First Aid - Prehospital Care

21-November-2004 Dr. T. R. Bhadran 1

“Welcome”


Presented by: Dr. T.R.Bhadran, MBBS; DTM&H; D.Ortho,.

Civil Surgeon & Orthopaedic Surgeon,Taluk Hospital, Cherthala.

First Aid


―First aid is the initial care of a suddenly sick or injured person‖ ,

( pre-hospital care) the aims being

To preserve life

To prevent further harm

To relieve pain

Definition


Immediate action

Don’t panic

Get help

Reassurance

What to do in an emergency?


Immediate action

Fix priority

Remain calm & controlled

Think before acting

Actions should be deliberate


Calling for help

Ambulance/fire/police/doctor/hospital

Stay on line until the called person gets

the proper message


Information to be conveyed from remote area

Exact address or location City or town Nearest junction or street Landmarks Distance from Callers identity Caller’s phone number Explain the incidence Number and condition of casualties Explain aid available & urgency


Explaining aid available &

urgency in a hospital casualty situation

Type & Time of accident

Number of casualties, age & sex

Did they walk in / were carried in?

First aid given

Body parts injured

Has an X-ray been taken?

Urgency:- Can the case wait until the called person completes more serious work at hand, while first aid is being given & an X-ray is being taken?


Methods to call for help…………

Direct – Call aloud, Clapping, Drumming

Phone- land/mobile

Wireless set

Flag flares

E-mail

Personal locator beacons

Medical alert devices


Reassurance*:-

Emotional support

Keep the casualty informed

Comfort the casualty

Console relatives of the casualty

Get the relatives involved in helping

Explain the situation to the concerned


First aid Kits*

Adhesive strips

Hand towels – 3

Adhesive tape – 1 roll

Non adhesive dressings

Alcohol swab

Plastic bag for amputations


Combine dressings

Safety pins, blades, scissors

Crepe bandages 5 & 7.5 cms

Splints

Triangular bandages

Gauze swab

Wound dressings

Gloves disposable

CPR barrier devices


Sorting and classification of casualties and

establishment of treatment priorities in

mass casualty situations.

Ask 3 questions Who can be saved?

Who will & who won’t benefit?

If I treat this case will the others suffer?

*Triage*(pronounced „tree-ahz‟)


High priority!!!

Unconscious casualty on his back!

Severe bleeding!

Head & face injury!

Shock!

Chest, Abdominal & Pelvic injury!

Respiratory embarrassment!

Severe burns!


“Approaching the scene”

Examine the scene

Control the scene with help

Assess the scene

How many casualties are there?

Gain access to the casualty

Assess the casualties

Triage the casualties

Attend to the casualty


“GOLDEN HOUR”

Period during which all efforts are made to

save life before irreversible pathological

changes take place, period from time of

injury to getting definitive treatment


„Platinum minutes‟

The first 10 minutes of golden hour

Assessment & injury survey – 1 min

Resuscitation & stabilization – 5 min

Immobilization & transport - 4 min


Attending the casualty-assess

Shock

Respiration

Airway

Bleeding

Consciousness

Injuries


Shock

Identify by

Cold limbs

Pale skin

Shallow breathing

Vomiting

Shivering

Lying on back


Shock

What to do

Keep him lying down

Elevate the legs

Stop bleeding from wounds

IV line


Bleeding from wounds

Have the injured person lie down

Remove any obvious dirt or debris from the wound

Apply pressure directly on the wound

Maintain pressure until the bleeding stops

Don't reposition displaced organs

Don't remove the gauze or bandage

Squeeze a main artery if necessary

Bind with tight bandage & immobilize the injured body part once the bleeding has stopped


Bleeding from nose

Usually stops within a few minutes

Lean forward

Pinch the bridge of the nose & mouth-breathe

Apply a cool wet cloth to the face & nose

Apply ice covered with cloth on bridge

Don’t pick or blow nose after bleeding stops

Decongestant nasal sprays


Respiratory arrest

No voluntary breathing movements

Clear the airway &/or Heimlich maneuver

Artificial respiration

Mouth to mouth

Intubations & Ambue bag / respirator

Tracheostomy (in expert hands only)


Choking

Choking is often the result of inadequately chewed

food becoming lodged in the throat or windpipe.

