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Lecture two
CPR (Cardio-Pulmonary-Resuscitation):
If the victim is not breathing and has no signs of
circulation, then begin CPR.
In Infants:



Place two of your fingers on the breastbone just
below the nipple line.
Your other hand on the infant's forehead to
keep the head tilted back and the airway open .
Using your two fingers, give 30 chest
compressions, compressing the chest about 5-1
inch each time. [V]
 With
the infant's head tilted back, cover
the infant's mouth and nose with your
mouth and give two gentle breaths.
 Repeat these Steps about four more
times, which should take about 2
minutes.
 Recheck for signs of circulation and
breathing. If infant does not have signs of
circulation and does not begin breathing,
continue CPR until medical help arrives.
In Child or Adult: .
 Place your hand on the breastbone midway
between the nipples.
 Use the heel of just one hand for a child, and
place other hand on child's forehead. [V]
 For adult, place other hand on top of hand that
is positioned on breastbone.
 Align your shoulder(s) above your hand(s) and
straighten your elbow(s), using the weight of
your upper body to do chest compression
 Perform 30 compressions. Count aloud at a
steady and fast pace to achieve this rate.
 With victim's head tilted back, pinch victim's
nose, place your mouth over victim's mouth,
and give 2 breaths for an adult or child.
 Repeat Steps 4-5 five times. This should
take about 2 minutes.
 Recheck for signs of circulation and
breathing.
 If victim does not have signs of circulation
and does not begin breathing, continue CPR
until the victim's signs of circulation and
breathing return or until medical help
arrives
Measuring Vital Signs
A- Breathing:
Examination of breathing:
Look to see if the chest is rising
Listen for any sounds of breathing
Feel for any air movement on your cheek.
Taking no more than 5–10 seconds
Normal respiratory rate:
Adults:12-20/min
Children and infants: 30-40/min.
First aid provider must check:
- Depth and regularity of respiration
- Presence of any strange odour (alcohol, acetone, etc.) or
Sound.



-
B- Circulation
Make sure that circulation is maintained by checking
pulse.
Figure 5
Carotid artery
Figure 6
Radial artery
Figure 7
Brachial artery
[V]
C- Temperature:
•
•
•

Temperature can give an indication of the
patient's condition.
Normal temperature ranges between 36.6ºC37.2ºC.
Temperature can be recorded by putting
thermometers under the tongue, in the rectum
(higher by ½ degree) or under the armpit
(lower by ½ degree).
Never use mouth thermometers in cases
of
unconsciousness,
injured
nose,
inflamed mouth or in young children.
The Recovery Position
The recovery position or more
technically known as the lateral
recumbent position.
A first aid technique recommended
for assisting people who are
unconscious (or nearly so) but are
still breathing.
When an unconscious person is laying face
upwards, there are risk factors which can
lead to suffocation:
1- Fluids (blood or vomitus) can collect in the
back of the throat, causing respiratory
obstruction.
2- Fluids may flow down into the lungs
causing a condition known as aspiration
pneumonia.
3- The oesophagus tilts down associated
with loss of muscular control, can lead to
the stomach contents flowing into the throat
leading to airway obstruction
To a limited extent, it is possible to protect against
airway obstruction by Head-Tilt-Chin-Lift
method.
However, an unconscious person will not remain in
this position unless held constantly.
If the person is placed in the Recovery Position,
the action of gravity will allow any fluids to drain.
The recovery position is suitable for any
unconscious person who does not need CPR
(can breathe) but never do it if spinal injury is
suspected.
How can you put a victim in the
recovery position? [V]
1- Check the mouth of the causality to make
sure there is no foreign matter in the
mouth.
2- Place near arm of the causality close to his
body (inserting the hand under the
nearside leg or put it 90 degree to the
body)
3- Cross the far arm over the chest towards
you and Lift up the patient's furthest knee.
4- Protect and support the head with one hand.
With the other hand use the patient's knee as a
lever and pull it onto your knees.
5- Bend the victim's uppermost arm into a
convenient position to support the upper body
and his uppermost leg at the knee to bring the thigh
well forward to support the lower body.
6- Carefully pull the other arm out from under the
victim and place it parallel to the patient to prevent
the victim from rolling on to the back. [V]
Medical
Emergency
A medical emergency is an injury or
illness that is acute and poses an
immediate risk to a person's life.
Response to an emergency medical
situation depend on:
 Situation
 Patient
 Availability of resources to help them.
I- Unconsciousness
 It
is a mental state that involves complete
or near-complete lack of responsiveness to
people and other environmental stimuli.
 When
a person is sleeping he awakes
when you call, touch or shake him but
when he fails to respond he is considered
unconscious.
Causes:
 Head injury or concussion.
 Hypoglycemia or Hyperglycemia as in diabetics.
 Anemia or excessive bleeding.
 Heat stroke or heat exhaustion.
 Hypoxia.
 Poisoning.
 A sudden change in body position like standing
up too fast (postural hypotension).
 A side effect of some medications.
 Drinking too much alcohol.
 Anxiety or sudden emotional stress or fright.
 Extreme pain.
General Management
“The main role of the first aider is to
maintain respiration and
circulation”
1- Make sure the casualty is still breathing.
2- Loosen any tight clothing.
3- Never give the person anything to eat or
drink, not even water.
4- Check for any key that can help in
diagnosis; as a medical alert tag, a drug
or anybody who can give you history tips
revealing the cause of fainting.
5- Try to wake him by shouting at him
loudly, gently shake him or pinch the
lobule of the ear.
6- If he in breathing normally place him in
the recovery position.
7- If the casualty is breathing but he is
snoring or gurgling, open the air way by
putting the tongue forward.
8- If he is not breathing normally, mouthto-mouth breathing is indicated in addition
chest compression CPR, may be done till
normal breathing is retained.
1- Brain injury or Concussion



