COURSE CONTENT

CHAPTER ONE

a. Principal of first aid

b. Aims and objectives of first aid

c. Content of first aid kits

CHAPTER TWO

TYPES OF FIRST AID REQUIRED IN DIFFERENT SITUATIONS

DIAGNOSIS OF CONDITIONS, FIRST AID MANAGEMENT AND REFERRAL

a. Shock

b. Hemorrhage, hematemesis, hemoptysis, epistaxis, bleeding from tooth, bleeding from

varicose vein, rectal bleeding

c. Wounds

d. Fracture: specific examples fractured mandible, clavicle, spine, ribs, pelvic and skull

e. Sprain, strains and dislocation

f. Unconsciousness: syncope, apoplexy/stroke, epilepsy fit, convulsion attacks, diabetics

and insulin coma

g. Asphyxia: various methods of artificial respiration

h. Poisons
 i. Foreign body in the eye, ear, nose, throat

j. Drowning

k. Burns and scales

l. Bites and stings: dog bites, snake, bee sting, wasp’s sting, scorpion bites and human bites

CHAPTER THREE

Skillful application pf various bandage: rules of bandages, method of application

CHAPTER FOUR

IDENTIFICATION OF EMERGENCY SITUATIONS, SAFETY MEASURES AND

MANAGEMENT

a. A.Basic technique: Airway Management and cardiopulmonary resuscitation, manager of

injuries

b. B. medical and surgical emergencies: cardiac arrest, cerebro -vascular accident, asthma,

diabetic coma, convulsive attack , acute abdomen , alcoholic coma, poisoning ,

hypertensive crises , sickle cell ,medication reaction, aggression , puerperal psychosis ,

status epilepticus ,delirium tremens .

CHAPTER FIVE

PRINCIPAL OF DISASTER MANAGEMENT INNURSING

 a. Types of disaster, road traffic accident and other accident involving many people, earth

quake, flood victim, fire outbreak

b. Disaster management

c. Reporting and documenting incident and accidents

CHAPTER SIX

Emergencies and appropriate use of monitoring tool/systems for management

a. Define emergency preparedness

b. Types of emergency preparedness

c. Levels of emergency response

d. Monitoring tools/system used in emergencies

e. Risk analysis and monitoring

f. Minimum preparedness action

g. Advanced preparedness action and contingency planning

 FIRST AID, EMERGENCY AND DISASTER NURSING

CHAPTER ONE

DEFINITION OF FIRST AID

First Aid is the skillful application of accepted principles of treatment on the

occurrence of an accident or in the case of sudden illness using facilities or materials

available at the time.

It can also be defined as “the immediate assistance given to any person

suffering a sudden illness/injury “, with care provided to preserve life, prevent

condition from worsening and promote recovery”.

It is otherwise, defined as the immediate and temporary care given to the victim of an

accident or sudden illness before the arrival of a qualified medical assistance or before

transporting the person to a medical facility.

NB: It does not however take the place of proper medical treatment.

AIMS AND OBJECTIVES OF FIRST AID

1. To prevent complications of the injury or illness and prevent worsening of the

condition

2. Preserve and save life

3. To ease pains and sufferings.

 4. To make the victim as comfortable as possible to prevent stress

5. To promote recovery.

6. Protect the unconscious casualty.

7. Ensure patient gets qualified medical attention as early and safely as possible.

8. To arrange for transportation to hospital

9. To assist the medical team with the necessary information

NOTE It must be remembered that there is a limit as to the effectiveness that first aid

can have on the victim, and with the vast majority of casualties, even partially

recovering from their injuries can be of great importance in the long term.

If a casualty reaches further medical aid without his/her condition becoming worse

than before first aid management was instituted then, the first aider has done his/her

job well.

PRINCIPLES OF FIRST AID

The principles and practice of first aid are based on the principles of practical medicine

and surgery; knowledge of which, in case of accident or sudden illness, enables trained

persons to give such skilled assistance as will preserve life, promote recovery and

prevent injury or illness becoming worse until medical aid is obtained

1. Take the victim away from the danger or the danger from the client or victim

depending on the nature of danger, the place of danger and the type of injury

client or victim has suffered.

2. Always remember to do first things first; treat the most urgent and life

threatening condition first in order of priority; that is: airway clearance,

Cessation of breathing, haemorrhage, shock

3. Ensure the victim’s airway is not blocked by tongue, secretions or foreign body –

restore respiration.

4. Make sure the person is breathing, if not administer artificial respiration - restore

respiration.

5. Check for pulse if no pulse administer cardiopulmonary resuscitation CPR to

restore circulation

6. Check for bleeding- if any take measures to control bleeding.

7. As much as possible prevent loss of body heat form the casualty by covering

him/her

8. Keep the victim or patient in a lying down position, It is vitally important not to

move patient with neck or back injury unless taking measures to prevent further

danger.

9. Turn unconscious patient in recovery position with the head turned to one side

to prevent aspiration.

10. Never give a patient who is bleeding or unconscious alcohol, stimulant or

anything to eat or drink.

 11. Verbally reassure the victim if conscious, try to remain calm yourself to allay his

fear and panic.

12. Organize untrained or unskilled bystanders or onlookers to keep away from the

victim in other to increase victim’s access to good ventilation.

13. Use first aid equipment if available. If not, use materials at hand or improvise to

meet the required situation

14. Stop any bleeding by pressing on pressure points and press on bleeding points

with a pad for at least 4 minutes. Do not remove the original pad, instead keep

adding fresh pads one on top of the other

15. Handle casualty properly. Do not lift him/her until sufficient helpers are available.

16. If you have a paper and a writing instrument, record your observations

17. Have someone called for medical assistance while applying the first aid, or

arrange immediately for transporting the victim to the hospital.

FIRST AID REPRESENT

F---------------Fast arrival

I----------------Intelligent care
R---------------Recording and reporting

S---------------Safety precautions

T---------------Timely action

A--------------Alertness

I----------------Initiation and implementation

D---------------Decision making

THE VALUE OF FIRST AID TRAINING, TO THE STUDENT

First aid training is valuable to the student in that, it:

1. Equips the student with the technical competence required to administer first aid

in different settings (clinical setting, home, school, marketplace etc.)

2. Enables him/her to give immediate treatment for his/her injury.

3. Enables him/her to be able to direct others towards proper care.

4. Helps him/her care for his/her family.

5. Helps him/her educate people on what to do in case of minor injuries.

THE FIRST AIDER

A first aider is anybody who has been trained by an authorized training body and

certified to operate or give first aid to victims.

The person must attend a course for theoretical and practical work and must pass

professionally supervised exams. The person must be trained, regularly, examined and

kept up to date in the knowledge and skill of first aid delivery.

QUALITIES OF A FIRST AIDER

In addition to theoretical knowledge and efficiency in practical work, there are certain

personal qualities, which every First Aider should have. These include the following;

1. Must be observant and good assessor; noting the cause and signs of injury

2. Gentle: - should not cause pain and should speak gently to the casualty.

3. Resourceful; using whatever is at hand to the best advantage of the victim

4. Trained and knowledgeable.

5. Should be patient and non-alarmist

6. Smart: -ability to act quickly and make decisions

7. Tactful; avoid thoughtless questions and focus on the possible aid to be given.

8. He/she should be empathetic.

 9. He/she should be efficient; - To be efficient means to function in the best

manner using the appropriate skills, knowledge and competent with the least

time and effort

10. Know his/her limit: - sometimes doing nothing is better.

a. Please don’t give a patient any prescription when you are not competent

11. Good sense of judgment: He/she should know when to and when not to

interfere with the injured/casualty.

RESPONSIBILITIES OF FIRST AIDER

1. To assess the general situation quickly and safely.

2. To arrive at a diagnosis and protect casualties and others at the scene from

possible danger.

3. To give each casualty early and appropriate treatment, treating the most serious

conditions first.

4. To arrange transport to hospital or health center or to casualty’s home.

5. To give follow up care during the journey to the hospital or health center or

appropriate care is available.

6. To report your observations to those taking over and give further assistance if

required.

7. To prevent cross-infection between yourself and the casualty.

 General Situation: - The amount of time spent on this will depend upon an

answer to how obvious the injury or illness is, how threatening to life is the surrounding

area.

FIRST AID KIT

DEFINITION

First Aid Kit is a box, bag or pack containing a set of medical materials and tools

that is used to give immediate medical treatment to an injured person or sick person.

HISTORY OF FIRST AID KIT

The tool First Aid Kit was first introduced by Robert Wood Johnson, co-founder of

Johnson & Johnson in 1888. He was travelling on the Denver & Rio Grande railroad

and picked a conversation with the Railway Company’s Chief Surgeon and became

aware that the rail workers often sustained serious injuries with no on-site

emergency support or nearby hospital facility. He did further research at other

railroad sites to identify the most appropriate supplies and introduced the first

commercial First Aid Kit with contents like sterile wound dressings, sutures ad

surgical tapes. Railroad and factory workers were the only early users of First Aid Kit

until it was introduced to other industries like automobile, marine vessels and

airplanes.

In order to properly administer first aid, you will need a good first-aid kit. The better

stocked and organized your first-aid kit is, the more likely you are to effectively
respond to emergencies. Use a container with a strong handle that can be closed

securely, and clearly mark it “First-Aid Kit.” Commercial kits can be purchased from

many sources, but any large, well-built plastic box or toolbox works great, and is

usually much cheaper. Ideally, the kit should be light enough to carry, but large

enough to hold all necessary items in an organized and easily accessible format. It

should be dust proof, waterproof, and sturdy enough to resist damage from falling or

crushing.

Contents

1. Tourniquet(s)

2. Cotton wool

3. Cotton-tipped applicator

4. Sterile gauze (pads and rolls)

5. Adhesive plaster

6. Roller bandages

7. Bandage scissors or blunt point scissors

8. Surgical gloves

9. Examination gloves

10. Disposable CPR face mask

11. Safety pins

12. Kidney dish

13. Dressing forceps

14. Dissecting forceps

15. Notebook, pen and pencil

16. Penlight/Flashlight

17. Small mackintosh

18. Sugar/glucose and Salt

19. Acetaminophen (Paracetamol) and ibuprofen

20. Benadryl (generic Diphenhydramine)

21. Activated charcoal (only use if instructed by the Poison Control Center)

22. Antacid (liquid)

23. Extra prescribed medications (such as inhalers)

24. Medicine spoon (transparent tube marked with typical dosage amounts) /

Graduated medicine glass

25. Clinical thermometer

26. Antiseptic lotion e.g. iodine, hydrogen peroxide

27. Antibiotic ointment or cream

28. Calamine lotion

29. Antihistamine cream 1% hydrocortisone cream

30. Bulb syringe

31. Small paper cups /disposable cups

32. Clean cloths and tissues

33. Hand sanitizer

34. Tweezers
 35. Magnifying glass

36. Whistle

CHAPTER TWO

a. SHOCK

Definition Shock is a syndrome that results from a decrease in circulating blood

volume or fluid in the body as a result of injury or illness.

Shock is defined as the depression of the vital centers in the brain (medulla oblongata)

due to a reduction in the blood to the brain and subsequent reduction in oxygen. Or

Shock is defined as a state of circulatory dysfunction in which tissue oxygen delivery is

less than required.

Shock is a life-threatening medical emergency as a result of insufficient blood

flow throughout the body, it is one of the leading causes of death, it can lead to many
other medical conditions such as’ multiple organ failure (example liver failure, kidney

failure) due to reduce blood supply to these organs.

The main feature of shock is lowered blood pressure (BP). Shock serves two purposes:

1. It is a warning that is not well with the body.

2. It serves as temporary defense mechanism

CAUSES OF SHOCK

1. Excessive bleeding

2. Loss of plasma from circulation (burns and crash injuries)

3. Heart failure e.g. acute heart attack

4. Acute abdominal emergencies e.g. Gastric perforation, ruptured appendix

5. General loss of body fluid e.g.…. through recurrent vomiting or diarrhea

6. Electric shock

7. Allergic reaction, insect stings or poisonous snake bite

8. Emotional stress or fright

9. Poisons taking internally

10. Severe allergic reactions

TYPES OF SHOCK

1. Hypovolemic Shock

This is the most common type of shock and is caused by insufficient circulatory volume.

Its primary cause is loss of fluid/blood in intravascular space. Causes may include;
extensive bleeding, profuse diarrhoea and vomiting, high output fistulae or severe

burns.

2. Neurogenic shock

Neurogenic shock is the rarest type of shock. It may be caused by trauma to the spinal

cord resulting in the sudden loss of autonomic and motor reflexes below the injury

level. It can occur in the following circumstances:

In states of fear

In states of high emotion due to bad news

Being involved in an accident though not physically injured

3. Anaphylactic shock

It is one of the most dramatic and feared allergic reaction. It occurs when an individual

who has been sensitized to an allergen or antigen during a previous contact, reacts

violently following a subsequent contact. E.g. Introduction of certain drugs or insect

stings may cause the body to release large amounts of histamine; causing widespread

capillary permeability and decreased SV, which leads to low blood pressure and swelling

around the eyes and the respiratory tract. This results in difficulty in breathing and

development of shock.

4. Cardiogenic Shock

Clinically, this occurs when there is decreased cardiac output and evidence of tissue

hypoxia in the presence of adequate intravascular volume. This can be due to damage

to the heart muscle, most often from a large myocardial infarction. Other causes of
cardiogenic shock include arrhythmias, cardiomyopathy, congestive heart failure (CHF),

cardiac tamponade or valvular diseases.

5. Septic shock

This is caused by an overwhelming infection causing damage to the vessel walls. The

impaired vascular integrity results in increased capillary permeability.

6. Respiratory shock

This occurs in severe chest injuries or airway obstruction when patient cannot breathe

adequately to provide sufficient oxygen to the tissue. In this situation, shock occurs as

a result of poor oxygen supply to the cells resulting in their death.

7. Metabolic shock.

This results from severe disturbance of body fluid and chemical balance in uncontrolled

diseases such as diabetes mellitus.

FORMS OF SHOCK

According to time, Shock may be primary or secondary.

Primary shock: It occurs immediately after an accident or sudden illness

Secondary shock: This develops several hours after the accident or after sudden

illness and it is usually serious /fatal.

SIGNS AND SYMPTOMS OF SHOCK

Early signs and symptoms

 1. Anxiety and restlessness

2. Fainting and disorientation

3. Shallow, rapid or gasping breathing.

4. Extreme thirst

5. Rapid and weak pulse which diminishes in strength

6. Decrease in blood pressure

7. Pupils are dilated.

8. Pale and grey skin especially within the lips

9. Sweaty, cold and clammy skin.

10. Subnormal temperature and low blood pressure

11. Air hunger and gasping

12. Unconsciousness may develop

13. Trembling of arms and legs

GENERAL MANAGEMENT OF SHOCK

1. Reassure patient to allay fear and anxiety; if the patient is conscious, reassure

him by appearing calm and confident.

2. As much as possible minimize the movement of patients.

3. Lay patient down in a recovery position with the head turned to one side.
 4. Raise the patient’s legs and rest them on any firm props available whilst making

him or her as comfortable as possible if the condition permit. Raising the lower

part of the body will help blood flow to the brain

5. Loosen tight clothes around chest, neck and waist. And make sure patient is not

being crowded by spectators.

Keep the patient comfortably warm with light or heavy cloth depending on the

surrounding temperature, put patient on a cloth or blanket if lying on a beer flow,

however the first aider must use his own inscription to decide whether moving the

victim will be more harmful than leaving him on the floor without cloth. Don’t over heat

patient as this will increase blood flow to the skin taking it away from the vital organs

where it’s needed most.

6. Treat any other injuries or conditions if the victim’s condition permits; if the

patient is bleeding, take necessary measures to stop bleeding. Also relieve pains

as much as possible example by supporting an injured part or placing the victim

in an uncomfortable position.

7. Check the breathing rate, pulse and level of responsiveness.( Read on signs of

recovery )

8. Arrange to evacuate the victim to the nearest health facility ensuring that the

feet are still raise

Note:
 9. Never give anything such as food or water to prevent subsequent administration

of anesthesia, the first aider is discouraged from given patient to take alcohol or

take any stimulant.

10. Ensure proper ventilation

SIGNS OF RECOVERY FROM SHOCK

 Pulse will be slower and heavy

 Slower and deep respiration

 The skin gets warm

 Reduction in pallor

b. HAEMORRHAGE

Haemorrhage may be defined as an escape of blood from any type of the blood vessels

or any part of the body.

CAUSES OF HAEMORRHAGE

 Direct injury to the blood vessel wall as a result of a wound as may be sustain in

an accident, fall, cut, etc or surgical intervention.

 Disease of the blood vessels wall. This may be caused by infection or

malignancy.

 Disease of the blood itself, for example, haemophilia. (Heamophilia is a condition

characterized by a delay in the coagulation time of blood. It is due to lack of a

specific factor in the blood which is necessary for satisfactory clotting)

CLASSIFICATION (VARIETIES) OF HAEMORRHAGE

Hemorrhage is classified according to its

1. Situation

2. Source And

3. Time It Occurs.

SITUATION OF HAEMORRHAGE: The situation of haemorrage can be classified as

external and internal haemorrage.

1. External haemorrage occur, when blood escape from the blood vessels onto

the surface of the body and can be seen.

2. Internal or concealed haemorrhage, when no blood is visible, that is, blood

does not escape on the surface of the body. e.g. From injury to an internal

organ, brain, chest as may occur in an accident, fall or collapse. In this

situation, blood escapes from a blood vessel into a cavity, organ or tissues. E.g.

A blunt blow or punch may rupture capillaries beneath the skin; causing blood to

leak into the tissues to form a haematoma.

SOURCE OF HAEMORRHAGE: Haemorrage can be classified based where the

bleeding is coming from, that is the type of blood vessel involved. Base on source, we

have four types;

ARTERIAL BLEEDING:
1. The colour of the blood is bright red because there is presence of oxygen in the

blood.

2. The bleeding spurts from the wound when the heart beats because the blood come

from a vessel which receives blood straight from the heart, therefore bleeding comes

with great pressure.

3. The blood is seen escaping from the part of the wound nearest to the heart

(proximal part of wound).

4. The blood escapes from the wound under great pressure.

VENOUS BLEEDING:

1. The blood is dark red in colour due to small amount of oxygen and greater amount

of carbon dioxide in the blood.

2. Bleeding is in a form of steady stream

3. Little pressure and

4. Bleeding is from the part of the wound farthest away from the heart.

CAPILLARY BLEEDING:

1. It occurs in superficial wounds as in scratches and minor cuts.

2. The blood oozes from the wound with very little force behind it and

3. The color is an ordinary red, neither bright red nor dark red in color.

4. The blood comes up from all over the wound with no definite bleeding point.
MIXED BLEEDING: all the three types of blood vessels may be involved, for instance

in lacerated wound. If both an artery and vein have been involved the bleeding may be

alarming.

TIME OF BLEEDING

PRIMARY HAEMORRHAGE: it occurs immediately at the time of injury or operation

or during damage to the blood vessels by disease.

Secondary haemorrhage: this occurs any time after the first twenty-four hours,

usually between the 7th to 10th day following the accident or operation. This type of

bleeding is dangerous and is due to the presence of micro-organisms that have infected

the wound, destroying both the blood clots which are acting as seals and also the new

tissues which are being formed in the process of natural repair.

REACTIONARY HAEMORRHAGE: it occurs after twenty-four hours after the injury or

operation and is due to the reaction of the body. In any haemorrhage, nature employs

three agencies to prevent serious blood loss by. The blood pressure is lowered, to

reduce blood flow to that part of the body. Formation of blood clot which ‘corks’ the

blood vessel and limits further bleeding. The blood vessel walls ‘turn in’ to hold the clot

in position and prevent further loss.

Reactionary bleeding is likely to occur when the blood pressure rises or returns to

normal in situations of shock and the blood clot is pushed out by this pressure.

SIGNS AND SYMPTOMS OF HEAMORRAGE

1. The skin; change in the skin is very obvious, skin becomes pale, cold and clammy –

this is due to the constriction of the peripheral or superficial blood vessels as the

body’s mechanism to increase blood flow to the deep and vital organs

2. There is subnormal temperature (below 350C ) as a result of the physiology explained

above

3. Pulse; pulse becomes rapid and weak – due to the loss of blood and the subsequent

reduction in the circulating blood volume, the heart compensate by contracting

rapidly

4. Sweating especially in the palms and forehead

5. The skin becomes pale and there is loss of normal pinkish colour of the finger-nails,

and under the eyelids.