Solid foods such as meat are frequently the cause

Talking while simultaneously chewing

Drinking alcohol while eating

Wearing dentures

Young children tend to put into their mouths


Choking

Panic

An expression of fear or terror

The victim may turn purple

The eyes may bulge

May wheeze or gasp

Can speak if block is partial / no if not.


Heimlich maneuver

-in a conscious adult

Stand behind him, wrap your arms around his waist, bend him slightly forward.

Make a fist with one hand and place it slightly above the person's navel, grasp your fist with the other hand

Press hard into the abdomen with a quick, upward thrust

Repeat this procedure until the object is expelled from the airway


Heimlich maneuver

-in an unconscious adult

Position adult on his back, look inside the mouth

Sweep the area with your finger

See if you can remove the blockage.

If not, kneel over the person and apply upward

thrusts to the upper abdomen

Repeat the process as necessary to remove the

blockage


Heimlich maneuver

-in a choking infant

Assume a seated position and hold the infant

facedown on your forearm, which is resting on

your thigh

Thump the infant gently but firmly five times on

the middle of the back using the heel of your hand

Repeat till breathing resumes

The combination of gravity and the back blows

should release the blocking object


Heimlich maneuver

-in a pregnant woman & in obese

Position your hands a little bit higher than

with a normal Heimlich maneuver, at the base

of the breastbone, just above the joining of

the lowest ribs


Cardiopulmonary resuscitation

Combination of mouth to mouth rescue

breathing and chest compression

Chest compression to move blood to vital organ

like brain,lungs and heart

Rescue breathing to oxygenate the blood


CPR

Check signs of life

Position person on back on hard surface

Lift chin forward to open airway

Watch for spontaneous breathing, if nil

Pinch his nostrils

Breath into his mouth @ 12 breaths/min

Completely refill your lung after each breath

What if still there are no signs of life?


No response,movement or breathing??

Begin chest compressions

Place heel of both hands on lower end of chest bone

Keep elbows straight

Lean forward and press making use of your weight

Push down 1.5 to 2 inches @ 80 –100 times/min

Between 15 each compressions breath into him twice

Check for signs of life after every four cycles of 15 compressions and 2 breaths: namely neck pulse, spontaneous breathing movement and/or cough.


Head trauma

Signs

Severe head or facial bleeding

Changes in level of consciousness

Blue-black discoloration near eye or ear

Cessation of breathing

Confusion

Loss of balance

Weakness or inability to use arm or leg


Head injury

What to do

Keep him lying down

Hold him still

Avoid moving the neck

Stop any bleeding

Watch out for respiratory &/or cardiac arrest


Chest injury

What to do

Seal all penetrating wounds with occlusive

dressing & prevent pneumothorax

Clear the airway

Take care, avoid chest compression

Plaster strapping in flail chest


Abdominal injury

What to do

Care of wounds

Don't reposition displaced organs

Abdominal binders


Spine injuries

Assessment

? Other associated head injury

C/o pain in neck or back

Weakness, numbness or paralysis or loss of control over a)limbs,

b)bladder

c) bowel


Spine injuries

What to do

Keep the person still

Stabilize the neck with a heavy towel

Never ever move the neck

Transport on hard board or wooden plank

Move with help of several people support

If alone, drag by his clothing, never turn him

Or, leave him in position he was found


Crush Injury Syndrome

Why serious?

A casualty trapped by compressing force for prolonged period

Collection of large quantities of acid and electrolytes and toxins in the crushed muscle

On release of compressing force, the liberated blood carries the toxin in high quantities to the vital organs with fatal results



Criteria for assessment:

Large muscle mass involved

Prolonged compression

Compromised blood circulation



Signs and symptoms

Compression in excess of 60 min

Large muscle mass

Absent pulse or capillary distal to crush

Pale, cool, clammy skin

Weak rapid pulse

Absence of pain in the affected limb

Onset of shock



Care and first aid

If < 1hr, release the crushing force

If > 1hr, do not relieve crush

Tourniquet- to or not to?

