First Aid -FCPC (4th Year Demo)

8/8/2019 First Aid -FCPC (4th Year Demo)

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A FIRST AID APPROACH TO NURSING CARE

PRESENTED BY:

BACHELOR OF SCIENCE IN NURSING 4TH

YEARSTUDENTS

EMERGENCY CARE NURSING



T RIAGE



What is T RIAGE?

y Triage is a French word which means ´to sortµ.

Purpose: The purpose of triage is to make acuity determinations and

set priorities.



Five levels of acuity

y Level I: Resuscitation Conditions needing immediate nursing and physician

assessment.Ù

Airway compromiseÙ Cardiac arrest

Ù Severe shock

Ù Cervical spine injury

Ù Multis ystem trauma

Ù Altered level of consciousnessÙ Eclampsia



y Level II: Emergent Nursing assessment and physician assessment within 15

minutesÙH

ead injuriesÙ Severe trauma

Ù Lethargy/ agitation

Ù Chest pain

Ù Back pain

Ù Gastrointestinal bleeding with unstable vital signsÙ Stroke with deficit

Ù Vomiting and diarrhea with dehydration



y Level III: Urgent Conditions requiring nursing and physician assessment

within 30 minutes of arrival.Ù Al

ert head

injury

with

vomiting

Ù Mild to moderate asthma

Ù Moderate trauma

Ù Abuse or neglect

Ù Gastrointestinal bleeding with unstable vital signs

ÙHistory of seizure, alert on arrival



y Level IV: Less urgent Conditions requiring nursing and physician assessment

within one hour.Ù Earache

Ù Minor allergic reaction

Ù Corneal foreign body

Ù Chronic back pain

Ù Alert head injury

Ù

Without vomitingÙ Minor trauma

Ù Vomiting and diarrhea with patient older than age 2 without evidence of dehydration.



y Level V: Non urgent Conditions requiring nursing and physician assessment

within 1 hour.Ù Minor trauma

Ù Sore throat

Ù Minor s ymptoms

Ù Chronic abdominal pain



Color Instances:

Red (immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival.

Yellow(observation)

those who require observation (and possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital care and would be treated immediatel y under normalcircumstances.

Green (wait) are reserved for the "walking wounded" who will need medicalcare at some point, after more critical injuries have been treated.

White (dismiss) are given to those with minor injuries for whom a doctor'scare is not required.

Black (expectant)

are used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the

care that is available.





y ImmediateVictims with a red "Immediate" tag require immediate medical attention because they

have life-threatening injuries. These patients cannot breathe well, lack a radialpulse, cannot follow simple commands and/or are in shock. Emergency workers know

that patients with a red tag must receive immediate care.y DelayedIf a victim in an emergency situation has a radial pulse, does not have fatal or life-

threatening injuries, is able to follow simple commands, but cannot sit or stand because of injuries, she is given a yellow-colored "delayed" tag. This tag tellsemergency workers that a victim does not need treatment within the next hour, but treatment should not be delayed for more than six hours.

y Minor

Victims in an emergency who are able to walk and onl y have minor injuries are placed at a "minor" triage level. "Minor" emergency triage tags are typicall y green and let emergency workers know victims with these tags should be treated onl y when patients of a higher priority are evacuated. Patients with these tags may be asked toassist emergency workers until more help arrives. According to the Agency for Healthcare Research and Quality, it can take anywhere from three hours to three days before patients with "minor" tags receive medical care.

y Deceased

Those who have fatal wounds, or have died because of a mass-casualty incident, are given black labels that read "deceased." If an emergency worker sees a victim is not breathing, he will try to clear the airway and perform CPR. If CPR fails, it is assumed the patient is dead. If a victim is not already dead, but death is inevitable, emergency workers will give them pain medication until death.



CPR



What is CPR?

y Is a technique of basic life support for the purpose of oxygenating the brain and heart until appropriate, definitive medical treatment can restore normal heart and ventilator action.

