Transcript الشريحة 1 - Philadelphia University

First Aid
Dr. Abdul-Monim Batiha
Assistant Professor
Critical Care Nursing
Philadelphia university
1
WHAT IS FIRST AID?
It is the immediate assistance or
care given to a person who has been
injured or suddenly became ill, from
the moment of the accident until
availability of specialized medical
care.
Note:
First Aid is not restricted to physical but
also involves psychological support as well.
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Who needs First Aid?
Cardiac and Respiratory Arrest
 Electric Shock
 Wounds
 Bleeding
 Burns
 Fractures and Traumatic Injuries
 Poisoning
 Drowning
 Snake bites
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In calling for an ambulance make
sure you give:
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or address form which you are calling
The nature of emergency
The number of people involve
The precise location of the emergency
Don’t hang up until you certain that the person
on the line has all the necessary information and
you telephone number
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Goals of first aid
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To restore and maintained vital functions (ABC)
To prevent further injury or deterioration
To reassure the victim and make him or her as
comfortable as possible
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Goals of first aid
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Assess victims for signs of life
Restore respiration
Restore heart action
Stop bleeding
Treat the shock
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Transporting the victim
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The victim should not be moved but should be
treated where he lies.
In certain circumstances injured person must be
moved to prevent further injury from fire , an
expulsion…etc.
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Equipment and supplies
Standard First Aid Boxes
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Various dressings, wire splints, tape, Band-Aids,
tourniquets, skin pencils, and other first aid
supplies are included in these boxes. Each box is
secured with a wire or plastic seal that can be
easily broken.
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The seals are used to identify whether the kit has
been opened. A broken seal indicates that the
first aid box must be inventoried( complete list of first aid)
and restocked. The standard first aid box has
three compartments. Each compartment should
have a plastic bag that is complete with the basic
first aid supplies. Take one of these bags with
you on your way to the casualty. Failure to take a
bag to the scene( location at which an event or action happens )may
result in you having to go back for supplies.
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The box does not contain needles, syringes, or
medications; but does contain the proper
supplies needed to render first aid until medical
assistance arrives. First aid boxes are for
emergency use only! Report all broken seals to
medical personnel as soon as possible. It is
important that you know the contents and
locations of these boxes.
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Dressings
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A dressing is a protective covering for a wound and is
used to control bleeding and prevent contamination of
the wound. A compress is a sterile pad that is placed
directly on the wound. A bandage is material used to
hold a compress in place. When applying a dressing,
ensure that it remains as sterile as possible. The part of
the dressing that is placed against the wound must
never touch your fingers, clothing, or any un-sterile
object. If you drop, a dressing across the casualty's skin
or it slips after it is in place, the dressing should not be
used.
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Battle Dressings
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Battle dressings are used most often aboard ship
and in the field. Each dressing is complete (no
other materials are needed) with four tabs which
help in applying and securing the dressing. They
have "other side next to wound" marked on the
outer side. This will help you in (Fig. 5-2)
placing the sterile side against the wound. Unless
contraindicated, to assist in controlling the
bleeding, tie the knot of the dressing over the
wound.
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Battle Dressing
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Compresses
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Emergencies may occur when it is not possible
to obtain a sterile compress. During these
situations, use the cleanest cloth available, a
freshly laundered (washed) handkerchief (square of cloth or
absorbent paper), towel, or shirt. Unfold the material
carefully so that you do not touch the part that
will be placed against the wound. The compress
should be large enough to cover the entire
wound and extend at least 1 inch beyond its
edges.
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If a compress is not large enough, the edges of
the wound will become contaminated. Materials
that will stick to a wound or may be difficult to
remove should never be used directly on a
wound. Absorbent cotton, adhesive tape, and
paper napkins are examples of materials that
should never come in contact with a wound.
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Bandages
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Bandages are strips or rolls of gauze or other materials
that are used for wrapping or binding any part of the
body and to hold compresses in place. It is not
necessary to take time to ensure that the bandage
resembles the textbook pictures. However, it is
important that the dressing controls the bleeding,
prevents further contamination, and protects the
wound from further injury. Some of the most
commonly used bandages are the roller bandage and
the triangular bandage.