Reassure the casualty

Treat any other associated injuries


Dislocations

―Injury to joint where the ends of bones are forced from their normal positions.‖

Splint the affected joint into its fixed position. Don't try to move a dislocated joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels.

Put ice on the injured joint.


FracturesDiagnosis

Pale, cool, clammy skin & rapid, weak pulse

Pain & Tenderness at the site

Loss of power to limb

Associated wound and blood loss

Associated organ damage

Deformity &/or Crepitus (never attempt to elicit)

If doubtful compare with opposite normal limb


Fractures

Immobilize the part- why & how:

A splint stabilizes & reduces pain

Include the joints above and below the fracture in

the immobilization technique used & prevent

unwanted movement

Don't attempt to align the bone back into position

The splint should be longer than the bone it is

splinting and extend above and below the injury


Fractures

Cont’d

Use a rigid material such as wood, plastic metal, tree branches or even rolled paper. Pad the splint

Fasten the splint to the limb with gauze, strips of cloth or string, or even a belt. Start wrapping from the extremity and work toward the body. Splint the limb firmly to prevent motion but not tight enough to stop blood flow


Fractures

Ideal equipments

Arm sling

Elevated sling

Collar & cuff (clove hitch) sling

Triangular bandage

Thomas splint

Collars (hard/soft)

Foldable trolley with body straps


Anatomical immobilization

Finger to finger

Forearm & arm to chest (use cuff button)

Leg-to-leg & Thigh-to-thigh


Sprains

―Injury to a ligament caused by excessive stretching‖

Protect the injured limb from further injury

Rest the injured limb.

Ice the area.

Compress the area with an elastic wrap or bandage.

Elevate the injured limb


*PAIN KILLERS*

―There is no better painkiller so good as

good immobilization of an injured limb‖


Drowning

Without placing yourself at risk, remove the casualty from the water

Make sure that his/her head is kept low, this will discourage the threat of inhaling one's vomit

Once on land/pool-side perform mouth -to-mouth resuscitation

Wrap them as quickly as possible with a blanket

Look/Listen or Feel for signs of breathing

CPR


Heart attack

Tell-tale symptoms & signs

Uncomfortable pressure, fullness or squeezing

pain in the center of chest, lasting more than a few

minutes

Pain spreading to shoulders, neck or arms

Lightheadedness, fainting, sweating, nausea or

shortness of breath


Heart attack

Seat the casualty comfortably

Call for emergency medical assistance

Open windows and let fresh air in

Decide on the fastest method of transportation

Chew aspirin

IV line

Monitor breathing and pulse

CPR if need be


Epilepsy

Allow the seizure to run its course

Place a soft padding around his/her head

Try and move objects away from the individual

Don’t attempt to put objects into epileptic's mouth

Don't restrain the epileptic

Wait for the jerking movements to cease

Place the casualty in the recovery position

Offer comfort and reassurance


Stroke

Occurs when there's bleeding into brain, or normal

blood flow to brain is blocked.

Within minutes of being deprived of essential

nutrients, brain cells start dying — a process that

may continue over the next several hours.


Stroke

Symptoms are sudden like bolt from the blue

Weakness or numbness in your face, arm or leg on one

side of your body

Dimness, blurring or loss of vision, particularly in one

eye

Loss or trouble of speech

Severe headache, disorientation

Unexplained dizziness, unsteadiness or fall


Stroke

True emergency

Seek immediate medical assistance.

The faster treatment is given, the more likely damage can be minimized.

Every moment counts.