6. There is air hunger respiration (ie. Quick, shallow and gasping).

7. There is extreme thirst due to rapid loss of blood.

8. The person becomes restless

9. Dehydration sets in if the fluid loss is not immediately replaced.

10. Effect on the brain will result in terminal symptoms such as buzzing or ringing noises

in the ear, dimness of vision, dilated pupils, mental confusion, giddiness, and later a

state of coma.

SIGNS AND SYMPTOMS OF INTERNAL HEAMORRHAGE OR BLEEDING

Internal bleeding may lead to shock without any obvious blood loss but slowly large

amount of blood may be loss internally. Signs and symptoms may include
 1. Patient becomes restless and anxious

2. Cold and clammy skin

3. Pale and pinched face

4. Subnormal temperature

5. Sunken eye

6. Breathing is deep and sighing

7. Weak, rapid and irregular pulse

8. Decreasing BP

9. Fainting and dizziness

A. NATURAL ARREST OF HAEMORRHAGE

When blood vessels are severed or damaged, nature adopts three methods in an

attempt to stop the initial haemorrhage. These are;

CLOTTING: blood tends to clot shortly after the vessel is damaged and thus small

clots of blood may form in the wound and succeed in plugging vessels from which blood

is escaping. These clots act like a cork in sealing the blood vessels.

CONSTRICTION OF THE BLOOD VESSELS: the muscular and elastic coats of the

blood vessel which have been damaged tend to contract (draw together) in such a way

that the lumen through which blood is escaping is reduced in size to such an extent that

bleeding stops or is in any case diminished.

REDUCTION IN CIRCULATION: the strength of the heart beat becomes weaker, so

that less blood reaches the affected vessel. As a result of this lowered efficiency in the

circulation, the patient faints, thus lying down and keeping still for treatment

B. Compensatory mechanism

1. Closing down the blood supply to non-emergency areas of the body (including

the skin and digestive system). In other words, there is shunting of blood to vital

organs.

2. Speeding up the heart (increasing heart rate) to maintain blood pressure.

FIRST AID TREATMENT OF HAEMORRHAGE

Management of External Bleeding

1. Sit or lay the victim in a comfortable position and keep him/her still.

2. Reassure casualty if conscious

3. Remove or cut clothing as necessary to expose part of the body.

4. Remove superficial foreign bodies that may penetrate more upon application of

pressure. Do not remove any embedded object such as knifes and stuck glasses

etc.

5. Press edges of wound together and apply direct pressure over the wound using a

clean cloth (sterile dressing) or ask victim to do same.

6. Secure the dressing with a bandage that is firm enough to maintain pressure but

not so tight that it may impair circulation.

 7. Apply digital pressure that is thumb or finger pressure to the artery known to

supply the part. The pressure is applied to the PRESSURE POINT. Maintain this

pressure for 10-15 minutes.

8. Raise and support the injured part (limb) above the level of casualty’s heart to

reduce blood loss while maintaining direct pressure on the wound.

9. If bleeding continues, do not take off the original dressing but keep on adding

more pads.

10. As a last resort, apply a tourniquet if the part is a limb, above the injury to cut

off arterial supply.

11. Treat for a shock if present.

12. Get casualty to the nearest hospital as soon as possible.

NB: always wear protective gloves when dealing with wounds and blood.
 Figure 1: How to

secure a pad of

gauze on an injured

arm with a bandage

Guidelines for the Application of Tourniquet

1. The tourniquet must be tight and even around the limb

2. Its presence must be shown by writing a “T” on the forehead of the patient.

3. Use braided material like a CRAVAT to have even pressure around the limb.

4. The effectiveness is seen when bleeding has stopped.

DANGERS ASSOCIATED WITH THE APPLICATION OF A TOURNIQUET:

 1. It can damage nerves and muscles (Ischaemia).

2. If it is loosely applied, it may only stop venous bleeding but not arterial bleeding

and may well increase bleeding. It can damage the skin too.

Serious damages can occur if left in position for more than 20 minutes such as

necrosis, gangrene and venous thrombosis

Management of internal hemorrhage

1. Lay the person down flat on the floor or bed or couch and keep absolutely still as

further movement may cause further bleeding.

2. Reassure Patient as he will be anxious and possibly afraid.

3. Remove tight clothing around neck and waist.

4. Give nothing by mouth.

5. Keep victim warm by covering with a cloth if available

6. If possible, the lower end of the bed or couch (or victim’s lower limbs), can be

raised. This may help the flow of blood by gravity to the brain and may prevent

fainting or unconsciousness.

7. Call for help- or get the casualty to hospital as quickly and gently as possible.

A. HAEMATEMESIS: - This is vomiting out of blood from the alimentary tract. It is

usually due to diseases of the stomach e.g. Gastric ulcer, and varicose veins at the

lower end of the Oesophagus. It can also be caused by trauma or injury to the

alimentary tract. The blood is gritty and days brown or coffee brown because the

blood has been in contact with food and gastric contents.

 CAUSES: -

 Oesophageal ulcer

 Peptic Ulcer

 Trauma/injury involving the alimentary tract.

TREATMENT: -

 The casualty must be laid down immediately.

 Loosen tight clothing around the neck, chest and waist.

 Reassurance is essential to allay anxiety and fears.

 Keep the casualty still and quiet.

 Don’t give the casualty anything by mouth but ice may be given to suck. Water

may also be given rinse the mouth.

 Medical aid should be obtained as soon as possible

 All specimen of vomitus should be retained for the doctor’s inspection.

B.HAEMOPTYSIS: - This term is used to describe coughing up blood from the

respiratory tract or lungs. The blood may come from any part of the respiratory tract or

lungs and usually indicate diseases like Tuberculosis (T.B.). It may also arise from a

complicated fracture of the ribs accompanied by injury to the lungs. The blood is bright

red and frothy because it mixed with air.

CAUSES: -
  Pulmonary Tuberculosis (T.B.)

 Cancer of the lungs (C.A. of the lungs)

 Fractures of the ribs with injury to the lungs.

TREATMENT: -

1. Place the casualty in a sitting up position on a chair or prop him up in bed. This

position prevents flooding of the unaffected parts of the lungs with blood.

2. Tight clothing around the neck, chest and waist must be removed.

3. Reassure the casualty and keep him very still and quiet to prevent further bleeding.

4. Ice may be given to suck.

5. Medical aid should be obtained as soon as possible.

6. Keep all specimen of vomitus for doctor’s inspection.

C. EPISTAXIS: -Epistaxis refers to bleeding from the nose either from the anterior or

posterior part of the nasal. However, it is recorded that majority of epistasis occur from

the anterior nasal septum

CAUSES

1. Injury: blow or trauma on the nose

2. Fracture of the base of the skull or head injury.

3. Growth in children. Nose bleeding occur during the process of development.

4. Varicose Veins inside the nose can rupture and cause profuse bleeding.
 5. Altitude: - slight nose bleeding occurs when one ascends to a high altitude like

mountain climbing. Nose bleeding is also a sign of hypertension.

6. Foreign bodies: - Nose bleeding with discharge in young children can be a sign of

foreign body.

7. In minor conditions like nose picking a dried crust from the nose and when

blowing a horn.

TREATMENT: -

1. Place the casualty in a sitting position with the head held forward. In severe

bleeding, it prevents blood flowing to the throat and may also prevent from being

swallowed or inhaled.

2. Loosen tight clothing round the neck, chest and waist and place the casualty near

an open window for fresh air.

3. Let the casualty breath through the mouth

4. Pinch the nose firmly between the thumb and fore finger.

5. A cold handkerchief wrung out in cold water or ice water can be applied over the

bridge of the nose and at the back of the neck.

6. Keep the casualty sitting very still

7. Send the casualty to hospital if bleeding is severe and will not stop within several

minutes or hours.
 D.HAEMATURIA: - This means blood in urine. It may result from injury or disease

in the kidney, ureters, the bladder or the urethra. The urine will appear smoky in

colour if only a small amount of blood is present. If a large amount of blood is being

lost, the urine looks light red in colour and in severe cases, the urine may appear

black.

CAUSES: -

1. Injury to the urinary tract e.g. kidney, ureters, bladder or urethra.

2. Schistosomiasis (Bilharzia)

TREATMENT:

1. Lay the casualty down still and quiet.

2. Loosen tight clothing round the neck, chest and waist.

3. Give sympathetic reassurance.

4. Send the casualty for medical aid as soon as possible.

NB: Any specimen of urine should be taken for inspection.

E.MELAENA: -

This term is used to describe the presence of blood in stool. It is black and tarry in

colour due to the action of digestive enzymes. The stools appear black and tarry if the

blood is escaping from vessels higher up in the intestinal tract due to the intestinal

juices e.g. duodenal ulcer. If a casualty has black stools, eliminate the presence of

drugs like iron tonic. Iron which is not absorbed is passed in the stool giving it a black
appearance. If the blood is bright red in stools then there is damage near the lowered

of the intestinal tract like Haemorrhoids, dysentery, CA of rectum, perforation of the

bowels and colitis.

TREATMENT

1. Keep the casualty on bed and keep him quiet and still.

2. Reassurance is very important.

3. A doctor has to assess the condition as soon as possible.

4. Any specimen of stools or blood should be kept for inspection.

F. BLEEDING FROM A TOOTH SOCKET:

The socket of an extracted tooth may continue to bleed. Also, when there is trauma to

the gum and diseases of the blood may cause bleeding.

TREATMENT: -

1. Rinse out mouth with cold water.

2. Insert into the socket a pad of cotton wool or gauze and ask casualty to clench the

teeth firmly. The roughness of the gauze and the pressure on the bleeding vessels

should stop the bleeding in about 10 minutes.

3. If a tooth has been knocked out:

4. Handle the displaced tooth by the crown and not the root.
5. Ask the patient to suck it clean and then try to replace the tooth in the original

position in the socket to keep the root alive. A small piece of folded aluminum foil

may be used as a splint to fix the tooth in place until a dentist is available. A dentist

should see the patient within 30 to 60 minutes if the tooth is to be saved.

6. Wrap the foil splint over at least one tooth on each side of the replaced tooth. Ask

the patient to bite down firmly on the splint to keep the tooth root in contact with

the tissues of the jaw.

7. If the patient cannot assist with replacement of the tooth in the socket, try to keep

the tooth moist and clean. If the patient is fully alert, ask the patient to carry the

tooth in the mouth between the lower front teeth and lip where it will be bathed in

saliva.

8. If the patient is unconscious place the tooth in a clean container with normal saline

or a little milk.

9. If there is serious bleeding or swelling of the mouth or throat, the patient needs to

see a doctor.

G. CUT THROAT

A cut throat may have occurred accidently or it may be a suicide attempt. It can be

extremely serious if the jugular vein or the carotid artery has been severed.

TEATMENT TO A CUT-THROAT
1. Let the casualty sit down with the head bent forward, this will help to keep the

edges of the wound together.

2. Apply clean dressing to the wound and bandage it in position.

3. Send the casualty to the hospital for medical treatment immediately

4. Never leave the casualty alone. Use helpers to get the dressing and arrange for the

transport

H.UTERINE BLEEDING (BLEEDING PER VAGINA)

Any bleeding occurring not associated with the normal menstrual period must be

considered as a serious and urgent matter. The commonest cause is a threatened

abortion or miscarriage or after birth. It is also due to a disease condition like cancer of

the uterus or fibroids or injury.

TREATMENT

1. Put the casualty to bed immediately.

2. Elevate the feet or the foot-end of the bed

3. Reassurance is very essential

4. Loosen tight clothing round the neck, chest and waist

5. Apply a pad to the vulva and keep all pads for the doctor’s inspection.

N.B. count the pads and keep them down

 Arrange for transport and give follow – up care. N.B. Treat all cases always for

shock
H.BLEEDING FROM A BURST VARICOSE VEIN

Varicose veins are tortuous (twisted), dilated (enlarged) veins near the surface of the

skin. They are most common in the legs and ankles. They usually aren't serious but can

sometimes lead to other problems.

Varicose veins are caused by weakened or incompetent venous valves. Normally,

competent valves promote blood flow in only one direction (towards the heart). When

these valves become weakened or incompetent, blood flows back and pools up in the

veins; especially in the lower extremities, dilating the vein.

Most commonly affected veins are the superficial veins of the legs (saphenous vein);

veins of the esophagus, anal region (haemorrhoids), and testes.

A varicose vein

TREATMENT

1. Lay the casualty flat and raise the leg as high as possible.

2. Apply a clean pad to the bleeding part and bandage firmly.

3. Loosen any constriction that may impede circulation.

4. Keep the leg raised

5. Reassurance is essential

6. Refer to hospital for medical aid.

7.

I.BLEEDING FROM THE EAR:

This is bleeding from the ear usually due to a fracture of the base of the skull. It may

also be as a result of an injury to the auditory meatus.

TREATMENT

1. Lay the casualty carefully down and raise the head slightly.

2. Induce the head to the affected part.

3. Place a dry dressing over the ear and secure it with bandage lightly.

4. Do not pack the ear canal with dressing.

5. Observe the vital signs.

6. Seek medical aid by sending him to the hospital.

WOUNDS

A wound is defined as a break in the continuity of the skin or mucous membrane or

simply tissue damage. Wounds can be used to describe injury to an organ or tissue

within the body e.g. wound of muscles and organs such as the liver, stomach and so

on.

DEPTH of the wound is more important than AREA

CAUSES OF WOUND

 TRAUMA ( industrial injuries, road traffic accidents,, war injuries etc)

 BURNS
  INFECTION

Classification of wound

1. Open: An open Wound is a break in the skin or mucous membrane

2. Closed: A closed wound involves injury to underlying tissue without a break in

the skin or mucous membrane.

Open wound

Open wounds can be classified according to the object that caused the wound. The

types of open wound are:

 Incisions or incised wounds, caused by a clean, sharp-edged object such as a

knife, a razor or a glass splinter.

 Lacerations, irregular tear-like wounds caused by some blunt trauma.

Lacerations and incisions may appear linear (regular) or stellate (irregular). The

term laceration is commonly misused in reference to incisions

 Puncture wounds, caused by an object puncturing the skin, such as a nail or

needle.

Others

Abrasions (grazes or scrapes), superficial wounds in which the topmost layer of

the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding

fall onto a rough surface OR occur when the skin is rubbed away by friction

against a rough surface (e.g., rope burns and skinned knees).

  Avulsions. Occur when an entire structure or part of it is forcibly pulled away,

such as in the loss of a permanent tooth or an ear lobe. In avulsion, piece of

skin is torn loose and hanging from body or completely removed. Eg. Explosions,

gunshots, and animal bites may cause avulsions.

 Penetrating wounds,(perforating wounds) caused by an object such as a knife

entering and coming out from the skin. Penetrating wounds have point of entry

and point of exit. The EXIT wound is usually LARGER than the entrance wound.

 Gunshot wounds, caused by a bullet or similar projectile driving into or

through the body. There may be two wounds, one at the site of entry and one at

the site of exit, generally referred to as a "through-and-through."

Closed wound

Closed wounds have fewer categories, but are just as dangerous as open wounds. The

types of closed wounds are:

 Contusions, more commonly known as bruises, caused by a blunt force trauma

that damage tissue under the skin.

 Hematomas, also called a blood tumor, caused by damage to a blood vessel

that in turn causes blood to collect under the skin.

Features or Characteristics of wounds

Incised wound: - this is a wound in which the edges are sharp and well defined. This

type of wound may bleed freely or profusely because blood vessels have been cut

across and are prevented from contracting. However, this wound can usually be

cleaned satisfactorily and tend to heal quickly leaving but a little scar. Edges of an

incised wound may remain in apposition or closed together but more often, they tend to

gape especially when the injured part is moved in certain directions.

Lacerated wound: - A lacerated wound is one in which the edges are jagged,

irregular and often bruised, the skin and tissues are torn and the edges of the wound

are irregular. The skin and muscles are crushed. It is usually caused by a blow with a

blunt instrument or by a fall on a rough surface. It occurs if a limb is cut up in

machinery or road accident, during scratching by the nails or because, the blood vessels

have been twisted in the process of tearing and therefore cannot readily bleed. Wounds

of this type heal slowly leaving a considerable scar. It has a high risk of sepsis because

it is a good medium for growth of microorganisms.

Punctured wound: - this is usually caused by a blow from a sharp instrument such as

a nail, tip of knife or a dagger or a gunshot which passes straight through the skin to

any depth. The depth of the wound is greater than the length. Usually punctured

wounds are deep, narrow wounds in skin and organs such as stab wound from nail or

knife
There is a danger of deep organs being damaged. Although the actual wound may

appear quite small on the surface, there is often a much deeper wound called “track”

hidden under the skin which may damage internal organs.

This type of wound is very dangerous. Microorganisms can grow easily and produce

severe complications. Dog bites are often of this variety and are mostly deceptive for

what may appear to be nothing more than a slight cut, may prove on more thorough

examination to extend quite deeply under the skin in various directions.

Contused wound: - A contused wound is any wound which is associated with

bruising. There may be little or no skin damage but underlying tissues may be severely

damaged with bleeding from vessels under the skin. It is caused by violence from a

blunt instrument such as hitting the finger with the hammer. There may be very little

external bleeding but quite considerable internal bleeding.

BURNS: - as a result of;

1. Wet - Hot water or hot liquids

2. Dry- sunlight or flame

3. Electrical
INFECTION: -

 Boils: also known as furuncle is an infection of the hair follicle that has a small

collection of pus called an abscess (reddened and often painful swellings on the

skin).

 Carbuncles: (large painful swelling under the skin) or rounded red gemstones or

painful cluster of boils connected to each other under the skin

Wounds can also be classified into Acute and Chronic wounds.

Acute wounds are the result of injuries that disrupt the tissue. Acute wound progessess

to healing within two weeks however when patients has an underlying medical

condition or decreased nutrients and oxygen supply, acute wound may fail to heal in

time and become chronic.

Chronic wounds are those that are caused by a relatively slow process that leads to

tissue damage. They are aggravated stage of an acute wound. Chronic wounds include

pressure, venous, and diabetic ulcers. This can result from diabetes, auto immune

disease, infection, peripheral vascular disease

 Management

AIMS OF FIRST AID in wound care is to

1. Stop bleeding.

2. To treat and prevent shock

3. Minimise germs or micro organisms from entering the wound (prevent infection

or contamination).

4. Obtain medical attention

Note

 Different types of wounds require specific first aid

 All wounds have risk of infection

General principles in Wound care (immediate)

1. Wash hands before attending to the wound (wear medical or exam gloves if

available or if you are at the hospital).

2. Gently wash wound with soap and water. Rinse for 3 to 5 minutes.

3. Clean wound to prevent infection unless it is very large or bleeding seriously.

Cleaning should be done by using clean materials as much as possible E.g.

cotton gauze, towels etc...

4. Do not use alcohol, hydrogen peroxide, on wound

 5. Avoid breathing or blowing on wound

6. Remove any large particles if you can.

7. Do not attempt to remove clothing stuck to wound.

8. Cut around clothing and leave in place

9. Do not scrub wound

10. Do not waste time cleaning a wound that is bleeding severely – controlling

bleeding is always the priority.

11. Do not try to clean major wound after controlling bleeding – it may bleed again

12. Pat area dry.

13. Cover wound with sterile dressing and bandage.

14. NB. Do not put antibiotic ointment on puncture or deep wound ( Use only on

abrasions and shallow wounds).

Specific management

Punctured wound

• Greater risk is infection

– Germs or micro organism may not be flushed out

• Remove small objects or dirt (not impaled object)

• For stabbed wound (with impaled objects)

– Removing an object could cause more injury and bleeding

– Leave it in place and dress wound around it

– Control bleeding by applying direct pressure at sides of object.

 – Pad object in place with large dressings or folded cloth

– Support object while bandaging it in place

– Keep victim still

– Seek medical attention

• NB. Do not put antibiotic ointment on puncture or deep wound ( Use only on

abrasions and shallow wounds)

Penetrating wound

 If the object (eg. Missile) lodges in the body fails to exit, DO NOT attempt to

remove it. OR If there is an object extending from the wound (impaled in),

DO NOT remove the object

 Apply a dressing around the object and use additional improvised bulky

materials/dressings (use the cleanest material available) to

build up the area around the object.

