
abdomen and is not removed promptly death may ensue
from breathing failure, heart failure or blood loss.
* DO NOT use a tourniquet for the First Aid management of a crush injury *
Internal Bleeding
Internal bleeding may be suspected, depending on:
•
type of trauma the patient has undergone
•
patient’s past medical history (e.g., stomach ulcers)
•
patient has signs and symptoms of shock
•
pain and swelling in the affected area
•
coughing up blood, ‘dark brown’ blood in vomit or excretion of blood
from urinary or digestive system
Management
•
•
•
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•
•
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seek urgent medical aid
conduct a primary survey and act accordingly
lay patient down, if possible, and raise legs slightly
keep still and reassure
thermoregulation
provide supplementary oxygen (if available)
monitor vital signs
conduct a secondary survey (if appropriate)
give nothing by mouth
Burns
Sources Of Burns
•
flames
•
hot objects
•
hot air
•
hot water and steam
•
chemicals
•
radiation
•
electricity
•
cold
When To Call 000
Ambulance is recommended for any:
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•
•
•
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flame burn the size of the patient’s palm
flame or scald burn involving the hands, face,
perineum or genitals
chemical burns
electrical burns
burns with suspected respiratory tract
involvement
infant or child with any type of burn
Types Of Burns
Superficial burn
Only the top layer of skin is involved (e.g. sunburn)
Partial Thickness Burn
The top layer and part of the next layer have been burnt
Full Thickness Burn
• both outer layers have been damaged, and possibly the
subcutaneous tissue being affected
• this can result in damage to fat, muscles, blood vessels
and nerve endings
Summary Of Burns
Superficial
Partial
Full
Redness
Severe pain
Painless
Pain
Redness
Swelling
Blistering
Itchy feeling
Weeping from
the burn when
blisters burst
Cracked and dry
appearance
White or charred
appearance
Mottled skin
General Burns
Management
•
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assess for dangers including flames, chemicals and noxious gases emitted
First Aid providers should not expose themselves or others to any of these
dangers
remove patient to safe environment
conduct a primary survey and act accordingly
arrange medical aid (as appropriate)
immediately cool the affected area with water for up to 20 minutes
only danger affected areas should be cooled due to the risk of patient
overcooling (greater concern with infants or children)
Do not use ice (as there is a possibility of sending a person into shock)
Do
• remove all rings, watches and other jewellery from the affected area
• elevate burn limbs (where feasible)
• cover burn area with a clean, sterile, lint-free dressing
• provide oxygen (if available)
Do Not
• peel off adherent clothing
• burst blisters
• apply ointments or lotions
Thermal Burns
Management of Burns caused by Flame or Scalding
•
•
•
remove any covering of material, especially if no water for flushing is
available
ensure no hot water is trapped within the patient’s skin folds
(especially children)
continue to cool the site, despite the application of dressing
Inhalation
Inhalation of hot gases or flame can cause burns along the respiratory tract
that can result in swelling and possible airway obstruction.
In addition, inhalation of smoke and toxic gases can result in breathing
distress and a variety of serious problems.
Management
• seek urgent medical aid
• conduct a primary survey and act accordingly
• provide supplemental oxygen (if available)
Chemical Burns
Sources of Chemical Burns:
• household cleaning agents
• pool or spa chemicals
• gardening and farm sprays
• car batteries
• industrial chemicals
Both acid and base chemicals can damage body tissues, causing them to
release heat. Base burns are more serious than acid burns as they can
penetrate further into the body.
Management
•
avoid / neutralise any dangers
•
brush any powdered chemical off patient
•
flush with fresh, cool water for 20-30 minutes
•
ensure that chemicals are not accessible by children
•
always keep Material Safety Data Sheets with chemicals
Electric & Lightning Burns
Electrical burns can be caused by faulty or misuse of electrical appliances.
In some accidents, downed power lines are a potential source of severe
electrical burns.