Remember: The longer a stroke goes untreated, the greater the damage and potential disability. Success of treatment may depend on how soon you receive care


Food poisoning

Avoid milky drinks or anything acidic such as

soft drinks

Drink plenty of fresh, boiled water constantly


Poison ingested

Call emergency services immediately

Do not force the individual to vomit

If the casualty has taken corrosive poison , it would be best to give the person sips of water or milk

Use the A B C technique and be prepared to carry out resuscitation

Be sure to place a conscious or unconscious individual in the recovery position until help arrives


Burns

Superficial Burn (First Degree)

Involves only the top layer of skin.

The skin is red and dry and usually painful.

The burned area may also swell.

The underlying skin is healthy.


Burns

What to do

Treat immediately with cool water. Keep the burn

under the water until there is little or no pain.

Then apply a moist dressing, and bandage loosely.

Where water is not available, apply a clean, dry

dressing.


Burns

Partial-thickness Burn (Second Degree)

Involves the partial layers of skin

The skin is red with blisters

May open and weep clear fluid

Giving the skin a wet appearance

The area may also appear mottled

Usually painful and often swells


Burns

What to do

Do not break the blisters - this will compound the

injury by causing an open wound.

If the blisters are not open, place in cool water until

the pain lessens,

Then apply a moist dressing, and bandage loosely.

Do not apply creams, ointments, or sprays.


Burns

Full-thickness Burn (Third Degree)

Destroys all layers of skin

Destroys any or all of the underlying structures

The burn appears brown or black (charred) with

the tissues underneath sometimes appearing white.

Extremely painful or relatively painless if the

burn destroys the nerve endings.


Burns

What to do

Do not apply creams, ointments, or sprays.

Wrap a clean sheet around the victim and,

If the weather is cool, cover them with blankets.

The victim should be rushed to hospital because

their life is at stake.


Burns

Chemical Burns

Remove the chemical immediately

Flush the area with large amounts of cool running

water

Remove any clothes with chemicals on them

Be careful not to spread the chemical to other

body parts or to yourself.


BurnsElectrical Burns

The power source has been turned off.

If the victim is unconscious, check breathing and pulse.

Check for other injuries

Do not move the victim because he may have spinal injuries.

Cover an electrical burn with a dry, sterile dressing.

Do not cool the burn. There may be two wounds, one where the current entered the body and one where it left, and they may be deep.


Cuts & scrapes

Wear latex gloves & avoid direct contact with body fluids

Stop the bleeding.

Clean the wound.

Apply an antibiotic.

Cover the wound.

Change the dressing.

Get stitches for deep wounds.

Tetanus toxoid


Part of body torn off

Find the part

Wrap it in clean dressing

Put the bag on ice, but don’t freeze

Take the part to the hospital


Bruise

Forms when a blow breaks small blood vessels near

the skin's surface

A small amount of blood leaks out under the skin

The trapped blood appears as a black-and-blue mark

Sometimes, there are tiny red dots or red splotches

The skin isn't broken


Bruise

First aid measures

Doesn't need a bandage.

Elevate the injured area.

Apply ice or a cold pack for 30 to 60 minutes


Muscle cramps

Symptoms & signs

Painful, involuntary muscle spasms that usually

occur during heavy exercise in hot environments.

Inadequate fluid intake often contributes to this

problem

Muscles most often affected include calves,

arms, abdomen and back


Muscle cramps

Rest briefly and cool down

Drink water or an electrolyte-containing

sports drink

Practice gentle, range-of-motion

stretching and gentle massage of the

affected muscle group


Foreign object in the skin

If not deeply embedded

Use tweezers to remove slivers of wood or

fiberglass, small pieces of glass or other foreign

objects projecting from your skin.

Clean the area well with soap and water and

apply alcohol to the wound.


Foreign object in the skin

If deeply embedded

Clean the area well with soap and water.

Break the skin over the object with the Sterile needle.

Use tweezers to remove the object. A magnifying glass may help you see the object better.

Apply antibiotic ointment to the area.

If the particles don't come out easily, cover with sterile pad and seek medical help


Foreign body in ear

First aid procedures

Don't probe your ear with a tool.

Remove the object if possible.

Try using gravity.

Try using oil for an insect.

