Transcript Standard First Aid

Standard First Aid
With CPR & AED
Course Objectives
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Safely assess emergency situations and carry out
appropriate action; contacting emergency services
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Identify and understand the limits of first aid
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Discuss and demonstrate the appropriate care for a
casualty
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Perform CPR, demonstrate appropriate first aid
care, and know how to use an AED
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Identify strategies that will promote a safe and
healthy lifestyle
Introduction to First Aid
First Aiders Roles &
Responsibilities
First Aid Terms
• First aid is the care given by first person on
scene
• First aider is a person who takes charge and
provides care to casualties
• Medical care is given by professionals,
doctors, nurses, paramedics and firefighters
Goals of First Aid
• Preserve life
• Prevent injuries or illnesses becoming
worse
• Promote recovery
Priorities of a First Aider
1. Airway – open and clear
2. Breathing – effective breathing
3. Circulation – effective circulation
(skin temperature, colour and
sweating)
Casualty
• Adults – Puberty + years
• Child – 1 to Puberty
• Infant – less than 1 year old
Signs & Symptoms
• Signs: conditions we can see by observing a
casualty
(see, feel, smell, hear)
• Symptoms: conditions that are reported by a
casualty
5 Common Fears
• Doing the wrong thing / making things
worse
• Personal safety
• Diseases
• Dealing with blood / gross situations
• Getting sued
The Good Samaritan Act
• Identify yourself
• Ask Permission
• Act Reasonable
( no cutting, sewing or poking)
• Stay with casualty
Principle of Abandonment
Once you start providing first aid to a
casualty, you must continue helping
unless:
• It is necessary in order to activate EMS
• Someone with equal or greater training takes
over
• Continuing to provide assistance would be
unsafe
• You are physically exhausted
Personal Protective Equipment (PPE)
• When providing first aid or CPR at a minimum
put on gloves ( latex free )
• Eye protection
• Use masks or face shields
• Gowns
Emergency Medical Services
Activating EMS
• Provide the dispatcher with:
• the number of casualties
• age and gender of casualties
• condition of casualties
• location of emergency
• Stay on line until the dispatcher tells you it is okay to
hang up
• Ask dispatcher the estimated time of arrival for EMS
• If a bystander calls EMS, ask them to report back to you
to ensure that EMS has been activated
Utilizing Bystanders
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Phone EMS
Wait for EMS
AED available
Remove hazards from scene
Crowd control
Get supplies (e.g., blankets)
Protect casualty’s belongings
Write down details of incident
Emergency Scene
Management (ESM)
Emergency Scene Management
• Emergency Scene Management (ESM) is a
rapid, systematic and orderly manner used to
treat a casualty in an emergency
• Steps to ESM
• Scene Survey
• Primary Survey
• Secondary Survey
• On Going Care
Scene Survey
• Check for hazards (ladder, glass, chemicals,
etc.)
• What is the risk to you? What, if any, further
risk is there to the casualty?
• What happened?
• Possible spinal injury?
• How many casualties are there?
• Is the scene changing?
• Is there an AED or First Aid kit close by?
Primary Survey
• Check responsiveness
Level of Consciousness
(1) Alert
(2) Verbal
(3) Painful
(4) Unconscious
Primary Survey
• Check Airway
• Check Breathing
• Check Signs of Circulation
Secondary Survey
Talk to a responsive casualty, or ask bystanders to
find out more about what happened and the
casualty’s history
Happened?
Hurt?
History?
On-Going Care
• Give first aid for any injuries or illness
discovered during assessment
• While waiting for help:
• Monitor the casualty
• With serious injury, repeat the ABCs, every
5 minutes
• Record condition and treatment given
Recovery Position
An unconscious adult or child who is breathing
and has no other life threatening emergencies
should be placed in the recovery position
Triage Assessment
Breathing
Bleeding
Burns
Bones
Review: ESM
Unconscious
• Scene Safety
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M.O.I.
Id. self / consent
Unresponsive
Call 911
• Primary survey
• Secondary survey
• Ongoing casualty care
Conscious
• Scene Safety
• M.O.I.
• Id. self / consent
• Responsive
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Primary survey
Secondary survey
Call 911 ?