•
•
•
•
consider DANGER when dealing with electrical burns
turn off power
if power lines are down, avoid coming close than at least 8-10 meters
to the lines
DO NOT attempt to move power lines, even with non-conductive
material as at high voltage electrocution is still possible
Lightning strikes cause a large number of deaths each year.
If caught outside in an electrical storm,
stay clear of:
•
•
•
•
tall trees or poles
bodies of water
metallic machinery and objects
most can occur on hilltops or in open spaces
Electrical burns are characterized by entry and exit wounds, which may
appear minimal.
Electricity may have passed through and damaged internal organs
resulting in:
• no breathing
• irregular or no heart beat
• damage to internal muscles and tissues
• fractures
Management
It is important to:
•
avoid / neutralise electrical and other dangers
•
conduct a primary survey and act accordingly
•
arrange medical aid, as required
•
treat burn as appropriate
Soft Tissue Injuries
Fractures
Definition - A fracture is a break in a bone.
Sometimes a fracture may be a single, clean break or there may be a number
of breaks.
Children often suffer a “greenstick” fracture, which is the splintering of a bone.
Fractures are usually defined as either:
Closed
Where the overlying skin is unbroken
or
Open
Where there is an open wound at the fracture site. The fracture can also cause
damage to underlying organs – this is known as a COMPLICATED fracture.
Serious internal bleeding can result from fractures of major bones such
as the femur or pelvis.
Causes
Direct force
• a bone is broken at the site of impact
Indirect force
• a bone breaks some distance from the
point of impact as a result of pressure
e.g. arm breaks from bracing a fall by
putting hands out
Abnormal muscular contraction
• a fracture can occur due to a “sudden”
muscular contraction.
* often associated with electrocution *
Recognition
• pain at or near the site of
fracture
• difficulty/inability to move
the injured part
• swelling
• deformity
• grating of bone
• tenderness
• possible shock
Management Of Fractures
Responsive patient
Unresponsive patient
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•
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Conduct a primary survey & act accordingly
The main aim is to prevent any movement at the site of the
fracture
If unsure, keep the patient still & comfortable and call
the ambulance
Immobilise the joint above or below the fracture site, if
possible
Splint in a position of comfort for the patient
Do not attempt to realign a badly deformed limb.
Where possible, an immobilized fractured limb should be
elevated
Treat for shock
Support a fractured jaw with the hand
If necessary, pull the lower jaw forward to keep the
airway open
•
•
•
Arrange urgent medical
assistance
Immediately place the patient in
the lateral position
Conduct a primary survey & vital
signs survey, and act accordingly
Provide supplemental oxygen is
possible
First Aid providers may need to improvise by:
•
•
•
tying shoelaces together to avoid feet moving when a fractured foot is suspected
using a long sleeve t-shirt to support arm by pulling arm through top and over shoulder
using a branch as a splint
Contusions & Bruises
•
•
•
•
arise after trauma to a site
trauma usually occurs as a result of a
blow to the area
underlying blood vessels are damaged &
dark, purple discolouration arises at the
site
changes colour as it starts to heal
(yellowish green) as the water material is
naturally removed
Sprains & Strains
Sprains:
Occur at the joint
• usually occur as a result of stretching and
possibly tearing of the ligaments or other
tissues at the joint
• swelling at the site quickly follows the
injury to the joint
• this acts as a protective mechanism to
stop further movement at the site
Strains:
• usually associated with muscles & tendons which attach the muscle to
the bone.
• can be caused by overuse or putting excessive load on a muscle or
muscle group.
• it can also occur if muscles are not warmed up properly prior to
strenuous use.
Varied severity
• mild discomfort with minor muscle damage
• complete tearing of the muscle resulting in
loss of use
Bruises, Sprains & Strains
Management
RICER/D
R est
•
ensure no further stress is placed on the injury
I ce
•
•
•
•
•
apply an ice pack or cold compress to the injured site
ice pack or cold compress should be wrapped in a damp cloth,
rather than being applied directly to the skin
the pack/compress should be applied for 10-20 mins ON/OFF
ice should not be applied to the head, genitals or nipples
ice can be applied for approx 48 hours after injury
C ompression
•
•
a compression bandage should be applied to the injured area
the bandage should not be so tight as to restrict circulation
E levation
•
the injured area should be elevated to minimise swelling and
facilitate the healing process
D iagnosis or R eferral
•
medical advice should be sought if you are at all unsure of the
extent of the injury
Dislocation
Definition
A joint is the site where bones join, and are often enclosed in a
capsule with surrounding ligaments and tendons
A dislocation is when there is a displacement at a joint.