Avulsion

• Try to move skin or tissue into normal position (unless contaminated)

• Control bleeding

• Provide other wound care

• If avulsed body part is completely separated – care for it like an amputation

In amputation,
  Control bleeding with direct pressure

 Elevate extremity

 Treat victim for shock

 Wrap severed part in dry, sterile dressing or clean cloth (do not wash)

 Place the part in plastic bag, seal it

 Place sealed bag in another bag/container with ice

 Part should not touch ice directly

 Give the amputated part to responding crew

Dangers of wounds: - The three chief dangers of wound in order of urgency of

treatment are haemorrhage, shock and infection or sepsis.

At greater risk are wounds from bites, puncture wounds, dirty wounds, wounds with

jagged edges………….

Complications Associated with Wounds

 Infection: when there is wound, microorganisms can enter easily to cause

infection. Signs of wound infection are Swelling and redness around wound,

Sensation of warmth, Throbbing pain, Pus discharge, Fever and chills, Swelling

or lymph nodes
  Haemorrhage: Damage to the blood vessels causes loss of blood.

Haemorrhage may be slight or severe and may be internal or external.

 Shock: The shock depends upon the extent of damage. It is not very severe in

lacerated and contused wounds.

 Injury to the vicinity: Wounds are often associated with injury to the other

important structures in the vicinity like blood vessels, nerves and tendons

muscles.

 Injury to deeper organs: Organs like the liver, spleen, the lungs, kidneys,

heart may damage when there is punctured wounds and may cause internal

haemorrhage.

 Fractures: Injury to a limb as seen in road accidents and machinery may cause

one or more bones to break.

Process wound healing

Wound healing is a natural restorative response to tissue injury. Healing is the

interaction of a complex cascade of cellular events that generates resurfacing,

reconstitution, and restoration of the tensile strength of injured skin.

Healing is a systematic process, traditionally explained in terms of 3 classic phases:

inflammation, proliferation and maturation/Remodelling phases.

1. Inflammatory phase

Following incision of the skin, a 5- to 10-minute period of vasoconstriction ensues,

mediated by epinephrine, norepinephrine, prostaglandins, serotonin, and thromboxane.

Within 24 hours of the initial injury, neutrophils, monocytes and macrophages are on

the scene to control bacterial growth and remove dead tissue.

This phase is Characterized by redness, heat, pain and swelling. Characteristic red color

and warmth is caused by the capillary blood system increasing circulation & laying

foundation for epithelial growth.

Last approximately 4 to 5 days. Platelet activity stops bleeding & triggers the immune

response

2. Proliferative phase

Begins within 24 hours of the initial injury and may continue for up to 21 days.

Proliferative phase is characterized by three events: Granulation, Epithelialization

and Collagen synthesis

 Granulation Formation of new capillaries that generate and feed new tissue.

Granulation tissue is the beefy red tissue that bleeds easily

 Epithelialization : Formation of an epithelial layer that seals and protects the

wound from bacteria and fluid loss. It is essential to have a moist environment to

foster growth of this layer. It is a very fragile layer that can be easily destroyed

with aggressive wound irrigation or cleansing of the involved area.

 Collagen synthesis: Creates a support matrix for the new tissue that provides

it with its’ strength.Oxygen, iron, vitamin C, zinc, magnesium & protein are vital

for collagen synthesis.This stage is the actual rebuilding and is influenced by the

overall patient condition of the wound bed

 3. Maturation/Remodelling phase

 Final stage of wound healing

 Begins around day 21 and may continue for up to 2 years

 Collagen synthesis continues with eventual closure of the wound and increase in

tensile strength

Healing of Wounds

Wound healing can also be classified into healing by First intention or granulation

depending on the type and the nature of the wound

1. First Intention: This method is more satisfactory and quicker method of

healing. It occurs in incised wounds, when the edges can be brought together

and kept in position while healing continues. Examples are cuts from blade and

sharp knife or surgical incisions. The edges of a wound can be brought together

in one of two ways:

a) By stitching, clips or adhesive dressing

b) By position. Most incised wounds gape when the injured part is moved in certain

directions. Often the position of the affected part can be so altered that the

edges of the wound come together.

 In the process of healing by first intention, blood clots temporarily hold the edges of

the wound together, where new cells are growing to replace those destroyed by the

accident. Healing by first intention can occur in healthy wounds, where sepsis has

been avoided by suitable treatment. The process usually takes from five to ten days.

2. Granulation: This is a slower method of healing and occurs in lacerated wounds

and those which have become septic. New cells, which at first immature grow in

clusters in the depths of wound. Each cluster appears like a small clot of blood,

and is called granulations.

The granulations increase in size and gradually grow upwards until they reach

the surface of the wound, when new cells grow across from the skin edges and

so complete the healing process. Healing by granulation also takes place

sometimes under the scab produced by superficial wounds, such as a graze.

Try

A co-worker’s young son, playing outside, falls and gets a nasty scrape on his palm.

The bleeding soon stops by itself, but the wound is full of dirt.

Describe the steps to take with this wound.

FRACTURES

A fracture occurs when there is a break or crack in the continuity of a bone. When a

bone has broken, the pieces which have been formed as a result of the fracture are

called fragments.

CAUSES OF FRACTURE

Direct force or violence: this is when a force or pressure is applied directly to a bone

and if the pressure is greater than the resistance of the bone, the point of the bone

where the force was exerted will break. This is by far the commonest cause of fractures

and is seen in blows, falls and gunshot.

Indirect violence: when the bone broken in an accident is situated some distance

away from the site at which the violence was received.

Thus for example, a fall on the outstretched hands often does not fracture the bone of

the hands but the clavicle due to the transmission of the force to the clavicle which is
relatively weak to resist the impact. Similarly, fall on the legs from a height often

fractures the spine.

Muscular violence: since the muscles are attached to bones, any violent muscular

contractions can fracture the bone into which the muscle is inserted or attached.

Example, the knee-cap (patella) is often fractured as a result of muscular contraction.

Pathological fracture Occasionally, a bone may be found to have broken without

application of violence. This is called spontaneous or pathological fracture and it is

generally due to a condition known as osteoporosis.

PREDISPOSING FACTORS:

 Disease of bone: occasionally, a bone will be found to have broken without the

application of violence. A bone may be rendered weak by a disease such as

sarcoma of bone, osteomyelitis, osteoporosis, rickets etc. and the bone fractures

spontaneously; such a fracture is called a ‘pathological fracture’.

 Extreme age: e.g. children and old age.

 Poor nutrition e.g. lacks of calcium containing diet.

CLASSIFICATION OF FRACTURES
Generally, Fractures can be classified into TWO according to the condition of tissues

surrounding the fractured bone or depending on the bone affected.

1. CLOSED/SIMPLE FRACTURE: There is only one clean break of the bone. The

bone is broken without any communication with the external environment that is

there is now open wound or skin does not break.

2. COMPOUND FRACTURE /OPEN FRACTURE: Here, the bone breaks in

several pieces. In addition to the broken bone, there is also tissue destruction.

The broken ends of the bone may penetrate through the skin. Open fractures are

highly susceptible to infections.

TYPES OR KINDS OF FRACTURES

  GREEN STICK FRACTURE: It mostly occurs in children under age 12. The

bone instead of breaking bends like a green twig. This fracture occurs because

the bones in children are still fairly soft.

 COMMINUTED FRACTURE: In comminuted fracture, the bone is usually

crushed or broken into several pieces’ bone. There are usually several fragments

of bone in the fractured area.

 IMPACTED FRACTURE: In this fracture, the ends of the broken bones are

pushed into each other and are tightly wedged.

It is common in fractures of the shaft of the femur

 Transverse fracture: In this, the bone is broken almost straight across. This

occurs in most fractures caused by direct violence.

 Oblique fracture: This occurs diagonally across the long axis of the bone.

 Spiral fracture: This is also known as torsion fracture. It occurs due to

rotational or twisting force.

 Fissured fracture: This is a common variety of simple fracture in which the

bone is cracked but not completely broken. Many simple fractures of this kind

are not always diagnosed owing to the symptom and sign of which they

produce.

 COMPLICATED FRACTURED: In this fractured there is damage to the bone

and associated injury to internal organs e.g. Fracture of the skull where the

fractured bone injures the brain, Vertebral fracture where the spinal cord is

damaged, Fracture of the rib where the broken bone pierces the lungs.
  Avulsion fracture: This is a bone fracture which occurs when a fragment of

bone tears away from the main mass of bone (a fragment of bone is pulled off

by ligament or tendon attachment) as a result of physical trauma.

TYPES OF FRACTURES

SIGNS AND SYMPTOMS OF FRACTURES

The first aider should be able to assess and determine if there is any fracture, the

following sign and symptoms should be look out for

1. Pain- severe pain at the affected part

2. Tenderness and swelling

3. Crepitus- abnormal grating sensation produce when the broken pieces rub against

each other

4. Loss of function and power of body part

5. Deformity of the affected part – there is irregularity in the outline of the site of

the fracture.

6. There may also be bruising or injury to surrounding skin/tissues

7. Abnormal mobility

REPAIR OF FRACTURES

When there is a break in a bone, there is escape of blood from damaged blood vessels.

A clot forms around the broken ends of the bone which gives rise to the development of

fibroblast. There is also the formation for new capillaries within 5-6 days after the

injury.

Osteoblasts (bone forming cells) are laid down which results in the formation of a

callus. This callus joins the broken ends of the bone together. It takes about 6 weeks

to show and after several months, new bones are formed completely.
MANAGEMENT OF FRACTURES

AIMS:

1. Avoid complications

2. To prevent further damage. Eg simple fracture to compound.

3. To reduce pain

4. Arrange for the transportation of casualty quickly to a health facility or qualified

medical attention

GENERAL PRINCIPLES OF FIRST AID MANAGEMENT OF FRACTURES.

 Proper positioning: put the casualty in such a position that greater pain or

further complication can be prevented. casualty must be kept lying down unless

the particular fractures makes such positioning unsuitable as in fracture of the

ribs where it is more convenient to have the casualty sitting up in a chair

 Don’t move patient limb if possible, if the need be, steadily support the injured

part at once to prevent movement.

 Prevention of infection: infection of the bone may delay healing and should

be prevented by managing any wound present

 stoppage of bleeding: try to arrest any obvious bleeding

 Treatment of shock: excruciating pain and severe bleeding can predispose

the casualty to shock. Counter act shock by handling patient gently, keeping

warm, and reassuring.

  Immobilization of the affected part – this is done as quickly as possible using

critical judgment and available materials to improvise. Immobilization of body

part can be done by splinting and the use of a sling

There are two methods of immobilization or splinting:

1. Body splinting

2. Mechanical splinting

BODY SPLINTING: Here the part that is fractured is immobilized by bandaging it to

another part of the body. E.g. A fractured leg can be bandaged to the other leg; a

fractured arm can be bandaged to the chest. The space or point of contact between

the two body parts can be padded with rags.

MECHANICAL SPLINTING: They are splints (splinting material) or improvised splints

which are used to immobilize the fractured body part. In splinting, the following are

considered seriously about the splints.

FACTORS TO CONSIDER IN SPLINTING:

 The splints must be strong enough to give the desired support

 The splints should be long enough extending from above the joint above the

fracture to below the joint.

 The splint should be adequately padded to minimize or prevent direct pressure

 The splint should be tied in position above and below the fracture and adjacent

joints and never over the fracture

 Materials used for securing splints includes; ties, belts, pieces of cloth, etc.

 To arrange to transport the casualty quickly to the hospital

 Movement of the casualty: never move a casualty with a fracture unless you

have enough people to assist with the lifting

Slings: - These are used in addition to body bandages example, some fractures of the

upper limbs are supported after treatment by slings.

FIRST AID TREATMENT OF SPECIFIC FRACTURES

In fracture management, the general principles of first aid treatment of fracture are

carried out with specific immobilization for the fracture type.

1. FRACTURE OF THE SKULL

It is treated as an emergency due to the likely injury to the brain. The fracture may be

at the vault or the base of the skull and could be simple, compound or a depressed

fracture. The two dangers associated with fracture of the skull are;

 Concussion: that is a ‘’shaking up’’ of the brain

 Compression: also known as cerebral compression occurs when there is

buildup of pressure on the brain. It could be due to blood in the skull, swelling of

an injured brain tissue or a piece of bone may have been pressing on the brain

or driven into it. This can result in bleeding into the brain

SIGNS AND SYMPTOMS OF SKULL FRACTURES

Depends on the severity of the injury

mild injury (as in concussion)

 Dizziness

 Headache

 Vomiting
  Dazed state

 Loss of memory of events; at the time of injury or immediately preceding the

event.

SERIOUS INJURY:

 Shock may be present with associated S/S

 Semi-conscious state

 May be roused but can’t understand spoken words

 Incoherent speeches

 Sudden relapse into unconsciousness

 Vomiting

3. COMPRESSION

 Restlessness

 Complains of headache

 Muscle twitching or weakness of one side of the body. Paralysis may ensue if

pressure is continuous.

 Flushed face with raised temperature, which may reach hyperpyrexia.

 Strong and bouncing pulse but slow.

 Slow and deep respiration with stertorous breathing.

 Dilated pupils which are unequal in size and may not react to light

 Drowsiness.

 There may be bleeding from the nose and ears.

 Noticeable change in personality or behavior such as irritability or disorientation

TREATMENT OF SKULL FRACTURES

 Keep the victim lying down and the head of the casualty absolutely still.

 In patient with breathing problem, place victim in three quarters prone position

 Cover any wound with a clean and near to sterile dressing and bandage lightly in

place.

 Do not apply any direct pressure to the wound

 If there is bleeding from the nose and ear, place a clean dressing and secure it

lightly.

 Loosen any tight clothing at the neck, chest and waist ensuring that patient can

breathe freely.

 Treat for shock if there is the need.

 Arrange and transport the casualty as quickly as possible to a health facility

FRACTURE OF THE PELVIC

CAUSES

Injury to the pelvis are usually cause by Crushing or indirect force as in a car crush. The

impact on the car dashboard on a knee can force the head thigh bone through the hip

socket. Pelvic structure is a complicated one that could possibly injure the internal

organs the pelvic protect, eg bladder, urinary passage, bleeding in pelvic structure may

be severe and internal and shock often develops.

SIGNS AND SYMPTOMS

  Inability to walk or stand; though leg appeals good.

 Pain and tenderness in the hip, groin, or back which increase when casualty

moves.

 Bleeding from the urinal orifice, male may not be able to pass urine, or finds this

painful.

 The person may manifest Signs of internal bleeding.

FIRST AID TREATMENT

1. Place the casualty flat from his back.

2. Place pads between the ankles and knees and tie the legs firmly together.

3. Apply a binder firmly round the pelvis e.g. a towel.

4. Reassure the casualty to allay fear and anxiety

5. Try to get the casualty not to pass urine. If the bladder or urethra is

damaged some urine may slip into the pelvic cavity and may be dangerous.

6. Keep him still and arrange for transport to the hospital immediately. If a

stretcher is used, it should have a hard base.

7. There must be sufficient people before lifting and it must be done slowly

and gently.

FRACTURE OF THE RIBS

Fractured ribs are common and may be caused by direct or indirect violence and

occasionally, by muscular action. Rib may break as a result of a blow on the chest, a
gunshot wound, or a fall onto a projecting surface such as a bar. Occasionally, a rib

may be broken as a result of severe coughing or sneezing. This is an unusual accident

and generally affects elderly patients. The danger is that the broken rib may be driven

inwardly and pierce into the lungs.

Signs and Symptoms

 The patient may complain of a sharp stabbing pain at the side of his chest;

which is worse on taking in deep breath, coughing or sneezing.

 The patient breathes cautiously and avoids taking in deep breath so that the ribs

do not move and cause more pain.

 On careful examination of the ribs suspected to have been injured, an area of

tenderness will be found over the affected bones. Sometimes, in broken ribs,

swelling, bruising, deformity and even irregularity are absent.

 If the lungs are injured, haemoptysis is present.

 If there is an open wound, air is sucked in and blows out as the casualty breaths.

 Signs and symptoms of internal haemorrhage may present if a sizable blood

vessel is ruptured.

 The patient may suffer severe shock.

Management

 Sit patient down on a chair in an upright position

 If the fracture is uncomplicated, apply two broad bandages to the affected part.

The upper bandage should overlap the lower one by half its width.
 Tie them lightly after the patient has breathed out with the knots near the front

of the uninjured part.

 Support the arm of the injured part in a sling.

 If there is a wound, cover with a dry dressing pad and bandage firmly.

 If there is a complicated fracture where the lung has been penetrated by bone,

do not apply a tight binder round the chest as this may push fragmented pieces

of bone further into the organ. The patient can be placed lying down; turned

slight towards the affected side and can be supported in this position with a

pillow or cushion.

 Treat for shock as far as possible.

 Arrange to get casualty transported to the hospital

FRACTURE OF THE SPINE OR VERTEBRAE

The spine may be broken either by direct or indirect force. A grave

complication of fracture of the spine is injury to the spinal cord or to the

nerves branching from it, causing complete or partial paralysis and loss of

sensation in all parts of the body below the site of the injury. Fracture of the

spine should be suspected in all cases in which there is a history of accident,

all injuries to the vertebral column with pain and shock even if there are no

indication of paralysis.

CAUSES
 1. Direct force fall of a heavy weight across the back or falling from a height

on the back across a bar causing a fracture at the site of impact.

2. Indirect force: a broken neck which may result from a fall on the head and

a fracture in the lumbar region due to sudden over flexion or jerking of the

spine.

SIGNS AND SYMPTOMS OF FRACTURED SPINE

1. There is distress indicated by pallor, a cold clammy skin and a subnormal

temperature. The pulse is rapid and feeble.

2. Pain at the site and referred pain i.e. pain which shoots round the body

along the course of the nerves issuing from the site of the injury.

3. There is swelling, tenderness and bruising.

4. Deformity which may be marked.

5. Paralysis may be present.

6. Finally, there may be shock

FIRST AID MANAGEMENT OF SPINE FRACTURE

1. It is important to present damage to the cord. The casualty lie still and

must not be moved until there are sufficient people to lift him on a

stretcher.

2. Try to immobilize the whole body by placing pads between the ankles,

knees and tie the legs firmly together.

3. When lifting the casualty, keep the body absolutely still and lift the body in

a straight line. Do not allow the back to be bent.

 4. If the casualty is unconscious, make that his breathing does not become

obstructed keep the mouth clear of saliva and the tongue forward.

5. Treat for shock if any.

6. If the fracture is at the cervical region transport the victim on his back,

head absolutely still.

7. If the fracture is at the lumbar region place the casualty in the prone

position

8. Arrange for transport to the hospital as soon as possible on a stretcher.

FRACTURE OF THE JAW (MANDIBLE)

Fractures of the lower jaw are usually caused by blows, kicks by a horse or gunshot

wounds. It may be simple, compound or complicated.

Signs and Symptoms

1. There is severe pain in the jaw.

2. Casualty has difficult in speaking and swallowing. He frequently adopts the

characteristic attitude of leaning forward and supporting his chin with the palm

of his hand.

3. All the usual signs and symptoms of a fracture such as swelling, deformity and

tenderness are present.

 4. There is irregularity of the teeth

5. There is a wound within the mouth which causes profuse flow of blood-stained

saliva from the lips.

Management

1. Instruct the patient not to speak.

2. Instruct him to lean slightly forward, support the lower jaw in the palm of the

hand raising it gently upward.

3. Apply a clean dressing on any wound.

4. The upper jaw acts as a splint, so press the lower jaw up against the upper jaw

(clenched teeth position).

5. Apply a bandage to maintain this position. The best type of bandage is the barrel

bandage.

FRACTURE OF THE CLAVICLE

Injury to this bone is a common accident and occurs in many kinds of sports. When a

person falls on outstretched hands, full weight of the body is thrown unto the arm and

the corresponding clavicle is fractured.

Signs and Symptoms

1. The patient is seen supporting weight of the arm.

2. The patient’s head is slightly inclined towards the injured side; with the intention

of relaxing the muscles which are attached to the bone.

3. If both clavicles are broken, there may be difficulty in breathing

 4. The patient has the usual signs and symptoms of fracture such as pain, swelling,

and loss of function.

5. Deformity may be noticed but it is desirable to compare the bone with that on

the opposite side; to exclude natural deformities.