GOAL: T o provide oxygenated blood to s ystemic circulation and

maintain perfusion to vital organs.



y Indications: Cardiac arrest Respiratory arrest

ÙDrowningÙ StrokeÙ ObstructionÙ Smoke inhalationÙDrug overdoseÙ SuffocationÙ AccidentÙ Coma Ù Epiglottitis



CRITERIA FOR NOT STARTING CPR

If patient has a valid DNAR order.y If patient has signs of irreversible death, rigor mortis,

decapitation, or dependent lividity.y No physiological benefit can be expected.y

Withholding resuscitation in the delivery room for newborns with Confirmed gestation < 2 3 weeks Anencephal y Confirmed trisom y 13 and 18



The chain of survival



COMPONENT S OF CPR

Basic life support ( BLS )

A : Airways B : Breathing C : Circulation D : Defibrillator

Advanced life support that includes (ALS )

Use of adjunctive equipment and techniques for assisting ventilation and circulation ECG monitoring Defibrillation Establishment of I.V. assess and Drug therapy



SEQUENCE OF BLS

y Assess injury and safety

y Determine responsiveness

y Activate emergency medical services

y Positioning the patienty Opening of airways

y Check for breathing

y Check circulation



Survey The Scene, then:

RAP

yR - ResponsivenessTap shoulder and

shout ´Are you ok?µ



RAP

yA - Activate EMS ( emergency medical services )if unresponsive.



RAP

yP - Position on backAll body parts rolled over at the same

timeÙAlways be aware of head and spinal cord

injuries

ÙSupport neck and spinal column



AIRWAY

If victim is unresponsive, determine whether victim isbreathing adequately .

POSITION OF THE VICTIM:

Supine and on a firm flat surface .

RESCUER POSITION:

On the side of the victim.

Cause Of Airway Obstruction?



Airway opening maneuver

y Head tilt ² Chin lift maneuver.

y Jaw ² Thrust Maneuver (in ² Spine injury)



BREAT HING

ASSESSMENT : Check for breathing.

Rescu er brings his/her ear near the victim· s

mou th and nose while maintaining an op en airway .

LOOK

LIST EN FEEL



BREAT HING (contd.)

y Mouth to Mouth breathing.y Mouth to Nose breathing.y Mouth to Stoma breathing.y Mouth to Barrier device.1. Mouth to face-shield rescue breathing.2. Mouth to mask rescue breathing.- One way val ve directs the rescuer·s

breath into the victim, while directing the victim·s

exhaled air away from rescuer

- Oxygen supplementation port





BREAT HING (contd.)

y If the victim is not breathing,give two breaths (of 1 secondeach )

Pinch the nose

Seal the mouth with yours

y If the first two don·t go in,re-tilt and give two morebreaths (if breaths still do not

go in, suspect choking)



CIRCULAT ION

y Not recommended for lay rescuery For health care rescuer, Assess pulse : (

CAROT ID ONLY )not more than 10 seconds.y Look for signs of circulationIf present ² continue

breathing,10-12 / minIf not present ²

go for Cardiac Massage



EXTERNAL CARDIAC MASSAGE



EXT ERNAL CARDIACMASSAGE

y Using both hands in adults;single hand in case ofchildren and tips of middle

and ring fingers in infantsy Rate : 100 compressions /

miny Compression: ventilation

ratio= 30:2 in adults (one or

two rescuers )y In children - 30:2 (1

rescuer);15:2 (2 medical rescuers)



EXT ERNAL CARDIAC MASSAGE

Depth of compressions: 1.5 to 2 inches in adults

For children: ½ to 1/3 of chest depth and use 1 or 2hands (keep one hand on forehead if possible)

Location : lower half of the sternum between the nipplesin adults ; just below the nipple line in infants and children.