Ongoing casualty care
Head & Spinal Injuries
Responsive Casualty
Head Injuries
• Concussion - bruising or
swelling of the brain
• Hematoma - pooling of
blood in the brain
• Laceration - tearing of the
brain tissue
General Signs & Symptoms Head Injuries
•Deformity
•Black Eye(s)
•Bruising
•Disabling headache or
one of sudden onset
•Unequal pupils
•Paralysis
•Ringing in ears
•Confusion
•Blood/Fluid from
Eyes/Ears/Nose
•Projectile vomiting
Spinal Injuries
• Falls from heights, sports injuries,
car accidents and direct blows to
spine are common causes of
spinal injuries
• Spinal injuries are also
associated with head injuries
Spinal Injuries
Signs & Symptoms of a Spinal Injury
• Numbness, tingling, weakness in arms and/or
legs
• Respiratory distress
• Fluid in the ears
• Deformity
• Pain in back or neck
• Inability to move arms and/or legs
• Loss of sensation or paralysis in upper or lower
extremities or below injury site
Spinal Injuries
• Do not move the casualty any more than
necessary
• Support the head and neck to prevent
worsening the injury
Pelvic Injuries
• Broken pelvis may cause severe internal
bleeding and organ damage
• Foot on injured side usually turns outward
• Can be a life-threatening injury even if no
significant injuries can be seen
• Complications include: injury to the spine and
damage to the bladder
Signs & Symptoms of Pelvic Injuries
• Signs of pain and tenderness around the
hips
• Inability to walk or stand
• Signs and symptoms of shock
Fainting & Shock
Shock
Failure of the cardiovascular system to
provide oxygen to cells and tissue
Causes include:
•External / internal bleeding
•Allergies
•Infection
•Dehydration
•Burns
•Trauma
•Heart attack
•Nervous system injuries
Signs & Symptoms of Shock
• Pale Skin
• Anxiety
• Sweating/Clammy • Cyanosis
Skin
(blueness) of
lips/ears
• Cold
• Weakness
• Trembling
• Nausea
• Labored breathing
• Thirst
• Weak/rapid pulse
Shock
Treat the cause
Rest & Reassure
Warm
Elevating the legs is no longer recommended
The risk of further injury outweighs the benefit of
elevation when a person is injured.
Fainting
• Fainting occurs when there is a temporary
lack of oxygen to the brain, causing a
person to ‘black out’ temporarily
• Casualty will usually be responsive within
10 seconds
Bleeding &
Wound Care
Bleeding
• Many injuries cause external or internal
bleeding
• Bleeding may be minor or life
threatening
Types of External Bleeds
Arterial Bleeding – squirting, bright red
Venous Bleeding – steady flow, dark red
Capillary Bleeding – dark red
Control of Bleeding
Direct Pressure
Rest
Signs of Infection
Swelling
Heat
Ache
Redness
Pus
External Bleeding
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Amputations (partial & complete)
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Embedded Objects
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Nosebleeds
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Scalp or Ear
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Gums, tongue and cheek
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Palm of the hand
Abdominal Injuries
• Includes closed and open wounds
• Commonly result from a blow or a
fall
• May involve internal and/or external
bleeding
• Can be a life-threatening injury even
if no significant injuries can be seen
Abdominal Injuries
• Closed abdominal injury can be life threatening.
Internal organs may have ruptured and there may
be serious internal bleeding
• Open abdominal injury can be life threatening.
May involve significant bleeding. Organs possibly
protruding from wound
Abdominal Injuries – Symptoms
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Trouble breathing/shallow breath
Tenderness at site of injury
Deformity and bruising of chest
Pain upon movement
Bluish lips or nail beds
May cough up blood
Crackling feeling upon touching victim’s
skin (ie. like “Rice Crispies”)
Bites & Stings
• Animal Bites
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Snake Bites
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Insect Bites and Stings
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Leeches and Ticks
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Jellyfish Stings
Internal Bleeding
• Any bleeding within body when blood does
not escape from wound
• Closed wound may cause local bruise
• More serious injury can cause deeper organs
to bleed severely
• Can be life threatening
Internal Bleeding
Minor:
Major:
• Bruise
• Abdominal
• Chest
• Pelvis
• Head
Seek Medical Attention
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Bleeding is not easily controlled
Any deep or large wound
Wound is infected
Any bite from an animal or human
Foreign object or material embedded in the wound
The casualty is unsure about tetanus vaccination
The casualty may need stitches for:
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Cuts on the face or hands when the edges do not close together
Gaping wounds
Cuts longer than 1 inch
Burns
Burns
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Burns are injuries to the skin and other
tissues caused by heat, radiation,
electrical or chemical
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They are the leading cause of injuries
in the home – how can we prevent??
