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FIRST AID TRAINING KIRKWOOD COMMUNITY COLLEGE HEALTH SCIENCE FIRST AID TRAINING Power Point #1 LEARNING OUTCOME the student should be able to identify their role in providing first aid PURPOSE OF FIRST AID provide temporary assistance in medical emergency situations until professional rescuers arrive and assumes responsibility for the victim LEGAL ASPECTS Good Samaritan Law minimizes the fear of legal consequences, but protects only those acting in good faith & without gross negligence or willful misconduct LEGAL ASPECTS Do no further harm to the victim LEGAL RESPONSIBILITY Legal responsibility varies from state to state as to who stops and renders first aid. Know your state law What is the state law of Iowa? How would you find this information out? Who can you call in you local community? What is Iowa’s law? * No legal responsibility in Iowa unless it is part of your job description LEGAL RESPONSIBILITY once you render first aid to a victim, you have a “legal obligation” to continue until professional rescuers arrive to discontinue would be considered abandonment MORAL OBLIGATION TO RENDER FIRST AID When designated by employment When a pre-existing responsibility exists, examples: parent/child driver/passenger student/teacher CONSENT FOR FIRST AID Permission from a conscious victim is required to avoid assault charges and termed “consent” Permission from an unconscious victim is not obtainable from the victim. Therefore, we assume the victim would want first aid. This action is termed “implied consent” TRIAGE is the action of sorting victims of disaster in order to determine who needs immediate care and transportation to the hospital, or could be delayed disaster: any situation that taxes emergency resources GET HELP!!!! call 9-1-1 for professional rescuers give your location describe nature of emergency (fire, explosion, drowning, fall, motor vehicle accident, etc.) tell them number of victims involved describe seriousness of injuries advise of hazardous material involvement TWO COMPONENTS OF VICTIM ASSESSMENT Primary Observation: designed to identify any life threatening problems and stabilize them immediately Secondary Observation: designed to detect obvious injuries or clues to illness and injury through a head-to-toe observation, gather history from victim or bystanders & inspect surroundings KEY COMPONENTS OF PRIMARY OBSERVATION A* AIRWAY B * BREATHING C * CIRCULATION LEVEL OF CONSCIOUSNESS AIRWAY is it open & functional? If not, correct. Consider cause or mechanism of injury. (Use headtilt, chin-lift if no injury; jaw-thrust maneuver if there is head/neck injury) airway may be obstructed BREATHING can victim speak? look, is the chest rising and falling? listen, do you hear air going in and out of airway? feel, do you feel air touching your cheek? CIRCULATION to determine a heartbeat. Is breathing, coughing or movement present? If NOT, assume no heartbeat and start CPR control severe bleeds with pressure dressing immediately LEVEL OF CONSCIOUSNESS is the victim oriented to person, place and time? the brain requires a constant supply of oxygen from the heart to remain oriented blood losses will affect oxygen supply and interfere with orientation breathing disorders will decrease oxygen supply also interfering with orientation HISTORY OF EVENT chief complaint. What hurts? obtain history about the condition of the victim from victim, family, friends or bystanders. What happened? find out events that lead to chief complaint. What were they doing? note the ENVIRONMENT (drugs, alcohol, weapons, falls, motor vehicle accidents, surrounding temperature,etc.) VITAL SIGNS HEARTBEAT is there breathing, coughing and movement? This would indicate the heart is beating when present when absent, compressions of heart must begin to circulate blood to vital organs VITAL SIGNS BREATHING is victim breathing or NOT? is the breathing pattern fast, slow, deep, shallow, labored, noisy? if NOT breathing, artificial breathing must be administered lungs ARTIFICIAL BREATHING mouth to mouth ventilation or use other artificial breathing assistive devices artificial breathing for an adult should take place once every 5 seconds (20/minute) VITAL SIGNS TEMPERATURE is skin hot, cold, warm? a “hot” to the touch or “cold” to the touch body indicates abnormality VITAL SIGNS Skin/mucous membrane color Pink? Adequate oxygen levels White (pale)? Peripheral blood shunted to core of body to self protect major organs Gray (ashen)? Indicates decreasing oxygen level in blood, body systems begin suffering Blue (cyanotic)? Indicates excessive amount of blood not carrying oxygen, body systems in critical state Red (flushed)? Harmful levels of carbon monoxide or increased carbon dioxide levels HEAD-TO-TOE OBSERVATION must be consistent and deliberate each time performed should be done for each victim when condition allows to make sure nothing is missed may be omitted if the primary observation components airway, breathing and heartbeat are compromised HEAD & NECK Observe for: bleeding (open wounds) deformities of facial structures (fractures) c/o pain/numbness/tingling of extremities (possible neck injury) pupil size and response to light (changes could indicate head injury) mouth for missing/broken teeth or bleeding CHEST Observe equal for: rising and falling on both sides of chest during breathing deformity of chest wall (indicating possible rib fractures) bleeding, indicating open chest wound complaint of chest pain from injury/disease abnormal breathing patterns coughing/bloody sputum ABDOMEN Observe for: hardness of abdomen indicates problem bleeding, indicating open wound complaints of pain bruising, a SERIOUS indicator of injury vomiting (save for professional personnel to observe for content & possible blood) Abdominal cavity has body organs suspended within. There is great potential for blood loss if connecting tissue is torn PELVIS Observe for: obvious swelling (pelvic trauma has a potential to bleed profusely due to “big” blood vessels in the pelvic cavity) obvious deformity, rotation, shortening of lower leg(s) may indicate hip fracture complaints of pain signs & symptoms of shock bleeding, indicating open wound EXTREMITIES Observe (arms & legs) for: obvious deformity or visible bone, indicates possible fracture shortening of one extremity to another, indicates possible fracture/dislocation obvious bleeding indicates open wounds complaint of marked tenderness/pain over injury site or false movement