In a dislocation, ligaments and tendons can become damaged and
it is also possible for the bones involved to fracture.
Main signs of dislocation:
• Deformed appearance
• Pain
• Inability to move joint normally
• If sensation and circulation beyond the
injured joint are impaired, urgent medical
assessment is required.
Dislocated Elbow
Management
•
•
•
•
immobilise the dislocated joint in the position found
patient need to be comforted and reassured
ambulance transport should be arranged if required
the First Aid provider should be aware that there is a strong
possibility that a fracture could also have occurred.
Bandaging
How to make a donut bandage
How to make a collar and cuff sling
The Elevation sling
Place bandage with apex pointing to elbow over the arm,
tuck in under the arm,
then twist both ends then tie off the two ends on the uninjured side
Lower Arm sling
Place bandage with apex to elbow over patients chest, bring
opposite end over patients arm,
tie off on injured side then twist remaining bandage at elbow.
Tuck in loose end.
Head bandage (pirate hat)
Place bandage over head, tying off at the back
Tucking in loose flap over the tie off
Criss-cross over loose flap and bring ends over to front
Criss-cross over to back and tie off ends at the back
Hand bandage (glove)
Fold over the end of the bandage and place over knee,
place fist on top of the bandage,
bring loose end over the fist.
Criss-cross the two sides over the fist.
Bring the loose bit over the tie off
Criss-cross again and tie off
Fractures / breaks
Place the patient’s injured part on a splint,
ask patient to assist you in order to minimise the pain they are experiencing,
using a long triangular bandage, tie off above and below the break.
Leave injured area exposed
Immobilisation
Place injured limb still in a comfortable position,
place a splint between the limbs bring uninjured to injured.
Using the natural hollows place bandage in and under the limb
Tie off the limbs on the uninjured side.
You can use the patient’s shoe laces if bandages are in short supply.
Pressure Immobilisation Technique
(P.I.T.)
Note: it is a good idea to mark the bite site on the bandage with a cross to
assist medical personnel to locate where the bite is.
Commencing at the bite site work your way down to the fingers,
Leave fingernails exposed
Work back up the arm covering two-thirds of the bandage at each turn of
the bandage.
Continue bandaging all the way up to the nearest lymph node.
P.E.R. (pressure, elevation, rest)
Place pad on injured area,
commence from bottom moving up over lapping ends of roller bandage.
Once completed tie off and elevate
Head Injuries
Head injuries, skull, facial and spinal fractures can all be caused by direct
trauma to those regions. These injuries can also occur without direct trauma
(e.g. a person who has been involved in a car accident, especially where the
car has rolled over, is a prime suspect for sustaining a spinal or head injury)
Other possible causes include:
• gunshot wound
• contact sports
• blow to the head
Patients with suspected head or spinal injuries should be kept as still as
possible. There are only 2 exceptions to this:
• if the patient’s airway is compromised
• if the patient is in a dangerous environment
If the patient needs to be moved then extreme caution should be taken to
minimise any twisting or turning movements to the patient’s head, neck or back
Concussion
Concussion is usually caused by head trauma to the head causing the brain to
be “shaken” inside the skull. This can result in a temporary impairment of
brain function which usually lasts for a relatively short period.
The patient may experience:
• brief period of unresponsiveness
• dizziness
• nausea, vomiting
• headache
• blurred vision
• confusion, loss of short term memory
In mild cases, these symptoms should resolve relatively quickly but medical
advice should still be sought.
The First Aid provider should closely observe for signs of deterioration which
could indicate the likelihood of a more serious head injury such as fractured
skull or cerebral compression.