Severity of the Burn
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The depth of the burn (degree)
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The amount of body surface that is burned
(rules of nine)
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The part(s) of the body that is burned
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The age and physical conditions of the
casualty
Burn Depth
First Degree
Second Degree
Third Degree
Complications
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Shock
Infection
Swelling
Medical Conditions
Diabetes, Seizures,
Asthma & Allergies
Diabetic Emergency
• Problem of maintaining a
balance of blood sugar and
insulin in body
• Without treatment, can quickly
progress to a medical
emergency
• Diabetics may carry glucose
tablets in case of low blood
sugar
Diabetic Emergency
• Type 1 - Insulin Dependent
• Type 2 - Non-Insulin Dependent
Low Blood Sugar = Insulin Shock
(hypoglycemia)
High Blood Sugar = Diabetic Coma
(hyperglycemia)
Low Blood Sugar
• Sudden dizziness, shakiness, or mood change
(even combativeness)
• Headache, confusion, difficulty paying
attention
• Pale skin, sweating
• Hunger
• Clumsy, jerky movements
• Possible seizure
High Blood Sugar
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Frequent urination
Drowsiness
Dry mouth, thirst
Shortness of breath, deep rapid breathing
Breath smells fruity
Nausea, vomiting
Eventual unresponsiveness
Seizures
• Caused by a sudden disruption of the
brain cells
• Epilepsy, brain injury, diabetes, fever,
drugs, alcohol and poisoning can all
cause seizures
Seizures
1.
Clear Area
2.
Protect Head
3.
9-1-1
4.
Recovery
•3 H’s
•Happen, Hurt, History
•Follow-Up
Asthma
• In an asthma attack, airway becomes narrow
and person has difficulty breathing
• Many asthma casualties know they have the
condition and carry medication for emergencies
• Untreated, a severe asthma attack can be fatal
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Asthma
•
Asthmatic attacks are often caused
by triggers such as cold, pollen,
paint, smoke, pet hair, foods, insect
bites, etc
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During an attack, airflow is restricted
or reduced to the lungs one of three
ways:
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Muscles around the air passage tighten
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Inner linings of air passages swell
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Amount and thickness of mucous
increases
Anaphylaxis
• Anaphylaxis is a severe and potentially lifethreatening allergic reaction, which needs
immediate medical attention
• Causes include:
• Insect bites and stings
• Foods
• Inhaled substances
• Chemicals
• Medications
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Epinephrine
• Epinephrine helps the victim breathe by
relaxing constricted airways in the lungs
• It increases heart rate, diverts blood to the
muscles, constricts blood vessels and opens
the airways
• The epinephrine auto-injectors delivers its
dose directly into muscle
Cardiovascular Diseases
(CVD)
Risk Factors
Preventable
Not preventable
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• Hereditary
• Age
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Diabetes
High Blood Pressure
(HBP)
High Blood Cholesterol
(HBC)
Stress
Lack of exercise
Smoking
Obesity
Alcohol
Diet
Stroke & TIA
Stroke & TIA Signs and Signals
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Numbness
Sudden weakness
Trouble speaking
Vision problems
Severe headache
Dizziness
Anatomy of the Heart
The function of the heart is to circulate (pump) blood
throughout the body to provide oxygen and nutrients
and to remove waste products
Angina & Heart Attacks
Angina:
A disease caused by the
narrowing of the coronary artery
Heart Attack:
Death to an area of the HEART
muscle due to a lack of oxygen
Heart Attack
Heart Attack
Pale
Indigestion
Anxious
Tightness
S.O.B.