indicates possible fracture complaint of loss of feeling below injury site, indicates nerve damage EXTREMITIES Observe pink for “P-M-S”: skin color and warm temperature below injury? movement, is it present or absent below injury site? sensation to touch, is it present or absent below injury site? “PMS” checks must be done before & after splinting and bandaging extremity injuries SPINE Observe for: complaint of pain over spine strong indicator of spine injury complaint of numbness, tingling, and/or inability to move strong indicator of spine injury DO NOT MOVE VICTIM UNLESS IMMINENT DANGER IS PRESENT MEDICAL ALERT IDENTIFICATION Check for: bracelets, necklaces & other forms of medical alert ID’s that could provide valuable information for professional team about pre-existing health conditions HEAD-TO-TOE OBSERVATION OMIT SECONDARY OBSERVATION WHEN: patient is unable to maintain an open airway patient is not breathing on their own there is no heartbeat your hands will be “full” doing CPR, and the secondary is not essential until later or never, depending on the circumstances Quizlet 1 You neighbor is painting his house from a ladder. You hear him cry out and hear the ladder hit the cement. When you arrive you find him on his back, his right arm is deformed and he is not moving. What is your assessment of the situation? In what order would you manage this victim? ABC Airway – How do you determine he is breathing? Breathing – Jaw thrust or chin thrust and why Circulation – Where do you check for a pulse on an adult? Call 911 What should you do with his arm? Straighten it out? Leave it alone? When can you leave the victim? FIRST AID TRAINING KIRKWOOD COMMUNITY COLLEGE HEALTH SCIENCE FIRST AID TRAINING Power Point #2 LEARNING OUTCOME identify types of bleeding wounds and shock, and the appropriate first aid interventions WOUNDS & SHOCK Average adult body contains 6 liters of blood (approximately 6 quarts) rapid loss of 1 quart blood (1000cc) from adult can lead to shock and death rapid loss of 1-cup blood (250 cc) from child can be deadly rapid loss of 2-Tablespoons blood (30 cc) from infant can be deadly SHOCK Definition: inadequate tissue/cell perfusion causing body cells and systems to begin death due to a loss of body fluids and oxygen within the blood vessels TISSUE PERFUSION Definition: is the process of providing all living cells with a constant supply of oxygen and nutrients, and removing waste products from the cells this process is essential for a healthy life CAUSES OF SHOCK trauma - blood loss illness - body fluid losses of vomit, diarrhea, fever (perspiration) heart disease - causing blood flow disruptions & rhythm disturbances gastrointestinal diseases - disrupt electrolyte balance and destroy cells, organs, & systems continued CAUSES OF SHOCK respiratory disease - causing disruption of the oxygen supply to cells allergic reactions - causing serious breathing spasms & vasodilatation head injury - causing central nervous system inability to command properly spine injury - may result in loss of ability for blood vessels to constrict causing (vasodilatation) MAJOR TYPES OF SHOCK Hypovolemic (hemorrhagic) Cardiogenic Anaphylactic Fainting HYPOVOLEMIC SHOCK Causes: blood loss dehydration, other body fluid losses due to fever (sweating), vomiting, major burns, serious respiratory crises diarrhea Circulatory System Full Fluid loss HYPOVOLEMIC SHOCK Signs & Symptoms restlessness/irritability altered level of consciousness weak/rapid pulse pale/moist skin rapid breathing nausea & vomiting dull, sunken appearing eyes big pupils obvious injuries (bruising/bleeding) TREATMENT FOR HYPOVOLEMIC SHOCK manage A-B-C’s & call 9-1-1 apply direct pressure to bleeds (barriers) elevate part if bleeding continues consider pulse pressure points if bleeding continues add dressings don’t remove soaked ones prevent body heat loss & chills if not contraindicated, elevate legs 12” DO NOT ELEVATE LEGS WHEN: the victim is unconscious or may have had a stroke (will increase pressure in the brain) chest pain is present (will increase workload to heart) there is a spine injury (may cause further injury) breathing problems are present (will make this condition worse) CARDIOGENIC SHOCK Causes: heart pump failure that in turn reduces or starves the cells of oxygenated blood CARDIOGENIC SHOCK Signs & Symptoms: severe cyanosis (blue-purple coloring of skin) one or more signs & symptoms of heart attack : (shortness of breath, anxiety, chest pressure/tightness, jaw pain, upper extremity pain, nausea, indigestion, light headed/dizzy, wet & cool skin,etc.) TREATMENT FOR CARDIOGENIC SHOCK manage A-B-C’s first recognize the emergency & call 9 -1-1 immediately keep patient in sitting position while conscious with legs dangling over the edge until they become unconscious be prepared to perform CPR ANAPHYLACTIC SHOCK Causes: exposure to allergens such as: insect/bee stings certain medications (penicillin & tetanus frequent offenders) certain foods (shellfish, berries, nuts) pollens/dust/molds (Vary per individual) ANAPHYLACTIC SHOCK Signs & Symptoms: redness, swelling at site of a bite or sting severe hives/itching swelling of face, throat, eyes & hands coughing, wheezing, breathing difficulties POSSIBLE DEATH IN 30 SECONDS TO 30 MINUTES Bronchial tubes TREATMENT FOR ANAPHYLACTIC SHOCK manage A-B-C’s recognize emergency & call 9-1-1 immediately if victim carries a bee sting kit or allergy kit, assist victim in the administration of injectable epinephrine be prepared to do CPR FAINTING Causes: interruption of blood flow to the brain blood pools in lower extremities when standing for long periods of time psychological disturbance fainting is often the only sign of heart problems in the elderly, therefore an elderly victim should always be seen by a physician to rule out heart problems after fainting FAINTING Signs & Symptoms dizziness skin color is pale skin cool and moist to the touch may complain of nausea “black out”spell TREATMENT FOR FAINTING break fall if possible to prevent injuries if there are no obvious injuries, place victim on back with legs elevated 12” loosen tight clothing around neck wipe forehead with cool/wet cloth turn vomiting victim onto side after a long rest, assist victim to a slow upright position if there are no injuries after regaining consciousness Quizlet 2 You are watching your daughter perform at her first junior high chorus concert. She suddenly starts to weave back and forth and then collapses to the ground. What is your