In this situation, medical advice must be sought immediately.
Tolerance to future similar injuries decreases and repeated head blows can
result in permanent damage.
Scalp Wounds
Scalp wounds tend to bleed heavily because the scalp itself has a very rich blood
supply.
The wound should be treated in the same manner as normal wound care, except
the First Aid provider needs to be aware that there could be associated head
injuries.
A cold compress should be used on the injury as opposed to ice.
Fractured Skull,
Cerebral Compression
Cerebral Compression
Head trauma can result in a skull fracture and/or bleeding within the skull.
As the skull is rigid it does not expand to accommodate additional fluid builtup. The soft brain can become compressed, affecting brain function and
possibly causing brain damage.
A fracture to the base of the skull may, along with internal bleeding and brain
compression, also cause leakage of cerebral fluid from the ears or nose.
Fractured Skull
Recognition
• possible period of unresponsiveness
• headache
• nausea & vomiting
• reduced responsiveness
• visual problems
• numbness, tingling
• paralysis
• convulsions
• altered breathing pattern
• breathing stops
• discharge from fluid from ears nose or mouth
• bruising around the eyes and behind the ears
• bleeding into the whites of the eyes
• unequal or slow responding pupils
Management of Head Injuries
(Consider the possibility of spinal injury)
If responsive:
• keep patient still and reassure them
• continually monitor the vital signs
• seek medical advice
If skull fracture or cerebral compression
is suspected:
• seek urgent medical assistance
• in the event of discharge from the ear, do
not plug the ear but cover lightly with a
sterile pad, allowing the ear to drain
(injured side down)
• provide supplemental oxygen if available
If unresponsive:
• conduct a primary survey
(use jaw thrust)
• seek urgent medical
assistance
• provide supplemental
oxygen if available
Eye Injury
Definition and recognition
Eye injuries can result from causes such as direct trauma, flash burns and chemical
contamination. Other conditions such as infection, allergies and certain other
medical conditions can affect the function of the eye.
The danger with all eye injuries is the possibility of permanent impairment, so if
at all concerned about the injury, medical advice should be sought immediately.
Recognition
• pain or irritation in the eye
• tears
• impairment or loss of vision
• light sensitivity (photophobia)
• swelling or closure of the eye
• bleeding within the eye
• loss of blood or fluid from the eye
• visible foreign body within the eye
General (management will vary depending in injury)
• keep the patient still and comfortable
• place a sterile pad over the affected eye
• avoid putting any pressure on the affected eye
• encourage the patient not to blink or to move either eye
• seek medical advice
• never place any object in eye, including fingers
Small foreign body
• encourage patient to blink several times
• flush the affected eye with clean water or saline
• seek medical aid if problem persists
Embedded object
• do not remove the object
• try to place a protective cover around and over
the injured eye (e.g. polystyrene cup) but avoid
putting any pressure on eye or object
• seek urgent medical aid
Chemical injury
• rinse the affected eye for at least 15 minutes with
copious fresh, clean flowing water, ensuring that
fluid does not enter the uninjured eye
• seek urgent medical aid
Teeth
Teeth can get dislodged or ‘knocked out’ from a blow to the mouth, often
associated with contact sports.
Management
• Put tooth back in ASAP
• Do not wash tooth
• Ask patient to bite down
• Keep tongue away from hole where tooth was
• Avoid drinking so as not to disturb clotting
• Can preserve tooth in saliva or milk
Spinal Injury
Definition
The spine consists of the spinal column and the spinal cord.
The column is made up of a series of bones called
vertebrae, separated by cartilage known as discs.
These discs act as shock absorbers during movement.
The spinal cord is made up of bundles of nerves and passes
through holes in the vertebrae. It acts as a pathway for
impulses between the brain and the rest of the body, and is
also involved in reflex actions. Nerve tracts run from the
spinal cord, through the gaps in the vertebrae to various
parts of the body.
•
Injuries to the spine may involve the body spinal column or the cord,
or both.