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Roller Bandages
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The roller bandage consists of a long strip of
material (usually gauze, or elastic) that is rolled
and is available in several widths and lengths.
Most are sterile, so pieces may be used as a
compress on wounds. A strip of roller bandage
can be used to make a four-tailed bandage by
splitting the cloth from each end, leaving as
large a center as needed. This type of bandage is
used to hold a compress (Fig. 5-4B) on the chin,
or (Fig. 5-4C) the nose.
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Four Tailed Bandage
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Triangular Bandages
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Triangular bandages (Fig. 5-5) are usually made
of muslin (thin cotton cloth). They are useful because
they can be folded in a variety of ways to fit
almost any part of the body. Padding can be
added to areas that may become uncomfortable.
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Cravat Bandage
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The triangular bandage can be folded to make a
cravat bandage, which is useful in controlling
bleeding from wounds of the scalp or forehead.
To make a cravat bandage, bring the point of
the triangular bandage
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The uses of the roller, triangular, and
cravat bandage.
Roller Bandage for the Hand and Wrist
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Roller Bandage for the Ankle and
Foot
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Triangular Bandage for the Head
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Triangular Bandage for the Chest
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- Cravat Bandage for the Elbow or
Knee
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Cravat Bandage for the Arm,
Forearm, Leg, or Thigh
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The three primary objectives are
(ABC) for first aid
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) (1) to maintain an open airway,
(2) maintain breathing, and
(3) to maintain circulation. During this process
you will also:
control bleeding, and
reduce or prevent shock.
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You must respond rapidly, stay calm, and think
before you act. Do not waste time looking for
ready-made materials, do the best you can with
what is at hand. Request professional medical
assistance as soon as possible.
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Initial Assessment
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When responding to a casualty (victim), take a
few seconds to quickly inspect the area. Remain
calm as you take charge of the situation, and act
quickly but efficiently. Decide as soon as
possible what has to be done and which one of
the injuries needs attention first.
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During your initial assessment,
consider the following:
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1. Safety - Determine if the area is safe. If the
situation is such that you or the casualty is in
danger, you must consider this threat against the
possible damage caused by early movement. If
you decide to move the casualty, do it quickly
and gently to a safe area where proper first aid
can be given. You cannot help the casualty if
you become one yourself.
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2. Mechanism of injury - Determine the extent
of the illness or injury and how it happened. If
the casualty is unconscious, look for clues. If the
casualty is lying at the bottom of a ladder (steps),
suspect that he or she fell and may have internal
injuries.
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3. Medical information devices - Examine the
casualty for a MEDIC ALERT (Fig. 1-1)
necklace, bracelet, or identification card. This
medical tag, provides medical conditions,
medications being taken, and allergies about the
casualty. The VIAL OF LIFE, a small,
prescription-type bottle, also contains medical
information concerning the casualty. This bottle
is normally located in the refrigerator.
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4. Number of casualties - Look beyond the
first casualty, you may find others. One casualty
may be alert, while another, more serious or
unconscious, is unnoticed. In a situation with
more than one casualty limit your assessment to
looking for an open airway, breathing, bleeding,
and circulation, the life-threatening conditions.
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5. Bystanders - Ask bystanders to help you find
out what happened. Though not trained in first
aid, bystanders can help by calling for
professional medical assistance, providing
emotional support to the casualty, and keeping
onlookers from getting in the way.
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6. Introduce yourself - Inform the casualty and
bystanders who you are and that you know first
aid. Prior to rendering first aid, obtain the
casualties consent by asking is it "OK' to help
them. Consent is implied if the casualty is
unconscious or cannot reply.
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General Rules
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1. Keep the casualty lying down, head level with
the body, until you determine the extent and
seriousness of the illness or injury. You must
immediately recognize if the casualty has one of
the following conditions that represent an
exception to the above.
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a. Vomiting or bleeding around the mouth - If
the casualty is vomiting or bleeding around the
mouth, place them on their side, or back with
head turned to the side. Special care must be
taken for a casualty with a suspected neck or
back injury.
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b. Difficulty breathing - If the casualty has a
chest injury or difficulty breathing place them in
a sitting or semi-sitting position.