assessment of the situation What type of shock has occurred? Why did it occur? What is the treatment ? CAUSES OF BLEEDING Injuries/Trauma: penetrating injury that breaks through skin with sharp objects blunt injury that does not break through the skin Diseases: ulcers, aneurysms, cancers CLASSIFICATION OF BLEEDING WOUNDS Open Wounds: skin is broken Closed Wounds: skin is intact OPEN WOUNDS (external) visible blood outside of the body; skin is broken ARTERIAL BLEED spurting bright red blood. Most dangerous, must be stopped. Could be life threatening VENOUS BLEED flowing blue/red blood that responds to direct pressure to stop. Pressure may be necessary 6-10 minutes before clotting takes place CAPILLARY BLEED oozing dark red blood. May clot spontaneously or rapidly with pressure. MOST COMMON type of bleed TYPES OF WOUNDS abrasion incision laceration puncture avulsion amputation ABRASION skin scrape, floor burn, road rash often embedded with dirt. This wound is typically a capillary bleed & prone to infections INCISION smooth edged cut made by a sharp object (knife, scissors) and bleeds easily LACERATION a jagged, irregular break in skin edge created by a sharp object through trauma, and bleeds freely PUNCTURE piercing through the skin (knife, nail, pen, etc.) Minimal bleeding until removed DO NOT REMOVE angle & depth of instrument determines what organ(s) are affected AVULSION flap type skin injury that bleeds freely and has small portion of the skin still attached to the body degloved AMPUTATION Partial amputation detachment of a body part or portion of the part (finger, toe, arm, leg, ear, etc.) Complete amputation TREATMENT OF OPEN WOUND INJURIES Minor wash wounds: hands with 3-5ml soap for 10-15 sec. use protective barrier gloves, plastic wrap or bag cleanse wound gently with soap & water, rinse thoroughly and dry cover wound with clean dressing & apply direct pressure apply bandage to secure dressing. Avoid it being too tight (P-M-S checks) TREATMENT OF OPEN WOUND INJURIES Major wounds: manage A-B-C’s first apply clean dressing to wound & apply direct pressure. Don’t remove soaked dressings, add more dressings so clots are not disturbed elevate part if bleeding continues may need to apply pressure to a pulse point above the bleed site ARTERIAL PULSE PRESSURE POINTS Pressure Points if direct pressure and elevation of a part has not stopped a bleed, find the pulse point between the wound and heart closest to the wound and apply pressure at that point TREATMENT OF OPEN WOUND INJURIES Major seek wounds: medical attention for all major wounds (may need a tetanus update, may need to have the wound closed, there could be bone injury also) Sutures must be done within 6-8 hours after injury all bites from animal or human should be seen by a physician. Identify the animal and it’s owner whenever possible, and notify the authorities so animal can be contained MANAGING AMPUTATED PARTS manage A-B-C’s & call 9-1-1 apply direct pressure to stump wrap body part in a dry, clean cloth place wrapped part into a plastic bag and seal place sealed bag into icy cold water DO NOT PUT AMPUTATED PART DIRECTLY INTO WATER OR ON ICE CLOSED WOUNDS Blunt injuries: (internal) blood not visible, but bleeding is active inside of the body; skin is intact. This type of bleeding is often most serious tire tracks on abdomen CONTUSION bruising caused by blunt injury HEMATOMA blood pooling under the skin resulting in blue colored mass hematoma (blood tumor) TREATMENT OF CLOSED WOUND INJURIES manage A-B-C’s and call 9-1-1 note how injury happened and be concerned when things “look bad” treat for shock treat problems appropriately when identified in observation apply ice to closed wounds with a barrier between ice & skin to prevent frostbite WOUNDS REQUIRING IMMEDIATE ATTENTION arterial bleeding deep wounds into muscle, bone & joints or open & gaping all puncture wounds, dirty wounds or wounds with embedded objects blunt injuries that produce a large bruise, or swelling bites, human or animal COMPLICATIONS OF WOUND INJURIES infection - invasion of disease-producing organisms into the body tetanus - an infectious disease caused by bacteria found in the soil, air, skin or feces producing a powerful toxin affecting the brain and spinal cord SIGNS & SYMPTOMS OF WOUND INFECTION redness, swelling, pain of affected area affected area “hot to the touch” drainage (pus) from wound “foul smell” possible fever, chills possible red streaks from affected area towards heart (SERIOUS SIGN, requires immediate medical attention) SIGNS & SYMPTOMS OF TETANUS Muscle spasms following a dirty wound Extreme body rigidity (“Lock Jaw”) No known antidote available Prevented by vaccination Quizlet 3 You and a friend are hiking in the woods. You friend slips off of the trail and falls down a hill, landing along side a tree. When you reach your friend, she is awake and complaining of chest pain and finds it hard to breathe. Her skin is cool and damp and she appears pale. What is your assessment of the situation? Identify the type of trauma that occurred – Why does it hurt to breathe? – Possible broken ribs/internal bleeding Why is the skin pale and damp? – Blunt force-no evident bleeding Going into shock What steps are taken to treat a patient in shock? Your friend complains of being thirsty. Is this a concern? BANDAGING bandages dressings hold dressings in place are placed directly over wounds to control bleeding and/or prevent further contamination. Whenever possible, dressings should be sterile. When sterile is not available, dressings should be clean ROLLER BANDAGES long strips of material or prepared gauze rolls in varying widths & lengths used in wrapping extremity and head wounds may be used to secure splints TRIANGULAR BANDAGES “cravat”, triangular in shape can be used as an arm sling with second wrapped around chest wall keeping arm close to chest ideal for splinting simple rib fractures PRINCIPLES OF BANDAGING P-M-S checks below injury site before & after bandaging apply secure enough to hold dressing in place, but not too tight to disrupt circulation do not include fingers & toes unless they are the wounded parts. You want to see their color & feel their temperature wrap towards heart during application use figure 8 techniques with roller bandages FIRST AID TRAINING KIRKWOOD COMMUNITY COLLEGE HEALTH SCIENCE FIRST AID TRAINING Power Point #3 LEARNING OUTCOME identify injuries to specific body areas, fractures, joint and muscle injuries and the appropriate first aid interventions