It is due to a blow to the head or
the jaw
Falling from heights
It occurs during sports as in
football or boxing.
Management:
– Check ABC
(perform CPR if
necessary)
– Rapidly call for medical help.
– If there is an injury or wound, try to
treat.
– If there is bleeding try to stop it till
medical help arrives.
– If the victim is breathing normally put
him in the recovery position. If not
begin CPR
2- Epilepsy (Convulsions):
The victim shows rigidity, convulsions,
loss of consciousness and some times
he produces some sounds (Epileptic
Cry).
In most cases the fit takes 5-10 minutes
then he regains his consciousness but
he remains confused for about 1
hour thereafter.
Management:
It should be known that you can not
do much during the fit but try to
protect him from danger.
 Loosen
any tight cloth
 Remove any furniture around him
 Try not to hold him or let anyone
interrupt the victim
 Don't give him any thing orally.
When the fit is over, turn him
comfortably to the recovery
position.
Hospitalize the victim if he did not
regain consciousness after the fit
ends.
[V]
3- Febrile convulsions (in children):
If a child suffers from fever (Temp =
39-40C) due to any cause
convulsions may occur.
The child seems flushed, sweating, his
eyes may roll up and his face may
show bluish discoloration.
Convulsions appear as stiffness in the
neck with arched body.
Figure 10
[V]
Management:
Permit good aeration and uncover the child
 Control
the fever: remove clothing, apply
cool washcloths to the face and neck.

Sponge the rest of the body with cool water
(do not immerse a seizing child in the
bathtub).
 Never
 At
give him anything by mouth
the end of the fit but him in the recovery
position and cover him with light cover. [V]
4- Nervous shock:
Sudden
and
temporary
loss
of
consciousness due to rapid decrease of
blood flow or O2 supply to the brain.
Causes:
Severe emotions, as stress, sudden fear
or astonishment.
 Severe pain.
 Standing for a long time in hot weather.

Manifestations:
– Loss of consciousness with no response to
external stimuli
– Weak and rapid pulse
– Dilated pupil.
Management:
 Let the causality lying with the head at lower
level than his legs.
 Untie any tight clothes.
 Pour some cold water on his face or smell a
stimulant (perfume or ammonium
hydroxide).
5- Diabetic coma:
A- Hypoglycemic coma
B- Hyperglycemic coma
A- Hypoglycemic coma:
Cause:
Insulin overdose can reduce the level of
glucose in the blood to extremely low
levels and cause hypoglycemic coma
Resulting in destruction of neurons in the
hippocampus and cerebral cortex,
which are essential to memory and
cognition.
Manifestations:
Sweating and wet tongue.
Stupor, coma and abnormal breathing.
Difficulty speaking and slurred speech
Management:
If the patient in conscious you can give him sugar
or juice.
If not conscious try to hospitalize him as soon as
possible where he will be given dextrose
infusion
B-Hyperglycemic coma
Cause:
In patients who suffers from diabetes mellitus and
ate food which is rich in carbohydrates or
sugar without taking their treatment
(hypoglycemic agent or insulin).
Manifestations:
 Dry tongue.
 Irregular breathing and weak pulse.