6. There is tenderness and irregularity.

Management

1. Immediately support the arm on the injured side with aid of an assistant

2. Remove the over coat if there is any

3. Apply padded material between the upper arm and the chest or the axilla

4. Flex the arms to allow the tips of the fingers to touch the opposite clavicle and

apply a sling

5. Bind the arm to the patient’s trunk with another sling

6. Feel the pulse to make certain that the circulation is active.

7. Arrange for transportation to the hospital.

FRACTURE OF THE FEMUR

The femur is the longest bone of the body. It is a common accident and may occur as a

result of direct or indirect violence. It may also occur form trivial violence e.g. sudden

twist of the leg.

Signs and symptoms

This may be quite difficult to diagnosis owing to the amount of muscle round the thigh.

All the classical signs of fracture may be present. There are however, 2 valuable signs

to look for:

a. Eversion of the foot: The foot on the injured side often lies powerless and

rolled over on to its outer side.

b. Shortening of the limb: This is due to the pull of the powerful muscles which

are attached to the lower fragment. The injured limb is shorter than its fellow of

the opposite side.

Management

 Apply a clean dressing if skin is broken

 Lay the patient down in a recumbent position

 If no splints are immediately available, place pads between the ankles and knees

and tie the legs together.

 The first bandage should tie the feet together. The second should tie the knees

and the third bandage should tie the thighs together.

 It is important that bandage should not be applied over the site of the fracture.

 If a splint, long enough to extend from the axilla to beyond the foot can be

obtained, then it should be padded.

 Apply and bandage firmly in position.

 Arrange to get the patient transferred to hospital as quickly as possible.

 DISLOCATIONS, SPRAINS AND STRAINS

DISLOCATIONS

This is said to occur when two bones forming a joint are thrown out of their normal

alignment or when one of the bones has been displaced. A dislocation is a joint injury in

which the bones are partially or completely pulled out of position. It is also known as

the displacement of the bones forming a joint. Dislocation can be caused by sudden

strong force, wrenching the bone into an abnormal position or by violent muscle

contraction. There is usually stretching and possible tearing of tendons and ligaments. A

subluxation is a partial dislocation of the articulating surfaces

The S/S look closely like those of simple or close fracture, but the deformity is normally

greater and more marked. Usually, dislocations are common in the shoulder, jaw and

joints of the thumb and fingers.

SIGNS AND SYMPTOMS

 Deformity

 Swelling

 Internal bleeding

 Loss of function

 Pain

 Tenderness

 Numbness

 Bruising

 Decreased ability to move the limb

  A popping sound may be heard if a ligament is torn

 Signs of shock may be present

TREATMENT OF DISCLOCATION

 Advise the casualty to keep still and support injured part in a position of comfort

 Apply splints for lower limbs

 Apply sling to support the dislocation at the upper limb

 The patient must be transported for qualified medical attention as soon as

possible to replace the bone.

 Avoid trying to reduce a dislocated bone into its socket for this may cause further

injury.

 Do not move the casualty until the injured part is secured and supported and

unless in Application of cold compress may reduce pain and prevent swelling.

SPRAINS AND STRAINS

SPRAINS

It is the sudden overstretching or tearing of ligaments surrounding a joint due to

indirect violence. The common sites of occurrence are the ankle and wrist joints but it

occurs at any joint. The severity of this condition occurs when the ligament is not only

stretched but torn completely. This needs a long-term immobilization and if necessary

surgery may be required.

DEGREES OF SPRAIN
Sprains are graded in four degrees or levels. These are not easily assessed by mere

signs and symptoms. It requires the use of Magnetic Resonance Imaging (MRI) for

effective assessment.

a.First degree:

This occurs when the ligament only stretches or sometimes with minor tear. This

usually occurs among first time trainers.

b.Second degree

This occurs when there is a tear of ligament and it is accompanied by swelling.

c.Third degree

This is a complete rupture of the ligament

d.Fourth degree

This occur when there are actual breaks of ligaments and it is associated with small

fractures. It is the most serious level and surgery is required.

SIGNS AND SYMPTOMS

1. There is intense pain and tenderness at the site of injury. The pain becomes

severe on movement of the part.

2. Swelling of the affected part occur and there is bruising due to bleeding under the

torn stretches.

3. Loss of function of the affected part but not so much as in fractures.

 4. There may be shock.

5. Inflammation of infected tissues.

PREVENTION OF SPRAIN

Sprain can best be prevented by:

1. The use of proper safety equipment when in action.

2. Adequate physical exercise at the joints and the entire body for flexibility and

strength.

3. Taking enough fluids for lubrication of joints.

FIRST AID TREATMENT OF SPRAIN

Unless there is a fracture, the acronym PRICE describes the standard first aid

treatment of sprain.

1. Position: casualty in a comfortable and safe place

2. Rest: short-term rest eases discomfort and does not increase morbidity.

3. Ice: apply ice packs/cold compresses for the first 24 hours intermittently: 20

minutes at a time every 4 hours. This will reduce pain and swelling.

4. Compression: apply padding and firm bandaging to reduce swelling.

5. Elevation: elevate the affected limb (above the waist) to reduce swelling, even

while asleep.

NB: Send the casualty to hospital for medical aid.

STRAINS
This is the overstretching or tearing of muscles and tendons which surround a joint.

The cause can be acute or chronic. Acute when caused by either direct or muscular

action and chronic when caused by continues over usage of muscles or tendons.

SIGNS AND SYMPTOMS OF STRAIN

1. Sudden severe pain at the site of injury

2. There is swelling and tenderness

3. Further excretion may be impossible or difficult.

4. If the back is affected the casualty may be unable to stand upright.

5. Loss or reduced muscle function.

6. Inflammation

FIRST AID MANAGEMENT

 Position: casualty in a comfortable place

 Rest: short-term rest eases discomfort and does not increase morbidity.

 Ice: apply ice packs/cold compresses for the first 24 hours intermittently: 20

minutes at a time every 4 hours. This will reduce pain and swelling.

 Compression: apply padding and firm bandaging to reduce swelling.

 Elevation: elevate the affected limb (above the waist) to reduce swelling, even

while asleep.

NB: Send the casualty to hospital for medical aid.

UNCONSCIOUSNESS
Consciousness: is the state of being aware of one’s surroundings partially or completely.

A conscious person is aware of his/her environment but an unconscious person is not

completely aware of the surroundings.

It can simply be defined as a state of unawareness

CAUSES

1. Brain infections – e.g. cerebral malaria, Meningitis, cerebral abscess, encephalitis

etc.

2. Metabolic disorders–e.g. hypoglycemia, diabetic ketoacidosis, hepatic coma,

dehydration, and uremia.

3. Poison and Drug overdose – E.g. alcohol, paracetamol, barbiturates, kerosene,

insecticides or snake poisoning (venom).

4. Major organ failure – E.g. Hepatic failure, renal failure.

5. Trauma/Head injury –E.g. skull fracture or concussion.

6. Space occupying lesions or tumors.

7. Cerebral ischemia. (Inadequate blood flow to the brain to meet the metabolic

demand.)

8. Haemorrhage

9. Fainting (syncope)

10. Apoplexy (stroke/CVA)

11. Epilepsy, Infantile convulsion:

12. Psychogenic e.g. Hysteria,

13. Asphyxia
 14. Hypoglycaemia

15. Shock

16. Heat stroke

Levels of Consciousness

1. Fully conscious: It is an awareness of one’s self, acts and environment.

Casualty is able to speak and answer questions.

2. Drowsiness: Casualty is not fully awake. He is lethargic (unnaturally tired) or

sleepy, with poor attention span.

3. Disorientation/Confusion: The person is confused and unable to identify the

time and place; although he may still be capable of answering simple question

such as his name, address although he does not know where he is.

4. Stupor: A state of incomplete loss of consciousness. Patient cannot respond to

his name but may obey commands and responds to painful stimuli (localizes

pain).

5. Coma: A state of complete loss of consciousness. The patient is unarousable;

and all reflexes are absent.

6. Coma vigil: A chronic state of brain dysfunction in which person shows no signs

of awareness, though his eyes are widely opened. It is an indication of great

exhaustion and prostration.

Clinical manifestation

For brief unconsciousness

1. weakness.

2. Unawareness of self, time and environment.

Clinical manifestations of coma – early symptoms

 Headache

 Localized sensor motor defect.

 Asphyxia

 Vision defect

 Seizures

Later symptoms

 Pronounced unilateral

 Changes in neurological status

 Acid – base imbalance

 Abnormal eye movement

 Loss of papillary reactivity to light

 tremor

GENERAL EXAMINATION OF THE UNCONSCIOUS CASUALTY

The first aider often cannot treat the cause of unconsciousness. The duty of the

first aider is to find out the cause.

 Always remember to bring the casualty out of danger. If immediate treatment

like asphyxia or haemorrhage is essential, start treatment without wasting time.

Put the casualty in either the recovery or on the back with the head turned to

one side and arrange that the casualty gets medical aid as fast as possible.

However, usually a careful history shoulder be obtained from by-standers or

relatives if possible and a careful but thorough examination should be done as

follows:

HISTORY:

1. Was the loss of consciousness gradual or sudden?

2. Was the casualty injured before becoming unconscious?

3. Whether there was previous attack e.g. epilepsy (the relatives can

give information about similar attacks occurring previously) and

eclampsia if a woman is pregnant

4. Formal health status e.g. history of diabetes, angina pectoris

5. Pulse: - pulse rate must be noted. Rapid pulse means shock, fainting or

collapse.

Slow and bounding pulse could be due to stroke cerebral compression.

Irregular pulse heart diseases and in the later stages of poisoning.

Examine and note the following to give report at the hospital;

Respiration, level of unconsciousness, how patient is positioned, natural or

unnatural, presence of wound and fracture,

Respiration: quick, shallow, stertorous (snoring) or irregular, colour of skin and

face , eye of size of the pupil and reaction to light, odour of breath, discharges

from ear, eyes, nose or mouth, check for any convulsive movement or rigidity of

body part, check for urine and bladder incontinence ,

check for any treatment card or tally card indicating that he is suffering from a

special illness or he is on certain drugs.

FIRST AID TREATMENT OF AN UNCONCIOUS CASUALTY

1. Try to ensure that the air passages are not obstructed. Remove false

teeth if any and clear the mouth of mucous, blood and vomitus using a

clean material or handkerchief.

2. Place the casualty in a semi prone position or recovery position.

3. Undo tight clothing around the neck, chest and waist.

4. Provide warmth by covering him but he must not be overheated.

5. An adequate supply of fresh air should be ensured by opening the

windows and doors and also by preventing bystanders from crowding

around the casualty.

6. If any future danger is still present e.g. fire, remove the casualty first

otherwise treat any obvious cause such as haemorrhage, fracture, etc.

 7. During the period of unconsciousness, no food or drink should be given by

mouth.

8. An unconscious casualty should never be left unattended and should also

be carefully watched after he has returned to consciousness.

9. Send for a lorry or ambulance and possibly for a doctor immediately.

10. Quick transport and give follow-up care.

NOTE: it is not the duty of the first aider to diagnose death.

FAINTING/SYNCOPE

It is a sudden dizziness or weakness accompanied by brief loss of consciousness. It is

associated with insufficient blood (oxygen) supply to the brain.

Causes

1. Physical exhaustion/fatigue.

2. Extreme emotional states e.g. shock or fear

3. Accidents especially; those involving loss of blood.

4. Lack of fresh air

5. Heat.

6. Hunger.

7. Standing at the same position for a long time e.g. a soldier on guarding duty.

8. Stuffy environment.

Signs and symptoms

1. Pallor of hands, face and lips

2. Dizziness
 3. Slow and weak pulse

4. Quick and shallow respirations

5. Cold and clammy skin

6. Victim collapses and sinks to the ground.

Treatment

1. Call for assistance

2. If signs are noticed before patient sinks to the ground, help him to sit in a chair

and put his head between (the knees to improve blood supply to the brain).

3. If in a state of unconsciousness, place him in the recovery position.

4. Provide warmth by covering the patient with blanket or coat.

5. Loosen all tight clothing round the neck, chest and waist.

6. Ensure adequate ventilation and keep onlookers from crowding in on the victim.

7. On return to consciousness, hot tea or coffee to which sugar has been added,

may be given in sips but it is undesirable to give too much at a time owing to

risk of vomiting.

8. When the cause is known, advise the patient to seek medical care if necessary.

EPILEPSY

Epilepsy, also called seizure disorder, is a chronic brain disorder that briefly interrupts

the normal electrical activity of the brain to cause seizures.

Causes of epilepsy

1. Hereditary
 2. Body build

3. Endocrine disorders

4. Degenerative diseases

5. In most cases of epilepsy, the cause is unknown (idiopathic).

Types of Epilepsy

a. Partial seizures/Focal epilepsy: In this type of epilepsy, the seizure activity

originates in one part of the brain and the victim is usually still conscious. Only a

particular part of the body is involved. The electrical discharge is usually localized to a

part of the brain and only the body part controlled by that part of the brain is affected.

Signs/symptoms

These include:

1. Unusual sensations such as uncontrollable jerky motions of a body part

2. Sight or hearing impairment,

3. Sudden sweating or flushing

4. Chewing of teeth and smacking of lips

5. May be preceded by an aura (a warning sensation characterized by feelings of

fear, abdominal discomfort, dizziness, or strange odors and sensations)

6. Victim may stare ahead blankly, drops things in hands and appears to be in a

daydream.

7. There may be “Déjà vu” phenomenon. A strong feeling of knowing unfamiliar

persons, places or events.

Management of Partial Seizures

 1. Protect casualty from endangering himself such as crossing busy roads

2. Talk to him quietly

3. Stay with patient until fully recovered

4. Advise him to seek medical advice or inquire if already on drugs.

b. Tonic-clonic/Major / Generalized seizures

Formerly known as grand mal seizures, this type of epilepsy is non-specific in origin

and affects the entire brain simultaneously. It usually comes on unexpectedly. This is

usually characterized by convulsions and tends to occur in four phases:

1. Aura stage: This stage turns to affect most epileptic cases. It serves as a

warning that something is going to happen. Casualty may experience:

 Feelings of fear,

 Abdominal discomfort,

 Dizziness and flashes of light

 Strange odors or taste.

2. Tonic stage: This stage is characterized by:

 The entire body becomes rigid with hands and teeth clenched.

 Breathing stops or becomes obstructed.

 There is cyanosis and the back arches.

 This stage lasts longer than the aura stage and lasts about 15-30 seconds.

 The victim stares bluntly.

 Contraction of respiratory muscles forcing air out of the respiratory tract to

produce a sound commonly termed as an “Epileptic Cry”. You may hear sounds
 like “Aaaaaah!!!” and immediately after the sound, the victim falls to the ground

and that ends the first stage.

3. Clonic stage: This stage lasts for about a minute and is usually characterized

by:

 Relaxation of the rigid muscles and the victim usually begins violent convulsions

 Alternate contractions and relaxations of the muscles throw the body into

sometimes violent agitation such that the person may be subject to serious

injury.

 The teeth may injury the tongue badly leading to bleeding from the mouth.

 Incontinence of urine and feces may occur

 Foaming from the mouth appears.

4. Coma stage: After the muscles relax and convulsion subsides, the person is

exhausted and may sleep heavily. Noisy breathing gradually returns to normal

and patient falls into coma which may last between 15min to 1hour.

5. Final stage: Casualty recovers from unconsciousness. Confusion, disorientation,

headache, nausea, and sore muscles are often experienced on awakening. The

individual may have no memory of the seizure. The partial consciousness, loss of

memory about the attack and the confusion after epileptic attacks is usually

termed as post epileptic automatism. This can occur in three forms:

 Epileptic Fugue. In this type, the victim wanders about his/her environment in a

confused state. For example, the victim may move aimlessly from one corner of
 the room or yard to the other and may try to remove his or her clothes. Any

restraint within this period may be met with violent attacks.

 Post Epileptic Furor/Terror. With this type of post epileptic automatism, the

victim becomes very violent and destructive after the attack.

 Epileptic Twilight state. This is a period of serious confusion where victims are

usually confused and disoriented for hours to days.

Management of Fits at Specific Stages

Aura stage: The patient who has an aura [warning of an impending seizure] may have

time to seek a safe, private place. If aware, assist him/her in this direction.

Tonic stage:

1. Provide privacy and protect the patient from curious on-lookers.

2. Ease the patient to the floor, if possible.

3. Protect the head with a pad to prevent injury (from striking a hard surface).

4. Loosen constrictive clothing.

5. Push aside any furniture, fire or water that may injure the patient during the

seizure.

6. If the patient is in bed, remove pillows and raise side rails.

7. If an aura precedes the seizure, insert a pad (e.g. a clean handkerchief) between

teeth to reduce the possibility of the tongue being bitten.

Clonic stage:
 1. Do not attempt to force open the jaws that are clenched in a spasm to insert

anything. Broken teeth and injury to the lips and tongue may result from such an

action.

2. No attempt should be made to restrain the patient during the seizure because

muscular contractions are strong; and restraint can produce injury.

3. If possible, place the patient on one side with head flexed forward, which allows

the tongue to fall forward and facilitates drainage of saliva and mucus (foam).

4. Clean foam from mouth.

Coma stage:

1. Keep the patient on one side (recovery position) to prevent aspiration.

2. Make sure the airway is patent and do not wake him up.

Final stage:

1. The patient, on awakening, should be reoriented to the environment.

2. If the patient becomes agitated after a seizure (postictal/ post epileptic terror),

use calm persuasion and gentle restraint.

3. Observations made on patient should be reported to medical team if possible.

General First Aid Management of Epileptic Fits.

1. Rush to the aid of the victim and assist victim to a safer place.

2. If already collapsed, remove victim from danger or danger from victim.

3. Protect the head with a soft padded material. If not feasible, put your legs

together (if not wearing shoes that have metals or articles that can hurt victim)

and place victim’s head on them.

 4. Loosen tight clothes around neck, chest and waist.

5. Allow victim to fit freely,

6. Protect tongue with a padded spatula where applicable

7. Never force to open the victim’s mouth

8. Note and time duration of fits

9. Immediately fitting subsides, turn victim’s head to one side for secretions to

drain out.

10. Stay with victim till full recovery

11. Assess for any injury and treat appropriately

12. Send victim for further management.

CONVULSIONS

A convulsive attack is an involuntary contraction and relaxation (paroxysms/spasms) of

the voluntary muscles resulting from an abnormal cerebral stimulation.

Stages of fit/convulsion

1. Prodromal stage: This lasts for a few seconds and may pass unnoticed. Patient

is restless, the eyeballs roll sideways, or upwards, the head may be drawn to one

side, breathing appears labored, saliva oozes from the mouth and twitching of

the facial muscles occurs.

2. Tonic stage: This stage lasts 10 -20 seconds. The whole body is rigid; the teeth

usually are tightly clenched, sometimes causing serious bites to the tongue and

the cheeks and because the diaphragm is in spasms the respiration is

momentarily arrested and cyanosis occurs.

 3. Clonic stage: It lasts for about a minute. Violent contractions of the muscles

produce convulsive movements with profusely secreted saliva (foaming). The

saliva may be blood-stained if the tongue or cheeks are bitten. Unconsciousness

and obstructed breathing set in with bounding pulse. Gradually, the convulsion

subsides.

Causes of fits

In adults:

1. Brain tumor/abscess

2. Apoplexy

3. Epilepsy

4. Poisons (e.g. chemicals)

5. Infection (e.g. CSM, TT, cerebral malaria, toxemia of pregnancy/eclampsia)

In children

1. High fever and severe dehydration (febrile convulsion)

2. Teething

3. worm infestation

4. Poisoning (e.g. lead poisoning)

5. Intracranial hemorrhage.

First Aid Management

During the fit

1. Protect patient from injury

2. Maintain patent airway

 3. Stay with patient during attack

4. Time the fit - make a note of the exact time and duration of the fitting.

5. Loosen tight clothing around the neck to help breathing.

6. Avoid restraining the victim.

7. Avoid unnecessary movement of the victim.

8. Avoid placing anything in the victim’s mouth.

9. Call for help if fit lasts more than 3 minutes.

After the fit

1. Check airway and breathing.

2. Clear the airway of any secretions and vomitus.

3. Clean victim of any soiling - thus urine or stool.

4. Place victim in the recovery position.

5. Constantly monitor airway and breathing.

6. Move bystanders away before victim wakes (up to protect modesty)

7. Tepid sponge (if febrile)

8. Transport victim to hospital or call for help if you cannot wake victim up within

10 minutes.

How to put an unconscious patient in a recovery position

 With the person lying on their back, kneel on the floor at their side.