SKULL FRACTURES open fractures indicate that the bone has broken through the skin & may or may not be visible SKULL FRACTURES closed fractures indicate the bone has been broken, but the skin is intact Closed fracture CAUSES OF SKULL FRACTURES trauma to the head from: motor vehicle accidents falls blows to the head HEAD INJURIES Signs & Symptoms of Skull Fractures pain at site of injury deformity “soft spot” drainage from ears & nose (CSF) unequal pupil size CONSIDER the mechanism of injury to assess seriousness CONCUSSION a temporary impairment of brain function due to injury to the skull CAUSES OF CONCUSSIONS blow to the head due to a fall, motor vehicle accident, industrial accident, weapon, etc. shaking the head causes severe bruising of the brain and tearing of the blood vessels creating the“Shaken Baby Syndrome”. This condition is often the cause of death for infants CONCUSSION Signs loss & Symptoms: of consciousness severe headache short term memory loss “seeing stars” sensation dizziness double or blurred vision projectile vomiting DEGREE OF CONCUSSION Mild - no loss of consciousness Moderate - unconscious less than 5 minutes Severe - unconscious more than 5 minutes BRAIN CONTUSION bruising on or in the brain very serious BRAIN CONTUSION EPIDURAL BLEED on top of brain, just below skull. The space between skull & brain is minimal. Any bleeding in this space is serious, causing pressure on the brain b l o o d brain BRAIN CONTUSION SUBDURAL BLEED takes place within the brain & often results in neurological disabilities or death B l o o d brain SIGNS & SYMPTOMS BRAIN CONTUSION Epidural initial Bleeds: blow to the head & possible brief period of unconsciousness “seeing stars” sensation, headache, dizziness, projectile vomiting, visual disturbances initially hours or days later, the patient suddenly becomes unconscious unequal pupil size TREATMENT HEAD INJURIES A-B-C’s (jaw thrust maneuver) cover bleeding wounds (don’t plug-up nose or ear bleeding/drainage) Call 9-1-1 for prolonged unconsciousness Always assume a neck/spine injury with any head or face injury until ruled out by x-ray COMPLICATIONS OF HEAD CONTUSIONS Need immediate medical attention: headache lasting more than 48 hours nausea & vomiting more than 2 episodes back to back, or projectile vomiting drowsiness (victim should be awakened frequently & assess their level of orientation) visual disturbances (blurred/double) unsteady gait speech problems seizures EYE INJURIES Blunt Trauma Penetrating Foreign Injuries Objects EYE INJURIES CAUSES OF BLUNT EYE TRAUMA: fists (altercations) snowballs baseballs/softballs doors, etc. TREATMENT BLUNT EYE TRUAMA have victim sit semi-upright close both eyes seek medical attention immediately DO NOT place any weight onto globe of eye DO NOT place ice on the eye PENETRATING EYE INJURIES CAUSES : pens ice picks knives bullets roofing staples pool sticks, etc. staple TREATMENT PENETRATING EYE place victim in semi-sitting position close both eyes of victim NO pressure on the eye dry gauze pads over both eyes seek medical attention immediately victim can’t see when both eyes are covered, keep them informed FOREIGN OBJECTS dust dirt metal splinter rust pens/pencils glass, etc. TREATMENT FOREIGN OBJECTS DO NOT rub the eye flush eye with tepid water from inner corner to outer corner of eye until object is free (use gentle water flow) may invert eyelid onto Q-tip, and gently flush object if still in, close both eyes & seek medical attention keep patient informed as they can’t see TREATMENT EMBEDDED OBJECT DO NOT remove the embedded object place paper cup over short object to protect object from being bumped and moved have patient close unaffected eye cover both eyes to reduce eye movement seek medical attention immediately keep patient informed about happenings CHEMICAL BURNS Alkali destroys eye in 30 seconds & appears “milky white” flush immediately with tepid, gentle flow water, from inner to outer corner of eye 20 minutes minimum Call 9-1-1 Acid destroys eye within 30 min. & appears “beefy red” flush immediately with tepid, gentle flow water, from inner to outer corner of eye 20 minutes minimum Call 9-1-1 CHEMICAL BURN TO THE EYE alkali acid NOSEBLEEDS Two Types: anterior - involving the superficial vessels in front portion of nose posterior - involving larger vessels in back portion of nose (could be life threatening bleed) CAUSES OF NOSEBLEEDS trauma sinus infections/allergies hypertension (high blood pressure) dry air conditions Patient applies squeezing pressure TREATMENT NOSE BLEEDS keep patient quiet sit upright/lean slightly forward to avoid swallowing of blood pinch nostrils for minimum of 5 minutes apply ice to forehead above nose seek medical attention if bleeding after 6-10 minutes question patient about anticoagulant drugs (drugs that affect clotting time) treat for shock DENTAL INJURIES a tooth completely knocked out of socket: place in whole milk take patient & tooth to dentist immediately DO NOT touch the root of the tooth missing If no dentist is available, rinse tooth with water and replace in socket and align with adjacent teeth DENTAL INJURIES partially extracted teeth: get to dentist immediately, if not: rinse with water and align tooth to adjacent teeth and push back into place CHEST INJURIES Types of chest injuries: open - chest wall is open - skin broken penetrating (could be ribs breaking through or foreign object such as bullet, knives, etc.) sucking wounds closed no - chest wall is closed obvious bleeding noted major injuries can be involved though. The largest blood vessels are in the middle of the chest BLUNT TRAUMA TO CHEST may cause serious injuries to the organs beneath the impact examples: (steering wheel to chest on impact, fists to face or chest, kicked by someone or other weapons, etc.) PENETRATING TRAUMA TO CHEST may cause serious injuries beneath site of penetration consider length of instrument penetrating & movement within body examples: (bullets, knives, picks, pens, etc. CRUSHING INJURY TO CHEST squeezes body, bones or organs to the point of bursting or prevents the body system the ability to function Example: (any heavy weight on chest impairs the action of breathing) SIGNS & SYMPTONS OF CHEST INJURIES chest pain open wounds pale/ashen color sucking sounds asymmetrical -shortness of breath -chest deformity -paradoxical movement -signs of shock chest wall movement coughing up of blood TREATMENT CLOSED CHEST INJURIES ABC’s - stabilize any vital sign problems Call 9-1-1 immediately allow