•
Injuries to the spinal cord may arise through fractures in the vertebrae
causing damage to the cord, which can be compressed or severed
(partially or totally). Injury can worsen as a result of swelling and
bleeding at the site.
•
There is also the potential to worsen some spinal injuries by
inappropriate handling of the patient.
• Spinal injuries are most often
associated with motor vehicle and
diving accidents, but can also be
caused by a number of other
mechanisms.
• When assessing the patient, the best
indicator of a possible spinal injury is
the history of the accident.
Breakdown
What happens to the spine when injured
C1-C7
Quadriplegic (neck down)
T1-T12
Paraplegic (with additional
damage to nerves)
L1-L5
Paraplegic (waist down)
S1-S5
Sacral
CX1 – CX4 Coccyc
Depending on the extent of the
spinal injury this is what area of
the body can be affected.
Likelihood
Incidents with high likelihood of spinal injury
•
•
•
•
patient falling, or having an object fall upon them, from a distance
greater than the patient’s height
Any penetrating injury, or injury involving major blunt force to the
head, neck or trunk
Any accident involving a pedestrian, cyclist, motorcyclist or patient
thrown from a vehicle
Diving and surfing accidents
Recognition
•
•
•
•
•
•
•
•
history of the incident
pain or discomfort in the neck or back region
altered sensation, movement or strength in the limbs or trunk
irregular bumps on the neck or back
slow pulse rate (50-60bpm)
erection in injured males (priapism).
does not necessarily mean no movement possible
diaphragmatic breathing
Management
If responsive:
• conduct Primary, Vital Signs and
Secondary Surveys and act accordingly
• use double trapezius grip and log roll to
move patient
• arrange urgent medical assistance
• keep the patient still and reassure them
• thermoregulation
• minimise any movement of the head and
spinal column
• manage any other injuries
• provide supplemental oxygen if available
Avoid YES/NO questions
• Ask When, Where, How, With, Who
questions
• Avoid Does, Can, If & Is questions
If unresponsive:
• arrange urgent medical
assistance
• conduct a Primary Survey and
act accordingly
• use jaw thrust method for
Rescue Breathing if required
• support the patients head and
neck, avoiding any twisting or
forward movement of the neck
(jaw thrust)
• thermoregulation
• continually monitor vital signs
Respiratory Conditions
Asthma
Asthma is an allergic reaction resulting in the narrowing of the smaller airways.
This narrowing is brought about by three mechanisms:
• acute narrowing and spasm of small air passages
• swelling of the airway lining
• secretion of mucus in the airway
“Preventer” medications, taken daily, act to
prevent the swelling and mucus secretion.
“Reliever” medications are taken to open the
small airways in the event of an asthma attack.
Triggers of Asthma:
•
•
•
•
•
changes in weather
allergies
upper respiratory tract infection
exercise
nervous tension
Recognition
Mild Cases
More Severe:
Very Severe:
Cough
Pale
Exhaustion
Rapid
breathing
Distressed, anxious
Altered
responsiveness
Wheeze
Fighting for breath
Cyanosis (blueness)
Rapid pulse
Aspiratory /
Expiratory wheeze
Difficulty / unable to
speak
No wheeze at all
Management
If responsive:
• reassure & encourage slow breathing with
arms elevated
• assist patient into a position of comfort
(they often prefer to have upper body
upright)
• 4 puffs of a bronchodilator (reliever) should
be taken every 4 minutes
• if there is no immediate improvement after
initial administration of medication or in
severe attack, call an ambulance promptly
• in a severe attack 6-8 puffs may be given to
an adult every 5 minutes
• even if medication appears to be effective,
medical advice should be sought
• spacers used with the aerosol puffer can be
very effective because a large dose can be
given rapidly
If unresponsive:
• seek urgent medical
assistance
• conduct a Primary Survey
and act accordingly
Hyperventilation
A condition where a person develops a CO2 and O2 imbalance in the
body related to an altered pattern of breathing.