 Extend the arm nearest you at a right angle to their body with their palm facing up.
 Take their other arm and fold it so the back of their hand rests on the cheek closest to

you, and hold it in place.

 Use your free hand to bend the person's knee farthest from you to a right angle.

 Carefully roll the person onto their side by pulling on the bent knee.

 Their bent arm should be supporting the head, and their extended arm will stop you

rolling them too far.

 Make sure their bent leg is at a right angle.

 Open their airway by gently tilting their head back and lifting their chin, and check that

nothing is blocking their airway.

 Stay with the person and monitor their condition until help arrive
RECOVERY POSITION.
 ASPHYXIATION

Asphyxiation is the deficiency of oxygen and an increase of carbon dioxide in the blood

and tissues. It occurs when the normal exchange of oxygen and carbon dioxide

between the lungs and the outside air is interrupted. If asphyxiation continues,

breathing and heart actions stop and death may occur. Asphyxia occurs when air

cannot reach the lungs, cutting off supply of oxygen to circulating blood. This can

cause irreparable damage to the brain Victims may collapse, be unable to speak or

breathe, and have bluish skin. Most people will suffer brain death within four to six

minutes after breathing ceases unless first aid is administered.

POSSIBLE CAUSES:

1. Occlusion or obstruction of air way such as:

 Swelling of tissues within the throat due to burns or diseases affecting the

throat.

 Compression of the wind pipe.e.g. hanging, strangulation, throttling.

 Foreign bodies in the air way passage causing chocking; e.g. been

chocked by a portion of food, swallowing of blood, teeth and vomited

matter (in unconscious patient is due to failure in the action of the

epiglottis) , tongue falling back in unconscious patient.

 Suffocation due to obstruction of the nose or mouth by any object e.g.

Pillow, polyethylene products.

 Pressure on the chest.

  Inhalation of liquid or foreign substances e.g. as in drowning.

 Complication in some conditions. E.g. cancer on the throat and mouth.

Smothering e.g. overlaying of an infant

2. Paralysis of the muscles of respiration due to:

 Electric shock

 Lightning strikes

 Ingestion of certain poisons Eg. Morphine

 Some diseases e.g. Poliomyelitis

3. Harmful effects of certain gases:

 Inhalation of gases like CO, NH3 AND CL

 Inhalation of smoke as in being trapped in a burning room, motor exhaust

fumes,

Signs and symptoms

 Difficulty in breathing (there is increase rate with short breathing)

 There is restlessness and agitation. There is noisy breathing, snoring and

gurgling.

 There is coughing and spitting

 There is cyanosis, congestion at the face

 There is possible unconsciousness if not relieved after cyanosis.

 There is cessation of breathing.

 Rapid pulse which becomes slow and irregular at the later part

 Swelling of the veins on the neck.

  Lips, mouth, nose, ear, figure become bluish-grey

NB: The above signs and symptoms may last for about 5mins, if not relieved; the

individual becomes unconscious and breathing stops. The heart continues to beat

for a while but becomes weaker and eventually stops and the person dies.

GENERAL TREATMENT OF ASPHYXIA

 Remove the cause or source of asphyxia or remove the patient from the source

of asphyxia.

 Loosen tight clothing especially around the neck, chest and the waist.

 Open the air way and clear the mouth of any obstruction such vomit, blood or

saliva

 Ensure adequate fresh air

 Give artificial respiration until natural breathing is restored

 If the casualty is unconscious, apply the ABC rule of resuscitation and put patient

in a recovery position

 Check the breathing rate, pulse and level of responsiveness

 Keep the patient adequately warm but guarding against over heating

 Seek qualified medical aid

First aid treatment in special cases of asphyxiation

HANGING/ STRANGLING/ THROTTLING

These causes pressure on the neck and squeeze the air way until it shut and block off.

AIM OF TREATMENT is to restore adequate breathing and transport patient to hospital.

FIRST AID TRREATMENT

 Remove the constriction from around the neck,

 In case of hanging, grasp the lower limbs and raise the body before removing

constrictions by removing or cutting the rope.

 If casualty is unconscious, open air way and check breathing, follow the ABC

resuscitation requirement.

 Arrange to transport patient to the hospital even if patient recovers fully.

DROWNING

 One can be drowned in a pond, canal or river. When drowning occurs few feet

from the shore, extend pole, branch, to the victim to hold and pull out

 Throw a floating object to the victim to grasp it so close to himself to keep the

face above the water.

 Do not swing out to rescue unless you have life-saving training skills.

 Recuing with a boat happens to be the best but should be done by an expert

because of the danger of been overturned.

 Put finger down the throat to scope out seaweed or other foreign material

 Pull tongue forward.

 Remove artificial teeth

 With your hand around the belly, raise the middle part of the body. This will

cause water to drain out of the body. Don’t force water out of the body.

 Keep patient warm, remove wet cloth and cover with blanket.

 Give artificial respiration until breathing is restored.

  Don’t allow patient to sit.

 Seek for medical attention.

SMOKE INHALATION; Fire uses up oxygen in the atmosphere, so oxygen level in a

burning room is low leading to asphyxiation. Smoke irritate the respiratory tract, throws

it into spasm and may close the air way.

AIM of treatment is to restore fresh air and breathing.

TREATMENT

 Call for emergency help; ask for both fire and emergency assistance.

 Move the casualty from fumes to fresh air.

 If clothings are still burning try to extinguish the fire.

 Resuscitate breathing if unconscious.

 Monitor and record vital signs and transport patient to the neares health

facility.

CHOKING

Choking is a special type of asphyxia in which a person is unable to breathe because

the trachea is blocked, constricted, or swollen. It can also be caused by muscular

spasms as in turn of inadequate chewing and hurriedly swallowing of food. Children

are usually at risk.

Causes
 1. Pieces of stone

2. Bottles

3. Pieces of food which may be swallowed

4. Denture which may be swallowed

5. Chewing of plastic materials

6. Talking while eating

7. Secretions of unconscious patients

Signs and symptoms

1. Restlessness

2. pallor, cyanosis

3. Dyspnea etc.

4. Inability to speak

5. Griping of the throat

6. Impaired consciousness.

First Aid Management (Conscious patient/victim)

1. Position victim either sitting or standing with head low.

2. Encourage the victim to cough if he is able to do so.

3. Bend the person forward at the waist and give 5 back blows between the

shoulder blades with the heel of one hand.

4. Place a fist with the thumb side against the middle of the person’s abdomen, just

above the navel. Cover your fist with your other hand. Give 5 quick, upward

abdominal thrusts (Heimlich’s maneuver).

 5. Continue sets of 5 back blows and 5 abdominal thrusts until the object is forced

out or the person is able to cough forcefully or breathe.

6. Avoid use of solid foods to push down object.

7. Sips of water may help in some situations.

8. Send for medical aid/transport to health facility if the above fails.

9. Resuscitate if breathing ceases.

Management of unconscious victim

1. Assess for the ABC of resuscitation:

 A-airway clearance

 B-breathing

 C-circulation

2. Tilt the head and give another rescue breath.

3. If the chest still does not rise, give 30 chest compressions.

4. look for and remove object if seen

5. Give 2 rescue breaths

6. If breaths do not make the chest rise—repeat steps 3 through 5.

7. If the chest clearly rises—check for breathing.

8. Give care based on conditions found.

9. If fails transport to health center.

HEIMLICH’S MANEUVER

It is applicable in choking. In this procedure quick upward thrusts are applied to the

victim’s abdomen to eject the object blocking the windpipe.

Steps:

1. The first-aid provider stands or kneels behind the victim with both arms around

the victim’s waist.

2. One fist is placed slightly above the navel and below the rib cage with the thumb

against the victim’s body. The other hand is used to hold the fist and apply

pressure.

3. The abdomen is then pressed quickly inward and upward, forcing air from the

lungs to eject the object from the windpipe.

4. If the victim is too large to hold while standing, or becomes unconscious, the

maneuver can be accomplished by laying the person down face up and using the

heel of one hand in the same manner as above.

5. Be careful not to apply pressure on the rib cage so as to avoid breaking ribs,

especially in children and the elderly.

6. For obese or pregnant choking victims, the provider’s hands should be placed

over the lower half of the sternum (breastbone) and pressure applied as

described above.
 Figure 23: Heimlich maneuver for an adult

Figure 24: Heimlich maneuver for babies

In this, there is some kind of foreign body blocking the respiratory tract.

SIGNS AND SYMPTOMS

1. Respiratory distress

2. Coughing and spluttering (choking)

3. Congestion of the of the face

4. Cyanosis
 5. Unconsciousness

TREATMENT

BABIES: - Hold the baby upside down by the feet and smack him firmly between the

shoulder blades

CHILDREN: - Lay the child face down over your knee and smack him sharply between

the shoulder blades to dislodge the obstruction.

ADULTS: - Stand behind the casualty and immediately strike him three or four sharp

blows between the shoulders.

Or stand behind the victim and cross your two hand to make a fixed infront of the

victim. Apply a sharp force at the mediasternum .

Repeat it for about 3-5times until object is dislodge out

After clearing any obstruction from the throat, give artificial respiration if necessary.

ARTIFICIAL RESPIRATION/ARTIFICIAL VENTILATION

Artificial respiration is any means of assisting or stimulating respiration. This aims at

inflating the lungs and allowing them to empty (forcing air in and out of the lungs).

It may take the form of manually providing air for a person who is not breathing or is

not making sufficient respiratory effort on his or her own, or it may be mechanical

ventilation; involving the use of a mechanical ventilator to resuscitate a casualty. It an

essential first aid treatment especially in asphyxia.

VARIOUS METHODS OF ARTIFICIAL RESPIRATION

There are two main methods of artificial respiration namely, manual methods and

instrumental respiration in which machines are used. This course concerns itself

basically with the

natural methods. They include the following:

1. Mouth to mouth method

The subject is laid in the supine position with extended head. The operator sits by the

side of the subject’s head. The operator holds the lower jaw of the subject by one

thumb and index-finger and clamps the nostrils with the other thumb and index-finer.

The operator then keeps his mouth over the subject’s mouth and exhales forcibly which

causes inflation of the lungs and thorax. The operator then takes off his mouth and the

process is repeated 10-20 times per minute. It is positive-pressure breathing.

2. Mouth to nose method (mostly used when the mouth cannot open, when

victim is a child, or when the mouth is injured).

3. Silvester’s method

The subject is placed in supine position. The operator stands or kneels at the head end

and holds the two arms of the subject. The operator then raises the subject’s hands

above his head and then folds the hands back upon the chest, compressing the chest

wall at the same time.

Such movements alternately increase and decrease the thoracic cavity, thus drawing in

and pushing out air from the lungs. This method is most commonly used in the
operation theatre or in other accidents. The tongue should be kept pulled out and the

mucus from the mouth cavity should be wiped out from time to time.

The rate is same as in Schafer’s method. In drowning cases, the water in the lungs

must, at first, be driven out, by holding the subject upside down or revolving the

subject by holding his legs. After this, the subject should be given artificial ventilation.

4. Schafer’s method

The subject is laid in prone position and a small pillow is placed underneath the chest

and epigastrium. The head is turned to one side. The operator kneels down by the side

of the subject facing towards his head. Two hands are placed on the two sides of the

lower part of the chest and then the operator slowly puts his body weight leaning

forwards and pressing upon the loins of the subject. Intra-abdominal pressure rises, the

diaphragm is pushed up and air is forced out of the lungs.

After this the operator releases the pressure and comes back to his original erect

position. The abdominal pressure falls, diaphragm descends, and air is drawn in. These

movements are repeated about twelve times a minute (roughly the normal rate of

respiration).

The advantage of this method is that the patient being in the prone position, mucus or

saliva comes out of the mouth and cannot obstruct his airways.
 Figure 22: Shafer’s method

5. Eve’s rocking method

The patient is tied on a stretcher. The head and feet are alternately tilted through an

angle of 45°. Eight or nine movements are carried out per minute, 7 seconds for each

movement—4 seconds head down and 3 seconds feet down. When the head is down,

the weight of the abdominal viscera presses against the diaphragm, so that air is

pushed out of the lungs (expiration). When the feet are down, diaphragm descends,

and air is drawn into the lungs (inspiration). This method is useful aboard ship when a

hammock can be used.

NOTE

In all the methods, the mouth to mouth method is the simplest to perform and can be

carried out in any circumstance.

Skin color improves from blue to pink once breathing is restored. Check patient’s pulse.

If pulse is present, he would not need external cardiac massage. If absent, then

another first aider should carry out the massage simultaneously with the ventilation.
 POISONING

 Poison is any substance (liquid, gas, or solid) that injures or destroy the body

tissues when taking in internal or externally.

 Poison is defined as a morbid condition cause by the ingestion of a toxic

substance. A person who has taken in poison must be treated urgently

MODE OF ENTRY OF POISONS (Routes of Poisoning)

1. Ingestion: This involves the oral intake of a poison.

2. Injection: This involves introducing a poison into the body by piercing the skin. It

includes poisons from reptiles, insects, some animals, and deliberately injected

drugs.

3. Inhalation: This involves breathing in a poisonous gas into the body. These

include household gases, fumes, smoke, carbon monoxide from vehicle

exhaustion etc.

4. Absorption (application on skin): These include pesticides, insecticides etc.

Cause

The causes of poisons can be classified into three

1. Accidental; these may include

 Eating contaminated food – food poison

 Drinking contaminated water, or dinking poisonous liquids usually with wrong

labeling
  Accidentally taking over dose drug or sleeping tablet

It is common in children about 80% in children under age 5 but more frequent in boys

than in girls because they are more active than girls. The kind of poison normally taken

differs from one country to another and with rural or urban area.

Common agents ingested are; medication, lead, cleaning and polishing solutions,

hydrocarbons such as kerosene, gasoline etc.

2. Suicidal; this mostly occurs in mental depression or even by a healthy person

3. Murder; poison can be introduced in small dose or in large dose by someone

with the attempt to murder.

SUBSTANCES CAPABLE OF COUNTERACTING THE EFFECT OF POISONING

To help remove or counteract the effect of poison, the following measures can be taken

1. Emetics can be given; emetics are any substances capable of producing

vomiting thereby removing poison from the body,

 This should be done as early as possible before the poison is absorbed

into the body. Some emetics that can be used are;

 Salt and water- two table spoon of salt dissolve in a cup of tepid water,

then with large intake of tepid water

 Oil

 Ipecac – is a special syrup used to induce vomiting

 Intake of several tepid water , followed by irritating the throat with the

finger to induce vomiting.

2. Antidotes; these are substances which counteract or neutralize the effect of the

poison

 Example of antidotes for acid is by given alkaline drink- this can be

prepared by adding one level of teaspoonful of bicarbonate of soda one

litter of water or administer milk of magnesium

 For a person who has ingested alkaline and acidic drink can be given. This

can be prepared by adding vinegar and water of equal amount or orange

juice

3. Aperients – an aperients are given after the stomach is emptied to remove

poison which might have already entered the stomach

 Castor oil or Epsom salt, two table spoon for adult and one for a child can

be given as aperients.

 Activated charcoal

4. Demulcents

A demulcent is a substance which soothes irritated mucous membranes. It can

be administered after the person has vomited. Example include;

 Milk,

 Mayonnaise or salad dressing

 Olive oil

 Liquid paraffin

 Thick barley water

CLASSIFICATION OF POISON

The type of poison can be classified base on its damaging effect; Poison can be;

irritant, narcotic or corrosive.

1. Irritant poison; act on the elementary system and causes irritation and

inflammation. Example of irritant poison are- contaminated tinned food, fish, sausage,

meat and common in reheated food, poisonous berries or fungi. Irritants can be

chemicals such as mercury lead and phosphorous which may be present in plants and

weeds killers.

Signs and symptoms

1. Acute abdominal pain/cramps

2. Nausea/ vomiting and diarrhea

3. Fainting or shock

4. Unconsciousness with slow respirations.

First aid management

1. Give an emetic and copious fluids if conscious

2. Give demulcent after vomiting

3. Give aperients (mild laxative)

4. Treat for shock

5. Give antidote (if known) and ORS

6. Prevent aspiration throughout by keeping head lower than the body

7. Collect vomitus for examination and send victim to hospital.

2. Narcotics; acts on the nervous system. The effect of narcotic can be;
  Hypnotics – induces sleep and unconsciousness e.g opium, morphine, herion,

cocaine and barbiturates such as phenobarbitone

 Deliriants – produce excitement initially but leads to unconsciousness later e.g

belladonna and atropine.

 Convulsant – produce twitching effect and eventually leads unconsciousness e.g

strychnine and prussic acid.

Signs and symptoms

For narcotic poisons

1. Drowsiness

2. Slow respiration

3. Feeble pulse

4. Pin-point pupils

5. Coma and subsequent death

For deliriant poison signs and symptoms may include;

1. Dryness of the mouth

2. Thirst

3. Dilated pupils

4. Unsteadiness

5. Delirium

6. Coma

Management

1. Position victim to prevent aspiration

 2. Don’t induce vomiting since it increases corrosive effect (volatile).

3. Give demulcent and an antidote.

4. Treat shock if present.

Resuscitate if necessary

Corrosive poisons – burns the body part they come in contact with. Corrosives may

be acid or alkaline in reaction Corrosives include strong acids or alkaline that cause local

tissue destruction, externally or internally; that is, they “burn” the skin or the lining of

the stomach. Common corrosive poisons include battery sulphuric acid, carbolic acid,

and dichloride of mercury, caustic soda, acetic acid, disinfectant, bleach and ammonia.

Signs and symptoms

1. Vomiting occurs immediately, and the vomitus is intermixed with blood.

2. Severe burns around the mouth and lips.

3. Severe pain in the mouth, throat and abdomen.

4. Shock.

First Aid Management

1. Do not give emetics. This may cause more injury to the mucous membrane.

2. Give an antidote if known. If it is not known whether it is alkalis or acid, dilute

the poison by giving copious fluids e.g. water.

3. Give a demulcent to sooth the damaged mucous membranes.

4. Treat for shock if present and send to hospital.

AIMS OF FIRST AID TREATMENT IN POISONING

1. To remove or counteract the effect of poison

 2. To send for medical aids or arrange for transport quickly

3. To identify the type of poison taken. Is important to go with any container or

evident of the poison, vomit, feases and urine should be kept for inspection

4. In case of death, police must be informed and the body must not be touched or

move until their arrival

FOREIGN BODIES IN THE EYE, EAR AND NOSE

FOREIGN BODIES IN THE EYE

This is a fairly common occurrence and it extremely painful. The danger of the foreign

body in the eye is that it may become embedded in the conjunctiva and subsequently

damage the cornea. Common foreign bodies entering the eye are dust, grit of sand and

metals, insects and etc.

Signs and symptoms

1. Discomfort/Irritation

2. Pain in the affected eye

3. Redness

4. watering of the eye

First aid treatment

1. Fill a bowl with fresh clean water and ask the casualty to blink

2. Place the person in a chair near a window ensuring a good light source.

3. Tilt the head backwards supporting it with a cushion or pillow

 4. Foreign body maybe present inside the lower or upper lid or actually on the front

of the eyeball.

5. Examine the lower lid instruct patient to look upward and, using thumb and

index finger, pull lower lid downwards drawing it away from the eyeball exposing

the inner surface.

6. Examine the upper lid by averting (turning inside out} the upper lid. Instruct

person to look downwards.

7. Thoroughly examine the eye e.g. to locate any foreign body still present

8. Wash the affected eye with copious amount of water if still necessary.

9. Refer for further medical treatment

FOREIGN BODIES IN THE EAR

Children subsequently insert beads, buttons or pebbles or berries into their ears.

Insects may also penetrate into the external auditory canal.

First aid treatment

1. If the object is not protruding prevent the child from poking the ear.

2. Place a pad over the ear and bandage in lightly in position.

3. Take the child to a doctor or the hospital where it can be removed without

damaging the ear drum or canal.

4. If the object can clearly be seen and is protruding remove it gently with a pair of

tweezers.

5. If an insect has entered the ear attempt to float it out by pouring a few drops of

olive oil, castor oil or liquid paraffin into the external auditory canal.
FOREIGN BODIES IN THE NOSE

Children again frequently insect beads, buttons, berries and pebbles into their noses.

First aid treatment

1. Close the unaffected nostril and tell the child to blow out through the affected

one.

2. Do not let child poke the nose and do not try to remove the foreign body.

3. If blowing the nose dislodges the foreign body, refer for further medical

attention if necessary

BURNS

 A Burn is a tissue damage caused by naked fire (dry heat), thermal, electrical,

chemical, or radioactive agents extreme temperature or a corrosive chemical.