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c. Shock - To reduce or prevent shock, place the
casualty on his or her back, with their legs
elevated 6 to 12 inches. If you suspect head or
neck injuries or are unsure of the casualty's
condition, keep them lying flat and wait for
professional medical assistance.
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2. During your examination, move the casualty
no more than is necessary. Loosen restrictive
clothing, at the neck, waist, and where it binds.
Carefully remove only enough clothing to get a
clear idea of the extent of the injuries. When
necessary, cut clothing along its seams (line of
stitching).
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Ensure the casualty does not become chilled,
and keep them as comfortable as possible.
Inform the casualty of what you are doing and
why. Respect the casualty's modesty, but do not
jeopardize( put at risk) quality care. Shoes may
have to be cut off to avoid causing pain or
further injury.
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3. Reassure the casualty that his or her injuries
are understood and that professional medical
assistance will arrive as soon as possible. The
casualty can tolerate pain and discomfort better
if they are confident in your abilities.
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4. Do not touch open wounds or burns with
your fingers or un-sterile objects unless it is
absolutely necessary. Place a barrier between
you and the casualty's blood or body fluids,
using plastic wrap, gloves, or a clean, folded
cloth. Wash your hands with soap and warm
water immediately after providing care, even if
you wore gloves or used another barrier.
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5. Do not give the casualty anything to eat or
drink because it may cause vomiting, and
because of the possible need for surgery. If the
casualty complains of thirst, wet his or her lips
with a wet towel.
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6. Splint all suspected, broken or dislocated
bones in the position in which they are found.
Do not attempt to straighten broken or
dislocated bones because of the high risk of
causing further injury. Do not move the casualty
if you do not have to.
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7. When transporting, carry the casualty feet
first. This enables the back carrier to observe
the casualty for any complications.
8. Keep the casualty comfortable and warm
enough to maintain normal body temperature.
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Infectious Diseases
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You will probably render first aid to someone
you know - family member. For this reason you
will probably know your risk of contracting an
infectious disease. Adopt practices that
discourage the spread of blood-borne diseases
(Hepatitis and HIV) and air-borne diseases such
as influenza when performing first aid
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1. Wear gloves or use another barrier.
2. Wash your hands with soap and warm water
immediately.
3. When possible, use a pocket mask or
mouthpiece during rescue breathing.
The risk of contracting infections from a
casualty is very remote (distant). Do not
withhold rendering first aid because of this rare
possibility.
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Patient Assessment
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Scene assessment
Primary survey
Secondary Survey
Reporting of data
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Scene Assessment
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Make a quick assessment of the overall situation
at an accident scene. Concentrate on the big
“big picture.”
Consider three things:
Environment
Hazards
Mechanism of injury
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Look for anything that may threaten your safety
and the safety of others, such as downed power
lines, falling rocks, traffic, fire, smoke, etc.
Do not move a casualty unless he or she is in immediate
danger, If you must move the casualty, do so as quickly
as possible.
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Mechanism Of Injury
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The mechanism of injury can alert you to the
possibility that certain types of injuries may be
present. For example, fractured bones are
usually associated with falls and motor vehicle
accidents, burns with fires, and soft tissue
injuries with gunshot wounds.
Remember, however, that for every obvious injury, there
may be a number of hidden ones.
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Primary Survey
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The primary survey is conducted once dangers
at the scene have been neutralized. It is the first
step in the physical assessment and consists of
the following:
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Check of level of consciousness (LOC) as you
approach the patient.
Check of DABC (Delicate spine, Airway,
Breathing, and Circulation)
Rapid body survey (RBS) for external blood
loss and deformities
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While conducting the primary survey, you may
discover life- threatening emergencies such as
obstructed airways, respiratory difficulties,
external bleeding, and obvious shock. Treat
these problems immediately.
For your protection, wear disposable gloves whenever you
might be handling blood, body fluids, or secretions.
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Perform A Primary Survey
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To perform a primary survey, you must be able
to do the following:
Assess level of consciousness (LOC) using the
AVPU method.
Manage a delicate spine.
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Open and maintain the airway.
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Clear obstructions from the patients mouth.
Open the airway.
Correctly use an oral airway for unconscious.