sitting position unless there are accompanying injuries that prevent it to immobilize major rib injuries, consider the use of pillow over the affected area to immobilize simple rib fractures, use a sling & swathe NEVER bind the chest to inhibit breathing TREATMENT OPEN CHEST INJURIES open wounds should be sealed quickly with cellophane wrap or plastic baggie, etc. large enough not to get sucked into wound & secured with tape on 3 sides only any chest wound has potential to become a life threatening problem Call 9-1-1 immediately TREATMENT EMBEDDED OBJECTS IN CHEST stabilize any embedded foreign objects to minimize movement of the object and further injuries DO NOT remove the embedded object ABDOMINAL INJURIES open injuries: there is an entry from outside the body into the abdominal cavity closed injuries: blunt injury to abdominal cavity that may result in serious abdominal organ contusions & lacerations, large & small blood vessel tears that result in major blood losses CAUSES OF ABDOMINAL INJURIES impaled objects objects that enter the abdomen by accident or assault & remain in the abdomen (knives, bullets, pens, ice picks, etc.) penetrating injuries objects that enter the abdomen causing injury, and if pulled out, suffer major bleeding (bullets, knives, pens, ice picks, motor vehicle parts, etc.) CLOSED ABDOMINAL INJURIES (BLUNT INJURY) Causes: blows with fists or other instruments during altercations falls onto blunt objects motor vehicle accidents SIGNS & SYMPTOMS history of injury pain, cramping , nausea, & possible vomiting guarded positioning/hardened abdomen evidence of blood in urine &/or stool evisceration (abdominal organs exposed) signs of shock: pale/ashen color, cool skin, moist skin, rapid breathing TREATMENT ABDOMINAL INJURIES check & correct A-B-C problems, call 9-1-1 keep victim quiet, warm and in position of comfort give patient nothing to eat or drink patient may vomit, save emesis cover eviscerated organs with sterile, moist, non-clinging dressing & bulky dry dressing do not remove or allow movement of impaled objects FRACTURES defined as: break in the bone cortex fracture fracture closed fractures have no break in the skin open fractures have a break in the skin DISLOCATION defined as: displacement of bones at a joint Elbow photo Elbow x-ray SPRAIN/STRAIN sprain defined as: temporary dislocation of joint usually involving ligament injury strain defined as: pulled muscle Sprained right ankle swollen CAUSES OF BONES & JOINT INJURIES sporting injuries motor vehicle accidents falls altercations, etc. SIGNS & SYMPTOMS OF BONE INJURIES pain &/or swelling over site of injury obvious deformity &/or false motion joint deformity with dislocations crepitus (grating sensation as fractured bones ends rub together) possible open wound with bone protrusion history of injury TREATMENT FRACTURE/DISLOCATIONS manage A-B-C’s before fractures remove clothing around injury site control bleeds with pressure dressings do not push protruding bone(s) under skin P-M-S, check skin color, temperature & movement below injury splint as found, include joint above & below recheck P-M-S, skin color, temperature & movement below injury TREATMENT MUSCLES INJURIES Ice to injury site 24-48 hours after injury (place barrier between ice & skin) Compress injury site with ace wrap for support (not too tight) P-M-S checks Elevate affected part to reduce swelling Apply heat to site 48 hours after injury Seek medical attention if pain/swelling persists SPINE INJURIES Causes of spine injuries: motor vehicle accidents falls diving accidents rodeo stunts gymnastic, etc. SIGNS & SYMPTOMS SPINE INJURY mechanism of injury suggestive of spine injury complaints of numbness, tingling, weakness or burning sensation in arms/legs loss of bowel or bladder control complaint of pain directly over a section of the spine not breathing TREATMENT SPINE INJURIES (jaw-thrust maneuver to open airway with spine injuries) Call 9-1-1 allow no patient movement (move patient only if imminent danger is present) keep patient warm A-B-C’s TREATMENT SPINE INJURIES assign someone to keep head aligned with body (a blanket rolled & shaped like a horseshoe around head & secured to a backboard works well) Do not use any weights on sides of head SPLINTING a splint is a supportive device applied to immobilize a fracture or restrict movement of an injured part splinting minimizes further surrounding tissue, vessel and nerve damage that the broken bone ends could do when not stable TYPES OF SPLINTS pillow rigid; boards, rolled newspaper/magazine professional; padded, vacuum, ladder, and traction padded rigid vacuum traction CREATIVE SPLINTS when professional splints are not available, consider using: rolled up magazine or newspaper a board or other flat firm object a pillow “buddy tape” affected extremity to an adjacent one with padding between. The unaffected finger, toe, or leg becomes the splint for the injured buddy body part PRINCIPLES OF SPLINTING apply splints before moving victim P-M-S checks (pink/warm skin, movement, sense of touch below fracture)before splint include joints above & below injury site secure splint with cravats or roller bandages keep fingers & toes exposed for assessment splint injury as found, do not straighten cover open fractures with sterile or clean dressings continued PRINCIPLES OF SPLINTING hand &/or finger fractures should be placed in position of function (cupped around roller bandage or something similar) remove jewelry, clothing, shoes, or socks when part of the injury site recheck P-M-S elevate fracture extremities after splinting apply ice to closed fracture site, with cloth barrier between ice & skin LEARNING OUTCOME identify victims skills in moving and rescuing MOVING VICTIMS do not move a victim until you have provided appropriate first aid for the injuries identified MOVING VICTIMS exceptions of moving before treatment of injuries: existing fire or imminent danger of fire when it is impossible to gain access to other victims in a vehicle in need of life-saving care DO NOT enter an area of explosives or hazardous materials regardless of situation to avoid injury to self ONE PERSON Emergency moves Drags: pull direction of long axis of body shoulder/clothing drag tug clothing at neck/shoulder area, stabilize head in forearms; used for short/rough surfaces blanket drag - pull blanket from behind the victim’s head ONE PERSON Emergency ankle moves: drag - pull victim by ankles; the fastest method for short distances on smooth surface one