Acetone odor (fruity odor) of the breath.
Management:
If the patient is conscious and can speak ask
him about the drug he takes and give it to
him till medical aid arrives.
If the patient is unconscious, try to ask
anyone with him about his medication
(injection only) and if not available
hospitalize him rapidly.
6- Alcoholism:
The drunk becomes comatose when he drinks
heavily.
His breath smells alcohol.
Management:
If the patient is conscious give him a cup of heavy
coffee.
if not conscious try to make him regain his
consciousness by putting cold water on his
face and shaking him them give him heavy
coffee.
II- Effects of
Temperature
Exposure to extremes of temperature is
harmful for body functions and may
be damaging to body tissues.
A- Hypothermia
B- Hyperthermia
A- Hypothermia
The drop of body temperature below 35C.
Causes
 Exposure to cold weather for a long period and
wearing unsuitable clothes.
 Falling into cold water.
 Malnutrition.
 Cardiovascular diseases.
 Hypothyroidism.
Elderly and young children are more liable to
hypothermia.
Manifestations:
 Cold, pale skin.
 Shivering, Slurred speech.
 Abnormally slow breathing.
 Fatigue, lethargy and confusion.
Management:
 Move the person out of the cold.
 Protect the person from the wind, cover his
head and insulate his body from the cold
ground.
 Immediately
give him rest and remove
any wet clothes.
 Try
to warm him by covering him with a
blanket, and if he is conscious give him
warm (non-alcoholic) drinks.
 Call
emergency and while waiting
monitor the person's breathing. If
breathing stops or becomes dangerously
slow or shallow, begin CPR immediately.
 Don't
apply direct heat. Don't use hot
water, a heating pad or a heating lamp to
warm the victim.
 If
the victim is unconscious put him in the
recovery position.
 Don't
massage or rub the person, handle
people with hypothermia gently, because
they're at risk of cardiac arrest.
B - Heat Stroke
Heatstroke is life-threatening:
as the body loses its normal
mechanisms for dealing with heat
stress, such as sweating and
temperature control.
Young
children, elderly and obese
people are at high risk.
Causes:
Standing,
Exercising or Working
in hot humid environments
combined with inadequate fluid
intake.
 Dehydration
 Alcohol use
Cardiovascular disease
 Medications.
Manifestation:
 The person appears restless, flushed, dizzy
and may faint.
 He suffers from sever headache.
 Markedly elevated body temperature,
generally greater than 40 ºC.
 Skin may be hot and dry, but if heatstroke is
caused by exertion, the skin may be moist.
 Rapid heartbeat.
 Rapid and shallow breathing.
 Nausea and vomiting.
First Aid Management:
 Move the person out of the sun
into a shady or air-conditioned space.
 Loosen or remove the person's clothing.
 Lay the person down and elevate the legs
and feet slightly.
 Cool the person by covering him or her
with damp sheets or by spraying or
sponging him with cool water.
 Direct
air onto the person with a fan or
newspaper.
 Monitor body temperature with a thermometer
and continue cooling efforts until the body
temperature drops to 38 -38.8°C.
 Call for medical aid (ambulance).
 Have the person drink cool water, if he or she is
alert.
Hyperthermia (fever)
Fever is the elevation of body temperature
(normal= 37°C).
Temperature is usually controlled by the
hypothalamus. It maintains normal temperature
through heating mechanisms (shivering and
metabolism) and cooling mechanisms (sweating
and dilating cutaneous blood vessels).
Fever is one of the body's reactions to infection.
Generally treatment of fever depends on its
cause.
Causes:
 Infections
(bacterial, fungal, viral, etc.).
 Poisons.
 Heat
exposure.
 Some medications (thyroxine, amphetamines,
antihistaminics,
sedatives,
some
antidepressants, anticonvulsants, etc.).
 Some
diseases (cancer, inflammation,
endocrine disorders, HIV, autoimmune
diseases, etc.).
When to Seek Medical Help?
In
babies with rectal temperature>38.0 °C.
In
children and adults with fever persists
for three days.
If
you suspect dehydration especially in
children (sunken eyes, dry diapers).
If
febrile seizures develop in children.
 If
any of these signs or symptoms accompanies
fever:
 Unusual skin rash
 Mental confusion.
 Persistent vomiting.
 Difficulty in breathing or chest pain.
 Abdominal pain.
 Pain when urinating or blood in stool.
 Leg swelling.
 Lack of appetite and difficulty in sleeping in
children
First Aid Measures:
A- In Adults:
Fever can be reduced with ibuprofen or
acetaminophen.
People with stomach ulcers or kidney disease,
pregnant women and those with aspirin allergy
should avoid ibuprofen.
Extremely large doses of acetaminophen may
cause liver failure and it should not be given to
people with liver disease.
Fever can result in dehydration; hence patient
should drink lots of fluids.
 If
the fever is caused by exposure to hot
weather or overexertion or if the patient was
confused
or
unconscious,
neither
acetaminophen nor ibuprofen will be
effective.
 The
person needs to be cooled immediately
(remove patient from the hot environment;
remove his or her clothes and cool the body
with a wet sponge with a fan directed over the
person).
B- In Children:
 Use acetaminophen or ibuprofen to reduce
temperature for at least 24 hours (if conscious).
 Dress the child in light cotton clothes and avoid
overdressing.
 You can give him a warm bath but do not use
alcohol in a bath or rub it on the skin.
 Try to give the child fluids to help in reducing
the temperature as clear fluids such as noncarbonated decaffeinated drinks or juice (not
water as it does not contain the necessary
electrolytes and glucose).
Do
not give tea or any caffeine-containing
product as it promotes water loss through
urination.
If
the child is vomiting, an anti-emetic drug
may be given by injection or by rectal
suppository. After a period of time, oral
fluids will be attempted.