Suction the mouth cavity if required.
Place unconscious patients and patients with
compromised airways in the recovery position
and monitor breathing.
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Assess and manage the patient’s
breathing.
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Determine when a patient is not breathing
adequately.
Use a pocket mask to ventilate patients with
inadequate breathing.
Ventilate an infant using a pocket mask,
connected to oxygen, and mouth-to-mask
ventilation's.
Use the bag-valve-mask-oxygen reservoir unit to
ventilate patients with inadequate breathing.
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Assess and manage the patients
circulation.
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Perform a rapid body survey (RBS).
Give oxygen at high flow (10 L/min) with a
standard face mask.
Describe the pathophysiology of hypoxic drive
and the management of a COPD patient.
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Assess Level of Consciousness (LOC)
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Check for LOC as you approach the patient.
The A,V,P,U method is a short and simple way
to assess the LOC:
A - patient is Alert
V - patient responds to Verbal (Voice) stimuli
P - patient responds to Pain
(Use a trapezoidal squeeze to administer a
painful stimulus.)
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U - patient is Unresponsive to verbal and
painful
stimuli
 Expose—undress the patient to look for
clues to injury or illness, such as wounds or
skin lesions.
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A change in the level of consciousness is the first sign of a
brain injury or other serious medical conditions.
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Manage A Delicate Spine
Always assume that the patient has a neck or
spine injury (delicate spine). You may rule it out
after considering the mechanism of injury, bur
always check for a delicate spine if the patient
must be moved.
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If you suspect that the patient has a
delicate spine, do the following:
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Approach the patient from the head.
Tell the patient, “If you can hear me, don’t
move.”
Stabilize the head in the position found.
Do not move the patient unless absolutely
necessary to maintain an open airway.
When using the various grips remember to use the
principles of STABLE to UNSTABLE
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Open and Maintain The Airway
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Airway management involves three things:
Opening the airway
Maintaining the open airway
Helping the patient breathe effectively
(ventilation)
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Look, listen, and feel for the movement of air
at the mouth and/ or nose. After an injury, a
patient’s airway may become closed or blocked
by teeth, the tongue, or foreign objects. “check for
5 seconds”
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Before taking steps to open the airway, make
sure you have ruled out a delicate spine or
protected the neck. The technique you use will
depend on whether or not the mechanism of
injury indicates a delicate spine.
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To manage the airway, you must be
able to do the following:
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Clear obstructions from the patient's mouth.
Open the airway.
Correctly use an oral airway for unconscious
patients.
Suction the mouth cavity if required.
Place unconscious patients and patients with
compromised airway in the recovery position
and monitor breathing.
Clear Obstructions From The Patient’s Mouth
And Throat.
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Make sure your patient’s airway is clear before
trying to open it. Remove foreign materials such
as broken teeth, vomitus, fluid and mucus
before attempting any further treatment. Use a
crossed-over finger technique to open the
patient's mouth, and do a visual check.
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Crossed-over Finger Technique
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Opening The Airway
Open the airway after clearing foreign materials
form the mouth. The tongue can easily act as a
lid, closing down onto the back of the throat
and making breathing impossible. To open your
patient’s airway, you must lift the tongue up and
off the back of the throat.
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NO NECK INJURY:
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Use the Head-Tilt/Chin-Lift Method
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Do not use this procedure on any patient with neck or
spinal injuries.
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NECK INJURY SUSPECTED:
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Use the jaw thrust or modified jaw thrust
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If you suspect a neck injury, take care not to move the
neck.
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Modified Jaw Thrust Method
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Oral Airways
Once the airway passage is clear and open, you
must keep it open, especially if the patient is
unconscious and cannot do it himself or herself.
The oral airway (oropharyngeal airway), a hard
plastic tube, is the ideal tool for this. Inserted
correctly, it prevents the tongue from falling
back and blocking
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Oral Airways For Unconscious
Patients
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Moving Patients
A general principle for First Responders is that patients
should be cared for in the position found. This
principle is based on the assumption that certain
conditions or injuries (such as a neck fracture in an
unconscious patient) can be hidden so that it is missed
during initial assessment, and unnecessary movement
may make the situation worse. However, there are three
situations in which you, the First Responder, will have
to move the patient:
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Repositioning the patient to manage immediate
ABC’s.