person assist - assist victim to walk if able ONE PERSON Emergency moves: Carries: fireman’s carry victim carried over your shoulder if injuries permit ONE PERSON Emergency moves: Carries: pack-strap carry - for longer distances when fireman’s carry might be unsafe TWO PERSON Emergency moves: two person assist help person to walk TWO PERSON Emergency moves: two handed seat carry TWO-THREE PERSON Emergency moves: four handed grip easiest when no equipment TWO-THREE PERSON Emergency chair carry move: TWO-THREE PERSON Emergency two moves: handed grip extremity carry hammock carry - 3 - 6 people on alternate sides of victim linking hands together beneath victim MOVING VICTIMS Principles of Moving Victims: immobilize & protect injuries before moving maintain firm footing with feet, shoulder’s width apart, one foot slightly in front of the other, knees bent slightly, & your arms close to your body, avoid twisting, & keep back straight with hips below shoulders. Let the leg muscles work, not your back keep motion(s) smooth know physical capabilities. Need help? Get it, for safety of all! WATER RESCUE drowning is 3rd leading cause of accidental death your goal will include not becoming the next victim and doing what you can do safely to help the victim WATER RESCUE Principles of attempting water rescue: Reach long stick, lightweight pole, or any object that will extend to victim secure yourself before reaching out to victim if bystander is nearby, have them hold onto you will you reach out to victim WATER RESCUE Principles of attempting water rescue: Throw attach a rope to anything that floats (ring buoy, life jacket, floating cushions, short pieces of wood, empty plastic jugs, etc.) throw object beyond victim so wind/current allows floating object to come back to victim lean backwards as you pull victim to safety to avoid getting pulled into water yourself WATER RESCUE Principles of attempting water rescue: Row if victim is beyond reach & rowboat/sailboat are available, you may attempt this type of rescue if you have the skill (a paddle/oar craft is slower & safer than a motor driven craft consider elements of danger victim should be pulled into boat over the back, NOT the side WATER RESCUE Principles of attempting water rescue: Go an assessment must be made by rescuer weighing the risk vs. reward to the victim this should be last resort, not first know your capabilities WATER RESCUE After a water rescue: protect victim & yourself against cold be prepared to start mouth to mouth resuscitation and/or CPR seek medical attention for victim and yourself ICE RESCUE attempt to reach victim with an object form a human chain, lying flat to distribute weight on the ice seek medical attention for victim immediately after rescue remove cold/wet clothing & cover with dry warm blankets after rescue DON’T become the next victim LEARNING OUTCOME identify poisoning, alcohol, and drug emergencies and first aid interventions Poisons, Alcohol & Drugs poison defined as: any substance that will cause a reaction that damages tissue, alters organ and system functions or may even cause death Recreational Drugs/Alcohol INGESTED POISONS swallowed (accidental or intentional) Drano INHALED POISONS the act of breathing subjects the respiratory system to inhaled poisons Carbon monoxide ABSORBED POISONS through the skin by coming in contact with a poison Poison ivy INJECTED POISONS through skin puncture that could be a bite from an animal or reptile, a sting from an insect or recreational drug injection Ouch! INGESTED POISONS Signs & Symptoms: nausea, vomiting, diarrhea, abdominal cramping obvious mouth burns, stains, odors obvious containers/evidence of poisons TREATMENT INGESTED POISONS manage A-B-C’s and call 9-1-1 determine what, amount & time ingested contact Poison Control Center Mercy Medical Center: (319)398-6770 St. Luke’s: (319)369-7105 University of Iowa: 1-800-272-6477 follow directions of poison center that may include inducing vomiting using Syrup of Ipecac INGESTED POISONS When NOT to induce vomiting: seizure activity unconsciousness or drowsiness pregnancy heart problems when corrosives, petroleum or strychnine products have been ingested INHALED POISONS Signs & Symptoms: headache dizziness/weakness visual disturbances hoarseness, tightness in throat,difficulty swallowing, coughing, wheezing cardiac & respiratory failure INHALED POISONS OFTEN ODORLESS, BEWARE!! TREATMENT INHALED POISONS don’t become the next victim manage A-B-C’s remove patient from environment if possible call 9-1-1, 100% oxygen is needed for victim ABSORBED POISONS Signs & Symptoms: redness of skin blisters/rashes swelling itching known contact with poison ivy/oak or other poisonous substance TREATMENT ABSORBED POISONS wash exposed area immediately with mild soap & tepid water (avoid strong water pressure) baking soda compresses to affected areas or poison ivy or oak 4 times/day hot baths (releases natural antihistamines) seek medical attention in severe cases INJECTED POISONS Signs & Symptoms: obvious markings (insect bites, bees, ticks, snake bites, etc. or “needle tracks” anywhere on the body) DO THOROUGH EXAM localized pain/burning swelling/redness possible nausea, vomiting, weakness tightness in throat, difficulty breathing possible respiratory/cardiac arrest TREATMENT INJECTED POISONS manage A-B-C’s identify poison pull off ticks with tweezers or fingers grasping close to skin (don’t twist it) call 9-1-1 for drug injected poisons or snake bites tick This bite resulted in Lyme disease MOOD ALTERING SUBSTANCES alcohol: a depressant, even though there is an initial “up feeling”. Abuse of alcohol causes physical & psychological disorders that affect personal & professional relationships MOOD ALTERING SUBSTANCES drugs: may be stimulants (“uppers”) or they may be depressants (“downers”) “UPPER’S” stimulate central nervous system gives feeling of well being/reduce fatigue may cause hyperactivity, restlessness and belligerence when high dosages are used frequently abused “uppers”: caffeine, cocaine, amphetamines, antiasthmatic drugs, vasoconstrictors, etc. “DOWNER’S” depress central nervous system cause drowsiness relieve anxiety relaxing frequently abused “downers”: marijuana, barbiturates, tranquilizers, narcotics, anticonvulsants, etc. MOOD ALTERING DRUGS Signs & Symptoms: possible alcohol odor on breath possible lack of coordination possible drowsiness possible slurred speech possible hyperactivity or combativeness possible nausea/vomiting possible flushed face (red) TREATMENT DRUG ABUSE 9-1-1 manage injuries/shock resulting from abuse (victims abusing drugs/alcohol are frequent ER patients) be prepared for vomiting & save for hospital observe environment for pills, alcohol, drug paraphernalia, etc. manage A-B-C’s/call FIRST AID TRAINING KIRKWOOD COMMUNITY COLLEGE HEALTH SCIENCE FIRST AID TRAINING Power Point #4 LEARNING OUTCOME identify burns, cold, and heat related emergencies and first aid interventions HEAT BURNS Causes: hot liquids, vapor or steam hot flames contact with hot coals, pipes, utensils, stoves, etc. radiant heat solar heat The hotter the source, the more serious the burn injury SUPERFICIAL BURNS epidermis or outer layer of skin involved once referred to as a first degree burn skin will appear very red. A good example of this is the typical sunburn PARTIAL THICKNESS BURNS includes entire outer skin layer & below once referred to as second degree burns in addition to redness, the skin will blister, swell and be very painful FULL THICKNESS BURNS includes all layers of skin & underlying fat, muscle & bone continued FULL THICKNESS BURNS once called third degree skin will be charred (black), white, or red no pain in full thickness burns, nerves destroyed, areas adjacent very painful (2nd degree) BURN ASSESSMENT Factors influencing seriousness of burn size & depth of burn age of victim body parts involved in burn previous medical history temperature of burning agent SIZE & DEPTH OF BURN the greater the size of the involved burn and the deeper the burn penetrates, the more serious the situation SIZING UP THE BURN call 9-1-1 when burn involves: face (possible inhalation) hands & feet (may result in muscle contractures) genitalia area (may result in serious infections) AGE INFLUENCE ON BURN RECOVERY a victim less than 5 years old will not tolerate serious burns because they will not have developed body systems mature enough to battle serious burns a victim older than 60 years of age will not tolerate serious burns, because the advanced maturity of the body systems may not be able to cope with the injury PREVIOUS MEDICAL HISTORY history of cardiac problems may compromise cardiovascular circulation history of respiratory problems may reduce adequate oxygen supply to affected areas history of diabetes will complicate recovery from burns TREATMENT/HEAT BURNS put out fire (wrap body in blanket if flames) manage A-B-C’s remove clothing unless stuck, cut around this area to avoid pulling off body tissue remove all jewelry cool superficial & partial thickness burns with tepid water continued TREATMENT/FULL THICKNESS BURNS cover full thickness burns with sterile dressing or clean cloth call 9-1-1 no ointments, butter or other home remedies do not break blisters do not wrap snug bandages over dressings maintain body temperature, do not allow the victim to get cold CHEMICAL BURNS most serious are the caustic or corrosive actions of chemicals that include: alkali-(examples: Drano - ammonia) alkali burns faster and deeper than acid. Most alkali burns can penetrate and burn within 30 seconds of contact Drano CHEMICAL BURNS most serious are the caustic or corrosive actions of chemicals that include: acid-(examples: bleach, vinegar) acid burns are a little slower to penetrate and are noticed at approximately 30 minutes after contact TREATMENT CAUSTIC OR CORROSIVES Caustic flush or Corrosive: area with gentle flow water15 minutes minimum. Do not use pressure water source (forces chemical into body) Call 9-1-1 & manage A-B-C’s remove clothing and jewelry note name of chemical for professionals remove contact lenses from eyes DO NOT TOUCH chemical yourself TREATMENT DRY CHEMICAL BURNS Dry do Chemicals: not wet (this will activate action of chemical) sweep chemical from clothing, body - do not touch with bare hands remove victim’s clothing manage A-B-C’s and call 9-1-1 note the name of the chemical ELECTRICAL BURNS industrial, bathroom & flooded basements are frequent sites of electrical burns ELECTRICAL BURN ACTION electrical current enters, crosses, and exits body causing an electrical heart rhythm disturbance PVC’s ELECTRICAL BURN ACTION after 24 hours, severe swelling develops around affected area causing “compartment syndrome” a condition that disrupts circulation that deprives cells of oxygenated blood TREATMENT ELECTRICAL BURNS consider your own safety first disconnect power or call power company manage A-B-C’s Call 9-1-1 DO NOT drive victim to hospital any electrical shock can lead to life threatening problems continued TREATMENT ELECTRICAL BURNS cover both wounds (entrance & exit) with sterile dry bandage or clean dry cloth be prepared to do CPR, patient may experience a cardiac arrest burn LIGHTNING STRIKE victim will be at risk for cardiac or respiratory arrest manage A-B-C’s and Call 9-1-1 victim is not electrically charged if the area is a high risk area of being struck again with lightening, get to safety DANGEROUS LIGHTNING SITES TO AVOID open fields under trees on or near water on the golf course on a telephone BOOM COLD EMERGENCIES FROSTBITE occurs when temperature is below freezing affects feet, hands, ears & nose initially severe consequences, gangrene and amputation freezes tissues, causing ice crystals that damage nerves, blood vessels, etc. FROSTBITE Superficial skin white, grayishyellow or flushed painful initially possible numbness, tingling or stinging sensation late sign, outer skin layer will be hard to touch FROSTBITE Partial & Full Thickness part very hard to the touch blisters appear 12-36 hours after freezing begins skin pale and waxy Partial usually no pain after part is frozen full TREATMENT FROSTBITE/FROSTNIP manage A-B-C’s move victim to a warm environment & remove any wet clothing cover with warm/dry blankets handle involved part gently (no rubbing) seek medical attention immediately HYPOTHERMIA anytime the body’s core temperature goes below 95 degrees Fahrenheit, the body is too cool for normal body systems to function MILD HYPOTHERMIA Signs & Symptoms: shivering slurred speech memory lapses poor coordination SEVERE HYPOTHERMIA Signs not & Symptoms: shivering stiff muscles cyanosis (blue) pupils dilated decreased pulse/respirations (or absent) appears dead (80% will die) TREATMENT HYPOTHERMIA manage A-B-C’s and Call 9-1-1 remove from cold environment gently remove wet clothing & cover with blanket heat packs to: head, neck, armpits & groin ventilate with mouth to mouth when necessary (98.6 degrees F) starts warming process be prepared to do CPR HEAT