Don't use oil to remove any object other than an insect.


Foreign body in nose

Don't probe at the object with any tool

Don't try forcefully breathing in & inhale the object

Breathe through mouth until the object is removed

Blow nose gently to try to free the object

If the object is visible and you can easily grasp it with

tweezers, gently remove it

Or else call for emergency medical assistance


Foreign body in eye

What to do

Seat the person in a well-lighted area.

Try to locate the object

If the object is floating in the tear film or on the surface of the eye, you may be able to flush it out or remove it manually

If the object is large . Don't remove the object cover the eye and the object with a paper cup

Seek emergency medical assistance


Corneal abrasion

Extremely painful, because the cornea is very

sensitive

Feeling of sand in eye

Tears

Blurred vision

Increased photo sensitivity

Redness around the eye


Corneal abrasion

Rinse the eye with lukewarm clean tap water over

the eye or splash the eye with clean water. This may

wash out the offending foreign body. Blink several

times. This movement may remove small particles

of dust or sand.

Pull the upper eyelid over the lower eyelid. The

lashes of the lower eyelid can brush the foreign

body from the undersurface of the upper eyelid.


Black eye

Bleeding beneath the skin around the eye

Sometimes indicates a more extensive injury,

even a skull fracture, particularly if the area

around both eyes is bruised or if there has been

head trauma.


Black eye

Using gentle pressure, apply ice or a cold pack to the

area around the eye for 10 to 15 minutes

Do not to press on the eye itself.

Apply cold as soon as possible after the injury to

reduce swelling.

Be sure there's no blood in the white and colored

parts of the eye.


Tooth loss

Handle the tooth by the top only, not the roots.

Don't rub it or scrape it to remove dirt.

Gently rinse the tooth in a bowl of tap water

Try to replace the tooth in the socket. Then bite

down gently on gauze to help keep it in place. If

you can't, immediately place it in milk, or , saline

Apply sterile gauze in the gap left by lost tooth


Fainting

Occurs when the blood supply to the brain is

momentarily inadequate, causing one to lose

consciousness for a brief spell.

Position the person on his or her back.

Watch the airway carefully

Check for breathing

Help restore blood flow


Motion Sickness

It can strike suddenly, progressing from a feeling of restlessness to a cold sweat, dizziness and then

vomiting

By ship:request a cabin in the middle of the ship, near the waterline

By plane:ask for a seat over the front edge of a wing. Once aboard, direct the air vent to your face

By train:take a seat near a window and face forward

By road:drive or sit in the front passenger's seat


Motion Sickness

Focus on the horizon or on a distant, stationary

object. Don't read.

Keep your head still, resting against a seat back.

Don't smoke or sit near smokers.

Avoid spicy foods and alcohol. Don't overeat.

Take anti-emetics on eve of journey


Snake bite

Poisonous

Fright & fear +

Fang marks +

Local reaction + / --

Systemic signs +

Non-poisonous

Fright & fear +

Fang marks nil

Local reaction nil

Systemic signs nil


Snake bite

Remain calm & don't try to capture the snake

Immobilize the bitten arm or leg and try to stay as quiet as possible

Don't cut the wound or attempt to remove the venom

Don't use a tourniquet or apply ice

Seek medical attention as soon as possible, especially if the bitten area changes color, begins to swell or is painful.


Insect stings

Move to a safe area to avoid more stings

Scrape off the stinger with a straight-edged object

Don't try to pull out the stinger doing so may release

more venom.

To reduce pain and swelling, apply ice or a cold pack

Apply 0.5 percent or 1 percent hydrocortisone cream,

calamine lotion or a baking soda paste

Antihistamine


“ All‟s well that ends well ”

The clean up

Take a break, relax and breathe easy

Talk about the incidence with peers

Clean up the scene

Clean equipment and restock your first aid kit

Replace all items used

Complete any documentation needed


“The purpose of life is to serve and show compassion and the

will to help others”

So,

“Help…………………………”Thank you

Documents

First Aid - Prehospital Care