Moving patients as quickly as possible out of
hazardous areas.
Rescuing and transporting patients.
Repositioning The Patients To Manage
Immediate ABC’s
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Many patients are found in unusual or difficult
positions. It may be necessary to move them in
order to effectively assess or manage their
ABC’s.
If you must move a patient, follow these
principles:
Moves are best done with the help of two or
more people.
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Although managing the ABC’s is always a
priority, try to minimize movement during
urgent repositioning.
Movement of the neck and spine is potentially
more dangerous than moving an extremity.
In an awake patient, increased pain with
movement should limit your repositioning.
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Positioning The Patient
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In most cases, positioning of the patient is
determined by patient comfort. If possible, the
patient should be left in the position found.
However, if moving the patient results in better
patient care, consider the following options:
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Semi-sitting
Shortness of breath; obese patients; chest pain.
Supine
Suspected neck injuries; patient with no radial
pulse; hip fractures.
Prone or Recovery Position
All unconscious patients with no neck injury.
All patients with airway problems that cannot be
controlled by suctioning.
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Suction
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Suctioning the mouth cavity is another
procedure used to keep the airway clear.
Secretions and other debris are removed by
applying negative pressure through a hollow
tube. If you do not remove the debris, you may
force it into the patient’s lungs during
ventilation.
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Assess And Manage The Patient’s
Breathing
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A patient may be breathing on his or her own
but not doing so adequately. Do not wait for
respiratory arrest before ventilating the
patient.(below 10, and over 30).
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To assess and manage the patient’s
breathing, you must be able to do the
following:
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Determine when a patient is not breathing
adequately.
Use a pocket mask to ventilate patients with
inadequate breathing.
Ventilate an infant using pocket mask,
connected oxygen, and mouth-to-mask
ventilation's.
Use the bag-valve-mask-oxygen reservoir unit to
ventilate patients with inadequate breathing.
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Determine When A Patient Is Not
Breathing Adequately
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A patient is not breathing adequately if he or she
has fewer than 10 respirations per minute and/
or shows some or all of the following signs of
hypoxia (low oxygen level in the blood):
agitation
irritability
drowsiness
headache
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decreased level of consciousness
rapid pulse
labored breathing
abdominal breathing
bluish skin color
irregular heartbeat
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Perform A Rapid Body Survey (RBS).
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The rapid body survey will help you to locate
and expose injury sites, stabilize fractures, and
control bleeding.
You should be able to accomplish the following:
Perform a rapid body survey.
Give oxygen at high flow (10 L/min) with a
standard face mask.
Describe the pathophysiology of hypoxic drive
and the management of a COPD patient.
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Rapid Body Survey
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Check for bleeding, deformity, and your
patient’s response to pain by systematically
running your hands over and under the
following:
head and neck
chest and abdomen
back
lower extremities
upper extremities
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You should take no more than 30 seconds to perform a
rapid body survey. It should be interrupted only long
enough to provide intervention for life-threatening injuries.
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Oxygen Flow Rates
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5 Litres per minute
COPD Patients (No Trauma)
10 Litres per minute
All trauma patients
Medical emergencies
15 Litres per minute
Smoke and/ or gas inhalation
Carbon monoxide poisoning
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Equipments for oxygen delivery
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Bag-Valve-Mask (BVM)
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Assist patients with inadequate respiration's.
Hyperventilate unconscious patients with head
injuries
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Circulation - Radial Pulse
Circulation - Carotid Pulse
Pocket Mask
CPR-on-the-move.
Infant ventilation's.
when resuscitation from BVM does not create
an effective seal.
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Non-Rebreather Mask
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Victims of smoke and/ or gas inhalation.
Victims of carbon monoxide poisoning
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Full Face Mask
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Patients with adequate respiration's.
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Oxygen
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As a first responder, you should use a standard
face mask to give oxygen at 10 L/min to:
All trauma patients
All medical patients except those with a history
of chronic obstructive pulmonary disease
(COPD)
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Oxygen therapy for the non-traumatic COPD
patient is 5 L/min through a standard adult oxygen
mask. But at a 10 L/min flow for traumatic
COPD patient’s.