EMERGENCIES Heat Stroke: most dangerous heat emergency sweating ceases body has more heat than it can handle 100 degrees 98% humidity Often enclosed in turnout gear or something similar HEAT STROKE Signs & Symptoms: skin” hot” to touch, “flushed” in color & “dry” to the touch body temperature in excess of 104 degrees decreased level of consciousness “bounding” pulse TREATMENT HEAT STROKE manage A-B-C’s call 9-1-1 move victim to cool environment ice packs to head, neck, armpits & groin keep head & shoulders slightly elevated a true life threatening emergency - - - may Air Lift HEAT EXHAUSTION “most common” heat emergency not as serious as heat stroke excessive perspiration common when hot weather emerges rapidly & the body has not had time to adjust common during hot weather sporting events & outdoor occupational activities due to inadequate fluid intake HEAT EXHAUSTION Signs & Symptoms: profuse sweating weakness, dizziness, headache rapid, weak pulse nausea/vomiting & diarrhea pale/ashen skin color normal body temp TREATMENT HEAT EXHAUSTION manage A-B-C’s remove victim from hot environment cool victim with cold packs/wet towels and a fan if conscious, may give cool liquids to drink (absolutely no alcoholic beverages should be given) seek medical attention HEAT CRAMPS Heat Cramps painful muscle cramps in arms/legs due to profuse sweating HEAT CRAMPS Signs & Symptoms: recent profuse sweating muscles cramping in extremities abdominal cramping TREATMENT HEAT CRAMPS manage A-B-C’s remove from hot environment replenish fluid loss with “water” do not massage cramping muscle(s) LEARNING OUTCOME identify common disease emergencies HEART ATTACK death of a portion of the heart muscle due to an inadequate supply of oxygenated blood pain HEART ATTACK Signs & Symptoms: chest pressure, tightness, pain jaw, neck & arm(s) ache/pain nausea/vomiting or indigestion skin white, gray or bluish in color skin cool & wet to touch shortness of breath pulse changes (rapid, weak, slow, irregular) possible fainting spell TREATMENT HEART ATTACK recognize problem & call 9-1-1 seat patient and provide calm atmosphere reassure patient that help is on the way if Nitroglycerin is being carried by the patient, help them use the drug be prepared to do CPR STROKE “brain attack” a disruption of blood flow to, or through the brain causes: possible burst of a blood vessel in the brain blood clot that traveled to the brain & became lodged attack STROKE Signs & Symptoms: sudden weakness/numbness of face, arm, &/or leg on one side of the body speech disturbances visual disturbances unexplained dizziness, unsteady gait or falls without cause sudden severe headache loss of bladder &/or bowel control TREATMENT/STROKE manage A-B-C’s Call 9-1-1 determine time of onset of symptoms if no injuries, turn patient onto affected side keep head/shoulder slightly elevated if there are no head/neck injuries that prevent it give nothing to eat or drink keep atmosphere calm, avoid creating greater anxiety to the patient TREATMENT/STROKE this patient needs clot-busting drugs in a timely manner. Do not delay definitive care DIABETES an inability of the body to properly metabolize carbohydrates created by a failure of the pancreas to produce insulin insulin carries sugar to body cells lack of insulin causes starving cells in need of fuel (sugar) creating “crises” for diabetics DIABETIC KETOACIDOSIS (High Blood Sugar) Signs & Symptoms slow onset warm, dry, flushed skin decreased level of consciousness “sweet, fruity, acetone” breath odor vomiting intense thirst (due to dehydration) frequent urination TREATMENT KETOACIDOSIS (High Blood Sugar) & call 9-1-1 if victim is conscious, & you are unable to determine if victim is in ketoacidosis or insulin shock, give them a sugar drink or food to eat (NO DIET soft drinks) if unconscious or level of consciousness is diminished, give nothing by mouth. Manage airway until professional rescuers arrive manage A-B-C’s INSULIN SHOCK (Low Blood Sugar) Signs & Symptoms: sudden onset behavior similar to intoxication skin pale, moist and cool to touch weak, disoriented or unconscious intense hunger TREATMENT INSULIN SHOCK & call 9-1-1 immediately if conscious, give sugar drink/food (NO DIET drinks) orange juice with extra sugar question about last insulin & last meal other illnesses? flu, diarrhea, vomiting, etc. extra physical activities? this is a life threatening emergency give nothing to eat or drink if unconscious manage A-B-C’s EPILEPSY a malfunction of the brain due to interruption of the brain wave signals, often a result of trauma or earlier illness that creates an uncontrollable muscle spasm activity SEIZURES Signs & Symptoms often an aura is experienced prior to seizure sudden rigidity & generalized muscle jerking activity begins skin color is blue during seizure eyes appear to roll back into head during seizure often drooling tinged with blood from mouth loss of bladder and/or bowel control deep drowsiness after seizure activity TREATMENT EPILEPTIC SEIZURES manage A-B-C’s (secretions) protect patient from injury (move nearby furniture & objects) DO NOT apply force to flailing patient place something soft under head turn on side for secretions to drain freely maintain privacy for patient continued TREATMENT EPILEPTIC SEIZURES NOT place anything in patient’s mouth call 9-1-1 if condition is new or lasts long than a few minutes DO Most common cause of a seizure in patient’s already diagnosed with the condition, is their failure to take their seizure medications as directed ASTHMA an allergic reaction that causes spasms within the bronchial airways of the respiratory system causing serious breathing problems ASTHMA CRISES Signs & Symptoms recent exposure to allergen difficulty breathing, often wheezing noise is heard (whistling noise) with breathing victim sitting in upright position & leaning slightly forward (tripod position) frightened patient history of asthma, may have an inhaler TREATMENT Asthma Crisis manage A-B-C’s allow patient to maintain sitting (tripod) position remain calm, dim lights, & keep atmosphere quiet assist patient with their asthma medications encourage patient to drink water continued TREATMENT Asthma Crisis CALL 9-1-1 IMMEDIATELY IF: if crisis is caused by a bee sting if no improvement with 30 minutes of initial medications skin color begins to turn gray/blue when breathing is barely heard when evidence of dehydration is present (dry mouth, dry skin, sunken eyes, decreasing level of consciousness is observed, etc.) THE END