Possible causes:
• stress related to fear
• head injury
• severe bleeding
• heart failure
• collapsed lung
• some poisoning
• diabetic emergencies
Recognition
• shallow breathing
• fear
• dizziness
• tingling (due to poor
circulation)
Management
• try to have the patient
remain calm
• reassure the patient
• count breaths aloud to
slow down breathing
• breathe into cupped hands
Anaphylaxis
Condition & Causes
Anaphylaxis is a severe allergic response to a foreign substance,
resulting in vasodilation and loss of blood pressure.
The substance could be some type of food (commonly peanuts and fish),
an insect bite (commonly bee-stings) or medication (commonly the latex
adhesive on band aids).
A true anaphylactic reaction presents an immediate life threat to the
patient & urgent medical aid needs to be obtained.
Allergies
Some people have very severe reactions to allergies such as peanuts,
seafood & eggs.
On contact or ingestion of these substances they may feel tingling
around the lips as a warning sign before the airway, lips or tongue
swell and restrict breathing.
People suffering from severe allergies usually carry an EpiPen. First
Aid providers can assist in getting the EpiPen to the patient but should
not administer the injection, which is usually in the thigh.
Signs & Symptoms
• swelling of the throat, tongue &
face
• difficulty swallowing & breathing
• wheezing, breathing distress
• red rash to face, neck & body
• skin becomes red or pale, cold &
clammy
• rapid weak pulse
• abdominal cramps, nausea,
vomiting, diarrhoea
• altered responsiveness
• collapse
Management:
• urgent medical aid!
• Primary Survey
• position of comfort
• assist with medication
• EpiPen (adrenaline injected into
thigh)
• loosen clothing, remove jewellery
• provide oxygen (if available)
• be prepared for resuscitation
A typical Action Plan
for the treatment of
Anaphylaxis
The tool used for the treatment of Anaphylaxis
Cardiac Conditions
Cardiac Emergencies Definition
•
The heart is a muscle that works continuously and which has a high
oxygen demand.
•
The heart muscle’s oxygen supply is provided by blood vessels called
the coronary arteries.
•
Factors such as lack of exercise, poor diet, smoking and hereditary
conditions can cause deposits to build up inside blood vessels,
including the coronary arteries.
•
These deposits in the coronary arteries can reduce the blood supply to
part of the heart and increase the chance of a complete blockage
occurring.
•
Heart disease is the leading cause of death in the developed world.
Types
Angina - Narrowing of coronary arteries
(least severe)
Acute Myocardial infraction (AMI) - Death
of heart muscle cells occurring as
a result of O2 deprivation (more
severe)
Chronic Heart Failure - Pumping failure
where the heart is unable to pump
enough blood to supply body
(most severe)
Angina & Heart Attack
Angina occurs when the blood flow through a narrowed coronary artery
is insufficient to meet the oxygen demand of the heart muscle.
Chain of Survival
A heart attack occurs when a coronary artery has become critically
blocked and remains blocked.
A clot develops in the lining of the coronary artery, preventing blood flow
beyond the clot.
Recognition
• chest pain or tightness
• may be gradual or sudden onset
• often described as heavy, dull or
crushing
• may radiate to neck, jaw, shoulders
and arms
• nausea or vomiting
• shortness of breath
• pale, cold & sweaty
• may appear distressed
Management
Management - Angina
• rest and reassure the patient
• if this is the first episode that the patient
has experienced, seek urgent medical
assistance
• if the patient has their own medication,
assist them to take it
• provide supplemental oxygen if available
• if no relief from medication and rest, seek
urgent medical assistance
Common medications used for the treatment
of angina are inserted under the tongue or
between the gum and the lip, or sprayed into
the mouth.
Management - Heart Attack - If
responsive
• send for urgent medical
assistance
• assist the person into a position
of comfort
• rest and reassurance
• loosen any tight clothing
• if the patient has their own
medication, assist them to take it
• provided supplementary oxygen
if available
• do not leave the person
unattended
• be prepared for sudden
unresponsiveness.
Both Cases:
• conduct a Primary Survey and act accordingly
• provide supplemental oxygen if able