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COPD Patients
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In normal people, the breathing reflex is triggered by
high level of carbon dioxide (CO2) in the blood.
Patients with emphysema, chronic bronchitis, and
chronic asthma may have a condition know as Chronic
Obstructive Pulmonary Disease (COPD). They retain
CO2 and thus have a chronically high level of this gas.
Their breathing reflex is triggered only when the oxygen
level in their blood is low. This mechanism is known as
hypoxic drive. By giving COPD patients oxygen, you
may suppress their breathing reflex.
100

Give the patient with COPD, 5 L/min through a
standard adult oxygen mask. Closely monitor the
patient’s respiratory rate, depth, and volume. Assist the
patient’s ventilation's if necessary.
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Perform A Secondary Survey
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The purpose of a secondary survey is to identify
problems that, while not immediately lifethreatening, may threaten the patient’s survival if
left undetected.
102
The secondary survey consists of the:
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Medical history (chief complaint and history of chief
complaint)
Vital signs (LOC, pulse, respiration's, and skin colour
and temperature)
Head-to-toe physical examination (if time permits)
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The information you gather here will be vital for the
patient’s later care. You should be able to report it
accurately and concisely to ambulance personnel when they
arrive.
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Chief Complaint
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The chief complaint is what the patient says is
wrong with him or her. Record and report it
using the patient’s own words. This will help
you avoid interpreting what was said, which may
obscure or change the nature of the problem.
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Most chief complaints are characterized by pain
or abnormal function. Find out what is
bothering the patient most. For example, a
victim of a motor vehicle accident may have an
obvious leg fracture but his chief concern may
be,”I can’t breath.” This may help you discover
an unsuspected chest injury.
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History Of The Chief Complaint

The history of the chief complaint examines the
chief complaint in greater detail. Get a
description of the events that caused the chief
complaint. If pain is the chief complaint, use the
PQRST method to help you organize your
questioning.
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History Of The Chief Complaint
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Ask the following:
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Position of the pain.
Quality of the pain.
Does the pain Radiate?.
Severity of the pain.
Timing of the pain.
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P - Position
Where is it located? Can you point to it?
Q - Quality
What does it feel like? Is it sharp, dull,
throbbing, or crushing?
R - Radiation
Does it radiate anywhere? or Does it stay in one
place or move around? Does anything relieve it?
What makes it worse?
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S - Severity
How would you rate the pain on a scale of 1 to
10
(10 being the worst)?
T - Timing
When did it start? What brought it on? Have
you had it before? How long does it last?
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Guidelines When Interviewing A
Patient
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Allow the patient to answer in his or her own words.
Avoid suggesting answers. (“What provoked the pain?”
Not “Does the pain come after exertion?”)
Use open-ended questions. Avoid asking questions that
can be answered with yes or no.
To pinpoint responses, give the patient alternatives.
(Does the pain stay in one place or does it move around?
Reassure the patient frequently.
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Baseline Vital Signs


Baseline vital signs are one of the most
important aspects of patient assessment. They
are taken after the primary survey and the
medical history.
Based on them, ambulance personnel and
receiving hospital staff can tell whether or not
the patient’s condition is deteriorating.
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As a First Responder you should record the
following:
LOC (using the AVPU method)
Skin - colour, condition and temperature
Pulse - rate, rhythm, and strength
Respiration's - rate, rhythm, and volume (quality)
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
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Monitor the LOC, take the pulse, and count the
respiration's every five minutes.
Check whether the patient’s skin is:
cool or warm
moist or dry
pale or normal in colour
condition
114
Recording And Reporting Data

Recording and reporting data is the last major
component of the patient assessment model.
Your report will help guide the ambulance
personnel and hospital staff in treating the
patient.
115
Report your findings orally to
responding ambulance personnel.
Your oral report should include the
following:






Mechanism of injury
Chief complaint
History of chief complaint
LOC, pulse, respiration's, and skin colour and
temperature
Treatment given
All relevant physical findings
116

Follow up your oral report with a completed copy of the
First Responder Report. (within 24 hours of the incident)
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