POSIT IONING DURING EXT ERNAL CARDIAC MASSAGE

y Patient should be firml y placed on a horizontal surfacey Onl y heels of the hands used for compressionsy

Fingers interlaced , off the chesty Arms extended, elbows lockedy Shoulders directl y above the handsy Weight of upper body used for compression



CPR on an Adult



CPR on an Infant



2 mechanisms explaining therestoration of circulation byexternal cardiac massage

Cardiacpump

Thoracicpump



ALT ERNAT IVE MET HODS OFCIRCULAT ORY SUPPORT

y ACT IVE compression-decompression CPRy SIMULT ANEOUS ventilation-compression CPRy Cough CPR

y INT ERPOSED abdominal compression CPRy Pneumatic vest CPRy High Impulse CPRy Abdominal binding with compressiony INVASIVE CPR



CHECK FOR CPR EFFECT IVENESS

y Check visible rise and fall of chest with every breath

y Have a second rescuer check pulse while you give the compression

y

ET C O2 monitoring ² excellent noninvasive guidey Invasive pressure monitoring - ideal



When Can I Stop CPR?

y Victim revives

y Trained help arrives

y Too exhausted to continue

y

Unsafe sceney Physician directed (do not resuscitate orders)

y Cardiac arrest of longer than 30 minutes - controversial



Complications of CPR

y Vomiting

y Aspiration

ÙPlace victim on left side

Ù

Wipe vomit from mouth with fingers wrapped in a clothÙReposition and resume CPR



Stomach Distension

y Air in the stomach Creates pressure against the lungs

y Preven tion of Stomach Distens ion Don·t blow too hard Slow rescue breathing Re-tilt the head to make sure the airway is open Use mouth to nose method



y Complications:

Postresuscitation distress syndrome

Neurologic impairment, brain damage



BURNS



BURNS

y To distinguish a minor burn from a serious burn, thefirst step is to determine the extent of damage to

body tissues.

3 TYPES OF BURN

1.First degree burn

2.Second degree burn

3.Third degree burn



y Actions taken for minor burns:

Cool the burn

Cover the burn with a sterile gauze bandage

Take an over the counter pain reliever

CA UTION!!!

1. Don¶t use ice

2. Don¶t apply butter or ointments to the burn.

3. Do not break the blisters.



y Actions taken for major burns:

1. Don¶t remove burned clothing

2. Don¶t immerse large severe burns in cold water.

3. Check for signs of circulation( breathing, coughingor movement)

4. Elevate the burned body parts or parts.

5. Cover the area of the burn



y Complications:



FRACTURE



FRACTURE

y A broken or cracked bone

y Occurs when pressure to bone

y Occurs with/without displacement of bone

fragments TYPES:

1. Open Fracture

2. Closed Fracture

3. Complicated Fractures4. Stress Fracture

5. Greenstick Fracture



y SYMPTOMS

1. severe pain

2. difficulty in movement

3. swelling/bruising/bleeding

4. deformity /abnormal twist of limb

5. tenderness on applying pressure



y First aid for open fractures: Control bleeding before treatment Rinse and dress the wound

First aid for open/closed fracturey Check the breathingy Calm the persony Examine for other injuriesy Immobilize the broken woundy

Apply ice to reduce pain/swellingy Consult a doctor



DO NOT:

y Massage the affected areas

y Straighten the broken bone

y Move

y Without support to broken bone

y Move joints above/below the fracture

y Give oral liquids/food



y Complications:

Early ComplicationsLocal V ascular injury. This can cause external or internal haemorrhage V isceral injury. This can cause damage to vital organs kidneys, intenstine or bladder V eural DamageInjury to surrounding tissueHaemarthrosis. this means blood in the jointCompartment syndrome. Due to bleeding the blood gets accumulated in thecompartments formed by fascia and bone. When this becomes too much in acompartment which does not expand, pressure on the surrounding tissuescauses ischaemia or lack of oxygen following poor blood supply. Wound contamination that could lead to infectionSystemic:

Fat embolism.Shock Thromboembolism Acute Respiratory Distress



y Late Complications

y Local:y Delayed Union. The bone takes more time to heal than what it normally takes.Union occurs eventually with or

without augmentation procedure.y Non-union. There occurs complete cessation of bone healing and bone would not heal without an

augmentation procedure like bone grafting.

y Malunion. the fracture unites in with fragments in unacceptable position leading to deformity and otherpotential problems of malalignment

y Joint stiffness

y Contractures of soft tissue. this may include tendon, ligaments, joint capsule and skiny Myositisossificans. This is a term used for abnormal ossification of soft tissues. if arounfd joint, it may limit

the range of motion.y Avascular necrosisy Algodystrophy or Sudeck¶s atrophy. It is neurovascular disturbance following abonormal behavior of

sympathetic nervous system.y Osteomyelitis. it is infection of bone and medullay Growth disturbance or deformity leading to limb length discrepancy.y

Pressure ulcers following casty Pin tract infectiony Systemicy Gangrene. It may occur due to vascular injury, failed vascular repair or as complication of pplaster casty Tetanus. This is as a result of contamination by tetanus spores at time of injury

y Septicaemia



Prevention

y Prevention:

Wear protective pads/helmets when driving

Teach children/practice, safe habits



FAINTING



FAINTING

y Occurs due to decreased blood supply to the brain.

y A fainting spell usually brief.

y It may or may not have medical significance.



Causes

y Causes:

Anxiety

Emotional upset

Stress

Severe Pain

Skipping meals

Standing up too fast

Standing for a long time in crowd

Some medications

Diabetes

Blood Pressure



y Symptoms:

Nausea

Giddiness

Excessive sweating

Dim vision

Rapid heartbeat

TREATMENT



TREATMENT

y First aid:

When a person feels faint-make them sit or lie down

If sitting position head between knees

When a person faints position him on his back

Check to see if airways are clear

Restore blood flow

Elevate feet above head level

Check if breathing or pulse is normal



y POSsible complications

y Injury while fainting, such as from a fall.

y Complications caused by a disorder that lead to the

fainting.y Recurrent fainting can have a major impact on a

person's lifestyle. It may prevent driving a motor vehicle.



RESCUE TRANSFER



What is rescue transfer?

y It is a procedure for moving a victim from the dangeror unsafe area to a safer place.



y Indications:

Danger of fire or explosion

Danger of toxic gases or asphyxia due to lack of oxygen

Risk of drowning Danger of electrocution

Danger of collapsing wall

Exposure to cold or intense weather condition

Danger or pinning by machinery



y Basic principles of transfer:

Maintained open airway

Hemorrhage is controlled

V ictim is safely maintained in the correct position

V ictim is safely secured

V ictim¶s condition are made

The body is moved as one unit



y Types of rescue transfer:

Three man Carry

Six Man Carry

Four-hand Carry

Hand as Litter

Chair as Litter

Lover¶s Carry



y Hand as a litter

This carry is used to for carrying a casualty for a short distanceand in placing him on the litter.



y Lover¶s carry:

This carry is used to move a casualty for a short distanceand to bring and place him on a litter.



OPEN WOUNDS



Open Wound

y A break in the skin or mucus membrane; or theprotective layer is damage





y First aid for wounds with severe bleeding:

C-Control bleeding

C-Cover the wound

C-Care for shock

C-Consult or refer to a physician



y Ways to treat an open wound:

Applying pressure

Cleaning the wound from infection

Washing the wound with cool water

Washing the wound with antibacterial soap

Get the wound stitched

Dress the wound

Frequently re-bandage the wound.



y Home care (wounds with severe bleeding not severe)

Clean the wound with soap and water

Apply mild antiseptics

Cover wound with dressing and bandage



Reminders:

y All wounds must be thoroughly inspected andcovered with a dry dressing to control bleeding andprevent further contamination.

Documents

First Aid -FCPC (4th Year Demo)