 Scalding is caused by hot liquids (water or oil) or gases (steam).

Burns are due to dry heat and scalds are due to wet heat, but generally both wet and

dry heat damage to the skin are referred to it as burns. Burns cause damages which

vary in depth, size and severity to the skin, mucous membrane or conjunctiva and

sometimes, the damages affect the underlying parts of the body as well as the skin.

Burns usually results in swelling, blisters formation & loss of plasma. The severity of

burns depends on the extent of the surface area, the age of the victim and the

site of the burns.

CAUSES OF BURNS

Dry burns. These are burns from:

a. Fire

b. Hot metals

Moist burns (scalds)

a. Boiling water

b. Steam from boiling water

c. Any other hot liquid such as tea or soup

Cold burns: coming in contact with:

a. Frost bite

b. Liquid oxygen

c. Liquid nitrogen

Chemical burns; cause by chemicals such as:

a. Acids

b. Alkalis (alkaline)

c. Caustic soda, caustic potash and strong ammonia.

Electrical burns

Radiation burns

CLASSIFICATIONS OF BURNS

Burns are classified based on the:

I. Magnitude/severity
 II. Surface Area involved

III. Depth

IV. Etiology (cause) e.g. chemical, thermal etc

Classification based on Magnitude/Degree/Severity of burns.

Burns are been classified into three degrees according to the depth of tissue destroyed.

Superficial or 1st degree burns: this involves only the epidermis or the upper layer

of the skin. Signs and symptoms include; redness, mild swelling tenderness and pain.

Thus the part is only scorched and it heals within 3 days even without treatment.

Partial thickness or 2nd degree burns: this involves the epidermis and the dermis, is

characterize by the formation of blisters, swelling, pain and weeping of fluid from the

wound. This is because blood capillaries in the dermis are damage. Healing is within a

period of 1 to 4 weeks.

Full thickness or 3rd degree burns: in this case there is destruction of the entire skin

extending into subcutaneous fat, muscle and sometimes bone and often cause much

scarring. Usually there is no pain because the nerves endings are destroyed, the skin

may not bleed; looks dry because blood vessels have been destroyed and it appear

waxy, grey or black in color

Fourth Degree: The whole thickness of the skin is destroyed giving the appearance of

white leather

Fifth degree: These burns penetrate the muscle and begin to burn bone.

Sixth Degree: These burns are the most severe. They cause complete charring of the

affected area; including underlying bones.

A blister

Classification according to total body surface area (extent)

(Calculating the extent of damage)

WALLACE RULE OF NINE

This is a method for estimating the surface area burnt in percentages with the body

surface area being divided into nine. The importance of this rule is that, it gives an idea

of the amount of fluid loss and the amount for replacement. It is suggested that for

every 9% surface area burnt, one litter of fluid should be infused.

RULE OF NINE

 HEAD AND NECK 9%

 EACH UPPER LIMB 9%

 THE ANTERIOR PART OF THE TRUNK 18%

 THE POSTERIOR PART OF THE TRUNK 18%

 EACH LOWER LIMB 18%

 THE PERINEUM 1%

 TOTAL = 100%

Percentage Burned Total Body Surface Area (TBSA) using Wallace Rule of

Nines
The injury is considered to be major when approximately 10% is or more in children

and 15% OR in adult, such patient require hospitalization and fluid replacement.

Normally if the surface area burnt is more than 60% the patient might not survive.

2.Palmer method: this method assesses smaller areas of burns. With glove hand,

the patient uses the palm to measure the burn area. Each palm measurement

amounts to 1% of the total body surface area.

Figure 2: Palmar Method

Other methods

Berkow formula

Lund and Browder Chart

General signs and symptoms of burns

1. Dyspnea due to oropharyngeal edema

2. Hypovolemic shock (resulting from fluid shifting from vessel into interstitial

space).

3. Skin lesion(wound)

4. Dehydration due to fluid loss

5. Edema
 6. Thirst

7. Tachycardia

8. Blisters

COMPLICATIONS OF BURNS

 Anaemia

 Infection

 Electrolyte imbalance

 Death of tissue

 Scarring and deformity

 Contractures

 Metabolic changes

 Renal failure

 Septic absorption such as septicemia, septic pneumonia and acute nephritis.

THE AIMS OF FIRST AID TREATMENT FOR BURNS

 To control the shock/Prevent shock

 To prevent infection

 To rehydrate/prevent dehydration

GENERAL TREATMENT OF BURNS AND SCALDS

 The patient should be removed from the source of burn and smother the flames;

this can be done by wrapping patient in a sheet or with a thick blanket; if

possible apply from below upwards or roll the patient on the floor.

 Remove clothing when saturated with boiling water, but clothing charred by

flames and or stacked to skin should not be removed.

 Gently remove any rings, watches, belts or any constricting cloth or clothing from

the affected area before it starts to swell

 The burnt area should be immersed in cold water for about 10 minutes to

prevent residual heat from doing further damage.

 For first and second degree burnt one can apply cold pack covered with pieces of

cloth to the site for about 20 minutes then release for 10 minutes.

 The first aider should wash his hands and cover the burns with clean material or

sheet to prevent infection.

 Blisters should not be broken and burnt area should be bandaged.

 Rings, bracelets or wrist watches must be taken off.

 Suitable support should be supplied to the injured part to relieve pain and keep

him warm.

 If the burn involves the limb, and is extensive, a splint should be employed,

supplemented by the use of a sling and elevate the area to prevent swelling.

 No fluids should be given by mouth if unconscious; however, a cupful of water or

weak tea can be given every 10 minutes if conscious.

  All unnecessary handling of the burnt area must be avoided and nothing topical

should be applied onto the burns.

 The patient should be transferred to hospital as quickly as possible for further

management

SPECIAL VARIETIES OF BURNS AND THEIR TREATMENT

Electrical burns: an electrical shock may stop the breathing, heart, or both as well as

causing burns. Restoring respiration is very important. The first action is to turn off the

current or remove the victim from the contact using an insulated lever or stick, which is

dry. If this is not possible, stand by some dry insulated material by means of dry wood

or folded newspaper or rubber.

Treatment

 Break the contact of the electrical source.

 Resuscitate to restore respiration and circulation (if muscle or the chest are

affected, Asphyxia may result).

 Cool the burn area with plenty water

 Cut off burn clothing gently

 Cover with sterile dressing and bandage

 If shock is present, treat for shock.

Chemical burns: and the treatment; Many chemicals produce severe burns e.g.

corrosive acids and alkali, iodine, phosphorous and other organic compound

First aid Treatment

 Remove all clothing contaminated by the chemical agent including under cloth,

glove, shoes.

 Wash burnt with plenty of plain water, where the specific chemical agent causing

the burnt or it neutralization agent is not known, dilute and reduce the effect of

the chemicals by washing the site with plenty of plain water.

Acid burns; If the burn was caused by acid, it should be bathed in weak alkaline

solution. This can be prepared by adding 1 spoon of baking soda in 1litres or cup full of

water. It should be applied thoroughly on the body

Alkaline burns; While alkali burns should be treated with weak acids solution can be

prepared by mixing domestic vinegar and water in equal part)

Burns of the eye:

Treatment

 Sit the patient down with the head held back or lie down with the head turned to

the side

 The substance which is causing the burn should be washed out as quickly as

possible with plain water.( if it’s an acid wash with alkaline solution and vise

versa)
  Irrigate the eye with olive oil or liquid paraffin to prevent dryness.

 Cover the eye with clean folded handkerchief and bandage lightly in position.

 Transport the person to the hospital.

BURNS OF THE MOUTH AND THROAT

When hot fluid or chemical substances have been taken through mouth, severe burning

of the mouth and throat can occur

Treatment

 Give the patient sips of cold water.

 Apply cold compresses outside the throat to relieve pain.

 Treat for shock or prevent it.

 If the substance ingested is not known, a demulcent should be given

(substance which sooths irritated mucous membrane). Milk is the most common

and the patient should be allowed to drink as much as possible.

 Send the patient to the hospital for appropriate treatment.

Burning Clothing

A victim; usually becomes terrified and runs for help; not realizing that his action only

increases the flame and the extent of burning. He should be forcibly made to lie on the

ground so that the flames are upper most and their action is thus, restricted to one part

of the body.

The flame must be put out immediately. This can be done by:
 1. Wrapping the patient up in a sheet, bedcover or travelling rug and smothering

the flame.

2. Rolling the patient up in a rug or carpet. When the patient is wrapped up in this

way, air is excluded; and the flames will go out.

3. After the flames are extinguished, lay the casualty down either in bed or on a

couch and remove the rug or bedcover and examine the burnt area.

4. Assess the extent of injury. It is best to send for the doctor with a written

message, advising him on the damage.

5. Treat for shock. The presence of shock is very likely to be occurred especially in

the very young and very old.

6. Reassure casualty. Do not give the casualty anything to sip if the burn is

extensive, as an anaesthetic may be required later.

BITES AND STINGS

Bites and stings are also another means of poisoning, and is common in children. Both

animal bite and insect sting require immediate first aid treatment. The common bites

are; Dog bite, snake bites. Common stings are; scorpion sting and other insect such as

bees and ant stings.

Dog bite
Dog bite can lead to viral diseases known as rabies or hydrophobia, though other

animals such as cat, horses, monkey, sheep, goat can also cause rabies, whereas rat

bite can cause plague. Dog, rat or cat may bite with the teeth or scratch with the nail.

Germs habour in the mouth of these animals and therefore wounds are highly

susceptible to infections

TREATMENT FOR DOG AND CAT BITE

An important aspect in the treatment of dog bite is the management of wound and

lastly treatment with antirabies. The first aider can manage wound by

 Wash wound with soap and running water.

 Apply potassium permanganate.

 Apply anti rabies serum around the wound if less than 24hours

 Cover wound with clean dressing and transport patient to the hospital.

SNAKE BITE

There are about 3,500 species of snakes all over the world but only about 250 of them

are venomous. 90% of land snakes are non-poisonous whereas 90% of sea snakes are

poisonous. The most dangerous aspect of snake bite is the absorption of poison known

as venom. Most people will not die because of the venom but from fear.

Dry bites: These occur when a snake doesn’t release any venom with its bite. As

you’d expect, these are mostly seen with non-venomous snakes.

Venomous bites: These are much more dangerous. They occur when a snake

transmits venom during a bite. A common sign of a bite from a venomous snake is the

presence of two puncture wounds from the animal's fangs The effect of snake venom

can be;

Cytotoxins: Cause swelling and tissue damage wherever you’ve been bitten.

Haemorrhagins: Disrupt the blood vessels which causes bleeding

Anti-clotting agents: Prevent the blood from clotting.

Neurotoxins: Cause paralysis or other damage to the nervous system.

Myotoxins: Break down muscles which leads to tissue necrosis.

Sign and Symptoms

1. Fang marks in the skin

2. Bleeding

3. Blurred vision

4. Warmth and burning at the site of the bite

5. Seizures

6. Diarrhoea

7. Dizziness

8. Sweating

9. Fainting

10. Fever

11. Increased thirst

12. Loss of muscle coordination

 13. Weakness

14. Nausea and vomiting

15. Numbness and tingling

16. Rapid heart rate

17. Severe pain at the site of the bite

18. Skin discoloration and swelling

First aid management

1. An attempt should be made to identify the snake if it can be done safely

(this can help with treatment of the snakebite). Do not bring the dead snake in

unless it can be done safely because snakes can bite for up to an hour after they

are dead.

2. Keep the victim still and calm (to slow down the spread of venom if the snake is

venomous)

3. Lay or sit the person down with the bite below the level of the heart.

4. Remove all constrictive items such as rings and clothes.

5. Apply pressure bandage that does not cut off blood flow, above the site

6. Wash the wound with warm soapy water immediately.

7. Cover the bite with a clean, dry dressing.

8. Immobilise the bandaged limb using splints.

9. Monitor temperature, pulse, rate of breathing, and blood pressure if possible.

 10. Manage signs of shock.

11. Refer/transport victim for further medical attention

immediately.

SCORPION STINGS

Common at the raining season. Scorpion sting is also fetal and it effect may be,

neurotoxic, hemotoxic, cardiotoxic, and myotoxic.

SIGNS AND SYMPTOMS

Intense local pains, swelling, profuse perspiration, tachycardia, hyper salivation,

lacrimation, frequent micturition, convulsion in children,

First aid management

1. Keep site lower than the rest of the body

2. Tie a constriction around the limb above the site of sting and release it every

15mins.

3. Squeeze site to eject some of the venom only when injury is fresh.

4. Wash area thoroughly with weak ammonia or sodium bicarbonate.

5. Avoid contact with water

6. Apply black stone to wound, if available.

7. Send to hospital.

Hymenoptera (Bee, Wasp or Hornet) Stings

The venom produced by these insects contains a combination of amines, kinins, specific

peptides and enzymes. Their stings usually have only local effects; pain and swelling

due to the histamines (kinin, amines etc.) that are released into the person. The main

danger is potential anaphylactic shock.

First aid management

1. If possible, remove stinger by scraping it off with a blunt edge (e.g. ATM card) or

with the tip of a sterilized needle. Do not use a tweezer.

2. Clean wound/bath the area thoroughly with weak ammonia solution or

bicarbonate soda; 2 teaspoonfuls to a pint of water, to relieve irritation.

3. Remove tight clothing and jewelry from areas near the bite in case swelling

occurs.
 4. Watch for signs of shock or allergic reaction. Signs include swelling or itching at

the wound site, dizziness, nausea or difficulty breathing.

5. Antihistamine crème may be applied to reduce the antigenic effect of the sting

6. A cold compress could be applied to relieve pain and reduce swelling.

7. Check victim’s Airway, Breathing, and Circulation (ABC’s). If ABC’s are impaired,

begin CPR.

8. Continue monitoring victim for shock until medical help arrives or until victim

gets to the hospital.

NB: Antihistamines comprises of a group of drugs used to block the tissue receptor for

histamine. It is used to treat allergic conditions resulting from stings, drug reactions,

etc.
 CHAPTER THREE

BANDAGING

A bandage is any material (e.g. gauze, cloth) used to immobilize body part, secure

dressing or support wound.

Bandaging is the technique used in the application of bandage to different body part.

PURPOSE OF BANDAGING

 To retain or secure dressing on a wound and splints in position.

 To support and immobilized fractured limb.

 To prevent and reduce swellings in case of sprain, strains, and oedema.

 To arrest and control haemorrage through the application of pressure.

 To provide support and aids in case of varicose veins or impaired circulation.

 To supply warm to a body part

  To support wound e.g. abdominal binder is used to support large abdominal

incision

MATERIALS USED FOR BANDAGING

 Gauze

 Domette- material made of cotton and wool, it gives warmth, absorbs secretion

and gives fairly good support.

 Crepe or elastic bandage – gives good support

 Calico- used with splint for support

 Rubber bandage- used for the purpose of arresting haemorrage

 Plaster of paris (POP)- for fracture and dislocation

 Tube gauze – combination of gauze and calico.

Points to notes when selecting a bandage material

 A good bandage should be firm enough to keep the dressing in place but not too

tight EXCEPT bandaging to arrest haemorrage and correct deformity.

 Should cover the dressing entirely but should not be cumbersome for the patient

to carry.

 Should be neat in appearance.

TYPES OF BANDAGES

THE TRIANGULAR BANDAGE

1. This is made by cutting a piece of material (linen or calico) about one yard or

one meter square diagonally into two, thus producing two bandages. These are
 usually made of cloths. They are used as slings or large dressings to secure

dressings and immobilize limbs. They include:

 Sling

 Scalp bandage

It is useful in many ways;

a) It can easily be improvised from a sheet or similar material.

b) It can be unfolded or can be folded to make a broad or narrow bandage or as a

ring pad.

c) It can be quickly and effectively applied to any part of the body.

Triangular bandages are used to form slings when it is necessary to supply comfort,

support and protection to the upper limb that has been affected or injured by an

accident.

THE ROLLER BANDAGE

2. The use of roller bandages is popular in medicine and nursing. They include:

 Crepe roller bandage

 Elastic roller

 Gauze roller bandage

 Open weave bandage

 Self-adhesive support bandage

Roller bandages are used for the following purposes:

1. To secure dressing
 2. To exert pressure as in the treatment of haemorrhage and varicose veins

3. To give support e.g. in cases of sprains

4. To lessen swelling in the early stages of sprains and strains

5. To secure splints in cases of fractures or deformities.

6. To correct deformities

7. To supply warmth

Parts of the bandage: - When partly unrolled, the unrolled part is called the drum or

head and the rolled part is the free end.

Roller bandages are made in various parts.

Parts width in cm

Thumb and fingers 2.5

Hand 4-5

Head, foot and forearm 5-6

Legs, thighs, upper arm 8 - 10

Breast, shoulder, trunk 10 – 15

Securing roller bandages

1. Adhesive tape or plaster

2. Bandage clips

3. Tucking in the ends

4. Safety pins
PINCIPLES OF BANDAGING

(RULES FOR APPLICATION OF BANDADGES -ROLLER BANDAGE)

1. Assume a comfortable position to enhance easy application of bandage.

2. Place and support the limb in position in which you want it to remain after

bandage.

3. Bandage in direction of venous circulation; from below upwards in case of limbs.

4. Bandage from within – outwards across the front of the uppermost part, holding

the drum uppermost.

5. Bandage firmly but not too tightly. Consult the patient on the degree of

tightness.

6. Never bandage two skin surface together. Put some dressing or layer of wool

between skin surface and bandage together. Pad the axilla and groin to avoid

“cutting “

7. Pressure must be even throughout.

8. Finish off securing with either reef knot, safety-pin, or special fastening, never

place a knot or pin over a bone prominence or wound, and do not place it at

where it will cause pressure when patient is lying down.

10. Hold the bandage in your right hand to bandage the left side and vice versa.

11. Unroll short length at a time so that the procedure can be controlled.

12. Make a figure-of- Eight when bandaging a joint and Keep the joints a little flexed

to allow some movement and free circulation of blood.

 13. To remove the bandage, loosen the end and pass the bandage from hand to

hand over the front and back of the limb gathering the loose bandage up into

the hand.

Patterns of Bandaging; bandaging can be describe by it pattern as;

1. Circular bandage: the bandage is wrapped round the part with complete

overlapping of the previous bandage turn. It is used at bandaging of the head and

trunk and to anchor bandage from where it begans and terminates.

2. Spiral bandage: the bandage ascends in spiral manner so that each turn overlaps

the preceding one by ½ - 2/3s of the bandage width. It has two types;

 The simple spiral used for a body part with equal dimension e.g wrist, fingers,

limbs of young children.

 Reverse spiral; used for body part with varying dimension when the part

increases in thickness. e.g leg and thigh.

3.Figure- of –eight: this consists of making an oblique overlapping turns that ascends

and descends alternatively. It is a type of bandage used at joint. Such as; knee, the

elbow. The ankle and wrist,

4.Spica; this is a variation of the figure of eight bandage. It is used at a joint where

one part makes an angle with the other. E.g. the hip joint, shoulder and the thumb

joint, breast. It is formed from a Figure–of-Eight in which one turn is very larger than

the other
Divergent spica; for heels and to cover flexed joint like elbow and knee

5.Recurrent bandage: this is use to cover extremities, to cover the tip end of the

thumb, fingers, stumps.

After a few circular turns to anchor the bandage, the initial end of the bandage is

placed in the center of the body part being bandage, well back from the tip to be

covered.

6.T- bandage: this is use to secure rectal or perineal dressing. The double T- bandage

is use for males and single T- for females. The strips of the T-bandage are brought

between the patient leg and pin in-between.

7.Special bandage: this is a special bandage made for particular body part. E.g the

breast, trunk, eyes and ear.

METHODS OF APPLICATION

Circular bandaging/turns

In application of this pattern of bandaging, each succeeding turn overlaps the entire

width of the previous turn. This is used to secure the bandage at the start of tying a

bandage. It is also used to cover small parts such as the fingers, head, trunk and toes.

Circular turns
Simple spiral bandaging/turns

In this pattern of bandaging, each turn of the bandage as it ascends, overlaps half (½)

or two-thirds (2/3) of the previous turn. It is used for cylindrical body parts like the

wrist, arm, finger and lower limbs.