Overall Weakness
Sweat
Nausea
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Sudden Cardiac Arrest
&
Cardiopulmonary
Resuscitation (CPR)
Sudden Cardiac Arrest
Sudden cardiac
arrest occurs when
the heart's
electrical system
malfunctions and
the heart stops
beating effectively
Time is Critical
Adult CPR (One Rescuer Sequencing)
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Assess environment
Determine unresponsiveness
Activate EMS
Attempt to get AED
Open airway
Check for breathing
Landmark and begin compressions
Provide two rescue breaths
30 compressions:2 breaths until EMS arrives or
victim responds to treatment
Reminders
• Ensure chest rises with each breath
• Location of Hands
• Depth rate: 2 inches
• Allow chest to recoil completely or return to
its normal position
• Compression rate: 100/minute
Automated External
Defibrillator (AED)
Introduction
What is an AED???
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An Automated External
Defibrillator (AED) is a
machine that can monitor
heart rhythms
It can tell if the heart has
stopped beating
effectively
If required, the machine
can then deliver an
electric shock to the heart
How AED Units Work
Defibrillators work by giving
the heart a controlled electric
shock, forcing all the heart
muscles to contract at once,
and, hopefully jolting it back
into a normal heart rhythm
Do AED units replace the use of CPR?
• CPR's function is to circulate blood and
oxygen throughout the body
• The AED does not take the place of CPR
• The function of an AED is to restore a
normal heart rhythm
Using an AED
• Turn “ON” AED unit
• Voice and visual
instructions occur
immediately
• Follow prompts
When pads are attached
to the patient the AED will
automatically assess the
patient.
Prompts: “Assessing
heart rhythm” and “Do
not touch the patient”
When ready to deliver a
shock, the unit will advise:
• “Press the shock button now”
• Button will illuminate when
system is charged
AED Algorithm
Chain of Survival
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Early activation of EMS
Early CPR
Early defibrillation
Effective advanced life support
Integrated post-cardiac arrest care
Choking
Effective vs. Ineffective Breathing
• Effective breathing can be defined as
having: a good air supply, an open airway,
an intact chest wall and one functioning
lung
• Ineffective breathing occurs when the
body is not getting enough oxygen to
function
Choking
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Unable to speak
Unable to cough
Hands at throat
Face changing colour
Choking
1. Determine severity of
obstruction.
2. If mild, encourage coughing
and reassure victim.
3. If severe, shout for help,
start cycles of 5 back blows
and 5 abdominal thrusts
until airway is clear, or
victim becomes
unconscious.
Choking
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Assess environment
Determine responsiveness
Activate EMS
Attempt to obtain AED
Open airway
Assess breathing
Landmark and provide 30 chest
compressions
8. Look in mouth for object (remove only if object seen)
9. Give one rescue breath, if it fails reposition head and try again
10. Repeat sequence until successful or EMS arrives
Special Considerations
Special Considerations for:
• Pregnant casualty
• Obese casualty
• Self-Rescue
END of DAY 1- Questions?
Day 2
Two-Rescuer CPR
Adult
Two-Rescuer CPR
• One rescuer delivers ventilations
• The other rescuer gives chest
compressions
• Compressions and ventilations should
remain rhythmic and uninterrupted
Switch Positions
• The rescuer giving chest compressions may
get tired if performing CPR for an extended
time
• Switching positions after every five cycles
improves quality of compressions
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Should be accomplished smoothly and
quickly
Child Resuscitation
Child CPR
• Child is defined as a person between 1 year of
age and the onset of puberty (12 to 14 years)
• Depth of compressions is 1/3 the depth of the
chest.
• One or two hands depending on the size of the
child.
• Five cycles of compressions and breaths are
performed before activating EMS.
Infant CPR: Differences
• Scratch foot to determine responsiveness.
• Compression depth is 1/3 the depth of the
chest.
• Two fingers used for compressions (just
below nipple line).
• Breaths are puffs and mouth
and nose are sealed with your mouth.
• Five cycles of compressions and breaths are
performed before activating EMS.
Choking: Infant Conscious to Unconscious
1. Determine severity of obstruction.
2. Perform five back blows followed by five chest
thrusts.
3. Continue until airway becomes clear or victim
becomes unconscious.
4. If the infant becomes unconscious begin the
infant CPR sequence.
Automated External
Defibrillator (AED)
How AEDs work
• Heart’s electrical system keeps chambers of the
heart synchronized and working together
• With heart attack or other heart problems, this
rhythmic electrical system may be disrupted
How AEDs work
• Ventricular fibrillation is an abnormal heart
rhythm that does not circulate blood
• A shock from the AED may restore a regular
rhythm—called defibrillation
How AEDs work
• VF is the most common cause of
sudden cardiac arrest (SCA)!
• The only definitive treatment for
SCA is defibrillation - an electric
current that "shocks" the heart so
that a normal rhythm may resume
Time is Important
Not everyone can be saved from SCA, even
with defibrillation.
But early defibrillation, especially when
delivered within three minutes of a person's
collapse from SCA, does provide the best
chance
How AEDs work
• Defibrillation works only if there is already
electrical activity going on in the heart
• A defibrillator doesn't work if a person is in flat
line. Since a defibrillator stops the heart, it
wouldn't make sense to stop a heart that is
already stopped
AED Algorithm
Are AED Units Hard to Use?
• AED units are very accurate and easy to use
• They are automated and wont let you administer
a shock unless it is necessary
• If a shock is not necessary you can not override
it and shock anyway
• There are many different brands of AED units,
but the same basic steps apply to all of them
Special Cases
• The casualty has a hairy chest
• The casualty is immersed in water or water is
covering the casualty’s chest
• The casualty has an implanted defibrillator or
pacemaker
• The casualty has a medical patch or other
objects (i.e. jewelry or metal) on the surface of
the skin
• The casualty is pregnant
Special Cases - Hypothermia
• Determining signs of circulation in hypothermia
can be difficult
• Handle a hypothermic casualty very carefully;
jarring may cause cardiac arrest
• Follow your local guidelines for AED use if you
find no signs of circulation
• Typically, only 3 shocks are given and then CPR
is performed
AED Reports
The delegating medical authority should
review all incidents of AED use through:
1. Review of written patient care report
2. Review of ECG tapes if the AED is so
equipped, or
3. Review of the AED memory module if
so equipped
Secondary Survey
Secondary Survey
• Ask the “Three Questions” known as the
THREE H’s
1. What …HAPPENED?
2. Where does it …HURT?
3. Do you have a …HISTORY?
• Vital Signs
• Head to toe assessment
• First aid as required
Vital Signs
•Level of Consciousness (LOC)
•Rate of Breathing
•Skin
Head-To-Toe Assessment
• HEAD
• NECK
• CHEST
• ABDOMEN
• PELVIS
• LEGS
• ARMS
Musculoskeletal
Injuries
Fractures
• Bone may be completely broken or only
cracked
• Closed fracture is when bone does not
break through skin.
• Open fracture is when the bone breaks
through skin.
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Sprains & Dislocations
• Sprains are the stretching or tearing of
ligaments.
• Dislocations are caused by bones getting
displaced in joints.
Both injuries may
appear like a fracture
Dislocation
First Aid
Rest
Ice
Compress
Elevate
Splints
• Any object used to immobilize a body part is
called a splint
• Splints help prevent further injury, reduces pain,
and minimizes bleeding and swelling
• Types of Splints
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Rigid splints
Soft splints
Anatomic splints
Improvised splints
Guidelines for Splinting
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Expose injury
Control any open wound before splinting
Don’t replace protruding bones
Splint to immobilize entire area
Put padding between splint and skin
Monitor extremities (fingers or toes) to make
sure circulation is not reduced
Femur Fractures
• Great force is normally needed to fracture
the femur; therefore, assess for a spinal injury
if you suspect a broken femur
• Complications for a femoral fracture often
include internal bleeding and severe shock
Strains
• Strains happen when muscles and tendons
are stretched or torn
• Repetitive Strain Injury (RSI) occurs when
muscles and tendons are injured when they
do the same movements repetitively,
causing stress on the tissues
Eye Injuries
Common Causes of an Eye Injury
• Scrap materials, waste, and windblown dust
• Flying material particles or slivers from wood,
metal, plastic, and cement
• Chemicals or chemical products
• Falling or misdirected objects
• UV light from welding torches
Eye Injuries
Signs & Symptoms of Eye
Injuries
• Redness
• Pain
• Visual problems
• Watery Eyes
Eye Examinations
• Compare one eye to the other
• Assess for abnormalities
• Assess pupils for size, shape, equality and
reactivity to light
Types of Eye Injuries
Types of Eye Injuries
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Penetrating
Blow
Chemical Burns
Extruding Eye
Foreign Object in the Eye
Guidelines for an Injured Eye
• Flushing – only for chemical injury and if eye is
not cut
• Do not remove blood clots
• Don’t force eye open unless flushing
• Patch both eyes
• Do not allow patient to eat or drink
• Have patient see doctor
Extruded or Impaled Eyeball
• With an extruded eyeball or an impaled object in
the eye you should cover both eyes but do not
apply pressure.