Simple spiral turns

Spiral reverse turns

This is a spiral bandage where the bandage is folded back on itself at 180 degrees after

each turn. That is, after the bandage is secured by two circular turns, reverses (turning

the bandage top to bottom) are made after each turn. This method is required when

using non – elastic roller bandages. It prevents gaps and ensures a smooth bandage. It

is less commonly used nowadays.

 Spiral reverse turns

Recurrent bandaging

The recurrent bandage is used to retain a dressing on the head, on a stump or on the

end of a finger. It is made by fixing the bandage with two circular turns. The roll of

bandage is then turned to cover the middle of the area. Next turns alternate on each

side of the midline, passing back to front and front to back. Each turn overlaps one half

of the previous turn directly over the first turn.

 Recurrent turns

Figure of eight bandaging

This form of bandaging involves two turns, with the strips of the bandage crossing each

other at the side where the joints flexes or extends. Usually used to bind flexing joints

or body parts below or above the joint.

Figure of eight turn

TRIANGULAR BANDAGES

They are made by cutting or folding a square meter of fabric (linen/calico) diagonally in

half. It parts include, the end, base and point. It can be folded in form of sling for use

in injured extremities of the body

Triangular bandage in use

Uses

1. Used as hand and foot cover

2. Formation of slings

3. Formation of broad/narrow-fold bandages

SLINGS

When triangular bandage is use in the form of a sling, it can be an arm sling or an

elevation sling

Arm Sling
It holds the forearm in a slightly raised or horizontal position. It provides support for an

injured upper arm, wrist or forearm on a casualty whose elbow can be bent, or to

immobilize arm for rib fracture.

Elevation Sling

This form of sling supports the forearm and hand in a raise position, with the fingertips

touching the victim shoulder. In this way, it helps control bleeding and minimize

swelling. Also used to support the arm in case of shoulder injuries.

An Elevation Sling
 CHAPTER FOUR

EMERGENCY NURSING

DEFINITION

A medical or surgical emergency is an injury or illness that poses an immediate threat

to the person’s life or long-term health.

CLASSIFICATION OF EMERGENCIES

1. Emergent/Major Emergency

These are conditions or injuries that are potentially life threatening and require

immediate assessment and intervention or treatment mostly within 15 minutes of

arrival. Any delay in treatment is potentially life-threatening. Examples are; head

injuries, severe trauma, shock, severe allergic reactions, chemical exposure to the eyes,

chest pain, severe headache, severe asthma attack, major bleeding etc.

2. Urgent/Minor emergency

These are also conditions or injuries that are not immediately life threatening and may

require treatment within 30 minutes on arrival. Such conditions include alert head injury

with vomiting, mild to moderate asthma, moderate trauma, GI bleed with stable vital

signs, history of seizures etc.

 3. Non-urgent

These are conditions requiring assessment within two hours. Examples, minor bleeding,

minor trauma, minor fractures, chronic abdominal pain, strain, sprain etc.

SOME MEDICAL AND SURGICAL EMERGENCIES

CARDIAC ARREST

Cardiac arrest is defined as the sudden unexpected cessation of the heartbeat and

effective circulation. All heart action may stop; or ventricular fibrillation may occur.

There is an immediate loss of consciousness and an absence of pulses and audible

heart sounds. Dilation of the pupils of the eyes begins within 45 seconds. Convulsions

may or may not be present. The most reliable sign of cardiac arrest is the absence of a

carotid pulsation. Valuable time should not be wasted taking the blood pressure or

listening for the heartbeat because 4 minutes after a cardiac arrest an irreversible brain

damage occurs.

First aid management

The victim should be managed using the steps in cardiopulmonary resuscitation

CEREBROVASCULAR ACCIDENT (STROKE/APOPLEXY/BRAIN ATTACK)

It is a brain damage as a result of interruption of perfusion of blood to portions of the

brain tissue, which may lead to loss of function of certain parts of the body. Blood

supply to part of the brain is suddenly impaired by a clot of blood blocking a vessel or

blood leaking from a ruptured vessel into the brain. Major strokes are fatal. There are

two main types of stroke: ischemic stroke and hemorrhagic stroke.

Risk factors of Stroke / CVA

 1. Advanced age

2. History of hypertension

3. Previous history of stroke or Transient ischaemic attack (TIA)

4. Diabetes

5. High Cholesterol

6. Cigarette smoking

7. Atrial fibrillation

8. Migraine with aura

9. Thrombophilia

Signs/Symptoms

Signs and symptoms can be remembered using the word F.A.S.O

FACE

1. The face may have dropped on one side

2. Victim may not be able to smile

3. Facial paralysis

4. Mouth or eye may have dropped

ARMS/LEGS

Victim may have weakness of arms and legs

Numbness of arms and legs

SPEECH

Slurred speech

May not be able to talk at all

OTHERS

1. Sudden severe headache

2. Altered consciousness (Disorientation, convulsions and anxious looking)

3. Unequal pupils

CHAPTER NINETEEN

EMERGENCY NURSING

DEFINITION

A medical or surgical emergency is an injury or illness that poses an immediate threat

to the person’s life or long-term health.

CLASSIFICATION OF EMERGENCIES

4. Emergent/Major Emergency

These are conditions or injuries that are potentially life threatening and require

immediate assessment and intervention or treatment mostly within 15 minutes of

arrival. Any delay in treatment is potentially life-threatening. Examples are; head

injuries, severe trauma, shock, severe allergic reactions, chemical exposure to the eyes,

chest pain, severe headache, severe asthma attack, major bleeding etc.

5. Urgent/Minor emergency

These are also conditions or injuries that are not immediately life threatening and may

require treatment within 30 minutes on arrival. Such conditions include alert head injury

with vomiting, mild to moderate asthma, moderate trauma, GI bleed with stable vital

signs, history of seizures etc.

6. Non-urgent
These are conditions requiring assessment within two hours. Examples, minor bleeding,

minor trauma, minor fractures, chronic abdominal pain, strain, sprain etc.

SOME MEDICAL AND SURGICAL EMERGENCIES

CARDIAC ARREST

Cardiac arrest is defined as the sudden unexpected cessation of the heartbeat and

effective circulation. All heart action may stop; or ventricular fibrillation may occur.

There is an immediate loss of consciousness and an absence of pulses and audible

heart sounds. Dilation of the pupils of the eyes begins within 45 seconds. Convulsions

may or may not be present. The most reliable sign of cardiac arrest is the absence of a

carotid pulsation. Valuable time should not be wasted taking the blood pressure or

listening for the heartbeat because 4 minutes after a cardiac arrest an irreversible brain

damage occurs.

First aid management

The victim should be managed using the steps in cardiopulmonary resuscitation

CEREBROVASCULAR ACCIDENT (STROKE/APOPLEXY/BRAIN ATTACK)

It is a brain damage as a result of interruption of perfusion of blood to portions of the

brain tissue, which may lead to loss of function of certain parts of the body. Blood

supply to part of the brain is suddenly impaired by a clot of blood blocking a vessel or

blood leaking from a ruptured vessel into the brain. Major strokes are fatal. There are

two main types of stroke: ischemic stroke and hemorrhagic stroke.

Risk factors of Stroke / CVA

10. Advanced age

 11. History of hypertension

12. Previous history of stroke or Transient ischaemic attack (TIA)

13. Diabetes

14. High Cholesterol

15. Cigarette smoking

16. Atrial fibrillation

17. Migraine with aura

18. Thrombophilia

Signs/Symptoms

Signs and symptoms can be remembered using the word F.A.S.O

FACE

5. The face may have dropped on one side

6. Victim may not be able to smile

7. Facial paralysis

8. Mouth or eye may have dropped

ARMS/LEGS

Victim may have weakness of arms and legs

Numbness of arms and legs

SPEECH

Slurred speech

May not be able to talk at all

OTHERS
 4. Sudden severe headache

5. Altered consciousness (Disorientation, convulsions and anxious looking)

6. Unequal pupils

7. Drooling

8. Dizziness

9. Hemiparesis (hemiplegia)

10. Loss of bladder and/or bowel control

11. Difficulty in breathing

12. Difficulty in swallowing

13. Tremors

14. Loss of balance.

How to assess for signs of stroke (THINK F.A. S. T.)

Face: Ask the person to smile. Does one side of face droop?

Arm: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask the person to repeat a simple sentence (such as, “The sky is blue.”). Is

the speech slurred? Can the person repeat the sentence correctly?

Time: Get help immediately if you see any signals of a stroke. Try to determine the

time when signals first appeared. Note the time of onset of signals and report it to the

medical personnel when they arrive.

First aid management

1. Reassure patient and relatives to allay fear and anxiety.

2. Check Air way, Breathing, Circulation

 3. Undo tight clothing around waist, neck and chest

4. If seen in coma, ensure clear airway

5. Remove any dentures and clear any saliva on the mouth.

6. If conscious, lay patient down on the affected side to aid drain the mouth, and

with head and shoulders slightly raised and supported

7. If unconscious, lay him/her in the recovery position

8. Do not give anything by mouth

9. Send to hospital immediately.

ASTHMA

It is a chronic illness involving the respiratory system in which the airway occasionally

constricts, becomes inflamed and is lined with excessive amounts of mucus, often in

response to one or more triggers.

These episodes may be triggered by such things as exposure to an environmental

stimulant (allergen) such as cold air, warm air, moist air, exercise or exertion, air

pollutants (smoke or fumes from cars) and emotional stress. The most common triggers

in children are viral infections such as common cold.

Signs and symptoms

1. Wheezing sounds during breathing

2. Shortness of breath

3. Tightness in the chest

4. Coughing

First aid treatment

The condition is controlled with a combination of drugs and environmental changes.

1. Remove patient from danger or danger from patient

2. Loosen all tight clothing around the chest.

3. Ensure adequate fresh air

4. If a known asthmatic, assist to administer bronchodilator oral inhaler if he has.

5. Transport to hospital immediately

6. Administer oxygen and prescribed bronchodilators if in the hospital.

SICKLE CELL CRISIS

Sickle cell anaemia is an inherited disorder in which the RBCs have a specific mutation

that makes the hemoglobin in the red cells very sensitive to oxygen changes. Any time

a decrease in the oxygen tension is sensed, the cells begin an observable physical

change process from their usual spherical shape to a sickle or crescent shape. Sickled

cells are very rigid and easily cracked and broken. Normal red cells live for about 120

days. Sickled cells survive only about 15-20 days; an 80-90% decrease in cell survival.

Aetiology

It is an autosomal recessive hereditary disorder

Common symptoms

1. Severe joint pain

2. Joint swelling
 3. Abdominal pain (due to hepatosplenomegaly)

4. Fever

5. Rapid respiration

6. Priapism (from impaired blood flow through the penis)

7. Repeated crisis and infarctions lead to chronic manifestations such as hand foot

syndrome, unequal growth of fingers and toes.

Management

1. In a patient with crisis, assess circulation in the extremities, including

peripheral oxygen saturation, capillary refill, peripheral pulses and temperature.

2. Frequently assess pain,

3. Encourage oral fluid intake

4. Administer intravenous fluids as prescribed

5. Monitor fluid intake and output

6. Apply warm compresses to painful areas.

7. Loosen tight clothes around the neck, chest and waist

8. Administer prescribed analgesic medication to control pain.

9. Encourage bed rest during the acute phase of the crisis

10. Provide warmth by covering casualty with blanket.

CHAPTER TWENTY

CARDIOPULMONARY RESUSCITATION (CPR)

Cardiopulmonary resuscitation is the process of restoring breathing or heartbeat

following respiratory failure or cardiac arrest. In other words, resuscitation is the timely
restoring of circulation and respiration by using combination of measures to bring a

victim to life from a terminal state, such as myocardial infarction, shock, massive blood

loss, obstruction of the airways or asphyxia etc.

COMPONENTS OF CPR

1. Artificial respiration

2. External cardiac massage (Also called external chest pressure/chest

compression).

SEQUENCE/ STEPS IN CPR

Use the acronym DRS ABC

D-Ensure a danger free environment.

R- Check for response: Assess conscious levels and victim response to stimulus.

S -Shout/ send for help or call (instruct bystander if present to call the ambulance)

A-OPEN THE AIRWAY:

Remove any obvious obstruction from the mouth such as dentures, vomitus, blood

inhaled food.

Methods of Opening the Airway

There are basically three methods of opening the airway. These are; chin lift, neck lift

and jaw thrust. Below are the steps involved in using each of them:

Head-tilt/chin-lift method

1. Place your hand that is closest to the victim’s head on his forehead and tilt his

head slightly.
 2. Place the fingertips of your other hand under his lower jaw on the bony part near

the chin.

3. Gently lift the chin up, taking care not to close his mouth.

Chin lift method

Head-tilt/neck-lift method

Place the palm of your hand that is closest to the victim’s head on his forehead and

your other hand under his neck.

Place the hand lifting his neck close to the back of his head to minimize cervical-spine

extension.

Then gently press back on his forehead while lifting up and supporting his neck.
 neck lift method

Jaw-thrust method

1. Kneel at the victim’s head, facing his feet.

2. Place your thumbs on his mandible near the corners of his mouth, pointing your

thumbs toward his feet.

3. Then position the tips of your index fingers at the angles of his jaw.

4. Push your thumbs down while you lift upward with the tips of your index fingers

NB: used if it is suspected that the victim has a neck or spine injury

Jaw Thrust
B-RESTORE BREATHING

 Check breathing: Kneel beside victim, put face closer to mouth. Look, listen,

feel for breathing. Observe along the chest for rise and fall indicating breathing,

listen to breath sounds, this should be done for ten seconds before concluding

absence of breath.

 If patient is breathing, turn her to the recovery position.

 If there is absence of breathing in the presence of an open airway, give mouth to

mouth.

Mouth to mouth (Rescue breathing):

1. Check for central pulse e.g. carotid pulse if present, then check for breathing, if

absent then you follow the steps below:

2. The provider tilts the victim’s head backward by placing one hand under the

victim’s chin and lifting while the other hand presses down on the victim’s

forehead.

3. At this point, the mouth and airway can be checked for foreign objects, which

can be removed with the fingers.

4. Place a clean cloth/handkerchief over victim’s mouth for hygienic purposes.

5. Gently pinch the victim’s nostrils together to prevent air from escaping out from

nose.

6. Take normal breaths, seal the victim’s mouth with a pocket mask or mouth, and

exhale into the mouth. When performed properly the victim’s chest should rise

visibly.
 7. Then listen for the victim to exhale; if using a pocket mask, it needs not be

removed.

8. This process is repeated at a rate of about 12 times per minute (one breath

every five seconds) for adults and about 20 times per minute for children, using

less pressure and volume for children.

9. Continue artificial respiration until victim begins to breathe or medical help

arrives.

How to give mouth to mouth.

C-RESTORE CIRCULATION

1. Check for pulse: this includes the carotid, apical, femoral, temporal, popliteal,

radial, etc.

2. If pulse is absent, start chest compressions as indicated below:

Chest compression

1. Chest compressions are delivered to the middle of the lower half of the sternum

2. Place the heel of your first hand on top of the patient

3. Put the other hand on top and interlock the fingers of both hands.
 4. Keep in midline to ensure that pressure is not applied over the Xiphoid process.

5. Lean well over the casualty and with your arms straight, press down vertically on

the sternum to depress it

6. Release the chest and allow it to recoil completely.

7. The compression depth should be approximately 2 inches (5 cm) and a

compression rate of at least 100/min (For every 30 compressions, 2 breaths are

given, 30:2).

How to do chest compressions/external cardiac massage

 Giving Cardiac Massage to an Infant

NOTE

If the Automated External Defibrillator is now available, then use it to resuscitate the

victim following instructions giving by the device.

When casualty begins to gain consciousness or begins breathing, place him or her in

recovery position as indicated in the diagrams below;

 CHAPTER FIVE

DISASTER NURSING

A disaster is a sudden, accidental event that causes many deaths, injuries, significant

property damage or drastic change to the environment. It destroys the economic, social

and cultural life of the people.

Classifications/Types of Disaster

1. Natural disaster

This is a catastrophic event that results from natural processes of the Earth. Various

disasters like earthquake, landslides, drought, hurricanes, typhoons, tornadoes,

tsunamis (tidal waves), volcanic eruptions, locust, flood and cyclones are natural

hazards that kill thousands of people and destroy billions of dollars of habitat and

property each year. The rapid growth of the world's population and its increased

concentration often in hazardous environment has escalated both the frequency and

severity of natural disasters.

2. Man-made disaster

These disasters come about as a result of human activity or negligence (i.e., due to

human action or inaction). Airplane, ship or railroad crashes, wars, terrorist attacks, are

examples of man-made disasters. They cause pollution, kill people, and damage
property. Other “man-made” disasters can be traced to the collapse of buildings,

bridges, tunnels and mines, as well as to explosions and wildfires unintentionally

triggered by humans.

Predisposing Factors of Disasters

1. Tropical climate and unstable landforms (global warming)

2. Deforestation

3. Unplanned growth proliferation

4. Non-engineered constructions which make the disaster-prone areas more

vulnerable

5. Poor or no budgetary allocation for disaster prevention.

Effects of Disaster

1. Primary effect: This is the immediate effect of disaster. E.g. the extent of

death, physical injuries, environmental destruction, destruction of property and

others.

2. Secondary effect: This is the indirect effect of the disaster event. E.g.

Malnutrition due to lack of food supply, traumatic stress disorder and

psychological trauma; due to the death of some relatives affects the health and

welfare of the people involved.

Impact of Disasters on Health (List of Effects)

1. Damage of water treatment plants, storage and pumping facilities, and

distribution lines resulting in interrupted water supply.

 2. Contamination of waterbodies/source of water supply

3. Communicable diseases outbreak.

Injuries from the event

4. Environmental exposure (no shelter)

5. Malnutrition

6. Excess Non-Communicable Disease mortality

7. Mental illness (disaster syndrome)

DISASTER MANAGEMENT

The International Federation of Red Cross and Red Crescent Societies define disaster

management as “The organization and management of resources and responsibilities

for dealing with all humanitarian aspects of emergencies…in order to lessen the impact

of disasters”.

1. Disaster Prevention

This refers to measures that are employed to detect, contain or prevent incidents which

if not checked, could result in disaster. Such measures may include but are not limited

to:

1. Ensuring buildings are not constructed in risk zones.

2. Mobilizing support of different coordinating agencies such as the local

government, voluntary organization, the insurance companies, NADMO, Red

Cross Society etc. to ensure co-ordination at the time of a disaster.

3. Ensuring that all buildings are earthquake and landslide resistant.

 4. Involving the local community in making and implementing safety norms.

5. Provision of maps of potential disaster sites.

2. Disaster Preparedness

Preparedness focuses on building capacity and identifying resources that may be used

to handle a disaster when it strikes. It involves training and equipping, expert

manpower, resource allocation and mobilization. In preparation towards a disaster:

1. A set of warning systems should be thought of, so that people are warned to

take safety measures. The warning systems may include: radio, television,

loudspeakers, personal messages, beating of drums, bells, etc.

2. The people must be educated to cope with a disaster. They should be taught to

keep a survival kit.

3. On the practical side, mock drill training and practice should be undertaken.

4. People in high risk areas must be evacuated.

5. Temporary housing must be arranged for those evacuated from their homes

6. Preventive measures must be instituted to prevent spread of diseases

A country’s level of preparedness allows them to have control over the loss. There are

certain types of disasters where the loss during the actual event is not high; but the

losses become high due to inability to manage the situation in a timely manner.

3. Disaster mitigation

Disaster mitigation refers to the steps taken prior to and after a disaster, to minimize

morbidity and mortality.It involves the prompt mobilization of administrative and

medical emergency services to tackle the outcome of the disaster (response), and

rehabilitation of the sufferers (including counseling).

a. Response (emergency management): This involves activities a hospital,

healthcare system, or public health agency take immediately before, during, and

after a disaster or emergency occurs.

b. Rehabilitation: It entails the restoration of basic and essential services on a

relatively temporary basis. Rehabilitation involves the following:

1. Essential services such as providing drinking water, transport, electricity, etc.

should be restored.

2. The people should be taught how to follow health and safety measures.

3. The victims should be provided with temporary accommodations, financial

assistance and employment opportunities.