• With an extruded eyeball, do not try to replace it,
cover it with moist dressings
• With an impaled object, do not attempt removal of
object. Keep patient still and keep talking to or
touching the patient so they know you are there.
Poisons
Poisons
Any substance that can be harmful to the body is
known as a poison.
Can cause:
• serious illness and death often direct result of
poisoning
• commonly involve unsupervised children
• Adults are frequently casualty’s of medication
errors and exposure to industrial chemicals
• accurate assessment can prevent serious
effects
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Routes of Poisons
Ingested - by mouth
Inhaled - by breathing
Absorbed - through the skin or tissues
Injected - entered into the blood stream
Determining the M.O.I
• How did the poison enter the body?
• Which poison was taken?
• How much poison was taken?
• When was the poison taken?
Poison Control Centre
1-800-268-9017
GTA:
416-813-5900
Environmental Illnesses &
Injuries
Heat & Cold Emergencies
• Cold or hot environments cause medical
problems if the body is not protected
• Injuries often begin gradually but become
emergencies
• Untreated, these injuries can lead to serious
injury or death
Heat emergencies
• Heat cramps are least serious
and usually first to occur
• Heat exhaustion develops when
body becomes dehydrated in hot
environment
• Heatstroke is a medical
emergency and, if untreated,
usually causes death
Heat Exhaustion
• Caused by exposure to hot, humid environment.
• Heat exhaustion is caused by excessive water
and salt loss.
• Signs include sweating, thirst, headache,
weakness and nausea
• Untreated, heat exhaustion may develop into
heatstroke, a true medical emergency
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Heat Stroke
• Life-threatening condition
• May develop slowly over several days or more
rapidly with strenuous activity in the heat
• Victim may be dehydrated and not sweating
• Signs of heat stroke include, hot skin, not
sweating, confusion and seizures
Heat Injuries
Cold Injuries
• Cold injuries can occur when the body is
exposed to excessive cold and/or wet
conditions.
• The result can be injury to the direct areas
exposed to the cold (frostbite) as well as a
lowering of the body’s core temperature
(hypothermia).
Mechanisms of Heat Loss
The body loses heat in five ways
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Breathing
Radiation
Conduction
Convection
Evaporation
Risk Factors
• Heat (decrease production/increase loss)
• Exercise and strenuous activity
• Age
• Medical condition
• Medications
• Physical Health
Cold Injuries
•Frostbite - localized freezing of skin
and other tissues
•Hypothermia - lowering of whole
body’s temperature
Frostbite
• Freezing of skin or deeper tissues
• Most common in exposed skin areas on head or
face, hands or feet
• Wind chill increases risk of frostbite
• Severe frostbite kills tissue and can result in
gangrene and having to amputate body part
Signs & Symptoms of Frostbite
• Skin looks waxy and white, gray, yellow, or
bluish
• Area is numb or feels tingly or aching
• Severe frostbite:
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Area feels hard
May become painless
After warming, area becomes swollen and may
blister
Hypothermia
• Occurs when body cannot make heat as fast as it
loses it
• Body temperature dropping below 350C
• Can occur whenever and wherever a person
feels cold, including indoors in poorly heated
areas
• May occur gradually or quickly, especially with a
wind chill or if victim is wet
Symptoms of Hypothermia
• Changing levels of responsiveness
• Shivering (but stops in severe hypothermia)
• Confusion, or irrational
• Lethargic, drowsiness
• Pale, cool skin
• Slow breathing
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