4. Those who have lost their family members should be consoled.

5. Survivors should be counselled to help them deal with the traumatic experience,

6. If there is a danger of epidemics, vaccination programs should be undertaken.

4. Recovery

This entails getting a community back to its pre-disaster status. It involves a more

precise assessment of damage of infrastructure, reconstruction of infrastructure, and

restoration of the livelihoods of affected persons. Thus, effort is geared towards long-

term restoration. Examples of recovery activities include:

1. Debris Removal

2. Provision of Care and Shelter

 3. Damage Assessments

4. Funding Assistance

How to Triage Casualties in a Disaster

1. Prioritize causalities according to severity of injury.

2. Assign priorities when resources are limited.

3. Do the best for the greatest number of patients.

Levels/colour coding for traige

Green:

 Minor injuries that can wait for longer periods of time for treatment.

 Victims who are walking wounded

Yellow:

 Potentially serious injuries, but are stable enough to wait a short while for medical

treatment.

 Victims with status not likely to deteriorate over several hours.

Red:

 Life-threatening but treatable injuries requiring rapid medical attention.

Black:
 Dead or expectant- still with life signs but injuries are incompatible with survival in

austere conditions.

 No CPR is needed.

Reasons for Triaging Casualties in a Disaster

1. Inadequate resource to meet immediate needs

2. Infrastructure limitations

3. Inadequate hazard preparation

4. Limited transport capabilities

5. Multiple agencies responding

6. Hospital Resources Overwhelmed

Nurses’ Roles in Disasters

1. Determine magnitude of the event

2. Define health needs of the affected groups

3. Establish priorities and objectives

4. Identify actual and potential public health problems

5. Determine resources needed to respond to the needs identified

6. Collaborate with other professional disciplines, governmental and non-

governmental agencies

7. Maintain a unified chain of command

8. Communication: Have a structured plan.

BASIC RESCUE EVACUATION TECHNIQUES/BASICS FOR MOVING DISASTER

VICTIMS

Evacuation & Rescue by applying simple manual techniques can save the life of the

victim/casualty.

A. ONE RESCUER TECHNIQUES

One Person Lift and Carry

This method only works well with a child or very light person.

1. Place your arms under the victim’s knees and around their back

2. Keep back straight and bend legs slowly

Ankle Pull

The ankle pull is the fastest method for moving a victim a short distance away from

danger over a smooth surface.

1. Grasp the victim by both ankles or pant cuffs

2. Pull with your legs keeping your back straight. DO NOT pull with your back
 3. Keep the pull as straight and in-line as possible

4. NOTE that the victim’s head is unsupported and may bounce over bumps and

surface imperfections

Shoulder Pull (Shoulder Drag)

The shoulder pull can be used to move a victim through a short distance over a rough

surface. It is preferred to the ankle pull because it supports the victim’s head. The

downside is that it requires the rescuer to bend over at the waist while pulling.

1. Grasp the victim by the clothing under the shoulders

2. Stabilize victim’s head with forearm

3. Pull from both sides of the head for victim head support

4. Keep the pull as straight and in-line as possible

Blanket Pull (Blanket Drag)

This is the preferred method of dragging a victim.

1. Place the victim on the blanket using the “logroll” or the three-person lift

2. Place victim’s head about 2 feet from one corner of the blanket

3. Wrap the blanket corners around the victim

4. Pull with your legs keeping your back straight. DO NOT pull with your back

5. Keep the pull as straight and in-line as possible

Firefighter Carry

This technique is for carrying a victim longer distances. It is very difficult to get the

person up to this position from the ground. Getting the victim into position requires a

very strong rescuer or an assistant(s).

 1. The victim is carried over on shoulder

2. The rescuer’s arm, on the side that the victim is being carried, is wrapped across

the victim’s legs and grasps the victim’s opposite arm

Pack-Strap Carry

When injuries make the firefighter carry unsafe, this method is better for longer

distance than the one-person lift.

1. Place both the victim’s arms over your shoulders

2. Cross the victim’s arms, grasping the victim’s opposite wrist

3. Pull the arms close to your chest

4. Squat slightly and drive your hips into the victim while bending slightly at the

waist

5. Balance the load on your hips and support the victim with your legs
B. TWO RESCUER TECHNIQUES

Two-Persons Drag or Human Crutches

For the CONSCIOUS victim, this method allows the victim to swing their leg (or assist

with a good leg) using the rescuers’ as a pair of crutches. If the victim is

UNCONSCIOUS this is a quick and easy way to move a victim out of immediate danger.

1. Start with the victim on the ground

2. Both rescuers stand on either side of the victim’s chest

3. The rescuer’s hand nearest the feet grabs the victim’s wrist on their side of the

victim

4. The rescuer’s other hand grasps the clothing of the shoulder nearest them

5. Pulling and lifting the victim’s arms, the rescuers bring the victim into a sitting

position.
 6. The CONSCIOUS victim will then stand with rescuers assistance

7. The rescuers place their hands around the victim’s waist

8. For UNCONSCIOUS victims, the rescuers will grasp the belt or waistband of the

victim’s clothing

9. The rescuers will then squat down

10. Place the victim’s arms over their shoulders so that they end up facing the same

direction as the victim

11. The rescuers will use their legs to then stand with the victim

12. The rescuers then move out, dragging the victim’s legs behind

Two-Persons Carry (by arms & legs)

1. One rescuer squats at the victim’s head and grasps the victim from behind at the

midsection.

2. The second rescuer squats between the victim’s knees, grasping the outside of

the knees.
 3. Both rescuers rise to a standing position.

Four-Handed Seat

This technique is used for carrying a conscious and alert victim to moderate distances.

The victim must be able to stand unsupported and hold themselves upright during

transport.

1. Position the hands as indicted in the illustration

2. Lower the seat using your legs (not your back) and allow the victim to sit

3. When the victim is in place, stand using your legs and keeping your back straight

Two-Handed Seat
This technique is for carrying a victim through longer distances. This technique can

support an unconscious victim as well.

1. Pick up the victim by having both rescuers squat down on either side of the

victim

2. Reach under the victim’s shoulders and under their knees 3. Grasp the other

rescuer’s wrists

3. From the squat, stand using your legs and keeping your back straight

4. Walk in the direction that the victim is facing

Wheelchair Evacuation

In wheelchair evacuation for individuals in NON-motorized wheelchairs,

1. Release brake. One rescuer grasps the wheelchair handles and gently leans the

chair backwards from behind

 2. The other rescuer faces the chair and holds onto the front footrest supports (or

parts that are securely attached to the main frame) to steady the wheelchair and

help control the descent

3. Both rescuers coordinate and work together to gently, slowly and safely descend

the stairs.

4. Rescuers utilize the wheels of the wheelchair to descend the stairs without

having to lift the wheelchair

Office Chair Evacuation

If for some reason you cannot use the disabled individual’s wheelchair, you can utilize a

sturdy office chair. This technique also works for people who use motorized

wheelchairs or scooters as they are too heavy and awkward to safely negotiate down

the stairs.

1. Transfer the physically challenged individual to a sturdy office chair

2. One rescuer gently leans the chair backwards from behind

3. The other rescuer faces the chair and holds onto the front legs of the chair.

Both rescuers lift the chair simultaneously and control descent by bending their

legs and keeping their backs straight

Improvised Stretcher

This technique requires two poles/ pipes, strong enough to support the victim's weight;

and at least two shirts.

Rescuers should not give up clothing if, for any reason, this might affect their health,

welfare, or reduce their effectiveness.

Reporting an Incident or Accident

1. Immediate Notification:

- Inform relevant authorities or supervisors immediately after the incident occurs.

- If in a workplace, notify your manager or the designated health and safety officer.

- In public places, alert security personnel or the establishment's management.

2.Emergency Services:

- Call emergency services (e.g., 911) if the situation is severe or life-threatening.

- Provide clear information about the nature of the injury, location, and any first aid

administered.

Documenting the Incident or Accident

1. Incident Report Form:

- Use a standardized incident report form if available. These forms often include

sections for details of the incident, the injured person, witnesses, and actions taken.

- If no form is available, document the following information:

2. Basic Information:

- Date and time of the incident.

- Exact location where the incident occurred.

3. Details of the Injured Person:

- Name, age, and contact information.

- Relevant medical history or known allergies (if known).

4. Description of the Incident:

- A detailed account of what happened, including the sequence of events leading up

to the incident.

- Conditions at the time of the incident (e.g., weather, lighting, hazards).

5. Injuries Sustained:

- Type and extent of injuries (e.g., cuts, bruises, fractures).

- Specific body parts affected.

6. First Aid Administered:

- Description of first aid measures taken (e.g., wound cleaning, bandaging, CPR).

- Names and contact information of those who provided first aid.

7. Witness Statements:

- Names and contact information of any witnesses.

- Written statements from witnesses detailing what they observed.

8. Follow-Up Actions:
 - Any additional care provided or needed (e.g., transportation to a hospital).

- Recommendations for preventing similar incidents in the future.

Maintaining Records

1.Confidentiality:

- Ensure that all records are kept confidential and only accessible to authorized

personnel.

- Follow any applicable privacy laws and regulations (e.g., HIPAA in the U.S.).

2. Storage:

- Store incident reports in a secure and organized manner, either physically or

digitally.

- Maintain records for the required period as per organizational policies or legal

requirements.

3. Analysis and Review:

 - Regularly review incident reports to identify patterns or common causes of

accidents.

- Use this information to improve safety protocols and training programs.

Example of an Incident Report Entry

Incident Report Form

Date and Time of Incident: May 18, 2024, 2:30 PM

Location: Main Office, Second Floor, Break Room

Injured Person:

- Name: John Doe

-Age:35

-Contact Information [Phone Number], [Email Address]

- Medical History: No known allergies

Description of Incident:

- John slipped on a wet floor near the sink in the break room.

- The floor was wet due to a spill that had not been cleaned up.

Injuries Sustained
- Sprained ankle (right).

- Minor abrasions on the right elbow.

First Aid Administered:

- Ice pack applied to the ankle.

- Abrasions cleaned and bandaged.

- Elevated the injured leg to reduce swelling.

Witnesses

- Jane Smith, [Contact Information]

- Michael Brown, [Contact Information]

Follow-Up Actions:

- John was advised to visit a healthcare provider for further evaluation.

- The spill was immediately cleaned up to prevent further accidents.

- A reminder was issued to all employees to report spills immediately.

By thoroughly reporting and documenting incidents and accidents, organizations can

enhance their safety practices and ensure proper care and follow-up for injured

individuals.
 CHAPTER 6

Emergency preparedness

a. Emergency preparedness in first aid involves being ready to respond effectively to

medical emergencies, natural disasters, or other crisis situations. It includes

having the knowledge, skills, and supplies necessary to provide immediate care to

those in need before professional medical help can arrive.

b. Types of Emergency Preparedness:

1. Medical Preparedness:

- Knowing basic first aid techniques (CPR, wound care, fracture management).

- Understanding how to use first aid kits and automated external defibrillators (AEDs).

- Recognizing symptoms of common medical emergencies (heart attack, stroke,

allergic reactions).

2. Natural Disasters:

- Preparing for events like earthquakes, hurricanes, floods, and wildfires.

- Creating evacuation plans and knowing safe places to take shelter.

- Having emergency supplies (water, non-perishable food, flashlight, batteries).

3. Workplace Preparedness:
 - Implementing safety protocols and emergency response plans.

- Training employees in first aid and emergency procedures.

- Conducting regular drills and ensuring availability of first aid supplies.

4. Home Preparedness:

- Keeping a well-stocked first aid kit and emergency supplies at home.

- Developing a family emergency plan, including meeting points and communication

strategies.

- Educating family members on basic first aid and emergency procedures.

5. Community Preparedness:

- Community-wide training programs in first aid and emergency response.

- Establishing community shelters and communication networks.

- Collaborating with local emergency services and health organizations.

c. Levels of Emergency Preparedness:

1. Individual Level:

- Personal knowledge of first aid and self-preparedness.

 - Carrying a personal first aid kit and essential medical information.

2. Family Level:

- Family emergency plans and shared responsibilities.

- Stocking sufficient emergency supplies for all family members.

3. Local Level:

- Community education and resources.

- Local emergency response teams and disaster drills.

4. Regional/State Level:

- Coordination between local governments, health departments, and emergency

services.

- Regional response plans and resource allocation.

5. National Level:

- National disaster response frameworks and agencies (e.g., FEMA in the U.S.).

- Large-scale resource mobilization and inter-state cooperation.

6. International Level:

- Global organizations and international aid (e.g., Red Cross, WHO).

- Cross-border collaboration during large-scale disasters.

d. monitoring tools in first aid

In first aid emergencies, monitoring tools are essential for assessing and stabilizing

patients until professional medical help arrives. Here are some key monitoring tools

used in first aid situations:

1. Vital Signs Monitors:

- Portable Pulse Oximeters: Measure oxygen saturation and pulse rate.

- Blood Pressure Monitors:Check blood pressure quickly and easily.

- Thermometers:Measure body temperature (digital, infrared, or traditional).

2. Cardiac Monitors:

- Automated External Defibrillators (AEDs):Monitor heart rhythms and deliver shocks

if needed for cardiac arrest.

- Portable ECG Monitors: Assess heart activity and detect arrhythmias.

3. Respiratory Monitoring Tools:

- Peak Flow Meters: Measure lung function, particularly useful for asthma patients.
 - Capnography Devices: Monitor CO2 levels in the breath, indicating respiratory

status.

4. Glucose Monitors:

-Glucometers: Measure blood sugar levels, crucial for diabetic emergencies.

5. Mobile Apps and Digital Tools:

- First Aid Apps: Provide step-by-step instructions and monitor the progress of care

(e.g., American Red Cross First Aid app).

- Emergency Response Apps:Share real-time data with emergency services (e.g.,

PulsePoint, which also locates nearby AEDs).

6. Wearable Health Devices:

- Smartwatches/Fitness Trackers:Monitor heart rate, activity levels, and sometimes

ECG readings.

- Medical Alert Systems: Devices that send alerts and vital information to emergency

contacts or responders.

7. Environmental Sensors:
 - Carbon Monoxide Detectors: Alert to the presence of dangerous CO levels.

- Thermal Imaging Cameras:Identify heat patterns and detect injuries or the presence

of people in low-visibility situations.

8. First Aid Kits with Monitoring Tools:

- Some advanced first aid kits come with integrated monitoring tools like digital

thermometers, pulse oximeters, and blood pressure cuffs.

Risk analysis and monitoring in first aid involve identifying potential hazards, assessing

the likelihood and impact of these hazards, and continuously observing the situation to

prevent or mitigate emergencies. Here’s how this process typically works:

E .Risk Analysis in First Aid

1. Hazard Identification:

- Physical Hazards: Potential injuries from falls, cuts, burns, and impacts.

- Environmental Hazards: Risks related to weather conditions, poisonous plants or

animals, and hazardous substances.

- Health Hazards: Pre-existing medical conditions, allergies, and the potential for

infectious diseases.
2. Risk Assessment:

- Likelihood:Determining how probable it is that a specific hazard will occur.

- Impact:Assessing the potential severity of the hazard if it occurs.

- Vulnerability: Evaluating the susceptibility of individuals or groups to specific

hazards (e.g., elderly, children, individuals with chronic illnesses).

3. Risk Evaluation:

- Prioritization: Ranking risks based on their likelihood and impact to determine which

risks need immediate attention.

- Mitigation Strategies: Developing plans to reduce the likelihood and impact of

prioritized risks (e.g., safety protocols, first aid training, appropriate equipment).

Monitoring in First Aid

1. Continuous Observation:

- Patient Monitoring: Keeping a close watch on vital signs (pulse, respiration,

temperature) to detect any changes that may indicate deterioration.

- Environmental Monitoring: Being aware of changing conditions that could impact

safety, such as weather changes or environmental hazards.

2. Use of Monitoring Tools:

- Vital Signs Monitors: Regularly checking and recording pulse rate, blood pressure,

and oxygen saturation.

- First Aid Apps: Using mobile apps to guide through the first aid process and track

the patient's condition.

3. Feedback Loops:

- Communication:Regularly updating emergency services, family members, or other

caregivers on the patient’s condition.

- Reassessment:Continuously re-evaluating the situation to adjust the first aid

approach as necessary.

4. Documentation:

- Incident Reports: Keeping detailed records of the incident, the first aid provided,

and the patient’s response. This can be crucial for further medical treatment and legal

purposes.

Examples of Risk Analysis and Monitoring Scenarios

s

1. Workplace First Aid:

- Risk Analysis: Identifying common workplace injuries (e.g., cuts, sprains, chemical

exposure) and vulnerable areas (e.g., machinery, sharp objects).

- Monitoring:Ensuring first aid kits are stocked, employees are trained, and regular

safety inspections are conducted.

2. Sports Events:

-Risk Analysis: Identifying potential sports-related injuries (e.g., fractures,

concussions) and high-risk participants (e.g., those with previous injuries).

- Monitoring: Having medical staff on-site, using monitoring tools like AEDs, and

observing athletes for signs of distress.

3. Community Preparedness:

- Risk Analysis: Identifying community-specific hazards (e.g., natural disasters, large

public gatherings) and vulnerable populations.

- Monitoring: Establishing communication networks, emergency response plans, and

regular community drills.

Risk analysis and monitoring in first aid are crucial for proactively managing potential

emergencies and ensuring timely and effective responses to incidents.

In the context of first aid, preparedness actions can be categorized into minimum,

advanced, and contingency preparedness actions. Each level of preparedness ensures

different degrees of readiness and response capability.

e. Minimum Preparedness Actions

These are the basic steps everyone should take to be prepared for first aid situations:

1. Basic First Aid Training:

- Learn essential first aid skills such as CPR, wound care, and choking response.

- Participate in basic first aid courses offered by organizations like the Red Cross.

2. First Aid Kit:

- Keep a well-stocked first aid kit at home, in your car, and at your workplace.
 - Ensure the kit contains essentials like bandages, antiseptic wipes, adhesive tape,

scissors, tweezers, gloves, and a CPR mask.

3. Emergency Contacts:

- Maintain a list of emergency contact numbers (e.g., local emergency services, family

doctors, and poison control centers).

- Ensure that everyone in your household knows how to call for help.

4. Personal Health Information:

- Carry important medical information (e.g., allergies, chronic conditions, medications)

and emergency contact details.

- Consider using medical ID bracelets or cards.

f. Advanced Preparedness Actions

These actions involve more comprehensive preparation and often require additional

training and resources:

1. Advanced First Aid Training

- Obtain advanced certifications such as Advanced Cardiac Life Support (ACLS) or

Pediatric Advanced Life Support (PALS).

- Learn to use more sophisticated equipment like Automated External Defibrillators

(AEDs).

2. Enhanced First Aid Kits

- Equip first aid kits with advanced tools like splints, tourniquets, and emergency

blankets.

- Include over-the-counter medications (e.g., pain relievers, antihistamines) and

specialized supplies (e.g., burn dressings).

3. Emergency Action Plans:

- Develop detailed emergency action plans for home, work, and other frequently

visited places.

- Conduct regular drills and practice emergency scenarios with family members and

coworkers.
4. CPR and AED Training:

- Ensure proficiency in performing CPR and using AEDs.

- Familiarize yourself with the locations of AEDs in public spaces and workplaces.

5. Participation in Community Programs:

- Engage in community emergency response teams (CERT) or similar volunteer

programs.

- Stay informed about local emergency response plans and resources.

Contingency Preparedness Actions

These actions are designed for high-risk situations and involve specialized preparation

for unexpected or severe emergencies:

1 .Specialized Training:

- Gain expertise in handling specific emergencies (e.g., wilderness first aid, disaster

response, hazardous materials).

- Participate in courses offered by professional emergency response organizations.

2. **Comprehensive Emergency Kits:**

- Assemble emergency kits tailored to specific environments or risks (e.g., hiking,

boating, travel).

- Include specialized items like water purification tablets, emergency rations, and

multi-tools.

3 .Emergency Communication Plans:

- Establish multiple methods of communication (e.g., satellite phones, two-way

radios) for use when standard systems fail.

- Create a network of contacts for coordinated response efforts.

4. Scenario Planning and Drills:

- Conduct advanced scenario planning for a variety of potential emergencies.

- Organize regular drills to practice responses to different types of emergencies,

including mass casualty situations.

5. Coordination with Professional Services:

 - Collaborate with local emergency services, hospitals, and disaster response

agencies.

- Participate in joint exercises and training sessions to ensure seamless coordination

during real emergencies.

By implementing these levels of preparedness actions, individuals and organizations can

enhance their ability to respond effectively to first aid emergencies, reducing the impact

of injuries and potentially saving lives.

Reporting and documenting incidents and accidents in first aid is crucial for ensuring

proper care, legal compliance, and continuous improvement in safety practices. Here’s a

guide on how to effectively report and document such events: